REPUBLIC OF THE PHILIPPINES

NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

CABANATUAN CITY, NUEVA ECIJA, PHILIPPINES
ISO 9001 :2015 CERTIFIED

TYPE 2
DIABETES
MELLITUS
SAN MIGUEL V.| SANTIAGO F,| SARAGPON R.|
SEBASTIAN R.| SOLITARIO K.
 CHAPTER 1
OBJECTIVES| INTRODUCTION| CLIENT’S PROFILE| FAMILY HISTORY| HISTORY OF PAST ILLNESS| PRESENTING COMPLAINT|
ADMITTING HISTORY| STATUS OF PRESENT ILLNES| NUTRITION AND METABOLIC PATTERN| ELIMINATION| ACTIVITY AND
EXERCISE| COGNITION AND PERCEPTION| SLEEP AND REST| SELF-PERCEPTION AND SELF-CONCEP| ROLES AND
RELATIONSHIP| COPING AND STRESS TOLERANCE| VALUES AND BELIEFS| VITAL SIGNS| HEIGHT AND WEIGHT| PHYSICAL
ASSESSMENT
 GENERAL OBJECTIVES
At the end of the clinical duty, students nurses
OBJECTIVES As a level 3 student nurses, the
will be able to:
general objectives of this case
study we can gain more
knowledge, improve our skills,
develop a positive attitude as
necessary in dealing with various
patients, perform basic nursing
skills confidently and
competently, and provide
appropriate nursing management
to an obstetric patient suffering
from a type 2 diabetes mellitus.
management of the disease.
SPECIFIC OBJECTIVES
Establish rapport and communication skills
in dealing with the client
Examine the client from head to toe,
focusing mainly on the area affected by
Gather, document, and present a
comprehensive medical history.
Define Type 2 Diabetes Mellitus and learn
about the primary diagnostic and laboratory
tests used to confirm and manage it.
Determine the clinical manifestations of the
disease.
Recognized the various medications used,
their side effects, and their action in the
Understand the recommended medical
management employed to resolve
problems.
Formulate an appropriate nursing
responsibility
 INTRODUCTION
According to the Centers for Disease
Control and Prevention, more than 37
million Americans have diabetes (about
1 in 10), and approximately 90-95% of
them have type 2 diabetes.
In the Philippines, however, diabetes
and its consequences are a leading
cause of illness and mortality. In fact,
there are now 3.7 million people with
diabetes in the country, up from 3.4
million in 2010.
With regards to the physiology of the
organ, the pancreas produces the
hormone insulin, which functions as a
key to allow blood sugar to enter your
body's cells to be used as fuel.
Insulin resistance, which occurs when
cells don't react to insulin as they should
in people with type 2 diabetes. To try and
elicit a response from cells, your
pancreas produces more insulin, and
blood sugar eventually rises as a result
of your pancreas' inability to keep up,
which can lead to type 2 diabetes and
prediabetes.
CLIENT'S PROFILE
Name of Patient: Patient X
Age: 37 years old
Date of Birth: October 21, 1985
Gender: Male
Height (cm): 168 cm
Weight (kg): 55 kgs
Admission Date: June 11, 2023
Ward: Male Medical Ward
Room/ Bed No.: 406 A
Attending Physician: Dr. Dela Torre
ASSESSMENT: HEALTH PERCEPTION AND
HEALTH MANAGEMENT
FAMILY HISTORY
Client X claimed that his
Grandmother, Grandfather, Aunty,
and Uncles had diabetes mellitus
type II
HISTORY OF PAST ILLNESS
Client X claimed he had been
diagnosed with diabetes
mellitus type II in 2021.
PRESENTING COMPLAINT
The client went to the hospital last June 11, 2023.
The patient went to the hospital to get the non-
healing wound on his left anterior foot checked
and examined by a medical professional. Prior to
the date of admission, the patient went to a
different hospital to get his wound cleaned but
according to the patient and his wife after the
physician cleansed his wound, they start to peel
the gangrene skin on his wound which eventually
lead to the wound becoming fresh again. The
patient also experienced an on-and-off headache
and throbbing pain around the wounded area of
the foot. The non-healing wound on the left
anterior foot also has a foul-smelling pungent
discharge. Upon admission, the patient’s random
blood sugar level is at 90 mg/dL.
ASSESSMENT: HEALTH PERCEPTION ADMITTING HISTORY
AND HEALTH MANAGEMENT On June 11, 2023, at around 5:00 pm Patient X, a
37 years old man who had a history of vehicular
accident and was currently experiencing a non-
healing wound on the left foot. Upon checking his
laboratories, it was found that his glucose which is
162 mg/dl; cholesterol is 223 mg/dl; triglyceride is
263 mg/dl; and uric acid is 8.26 mg/dl were higher
than normal, which was the reason for him to be
admitted. His vital signs are as follows; his
temperature is 36.8°C, his pulse rate is 98 beats
per minute, his respiration is 21 breaths per
minute, and his blood pressure is 130/100 mmHg.
ASSESSMENT: HEALTH PERCEPTION
AND HEALTH MANAGEMENT
STATUS OF PRESENT ILLNESS
The client was involved in a vehicular accident that results in him having a
huge wound on his left anterior foot. With the patient having already been
diagnosed with diabetes mellitus II, the wound becomes non-healing and
starts to spread around his anterior foot. After that, the patient’s wound is
cleaned and dressed aseptically. Additionally, the patient was also given a
stat dose of Regular Insulin 6 units/ gram given subcutaneously to lower
the patient’s blood sugar level. The patient also takes Ceftriaxone 2 grams
once a day via IV, Metronidazole 500 mg q8H via IV, Gliclazide 80 mg
once a day orally, Atorvastatin 40 mg once a day orally, Fenofibrate 20 mg
per 1 tab orally, Allopunirol 100 mg once a day orally, Gliclazide 80 mg
twice a day orally, Silver Sulfadiazine Flammazine cream once a day,
Cilostazol 50 mg, and Empagliflozin/ Linagliptin 5 mg once a day orally
NUTRITION AND METABOLIC PATTERN
FOOD RESTRICTIONS USUAL FOOD INTAKE

The client was advised to
limit his food intake by
taking a diabetes mellitus
diet
The client claimed that before he was diagnosed
with diabetes mellitus type II, he usually ate foods
high in carbohydrates, such as rice, bread, and pasta,
as well as foods high in cholesterol, such as bacon,
eggs, and pork. Also, client X was an alcoholic and
smoker.

