Self Care Education for Patient: Role of Nurses in

improvement of Quality of Life in Patients with

Amputated Leg from Uncontrolled DM
Mark Angelo Picar Abellera

Kristine Czarina Dadivas Bayoran

Maricar Veronica Sacramed Butel

Windy Doro Cadiam

Background
• Diabetes results from the body's inability to create or use
insulin.

• High blood sugar levels result from a body's inability to

properly metabolize glucose.

• The body's natural healing process may be slowed as a result.

• cuts, grazes, scratches, and blisters may happen everywhere

on the body, but feet are the most prevalent.

• 15% of diabetics get foot ulcers.

Complications of Diabetes Mellitus
 Kidney disease, Amputations, Blindness, Cardiovascular disease,
Obesity, Hypertension, Hyperglycemia, Dyslipidemia, and risk of heart
attack or stroke.

 49.7 percent of peripheral artery disease patients had type 2 diabetes

(Dening, 2022).

 In the Philippines, Diabetes Mellitus is one of the leading four causes of

mortality (Cabico, 2023).
 Diabetes-related amputation estimates worldwide

• 505,390 diabetes-related lower extremity amputations IR estimates of 95%

per 100,000 diabetics. 2010–2020 (Ezzatvar & García-Hermoso, 2023).

 Diabetes affects over 29 million people in the United States, according

to the American Diabetes Association.
 Diabetes affects 347 million people globally, according to the World
Health Organization.
 Diabetes is becoming more prevalent in the Philippines.

• Rapid urbanization
• Increased dependency on technological devices
• Inactive lifestyle
 Asia will have the largest rise in diabetes cases by 2025 (World
Health Organization 2004).
Taguig Pateros District Hospital
2022 Annual Census
• Based on the Out-Patient Department Top 10 Morbidity List, Diabetes Mellitus
ranks first with 1551 cases.

• In the Medicine Ward census for 2022, 38 of the 477 patients had Diabetes
Mellitus, and 9 had Diabetic Foot.

• Out of 316 main cases performed in 2022, two are above knee amputations
(AKA) and 28 are below knee amputations (BKA).

• DM was listed eight among our hospital's top ten primary causes of death.
How did we come up with this problem?

As of 2022, Taguig Pateros District Hospital Outpatient Department recorded

Diabetes Mellitus as the number 1 cause of Morbidity. Most of the patients with
this condition were not knowledgeable enough about the disease which leads
them to suffer further complications such as foot ulcers and eventually
amputations. The hospital also documented that almost all amputation cases
were due to diabetes mellitus. This situation alarms nurses to exert more effort
to educate not just the patients but their families and significant others as
well.

As for the amputees, additional complications arise because of the post-

amputation consequences that are managed incorrectly. Amputees will
experience the usual onset of major depressive disorders. Great support to
health care providers and family members is needed to improve their life
quality. The healthcare provider’s role is to educate and help the patients
adjust to their lives after amputation in a way that they will not be dependent
on others.
Why it’s a problem?
 As one of the noncommunicable illnesses, diabetes has a significant
impact on the cost, time, and human resources of health systems
(Srivastava et al., 2010)
 Amputated legs impair function, sensation, body image, and
mental health (Srivastava et al., 2010)
• Low self-esteem
• Body image distortion
• Increased dependency
• A high degree of social isolation
• Relationships and career

 The Philippines has a low doctor-to-household ratio. Ball, D., & Tisocki, K. (2009).

• 12 doctors per 10,000 families

• 61 nurses per 10,000 Filipino families.
 PhilHealth Circular No. 17s 2014 covers diabetes, hypertension, and dyslipidemia
drugs. Philippine Health Insurance Corporation, Republic of the Philippines (2014)

“Considering the increasing burden of NCDs vis-à-vis the cost of maintenance

drugs for these diseases, PhilHealth Primary Care Benefit 2 Package (PCB2) will
pay for outpatient medicines for PhilHealth qualified members or dependents
with hypertension, diabetes and dyslipidemia long before their conditions
become catastrophic”

• Only glibenclamide and metformin, given monthly, were

covered for diabetes.

