6. DIAGNOSTICS AND LABORATORY PROCEDURES Diagnostic/ Laboratory Procedures Complete Blood Count CBC!

"BC count Date Ordered Date results IN ##/#$/%& Indication or Purpose Results Normal Values Analysis and Interpretation of results

Lymp)ocytes

4osinop)ils

6emoglobin

'(easures t)e number of "BCs in a cubic mm of blood* 'It is used to detect infection or inflammation and to monitor client+s response to or ad,erse effects of c)emot)erapy or radiation t)erapy* '/o determine immune function1 pro,ides a gross measure in nutritional status* '/o fig)t infection and control mec)anism associated 0it) allergies and ast)ma* '/o e,aluate t)e )emoglobin content iron status and O2 carrying capacity! of eryt)rocytes by measuring t)e

##*$ #%g/L

.'#% - #% g/L

/)e result is slig)tly abo,e t)e normal range 0)ic) may signify infection*

%*2#

%*2% ' %*3%

/)e result is 0it)in t)e normal range*

%*%#

%*%# ' %*%5 /)e result is 0it)in t)e normal range*

#%$g/L

#3% ' #7% g/L

/)e result is belo0 t)e normal range 0)ic) indicates anemia*

6ematocrit

no* of grams of )emoglobin /dl of blood* ' (easures t)e ,olume of RBCs in 0)ole blood e-pressed as a percentage* ' It is also a useful in t)e diagnosis of anemia1 polycyt)emia1 and abnormal )ydration states* 'Value is roug)ly t)ree times t)e )emoglobin concentration*

%*82

%*3% 9 %*.3

/)e result is belo0 t)e normal range 0)ic) indicates anemia*

Nursing Responsibilities Prior to t!e pro"e#ure 4-plain t)e procedure to t)e pt* and 0)y it is indicated Inform t)e patient t)at fluid and food restriction is not re:uired Inform t)e patient t)at a blood sample 0ill be ta;en* /ell t)e patient t)at )e may e-perience transient discomfort from t)e needle pincture <ill up laboratory re:uest form properly and send it to t)e laboratory tec)nician during t)e collection of sample/specimen* During t!e pro"e#ure Inform t)e patient t)at pain may be felt t)roug) pric; in t)e needle Instruct t)e patient to calm do0n to a,oid uneasiness*

A$ter t!e pro"e#ure

Apply brief pressure to pre,ent bleeding Apply 0arm compress if 6ematoma 0ill de,elop at t)e ,enipuncture site* Date Ordered Date results IN ##/#$/%& Indication or Purpose /o measure blood glucose regardless of 0)en you last ate* Results Normal Values > #3% mg/dl Analysis and Interpretation of results /)e result is abo,e t)e normal range 0)ic) indicates too little insulin/ diabetes mellitus*

Diagnostic/ Laboratory Procedures Random Blood =ugar

#3.*8 mg/dl

Nursing Responsibilities Prior to t!e pro"e#ure Inform patient t)at t)ere are no food restrictions* "as) your )ands t)oroug)ly before beginning procedure* Ready your meter according to on'screen instructions or o0ner?s manual e,ery meter is slig)tly different!* During t!e pro"e#ure =0ab your finger tip or arm if your meter allo0s! 0it) alco)ol and allo0 to dry or dry 0it) gau@e* "ipe a0ay t)e first drop of blood =:uee@e slo0ly and r)yt)mically1 gripping t)e digit firmly bet0een t)e base of t)umb and first finger* A$ter t!e pro"e#ure C)ec; for sample acceptance and allo0 time for t)e mac)ine to 0or;* Apply firm pressure to puncture 0it) an alco)ol 0ipe1 gau@e or a bandage 0)ile you 0ait*

Record your glucose le,el and follo0 your p)ysician?s guidelines pertaining to necessary actions for lo0 or )ig) glucose le,els*

Diagnostic/ Laboratory Procedures Aidney <unction /est Createnine

Date Ordered Date results IN ##/#$/%&

Indication or Purpose

Results

Normal Values

Analysis and Interpretation of results

/o monitor renal 8*$ function1 mg/dl specifically t)e ability of t)e ;idney to e-crete 0aste products

