DR.

CARLOS LANTING COLLEGE

COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

I. DEMOGRAPHIC DATA

NAME : Y.L.
AGE : 34 Y/O
GENDER : FEMALE
RACE : ASIAN
MARITAL STATUS : NOT SPECIFIED
OCCUPATION : FULL TIME CLERK, LOAN COMPANY
NO. OF PEOPLE : NOT SPECIFIED
IN THE HOUSEHOLD

IS THERE SOMEONE : UNKNOWN

FROM THE HOME
WHO WILL HELP IN
DIABETES CARE?

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

II. PATIENT HISTORY

PRESENTING PX PRESENTS WITH CHRONIC FATIGUE, INCREASED

COMPLAINT THIRST, CONSTANT HUNGER AND URINARY FREQUENCY
PRESENT HISTORY
When was the patient first diagnosed with diabetes? 2014 Type: GESTATIONAL
What type of diabetes does the patient currently have? TYPE 2
Does the patient have the following complications of diabetes of other medical conditions?
Specificatio
Eye problems YES n DIFFICULTY READING
High blood pressure YES, 152/97 mm Hg
Foot problems YES Specificatio BURNING/TINGLING
n SENSATION
Neuropathy YES
Kidney problems YES, INCREASED THIRST & URINARY FREQUENCY
High cholesterol/triglycerides YES, HIGH - 346 mg/dL
Other (Please specify) VAGINAL YEAST INFECTION
What are the patient's possible sources of stress?
WORK - PX REPORTS DIFFICULTY READING HENCE HER LOW PERFORMANCE AT WORK
FITNESS - PX CAN'T EXERCISE AFTER THE DAY'S WORK AND CHORES DUE TO FATIGUE
What areas of diabetes does the patient need to learn more about?
DIET, EXERCISE, BLOOD TESTING, COMPLICATIONS, LOW BLOOD SUGAR
HIGH BLOOD SUGAR, PREGNANCY AND DIABETES, Rx FOR DIABETES
NUTRITION
Had the patient's weight changed from when she was first diagnosed? YES, DIFFERENCE NOT SPECIFIED
How many times do the patient eat per day? NOT SPECIFIED, BUT CONSTANTLY HUNGRY
What is the patient's current diet at home? HIGH IN CARBOHYDRATES
Does the patient follow any special diet? NO
EXERCISE
Does the patient exercise regularly? NO How often? N/A
List any problems the patient have with exercise FATIGUE, FOOT PAIN
PAST MEDICAL HISTORY
When was the patient's last
PHYSICAL
EXAM 2014
Had the patient been hospitalized with diabetes? YES, DURING GESTATION
Had the patient been in the emergency department because of diabetes? NO

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

SOCIAL HISTORY
Work
Occupation CLERK hours FULL TIME

III. REVIEW OF SYSTEM / PHYSICAL ASSESSMENT

ORGAN REVIEW OF SYSTEMS PHYSICAL ASSESSMENT

Eyes Difficulty reading Blurry vision
Recommendation: Visual Acuity Test
Ishihara Test

Cardiovascular Sedentary lifestyle ↑ Blood Pressure: 152/97 mm/Hg

↑ Total cholesterol: 256 mg/dL
↑ Triglycerides: 346 mg/dL
↑ LDL: 155 mg/dL
↓ HDL: 32 mg/dL
Gastrointestinal High carbohydrate diet ↑ Weight: 173 lbs
Urinary Frequent urination
Central Nervous Feet hurt; they often “burn or feel like
there are pins in them”
Endocrine Chronic fatigue ↑ Random plasma glucose: 291 mg/dL
Increased appetite ↑ Fasting glucose: 184 mg/dL
Increased thirst ↑ HbA1C: 8.8%
Increased urine production (+) Glycosuria
Reproductive Px reports vaginal yeast infection
Psychiatric Stress from poor work performance

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

IV. PATHOPHYSIOLOGY

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

V. LABORATORY RESULTS AND DRUG STUDY

LABORATORY FINDINGS
Test Normal Range Results Clinical Significance
Random Plasma Glucose < 200 mg/dL 291 mg/dL High
Body isn't properly using or doesn't
make the hormone insulin

Fasting Glucose <100 mg/dL 184 mg/dL Diabetes

Can cause damage to your nerves,
blood vessels, and organs; can also
lead to other serious conditions

HbA1c <6.0% 8.80% Diabetes

increased likelihood to develop
diabetes complications, like serious
problems with eyes and feet

Total Cholesterol <200 mg/dL 256 mg/dL High

Increased risk of heart disease, with
high cholesterol, one can develop
fatty deposits in your blood vessels.
Eventually, these deposits grow,
making it difficult for enough blood
to flow through your arteries.

