Davao Doctors College, Inc.

General Malvar St., Davao City

Nursing Program

Nursing Management of a Patient with

Diabetes Miletus

A Case Study Presented to the Nursing Clinical Instructors

of Davao Doctors College, Inc.

In Partial Fulfillment of the Requirements in NRG304: Care of Clients with Problems in

Nutrition, and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination
(Acute & Chronic).

Fadi Omran, Aira Maiso, john E. Magliwang,

Jerremy Luque, Allyssa marie Pintal Lascano, Darl Pableo

Mosaima Maruhom, Christine Pamelgan

February 22, 2021

1
Table of Contents
A. Table of Contents

B. Introduction 3
C. Objectives 4

D. Patients Profile 4-5

a. Biographic Data
b. Clinical Data
c. Past Health History
d. Present Health History
e. Family History

E. Health Assessment 6-7

F. Review of Anatomy & Physiology 7-15

G. Pathophysiology 14-20

a. Definition of Diagnosis
b. Etiology
c. Symptomatology
d. Schematic Diagram
e. Narrative

H. Course in the ward/Treatment/Interventions 21-24

I. Medical Management
a. Doctor’s Progress Notes
b. Laboratory/Diagnostic Examinations
c. Pharmacologic Management (Drug Study)
d. Surgical Management

I. Laboratory Results 25-36

J. Nursing Management 37

a. Nursing Care Plan

b. Nurses Notes
c. Clinical Reasoning Questions
d. Discharge Plan

K. Reference
2
Introduction

According to the Department of Health, Diabetes is a serious, chronic metabolic

disease characterized by an increase in blood sugar levels associated with long term
damage and failure or organ functions, especially the eyes, the kidneys, the nerves, the
heart and blood vessels. It occurs when the body fails to properly regulate the amount
of dissolved sugar or glucose in the blood stream. Glucose is a type of sugar that is
needed by the body’s tissue and cells to survive. Glucose is from the foods that are
eaten by humans. After food is being digested, sugar or the glucose enters the blood
stream making the level of dissolved glucose in the blood arise.

Patient M, a 50 years old male and an African-American citizen was diagnosed

with Diabetes Mellitus particularly Type 1. He came in due to vision changes, increase
urination, increase in thirst, increase in appetite, fatigue and weakness. According to the
study conducted by M.C Marshall Jr, African-American have a high rate of diabetic
complications because of a poor glycemic control and racial disparities in health care in
the USA. African Americans with diabetes may have an atypical presentation that
simulates type 1 diabetes, but then their subsequent clinical course is typical of type 2
diabetes. Between 2000 and 2010, the Asian population grew by 46 %, which was
faster than any other ethnic group.

In 2012, this population continued to be the fastest-growing ethnic group (Joslin

Diabetes Center, 2013) The National Health and Nutrition Examination Survey
(NHANES) in 2012 – 2013 showed that 20.6% of Asian Americans have diabetes and
32.2% of Asian Americans have pre-diabetes, and 50.9% of diabetes cases were
undiagnosed which is higher than any other ethnic or racial group. Data from the NYC
Health Department shows that 48.5% of Asian American adults living in NYC have
either diabetes or pre-diabetes This case analyses aims to understand the etiology of
diabetes mellitus and how it can contribute to other complications related to disease
process.

3
Objectives

This case analysis aims to understandthe disease process of diabetes mellitus including
the organs involve. It also aims to understand how it is correlated to other diseases
such as heart disease, obesity, vision imapairement, skin lesions, infections and fatigue.

A. Biographical Data

Name : M.D

Age : 50

Birth date : 2/11/1971

Gender : Male

Nationality : Filipino

Occupation : Not mentioned

B. Clinical Data

Chief Complaint : Sudden vision change, increase in urination, increase thirst,

increase in appetite, fatigue, and weakness.

Date of Admission : February 22, 2021

Time of Admission : @ 9:00 AM

Room and Bed No. : 505

Attending physician : Dr. Nimo, Dr. Dher Mah

Tentative Diagnosis : Type 1 diabetes mellitus with DKA and moderate DHN and
with electrolyte imbalance (hyponatremia and hypokalemia)

Hospital : Davao Doctors Hospital

4
Vital Sign Upon Admission

Temperature : 36.5°C

Blood Pressure : 160/100 mmhg

Respiratory Rate : 28 cpm

Pulse Rate : 120 bpm

Weight : 100kg

Height : 5’5ft

BMI. : 36.6

C. Past Health History

Patient M.D a 50 years old Asian-American male, born on February 11, 1971 was
diagnosed with obesity last 2010 when he was 40 years old and year after that he was
also diagnosed with hypertension. He had maintenance medicine includes Amlodipine.
He had no history of any surgery as he stated during the interview.

D. Present Health History

2 weeks prior to admission patient M.D hasn’t been able to get enough sleep and would
wake up late at night or even at dawn just to urinate. That’s why he feels tired and
sleepy all the time as he verbalize.

