DESIMINATION

GERONTICAL NURSING PRACTICE

MATARAM HEALTH POLYTECHNIC
DEPARTMENT OF NURSING PROFESSIONAL NERS

"Gonetic Nursing Care for Mrs. R with a Medical Diagnosis of Type 2

Diabetes Mellitus in the Working Area of Suranadi Health Center
November 28 – December 2, 2022"

ARRANGED BY

1. I Gusti Agung Ayu Switari Pratika Sitarasmi

2. Qibithia Maria Malik
3. I Gusti Ayu Putu Candra Wulandari
4. Ni Made Wini Putri Febrina Sari
5. Panji Yudana Rangkuti
6. Tetik Oktaviani
7. Nurunniswati
8. Rizky Dwi Kurniawan

MINISTRY OF HEALTH REPUBLIC OF INDONESIA

MATARAM HEALTH POLYTECHNIC
NURSING MAJOR
NERS PROFESSIONAL EDUCATION STUDY PROGRAM
2022
 APPROVAL PAGE

Group : Suranadi Health Center

Report Title : Desimination Gerontical Nursing Practice
Mataram Health Polytechnic Department Of
Nursing Professional Ners "Gonetic Nursing
Care for Mrs. R with a Medical Diagnosis of
Type 2 Diabetes Mellitus in the Working Area
of Suranadi Health Center November 28 –
December 2, 2022"

HAS BEEN APPROVED

ON THE DATE ……….. AT ……….

BY

ACADEMIC SUPERVISOR LAND SUPERVISOR

(SAHRIR RAMADHAN, M.Kep) (LALU MANSYUR, SST., Ns.)

NIP. NIP.19731231 199303 1 024

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 VISION AND MISSION OF NERS PROFESSIONAL PROGRAM

VISION:
"Becoming a Study Program that Produces Expert, Innovative, Entrepreneur and
Efficient Nurses in the Field of Emergency and Disaster Nursing in Creating a
Healthy, Productive and Equitable Society in 2022"

MISSION:
a. Organizing expert, innovative and entrepreneurial education and teaching in
the field of emergency and disaster nursing.
b. Develop innovative based research in the field of emergency and disaster
nursing.
c. Organizing and increasing effective community service in the field of
emergency and disaster nursing in realizing a healthy, productive and just
society.
d. Increase collaboration with local governments, educational institutions and
health service institutions in the field of nursing.

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 FOREWORD

Praise be to God Almighty who has given us His guidance and grace so
that we can complete the 5D dissemination of Nursing Profession Practice
according to the predetermined time.
This 5D Reflective Dissemination was compiled as a result of an analysis
of journals regarding actions that can be applied to patients at the Suranadi Health
Center on an evidence-based basis according to the cases we encountered at the
Gerontic Nursing Practice Station for Student Health Polytechnic, Ministry of
Health, Mataram Department of Nursing Nursing Professional Education Program
2022. Completion of this Dissemination could not be separated from the help of
Group Members, Land Advisors, Academic Advisors and various parties,
therefore through this opportunity we would like to thank all parties for all their
support and guidance so that this dissemination can be completed on time.
We hope that this Dissemination can be beneficial for the environment or
area where the Nursing Profession Practice is practiced, for members of the Basic
Professional Nursing Practice group and for the entire academic community of the
Health Polytechnic of the Ministry of Health Mataram for the Nursing
Department of the Nurse Professional Education Program.

Mataram, December 2022

Compiler

Suranadi Health Center Group

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 TABLE OF CONTENTS

TITLE PAGE
APPROVAL PAGE .............................................................................................i
VISION MISSION OF NERS PROFESSIONAL STUDY PROGRAM ............ ii
FOREWORD ....................................................................................................... iii
TABLE OF CONTENTS ..................................................................................... iv
LIST OF ATTACHMENT .................................................................................. v
CHAPTER I PRELIMINARY ............................................................................. 1
A. Background ............................................................................................... 1
B. Purpose ..................................................................................................... 1
C. Benefits ..................................................................................................... 1
CHAPTER II REFLECTIVE REPORT ............................................................... 2
A. Different/Doubt......................................................................................... 2
B. Description................................................................................................ 2
C. Dissection.................................................................................................. 3
D. Discover..................................................................................................... 4
E. Decision..................................................................................................... 4
CHAPTER III CONCLUSION ............................................................................ 5
A. Conclusion ................................................................................................ 5
REFERENCES ..................................................................................................... 6
DOCUMENTATION ........................................................................................... 7
Attachment