FOOD ALLERGIES

The client claimed that he has no

history of food allergies.
 ELIMINATION

BLADDER
Based on the client’s urinalysis
result, the urine output is normal and
it ranges from two to six times per
shift.

BOWEL
The client has regular bowel
movement as he was able to
defecate once to twice a day
 SELF-CARE ABILITY
After assessing Client’s X self-care ability, it denotes that
most of the activities he does not need assistance from
others or from equipment because he can perform it on his

ACTIVITY AND
own. However, he needs assistance from others when

EXERCISE
climbing stairs, home maintenance, and shopping because
of the non-healing wound on his left foot.
0 – Independent
1 – Assistive
2 – Assistive from Others
3 – Assistance from person and equipment
4 – Dependent/Unable
 ACTIVITY AND
EXERCISE
SELF-CARE ABILITY
 COGNITION AND SLEEP AND REST SELF-PERCEPTION AND
PERCEPTION SELF-CONCEPT
The client claimed
During the
Client X understood that he goes to bed
interview, the client
the inquiries and at 9:00 pm and often
was calm and eye to
was able to wakes up around
eye contact was
6:00 am. He also
recognize and maintained and he
takes a nap
explain his illness. was able to respond
whenever there’s no
passenger as he is a to questions during
tricycle driver. the assessment.
 ROLES AND COPING AND STRESS VALUES AND BELIEFS
RELATIONSHIPS TOLERANCE

Client X is currently He is a Roman

According to him,
living with his family.
when he’s feeling Catholic. Client X
He is a tricycle driver
and his wife is a unwell or upset, he said that he
government smokes. This is goes to church
employee. Their his way to cope up every Sunday.
occupation is enough with stress.
to sustain their
everyday needs.
 VITAL SIGNS

BLOOD PULSE
DATE TEMPERATURE RESPIRATORY
PRESSURE RATE

JUNE
120/90 mmHg 36.8 °C 19 cpm 82 bpm
16, 2023

VITAL SIGNS
 HEIGHT AND WEIGHT

GIVEN AND FORMULA:

Weight: 55 kg
Height: 168 cm
BMI: Normal Weight

The client’s height was 168 cm with a weight of 55 kg

upon assessment. Using the BMI formula, the BMI of
the client is 19.5 interpreted as normal weight.

 PHYSICAL ASSESSMENT
BODY PARTS NORMAL FINDINGS FINDINGS

-Round, with prominences in the frontal and

Skull occipital area (Normocephalic) No abnormal findings

-No tenderness noted upon palpation

-No scars noted

Scalp -No lesions No abnormal findings
-Free from lice, nits and dandruffs

-No evidence of alopecia

Hair -Maybe thick or thin, coarse or smooth No abnormal findings

 PHYSICAL ASSESSMENT
BODY PARTS NORMAL FINDINGS FINDINGS

-Face is symmetrical
Face No abnormal findings
-Shape may be oval or rounded

-Can move facial muscles at will

-None protruding
Eyes -Evenly placed and inline with each other No abnormal findings
-Equal palpebral fissure

-Earlobes are bean-shaped, parallel, and

symmetrical
Ears
-No discharges or lesions noted at the ear No abnormal findings

canal

 PHYSICAL ASSESSMENT
BODY PARTS NORMAL FINDINGS FINDINGS

-No discharges
-Both nares are patent
Nose and Paranasal
-Nasal sputum in the midline and not No abnormal findings
sinuses
perforated

-No tenderness noted on palpation of

paranasal sinuses

-With visible margin

-Pinkish in color
Mouth No abnormal findings
-Symmetrical in appearance and
movement

-No visible mass or lumps

Neck -Symmetrical No abnormal findings
-No jugular venous distention
 PHYSICAL ASSESSMENT
BODY PARTS NORMAL FINDINGS FINDINGS

-No breath sounds

No abnormal findings
Chest -Normal chest shape

-No muscle retractions when breathing

-No fail chest which is suggestive of rib

fracture
Thorax No abnormal findings
-The spine is straight, with slightly curvature
in the thoracic area

-Skin color is uniform, no lesions

Abdomen No abnormal findings
-Contour may be flat, rounded or scaphoid
 PHYSICAL ASSESSMENT
BODY PARTS NORMAL FINDINGS FINDINGS

-No tenderness or deformity Non-healing wound in

Extremities (Upper and
-No edema left foot
Lower)
-No involuntary movements

Skin
Fair color No abnormal findings

Genital Area No lesions, no discharge and no masses or

No abnormal findings

tenderness
 CHAPTER 2
DEFINITION OF CASE| ANATOMY AND PHYSIOLOGY| PATHOPHYSIOLOGY (BOOK-BASED AND CLIENT-BASED)| CLINICAL
MANIFESTATION (BOOK-BASED AND CLIENT-BASED)| MEDICATIONS| DIET| ENVIRONMENTAL AND LIFESTYLE| MEDICAL
MANAGEMENT| NURSING MANAGEMENT
DEFINITION OF CASE
Diabetes Mellitus type II is
characterized by high blood
glucose levels due to insufficient
production of insulin or insulin
resistance, which leads to glucose
entering the bloodstream and
causing serious health problems.
When a person has type 2 diabetes,
the body can no longer respond
properly to insulin, so it needs to
produce more of the hormone than
normal.
ANATOMY AND
PHYSIOLOGY
ANATOMY AND
PHYSIOLOGY
BOOK-BASED PATHOPHYSIOLOGY
MODIFIABLE FACTORS NON-MODIFIABLE
LIFESTYLE (SMOKING, FACTORS
ALCOHOL CONSUMPTION, NO AGE (30 YEARS OLD)
EXERCISE) GENDER (BOTH)
UNHEALTHY DIET GENES (MODY)
OVERWEIGHT
MEDICATIONS
(CORTICOSTEROIDS, ANTI-
PSYCHOTICS, HIGHLY ACTIVE
ANTI-RETROVIRAL,
PROGESTIN-ONLY ORAL
CONTRACEPTIVES)
 UNHEALTHY LIFESTYLE,
UNHEALTHY DIET,
MEDICATIONS

