Type 2 Diabetes Mellitus Ics

Saint Mary’s University
Bayombong, Nueva Vizcaya

SCHOOL OF HEALTH and NATURAL SCIENCES
NURSING DEPARTMENT
ASCITES RELATED TO LIVER CIRRHOSIS
An Individual Case Study
Presented to
The Faculty of
NURSING DEPARTMENT
In Partial Fulfillment of
NCM 118: NURSING CARE OF CLIENTS WITH LIFE ( RLE )
SUBMITTED BY:
KITONG, HAROLD CHRIS D.
SUBMITTED TO:
MR. MANUEL MARTIN
NOVEMBER 2021
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NURSING DEPARTMENT
CONTENT PAGE NO.

I. PROFILE OF THE CLIENTS 3
HISTORY OF PRESENT ILLNESS 3
HISTORY OF PAST ILLNESS 4
FAMILY HISTORY 4
LIFESTYLE HISTORY 4
SOCIO-ECONOMIC HISTORY 4
II. BRIEF DESCRIPTION 4
DM Type 2 4
Etiology 5
Epidemiology 5
Predisposing Factors 5
Clinical Manifestation 5
Diagnostic Procedure 6
Medical Management 6
III. ANATOMY AND PATHOPHYSIOLOGY 6
A. Anatomy 6
B. Pathophysiology 12
IV. LABORATORY RESULTS 13
V. PHYSICAL ASSESSMENT AND PHYSIOLOGICAL BASIS 22
PERSON Assessment 22
VI. DRUG ANALYSIS 28
VII. COURSE IN THE WARD 34
VIII. NURSING CARE PLAN 38
REFERENCES 47
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NURSING DEPARTMENT
I. 3P’s
PROFILE OF THE CLIENTS

PATIENT’S PROFILE
NAME Mrs. AG
AGE 77
BIRTHDATE April 15,1961
BIRTHPLACE Mayauyo, Ifugao
SEX Male
ADDRESS Brngy Magsaysay, Bayombong, Nueva Vizcaya
RELIGION Roman Catholic
NATIONALITY Filipino
ETHNICITY Ifugao
EDUCATIONAL ATTAINMENT College Graduate
OCCUPATION Retired Police
CHIEF COMPLAINT
ADMITTING DIAGNOSIS Type 2 Diabetes Mellitus
SIGNIFICANT OTHERS
NAME Mrs. MD
AGE 50
ETHNICITY Filipino
RELATIONSHIP TO THE PATIENT Wife
EDUCATIONAL ATTAINMENT College Graduate
OCCUPATION Retired Teacher
PRESENT ILLNESS
On September 12, 2022, at 9:00 AM, we conducted a home visit at Brgy. Magsaysay, Bayombong,
Nueva Vizcaya. I, and Ms. Mildred Dumangeng, was assigned to a client suffering from type 2 Diabetes
Mellitus. We gathered our things and went straight to our client right after we arrived at the area. We greeted
the client first and introduced ourselves. He welcomed us to their house and allowed us to conduct the home
visit. We started the interview and health assessment by introducing ourselves and asking for the client’s
name. We asked about health concerns the client may have been experiencing or any past and/or existing
health problems. He mentioned his Diabetes Mellitus which he is suffering from at the moment. We asked
about when he started to feel the symptoms and what prompted them to visit the hospital. According to the
client, He started to feel dizzy when he was having his training way back in 2015. They rushed him to the
hospital and advised him to have some rest. His diagnosis at that time was not clear according to the client. In
2017, he again was brought to the hospital for a check-up and it was shown from his lab result that he has high
blood sugar. He was then diagnosed with type 2 DM from the lab test he had gone through. According to the
client, his family has no history of Diabetes Mellitus, only hypertension.
At 9:30 AM, we assessed our client’s vital signs and the result are as follows, T-36, PR-86, RR-20,
BP-150/100, and O2sat of 98%. We followed the PERSON assessment as a basis for getting our data. We
asked if he is taking his maintenance or has any, however, he doesn’t take medications prescribed by the
doctor. He only takes his insulin but irregularly. After getting the client’s information and overall assessment
we conducted a short health teaching in relation to his condition. We advised the client to take his meds as
prescribed and to follow a strict diet. He mentioned that he has sleep disturbances due to frequent urination at
night. We advised him of the things he need to do to cope with it. We finished with our assessment and
interview at around 10:00 AM. We excused ourselves from the client and went our way to our CI.
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NURSING DEPARTMENT
PAST ILLNESS
According to the client, He started to feel dizzy when he was having his military training way back
in 2015. They rushed him to the hospital and advised him to have some rest. His diagnosis at that time
was not clear according to the client. In 2017, he again was brought to the hospital for a check-up and it
was shown from his lab results that he has high blood sugar. He was then diagnosed with type 2 DM from
the lab test he had gone through. According to the client, he did not experience any other illnesses in the
past including surgical procedures and hospitalization aside from the above-mentioned.
FAMILY HISTORY
Mr. AG claims that no one in his family has ever had a Diabetes-related ailment. He is the first family
member to develop the illness. His parents, however, has hypertension. His wife has also hypertension as
mentioned by the client. Aside from the disorders mentioned, no one else has ever had the condition.
LIFESTYLE HISTORY
Mr. AG sleeps at 9:00 PM and wakes up at 3 AM every day. He eats breakfast at 7:30 AM, which mainly
consists of egg, dried fish, and half a cup of rice. He sometimes goes to their farm and manages it. He
stays mainly in their house managing their sari-sari store. His fluid intake is about 2 liters a day. According
to him, he secretly drinks a bottle of alcohol and consumes 4 sticks of cigarettes a day. During the night,
he spends more time watching television.
SOCIO-ECONOMIC HISTORY
Mr. AG and Mrs. MD are both college graduates. Mr. AG used to work as a police officer and his wife
worked as a teacher. They both receive their pension used for their daily living. Today, the family put up
a sari-sari business to add up for their expenses. They also have a child who works as a nurse and is
contributing in paying their monthly bill. The money they earn each month is enough for their living.
II. BRIEF DESCRIPTION
I. DEFINITION
TYPE 2 DIABETES MELLITUS
- Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose)
as a fuel. This long-term (chronic) condition results in too much sugar circulating in the
bloodstream. Eventually, high blood sugar levels can lead to disorders of the circulatory,
nervous and immune systems.
- In type 2 diabetes, there are primarily two interrelated problems at work. Your pancreas
does not produce enough insulin — a hormone that regulates the movement of sugar into
your cells — and cells respond poorly to insulin and take in less sugar.
- Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and type 2
diabetes can begin during childhood and adulthood. Type 2 is more common in older
adults, but the increase in the number of children with obesity has led to more cases of
type 2 diabetes in younger people.
- There's no cure for type 2 diabetes, but losing weight, eating well and exercising can help
you manage the disease. If diet and exercise aren't enough to manage your blood sugar,
you may also need diabetes medications or insulin therapy.
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NURSING DEPARTMENT
II. ETIOLOGY
TYPE 2 DIABETES MELLITUS
- Type 2 diabetes mellitus (T2DM) accounts for around 90% of all cases of diabetes. In
T2DM, the response to insulin is diminished, and this is defined as insulin resistance.
During this state, insulin is ineffective and is initially countered by an increase in insulin
production to maintain glucose homeostasis, but over time, insulin production decreases,
resulting in T2DM. T2DM is most commonly seen in persons older than 45 years. Still, it
is increasingly seen in children, adolescents, and younger adults due to rising levels of
obesity, physical inactivity, and energy- dense diets.
III. EPIDEMIOLOGY
- Globally, an estimated 462 million individuals are affected by type 2 diabetes,
corresponding to 6.28% of the world’s population. More than 1 million deaths were
attributed to this condition in 2017 alone, ranking it as the ninth leading cause of
mortality. This is an alarming rise when compared with 1990, when type 2 diabetes was
ranked as the eighteenth leading cause of deaths. In terms of human suffering (DALYs),
diabetes ranks as the seventh leading disease.
- In 2017, approximately 462 million individuals were affected by type 2 diabetes
corresponding to 6.28% of the world’s population (4.4% of those aged 15–49 years, 15%
of those aged 50–69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per
100,000.
IV. RISK FACTORS
Modifiable Risk Factors:
 hypertension
 Smoking
 Physical inactivity.
 overweight/obesity
 poor diet
Non-modifiable Risk Factors:
 Genetics
 Ethnicity
 Age
V. CLINICAL MANIFESTATION
Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can be living with
type 2 diabetes for years and not know it. When signs and symptoms are present, they may
include:
 Increased thirst
 Frequent urination
 Increased hunger
 Unintended weight loss
 Fatigue
 Blurred vision
 Slow-healing sores
 Frequent infections
 Numbness or tingling in the hands or feet
 Areas of darkened skin, usually in the armpits and neck
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NURSING DEPARTMENT
VI. DIAGNOSTIC PROCEDURES
GLYCATED HEMOGLOBIN (A1C) TEST
- The glycated hemoglobin (A1C) test is a long-term measure of blood sugar control. It
allows your doctor to figure out what your average blood sugar level has been for the past
two to three months.
- This test measures the percentage of blood sugar attached to hemoglobin. Hemoglobin is
the oxygen-carrying protein in your red blood cells. The higher your A1C is, the higher
your recent blood sugar levels have been.
- The A1C test isn’t as sensitive as the fasting plasma glucose test or oral glucose tolerance
test. This means that it identifies fewer cases of diabetes. Your doctor will send your
sample to a certified laboratory for diagnosis. It may take longer to get results than with a
test conducted in your doctor’s office.
- An advantage of the A1C test is convenience. You don’t have to fast before this test. The
blood sample can be collected at any time of day. Also, your test results aren’t affected
by stress or illness.
NURSING CONSIDERATION
BEFORE:
- You may need to fill out a form or two before the test, for example, to give consent for
the test to be done or to authorize billing your insurance. The receptionist or nurse will let
you know.
- Be sure to let the technician know if you have a history of feeling faint or actually
fainting during medical procedures. This allows the technician to take precautions, such
as having you lie down on a table as your test is performed.
DURING:
- The technician will ask you which arm you want to use (most people choose their non-
dominant arm). You'll roll up your sleeves, if applicable, to expose the area for the blood
draw.
- The technician will look for a vein—usually on the inside of your arm, in the crook of
your elbow—and tie an elastic band around your arm above the vein to help push the
blood down.
- After the area is cleaned with alcohol, a small, fine needle will be inserted into your vein.
You will probably feel a sharp prick, pinch, or poke that lasts for just a few moments. Let
the technician know if you start to feel faint, dizzy, or lightheaded.
- Your blood will be collected in a tube. As it begins to fill up, the technician will untie the
elastic band and then take the needle out of your arm.
- If the area is bleeding, a cotton ball or tissue will be pressed over it for a few seconds. If
this doesn't stop the bleeding, the technician will place a bandage over the area.
AFTER:
- As long as you aren't feeling nauseous or faint, you will be free to leave as soon as your
blood sample has been taken. If you aren't feeling well, you may need to stay for a few
minutes to recover first. As soon as you are up to it, you can leave.
RANDOM GLUCOSE TESTING
- Random glucose testing measures a person’s blood glucose levels at any given point in
the day. Blood glucose is also known as blood sugar.
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NURSING DEPARTMENT
- Many blood tests for diabetes involve either fasting or continuous monitoring, but this
test does not.
- It is useful for people who need a speedy diagnosis, such as those with type 1 diabetes
who require urgent supplementary insulin.
BEFORE
- Inform the client

