TARLAC STATE UNIVERSITY COLLEGE OF NURSING Lucinda Campus Brgy.

Ungot, Tarlac City

A Case Study on Diabetes Mellitus Type II

In Partial Fulfillment of the Requirements of the Subject Nursing Care Management 101 RLE

Presented to the Faculty Of the Tarlac State University College of Nursing

Presented by: BSN III - D Group D4 Sotelo, Jeffrey R. Suarez, Christine Karen A. Suba, Mary Joy L. Sumang, Jerico B. Sy, Ruby Ann U. Tabago, Nicole Angelo M. Tan, Jaizelien D. Timbang, Michael Rico M. Tipay, Renceeh S. Tolentino, Troy T. Tomas, Judith G.

Date Submitted: October 19, 2009

TABLE OF CONTENTS: A. Acknowledgement I. Introduction a. Reason for choosing this case study b. Importance of the study II. Objectives of the Study III. Personal Data a. Demographic Data b. Environmental Status c. Lifestyle IV. Family History of Health and Illness V. History of Past Illness VI. History of Present Illness VII. 13 Areas of Assessment VIII. Anatomy and Physiology IX. Pathophysiology a. Book Based b. Patient Based X. Nursing Care Plan/s XI. Medical Management/Treatment a. Names of Drugs b. Type of Diet c. Type of Exercise XII. Soapie/r XIII. Conclusion XIV. Recommendation XV. Bibliography

Acknowledgment The group would like to extend their gratitude to the following: To their Clinical Instructor, Ms. Elaine Alamo, R.N., R.M, for giving her time in editing and checking our Case Study. The group thanked her for guiding us as we had our duty at the Community Health Nursing RHU at Baras Baras, Tarlac City for assisting us on the chosen case study. To Mrs. R and her family for sharing their knowledge and information needed for the case study. We express our gratitude for the kindness of Mrs. R and willingness to cooperate. To the members of the group: Jeffrey R. Sotelo, Christine Karen A. Suarez, Mary Joy L. Suba, Jerico B. Sumang, Ruby Ann U. Sy, Nicole Angelo M. Tabago, Jaizelien D. Tan, Michael Rico M. Timbang, Renceeh S. Tipay, Troy T. Tolentino, and Judith G. Tomas, for their efforts, and continuous cooperation in finishing this Case Study. To our Dean, Prof. Lucila O. Sunga, we express our cordial gratitude for continuously guiding us and encouraging us to become competent nurses in the future. To our beloved parents, we thank you for giving us the opportunity and encouragement in taking up the nursing course, and for showing their support morally and financially. And above all, we would like to express our sincerest homage and love to our Lord God, who constantly guides us in this course of our life. The group thanked him for his unconditional love for each and every one of us.

I. INTRODUCTION One of the common endocrine diseases affecting all age groups is Diabetes Mellitus. However, there seem to be both hereditary (genetic factors passed on in families) and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the bodys defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role. (www.yahoohealth.com) Diabetes Mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Normally a certain amount of glucose circulates in the blood. The major sources of this glucose are absorption of ingested food in the gastrointestinal (GI) tract and formation of glucose by the liver from food substances. (Brunner and Suddarths Textbook of Medical and Surgical Nursing, 11th Edition) There are two major types of Diabetes Mellitus: Type I and Type II. Type I diabetes is characterized by destruction of the pancreatic beta cells. It is thought that combined genetic, immunologic, and possibly environmental (eg, viral) factors contribute to beta cell destruction. Although the events that lead to beta cell destruction are not fully understood, it is generally accepted that a genetic susceptibility is a common underlying factor in the development of type 1 diabetes. People do not inherit type I diabetes itself; rather, they inherit a genetic predisposition, or tendency, toward developing type I diabetes. Type II diabetes are insulin resistance and impaired insulin secretion. Insulin resistance refers to decreased tissue sensitivity to insulin. Normally, insulin binds to special receptors on cell surfaces and initiates a series of reactions involved in glucose metabolism. In type II diabetes, these intracellular reactions are diminished, thus rendering insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver. The exact mechanisms that lead to insulin resistance and impaired insulin secretion in type II diabetes are unknown, although genetic factors are thought to play a role. (Brunner and Suddarths Textbook of Medical and Surgical Nursing, 11th Edition) Diabetes mellitus affects about 17 million people, 5.9 million of whom are undiagnosed. In the United States, approximately 800,000 new cases of diabetes are diagnosed yearly. Diabetes is especially prevalent in the elderly, with up to 50% of people older than 65 suffering some degree of glucose intolerance. Among adults in the United States, diagnosed cases of diabetes increased 49% from 1990 to 2000, and similar increases are expected to continue (Centers for Disease Control and Prevention [CDC], 2002).