• Family health coverage is minimal.

• PhilHealth covers hospitalization in authorized facilities with a

maximum cost per diagnostic and treatment (Obermann et al.,
2006)

• Limited diabetic treatment is a significant drawback for this

care model since it is not covered by either public or private
insurance.
 Diabetes and Endocrinology Group of the Philippines. The Philippine Society
for Endocrinology, Diabetes, and Metabolism (PSEDM) only recognizes 7
training schools, which annually produce a total of 30 board-certified
endocrinologists. Rafael, C. (2015)

 The Cost and Availability of Diagnostic Procedures

• A1C is unavailable in public hospitals and health institutions, making glycemic

monitoring and diabetes management more difficult.

• Unite for Diabetes Philippines (composed of >20 specialities) asserts that A1C
cannot be used to diagnose diabetes in the Philippines due to a lack of uniformity
(Higuchi, 2010)
  Having access to medicines

• Metformin is often prescribed, but the fact that sulfonylurea is still often
prescribed even though it is no longer a top priority in almost all diabetes care
guidelines (due to high rates of hypoglycemia) shows that money is still the
most important factor in diabetes care (Koye et al., 2018).
 Family Assistance

• Filipinos are distinguished for their strong family connection. The care of parents is
provided by family members till the time of their death. Diabetes is not
discriminated against by family members, but rather is met with extremely strong
family support (Torres, 2002)

• The financial burden of diabetes and its consequences, from medications to labs, is
borne and shared by family members until the patient's death.
 Elderly lower limb amputees need substantial rehabilitation and long-term care,
straining health resources. Mobility is essential to recovering independence, but
various comorbidities in this patient group might make it difficult (Fortington et
al., 2012)
Standard Nursing Practice
American Nurses’ Association (ANA)

Standards of nursing practice developed by the American Nurses’ Association

(ANA) provide guidelines for nursing performance. They are the rules or
definition of what it means to provide competent care. The registered
professional nurse is required by law to carry out care in accordance with what
other reasonably prudent nurses would do in the same or similar circumstances.
Thus, provision of high quality care consistent with established standards is
critical.

Standards of Nursing Practice consist of three components:

• Professional standards of care define diagnostic, intervention, and evaluation

competencies.

• Professional performance standards identify role functions in direct care,

consultation, and quality assurance.

• Specialty practice guidelines are protocols of care for specific populations.

 National Standards for Diabetes Self-Management Education

• DSMES facilitates the information, skills, and abilities required for

diabetic self-care and helps a person execute and retain the behaviors
needed to manage their illness beyond formal self-management
training (Beck et al., 2017)

Standard Nursing Practice Philippines

• Article III, section 9 (c) of Republic Act No. 9173 or the Philippine Nursing Act of 2002,
states that the Professional Regulatory Board of Nursing is empowered to “monitor and enforce
quality standards of nursing practice in the Philippines and exercise the powers necessary to ensure
the maintenance of efficient, ethical and technical, moral and professional standards in the practice
of nursing taking into account the health needs of the nation.” It is, therefore, incumbent upon the
Board of nursing to take the lead in the improvement and effective implementation of the core
competency standards of nursing practice in the Philippines to ensure safe and quality nursing care,
and maintain integrity of the nursing profession.
UNITE FOR DIABETES PHILIPPINES

UNITE FOR DM, a collaboration of diabetes mellitus groups, piloted the Philippine
Practice Guidelines on Diagnosis and Management of Diabetes Mellitus. The Diabetes
Philippines (previously The Philippine Diabetes Association), the Institute for Studies
on Diabetes Foundation, Inc. (ISDFI), the Philippine Society for Endocrinology and
Metabolism (PSEM), and the Philippine Center for Diabetes Education Foundation
(PCDEF) constitute this alliance (PCDEF). This project aims to establish clinical
practice guidelines on diabetes screening, diagnosis, and care that include current
best evidence and local data to help clinical decision making for Filipino patients.
The International Diabetes Federation (IDF) requested coordinated worldwide efforts
to create systematic ways to prevent diabetes and its complications. By 2025, there
will be 380 million diabetics globally, up 55% from 246 million in 2007.

