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Nurse Training Program January 2011 Batch

A Case Study

on

DIABETES MELLITUS TYPE II

In partial fulfillmentof the requirements of CVMC Training Program

SUBMITTED BY:

Jomar Balisi, RN

Krista Caculitan, RN

Chinnie Rose Carag, RNKristel Rashette Catabay, RN

Ralph Lourenz Cruz,RN



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INTRODUCTION

Definition

Diabetes is a group of diseases characterized by high blood glucose levels

that result from defects in the body's ability to produce and/or use insulin.

Prevalence and Incidence• More than 220 million people worldwide have diabetes and by 2025

this total is expected to increase to over 380 million

• In 2004, an estimated 3.4 million people died from consequences of

high blood sugar

• In the Philippines, there are about 4 million diabetics, with more than 3

million not knowing they have it. Out of the 1 million who know they

have the disease, only 200,000 are undergoing treatment

Risk and Predisposing Factors

• Age older than 45

• Family history of diabetes

•

Overweight• Inactive lifestyle

• Diet

R



• Poor wound healing

• Altered mental status

• Blurry vision

Different types of Diabetes Mellitus

Types of Diabetes MellitusFactors Type 1 Type 2 Gestational

Diabetes

Synonyms Insulin-dependentdiabetes mellitus

(IDDM); juvenile-

onset diabetes

Non-insulin-dependent

diabetes mellitus

(NIDDM); or

adult-onset

diabetesDescription Body's immune

system destroyspancreatic beta

cells, the only

cells in the body

that make the

hormone insulin

that regulates

blood glucose

Begins as insulin

resistance, adisorder in which

the cells do not

use insulin

properly. As the

need for insulin

rises, the

pancreasgradually loses its

ability to produce

A form of glucose

intolerance that isdiagnosed in

some women

during pregnancy



Insulin production Little or none Below normal; or

above normal

Risk Factors Autoimmune,genetic, and

environmental

factors

Associated witholder age,

obesity, family

history of

diabetes, history

of gestational

diabetes,

impaired glucose

metabolism,

physical

inactivity, and

race/ethnicity

Obese womenand women with

a family history of

diabetes

Incidence 5% to 10% 90% to 95% 20% to 30%

Ketosis May occur Unlikely to occur May or may notoccurInsulin injections Required Necessary for

only 20-30%

Required during

pregnancy

especially those

remain

overweight after

deliveryBody weight at

onset

Ideal body weight

or thin

80% of clients are

obese

Some are obese;

some with normal

weight during



2. Random Blood Glucose Test

Random blood glucose screening involves drawing of blood anytime of the day regardless of whether the person has eaten or not. However, the

time and content of the last meal should be noted. Random blood glucose

result of greater than or equal to 200mg/dl should be monitored closely.

3. Oral Glucose Tolerance Test

The oral glucose tolerance test (OGTT) is principally used for diagnosis

when blood glucose levels are equivocal, during pregnancy, or in

epidemiological studies. The oral glucose tolerances test (OGTT), also

referred to as the glucose tolerance test, measure the body’s ability to

metabolize glucose, or clear it out of the bloodstream.

The test should be performed in the morning on subjects who have had

at least 3 days of unrestricted diet. The subject should have fasted overnight

for 10-16 hours and remain seated and not smoke throughout the test. Afasting blood sample should be collected, after which the subject should

drink 75 g of glucose in a concentration no greater than 25 g per 100 ml.

Commercially prepared carbohydrate loads equivalent to this are available.

For 75 grams of glucose, normal blood glucose values are:

• 1 hour: less than 200 mg/dL

• 2 hours: less than 140 mg/dL. Between 140-200 mg/dL indicates

impaired glucose tolerance (prediabetes). If test results are in thisrange, a patient is at an increased risk for developing diabetes. Greater

than 200 mg/dL indicates diabetes.



PATIENT’S PROFILE

Name: Sugar Mommy

Age: 56 y/o

Sex: Female

Address: Bagay, Tuguegarao City

Date of Birth: May 25, 1955

Religion: Roman Catholic

Nationality: Filipino

Civil Status: Married

Educational Attainment: Elementary Graduate

Attending Physician: Dr. Jena Lynn M. Alan

Chief Complaint: Difficulty of breathing

Diet: DM diet

Date of Admission: April 6, 2011

Time of Admission: 9:35 PM



NURSING HEALTH HISTORY

PAST HEALTH HISTORY

Patient can’t remember if she completed her vaccines

1970, had appendectomy at Manila.

