Case Study:

Diabetes Mellitus
Type2

Prepared by:
John Carlo E. Garcia, RN, REB
Emerson B. Chavez, RN
Glaiza R. De Guzman, RN

Submitted to:
Ms. Princess Tumambing, MSN, RN
Nurse Supervisor

Ms. Margret Nichelle Villavicencio, MAN, RN

Unit Manager

March 3, 2023
A.1 Introduction
Diabetes Mellitus (DM) is a chronic disease characterized by insufficient insulin production in
the pancreas or when the body cannot efficiently use the insulin it produces. This leads to an
increased concentration of glucose in the bloodstream (hyperglycemia). It is characterized by
disturbances in carbohydrate, protein, and fat metabolism. Sustained hyperglycemia has been
shown to affect almost all tissues in the body. It is associated with significant complications of
multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.

Classification of DM
1. Type 1 DM or Insulin Dependent Diabetes Mellitus- it is due to absolute insulin
deficiency (inability of B cells to secrete sufficient insulin) and cause is unknown but
may be genetically acquired. This condition requires administration of exogenous
insulin for survival. People with this condition are ketosis prone because they utilize
fats and proteins as a source of energy. It is common for people below 30 years of
age. Usually thin at diagnosis and the onset is sudden and dramatic.

2. Type 2 DM or Non-Insulin Dependent Diabetes Mellitus- is due to relative insulin

deficiency (inability to produce sufficient insulin). Oral antidiabetic agents are
administered to control the blood glucose levels. Predisposing factors include the 4Fs:
Fat, Female, Forty and Familial Tendency. People with this disease are non-ketosis
prone because they use carbohydrates as a source of energy. Usually fat or obese
upon diagnosis and the onset is slow and gradual.

3. Gestational DM- due to placental hormones which inhibits the action of insulin.
Glucose intolerance with its onset during pregnancy, usually in the second or third
trimester. Risk factors are obesity, 30 years old and above, family history and
previous large babies.

Risk Factors
1. Non-Modifiable
● Age
● Ethnicity
● Family History
● Genetic predisposition
2. Modifiable
● Physical activity
● Diet
● Excess alcohol intake
● Are 45 years or older
● Have a parent or brother or sister with type 2 diabetes
● Have a family history of diabetes are not physically active because of physical
limitation, sedentary lifestyle or a job that requires sitting for long period of time
● Have a history of gestational diabetes, a type of diabetes that develops pregnancy
or gave birth to a baby weighing or more
Clinical Manifestations
· Classical Symptoms of DM: Polyuria, Polydipsia and Polyphagia.
· Clinical Signs of DM: Hyperglycemia, Glycosuria and Ketonuria.
· Pruritus Vulvae
· Unexplained weight loss
· Weakness and fatigue
· Lowered resistance to infection
· Sudden vision changes
· Skin lesions and wounds that are slow to heal
· Tingling or numbness in hands and feet
· Dry skin

Diagnostic Evaluation:
· Random Blood Sugar
· Fasting Blood Sugar
· Oral Glucose Tolerance Test
· Glycosylated Hemoglobin Test (HBA1c)
· Post-prandial Glucose Test

Diabetic Management
· Nutritional Therapy/ Diet
· Exercise- improves insulin utilization in the body
· Monitoring- to detect episodes of hypoglycemia or hyperglycemia
· Pharmacologic Therapy- Insulin Injection and Oral Antidiabetic Agents

Common Types of Insulin

· Rapid acting insulin (Humalog)
· Short acting insulin (Humulin R)
· Intermediate acting insulin (Humulin N)
· Long acting insulin (Humulin U)
· Premixed insulin(70%NPH and 30% HR)

Complications of Insulin Therapy

· Lipodystrophy
· Hypoglycemia (cardinal signs: cold sweats, weakness and trembling)
· Somogyi/ Dawn Phenomenon (a paradoxical situation in which sudden falls in blood
glucose are followed by rebound hyperglycemia that is due to excessive insulin
dosages)

Complications of Diabetes Mellitus

1. Acute Complications:
· Diabetic Ketoacidosis (DKA)
· Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

2. Chronic Complications:
 a. Macrovascular Complications
o Atherosclerosis and arteriosclerosis
o Hypertension
o Coronary Artery Disease
o Arterial occlusive disease that can lead to diabetic gangrene
b. Microvascular Complications
o Diabetic Retinopathy
o Nephropathy
● Diabetic Neuropathies such as peripheral neuropathy and autonomic
neuropathy.
Prevalence
According to the World Health Organization (WHO) diabetes mellitus is a chronic, metabolic
disease characterized by elevated levels of blood glucose, which leads overtime to damage to the
heart, eyes, kidneys and nerves. Over 90 % of diabetes mellitus cases are Type 2 DM.

According to the latest International Diabetes Federation (IDF), the global prevalence of T2 DM
in adults was 536.6 million people (10.5%) in 2021, and with that there would be 783.2 million
people (12.2%) living with diabetes worldwide by 2045.
Total of 37.3 million people have diabetes (11.3%)of the US population diagnosed 28.7 million
people including 28.5 million adults.

Who is more susceptible in acquiring Type 2 DM?

Type 2 is more common in Older Adults but the increase in the number of children with
obesity has led to more cases of type 2 diabetes in younger people.
Countries that have highest prevalence rate of DM
China is the country with the highest number of diabetics Worldwide, with around 141
million people suffering from the disease. By the year 2045, it is predicted that China will have
around 174 million people with diabetes.

Epidemiology
According to the World Health Organization (WHO) diabetes mellitus is a chronic,
metabolic disease characterized by elevated levels of blood glucose, which leads overtime to
damage to the heart vasculature, eyes, kidneys and nerves.

Over 90 % of diabetes mellitus cases are Type 2 DM.