%*3'#*3 mg/dl

Creatinine le,el is abo,e t)e normal range 0)ic) indicates ;idney impairment*

Nursing Responsibilities Prior to t!e pro"e#ure 4-plain to t)e patient t)e purpose of t)e procedure* Inform t)e patient t)at )e need not restrict food or fluids before t)e test1 NPO post midnig)t C)ec; t)e patient+s )istory for use of drugs t)at may influence test results* Inform t)e patient t)at t)e test re:uires blood sample* 4-plain 0)om 0ill perform t)e ,enipuncture and 0)en it 0ill be done During t!e pro"e#ure 4-plain to t)e patient t)at may e-perience slig)t discomfort from t)e needle puncture and t)e tourni:uet but t)at collecting t)e sample usually ta;es less t)an 8 minutes Instruct t)e patient to calm do0n to a,oid uneasiness*

A$ter t!e pro"e#ure Apply 0arm compress if 6ematoma de,elops at t)e ,enipuncture site*

Apply pressure on t)e site to a,oid bleeding* Date Ordered Date results IN ##/#$/%& Indication or Purpose Results Normal Values Analysis and Interpretation of results

Diagnostic/ Laboratory Procedures =erum 4lectrolytes =odium Na!

/o reflect 0ater balance*

#8.*2 mmol/L

#8$ 9 #3. mmol/L

Potassium A!

C)loride Cl!

/o e,aluate fluid and electrolyte balances and identify renal dysfunction* Potassium is critical to neuromuscular function1 specifically s;eletal and cardiac muscle acti,ity* It reflects a c)ange in t)e dilution or concentration of t)e 4C< and does so in direct proportion to sodium concentration*

8*5 mmol/L

8*5 9 .*% mmol/L

/)e result is belo0 t)e normal range 0)ic) indicates t)at t)ere is a relati,e increase in t)e amount of body 0ater relati,e to sodium* /)e result is 0it)in t)e normal le,el 0)ic) indicates normal osmotic pressure and cardiac and neuromuscular electrical conduction* /)e result is 0it)in t)e normal range 0)ic) indicates normal balance of fluids*

&$ mmol/L

&5 9 ##% mmol/L

Be$ore t!e pro"e#ure 4-plain to t)e patient t)at t)e test is used to e,aluate t)e electrolytes content of blood* Inform t)e patient t)at )e need not restrict food or fluids before t)e test1 NPO post midnig)t C)ec; t)e patient+s )istory for use of drugs t)at may influence test results* Inform t)e patient t)at t)e test re:uires blood sample* 4-plain 0)om 0ill perform t)e ,enipuncture and 0)en During t!e pro"e#ure 4-plain to t)e patient t)at may e-perience slig)t discomfort from t)e needle puncture and t)e tourni:uet but t)at collecting t)e sample usually ta;es less t)an 8 minutes Instruct t)e patient to calm do0n to a,oid uneasiness*

A$ter t!e pro"e#ure Apply 0arm compress if 6ematoma de,elops at t)e ,enipuncture site* Apply pressure on t)e site to a,oid bleeding* Date Ordered Date results IN ##/#7/%& Indication or Purpose /o measure blood glucose after you )a,e not eaten for at least 7 )ours* It often is t)e first test done to c)ec; and monitor treatment of diabetes* Results Normal Values $% 9 ##% mg/dl Analysis and Interpretation of results /)e result is abo,e normal range 0)ic) indicates too little insulin/ diabetes mellitus*

Diagnostic/ Laboratory Procedures <asting Blood =ugar <B=!

#35 mg/dl

Nursing Responsibilities

Prior to t!e pro"e#ure As; patient if )e/s)e )ad not eaten at least 7 )ours* "as) your )ands t)oroug)ly before beginning procedure* Ready your meter according to on'screen instructions or o0ner?s manual e,ery meter is slig)tly different!* During t!e pro"e#ure =0ab your finger tip or arm if your meter allo0s! 0it) alco)ol and allo0 to dry or dry 0it) gau@e* "ipe a0ay t)e first drop of blood =:uee@e slo0ly and r)yt)mically1 gripping t)e digit firmly bet0een t)e base of t)umb and first finger* A$ter t!e pro"e#ure C)ec; for sample acceptance and allo0 time for t)e mac)ine to 0or;* Apply firm pressure to puncture 0it) an alco)ol 0ipe1 gau@e or a bandage 0)ile you 0ait* Record your glucose le,el and follo0 your p)ysician?s guidelines pertaining to necessary actions for lo0 or )ig) glucose le,els*

I.