The four broad categories that will be addressed by the recommendations are as follows:

(1) diabetes screening and diagnosis;

(2) diabetes follow-up care and screening for complications;
(3) diabetes prevention and treatment; and
(4) diabetes in pregnancy.
The four broad categories that will be addressed by the recommendations are
as follows:

(1) diabetes screening and diagnosis;

(2) diabetes follow-up care and screening for complications;

(3) diabetes prevention and treatment; and

(4) diabetes in pregnancy.

Duties and Responsibilities
Nurses caring for diabetes patients have five responsibilities.

1. Balance the fluids, electrolytes, and acid-base levels.

2. Reverse/correct abnormal metabolic processes
3. Manage the underlying cause of diabetes and the progression of the condition
4. Reduce the risk of diabetes complications.
5. Patients should be taught about the disease's effects, how to take care of
themselves, and how to get the therapy they need.

Diabetes Educator
1. The best ways to improve one's health are lifestyle modifications, such as adopting more
healthful eating habits, getting more exercise, and (if relevant) giving up smoking

2. Monitoring and controlling diabetes using a blood glucose monitor.

3. Treatment of diabetes, including insulin injection technique

 4. Reactions to insulin and how to handle them

5. Instructions for recognizing and responding to signs of low and high blood sugar

6. Techniques for identifying foot injuries that may need medical care

Diabetic Foot Care

1. Examine the feet for any lacerations or sores. Look for skin that is dry and
cracked, as well as redness, warmth, or soreness.  Instruct the patient not to treat
corns or calluses on their own.

2. Cleanse, dry, and hydrate the patient's feet. Ensure that the water is not too
hot, and pat the feet dry completely afterward. Use lotion on dry skin, but avoid
the space between your toes, as this might result in an excess of moisture.

3. The patient should avoid walking barefoot.

4. Promote the use of shoes that are both supportive and pleasant,
allowing the feet to breathe easily.
5. Daily changing of loose-fitting socks.

6. Maintain a comfortable temperature for the patient's feet. Remind the patient
to stay away from heating pads and to always test water temperature with a
hand or elbow before submerging a foot.

7. Toe nails should be trimmed straight across. Avoid cutting any corners.

8. If possible, encourage the patient to quit smoking.

9. Encourage the patient not to cross their legs, since this reduces sensation and
blood flow.

5. Modifying the self- concept and self-image in a particular state of health

• No issue

6. Learning to live with effects of pathological conditions

• She didn't see her diabetes or her weight as an issue and actively worked to keep
her blood sugar levels in check. 
Hospital Related Protocol

All patients who underwent amputations are required to follow up in the

Outpatient department under the care of Endocrinology and Ortho/Surgery.
Before discharging the patients, nurses reiterate the importance of attending to
their follow-up schedules, instructed them to bring the results of the workups
requested, and that they will receive a confirmation text message for their
appointment prior to their schedules.

The discharge nurse will then endorse the details of the patients and the date of
follow-up to OPD nurses. The Endo and Ortho/Surgery nurse will be responsible
for calling/texting the patient to ask if the workups requested were done and to
confirm the given date of the follow-up schedule.

On the day of the appointment, additional health teachings will be provided to

the patients on how to prevent and reduce further complications. Proper wound
care, self-monitoring and control of blood sugar, varying nutrition to meet daily
demands, and proper insulin doses to meet actual needs were reiterated.
 Dorothea Orem

Self-Care
Deficit Theory
Dorothea E. Orem was born in Maryland's Baltimore in 1914. She received her
nursing diploma from the Providence Hospital School of Nursing in Washington,
D.C., in the early 1930s. She graduated from the Catholic University of America
in Washington, D.C. with a Bachelor of Science in Nursing in 1939 and a Master of
Science in Nursing in 1945. She passed away on June 22, 2007.
Introduction
 The prevalence of type 2 diabetes is epidemically expanding worldwide.
The World Health Organization (WHO) estimates that 347 million people
have diabetes globally. More than 80 percent of diabetics reside in low-
and middle-income nations (WHO, 2013).

