Group: 4

Members:
GONZAGA, ANNGELA MARY ROSE CALONIA
JOSOL, RIZZA JOY MACARIO
JULKIRAM, YUOZEF SALEM
KONG, MOHAMMAD LACAY
LEGARA, CARLEY MELLEN SALAZAR
MARIMON, JESSA ALUMBRO
 Diabetes Mellitus (type 2)
General Objective:
 This case presentation is conducted in order to give relevant and
important information regarding with the disease presented by the
group that might help other students in their nursing practice in the
future.
 PATIENT CASE
Patient’s Chief Complaints
“My left foot feels weak and numb. I have a hard time pointing my toes up.”

History of Present Illness

C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had
high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic
work-up. She had participated in the state’s annual health screening program and noticed that her
fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the
time” and could not afford any more medications. Except for a number of “female infections,” she
has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining
that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex.
She denies any other weakness or numbness at this time. However, she reports that she has been
very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to
the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65
pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Past Medical History
•Seasonal allergic rhinitis (since her early 20s)
•Breast biopsy positive for fibroadenoma at age 30
•Gestational diabetes with fourth child 14 years ago
•Morning sickness with all four pregnancies
•HTN _ 10 years
•Moderate-to-severe osteoarthritis involving hands and knees _ 4 years
•Multiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt
baths
•Occasional constipation
Past Surgical History
•C-section 14 years ago

OB-GYN History
•Menarche at age 12
•Menopause, natural, at age 461⁄2; despite problematic hot flashes, she has chosen not to initiate HRT
•First child at age 17, last child at age 34, G4P4A0, all babies were healthy, 4th child weighed
•10 lbs 61⁄2 oz at birth
•Last Pap smear 4 years ago
Family History
•Type 2 DM present in younger sister and maternal grandmother; both were diagnosed in their late
40s; maternal grandmother died from kidney failure while waiting for a kidney transplant; sister is
taking “pills and shots”
•Father had emphysema
•Two older siblings are alive and apparently well
•All four children are healthy

Social History
•Married 29 years with 4 children; husband is a migrant farm worker
•Family of 5 lives in a 2-bedroom trailer
•Patient works full-time as a seamstress in a small, family-owned business
•Smokes 2 ppd (since age 14) and drinks 2 beers most evenings
•Has “never used illegal drugs of any kind”
•Rarely exercises and admits to trying various fad diets for weight loss but with little success; has
given up trying to lose weight and now eats a diet rich in fats and refined sugars
Review of Systems
General
•Admits to recent onset of fatigue
 
HEENT
•Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon
standing; denies vertigo, head trauma, ear pain, ringing sensations in the ears, difficulty swallowing,
and pain with swallowing

Cardiac
•Denies chest pain, palpitations, and difficulty breathing while lying down
 
Lungs
•Denies cough, shortness of breath, and wheezing
GI
•Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits to
occasional episodes of constipation
GU
•Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary
incontinence 

Ext
•Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tingling, or numbness in arms or legs
prior to this episode
 
OB-GYN
•Menses stopped 2 years ago; is not sexually active but denies sexual dysfunction; also denies any vaginal discharge, pain, or
itching

Neuro
•Has never had a seizure and denies recent headaches
Derm
•No history of chronic rash or excessive sweating
 
End
•Denies a history of goiter and has not experienced heat or cold intolerance
 
Allergies
•Sulfa drugs → confusion
Medications
•Lisinopril 20 mg po QD
•Acetaminophen 500 mg with hydrocodone bitartrate 5 mg 1 tablet po Q HS and Q 4h PRN
•Naproxen 500 mg po BID (for mild-to-moderate osteoarthritis _ 31⁄2 years)
•Omeprazole 20 mg po QD
•Docusate sodium 100 mg po TID
•Loratadine 10 mg po QD PRN

Physical Examination and Laboratory Tests

General
•Significantly overweight Native American woman who appears slightly nervous
•The patient is alert, oriented, and uses appropriate words
•She does not appear to be acutely distressed and looks her stated age
Vital Signs
PATIENT CASE TABLE VITAL SIGNS

BP - 165/100 without orthostatic changes T - 98°F

P – 88, regular HT – 5 feet – 3 inches

RR – 15, not labored WT – 203 lbs

Skin
•Dry and cool with tenting/poor skin turgor
•Significant xerosis on both feet with cracking
•Erythematous scaling rash in the axilla bilaterally
•(_) petechiae, ecchymoses, moles, or tumors upon careful inspection
•Normal capillary refill throughout
Head, Eyes, Ears, Nose, and Throat
•PERRLA
•EOMI
•Pink conjunctiva
•R & L funduscopic exams showed mild arteriolar narrowing but without hemorrhages, exudates, or
papilledema
•Non-icteric sclera
•TMs intact
•Nares and oropharynx clear without exudates, erythema, or lesions
•Mucous membranes dry
 
