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Diabetes Mellitus
Diabetes Mellitus
INTRODUCTION
In the modern and improved technological world of medicine
there are some people who are still home care of the treatment
modalities . For such people they need awareness regarding the
approach for treatment . In that aspect Community Health Nursing
plays on integral past this identifies the needs and problems and
initiates treatment.
Diabetes is the second most common endocrine disorders. It is
the major Non Communicable disease of the society. Govt of India
created awareness to control Non Communicable disease via NCD
clinics 70% of the diabetes can be controlled by life style
modifications. So I have selected Diabetes mellitus.
Diabetes mellitus is the condition in which carbohydrates
metabolism disturbed due to insufficient secretion of insulin
hormones. It is characterised by triad features polyuria, polyphagia,
polydypsia.
1
NEED FOR STUDY
We are the 7th batch Post Basic B.sc (N) II Year were posted
to undertake survey in Kollapatti (rural health post) as post of our
training program in community health nursing .I was posted in
S.Kollapatti area in Thalavaipatti yeri colony.
I have been asked to all the family folder for new families . I
selected the diabetes mellitus client Mrs.Vadivukarasi 32 years old .I
focused my attention of that particular person and gave care during
the every next visit .I have also selected the family for my family
care study in the community health nursing .
Home visit strengthens the ties that bind the family sickness
through community health guidance and services that is provided
orally by the community health nurse.
2
LEARNING OBJECTIVES
To promote and maintain the health of the members
To remove anxiety and fear associated diabetes.
To learn the future complaints about hyper glycemic condition
to improve their activities.
To describe the relationships among diet exercise and
medication for people with diabetes
To learn about the detailed study about diabetes mellitus.
To know about physical and psychological changes.
To know about health status of the client
To develop knowledge about disease condition.
To know the complaints.
3
REASON FOR SELECTING THE FMILY
4
COMMUNITY PROFILE:
EDUCATION : Government and private
HIGHER SECONDARY SCHOOL : 1
HIGH SCHOOL :2
MIDDLE SCHOOL :2
PRIMARY SCHOOL :2
ICDS :1
WATER SUPLY : Tap Water
NO OF OVER HEAD TANKS : 2 TANKS
NO. OF BORE WELL :2
MARKET : Weekly market on
Saturday S.kollapatti.
LATERINE : RCA type of latrine
DRAINAGE : Closed and open drainage
facilities available
REFUSE DISPOSAL :Disposal in bins open
/closed by panjayat worker.
Burial of refuse also present
DISPOSAL OF DEAD:
This is done in germ yard sanitation of the area, is supervised
and maintained by Health inspection.
5
CLIENT PROFILE:
6
SOCIO ECONOMIC STATUS:
7
LAY OUT OF CLIENT HOUSE:
Toilet
OFFICE ROOM
HALL
WASHING AREA
ENTERANCE
8
FAMILY HEALTH BELIEF AND PRACTICES WITH
REGARD TO:
HISTORY COLLECTION
PAST HISTORY
FAMILY HISTORY
9
FAMILY COMPOSITION
10
FAMILY PEDIGREE
11
PERSONAL HISTORY
- No Tobacco Chewing
- Mixed Diet
- Sleep 8 hours night
- Good interpersonal relationship with others
- Watching television
MENSTURAL HISTORY
-Menarche at the age of 12 years
- Irregular cycle 3-5 /35 days
- Normal flow
MARITAL HISTORY
- Married since 11 year before
- Non consanguineous marriage
OBSTERTICAL HISTORY:
- Ist – LSCS- Placenta previa –Salem medical center Pvt clinic