 The primary issue in people with diabetes is an uncontrolled blood glucose

level, which in turn causes consequences such as cardiovascular disease,
nephropathy, neuropathy, lower extremity disorders, amputation, and vision
loss. The goals of diabetes treatment include glucose control and the
avoidance of complications. (ADA, 2012)

 According to Orem's self-care deficiency nursing theory (Orem, 1995),

ADA's (2012) clinical advice recommends addressing to health
deviation self-care requirements. Consequently, the individual with
diabetes must re-regulate medical nutrition therapy and physical
activity, if required, utilizing medicine and blood-glucose monitoring
to assess the efficacy of self-care activities. The individual with
diabetes must learn how to assess oneself, determine what steps are
necessary to meet their requirements, and carry out those actions.
“Learning and practicing self-care, whether for one's own care or for a
defendant who receives care from another (e.g., a family member), is
essential to survival, proper functioning, and overall health.”
1. Agency

• is a human capacity defined as "the ability to engage in self-care," which

is influenced by age, developmental status, life experience, sociocultural
orientation, health, and accessible resources.

2. Therapeutic Self-care Demand

• is a sophisticated theoretical construct that encapsulates all actions that

should be taken throughout time to promote life, health, and well-being.

3. Self-Care Requisites

• These types of self-care requisites (or needs for action) were devised to
give the basis for calculating the TSCD: universal, developmental, and
health deviation.
These are the aims or objectives for which actions for
life, health, and well-being are taken.

1. Universal self-care requisites

• All individuals must possess the eight universal self-care requirements

(USCR).Humans of all ages and all environmental situations, including air,
food, and exercise, and isolation and connection with others. The action to
be undertaken over time to achieve the need, prevention of danger to human
life, human functioning, and human well-being (the goal), will differ for a
newborn (e.g., keeping crib rails up) vs an adult (e.g., keeping crib rails up)
(e.g., ambulation safety).

2. Developmental self-care requisites

• The first refers to general human developmental processes that occur

throughout the lifetime. When caring for growing babies and children, or
when catastrophe and significant physical or mental disease afflict
adults, dependent care agents often meet these requirements.
3. Health deviation self-care requisite

• Health concerns Self-care requirements are situation-specific requirements or

objectives for individuals with sickness, injury, or who are receiving
professional medical treatment.
 The Self-Care Deficit Theory
• is a compilation of facts regarding the concepts of self-care (and dependent-
care), self-care agency (and dependent-care agency), therapeutic desire for
self-care, and the relational concept of dependency.

The Self-Care Deficit Theory of Nursing, created by Orem, is a combination of

three distinct but related theories:

1. The theory of self-care

2. The self-care deficit theory

3.The theory of nursing systems. (Theoretical Foundations of Nursing.1991)

To engage in self-care person must have value and

capabilities to learn ( to know), to decide, and to manage self (Orem, 1991, p.67).
 The Theory of Nursing Systems
• A nursing system, as defined by Orem, is "an action system" (or "activity and
sequence of acts performed for purpose").

These steps included three distinct kinds of subsystems

1. Interpersonal

• Includes all required activities or processes including establishing

and maintaining productive relationships with patients, families,
and other care providers.
2. Social/Contractual

• Pertains to all nursing actions/operations essential to achieve an agreement

with the patient and other information required to assess the therapeutic Self-
care need and Self-care agency of a person and caregivers.
3. Professional Technology

• Consists of diagnostic, prescriptive, regulatory, evaluative, and case

management functions (Parker, M.E., 2010, p. 130)
Based on the patient's level of self-care or dependence, the nursing system
creates one of three care plans:

1. Wholly compensatory

• To facilitate the patient's therapeutic self-care, make up for the patient's

incapacity to do self-care, and provide safety and support (Parker, M.E.,
2010, p. 134)
2. Partly compensatory

• "both nurse and undertake care measures or other acts requiring

manipulative tasks or ambulation" represents the system. The patient
or the nurse may have a significant role in the achievement of care
measures (Orem, 1991).