Neck and Lymph Nodes
•Supple
•(_) thyromegaly, adenopathy, JVD, or nodules
•(_) bruit auscultated over right carotid artery
Chest and Lungs
•No chest deformity; chest expansion symmetric
•Clear to auscultation and percussion throughout
Heart
•Regular rate and rhythm with no murmurs, gallops, or rubs
•Apical impulse normal at 5th ICS at mid-clavicular line
•Normal S1 and S2
•No S3, S4

Abdomen
•Soft, NT with prominent central obesity
•(_) BS in all four quadrants
•(_) organomegaly, distension, or masses
•Faint abdominal bruit auscultated
Breasts
•No masses, discoloration, discharge, or dimpling of skin or nipples
 
Genitalia/Rectum
•(_) vaginal discharge, erythema, and lesions
•(_) hemorrhoids
•Good anal sphincter tone
•Stool is guaiac-negative
 
Musculoskeletal and Extremities
•Normal ROM in upper extremities
•Reduced ROM in knees
•(_) edema or clubbing
•Peripheral pulses diminished to 1_ in both feet
•Feet are cold to touch and dry with cracking, but no ulceration observed
•Strength 5/5 throughout except 2/5 in left foot

Neurologic
•Alert and oriented _ 3
•Cranial nerves II–XII intact (including good visual acuity)
•Sensory response to light touch, proprioception, and vibration subnormal in both feet with abnormalities
greater in the left foot
•DTRs 2_ throughout
•Gait normal except for left foot weakness
Laboratory Blood Test Results (After Overnight Fast)

PATIENT CASE LABORATORY BLOOD TESTS RESULTS

Na – 139 mcq/L Ca – 9.8 mg/dL T. cholesterol – 246 mg/dL

K – 4.0 mcq/L PO₄ - 3.3 mg/dL HDL – 28 mg/dL

Cl – 102 mcq/L Mg – 1.9 mg/dL LDL – 168 mg/dL

HCO₃ - 22 mcq/L AST – 19 IU/L Trig – 458 mg/dL

BUN – 14 mcq/L ALT – 13 IU/L HbA₁c – 8.2%

Cr – 0.9 mcq/L Alk phos – 43 IU/L Ins – 290 µU/mL

Glu – 168 mcq/L T. bilirubin – 1.0 mg/dL

URINALYSIS

PATIENT CASE URINALYSIS

Appearance – Pale yellow and Bilirubin – Negative Microalbuminuria - Negative
clear

pH – 5.8 Ketones – Negative Glucose – Positive

SG – 1.008 Proteins - Negative Microscopy – Negative for

microbes, red cells, and white
cells
Electrocardiogram
•Findings consistent with early left ventricular hypertrophy
 DIABETES MELLITUS TYPE 2 CLIENT’S PROFILE
Type 2 diabetes is an impairment in the way the body NAME: C.B.
regulates and uses sugar (glucose) as a fuel. This long-term
(chronic) condition results in too much sugar circulating in the AGE: 48 years old
bloodstream. Eventually, high blood sugar levels can lead to
disorders of the circulatory, nervous and immune systems.
GENDER: Female
Statistics: Philippine Statistics Authority data showed that CIVIL STATUS: Married
deaths due to diabetes mellitus ranked fourth in 2020 at
37,265, after heart diseases (99,680), cancer (62,289), and
ATTENDING MD: N/A
cerebrovascular diseases (59,736).
Prognosis: There's no cure for type 2 diabetes, but losing
weight, eating well and exercising can help you manage the
disease. If diet and exercise aren't enough to manage your
blood sugar, you may also need diabetes medications or insulin
therapy.
 HEALTH HISTORY
Present Illness: She is complaining that her left foot has been weak and numb for nearly 3 weeks and that her foot is difficult to flex.
Past Medical History: She has gestational diabetes with her fourth child 14 years ago
She was diagnosed with hypotension for 10 years
She also suffered from moderate-to-severe osteoarthritis involving hands and knees (4 years ago)
Past Surgical History: Has C- section 14 years ago
Medication History:
• Lisinopril 20 mg po twice a day
• Acetaminophen 500 mg with hydrocodone bitartrate 5 mg 1 tablet po Q HS and Q 4h PRN
• Naproxen 500 mg po BID (for mild-to-moderate osteoarthritis_31/2 years)
• Omeprazole 20 mg po QD
• Docusate sodium 100 mg po thrice a day
• Loratadine 10 mg po QD PRN
Family History:
• Type 2 DM present in younger sister and maternal grandmother; both were diagnosed in their late 40s; maternal grandmother died
from kidney failure while waiting for a kidney transplant; sister is taking “pills and shots”
• Father had emphysema
• Two older siblings are alive and apparently well
• All four children are healthy
 PREDISPOSING FACTORS:
PRECIPITATING FACTORS:
• AGE
DIET: eating foods high in fats and refined sugars
• FAMILY HISTORY OF DIABETES
LIFESTYLE: Smoking, Physical inactivity, Drinking alcohol