A condition marked by deficient insulin secretion by pancreatic islet B-cells, Tissue

insulin resistance [IR] and an inadequate compensatory insulin secretory response.

Progression of the disease makes insulin secretion unable to maintain glucose

homeostasis producing hyperglycemia.
Patients with type 2 DM are mostly characterized by being

● OBESE or having a higher body fat percentage

● Distributed predominantly in the abdominal region. Type 2 DM epidemic
are the global rise in obesity, sedentary lifestyle high chloric diet and
population aging

Endocrine Pancreas

Comprise the Islets of Langerhans: each of which is a cluster of 4 endocrine cell types, whose
products are ultimately secreted into the hepatic portal blood and delivered to the liver.

A key function of pancreatic endocrine cells is to maintain basal blood glucose concentration via
regulated storage and release: glucose is a major source of energy for the body.

In order to maintain homeostatic blood glucose concentrations, the islet cells engage in
communication via neural, hormonal, and cell-to-cell signaling.

Pancreatic endocrine cell types:

Alpha cells

Comprise approximately 20% of the islet cells

They secrete glucagon, which increases blood glucose concentrations between meals.

Beta cells

Comprise approximately 65% of the islet cells

They secrete insulin, which lowers blood glucose concentrations after a meal.

Delta cells

Comprise approximately 10% of the islet cells

Secrete somatostatin, which inhibits insulin and glucagon secretion to moderate their effects on
blood glucose concentrations.
F cells Are rare

They secrete pancreatic polypeptides; whose specific functions are uncertain.

Beta cell insulin secretion.

Beta cells release insulin in response to multiple stimuli, but glucose is the primary stimulus.

Step 1:

Glucose diffuses into the beta cell via GLUT – 2 receptors;

Step 2:

Within the cell, glucose is phosphorylated by the enzyme glucokinase.

Step 3:

Oxidation of phosphorylated glucose produces ATP.

Step 4:

ATP closes potassium channels, trapping potassium inside the cell.

This depolarizes the cell membrane.

Step 5:

In response to depolarization, calcium channels open, and the intracellular calcium concentration
increases.

Step 6:
This triggers exocytosis of insulin-containing vesicles.

Bear in mind that the beta cell response to fatty acids and proteins is similar, though not
identical.

As discussed in detail elsewhere, insulin is released into the nearby capillaries, drains into the
hepatic portal system, and, eventually, enters systemic circulation to reach its target tissues.

Clinical Correlations:

Insulin-dependent, aka, Type I diabetes

Destruction of beta cells (often by autoimmune disorders) causes insufficient circulating levels
insulin; thus, carbohydrate, protein, and fat metabolism is inhibited.

Because Type I diabetes is due to insulin insufficiency, insulin replacement therapy is the
primary treatment to normalize blood nutrient concentrations.

Insulin-resistant, aka, Type II diabetes

Down-regulation of insulin receptors on target tissues, specifically in the liver, skeletal, and
adipose tissues, inhibits metabolism of carbohydrates, protein, and fat.

Despite normal, or even elevated, levels of insulin, the target tissues cannot respond as usual;
thus, treatment includes insulin receptor sensitizers (in addition to insulin therapy).

Reference: Draw It to Know It, Creations, LLC

What is the endocrine system?

Your endocrine system is made up of several organs called glands. These glands, located all over
your body, create and secrete (release) hormones.

Hormones are chemicals that coordinate different functions in your body by carrying messages
through your blood to your organs, skin, muscles and other tissues. These signals tell your body
what to do and when to do it.

The role of the Endocrine System

What does the endocrine system do and how does it work?

Your endocrine system continuously monitors the amount of hormones in your blood. Hormones
deliver their messages by locking into the cells they target so they can relay the message.

The pituitary gland senses when your hormone levels rise, and tells other glands to stop
producing and releasing hormones. When hormone levels dip below a certain point, the pituitary
gland can instruct other glands to produce and release more. This process, called homeostasis,
works similarly to the thermostat in your house. Hormones affect nearly every process in your
body, including:

-Metabolism (the way you break down food and get energy from nutrients).

-Growth and development.

-Emotions and mood.

-Fertility and sexual function.

-Sleep.

-Blood pressure.

Sometimes glands produce too much or not enough of a hormone. This imbalance can cause
health problems, such as weight gain, high blood pressure and changes in sleep, mood and
behavior. Many things can affect how your body creates and releases hormones. Illness, stress
and certain medications can cause a hormone imbalance.

Reference: Cleveland Clinic. 9500 Euclid Avenue, Cleveland, Ohio 44195 |

Metabolism of endocrine system:

The thyroid's main role in the endocrine system is to regulate your metabolism, which is your
body's ability to break down food and convert it to energy. Food essentially fuels the body, and
each of our bodies uses that fuel at different rates.

Reference: Robert M. Sargis, MD, PhD

Anatomy of endocrine system

What are the parts of the endocrine system?

The endocrine system is made up of organs called glands. Glands produce and release different
hormones that target specific things in the body. You have glands all over your body, including
in your neck, brain and reproductive organs. Some glands are tiny, about the size of a grain of
rice or a pea. The largest gland is the pancreas, which is about 6 inches long.

The main glands that produce hormones include:

Hypothalamus: This gland is located in your brain and controls your endocrine system. It uses
information from your nervous system to determine when to tell other glands, including the
pituitary gland, to produce hormones. The hypothalamus controls many processes in your body,
including your mood, hunger and thirst, sleep patterns and sexual function.

Pituitary: This little gland is only about the size of a pea, but it has a big job. It makes hormones
that control several other glands such as the thyroid gland, adrenal glands, ovaries and testicles.
The pituitary gland is in charge of many different functions, including how your body grows. It’s
located at the base of your brain.

Thyroid: Your thyroid is a butterfly-shaped gland in the front of your neck. It’s responsible for
your metabolism (how your body uses energy).