Prior to his admission, patient M.D looked anxious and displayed sign of depression,
sometimes giving a blank expression on his face, his shoulders are slumped, and head
is down he even verbalize that “Gi kulbaan man ko aning akong sakit uie. Basin Mao na
ni reason nga mamatay ko” he also appears to be (+) Polydipsia, (+) Polyphagia, (+)
Polyuria, (+) Fatigue, (+) weakness, (+) Dry skin, (+) Ulceration and redness on both
foot, (+) Glucosuria in UA, (+) ketonuria. His laboratory results is FBS - 350mg/dl (high),
Cholesterol - 315mg/dl (high), Triglycerides - 447mg/dl (high), HDL – C - 69mg/dl (high),
LDL 228md/dL (high), HbA1C – 9.5%, K+ : 3.0mg/dl (low), Na+ : 120mg/dl (low).

Patient appears to be a bit older than his age. He looked weak and has a huge body
built which look obese. Patient does feel thirsty and hungry and also urinate most of the
time and eat a lot of rice and likes to drink soft drink along with his meals as he

5
verbalize . Patient has an ulceration or redness on the skin of his foot. He also has
difficulty breathing with shortness of breath.

E. Family History

During the assessment patient stated that his father was diagnosed of having a type 1
Diabetes Mellitus and Hypertension and his mother was also diagnosed with gouty
arthritis and Hypertension.

F. Patient Social Lifestyle

Upon doing an interview to patient M.D, he reported that he likes to eat sweets
especially chocolate and ice cream at the same time he also likes to eat buffet
especially at Vikings for almost 3 times a week with his friends. He also stated that he
smoke and drink alcoholic beverages occasionally especially if there is a party. Patient
doesn’t do any physical activities such as exercises due to the reason that “kapoy daw”
as patient verbalize

Health Assessment

Head, Face : Head is normocephalic in shape, face look big and round, check
are puffy with fats.
Eyes : Patient eyes looks sunken, both eyes are at 3mm in size equally
reactive to light with brisk response.
Ears: Both ears are symmetrical with no discharges noted.
Nose and throat : Nose and throat are located at the midline of his head
Skin: Patient skin looks flushed and is warm to touch with a
temperature of 36.5°C his skin is dry with poor skin turgor,
presence of ulceration or redness is observed on the skin of the
foot of the patient.
Neck : Patient neck was a little bit big with slight neck vein distention
noted no palpable masses were noted.
Breast : Patients left Breast is slightly bigger than the right, his nipples
and areola are light brown in color. He appears to have
gynecomastia.
Cardiovascular : Respiratory rate of 28cpm, SpO2 of 92%
Respiratory : Breath sounds are heard in all areas of the lungs, no murmurs or
gallops were heard. Difficulty breathing with shortness of breath
were observed.
Urinary : Frequently urination is observed, urine output 350 ml/hr.
Genital : Patient genitalia is in a normal condition according to the patient
Peripheral/Vascular : Tingling and numbness on hand and feet were present.

6
 Musculoskeletal: Patient is week and need assistance in doing daily activities,
nasal flaring and uses of accessory muscles in breathing were
observed.
Neurologic : Patient is conscious, awake and coherent with GCS of 15/15

Hematologic : (+) Glucosuria in UA

(+) ketonuria
FBS - 350mg/dl (high)
Cholesterol - 315mg/dl (high)
Triglycerides - 447mg/dl (high)
HDL – C - 69mg/dl (high)
LDL 228md/dL (high)
HbA1C – 9.5%
K+ : 3.0mg/dl (low)
Na+ : 120mg/dl (low
Psychiatric : Patient looked anxious, display sign of depression, and
sometimes give a blank expression on his face.

Reference: Weber, Kelley (1944) Health Assessment in Nursing (6th edition)

Anatomy and Physiology

The pancreas
The pancreas is a long, slender
organ, most of which is located
posterior to the bottom half of the
stomach. Although it is primarily an
exocrine gland, secreting a varitey of
digestive enzymes, the pancreas has
an endocrine function. Its pancreatic
islets- clusters of cells formely known
as the islets of Langerhans- secret
the hormones glucagon, insulin,
somatostatin and pancreatic
polyptide.

When you heard about “diabetes,”

the first thought is likely about high blood sugar. Blood sugar is an often-underestimated

7
component of your health. Diabetes affects your body’s ability to produce or use insulin,
a hormone that allows your body to turn glucose (sugar) into energy.

Normally after eating or drinking, the body will break down sugars from food and use
them for energy in the cells. To accomplish this, the pancreas needs to produce a
hormone called insulin. Insulin is what facilitates the process of pulling sugar from the
blood and putting it in the cells energy.

If you have diabetes, the pancreas either produces too little insulin or none at all and
this allows blood glucose levels to rise while the rest of your cells are deprived of much-
needed energy. This can lead to a wide variety of problems affecting nearly every
major body system.

Circulatory system

The circulatory system is responsible to

provide the route ways for the blood to
transport oxygen, nutrients and hormones to
and from the cells and organs, delivery of
blood, therefore glucose in the blood around
the body.

The circulatory system allows blood glucose

levels to be regulated. If blood glucose levels
become too high for extended periods of time, damage can be sustained by the blood
vessels.

