University of Muthanna

College of nursing

Nursing Report of

Diabetes Mellitus

Area: Medical ward

Preparation: Noor Raad Majeed

Administered: Dr. Sabah Abdullah

Second Stage
Group : A
Diabetes Mellitus:
A group of chronic metabolic diseases that last a lifetime. Which characterized
High blood glucose levels (hyperglycemia) caused by defects in insulin secretion or
insulin action.

Type Diabetes Mellitus:

1-types 1 Diabetes: affects approximately 5 % to 10 % with the disease (CDC 2011).
It is characterized by destruction of the pancreatic beta cells ( Porth & Matfin , 2009).
Combined genetic, immunologic, and possibly environmental (en viral) factors are
thought to contribute to beta - cell destruction although the events that lead to beta -
cell destruction are not a genetic successfully understood
2-Type 2 diabetes: affects approximately 90 % to 95 % of although its incidence is
rapidly increasing in younger people because of the growing epidemic of obesity in
children, ado lescents , and young adults ( CDC , 2011 ) . The two main problems
related to insulin in type 2 dia Insulin resistance refers to a decreased tissue
sensitivity to betes are insulin resistance and impaired insulin secretion insulin.
3-Gestational Diabetes: Gestational diabetes is any degree of glucose intolerance
with its onset during pregnancy. Hyperglycemia develops during pregnancy because
of the secretion of placental hormones, which causes insulin resistance. Gestational
diabetes occurs in as many as 18 % of pregnant women and increases their risk for
hypertensive disorders during pregnancy (CDC, 2011).

Clinical Manifestations
Clinical manifestations depend on the patient's level of hyper glycemia .
Classic clinical manifestations of diabetes include the "three Ps": polyuria,
polydipsia, and polyphagia. Polyuria (increased urination) and polydipsia (increased
thirst) occur as a result of the excess loss of fluid associated with osmotic diuresis.
Patients also experience polyphagia (increased appetite) that results from the
catabolic state induced by insulin deficiency and the breakdown of proteins and fats
(Porth & Matfin, 2009). Other symptoms include fatigue and weak ness, sudden
vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or
wounds that are slow to heal, and recurrent infections. The onset of type 1 diabetes
may also be associated with sudden weight loss or nausea, vomiting, or abdominal
pains, if DKA has developed.

Pathophysiology and cause

Use the tissues of the body and the cells that make up Energy Glucose.
Glucose: is a simple sugar that is provided by the foods we eat such as:
1- When carbohydrates are eaten, they are digested and converted into sugars.
Including glucose, which is then absorbed into the bloodstream.
Carbohydrates provide most of the glucose used by the body.
2- Proteins and fats can indirectly produce smaller amounts of glucose. Glucose is
able to enter cells only with the help of insulin,

Pathophysiology action
Insulin: is a hormone produced by the beta cells of the islets of Langerhans of the
Pancreas.
When insulin come in by Connecting with the cell membrane, it combines with
receptors Allows activation of special glucose transporters in
Membrane by helping glucose enter the cells of the body,
Insulin does the following:
1- It lowers the level of glucose in the blood.
 2- Insulin helps the body too Excess glucose is stored in the liver as glycogen
Another hormone, glucagon, is produced by alpha Hives in the Islets of Langerhans.
Glucagon dose the following:
1- It raises blood glucose when needed by releasing stored glucose from
Liver and muscles.
2- Insulin and glucagon work together to maintain it Blood glucose at
A constant liver.

Diabetes causes:
The exact cause of type 1 diabetes is unknown. What is known is that your
Immune system — which normally fights harmful bacteria and viruses — attacks
and destroys insulin-producing cells in the pancreas. This makes your body no or
little insulin. Instead of moving into the cells, the sugar builds up in the bloodstream.
It could be because of:
1. Diabetes is caused by a lack of insulin production beta cells in the
pancreas
2. Inability of body cells to use insulin. When glucose is unable to enter the
cells of the body, it the results of high blood sugar remain in the
bloodstream.

Signs and symptoms of D.M

1. extreme thirst
2. frequent urination
3. Unexplained weight loss
4. blurred vision
 5. fatigue
6. Drink a lot of water

Signs and symptoms of D.M of patient

1. Hypertension
2. Short of breath (Sob)
3. Abdominal pain,
4. Vomiting
5. Coughing
6. Acute infections in chest

Medications of D, M
1- Azithromycin:
 Generic name: Azithromycin
 Trade name: Zimax
 Action: Azithromycin belongs to the macrolide family of antibiotics
that inhibit the synthesis of proteins in bacterial cells, stopping their
growth. The drug is used in the treatment of some bacterial germs
such as: upper respiratory tract infections, pneumonia, otitis media,
urinary tract infections and others.
 Dose: 500 mg daily.
 Round of administration: the medicine is taken orally.
 Side effects: nausea, gastrointestinal discomfort (pain, cramps),
vomiting, flatulence, diarrhea. Occasionally: Allergic reaction such
as rash, severe hypersensitivity, transient neutrophil count decrease.

