Republic of the Philippines

Commission on Higher Education

UNIVERSITY OF EASTERN PHILIPPINES
University Town, Northern Samar
Graduate Studies
Master of Arts in Nursing

In Partial fulfilment for the requirements

In

(Adult Health Nursing)

CASE STUDY ON DIABETIS MELLITUS

SUBMITTED BY:
RYAN B. BALICOT

SUBMITTED TO:
MARIA LINDA S. AGUS
PROFESSOR

1st
SEMESTER S.Y. 2022
II. EXECUTIVE SUMMARY

The researches have the following objectives in this case study:

 Described and explained Diabetes Mellitus together with the risk

factors contributing to the occurrence of the condition.
 Reviewed the anatomy and physiology of the organs involved.
 Interpreted the results in the laboratory and diagnostic procedures done
with the patient including their purposes, and specific nursing
responsibilities before, during and after the procedure.
 Enumerated the different medications administered for the condition,
their indications and specific nursing responsibilities.
 Formulated significant nursing diagnoses, with their significantly
related nursing care plans.

III. INTRODUCTION

Diabetes mellitus is a group of metabolic diseases characterized by high blood

sugar (glucose) levels that result from defects in insulin secretion, or action, or both.
In patients with diabetes, the absence or insufficient production of insulin causes
hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can
be controlled, it lasts a lifetime.

Diabetes mellitus type 2 or type 2 diabetes (formerly called non-insulin-

dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a disorder that is
characterized by high blood glucose in the context of insulin resistance and relative
insulin deficiency.

Over time, diabetes can lead to blindness, kidney failure, and nerve damage.
These types of damage are the result of damage to small vessels, referred to as
microvascular disease. Diabetes is also an important factor in accelerating the
hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary
heart disease, and other large blood vessel diseases.
 There are an estimated 23.6 million people in the U.S. (7.8% of the
population) with diabetes with 17.9 million being diagnosed, 90% of whom are type
2. With prevalence rates doubling between 1990 and 2005, CDC has characterized the
increase as an epidemic.

PERSONAL HISTORY

a. Demographic data

Mrs. DM, a 84 years old male who is not married and has no children, was
born on June 27, 1938 at Borongan, Eastern Samar. She is pure Filipino. Mrs. DM
graduated Bachelor of Science in Education at the college of University of the
Philippines. After graduation, she worked at one of the University in Northern Samar.
She presently resides at Brgy. Urdaneta Lavezares.

b. Socio-economic and Cultural factors

Mrs. DM used to work at the University for. Due to a confidential incident at

work, Mrs. DM retired at the age of 65. She never smoked and used to drink. She was
diagnosed at the age of 83. She regularly has a walk in the morning as a form of
exercise. He is not choosy in eating foods and loves to eat fruits regularly. Mrs. DM is
a Roman Catholic. Last 3 years ago she made a habit of going to Apo to visit the
church there but rarely attends mass.
When it comes to health practices, she usually practices self-medicate when
the sickness isn’t severe and tolerable. Paracetamol is the usual medications they use
for treating colds and colds. She doesn’t use herbs or seek herbalarios or albularyo. If
her condition gets worse, medical attention is sought. She usually goes to Catarman
Doctors Hospital for check-ups and emergency cases. Aside from emergencies, she
has a monthly check up with his private doctor.
 1. FAMILY HEALTH ILLNESS HISTORY

Mrs. DM is eight children of twelve children. Diabetes Mellitus runs in the

family. Her grandfather and father had Diabetes 2 while her mother was diagnosed
with hypertension and died because of a stroke. Among her siblings, one has
hypertension and the two has Diabetes Mellitus while the others are almost at pre-
hypertension. Her brother before her is his twin who experiences almost the same as
she does.

3. HISTORY OF PAST ILLNESS

Mrs. DM was a drinker before. When she is working household chores, she
noticed that she got really weak and easily fatigue, so she decided to get a check up
and was diagnosed to have Diabetes Mellitus type 2 on 2021. Medications were given
to control her situation such as Insulin glargine and a device such as Glucoplus to
monitor her blood glucose.