- Instruct the patient to fast for at least 8 hr before specimen collection for the fasting
glucose test and not to consume any caffeinated products or chew any type of gum before
specimen collection; these factors are known to elevate glucose levels.
DURING
- Instruct the client to relax
AFTER
- Discuss results to the client
THE ORAL GLUCOSE TOLERANCE TEST (OGTT)
- The oral glucose tolerance test (OGTT) is used to evaluate abnormal fasting blood
glucose levels that are not able to clearly indicate diabetes. The test takes 2 hours to
complete and involves having patients drink 75 grams of glucose and then having glucose
samples taken at baseline, 30, 60, and 120 minutes. The test should be performed on
ambulatory patients after fasting 8 to 12 hours. Various factors can influence the test
results, such as caffeine and smoking. The patient’s diet 3 days before the test should
include 150-300 grams of carbohydrate with intake of at least 1500 cal/day.
BLOOD TESTS
BEFORE
 Inform the client

 Encourage to avoid stress
DURING
 Explain that slight discomfort may be felt

AFTER
 Discuss results to the client
CT SCAN
- A CT scan is a type of X-ray that creates a more detailed image than a standard X-ray.
Any type of X-ray that your doctor chooses will give a picture of the structures inside
your chest, including your heart, lungs, and blood vessels.
- CT scans and standard X-rays are painless, but they do expose you to small amounts of
radiation.
BEFORE
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NURSING DEPARTMENT
 Informed Consent
 Look for allergies
 Get health history
 Check for NPO status
 Get dressed up
 Provide information about the contrast medium
 Instruct the patient to remain still
 Inform about the duration of the procedure
AFTER
 Diet as usual
 Encourage the patient to increase fluid intake (if contrast is given).
.
ANTIGEN TEST
- This test typically involves a nasal or throat swab, or saliva test. It confirms viral
exposure in the recent past, but they do not test for the virus directly.
 Inform the client about the test procedure

