Update Checked by Maam V Sep 10

A CASE PRESENTATION OF
DIABETES MELLITUS TYPE 2 UNCONTROLLED;

NON- HEALING WOUND
PREPARED BY: ASHRAL R. CABUGATAN
1
II. TABLE OF CONTENTS
Title page
Table of contents
Introduction
Nursing theories
Patient’s data
History of present illness
Review of systems
Physical assessment
Course in the ward
Review of related literature
Anatomy and physiology
Pathophysiology
Laboratory and diagnostic procedures
Drug study
NCP
Bibliography
2
III. INTRODUCTION
The case study that is to be presented features a patient who has a Type 2 Diabetes Mellitus
Uncotrolled; Non- healing wound.
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. Type 2 diabetes
mellitus (formerly called non-insulin-dependent diabetes mellitus (NIDDM) is a group of
disorders characterized by hyperglycemia and associated with microvascular (ie, retinal, renal,
possibly neuropathic), macrovascular (ie, coronary, peripheral vascular), and neuropathic (ie,
autonomic, peripheral) complications. Unlike patients with type 1 diabetes mellitus, patients with
type 2 are not absolutely dependent upon insulin for life, even though many of them are
ultimately treated with insulin.
Type 2 diabetes is determined primarily by lifestyle factors and genes. A number of

lifestyle factors are known to be important to the development of type 2 diabetes. In one study,
those who had high levels of physical activity, a healthy diet, did not smoke, and consumed
alcohol in moderation had an 82% lower rate of diabetes. When a normal weight was included
the rate was 89% lower. Obesity has been found to contribute to approximately 55% type 2
diabetes. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives
(especially first degree) with type 2 increases risks of developing type 2 diabetes very
substantially.
I as a nursing student is involved in learning what type of nursing interventions that I will
apply to this type of patient. Beyond understanding the relevant health issue, this case study will
also explore other factors that can enhance my knowledge in the field of our nursing practice.
This is also the primary reason why I choose this case study because I know that it is highly
beneficial aside from it is being considered unique.
Included with the case study are the discussions of the anatomical parts, through physical
assessment of the patient, laboratory results and their corresponding findings. Added to this I
also have a discussion of the patient’s daily activities and nursing care plans.
3
IV. NURSING THEORIES
Dorothea Orem
"Self-Care Nursing Theory"
Self-Care Nursing Theory or the Orem Model of Nursing was developed by Dorothea Orem
between 1959 and 2001. It is considered a grand nursing theory, which means the theory covers a
broad scope with general concepts that can be applied to all instances of nursing.
OREM’S GENERAL THEORY OF NURSING
Major Concepts of the Self-Care Deficit Theory
 Nursing
is an art through which the practitioner of nursing gives specialized assistance to persons with
disabilities which makes more than ordinary assistance necessary to meet needs for self-care.
The nurse also intelligently participates in the medical care the individual receives from the
physician.
 Humans
Humans are defined as “men, women, and children cared for either singly or as social units,” and
are the “material object” of nurses and others who provide direct care.
 Environment
The environment has physical, chemical and biological features. It includes the family, culture,
and community.
 Health
Health is “being structurally and functionally whole or sound.” Also, health is a state that
encompasses both the health of individuals and of groups, and human health is the ability to
reflect on one’s self, to symbolize experience, and to communicate with others.
 Self-care
Self-care is the performance or practice of activities that individuals initiate and perform on their
own behalf to maintain life, health, and well-being.
4
Self-care Agency
Self-care agency is the human’s ability or power to engage in self-care and is affected by basic
conditioning factors.
Therapeutic Self-care Demand
Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some
duration in order to meet known self-care requisites by using valid methods and related sets of
actions and operations.”
 Self-care Deficit
Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the
case of a dependent, the parent or guardian) is incapable of or limited in the provision of
continuous effective self-care.
 Nursing Agency
Nursing Agency is a complex property or attribute of people educated and trained as nurses that
enables them to act, to know, and to help others meet their therapeutic self-care demands by
exercising or developing their own self-care agency.
 Nursing System
Nursing System is the product of a series of relations between the persons: legitimate nurse and
legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds
available self-care agency, leading to the need for nursing.
 Theories
The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories:
(1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems,
which is further classified into wholly compensatory, partial compensatory and supportive-
educative.
 Theory of Self-care
This theory focuses on the performance or practice of activities that individuals initiate and
perform on their own behalf to maintain life, health and well-being.
5
 Self-care Requisites
Self-care Requisites or requirements can be defined as actions directed toward the provision of
self-care. It is presented in three categories:
 Universal self-care requisites
Universal self-care requisites are associated with life processes and the maintenance of the
integrity of human structure and functioning.
The theory of nursing systems describes how the patient's self-care needs will be met by the
nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the
self-care requisites of the patient: wholly compensatory system, partly compensatory system, and
supportive-educative system.
Orem recognized that specialized technologies are usually developed by members of the health
care industry. The theory identifies two categories of technologies.
The first is social or interpersonal. In this category, communication is adjusted to age and health
status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the
coordination of efforts. The nurse should also maintain a therapeutic relationship in light of
pscyhosocial modes of functioning in health and disease. In this category, human assistance
adapted to human needs, actions, abilities, and limitations is given by the nurse.
The second is regulatory technologies, which maintain and promote life processes. This category
regulates psycho- and physiological modes of functioning in health and disease. Nurses should
promote human growth and development, as well as regulating position and movement in space.
Orem's approach to the nursing process provides a method to determine the self-care deficits and
then to define the roles of patient or nurse to meet the self-care demands. The steps in the
approach are thought of uas the technical component of the nursing process. Orem emphasizes
that the technological component "must be coordinated with interpersonal and social pressures
within nursing situations.
The nursing process in this model has three parts. First is the assessment, which collects data to
determine the problem or concern that needs to be addressed. The next step is the diagnosis and
creation of a nursing care plan. The third and final step of the nursing process is implementation
and evaluation. The nurse sets the health care plan into motion to meet the goals set by the
patient and his or her health care team, and, when finished, evaluate the nursing care by
interpreting the results of the implementation of the plan.
6
THEORY
THEORY THEORIST DESCRIPTION APPLICATION OF THEORY

TO THE PATIENT
A health promoting
1. Health Nola J. Pender behavior is an end Health promotion model
Promotion point or action can help Mr. A.S, to attain
Model
outcome directed positive health outcomes by
toward attaining eating of healthy diet,
positive health exercise regulary,
outcome such as managing stress, gaining
optimal well being, adequate rest, spiritual
personal fulfillment, growth and building
and productive living. positive relationship.
The central idea of the

2. Self-Care Dorothea E. theory of self-care In this theory suggests that
Deficit theory Orem deficit is that the Mr. A.S, recover quicker
and more effectively when
requirements of they are allowed to meet
persons for nursing are their own basic needs, such
associated with as eating, grooming, and
subjectivity of mature using the restroom. I used
and maturing persons it as a guide to provide care
to health-related or and to help patient to
attain self care,
health care-related
action limitations
7
8
V. PATIENT’S DATA
GENERAL DATA:
NAME: Mr. A.S

MALE: Male
AGE: 45
ADDRESS: Marikina city
OCCUPATION: None
MARITAL STATUS: N/A
RELIGION: Roman Catholic
ADMITTING DIAGNOSIS: DM TYPE 2 Uncontrolled; Non Healing Wound
DATE OF ADMISSION: June 23 2019
SOURCE OF INFORMATION: Patient
Weight: 84 kgs (186lbs)
Height: 5’3”
BMI: 32.9
CHIEF COMPLAINT:
“Ang sakit po ng paa ko dahil sa sugat ko” As verbalized by the patient.
9
HISTORY OF PRESENT ILLNESS
3 years prior to admission (year 2016) According to the patient
2 years prior to admission (year 2017) patient observed less sensation and numbness on his
feet. And a feeling of body weakness, those symptoms lasted 4-5 days. patient stated that he also
experienced dizziness when his blood pressure get high that persist only for a day with no other
associated symptoms . only periods of rest until symptoms were gone and didn’t seek medical
attention and no medication was taken.
1 year prior to admission (January 2019) The following months after the appearance of
mentioned symptoms, According to the patient those symptoms that he experienced did not cease
but was persistent. He did not experience worsening of the symptoms as well. No consultation
was done and no medications taken. He managed it by rest.
One month prior to admission (May 02 2019)- According to the patient, there was flood in
their area in Marikina. Accidentally, he stepped on a nail. Using a clean fabric, he applied
pressure to stop bleeding from his wound. He thought that it's just a simple wound that will heal
immediately so he didn't seek medical attention and no medication was taken. After that incident
he still went back to his activities of daily living.
Two weeks prior to admission (May 09 2019)- patient start experienced fever and pain with a
pain scale of 5/10. He also observed that there was a swelling and tenderness with pus on the
heel part of his right foot. He applied Betadine once with no relief. patient mentioned that he
utilizes “bayabas” leaves decoction to cleanse his wounds and amoxicillin powder (from the
amoxicillin capsule) as his medication to his wound. The said amoxicillin was only a suggested
intervention that was not prescribed by a medical practitioner. According to him, He only
changes his dressings once everyday due to economic constraints. He took OTC medication
paracetamol (Biogesic) 500mg/tab for fever. Patient managed it by elevating his right leg at
night until it subsides. No other symptoms felt, no consultation was done.
One week prior to admission (May 16 2019)- Patient still experienced fever and progressive
pain with a pain scale of 7/10, His siblings decided to bring him in Amang Rodriguez Hospistal
for check up. Patient stated that he was prescribed Paracetamol 500mg for fever, tramadol of
50mg/tab for pain and unrecalled medication of antibiotic. Patient went home, He further advised
to comeback if the fever persists after 1 week.
Four days prior to admission- (June 19 2019) patient experienced consistent pain radiating
from foot to his leg with a pain scale of 8/10. He took tramadol of 50mg/tab for pain, pain was
10
relieved. He managed it by elevating his right leg under the pillow until it relieve. No
consultation was done.
5 hours prior to admission (June 23 2019) -According to the patient, pain continued to
gradually increase in severity by pain scale of 9/10 associated with fever. Hence, consulted at
Quirino Memorial Medical Center.
June 23 2019- In the ER at QMMC Mr. A.S, is a 45 years old male with a chief complaint of
severe foot pain by pain scale of 9/10 and fever, and an admitting diagnosis of Type 2 Diabetes
Mellitus Uncontrolled; Non-healing wound. He did an initial assessment with positive fever,
with a blood pressure of 140/100 Respiratory rate of 23 cpm Pulse rate of 107 bpm and
Temperature of 39.3.
Part of the confirmation of the disease, The following test was requested to be done such as
Capillary Blood Glucose and certain blood test. He was admitted at medicine ward at 10:00AM
11
PAST MEDICAL HISTORY
 According to the patient he never had any serious illnesses during his childhood and
he was not hospitalized other than the said hospitalizations above.
FAMILY HISTORY
 (+) Hypertension- paternal side
 (-) Diabetes- Mr A.S claimed that there’s no reported history of Diabetes