Hypertension arised last 3 months ago and was prescribed a maintenance of Neoblock
one tab every morning and Combizar at night.
4. HISTORY OF PRESENT ILLNESS
On November 13, 2021, Mrs. DM started to have the feeling of fullness but
didn’t affect his appetite. She also noticed that her bowel pattern started to change
because the urge to defecate is gone.
After 2 days, she started to vomit a lot of times. She mentioned that “parang
hindi nadigest ang mga kinakain ko.” Mrs. DM was afraid to go to the hospital but her
daughter noticed him getting weak and pale. She went to Catarman Doctors Hospital
on November 17, 2021 at 7:30pm with a chief complaint of body weakness and
abdominal pain. Diagnostics exams were done and her tentative diagnoses were
constipation, Diabetes Mellitus type 2 and Pre-renal disease.
She was then admitted for observation and treatment. A stool softener,
Senokot 2 tabs was prescribed so that she can eliminate and to lessen the abdominal
pain. On November 18, 2021 when the nurses had their nurse-patient interaction, the
patient stated she defecated twice and the pain eased.
After discharged, her doctor prescribed home medication of Insulin Glargine
to inject subcutaneous 28 units in 5 am and 14 units in the afternoon, and to monitor
her random blood sugar in the morning and afternoon using glucometer.

5. PHYSICAL EXAMINATION

Vital Signs: Bp- 160/110 mmHg; PR- 90bpm; RR- 19bpm; T- 36.4 ºC\
General Appearance:

SKIN:
 Pale
 No lesions observed
 Dry skin
HEENT:
Head
 Hair is thin and quite moist, black with minimal white hair strands
 Even distribution of hair
 No dandruff observed
Eyes
 Pale palpebral conjunctiva
 Anicteric sclera
 Patient has blurred vision
Ears
 External canal is clean
 No discharge noted
 Nose
 No discharge seen
Tongue and mouth
 Incomplete set teeth
 Pale lips
 Dry lips
 No breath odor
LUNGS:
 Chest expands during inhalation
ABDOMEN:
 Rigid upon palpation
MUSCULOSKELETAL:
 No edema

6. DIAGNOSTICS AND LABORATORY PROCEDURES

Diagnostic/ Date Indication or Results Normal Analysis and

Laboratory Ordered Purpose Values Interpretation
Procedures Date results of results
IN
Random 11/17/21 To measure 245.3 < 140 The result is
Blood Sugar blood glucose mg/dl mg/dl above the
regardless of normal range
when you last which
ate. indicates too
little insulin/
diabetes
mellitus.

Nursing Responsibilities:
Prior to the procedure:
 Inform patient that there are no food restrictions.
 Wash your hands thoroughly before beginning procedure.
 Ready your meter according to on-screen instructions or owner's manual
(every meter is slightly different).

During the procedure:

 Swab your finger tip (or arm if your meter allows) with alcohol and allow to
dry or dry with gauze.
 Wipe away the first drop of blood
  Squeeze slowly and rhythmically, gripping the digit firmly between the base
of thumb and first finger.

After the procedure:

 Check for sample acceptance and allow time for the machine to work. Apply
firm pressure to puncture with an alcohol wipe, gauze or a bandage while you
wait.

 Record your glucose level and follow your physician's guidelines pertaining to
necessary actions for low or high glucose levels.

IV. BODY
 ANATOMY AND PHYSIOLOGY

Every cell in the human body needs energy in order to function. The body’s
primary energy source is glucose, a simple sugar resulting from the digestion of foods
containing carbohydrates (sugars and starches). Glucose from the digested food
circulates in the blood as a ready energy source for any cells that need it. Insulin is a
hormone or chemical produced by cells in the pancreas, an organ located behind the
stomach. Insulin bonds to a receptor site on the outside of cell and acts like a key to
open a doorway into the cell through which glucose can enter. Some of the glucose
can be converted to concentrated energy sources like glycogen or fatty acids and
saved for later use. When there is not enough insulin produced or when the doorway
no longer recognizes the insulin key, glucose stays in the blood rather entering the
cells.

