NCPDM 231208094146 8e570409

lOMoAR cPSD| 24626089
lOMoAR cPSD| 24626
NURSING
CARE PLAN
ON
DIABETES MELLITUS
NURSING ASSI PRO. MR.JITENDRA BARDE
NURSING
CARE PLAN
DM
SUBMITTED TO : SUBMITTED BY :
MR. JITENDRA BARDE MS.
(ASS .PROFESSOR) BSC 3d YEAR STUDENT
.
SUBMISSION DATE
HISTORY-TAKING
&
PHYSICAL-
EXAMINATION
DEMOGRAPHIC DATA:
NAME :-Mr. Shrikant kisan Chavan

AGE :-49 Year
SEX :-Male
ADDRESS :-Sr No -1,Mandan Nagar,Anant Nivas,Pune-33
IP NUMBER :-23451
EDUCATION :- B.A.
OCCUPATION :- Peon in corporation
INCOME :-15000/Month
MARITAL STATUS : - Married
RELIGION :-Hindu
MOTHER TONGUE:- Marathi
WARD :-MICU
DATE OF ADMISSION: -03/01/2020
DIAGNOSIS :- Diabetes mallitus with DKA with hypotension with l-5

rediculopathy.
HISTORY-TAKING
CHIEF COMPLIANTS: -
Sweating and gidiness since 1 day
Genralised weakness since 2 days
Pain in the back since 2 days
Weakness in right lower limb since 2 days
PRESENT HISTORY OF ILLNESS:-
Patient was apparently all right, asymptomatic1 day before when he developed sweating and
gidiness, pain in the back radiating to the right foot since 2 days, he experienced this while
walking, following which he developed weakness of right lower limb which is sudden in onset
associated with loss of balance and falling in a front posture on the knee.
Difficulty in walking
Difficulty in getting up from sitting
positionH/O Loss of balance
PAST HISTORY OF ILLNESS:-
MEDICAL HISTORY: -Patient is a known case of diabetes mallitus-2 since 4 years not on
regular tretment with tab glimepride gp half tablet, before meal. not taken since last 5 days.
SURGICAL HISTORY: -Patient is operated for inguinal hernia 12 years back.
MENSTRUAL HISTORY [FEMALE] - Not applicable
FAMILY HISTORY:-
NAME AGE SEX OCCUPATION RELATIONSHIP HEALTH

STATUS
MR. SHRIKANT 49 YEARS Male BA./PEON Himself Sick
KISAN CHAVAN
MRS. SAVITA S. C. 45 YEARS Female HOUSEWIFE Wife Healthy
MR. RAHUL S.C. 23 YEARS Male B.COM Son Healthy
/STUDENT
MRS.RENUKA K. 43 YEARS Female HOUSEWIFE Sister DM-2
C.
PERSONAL HISTORY:-
HABITS : Non-alcoholic, non-smoker
DIET : Non- vegetarian, 4 times/day.appetite incresed, excessive thirst.
SLEEPING HABITS : Patient sleeps 1 hrsat day time and 8 hrs at night time,
currentlysleep pater distrubed
ALLERGY : No history of allergy to any food/medications given by
patient.BOWEL AND BLADDER HABITS: Bowel movement normal&polyurea -
present.
SOCIO- ECONOMIC STATUS:-
Condition of the house:pakka house& adequate ventilation 2room&1 window, kitchen

WATER SUPPLY: Corporation water
DRAINAGE SYSTEM: Closed drainage
SURROUNDING ENVIRONMENT: The environment is clean around the house.
PHYSICAL EXAMINATION
GENERAL APPEARANCE:
CONSTITUTION : Well-build
STATE OF NUTRITION : Obesity
PERSONAL APPEARANCE :Fair
POSTURE: NORMAL
SKIN AND HAIR : Skin is dried & cold, colour, and no any infection &
hyperpigmented skin lesions seen on medial aspect of the thigh.
EMOTIONAL STATE : Anxious
CO-COOPERATIVENESS : Patient is co-operative
HEIGHT AND WEIGHT:
HEIGHT : 5.0 Feets
WEIGHT : 69kg
VITAL SIGNS:
TEMPERATURE : 98.0F
PULSE : 105B/ Minute
RESPIRATION : 28/Minute
BLOOD PRESSURE : 90/50Mm Hg
HEAD AND FACE:
SKULL: Round in shape
SCALP: Clean, no dandruff, scar present

HAIR: No hair
FACE: Symmetrical
NODE: Not palpable
EYES:
EYEBROWS: Symmetrical
EYELASHES: Equally distributed and there is no infection, lesion present.
EYELID : Intact, no discharge, discoloration, and lids close symmetrically
EYEBALLS: Both eyes coordinated; move in unison with parallel alignment.
CONJUNCTIVA : No redness and lesion
SCLERA: White
PUPIL: Reactive to light
LENS: Dilated
VISION: Patient has good visual capacity; he can read and saw easily.
EARS:
EXTERNAL STRUCTURE: No any tenderness
CANAL : No any discharge from ears.
TYMPANIC MEMBRANE : Intact
HEARING: Weber test- patient hear equal in both
RINNIE TEST- Sound conducted by air is heard is more sound conducted by bone.air
conduction is more than bone conduction.
NOSE:-
EXTERNAL STRUCTURE – Symmetric and straight
SEPTUM - No deviated nasal septum
MUCOUS MEMBRANE -Moist
OLFACTORY SENSE -Present

PATENCY –Patent
MOUTH AND PHARYNX:
LIPS- Pink color
TEETH- No dental caries,shiny tooth enamel present.
GUMS -Healthy (no bleeding)
PALATES – Smooth and soft palate
VOICE – Soft and clear.
BREATHE – No any bad smell present.
TASTE –Good
NECK:
LYMPH NODES - Not palpable
MUSCLES –Muscles are in equal in both size and head in centered.
TRACHEA -Centrally situated and space are equal in both side.
THYROID GLAND -Not palpable
RANGE OF MOTION- Present
BREAST AND AREA NODES: -
INSPECTION:-NOT Applicable
PALPATION:-NOT Applicable
CHEST:
CHEST SHAPE: - Symmetrical shape
TYPE OF RESPIRATION: - Rhythmic and effortless respiration.
EXPANSIONS -Chest is bilatraly equally expanded during respiration.
INSPECTION- No any tender scar, mass, node present
PALPATION- Bilateral
PERCUSSION-No any dull sound present and not present any fluid.
AUSCULTATION -During auscultation normal boncho-vesicular sound present
CARDIOVASCULAR SYSTEM:-
RATE AND RHYTHM: - Regular &weak pulse felt
APICAL AND RADIAL:-105/M And regular
CAROTID PULSE: - Full pulsation present and no bruit sound.
JUGULAR VENOUS DISTENSION: -No distended jugular vein
DESCRIPTION OF PERIPHERAL PULSES:-
BRACHIA RADIAL FEMORAL POPLITEA DORSAL POST TIBIAL