 Explain that slight discomfort may be felt
 Discuss the result to the client
VII. MEDICAL MANAGEMENT
Metformin
- Is generally the preferred initial medication for treating type 2 diabetes unless there’s a
specific reason not to use it. Metformin is effective, safe, and inexpensive. It may reduce
the risk of cardiovascular events. Metformin also has beneficial effects when it comes to
reducing A1C results. It may also help with weight management. It works by reducing
glucose production by the liver.
Semaglutide (rybelsus)
- An oral form of semaglutide (Rybelsus) that can be taken once per day. This type of
medication is effective, and may be beneficial for the heart and help with weight loss. But
it may also cause side effects, such as nausea and diarrhea.
Alpha-glucosidase inhibitor
- This medication, acarbose, is rarely used. It causes flatulence and decreases carbohydrate
absorption.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors)
- This is the newest class of diabetes medications. They lower blood glucose levels by
removing glucose from the body through urine. There’s growing evidence that this class
provides cardiovascular benefits, apart from the benefits of improved blood glucose
management.
III. ANATOMY AND PATHOPHYSIOLOGY
A. BLOOD VESSELS AND CIRCULATORY SYSTEM
The blood vessels of the body form a network more complex than an interstate highway system.
The blood vessels carry blood to within two or three diameters of nearly all the trillions of
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NURSING DEPARTMENT
cells that make up the body. Blood flow through them is regulated, so that cells receive adequate nutrients
and so that waste products are removed. To keep things moving in the right direction, these roadways only
go in one direction.
FUNCTIONS OF CIRCULATORY SYSTEM
• Carries blood – the blood vessels carry the blood from the heart to all the tissues of the
body and back to the heart.
• Exchanges nutrients, waste products, and gasses with tissues – nutrients and
oxygen diffuse from blood vessel to cells in essentially all areas of the body. Waste
products and carbon dioxide diffuse from cells, where they are produced, to blood vessels.
• Transports substances – blood transports hormones, components of the immune
system, molecules required for coagulation, enzymes, nutrients, gases, waste prod,ucts and
other substances to and from all areas of the body.
• Helps regulate blood pressure – the circulatory system and heart work together to
regulate blood pressure within a normal range
• Directs blood flow to tissue – the circulatory system directs blood to tissues when
increased blood flow is required to maintain homeostasis.
PARTS OF THE CIRCULATORY SYSTEM
• Pulmonary vessels – transports blood from the right ventricle of the heart through the
lungs and back to the left atrium.
• Systemic vessels – transports blood from the left ventricle of the heart through all parts
of the body and back to the right atrium
GENERAL FEATURES OF BLOOD VESSEL STRUCTURE
• Arteries – carry blood away from the heart, usually the blood is oxygenated (oxygen-
rich).
• Capillaries – the blood flows from arterioles into capillaries. It is at capillaries where the
exchange of substances such as oxygen, nutrients, and other waste products occurs between
blood and tissue fluid.
• Veins – carry blood toward the heart, usually the blood is deoxygenated (oxygen- poor).
Compared to arteries, the walls of veins are thinner and contain less elastic tissue and fewer
smooth muscle cells.
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NURSING DEPARTMENT
THE CIRCULATORY SYSTEM AND DIABETES MELLITUS
The circulatory system allows blood glucose levels to be regulated. The hormone glucagon, carried in
the blood signals the liver to release glucose into the blood and the presence of insulin in the blood
instructs the cells to take in glucose from the blood.
If blood glucose levels become too high for extended periods, damage can be sustained by the blood
vessels. If significant numbers of blood vessels are damaged, this can have a hurting of the body, and
diabetic complications will develop such as neuropathy and kidney failure.
B. NERVOUS SYSTEM
The nervous system is involved in some way in nearly every body function. It is considered as a
communication system, receiving signals from and sending commands to different areas of the body. By
way of this communication, the nervous system helps coordinate the body functions to maintain
homeostasis.
FUNCTIONS OF NERVOUS SYSTEM
• Receiving sensory input – sensory receptors monitor numerous external and internal stimuli.
We are aware of sensations from some stimuli such as vision, hearing, taste, smell, touch, pain,
body position, and temperature.
• Integrating information – the brain and spinal cord are the major organs for processing
sensory input and initiating responses. The input may produce an immediate response, be stored
as a memory, or ignored.
• Controlling muscles of glands – skeletal muscles normally contract only when stimulated
by the nervous system. Thus, by controlling skeletal muscle, the nervous system controls the
major movements of the body.
• Maintaining homeostasis – this function depends on the nervous system’s ability to detect,
interpret and respond to changes in internal and external conditions.
• Establishing and maintaining mental activity – the brain is the center of mental activity,
including consciousness, memory, and thinking.
B. PANCREAS
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NURSING DEPARTMENT
The pancreas is located retroperitoneal, posterior to the stomach in the inferior part of the left
upper quadrant. It is a soft oblong gland about 6 inches long and 1 inch thick.
PARTS OF PANCREAS
• Head: The wider part of the pancreas that sits in the curve of the duodenum.
• Body: The middle part of the pancreas between the head and neck, which extends upward.
• Tail: The thinnest part of the pancreas, located near the spleen.
The pancreas is also a complex organ composed of both endocrine and exocrine tissues that
perform several functions.
Exocrine Part
It is part of the pancreas that is a compound acinar gland, the acini produces digestive
enzymes. Clusters of acini are connected by small
ducts, which join to form larger ducts, and the larger
ducts join to form the pancreatic duct. The pancreatic
duct joins the common bile duct and empties into the
duodenum.
Endocrine Part
It consists of pancreatic islets or Islets of
Langerhans. It produces hormones that are important
in controlling blood levels of nutrients such as
glucose and amino acids.
Four Hormones
• Alpha cells – it releases hormone glucagon in
response to low blood glucose.
• Beta cells – releases insulin, responsible for controlling the level of glucose in the blood.
• Delta cells – it produces somatostatin which, the third most abundant of the pancreatic islet
hormones, its physiological importance is not understood but maybe its major role is as a
paracrine regulator of insulin and glucagon secretion.
• PP cells – Pancreatic polypeptides secreted by PP cells decrease gastrointestinal motility,
pancreatic secretion, and gallbladder contraction.
FUNCTION OF PANCREAS
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NURSING DEPARTMENT
• Exocrine function – it produces enzymes that help with digestion. The pancreas releases
Lipase which works with bile a fluid produced by the liver to break down fats, Amylase which
breakdowns carbohydrates for energy, and Protease that breakdowns protein.
• Endocrine function - The endocrine component of the pancreas consists of islet cells (islets of
Langerhans) that create and release important hormones directly into the bloodstream. Two of the
main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts
to raise blood sugar.
THE PANCREAS AND DIABETES
Without insulin, the cells cannot get enough energy from food. This form of diabetes results
from the body’s immune system attacking the insulin-producing beta cells in the pancreas. The beta
cells become damaged and, over time, the pancreas stops producing enough insulin to meet the
body’s needs.
IV. PATHOPHYSIOLOGY
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NURSING DEPARTMENT
V. LABORATORY RESULTS AND DIAGNOSTIC STUDY
RAPID ANTIGEN TEST
RESULT INTERPRETATION
A negative test result indicates that SARS- CoV-2