Parathyroid: These four tiny glands are no larger than a grain of rice. They control the level of
calcium in your body. For your heart, kidneys, bones and nervous system to work, you need the
right amount of calcium.
Adrenal: You have two adrenal glands, one on top of each kidney. They control your
metabolism, blood pressure, sexual development and response to stress.

Pineal: This gland manages your sleep cycle by releasing melatonin, a hormone that causes you
to feel sleepy.

Pancreas: Your pancreas is part of your endocrine system, and it plays a significant role in your
digestive system too. It makes a hormone called insulin that controls the level of sugar in your
blood.

Ovaries: In women, the ovaries release sex hormones called estrogen, progesterone and
testosterone. Women have two ovaries in their lower abdomen, one on either side.

Testes: In men, the testes (testicles) make sperm and release the hormone testosterone. This
hormone affects sperm production, muscle strength and sex drive.

Reference: Cleveland Clinic. 9500 Euclid Avenue, Cleveland, Ohio 44195 |

Pathogenesis of DM type 2
A.3 Concept Map (Pathophysiology/ Pathogenesis)

CONCEPT MAPPING (I)

RISK FACTORS NON MODIFIABLE

 1. AGE –
ARE 45 YEARS
OR OLDER People over age 45 still have a high risk of developing Type 2
diabetes than younger people, but it’s becoming more common to
receive a diagnosis at a younger age.

Reference: kristeen cherney July 6,2022

2. MALE Diabetes, especially type 2, is more common in males rather than

females. However, females often have more serious complication
and a greater risk of death

Ref. Hannah Simmons, m.sc

3.FAMILY
HISTORY
NONE

CONCEPT MAPPING (II)

RISK FACTORS MODIFIABLE

1.PHYSICAL >is a life style type in which one is physically inactive and does little or
INACTIVITY no physical movement and exercise a person living a sedentary life
style is often sitting or lying down while engaged in an activity like
socializing, watching tv, playing video games, reading or using mobile
phone or computer.Reference: SASSOS(17 March 2020)

2.ALCOHOL To reduce the risk of alcohol-related harms, the 2020-2025 Dietary

INTAKE Guidelines for Americans recommends that adults of legal drinking age
can choose not to drink, or to drink in moderation by limiting intake to
2 drinks or less in a day for men or 1 drink or less in a day for women,
on days when alcohol is consumed.

moderate drinking

Centers for Disease Control and Prevention (.gov)

https://www.cdc.gov › alcohol › fact-sheets › moderate-d.

3.DIETARY A diet that includes carbohydrates from fruits, vegetables, whole

grains, legumes, and low-fat milk is encouraged. People with diabetes
INTAKE are advised to avoid sugar-sweetened beverages (including fruit juice).
The ideal amount of carbohydrate intake is uncertain.
A.4 Patient’s Profile

Name of the Patient: Patient NA

Age: 54 y/o
Sex: Male
Date of Birth: November 14, 1968
Place of Birth: Quezon City
 Address: Road 6 Manggahan Site North
Daang Hari, Taguig City
Religion: Roman Catholic
Nationality: Filipino
Civil Status: Single
Occupation: None
Educational Attainment: Elementary Graduate
Attending Physician: Dr. Janica Francisco
Admitting Impression: Type 2 DM Newly Diagnosed

Admission Data

Name of the Hospital: Taguig Pateros District Hospital

Case Number: 542xxx
Ward Service: Covid Ward
Date of Admission: January 25, 2023
Time of Admission: 11:55 pm
Mode of Admission: Wheelchair; Direct Admission

A.5 Nursing Health History

Chief Complaint

The patient sought consultation with the ER with a cough of 3 weeks duration as his main
concern.

Present Illness

3 weeks prior to consultation, the patient experienced cough and fever and was consulted with a
private physician and prescribed with Co-amoxiclav 625mg/tab 3x a day for 7 days. 1 day prior
to consultation, the patient was still with cough and fever, thus decided to consult at ER.

Past Medical, Personal and Social History

Patient NA is an elementary graduate. He currently works as a driver at the Barangay North

Daang Hari, Taguig City. Patient NA is living with his common law wife and employed at SMX
MOA as housekeeper. He is an occasional alcoholic drinker, who consumed 3 bottles (mucho) of
Red Horse a day, 3x a week for 36 years. His daily meal includes rice (3 cups/meal), vegetables,
fish, and fond of eating 1 gallon of ice cream twice a week. He said that he doesn’t have any
form of exercise and tends to lie down after eating. He also stated that in his free time he watches
news on television and browse the internet as his leisure.

A.6 Genogram
A.7 Gordon’s Functional Health

Before Hospitalization During Hospitalization Interpretation

Health Perception Patient is 54 years old no Patient thinks that he cannot During hospitalization,
history of hospitalization and function well same as before, he thinks he can’t
doesn’t take any medication. but he’ll try to be healthy by function well which
He perceives himself as following the medical advised affects his perception
healthy individual. instructed to him. about health. Perception
of health is natural
progression from relative
nature of health.
(pdhpe.net, 2023).

Nutritional-Metabolic Patient describes his appetite Patient is currently on DM Before hospitalization,

Pattern is good he eats fish and diet; he still describes his the patient had a good
vegetables but loves fried appetite same as before. appetite, but during
foods especially daing. He confinement, he was on a
loves eating ice cream twice a DM diet to monitor his
week and can finished 1 blood sugar. Nutritious
galloon per intake. He drinks foods may decrease your
6-8 glasses of water not a fun risk of disease
of soda drinks, but his family (Healthline by Kubala,
loves to eat in fast foods, 2019).
includes three cups of rice per
meal and he drinks alcohol
three times a day.