3. Supportive educative

• The individual "can do, or can and should learn to perform,

essential measures of outwardly or internally directed
therapeutic self-care but cannot do so without support."(Orem,
1991).
Metaparadigm Concepts of Nursing
A metaparadigm is a field's overall viewpoint that defines its central
phenomena of interest and the unique way it approaches these phenomena
(McEwen & Willis, 2011).

1. Person

• The term "person" encompasses a wide range of concepts, including but not
limited to: a human energy field; a holistic being in the world; an open
system; an integrated whole; an adaptive system; and a being who is more
than the sum of his parts.

2. Health

• When a person is healthy, they have the mental, physical, and spiritual
capabilities all in harmony, and they are able to take care of themselves in
any situation that may arise.
3. Environment

• As a general rule, when people talk about their environment, they're

referring to the things outside of themselves, the people with whom they
contact often, and an open system with limits that allows for the
interchange of matter, energy, and information with other humans.

4. Nursing

• Nursing is defined as the human service necessary for constant self-

care maintenance. Nursing involves specialized techniques and
scientific application.
THEORY IS APPLICABLE IN THE CASE OF DIABETES MELLITUS

• Clients  with Diabetes Mellitus benefit greatly from having accurate information
about the best way to manage their illness. The self-care approach proposes that
nurses should help their patients manage their diabetes by acting as their
advocates and educators. Both internal and external variables, such as the
client's age, height, weight, culture / ethnicity, marital status, religion,
education, and occupation, might have an impact on how well they are able to
care for themselves. Family and cultural groups are examples of the outside
influences that affect clients.

Self-Care Need Details

Universal self-care Which usually requires needed by the client throughout its life
requisites cycle, such is the need for oxygen, water, food, elimination,
rest, social connection, and facing life-threatening threats;
these may be broken down into two categories: physiological
needs and non-physiological needs. If a DM client takes
proactive measures to manage their condition, like engaging in
regular physical activity, eating a healthy diet, and keeping tabs
on their blood glucose levels, they may reduce their need on
medical intervention.
Developments of Clients with DM often struggle with role functioning.
self-care requisites Diabetic clients may have difficulties in the areas of
urinating (polyuria), eating (polyphagia), drinking
(polydipsia), exhaustion (hypoglycemia), weakness,
skin sores, vaginal infections, and eyesight (if high
glucose levels).

Health deviation Health-related issues, including but not limited to: fluid
self-care requisites and electrolyte loss (dehydration), hypotension, sensory
abnormalities, seizures, tachycardia, and hemiparesis as
a result of hyperglycemic syndrome. The client with
diabetes has an unmet demand that is out of proportion
to the resources available to meet that need. Clients
with DM suffer deterioration and several difficulties that
might lessen their standard of living. The nurse's job
here, according to Orem, is to determine the client's
level of self-care competence and categorize them
accordingly. After a thorough evaluation and collection
of data, nurses get to work rehabilitating patients' and
clients' self-care skills to their pre-injury levels.
Nursing Practice Application

Case

Mrs. X, age 57, collapsed following a light workout and was taken to the hospital.
She has had type 2 diabetes for 15 years. She also suffers from conditions like
hypertension and high cholesterol. Although she is eager to learn more about the
greater prevalence of type 2 DM in persons of his ethnicity, she has had trouble
securing appointments for regular management. Whenever she needed it, she could
seek the counsel of the nurses. Her fasting blood sugar is 250 mg/dl and her
postprandial sugar is 285 mg/dl. It's safe to say she avoided both alcohol and
tobacco. She claims she didn't get much exercise beyond shopping and cleaning,
although she did take a spinning yarn class as a pastime.