When you have high blood glucose levels, this can contribute to the formation of fatty
deposits in blood vessel walls. Over time, it can restrict blood flow and increase the risk
of atherosclerosis, or hardening of the blood vessels.

Excess blood sugar decreases the elasticity of blood vessels and causes them to
narrow, impeding blood flow. This can lead to a reduced supply of blood and oxygen,
increasing the risk of high blood pressure and damage to large and small blood vessels.

Central Nervous System

Nerves are a collection of neurons, which are the individual nerve cells. Nerves can be
damaged by diabetes – known as neuropathy.

8
A neuron has a soma (the cell body) which
includes the cell nucleus, dendrites which
conduct stimulation of the nerve, one or
more axons which provide nerves with
their length and axon terminals which
transmit impulses to other nerves.

Our nerves are located throughout our

bodies from our skin, through and round
our organs and towards their centre, the
brain.

Diabetes causes diabetic neuropathy, or

damage to the nerves. This can affect the
perception of heat, cold, and pain. It can also make you more susceptible to injury.

Neuropathy can affect any part of the nervous system, including the nerves that control
autonomic or involuntary functions, such as digestion.

The term for nerve damage as a result of diabetes is diabetic neuropathy and can be
categorised in different forms:

√Sensory neuropathy
√Motor neuropathy
√Autonomic neuropathy

Sensory neuropathy is when the nerves that sense touch and heat are affected. This
typically affects the extremities, such as the hands, feet and lower legs, and affects our
ability to feel pain from these parts of our body.

Motor neuropathy is when the nerves controlling muscular movement are affected. If the
feet are affected, it can affect how we distribute our body weight on our feet and could
lead to a foot complication.

Autonomic neuropathy can affect the nerves which control involuntary functions
including stomach emptying, bowel movements, our ability to pass urine and sweat and
can affect functioning of the heart

Kidney/Urinary System

9
The urinary system, also known as the
excretory system, allows the body to remove
waste or unneeded products from the body
through the urine.The urinary system can also
help the body to remove excess glucose from
the blood.

The following organs and vessels make up the

urinary system:
•Kidneys
•Ureters
•Bladder
•Urethra

√Diabetes can have short term and long term effects on the urinary system. In the short
term, high blood glucose levels can promote bacterial growth which can raise the risk of
urinary tract infections or thrush developing.

√Long term effects of diabetes on the urinary system can include kidney damage and
damage to nerves controlling the bladder can result in difficulty urinating or urinary
incontinence.

High levels of blood sugar can damage the kidneys. The result is an illness known as
diabetic nephropathy that can eventually lead to kidney failure. High blood sugar levels
initially damage the blood vessels in the kidneys. As diabetic nephropathy progresses,
there is thickening of kidney tissue and scarring. When the kidneys are damaged, they
cannot filter the blood properly. This results in waste and fluid buildup in the blood, and
leakage of important blood proteins into the urine.

The elevated amounts of protein in the urine, could be a sign that the kidneys aren’t
functioning properly.

Integumentary system

Diabetes can also affect your skin, the largest organ

of your body. Along with dehydration, your body’s
lack of moisture due to high blood sugar can cause
the skin on your feet to dry and crack.
Moist, warm folds in the skin are susceptible to
fungal, bacterial, or yeast infections.
10
Poor circulation affects the body’s ability to heal when there is a wound or an infection.
This is due to a low supply of blood, oxygen, and nutrients.

A person with diabetes should check their skin regularly for wounds and see their doctor
if they have any signs of an infection, including redness, swelling, or fever.

Unmanaged diabetes can also lead to three skin conditions:

√eruptive xanthomatosis, which causes hard yellow bumps with a red ring
√digital sclerosis, which causes thick skin, most often on the hands or feet
√diabetic dermopathy, which can cause brown patches on the skin

Eyes

The human eye has a light-sensitive structure called the

retina. It is this retina or the light sensitive structure of the
human eye that is most adversely affected by diabetes.
This condition is called diabetic retinopathy.

Diabetic Retinopathy' is one such condition wherein

abnormally high blood glucose or blood sugar levels
cause slow, progressive and long-standing damage to
the eyes.

If the blood sugar levels continue to remain uncontrolled, the retina suffers from larger
bleeding spots and blood may entirely fill up the jelly inside the eye causing a sudden
loss of vision. Many patients go undetected until this stage of the disease because they
miss undergoing an eye check-up while they
suffer from diabetes all these years.

√Short-term problems include blurred vision,

due to high blood sugar.
√Long-term complications include: glaucoma,
diabetic retinopathy, macular edema, cataracts

Endocrine System

11
The endocrine system consists of a number of different glands which secrete hormones
that dictate how cells and organs behave.

The hormones produced by the endocrine system help the body to regulate growth,
sexual function, mood and metabolism.
the roles of glands in the endocrine system:

Diabetes affects how the body regulates blood glucose levels. Insulin helps to reduce
levels of blood glucose whereas glucagon’s role is to increase blood glucose levels.