INTRAPERITONEAL CAVITY
ACCUMULATES "VISCERAL
FATS"

INFLAMMATORY
ADIPOKINES FREE FATTY ACIDS
MEDIATORS
INFLAMMATORY
ADIPOKINES FREE FATTY ACIDS
MEDIATORS

ALTERS THE
FUNCTIONS

INSULIN
RESISTANCE
 BETA-CELLS OF THE PANCREAS
WORK OVERTIME TO INCREASE
INSULIN SECRETION

BLOOD GLUCOSE
KEPT IN NORMAL BODY PERCIEVES A
STATE OF
INSULIN
"STARVATION", THUS
DEFICIENCY
MOBILIZING
TRIGLYCERIDES INTO
FFAs, TO BE USED AS A
FUEL BY CELLS
 INSULIN BODY PERCIEVES A STATE OF
DEFICIENCY "STARVATION", THUS
MOBILIZING TRIGLYCERIDES
INTO FFAs, TO BE USED AS A
FUEL BY CELLS

BETA-CELLS DETERIORATE FFAs INHIBIT THE FUNCTION OF

UNTIL THEY FINALLY STOP GLUT2 ON BETA-CELLS, LOWER
PRODUCING INSULIN DOONE GLUCOSE IMPORT

BETA-CELLS DO NOT RECOGNIZE

HIGH BLOOD GLUCOSE; LOWER
DOWN THE SECRETION
 FREE FATTY ACIDS

FFAs INHIBIT THE FUNCTION OF

GLUT2 ON BETA-CELLS, LOWER
DOONE GLUCOSE IMPORT

BETA-CELLS DO NOT RECOGNIZE

HIGH BLOOD GLUCOSE; LOWER
DOWN THE SECRETION

BETA-CELLS DETERIORATE
UNTIL THEY FINALLY STOP
PRODUCING INSULIN
 BETA-CELLS DETERIORATE UNTIL THEY FINALLY
STOP PRODUCING INSULIN

SIGNS AND SYMPTOMS:

· HYPERGLYCEMIA
· 3 P’s (POLYURIA, POLYPHAGIA, POLYDIPSIA)
· FATIGUE
· WEAKNESS
· SUDDEN VISION CHANGE
· TINGLING OR NUMBNESS IN HAND OR FEET
· DRY SKIN
· SKIN LESION OR WOUNDS THAT ARE SLOW TO HEAL

DIABETES MELLITUS TYPE II

CLIENT-BASED PATHOPHYSIOLOGY
MODIFIABLE NON-MODIFIABLE
FACTORS FACTORS

SEDENTARY AGE (37 YEARS OLD)

LIFESTYLE (SMOKING GENDER (MALE)
AND ALCOHOL) GENES (MATERNAL +
GGHGH
DIET (eat lots of rice) PATERNAL)
 ALTERATIONS IN
ENDOCRINE FUCTIONS

INSUFFICIENT
INSULIN RESISTANCE
INSULIN SECRETION

INCREASE INSULIN
DEMAND
B CELL EXHAUSTION AND
DYSFUNCTIONTIONS

IMPAIRED SECRETION
OF INSULIN

GLUCOSE IS UNABLE
TO ENTER THE CELL
GLUCOSE REMAINS IN THE
BLOOD STREAM

SIGNS AND SYMPTOMS:

Hyperglycemia
excessive eating
(polyphagia
slow wound healing)

TYPE II DIABETES
MELLLITUS
 CLINICAL MANIFESTATION

BOOK BASED CLIENT BASED

3 P’s (Polyuria, Polyphagia, Polydipsia

Hyperglycemia
Fatigue 3 P’s (Polyuria, Polyphagia,
Weakness Polydipsia)
Sudden vision changes Hyperglycemia
Tingling or numbness in hands or feet Dry skin
Dry skin Numbness of left foot
Skin lesions or wounds that are slow to Non-healing wound
heal
 MEDICATIONS
CEFTRIAXONE
Ceftriaxone is an injection type of medication
that is used for treating infections in the
lungs, ears, urinary tract, blood abdomen, and
skin. This medication works by killing the
bacteria that is causing the infection.

METRONIDAZOL GLICLAZIDE
Metronidazole is E
an antibiotic medication Gliclazide is a second-generation sulfonylurea. It
that is used for treating bacterial is an oral drug used for lowering blood glucose
infections in the lungs, stomach, liver, levels. This medication works by increasing the
brain and spinal cord, and heart or amount of insulin that the pancreas makes
bloodstream which in return effectively lowers the amount of
blood glucose in the blood.
 MEDICATIONS
CILOSTAZOL
Cilostazol is a type of drug used for
reducing the symptom of intermittent
claudication. Claudication is the pain in
the legs that worsens when walking and
improves when resting. Pain in the legs is
caused by the narrowing of the blood
vessels that supply blood into the legs
ATROVASTATIN
Atorvastatin is a medication that is used
for treating high blood cholesterol. This
medication works by lowering the bad
cholesterol and fats such as low-density
lipoprotein (LDL) and triglycerides and
raising the level of good cholesterol or the
high-density lipoprotein (HDL) in the
blood.

DIET
Diabetes Mellitus Diet. Limit carbohydrates in
the diet and eat foods such as foods
vegetables, such as salad, green beans,
broccoli, cauliflower, cabbage, and carrots.
ENVIRONMENTAL AND
LIFESTYLE
Monitor Vitals. Monitoring of blood pressure,
weight and other vital signs in order to
determine appropriate medication needed.
 MEDICAL
MANAGEMENT
1. PROPER WOUND CLEANING AND DRESSING

Proper wound care and dressing is

essential for diabetic foot ulcer, its
goal is to create a healthy
environment in the wound area in
order for new skin cells to migrate
around the wound.
 MEDICAL
MANAGEMENT
2. DEBRIDEMENT

Debridement is a medical
procedure of removing
necrotic or infected skin
tissue.
 MEDICAL
MANAGEMENT
2. ANTIBIOTIC THERAPY