L L PEDIAL
RATE 105/m 105/m 102/m 102/m 102/m 102/m
RHYTHAM Regular Regular Regular Regular Regular Regular
ABDOMEN AND INGUINAL AREAS:-
CONTOUR AND TONE : - Convex, no any tenderness present
SCAR : - No any scar present
LIVER: - Not palpable and no hepatomegaly
SPLEEN: - Not palpable and no spleenomegaly
KIDNEY: - Not palpable
BLADDER: -Not distended
MASSES : - Mass is palpable in left L.H.C. area.
PALPATION : - There is no tenderness, relax abdomen with consistent tension.
PERCUSSION : - Tympany sound present, no sign of ascitis or fluid collection.
AUSCULTATION : - Audible bowel sound present.
GENITALS AREA:
RECTAL EXAMINATION: - It’s smooth and not tender.
MUSCULOSKELETAL SYSTEM:
UPPER EXTREMITIES : No any deformity, normal rom present
LEFT LOWER EXTREMITIES : No any deformity, normal rom present
RIGHT LOWER EXTREMITIES :No any deformity, normal rom present (slow).
JOINT EVALUATION : No tenderness, no any crepitation, nodules etc
MUSCLE STRENGTH: - Grade-2, 25% of normal strength of right lowers limb -present
MUSCLE MASS : No any mass present
NODE: NOT PRESENT
RANGE OF MOTION : Decresed due to pain
VERTEBRA: - Back pain radiating to right leg.
NERVOUS SYSTEM:-
MENTAL STATUS:- Patient is oriented to time , place and person.
He can calculate the normal value like 12+17=29
He has good judgment quality.
Patient has good immediate, recent and recall memory.
CRANIAL NERVES: - Present the sensory and motor response of the nerves.
DEEP TENDON REFLEX: - Deep tendon reflex present, bicep’s, triceps, patellar, brachio-
radialis and planter reflex etc.
SUPERFICIAL SENSORY REFLEX:-The reflex is reactive to light, pain, vibration, and touch.
INVESTIGATION:-
TYPE PATIENT REPORT NORMAL VALUES IMPRESSION

HEMOGRAM
HB 11.5 MG/DL 13-18 MG/DL Decresed
TLC 11300/ CUMM 4000-11000/CUMM Increased
PLATELET COUNT 4.0 LAKH/CUMM 1.5-4.5 LAKH/CUMM Normal
BSL PROFIL
BSL RANDOM
BSL-FASTING 350 MG/DL UPTO 150 MG/DL Hypergycemia
BSL-PP-1 243 MG/DL 70-100MG/DL
BSL-PP-2 268 MG/DL
316MG/DL
HBA1C
8.5 % 4.5-6.3% Poor diebetic control
LFT
SR.BILURUBINE
TOTAL 0.4 0.2-1.0 GM% Normal
DIERECT 0.2 0-0.3 GM% Normal
SR.PROTIEN 5.3 6.2-8.0 GM%
ALBUMIN 3.0 3.5-4.6 GM%
GLOBULIN 2.0 2.3-3.2 GM% Hypoprotinemia
SGPT 18 0-40 Normal
SGOT 46 18-112 Normal
SERUM
ELECTROLYTE
SERUM SODIUM 137 meq/l 135-145meq/l Normal
SERUM 5.8 meq/l 3.5-5.5 meq/l Normal

POTASSIUM
RFT
BLOOD UREA 48 mg% 15-50mg%
SERUM 1.4 mg% 0.6-1.4 mg% Normal

CREATININE
Normal
URINE
SUGAR ABSENT Indicating high blood
PRESENT glucose level
ALBUMIN ABSENT
PRESENT
KETONE ABSENT Indicating dka
PRESENT
LIPID PROFILE
TEST
S.CHOLESTEROL Patient is in
130-200 hyperlipidemic status.
S.TRIGLYCERIDES 235 MG/DL
S. HDL LESS THAN 150
S VLDL 210 MG/DL LESS THAN 40
S.LDL 42 MG/DL UPTO 34.0
35 MG/DL LESS THAN 100
112 MG/DL
NCV STUDY:-Ascornal sensory-motor peripheral neuroparhy.
MRI STUDY: - Posterior disc pertusion at c3-c4, c4-c5 &c5-c6 level, compressing anteriorneural
sac & spinal.
L-5 Rediculopathy is present.
MEDICATION:-
DRUG NAME ROUT DOSE FREQUENCY TIME

INJ HUMINSULINE-R SC 2 ML/HR CON INFUSION 24 HRS.
TAB.GLYCOMET GP-1 PO BD 8AM, 8PM.
TAB.PREGBA-M PO 75MG OD 9PM
TAB ATORE-F PO OD 9PM
TAB.SHELCAL PO 500 MG OD 3 PM
TAB.NEUROBION PO OD 10AM
FORTE
TAB.MYOSPAS FORTE PO SOS 11AM
TAB.PAN PO 40 MG O.D 10 AM
CAP.MVBC PO OD 10 AM
DEFINITIONS:-
DIABETES MELLITUS: - Diabetes mellitus is a group of metabolic diseases characterized by

elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin
secretion, insulin action, or both. [ada].
INSULIN:-A hormone produced by the pancreas, controls the level of glucose in the blood by
regulating the production and storage of glucose. in the diabetic state, the cells may stop re-
sponding to insulin or the pancreas may stop producing insulin entirely.
HYPERGLYCEMIA:-Elevated blood glucose level—fasting level greater than 110 mg/dl and
2-hour postprandial level greater than 140 mg/dl
HYPOGLYCEMIA: - Low blood glucose level (less than 60 mg/dl ).
CLASSIFICATION OF DIABETES:-
CURRENT PREVIOUS CLINICAL CHARACTERISTICS AND CLINICAL

CLASSIFICATION CLASSIFICATIONS IMPLICATIONS
TYPE 1 (5%–10% Juvenile diabetes. :-onset at any age, usually younger(less than 30 yr)
OF ALL DIABETES) Juvenile-onset diabetes. :-usually thin at diagnosis; with recent weight loss
Ketosis-prone diabetes. :-etiology includes genetic, immunologic, or

brittle diabetes. Environmental factors (eg, virus).
Insulin-dependent :-often have islet cell antibodies.
diabetes mellitus :-often have antibodies to insulin even. Before insulin
(IDDM). treatment.
: - little or no endogenous insulin.
:-need insulin to preserve life.
:-ketosis-prone when insulin absent.
:-acute complication of hyperglycemia: diabetic
ketoacidosis.
TYPE 2 (90%–95% Adult-onset diabetes. :-onset any age, usually over 30 years.
OF ALL DIABETES: Maturity-onset :-usually obese at diagnosis.
OBESE— 80% OF diabetes. :-causes include obesity, heredity, or environmental factors.
TYPE 2; Ketosis-resistant :-no islet cell antibodies.
NONOBESE—20% diabetes. :-decrease in endogenous insulin, or increased with insulin
OF TYPE 2) Stable diabetes. Non– resistance.
insulin-dependent :- most patients can control blood glucose through weight
diabetes (NIDDM). loss if obese.
:-oral antidiabetic agents may improve blood glucose levels
if dietary modiﬁcation and exercise are unsuccessful.
:- may need insulin on a short- or long-term basis to prevent
hyperglycemia.
:-ketosis rare, except in stress or infection. :-acute
complication: hyperglycemic hyperosmolar nonketotic
syndrome.
RISK FACTORS FOR DIABETES MELLITUS:-
BOOK PICTURES PATIENT PICTURES