Elimination Pattern Patient has a normal bowel During hospitalization the Before and during
pattern, he frequently urinates Patient urinates frequently hospitalization the
about 5-6 times a day and and he does not experience Patient still urinates
does not experience pain, his any problems in urinating.. frequently. Frequent
urine is clear and yellow in urination can be sa sign
color. of Diabetes, when
diabetes is not controlled,
excess sugar causes more
fluid to pass from
kidneys into urine.
(Kathleen Smith M.D.
Sept 2022; eveyday
health.com; Frequent
urination symptoms and
treatment).

Activity and Exercise Patient is completely Patient is unable to perform During confinement in
Pattern independent performing ADLs due to hospitalization. hospital, there is
ADLs, he usually lies-down limitation in activities of
after eating. Patient often to daily living and
walk outside the house as disruption in leisure and
form of exercise. recreation pattern. A
problem with the
activity-exercise pattern
may be the primary
reason for the pt. entering
the health care system or
may arise secondary to
problems in another
functional pattern.
 (Cox Clinical
Application of Nursing
Diagnosis 5th edition
page 270).

Sleep-Rest Pattern Patient usually sleep 5-6 Patient has no difficulty in Patient is having
hours after work. sleeping and usually sleeps 8- prolonged sleep at night,
10 hours at night. he gains rest/ sleep.
Getting enough sleep is
essential for maintaining
optimal health and well-
being like exercise and a
balanced diet, sleep may
help prevent a range of
health issues.
(medicalnewstoday.com,
2023).

Cognitive and Perceptual Patient has no problem with Nothing has changed in his Patient is coherent and
Pattern his hearing; he has normal cognitive perception. cooperative and alert
cognitive perception. with no problems with
his senses. Pt. manifest
intact sensory
mechanism and
perception.
(Kozier and Erb’s
Fundamentals of Nursing
8th Edition vol 2, page
981).

Self-Perception/ Self Patient views himself as a During the assessment the pt Patients’ self-perception
Concept healthy strong individual. was responsive due to was strongly affected due
hospitalization the pt. can’t do to his condition. The
his daily activity. concept of oneself for
each person is like a
collage. At the center of
the collage are the beliefs
and images that are most
vital for the individual's
identity and self-esteem.
(The Fundamentals of
Nursing, Kozier, page
382).

Role Relationship Pattern Patient lives with his wife Relationship of his family The Patient relationship
and children; he views remains strong; his wife and with his family remains
himself as a responsible his children are the source of strong. Patient
father to his children. his strength after this hospitalization made
hospitalization. their family become
stronger to support, they
used each other as a
source of energy and
hope.
(Cox’s Clinical
Application of Nursing
Diagnosis 5th Edition
page 606).

Coping Stress Patient usually copes stress Patient Family supports him His family supports each
by taking responsibility for for his immediate to recover other in every situation
situation. And share with his from his hospitalization. may occur. Coping
 wife to maintain emotionally mechanisms are the
supportive relationship. strategies people often
use in the face of stress
and/or trauma to help
manage painful or
difficult emotions.
Coping mechanisms can
help people adjust to
stressful events while
helping them maintain
their emotional well-
being.
(goodtherapy.org, 2018).

Sexual Reproductive Patient had two children, During hospitalization still no Patient sexual
Pattern according to the Patient no disease/dysfunction in his reproductive pattern is
history of disease/dysfunction reproductive system. not affected. The changes
affecting his reproductive that happen in a person's
system. body or life have an
impact on their sexuality
and reproductive
patterns. "Factors
influence a person’s
sexuality; developmental
level, culture, religion,
values, personal ethics,
disease processes, and
medications." (The
Fundamentals of
Nursing, Kozier, p. 327)

Values-Belief Pattern Ptatient is a Roman Catholic, Patient has a good faith to Patient hospitalization
he rarely goes to church every God. doesn't change his
Sunday, but prays to God values/belief pattern.
often. Spiritual and Religious
beliefs play a significant
approach in major life
events.
(Fundamentals of
Nursing by Kozier page
1048.)

A.8 Nursing Health Assessment

Vital Signs upon Admission (January 25, 2023)

Blood Pressure: 130/90 mmhg
Pulse Rate: 118 bpm
Respiratory Rate: 22 cpm
Body Temperature: 38.9 °c
Weight: 54.5 Kg
Height: 160.02 cm
Body Mass Index: 21.3 (Normal)

Vital Signs during Assessment (January 30, 2023)

Blood Pressure: 110/70 mmhg
 Pulse Rate: 93 bpm
Respiratory Rate: 18 cpm
Body Temperature: 36.8 °c

Review of System

PARTS ACTUAL FINDINGS

SKIN - Even skin tone, dry, and

with good skin turgor
and integrity.

HAIR - Hair color is mixed of

black and white, and
evenly distributed.

EYES - Rounded and

proportional to the size
of the face.
- With good elasticity on
both eyelids.

SCLERA - White and clear.

PUPIL - Pupils are equally round

and reactive to light
accommodation.

VISUAL - 20/20 vision. Able to

ACUITY read words at a distance
of 18-20 feet.

HEARING - Able to hear whisper

ACUITY words without any
difficulties.

LIPS - Symmetrical, pale and

dry lips upon inspection.

GUMS - Gums are symmetrical,

pinkish, moist and with
well-defined margins.

BUCCAL - Moist, smooth, shiny and

MUCOSA pink.
TEETH - Presence of dental carries
on both upper and lower
teeth.
- Just 2 upper second
molar teeth on the right
side without dentures
noted.
- With complete teeth
below.

TONGUE - Pink, smooth and moist.

- Able to move freely.

VOICE - (-) Hoarseness

NECK, - No areas of tenderness,

THYROID, and absence of masses.
THROAT

THORAX AND - No visible deformities.

LUNGS - Symmetrical chest shape.
- No muscle retractions
when breathing.
- Quiet unlabored
respirations with no use
of accessory muscles.
- No adventitious breath
sounds upon
auscultation.

HEART - No murmurs, thrills and

heaves auscultated.