14 yrs back
12
PHYSICAL ASSESSMENT:
GENERAL APPEARANCE:
- Conscious
- Moderately built
HEAD
- Normal Size
- B lack In Colour Of Hair
NOSE
- No septal deviation
- Sense of smell
EAR
- Symmetrical
- Normal hearing
- No wax
MOUTH
- Lips moist
- No dental carries
- No staining teeth
NECK:
- No neck stiffness
- Thyroid gland is not enlargement
ABDOMEN
- Soft no organomegaly
- Bowel sounds are norma
- Normal range of motion
CHEST
- Symmetrical movement of chest
- Bilateral air empty present
13
SYSTEMIC ASSESSMENT
CENTERAL NERVOUS SYSTEM:
- Client Conscious
- Oriented do place ,person, time
CARDIO VASCULAR SYSTEM:
- S1 s2 Heard
- Pulse rate 76/min
- Bp-120/80 mm/hg
RESPIRATORY SYSTEM:
- Bilateral air entry
- Respiratory rate 20/min
GASTTRO INTESTINAL SYSTEM:
- Abdomen soft
- Bowel sounds heard
GENITO URINARY SYSTEM:
- Frequency of urinary function
- No urethral discharge
MUSCULO SKELETAL SYSTEM:
- Upper extremities ,lower extremities normal
- Normal range of motion
INTEGUMENTRY SYSTEM:
- Skin turgor good
- Temperture:98.4 F
- No skin colour changes
- No rashes
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VITAL SIGNS:
- Temperature :98.4 F
- Pulse :76/mt
- Respiration :20/mt
- Blood pressure :120/80 mm hg
NUTRITIONAL ASSESSMENT:
- Height :160cm
- Weight :68 kg
- Body Mass Index :Weight in kg/Height in (𝑚2 )
- BMI :26
- Obese
15
24 HOURS RECALL FOR NUTRITIONAL ASSESSMENT
Coffee 200 65
6AM 4.9 3.5 3.7 0.4 0.12
biscuit ml 20
Rice
2cup 15.8 12.8 0.8 4.4 0.02 690
Dhallsambar
2PM 100ml 30 10.4 2.8 4.5 0.03 185
With beans
100gm 10.0 4.5 0.1 1.6 0.01 59
poriyal
0.01
Idli 78.9 6.4 0.4 2.2 345
4 0.005
9pm Sambar 15 6 0.26 2.2 8
100ml 0.03
withdhall 30 10.4 2.8 4.5 185
Coffee 200 65
6AM 4.9 3.5 3.7 0.4 0.12
biscuit ml 20
16
INTERPRETATION:
1875
1 Calorie 2245 Excess
Kcal
2 Protein 60gm 83.8 Excess
3 Fat 20gm 21.72 Excess
4 CHO 250gm 318.3 Excess
5 Iron 30mg 29.5 Deficit
6 Calcium 800mg 0.55 Deficit
INFERENCE:
17
RECOMMENDED MENU PLAN
18
DIABETES MELLITUS
DEFINITION:
- BRUNNER.
- NEELAM KUMARI
19
INCIDENCE
As of 2014,an estimated 387 Million have diabetes worldwide,
with type 2 diabetes mellitus making up about 90% of cases, this
is e 8.3%Of the adult population, with equal rates in both
women and men. In the year 2012,2014 diabetes is estimated to
have resulted in 1.5 to 4.9 million deaths per year. Diabetes at
least doubles the risk of death.
20
TYPES OF DIABETUS MELLITES
21
ETIOLOGY /RISKFACTORS
1) Hereditary.
2) Obesity . mostly due to imbalance insulin level because
supply of insulin level because supply of insulin is less and
requirement is more in Obesity .
3) Old age (pancreatic function become slow)
4) Other systemic disease like
Heart disease
MI
Stroke
5) Renal disease
6) Viruses (coxsackie –B, Strepto)
7) Africans and Asians are more susceptible
23
DIAGNOSIS:
Fasting plasma glucose level
Postprandial glucose level
Glycated albumin
Urine sugar
Urine albumin
Electro cardiogram
Ultra sonogram glucose tolerance test
Glucose tolerance test
Symptoms of Hypoglycaemia and causal plasma glucose
24
MANAGEMENT
There are two categories
1) Oral hypoglycaemic
2) Insulin therapy
ORAL HYPOGLYCAEMICS
There are 2 types of tablet used sulphonyl urea tablets are in
common use to bring down blood sugar these compounds stimulate
the pancreas to produce more insulin and this explains why they are
ineffective in the more severe type of diabetes where the pancreas is
incapable of protecting any insulin at all.