Anatomy of the pancreas:

The pancreas is an elongated, tapered organ located across the back of the
abdomen, behind the stomach. The right side of the organ (called the head) is the
widest part of the organ and lies in the curve of the duodenum (the first section of the
small intestine). The tapered left side extends slightly upward (called the body of the
pancreas) and ends near the spleen (called the tail).
The pancreas is made up of two types of tissue:
 Exocrine tissue
The exocrine tissue secretes digestive enzymes. These enzymes are secreted
into a network of ducts that join the main pancreatic duct, which runs the
length of the pancreas.
 Endocrine tissue
The endocrine tissue, which consists of the islets of Langerhans, secretes
hormones into the bloodstream.

Functions of the pancreas:

The pancreas has digestive and hormonal functions:
 The enzymes secreted by the exocrine tissue in the pancreas help break down
carbohydrates, fats, proteins, and acids in the duodenum. These enzymes
travel down the pancreatic duct into the bile duct in an inactive form. When
they enter the duodenum, they are activated. The exocrine tissue also secretes
a bicarbonate to neutralize stomach acid in the duodenum.
 The hormones secreted by the endocrine tissue in the pancreas are insulin and
glucagon (which regulate the level of glucose in the blood), and somatostatin
(which prevents the release of the other two hormones.
 Anatomy of kidney

The kidneys play key roles in body function, not

only by filtering the blood and getting rid of waste
products, but also by balancing levels of electrolytes in
the body, controlling blood pressure, and stimulating the
production of red blood cells.

The kidneys are located in the abdomen toward

the back, normally one of each side of the spine. They get their blood supply through
the renal arteries directly from the aorta and send blood back to the heart via the renal
veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)

The kidneys have the ability to monitor the amount of body fluid, the
concentrations of electrolytes like sodium and potassium, and the acid-base balance of
the body. They filter waste products of body metabolism, like urea from protein
metabolism and uric acid from DNA breakdown. Two waste products in the blood can
be measured: blood urea nitrogen (BUN) and creatinine (Cr).

Kidneys are also the source of erythropoietin in the body, a hormone that
stimulates the bone marrow to make red blood cells. Special cells in the kidney
monitor the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels
rise and the body starts to manufacture more red blood cells.

 PATHOPHYSIOLOGY

THE PATIENT AND HIS ILLNESS

a. Schematic diagram

Precipitating Factors:
Pre-disposing Factors: Obesity
Age > 40 y/o Lifestyle
Hereditary Diet
Race (African-Americans, Hispanic Environmental Stress
Americans)

Destruction of Beta-cells in the

pancreas

↓ production of insulin

↑ insulin resistance
b.1. Definition of the disease
Diabetes Mellitus
Diabetes Mellitus type 2 is the most common form of Diabetes.
Formerly known as adult-onset diabetes, it usually affects people aged over 40
and progresses gradually. In this type the pancreas has not ceased to produce
insulin, but the quantity is insufficient, or the hormone is not stimulating the
glucose uptake in muscles and tissues required for energy. The result is a
build-up of glucose in blood and urine.
Although the cause of this malfunctioning is unclear, non-insulin
dependent diabetes mellitus tends to run in families. Other risk factors, such as
increasing age, obesity, and a sedentary lifestyle, probably contribute to its
increased incidence in developed countries.
Non-insulin dependent diabetes mellitus can often be controlled
initially by diet alone, or in combination with tablets that reduce the amount of
blood glucose. There are two main types of blood glucose-reducing drugs:
sulphonylureas work mainly by stimulating the pancreas’s islet cells (known
as the islets of Langerhans) to produce more insulin and biguanides increase
 the effectiveness of insulin on cells. Eventually, however, patients may need
insulin injections.