Basic Patient Conditioning Factor Evaluation

Age : 57
Gender : Woman
Developmental State : Older
Status of Health

After suffering from Type II diabetes for 15 years

Measurements in the Lab (20 January 2023):

Glycosylated hemoglobin (HbA1c): 10.2

Fasting blood sugar (FBS): 250 mg/dl
Postprandial glucose (PBG): 285 mg/dl
High-density lipoprotein (HDL): 35 mg/dl
Low-density lipoprotein (LDL): 200 mg/dl
Total cholesterol: 250 mg/dl
Triglyceride: 150 mg/dl
Blood pressure (BP): 170/100mmHg

Complication: Retinopathy, nephropathy, and neuropathy are absent,

although the patient wears glasses owing to
astigmatism.

Other disease: Hypertension,Hyperlipidemia.

Medicines: Insulin glargine 20 units, losartan potassium 50mg,
amlodipine 5mg.

Health perception: The status of the patient's health was characterized as being
average.

Sociocultural Orientation: A college graduate who retired from teaching 10 years

ago and is now unemployed. In addition to the
medications given by the physician, she consumed soft
drinks or coffee three times every day.
Health Care System: She added that she used Barangay health clinics and
government hospitals for health examinations.

Family System: Married and had three children. She lived with his husband

Pattern of Living: She did not smoke or drink alcohol. She took a spinning
yarn course as a pastime and claims to have done little
physical exercise other than shopping and cleaning.
Environmental Factors: She resided on the sixth level of a stairwell- equipped
apartment building. For physical exercise, the building
included a garden and a pathway surrounding it.

Resource Availability and Adequacy: She claimed that she could readily get the
medications and supplies required for her
treatment (insulin, needles, etc.) but had
trouble obtaining appointments for regular
checks. She could receive counsel from nurses
as requested/needed.
Assessment Therapeutic Self-care Demands and Self-care deficit

1. Air: No issue
2. Water: No issue
3. Food: No issue
4. Excretion: No issue
5. Activity- Rest: No issue
6. Social Interaction: She lives with her spouse, and her sister may assist
her in times of need. She took the embroidery class
as a pastime.
7. Prevention of Hazards: No visual, auditory, or bodily impairments that
pose a threat. Uses glasses due to astigmatism.

8. Promotion of normalcy: Declares that there was never a time when the
condition prevented her from doing what she
desired.

Developmental Self-Care Requisites and Self-Care Deficit

1. She went in for a mammogram once every two years so that she could safeguard
and preserve the developing environment. She is a very knowledgeable woman.
Requisites and Self-Care Deficit
1. Seeking and obtaining the necessary medical care. When she became unwell,
she sought therapy and examinations at institutes staffed by internal-diseases
or endocrine specialists. No issue.
2. Knowing and being ready for the symptoms and outcomes of diseased
conditions. She was unaware of HbA1c and lipid profile, as well as the
difficulties induced by high HbA1c, changes in lipid profile (down in total
cholesterol level and rise in HDL cholesterol), and obesity.
3. Implementation of diagnostic, therapeutic, and rehabilitative treatments
suggested by a physician

• Did not engage in regular physical activity. When she felt hungry in the
morning, she occasionally went for a walk. She did not adhere to the diabetic
diet and did not have any snacks.

• She only injected insulin into the umbilicus and the area surrounding it, never
checked the injection site, never measured the interval between injections,
never grabbed the skin at a 90-degree angle, and never used the correct
quantity of insulin.

• She neglected to check her feet every day, did not keep her nails trimmed,
and wore flip-flops instead of supportive shoes and cotton socks.

• She measured her own blood-glucose levels at random. She reported that she
slept when her blood glucose was less than 70 mg/dl after eating a piece of
bread, did not test her blood glucose for control, and ate when her
postprandial blood glucose was more than 200.
• She had never had a foot examination, had never had an eye examination or
kidney function tests at random, and had only had a cholesterol control and
HbA1c follow-up every six months. When she was feeling ill, she took her
blood pressure.
Self-care deficit:
Insufficiently effective handling of medical treatments and rehabilitative interventions due to lack of
knowledge, disbelief that her health could improve, ignoring some disorders and the belief that these
disorders will fade away on their own.

