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Case Study About Type II Diabetes Mellitus
Case Study About Type II Diabetes Mellitus
TYPE II DIABETES
MELLITUS
SUBMITTED BY: bsn iv- G
CHONAMARIE R. BUTARDO
SUBMITTED TO:
INTRODUCTION
The case study that is to be presented features a patient who
understanding the relevant health issue, this case study will also
explore other factors that can enhance our knowledge in the field of
our nursing practice. This is also the primary reason why we choose
OBJECTIVES
General Objectives
Specific Objectives
Student-Nurse Centered:
disease management.
Client Centered:
might occur.
appropriate exercise.
CLIENT’S PROFILE
Name: R.C.
Sex: Male
Height: 5’1”
Nationality: Filipino
No. of Children: 3
Occupation: Vendor
Dr. Narag at General Tinio Street, Cabanatuan City for this follow
found out that the blood glucose level is high and diagnosed to have
aware of the signs and symptoms of the disease and found out
rich food.
None
Supplement
Multivitamins
ELIMINATION PATTERN
None
SLEEP PATTERN
Usual Sleep Pattern on Bed time
9:00 PM
5:00 AM
Hours Slept
8 hours
Sleep Routine
PHYSICAL EXAMINATION
VITAL SIGNS
20, 2009
Weight – 63 kg (140lbs)
Height – 5’1”
BMI – 26.22
MENTAL STATUS
Attitude: Cooperative
symmetrical
>Hair is evenly Inspection
>Black in color
Inspection
involuntary muscle
movement
Inspection
conjunctiva, white
reactive to light
Inspection
distinguish objects
displayed in his
periphery
>Color is same in Inspection
>Flexible symmetrically
the eye
>Symmetrical Inspection
straight
No discharge or
flaring
Inspection
brown symmetrical,
moisture
>Pink Inspection
membrane
Inspection
and no tenderness
Inspection
and no tenderness
Inspection
>Umbilical is
centrally located
>Symmetrical Inspection
>Uniform Palpation
>Uniform Palpation
Inspection
color
CASE DISCUSSION
glands that processes food. In order to use the food we eat, our
body has to break the food down into smaller molecules, and it also
Most of the digestive organs (like the stomach and the
intestines) are tube-like and contain the food as it makes its way
twisting tube that runs from the mouth to the anus, plus few other
organs (like the liver and pancreas) that produce or store digestive
enzymes.
After being chewed and swallowed, the food enters the
esophagus. The esophagus is a long tube that runs from the mouth
that churns the food and bathes it in a very strong acid (gastric
acid). Food in the stomach that is partly digested and mixed with
After being in the stomach, food enters the jejunum, the
duodenum and then the ileum of the small intestine. In the small
inner wall of the small intestine help in the break down of food.
After passing through the small intestine, food passes into the
intestines help in the digestion process. The first part of the large
then travels upward in the ascending colon, then travels across the
anus.
maintain homeostasis in the body. When glucose levels are too high
for storage. When glucose levels are too low the pancreas produces
DESCRIPTION
glucose, fats and even proteins are broken down and used to meet
occurs most often in people who are overweight and who do not
because of its slow onset and can usually be controlled with diet
gluconeogenesis
Dehydration of glucosuria Stimulate rennin
cells release
Hypoglycemic Agent)
DIET
DIABETIC DIET
PURPOSE
FOODS ALLOWED
a. 45-55% carbohydrates
b. 30-35% fats
c. 10-25% protein
Coffee, tea, broth, spices and flavorings can be used
as desired
FOODS TO BE AVOIDED
EXERCISE
PURPOSE
surgery).
INSULIN
intravenously.
o HUMULIN R
2. INTERMEDIATE –
ACTING
o NPH (NEUTRAL
PROTAMINE
HAGEDON)
3. LONG – ACTING
o ULTRA LENTE
o PZI (PROTAMINE
ZINC INSULIN)
CHARACTERISTICS
Never aspirate.
SULFONYLUREAS
CHLORPROPAMIDE (DIABINASE)
TOLBUTAMIDE (ORINASE)
GLIMEPIMIDE (SOLOSA)
ACETOHEXAMIDE (DYMELOR)
MEGLITINIDES
pancreas.
REPAGLINIDE (NOVONORM)
ROSIGLITAZONE (AVANDIA)
BIGUANIDES
Have complex peripheral actions in the presence of
insulin release.
METFORMIN
THIAZOLIDINEDIONES
ROSIGLITAZONE
DIOGLITAZONE
ALPHA-GLUCOSIDASE INHIBITORS
ACARBOSE
MIGLITOL
VOGLIBOSE
CLINICAL MANIFESTATIONS:
Manifested by client: Signs and Symptoms (from the
book)
Polyuria polyuria
polyphagia
Poly dipsia
fatigue
weakness
tingling or numbness in
hands or
feet
weight loss
dry skin
GENETICS/HEREDITARY
whos mother had diabetes where twice as likely to get the disease
RACE
Diabetes occurs more often in Hispanic/Latino Americans,
HYPERTENSION
SEDENTARY LIFESTYLE
AGE
Some doctors advise anyone over 45 to be screened for
PREVENTION
Maintain body weight and prevent obesity through proper
salt and fat intake, avoid simple sugars like cakes and
the body.
coma or even death. When the cells don’t get the glucose they need
for energy, your body begins to burn fat for energy, which produces
ketones. Ketones are acids that build up in the blood and appear in
CLINICAL MANIFESTATIONS
Frequent urination
Polyphagia
Confusion
SYNDROME (HHNS)
in people with type 2. In HHNS, blood sugar levels rise, and your
body tries to get rid of the excess sugar by passing it into your
Extreme thirst
Weakness
Polyuria
Polydipsia
Polyphagia
NEPHROPATHY
tiny blood vessels that act as filters. Their job is to remove waste
products form the blood. Diabetes can damage the kidneys and
cause them to fail. High levels of blood sugars make kidneys filter
too much blood. At this extra work is hard on the filters. After many
years, they start to leak and useful protein is lost in the urine.