RNA was not detected above the detection limit in
the samples. A negative result does not rule out
COVID-19, and it should not be utilized as the
primary basis for treatment or patient management
decisions. Re-testing should be considered in
cooperation with public health authorities if
COVID-19 is still suspected based on exposure
history and other clinical symptoms. When
reaching a final diagnosis and patient care choice,
laboratory test results should always be examined
in the context of clinical observation and
epidemiological data.
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NURSING DEPARTMENT
URINALYSIS
A urinalysis is a test of your urine. It's used to detect and manage a wide range of disorders, such as
urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the appearance,
concentration and content of urine.
Nursing Considerations
Before
• Assess the patient history of medication and food intake

• Assess changes in urinary pattern such as frequency, urgency, or hesitancy.
• Explain to the patient that this test can detect the blood protein albumin in your urine
During
• Instruct the patient the proper way of collecting urine sample

• If a urine sample is obtained from an indwelling catheter, it may be necessary to clamp the
catheter for about 15-30 minutes before obtaining the sample. Clean the specimen port with
antiseptic before aspirating the urine sample with a needle and a syringe.
After
• Cover the specimens tightly, label properly and send them immediately to the laboratory.
• Observe standard precautions when handling urine specimens.
• If the specimen cannot be delivered to the laboratory or tested within an hour, it should be
refrigerated or have an appropriate preservative added.
URINALYSIS Date : February 15,

2022
Time: 10:00 AM
Macroscopic and Results Normal Range/ Physiological Basis

Chemical Results
Examination
Color/ Dark yellow , Cloudy Clear/ Light Yellow Diabetes can cause
Transparency Urine cloudy urine when too
much sugar builds up
in the urine. Diabetes
can also lead to kidney
complications or
increase risk of
infection of the urinary
tract, both of which
can also make
urine appear cloudy.
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NURSING DEPARTMENT
pH Reaction 5.66 4.5 - 8 Without enough

insulin, your body can't
use sugar properly for
energy. This prompts
the release of
hormones that break
down fat as fuel, which
produces acids known
as ketones. Excess
ketones build up in the
blood and eventually
"spill over"
into the urine.
Glucose Positive Negative The pancreas of a

person with type 2
diabetes does not create
enough insulin or the
insulin becomes
ineffective. As a result,
the body is unable to
control glucose levels
well.
When the blood sugar
spikes, it can cause
blood glucose to enter
the urine,
causing glycosuria.
Protein Negative Negative Protein is normally
found in the blood. If
there is a problem
with the kidneys,
protein can leak into
the urine. While a
small amount is
normal, but a large
amount of protein in
urine may indicate
kidney disease.
Specific Gravity 1.000 1.005 to 1.030 Low specific gravity
suggests that urine is
too diluted. The person
may be drinking too
much fluid or have a
condition that makes
them thirsty.
Microscopic Results Normal Values Physiological Basis

Examination
Pus Cells 0-5/HPF 0-5/ HPF An increased puss in the
urine may indicate
UTI
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Red Blood Cells 0-4/ HPF 0-4/ HPF Erythrocytes might

be a sign of kidney
disease, a blood
disorder, or another
underlying medical
condition, such as
bladder cancer.
Squamous 1/5 /HPF 1/5 / HPF Having a
Epithelial Cells moderate
number or many
cells
may indicate: a
yeast
or urinary
tract
infection (UTI)
kidney
or liver
disease.
Mucus Thread Few A small amount of
mucus in your urine is
normal. An excess
amount may indicate a
urinary tract infection
(UTI) or other medical
condition.
Bacteria Negative Negative Urine typically

doesn’t contain
bacteria (germs).
However, bacteria can
get into the urinary
system from outside of
the body, causing
problems like
infection and
inflammation. This is
a urinary tract
infection (UTI).
Cast(s) Negative Negative If a cast is seen in the
urine, kidney disease
or in- volvement
exists; the presence of
casts
indicates kidney
(renal) disease rather
than lower urinary tract
disease.
Complete Blood Count
A complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide
range of disorders, including anemia, infection and leukemia.
Nursing Consideration
Before:
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NURSING DEPARTMENT
• Inform the client of the test procedure.

• Encourage to avoid stress if possible because altered physiologic status influences and changes
normal hematologic values.
• Instruct the patient to wear a short-sleeved or loose shirt on the day of the test.
During
• Instruct the patient to stop any medicines that may affect the result.
After
• Label the specimen properly and send immediately to the laboratory.

• If the punctured site is still bleeding, press a cotton ball or tissue over the area for a few seconds
• Instruct the patient that there are typically no restriction after the test.
CBC COMPLETE FEBRUARY 15, 2022 at 10:00 AM
BLOOD COUNT
Investigation Observed Normal Value Physiological Basis

Results
HEMOGLOBIN 110 g/L 110- 150 g/L Low Hgb: Hemoglobin level is
lower than normal, it means you
have a low red blood cell count
(anemia).
High Hgb: A high hemoglobin

count indicates an above-
normal level of the iron-
containing protein in red blood
cells.
HEMATOCRIT 53.0 % 37.0 – 47. 0 % Hyperglycemia may cause

osmotic diuresis, reducing
plasma volume, thereby
increasing hematocrit, and
blood viscosity.
RED BLOOD 6.00 10ᶺ12/L 3.50 – 5.00 People with diabetes are more
CELLS likely to have inflamed blood
vessels. This can keep bone
marrow from getting the signal
they need to make more red
blood cells.
PLATELET 450 10ᶺ12/L 150- 400 10ᶺ12/L People with diabetes,
particularly those with type 2
diabetes, exhibit increased
platelet reactivity.
Hyperglycemia contributes to
greater platelet reactivity through
direct effects and by promoting
glycation of platelet proteins.
Hypertriglyceridemia
increases platelet reactivity.
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MEAN 105.0 fL 80.0 – 100. 0 fL Increase in mean corpuscular