4. Being aware of and ready for the results of medical treatment

• She was unaware that insulin administration errors might lead to

hypoglycemia, hyperglycemia, and lip hypertrophy.
Self-care deficit:
Insufficient awareness of the effects of medical care due to lack of knowledge.
5. Modifying the self- concept and self-image in a particular state of health

• No issue

6. Learning to live with effects of pathological conditions

• Though she was overweight and diabetic, she made an effort to control her
condition.
 Type of
Orem Theory Nursing diagnosis Goal Nursing intervention Evaluation
system

Maintain enough fluid Risk for dehydration Dehydration may be Supportive education  Explain the  Skin turgor return <
consumption and related to increased avoided. significance of fluid 2 sec
elimination urination consumption
 Eyes are not
 Discuss the sunken, with no
equivalents for cup signs of dry mucous
and glass membrane

 With good pulse

80bpm

Maintain sufficient Deficit knowledge The diabetic diet will Supportive education  Describe the kind  Daily adherence to
intake of food regarding the type of be explained to the of foods he or she a diabetes diet plan
diet intake related to patient. can consume and by the patient
lack of information those he or she
resources. cannot.  Patient body
Self-care agency: weight maintained.
patient and family  Explain the
significance of
maintaining a
consistent food
routine.

 Plan their daily

nutritional pattern
and urge them to
follow it
 Type of
Orem Theory Nursing diagnosis Goal Nursing intervention Evaluation
system
Activity and Rest Deficit knowledge Keep a healthy Supportive education  Give information on  The patient's
regarding adjustment balance of activity and the progress of the physical activity
of relaxation. program's steps. was increased to
activity and rest as per 150 minutes per
meal pattern  Maintain 10,000 week.
steps-per-day until
goal are met (ADA,
2009)
Knowing and being Deficit knowledge Reduce and maintain  Wholly  Test glucose levels  Normal level of
ready for the regarding maintenance normal blood glucose compensatory twice daily, once glucose in the blood
symptoms and of blood glucose level levels, and increase prior to breakfast
outcomes of diseased and glucose daily blood glucose  Supportive and once two hours  There are no acute
conditions monitoring monitoring to twice or Education after a meal. (ADA, or chronic
thrice a day before complications, such
and after meal  Explain to the as diabetic foot,
patient that they ketoacidosis, vision
should seek medical loss, etc.
attention when
their levels are  Patients are aware
below 60 mg/dL or of and comprehend
above 300 mg/dL the signs and
and they are symptoms of
experiencing diabetes mellitus.
exhaustion, thirst,
and visual
abnormalities.

 Explain the
necessity of
modifying exercise
and food planning
when levels are
outside of
acceptable ranges.
 Type of
Orem Theory Nursing diagnosis Goal Nursing intervention Evaluation
system

 Explain through
health education
the major factors
of Diabetes
mellitus and its
complications.
References:

American Diabetes Association (2012). Standards of medical care in diabetes--2012. Diabetes care, 35 Suppl 1(Suppl 1),
S11–S63.
https://doi.org/10.2337/dc12s011

American Nurses Association. (n.d.). Nursing Scope of Practice | American Nurses

Association. ANA.
https://www.nursingworld.org/practice-policy/scope-of-practice/

Ball, D., & Tisocki, K. (2009). Medicines price components in the Philippines. Health Action International Global.

Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., Cypress, Marjorie, Faulkner, P., Fischl, A.
H., Francis, T., Kolb, L. E., Lavin-Tompkins, J. M., MacLeod, J., Maryniuk, M., Mensing, C., Orzeck, E. A., Pope, D. D., Pulizzi,
J. L., Reed, A. A., . . . Wang, J. (2017a, July 28). 2017 National Standards for Diabetes Self-Management Education
and Support. American Diabetes Association.
https://diabetesjournals.org/care/article/40/10/1409/29569/2017-National-Standards-for-Diabetes-Self

Cabico, G. K. (2023, January 25). COVID-19 not among top 10 causes of death in 2022. Philstar.com.
https://www.philstar.com/headlines/2023/01/25/2240134/covid-19-not-among-top-10-causes-death-2022
Center for International Rehabilitation Research Information and Exchange. (2002). Understanding Persons of Philippine Origin: A
Primer for Rehabilitation Service Providers | Center for International Rehabilitation Research Information and Exchange.
http://cirrie-sphhp.webapps.buffalo.edu/culture/monographs/philippines.php

Dening, J. (2022, April 19). What’s the Connection Between Diabetes and Wound Healing? Healthline.
https://www.healthline.com/health/diabetes/diabetes-and-wound-healing

Diabetes care 2008: survey on glycemic control and the status of diabetes care and complications among patients with type 2 diabetes
mellitus in the Philippines

Ezzatvar, Y., & García-Hermoso, A. (2023). Global estimates of diabetes-related amputations incidence in 2010–2020: A systematic
review and meta-analysis. Diabetes Research and Clinical Practice, 195, 110194. https://doi.org/10.1016/j.diabres.2022.110194

Fortington, L. V., Rommers, G. M., Geertzen, J. H., Postema, K., & Dijkstra, P. U. (2012). Mobility in Elderly People With a Lower
Limb Amputation: A Systematic Review. Journal of the American Medical Directors Association, 13(4), 319–325.
https://doi.org/10.1016/j.jamda.2010.12.097

Higuchi, M. (2010). Access to Diabetes Care and Medicines in the Philippines. Asia Pacific Journal of Public Health, 22(3_suppl),
96S-102S. https://doi.org/10.1177/1010539510373005

McEwen, M. and Wills, E.M. (2011) Theoretical Basis for Nursing. Wolters Kluwer/Lippincott Williams & Wilkins,
Philadelphia.

Obermann, K., Jowett, M. R., Alcantara, M. O. O., Banzon, E. P., & Bodart, C. (2006). Social health insurance in a
developing country: The case of the Philippines. Social Science &Amp; Medicine, 62(12), 3177–3185.
https://doi.org/10.1016/j.socscimed.2005.11.047
Orem, E. Dorothea. (1991). Nursing concept of practice (4th ed.). philadelphia: Mosby

Orem, D. E., & Vardiman, E. M. (1995). Orem’s Nursing Theory and Positive Mental Health: Practical Considerations. Nursing Science
Quarterly, 8(4), 165–173. https://doi.org/10.1177/089431849500800407

Parker, ME., & Smith, MC. (2010). Nursing Theories and Nursing Practice. 3rd ed. USA, F.A davis Company

Rafael, C. (2015). The need for more diabetes specialists. The Philippine Daily Inquirer, 2015.

Republic Act No. 9173 | GOVPH. (2002, October 21). Official Gazette of the Republic of the
Philippines. https://www.officialgazette.gov.ph/2002/10/21/republic-act-no-9173/

Srivastava, K., Saldanha, D., Chaudhury, S., Ryali, V., Goyal, S., Bhattacharyya, D., & Basannar, D. (2010). A Study of Psychological Correlates
after Amputation. Medical Journal Armed Forces India, 66(4), 367–373.
https://doi.org/10.1016/s0377-1237(10)80021-8

Themes, U. (2016b, November 17). Theoretical Foundations of Nursing Practice. Nurse Key.
https://nursekey.com/theoretical-foundations-of-nursing-practice

View of A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of Diabetes (Part I:
Screening and Diagnosis of DM) | Journal of the ASEAN Federation of Endocrine Societies. (n.d.)
https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/98/317

World Health Organization. (2004). Diabetes action now: an initiative of the World Health Organization and the International Diabetes
Federation.

World Health Organization. (2013). World health statistics 2013. World Health Organization. https://apps.who.int/iris/handle/10665/81965
 u !! !
k Yo
ha n
T