Antibiotics which is usually

in a form of ointment is
usually prescribed for
diabetic foot ulcers.
 MEDICAL
MANAGEMENT
4. OPTIMAL CONTROL OF BLOOD GLUCOSE LEVEL

Optimal control of blood glucose

level is necessary for patients
with type 2 diabetes mellitus
especially if they have a foot
ulcer.
 NURSING MANAGEMENT

EDUCATION & BLOOD GLUCOSE MEDICATION

EMPOWERMENT MONITORING MANAGEMENT
 NURSING MANAGEMENT

DIETARY GUIDANCE PHYSICAL ACTIVITY PSYCHOSOCIAL

SUPPORT
 NURSING MANAGEMENT

COMPLICATION STRESS
FOOT CARE
PREVENTION MANAGEMENT
CHAPTER 3
LABORATORY REPORTS

RANDOM BLOOD SUUGAR DATE NORMAL RANGE RESULT

90-148 mg/dL
 6/16/2023 (6 AM) 86 mg/dL
MONITORING

90-148 mg/dL
 6/14/2023 (6 AM) 94 mg/dL

90-148 mg/dL
 6/13/2023 (11 AM) 170 mg/dL

90-148 mg/dL
 6/13/2023 (6 AM) 170 mg/dL

90-148 mg/dL
 6/12/2023 (6 PM) 120 mg/dL
RANDOM BLOOD SUUGAR DATE NORMAL RANGE RESULT

90-148 mg/dL
 6/12/2023 (11 AM) 175 mg/dL
MONITORING

90-148 mg/dL
 6/12/2023 (6 AM) 175 mg/dL

90-148 mg/dL
 6/11/2023 (6 PM) 90 mg/dL

90-148 mg/dL
 6/11/2023 (6 AM) 200 mg/dL
COUNT (6/15/2023)
COMPLETE BLOOD NORMAL RANGE RESULT

Hematocrit 0.40-0.52 0.40

124 g/L
Hemoglobin 140-170 g/L

RBC Count 4.5-6.2 10^12/L 4.52 x 10^12/L 

WBC Count 5.00-10.00 x 10^12/L 9.3 x 10^ 12/L

Platelet Count 150-350 x 10^9/L 348 x 10^9/L 

Segmenters 0.58-0.65 0.61

Lymphocyte 0.21-0.30 0.39

CLINICAL CHEMISTRY NORMAL RANGE RESULT

(6/15/2023)
Random Blood
90-148 mg/dL 108 mg/dL
Sugar

Creatinine 0.7- 1.2 mg/dL 1.5 mg/dL

Sodium 134-148 mmol/L 138 mmol/L

Potassium 3.5-5.4 mmol/L 4.3 mmol/L

 NORMAL RANGE RESULT
CLINICAL CHEMISTRY

Fasting
70-105 mg/dL 162 mg/dL
Blood Sugar
(6/10/2023)

Total Cholesterol <200 mg/dL 223 mg/dL

Triglyceride <150 mg/dL 263 mg/dL

HDL-Cholesterol 26-80 mg/dL 39 mg/dL

LDL-Cholesterol 65-178 mg/dL 131.4 mg/dL

CLINICAL CHEMISTRY NORMAL RANGE RESULT

(6/10/2023)
Creatinine 0.60 - 1.30 mg/dL 0.92 mg/dL

Uric Acid 2.60- 7.20 mg/dL 8.26 mg/dL

BUN 12.8-42.8 mg/dL 26 mg/dL

ALT/SGPT 0-41 IU/L 17 IU/L

COUNT (6/10/2023)
COMPLETE BLOOD
NORMAL RANGE RESULT

Hematocrit 0.37-0.54 0.37

Hemoglobin 110-160 g/L 123 g/L

RBC Count 3.5-5.50 10^12/L  4.3 x 10^12/L 

8.7 x 10^12/L 
WBC Count 4.0-10.0 x 10^12/L 
COUNT (6/10/2023)
COMPLETE BLOOD
NORMAL RANGE RESULT

Platelet Count 150-400 x 10^9/L  426 x 10^9/L 

Segmenters 0.50-0.70 0.65

Lymphocyte 0.20-0.40 0.28

Monocytes 0.03-0.15 0.07

 PHYSICAL EXAMINATION NORMAL RANGE RESULT

CYTOMETRY
Color    Yellow
URINE FLOW

(6/10/2023)

Transparency   Clear

Reaction   6.0

Specific Gravity   1.030

 CHEMICAL
NORMAL RANGE RESULT
EXAMINATION

Sugar   Negative
CYTOMETRY
URINE FLOW

(6/10/2023)

Protein   Negative

Specific Gravity   1.010

pH   6.0

Red Blood Cells 0-1/HPF

Leukocyte/WBC 0-1/HPF
 MICROSCOPE
NORMAL RANGE RESULT
EXAMINATION

CYTOMETRY

URINE FLOW

(6/10/2023)
Epithelial
  Rare
Cell

Mucus
  Rare
Threads

Amorphous   Rare
CHAPTER 4
NURSING CARE PLAN

 NCP#1: IMPAIRED SKIN INTEGRITY

ASSESSMENT
SUBJECTIVE:
“Kumikirot yung sugat ko sa kaliwa kong paa”
as verbalized by the client.
Pain scale: 6/10
(+) pruritus on the wound site
OBJECTIVE:
-Disruption of the skin surface on
the left anterior foot
-Wound is 60mm in width; 70mm

in length; 15mm in depth

VITAL SIGNS OF THE CLIENT: -Crusted wound on left anterior
foot
T: 36.8 °C -Foul smelling purulent
BP: 110/100 mmHg discharged on left anterior foot
PR: 98 bpm -Localized erythema
RR: 21 bpm
 NURSING OUTCOME
DIAGNOSIS IDENTIFICATION

Impaired skin integrity related to After 2 days of nursing

vehicular accident as evidenced interventions, the client will be
by disruption of skin surface on able to facilitate timely healing
the left anterior foot. process and wound closure.
 NING
PLANNING
SHORT TERM:
After 4 hours of nursing
interventions, the client will
demonstrate understanding of the
plan to heal tissue such as proper
skin hygiene, maintenance of skin
LONG TERM:
After 2 days of nursing
interventions, the client will be
able to display improvement in
wound healing.

integrity and prevent injury.