CORPUSCULAR volume indicates in consistency in
VOLUME erythrocyte size.
MCH 34.0 pg 27.0 – 34. 0 pg MCH stands for mean corpuscular

hemoglobin. MCH levels refer to
the average amount of
hemoglobin found in the red
blood cells in the body.
Hemoglobin is a protein in the
blood that allows red blood cells
to deliver oxygen to the
cells and tissues in the body.
MCHC 360 g/L 320- 360 g/L A normal (normochromia) or high
(hyperchromia) MCHC means that
the oxygen-carrying capacity of
the red blood cells
is normal
RDW 20. 0 % 11.0 – 16.0 % Increase in red cell distribution
with indicates in consistency in
erythrocyte size.
WHITE BLOOD 11.00 10ᶺ12/L 4.00 – 10.00 High white blood cell count is
CELL 10ᶺ12/L associated with a worsening of
insulin sensitivity and predicts the
development of type 2
diabetes.
NEUTROPHILS 80% 50.0 – 70.0 % Neutrophils in diabetes are
functionally altered, due to
exposure to the diabetic
microenvironment, including
changes to blood glucose as
well as other factors
LYMPHOCYTES 50% 20.0 – 40.0 % As type 2 diabetes starts to
develop, the body becomes less
sensitive to insulin and the
resulting insulin resistance also
leads to inflammation.
MONOCYTES 12 % 3.0 – 12.0 % Under certain conditions, diabetes

results in elevated levels of
monocytes in circulation, which
when present contribute to
increased recruitment of
monocytes to the artery wall.
EOSINOPHILS 7% 0.5 – 5.0 % The albumin excretion rate is a

key indicator of kidney disease,
one of the major complications of
diabetes. In men, a higher number
of eosinophils in the blood
correlates with higher
urinealbumin—a critical early
sign of diabetic kidney disease.
18
NURSING DEPARTMENT
BASOPHILS 3.0 % 0.0 – 1.0 % It can be caused by infections,

severe allergies, or an overactive
thyroid gland. An abnormally high
basophil level is called basophilia.
It can be a sign of chronic
inflammation in your body. Or it
can mean that a condition is
causing too many white blood
cells to be
produced in your bone marrow.
Glycated hemoglobin (A1C) test- is a blood test used to diagnose and monitor diabetes. It
shows your average blood sugar levels for the past two to three months.
Nursing Considerations
Before
• Establish rapport
• Explain the procedure to the patient
During
• Explain that slight discomfort may be felt when the skin is punctured.
After
• Ensure the client

• If the punctured site is still bleeding, press a cotton ball or tissue over the area for a few seconds
TEST NAME DATE AND TIME RESULT REFERENCE

RANGE
Glycated hemoglobin February 15,2022 The patient result is < 5.7 % of total Hgb
(A1C) Test 10:00 AM consistent for
diabetes with a total
of 7.5 % of Hgb
Interpretation of the Result

5.7 % of total Hgb Consistent with Absence of Diabetes
5.7 – 6.4 % of total Hgb Consistent with Increased risk for Diabetes
(Prediabetes)
6.5 % or higher of total Consistent with
Hgb Diabetes
FASTING BLOOD SUGAR – A test that measures blood sugar levels.
Before
 Explain the procedure to the patient

 NPO 8- 12 hours
 Instruct the patient to wait before eating and/or taking a hypoglycemic agent (insulin or oral
medication) until after test has been drawn, unless told otherwise.
19
NURSING DEPARTMENT
 Instruct the patient to wear a short-sleeved or loose shirt on the day of the test
During
 Explain to the patient that he may experience slight discomfort from the tourniquet and
needle puncture.
After
 Apply direct pressure to the venipuncture site until bleeding stops.

 Instruct the patient that he may resume his usual medications that were stopped before
the test.
TEST NAME DATE AND TIME RESULT REFERENCE

RANGE
FASTING BLOOD February 05,2022 7.2mmol/L 3.50 - 5.50mmol/L
SUGAR 7:00 AM
INTERPRETATION
Elevated levels are associated with diabetes and insulin resistance, in which the body cannot properly
handle sugar (e.g. obesity).
LIVER FUNCTION TEST

Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests
measure the levels of certain enzymes and proteins in your blood. Some of these tests measure how well
the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste
product. Other liver function tests measure enzymes that liver cells release in response to damage or
disease. Abnormal liver function test results don't always indicate liver disease. Your doctor will explain
your results and what they mean.
Before
 NPO 10- 12 hours
 Instruct the patient to avoid certain foods and medication that might affect to the result
 Instruct the patient to wear a short-sleeved or loose shirt on the day of the test
During
 Explain to the patient that he may experience slight discomfort from the tourniquet and
needle puncture.
After
 Label properly and send immediately the specimen to the laboratory.
 Observe standard precautions when handling the specimens.
TEST DATE AND TIME RESULTS REFERENCE

COMPONENTS RANGE
ALT (SGPT ) February 16,2022 47.00 mml/L Male:0.00 – 45.00
7:00 AM mml/L
Female: 0.00 – 34.00
mml/L
ALT (SGOT) February 16,2022 37.00 mml/L Male:0.00 – 35.00
7:00 AM mml/L
Female: 0.00 – 31.00
mml/L
INTERPRETATION:
20
NURSING DEPARTMENT
The mechanism of the development of a fatty liver is explained by the insulin resistance that
activates lipolysis, resulting in the accumulation of non-esterified fatty acids. This enhanced fat
accumulation in the liver is known to be directly toxic to hepatocytes. This results in an increase in ALT.
If the results of your SGOT test are high, that means one of the organs or muscles containing the enzyme
could be damaged. These include your liver, but also the muscles, heart, brain, and kidneys.
CBC Complete Blood Count
Test Components 2nd CBC 3rd CBC 4th CBC Normal

February 16 February 18 February 20, Value
,2022 ,2022 2022
7:00 AM 7:00 AM 7:00 AM
HEMOGLOBIN 150g/L 120g/L 115g/L 110- 150 g/L
HEMATOCRIT 47% 40% 40% 37.0 – 47. 0

%
RED BLOOD 3.50 – 5.00
CELLS
PLATELET 400 10ᶺ12/L 350 10ᶺ12/L 250 10ᶺ12/L 150- 400

10ᶺ12/L
MEAN CORPUSCULAR 115 fL 100 fL 80.0 – 100. 0
VOLUME fL
MCH 34.0 pg 28.0 pg 28.0 pg 27.0 – 34. 0

pg
MCHC 360 g/L 330 g/L 320 g/L 320- 360 g/L
RDW 16.0% 13% 13% 11.0 – 16.0

%
WHITE BLOOD CELL 10.00 6. 00 10ᶺ12/L 5. 00 10ᶺ12/L 4.00 – 10.00
10ᶺ12/L 10ᶺ12/L
NEUTROPHILS 70.0% 65.0% 60.0% 50.0 – 70.0
%
LYMPHOCYTES 40.0 % 35.0% 30.0% 20.0 – 40.0
%
MONOCYTES 11.0 % 6.0% 4.0% 3.0 – 12.0 %
EOSINOPHILS 5.0 % 3.0% 3.0% 0.5 – 5.0 %
BASOPHILS 1.0% 1.0% 1.0% 0.0 – 1.0 %
URINALYSIS
Macroscopic and 2nd Urinalysis 3RD Urinalysis Normal Range/

Chemical February 16, 2022 February 18, 2022 Results
Examination 12:30 AM 7:00 AM
Color/ Dark yellow, Cloudy Light Yellow, Clear Clear/ Light Yellow
Transparency Urine
pH Reaction 5.7 8 4.5 - 8