Glypizide have a short duration action and are normally taken
twice a day.
All these tablets are well tolerated and seldom give rise to
hypoglycaemia other ill effects
25
OVERWEIGHT DIABETES
INSULIN THERAPY
There are 4 types
Soluble insulin
The medium (or) intermediate
The long acting insulin
Ready mixed combinations
SOLUBLE INSULIN
This is clear insulin
And its effects last about 6 hours in order to control
diabetes on its own it must be given at least twice a day. It can be
given Intravenously in the treatment of diabetic coma .Human
actrapid are preparations of soluble Insulin.
26
THE MEDIUM (OR) INTER MEDIATE INSULIN:
If injected in the morning before breakfast exert their
maximum effect at lunch time and early afternoon, the effect is less
marked overnight, consequently a second injected is often necessary
before the evening meal.
LONG ACTING INSULIN
Such as ultratard (or)protamine zinc are useful as single
injection ,in the morning . they are suitable for diabetes who are have
easily controlled blood sugar and do not need a large doses.
READY MIXED
The comdination of short and long acting insulin are also
available .These have a wide range of duration of action depending on
the proportion.
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NURSING MANAGEMENT
ASSESSMENT:
We should get baseline information (eg)
3P s Symptoms
Polyurea
Poly phagia
Polydipsia
Take family history of DM
Assess knowledge level of patients and family
Perform to physical assessment
Assess anxiety level patient
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COMPLICATION
Kidney disease
Albuminuria
High BP
Neuropathy
Pain in legs
Sexual impotency
Retrograde ejaculation
Sweating
Muscle damage
Arteriosclerosis
Infection
Tonsillitis
Pneumonia
Appendicitis
Pyelitis
29
PREVENTION AND CONTROL
NUTRITIONAL
MANAGEME
NT
EDUCATION EXERCISE
PATIENT
PHARMACOL
OGICAL MONITORING
THERAPY
30
CLINICAL MANIFESTATIONS
CLIENT PICTURE
SNO BOOK PICTURE
1 Polyuria Present
2 Polyphagia Absent
3 Polydypsia Absent
6 Fatigue Present
7 Itching Absent
11 Paresthesia Absent
31
INVESTIGATION
BOOK CLIENT
S.NO INVESTIGATION REMARKS
PICTURE PICTURE
1 Random blood 80- 172mg/dl Increased
sugar 120mg/dl
32
NITGHTINGALE’S THEORY
ENVIRONMENTAL THEORY
Florence Nightingale considered as the first nurse theorist defined
nursing as “the act of utilising the environment of the patient to
assist him in recovery”
o Pure or fresh air
o Pure water
o Efficient drainage
o Cleanness
o Light
PATIENT
Refers to as individual or person who is responsible creative in
control of his eye and death patient can be ached by the nurse or
affected by the environment
HEALTH
Using ones power to the fullest as a stage of well being.
ENVIRONMENT
Refers to the external to the persons but affecting the health
of both sick and well persons.
Nightingale also stressed upon the importance of keeping the
client warm, maintaining a noise free environments, attending
the client’s diet in term of assessing intake time less of food.
It also includes fresh air ventilation, quiet, warmth,
cleanliness and light
ILLNESS
Defined as the reaction of nature against the conditions in which
we have placed ourselves.
33
NURSING
Means to have change of the personal health of some body and
what nursing has to do it put the patient in the least condition of
nature to act upon him
This includes appropriate nursing, nutrition, hygiene, light
comfort, socialization and hope
Health maintenance and health restoration are the nurses goals.
Nightingale theory a frame work for the nurses to think and
focuses on the patient and the environment
PRINCIPLES OF THEORY
According to this Nightingale theory “poor environment is one
is one of the main factor affecting of the health of the people”
There is water stagnation is front of my clients house. no proper
disposal of waste.