ANATO%Y AND P&YSIOLOGY

4,ery cell in t)e )uman body needs energy in order to function* /)e body+s primary energy source is glucose1 a simple sugar resulting from t)e digestion of foods containing carbo)ydrates sugars and starc)es!* Blucose from t)e digested food circulates in t)e blood as a ready energy source for any cells t)at need it* Insulin is a )ormone or c)emical produced by cells in t)e pancreas1 an organ located be)ind t)e stomac)* Insulin bonds to a receptor site on t)e outside of cell and acts li;e a ;ey to open a door0ay into t)e cell t)roug) 0)ic) glucose can enter* =ome of t)e glucose can be con,erted to concentrated energy sources li;e glycogen or fatty acids and sa,ed for later use* ")en t)ere is not enoug) insulin produced or 0)en t)e door0ay no longer recogni@es t)e insulin ;ey1 glucose stays in t)e blood rat)er entering t)e cells* An'to() o$ t!e p'n"re's /)e pancreas is an elongated1 tapered organ located across t)e bac; of t)e abdomen1 be)ind t)e stomac)* /)e rig)t side of t)e organ called t)e )ead! is t)e 0idest part of t)e organ and lies in t)e cur,e of t)e duodenum t)e first section of t)e small

intestine!* /)e tapered left side e-tends slig)tly up0ard called t)e body of t)e pancreas! and ends near t)e spleen called t)e tail!* /)e pancreas is made up of t0o types of tissueC

4-ocrine tissue /)e e-ocrine tissue secretes digesti,e en@ymes* /)ese en@ymes are secreted into a net0or; of ducts t)at Doin t)e main pancreatic duct1 0)ic) runs t)e lengt) of t)e pancreas*

4ndocrine tissue /)e endocrine tissue1 0)ic) consists of t)e islets of Langer)ans1 secretes )ormones into t)e bloodstream*

*un"tions o$ t!e p'n"re's /)e pancreas )as digesti,e and )ormonal functionsC

/)e en@ymes secreted by t)e e-ocrine tissue in t)e pancreas )elp brea; do0n carbo)ydrates1 fats1 proteins1 and acids in t)e duodenum* /)ese en@ymes tra,el do0n t)e pancreatic duct into t)e bile duct in an inacti,e form* ")en t)ey enter t)e duodenum1 t)ey are acti,ated* /)e e-ocrine tissue also secretes a bicarbonate to neutrali@e stomac) acid in t)e duodenum*

/)e )ormones secreted by t)e endocrine tissue in t)e pancreas are insulin and glucagon 0)ic) regulate t)e le,el of glucose in t)e blood!1 and somatostatin 0)ic) pre,ents t)e release of t)e ot)er t0o )ormones*

An'to() o$ +i#ne)

/)e ;idneys play ;ey roles in body function1 not only by filtering t)e blood and getting rid of 0aste products1 but also by balancing le,els of electrolytes in t)e body1 controlling blood pressure1 and stimulating t)e production of red blood cells*

/)e ;idneys are located in t)e abdomen to0ard t)e bac;1 normally one of eac) side of t)e spine* /)ey get t)eir blood supply t)roug) t)e renal arteries directly from t)e aorta and send blood bac; to t)e )eart ,ia t)e renal ,eins to t)e ,ena ca,a* /)e term ErenalE is deri,ed from t)e Latin name for ;idney*! /)e ;idneys )a,e t)e ability to monitor t)e amount of body fluid1 t)e concentrations of electrolytes li;e sodium and potassium1 and t)e acid'base balance of t)e body* /)ey filter 0aste products of body metabolism1 li;e urea from protein metabolism and uric acid from DNA brea;do0n* /0o 0aste products in t)e blood can be measuredC blood urea nitrogen BFN! and creatinine Cr!* Aidneys are also t)e source of eryt)ropoietin in t)e body1 a )ormone t)at stimulates t)e bone marro0 to ma;e red blood cells* =pecial cells in t)e ;idney monitor t)e o-ygen concentration in blood* If o-ygen le,els fall1 eryt)ropoietin le,els rise and t)e body starts to manufacture more red blood cells*