According to the Department of Health (DOH) of the Philippines, 13,854 per 100, 000 persons are having Diabetes Mellitus and it was updated last June 29, 2009. And it is the 8th leading cause of death in the country. (www.doh.com) REASON FOR CHOOSING THE CASE The group chose this case in able to disseminate information about Diabetes Mellitus. In particular, to this, the group wants to discuss the signs and symptoms that could possibly develop in the occurrence of the disease. Moreover, the possible complications that can occur if left untreated. In addition, this condition is ranked as the 8th leading cause of death in our country, according to Department of Health (DOH, 2009). IMPORTANCE OF THE STUDY This case study is important because the students can impart their knowledge and skills needed for the disease. With this, the student nurses will be able to provide the appropriate nursing interventions that would help in restoring the wellness of the patient regarding her condition. It provides broader understanding about the condition of the patient.

OBJECTIVES General: The objective of our case study is to develop and acquire skills and knowledge about the disease, and health promotion and as well, as provide health teachings to prevent further complications on the condition of the patient. Specific: Nurse Centered To provide necessary health teachings to the patient
To perform appropriate nursing interventions regarding the condition of the

patient To widen and enhance the student nurses knowledge and skills through additional research about the nature of the disease, its signs and symptoms, its pathophysiology, its diagnosis and treatment. To describe effects of illness on individuals and family members roles and functions To apply the nursing process in the care of the patient

Patient Centered Discuss indications for and management of clients with Diabetes Mellitus. To know, when to seek help from the health care providers whenever signs and symptoms occur. To know what other complications may arise, if left untreated.

 Encourage the client and the family to ask questions so that information can be clarified and understand. Identify major risk factors for the development of Diabetes Mellitus. II. NURSING PROCESS A. Assessment 1) PERSONAL DATA a. Demographic Data Name: Age: Sex: Civil Status: Occupation: Religious Affiliation: Role position in the family: Address: Date and Place of birth: Nationality: Health Care Financing: Mrs. R 55 years old Female Widow House Keeper Roman Catholic Mother Baras - Baras, Tarlac City March 26, 1954 / Paniqui, Tarlac Filipino Family

b. Environmental Status Mrs. R is presently residing at Baras - Baras, Tarlac City. Their house is a mixed type of house made up of cement and wood. Their source of water is through water pump, which is located 2 meters away from their house. According to her, they have no other source of entertainment aside from their television set. Their garbage is collected thrice a week by local garbage collectors. The family maintains a good relationship with each other. In times of need, their relatives help them. They have their own drainage system but its not draining well. In times of boredom, Mrs. R goes to her neighbors and she would have some chitchat with them. In addition, their source of electricity is through Tarlac Electric Company (TARELCO), in which they pay monthly. c. Lifestyle According to Mrs. R, she usually has an 8-hour sleep. She sleeps at around 9:00 pm and wakes up at 5:00 am the following day. Before she had this condition, she is a dressmaker, but now she stays at home and does the household chores. Mrs. R is fond of eating foods with sugar like candies, ice cream, chocolates. Moreover, she eats almost 34 cups of rice every meal and do not have any control in it. Because according to her, it really does satisfy her. She is not drinking any form of alcoholic beverages nor is smoking cigarettes. According to her, her exercise is through doing household chores and taking care of her grandchild.