1987, the patient felt numbness all over her body and loss of

consciousness. She was splashed with a pail of water and was

relieved few hours after (according to her relatives).

Few months later, the incidence reoccurred. In addition, she felt

nape pain and distorted lower lips as observed by her relatives,which made them seek medical consultation at PIPOL’s. Her

blood pressure upon admission is 140/100 and was admitted for

1 day due to persistent Hypertension. She was referred to CVMC

for further management and evaluation and was confined for 3

days.

2009, the patient had chicken pox which made her consult toMakati Hospital. However, she was not able to finish her check

up and was not prescribed any medications.



February 5, 2011 – The patient experienced fever with chills with

abdominal pain, hence seek medical consultation at

Tuguegarao City People’s General Hospital and was referredto CVMC for further evaluation and management. She was

diagnosed to have Diabetes Mellitus Type 2 and UTI. She was

confined for 1 week and discharge on February 13. She went

for follow-up check-up on February 17 and was noted to have

bipedal edema. She was prescribed with Spironolactone and

to continue her previous medications.

February 22, 2011 – the patient complained of fever and “pigsa” at

her right buttocks hence admitted and confined for less than

1 week. She underwent incision and drainage. Her boil

healed.

March – the patient seek follow-up check-up. She still has bipedal

edema and was advised to continue her medications.

April 6 – 2 days prior to admission, the patient experienced “pigsa”

again at her left buttocks and swelling of the feet. Few hours

PTA, the patient had difficulty of breathing which made her

relatives seek medical consultation at CVMC. She was

admitted under the service of Dr. Jena Lynn Alan, yellow

team, with admitting diagnosis of Diabetes MellitusNephropathy.

FAMILY HISTORY



SOCIAL

Educational Attainment: Elementary graduate

Active Filipino Citizen

Attends Barangay meetings

Attends Barangay activities



GORDON’S 11 FUNCTIONAL HEALTH PATTERN

1. HEALTH-PERCEPTION HEALTH MANAGEMENT PATTERN

BEFORE HOSPITALZATION

•

According to the patient,“Malusog ang tao kapag kumakain siya nggulay at kapag wala siyang sakit.

• She usually skips breakfast and regularly eats her lunch and dinner

• She self-medicates whenever she has cough and colds.

• She rarely goes to hospital for check-up unless her condition is getting

worse.

• She does not take any vitamins.

• She has no known allergies to food and drugs.

DURING HOSPITALZATION

• She perceives herself as unhealthy because she is diagnosed withdiabetes.

• In order to manage her condition she follows the orders of the doctor



• She consumes about 5 bottles of 8 oz coke and 3 cups of coffee in a

day.

• Her water intake is at least 10 full glasses of water a day.

DURING HOSPITALIZATION

• Sugar Mommy is under DM diet.

• She said that her appetite has decreased.

• She usually eats the food served at CVMC.

• Her snacks usually consist of “lugaw” and juice.

• Her water intake is 5 glasses of water a day.

• She doesn’t drink coffee or coke anymore since it is prohibited.

3. ELIMINATION PATTERN

BEFORE HOSPITALIZATION

• According to the patient, she passes stool every other day.



• She does not experience difficulty in passing stool.

• She complains of pain during urination.

4. ACITIVITY-EXERCISE PATTERN


• According to the patient, she does not exercise but does the household

chores such as cleaning the house and washing the dishes.

• She is capable of performing her daily activities.

• She is also capable of doing her job as a cook.

• She verbalizes that she doesn’t get tired easily.


• The patient said that she does not exercise since she’s at the hospital.

• She just lies on bed to rest and sleep because she feels weak.

• She is still unable to perform her self-care activities

• She gets tired easily.




• According to the patient, she still sleeps at around 9 10 pm and wakes

up at 5 in the morning.

• She has more time to sleep and usually takes a nap at around 1-3 in

the afternoon.

• She experiences difficulty in sleeping because of the pain sheexperiences at her gluteal area.

6. COGNITIVE-PERCEPTUAL PATTERN


• According to the patient, she is an elementary graduate.

• She does not see clearly anymore. She cannot read newsprints. She

wears eyeglasses to aid her in reading. Unfortunately, she broke

eyeglasses and was not able to buy a new one.