Prerenal Acute Renal Failure

It is categorized as an acute renal failure which is characterized by inadequate
blood circulation (perfusion) to the kidneys, which leaves them unable to clean
the blood properly. Many patients with prerenal ARF are critically ill and
experience shock (very low blood pressure).There often is poor perfusion
within many organs, which may lead to multiple organ failure.

Prerenal ARF is associated with a number of preexisting medical

conditions, such as atherosclerosis ("hardening" of the arteries with fatty
deposits), which reduces blood flow. Dehydration caused by drastically
reduced fluid intake or excessive use of diuretics (water pills) is a major cause
of prerenal ARF. Many people with severe heart conditions are kept slightly
dehydrated by the diuretics they take to prevent fluid buildup in their lungs,
and they often have reduced blood flow (underperfusion) to the kidneys

b.2. Predisposing Factors

 Age - Type 2 DM usually occurs at the age 40 years old and above. Type 2
DM occurs most commonly in people older than 30 years who are obese.
 Family history of DM - Type 2 DM has a strong genetic component. Although
the major gene that places the patient at risk is not yet identified, it is clear that
the disease is polygenic and multifactorial. Individuals with a parent with type
2 DM have an increased risk for diabetes. Genetic factors are thought to play a
role in insulin résistance and impaired insulin secretion in type 2 DM.
 Race (African-Americans, Hispanic-Americans) - The risk for type 2 diabetes
varies among population groups. Diabetes also seems to pose higher or lower
risks for specific complications among racial groups.

Precipitating Factors
 Obesity - Elevated levels of free fatty acids, a common feature of obesity, may
contribute to the pathogenesis of type 2 DM. It can impair glucose utilization
 in skeletal muscles, promote glucose production by the liver and impair beta
cell function.
 Environmental Factors/Stress – An increase in stress hormone triggers the
release of epinephrine and norepinephrine which will promote the secretion of
glucose leading to hyperglycemia.
 Inactive Lifestyle – A risk factor that had contributed in the occurrence of DM
due to the fact that lack of muscle activities decreases the need for the body to
utilize glucose as a form of energy.
 Diet – Foods rich in carbohydrates can easily promote the increasing level of
glucose along the bloodstream.

Prerenal Risk Factors

 Atherosclerosis cause obstruction to the flow of blood reaching the kidneys

 Blood loss can lead to the constriction of the arteries carrying blood
throughout the body, reducing the volume of blood reaching various organs
including the kidney
 Heart disease can lead to a reduction in the pumping effect of the heart,
reducing the amount of blood reaching the kidneys and other organs.

b.3. Signs and Symptoms with Rationale

Diabetes Mellitus
HYPERGLYCEMIA (INCREASED BLOOD SUGAR LEVEL)
 May be due to lack of physiologically active insulin that transports
glucose from extracellular to intracellular leading to accumulation of
glucose in the intravascular space. The glucose is not utilized by the
body and it remains in the blood streams.
POLYURIA
 Increased frequency of urination. This may be due to the osmotic
diuretic effect of the glucose, wherein it attracts water during urination.
POLYDIPSIA
  Increased thirst and fluid intake. This may be due to the activation of
the thirst center in the hypothalamus resulting form the intracellular
dehydration or volume depletion.
POLYPHAGIA
 Increased hunger and food intake. This may be due to the decrease
glucose uptake by the cells leading the stimulation of the satiety center
in the hypothalamus resulting to the ‘hunger sensation.”

WEAKNESS/ FATIGUE

 This is due to the decreased glucose uptake by the cells leading to

decreased energy production.

GLYCOSURIA
 The kidney filters the blood, making it to its normal state. Glucose was
filtered out and excreted in the urine.
 Due to the excess glucose ad compared to the kidney threshold, which
results to the excretion of glucose in the urine.

GASTROPARESIS (Stomach fullness) ,CONSTIPATION and BLOATING

 This is due to changes in nerves and damages the blood vessels that
carry oxygen and nutrients to the nerves. Over time, high blood
glucose can damage the vagus nerve. The stomach fails to empty
properly and is likely due to the generalized neuropathy.