 NURSING INTERVENTIONS:
INDEPENDENT
1. Always check the site of impaired 2. Protect bony prominences with
tissue integrity, color changes, pillows, sheepskin, and heel or elbow
redness, swelling, and warmth, pain, or protectors.
other signs of infections.

3. Keep skin surfaces dry and clean and 4. Provide egg-crate, alternating air
linens dry and wrinkle-free. pressure, or water mattress.
 NURSING INTERVENTIONS:
INDEPENDENT
5. Massage and lubricate skin
bland lotion/oil.
7. Keep a sterile dressing technique
during wound care.
6. Tell the patient to avoid rubbing
and scratching. Provide gloves or
clip the nails if necessary.
8. Encourage a diet that meets
nutritional needs.
 NURSING INTERVENTIONS:
INDEPENDENT
9. Teach skin and wound
assessment and ways to monitor
for signs and symptoms of
infection, complications, and
healing.
10. Instruct patient, significant
others, and family in the proper care of
the wound, including handwashing,
wound cleansing, dressing changes,
and application of topical medications).

11. Encourage patient to utilize

12. Instruct patient and relative
other non-pharmacological pain
to reposition or turn regularly
management such as
to relieve pressure on the
positioning and relaxation
wounded area.
technique.

NURSING INTERVENTIONS:
DEPENDENT:
1. Administer antibiotics as 2. Encourage continuation or
ordered. regular exercise program.

COLLABORATIVE:
1. Collaborate with a nutritionist to ensure
that the patient receives a well-balanced
diet with adequate protein, vitamins and
minerals.

 EVALU ATION
SHORT TERM:
After 4 hours of nursing interventions, the
client demonstrates understanding of the plan
to heal tissue such as proper skin hygiene,
maintenance of skin integrity and prevent
injury.
GOAL WAS MET
LONG TERM:
After 2 days of nursing interventions, the client
was able to display improvement in wound
healing as evidenced by:
-Intact skin or minimized presence of wound.
-Absence of itchiness.
-Absence of purulent discharge.
-Absence of erythema.
-Describe satisfactory pain control at a level
4/10 from 6/10.
GOAL WAS
PARTIALLY MET
 NCP#2: RISK FOR INFECTION
ASSESSMENT
SUBJECTIVE: OBJECTIVE:
“Ang tagal maghilom ng sugat ko kaya - non-healing wound on left foot with
ibinalik ko na, e habang mas tumatagal, persistent foul odor, discharge and
lalong bumubuka. Maliit lang po ‘yan dati swelling
e dala na rin po siguro ng diabetes ko”, as LABORATORY FINDINGS:

verbalized by the patient. RBS- 228 mg/dl

VITAL SIGNS:
T: 36.8 °C
BP: 110/100 mmHg
PR: 98 bpm
RR: 21 bpm

 NURSING OUTCOME
DIAGNOSIS IDENTIFICATION

Risk for Infection related At the end of 8 hours of

to a non-healing wound nursing interventions,
on the left foot the patient will be able
secondary to Diabetes to demonstrate
measures to prevent
Mellitus II.
infection, such as

handwashing and
proper wound care.

 PLANNING
SHORT TERM: LONG TERM:

At the end of 8 hours of At the end of 2 days of

nursing interventions, nursing interventions,
the patient will be able the
to identify client will be able to
interventions to demonstrate
prevent or reduce the techniques, and lifestyle
risk of infection. changes to prevent
development of infection.

 NURSING INTERVENTIONS:
INDEPENDENT
1. Evaluate patient’s 2. Practice meticulous hand
nutritional state hygiene and teach patient about

the importance of handwashing

3. Maintain strict asepsis for 4. Ensure that any

dressing changes and wound instruments/articles used
care are properly disinfected
or sterilized before use.

 NURSING INTERVENTIONS:
INDEPENDENT
6. Demonstrate and
5. Instruct patient in foot educate the patient or
care guidelines. relatives on proper wound

care.

7. Provide wound care as

needed
NURSING INTERVENTIONS:
DEPENDENT
1. Administer prescribed
antibiotics as ordered.

COLLABORATIVE
1. Refer to a
dietitian.
 EVALUATION
SHORT TERM: LONG TERM:
After 8 hours of nursing After 2 days of
interventions, the patient nursing interventions, the
was able to identify client was able to
interventions to prevent demonstrate techniques,
or reduce the risk of and lifestyle changes to
infection. prevent development of
infection.
GOAL WAS MET
GOAL WAS MET
CHAPTER 5
DRUG STUDY
 CEFTRIAXONE
Generic Name: MECHANISM OF ACTION
Ceftriaxone Ceftriaxone functions by obstructing the

production of mucopeptides in the
bacterial cell wall. By attaching to
Classification: carboxypeptidases, endopeptidases, and
Antibiotic transpeptidases within the bacterial

cytoplasmic membrane, the betalactam
component of ceftriaxone disrupts the
Dosage:
activity of these enzymes. Since these
2 grams enzymes are responsible for the synthesis

of cell walls and cell division, their
Route: inactivation by ceftriaxone results in the
formation of faulty cell walls, ultimately
IV
leading to the demise of the bacteria.

 CONTRAINDICATION
INDICATION
Hypersensitivity: confirmed
Respiratory tract
hypersensitivity or allergy to
infections ceftriaxone, any of its
Urinary tract infections components, or any other
Skin and soft tissue cephalosporin antibiotics.
infections
Intraabdominal infections Previous severe hypersensitivity
Bone and joint infections reactions: If a person has
Meningitis previously experienced severe
hypersensitivity reactions, such
Gonorrhea
as anaphylaxis, to cephalosporins
or other beta-lactam antibiotics.
 ADVERSE REACTION
Gastrointestinal disturbances: Nausea, vomiting, diarrhea, and abdominal pain
Hypersensitivity reactions: Allergic reactions can range from mild rash and
itching to severe reactions like anaphylaxis.

Injection site reactions: Pain, redness, or swelling at the injection site.

Liver dysfunction: Rare instances of liver problems, including elevated liver

enzymes or hepatitis.
Hematologic effects: may cause changes in blood cell counts, such as low white
blood cell count, low platelet count, or destruction of red blood cells.