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 LIST OF ATTACHMENTS

Attachment 1 : Reference Journal

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 CHAPTER I
PRELIMINARY
A. Background
Elderly according to the Law of the Republic of Indonesia Number 13
of 1998 Concerning Elderly Welfare, it is explained that the elderly is
someone who has reached the age of more than 60 (sixty) years and over.
According to Nugroho (2020) growing old or aging is an event that occurs in a
human's life. The process of getting old or aging is a process throughout life,
where it starts from the beginning of life. Aging or growing old is a natural
process, in which the condition of an individual has gone through the stages of
the life process, namely children and adults. (Wahyudi Nugroho, 2020)
Diabetes mellitus is a group of metabolic disorders characterized by an
increase in blood glucose levels (hyperglycemia) due to defects in insulin
secretion, insulin action or both (Smelzel and Bare, 2015). Diabetes mellitus is
a group of metabolic diseases or disorders with characteristic hyperglycemia
resulting from defects in urine secretion, insulin action, or both (ADA, 2017).
The increase in the number of people with DM in Indonesia is
predicted by WHO, in 2020 there will be eight point four million, an increase
in 2030 of 21.3 million people with DM. So it can be concluded that the
increase in the number of diabetes patients in 2035 will reach two to three
times. Meanwhile, the International Diabetes Federation estimates that in 2013
Indonesia will see an increase in the number of diabetes patients by 9.1
million, in 2035 it will increase to 14.1 million. The prevalence of the
Indonesian population diagnosed with DMT-2 in 2013 increased by 2.1%, this
figure was 1.1% higher compared to 2007.
B. Purpose
1. To add insight about Diabetes Mellitus
2. To add insight into the care of patients with Diabetes Mellitus in particular
C. Manfaat
1. For Health Agencies
The paper is expected to be developed and can be used as a good reference
for handling Diabetes Mellitus cases.

1
2. For Readers
The paper is expected to be developed and can be used as a good reference
for handling Diabetes Mellitus cases.

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 CHAPTER II

REFLECTIVE REPORT
NERS PROFESSIONAL CLINIC PRACTICE OF NURSING
DEPARTMENT OF NURSING POLTEKKES KEMENKES MATARAM

A. Differences/Doubt
Is there any effect of foot exercise on reducing blood sugar levels in patients
with a medical diagnosis of Diabetes Mellitus?
B. Description
During my morning service on December 14, 2022, I conducted a study on
Mrs. R with a medical diagnosis of Diabetes Mellitus at the General Polyclinic
at the Suranadi Health Center. The patient arrived at 08.30 WITA with
complaints of tingling in the extremities, feeling weak, dizzy, easily drowsy,
the patient looked pale and weak. The general condition of the patient was
obtained that the patient's BP: 144/100 mmHg, Pulse: 90x/min, RR:
20x/minute, S: 360C. After examining the GDS (Blood Sugar During) in the
laboratory, it was found that the patient's GDS result was 322 mg/dl. At the
General Polyclinic the patient was prescribed drugs in the form of amlodipine,
glimepiride, metformin and vitamin B complex. In the afternoon at 16.00
WITA I visited the patient's house according to the time contract with the
patient when conducting an assessment and planned to do Diabetes Mellitus
foot exercises to help smoothen the patient's blood glucose lowering and
reduce the tingling that the patient feels. This leg exercise can be done for 30
minutes and done for 3 consecutive days. Here I use the references of Elang
Wibisama (2017) and (Bangun Dwi 2018) where in these two research
journals leg exercises are carried out 3-5 times a week with a duration of 30-
60 minutes, but due to limited time for implementing the askep here I took the
time to carry out 3 days in a row with a duration of 30 minutes. I took GDS
measurements pre and post doing leg exercises, on the first day the patient's
GDS was 322 mg/dl and after doing leg exercises it was measured again with
results of 310 mg/dl. On December 15, 2022 I visited the patient's house again

2
 at 9.30 WITA and examined TTV and also the patient's GDS before
exercising (301 mg/dl) then the patient did leg exercises and after a few
minutes after the foot exercise the patient's GDS was measured again and the
results 298mg/dl. Then the next day on December 16 2022 I made another
home visit and as usual measured the patient's TTV and GDS before doing the
leg exercise (290 mg/dl) and then measured the patient's blood glucose level
again afterwards (282 mg/dl). During a home visit, the patient said that he also
continued to take his medicine regularly and said that the tingling in his feet
and hands had decreased and the patient seemed enthusiastic about doing leg
exercises.
C. Dissection
Diabetes is a degenerative disease that has special characteristics, namely
hyperglycemia caused by abnormal insulin secretion and insulin performance
that is not optimal or both occur. Various management of diabetes include
education, diet, physical exercise, and pharmacological interventions. Physical
exercise is one of the first attempts to prevent, control and treat DM.
According to Chaveau. and Kaufman in Afridon (2018), explained that
physical exercise can have an effect
immediately lowers blood sugar levels. This is caused when the process of
physical exercise requires active use of glucose by the muscles. As well as
increased blood flow so that there are more capillary nets open. Attempts to
control blood sugar are not effective only with medication. This is because
people with diabetes mellitus are caused by damage to the pancreas in
producing insulin, where insulin functions to control blood sugar levels. This
decrease in blood sugar levels is one of the indications of an improvement in
diabetes mellitus that is experienced. Therefore, giving foot exercise activities
is an effective way to manage diabetes mellitus (Ruben, Rottie, and
Karundeng, 2016). Research conducted by Ruben, Rottie, Karundeng, (2016),
showed that
There is a significant effect between before and after diabetic foot exercise.
Likewise with the results of research by Santosa and Rusmono (2016) which
suggested that foot exercise in patients with diabetes mellitus can reduce blood