In people without diabetes, insulin and glucagon work together to keep blood glucose
levels balanced.

In diabetes, the body either doesn’t produce enough insulin or doesn’t respond properly
to insulin causing an imbalance between the effects of insulin and glucagon

F. DEFENITION OF THE DISEASE

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is
too high. Blood glucose is your main source of energy and comes from the food you eat.
Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to
be used for energy. Sometimes your body doesn’t make enough or and insulin or
doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Type 1 diabetes - your body does not make insulin. Your immune system attacks and
destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually
diagnosed in children and young adults, although it can appear at any age. People with
type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes - your body does not make or use insulin well. You can develop type 2
diabetes at any age, even during childhood. However, this type of diabetes occurs most
often in middle-aged and older people. Type 2 is the most common type of diabetes.

ii. Etiology

Predisposing Factors Present Justification

1. Age  Although type 1 diabetes
can appear at any age, it
appears at two noticeable
peaks. 
2. Family history  Anyone with a parent or
sibling with type 1 diabetes
has a slightly increased
12
 risk of developing the
condition.
3. Genetics  The presence of certain
genes indicates an
increased risk of
developing type 1
diabetes.
4. Geography Certain countries, such as
Finland and Sweden, have
higher rate of type 1
diabetes.
5. The presence of Sometimes family
damaging immune members of people with
system cells type 1 diabetes are tested
(autoantibodies) for the presence of
diabetes autoantibodies. If
you have these
autoantibodies, you have
an increased risk of
developing type 1
diabetes. But not everyone
who has these
autoantibodies develops
diabetes.

Precipitating factors Present Justification

Eating habit  A diet high in fat, calories, and
cholesterol increases your risk
of diabetes. A poor diet can lead to
obesity (another risk factor
for diabetes) and other health
problems. 
Diet  Healthy eating helps keep your
blood sugar in your target range. It
is a critical part of managing
your diabetes, because controlling
your blood sugar can prevent the
complications of diabetes.
Alcoholism  . It increases the risk that
a patient will experience
hypoglycemia. This is true even
when only modest amounts
of alcohol are consumed. For this
reason, even patients who do not
have alcoholism need to closely

13
 monitor their blood sugar levels if
they drink, especially before going
to sleep.
Smoking  .  increases this risk
for diabetic nephropathy,
retinopathy, and neuropathy,
probably via its metabolic effects in
combination with increased
inflammation and endothelial
dysfunction.
Lack of physical activity  In type 1 diabetes aerobic training
increases cardiorespiratory fitness,
decreases insulin resistance, and
improves lipid levels and
endothelial function. In individuals
with type 2 diabetes, regular
training reduces A1C, triglycerides,
blood pressure, and insulin
resistance

iii. Symptomatology

Signs and Present Justification

Symptoms
Frequent urination  Elevated glucose levels force fluids from your
Excessive thirst
Unexplained weight
loss-
cells. This increases the amount of fluid
delivered to the kidneys. This makes you
need to urinate more. It may also eventually
dehydrate you.
 Your kidneys are forced to work overtime to
filter and absorb the excess glucose. When
your kidneys can't keep up, the excess
glucose is excreted into your urine, dragging
along fluids from your tissues, which makes
you dehydrated. This will usually leave you
feeling thirsty
 The sugar stays in your blood; your body
doesn't get the fuel it needs. As a result, it
begins burning fat and muscle for energy,
which can result in unexplained weight loss.
The most common types of diabetes
are Type 1 and Type 2 diabetes.

Extreme hunger  In uncontrolled diabetes where blood glucose

levels remain abnormally high
(hyperglycemia), glucose from the blood

14
 cannot enter the cells – due to either a lack
of insulin or insulin resistance – so the body
can't convert the food you eat into energy.
This lack of energy causes an increase in
hunger
Sudden vision  Diabetic retinopathy is caused by high blood
changes sugar due to diabetes. Over time, having too
much sugar in your blood can damage your
retina — the part of your eye that detects
light and sends signals to your brain through
a nerve in the back of your eye (optic nerve)
Tingling or  High blood sugar can cause
numbness in the diabetic neuropathy, which damages the
hands or feet nerves that send signals from your hands
and feet. Diabetic neuropathy can cause
numbness or tingling in
your fingers, toes, hands, and feet.
Feeling very tired With diabetes, fatigue is caused by a number
much of the time of factors, including: High blood sugar levels,
either from a lack of the insulin hormone or
from insulin resistance, can affect the body's
ability to get glucose from the blood into cells
to meet our energy needs.
Very dry skin High blood sugar (glucose) can cause this. If
you have a skin infection or poor circulation,
these could also contribute to dry, itchy skin.
Sores that are slow with uncontrolled diabetes may develop poor
to heal circulation. As circulation slows down, blood
moves more slowly, which makes it more
difficult for the body to deliver nutrients
to wounds. As a result, the injuries heal
slowly, or may not heal at all.