1. Family history of diabetes (parents or siblings Present
with diabetes).
2. Obesity (if, ≥20% over desired body weight or Present

bmi ≥27 kg/m2).
3. Race/ethnicity (eg, african americans, hispanic Absent
americans, native americans, asian americans,
pacific islanders).
4. Age≥45 years. Present
5. Previously identified impaired fasting glucose or Absent

impaired glucose tolerance.
6. Hypertension (≥140/90 mmhg),hdl cholesterol Absent

level ≤35 mg/dl (0.90 mmol/l) and/or tri-
glyceride level ≥250 mg/dl (2.8 mmol/l).
7. History of gestational diabetes or delivery of Absent

babies over 9 lbs
DESTRUCTIONS OF β-CELLS OF THE PANCREAS
INABILITY TO SECREAT INSULIN FROMβ-CELLS OR TISSUE RESISTANCE TO

INSULIN
ACUTE ELIVATION IN BLOOD GLUCOSE LEVEL BUT LESS IN THE CELLS

INCREASED OSMOLARITY OF BLOOD PRODUCING EXCESS

GLUCAGONE
LEADES TO GLYCOSUREA PRODUCTION OF MORE GLUCOSE FROM

PROTIEN &FAT
CHRONIC ELIVATION IN BLOOD GLUCOSE LEVEL WEIGHT LOSS
DIABETIC NEUROPATHY ANGIOPATHY RETINOPATHY NEPHROPATHY
CLINICAL MENIFASTATION:- PATIENT PICTURES

BOOK PICTURES
Polyuria (increased urination) Present
Polydipsia (increased thirst). Present

Occur as a result of the excess loss of fiuid associated
with osmotic diuresis.
Polyphagia (increased appetite) resulting from the Absent

catabolic state induced by insulin deficiency and the
breakdown of proteins and fats.
Fatigue and weakness, Present
Sudden vision changes, Absent
Tingling or numbness in hands or feet, Absent
Dry skin, Present

Skin lesions or
Wounds that are slow to heal, Absent
Absent
Recurrent infections. Absent
The onset of type-1diabetes may also be associated

with
Sudden weight loss or
Absent
Nausea, vomiting,
or abdominal pains, if dka has developed. Absent
Absent
DIAGNOSTIC FINDINGS:-
CRITERIA FOR THE DIAGNOSIS OF DIABETES MELLITUS:-
BOOK PICTURES PATIENT PICTURES

Symptoms (polyuria, polydipsia, and unexplained Symtoms(polyuria, polydipsia) plus
weight loss.) Plus bsl-randome more than 200 mg/dl. bsl-randome is 350 mg/dl
Fasting blood glucose greater than or equal to 100 Bsl- fasting is 243 mg/dl
mg/dl
2-hour postload glucose equal to or greater than 200 Patient’s pp-1 is 268mg/dl and pp-2 is 316 mg/dl.
mg/dl, during an oral glucose tolerance test.
Hba1c more than 6.3% 8.5 % poor diebetic control

Fasting lipid profile values increased Present
Microalbuminuria, Present
Urinalysis Present
Glycosuria Present
Ketonurea
DIABETES MANAGEMENT:-there are five components of diabetes management:-
• nutritional management
• exercise
• monitoring
• pharmacologic therapy
• education
NUTRITIONAL MANAGEMENT:-
MEAL PLANNING:-
CALORIC REQUIREMENTS:-
Calorie-controlled diets are planned by first calculating the individual’s energy needs and caloric
requirements based on the patient’s age, gender, height, and weight. An activity element is then
factored in to provide the actual number of calories required for weight maintenance. To promote
a 1- to 2-pound weight loss per week, 500 to 1,000 calories are subtracted from the daily total.
CALORIC DISTRIBUTION:-
A diabetic meal plan also focuses on the percentage of calories to come from carbohydrates,
proteins, and fats. in general, carbohydrate foods have the greatest effect on blood glucose
levels because they are more quickly digested than other foods and are converted into glucose
rapidly.
CARBOHYDRATES:-
Currently, the ada and the american dietetic association recommend that for all levels of caloric
intake, 50% to 60% of calories should be derived from carbohydrates.
FATS:-
The recommendations regarding fat content of the diabetic diet include both reducing the total
percentage of calories from fat sources to less than 30% of the total calories and limiting the
amount of saturated fats to 10% of total calorie.
Additional recommendations include limiting the total intake of dietary choles terol to less than
300 mg/day.
FIBER:-
The use of fiber in diabetic diets has received increased attention as researchers study the effects
on diabetes of a high- carbohydrate, high-fiber diet. This type of diet plays a role in low- ering
total cholesterol and low-density lipoprotein cholesterol in the blood. Increasing fiber in the diet
may also improve blood glucose levels and decrease the need for exogenous insulin.
SWEETENERS:-
There are two main types of sweeteners: nutritive and non-nutritive. The nutritive sweeteners
contain calories, and the non-nutritive sweeteners have few or no calories in the amounts
normally used.
NUTRITIVE SWEETENERS INCLUDE:-
Fructose (fruit sugar), sorbitol, and xylitol they are not calorie-free; they provide calories in
amounts similar to those in sucrose, they cause less elevation in blood sugar levels than sucrose
and are often used in “sugar-free” foods. Sweeteners containing sorbitol may have a lax- ative
effect.
NON-NUTRITIVE SWEETENERS:-
Have minimal or no calories they are used in food products and are also available for table use.
They produce minimal or no elevation in blood glucose levels and have been approved by the
food and drug administration as safe for people with diabetes.
EXERCISE:-
BENEFITS:-
1. Exercise lowers the blood glucose level by increasing the uptake of glucose by body muscles
and by improving insulin utilization.
2. It also improves circulation and muscle tone.
3. Resistance (strength) training, such as weight lifting, can increase lean muscle mass, thereby
increasing the resting metabolic rate. These effects are useful in diabetes in relation to losing
weight, easing stress, and maintaining a feeling of well-being.
EXERCISE PRECAUTIONS:-
Patients who have blood glucose levels exceeding 250 mg/dl, and who have ketones in their
urine should not begin exercising until the urine tests negative for ketones and the blood glucose
level is closer to normal. Exercising with elevated blood glucose levels increases the secretion of
glucagon, growth hormone, and catecholamines. The liver then releases more glucose, and the
result is an increase in the blood glucose level
Patients who take insulin is at risk for hypoglycemia that occurs many hours after exercise. To
avoid post exercise hypoglycemia, especially after strenuous or prolonged exercise, the patient
may need to eat a snack at the end of the exercise session
People with diabetes should exercise at the same time (preferably when blood glucose levels are
at their peak) and in the same amount each day. Regular daily exercise, rather than sporadic
exercise, should be encouraged.
Exercise recommendations must be altered as necessary for patients with diabetic complications
such as nephropathy, autonomic nephropathy, somatosensory nephropathy, and cardiovascular
disease
MONITORING:-
Self-monitoring of blood glucose (smog) levels by patients has dramatically altered diabetes
care. Frequent smog enables people with diabetes to adjust the treatment regimen to obtain
optimal blood glucose control.
1. SELF MONITORING BLOOD GLUCOSE:-
CANDIDATES FOR SMBG:-
Everyone with diabetes, smbg is useful for managing self- care. It is a key component of
treatment for any intensive insulin therapy regimen (including two to four injections per day or
in- insulin pumps) and for diabetes management during pregnancy. It is also recommended for
patients with:
• Unstable diabetes
• A tendency for severe ketones or hypoglycemia
• Hypoglycemia without warning symptoms
FREQUENCY OF SMBG:-
Most patients who require insulin, smbg is recommended two to four times daily (usually before
meals and at bedtime).
For patients who take insulin before each meal, smbg is required at least three times daily before
meals to determine each dose.
Patients not receiving insulin may be instructed to assess their blood glucose levels at least two
or three times per week, including a 2-hour postprandial test.
2. GLYCOSYLATED HEMOGLOBIN:-
Glycosylated hemoglobin (referred to as hgba1c or a1c) is a blood test that reflects average blood
glucose levels over a period of approximately 2 to 3 months. When blood glucose levels are
elevated, glucose molecules attach to hemoglobin in the red blood cell. The longer the amount of
glucose in the blood remains above normal, the more glucose binds to the red blood cell and the
higher the glycosylated hemoglobin level.
3. URINE TESTING:-
Glucose before smbg methods were available, urine glucose testing was the only way to monitor
diabetes on a daily basis. Today its use is limited to patients who cannot or will not perform
smbg.
4. TESTING FOR KETONES:-