Insulin resistance
LAB/ DIAGNOSTIC
TEST RESULTS
Impaired Glucose Utilization - provides the basis for
the diagnosis or proof of
the existence of the
Glucose Remains in the Bloodstream disease/symptom
- include the date

Increased Serum Glucose Level (Hyperglycemia)

Dysglycemia Fatigue

Risk for unstable blood glucose related to Fatigue related to poor physical condition
hyperglycemia
COMPLICATIONS
 GENOGRAM
TYPE 2
DM
DM

Maternal Grandmother
LEGEND:
= MALE
HEALTHY
HEALTHY EMPHYSEMA
= Female

Mother Father = Deceased

TYPE
TYPE 2
2 TYPE
TYPE 2
2
HEALTHY
HEALTHY HEALTHY DM
DM DM
DM

1st Older Sibling 2nd Older Sibling Client Younger sister

HEALTHY
HEALTHY HEALTHY HEALTHY HEALTHY
HEALTHY HEALTHY HEALTHY

Clients Children
 ASSESSMENT
SUBJECTIVE DATA:
 “My left foot feels weak
and numb. I have a hard
time pointing my toes
up.” As verbalized by the
patient.
 
OBJECTIVE DATA:
 Overweight
 Blood sugar 141
 Cholesterol 225
 Blurred vision
 Dizziness
DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
PROBLEM IDENTIFIED SHORT-TERM OBJECTIVES INDEPENDENT SHORT-TERM OBJECTIVES
1. To gain patient’s trust.
 unstable blood glucose (WITHIN THE SHIFT) 1. Establish rapport  Short term objectives were
2. To obtain baseline data
   At the end of nursing 2. Monitor vital signs met: Patient was able to
3. When patients know their
NURSING DIAGNOSTIC STATEMENT intervention the pt will: 3. Provide instruction to monitor in maintaining
-Increase engagement in daily SMBG results, they can blood glucose within normal
(2- OR 3-PART) patients using self
adjust their treatment
 Risk for unstable blood activities. monitoring blood glucose. range.
regimen and obtain optimal
glucose related to   4. Educate the patient about  
blood glucose control.
hyperglycemia.   the importance of LONG-TERM OBJECTIVES
4. A prescribed meal plan will
CAUSE ANALYSIS (WITH LONG-TERM OBJECTIVES (UNTIL following a prescribed help the patient maintain  Objectives were fully met:
REFERENCE) DISCHARGE) meal. stable blood glucose levels
The patient was able to use
 It occurs when the body has  At the end of 2 days 5. Discuss the different types 5. Knowing and following
information to develop
difficulty processing sugar intervention, the patient of insulin as well as each proper administration
important plan in health
into energy, is twice as Increase Knowledge of how type’s administration method is important in
care needs.
common among patient with to; and importance of method. ensuring drug’s efficiency.
chronic nerve dysfunction of maintaining blood glucose  
at normal level.  To control glucose levels if
unknown cause than among DEPENDENT/COLLABORATIVE diet and oral agents fail.
general population and
 Administer the prescribed  
maybe a risk factor for the insulin that has T2DM.  For patients who have type
condition. (sciencedaily 19
 Oral Antidiabetic Agents 2 diabetes that cannot be
june 2006).
 Reducing Anxiety treated by diet and exercise
  alone; to keep blood sugar
 Improving self-care in a healthy range.

Provide emotional support
and sets aside time to talk
with the patient who wishes
to express feelings.
 Restoring balance in our life
requires dedication and
practice.
 ASSESSMENT
SUBJECTIVE DATA:
 The patient complains
that her left foot has
been weak and numb for
nearly three weeks and
that the foot is difficult to
flex.” As verbalized by the
patient.
 
OBJECTIVE DATA:
 weak and numbness
 
DIAGNOSIS
PROBLEM IDENTIFIED
 Fatigue
NURSING DIAGNOSTIC
STATEMENT (2- OR 3-PART)
 Fatigue related to poor
physical condition
 
CAUSE ANALYSIS (WITH
REFERENCE)
 Fatigue failure occur during
normal use in many bones,
especially in those of the leg
and foot, due to excessive
numbers of high-strain
cycles.(Seyed B.
Behravesh,et.al.,Handbook
of Materials Failure Analysis
with Case Studies from the
Chemicals, Concrete and
Power Industries, 2016)
PLANNING
SHORT-TERM OBJECTIVES
(WITHIN THE SHIFT)
 At the end of nursing
intervention the pt will:
-able to cope with fatigue as
verbalized of feelings of
comfort and increase activity
participation.
 