• She is oriented to person, place, and time but unable to recall past

events especially exact dates, places and person.

• She can speak Itawes, Ybanag, Ilocano and Tagalog.



• Her family is her source of happiness.


• She perceives herself as unhealthy. She prays hard for her condition to

get better.

• Her source of strength and happiness are still his friends and family.

Moreover she verbalized. “Tanggap ko na po may sakit ako. Walanaman po akong sinisisi sa nangyari.”

8. ROLE-RELATIONSHIP PATTERN


• Patient Sugar Mommy is the 3rd child among the 4 children in the

family. She has harmonious relationship with her siblings and still

maintains communication with them.

• As a mother and wife, she is very responsible and loving. She never

fails to keep in touch with her children even if they are in Manila and

have their own families already.

• Moreover, she has good relationship with her neighbors.



• She and her husband tried different methods of family planning such

the rhythm method, withdrawal, IUD and oral contraceptive pills.

10. COPING-STRESS PATTERN


• According to Sugar Mommy, whenever she has problems, she shares it

to her husband right away. She also talks to her friends and children to

ask for advice.

• She prays and watches television whenever she feels stressed.


• She copes with her situation by saying her problems to her husband

and children. She also sticks with her treatment regimen in order to

manage her situation. Moreover, she asks God for help and guidance.

11. VALUE-BELIEF PATTERN

BEFORE HSOPITALIZATION

• Sugar Mommy is a Roman Catholic. She goes to mass every Sunday.

She prays every day especially before going to bed. She highly

respects and observes the practices of the Catholic Church.



COURSE IN THE WARD

Date/Time Doctor’s Order Rationale Nursing



Date/Time Doctor s Order Rationale NursingResponsibility

04-06-11 Admit to medical wardunder the service of yellow team.

For furtherevaluation,treatment and mgt.on the condition of the patient for thecontinuity of

holistic care.

Assisted thepatient in theward, performinitial assessmentand vital signs.

Secure consent foradmission andmanagement

For legal basis anddocumentation

Clarified patient’sunderstandingregarding contentof consent foradmission andwitnessed.

DM diet To control further

increase of patient’s bloodsugar level.

>Instructed

patient to avoideating too muchcarbohydratesand sweets.>InformedNursing Aideabout the diet of the patient

V/s q hourly and record To assess anydeviation in thevital signs and forbaseline purposes.

Monitored andrecorded vitalsigns taken hourlyand reported anyalterations fromnormal ranges.

Diagnostics: CBC withAPC

Na, K, Ca

BUN, CREA

>To determinelevels of blood

component>To determine Na,K, & Ca levels inthe blood

>Facilitatedlaboratoryrequests.



ANATOMY AND PHYSIOLOGY

THE ENDOCRINE SYSTEM

The endocrine system consists of ductless glands. Some glands of the

endocrine system perform more than one function.

Major functions

1. Regulates metabolism and growth

2. Regulates absorption of nutrients

3. Regulates fluid balance and ion concentration

4. Regulates the body’s response to stress

5. Regulates sexual characteristics, reproduction, birth and lactation

ENDOCRINE GLANDS AND THEIR HORMONES

Pancreas, insulin, and diabetes

The pancreas is an elongatedorgan located toward the back of

the abdomen behind the stomach. The pancreas has digestive and

hormonal functions. One part of the pancreas,

the exocrine pancreas, secretes digestive enzymes. The other part

http://www.emedicinehealth.com/script/main/art.asp?articlekey=21288












Insulin is released from beta cells primarily in response to the

elevated blood glucose levels and increased parasympathetic

stimulation that is associated with digestion of a meal. Increased

blood levels of certain amino acids also stimulate insulin secretion.

Decreased insulin secretion results from decreasing blood glucose

levels and from stimulation by the sympathetic division of the

nervous system. Sympathetic stimulation of the pancreas occurs

during physical activity. Decreased insulin levels allow blood

glucose to be conserved to provide the brain with adequate glucose

and to allow other tissues to metabolize fatty acids and glycogen

stored in the cells.

Glucagon is released from the alpha cells when blood glucose levels

are low. Glucagon binds to membrane-bound receptors primarily in

the liver and cause the conversion of glycogen stored in the liver to

glucose. The glucose is then released into the blood to increase

blood glucose levels. After a meal, when blood glucose levels are

elevated, glucagon secretion is reduced.