IV. FAMILY HISTORY OF HEALTH AND ILLNESS Paternal Side X X DM * * ** X DM * * DM * * ** * * ** * * * * X Maternal Side X X

* *

DM

X CHO

D M

D M

Legend: ** Male Female Patient X - Deceased Male - Deceased Female CHO - Cholecystitis DM Diabetes Mellitus

* *

V. HISTORY OF PAST ILLNESS Mrs. R said that she had asthma when she was still young and as far as she can remember, it was cured during her childhood years. Moreover, during her childhood years, she has experienced childhood illnesses like chicken pox, measles, fever and cough and during these situations; she takes Over-the-counter (OTC) drugs such as Paracetamol or herbal medicines like Lagundi. Regarding her immunization record, she said that she did not receive any kind of immunization because during her time, it is very expensive and some immunizations are not yet available that time. Mrs. R stated that she is not allergic to any drugs, insects, animals, or other environmental agents. She had undergone a procedure of Dilatation and Curettage (D&C) in her second pregnancy in the year 1990 because of miscarriage, aside from that she has never been hospitalized for any serious illnesses. VI. HISTORY OF PRESENT ILLNESS According to Mrs. R, the symptoms started 3 years ago and she experienced sudden changes like excessive urination, excessive thirst, frequent eating and as well as weight loss, but she ignored the symptoms. In June 2009, she decided to seek medical advice at the Tarlac Provincial Hospital (TPH) about the symptoms she is experiencing. She was diagnosed of having Type II Diabetes Mellitus. The physician prescribed Metformin HCl, 500 mg, to be taken twice a day after meals.

VII. 13 AREAS OF ASSESSMENT 7.1. SOCIAL STATUS Mrs. R is recently residing at San Roque, Tarlac City in an apartment before, but few months later, they decided to transfer in their new house and is now presently residing at Brgy. Baras-Baras, tarlac. She is the second eldest among the eight children in their family. The family maintains a good relationship with each other. According to her, they express their love and concern within the family by helping each other when they have their problems and doing the household chores together. Mrs. R mentioned that she is socially and occasionally active before her condition occurred, but now she is not active in mingling with others and because they are just a new resident of Brgy. barasbaras and she has no any vices at all. She can cope up with her stressors by relaxation and praying. She now accepts and understands her condition and was still hopeful to regain her good health. STANDARDS: Social support is a perception that one has an emotional and tangible resources to call on when needed; perceived social support is being followed by the family to express the love of the family, financial aspect is one of the normal constraints in the family.(Nursing fundamentals by Rick; Community Health Nursing in the Philippines.) Analysis and Interpretation: The patient develops interpersonal relationship within the family with a certain degree of satisfaction. She developed a good coping ability as evidenced by being hopeful to regain her normal functioning or health condition. 7.2. MENTAL STATUS Level of Consciousness During our visits for interview, Mrs. R acknowledges us and responds to the questions being asked to her. She is alert and aware with the time and place. She is also capable in establishing eye contact. Appearance and Movement Mrs. R was in sitting position during our visit. On our first visit for interview, she looks pale, weak and untidy. Moreover, on the following visits, the group noticed that she still looks weak because of thin body figure and she needs minimal assistance. Mood Mrs. R is coherent and attentive with all the questions being asked to her. Thought Process and Perception

Mrs. R can be able to express her thoughts and feelings about her condition and with the answers to the questions clearly and smartly. Cognitive Abilities Mrs. R understands about her present condition. STANDARDS: Appearance and behavior: posture must be relaxed. Body movement should be voluntary and coordinated. The patient should be dressed appropriately with the season, age and gender. Grooming and hygiene should be proper and neat. Facial grimace are a sign of pain to the patient level of consciousness for the patient should be alert, awake and aware of the stimuli. Facial expression should be appropriate with the topic being discussed. Ability to form words (articulation) should be understandable and clear. (Physical Examination and health Assessment, Carolyn Jarvis, 107-108) Analysis and interpretation: Based on the above standards, the patient is able to respond to questions and is oriented about the time and place where she is, and able to establish eye contact during the visits. Mrs. R can able to express her thoughts and feelings about her condition and with the answers to the questions clearly and smartly. But she looks pale, weak and untidy. 7.3. EMOTIONAL STATUS During the visit with Mrs. R, the group noticed that her emotional status was affected because of her condition. She is responsive and open with the questions being asked. However, the group asks questions about her condition, she keeps quiet and sometimes changes the topic. STANDARDS: Carrying out emotional feelings through words and facial expressions are normal signs of awareness on present condition. (Nursing Fundamentals by Rick Daniels) Peoples emotional patterns vary according to what the person feels. In times of sickness, the person experiences emotional problems that may either affect her own self on the persons significant others. (Fundamentals of nursing by Kozier) Analysis and Interpretation: Mrs. R can express her thoughts and feelings but her emotional status was still affected due to her condition. 7.4. SENSORY PERCEPTION Sense of Sight Mrs. R is experiencing difficulty in her vision. The group assessed Mrs. Rs vision by using the headline of a newspaper and instructed to read it but she cannot read