Presence of  If your cells don't get enough glucose, your

ketones in the urine body burns fat for energy instead. This
produces a substance called ketones, which
can show up in your blood and urine.
High ketone levels in urine may
indicate diabetic ketoacidosis (DKA), a
complication of diabetes that can lead to a
coma or even death.
Fatigue-  With diabetes, fatigue is caused by a number
of factors, including: High blood sugar levels,
either from a lack of the insulin horomone or
from insulin resistance, can affect the body's
ability to get glucose from the blood into cells

15
 to meet our energy needs.
Irritability  Changes in blood sugar level can affect a
person's mood and mental status. When
blood sugar returns to a normal range, these
symptoms often resolve.
Fluctuations in blood glucose can
result in rapid mood changes, including low
mood and irritability.
Frequent infections  High blood sugar levels can weaken a
person's immune system defenses. People
who have had diabetes for a long time may
have peripheral nerve damage and reduced
blood flow to their extremities, which
increases the chance for infection.

iv.

Schematic Diagram

DM type 1

Etiology
Signs and symptoms
• Age
• Smoker • Fatigue
• Alcohol drinker • Polyuria
• Genetics • Hypertension
• Obesity • polydipsia
• Eating habits

Exhaustion of beta cells

No production of beta
cells

Exhaustion of beta cells

Glucose absorption ion
the cell
Polyphagia
16
 hyperglycemia

Impaired kidney Capillary basement

filtration mechanism membrane thickening

Diffused glomerular
glycosuria sclerosis

Urine acidity polyuria Neuropathy

UTI
hypovolemia

hypertension

G.Course in the ward

Date Physician’s Order Rationale

17
02/22/202
1 Secure content to care  for the protection of our patient
@9am 
Place patient on Diabetic diet  helps you control your blood sugar
(glucose), manage your weight
and control heart disease risk
factors, such as high blood
pressure and high blood fats.
When you eat extra calories and
fat, your body creates an
undesirable rise in blood glucose
Vsq4
 To obtain baseline data of VS and
IVF with PNSS monitor condition of patient until
stable.

Place in moderate high back  It is ordered because it contains
rest electrolytes (sodium and chloride
ions) which dissociates in
solutions.
Regular Insulin 10 units SQ
STAT then recheck CBG after
30 mins
 To prevent pressure ulcers.

Attach o2
Labs:  To supply oxygen in the body.
CBC
 This is to evaluate the cells
that circulate in blood,
including red blood cells
(RBCs), white blood cells
UA (WBCs), and platelet
(PLTs).

 To detect common
diseases. It may be used to
screen for and/or help
CXRAY diagnose conditions such
as a urinary tract infection,
kidney disorders, liver
problems, diabetes, or other
Feb Serum Crea metabolic conditions.
23,2021
@ 11am  To evaluate the lungs, heart

18

ECG
HgbA, FBS, LP
CBG
Amlodipine 10mg/tab-1 tab PO
once daily
Spinorolactone 25mg/tab 1 tab
PO once daily
Metformin500mg/tab – 1 tab
PO once daily
Paracetamol 500mg/tab 1 tab
Do wound care with normal
saline solution and change OD
Elevate both legs with pillow
Refer for any unusualities
Monitor CBG q TID
and chest wall and can
detect medical conditions
such as: Pneumonia, Heart
failure.
 To assess your creatinine
levels if you show signs of
kidney disease.
 To check heart’s rhythm
and electrical activity.
Sensors attached to the
skin are used to detect the
electrical signals produced
by the heart each time it
beats.
 To measures the blood
sugar after an overnight fast
(not eating). A fasting blood
sugar level of 99 mg/dl or
lower is normal, 100 to 125
mg/dl indicates that have
prediabetes and 126 mg/dl
or higher indicates
diabetes.
 A blood sugar test that
measures the amount of
sugar, or glucose in the
blood.
 It is ordered people with type 1
diabetes mellitus do not produce
enough of this hormone to sustain
life and therefore depend on
exogenous insulin for survival. 
 It is ordered to relax blood vessels
so blood can flow more easily.
 It is ordered to treat patients
low potassium levels and heart
failure
 It lowers your blood sugar levels
19
Ezetimibe 10mg tab 1 tab PO by improving the way your body
once a day handles insulin.

 help treat pain and reduce a high

temperature
Alirocumab 75mg SQ once
every 2 weeks
 To irrigate the wound. Saline is the
preferred cleanser for most
wounds because it is physiologic
and will ALWAYS be safe.

Dapagliflozin 5mg/tab 1 tab  To help reduce fluid retention in

PO once a day the lower part of your body.
Instead of fluid collecting in your
foot, fluid returns toward your
Kalium durule 2 tabs PO twice body.
a day
 To be given prompt intervention.
Liraglutide 0.6mg SQ once a
week  It is used along with a
low cholesterol/low
fat diet and exercise to help
lower cholesterol in the blood.

 It is used block the heart blood

Pramlintide 15mcg SQ pre vessels to reduce the risk of heart
meals attack, stroke, and certain types of
chest pain that require treatment in
a hospital.
Octreotide 20mg/cap PO pre
meals

Cont. Monitoring Vsq4 I&O qS  It is used with a proper diet and

exercise program and control high
blood sugar.