II. T&E PATIENT AND &IS ILLNESS a* =c)ematic diagram P't!op!)siolog) ,boo+-b'se#.

b./. De$inition o$ t!e #ise'se Di'betes %ellitus Diabetes (ellitus type 2 is t)e most common form of Diabetes* <ormerly ;no0n as adult'onset diabetes1 it usually affects people aged o,er 3% and progresses gradually* In t)is type t)e pancreas )as not ceased to produce insulin1 but t)e :uantity is insufficient1 or t)e )ormone is not stimulating t)e glucose upta;e in muscles and tissues re:uired for energy* /)e result is a build'up of glucose in blood and urine* Alt)oug) t)e cause of t)is malfunctioning is unclear1 non'insulin dependent diabetes mellitus tends to run in families* Ot)er ris; factors1 suc) as increasing age1 obesity1 and a sedentary lifestyle1 probably contribute to its increased incidence in de,eloped countries* Non'insulin dependent diabetes mellitus can often be controlled initially by diet alone1 or in combination 0it) tablets t)at reduce t)e amount of blood glucose* /)ere are t0o main types of blood glucose'reducing drugsC sulp)onylureas 0or; mainly by stimulating t)e pancreas+s islet cells ;no0n as t)e islets of Langer)ans! to produce more insulin and biguanides increase t)e effecti,eness of insulin on cells* 4,entually1 )o0e,er1 patients may need insulin inDections* Preren'l A"ute Ren'l *'ilure It is categori@ed as an acute renal failure 0)ic) is c)aracteri@ed by inade:uate blood circulation perfusion! to t)e ;idneys1 0)ic) lea,es t)em unable to clean t)e blood properly* (any patients 0it) prerenal AR< are critically ill and e-perience s)oc; ,ery lo0 blood pressure!*/)ere often is poor perfusion 0it)in many organs1 0)ic) may lead to multiple organ failure* Prerenal AR< is associated 0it) a number of pree-isting medical conditions1 suc) as at)erosclerosis E)ardeningE of t)e arteries 0it) fatty deposits!1 0)ic) reduces blood flo0* De)ydration caused by drastically reduced fluid inta;e or e-cessi,e use of diuretics 0ater pills! is a maDor cause of prerenal

AR<* (any people 0it) se,ere )eart conditions are ;ept slig)tly de)ydrated by t)e diuretics t)ey ta;e to pre,ent fluid buildup in t)eir lungs1 and t)ey often )a,e reduced blood flo0 underperfusion! to t)e ;idneys b.0* Pre#isposing *'"tors

Age ' /ype 2 D( usually occurs at t)e age 3% years old and abo,e* /ype 2 D( occurs most commonly in people older t)an 8% years 0)o are obese* <amily )istory of D( ' /ype 2 D( )as a strong genetic component* Alt)oug) t)e maDor gene t)at places t)e patient at ris; is not yet identified1 it is clear t)at t)e disease is polygenic and multifactorial* Indi,iduals 0it) a parent 0it) type 2 D( )a,e an increased ris; for diabetes* Benetic factors are t)oug)t to play a role in insulin rGsistance and impaired insulin secretion in type 2 D(*

Race African'Americans1 6ispanic'Americans! ' /)e ris; for type 2 diabetes ,aries among population groups* Diabetes also seems to pose )ig)er or lo0er ris;s for specific complications among racial groups*

Pre"ipit'ting *'"tors

Obesity ' 4le,ated le,els of free fatty acids1 a common feature of obesity1 may contribute to t)e pat)ogenesis of type 2 D(* It can impair glucose utili@ation in s;eletal muscles1 promote glucose production by t)e li,er and impair beta cell function*

4n,ironmental <actors/=tress 9 An increase in stress )ormone triggers t)e release of epinep)rine and norepinep)rine 0)ic) 0ill promote t)e secretion of glucose leading to )yperglycemia*

Inacti,e Lifestyle 9 A ris; factor t)at )ad contributed in t)e occurrence of D( due to t)e fact t)at lac; of muscle acti,ities decreases t)e need for t)e body to utili@e glucose as a form of energy*

Diet 9 <oods ric) in carbo)ydrates can easily promote t)e increasing le,el of glucose along t)e bloodstream*

Preren'l Ris+ *'"tors

At)erosclerosis cause obstruction to t)e flo0 of blood reac)ing t)e ;idneys Blood loss can lead to t)e constriction of t)e arteries carrying blood t)roug)out t)e body1 reducing t)e ,olume of blood reac)ing ,arious organs including t)e ;idney