Insulin and glucagon function together to regulate blood glucose

levels. When blood glucose level increase, insulin secretion



LABORATORY EXAMINATION

April 7, 2011

1. Hematology Result Form

NORMAL RESULT ACTUAL RESULT ANALYSISHemoglobin Massconcentration

(male- 135-145;female-120-160g/dl)

87 g/dl Due to decreaseoxygen in theblood.

Erythrocytevolume fraction

(male-0.40;female- 0.38-

0.47)

0.26 Due to decreasedhemoglobin

synthesis

Erythrocytenumberconcentration

(4.5- 6.0x10^9/L)

3.26 Due to decreasedhemoglobinsynthesis

Thrombocytenumber

(150-400 x10^9/L)

508 Due to benignreaction to

infectionLeukocytenumberconcentration

(4.5-11 x 10^9/L) 27.53 Due to benignreaction toinfection



2. Blood Chemistry

NORMAL RESULT ACTUALRESULT

ANALYSIS

BUN (1.70-8.30mmol/L)

19.87 Due to impairedkidney function

Creatinine (44-97) 200.09 Due to renalinsufficiency

ALT (0.00-41.00 u/L) 24.41 NORMALAST (0.0-42.0 u/L) 17.1 NORMALNA⁺ (135-145 mmol/L) 140.4 NORMALK⁺ (3.5-5.4 mmol/L) 3.19 Due to metabolic

imbalance

3. Clinical Chemistry

NORMAL RESULT ACTUAL RESULT ANALYSISGlycosylatedHgbA

(4.0-6.3) 13.79 Due toincompliance of medication anddiet



Cannula (check)



April 8, 2011


NORMAL RESULT ACTUAL RESULT ANALYSISHemoglobin Mass

concentration

(male- 135-145;

female-120-160g/dl)

130 g/dl NORMAL

Erythrocytevolume fraction

(male-0.40;female- 0.38-0.47)

0.39 NORMAL

Erythrocytenumber

concentration

(4.5- 6.0 x10^9 /L)

4.61 NORMAL

Thrombocytenumber

(150-400 x10^9/L)

477 Due to benignreaction toinfection

Leukocytenumberconcentration

(4.5-11 x 10^9/L) 32.6 Due to benignreaction toinfection

2 WBC Diff ti l C t



April 16, 2011


NORMAL RESULT ACTUAL RESULT ANALYSISWBC 4.5-11 X 10^9/L 27.5 X 10^9/L Due to bacterial

infectionRBC 4.5-6.0 4.71 NORMALHgB 120-160 g/L 131 g/L NORMALHct 0.38-0.47 0. .427 NORMALMCY 80-100 fL 91 fL NORMAL

2. WBC Differential Count

NORMAL RESULT ACTUAL RESULT ANALYSISNeutrophils (35-65) 87.3 Due to bacterial

infectionLymphocyte (20-40) 6.1 Due to bacterial

infection

Monocyte (0-5) 1.5% Due to bacterialinfection

Eosinophil (2-8) 4.5% Due to bacteriali f ti



PHYSICAL ASSESSMENT

Date assessed: April 09, 2011General assessment: The patient is awake, conscious and coherent

The patient is on green blouse and brown shorts. She is notwell groomed with hair unkempt.With ongoing IVF of PNSS IL X KVO

Vital signs: T=37.1 o C, RR=25 cpm, BP=130/80 mmHg, PR=80 bpm

AreaAssessed

Technique NormalFindings

Actual Findings Evaluation

SkinColor Inspection Light brown,

tanned skin(vary accordingto race)

Tanned skin Normal

Presence of lesions andother skinabnormalities

Inspection Intact skin, nolesions orabrasion

With boils atthe left glutealarea

Due toabscess atthe leftgluteal area

Soles andpalms

Inspection Lighter coloredpalms andsoles

Lighter coloredpalms andsoles

Normal

Moisture Inspection/Palpation Skin normallydry Skin normallydry Normal

Temperature Palpation Normally warm Normally warm NormalTexture Palpation Smooth and Slightly rough Due to



Capillary refill Inspection/Palpation

nail bed underpressure should

return to pinkwithin 2-3seconds

nail bed underpressure

returned topink within 2-3seconds

Normal

b. HairDistribution Inspection Evenly

distributedEvenlydistributed

Normal

Color Inspection Black (varieswith age and

race)