Cont. Daily weighing of pt.  To prevent potassium loss or

replace potassium lost by the body

 is used with
a diet and exercise program to
Refer accordingly control blood sugar levels 

20
  is used to treat patients whose
blood sugar could not be
controlled by insulin or insulin and
an oral medication for diabetes.

 suppresses insulin and glucagon

release, leaving glucose levels
either unchanged or somewhat
elevated.

 To obtain baseline data of VS and

monitor condition of patient until
stable.

 Losing weight can help improve

your body's ability to effectively
respond to insulin resistance, but if
it doesn't help you achieve better
blood glucose control, that doesn't
mean you should give up.

 Ensures a close relationship

between all levels of the health
system and helps to ensure
people receive the best possible
care closest to home. It also
assists in making cost-effective
use of hospitals and primary
health care services.

Laboratory Results

CBC: February 23, 2021: 8:00AM

21
TEST PURPOSE NORMA RESUL NURSING MANAGEMENT
L VALUE T
WBC CBC provides 4.0-10.5 5.7 1. Explain test procedure.
valuable normal Explain that slight
RBC information about 4.10-5.60 5.27 discomfort may be felt
the blood and to normal when the skin is
Hgb some extent the 12.5-17.0 15.4
bone marrow, punctured.
normal
Hct which is the blood 36.0-50.0 44.1 2. Encourage to avoid
forming tissue. It normal stress if possible
MCV is use as a 80-96 84 because altered
preoperative test normal physiologic status
MCH to ensure both 27-34 29.2 influences and changes
adequate oxygen normal normal hematologic
MCHC carrying capacity 32-36 34.9
and homeostasis, values.
normal
identify persons 11.7-15 3. Explain that fasting is not
RDW 13.7
who may have an necessary. However, fatty
normal
infection, meals may alter some test
Plt 140-415 268
diagnose anemia, results as a result of
normal
identify acute and 40-74 lipidemia.
Neutro- 47
chronic illness, 4. Thoroughly cleanse the
phils normal
bleeding skin area to be punctured
Lymphs 14-46 46 before inserting the needle
tendencies, and normal
white blood cell 4-13 5. Apply manual pressure
Mono- 6 normal
disorders, monitor and dressings over
Cytes
treatment for 0-7 puncture site on removal
Eos 1 normal
anemia and other of syringe.
Basos 0-3 0 normal
blood diseases 6. Monitor the puncture site
(Absolute)
detected in
: for oozing or hematoma
human plasma
Neutrophil 1.8-7.8 2.6 formation.
and blood cells,
s normal 7. Instruct to resume normal
and to determine
Lymphs the effects of .7-4.5 2.6 activities and diet.
chemotherapy normal
Monocyte and radiation .1-1 .4
s therapy on blood normal
Eos cell production .0-.4 .1
(Thompson,2020) normal
Baso .0-.2 .0
normal
Immature 0-1 0 normal
granulocyt
e
Immature .0-1 .0
Grans(Abs normal
)

22
23
Urinalysis: February 23, 2021: 8:00AM

Test Purpose Normal Result Nursing management

Value
Color A urinalysis Yellow Yellow 1) Instruct the patient to clean
Appearanc is used to Clear Cloudy
aroun the urethra meatus
e detect and
Specific manage a 1.001- 1.019 and for women should clean
Gravity wide range 1.035
the part of the labia and
pH of disorders, 5.0-8.0 7.5
Glucose such as negative 10+ clean from fron to back
Bilirubin urinary tract Negative Negative 2) ask the patient to pass 15-
Ketone infections, Negative Positive
Occult kidney Negative Trace 30ml of urine into the toilet
blood disease and
to wash away any bacteria
Protein diabetes. A Negative 3+
Nitrite urinalysis Negative Negative colonizing the distal urethra.
Leukocyte involves Negative 1+ Instruct the patient to void
esterase checking
WBC the <=5 0-2 directly into a clean, dry
appearance WBC/HP
container. Sterile,
, F
concentratio <=2 disposable containers are
RBC 0-2
n and RBC/HPF
recommended. Women
content of
Squamus <=5 HPF None
urine should always have a clean-
epithelial seen
(Anderson,2
Bacteria None Many catch specimen if a
012).
seen HPF
microscopic examination is
Crystals None Few
seen HPF ordered. Feces, discharges,
Triple None Few vaginal secretions and
Phosphate seen HPF
Crystals menstrual blood will
Casts None None contaminate the urine
seen HPF seen
Yeast None None specimen.
seen HPF seen 3) Collect specimens form
infants and young children
into a disposable collection
apparatus consisting of a
plastic bag with an adhesive
backing around the opening
that can be fastened to the

24
 perineal area or around the
penis to permit voiding
directly to the bag.
Depending on hospital policy,
the collected urine can be
transferred to an appropriate
specimen container.
3) Cover all
specimens tightly, label
properly and send
immediately to
the laboratory.
4) If a urine sample is obtained