Mellitus in his maternal and paternal side.
 (-) Cancer
 (-) Stroke
PERSONAL AND SOCIAL HISTORY

Mr. A.S. He has no work, He just spending his time watching television, playing “tong-
its” and exchanging stories with his relatives. Patient stated that he never smoked just an
occasional alcohol drinker, patient usually takes heavy meals more frequently such as 4
cups of rice every meal, He like also sweets such as softdrinks , 4 tablespoon of sugar in
coffee and he prefers to use “ginaok” as stuffing with breads, He likes to eat too much
rice and porks. His lifestyle becomes sedentary, having no enough exercise to burn extra
calories.
ENVIRONMENTAL HISTORY:
 He lived in Marikina city together with his family, He described his place was always get
flooded in their area.
12
FUNCTIONAL HEALTH PATTERN
1. Health Perception/ health management pattern
-Mr. A.S , a 45 y/o, male patient. Prior to admission once he felt something wrong about his
condition such as less sensation on his feet, and fever, he does not often seek for medical
attention. He just relieve it by rest.
2. Self-esteem, self-concept, self-perception pattern
-According to him, He was more motivated to do follow the proper regimen for diabetes mellitus
3. Activity/exercise pattern
-He says that going to store and walking upstairs requires lot of movements or sometimes he
spends his time relaxing at home or doing some simple household repairs and he considers it as
his daily exercise.
4. Nutritional-metabolic pattern
-The patient usually takes heavy meals more frequently such as 4 cups of rice every meal, He
typically drink softdrinks every meal from his sari-sari store, He used to consume softdrinks 5-8
botlles a month of a total 96 bottles a year. he like also sweets such as softdrinks, 4 tablespoon of
sugar in coffee and he prefers to use “ginaok” as stuffing with breads, He likes to eat too much
rice and porks.
Elimination pattern
-He has a regular bowel movement prior to admission. According to him, he defecates once a
day yellow to brown colored formed stool and seldom experiences constipation/diarrhea. He
urinates approximately 4 times a day, No urine/ bowel incontinence was expressed by the client.
5. Sleep-rest pattern
-He has a regular sleeping hours at night. He says that he sleep in the afternoon.
6. Cognitive-perceptual pattern
-Sense of hearing, touch, smell, sight and taste are normal, Patient expressed experience of
chronic pain as a result of his infected wound at right foot When asked about the level of pain, he
responded a score of 8 from a scale of 1-10. He managed the pain by takes mefenamic and
relaxes his foot to relieve.
7. Role-relationship pattern
13
-He lives with his family, Has 3 brothers. He is the youngest in the family and states good
relationship with family and friends
8. Sexuality-reproductive pattern
-Patient doesn’t want to talk about his sexual life because he is single.
9. Coping-stress tolerance pattern
- When he was diagnosed of DM Type 2, there have been many changes occurred that made
difficult to him to adjust. He cannot perform the usual activities that he had before. He felt
conscious of his physical appearance . But he feels good when he see and feel the presence of his
family to the hospital
10. Value-belief pattern
-Mr. A.S, is Roman Catholic and according to him he went to church with his father every
Sunday. He has high regard of good character values and he believes that the way of living today
is very difficult due to poverty and economic problem. Religious is still a part of patient’s life.
14
REVIEW OF SYSTEMS
(JULY 11 2019) 8:00AM
GENERAL:
 “Ang sakit ng paa ko dahil sa sugat ko”

 “ Mainit yung pakiramdam ko”
 “ Namamayat na ako”
 “Ang tagal gumaling ng sugat ko”
(June 2019) From Weight: 87 kg

(July 2019) To Weight: 84 kg
HEAD AND NECK:
 “Nahihilo po ako”
 “Maayos naman paningin at pang dinig ko wala naman problema”
 “Nagagalaw ko naman ng maayos leeg ko , hindi naman masakit”
RESPIRATORY
 “ Wala naman po akong problema sa paghinga at wala rin naman akong ubo”
HEART AND BLOOD VESSELS:
 “Hindi pa ako nakakaranas ng paninikip ng dibdib.”

 “Mataas lagi blood pressure ko”
GASTROINTESTINAL:
 “Wala pong problema sa paglunok ko”

 "Wala naman masakit sa tyan ko"
 "Normal naman pag pag dumi ko hindi naman ako nahihirapan"
15
GENITOURINARY:
 “Wala naman po akong problema sa pag ihi"

 “Hindi naman ako ihi ng ihi”
INTEGUMENTARY:
 “Ito lang sugat ko sa kanan paa matagal lang gumaling”
ENDOCRINE:
 "Hindi naman ako gaanong pinagpapawisan"
PSYCHIATRIC:
 "Medyo na dedepress ako kasi baka tuluyan na ako maputulan ng paa"
MUSCOSKELETAL:
 "Hindi ko mailakad itong kanan paa ko dahil sa sugat ko pero naangat ko naman siya"
 "Itong kaliwa okay naman nailalakad ko medyo hindi ko lang nararamdaman minsan
parang nangangapal "
16
PHYSICAL ASSESSMENT
Received patient awake, lying semi-fowler’s with the right foot positioned away from left foot in
bed. Weak in appearance and obvious in pain. Oriented to time and place, noticed that right foot
are swelling. with ongoing IV fluid of 0.9 PNSS 1L inserted at dorsal metacarpal regulated at 40
gtts/min.
(JULY-11-2019) 8:30AM
DAY and Day 1 Day 2

DATE July-11-2019 July-12-2019
VITAL SIGNS 8am 12pm 8am 12pm
Blood Pressure 140/80 130/100 130/80 130/80
mmHg mmHg MmHg mmHg
Pulse Rate 102 bpm 98 bpm 96 bpm 87 bpm
Respiration Rate 21 cpm 19 cpm 19 cpm 18 cpm
Temperature 38.2oC 37.3 oC 36.6 oC 36.4 oC
BODY PART TECHNIQUE ACTUAL FINDINGS ANALYSIS/

INTERPRETATION
 Darkening of lower Due to hydration status
INTEGUMENTARY INSPECTION extremities, and melatonin deficiency
no presence of edema, boil
SKIN of the client, possible of
scar in left leg, poor skin
turgor, dry skin, Warm to high body temperature
touch, flushed skin
 Evenly distributed;
no lesions.
HAIR INSPECTION
Normal
 Pale color of nails
beds & presence of
INSPECTION
NAILS dead toe nail.
Due to decrease of
PALPATION  Poor capillary refill oxygen in the tissue cells.
more than 3 seconds.
 Normocephalic,
HEAD INSPECTION absence of nodules, Normal
symmetric facial
features, symmetric
facial movements
EYES INSPECTION  Pale conjunctiva
positive reaction to light Decrease RBC and Hgb
and accommodation. No level
17
blurred vision.
INSPECTION  Symmetric position,
EARS able to hear sounds Normal
on both ears, no
signs of discharges.
 Symmetric and
INSPECTION straight, no Normal
NOSE discharge, nasal
septum intact and in
the midline breaths
freely and regularly
Normal
 moist lips,
INSPECTION symmetrical in shape
MOUTH
no lesions.tongue is in
central position Normal
 Head centered,
NECK INSPECTION smooth movements Normal
with no discomfort,
PALPATION
lymph nodes not
palpable.
INSPECTION  Chest is
CHEST AND LUNGS symmetrical, skin is Normal
AUSCULTATION
intact, full
symmetric chest
PERCUSSION
expansion, no
PALPATION
masses, clear breath
sounds, RR: 19 cpm
 Full pulsations,
CARDIOVASCULAR INSPECTION
symmetric pulse Stage 1 hypertension
PERCUSSION
volumes, blood
pressure is noted to
PALPATION be 140/80;
AUSCULTATION
INSPECTION  Uniform in color, no
ABDOMEN AUSCULTATION Normal
PERCUSSION lesions
PALPATION  flabby and soft
Bowel sounds are
audible.
18
Has an equal size on both
MUSCULOSKELETAL sides of the body, no
SYSTEM
INSPECTION contracture, no tremors, no
involuntary movement, Client Due to poor circulation
Upper extremities
Note: patient can flex, extend, and
claimed that he hyperextend w/o pain.
experienced There is full range of motion
numbness and against resistance.
paresthesia.
Lower extremities Right lower extremity:
 He had undergone To prevent infection and