Kidney complications: in rare cases, kidney dysfunction, such as interstitial

nephritis or elevated blood urea nitrogen (BUN) or creatinine levels.

Central nervous system effects: Rarely, neurological symptoms like

headache, dizziness, or seizures.
 NURSING RESPONSIBILITIES
(BEFORE)

Verify the doctor’s order before

administering the medication.
Monitor for the 10 rights of medication.
Check the medication’s expiration date.
Determine history of hypersensitivity reactions to
cephalosporins and penicillins and history of other
allergies, particularly to drugs, before therapy is
initiated.
 NURSING RESPONSIBILITIES
(BEFORE)

Perform culture and sensitivity tests before initiation

of therapy and periodically during therapy. Dosage
may be started pending test results. Periodic
coagulation studies (PT and INR) should be done.
Provide comfort measures for the patient.
Check the vital signs to obtain baseline data.
Emphasize to the client the importance of strict
adherence to drug therapy to ensure maximum
therapeutic effects.
 NURSING RESPONSIBILITIES
(DURING)

● Administer the medications to the right

patient, with right medication, right dose, right
route, and right time aseptically.

 NURSING RESPONSIBILITIES
(AFTER)

Inspect injection sites (IM) for inflammation and induration.

Rotate sites of administration. Note IV injection sites for
signs of phlebitis (redness, welling, and pain).
Monitor for any signs of hypersensitivity toward the drug
and discontinue administration if hypersensitivity occurs.
Observe patient for signs of petechiae, ecchymotic areas,
epistaxis, or any unexplained bleeding.
Monitor BUN and serum creatinine for early indications of
nephrotoxicity.
Monitor the intake and output, decrease in urine output is
also a sign of nephrotoxicity.
 NURSING RESPONSIBILITIES
(AFTER)

Assess bowel pattern daily. if diarrhea occurs

immediately notify the physician. Severe diarrhea may
be an indication of pseudomembranous colitis that is
caused by clostridium difficile.
Instruct patient to immediately report any signs of
bleeding.
Instruct patient to report immediately if they have a
loose stool or diarrhea.
Document the procedure.
 METRONIDAZOLE
Generic Name: MECHANISM OF ACTION
Metronidazole

Undergoes intracellular chemical
Classification: reduction during anaerobic
Nitroimidazole derivative metabolism. After metronidazole

is reduced, it damages DNA’s
Dosage: helical structure and breaks its
500 mg strands, which inhibits bacterial
q8 nucleic acid synthesis and causes

cell death.
Route:
IV

 CONTRAINDICATION
INDICATION
To treat systemic anaerobic Breast-feeding,
infections caused by hypersensitivity to
Bacteroides fragilis, metronidazole or its
Clostridium difficile, components, trichomoniasis
Clostridium perfringens, during first trimester of
Eubacterium, Fusobacterium, pregnancy.
Peptococcus,
Peptostreptococcus, and
Veillonella species.
 ADVERSE REACTION

NS: Aseptic meningitis (parenteral form), ataxia, confusion,

dizziness, encephalopathy, fever, headache, incoordination,
insomnia, irritability, light-headedness, peripheral neuropathy,
seizures (high doses), syncope, weakness, vertigo.

EENT: Dry mouth, lacrimation (topical form), metallic taste, nasal

congestion, optic neuropathy, pharyngitis.

GI: Abdominal cramps or pain, anorexia,

diarrhea, nausea, pancreatitis, and vomiting.
 ADVERSE REACTION
GU: Dark urine, vaginal candidiasis (oral, parenteral, and topical
forms); burning or irritation of sexual partner’s penis, candidal
cervicitis or vaginitis, dysuria, dryness of vagina or vulva, urinary
frequency, vulvitis (vaginal form).

HEME: Leukopenia

MS: Back pain, dysarthria.

SKIN: Burning or stinging sensation, dry skin (topical form);

erythema, flushing, pruritus, rash, Stevens Johnson
syndrome, urticaria (oral and parenteral forms).
Other: Injection site edema, pain, or tenderness.
 NURSING RESPONSIBILITIES
(BEFORE)

Check and verify the medication chart of the

client of his/her due meds.
Identify the patient using 2 identifiers
Obtain CBC
Assess if the patient has severe liver disease.
Perform skin testing
Obtain the vital signs of the client.
Observe 10 rights of administration.
 NURSING RESPONSIBILITIES
(DURING)

● Administer the medications to the right patient,

with right medication, right dose, right route, and
right time aseptically.

 NURSING RESPONSIBILITIES
(AFTER)

Obtain the vital signs of the client

Assess for signs and symptoms of any adverse effects
Advise the patient to avoid drinking alcohol during the
course of the medication and at least 3 days afterward.
Advise patient to avoid hazardous activities until drug’s
CNS effects are known and to report any abnormal
neurologic signs or symptoms, such as weakness,
numbness, seizures, or vision changes.
 NURSING RESPONSIBILITIES
(AFTER)

If patient reports dry mouth, suggest ice chips or

sugarless hard candy or gum; suggest a dental visit if
dryness lasts longer than 2 weeks.
Monitor CBC and culture and sensitivity tests if
therapy lasts longer than 10 days or if second course
of treatment is needed.
Document the medication, time and date.
 GLICLAZIDE
Generic Name: MECHANISM OF ACTION
Gliclazide

It acts by stimulating β cells
Classification: of the pancreas to release
Sulfonylurea insulin. It lowers blood

glucose by stimulating the
Dosage: release of insulin from the
80 mg pancreas and increasing

sensitivity to insulin at
Route: receptor sites.
Oral

 INDICATION CONTRAINDICATION

Control of blood sugar in Hypersensitivity to gliclazide,

type 2 diabetes mellitus other sulfonylureas or
sulfonamides. Type 1 diabetes
when control of diet and
mellitus, diabetic coma and
exercise fails or when pre-coma, diabetic
insulin is not an option. ketoacidosis. Severe hepatic
Requires some or renal impairment.
pancreatic function Pregnancy and lactation.
Concomitant use with
miconazole.
 ADVERSE REACTION

Eye: Rarely, transient visual disturbances

Endo: hypoglycemia

GI: abdominal pain, diarrhea, dyspepsia, ↑ liver enzymes, nausea, vomiting

Derm: photosensitivity, rash

Blood and lymphatic system: Rarely, reversible anaemia,

leucopenia, thrombocytopenia, agranulocytosis

Nervous system: Headache

 NURSING RESPONSIBILITIES
(BEFORE)

● Check the physician’s order.