GASTROINTES - Proportional to good

TINAL appetite.
- No abdominal distention
and tenderness noted.
- No constipation noted.
Patient NA can defecate
freely.
- With normal color of
feces.
 UPPER - No deformities noted
EXTREMITIES upon inspection.
- Pinkish fingernails and
capillary refill of less
than 2 seconds.
- Warm to touch.
- No swelling or redness
of joints.

LOWER - Fine hair, warm to touch,

EXTREMITIES firm muscles.
- No presence of edema
and varicosities.
- No swelling or redness
of joints.

NEUROLOGIC - Patient NA is oriented to

time, person and place.
- Patient was able to
answer well when asked
for his complete name,
birth date, age and state
where he lives.

URINARY - Patient NA can void

freely.
- Polyuria was noted.

REPRODUCTIV - Patient NA refused to be

E assessed with his
external reproductive
organ.

A.9 Laboratory Tests

COMPLETE BLOOD COUNT

Date: January 26, 2023
NORMAL RANGE RESULT INTERPRETATION

HEMOGLOBIN 12-17g/dl 12.40g/dL NORMAL

HEMATOCRIT 36.052.0% 38.40% NORMAL

 RED BLOOD CELLS 4.70-5.40 mil/mm^3 4.58mil/mm^3 SLIGHTLY LOW

MCV 80-100Fl 84 NORMAL

MCH 28-30pg 27 SLIGHTLY LOW

MCHC 32-38% 32 NORMAL

WHITE BLOOD 5,000-10,000/mm ^3 25,400mm^3 HIGH

CELLS

NEUTROPHILS 50-70% 85 HIGH

LYMPHOCYTES 25-35% 4 LOW

MONOCYTES 4-6% 7 SLIGHTLY HIGH

EOSINOPHILS 1-3% 3 NORMAL

BASOPHILS 0.4-1% 1 NORMAL

PLATELETS 150,00-450,00/mm ^3 337,000/ mm ^3 NORMAL

URINALYSIS
Date: January 26, 2023
NORMAL FINDINGS RESULT INTERPRETATION

APPEARANCE YELLOW YELLOW HAZZY NORMAL

SPECIFIC 1.015-1.025 1.010 NORMAL

GRAVITY

PH 4.8-7.8 6.5 NORMAL

SUGAR NEGATIVE +3 POSITIVE

KETONES NEGATIVE NEGATIVE NORMAL

BLOOD NEGATIVE NEGATIVE NORMAL

NITRITES NEGATIVE NEGATIVE NORMAL

PROTEIN NEGATIVE NEGATIVE NORMAL

BILIRUBIN NEGATIVE NEGATIVE NORMAL

UROBILINOGEN NEGATIVE NEGATIVE NORMAL

LEUKOCYTES NEGATIVE NEGATIVE NORMAL

 PUS CELLS NEGATIVE 1-3/HPF POSITIVE

RED BLOOD NEGATIVE 1-3/HPF POSITIVE

CELLS

EPITHELIAL NEGATIVE RARE POSITIVE

CELLS

AMORPHOUS NEGATIVE FEW POSITIVE

DEPOSITS

BACTERIA NEGATIVE FEW POSITIVE

MUCUS NEGATIVE FEW POSITIVE

THREADS

CLINICAL CHEMISTRY
Date: January 31, 2023
RESULT REFERENCE RANGE INTERPRETATION

CREA 0.86 0.5-1.30 mg/dL NORMAL

BUN 20 7-18 mg/dL HIGH

HBa1c 13.5% 4.5-6.2% HIGH

SGPT/ALT 75 14-63 u/L HIGH

SGOT/AST 74 15-37 u/L HIGH

SODIUM 130 136-15 mmol/L LOW

POTASSIUM 3.9 3.5-5.1 mmol/L NORMAL

CHLORIDE 101 98-107 mmol/L NORMAL

A.10 Diagnostic Procedures

Date: January 26, 2023

PROCEDURE: CHEST X-RAY PA

IMPRESSION:
PTB WITH CAVITATION, LEFT; CANNOT RULE OUT NEW GROWTH

Date: January 27, 2023

PROCEDURE: CHEST CT-SCAN WITH IV CONTRAST
 IMPRESSION:
-PTB, BILATERAL, MORE AND WITH CAVITATION IN THE LEFT UPPER LOBE
-ENLARGED MEDIASTINAL NODES, LIKELY REACTIVE INFLAMMATION
-SUGGEST FOLLOW UP STUDY TOI EXCLUDE NEW GROWTH

A.11 Drug Study

1. Clindamycin 600mg TIV q6h
2. Ciprofloxacin 400mg TIV q12h
3. Humulin R 6U SQ TID premeal
4. Humulin N 16U SQ ODAM and ODPM
5. Paracetamol 300mg TIV q4h PRN for fever and headache
 DRUG DETAILS MECHANISM OF ACTION INDICATION AND SIDE EFFECTS AND NURSING
CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES

Generic Name: Inhibits protein synthesis of Indication: Side Effects: 1. Monitor daily pattern of
Clindamycin bacterial cell wall by binding to For treatment of respiratory tract Abdominal pain, nausea, bowel activity, stool
bacterial ribosomal receptor infections, skin/ soft tissue vomiting, diarrhea. consistency.
Brand Name: sites. Topically, it decreases infections, sepsis, intra-abdominal Allergic ration, phlebitis
Clinsea fatty acid concentration on skin. infections.
Contraindication: Adverse Reactions: 2. Assess skin for rash
Classification: None known. Antibiotic-associated (dryness, irritation).
Antibiotic, Cautions: Severe hepatic colitis, other
Lincosamide dysfunction; history of GI disease. superinfections (abdominal 3. Instruct pt to notify if they
cramps, severe watery have signs of severe
Dosage: 600mg diarrhea, fever) may occur persistent diarrhea, cramps,
Route: IV during and several weeks
bloody stool.
Frequency: q6h after clindamycin therapy.