Glucose Positive Negative Negative
Protein Negative Negative Negative
21
NURSING DEPARTMENT
Specific Gravity 1.005 1.015 1.005 to 1.030
Microscopic
Examination
Pus Cells 0-1/HPF 0-1/ HPF 0-5/ HPF
Red Blood Cells 0-1/ HPF 0-1/ HPF 0-4/ HPF
Squamous 1/5 /HPF 1/5 / HPF 1/5 / HPF
Epithelial Cells
Mucus Thread Few Negative
Bacteria Negative Negative Negative
Cast(s) Negative Negative Negative
VII. PHYSICAL ASSESSMENT AND PATHOPHYSIOLOGICAL BASIS
ASSESSMENT
Patient’s Initial Mr. AG

Age 77
Sex Male
PSYCHOLOGICAL
PRE-ASSESSMENT POST-ASSESSMENT
February 15, 2021: 9 AM February 19, 2021: 9 AM
Significant Other Mrs. MD, wife
Family Structure Nuclear
Religion Roman Catholic
Primary Language Ilocano

Primary Source of Region 2 Trauma Medical Center
Health Care
Financial Resources Both the client and his significant other receive a pension which they use as their
financial resources. They also have a child who works abroad which contributes to
their living expenses. They also have a store (Sari-sari) which provides them
income.
Coping Mechanism He drinks 1 bottle of alcohol and consumes 4 sticks of cigarettes a day to cope.
- Stress
- Pain
General Appearance Mr. AG is not wearing his tops during Mr. AG was wearing a white T-shirt and
the visit. He is showing a good posture short pants during the time of visit. He
when we were interviewing him. stands straight and no difficulties
answering our questions.
Orientation Mr. AG was oriented during the visit. The client can immediately answer the
He was able to answer questions such question that was asked.
as what the time is and what he ate
during breakfast.
22
NURSING DEPARTMENT
Memory He has a good immediate memory. He has a good immediate memory.
He has a good recent memory because He has a good recent memory because he
he can recall what he ate for breakfast can recall what she ate for breakfast.
stating he ate tinapa.
He has a good remote memory because
He has a good remote memory because he can recall their anniversary.
he can recall his wife's birthday.
Pathophysiological Basis:
The patient’s condition doesn’t
affect his memory.
Speech He can speak clearly, but only for a He speaks clearly and is easy to
short time. understand
Non-verbal behavior When responding, he nods or shakes his When responding, he nods or shakes his
head. head. He can also communicate with
hand motions.
Posture The client can stand or walk well. He can stand and walk without requiring
support from her wife when standing or
balancing.
ELIMINATION
Stool
I. Frequency I. He defecates everyday I. 2 times a day
II. A sausage shape with cracks in

II. Consistency/Shape the surface. II. Loose and watery stools
III. Color III. Yellow III. Brown
IV. Odor IV. Foul-smelling IV. Less smelling
23
NURSING DEPARTMENT
Urine
I. Frequency I. 4 times a day I. 4 times a day
II. Amount II. 800 ml II. 800 ml
III. Color III. Light Yellow III. Light Yellow
Toilet ability Not Assessed The patient can go to the toilet without
any assistance from her husband.
Activity Intolerance He asks for assistance when going down He asks for assistance when going
and moving up stairs. down and moving up of stairs.
REST AND ACTIVITY

Current He can walk well from one point He can walk, moves in and out of their
Activity to another. Patient verbalized no house without problems.
Level complaints on daily activities
ADL: The patient can groom, feed, and move, as

well as do basic self-care and hygiene.
Groom He needs assistance in wearing his
herself hospital shirt
He can feed himself

Feed
herself
Sleep He sleeps at around 9 PM and wakes He sleeps at around 9 PM and wakes up at

up at around 3 AM. around 3 AM.
Body Frame Endomorph
Coordination Movements are well coordinated. Movements are well coordinated.
24
NURSING DEPARTMENT
Balance He can balance himself well. No assistance required.
Muscle Strength No involuntary movements like twitching and spasms, he also has full energy or
muscle strength.
Use of No assistive devices were noted. No assistive devices were noted.

Assistive
Devices
SAFE ENVIRONMENT
Allergies He has an allergic reaction to seafoods and He has an allergic reaction to seafood and
certain foods such as itlog. No allergies to certain foods such as itlog. No allergies to
medications and to environmental factors medications and to environmental factors
were noted. were noted.
Vision PERRLA (Pupils Equally Round and React PERRLA (Pupils Equally Round and
to Light and Accommodation (both eyes)). React to Light and
Accommodation (both eyes).
Normal blinking of the eye (15-20 blinks per
minute). Normal blinking of the eye (15-20
blinks per minute).
There is no discharge, no jaundice, and no
problems with vision as determined. There is no discharge, no jaundice, and no
problems with vision as determined.
Hearing There is no discharge, swelling, and There is no discharge, swelling, or

difficulties in hearing difficulties in hearing
Skin Integrity Aside from the healed wounds on his feet, his Aside from the healed wounds on his feet,
overall skin is intact. his overall skin is intact.
Turgor The skin returns to normal after being The skin returns to normal after being
pinched for about 1-2 seconds. pinched for about 1-2 seconds.
25
NURSING DEPARTMENT
Mucous Oral and Nasal Mucosa is moist and intact. Oral and Nasal Mucosa is moist and
Membrane intact. He hydrates himself with water.
Temperature 36.7 ̊ C 36.5 ̊ C
OXYGENATION
Airway His nose has no secretion and hi s mouth has There is no secretion in his nose, and
Clearance no obstruction. there is no obstruction in his mouth.
He is able to breathe normally.
Lung Sound There are no abnormal sounds There are no abnormal sounds
Color Skin: Brown in color Skin: Brown in color

Nails: Pinkish in color Nails: Pink tone in color
Lips: Pinkish lips without lesions or swelling Lips: Moist without lesions or
swelling
Chest Normal rise and fall of the chest. There is an equal rise and fall of the
Movement chest.
Capillary Refill His capillary refill is normal. Pink tone returns His capillary refill is normal. The pink
immediately when pressure is released. tone returns immediately when
pressure is released.
Pulse Rate 86 beats per minute 88 beats per minute
Blood Pressure 150/100 mmHg 140/80 mmHg
Respiratory 20 breaths per minute 21 breaths per minute