it clearly. According to her, she visited an ophthalmologist few months ago because of experiencing blurring of vision and the ophthalmologist recommended her to use eyeglasses. Moreover, her both eyes move in a smooth and coordinated manner in all direction. Mrs. R also established eye contact during the visits and interviews. STANDARDS: The patient should have a visual acuity on 20/20; lid margins are moist and pink; lashes short, evenly spaced and curled outward; blinking symmetrical, involuntary; bulbar conjunctiva is pale with no discharge; both eyes move in a smooth, coordinated manner in all directions. (Nurses Handbook of nursing Assessment, Weber, Janet) ANALYSIS AND INTERPRETATION: Mrs. R is experiencing difficulty in her vision because she cannot clearly read the words that the group asked her to read. She needs to wear her eyeglasses before she can read the words. Sense of Taste The tongue of Mrs. R was assessed and it is in the midline of the mouth, moist, smooth and pink with no lesions. The gum margins has no swelling. She can able to determine the foods taste with the use of salt, sugar, vinegar and coffee. The group a blindfold on her both eyes and instructed to taste and differentiate the four. STANDARDS: The tongue is in the midline of the mouth. The dorsum of the tongue should be pink, moist and rough without lesions. (Health assessment and physical assessment, Mary Ellen Zator Estes) ANALYSIS AND INTERPRETATION: The tongue of Mrs. R was assessed and it is in the midline of the mouth, moist, smooth and pink with no lesions. The gum margins has no swelling. Mrs. R does not have a difficulty in identifying various taste of foods. Sense of smell During the visits weve rendered, Mrs. R nose was symmetrical with no lesions and nodules. Mrs. R can differentiate and distinguished odors. The group used cologne and alcohol in assessing her sense of smell as the group instructed her to inhale and slightly smell as we passed it through her nose and close her eyes then identify if it is cologne or alcohol. STANDARD: The nose is smooth and symmetrical; with no lesions, no nodules, or masses; not-tender when palpated. The patient should be able to determine the different smells of different objects. (Health assessment and physical assessment, Mary Ellen Zator Estes) ANALYSIS AND INTERPRETATION: The nose of Mrs. R was symmetrical with no lesions and nodules. She can differentiate odor such as cologne and alcohol.

Auditory Acuity Mrs. Rs ears was assessed, it similar in appearance, smooth, without nodules and no tenderness or pain when palpated. She can hear the voice clearly and responds whenever the group asked questions and through whispered test, She can repeat the words clearly in a distance of 2 inches. STANDARD: The patient should be able to hear words within 2 inches away. The pt. should not complain of pain upon palpation. (Health assessment and physical assessment, Mary Ellen Zator Estes) ANALYSIS AND INTERPRETATION: Mrs. Rs ears are similar in appearance, smooth without nodules upon palpation. She can hear the voice clearly and responds whenever the group asks questions and can repeat the words clearly in a distance of 2 inches. 7.5. MOTOR STABILITY During our assessment, the group asked Mrs. R to walk to determine if she can move with or without assistance. As we have observed, Mrs. Rs motor stability is affected because she needs minimal assistance during ambulation. STANDARD: Full ranges of motion on voluntary muscles should be performed without much strain and there are no feelings of pain or tenderness. (Nurses Handbook of Health Assessment by Weber, Janet) Analysis and interpretation: Based on the given statement, Mrs. Rs motor stability is not in good condition. She can move but with minimal assistance during ambulation. 7.6. BODY TEMPERATURE As we go on to our assessment,we took her body temperature to identify if there is any problem. Date October 2, 2009 October 8, 2009 October 9, 2009 October 10, 2009 Time 1:30 pm 2:00 pm 9:30 am 10:00 am Body temperature(axilla) 36.1C 36.5C 36.3C 36.5C