2- Ceftriaxone:
 Generic name: Ceftriaxone
 Trade name: Samixon
 Action: Cephalosporin antibiotic the drug is given in hospitals
to treat acute bacterial infections, especially in the respiratory tract
and urinary tract. It is also used to treat patients suffering from
meningitis and sepsis. Ceftriaxone is used in small doses to treat
Gonorrhea.
 Dose: 1g / 200 cc N /S
 Round of administration: I. V. INFUSION
 Side effects:
1. Nausea.
2. Vomiting.
3. Rash.
4. Fever.
 3- Decadron
 Generic name: Dexamethasone
 Trade name: Decadron
 Action: Dexamethasone is used to treat conditions related to infections,
disorders of the immune system, hormonal deficiencies.
 Dose: Twice a day
 Round of administration: I.V
 Side effects: fluid retention increase in appetite Mood changes, sleep
disturbances. Skin rash, bruising, or skin discoloration.‫ة‬The appearance of
acne. Increased sweating, increased hair growth. headache and dizziness
Nausea and vomiting upset stomach

 Note // Monitor blood sugar and give insulin

according to blood sugar levels.

Lab. and diagnostic test

1. Glycated hemoglobin (A1C) test:
This blood test, which does not require fasting, shows the average level
of your blood sugar over the past two to three months. It measures the
percentage of blood sugar bound to hemoglobin, the oxygen-carrying
protein in red blood cells.
The higher the blood sugar levels, the more hemoglobin is bound to sugar.
An A1C level of 6.5% or higher on two separate tests indicates that you
have diabetes. An A1C value between 5.7 and 6.4% indicates prediabetes.
A level below 5.7 is considered normal.

2. Random blood sugar test:

A blood sample will be taken from you at a random time. No matter when
you last ate, a blood sugar level of 200 mg/dL (mg/dL) - 11.1 mmol/L
(mmol/L) or more indicates diabetes.

3. Fasting blood sugar test:

A blood sample will be taken from you after fasting overnight. An adult's fasting

blood glucose level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood
sugar level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If
it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

4. Oral glucose tolerance test:

For this test, you fast overnight and your fasting blood sugar level is measured. Then
you drink a sugary liquid, and your blood sugar levels are tested periodically over
the next two hours.
A permanent blood sugar level of less than 140 mg/dL (7.8 mmol/L) is normal. A
reading of more than 200 mg/dL (11.1 mmol/L) after 2 hours indicates diabetes. A
reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates
prediabe
Assessment:
Subjective data: the patient have acute pain,
Headache, nausea, vomiting, hypertension, short of breath
and cough.

Objective data: the patients haven’t any skin

Discoloration, rash and redness
 Temperature: 35.5 C
 Pulse: 70 beats /mint
 Blood pressure: 160/90 mmHg
 SPO2: 95%

Nursing diagnosis
1- Acute pain
Nursing Interventions and Rationale: Provide measures to relieve pain
before it becomes severe.
It is preferable to provide an analgesic before the onset of pain or before it becomes
severe when a larger dose may be required.
 2- Risk for Injury
Nursing Interventions and Rationale: Instruct the patient to inspect
the feet daily for cuts, scratches, and blisters. A mirror may be
necessary to assess the bottom of the foot. Instruct to use both
visual inspection and touch.
All surfaces of the foot need to be examined, including the skin
between toes. Touch will identify skin surface alterations that are
not evident by sight.

3- Imbalanced Nutrition: Less than Body Requirements

Nursing Interventions and Rationale: Risk for Deficient Fluid Volume:
Provide liquids containing nutrients and electrolytes as soon as
the patient can tolerate oral fluids, then progress to a portion of
more solid food as tolerated.
The oral route is preferred when the patient is alert, and bowel
function is restored.

4- Risk for Deficient Fluid Volume

 Nursing Interventions and Rationale: Imbalanced
Nutrition: Less Than Body Requirements: Maintain fluid
intake of at least 2500 mL/day within cardiac tolerance when
 oral intake is resumed Maintains hydration and circulating
volume.
 Promote a comfortable environment—cover patient with
light sheets Avoids overheating, which could promote
further fluid loss

5- Fatigue
 Nursing Interventions and Rationale: Discuss with the
patient the need for activity. Plan schedule with the patient
and identify activities that lead to fatigue. Education may
motivate to increase activity level even though the patient
may feel too weak initially.
 Alternate activity with periods of rest or uninterrupted sleep.
Prevents excessive fatigue.
 Discuss ways of conserving energy while bathing,
transferring, and so on.
The patient will be able to accomplish more with a decreased
expenditure of energy.
Reference
1- Williams, L.S and Hopper, P.D (2015)
2- Medical surgical Nursing.
3- F.A. Davis Company (1915) Arch Street
4- Philadelphia, PA 19103. Pp (953-962)