Rate
96% 97%
26
NURSING DEPARTMENT
Oxygen
Saturation
NUTRITION
Diet Less Carbohydrate Less Carbohydrate
The patient was advised to eat less rice by the The patient was advised to eat less rice
physician, however, is not maintained. by the physician, however, is not
maintained.
Fluid Intake Mr. B said that he was drinking 1.5L to 2L of Mr. B drinks 1.5 to 2L of water per
water per day. (6-8 glasses of water) day. (6-8 glasses of water)
Height 5’7 5’7
Weight 77 kg 77 kg
BMI 26.6 26.6
Pathophysiological Basis:
BMI results of 18.5 to 24.9 is considered
healthy. Below 18.5 is underweight. 30.0 and
above indicates obesity. While 25.0 to
29.9 is considered overweight.
Ability to:
I. Chew The patient has the ability to chew and The patient has the ability to chew and
II. Swallow swallow. He can also feed himself without swallow. He can also feed himself
assistance. without assistance.
III. Feed self
27
NURSING DEPARTMENT
VIII. DRUG ANALYSIS
Complete
Name of Drug Doctor’s Mode of Action Contraindication Side Effects Adverse Effects Nursing Consideration
Order
Generic name: D.O-dose: Metformin  Insulin • GI-  Taste changes  Encourage the patient
Metmorfin 180 mcg Resistance diarrhea,  Shortness of to take metformin
loose breath with meals
Active stools, Hypoglycemia  Starts with dinner 1x a
Brand Name: Time: 
abdominal day
Glucophage 10:00  Vitamin B12
AMPK enzymes in pain,
Classification: bloating Deficiency
liver
Antidiabetic Route: gas,  Lactic acidosis
drugs Oral flatulence,
constipatio
Inhibition of
Date started: Frequency: n, nausea
gluconeogenes is and
February 15, 2 puffs every 4- sis
vomiting
2022 6 hours
• Cardiova
Date Form: Decrease scular -
discontinued: Aerosol glucose Palpitation
metered-dose production. , chest
inhaler pain,
flushing,
heartburn
and
dyspepsia
• Neurologi
c-
dizziness,
28
NURSING DEPARTMENT
headache
and
weakness
• Respirato
ry-
respiratory
infections
Complete
Name of Drug Mode of Action Contraindication Side Effects Nursing Consideration
Doctor’s Order
Generic name: D.O-dose: This drug  Not specified  Genital For Patient:
Canagliflozin 100 mg increases urinary Tract Strongest effect on
glucose excretion Infection reducing BP; Increased
Brand Name: Time: and decreases the  Amputation risk of lower limb
(Invokana) amputations
1:00 renal threshold for s
glucose (RTG) in a  Bone Use in patients with
Classification: Route: dose-dependent fractures previous stroke or MI
Mucolytics Oral manner. The renal  Electrolyte
threshold is defined Imbalance Positive effects on LDL-C and
Date started: Frequency: as the lowest level HDL-C
4 time a day of blood glucose
29
NURSING DEPARTMENT
November 15 associated with the  Diabetic

,2021 Form: appearance of Ketoacidos
Syrup detectable glucose in isLipids
Date the urine.. The end increase
discontinued: result of  Renal
Not specified. canagliflozin Effects
administration is
increased urinary
excretion of
glucose and less
renal absorption of
glucose, decreasing
glucose
concentration in
the blood and
improving glycemic
control.
Complete
Name of Drug Mode of Action Contraindication Side Effects Nursing Consideration
Doctor’s Order
30
NURSING DEPARTMENT
Generic name: D.O-dose: You should not use  vision  Watch for seizures;
Semaglutide changes;
Semaglitude 3mg once a day Rybelsus if you have notify physician
Rybelsus and Oze  unusual
mpic) is used with multiple endocrine immediately if patient
Brand Name: Time: neoplasia type2 mood develops or increases
diet and exercise to changes,
Rybelsus 1:00 improve blood (tumors in your seizure activity.
thoughts
sugar control in glands), a personal or about
adults with type You should not use
Classification: Route: family history of hurting
2 DM (not for type semaglutide if patient has
Incretin Mimetics Oral medullary thyroid yourself; allergic to it, or if patient
1 DM)
cancer, insulin-  pounding have:
Date started: dependent diabetes, or heartbeats or
It is used with diet fluttering in
February 18, 2021 diabetic ketoacidosis  multiple endocrine
and exercise to your chest;
manage weight neoplasia type 2
 a light- (tumors in your
Date in overweight adult s headed glands);
discontinued: who also have least feeling, like
one weight- related  a personal or family
Not specified. you might
medical condition history of medullary
pass out; thyroid carcinoma (a
such  signs of a
as type 2 diabetes, type of thyroid
thyroid cancer); or
high blood pressure tumor -
or high cholesterol  diabetic
swelling or ketoacidosis (call
a lump in your doctor for
Semaglutide may your neck, treatment).
also be used for trouble
purposes not listed swallowing, Assess if the patient has a
in this medication a hoarse stomach or intestinal
guide. voice, disorder;
feeling short
of breath;  pancreatitis;
 symptoms  kidney disease; or
of
31
NURSING DEPARTMENT
pancreatiti  eye problems caused

s - severe by diabetes
pain in your (retinopathy).
upper
stomach
spreading to
your
back, nausea
with or
without
vomiting, fa
st heart
rate;
 gallbladde
r
problems -
upper
stomach
pain, fever,
clay-
colored
stools, jaun
dice (yello
wing of the
skin or
eyes);
 low blood
sugar - he
adache,
hunger,
weakness,
sweating,
confusion,
32
NURSING DEPARTMENT
irritability,
dizziness,
fast heart
rate, or
feeling
jittery;
 kidney
problems -
swelling,
urinating
less, feeling
tired or
short of
breath; or
 stomach
flu
symptoms
- stomach
cramps,
vomiting,
loss of
appetite,
diarrhea
(may be
watery or
bloody).

33
NURSING DEPARTMENT
COURSE OF VISIT
On September 12, 2022, at 9:00 AM, we conducted a home visit at Brgy. Magsaysay,
Bayombong, Nueva Vizcaya. We greeted the client first and introduced ourselves. He welcomed us to
their house and allowed us to conduct the home visit. We started the interview and health assessment by
introducing ourselves and asking for the client’s name. We asked about health concerns the client may
have been experiencing or any past and/or existing health problems. He mentioned his Diabetes Mellitus
which he is suffering from at the moment. We asked about when he started to feel the symptoms and what
prompted them to visit the hospital. According to the client, He started to feel dizzy when he was having
his training way back in 2015. They rushed him to the hospital and advised him to have some rest. His
diagnosis at that time was not clear according to the client. In 2017, he again was brought to the hospital
for a check-up and it was shown from his lab result that he has high blood sugar. He was then diagnosed
with type 2 DM from the lab test he had gone through. According to the client, his family has no history
of Diabetes Mellitus, only hypertension.
At 9:30 AM, we assessed our client’s vital signs, and we followed the PERSON assessment as a
basis for getting our data. We asked if he is taking his maintenance or has any, however, he doesn’t take
medications prescribed by the doctor. He only takes his insulin but irregularly. After getting the client’s
information and overall assessment we conducted a short health teaching in relation to his condition. We
advised the client to take his meds as prescribed and to follow a strict diet. He mentioned that he has sleep
disturbances due to frequent urination at night. We advised him of the things he need to do to cope with
it. We finished with our assessment and interview at around 10:00 AM. We excused ourselves from the
client and went our way to our CI.
On September 19, 2022, at around 9 AM, we went back to our client’s house to have our final
home visit. We greeted the client and he let us enter. We asked how our client had been for the past few
days. He told us that nothing much has changed, he did his usual thing to do day by day. We asked if we
could have his vital signs and he gave us permission. After having his vital signs we again had a quick
assessment. We noted the data gathered and did a quick health teaching before going back to our quarters.
We thanked our client for actively participating in our home visit.
34
Saint Mary’s University Bayombong, Nueva Vizcaya
SCHOOL OF HEALTH and NATURAL SCIENCES NURSING DEPARTMENT
REFERENCES:
Type 2 diabetes - Symptoms and causes. (2021). Mayo Clinic;