STANDARD: Normal range of body temperature of an adult is 36.5C to 37.5C per axilla. (Fundamentals of Nursing by Rick Daniels)

Analysis and interpretation: normal range. 7.7. RESPIRATORY STATUS

As the data shown, Mrs Rs body temperature is in

Upon assessing her respiration rate ranges 19-22 cpm with no difficulty of breathing. Date October 2, 2009 October 8, 2009 October 9, 2009 October 10, 2009 Time 1:30 pm 2:00 pm 9:30 am 10:00 am Respiratory Rate 22 cpm 21 cpm 19 cpm 20 cpm

STANDARD: Normal respiratory rate for adults is 12-20 cpm. In terms of pattern, normal respiration must be regular and even in rhythm. The normal depth of respiration is non exaggerated and effortness. (Health assessment and Physical Examination 3rd edition by Mary Ellen Zator Estes) Analysis and interpretation: As we checked Mrs. Rs respiratory rate, it exceeded within the normal range, but she stated that she is not having trouble during respiration. 7.8. CIRCULATORY STATUS The table shows the pulse rate and blood pressure of Mrs R during our home visit: Date October 2, 2009 October 8, 2009 October 9, 2009 October 10, 2009 Time 1:30 pm 2:00 pm 9:30 am 10:00 am Pulse rate 84 bpm 81 bpm 85 bpm 80 bpm Blood pressure 120/110 mmHg 120/90 mmHg 130/90 mmHg 120/90 mmHg

STANDARD: Normal pulse rate ranges from 60 to 100 beats per minute and described as regular with equal bilateral strength upon bounding. Average blood pressure varies in different individuals, 120/80 mmHg was considered the standard rate. Standard rate of tissue perfusion is 2 to 3 seconds. Paleness is a sign of having poor blood circulation. Poor capillary refill is one of the manifestations of having arterial deficiency. (Fundamentals of Nursing by Kozier) Analysis and interpretation: Based on the data shown, the result of the pulse rate of the patient is in normal range. The blood pressure of Mrs. R is elevated. 7.9. NUTRITIONAL STATUS

During our assessment, Mrs. R is thin in appearance. Her weight is 42 kg (92 lbs) and her height is 5 feet. Her nutritional status, she is suffering from nutritional imbalance, she eats 3-4 times a day. She usually takes 6-8 glasses of water in a day. Formula of BMI BMI = Weight in kg Height in m Equation BMI = 42 kg 2.3226 Standard Scoring =18.08 < 18.5.underweight 18.5-24.9...normal weight 25.0-29.9overweight 30.0-39.9obesity 40>.............extreme obesity

Result: Normal weight

STANDARD: Average BMI is within 18.5-24.9. Height for weight is 100-124 lbs. The normal fluid intake should be 8-10 glasses of water per day. Diet as tolerated is the standard type of diet. (Health Assessment by Weber) Analysis and interpretation: Based on the data shown, Mrs R nutritional status is below the standard scoring compared to the norm. 7.10. SLEEP AND REST PATTERNS Mrs. Normally sleeps at around 9:00 pm and will wake up in 6:00 am in the morning (consuming 8-9 hours of sleep). When she diagnosed having Diabetes Mellitus she had still the same sleeping pattern. STANDARD: There is a wide range of sleep time that is considered normal. The average sleep of an individual is 8 hours per night. (www.umm.edu/sleep/normal_sleep.html) Analysis and interpretation: At her present condition, Mrs. R. has a normal sleep pattern consuming 8-9 hours, having her to have an enough sleep. 7.11. ELIMINATION STATUS According to her, she usually voids 2-3 times a day depending on the amount of fluid she takes. When she was diagnosed of having Diabetes Mellitus, she is voiding 5-6 times a day. She stated that she had 1 bowel movement per day, and has brownish in color stool, intact and in moderate amount. STANDARD: The normal bowel movement of a person must be 1 2 times a day and voiding of 2 3 times a day. The normal color of stool is brown and well formed. The urine is clear and yellowish in color. (Health Assessment and Physical Examination, 3rd edition by Mary Ellen Zator Estes)