● Identify the patient using 2 identifiers
● Observe 10 rights of administration
● Gather the patient’s medical history, from past
medical history up to existing medical conditions.
 NURSING RESPONSIBILITIES
(BEFORE)

● Assess for the mentioned contraindications to this

drug to prevent potential adverse effects.
● Assess patient for allergy to sulfonylureas
● Advise patient to take medication at the same time
every day to maximize its effect.
● Explain the instructions carefully to the patient and
encourage them to ask questions if they have any
concerns or clarifications.
 NURSING RESPONSIBILITIES
(DURING)

● Make sure that the right patient if

he/she swallowed the right medication
at the right dose and at the right time.
 NURSING RESPONSIBILITIES
(AFTER)

● Observe for signs and symptoms of hypoglycemia (hunger,

weakness, sweating, dizziness, tachycardia, anxiety).
● Encourage patient to follow prescribed diet, medication, and
exercise regimen to prevent hypoglycemic or hyperglycemic
episodes.
● Caution patient to avoid other medications, especially aspirin
and alcohol, while on this therapy without consulting health
care professional
● Instruct patient to avoid sun exposure and to wear
protective clothing and sunscreen when outdoors
 NURSING RESPONSIBILITIES
(AFTER)

● Instruct patient on proper technique for home glucose

monitoring. Monitor closely during periods of stress or
illness and notify health care professional if significant
changes occur.
● Advise patient to notify health care professional promptly
if unusual weight gain, swelling of ankles, drowsiness,
shortness of breath, muscle cramps, weakness, sore throat,
rash, or unusual bleeding or bruising occurs
● Document the procedure and other findings.
 CILOSTAZOL
Generic Name: MECHANISM OF ACTION
Cilostazol May inhibit phosphodiesterase ,

decreasing phosphodiesterase
Classification: activity and suppressing cyclic
Platelet aggregation inhibitor adenosine monophosphate

(cAMP) degradation. This action
Dosage: increases cAMP in platelets and
100 mg b.i.d blood vessels, which inhibits

platelet aggregation and
Route: causes vasodilation. This in turn
PO relieves symptoms of
claudication

 INDICATION CONTRAINDICATION

Indicated for the

alleviation of symptoms
Heart failure, and
of intermittent hypersensitivity to
claudication (pain in the cilostazol or its
legs that occurs with
components
walking and disappears
with rest).
 ADVERSE REACTION

CNS: Cerebral hemorrhage, dizziness, headache,

paresthesia

CV: Angina, chest pain, hypertension, hypotension,

palpitations, peripheral edema, prolonged QT interval,
subacute thrombosis, tachycardia

EENT: Pharyngitis, rhinitis

ENDO: Diabetes mellitus, hot flashes, hyperglycemia

 ADVERSE REACTION

GI: Abdominal pain, diarrhea, elevated liver function test

results, flatulence, GI hemorrhage, hepatic dysfunction,
indigestion, jaundice
GU: Elevated BUN level, hematuria
HEME: Agranulocytosis, aplastic anemia, bleeding
tendency, and decreased platelet count
MS: Back pain, myalgia
RESP: Cough, interstitial pneumonia, pulmonary
hemorrhage
SKIN: Eruptions, pruritus, rash
 NURSING RESPONSIBILITIES
(BEFORE)

● Check the physician’s Order

● Identify the patient using 2 identifiers
● Check the medical history of the patient.
● Ensure that the patient does not have any contraindications
● Observe 10 rights of administration
● Check the expiration date of the drug before giving it to
the patient
 NURSING RESPONSIBILITIES
(BEFORE)

● Instruct patient to take cilostazol on an empty stomach

because high-fat foods can increase the risk of adverse
reactions. It should be taken at least 30 min before or 2 hr
after breakfast and dinner.
● Advise patient to avoid grapefruit juice during therapy
because it can increase the risk of adverse reactions.
● Advise patient to take the medication exactly as prescribed
● Inform the patient and family about the purpose of
medication and the drug’s side and adverse effects.
● Obtain the patient’s vital signs for baseline data.
 NURSING RESPONSIBILITIES
(DURING)

● Make sure that the patient can swallow the

medication and it is given to the right patient with
the right dosage through the right route at the right
time
 NURSING RESPONSIBILITIES
(AFTER)

● Monitor and record patient response to the medication

● Monitor patient’s vital signs and cardiovascular status closely
because cilostazol may cause cardiovascular lesions, which could
lead to problems, such as endocardial hemorrhage.
● Advise patient to report any adverse effects like nausea, vomiting
or abdominal pain.
● Instruct the patient to stop taking the medication if he experience
any easy bruising and bleeding. Report it to the physician.
● Urge patient not to smoke because it decreases the drug's
effects.
● Document the procedure and other findings.
 ATORVASTATIN
Generic Name: MECHANISM OF ACTION
Atorvastatin

Reduces plasma cholesterol
Classification: and lipoprotein levels by
Antihyperlipidemic and HMG- inhibiting HMG-CoA
CoA reductase inhibitor reductase and cholesterol

synthesis in the liver and by
Dosage: increasing the number of LDL
40 mg OD HS receptors on liver cells to

enhance LDL uptake and

Route:
breakdown.
PO

 INDICATION CONTRAINDICATION
To control lipid levels as Active hepatic disease,
adjunct to diet in primary hypersensitivity to
(heterozygous familial and atorvastatin or its
nonfamilial) components,
hypercholesterolemia and unexplained persistent
mixed dyslipidemia. rise in serum
transaminase level.
 ADVERSE REACTION

CNS: Abnormal dreams, amnesia, asthenia, emotional

lability, facial paralysis, fever, headache, hyperkinesia,
lack of coordination, malaise, paresthesia, peripheral
neuropathy, somnolence, syncope, weakness.
CV: Arrhythmias, elevated serum CK level, orthostatic
hypotension, palpitations, phlebitis, vasodilation.
EENT: Amblyopia, altered refraction, dry eyes, dry
mouth, epistaxis, eye hemorrhage pharyngitis, sinusitis,
stomatitis, taste perversion, tinnitus
ENDO: Hyperglycemia or hypoglycemia
 ADVERSE REACTION