Triglycerides <150 mg/dL 346 mg/dL High

May result in hardening of the
arteries (atherosclerosis), which
increases risks of stroke, heart attack,
and heart disease.
LDL <100 mg/dL 155 mg/dL Borderline High
Leads to a buildup of cholesterol in
your arteries

HDL >60mg/dL 32 mg/dL Low

Increased coronary risk

UA: Glycosuria (-) (+) Presence

Excess glucose in the bloodstream is
excreted through urine; a sign of
diabetes
UA: Ketones (-) (-) Normal

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

V. LABORATORY RESULTS AND DRUG STUDY

DRUG STUDY
METFORMIN
Generic Name/
Therapeutic Adverse
Brand Name/ Side Effect/s Contraindication/s
Action Reaction/s
Classification
- changes in blood sugar
reduce glucose level
absorption from - diarrhea
Generic Name:
the GI tract, - bloating
Metformin
reduce - stomach pain - chest pain
Hydrochloride - flatulence Acute or chronic
gluconeogenesis - rash
- indigestion metabolic acidosis
and enhance - Lactic
Brand Name: - constipation with or without coma
insulin - unpleasant metallic taste acidosis
Glucophage (including diabetic
sensitivity by in mouth - Presence of
ketoacidosis).
increasing - heartburn renal failure
Class: Biguanide; - headache
peripheral
Antidiabetic - flushing of the skin
glucose uptake
- nail changes
and utilisation - muscle pain
Dosage and Route Nursing Considerations
Assessment
History: Allergy to metformin; diabetes complicated by fever; severe
infections; severe trauma, major surgery, ketosis, acidosis, coma; type 1
diabetes, serious hepatic or renal impairment, uremia, thyroid or endocrine
impairment, glycosuria, hyperglycemia associated with primary renal
Available forms: Tablets – 500, 850, 1000 disease, CHF, pregnancy, lactation
mg; ER tablets – 500,750, 1000 mg; oral Physical: Skin color, lesions, orientation, reflexes, peripheral sensation
solution – 500 mg/5mL Interventions
Monitor urine or serum glucose levels frequently to determine effectiveness
ADULT of drug and dosage
500 mg – 850 mg/day PO in divided doses to a WARNING: Arrange for transfer to insulin therapy during periods of high
maximum of 2550 mg/day. Dose should be stress (infections, surgery, trauma)
adjusted based on response and blood glucose WARNING: Use of IV glucose if severe hypoglycemia occurs as a result of
level. overdose
Px Education
PEDIA (10-16 YO) Do not discontinue this medication without consulting your physician
500 mg/day PO in divided doses; may be Monitor urine or blood for glucose and ketones as prescribed
increased by 500 mg each wk to a max of 2000 Swallow extended-release tablets whole; do not cut, crush, or chew
mg/day. ER tablet not recommended. Don’t use this drug during pregnancy; if you become pregnant, consult with
your health care provider for appropriate therapy.
Avoid using alcohol while taking this drug
Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light
colored stools, hypo- or hyperglycemic reactions

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

DRUG STUDY
GLIPIZIDE
Generic Name/
Therapeutic
Brand Name/ Adverse Effect/s Contraindication/s
Action
Classification
Directly stimulates GI: Nausea, diarrhea, constipation, Diabetic ketoacidosis;
functioning pancreatic gastralgia, cholestic jaundice (rare) pregnancy; lactation;
beta cells to secrete Metabolic: Hepatic porphyria, hypoglycemia
Generic Name: insulin, leading to an Skin: Erythema, morbilliform or
children
Glipizide acute drop in blood maculopapular rash, pruritus, urticaria,
glucose. Indirect eczema (transient).
Brand Name: action leads to altered Body as a Whole: Hypersensitivity (fatigue,
numbers and drowsiness, hunger, GI distress with
Glucotrol
sensitivity of heartburn, abdominal pain, anorexia)
peripheral insulin CNS: Transient drowsiness, headache,
Class: Hormones receptors, resulting in anxiety, ataxia, confusion, seizures, coma
and synthetic increased insulin CV: Tachycardia
substitutes; binding. It also causes Special Senses: Visual disturbances
inhibition of hepatic
Antidiabetic;
glucose production
Sulfonylurea and reduction in serum
glucagon levels