Ketones (or ketone bodies) in the urine signal that control of type 1 diabetes is deteriorating, and
the risk of dka is high. When there is almost no effective insulin available, the body starts to
break down stored fat for energy. Ketone bodies are byproducts of this fat breakdown, and they
accumulate in the blood and urine.
PHARMACOLOGIC THERAPY:-
1. INSULIN THERAPY AND INSULIN PREPARATIONS:-
TIME AGENT ONSET PEAK DURATION INDICATIONS

COURSE
Rapid-acting Lispro 10–15 1h 3h Used for rapid reduction of glucose

(humalog) min level,
Aspart 10–15 40–50 min 4–6 h To treat postprandial hyper-
(novolog) min glycemia, and/or
To prevent nocturnal hypoglycemia
Short-acting Regular 1Ú2–1 h 2–3 h 4–6 h Usually administered 20–30 minutes

(humalog-r, before a meal;
novolin-r, May be taken alone or in
Iletin ii regular) combination with longer- acting
insulin
Intermediate- Nph (neutral 2–4 h 6–12 h 16–20 h Usually taken after food
acting protamine
hagedorn)
(humulin- 3–4 h 6–12 h 16–20 h
n,novolin-n
[nph])
Long-acting Ultralente (“ul”) 6–8 h 12–16 h 20–30 h Used primarily to control fasting
glucose level
Very long- Glargine (lantus 1h Continuous 24 h Used for basal dose
acting (no peak
ORAL ANTIDIABETIC AGENTs:-
MECHANISUM OF ACTION:-
SULFONYLUREAS: -
The sulfonylureas exert their primary action by directly stimulating the pancreas to secrete
insulin. Therefore, a functioning pancreas is necessary for these agents to be effective, and they
cannot be used in patients with type 1 diabetes. These agents improve insulin action at the
cellular level and may also directly decrease glucose production by the liver.
BIGUANIDES: -
Metformin (glucophage) produces its antidiabetic effects by facilitating insulin’s action on

peripheral receptor sites. Therefore, it can be used only in the presence of insulin. Biguanides
have no effect on pancreatic beta cells.
ALPHA GLUCOSIDASE INHIBITORS:-
Acarbose (precose) and miglitol (glyset) are oral alpha glucosidase inhibitorsused in type 2
diabetes management. They work by delaying the absorption of glucose in the intestinal system,
resulting in a lower postprandial blood glucose level. As a consequence of plasma glucose
reduction, hemoglobin a1c levels drop.
THIAZOLIDINEDIONES: -
Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion
from the beta cells of the pancreas,they are indicated for patients with type- 2 diabetes who take
insulin injections and whose blood glucose control is inadequate (hemoglobin a1c level greater
than 8.5%). They have also been approved as firstline agents to treat type-2 diabetes, in
combination with diet.
MEGLITINIDES:-
Lowers the blood glucose level by stimulating insulin release from the pancreatic beta cells. Its
effectiveness depends on the presence of functioning beta cells. Therefore, repaglinide is
contraindicated in patients with type 1 diabetes. Repaglinide has a fast action and a short
duration. It should be taken before each meal to stimulate the release of insulin in response to
that meal. It is also indicated for use in combination with metformin in patients whose
hyperglycemiacannot be controlled by exercise, diet, and either metformin or repaglinide alone.
ORAL ANTIDIABETIC AGENTs:-
S.N DRUG NAMES DAILY DOSE MAXIMUM DURATION

. DOSE OF
ACTION
1 FIRST-GENERATION SULFONYLUREAS:-
➢ ACETOHEXAMIDE 250–1500 (D) 1,500 12–24
➢ CHLORPROPAMIDE 100–500 (S) 750 60
➢ TOLAZAMIDE 100–750 (D) 1,000 12–24
➢ TOLBUTAMIDE 500–2000 (D) 3,000 6–12
2 SECOND-GENERATION SULFONYLUREAS:-
➢ GLIPIZIDE 5–25 (D) 40 10–24