debridement at the farther tissue damage.
INSPECTION
right foot. Because of DM and non
PERCUSSION  Asymmetric with the healing wounds.
left lower extremity.
PALPATION
 (+) Numbness
 (+) Swelling
 tenderness to
palpation
 Joints are unstable,
Range of motion and
tone are limited.
 Poor capillary refill
Left lower extremity:
 Appears asymmetric
with the Right foot.
 Scar from boil in his
left leg Because of DM and non
 (+) Numbness healing wounds.
 (-) Swelling
 (-)tenderness
 Joints are stable,
range of motion and
tone are within
normal limits
 Poor capillary refill
 Numbness and
paresthesia
19
 Concious and
coherent
INSPECTION
NEUROLOGIC  No language Normal
deficiency,
 well oriented to time
and place,
 coordinated body
movements
 Flushing skin
 (-) Polydypsia,
polyphagia and
polyuria
INSPECTION  Darkening was noted
ENDOCRINE on patient’s stiffed Due to type 2 diabetes
joints and skin is dry mellitus and non healing
to touch. wounds.
 lower extremities
have poor muscle
tone
20
COURSE IN THE WARD
Day 1 (June 23 2019)
A 45 years old female was admitted Last June 232019, accompanied by his brothers at the
Emergency Room of Quirino Memorial Medical Center with a chief complaint of “Sobrang sakit
po ng sugat ko sa paa”
He was admitted under the care of the Doctors of Quirino memorial Medical Center.
Following orders were given.
 Secure consent of admission and management
Laboratory and Diagnostics
 For CBC, Na, K, Cl, BUN and Creatinine, Albumin, (Extracted)
Medications/Therapeutics
 PNSS 1Liter regulated at 20 mins gtts/min
 Paracetamol 300 mg TIV q4 for fever and also for pain
Nursing care
 Vital signs are monitored and recorded
 Doctors order are carried out
 Secured consent for management
 Keep right foot elevated
 Avoid pressure on right heel
 Patient’s safety maintained. Side rails up
Day 2 (June 24 2019) 8:45am

Physical examination
 (+) awake and coherent
 (+) fever (Temperature 37.8C)
 (+) Tenderness and swelling right foot.
Diet:
 Diet as tolerated
Nursing notes/care:
 Provision of care
 Safety measures provided. Monitored closely
 Vital signs taken (T=37.8C)
21
 TSB done
 Given paracetamol 300 mg TIV Q6
 Patienty safety maintained. Side rails kept up
Day 3 (June 25 2019) 8:00am
Diet:
 Diet as tolerated
Doctor’s order:
 For wound debridement of right heel
 Secure consent for procedure.
 Follow up for cultures
 Avoid pressure on right foot
Nursing notes/ care

Day 4 (June 26 2019) 9:00am
ORTHO
Diet:
 NPO
Therapeutics
 IVF of PNSS 30 gtts/min tto be given every 8 hours
Doctor’s order:
 Follow up update laboratories
 For wound debridement right heel
 Secure consent for procedure
Working diagnosis:
#1 DM foot right wound debridement

(+) pain
(+) Intact dressing
22
(-) Discharge
#2 Type 2 DM Uncontrolled
109-228 mg/dl
Nursing notes/ care

Day 5 (June 27 2019) 9:00am

The day I received the patient
Procedure: Wound debridement
ANESTHESIA PRE-OP
1:45pm
 Patient was seen and examined
 History, PE and chart reviewed
 Anesthesia plan explained, understood and accepted by patient
 Secure consent for anesthesia
 NPO
 Monitor VS q4
 Treatment:
1. PNSS 1 liter for 100 cc/hr
2. Omeprazole 40mg TIV OD
3. Vitamin K tab q8
3:45pm
 Noted for wound debridement today
 Hold medications
 Follow up cultures
 Continue present management
 Continue CBG monitoring q4 while on NPO
Nursing care:
 Awake, conscious and coherent
 Vital signs are monitored and recorded. (T= 36.6C BP=120/80 PR=97bpm RR=20)
23
 Maintained NPO
Day 6 (June 28 2019) 8:00pm

ANESTHESIA POST-OP ORDERS
8:00pm
 To PACU
 Hook to O2 via face mask at 4-5 LPM
 Monitor VS q15
 Moderate high back rest
 NPO temporary
 Keep thermoregulated
 IVF PNSS 1 liter for 8 hours
 Treatment:
1. Paracetamol 300 mg q8 x 3 doses
2. Ketorelac 30 mg/ IV q8h x 3 doses (-) ANST
3. Butorphanol 1mg/ IV q6h x 4 doses
ORTHO POST-OP
Status post wound debridement right foot
1:00am
Doctor’s order:
 Resume diet once fully awake
 Continue IVF
 Continue medications
2:25pm
 Transfer to hallway
3:00pm
Doctors order:
 Inquire with IDS, antibiotic continuation

 May resume metformin only
 Hold insulin temporarily
 Follow up update laboratories post op
24
Nursing care:

 Maintained dressing
 Vital signs are monitored and recorded.
 Positioned patient to comfortable position
 Encouraged adequate rest and sleep
Day 7 (June 29 2019) 10:00am

 Maintain dressing
11:00am
 Increase metformin 500 mg tab TID

 Follow up updates laboratory
 Provides adequate analgesia
Day 8 (June 30 2019) 9:00am
Therapeutics/Treatment:
 IVF PNSS 1 liter at regulated at 30 gtts/min to be give every 8 hours

 To complete ciprofloxacin and clindamycin for 28 days
Doctor’s order:
 Follow up for ortho plans

Nursing care/notes:

 Vital signs are monitored and recorded.
 Positioned patient to comfortable position
 Encouraged adequate rest and sleep
25
Day 9 (July 01 2019) 9:00am

ORTHO
 Plan: for “E” Repeat wound debridement right heel prior to possible flap coverage
 Secure consent for procdure
 NPO by 12 midnight
 Start omeprazole 40mg IV OD while on NPO
Day 10 (July 02 2019) 8:35am

ANESTHIA PRE-OP
 NPO
 Suggest connection anemia
 Monitor VS q4
 Treatment:
4. PNSS 1 liter for 100 cc/hr
5. Omeprazole 40mg TIV OD
6. Vitamin K tab q8
11:20am
 Noted ortho plans, Hold insulin today
 Facilitate “E” wound debridement
 CBG monitoring q4 once on WPO then q1 at OR
11:40am
 NPO
 Continue IVF
 Medications main secure
 Give omeprazole 20 mg IV OD while on NPO
 Secure content for procedure
26
Day 11 (July 03 2019) 6:05am

 DAT then NPO by 7am
 Continue IVF
 Continue Medications
 Give omeprazole 40mg IV OD while on NPO
 Still for “E” wound debridement, Right heel
10:00am
 Hold Vitamin K and Metformin
 Start Lantus 10 “u” SQ 6pm, Hold if NPO
 CBG q4h while on NPO
 Repeat CBCPC, Na, K, PT PTT, Crea, BUN tomorrow 8am
 Keep wound dressing
2:00pm
 Noted Ortho plan
 Hold metformin today
 CBG q4 monitoring once on WPO
 D5050 1 vial PRN CBG <100 mg/dL
 D5050 2 vials PRN CBG <70 mg/Dl
 CBG q1 at OR
Day 12 (July 04 2019) 1:55am
POST-OP
 To PACU
 Hook to O2 via face mask at 4-5 LPM
 Monitor VS q15
 Moderate high back rest
 NPO temporary
 Keep thermoregulated
 IVF PNSS 1 liter for 8 hours
 Treatment:
1. Ketorolac 30 mg/ IV q8h x 3 doses (-) ANST
2. Butorphanol 1mg/ IV q6h x 4 doses
 Refer
2:00pm
27
 Resume diet once fully awake
 Continue IVF
 Continue medications
 Repeat CBCPC, Na, K, Cl, BUN, Crea tomorrow AM
 Refer
Day 13 (July 05 2019) 10:00am

ORTHO
 Maintain splint and dressing
 Plan: For revine sural flap of right heel
 Once with culture negative wound bed or with variable wound bed
 Keep right leg elevated
 Refer
3:00pm
 Noted ortho plans
 Increase insulin to 12 “u” SQ OD PM
 Provide adequate analgesia
5:30pm
 Give K, 4 tabs now
 Repeat K 2 hours post correction
Day 14 (July 06 2019) 11:30am

 Maintain splint and dressing
 For reverse sural flap for right heel
 No pressure on right heel
10:00pm
Day 15 (July 07 2019) 8:45am

ORTHO
 Plan: For flap right heel once with viable wound bed
 Keep foot elevated
 Continue wound care with dakins solution
28
2:45pm
 Follow up update cultures
 Hold Clindamycin
 Revise tramadol IV to Paracetamol 1 tab PO TID RTZ
 Secure crutches
Day 16 (July 08 2019) 6:00am

 Follow up culture
 Keep right leg elevated
11:00am
 Noted ortho plan
 Increase Lantus to 16 “u” SQ OD today and shift tomorrow
 Start Humulin R 6 “u” SQ pre dinner only
12:00am
 Plan: Flap right heel once with viable wound bed
 Daily dakens
Day 17 (July 09 2019) 8:40am

 Daily daiken’s
2:00pm
 Still for flap right heel
Day 18 (July 10 2019) 7:45am

 Daily daikens
29
10:00pm
 Still for flap right heel
 Secure ortho crutches
 Repeat CBCPC, Na, K, tomorrow AM
Day 19 (July 11 2019) 8:00am

Received patient awake, lying semi-fowler’s with the right foot positioned away from left foot in
bed. Weak in appearance and obvious in pain. Oriented to time and place, noticed that right foot
are swelling. with ongoing IV fluid of 0.9 PNSS 1L inserted at dorsal metacarpal regulated at 40
gtts/min.
Doctor’s order:
 Continue wound care with dakins solution
 Give paracetamol 300 mg TIV PRN for fever
Student nursing care: 8:00am
 Vital signs are monitored and recorded. Temp = 38.2 PR= 102bpm RR= 21cpm BP=
140/80mmHg
 CBG taken 131mg/dl
 Performed ROS and Physical Assessment
 Performed tepid sponge bath.