Black with greyhair

Normal

Texture Inspection/Palpation

Smooth Coarse Due to self-care deficit

EyesEyes Inspection Parallel to each

otherParallel toeach other

Normal

Reaction

to light

Inspection

(penlight)

PERRLA- Pupils

equally roundreact to lightandaccommodation

PERRLA- Pupils

equally roundreact to lightandaccommodation

Normal

Visual Acuity Inspection Able to readletter or newsprint

Unable to readletter or newsprints; with the

aid of eyeglasses

Due toaging

Eyebrows Inspection Symmetrical in Symmetrical in Normal



Symmetry Do not cover

the pupil andthe sclera, lidsnormally closesymmetrically

the pupil andthe sclera, lids

normally closesymmetrically

Normal

Conjunctiva Inspection Transparentwith light pinkcolor

Transparentwith light pinkcolor

Normal

Sclera Inspection Color is white Color is white Normal

Cornea Inspection Transparent,shiny

Transparent,shiny

Normal

Pupils Inspection Black, constrictbriskly

Black, constrictbriskly

Normal

Iris Inspection Clearly visible Clearly visible NormalEarsEar canal

opening

Inspection Free of lesions,

discharge orinflammation

Canal wallspink

Free of lesions,

discharge orinflammation

Canal wallspink

Normal

Normal

HearingAcuity

Inspection Client normallyhears wordswhen

whispered

Client normallyhears words insoft voice

Normal

NoseShape, sizeand skin color

Inspection Smooth,symmetric with

Smooth,symmetric Normal



Gums Inspection Slightly pinkcolor, moist

and tightly fitagainst eachtooth

Slightly pinkcolor, moist

and tightly fitagainst eachtooth

Normal

Tongue Inspection Moist, slightlyrough on dorsalsurfacemedium or dullred

Moist, slightlyrough ondorsal surfacemedium or dullred

Normal

Teeth Inspection Firmly set,shiny32 teeth

Firmly set,yellow coloredteeth, 8 teethUsesprosthesis

Due toaging

NeckSymmetry of neck muscles Inspection

Neck is slightlyhyperextended,without massesor asymmetry

Neck is slightlyhyperextended,withoutmasses orasymmetry

Normal

Neck ROM Inspection Neck movesfreely, withoutdiscomfort

Neck movesfreely, withoutdiscomfort

Normal

Thorax and

Lungs

Breathsounds

Auscultation Clear breathsounds

Clear breathsounds

Normal



Size

ROM

Inspection

InspectionEqual size

Full mobility of each jointmovement isdeliberate,accurate,

smooth andcoordinated

Equal size

Full mobility of each jointmovement isdeliberate,accurate,smooth and

coordinated

Normal

Normal

LowerExtremity

Skin Color

Size

ROM

Inspection

Inspection

Inspection

Light brown,tanned skin(vary accordingto race)

Equal size

Full mobility of

each jointmovement isdeliberate,accurate

Tanned skin

With non-pitting edemaon bothextremities

Full mobility of

each jointmovement isdeliberate,accurate

Normal

Due to fluidvolumeexcess

Normal



feelings withresponse to the

situation

feelings withresponse to

the situation



DRUG STUDY

CEFTRIAXONE

Classification: antibiotic

Indication: treatment of systemic infections caused by susceptible strains of microorganisms

Actions: third generation cephalosporins that inhibits cell-wall synthesis,

promoting osmotic instability, usually bacteridal

Contraindication: Use cautiously in patients hypersensitive to penicillin

because of possibility

Adverse Reactions: fever, headache, dizziness

Nursing Responsibilities:

• Check if the patient has allergy to the drug by doing skin test

• Observe ten rights in giving medications

• Note further reactions after administration



• Monitor fluid intake and output

• Watch for signs of hypokalemia, such as muscle weakness and cramps

FERROUS SULFATE

Classification: hematologic Drugs

Indications: iron deficiency

Actions: Provides elemental iron, an essential component in the formation of

hemoglobin

Contraindications: Peptic ulceration, in those receiving repeated blood

transfusion

Adverse Reactions: Nausea, epigastric pain, vomiting, constipation, blackstools, diarrhea, anorexia


• Monitor hgb level, hct and reticulocyte count during therapy.