➢ GLIPIZIDE 5 (S) 10 24
➢ GLYBURIDE 2.5–10 (D) 20 12–24
➢ GLIMEPIRIDE 1–2 (S) 8 24
3 BIGUANIDES:-
➢ METFORMIN (GLUCOPHAGE +
GLUCOPHAGE XL) 1,500 (D) 2,500 10–16
➢ METFORMIN WITH GLYBURIDE
4 ALPHA GLUCOSIDASE INHIBITORS :- 1,500 (D) 2,500 8
➢ ACARBOSE
5 THIAZOLIDINEDIONES:-
➢ PIOGLITAZONE 15–30 (S) 45 ?
➢ ROSIGLITAZONE 4 (S or D) 8 ?
6 MEGLITINIDES:-
➢ REPAGLINIDE 0.5–4 (D) 16 2
➢ NATEGLINIDE 180–360 (D) 360 4
ACUTE COMPLICATIONS OF DIABETES:-
1. HYPOGLYCEMIA (INSULIN REACTIONS):-Hypoglycemia (abnormally low blood

glucose level) occurs when the blood glucose falls to less than 50 to 60 mg/dl (2.7 to 3.3
mmol/l).
CAUSES:-
1. High insulin or oral hypoglycemic agents,
2. Too little food, or
3. Excessive physical activity.
4. Hypoglycemia may occur at any time of the day or night. It often occurs before meals,
especially if meals are delayed or snacks are omitted.
CLINICAL MANIFESTATIONS:-
MILD HYPOGLYCEMIA:-
Sweating, tremor, tachycardia, palpitation, nervousness, and hunger.
MODERATE HYPOGLYCEMIA:-
Inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the

lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or
combative behavior, double vision, and drowsiness.
SEVERE HYPOGLYCEMIA:-
Disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.
MANAGEMENT:-
The usual recommendation is for 15 g of a fast-acting concentrated source of carbohydrate such

as the following, given orally:
• Three or four commercially prepared glucose tablets
• 4 to 6 oz of fruit juice or regular soda
• 6 to 10 life savers or other hard candies
• 2 to 3 teaspoons of sugar or honey
INITIATING EMERGENCY MEASURES:-
Patients who are unconscious and cannot swallow, an injection of glucagon 1 mg can be
administered either subcutaneously or intramuscularly.
2. DIABETIC KETOACIDOSIS:-
A metabolic derangement in type- 1 diabetes that results from a deficiency of insulin. Highly
acidic ketone bodies are formed, resulting in acidosis; usually requires hospitalization for
treatment and is usually caused by nonadherence to the insulin regimen, concurrent illness, or
infection.three main feature include:-
• Hyperglycemia
• Dehydration and electrolyte loss
• Acidosis
CLINICAL MANIFESTATIONS:-
1. The hyperglycemia of dka leads to polyuria and polydipsia (increased thirst).

2. Orthostatic hypotension (drop in systolic blood pressure of 20 mm hg or more on

standing).
3. Frank hypotension with a weak, rapid pulse.
4. GI symptoms such as anorexia, nausea, vomiting, and abdominal pain. the abdominal
pain and physical findings on examination can be so severe that they resemble an acute
abdominal disorder that requires surgery.
5. Patients may have acetone breath (a fruity odor), which occurs with elevated ketone
levels.
6. Hyperventilation (with very deep, but not labored, respirations) may occur.
ASSESSMENT AND DIAGNOSTIC FINDINGS:-
1. Blood glucose levels may vary from 300 to 800 mg/dl
2. Low serum bicarbonate (0 to 15 meq/l) and
3. Low ph (6.8 to 7.3) values.
4. A low pco2 level (10 to 30 mm hg) reflects respiratory compensation for acidosis.
5. Ketone bodies is reflected in blood and urine ketone measurements.
6. Sodium and potassium levels may be low, normal, or high, depending on the amount of
water loss (dehydration).
MANAGEMENT:-
REHYDRATION:-
Initially, 0.9% (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 l per hour
for 2 to 3 hours.
0.45% normal saline solution may be used for patients with hypertension or hypernatremia or
those at risk for heart failure.
0.45% n.s. can be continues 250-500 ml/hrs for several hours.
RESTORING ELECTROLYTES:-
Potassium replacement up to 40 meq per hour may be needed.
REVERSING ACIDOSIS:-
The acidosis that occurs in dka is reversed with insulin, which inhibits fat breakdown, thereby
stopping acid buildup.
Insulin is usually infused intravenously at a slow, continuous rate (eg, 5 units per hour). Hourly
blood glucose values must be measured.
Iv fluid solutions with higher concentrations of glucose, such as normal saline (ns) solution (eg,
d5ns or d50.45ns), are administered when blood glucose levels reach 250 to 300 mg/dl (13.8 to
16.6 mmol/l) to avoid too rapid a drop in the blood glucose level.
3). HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNS):
A metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an
intercurrent illness that raises the demand for insulin; associated with polyuria and severe
dehydration.
NURSING MANAGEMENT:-
ASSESSMENT:-
HISTORY:-
➢ History of symptoms related to the diagnosis of diabetes, hyperglycemia, hypoglycemia,

if present than their frequency, timing, severity.
➢ History of blood glucose monitoring status, symptoms, and management of chronic

complications of diabetes.
➢ History of eye; kidney; nerve; genitourinary and sexual, bladder, and gastrointestinal
cardiac; peripheral vascular; foot complications associated with diabetes compliance with
prescribed dietary management plan.
➢ History of prescribed exercise regimen
➢ History of compliance with prescribed pharmacologic treatment (insulin or oral

antidiabetic agents)
➢ History of use of tobacco, alcohol, and prescribed and over-the-counter

medications/drugs
➢ History of lifestyle, cultural, psychosocial, and economic factors that may affect diabetes
treatment
PHYSICAL EXAMINATION:-
➢ Blood pressure (sitting and standing to detect orthostatic changes)

➢ Body mass index (height and weight)
➢ Fundoscopic examination foot examination (lesions, signs of infection, pulses)
➢ Skin examination (lesions and insulin-injection sites)
➢ Neurologic examination vibratory and sensory examination using monofilament deep

tendon refiexes
➢ Oral examination.
NURSING DIAGNOSIS:-
1. Risk for fluid volume deficit related to polyuria and dehydration secondary to D.M.
INTERVENTION:-
1. Intake and output measurement.
2. Iv fluids and electrolytes are administration as prescribed,
3. Oral fluid intake is encouraged when it is permitted.
4. Serum electrolytes (especially sodium and potassium) are monitoring.
5. Vital signs are monitored for signs of dehydration (tachycardia, orthostatic

hypotension).
2. IMBALANCED NUTRITION RELATED TO IMBALANCE OF INSULIN, FOOD,

AND PHYSICAL ACTIVITY SECONDARY TO D.M.
INTERVENTION:-
1. Identify the patient’s lifestyle, cultural background, activity level, and food preferences.
2. Plan appropriate caloric intake to achieve and maintain the desired body weight.
3. The patient is encouraged to eat full meals and snacks as prescribed per the diabetic diet.
4. Arrangements are made with the dietitian for extra snacks before increased physical
activity.
3. ANXIETY RELATED TO LOSS OF CONTROL, FEAR OF INABILITY TO