6eart disease can lead to a reduction in t)e pumping effect of t)e )eart1 reducing t)e amount of blood reac)ing t)e ;idneys and ot)er organs* b.1. Signs 'n# S)(pto(s 2it! R'tion'le Di'betes %ellitus 6HP4RBLHC4(IA INCR4A=4D BLOOD =FBAR L4V4L! (ay be due to lac; of p)ysiologically acti,e insulin t)at transports glucose from e-tracellular to intracellular leading to accumulation of glucose in t)e intra,ascular space* /)e glucose is not utili@ed by t)e body and it remains in t)e blood streams* POLHFRIA

Increased fre:uency of urination* /)is may be due to t)e osmotic diuretic effect of t)e glucose1 0)erein it attracts 0ater during urination*

POLHDIP=IA

Increased t)irst and fluid inta;e* /)is may be due to t)e acti,ation of t)e t)irst center in t)e )ypot)alamus resulting form t)e intracellular de)ydration or ,olume depletion*

POLHP6ABIA

Increased )unger and food inta;e* /)is may be due to t)e decrease glucose upta;e by t)e cells leading t)e stimulation of t)e satiety center in t)e )ypot)alamus resulting to t)e I)unger sensation*J

"4AAN4==/ <A/IBF4

/)is is due to t)e decreased glucose upta;e by t)e cells leading to decreased energy production*

BLHCO=FRIA

/)e ;idney filters t)e blood1 ma;ing it to its normal state* Blucose 0as filtered out and e-creted in t)e urine* Due to t)e e-cess glucose ad compared to t)e ;idney t)res)old1 0)ic) results to t)e e-cretion of glucose in t)e urine*

BA=/ROPAR4=I= =tomac) fullness! 1CON=/IPA/ION and BLOA/INB /)is is due to c)anges in ner,es and damages t)e blood ,essels t)at carry o-ygen and nutrients to t)e ner,es* O,er time1 )ig) blood glucose can damage t)e ,agus ner,e* /)e stomac) fails to empty properly and is li;ely due to t)e generali@ed neuropat)y* NAF=4A/ VO(I/INB Due to stomac) fullness1 t)ere 0ill be an in,oluntary emptying of stomac) contents t)at are forcefully e-pelled by t)e mout)* A compensatory mec)anism due to acidity of body because of decrease e-cretion of metabolic 0aste* PAL4 Due to decreased production of eryt)ropoietin*

'.

S"!e('ti" #i'gr'( o$ t!e #ise'se PAT&OP&YSIOLOGY,"lient3"entere#.

b./. Pre#isposing4 Pre"ipit'ting *'"tors Pre#isposing *'"tors

Age' .2 years old* 6eredity' patient+s grandfat)er and fat)er )as D( =edentary lifestyle

Pre"ipit'ting *'"tors

b.0. Signs 'n# S)(pto(s Bastroparesis =tomac) fullness! and Constipation o No,ember #81 2%%& o /)is is due to c)anges in ner,es and damages t)e blood ,essels t)at carry o-ygen and nutrients to t)e ner,es* O,er time1 )ig) blood glucose can damage t)e ,agus ner,e* /)e stomac) fails to empty properly and is li;ely due to t)e generali@ed neuropat)y* Nausea/,omiting o No,ember #.1 2%%& o Due to stomac) fullness1 t)ere is a in,oluntary emptying of stomac) contents t)at are forcefully e-pelled by t)e mout)* o A compensatory mec)anism due to acidity of body because of decrease e-cretion of metabolic 0aste* 6yperglycemia o No,ember #$1 2%%& o Due to lac; of p)ysiologically acti,e insulin t)at transports glucose from e-tracellular to intracellular 0ill lead to accumulation of glucose in t)e intra,ascular space* /)e glucose is not utili@ed by t)e body and it remains in t)e blood streams*

6ypertension o No,ember #$1 2%%& #5%/##% mm6g

o Due to increase in osmotic pressure1 fluid goes to t)e ,ascular space increasing t)e blood ,olume*

"ea;ness/fatigue o No,ember #$1 2%%&

o

Due to decreased glucose upta;e by t)e cells leading to decreased energy production*