According to Nightingale’s theory effective drainage “all while
the sewage may be nothing but a laboratory from which
epidemic disease and ill health being installed in to the house”
Any deficiency in environmental factors could lead to impaired
functioning of life process of diminished health status.
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NURSING DIAGNOSIS
35
DAY -1
TIME PLAN
DATE:19.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Self introduction done
36
DAY -2
TIME PLAN
DATE: 20.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport
Well co operate
doing collection of
11.00AM Vital signs checked and recorded the history of the
Temperature :98.6 F family members
Pulse :76/mts
Respiration :20/mt
Blood pressure :120/80 mmhg
37
DAY -3
TIME PLAN
DATE: 21.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport
38
DAY -4
TIME PLAN
DATE:22.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport
39
DAY -5
TIME PLAN
DATE: 23.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport
40
DAY -6
TIME PLAN
DATE:01.03.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport
41
DAY -7
TIME PLAN
DATE:02.03.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport
42
HEALTH EDUCATION
PERSONAL HYGIENE
Advised to maintain personal hygiene such as daily bathing and
washing and nail cutting, changing of dress etc.
NUTRITION
Advised to maintain high protein, high fibre diet such as cereals,
pulses , green leafy vegetables , pulses cereals with fruits . It
has more fibre diet.
REGULAR MEDICATION
Advised to maintain blood sugar level under controlled by
regular intake of hypoglycaemia drugs $ vitamins.
EXERCISE
Advised to have regular walking cycling and day to day
activities to maintain normal nutritional status.
FOLLOW UP
Regular check up of the blood glucose level in a available area
or nearby primary health centre.
43
SUMMARY
44
Relevant review literature under health problems
Article:
Education and diabetes mellitus
By:
Marina kosti, Marina kanakari
Abstract:
Diabetes mellitus is a multi factorial disease that requires long-
term care since it involves major changes in both physical and
physiological dimension of each patient. Diabetes education is a
critical element of care that improves patient outcomes.
Aim:
The aim of the present study was to review the literature about the
education in diabetes mellitus management.
Method:
The method of this study included bibliographic research of the
literature from review and researches, which researches, mainly in the
pubmed data base, which referred to education in diabetes mellitus
management. Pubmed was searched using the following key search
terms “diabetes mellitus” , “self management” education while
research covered the period 1999-2012
Results:
According to the literature, education should not be a mere
transmission of information, but a dynamic ,holistic, planned care
based on individual’s need (patient –cantered approach)Further
more motes self-management and health related behaviour
modification. moreover, education should be consistent with
individual’ learning
Skills and psycho social state.. Diabetes education should be
reinforced after its completion and enhance in depth understanding
the significance of check up and follow-up. Last but not least
45
effective education requires good communication among diabetic
patients and health professionals.
CONCLUSIONS:
The overall goal of diabetes education is to help individuals and
their families gain the necessary knowledge, life skills resources and
support needed to achieve optimal health.
Key words:
Diabetes mellitus ,self management education.
ARTICLE
Diabetes mellitus –its complications, factors influencing
complications and prevention an over view.
BY
S.Rambhade,A.K.Chakkarabatorthy,U.k.PPatil,A.Rambhade.
ABSTRACT:
This review aims to summarize the major advances of the
proceeding year and to put them in to the context of current opinion
on diabetes mellitus. Despite the advent of prolonging insulin for the
treatment of diabetes, the appearance and progression of many of the
disabling complications associated with this disease cannot be
prevented through the administration of insulin clinically, the onset
and rate of progression of diabetic complications , including cataract,
corneal epitheliopathy, micro anjiopathy,appearto be dependent upon
both the duration and the severity of the diabetes .This review
summarizes the specific pathogenic mechanisms of micro vascular
46
complications for which clinical therapies have been developed,
including the poly ol path way, advanced glycation and
products,protein kinase C,vascular epithelium growth factor, and the
super oxide path way .The undergoing late-stage clinical trials.
47
BIBLIOGRAPHY:
K.Park 201 “preventive and social medicine 21st Edition M/s
bterasides bharot publishes Jabalpur.
WWW.Wikipedia.com
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CONCLUSION:
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