Analysis and interpretation: Based on the data given Mrs. Rs bowel movement is normal while voiding has a deviation from normal as compared to the standard form. 7.12. REPRODUCTIVE STATUS Mrs. R had her first menarche when she was 16 yrs. Old. Her cycle usually last for 5 days. She experiences headache and pain on the pelvic area during her cycle. She usually consumes 2 3 fully soaked pads during her cycle. According to her, she is not sexually active because she said that she is too old for that. STANDARD: Menarche, which is the first menstruation occur at an average age of onset between 9 to 17 years old. (Maternal and Child Health Nursing 4th Edition by Pilliterri) Analysis and interpretation: The patient had a normal reproductive system since she had her menarche at the right age. 7.13. STATE OF SKIN AND APPENDAGES Generalized color: Mrs. R. had a fair complexion. Texture: There is no redness noted on the skin of Mrs. R. Moisture: The skin is dry, perspiration was absent on her. Temperature: The patient skin is warm and dry. STANDARD: Skin is warm to touch, and returns to its original state immediately within 2 -3 seconds. (Health Assessment and Physical Examination, 3rd edition by Mary Ellen Zator Estes) Analysis and Interpretation: Mrs. Rs skin and appendages status was not affected. There is no presence of redness on her skin, skin is warm to touch, and returns to its original state immediately within 2 seconds.

VIII. ANATOMY AND PHYSIOLOGY

The pancreas is a soft oblong gland about 6 inches long and 1 inch thick. It is found beneath the great curvature of the stomach and is connected by a duct to the duodenum of the small intestine the pancreas is divided into a head (the part closet to the duodenum) the body(the main part)and the tail. Internally, the pancreas is made up of clusters of glandular epithelial cells. One of group of these cluster, the islets of langerhans or the pancreatic islets form the endocrine portion of the gland and are therefore part of the endocrine system. Some of these clusters consist of alpha cells that secrete the hormone glucagons. Other clusters consist of beta cells that secrete the hormone insulin the other masses of cells are called the acini which are the exocrine glands of the organ. The acini release a mixture of digestive enzymes(lipases carbohydrases and proteases)called the pancreatic juice which leaves the pancreas through main tube called the pancreatic duct or duct of wirsung. The duct cells secrete sodium bicarbonate. In most individuals the pancreatic duct unites with the common bile duct of the liver and enters the duodenum is a common duct originally called the ampulla of vater but now is called the hepatopancreatic ampulla. The functions of the pancreas are therefore twofold the acini secrete enzymes that continue the digestion of food in the small intestine and the alpha and beta cells secrete the hormones glucagons and insulin which regulate and control blood sugar levels.

IX.I.) PATHOPHYSIOLOGY (Book Based)

Non Modifiable Factors: Age (> 45 y/o) Heredity Race/Ethnicity Hypertension (>140/90 mmHg) Obesity Modifiable factors: Diet (eating sugary foods such as delicacies, pastries and foods that have a content of carbohydrates like rice ( 3 4 cups per meal) Lifestyle (consuming 8 9 hours of sleep per night, watching television at lunch time, walking is her type of exercise) Lack of Immunization

Impaired insulin secretion Reduce tissue uptake of glucose

Intracellular hypoglycemia Glucogenesis and gluconeogenesis

Extracellular hyperglycemia

Hyperosmotic plasma Breakdown of fats High levels of ketones Diabetic ketoacidosis

Decreased protein synthesis, cachexia, lethargy, polyphagia Decreased gamma globulins, susceptibility to infections, impaired wound healing

Blood glucose > renal threshold

Glucosuria

Dehydration of cells Hyperglycemic coma

Polydipsia, polyuria, hypokalemia, hyponatremia

Medical-surgical nursing book

IX.II.) PATHOPHYSIOLOGY (Patient Based)

Modifiable factors: Diet (eating sugary foods such as delicacies, pastries and foods that have a content of carbohydrates like rice ( 3 4 cups per meal) Lifestyle (consuming 8 9 hours of sleep per night, watching television at lunch time, walking is her type of exercise) Lack of Immunization