 Assisted wound care with dakins solution.
 Maintained right foot elevated
 Assisted patient to comfortable position
 Encouraged adequate rest
 Nursing care was done.
Therapeutics/Treatment:
 Paracetamol 300mg given
 Increase lantus to 18 “u” SQ OD PM
 Increase Humulin R 18 ‘u” pre dinner only
 Increase insulin to 18 “u” SQ OD AM
 CBG monitoring
30
12:00PM
Student nurse care:
 Vital signs monitored and recorded. Temp = 37.3 PR= 98bpm RR= 19cpm BP=
130/100mmHg
 Encouraged adequate rest
 Nursing care was done.
10:00pm
 NPO now 10pm
 Medications: Omeprazole 40mg TIV OD once on NPO
 Hold hypoglycemic agents prior to procedure
 Monitor VS q4 and record
10:30pm
 For fluorescein angiography as out patient basis
 (Normal BUN Crea) for baseline evaluation of patients posterior segment
 Ensure strict glucose control
OPTHA
 No immediate optha intervention for now
 Refer back if there new onset optha symptoms
 Advised follow up at Eye center for evaluation with diagnostics
 Eye exam was done
31
Day 20 (July 12 2019) 8:00am
ORTHO PRE-OP
 NPO
 Continue IVF
 Continue IV medications
 For “E” Repeat wound debridement, right heel
 Secure 1 unit PRBC for OR
 Start Omeprazole 40 mg IV OD while on NPO
Student nursing care:
 Vital signs are monitored and recorded. Temp = 36.4 PR= 87bpm RR= 18cpm
BP=130/80mmHg
 Assisted wound care with dakins solution.

 Maintained right foot elevated
 Nursing care was done
32
REVIEW OF LITERATURE
DIABETES MELLITUS
Somatostatins are hormones secreted directly into the bloodstream, and together, they regulate
the level of glucose in the blood. Insulin lowers the blood sugar level and increases the amount
of glycogen (stored carbohydrate) in the liver; Diabetes mellitus is a metabolic disorder,
specifically affecting carbohydrate metabolism. It is a disease characterized by persistent
hyperglycemia (high glucose blood sugar). It is a metabolic disease that requires medical
diagnosis, treatment and lifestyle changes. The World Health Organization recognizes three main
forms of diabetes: type 1, type 2 and gestational diabetes (or type 3, occurring during
pregnancy), although these three "types" of diabetes are more accurately considered patterns of
pancreatic failure rather than single diseases. Type 1 is generally due to autoimmune destruction
of the insulin-producing cells, while type 2 and gestational diabetes are due to insulin resistance
by tissues. Type 2 may progress to destruction of the insulin-producing cells of the pancreas, but
is still considered Type 2, even though insulin administration may be required.
Since the first therapeutic use of insulin (1921) diabetes has been a treatable but chronic
condition, and the main risks to health are its characteristic long-term complications. These
include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for
dialysis in developed world adults), retinal damage which can lead to blindness and is the most
significant cause of adult blindness in the non-elderly in the developed world, nerve damage,
erectile dysfunction (impotence) and gangrene with risk of amputation of toes, feet, and even
legs.
33
TYPE 1 DIABETES MELLITUS
Type 1 diabetes mellitus formerly known as insulin-dependent diabetes (IDDM), childhood

diabetes, or juvenile-onset diabetes - is characterized by loss of the insulin-producing beta cells
of the islets of Langerhans of the pancreas leading to a deficiency of insulin. Sensitivity and
responsiveness to insulin are usually normal, especially in the early stages. This type comprises
up to 10% of total cases in North America and Europe, though this varies by geographical
location. This type of diabetes can affect children or adults, but has traditionally been termed
"juvenile diabetes" because it represents a majority of cases of diabetes affecting children. The
most common cause of beta cell loss leading to type 1 diabetes is autoimmune destruction,
accompanied by antibodies directed against insulin and islet cell proteins. The principal
treatment of type 1 diabetes, even from the earliest stages, is replacement of insulin. Without
insulin, ketosis and diabetic ketoacidosis can develop and coma or death will result.
Currently, type 1 diabetes can be treated only with insulin, with careful monitoring of blood
glucose levels using blood testing monitors. Emphasis is also placed on lifestyle adjustments
(diet and exercise). Apart from the common subcutaneous injections, it is also possible to deliver
insulin via a pump, which allows infusion of insulin 24 hours a day at preset levels, and the
ability to program a push dose (a bolus) of insulin as needed at meal times. This is at the expense
of an indwelling subcutaneous catheter. It is also possible to deliver insulin via an inhaled
powder.
Type 1 treatment must be continued indefinitely at present. Treatment does not impair normal
activities, if sufficient awareness, appropriate care, and discipline in testing and medication. The
average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6
mmol/l) as possible.
TYPE 2 DIABETES MELLITUS
34
Type 2 diabetes mellitus is previously known as adult-onset diabetes, maturity-onset diabetes, or
non-insulin dependent diabetes mellitus (NIDDM) - is due to a combination of defective insulin
secretion and defective responsiveness to insulin (often termed insulin resistance or reduced
insulin sensitivity), almost certainly involving the insulin receptor in cell membranes. In early
stages, the predominant abnormality is reduced insulin sensitivity, characterized by elevated
levels of insulin in the blood. In the early stages, hyperglycemia can be reversed by a variety of
measures and medications that improve insulin sensitivity or reduce glucose production by the
liver, but as the disease progresses the impairment of insulin secretion worsens and therapeutic
replacement of insulin often becomes necessary. There are numerous theories as to the exact
cause and mechanism for this resistance, but central obesity (fat concentrated around the waist in
relation to abdominal organs, not it seems, subcutaneous fat) is known to predispose for insulin
resistance, possibly due to its secretion of adipokines (a group of hormones) that impair glucose
tolerance. Abdominal fat is especially active hormonally. Obesity is found in approximately 90%
of Developed world patients diagnosed with type 2 diabetes. Other factors may include aging
and family history, although in the last decade it has increasingly begun to affect children and
adolescents.
Type 2 diabetes may go unnoticed for years in a patient before diagnosis, since the symptoms are
typically milder (e.g. lack of ketoacidotic episodes) and can be sporadic. However, severe
complications can result from unnoticed type 2 diabetes, including renal failure, vascular disease
(including coronary artery disease), vision damage, etc.
Type 2 diabetes is usually first treated by changes in physical activity (usually increase), diet
(generally decrease carbohydrate intake, especially glucose generating carbohydrates), and
through weight loss. These can restore insulin sensitivity, even when the weight loss is modest,
for example, around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. The
next step, if necessary, is treatment with oral antidiabetic drugs. As insulin production is initially
unimpaired, oral medication (often used in combination) can still be used that improves insulin
production (eg, sulfonylureas) and regulate inappropriate release of glucose by the liver (and
attenuate insulin resistance to some extent (eg, metformin), and substantially attenuate insulin
resistance (eg, thiazolidinediones). If these fail, insulin therapy will be necessary to maintain
normal or near normal glucose levels. A disciplined regimen of blood glucose checks is
recommended in most cases, most particularly and necessarily when taking most of these
medications.
SIGNS AND SYMPTOMS OF DIABETES MELLITUS
Type 2 diabetes almost always has a slow onset (often years), but in Type 1, particularly in
children, onset may be quite fast (weeks or months). Early symptoms of Type 1 diabetes are
35
often polyuria (frequent urination) and polydipsia (increased thirst and consequent increased
fluid intake). There may also be weight loss (despite normal or increased eating), increased
appetite, and unreduceable fatigue. These symptoms may also manifest in Type 2 diabetes,
though this seldom happens for some years, and sometimes not at all. Clincally, it is most
common in Type 2 patients who appear at the doctor with frank poorly controlled diabetes.
Another common presenting symptom is altered vision. Prolonged high blood glucose causes
changes in the shape of the lens in the eye, leading to blurred vision and, perhaps. All
unexplained quick changes in eyesight should force a fasting blood glucose test.
Especially dangerous symptoms in diabetics include the smell of acetone on the patient's breath
(a sign of ketoacidosis), Kussmaul breathing (a rapid, deep breathing), and any altered state of
consciousness or arousal (hostility and mania are both possible, as is confusion and lethargy).
The most dangerous form of altered consciousness is the so-called "diabetic coma" which
produces unconsciousness. Early symptoms of impending diabetic coma include polyuria,
nausea, vomiting and abdominal pain, with lethargy and somnolence a later development,
progressing to unconsciousness and death if untreated.
Signs and symptoms of diabetes mellitus are due to the high amounts of sugar in the body. The
signs and symptoms of Type 1 diabetes develop quicker and become more severe than those of
Type 2 diabetes. However, the symptoms of Type 2 diabetes may not be noticed until a regular
medical checkup. The more severe the diabetes is, the more sugar is in the blood and the longer
high blood sugar levels last. The high amount of sugar in the blood means that more urine is
needed to carry it out of the body. As a result, people with diabetes usually experience a strong
urge to pee, high amounts of urination (peeing), and constant thirst. The strong urge to pee can
occur at night and lead to low amounts of sleep. A high amount of peeing also leads to high
amounts of water and electrolyte loss. Electrolytes are chemical substances that are able to
conduct electricity after they are melted or dissolved in water.
For people with diabetes mellitus, the urine smells sweet because the extra sugar comes out in
the urine flow. Weakness and tiredness occur because the cells in the body are not able to store
or use the sugar that they need for energy. Thus, the body is being starved of one its main energy
sources. The body still gets some energy, however, from breaking down stored fat. The breaking
down of stored fat, in turn, leads to weight loss.
Although people with diabetes mellitus can break down stored fat for energy, the body has a
difficult time doing so. People with diabetes mellitus also have a difficult time breaking down
proteins. The difficulty in breaking down fats, especially when the body does not produce
insulin, can lead to the production of acids and poisonous chemical substances called ketones.
This condition is known as ketoacidosis. Ketoacidosis is a medical emergency because it can
cause coma, severe loss of body fluids, and even death. A coma is a state of deep
unconsciousness in which there are no voluntary movements, no responses to pain, and no verbal
36
speech. The signs and symptoms of ketoacidosis are nausea, vomiting, abdominal pain,
confusion, deep breathing, and foul-smelling breath. The foul-smelling breath smells like nail
polish remover.
Emergency treatment for ketoacidosis includes giving the person fluids to correct for fluid loss
and to bring back a normal chemical balance in the blood. Insulin injections are alsogiven to
allow cells to better absorb glucose from the blood. Ketoacidosis can occur in people with Type
1 and Type 2 diabetes. The difficulty with breaking down fats is especially true for people with
Type 1 diabetes (see two sections down for a description) if they miss several doses of insulin or
develop another disease. The reason for this is that developing another disease increases the
body's use of insulin. Other symptoms of diabetes mellitus are blurry vision, increased hunger,
boils, as well as tingling and loss of sensation in the feet and hands. Boils are inflamed, pus-filled
areas of the skin. Pus is a yellow or green creamy substance sometimes found at the site of
infections.
RISK FACTORS OF TYPE II DM
OBESITY
Obesity is a medical condition in which excess body part has occumulated to the extent that it
may have an adverse effect on health, leading to reduce life expectancy. Body mass index, which
compares weight and height, is used to define a person as overweight when their BMI is between
25 kg/m2 and 30kg/m2 and obese when it is greater than 30 kg/m2 .The primary treatment for
obesity is dieting and physical exercise. If this fails, antiobesity drugs may be taken to reduce
appetite or inhibit fat absorption.
IMPAIRED GLUCOSE TOLERANCE
Several factors have contributed to induce the impairment of glucose tolerance in the elderly.
Especially, changes of body composition with aging, the loss of skeletal muscle mass and
relatively increased fat tissues, could occur the insulin resistance state. Such state would be well
known to accompany with diabetes mellitus and hypertension. Therefore, the treatment of
hypertension with diabetes in the elderly would be very important to prevent not only
microangiopathy but also macroangiopathy. The optimal blood pressure levels to reduce
hypertension – related morbidity and mortality in diabetic elderly have been proposed 130/85.
The first step therapy in this case would be recommended calcium channel blocker, angiotensin
converting enzyme inhibitor, and angiotensin receptor blocker. In addition, comprehensive
geriatric assessment must be important to maintain drug compliance for well controlled blood
pressure levels.
GENETICS/HEREDITARY
37
In a study of 200 adults with type 2 diabetes, about 2/3 reported atleast one close relative with
diabetes and nearly 50 % had atleast two relatives with the disease. In particular, people whos
mother had diabetes where twice as likely to get the disease as those whos father had diabetes.
RACE
Diabetes occurs more often in Hispanic/Latino Americans, African-Americans, Native