NAUSEA/ VOMITING

 Due to stomach fullness, there will be an involuntary emptying of

stomach contents that are forcefully expelled by the mouth.
 A compensatory mechanism due to acidity of body because of
decrease excretion of metabolic waste.

PALE
  Due to decreased production of erythropoietin.

a. Schematic diagram of the disease

PATHOPHYSIOLOGY(client-centered)
b.1. Predisposing/ Precipitating Factors
Predisposing Factors
 Age- 84 years old.
 Heredity- patient’s grandfather and father has DM
Precipitating Factors
 Sedentary lifestyle

b.2. Signs and Symptoms

 Gastroparesis( Stomach fullness) and Constipation

o November 13, 2021
o This is due to changes in nerves and damages the blood vessels
that carry oxygen and nutrients to the nerves. Over time, high
blood glucose can damage the vagus nerve. The stomach fails
to empty properly and is likely due to the generalized
neuropathy.
 Nausea/vomiting
o November 15, 2021
o Due to stomach fullness, there is a involuntary emptying of
stomach contents that are forcefully expelled by the mouth.
o A compensatory mechanism due to acidity of body because of
decrease excretion of metabolic waste.
 Hyperglycemia
o November 17, 2021
o Due to lack of physiologically active insulin that transports
glucose from extracellular to intracellular will lead to
accumulation of glucose in the intravascular space. The glucose
is not utilized by the body and it remains in the blood streams.
 Hypertension
o November 17, 2021 160/110 mmHg
o Due to increase in osmotic pressure, fluid goes to the vascular
space increasing the blood volume.

 Weakness/fatigue
 o November 17, 2021

o Due to decreased glucose uptake by the cells leading to

decreased energy production.
 Pale
o November 17, 2021
o Due to decreased production of erythropoietin.
Drugs
Date
Route of
Ordered/ General Action,
administration, Client’s
Name of Date Taken/ Classification
Dosage and response to the
Drug Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C

Generic 11/17/09 2 tabs, It is laxative that is The patient had

Name: used as a short- defecated.
Senna term treatment of
constipation and to
evacuate the colon
Brand for bowel or rectal
Name: examinations.
Senokot

Prior to Administration
 -Check the doctor’s order
 -Prepare the medication as ordered.
 -Explain the purpose, indication and possible adverse effects of the
medication.

After Administration
 -Monitor bowel movement.
  -Instruct patient not to drink alcohol during therapy.

Date
Route of
Ordered/ General Action,
administration, Client’s
Name of Date Taken/ Classification
Dosage and response to the
Drug Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C

Generic 11/17/09 1 tab, PO, OD Metoprolol is in a Patient’s blood

Name: group of drugs pressure is still
metoprolol called beta- high. From
blockers. It is a 160/110
selective inhibitor mmHg upon
Brand Name: of beta1- admission rises
Neobloc adrenergic to 170/ 90
receptors affecting mmHg.
the heart and
circulation. It is
used to treat
angina and
hypertension.

Nursing Responsibilities:
Prior to Administration
 Check the doctor’s order
 Prepare the medication as ordered.
 Explain the purpose, indication and possible adverse effects of the
medication.

After Administration
 Monitor for signs of tachycardia, palpitations and especially blood
pressure
 Instruct patient to sit before standing

Name of Date Route of General Action, Client’s

Drug Ordered/ administration, Classification response to the
Date Taken/ Dosage and Mechanism of medication
 Date
Frequency of
Changed/ Action
administration
D/C

Generic 11/17/09 1 tab, PO, OD Losartan is in a Patient’s blood

Name: group of drugs pressure is still
losartan called angiotensin high. From
II receptor 160/110
antagonists. mmHg upon
Brand Name: Losartan keeps admission rises
Combizar blood vessels from to 170/ 90
narrowing, which mmHg.
lowers blood
pressure and
improves blood
flow. It is also used
to slow long-term
kidney damage in
people with type 2
diabetes who also
have high blood
pressure

Nursing Responsibilities:
Prior to Administration
 Check the doctor’s order
 Prepare the medication as ordered.
 Explain the purpose, indication and possible adverse effects of the
medication.