3
 sugar levels during. Another study by Rusli and Farianingsih (2015) showed
that there was a strong effect of diabetic foot exercise on reducing blood sugar
levels in type II diabetes mellitus patients. Diabetic foot exercise is needed in
managing diabetes mellitus, regular physical exercise can reduce blood sugar
levels.
D. Discover
Diabetes mellitus foot exercise is an activity or exercise performed by people
with diabetes mellitus to prevent injuries and help improve blood circulation
in the legs. Diabetic foot exercises can help improve blood circulation and
strengthen the small muscles of the feet and prevent foot deformities from
occurring. Apart from that, it can increase the strength of the calf muscles,
thigh muscles, and also overcome the limitations of joint movement (Bangung
2018). Foot exercise is very easy to do (indoor or outdoor) and does not
require a long time (only about 30-60 minutes) and does not require
complicated equipment (a chair and an old newspaper). At a minimum, leg
exercise movements are carried out 3 (three) times a week, but it would be
better if done every day. Doing regular foot exercises can help diabetes
mellitus patients regulate their blood glucose levels within a normal and stable
range.
E. Decision
What I do:
a. Observing tingling and signs of hyperglycemia felt by the patient.
b. Providing nursing actions in the form of diabetic foot exercises

4
 CHAPTER III
CONCLUSION

A. Conclusion
Diabetes mellitus is a group of heterogeneous metabolic disorders that
cause hyperglycemia, resulting from inadequate insulin production,
inadequate insulin secretion, or a combination of both. Diabetes mellitus
disease requires ongoing care and risk management, ongoing patient self-
education and support to prevent acute complications and reduce long-term
complications.
Efforts to control blood sugar are not effective only with medication.
This is because people with diabetes mellitus are caused by damage to the
pancreas in producing insulin, where insulin functions to control blood sugar
levels. This decrease in blood sugar levels is one of the indications of an
improvement in diabetes mellitus that is experienced. Therefore providing foot
exercise activities is an effective way of managing diabetes mellitus (Ruben,
Rottie, and Karundeng, 2016).

5
 REFERENCE

Wibisana, E & Sofiani, Y. (2014). Pengaruh senam kaki terhadap kadar gula
darah pasien diabetes mellitus di RSU Serang Provinsi Banten.
Ruben, G & Rottie, P,. J,. (2016). PENGARUH SENAM KAKI DIABETES
TERHADAP PERUBAHAN KADAR GULA DARAH PADA PASIEN
DIABETES MELITUS TIPE 2 DI WILAYAH KERJA PUSKESMAS
ENEMAWIRA. eJournal Keperawatan (eKp) Volume 4 Nomor 1.
Dwi, B. (2018). PENURUNAN GULA DARAH PADA PASIEN DIABETES
MELITUS TIPE II MELALUI SENAM KAKI DIABETES.
MEDISAINS: Jurnal Ilmiah Ilmu-ilmu Kesehatan, Vol 16 No 2
Risnasari, N,. Herawati, E. Dkk. (2022). Pelatihan Senam Diabetes untuk
menurunkan Kadar Glukosa Dalam Darah pada Lansia di Posyandu
Lansia Bagas Waras. Journal of Community Engagement in Health. ISSN:
2620-3758 (print); 2620-3766 (online) Vol. 5 No 2. September 2022.
Page. 194 - 198. https://jceh.org/ https://doi.org/10.30994/jceh.v5i2.309
Oktavianisya, N., Aliftitah., S. (2022). Pengaruh Senam Diabetes Mellitus
terhadap Penurunan Kadar Gula Darah pada Penderita Diabetes Mellitus
Tipe 2 Poltekita: Jurnal Ilmu Kesehatan Vol.16 No.2 Agustus 2022: Hal.
214-219 p-ISSN: 1907-459X e-ISSN: 2527-7170.
http://jurnal.poltekkespalu.ac.id/index.php/JIK

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DOCUMENTATION

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Attachment
Evaluation of blood glucose levels in patients with diabetes mellitus

Day Vital Sign GDS

Pre Post
H1 TD :144/100 mmHg 322 mg/dl 310 mg/dl
December 14, 2022 N: 90x/minute
RR:20x/minute
H2 TD :140/90 mmHg 301 mg/dl 298 mg/dl
December 15, 2022 N: 92x/minute
RR:19x/minute
H3 TD :130/80 mmHg 290 mg/dl 282 mg/dl
December 16, 2022 N: 85x/minute
RR:19x/minute

Discussion:
Based on the table above, it can be seen that from the first day to the third day, the
patient's blood sugar decreased.