GI: Abdominal or biliary pain, anorexia, colitis, constipation,

diarrhea, duodenal or stomach ulcers, dysphagia,
hepatitis, increased appetite, indigestion, melena,
pancreatitis, rectal hemorrhage, tenesmus, vomiting.
GU: Abnormal ejaculation; cystitis; decreased libido;
dysuria; epididymitis, urine retention; vaginal hemorrhage
HEME: Anemia, thrombocytopenia.
MS:Arthralgia, back pain, bursitis, gout, leg cramps,
myalgia, myasthenia gravis
RESP: Dyspnea, pneumonia.
 ADVERSE REACTION

SKIN:Acne, alopecia, contact dermatitis,

diaphoresis, dry skin, ecchymosis, eczema, jaundice,
petechiae, photosensitivity, pruritus, rash,
seborrhea, ulceration, urticaria
Other: Allergic reaction, facial or generalized
edema, flulike symptoms, infection,
lymphadenopathy, weight gain.
 NURSING RESPONSIBILITIES
(BEFORE)

● Check and verify the medication chart of the client of

his/her due meds.
● Identify the patient using 2 identifiers
● Obtain a liver function test.
● Obtain CBC
● Perform skin testing
● Obtain the vital signs of the client.
●Observe 10 rights of administration
● Tell patient to take drug at the same time each day to
maintain its effects.
 NURSING RESPONSIBILITIES
(DURING)

● Make sure that the right client correctly

swallowed the right medication at the right
time with right dose.
 NURSING RESPONSIBILITIES
(AFTER)

● Obtain the vital signs of the client

● Assess for signs and symptoms of adverse effects
● Instruct patient to consult prescriber before taking
OTC niacin because of increased risk of rhabdomyolysis.
● Advise patient to notify prescriber immediately if he
develops unexplained muscle pain, tenderness, or
weakness, especially if accompanied by fatigue or fever.
● Document the medication, time and date.
 CHAPTER 6
SUMMARY OF FINDINGS | CONCLUSIONS | RECOMMENDATIONS

 SUMMARY OF FINDINGS
1. The client’s name was kept private due to the right of
privacy; Client X lives in Bongabon, Nueva Ecija.

2. The client was diagnosed with Diabetes Mellitus type 2

in 2021.

3. The client and the family had a little information about

the disease process due to most of the family member
were diagnosed with the same disease.
 SUMMARY OF FINDINGS
4. The student nurses conducted a health
teaching to the client and family about
Diabetes Mellitus.

5. The student nurses implemented nursing

interventions to the client that will improve
the client’s health status.
 CONCLUSIONS
1. Client’s risk for other
complications was diminished
after ongoing assessment and
early intervention.
3. The client was able to
verbalized understanding on
proper management towards
to his disease.

2. The client was able to

participate in treatment
regimen.
 RECOMMENDATIONS
MEDICATIONS
Medications that are prescribed include antibiotics specifically:

CEFTRIAXONE METRONIDAZOLE FLAMIZINE CREAM GLICLAZIDE

 RECOMMENDATIONS
MEDICATIONS
Medications that are prescribed include antibiotics specifically:

REGULAR
MONITORING OF
BLOOD GLUCOSE
ATORVASTATIN CILOSTAZOL
LEVEL

FENOFIBRATE EMPAGLIFLOZIN
 RECOMMENDATIONS
EXERCISE
It is recommended that the patient
should be aware of any restrictions on
exercise or activity he/she needs to follow
such as: do not exercise if the patient's
blood sugar level is less than 100 mg/dl.
Encourage patient to have non-weight
bearing exercises, if not contraindicated, to
ensure wellness and enhance the wound
healing. Explain the importance of having
regular exercise and instruct to not overdo
it because too much exercise may lower
blood sugar level.
 RECOMMENDATIONS
TREATMENT
Educate the client about proper wound dressing, correct application of
topical antibiotics for ulcers and encourage daily inspection and disinfection
on the foot to prevent the infection. Antihyperglycemic drugs are also given,
therefore, teach the client that this medication works by increasing the insulin
in the body which actually lowers the blood sugar. Also, antiplatelet and
vasodilator drug is prescribed, which are being used for reducing the
claudication that is caused by the narrowing of blood vessels in the legs.
Moreover, an antilipidemic drug is also prescribed that lowers the cholesterol,
LDL fats and triglycerides in the body. Remind and encourage the client to
comply with regular check-ups and blood glucose monitoring as well as to take
the medications on the right time, right dose and duration to ensure the
potency and efficacy of the drugs.
RECOMMENDATIONS
HEALTH TEACHING
Advise the client to eat healthy foods or follow
proper diet in order to maintain his blood glucose
level within in the normal level. Instruct the client
to have a proper exercise. Also, limit his alcohol
intake and avoid using vape and smoking because
these factors can trigger his blood glucose level to
increase.

Instruct the client to always be attentive to avoid

getting wounds or cut even in a smallest way,
because having diabetes mellitus it slower the
healing of the wounds.
 RECOMMENDATIONS

OUTPATIENT/REFERRAL
Consider increasing the frequency of visits to monitor the
client’s condition. Provide health education on proper diet and
exercise to reduce blood sugar.
 RECOMMENDATIONS
DIET
Instruct the client about diabetes
mellitus, wherein he may eat a
nonstarchy foods vegetables, such
as salad, green beans, broccoli,
cauliflower, cabbage, and carrots.
Also, minimize or about foods that
have a high amount of
carbohydrates due to this connect
can increase the blood sugar level
of the client.
 RECOMMENDATIONS
SPIRITUAL
Spirituality is proven to give people, including those who have
illness, a sense of strength and positive coping mechanisms. It is
best to advise the client to pray and have faith in God especially in
trying times such as facing complications while treating the
disease.
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 THANK YOU
SAN MIGUEL | SANTIAGO | SARAGPON |
TYPE 2 DIABETES MELLITUS
SEBASTIAN | SOLITARIO