MANAGE DIABETES, MISINFORMATION RELATED TO DIABETES, FEAR
OF DIABETES COMPLICATIONS SECONDARY TO D.M.
INTERVENTION:-
1. The nurse provides emotional support and sets aside time to talk with the patient who
wishes to express feelings.
2. Any misconceptions the patient or family may have regarding diabetes should be
clarified.
3. The patient and family are assisted to focus on learning self-care behaviors
4. The patient is encouraged to perform the skills such as self injection or lancing a finger
for glucose monitoring is performed for the first time, anxiety will decrease.
5. Positive reinforcement is given for the self-care behaviors attempted.
4. KNOWLEDGE DEFICIT RELATED TO COMPLICATIONS, SELF –CARE

SECONDARY TO D.M.
INTERVENTION:-
1. Tech patient regarding the disease condition.
2. Teach skills, how to take injections, drugs at home.
3. Advice to have regular follow-up and monitoring.
4. Advice to give immediate attention on foot injury, eye care, altered peripheral sensations
etc.
NAME OF DOSAGE/ MODE OF ACTION SIDE EFFECTS NSG RESPONSIBILITY

DRUG ROUTE
TAB, ADULT: Glimepiride stimulates the • Diarrhoea, vomiting, • Monitore for renal and
GLYCOMET PO per tab insulin release from • Metallic taste, hepatic impairment.
GP-1 contains functioning pancreatic β- • Rash, isolated transaminase elevations,
glimepiride cells and inhibits cholestatic jaundice, • Advice patient to avoid
1 mg and gluconeogenesis at hepatic • Allergic skin reactions, alcohol consumption.
metformin cells. It also increases insulin • Photosensitivity reactions,
250 mg or sensitivity at peripheral • Leukopaenia, • Monitoring of bsl for
glimepiride target sites. Metformin • Agranulocytosis, preventon the hypoglycaemic
2 mg and decreases hepatic • Thrombocytopaenia, episodes.
metformin gluconeogenesis, decreases • haemolytic anaemia,
500 mg. intestinal absorption of • aplastic anaemia,
glucose and improves insulin • Pancytopaenia,
sensitivity (increases • Blurred vision.
peripheral glucose uptake
and utilisation). potentially fatal:
• lactic acidosis.
Downloaded by Jitendra bhargav bhargav (jitendrabardebarde98@gmail.com)

NAME OF DOSAGE/ MODE OF ACTION SIDE EFFECT NSG RESPONSIBILITY

DRUG ROUTE
TAB. 75 MG./PO Pregabalin is an analog of Somnolence, dizziness, headache, diplopia, Patient w/ history of angioedema
PREGBA-M the neurotransmitter gaba. It blurred vision, vertigo, fatigue, irritability, episodes, severe cv disease, renal
binds potently to the α2-δ arthralgia, muscle cramp, back and limb pain, impairment. Avoid abrupt
subunit resulting in cervical spasm, disorientation, insomnia, withdrawal. Pregnancy and
modulation of ca channels nasopharyngitis, ataxia, tremor, dysarthria, lactation. Patient counselling may
and reduction in the release amnesia, paraesthesia, hypoaesthesia, lethargy, impair ability to drive, operate
of several neurotransmitters, sedation, oedema, peripheral oedema, dry mouth, machinery or engage in hazardous
including glutamate, constipation, diarrhoea, vomiting, nausea, activities. Monitoring parameters
norepinephrine, serotonin, flatulence, abdominal distension, increased monitor visual disturbances. Closely
dopamine, calcitonin gene- appetite, wt gain, euphoria, confusion, reduced observe for clinical worsening,
related peptide and substance libido, erectile dysfunction; attention, memory, suicidality and unusual changes in
coordination and gait disturbances; fall, feeling behaviour.
drunk, abnormal feeling. Rarely, stevens-johnson
syndrome, rhabdomyolysis, breast enlargement,
gynaecomastia.
Potentially fatal: angioedema.

NAME OF DOSAGE/ MODE OF ACTION SIDE EFFECT NSG RESPONSIBILITY

DRUG ROUTE
TAB. 133 Thiamine mononitrate 10 MILD DIARRHEA; FOLLOW THE SIX RIGHTS OF
NEUROBIO MG./PO mg, riboflavin 10 mg, NAUSEA; STOMACH UPSET. DRUG ADMINISTRATION.
N FORTE pyridoxine hydrochloride 3 Severe allergic reactions Monitore patent for serum vitamin
mg, cyanocobalamin 15 mcg, (rash; hives; itching; difficulty breathing; or mineral level.
nicotinamide 45 mg, calcium tightness in the chest; swelling of the mouth, face, monitore patient for improvement in
pantothenate 50 mg. lips, or tongue); the neurological functions.
Feeling of swelling of the entire body;
Act as Numbness or tingling of the skin.
nootropics &
neurotonics/neurotrophics / v
itamin b-complex / with c
Indicated for peripheral

neuropathy, neck &
shoulders nerve pain & vit
b12 deficiency.

NURSING DIAGNOSIS:-
1. Discomfort related to pain in leg and back secondary to l-5 rediculopathy.
2. Impared tissue perfusion related to hypotension,acidosis secondary to diabetis

mellitus
3. fluid volume deficit related to polyuria and dehydration secondary to d.m.
4. Activity intolrance related to right leg weakness secondary to l-5 rediculopathy.
5. Imbalanced nutrition related to imbalance of insulin, food, and physical activity

secondary to d.m.
6. Anxiety related to loss of control, fear of inability to manage diabetes, fear of

diabetes complications secondary to d.m.
7. Knowledge deficit related to complications, self –care secondary to d.m.
8. High risk for infection related to uncontroled hypergycemia,secondary to d.m.
9. High risk for impared skin integrity related to dry skin secondary to d.m.

APPLICATION OF ROYS ADAPTATION MODEL:-
STIMLI EFFECTORS
Fluid volume deficit
Discomfort related to pain

Focal
High risk for infection
Back pain radiating to right leg.
Activity intolerance
Physiological
Polyurea
High risk for impaired skin integrity
Function
Polydepsia
High risk for infection
Obesity
Spinal nerve compression Self-concept Interventions

Knowledge deficit of home care
Right leg weakness.
Anxiety related to diseases condition
Fatigue. Role-function
Residual Interdependence
Ineffective family coping related to financial
Male issue,
Family history of dm.
Earning member of family
Peon-occupationally

ASSESSMENT NURSING GOAL NURSING PLANING NURSING RATIONAL EVALUATIO

DIAGNOSIS INTERVENTION N
Subjective Discomfort The patient Assess the general condition Assessed the general To plan for The EOC
data: - related to pain in will have of the patient condition of the patient, further care partially met as
The patient says leg and back reduced pain nature, site and severity of evidence by
that he is having as (level of pain 6) reduced pain
secondary to
pain in the back evidence by by facial
and radiating to L-5 facial Give diversion therapy to Diversion therapy To reduce pain expression and
right leg. rediculopathy. expression the patient given( allow relative to talk pain scale =3
and pain with the patient)
Objective data:- scale0-3
patient
facialexpression Give position to the patient Supine and Right lateral To reduce pain
shows that he is position given alternately to
having pain the patient
Pain scale rate is Give comfort devices to the