25
Chest Xray: February 23, 2021: 10:00AM

PURPOSE NORMAL RESULT NURSING

VALUE MANAGEMENT

CXR is used to Normal findings  The lungs are clear 1. Remove all
screen for in a chest x-ray metallic objects.
ascites, seek
will show a:  Tracheal air Items such as
evidence of
bowel column is at jewelry, pins,
perforation in midline buttons etc can
patients with Normal lung
hinder the
suspected fields, cardiac
spontaneous  The heart is not visualization of the
size,
bacterial enlarge chest.
peritonitis, and mediastinal
monitor bowel structures, 2. No preparation is
distension in (normal result) required. Fasting or
thoracic spine,
acutely ill
ribs, and medication
patients adm
itted for diaphragm restriction is not
treatment of needed unless
decompensatio
directed by the
n or variceal
hemorrhage. X health care
ray may show provider.
elevation of the
diaphragm from 3. Ensure the patient is
ascites.Cirrhosi not pregnant or
s can be
suspected to be
diagnosed by
radiology te pregnant. X-rays are
sting such as usually not
computed recommended for
tomography
(CT), ultrasound pregnant women
or magnetic unless the benefit
resonance outweighs the risk of
imaging (MRI)
damage to the
or via a needle
biopsy of the mother and fetus.

26
liver. A new 4. Assess the patient’s
imaging ability to hold his or
technique called
her breath. Holding
elastography,
which can be one’s breath after
performed with inhaling enables the
ultrasound or
lungs and heart to
MRI, can also
diagnosis cirrh be seen more clearly
osis (Jones, in the x-ray.
2019).
5. Provide appropriate
clothing. Patients
are instructed to
remove clothing
from the waist up
and put on an X-ray
gown to wear during
the procedure.

6. Instruct patient to
cooperate during
the procedure. The
patient is asked to
remain still because
any movement will
affect the clarity of
the image.

27
FBS and Lipid Profile: February 23, 2021: 10:00AM

Test Purpose Normal Result Nursing Management

Value
Glucos A complete 100-125 350 1. Instruct patient not to eat or
e (FBS) cholesterol test is drink for 9 to 12 hours before
Lipid also called a lipid 125-200 315 the test.
Choles panel or lipid 125-200 446
terol profile. Your doctor 2. For the most accurate results,
Trigly can use it to <150 69 wait at least two months after a
Cerides measure the heart attack, surgery, infection,
HDL-C amount of “good” 60> 228 injury or pregnancy to check
LDL and “bad” <100 none cholesterol levels.
cholesterol and
triglycerides, a type 3. Schedule a fasting glucose test
of fat, in your blood first thing in the morning so
(Pagana,2019 patient don't have to fast during
). FBS is often a the day.
test done to check
for prediabetes and
diabetes. Random
blood sugar (RBS)
measures blood
glucose regardless
of when you last
ate.

HbA1c: February 23, 2021: 10:00AM

Test Purpose Normal Value Resul Nursing Management

t
HbA1c An HbA1c test may Normal: <5.6 9.5
1. No preparation is
be used to check Pre-diabetes:
for diabetes or 5.7-6.4 required. Fasting or
prediabetes in Diabetes: >6.5 medication restriction
adults. Prediabetes is not needed unless
means your blood directed by the health
sugar levels show care provider.
you are at risk for 2. Explain that fasting is
getting diabetes. If not necessary. However,
you already have fatty meals may alter
diabetes, an HbA1c some test results as a
test can help result of lipidemia.
monitor your
condition and 3. Thoroughly cleanse
glucose levels.

28
 the skin area to be
punctured before
inserting the needle

4. Explain test procedure.

Explain that slight
discomfort may be felt
when the skin is
punctured.
5. Apply manual pressure
and dressings over
puncture site on
removal of syringe.
6. Monitor the puncture
site for oozing or
hematoma formation.
7. Instruct to resume
normal activities and
diet.

29
Basic Metabolic Panel: February 23, 2021: @ 10:00AM

Test Purpose Normal Result Nursing management

Value
Sodium This blood 135-147 120
1. No preparation is required.
Potassium test gives 3.5-5.2 3.0
Chloride information 95-107 100 Fasting or medication restriction
CO2 about your 22-30 24 is not needed unless directed by
BUN body's 7-20 20
Creatinine metabolism .5-1.2 1.2 the health care provider.
Glucose , or how 60-110 185
your body 2. Thoroughly cleanse the skin
uses food
for energy. area to be punctured before
It gives a inserting the needle.
snapshot of
the health 3. Explain test procedure. Explain
of your that slight discomfort may be felt
kidneys,
your blood when the skin is punctured.
sugar 4. Apply manual pressure and
levels, and
the levels of dressings over puncture site on
key removal of syringe.
electrolytes,
such as 5. Monitor the puncture site for
potassium oozing or hematoma formation.
and
sodium. 6. Instruct to resume normal
activities and diet.

30
ECG: Done on February 16, 2021: 8:00AM

Purpose

It is a simple test that can be used to check your heart's rhythm and electrical activity.
Sensors attached to the skin are used to detect the electrical signals produced by your
heart each time it beats (Bailey,2007).