CALCIUM CARBONATE

Classification:G.I Drugs



SODIUM BICARBONATE

Classification: Drugs for fluid and electrolyte balance, Antacid

Indications: Antacid

Actions: Restores buffering capacity of the body and neutralizes excess acid

Contraindications: contraindicated to patient with metabolic and respiratory

alkalosis

Adverse Reactions:nausea or vomiting, headache, sever mood changes,

muscle pain, swelling of feet, ankles or legs decreased appetite, unusual

tiredness, constipation

Nursing Responsibilities:obtain blood pH, partial pressure of arterial oxygen,

partial pressure of arterial carbon dioxide, and electrolytes level

ATORVASTATIN

Classification:Antilipemics

Indications: To reduce LDL cholesterol

Actions: Inhibits HMG-CoA reductase, an early step in cholesterolbiosynthesis

Contraindications: Contraindicated to patient hypersensitive to drugs and in



Indications: Hypertension

Actions: Inhibits calcium ion influx across cardiac and smooth muscle cells,

thus decreasing myocardial contractility and oxygen demand

Contraindications: contraindicated to patients hypersensitive to drugs and

with hypotension

Adverse Reactions: Headache, somnolence, fatigue, dizziness


Monitor BP frequently during initiation of therapy. Because drug

induced vasodilatation has a gradual onset, acute hypotension is rare.

LOSARTAN

Classification:

Indications: Hypertension

Actions: Inhibits vasoconstrictive and aldosterone secreting action of

angiotensin II by blocking angiotensin II receptor on the surface of vascular

smooth muscle and other tissue cells.

Contraindications:Use cautiously in patient with impaired renal or hepatic

functions



Actions: Inhibits bacterial protein synthesis by binding the 50S subunit of the

ribosome

Contraindications: Contraindicated to patient hypersensitive to drug or

lincomycin.

Adverse Reactions: Thrombophlebitis, nausea, vomiting. Abdominal pain,

diarrhea


Obtain specimen for culture and sensitivity test before giving he first

dose. Observe patient for signs of super infections.

MEFENAMIC ACID

Classification: Non-steroidal Anti-inflammatory drug

Indications: short-term treatment of mild to moderate pain from variousconditions

Actions: inhibits the enzyme cyclooxygenase (COX)-1 and COX-2 and reduces

the formation of prostaglandins and leukotrienes. It also acts as an

antagonist at prostaglandin receptor sites. It has analgesic and antipyretic

properties with minor anti-inflammatory activity.

Contraindications: inflammatory bowel disease, peptic ulcer, neonates,

coronary artery bypass graft surgery, severe renal impairment, severe heart

failure



Indication: Hypokalemia. As prophylaxis during treatment with diuretics

Dosage: 1 tab BID

Contra Indication: Renal insufficiency, hyperkalemia, untreated Addison’s

disease,

stricture of the esophagus and or destructive changes in the

alimentary tract.

SP: Obstructive changes in the alignmentary tract, stricture of the

esophagus. Heart/

Kidney disease. Pregnancy and lactation

DI: K salts and K- sparing diuretics ,e.gspironolacture , amiloride ,

triamferene,

tacrolimus. ACE inhibitors.


1. Instruct patient to take drug with meals.2. Instruct pt. to swallow the drug whole with ½ glass of liquid, do not

chew/crush.

3. Do not administer to a pt. in a supine position.



Discharge Teachings

Medicationa. Advice to strictly adhere to treatment regimen especially

on supplementsb. Always check the expiration of medicines before taking.

Environment

a. Provide an environment conducive for patients recoveryb. Maintain a clean and well ventilated environment to

prevent spread of infection. Encourage the SO and the

patient to clean environment specially their own backyardor place to allow good rest and stress free surroundings forthe patient to regain strength and comfort.

c. Patient/SO will provide clean environment which is free

from infectious agents and to allow patient to rest with a

clean surrounding.



Advice exercise same time every day, preferably when peak of glucose level.

Regular exercise

a. Maintain ideal body weightb. Maintain cardiovascular reservesc. Maintain normal blood sugar-total cholesterol, triglyceridesd. Monitor fbs-increase 140 twice get possible dm

Inform the patient the importance of follow-up appointments

• Promotion of health from illness.