 
LONG-TERM OBJECTIVES (UNTIL
DISCHARGE)
 At the end of 2 days
intervention, the patient
will be able to demonstrate
an increase in physical
activity by doing simple
ADL’s
INTERVENTION
INDEPENDENT
1. Establish rapport
2. Monitor vital signs
3. Alternate activity with
periods of rest and
uninterrupted sleep.
4. Provide adequate
ventilation
5. Promote sufficient
nutritional intake
6. Instruct patient to
perform deep breathing
exercises.
7. Set practical activity goals
with patient.
8. Provide comfort and
safety measures.
 
DEPENDENT/COLLABORATIVE
 Eating a healthful diet
 Managing and limiting
stress
 Getting regular exercise
 Seeking support from
friends and family.
 Regularly monitoring blood
sugar levels
 
 
RATIONALE EVALUATION
  SHORT-TERM OBJECTIVES
1. To gain patient’s trust.  Short term objectives were
2. To obtain baseline data met: the patient was able
3. To prevent excessive to subsist with fatigue as
fatigue. verbalization of feelings of
4. For proper relaxation. comfort and participating
5. The patient will need passive ROM.
properly balanced intake of  
fats, carbohydrates, LONG-TERM OBJECTIVES
proteins, vitamin, and  Objectives were fully met:
minerals to provide energy The patient participated to
resources. simple ADL’s
6. Helps promote relaxation.
7. This offers a sense of
control and feelings of
achievements.
8. To be free from injury
during activity.
 To maintain good health
and good nutrition.
 It helps your mind and
body adopt resilience.
 It can improve the patient’s
muscles strength and boost
your endurance.
 To empower and build
confidence to take charge
of life.
 To monitor and help the
patient take control of
diabetes.
 ASSESSMENT
SUBJECTIVE DATA
• “ The patient reports that
she has been very thirsty
lately and gets up more
often at night to urinate.”
OBJECTIVE DATA
• Poor skin turgor.mucous
membranes dry.Significant
xerosis on both feet with
cracking.Normal capillary
refill.
REFERENCE/S: NURSES POCKET GUIDE P.90 MARILYNN E.DOENGES, MARY FRANCES MOOR HOUSE, ALICE CMURR
DIAGNOSIS
PROBLEM IDENTIFIED
• Increases thirst and
urination.
NURSING DIAGNOSTIC
STATEMENT (2- OR 3-PART) -
• Risk for deficit fluid volume
related to increasing thirst &
urination.
CAUSE ANALYSIS (WITH
REFERENCE)
• Deficient fluid volume is
decrease intravascular,
interstitial and intracellular
fluid. Refers to dehydration
water loss alone without
change in sodium.
PLANNING
SHORT-TERM OBJECTIVES
(WITHIN THE SHIFT)
 Within 8hours of nursing
intervention the patient
will;Identify individual risk
factors and appropriate
intervention.Maintain fluid
volume at a functional level.
LONG-TERM OBJECTIVES
(UNTIL DISCHARGE)
 Demonstrate lifestyle
changes to prevent
development of fluid volume
deficit.
INTERVENTION
INDEPENDENT
1. Establish rapport.
2. Discuss & emphasize the
importance of oral hygiene.
3. Monitor intake and output
4. .Encourage the patient to drink
prescribe amount of fluid.
5. Assess for skin turgor & mucous
membrane.
6. Plan daily activities.
DEPENDENT/COLLABORATIVE
 Review the client’s medication
including over the counter drugs,
herbals & nutritional
supplements.Review laboratory
data.
RATIONALE
1. To obtain baseline data.
2. To promote interest in
drinking water & reduce
discomfort of dry mucous
membrane.
3. To know patient’s fluid.
4. To replace the fluid losses.
5. To know if the patient is
lack of fluid.
6. To conserves patient’s
energy.
 To determine if adjustment
may be needed e.g change
in dose or the time of
medication taken.
 To evaluate fluid &
electrolyte status.
EVALUATION
SHORT-TERM OBJECTIVES
 Intervention, the goal was
met. The patient able to
know the importance of
fluid intake.
LONG-TERM OBJECTIVES
 After 1 week of nursing
intervention the goal was
fully met the patient able to;
Maintain the fluid volume
at the functional level as
evidenced by good skin
turgor.
THANK YOU!