Non Modifiable factors: Age ( 55 y/o ) Heredity

Impaired insulin secretion Reduce tissue uptake of glucose

Intracellular hypoglycemia Glucogenesis and gluconeogenesis

Polyphagia Weight loss

Extracellular hyperglycemia Blood glucose > renal threshold Polydipsia Polyuria

XI. Implementation a.) Medical Management i. Drugs Name of drug ( Generic name and Brand name) Generic name: Metformin Hydrochloride Brand name: Diazen Dosage, Route of Administration, Frequency 500 mg orally, twice a day Mechanism of Action Decreases hepatic glucose production, decreases intestinal absorption of glucose, and increases peripheral uptake and utilization of glucose. Indications/ Purposes As an adjunct to diet and exercise, to improve glycemic control in clients with Type II Diabetes. Adverse Reaction Hypoglycemia, headache, nausea, vomiting, diarrhea, abdominal pain or discomfort, anorexia, chills, rash, and flatulence.

Nursing Responsibilities BEFORE 1) Monitor blood sugar before giving medication 2) Ask if the patient have allergy to the drugs. AFTER 1) Monitor for side effects of the drugs. 2) Checked the effectiveness of the medication.

ii. Diet Date Ordered, date Started, Date Changed

Type of Diet

General Description

Indication/s or Purpose/s

Specific Foods Taken

Clients Response and/or Reaction to the Diet The patient understood the purpose and importance of low sugar diet.

Low Carbohydrate Diet

Strictly not To avoid Sugar allowed to further free take or limit complications any kind of foods or liquids that contains sugar.

NURSING RESPONSIBILITIES: Before, during and after the administration of the diet: 1. Explain the procedure. 2. Teach the patient and her family about the diet. 3. Document all pertinent data regarding patients diet.

iii. Exercise

Type of Exercise

Date Ordered, Date Started, Date Changed

General Description

Indication/s or Purpose/s

Clients response / reaction to the activity / exercise

Ambulation

Ambulation is the recommended for a healthy lifestyle, and has numerous environmental benefits.

For better She can tolerate progress of the walking without patients health assistance of status. significant others.

NURSING RESPONSIBILITIES: 1. Educate the patient about the importance of ambulation, and the appropriate way of doing the exercise. 2. Assisted the patient in ambulation.

XIV. RECOMMENDATION Based on what the group observed in the patients condition and what the group perceived as her needs. The group recommended the patient to continue medications as ordered by her physician in the right time and right dosage. The group also recommends to the patient to avoid eating fatty and salty foods, and she should eat foods high in fiber and limit to take foods that are high in sugar like pastries, cakes, chocolates, delicacies and dessert. The group recommends that patient should have regular exercise and monitor her glucose level regularly to determine if there is improvement on her condition. The group recommended to the patient to visit to their nearest Health Care Unit, and she should be alert to any deviations on her condition that will need immediate attention.

XV. BIBLIOGRAPHY

Fundamentals of Nursing, Daniels Fundamentals of Nursing: Process, Concepts and Practice, 7th Edition Health Assessment and Physical Examination, 3rd edition by Mary Ellen Zator Estes Brunner and Suddarths Textbook of Medical - Surgical Nursing, 11th Edition Nursing Diagnosis Handbook, 5th Edition 2006 by Ackley and Ludwig Friedman and Smith, 1998 www.umm.edu/sleep/normal_sleep.html http://medical-dictionary.thefreedictionary.com/nutritional+status www.scribd.com www.yahoo.com www.google.com www.nursingcrib.com

XIII. CONCLUSION

Having this case made us familiar about the disease Diabetes Mellitus. It increased our knowledge and awareness about these, thus will make us more knowledgeable and competent in doing such procedures that will intervene in the said disease. All objectives are constructed for our patients benefit and as well as for the group. In order for us to have prioritized nursing actions, we constructed and considered all the objectives that we gathered from our patient. In doing this, we have gained lots of knowledge that we know it can improve and develop our skills as a student nurse and as a future registered nurse someday. Finally, this case study developed our cooperation and unity in doing something that is very essential for a person to do such thing like a case study.