 Rate: 110- 120bpm

 Rhythm: Regular
 P Wave- normal
 PR interval: normal (.16se)
 QRS: Normal (.08)
IMPRESSION: Sinus Tachycardia, ST segment Depression, Presence of U Wave

Nursing Management:

1. Explain the procedure to the patient. Inform the patient that

echocardiography is used to evaluate the size, shape, and motion of
various cardiac structures. Tell who will perform the test, where it will
take place, and that it’s safe, painless, and is noninvasive.
2. No special preparation is needed. Advise the patient that he doesn’t

31
 need to restrict food and fluids for the test.
3. Ensure to empty the bladder. Instruct patient to void prior and to
change into a gown.
4. Encourage the patient to cooperate. Advise the patient to remain still
during the test because movement may distort results. He may also be
asked to breathe in or out or to briefly hold his breath during the exam.
5. Explain the need to darkened the examination field. The room may be
darkened slightly to aid visualization on the monitor screen, and that
other procedure (ECG and phonocardiography) may be performed
simultaneously to time events in the cardiac cycles.
6. Explain that a vasodilator (amyl nitrate) may be given. The patient may
be asked to inhale a gas with a slightly sweet odor while changes in
heart functions are recorded.

Discharge Instructions

METHOD
MEDICATION :
 Patient is instructed regarding on his
medication at home that is prescribed by his
physician.
EXERCISE :
 Patient is advised to walk daily such every
morning as his form of exercise but make sure
that the patient can tolerate the activity.
TREATMENT :
 Encourage the patient to do the follow up
check up during the exact schedule given by
the physician and to visit a health center or
hospital if he feels any unusualities.
HYGIENE :
 Encourage the patient to do wound care
everyday with normal saline solution and
change dressing once a day
 Encourage the patient to bath every day
RATIONALE
 For the patient to understand the purpose of his
medication and the proper dosage of each
medication so that we could avoid
complication during taking the medication, at
the same time to increase the patients
motivation in taking the medication due that it
might promote fast recovery for the patient.
 This will help the patient to maintain body
movements because exercising does help blood
to circulate properly through out the body even
in lungs at the same time it does help in
avoiding acquiring ulcer pressure.
 Monitoring the patient could help prevent
possible problems regarding the disease at the
same time it can help the patient to recover
properly.
 Proper cleansing of the wound could prevent
infection which could lead to more
complications.
 Bathing does help body to freshen up and be

32
  Informed the family or guardian to help the
patient in doing the wound care.
OUTPATIENT :
 Patient was informed about his schedule in
visiting her physician for follow up check up.
DIET :
 Patient is instructed about his DM diet, eating
nutrition food, avoiding alcohol and sweets,
lessen eating of rice or any food that are with
large amount of cholesterol.
SPIRITUAL :
 Patient was educated about having a strong
faith with Allah s.w.a via praying and seek for
good health, strength, specially to ask for help
at the same time don’t forget to think Allah
s.w.a for always being there.
more active.
 Helping the patient in doing the wound care
could lessen the struggle of the patient at the
same time to avoid the patient in having
fatigue.
 Follow up check up from his physician will
help to determine for the progress of the
patient and to prevent possible complications.
 Having a proper diet will help the patient fast
recovery from his illness.
 Spiritual beliefs does help a person to keep
going and never giving up and it does give
strength to the patient to keep fighting and
never doubt.
33
34
35
36
All other documents has been passed separately.

I.

REFERENSES

Weber, Kelley (1944) Health Assessment in Nursing (6 th edition)

Vera, M., By, -, Vera, M., & Matt Vera is a registered nurse with a bachelor of science in nursing
since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During
his time as a student. (2020, December 08). 7 gastroesophageal reflux Disease (GERD)
nursing care plans. Retrieved February 08, 2021, from
https://nurseslabs.com/gastroesophageal-reflux-disease-gerd-nursing-care-plans/

-, I., By, -, Ira Hope RN MDGone are the days when doctors become nurses. Now the table is
turned, MD, I., Gone are the days when doctors become nurses. Now the table is turned, &
Here, P. (2020, September 08). Diabetes pathophysiology & diseases process (diagram).
Retrieved February 22, 2021, from https://rnspeak.com/diabetes-pathophysiology-diseases-
process-diagram/

What is diabetes? (2016, December 01). Retrieved February 24, 2021, from
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

www.mayoclinic.org  ›  in-depth › art-20044248

www.mayoclinic.org  ›  in-depth › art-20044248

www.creeksidefamilypractice.com  ›  blog › unexplained

www.diabetes.co.uk  ›  symptoms › polyphagia

www.nei.nih.gov  ›  eye-conditions-and-diseases › diabetic..

www.healthline.com  ›  health › tips-treating-diabetic-nerv

www.diabetes.co.uk  ›  symptoms › extreme-tiredness

37
www.aad.org › public › diseases › diabetes-warning-signs

www.medicalnewstoday.com  ›  articles

medlineplus.gov  ›  Medical Tests

www.diabetes.co.uk  ›  symptoms › extreme-tirednes
www.icalnewstoday.com  ›  articles

apic.org  ›  Consumers

38