Pale
o o

No,ember #$1 2%%& Due to decreased production of eryt)ropoietin*

5. PATIENT AND &IS CARE #* (edical (anagement a* IV< (edical (anagement /reatment Plain Normal =aline =olution PN==! #L 3%gtts/min* Date Ordered/ Date Performed/ Beneral Date Description C)anged/ D/C ##/#$/%& An a:ueous solution of %*& percent sodium c)loride1 isotonic 0it) t)e blood and tissue fluid1 used in medicine c)iefly for bat)ing tissue and1 in sterile form* Client+s response to t)e treatment

Indication or Purpose

It can be used for /)e drug 0as )ydration1 and1 as a sol,ent for drugs t)at are to be administered parenterally* administered properly1 0it) e-pected effects ac)ie,ed1 and t)e patient did not e-perience de)ydration*

Nursing Responsibilities Prior t!e pro"e#ure Read t)e doctor+s order C)ec; IV label

During t!e pro"e#ure C)ec; for patency of tubing Regulate as ordered

A$ter t!e pro"e#ure

C)ec; IV infusion and amount e,ery 2 )ours

b* Drugs Date Ordered/ Date /a;en/ Date C)anged/ D/C ##/#$/%& Route of administration1 Dosage and <re:uency of administration # amp1 IV =/A/ t)en : 7 Beneral Action1 Classification (ec)anism of Action Client+s response to t)e medication

Name of Drug

Beneric NameC metoclopramide Brand NameC Plasil

An anti'emetic drug t)at bloc;s dopamine1 but also stimulates acetylc)oline to increase gastric emptying* It increases t)e force of gastric contraction1 rela-es pyloric sp)incter1 and increases peristalsis in t)e duodenum and DeDunum 0it)out affecting t)e motility of t)e large intestine*

/)e patient did not ,omit t)e day after t)e medication 0as gi,en and )as bo0el mo,ement*

Nursing ResponsibilitiesC Prior to A#(inistr'tion

'C)ec; patient+s name before administration 'C)ec; t)e doctor+s order 'Prepare t)e medication as ordered* '4-plain t)e purpose1 indication and possible ad,erse effects of t)e medication* A$ter A#(inistr'tion '(onitor bo0el mo,ement* 'Instruct patient not to drin; alco)ol during t)erapy* Date Ordered/ Date /a;en/ Date C)anged/ D/C ##/#$/%& Route of administration1 Dosage and <re:uency of administration 2 tabs1 Beneral Action1 Classification (ec)anism of Action Client+s response to t)e medication

Name of Drug

Beneric NameC =enna

It is la-ati,e t)at is used as a s)ort'term treatment of constipation and to e,acuate t)e colon

/)e patient )ad defecated*

Brand NameC =eno;ot

for bo0el or rectal e-aminations*

Prior to A#(inistr'tion 'C)ec; patient+s name before administration 'C)ec; t)e doctor+s order 'Prepare t)e medication as ordered* '4-plain t)e purpose1 indication and possible ad,erse effects of t)e medication* A$ter A#(inistr'tion '(onitor bo0el mo,ement* 'Instruct patient not to drin; alco)ol during t)erapy*

Name of Drug

Date Ordered/ Date /a;en/ Date C)anged/ D/C ##/#$/%&

Route of administration1 Dosage and <re:uency of administration # tab1 PO1 OD

Beneral Action1 Classification (ec)anism of Action

Client+s response to t)e medication

Beneric NameC metoprolol

(etoprolol is in a group of drugs called beta' bloc;ers* It is a selecti,e in)ibitor

Patient+s blood pressure is still )ig)* <rom #5%/##% mm6g upon admission rises to #$%/ &% mm6g*

Brand NameC Neobloc

of beta#'adrenergic receptors affecting t)e )eart and circulation* It is used to treat angina and )ypertension*

Nursing Responsibilities Prior to A#(inistr'tion 'C)ec; patient+s name before administration 'C)ec; t)e doctor+s order 'Prepare t)e medication as ordered* '4-plain t)e purpose1 indication and possible ad,erse effects of t)e medication* A$ter A#(inistr'tion '(onitor for signs of tac)ycardia1 palpitations and especially blood pressure 'Instruct patient to sit before standing Name of Drug Date Ordered/ Date /a;en/ Date C)anged/ Route of administration1 Dosage and <re:uency of administration Beneral Action1 Classification (ec)anism of Action Client+s response to t)e medication