=6 patient. Pillow for leg elevation
given To reduce pain
Patient look
restlessness Administer analgesic to the
patient as prescribed Analgesic administer as To reduce pain
L-5 nerve prescribed
compression Tab. pregba-m75 mg ,OD

Administer muscular
relaxant to reduce pain. Administered tab.myospas To reduce pain
forte to patient

Subjective Activity The patient Assess the activity pattern Assessed activity pattern of To plan for The EOC
data: - intolerance will have of the patient. the patient,- further care partially met as
The patient says related to right activity evidence by
that he is feel leg weakness tolerance as reduced inpain
generalized secondary to evidence by Administer nutritive Administered nutritive To reduce fatigue and
weakness during L-5 Reduction in diabetic diet to the patient. diabetic diet to the patient as Improvement
activity rediculopathy. pain and prescribed. In right leg
Improvement muscular
Objective data:- In right leg To improve strength from
muscular Advice patient to follow Advised patient to follow muscle strength. g-2 to g-4.
L-5 nerve strength. regular exercise program. regular exercise program.
compression
present. To reduce
Administer analgesic to Analgesic administer as neurogenic pain
Activity restricted the patient as prescribed prescribed
due to pain. Tab. pregba-m 75 mg ,OD To reduce
musclecontractio
Right leg Administer muscular Administered tab. myospas n.
weakness present. relaxant to reduce pain. forte to patient
To reduce fatigue
Assist patient in doing & prevent falls.
activities &give rest in
between continues activity. Assisted patient in doing
activities &give rest in
between continues activity.

Subjective Imbalanced The patient Assess the activity pattern Assessed activity pattern of To plan for The EOC
data: - nutrition more will have of the patient. the patient,- further care partially met as
The patient says than body Normal evidence by
that he is feel nutrition reduction
requirement
generalized asevidence by Administer nutritive Administered nutritive To reduce fatigue infatigue and
weakness. related to Reduction in diabetic diet to the patient. diabetic diet to the patient as Improvement
imbalance of weight, normal Upto-1850 kcal/day prescribed. In BSL.
Objective data:- insulin, food, BSL level and Profile.
physical Absence of Advice patient to follow To improve
Activity restricted activity and fatigue. regular exercise program. Advised patient to follow insulin secretion
due to pain. obesity regular exercise program. and reduce
peripheral tissue
Secondary to
Patient is obese. resistant.
Wt.-69 kg. D.M.
Administer OHG agents to To control
Uncontrolled patient. hyperglycemia
hyperglycemia. Administered tab
Administer supplemental GYCOMET GP-1, BD, PO. To improve
minerals and vitamins. nutrition and
Administered TAB prevent fatigue.
NEUROBION FORTE,
TAB. MVBC.

PATIENT NAME: - Mr. SHRIKANT KISAN CH AVAN NURSE’S NOTE- 1 DIAGNOSIS:-DM ,DKA, HYPOTENSION WITH L-5
REDICULOPATHY
AGE:- 49 YEAR D.O.A:- 03/01/2020
SEX: - MALE SURGERY:-NOT DONE
WARD:- MICU STUDENT NAME- SONALI VAIDHYA
DATE DIET MEDICATION TIME NURSING OBSERVATION NURSING CARE REMARK SIGN.
4/01/2020 9am 9am Patient is oriented to time place, Assessed the Patient was co- Sonali
Breakfast:- INJ person but has little confusion and general condition operative
HUMINSULINE-R laziness. of the patient
POHA 1 2 ML/HR
PLATE INFUSION Patient was not slept at last night
Tea-50 ml because of back pain and
TAB. GLYCOMET hospitalization. Sonali
GP-1 BD ,PO,8 AM,
8 PM. Patient has activity intolerance due
to pain&parasthesia in right foot.
TAB.PREGBA-M
75 MG OD,PO, 10 Patient’s personal hygiene is
PM. maintained
TAB SHELCAL 500 Patient’s appetite is normal&

MG PO, OD, 3 PM. excessive thirst present.
TAB. NEUROBION Patient bowel movement is

FORTE OD 10 AM. normal& excessive urination is
present(10-12 episodes /day).
TAB MVBC. OD
PO, 3 PM. Patient bed looks unclean and Bed making done Bed looks clean Sonali
untidy and tidy.

TAB, MYOSPAS
FORTE SOS, PO, 11
AM. Sonali
Vital signs Patients vital are
TAB. ATOREF OD, Vital sign has to be check checked within normal
PO 10 PM. T -98F, BP-100/70 ranges.
P -84/m ,RR-16/m
TAB.PAN 40 MG, Sonali
OD PO, 10 AM No local
Medication has to be give Medication given complication
to the patient. occurred.
Sonali
Patient had mild
Patient has pain in back radiating Tab myospas forte pain.
to right leg. is given.
Patient is Sonali
Patient is alone on bed, History taking and cooperative.
physical
examination was
done

REDICULOPATHY
AGE:- 49 YEAR D.O.A:- 03/01/2020

6/01/2020 9am TAB. GLYCOMET 9am Patient is oriented to time place, Assessed the Patient was co- Sonali
Breakfast:- GP-1 BD ,PO,8 AM, person. general condition operative
8 PM. of the patient
POHA 1 Patient was not slept at last night
PLATE TAB.PREGBA-M because of back pain and
Tea-50 ml 75 MG OD,PO, 10 hospitalization. Sonali
PM.
Patient has activity intolerance due
TAB SHELCAL 500 to pain& parasthesia in right foot.
MG PO, OD, 3 PM.
Patient’s personal hygiene is
TAB. NEUROBION maintained
FORTE OD 10 AM.
Patient’s appetite is normal&
TAB MVBC. OD excessive thirst present.
PO, 3 PM.
Patient bowel movement is
TAB, MYOSPAS normal& excessive urination is
FORTE SOS, PO, 11 present(10-12 episodes /day).
AM. Sonali
TAB. ATOREF OD, Patient bed looks unclean and Bed making done Bed looks clean
PO 10 PM. untidy and tidy.