Americans, Asian Americans, Pacific Islanders, and Alaska Natives.
HYPERTENSION
Hypertension, or high blood pressure, is a major risk factor of diabetes. High blood pressure is
generally defined as 140/90 mmHg or higher. Low levels of HDL ( good cholesterol) and high
triglyceride levels also put you at risk.
SEDENTARY LIFESTYLE
Being inactive – exercising fewer than 3 times a week makes you more likely to develop
diabetes.
AGE
Some doctors advise anyone over 45 to be screened for diabetes. That’s because increasing age
puts you at higher risk of developing type 2 dibetes. It’s important to remember, though, that
people at any age can develop diabetes.
PREVENTION
Maintain body weight and prevent obesity through proper nutrition and physical
activity/exercise.
Encourage proper nutrition – eat more dietary fiber, reduce salt and fat intake, avoid simple
sugars like cakes and pastries; avoid junk foods.
Promote regular physical activity and exercise to prevent obesity,hypercholesterolimia, and

enhance insulin action in the body.
Advise smoking cessation for active smokers and prevent exposure to second hand smoke.
Smoking among diabetes increases risk for heart attack and stroke.
HYPOGLYCEMIA
38
Hypoglycemia, sometimes called an insulin reaction, can happen even during those times where
you’re doing all you can to manage your diabetes.
CLINICAL MANIFESTATIOS
 Shakiness
 Dizziness
 Sweating
 Hunger
 Pale skin color
 Clumsy or jerky movements
 Confusion
NEUROPATHY
Neuropathy affects all peripheral nerves: pain fibers, motor neurons, autonomic nerves. It
therefore necessarily can affect all organs and systems since all are innervated.
CLINICAL MANIFESTATIONS
 Numbness and tingling of extremities

 Decreased or loss of sensation to a body part
 Muscle weakness
 Difficulty swallowing
 Speech impairment
 Vision changes
 Urinary incontinence
MACROVASCULAR DISEASES
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels
supplying the brain. Hypertension is the most important cause; it damages the blood vessel
lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a
repairing process which is not always complete and perfect. Sustained hypertension permanently
changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and
more vulnerable to fluctuations in blood pressure.
A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the
narrowed blood vessels causing ischemic stroke in the morning. Conversely, a sudden rise in
blood pressure due to excitation during the daytime can cause tearing of the blood vessels
39
resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are
elderly or have a history of diabetes, smoking, or ischemic heart disease.
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart
attack, is the interruption of blood supply to part of the heart, causing some heart cells to die.
This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of
a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and
white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia
(restriction in blood supply) and ((oxygen shortage, if left untreated for a sufficient period of
time, can cause damage or death (infarction) of heart muscle tissue (myocardium).
PERIPHERAL VASCULAR DISEASE
In peripheral vascular disease, a diabetic client can develop arterial occlusion and thrombosis
that can lead to gangrene but this can be developed years after you have been diagnosed of
diabetes mellitus and not properly treating it. Both the types of diabetes mellitus have a risk to
develop this type of disease.
CLINICAL MANIFESTATIONS
 Tingling sensation of affected area

 Numbness / loss of sensation
 Pale skin color
DIAGNOSTIC EXAMS:
Random blood glucose test (RBS)

For a Random blood glucose test, blood can be drawn at any time throughout the day, regardless
of when the person last ate. A random blood glucose level of 200mg/dl (11.1mmol/L) or higher
in persons who have symptoms of high blood glucose suggest a diagnosis of diabetes.
Fasting blood glucose test (FBS)

Fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8
to 12 hours (usually overnight). A normal fasting blood glucose level is <100 mg/dL. A fasting
blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test is done by taking
a small sample of blood from a vein or fingertip. It must be repeated on another day to confirm
that it remains abnormally high.
Hemoglobin A1C test (HbA1c)
40
The A1C blood test measures the average blood glucose level during the past 2 to 3 months. It is
used to monitor blood glucose control in people with known diabetes, but is not normally used to
diagnose diabetes. Normal values for A1C are 4 to 6 percent. The test is done by taking a small
sample of blood from a vein or fingertip.
Oral glucose tolerance test (OGTT)
Oral glucose tolerance testing is the most sensitive test for diagnosing diabetes and pre-diabetes.
However, the OGTT is not routinely recommended because it is inconvenient compared to a
fasting blood glucose test.
The standard OGTT includes a fasting blood glucose test. The person then drinks a 75 gram
liquid glucose solution (which taste very sweet, & is usually cola or orange flavored). Two hours
later, a second blood glucose level is measured.
MANAGEMENT OF DIABETES
TYPE I Diabetes Mellitus – Insulin
TYPE II Diabetes Mellitus – Diet, Exercise, OHA (Oral Hypoglycemic Agent)
Gestational Diabetes Mellitus – Insulin, Diet, Exercise
DIET
DIABETIC DIET:
Maintain blood glucose as near as normal as possible, delay or prevent onset of diabetic
complications.
FOODS ALLOWED
Choose foods with low glucose index compose of:
45-55% carbohydrates
30-35% fats
10-25% protein
41
EXERCISE
Helps burn fats which in excess may lead to obesity that can cause serious complications, Not
allowed during period of stress (illness or surgery).
INSULIN
Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen,
decreasing serum glucose levels. Primarily acts in the liver, muscle, adipose tissue by attaching
to receptors on cellular membranes and facilitating transport of glucose, potassium and
magnesium. Hormone secreted by the alpha cells of the islets of langerhans in the pancreas.
Increase blood glucose by stimulating glycogenolysis in the liver.
Given subcutaneously, intramuscularly or intravenously.
TYPES OF INSULIN ONSET PEAK DURATION
SHORT – ACTING
REGULAR 30 minutes to 1 3 hours 7 hours

hour
SEMI LENTE
HUMULIN R
INTERMEDIATE –ACTING
LENTE
HUMULIN N 3 hours 7 hours 21 hours
NPH (NEUTRAL PROTAMINE

HAGEDON)
LONG – ACTING
ULTRA LENTE
HUMULIN U 7 hours 21 hours 28 hours
PZI (PROTAMINE ZINC INSULIN)
42
CHARACTERISTICS:
CLEAR – REGULAR, HUMULIN R
CLOUDY – REST OF INSULINS
DO’S AND DON’T’S IN ADMINISTERING INSULIN
 Check the expiration date.