4. Assess Iv site of the patient

when administering
antibiotics.

Reference:
● Saunders Nursing Drug Handbook, 2016, page 269

DRUG DETAILS MECHANISM OF ACTION INDICATION AND SIDE EFFECTS AND NURSING
 CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES

Generic Name: Ciprofloxacin, a Indication: Side Effects: 1. Monitor for signs and
Ciprofloxacin fluoroquinolone anti-infective Lower respiratory tract infections, Nausea, Diarrhea, symptoms of
agent, acts by inhibiting DNA Skin and soft tissue infections, Dyspepsia, vomiting. hypersensitivity reactions
Brand Name: gyrase and topoisomerase IV, Upper respiratory tract infections. constipation, flatulence, and altered mental status.
Acipro both essential in bacterial DNA Crystalluria
replication, transcription, repair Contraindication: 2. Obtain culture and
Classification: and recombination. Hypersensitivity to ciprofloxacin or Adverse Reactions: sensitivity test tests prior to
Fluoroquinolones other quinolones. Irreversible tendinitis, treatment initiation.
tendon rupture, peripheral
Dosage: 400mg neuropathy, CNS effects 3. Monitor daily pattern of
Route: IV (e.g., seizures, increased bowel activity.
Frequency: q12h intracranial pressure).
Nephropathy, 4. Encouraged hydration
Cardiopulmonary arrest,
hypersensitivity reaction 5. Check blood glucose levels,
(rash, pruritus) CBC, renal function, LFT
periodically and during
prolonged therapy.

Reference:
● Ciprofloxacin mims.com
● Saunders Nursing Drug Handbook 2016, page 260

DRUG DETAILS MECHANISM OF ACTION INDICATION AND SIDE EFFECTS AND NURSING
CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES
 Generic Name: Humulin R insulin (human Indication: Side Effects: 1. Assess for symptoms of
Insulin (Human recombinant)) is a hormone that Humulin R (insulin (human Hypoglycemia is one of the hypoglycemia.
Recombinant) is produced in the body used to recombinant)) U-100 is indicated as most frequent adverse
Insulin Human (rDna) treat diabetes. an adjunct to diet and exercise to events experienced by 2. Inspect skin areas that will
Brand Name: improve glycemic control in adults insulin users. Symptoms of be used for injection; note
Insurgent R Humulin R: Short Acting and children with type 1 and type 2 mild to moderate any areas that are bruised,
diabetes mellitus. hypoglycemia may occur thickened, or scarred, which
Classification: Onset: 30-60 min suddenly include sweating, could interfere with insulin
Insulin and Analogue Peak: 1-5 hours Contraindication: dizziness and palpitation. absorption and alter
Duration: 6-10 hours Humulin R (insulin (human anticipated response to
Dosage: 6U recombinant)) U-100 is insulin therapy.
Route: SQ contraindicated during episodes of
Frequency: TID hypoglycemia and in patients 3. Give maintenance doses
premeal hypersensitive to Humulin R subcutaneously as needed,
(insulin (human recombinant)) U- rotating injection sites
100 or any of its excipients. regularly to decrease
incidence of lipodystrophy.

Reference:
● HUMULIN R rxlist.com

DRUG DETAILS MECHANISM OF ACTION INDICATION AND SIDE EFFECTS AND NURSING
CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES
 Generic Name: Acts via specific receptor to Indication: Side Effects: 1. Check blood glucose level.
Insulin (Human regulate metabolism of Treatment of insulin-dependent type Localized redness,
Recombinant) carbohydrates, protein, and fats. 1 diabetes mellitus; non–insulin- swelling, itching (due to 2. Discuss lifestyle to
Insulin HUman (rDna) Acts on liver, skeletal muscle, dependent type 2 diabetes mellitus improper insulin injection determine extent of learning,
and adipose tissue. (NIDDM) to improve glycemic technique), lipodystrophy emotional needs.
Brand Name: control. (depression at injection site
Insurgent-N Humulin N: Intermediate due to breakdown of 3. Assess for hypoglycemia
Acting Contraindication: adipose tissue). Somogyi (cool, wet skin, tremors,
Classification: Hypersensitivity, hypoglycemia. effect with chronically dizziness, headache, anxiety,
Insulin and Analogue Onset: 1-2 hours Cautions: Pts at risk for excessive insulin dosage. tachycardia, numbness in
Peak: 6-14 hours hypokalemia mouth, hunger, diplopia.)
Dosage: 16U-0-8U Duration: 16-24 hours Adverse Effects:
Route: SQ Severe hypoglycemia (due 4. Advised diet is an essential
Frequency: ODAM & to hyperinsulinism) may part of treatment; do not
ODPM occur with insulin skip/delay meals.
overdose.

Reference:
● Saunders Nursing Drug Handbook, 2016, page 636

DRUG DETAILS MECHANISM OF ACTION INDICATION AND SIDE EFFECTS AND NURSING
CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES
 Generic Name: Happens to inhibit Indication: Side Effects: 1. Assess alcohol consumption
Paracetamol prostaglandin synthesis in the Relief of Mild to moderate pain such Tachycardia, nausea, before administering
CNS and to lesser extent, block as muscle aches, back pain, Hypersensitivity Reaction Paracetamol.
Brand Name: pain impulses through headache; fever reduction (rash, pruritus)
Amcetam peripheral action. It produces 2. Assess For fever, for clinical
antipyresis by inhibiting the Contraindication: Adverse Reaction: improvement of fever.
Classification: hypothalamic heat regulating Severe Hepatic Impairment or Early Signs of
Analgesic and centre. severe active liver disease. Acetaminophen Nausea, 3. Assess Pain onset type,
Antipyretic Fatigue: Location duration of Pain
Late Signs:
Dosage: 300mg Vomiting, Right Upper 4. Assess for symptoms of
Route: IV Quadrant Tenderness hypersensitivity reactions.
Frequency: q4h PRN
for fever and headache

Reference:
● Saunders Nursing Drug Handbook, 2016, page 9-11
A.12 Nursing Care Plan
1. Acute Pain related to increased cerebral blood flow secondary to vasodilation, as evidenced by
facial grimace, guarding behavior on the affected area, and increased heart rate.