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc- 20351193
Goyal, R., & Ishwarlal Jialal. (2021, September 28). Diabetes Mellitus Type 2. Nih.gov; StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/
Pal, S. (2019, October 16). Modifiable Risk Factors for Diabetes Complications.
Uspharmacist.com. https://www.uspharmacist.com/article/modifiable-risk-factors-for-
diabetes- complications#:~:text=Among%20diabetic%20patients%2C%2090%25%20to,%2C%20s
moking%2C%20and%20physical%20inactivity
Spranger, L. (2020, December 17). Modifiable and non-modifiable risk factors for type 2 diabetes.
Counterweight; Counterweight. https://www.counterweight.org/blogs/articles/modifiable- and-
non-modifiable-risk-factors-for-type-2-diabetes
Watson, S. (2017, August 18). Getting to the Root of Glucose Testing Anxiety. Healthline; Healthline
Media. https://www.healthline.com/health/type-1-diabetes/living-with-type- 1/testing-
anxiety#Anthonys-Type-1-Diabetes-Story
Glucose | Davis’s Lab & Diagnostic Tests. (2017). Unboundmedicine.com.

https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-
Tests/425087/all/Glucose#:~:text=There%20are%20no%20restrictions%20for,known%20t o
%20elevate%20glucose%20levels.
Basina, M. (2021, October 14). Finding the Best Type 2 Diabetes Treatment: Factors to Consider.
Healthline; Healthline Media. https://www.healthline.com/health/type-2-diabetes/treatment-
factors-ask-expert#lifestyle-factors
https://www.facebook.com/verywell. (2012). How Are Your Body Organs Affected by Diabetes?

Verywell Health. https://www.verywellhealth.com/organs-affected-by-diabetes- 5118060
Skin turgor: MedlinePlus Medical Encyclopedia. (2019). Medlineplus.gov.

https://medlineplus.gov/ency/article/003281.htm
Higuera, V. (2021, March 19). What to Know About Diabetes and Dehydration. Healthline; Healthline
Media. https://www.healthline.com/health/diabetes/diabetes-and-dehydration
Dresden, D. (2019, April 29). Effects of diabetes on the body and organs. Medicalnewstoday.com;
Medical News Today. https://www.medicalnewstoday.com/articles/317483
The Cerebellum | Facts, Position In Brain, Summary & Function. (2019, November 26). Brain
Made Simple. https://brainmadesimple.com/cerebellum/
https://www.facebook.com/Drugscom. (2021). Semaglutide. Drugs.com; Drugs.com.

https://www.drugs.com/mtm/semaglutide.html
Canagliflozin: Uses, Interactions, Mechanism of Action | DrugBank Online. (2013).

Drugbank.com; DrugBank. https://go.drugbank.com/drugs/DB08907
Simes, B. C., & MacGregor, G. G. (2019). Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors:

A Clinician’s Guide. Diabetes, Metabolic Syndrome and Obesity: Targets and
Therapy, Volume 12, 2125–2136. https://doi.org/10.2147/dmso.s212003
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Type 2 Diabetes Mellitus Ics

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Saint Mary’s University

Bayombong, Nueva Vizcaya

ASCITES RELATED TO LIVER CIRRHOSIS

An Individual Case Study

KITONG, HAROLD CHRIS D.

MR. MANUEL MARTIN

CONTENT PAGE NO.

PROFILE OF THE CLIENTS

ADMITTING DIAGNOSIS Type 2 Diabetes Mellitus

II. BRIEF DESCRIPTION

IV. RISK FACTORS

Modifiable Risk Factors:

Non-modifiable Risk Factors:

VI. DIAGNOSTIC PROCEDURES

GLYCATED HEMOGLOBIN (A1C) TEST

RANDOM GLUCOSE TESTING

- Inform the client

- Instruct the client to relax

- Discuss results to the client

THE ORAL GLUCOSE TOLERANCE TEST (OGTT)

 Inform the client

 Explain that slight discomfort may be felt

 Discuss results to the client

 Inform the client about the test procedure

VII. MEDICAL MANAGEMENT

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors)

III. ANATOMY AND PATHOPHYSIOLOGY

A. BLOOD VESSELS AND CIRCULATORY SYSTEM

FUNCTIONS OF CIRCULATORY SYSTEM

GENERAL FEATURES OF BLOOD VESSEL STRUCTURE

THE CIRCULATORY SYSTEM AND DIABETES MELLITUS

FUNCTIONS OF NERVOUS SYSTEM

THE PANCREAS AND DIABETES

V. LABORATORY RESULTS AND DIAGNOSTIC STUDY

RAPID ANTIGEN TEST

A negative test result indicates that SARS- CoV-2

• Assess the patient history of medication and food intake

• Instruct the patient the proper way of collecting urine sample

URINALYSIS Date : February 15,

Macroscopic and Results Normal Range/ Physiological Basis

pH Reaction 5.66 4.5 - 8 Without enough

Glucose Positive Negative The pancreas of a

Microscopic Results Normal Values Physiological Basis

Red Blood Cells 0-4/ HPF 0-4/ HPF Erythrocytes might

Bacteria Negative Negative Urine typically

Complete Blood Count

• Inform the client of the test procedure.

• Label the specimen properly and send immediately to the laboratory.

Investigation Observed Normal Value Physiological Basis

High Hgb: A high hemoglobin

HEMATOCRIT 53.0 % 37.0 – 47. 0 % Hyperglycemia may cause

MEAN 105.0 fL 80.0 – 100. 0 fL Increase in mean corpuscular

MCH 34.0 pg 27.0 – 34. 0 pg MCH stands for mean corpuscular

MONOCYTES 12 % 3.0 – 12.0 % Under certain conditions, diabetes

EOSINOPHILS 7% 0.5 – 5.0 % The albumin excretion rate is a

BASOPHILS 3.0 % 0.0 – 1.0 % It can be caused by infections,

• Ensure the client

TEST NAME DATE AND TIME RESULT REFERENCE

Interpretation of the Result

FASTING BLOOD SUGAR – A test that measures blood sugar levels.

 Explain the procedure to the patient

 Apply direct pressure to the venipuncture site until bleeding stops.

TEST NAME DATE AND TIME RESULT REFERENCE

LIVER FUNCTION TEST