D/C Beneric NameC losartan ##/#$/%& # tab1 PO1 OD Losartan is in a group of drugs called angiotensin II receptor antagonists* Brand NameC Combi@ar Losartan ;eeps blood ,essels from narro0ing1 0)ic) lo0ers blood pressure and impro,es blood flo0* It is also used to slo0 long'term ;idney damage in people 0it) type 2 diabetes 0)o also )a,e )ig) blood pressure Patient+s blood pressure is still )ig)* <rom #5%/##% mm6g upon admission rises to #$%/ &% mm6g*

Nursing Responsibilities Prior to A#(inistr'tion 'C)ec; patient+s name before administration 'C)ec; t)e doctor+s order 'Prepare t)e medication as ordered* '4-plain t)e purpose1 indication and possible ad,erse effects of t)e medication* A$ter A#(inistr'tion '(onitor for signs of tac)ycardia1 palpitations and especially blood pressure 'Instruct patient to sit before standing

Name of Drug

Date Ordered/ Date /a;en/ Date C)anged/ D/C ##/#$/%&

Route of administration1 Dosage and <re:uency of administration # tab1 PO1 OD

Beneral Action1 Classification (ec)anism of Action

Client+s response to t)e medication

Beneric NameC metformin

It decreases )epatic glucose production1 decreasing of glucose and

Blucose le,el of t)e patient may decrease* No

intestinal absorption a,ailable data! Brand NameC Blucop)age impro,es insulin sensiti,ity

Nursing Responsibilities Prior to A#(inistr'tion 'C)ec; patient+s name before administration 'C)ec; t)e doctor+s order 'Prepare t)e medication as ordered* '4-plain t)e purpose1 indication and possible ad,erse effects of t)e medication* During A#(inistr'tion 'Instruct t)e patient to calm do0n to a,oid uneasiness* A$ter A#(inistr'tion '(onitor glucose le,el closely in t)is patient because se,ere )ypoglycemia may result before t)e patient de,elops symptoms* 'Ad,ice patient to a,oid ,igorous e-ercise immediately after dose*

'Inform patient to a,oid alco)ol1 0)ic) lo0ers glucose le,el* c* Diet /ype of diet Not)ing per orem NPO! Date started/ Date c)anged ##/#$/#& Beneral description It is a type of diet t)at 0it))olds oral fluids and foods* Indication or purpose* Indicated for patients unable to consume a regular diet and patients 0ild mild B*I* problems* Client+s response and/or reaction to t)e diet =ince t)e patient 0as oriented and understands needed inter,entions1 )e follo0ed 0it) t)e doctors prescriptions* Nursing Responsibilities Prior Verify doctor+s order* 4-plain t)e diet prescribed to t)e patient* Instruct patient to 0it))old oral fluids and foods* During 4nsure t)at t)e patient strictly follo0 t)e diet* A$ter Assess for patient+s conditionK )o0 )e responds to t)e diet* d* 4-ercise/ Acti,ity Date Ordered1 Date =tarted1 Date C)anged or D/C ##/#$/%&

/ype of e-ercise

Beneral description

Indication or Purpose

Client+s Response and/or reaction to acti,ity Patient responded to doctor+s order and stated decreased body 0ea;ness*

Aeep rested

An acti,ity 0)ere strenuous acti,ities s)ould be a,oided* Bed rest s)ould be implemented but 0it)

Indicated to a,oid fatigue*

assisted bat)room pri,ilege to a,oid furt)er aggra,ation of t)e gangrene and to reduce pain as 0ell* Nursing Responsibilities Prior C)ec; doctor+s order for any ot)er considerations needed* 4-plain t)e acti,ity to t)e patient* 4-plain 0)y it is important and 0)at it could impro,e in )er condition* During Assess patient+s present condition* Reinforce information as appropriate* A$ter Note patient+s response to acti,ity*

5I. NURSING CARE PLAN

5II. DISC&ARGE PLANNING /. Gener'l Con#ition o$ t!e Client (r* =ugar 0as seen lying on )er bed 0earing a s)irt and pants1 0it) )air dis)e,eled1 0it) an IV fluid of %*& NaCl #L regulated 3%gtts/min infusing 0ell at left )and* 6e reported t)at )e )ad already t0o bo0el mo,ements* 0. %ET&ODS %'edication (etoprolol #tab PO1OD Losartan #tab PO1OD (etformin #tab PO1OD