 Never aspirate.
 Never massage the injection site.
 Never inject a cold insulin.
 Rotate the injection site
ORAL HYPOGLYCEMIC AGENT If normal blood glucose levels are not achieved after 2-3
months of lifestyle modifications, treatment with an oral antihyperglycemic drug is often
prescribed. However, the patient should be clearly advised that the ability of any drug therapy to
improve the health of any diabetic patient is aided by appropriate changes in diet and activity
exercise.
43
Anatomy and Physiology
The endocrine system is made

up of glands that produce and
secrete hormones. These
hormones regulate the body's
growth, metabolism (the
physical and chemical
processes of the body), and
sexual development and
function. The hormones are
released into the bloodstream
and may affect one or several
organs throughout the body.
Hormones are chemical

messengers created by the
body. They transfer
information from one set of
cells to another to coordinate
the functions of different parts
of the body.
The major glands of
the endocrine system are the
hypothalamus, pituitary,
thyroid, parathyroids,
adrenals, pineal body, and the
reproductive organs (ovaries
and testes). The pancreas is
also a part of this system; it
has a role in hormone
production as well as in
digestion.
The endocrine system is regulated by feedback in much the same way that a thermostat regulates
the temperature in a room. For the hormones that are regulated by the pituitary gland, a signal is sent from
the hypothalamus to the pituitary gland in the form of a "releasing hormone," which stimulates the
pituitary to secrete a "stimulating hormone" into the circulation. The stimulating hormone then signals the
target gland to secrete its hormone. As the level of this hormone rises in the circulation, the hypothalamus
and the pituitary gland shut down secretion of the releasing hormone and the stimulating hormone, which
in turn slows the secretion by the target gland. This system results in stable blood concentrations of the
hormones that are regulated by the pituitary gland.
44
Hormone Pituitary Stimulating Hormone Hypothalamic Releasing Hormone
 Thyroid hormones T4,

T3 Thyroid-stimulating hormone Thyrotropin-releasing hormone (TRH)
(TSH)
 Cortisol Adrenocorticotropin hormone Corticotropin-releasing factor (CRF)

(ACTH)
 Estrogen or testosterone Follicle-stimulating hormone Luteinizing hormone-releasing hormone

(FSH), luteinizing hormone (LH) (LHRH) or gonadotropin-releasing
hormone (GnRH)
 Insulin like growth Growth hormone Growth hormone-releasing hormone

factor-I (IGF-I) (GHRH)
THE PANCREAS
The pancreas is a pinkish white
glandular organ found in vertebrates near
the stomach and small intestine. The
pancreas is the second largest gland that is
connected to the digestive tract, after the
liver.
The pancreas is one of the few
organs that have both an exocrine and an
endocrine function. Exocrine glands are
glands that secrete their products into
ducts (duct glands). Endocrine glands are
glands that secrete their product directly
into the blood rather than through a duct.
The pancreas' exocrine function involves
the secretion of bicarbonate and digestive
enzymes into the small intestine. Its endocrine function involves the regulation of blood sugar levels by
secreting the hormones insulin, glucagon, and somatostatin directly into the blood. The endocrine portion
of this organ consists of about 1 million islets of Langerhans, amounting to only 1-3 percent of the organ
weight. The majorities of cells are exocrine and secrete one to three liters of digestive fluid per day.
The pancreas is an important organ for digestion
and the control of circulating levels of glucose. This
organ is an excellent example of an intricate, well-
tuned organ that functions in harmony with other
parts of the body, providing a service to the body
while receiving the nutrients and removal of wastes
necessary for its survival. For example, in terms of its
function in the digestive system, it is one of several
parts of the body that work together, involving
cooperative giving and receiving, including the
stomach, intestines, liver, pancreas, heart, brain, and
45
so forth.
Anatomy
In human beings, the pancreas is a 6-10 inch elongated organ weighing 65 to 160 grams and lying
in the abdominal cavity. It lies posterior to the stomach, anterior to the kidneys, and empties into the
duodenum portion of the small intestine.
The human pancreas can be divided into five regions: (1) the head, which touches the duodenum,
(2) the body, which lies at the level of second lumbar vertebrae of the spine, (3) the tail, which extends
towards the spleen, (4) the uncinate process, and (5) the pancreatic notch, which is formed at the bend of
the head and body.
1: Head of pancreas
2: Uncinate process of pancreas
Blood Supply
3: Pancreatic notch
4: Body of pancreas
The pancreas is supplied arterially by the pancreaticoduodenal
5: Anterior surface of pancreas
arteries: 6: Inferior surface of pancreas
7: Superior margin of pancreas
 the superior mesenteric artery feeds the inferior 8: Anterior margin of pancreas
pancreaticoduodenal arteries 9: Inferior margin of pancreas
• the gastroduodenal artery feeds the superior pancreaticoduodenal 10: Omental tuber
artery 11: Tail of pancreas
12: Duodenum
Nerve Supply
The pancreas receives neural innervation from the vagus (cranial X). This is part of the autonomic
parasympathetic supply. The role of the vagus is to stimulate secretion of the pancreatic digestive
juices.
Autonomic sympathetic nerves to the pancreas derive from the celiac ganglionic plexus, the
superior mesenteric plexus, and the hepatic plexus. These plexuses lie outside the pancreas and
send postganglionic fibers into the pancreatic cells. These sympathetic nerves inhibit the
production of digestive enzymes (Berne et al. 1996).
The innervation of the pancreas is comprised of both an intrinsic component that consists of many
intrapancreatic ganglia and an extrinsic component made of neurons lying outside the digestive
tract and belonging to the sympathetic and parasympathetic systems
Many different neurotransmitters have been found within the pancreas including acetylcholine,
epinephrine, norepinephrine, serotonin, nitric oxide, and others (Salvioli et al. 2002).
|Microscopic Anatomy
When the pancreas is sliced, stained, and then viewed with a microscope, it is easy to distinguish
many different types of cells that correspond to different pancreatic functions. The microscopic
appearance of the pancreas shows a series of islands (the Islets of Langerhans) consisting of small cells
packed closely together, surrounded by much larger and less dense acinar cells. The islands have an
endocrine function and the surrounding cells have an exocrine function.
Appearance Region Function
 centralized islands endocrine pancreas secretes hormones that regulate

(islets of Langerhans) blood glucose levels
 surrounding acinar cells exocrine pancreas produces enzymes and
46
bicarbonate
Endocrine Function
There are four main types of cells in the islets of Langerhans. They all look similar when using
standard staining techniques, but when special stains are used they can be classified into four different
types:
Name of cells Product % of islet cells Representative function
beta cells Insulin and Amylin 50-80% lower blood sugar
alpha cells Glucagon 15-20% raise blood sugar
delta cells Somatostatin 3-10% inhibit endocrine pancreas
gamma cells Pancreatic polypeptide 1% inhibit exocrine pancreas
The islets are a compact collection of endocrine cells arranged in clusters and cords that are
crisscrossed by a dense network of capillaries. The capillaries are lined by layers of endocrine cells in
direct contact with them by either cytoplasmic processes or by direct apposition. The cells release their
hormones, without ducts, directly into the capillaries.
HORMONES PRODUCED BY THE PANCREAS
Insulin- is a polypeptide containing two chains of amino acids joined together by two disulfide
bridges, and contains a total of 51 amino acids.
 helps to transport glucose into skeletal muscle and liver.
 is produced when blood sugar exceeds 50 mg/deciliter.
 has an average production of 1.0 to 2.5 mg/day.
 stimulates skeletal muscle and liver to convert glucose to a storage form called glycogen.
 stimulates fat cells to synthesize fat.
 acts on the hypothalamus to reduce appetite.
Amylin- is another polypeptide secreted by the beta cells. It is slightly smaller than insulin with
37 amino acids. It works to supplement the actions of insulin.
 inhibits the secretion of glucagon.
 lowers the level of glucose in the blood.
 slows the emptying of the stomach into the intestine.
 sends a signal of satiety to the brain.
Glucagon- is a polypeptide containing 29 amino acids.