• Healing process from treatment

Foot care

o Avoid walking barefoot

o Do not soak feet in cold water

o No to use alcohol

o Use lotion & moisturizero Instruct to inspect the shoes all the times

o Cut the nails straight across



• Advice moderation in alcohol

• Excessive salt intake is to be avoided

• Artificial sweeteners are to be used in moderation.• Meals should be evenly distributed throughout the day.



NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Data:

“Sumasakit samay bandangpwet ko”, asverbalized by thepatient

Objective Data:

• Facial grimace

• Guardingbehavior

• (+)Irritability

• (+)restlessness

• Pain scale of 7/10

• BP:140/100

Alterationincomfort;Pain r/ttraumatized nerveendingssecondaryto tissuedestruction.

After 30minutes of nursingmanagement,the patientwill manifestsigns of relief like (-)irritability,facial grimace,restlessnessand patient’spain scale willdecrease from7/10 to 3/10

• Encourageddeep breathingexercises

• Placed theclient incomfortableposition (rightside lying and

semi fowler )

• Providedrelaxationexercises ortechniques.

• Provided back

rubs

• Administeredanalgesic asordered

• To distractattention andreduce tension

• To allocatepain and topromotecomfort

• The goal of thesetechniques isto reducetension,subsequentlyreducing pain.

• To promote

nonpharmacological pain

management.

• To maintainacceptablelevel of pain

After 30minutes of nursingmanagement, thepatientmanifestedsigns of relief like (-)irritability,facialgrimace,restlessnessandpatient’spain scaledecreasedfrom 7/10 to3/10



(Mefenamic acid500mg /tab q 4hours)


Objective Data:

• Capillaryrefill time of 3 seconds

• Pale skin,conjunctivaand buccalmucosa

• Presence of edema

• Delayedwoundhealing

• Hgb = 87

mg/ dl• Erythrocytes

numberconcentration = 3.26

• Pulse rate =63bpm

•

Alteredperipheraltissueperfusionrelated todecreasedarterial

blood flow

Within theshift thePatient willdemonstrateincreasedtissueperfusion as

manifestedby strongperipheralpulses, vitalsigns withinnormalrange,absence of edema andnormalcapillary refilltime.

• Positionedproperly(moderatehigh backrest).

• Performedpassiverange-of-motion (ROM)exercises tounaffectedextremityevery 2 to 4hours.

• Provided quietand restfulatmosphere

• Caution clientto avoidactivities thatincrease

• This promotes

optimal lung

ventilation and

perfusion.

• Exercise

prevents

venous stasis.

•

Conservesenergy and

lowers tissue

O2 demand

• Conserves

energy and

lowers tissue

Goalpartiallymet.After an 8hournursingintervention

the patientthedemonstratedincreasedtissueperfusion asmanifestedby strongperipheralpulses, vitalsigns withinnormalrange, (+)edema anda capillaryrefill time of 1-2



cardiacworkload

• Hooked to O2as needed.

• Emphasizedimportance of takingprescribedmedications

O2 demand

• This saturates

circulating

hemoglobinand increases

the

effectiveness

of blood that is

reaching the

ischemic

tissues.

• Strictadherence to

medication

regimen results

to better health

outcome

seconds.




SubjectiveData:

• “ Nursepakitinginnaman itongsugat ko,”asverbalized bythe patient

Objective Data:

• Presenceof areddened

• pus-filled

• warm andtenderlump onthe upperleftglutealarea

Impairedskinintegrityrelated toinflammatory responsesecondaryto

infection/boil.

Within 8hours of nursingintervention thepatient willbe keptclean and

free fromany furtherinfection.

• Encouragedverbalization of feelings

• Changed positionfrequently, movepatient carefully

• Recommend clientto use lotion andmoisturizer to helppromote a soothingskin.

• Emphasized properhygiene like:

Handwashingbefore and aftertouching theinfected area

• To establishrapport andacquireadditionalinformation

• Decreases

pressure on

edematous,

poorly perfused

tissues to

reduce

ischemia.

• Lotions andointments may

be desired torelievedry, cracked ski n

• To preventfurther infection

After an 8hour of goodnursinginterventionthe patienthas beenclean and isfree from anyfurther

infection

http://bsnurse.com/ncp-impaired-skin-integrity-rt-decreased-peripheral-circulation/







Wound care done

Keeping the skinclean

Keeping the nailsshort

• Informed about theimportance of takingantibiotics and otherprescribed medications

• To promoteadherence tomedicationregimen forbetter healthoutcome

dm case final

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