E3-ercise Instruct to e-ercise at least 8 days a 0ee; and a,oid strenuous acti,ity* LRegular e-ercise1 e,en of moderate intensity suc) as bris; 0al;ing!1 impro,es insulin sensiti,ity and may play a significant role in pre,enting type 2 diabetes T'reatment &' Instruct pt* to comply 0it) t)e gi,en diet* 4-plain t)e importance of e-ercise in maintaining or losing 0eig)t* Ad,ise patient to c)ec; blood glucose le,el before doing any acti,ities and to eat carbo)ydrate snac; before e-ercising to a,oid )ypoglycemia* <ollo0'up c)ec; up on )is pri,ate doctor*

LBlood glucose le,els s)ould be monitored before and after e-ercise to establis) blood glucose response patterns to t)e e-ercise regimen* If blood glucose is L2.% mg/dl1 t)e patient s)ould delay t)e e-ercise session* O'PD follo0'up D'iet Diabetic Diet LCarbo)ydrates s)ould pro,ide 3. ' 5.M of total daily calories* Best c)oices are ,egetables1 fruits1 beans1 and 0)ole grains* /)ese foods are also )ig) in fiber* Carbo)ydrate counting or meal planning e-c)ange lists* L<ats s)ould pro,ide 2. ' 8.M of daily calories* Limit saturated fat* LProtein s)ould pro,ide #2 ' 2%M of daily calories1 alt)oug) t)is may ,ary depending on a patient indi,idual )ealt) re:uirements A,oid eating too muc) s0eet foods* 4at foods ric) in fiber suc) as banana*

5III. CONCLUSION In t)is study1 t)e student nurses+ aim is to understand t)e disease more1 manifestations1 ris; factors and complications* Diabetes mellitus is a condition in 0)ic) t)e pancreas no longer produces enoug) insulin or cells stop responding to t)e insulin t)at is produced1 so t)at glucose in t)e blood cannot be absorbed into t)e cells of t)e body* (r* =ugar+s diabetes mellitus 0as caused mainly by )is sedentary lifestyle1 )is food preference and due to )ereditary factor since )is grandfat)er and )is fat)er bot) )ad diabetes* Diabetic retinopat)y1 a complication of diabetes mellitus1 also occurred and (r* =ugar opted to undergo laser t)erapy a mont) ago* It is best managed 0it) a team approac) to empo0er t)e client to successfully manage t)e disease* As part of t)e team t)e1 t)e nurse plans1 organi@es1 and coordinates care among t)e ,arious )ealt) disciplines in,ol,edK pro,ides care and education and promotes t)e client+s )ealt) and 0ell being* Diabetes is a maDor public )ealt) 0orld0ide* Its complications cause many de,astating )ealt) problems* /)roug) t)is case study1 0e s)ould be able to learn and understand t)e disease Diabetes (ellitus type 2 and t)erefore gi,e us ;no0ledge in proper management1 pre,ention and treatment* As a student nurse1 it is ,ery important to ;no0 many t)ings including t)e said disease condition* After t)e )ards)ips of completing our case study1 a re0ard of self'fulfillment and credential to our ;no0ledge and s;ills )as been added to us being student nurses as 0ell as professionals in t)e near future*

IN* RECO%%ENDATION /)e researc)ers 0ould recommend t)e furt)er study of t)is case as t)is is a disease t)at is interesting* It 0ould be better if anot)er causati,e factor 0ould be studied to be able to pro,ide di,erse information about t)is disease and to be able to compare to spot similarities and differences in t)e manifestations of t)is disease if t)ere is a different causati,e factor* /o be able to appreciate t)e p)ysical manifestations of t)is disease1 0e ad,ise future researc)ers to in,estigate t)is case on t)e onset of t)e disease to be able to assess and note more o,ert manifestations bot) for educational and documentation purposes*

6. BIBLIOGRAP&Y )ttpC//en*0i;ipedia*org/0i;i/DiabetesOmellitusPCauses )ttpC//;idney*nidd;*ni)*go,/;udiseases/pubs/;dd/inde-*)tm )ttpC//000*Dpsimbulan*com/2%%7/%$/25/incidence'of'type'#'and'type'2'diabetes'in't)e' p)ilippines'and'0orld0ide/ )ttpC//nursingcrib*com/diabetes'mellitus'case'study/ Brunner&Suddarth.Textbook of medical-surgical nursing.2008.Lippincott Williams & Wilkins.