2. Elevated body temperature related to increased metabolic rate secondary to infection, as

evidenced by warm to touch, increased heart rate and white blood cells.

3. Unstable blood glucose level related to inadequate knowledge on disease process secondary to
dietary intake, as evidenced by increased random blood sugar, elevated HBa1C, and presence of
glucose in urine.
 Assessment Nursing Diagnosis Planning Interventions And Evaluation
(Goals of Care) Rationale
Subjective Hyperthermia related to Short Term Goal Independent Short Term Goal
“Mainit ang increased metabolic rate After 30 to 45 minutes 1. Establish rapport with Goal was met: the
pakiramdam ko,” as secondary to infection, of nursing interventions, the patient and relative. patient’s body
verbalized by the as evidenced by the patient’s body Rationale: To promote temperature and heart
patient. elevated body temperature will return cooperation in the rate returned to normal
temperature, increased to normal range of nursing care. as evidenced by body
Objective heart rate and white 36.5°C to 37.5°C, and temperature of 36.8°C
- Flushed skin blood cells. heart rate of 60- 2. Assess and monitor and heart rate of 80bpm.
- Warm to touch 100bpm. patient’s temperature
- Body Temp- 38.9°C and patterns of Long Term Goal
- Tachycardia (HR Long Term Goal occurrence as well as Goal was met: the
110bpm) After 12 hours of the presence of chill. patient’s vital signs are
- RR- 22cpm nursing interventions, Rationale: This will maintained within the
- WBC- 25,400/mm3 the patient’s vital signs help to identify the normal range as
will be able to maintain development of the evidenced by body
normal range of body patient’s temperature temperature of 36.6°C,
temperature (36.5°C - and guide in HR- 77 bpm, BP- 120/
37.5°C), and heart rate formulation of 80mmhg, and RR-
(60-100bpm). diagnosis and 19cpm. No episodes of
management. fever occurred.

3. Assess patient’s
clothing that is too
warm for the
environment.
Rationale: removing
excess clothing or
blanket will promote
heat loss. Furthermore,
used of many clothes or
blankets inhibits the
body’s natural ability to
reduce body
temperature.

4. Advise patient to
have adequate oral fluid
intake.
Rationale: Water helps
to reduce body
temperature and to
prevent dehydration.

5. Provide tepid sponge

bath.
Rationale: To promote
heat loss by
evaporation and
conduction.

6. Provide cool and

well-ventilated
environment.
Rationale:
Environmental
temperature greatly
affect body
temperature.

7. Monitor patient’s
intake and output.
Rationale: To monitor
patient’s fluid volume
 accurately and to
maintain metabolic
functions during fever.

Collaborative
8. Administer IV fluids
as prescribed.
Rationale: To support
circulating volume and
tissue perfusion.

9. Administer
antipyretic as
prescribed.
Rationale: To reduce
fever by its central
action on
hypothalamus.

10. Administer
antibiotics as
prescribed.
Rationale: To control
the spread of infection
and treats underlying
cause.

Reference:

Williams, L. & Wilkins, L. (2008). Understanding the pathophysiology of fever. Nursing 38(8), 56cc1-56cc2.
https://doi.org/10.1097/01.NURSE.0000327497.08688.47

Baracos, V., Whitmore, W. & Gale, R. (1987). The metabolic cost of fever. Can J Physiol Pharmacol, 65(6),
 1248-54. https://doi.org/10.1139/y87-199

Assessment Nursing Diagnosis Planning Interventions And Evaluation

(Goals of Care) Rationale
Subjective Acute Pain related to Short Term Goal Independent: Short Term Goal
“Masakit ang ulo ko,” increased cerebral blood After 1-2 hours of 1. Establish rapport with Goal was met: the
as verbalized by the flow secondary to nursing interventions, the patient and relative. patient verbalized
patient. vasodilation and fever, the patient will Rationale: To promote reduction of pain from
as evidenced by facial verbalize reduction of cooperation in the scale of 8/10 to 4/10,
Objective grimace, guarding pain with acceptable nursing care. with improved heart rate
- Pain Scale 8/10 behavior on the affected pain scale of 4 out of 10 of 82bpm.
- With facial grimace area, increased heart and will exhibit 2. Monitor patient’s
- With guarding rate and elevated body improvement in heart vital signs. Long Term Goal
behavior on the affected temperature. rate from 118 bpm to Rationale: Vital signs Goal was met: the
area within the normal range can alter when pain is patient able to:
- Body Temperature- of 60-100bpm. presence. ● verbalized relief
38.9°C from pain at
- HR 118bpm Long Term Goal 3. Perform a thorough scale of 0/10.
-BP 130/90mmhg After 12 hours of assessment of pain by ● demonstrated the
nursing interventions, identifying the use of different
the patient will be able following: onset, relaxation
to: duration, frequency, exercises and
● Verbalize relief quality, and intensity. diversional
from pain at a Rationale: The patient activities.
scale of 0/10. is the most accurate ● the ability to
● Demonstrate source of information engage in ADLs
diversional about the pain they without
activities and have. It is the gold experiencing
relaxation standard in the pain.
techniques. assessment of pain, for
● Perform ADLs they can provide
as tolerated. relevant details such as
pain severity and length
of time. Furthermore, it
helps the nurse in
planning optimal pain
management strategies.