Dosage and Route Nursing Considerations

Assessment & Drug Effects

- Observe response to the initial dose and establish maintenance regimen

Available forms: 5 mg, 10 mg tablets; 5
mg, 10 mg sustained release tablets
ADULT
PO 2.5–5 mg/d 30 min before breakfast, may
increase by 2.5–5 mg q1–2wk; >15 mg/d in
divided doses 30 min before morning and
evening meal (max: 40 mg/d); 5–10 mg sustained
release tablets once/d
cautiously in older adult or debilitated patients; early signs of
hypoglycemia are easily overlooked.
- Lab tests: monitor periodically during long-term therapy: Liver
function tests, serum electrolytes, and serum osmolarity.
- Note: Severe drug-induced skin rashes and pruritus may necessitate
discontinuation of drug use. Symptoms usually subside rapidly when
drug is withdrawn.
- Check urine for sugar and ketone bodies at least 3 times daily during
insulin withdrawal and transfer to glipizide. Contact physician if tests
are abnormal.
- Note: Patients transferred from a sulfonylurea with a long half-life
(e.g., chlorpropamide, half-life: 30–40 h) must be observed for
hypoglycemic responses (see Appendix F) for 1–2 wk because of
potential overlapping of drug effect.
- Note: The first signs of hypoglycemia may be hard to detect in patients
receiving concurrent beta blockers or older adults.

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

DRUG STUDY
ATORVASTATIN
Generic Name/
Therapeutic Side Effect/s
Brand Name/ Contraindication/s
Action Adverse Reaction/s
Classification
Lowering of CNS: dizziness, fatigue Hypersensitivity

Generic Name: lipids with Resp: cough

Active liver disease or
Atorvastatin decreased GI: abdominal pain, ↑ liver enzymes, unexplained persistent
progression of nausea elevations in AST and
Brand Name: atherosclerosis. Derm: hot flushes ALT
Lipitor F and E: hyperkalemia
MS: MYOPATHY/RHABDOMYOLY Concurrent use of
cyclosporine, gemfibrozil,
Class: Lipid- SIS, arthralgia, musculoskeletal pain, or tipranavir/ritonavir
lowering agent; muscle weakness
reductase inhibitors; OB: Potential for fetal
cholesterol anomalies
absorption inhibitors
Lactation: May appear in
breast milk
Dosage and Route Nursing Considerations
Assessment
Obtain a diet history, especially with regard to fat consumption
Evaluate lab tests for contraindications and adverse effects
Potential Diagnoses
Noncompliance related to diet and medication regimen
Available forms: Tablets: ezetimibe 10
mg/atorvastatin10 mg, ezetimibe 10 Implementation
mg/atorvastatin 20 mg, ezetimibe 10 PO Administer as a single dose any time of day, without regard to food.
mg/atorvastatin 40 mg, ezetimibe 10 Swallow tablets whole, do not crush, break, dissolve of chew (If taking bile
mg/atorvastatin 80 mg acid sequestrants, administer atorvastin at least 2 hr before or at least 4 hrs
after)
Patient and family teaching about diet restrictions, dosage and schedule, etc
Evaluation/Desired Outcomes
Decrease in levels of serum total cholesterol, LDL cholesterol, and
triglycerides in patients who cannot control levels by diet and exercise alone

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

Assessment Nursing Diagnosis Planning/Goal

Unstable blood pressure
Signs related to increased blood
Random plasma glucose – 291 glucose level and increased
mg/dL body weight as manifested by
HbA1c – 8.8% high B/P, random plasma
Fasting glucose – 184 mg/dL glucose, HbA1c, fasting
B/P – 152/97 mm/Hg glucose, total cholesterol,
Total cholesterol – 256 mg/dL LDL, triglycerides and low
Triglycerides – 346 mg/dL HDL
LDL – 155 mg/dL
HDL – 32 mg/dL R: Increased blood glucose levels
Weight – 173 lbs results to decreased elasticity and
narrowed blood vessels impeding
the flow of blood. When blood flow
is impeded, the supply of blood and
oxygen is reduced causing high
blood pressure among people with
diabetes.
R: With high cholesterol, one can
develop fatty deposits in blood
vessels, making it difficult for
enough blood to flow through
arteries.
Short Term
After 2h of nursing intervention,
patient shall have verbalized
understanding of causative factors
and purpose of individual
therapeutic interventions and
medications.
After 8h of NI, the px’s B/P shall
decrease from 152/97 mm/Hg to
normal range.
Long Term
The patient shall maintain a B/P at
normal levels as evidenced by a
B/P reading within the normal
range (110-120/80-90 mmHg).