 is released into the blood in response to a blood glucose level falling below 80 mg/deciliter
 acts primarily on the liver to stimulate glucose production by breaking down glycogen and
converting protein and fat into glucose
 secretion is inhibited by amylin (Bowen 2002).
47
Somatostatin
Purpose: Regulate the production and excretion of other endocrine tumors
Action: Slows down production of insulin, glucagon, gastrin, and other endocrine tumors
Secreted in response to: High levels of other endocrine hormones
Secretion inhibited by: Low levels of other endocrine hormones
Disease due to deficient action: Poorly defined
Disease due to excess action: Diabetes, gallstones, and dietary fat intolerance
Tumor called: Somatostatinoma
The endocrine function of the pancreas is to produce important hormones including insulin,
glucagon, and somatostatin and export them to the blood supply on demand.
Pancreatic polypeptide is secreted by the gamma cells and consists of 36 amino acids. It is
produced in response to chewing and swallowing food. It probably acts to reduce appetite (Taylor et al.
1982).
| Insulin
Insulin is a hormone that has profound effects on metabolism. Insulin causes cells in the liver, muscle,
and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle, and
stopping use of fat as an energy source. When insulin is absent (or low), glucose is not taken up by body
cells, and the body begins to use fat as an energy source, for example, by transfer of lipids from adipose
tissue to the liver for mobilization as an energy source. As its level is a central metabolic control
mechanism, its status is also used as a control signal to other body systems (such as amino acid uptake by
body cells). In addition, it has several other anabolic effects throughout the body.
When control of insulin levels fails, diabetes mellitus will result. Consequently insulin is used
medically to treat some forms of diabetes mellitus. Patients with Type 1 diabetes mellitus depend on
external insulin (most commonly injected subcutaneously) for their survival because the hormone is no
longer produced internally. Patients with Type 2 diabetes mellitus are insulin resistant, and because of
such resistance, may suffer from a relative insulin deficiency. Some patients with Type 2 diabetes may
eventually require insulin if other medications fail to control blood glucose levels adequately, though this
is somewhat uncommon.
Insulin also influences other body functions, such as vascular compliance and cognition. Once insulin
enters the human brain, it enhances learning and memory and in particular benefits verbal memory.
Insulin is a peptide hormone composed of 51 amino acids and has a molecular weight of 5808 Da. It
is produced in the islets of Langerhans in the pancreas. The name comes from the Latin insula for
"island". Insulin's structure varies slightly between species of animal. Insulin from animal sources differs
somewhat in 'strength' (in carbohydrate metabolism control effects) in humans because of those
variations. Porcine (pig) insulin is especially close to the human version.
48
Precipitating Factors: Predisposing Factors:
 Obesity  Male
 Unhealthy eating  Age 45
 Physical
inactivity
Insulin resistance
Production of excess
glucagon Dysfunction of the beta
cells in the pancreas
Production of glucose
from protein and fat Impaired insulin
stores secretion
Wasting of lean body

mass
Decreased sensitivity of
the cells to insulin
Body Weight Loss Glucose is unable to

weakness enter the cells
Glucose remains in the

blood steam
Hyperglycemia
Increase viscosity of blood Microvascular

vasoconstriction
Thickening of blood vessel

walls Capillary basement
membrane thickening
Occlusion of plaque
Thickening of the walls of
Blood flow blocked the nutrient vessels
supplying the nerve cells
Decreased circulatory 49 Vessel ischemia

blood volume
Segmental demyenalization
of the nerve
Delayed wound Increased blood
healing pressure Slowing of the conductive
system
Disruption of Hypertension Nerve dysfunction

skin
Numbness
Impaired sensation on
lower extremities
50
LABORATORY AND DIAGNOSTIC
PROCEDURES
QUIRINO MEMORIAL MEDICAL CENTER
HEMATOLOGY
Received Lab Checked-in Released Printed
26-June-2019 12:23 AM 26-June-2019 12:42 AM 26-June-2019 1:16 AM 26-June-2019 2:36
TEST NAME RESULT UNIT REFERENCE RANGE INTERPRETATION
Low RBC count

may indicate
anemia, bleeding,
RBC COUNT 3.20 X10^12/L 4.7-6.1 kidney disease,
bone marrow
failure,
malnutrition or
other causes.
Low hemoglobin
level may indicate
to anemia may be
HEMOGLOBIN 114 G/L 120-160 due to nutritional
deficiencies,
blood loss, Bone
marrow failure
Low hematocrit
level may indicate
to anemia may be
due to nutritional
HEMATOCRIT 0.32 VOL % 0.40-0.54 deficiencies,
blood loss,
destruction of
blood cells
internally.
MCV 82.0 FL 80.0-96.0 NORMAL
MCH 27.10 PG 27.0-31.0 NORMAL
MCHC 33.00 % 32.0-36.0 NORMAL
51
RDW 14 11.-14.6 NORMAL
High platelet
PLATELET 478 X10^9/L 150-450 count may be
COUNT reffered to as
thrombocytosis
High white blood

cell count may
indicate that the
WBC 21.6 X10^9/L 5.0-10.0 immune system is
working to
destroy an
infection
DIFFERENTIAL
COUNT
High neutrophils
is a sign that your
NEUTROPHIL 0.90 0.50-0.70 body has an
infection
High lymphocyte
blood levels
LYMPHOCYTES 0.07 0.2-0.5 indicate your
body is dealing
with an infection
EOSINOPHIL 0.01 0.0-0.6 NORMAL
MONOCYTES 0.05 0.02-0.09 NORMAL
BASOPHIL 0.00 0.0-0.2 NORMAL
Nursing responsibilities:
Prior to examination:
 Check the doctors order

 Explain the procedure to the client
 Assess for the presence of hematophobhia
 Check the medications of the patient that may affect the result.
During: Provide comfort to lessen patient’s anxiety while waiting for the result
After:
 Secure laboratory result to the chart of the patient.

 (Refer result to the physician)
52
Arterial Blood Gas
Parameters pH PCO2: PO2 HCO3 O2 Sat:
Actual
range: 7.472 28.7mmHg 138 mmHg 25 m/L 99%
Normal
range: 7.35-7.45 36-45 mmHg 80-120 22-26 m/L 95-100%
mmHg
Interpretation:
Respiratory alkalosis: high pH, Low PaCO2. Normal or high normal bicarbonate.
Causes: any cause of hyperventilation (e,g. anxiety, pain)
53
CLINICAL CHEMISTRY
High results of
GLUCOSE, 12.27 Mmol/L 2.5-7.2 Random blood
RBS sugar test suggests
Diabetes.
SODIUM 137.57 Mmol/L 136-145 Normal

POTASSIUM 3.28 Mmol/L 3.5-5.1 Normal
BLOOD UREA
NITROGEN 8.64 Mmol/L 3.0-9.2 Normal
CREATININE 98.04 Umol/L 64-104 Normal
CKMB 23.82 U/L 7.0-25.0 Normal
CLINICAL CHEMISTRY
High result of
Hemoglobin 7.65 % 5.7-6.4
Hemoglobin
A1C A1C may
indicate Diabetes
Pre-Test: Don’t need to do anyting to prepare for this test. There are no fasting requirements for
this test.
Intra-Test: An A1C test is done via regular blood draw or with a small drop of blood that’s
obtained from pricking your finger with a lancet.
Post-Test: As long as there’s no sign of nauseous or faint, they will be free to leave as soon as
they blood sample has taken.
54
INTAKE AND OUTPUT SHEET
INTAKE OUTPUT
Shift Oral Parenteral Total Urine Drainage Vomitus Total
6-2 400 700 1100 1100 1000
2-10 500 600 1000 900 900
10-6 500 500 1000 900 900
Date: _06-23-19_ 3100 2,800
INTAKE OUTPUT
6-2 300 800 1100 300 700
2-10 400 500 900 300 700
10-6 300 200 500 300 200
Date: _06-24-19_ 2500 2200
INTAKE OUTPUT
6-2 400 400 800 700 700
2-10 NPO 1000 1000 1000 1000
10-6 500 500 1000 600 700
Date: _06-25-19_ 2800 2400
INTAKE OUTPUT
6-2 500 800 1300 800 800
2-10
10-6 500 900 1400 600 600
Date: _06-26-19_ 2600 2200
INTAKE OUTPUT
6-2 700 600 1300 800 800
2-10 400 900 1300 700 700
10-6 400 600 1000 1000 1000
Date:_06-27-19_ 2800 2500
55
INTAKE OUTPUT
6-2 800 500 1200 1000 1000
2-10 500 1000 1000 1000 1000
10-6 300 500 800 900 900
Date: _06-28-19_ 3000 2800
INTAKE OUTPUT
6-2 400 600 1000 700 700
2-10 400 400 800 700 700
10-6 300 400 700 600 600
Date: _06-29-19_ 2500 2100
INTAKE OUTPUT
6-2 400 500 900 600 600
2-10 300 700 900 900 900
10-6 400 600 1000 1000 1000
Date: _06-30-19_ 2800 2500
INTAKE OUTPUT
6-2 1000 800 900 700 700
2-10 400 800 800 600 600
10-6 350 500 800 600 900
Date: _06-01-19_ 2500 2200
INTAKE OUTPUT
6-2 500 700 1200 1000 1000
2-10 200 600 800 700 700
10-6 500 700 1000 1000 1000
Date: _06-02-19_ 3000 2700
56
INTAKE OUTPUT
6-2 500 800 1300 700 700
2-10 400 500 900 800 800
10-6 300 700 1000 900 900
Date: _06-03-19_ 2700 2400
INTAKE OUTPUT
6-2 600 500 1100 1000 1000
2-10 300 1000 1300 1000 1000
10-6 300 500 800 900 900
Date: _06-04-19_ 3200 2900
INTAKE OUTPUT
6-2 500 400 900 700 700
2-10 500 500 1000 700 800
10-6 400 500 900 900 900
Date: _06-05-19_ 2800 2400
INTAKE OUTPUT
6-2 800 500 1200 1000 1000
2-10 500 1000 1000 1000 1000
10-6 300 500 800 900 900
Date: _06-06-19_ 3000 2800
INTAKE OUTPUT
6-2 300 400 700 700 700
2-10 NPO 1000 1000 1000 1000
10-6 500 300 800 600 600
Date: _06-07-19_ 2500 2300
57
INTAKE OUTPUT
6-2 600 500 1100 1000 1000
2-10 300 1000 1300 1000 1000
10-6 300 500 800 900 900
Date: _06-08-19_ 3200 2900
INTAKE OUTPUT
6-2 500 700 1200 1000 1000
2-10 200 600 800 700 700
10-6 500 700 1000 1000 1000
Date: _06-09-19_ 3000 2700
INTAKE OUTPUT
6-2 400 600 1000 700 700
2-10 400 400 800 700 700
10-6 300 400 700 600 600
Date: _06-10-19_ 2500 2100
INTAKE OUTPUT
6-2 500 800 1300 700 700
2-10 400 500 900 800 800
10-6 300 700 1000 900 900
Date: _06-11-19_ 2700 2400
INTAKE OUTPUT
6-2 1000 800 900 700 700
2-10 400 800 800 600 600
10-6 350 500 800 600 900
Date: _06-12-19_ 2500 2200
58
Problem list:
 Impaired skin integrity