After Administration
 Monitor for signs of tachycardia, palpitations and especially blood
pressure
 Instruct patient to sit before standing
 Date
Route of
Ordered/ General Action,
administration, Client’s
Name of Date Taken/ Classification
Dosage and response to the
Drug Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C

Generic 11/17/09 1 tab, PO, OD It decreases Glucose level

Name: hepatic glucose of the patient
metformin production, may decrease.
decreasing ( No available
intestinal data)
Brand Name: absorption of
Glucophage glucose and
improves insulin
sensitivity

Nursing Responsibilities:
Prior to Administration
 Check the doctor’s order
 Prepare the medication as ordered.
 Explain the purpose, indication and possible adverse effects of the
medication.

During Administration
 Instruct the patient to calm down to avoid uneasiness.

After Administration
 Monitor glucose level closely in this patient because severe
hypoglycemia may result before the patient develops symptoms.
 Advice patient to avoid vigorous exercise immediately after dose.
 Inform patient to avoid alcohol, which lowers glucose level.
 Exercise/ Activity

Date
Ordered,
Date Client’s Response
Type of General Indication or
Started, and/or reaction to
exercise description Purpose
Date activity
Changed or
D/C
Keep rested An activity Indicated to 11/17/21 Patient responded
where strenuous avoid fatigue. to doctor’s order
activities should and stated
be avoided. Bed decreased body
rest should be weakness.
implemented
but with
assisted
bathroom
privilege to
avoid further
aggravation of
the gangrene
and to reduce
pain as well.

Nursing Responsibilities
Prior
 Check doctor’s order for any other considerations needed.
 Explain the activity to the patient.
 Explain why it is important and what it could improve in her condition.
During
 Assess patient’s present condition.
 Reinforce information as appropriate.

After
 Note patient’s response to activity.
VIII. CONCLUSION AND RECOMMENDATION

CONCLUSION

In this study, the student nurses’ aim is to understand the disease more,
manifestations, risk factors and complications. Diabetes mellitus is a condition in
which the pancreas no longer produces enough insulin or cells stop responding to the
insulin that is produced, so that glucose in the blood cannot be absorbed into the cells
of the body.
Mr. Sugar’s diabetes mellitus was caused mainly by his sedentary lifestyle, his
food preference and due to hereditary factor since his grandfather and his father both
had diabetes. Diabetic retinopathy, a complication of diabetes mellitus, also occurred
and Mr. Sugar opted to undergo laser therapy a month ago.

It is best managed with a team approach to empower the client to successfully

manage the disease. As part of the team the, the nurse plans, organizes, and
coordinates care among the various health disciplines involved; provides care and
education and promotes the client’s health and well being. Diabetes is a major public
health worldwide. Its complications cause many devastating health problems.

Through this case study, we should be able to learn and understand the disease
Diabetes Mellitus type 2 and therefore give us knowledge in proper management,
prevention and treatment. As a student nurse, it is very important to know many
things including the said disease condition. After the hardships of completing our case
study, a reward of self-fulfillment and credential to our knowledge and skills has been
added to us being student nurses as well as professionals in the near future.
RECOMMENDATION
The researchers would recommend the further study of this case as this is a
disease that is interesting. It would be better if another causative factor would be
studied to be able to provide diverse information about this disease and to be able to
compare to spot similarities and differences in the manifestations of this disease if
there is a different causative factor. To be able to appreciate the physical
manifestations of this disease, we advise future researchers to investigate this case on
the onset of the disease to be able to assess and note more overt manifestations both
for educational and documentation purposes.
VI. REFERENCES

http://en.wikipedia.org/wiki/Diabetes_mellitus#Causes
http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm
http://www.jpsimbulan.com/2008/07/26/incidence-of-type-1-and-type-2-diabetes-in-
the-philippines-and-worldwide/
http://nursingcrib.com/diabetes-mellitus-case-study/
Brunner&Suddarth.Textbook of medical-surgical nursing.2008.Lippincott
Williams & Wilkins.
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION
Independent:

Subjective:  Risk for  After 8 hours  Observe for signs  Patient may be  After 8
infection Type 2 diabetes of nursing of infection and admitted with hours of

“Hindi gumagaling related to high mellitus occurs interventions, inflammation. infection, which nursing

” (My glucose levels, when the the patient could have intervention

wounds are not decreased pancreas will identify precipitated the s, the
as
healing) leukocyte produces interventions ketoacidotic patient was
verbalized by the function. insufficient to prevent or state, or may able to
patient. amounts of the reduce risk develop a identify

hormone insulin of infection. nosocomial intervention

Objective: and/or the body's infection. s to prevent
tissues become or reduce

 Flushed resistant to normal  Promote good  Reduces the risk of

appearance. or even high handwashing by risk of cross- infection.

levels of insulin. nurse and patient. contamination

 Wound This causes high

drainage. blood glucose  Maintain aseptic  High glucose in

(sugar) levels, technique for IV the blood

 V/S taken as which can lead to insertion creates an

follows: a number of procedure, excellent

complications if administration of medium for

T:37.4 untreated. medications, and bacterial
P:87 providing growth.

R:19 maintenance and

BP: 120/90 site care. Rotate

IV sites as

indicated.

 Provide catheter  Minimizes the

or perineal care. risk for

Teach the female infection.

patient to clean
from front to back
after elimination.

 Provide  Peripheral

conscientious circulation may

skin care, gently be impaired,
 massage bony placing patient
areas. Keep the at increased
skin dry, linens risk for skin
dry and wrinkle irritation or
free. breakdown and
infection.

 Place in semi -  Facilitates lung

fowler’s position. expansion and
reduces risk of
aspiration.

 Encourage  Decrease
adequate dietary susceptibility to
and fluid intake of infection.
3000 ml per day.

Collaborative:
 Obtain specimen  Identifies
for culture and organisms so
sensitivities as that most
indicated. appropriate
drug therapy
can be
instituted.
VII. DISCHARGE PLANNING
1. General Condition of the Client

Mr. Sugar was seen lying on her bed wearing a shirt and pants, with hair disheveled,
with an IV fluid of 0.9 NaCl 1L regulated 40gtts/min infusing well at left hand. He reported that
he had already two bowel movements.

2. METHODS

M-edication

Metoprolol 1tab PO,OD

Losartan 1tab PO,OD
Metformin 1tab PO,OD

E-xercise

 Instruct to exercise at least 3 days a week and avoid strenuous activity.

>Regular exercise, even of moderate intensity (such as brisk walking), improves

insulin sensitivity and may play a significant role in preventing type 2 diabetes

T-reatment

 Follow-up check up on his private doctor.

H-

 Instruct pt. to comply with the given diet.

 Explain the importance of exercise in maintaining or losing weight.

 Advise patient to check blood glucose level before doing any activities and to eat

carbohydrate snack before exercising to avoid hypoglycemia.

>Blood glucose levels should be monitored before and after exercise to establish

blood glucose response patterns to the exercise regimen. If blood glucose is >250

mg/dl, the patient should delay the exercise session.

O-PD follow-up

D-iet

 Diabetic Diet

>Carbohydrates should provide 45 - 65% of total daily calories. Best choices are

vegetables, fruits, beans, and whole grains. These foods are also high in fiber.

Carbohydrate counting or meal planning exchange lists.

>Fats should provide 25 - 35% of daily calories. Limit saturated fat.

>Protein should provide 12 - 20% of daily calories, although this may vary
depending on a patient individual health requirements

 Avoid eating too much sweet foods.

 Eat foods rich in fiber such as banana.