TAB.PAN 40 MG,
OD PO, 10 AM
Vital signs Patients vital are Sonali
Vital sign has to be check checked within normal
T -98F, BP-100/70 ranges.
P -84/m ,RR-16/m
No local Sonali
Patient had mild SonaIi

Patient is
Patient is alone on bed, health-education is cooperative. Sonali
given to patient

REDICULOPATHY
AGE:- 49 YEAR D.O.A:- 03/01/2020

7/01/2020 9am TAB. GLYCOMET 9am Patient is oriented to time place, Assessed the Patient was co- Sonali
Breakfast:- GP-1 BD ,PO,8 AM, person. general condition operative
8 PM. of the patient
POHA 1 Patient was not slept at last night
PLATE TAB.PREGBA-M because of back pain is reduced
Tea-50 ml 75 MG OD,PO, 10 and hospitalization.
PM. Sonali
Patient has activity intolerance due
TAB SHELCAL 500 to pain& parasthesia in right foot.
MG PO, OD, 3 PM.
Patient’s personal hygiene is
TAB. NEUROBION maintained
FORTE OD 10 AM.
Patient’s appetite is normal&
TAB MVBC. OD excessive thirst present.
PO, 3 PM.
Patient bowel movement is
TAB, MYOSPAS normal& excessive urination is
FORTE SOS, PO, 11 present(3-4) episodes /day).
AM.
TAB. ATOREF OD, Patient bed looks unclean and Bed making done Bed looks clean Sonali
PO 10 PM. untidy and tidy.

TAB.PAN 40 MG,
OD PO, 10 AM
Vital signs Patients vital are Sonali
Vital sign has to be check checked within normal
T -98F, BP-100/70 ranges.
P -84/m ,RR-16/m
No local Sonali
Patient had mild Sonali


PROGRESS NOTE:-
My patient Mr.Shrikant kishan,49 year old male known case of diabetes mellitus with diabetic
ketoacidosis with hypotension came with complaints of pain in back radiating to right leg and
weakness in right leg and generalized fatigue, sweating and restlessness.
FIRST DAY:-
Patient has pain in back and leg and has decreased motor functions of right leg.
Patient has normal appetite, polyuria and excessive thirst and dry skin.
Patient’s vital signs are (BP-90/50, P-105/m, RR-28, temp.-98.0 f) and show hypotension
patient has hypergycemia and urine for ketone possitive
Patient is on insulin infusion &oral hypogycemic agents and planed for MRI spine and NCV
study.
Patient is on iv fluid 0.45% bicarbonate with 2 amp KCL is continues through infusion pump.
SECOND DAY:-
Patient still has pain in the back and weakness in the right leg.
Patient is posted for mri study of spine and ncv test.
Patient’s vital signs are (bp-100/70, p-88/m, rr-16, temp.-98.6 f) and within normal range.
Patient has uncotroled hypergycemia and started on inj. Mixtrad for acute management of
hypergycemia (bbf-24 iu, bd-12 iu.)
Urine for ketone is negative
THIRD DAY:-
Patient’s vital signs are (bp-100/70, p-88/m, rr-16, temp.-98.6 f) and within normal range.
Patient ‘s mri has shown posterior disc protusion and l-5 rediculopathy.
Patient started on the conservative management with tab myospas forte, tab pregb-m and tab
neurobion forte for neurological improvement.
Patient ‘s pain is reduced and motor function in improving (as muscle strength of right leg is
shifted from grade-2 to grade-4).

HEALTH-EDUCATION:-
DIETARY CHANGES:-Patient has advised to limit daily dietary intake upto 1850 kcal. and
reduce cho s in diet upto 40 %. consultation with diatician is done and menu planing is done.
EXERCISE: - Advice patient to follow a regular program of 30 min daily exercise in the
morning with some snacks to avoid the hypogycemia.
Advice patient to avoid streaching of the vertibral disc while exercising
MEDICATION: - Advised patient to continue with the regular medication and should not have
non-compliance of OHGs agents.
COMPLICATION:-Advice patient to wear proper shoes to prevent foot injury, adviced to do

regular assessment of extremities for injury or open wound ,if present than take immediate
treatment.
MONITORING:-Advice patient to do self glucose monitoring at least 3 times per week and
hba1c as per physician’s advice
FOLLOW-UP:- advice to patient to take regular follow up and check-up for neurological,
opthalmology, and renal functions.

NCPDM 231208094146 8e570409

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lOMoAR cPSD| 24626089

lOMoAR cPSD| 24626

MR. JITENDRA BARDE MS.

(ASS .PROFESSOR) BSC 3d YEAR STUDENT

NAME :-Mr. Shrikant kisan Chavan

AGE :-49 Year

ADDRESS :-Sr No -1,Mandan Nagar,Anant Nivas,Pune-33

OCCUPATION :- Peon in corporation

MARITAL STATUS : - Married

MOTHER TONGUE:- Marathi

DATE OF ADMISSION: -03/01/2020

DIAGNOSIS :- Diabetes mallitus with DKA with hypotension with l-5

Sweating and gidiness since 1 day

Genralised weakness since 2 days

Pain in the back since 2 days

Weakness in right lower limb since 2 days

PRESENT HISTORY OF ILLNESS:-

Difficulty in getting up from sitting

positionH/O Loss of balance

PAST HISTORY OF ILLNESS:-

SURGICAL HISTORY: -Patient is operated for inguinal hernia 12 years back.

MENSTRUAL HISTORY [FEMALE] - Not applicable

NAME AGE SEX OCCUPATION RELATIONSHIP HEALTH

HABITS : Non-alcoholic, non-smoker

DIET : Non- vegetarian, 4 times/day.appetite incresed, excessive thirst.

currentlysleep pater distrubed

ALLERGY : No history of allergy to any food/medications given by

patient.BOWEL AND BLADDER HABITS: Bowel movement normal&polyurea -

SOCIO- ECONOMIC STATUS:-

Condition of the house:pakka house& adequate ventilation 2room&1 window, kitchen

WATER SUPPLY: Corporation water

DRAINAGE SYSTEM: Closed drainage

SURROUNDING ENVIRONMENT: The environment is clean around the house.

STATE OF NUTRITION : Obesity

PERSONAL APPEARANCE :Fair

EMOTIONAL STATE : Anxious

CO-COOPERATIVENESS : Patient is co-operative

HEIGHT AND WEIGHT:

HEIGHT : 5.0 Feets

PULSE : 105B/ Minute

BLOOD PRESSURE : 90/50Mm Hg

HEAD AND FACE:

SKULL: Round in shape

SCALP: Clean, no dandruff, scar present

NODE: Not palpable

EYELASHES: Equally distributed and there is no infection, lesion present.

EYELID : Intact, no discharge, discoloration, and lids close symmetrically

EYEBALLS: Both eyes coordinated; move in unison with parallel alignment.

CONJUNCTIVA : No redness and lesion

PUPIL: Reactive to light

EXTERNAL STRUCTURE: No any tenderness

CANAL : No any discharge from ears.

TYMPANIC MEMBRANE : Intact

HEARING: Weber test- patient hear equal in both

EXTERNAL STRUCTURE – Symmetric and straight

SEPTUM - No deviated nasal septum

MUCOUS MEMBRANE -Moist

OLFACTORY SENSE -Present

MOUTH AND PHARYNX:

LIPS- Pink color

TEETH- No dental caries,shiny tooth enamel present.

GUMS -Healthy (no bleeding)