 Imbalance Nutrition: Less than body requirements
 Hyperthermia
 Hypertension
 Anxiety
59
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
INDEPENDENT: 1. Establishes After 8 hours of
SUBJECTIVE Impaired skin After 8 hours of cooperative baseline nursing interventions
DATA: integrity related to nursing 1. Assessed skin, providing the patient was able
“Ang tagal gumaling altered circulation as interventions the Noted color, turgor and
ng sugat ko sa paa” patient will be able opportunityFor timely to Participate in
manifested by sensation. Described
As verbalized by the Disruption of skin to Participate in intervention. prevention measures
wounds and observed and treatment
patient. (+) swelling and prevention
measures and changes. 2. Maintaining clean, program and
tenderness
OBJECTIVE (+) Poor skin turgor treatment program dry skin provides a Demonstrate proper
2. Assisted proper barrier to infection.
DATA: (+) Dry skin and Demonstrate wound care to
proper wound care wound care with Patting skin dry
dakins solution minimize skin
-Disruption of skin to minimize skin instead of rubbing
(+) swelling and breakdown or breakdown or injury.
tenderness injury. 3. Provided and 3. Wound dressings
(+) Poor skin turgor applied wound protect the wound and
(+) Dry skin dressings carefully. surrounding tissues.
4. . Kept leg elevated 4. To promote proper
DEPENDENT: venous return
5. Administered
medication as 5. Antibiotic
prescribed: medications are
Clindamycin 300mg, widely used in the
TIV x 28 day Q6 treatment and prevent
ion of such infections.
7. For debridement as
indicated
60
61
62
63
Hypertension and After 8 hours of INDEPENDENT

SUBJECTIVE Decrease cardiac output nursing 1. Changes in BP may After 8 hours of
DATA: Related to increased intervention the 1. Monitored and indicates changes in nursing intervention the
peripheral vascular patient will be recorded blood
“Nahihilo po ako” pressure every 1 patient status requiring patient was able to
resistance as manifested able to verbalize
as verbalized by the hour prompt attention. stabilize her blood
by dizziness and restlessness
an absent of,
patient. BP= 140/90mmHg dizziness, pressure from 140/90 to
2. Assessed patient’s 2. To ensure patients 130/80 and dizziness,
restlessness and
dizziness and safety
and BP will restlessness were
OBJECTIVE blurred vision every
stabilized to 3. For the patient to be relieved.
DATA: 4 hours until absent.
120/80
comfortable during
-Dizziness 3. Promote adequate
therapy.
rest by decreasing
-Restlessnes stimuli. 4. Salt retains water
V/S taken: 4. Provide for thus increasing blood
restrictive diet: Low volume and blood
BP = 140/80 mmHg
salt and low fat diet. pressure
5. Suggest frequent 5.It may decreases
position changes. peripheral venous
DEPENDENT: pooling that may be
potentiated by
6. Administered vasodilators and
medication as
prolonged sitting or
prescribed:
Atorvastatin standing
40mg/dl
1 tab OD HS
64
SUBJECTIVE Hyperthermia Short Term: Independent: 1. Vital signs After 8 hours of

DATA: related to bacterial 1. Monitored and provide more nursing intervention
“Mainit ang infection as After 4 hours of recorded vital signs accurate indication Patient’s
pakiramdam ko” as manifested by nursing intervention of core temperature temperature is
verbalized by the Temperature: 38.2C the patient’s 2. Removed excess already in the range;
patient flushed skin temperature will clothing and covers 2. These decrease T= 37.3C
Warm to touch decrease to 36.5C warmth and Skin is cool,
3.Promoted a well- increase evaporative absence of flushing
OBJECTIVE Long Term: ventilated area to cooling skin.
DATA: patient
After 8 hours of 3. To promote clear
Temperature: 38.2C nursing intervention 4. Provided tepid flow of air in the
flushed skin the patient’s vital sponge bath. patient’s area. One
Warm to touch signs will return to way of promoting
normal range; with 5.Advised patient to heat loss
Weak in appearance
a temperature of increase oral fluid
36.5-37.5C. intake 4. TSB helps
lowering the body
6. Maintained bed temperature.
rest
5. Fluids help
7. Educated and prevent elevated
advised support temperature
system (relative) to associated with
do TSB when dehydration
patient feels hot.
Teaching the
Dependent: support system the
65
8. Administered right way to do the
antipyretic TSB will help in
medication as knowing what to do
prescribed: in case the patient’s
Paracetamol 300mg increase
TIV Q4 PRN temperature
increases
These drugs inhibit

the prostaglandin
that serve as
mediators of pain
and fever
66
SUBJECTIVE Impaired comfort After 8 hours of Independent: After 8 hours of

DATA: related to affected nursing intervention 1. Monitored 1. To detect nursing intervention
“Ang sakit ng paa body part as patient will show Vital sign any patient was able to
ko dahil sa sugat improvement in abnormal show improvement
manifested by facial
ko” as verbalized by comfort with his 2. Assisted changes in comfort with his
the patient grimace, restless at present condition as patient in a 2. To promote present condition as
times, rubbing manifested by comfortable relaxation manifested by
affected body part, absence of facial position absence of facial
OBJECTIVE Insufficient physical grimace and pain grimace and pain
DATA: activity and Pain scale will decrease 3. Kept leg 3. To promote scale will decrease
scale of 7/10 to 5/10. elevated proper to 5/10.
>Restless at times 4. Instructed venous
patient to do return
>Facial grimace
deep
>Rubbing affected breathing 4. To aid in
exercise comfort and
body part
5. Suggested relaxation
>Insufficient deiversional
activities
physical activity
like listening 5. To divert
> Pain scale of 8/10 to music. attention and
lessen pain
Dependent:
Administered pain
reliever by doctor’s
order:
Butorphanol 1mg/
IV q6h x 4 doses
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83

Update Checked by Maam V Sep 10

Uploaded by

Copyright:

Available Formats

Update Checked by Maam V Sep 10

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Update Checked by Maam V Sep 10

Uploaded by

Copyright:

Available Formats

A CASE PRESENTATION OF

DIABETES MELLITUS TYPE 2 UNCONTROLLED;

PREPARED BY: ASHRAL R. CABUGATAN

History of present illness

Course in the ward

Review of related literature

Anatomy and physiology

Laboratory and diagnostic procedures

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

Type 2 diabetes is determined primarily by lifestyle factors and genes. A number of

"Self-Care Nursing Theory"

OREM’S GENERAL THEORY OF NURSING

Major Concepts of the Self-Care Deficit Theory

Therapeutic Self-care Demand

 Universal self-care requisites

THEORY THEORIST DESCRIPTION APPLICATION OF THEORY

The central idea of the

NAME: Mr. A.S

MARITAL STATUS: N/A

RELIGION: Roman Catholic

ADMITTING DIAGNOSIS: DM TYPE 2 Uncontrolled; Non Healing Wound

DATE OF ADMISSION: June 23 2019

SOURCE OF INFORMATION: Patient

Weight: 84 kgs (186lbs)

“Ang sakit po ng paa ko dahil sa sugat ko” As verbalized by the patient.

3 years prior to admission (year 2016) According to the patient

 (+) Hypertension- paternal side

 (-) Diabetes- Mr A.S claimed that there’s no reported history of Diabetes

PERSONAL AND SOCIAL HISTORY

1. Health Perception/ health management pattern

2. Self-esteem, self-concept, self-perception pattern

9. Coping-stress tolerance pattern

10. Value-belief pattern

 “Ang sakit ng paa ko dahil sa sugat ko”

(June 2019) From Weight: 87 kg

HEAD AND NECK:

HEART AND BLOOD VESSELS:

 “Hindi pa ako nakakaranas ng paninikip ng dibdib.”

 “Wala pong problema sa paglunok ko”

 “Wala naman po akong problema sa pag ihi"

 “Ito lang sugat ko sa kanan paa matagal lang gumaling”

 "Hindi naman ako gaanong pinagpapawisan"

 "Medyo na dedepress ako kasi baka tuluyan na ako maputulan ng paa"

DAY and Day 1 Day 2

BODY PART TECHNIQUE ACTUAL FINDINGS ANALYSIS/

Lower extremities Right lower extremity:

 He had undergone To prevent infection and

Left lower extremity:

Day 1 (June 23 2019)

 Secure consent of admission and management

Laboratory and Diagnostics

 For CBC, Na, K, Cl, BUN and Creatinine, Albumin, (Extracted)

Day 2 (June 24 2019) 8:45am

Day 3 (June 25 2019) 8:00am

Nursing notes/ care

 Vital signs are monitored and recorded

Day 4 (June 26 2019) 9:00am

#1 DM foot right wound debridement