Intervention Expected Outcomes

Independent NI Short Term
After 2h of nursing intervention,
 Establish rapport R: Friendly relationship with px to encourage open patient verbalized understanding of
communication and for px to verbalize concern/s causative factors and purpose of
 Take and record vital signs R: To obtain baseline data individual therapeutic
 Monitor B/P R: To monitor the changes in B/P readings and to validate if interventions and medications.
treatments are working
 Encourage px to maintain a healthy diet R: Foods high in cholesterol After 8h of NI, the px’s B/P
and carbohydrates may cause blockage of the blood vessels
decreased from 152/97 mm/Hg to
 Encourage px to exercise daily R: To lose and maintain a healthy
weight
normal range.

Dependent NI Long Term

Patient maintained a B/P at normal
 Administer antihypertensive medication as prescribed by the levels as evidenced by a B/P
physician R: To regain normal blood pressure reading within the normal range
 Administer anti-diabetic medication as prescribed R: To maintain (110-120/80-90 mmHg).
normal blood glucose level
 Administer lipid-lowering agent as prescribed R: To decrease the

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

levels of total cholesterol, LDL, and triglycerides

VI. NURSING CARE PLANS

Assessment Nursing Diagnosis Planning/Goal
Risk for unstable blood Short Term
Signs glucose level related to After 3h of nursing intervention,
Random plasma glucose – 291 inadequate amount of insulin patient shall verbalize
mg/dL as evidenced by high random understanding of causative factors
HbA1c – 8.8% plasma glucose, high fasting and purpose of individual
Fasting glucose – 184 mg/dL glucose, high HbA1c, high therapeutic interventions and
B/P – 152/97 mm/Hg B/P, glycosuria, increased medications.
Glycosuria – (+) glucose in UA thirst, hunger and urinary
frequency and chronic fatigue After 3h of NI, patient shall
Symptoms demonstrate the skill to monitor
Increased thirst R: Insufficient insulin level results levels of blood glucose.
Urinary frequency to inadequate reuptake of glucose in
cells. Insulin is utilized to help the
Increased hunger glucose pass through the cells so
After 8h of NI, px’s blood glucose
Chronic fatigue that glucose is converted to energy. shall decrease from 291 mg/dL to
“By the time I get home to make Inadequate level of such leads to normal range 80-110 mg/dL.
supper for my family, then put my extracellular hyperglycemia which
child to bed, I am too tired to means that the glucose remains Long Term
outside the cells thereby
exercise” as verbalized by the Px concentrating the blood.
Patient shall maintain a blood
glucose level within normal
ranges.
Intervention Expected Outcomes
Independent NI Short Term
After 3h of nursing intervention,
 Establish rapport R: Friendly relationship with px to encourage open patient verbalized understanding of
communication and for px to verbalize concern/s causative factors and purpose of
 Take and record vital signs R: To obtain baseline data individual therapeutic
 Monitor the blood glucose level R: To monitor the changes in blood interventions and medications.
glucose serum level
 Assess for increased thirst, polyuria, polyphagia, and lethargy R: After 3h of NI, patient
Polydipsia, polyuria, polyphagia, and lethargy are signs of high blood
glucose level
demonstrated the skill to monitor
 Teach patient how to check for blood glucose level and its levels of blood glucose.
normal level R: To allow continuous monitoring of blood glucose serum
level at home After 8h of NI, px’s blood glucose
 Encourage px to avoid foods that triggers increase of blood decreased from 291 mg/dL to
glucose level R: To maintain normal serum glucose level normal range 80-110 mg/dL.