CLINICAL MANIFESTATIONS
gone. The first symptom of kidney disease is often fluid build up.
Loss of sleep
Poor appetite
Weakness
Microalbuminuria
RETINOPATHY
Blurring of vision
Floating spots
HYPOGLYCEMIA
happen even during those times where you’re doing all you can to
CLINICAL MANIFESTATIOS
Shakiness
Dizziness
Sweating
Hunger
Confusion
NEUROPATHY
CLINICAL MANIFESTATIONS
Muscle weakness
Difficulty swallowing
Speech impairment
Vision changes
Urinary incontinence
MACROVASCULAR DISEASES
pressure.
blood supply to part of the heart, causing some heart cells to die.
diabetes mellitus and not properly treating it. Both the types of
DIAGNOSTIC EXAMS
The A1C blood test measures the average blood glucose level
fingertip.
Oral glucose tolerance test (OGTT)
taste very sweet, & is usually cola or orange flavored). Two hours
INDICATORS
NORMAL VALUES
Random Blood Sugar 90 to 140 mg/dL
Fasting Blood Sugar 70 to 110 mg/dL
Post Prandial Blood Sugar < 200 mg/dL
Glycosylated Hemoglobin 4.5 to 6.5%
(HbA1c)
Blood Pressure 120/80 mmHg
Pulse Rate 60-100 bpm
Respiratory Rate 16-20 bpm
Temperature 36.8-37 oC
NURSING DIAGNOSIS
output.
Risk for infection related to insufficient knowledge on
frequent urination.
output.
INTERVENTIONS RATIONALE
duration of intensity of
urination.
dehydration.
deficit.
manifested by hypotension
Recumbent to a sitting or
standing position.
resumed.
NURSING DIAGNOSIS: Risk for infection related to
development of infection.
INTERVENTIONS RATIONALE
during educating
process.
infection.
INTERVENTIONS RATIONALE
By absorption and
utilization of
nutrients.
2.Identify food 2. If patient’s food
meal plan,
cooperation with
dietary requirements
may be facilitated.
achieve.
NURSING CARE PLAN FOR
COLLABORATIVE PROBLEMS
DIABETIC KETOACIDOSIS
INTERVENTION RATIONALE
1. Monitor for signs and
symptoms of diabetic
ketoacidosis
frequently. Frequency in
dehydration.
importance of careful
management is emphasized
visual changes.
through respirations,
breakdown of acetoacetic
acid and should diminish
as ketosis is corrected
Correction of hyperglycemia
Hypovolemia may be
manifested by hypotension
sitting/standing position.
of volume replacement
disease.
disease
HYPEROSMOLAR HYPERGLYCEMIA NON-KETOTIC
SYNDROME
INTERVENTION RATIONALE
1. Monitor for signs and Hyperosmolar
hyperglycemia, it leads to
Severe dehydration
hyperosmolarity and
Serum osmolarity 350
osmotic dieresis which
mOsm/kg
cause severe dehydration.
Hypotension in
Hyperosmolar
b. Hypotension
hyperglycemia non-ketotic
immediate fluid
replacement.
HYPOGLYCEMIA
INTERVENTION RATIONALE
1. Monitor for signs and
symptoms of hypoglycemia
such as:
palpitations. Profuse
sweating indicates
hypoglycemia so
administration of insulin
should be avoided.
for treatment of
hypoglycemia.
DIABETIC RETINOPATHY
INTERVENTIONS RATIONALE
a. 1-a.3. Asymptomatic
a. Stages of
retinopathy blood vessels
retinopathy.
within the retina develop
a. 1 non proliferative
microaneutysms that leak
a. 2 preproliferative
fluid, causing swelling and
a. 3 proliferative
forming deposits or
proliferative retinopathy
increase destruction of
proliferative neuropathy
the retina.
symptoms of diabetic
retina.
line of vision.
activities, requiring
e. Difficulty of
adequate focusing power
breathing
become more and difficult.
DIABETIC NEPROPATHY
INTERVENTIONS RATIONALE
1. Monitor for signs and
symptoms of diabetic
nephropathy
disease secondary to
diabetic microvascular in
complication of diabetic.
diabetes develops
disease.
evidence of nephropathy at
filtration mechanism is
development of
nephropathy.
MACROVASCULAR DISEASE
INTERVENTION RATIONALE
Assess Characteristics of Assisting the client in pain
c. Intensity complications
complications
pain.
Decrease oxygen
environment to promote
calmness.
Pain control is a priority as
it indicates ischemia.
Administer medications
abate.
NEUROPATHY
INTERVENTION RATIONALE
Initial symptoms of
peripheral Neuropathy
includes:
propriconception and a
neuropathy at increased
levels related to
inconsistent absorption of
secondary to inconsistent
gastric emptying.
A decreased sensation of
a. Gl neurogenic.
developing urinary
EVALUATION
effects of therapy.
possible complications.
Recommendation
status.
essential nutrients.