Dependent NI Long Term

Patient maintained a blood glucose

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

 Administer anti-diabetic medication as prescribed R: To maintain level within normal ranges.

normal blood glucose level

Assessment Nursing Diagnosis Planning/Goal

Risk for deficient fluid
Signs volume related to increased
Glycosuria – (+) glucose in UA blood glucose level as
manifested by glycosuria,
Symptoms increased thirst, and urinary
Increased thirst frequency.
Urinary frequency
R: When blood glucose level is
abnormally high, it means that the
blood is concentrated of glucose. If
this happens, the kidneys will reach
its renal threshold thereby
removing the excess glucose from
blood through urine. This results to
glycosuria (presence of glucose in
urine), as well as polyuria and
polydipsia where huge amt of water
is voided as an attempt of the kidney
to rid off the excess glucose in the
body.
Short Term
After 3h of nursing intervention,
patient shall verbalize
understanding of causative factors
and purpose of individual
therapeutic interventions and
medications.
After 8h of NI, the px shall
verbalize decreased urge to urinate.
Long Term
Patient shall maintain fluid volume
at a functional level as evidenced
by individual good skin turgor,
moist mucous membrane and
stable vital signs.

Intervention Expected Outcomes

Independent NI Short Term
After 3h of nursing intervention,
 Establish rapport R: Friendly relationship with px to encourage open patient verbalized understanding of
communication and for px to verbalize concern/s causative factors and purpose of
 Take and record vital signs R: To obtain baseline data individual therapeutic
 Monitor the temperature R: To monitor the changes in the temperature interventions and medications.
 Assess skin turgor and mucous membranes for signs of
dehydration R: Dry skin and mucous membranes are signs of dehydration After 8h of NI, the px verbalized
 Encourage px to increase fluid intake R: To replace fluid loss and decreased urge to urinate.
prevent dehydration
Long Term
Dependent NI
Patient maintained fluid volume at
 Administer IVF as ordered by the physician R: To replace a functional level as evidenced by
electrolytes and fluid loss
individual good skin turgor, moist
 Administer anti-pyretic as prescribed by the physician R: To
mucous membrane and stable vital

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

decrease body temperate and to have less occurrence of dehydration

signs.

VII. DISCHARGE PLANNING

DIABETES MELLITUS TYPE II

Health
Medications Environment Treatment Outpatient Diet
Teaching
Breakfast: Remove Eat and follow Home blood See a physician 1200 calorie
Metformin obstacles on the the suggested sugar testing if: daily using an
(Glucophage) floor at home diet exchange
500mg – oral 1 where px might Neuropathy, - once every 4- system
tab trip onto. Minimize foot care 6 months with
alcohol or without (see the
Glipizide Regularly consumption Reducing the complications American
(Glucotrol) sanitize areas risk for - experiencing Diabetes
5mg – oral 1 where the px Exercise cardiovascular any adverse Association
tab frequents to regularly for at complications effects from and the
minimize risk least 30 (quitting the American
Bedtime: for infection. minutes, 5 times smoking, if px medications Dietetic
Atorvastatin a week to smokes; - you have a Association’s
(Lipitor) 20mg Frequently control for managing high wound that “THE
– oral 1 tab perform hand blood sugar B/P and high doesn’t heal DIABETIC
and overall level and to cholesterol - experiencing EXCHANGE
IMPORTANT: hygiene to control weight thru diet, symptoms of LIST” for
Swallow minimize risk exercise and eye, nerve, reference)
tablets whole, for infection. Increase fluid compliance in kidney or
do not crush, intake taking meds) cardiovascular
break, dissolve Minimize stress problems
of chew at home and at Proper hygiene (blurred vision,
work. Notify to reduce risk tingling of feet,
persistent hand,
DO NOT immediate head of infection feet, face of leg
discontinue about health swelling,
medications concern if it Side and camping of the
without affects adverse effects legs, chest pain,
doctor’s advice performance. of medications shortness of
breath, numbness
of weakness,
unusual weight
gain)
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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

FOLLOW UP QUESTIONS:
1. What are the significant assessment findings that you have noted on the case?

For patients with DM Type II diagnosis, objective assessments such as weight gain, high
random plasma glucose, hbA1c, total cholesterol, LDL, triglycerides, blood pressure, low HDL
and glycolysis are important to determine the pharmacotherapy needed by the px. Meanwhile,
the subjective symptoms experienced by the px like increased thirst, hunger, urination, tingling
of the feet and chronic fatigue combined with all the objective assessment also provide vital
information for her individualized treatment plan.

2. Based on the case given, identify the risk factors related to the case.

History of gestational diabetes mellitus, weight gain, high carbohydrate diet, stress and
sedentary lifestyle

3. Trace the pathophysiology of the condition and course of the disease mentioned on the case.

Genetics, age, and other comorbid condition/s combined with other precipitating factors such
as unhealthy diet and lifestyle, sedentary lifestyle, obesity, and stress may all lead to
insufficient insulin level. When the amount of insulin in our system is inadequate, the glucose
in our blood can’t pass through the cells which leads to extracellular hyperglycemia there is
increased level of sugar or glucose in blood. Inability of glucose to enter the cells means that
our body can’t convert the foods we have ingested into energy, thus the lack of energy and
increased in hunger of our patient. All of these paired up with significant findings on various
laboratory tests and physical assessment leads to DM Type II diagnosis.

Diabetes may lead to various serious complications if left uncontrolled. In this case, the
patient’s B/P shoot up to 152/97mmHg, a serious concern that needs to be addressed
immediately. When blood sugar level is high, there is decreased elasticity in our blood vessels
which narrows the pathway of blood. This reduces the supply of blood and oxygen to the body
that poses a risk for high blood pressure.

Another concern that might lead to serious complication to the kidney is the presence of
glucose in the patient’s urine analysis. When blood glucose level is abnormally high, it means
that the blood is concentrated of glucose. If this happens, the kidneys will reach its renal
threshold thereby removing the excess glucose from blood through urine. This results to

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

glycosuria (presence of glucose in urine), as well as polyuria and polydipsia where huge volume
of water is voided as an attempt of the kidney to rid off the excess glucose in the body.

4. What are the nursing responsibilities related to laboratory and diagnostic examination including the
procedures and medications?

Reading of laboratory results and prescribing medications are outside of the scope of nursing
responsibilities. However, with doctor’s prescription, I can teach the patient about the side and
adverse effects of the medications that warrant immediate attention as well as encourage the
patient to be fully compliant with the medications. As to laboratory findings, the patient is
encourage to regularly check the blood sugar level at home, thus the need to teach the patient
on blood sugar testing at home.

5. What are the treatments and procedures performed during the course of hospitalization?

Physical assessment and review of systems (vital signs, interview)

Laboratory Testing
Health teaching
Medications

6. Enumerate appropriate discharge plan and health teaching for your patient.

Medications
Breakfast:
Metformin (Glucophage) 500mg – oral 1 tab
Glipizide (Glucotrol) 5mg – oral 1 tab
Bedtime:
Atorvastatin (Lipitor) 20mg – oral 1 tab
IMPORTANT:
Swallow tablets whole, do not crush, break, dissolve of chew
DO NOT discontinue medications without doctor’s advice

Environment
Remove obstacles on the floor at home where px might trip onto.
Regularly sanitize areas where the px frequents to minimize risk for infection.
Frequently perform hand and overall hygiene to minimize risk for infection.
Minimize stress at home and at work. Notify immediate head about health concern if it
affects performance.

Treatment
Increase fluid intake
Eat and follow the suggested diet
Minimize alcohol consumption
Exercise regularly for at least 30 minutes, 5 times a week to control for blood sugar level and
to control weight
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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TAMAYO, VICTORIA C. NOVEMBER 12, 2020

ALLIED 3.1. LUCINDA GABRIEL, RN

Health Teaching
Side and adverse effects of medications
Home blood sugar testing
Neuropathy, foot care
Reducing the risk for cardiovascular complications (quitting smoking, if px smokes;
managing high B/P and high cholesterol thru diet, exercise and compliance in taking
meds)
Proper hygiene to reduce risk of infection

Outpatient
See a physician :
 once every 4-6 months with or without complications
 if experiencing any adverse effects from the medications
 if you have a wound that doesn’t heal
 experiencing symptoms of eye, nerve, kidney or cardiovascular problems (blurred vision,
tingling of feet, persistent hand, feet, face of leg swelling, camping of the legs, chest
pain, shortness of breath, numbness of weakness, unusual weight gain)
Diet

1200 calorie daily using an exchange system 7.

7.
(see the American Diabetes Association and the American Dietetic Association’s “THE 7.
DIABETIC EXCHANGE LIST” for reference) 7.
7.
7.
Identify at least three (3) priority nursing problems and formulate 3 nursing care plans with appropriate
objective and evaluation of care.

See above NCPs

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