4. Evaluate the site of

the pain by asking the
patient to point to the
location that has
discomfort.
Rationale: To identify
the exact location of the
pain.

5. Encourage patient to
verbalize his feelings.
Rationale: To alleviate
anxiety, tension, and
provide psychological
relief.
6. Provide non-
pharmacological pain
management such as
quiet environment, calm
activities, comfort
measures, use of
relaxation exercise (e.g.,
breathing exercise), and
diversional activity
(e.g., surfing the net,
listening to calm music
or watching tv- if
available).
Rationale: To decrease
environmental factors
which contributes to
pain. To distract
attention from pain and
decrease tension.

7. Assist patient in self-

care activities as
tolerated.
Rationale: To promote
client independence as
much as possible and
acquire sense of
function.

Collaborative:
8. Administer
analgesics as
prescribed.
Rationale: Medication
will provide synergistic
effect with non-
pharmacologic
interventions for pain
relief and promote
better circulation by
aiding in vasodilation
for better blood flow to
the brain and altering
prostaglandin synthesis
to decrease pain.

9. Assess the
effectiveness of pain
medications as
prescribed.
Rationale: Evaluation
of effectiveness of pain
relievers must be done
because absorption and
metabolism of
medication differ from
one person to another.
Notify the physician if
the regimen is
inadequate to meet the
pain control goal.

10. Encourage watcher

to assist patient during
diversional activities by
 minimize noise, allow
patient to verbalize
feelings, and promote
rest and sleep.
Rationale: The
significant others know
the patient more and
will be able to aid in
diverting client’s
attention from pain.

Reference:

Villanueva, R. (2019). NCP-Headache.

https://www.studocu.com/ph/document/our-lady-of-fatima-university/nursing/ncp-headache-ncp/
10448955

Baraness, L. & Baker, A. (2022). Acute Headache. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK554510/

Silberstein, S. (2021). Approach to the patient With Headache.

https://www.msdmanuals.com/professional/neurologic-disorders/headache/approach-to-the-patient-
with-headache
 Assessment Nursing Diagnosis Planning Interventions And Evaluation
(Goals of Care) Rationale
Subjective Unstable blood glucose Short Term Goal Independent: Short Term Goal
“Mahilig ako kumain level related to lack of After 2-3 hours of 1. Establish rapport Goal was met: the patient
ng matatamis lalo na knowledge on disease nursing interventions, with the patient and verbalized the importance
ang ice cream at process secondary to the patient will relative. of key factors that may
umiinom ng alak araw dietary intake, as acknowledge key factors Rationale: To promote contribute to unstable
araw,” as verbalized by evidenced by increased that may contribute to cooperation in the blood glucose level as
the patient. random blood sugar unstable blood glucose nursing care. evidenced by lower RBS
elevated HBa1C, and level as evidenced by result 175mg/dL.
Objective presence of glucose in decrease in RBS from 2. Monitor vital signs.
- Polyphagia urine. 494mg/dL to within the Rationale: To obtain Long Term Goal
- Polydipsia normal range of 80- baseline data. Goal was met: the patient
- Polyuria 180mg/dL. able to:
- RBS 494mg/dL (80- 3. Assess for signs of - Maintained blood
180mg/dL) Long Term Goal hyperglycemia. glucose level
- HbA1c 13.5% (4.5- After 48 hours of Rationale: within the normal
6.2%) nursing interventions, Hyperglycemia results level
- UA result: Glucose the patient will be able when there is an (80-180mg/dL)
3+ to: inadequate amount of - Verbalized
● Maintain blood insulin to glucose. understanding of
glucose level Excess glucose in the management and
within the blood creates an how to prevent
satisfactory range osmotic effect that complications like
of 80-180mg/dL. results in increased DKA and HHNS.
● Verbalize thirst, hunger, and - Acknowledged the
understanding of urination. The patient importance of
 plan to prevent may also report blood glucose
complications. nonspecific symptoms monitoring as
● Acknowledge the of fatigue and blurred manifested by
importance of vision. having NPO 2
blood glucose hours prior
monitoring. 4. Assess patient’s extraction.
● Adherence on alcohol intake. - Complied with his
DM diet. Rationale: Excessive dietary intake.
● Recognize the alcohol consumption, - Exhibited physical
significance of without food intake, activity by
physical activity. blocks the release of walking around
glycogen from the liver, the room and
causing hypoglycemia. perform light
exercises as
5. Assist the patient in tolerated.
determining dietary
habits that must be
altered.
Rationale: This serves
as the foundation for
personalized dietary
advice relating to the
clinical condition that
leads to blood glucose
level fluctuations.

6. Educate the patient to

the significance of
adhering to a prescribed
meal plan (low
glycemic index, high
fiber and low-fat
content).
Rationale: This will
assist the patient in
maintaining consistent
blood glucose levels.
These foods produce
slower rise in blood
glucose level.

7. Monitor blood
glucose levels.
Rationale: To ensure
that the blood glucose
level is within target
range.

8. Encourage patient to
increase physical
activity.
Rationale: Physical
activity helps lower
blood glucose levels.
Regular exercise is a
core part of diabetes
management and
reduces risk for
cardiovascular
complications.

9. Instruct patient to
avoid using heating
pads and always wear
shoes when walking.
Rationale: Patients
have decreased
sensation in the
extremities due to
peripheral neuropathy.

Collaborative:
10. Administer insulin
as prescribed.
Rationale: This helps to
regulate blood glucose
levels by alerting the
liver, muscle and fat
cells to absorb glucose
from the blood.

11. Educate the

patient’s family about
the need of maintaining
consistency in the
amount of food
consumed and the
estimated time intervals
between meals.
Rationale: A regular
amount of food and
time interval among
meals helps in the
prevention of
hypoglycemia and the
maintenance of overall
blood glucose
management.
Reference:

Herdman, T. H., PhD, RN, FNI. (Ed.) and Kamitsuru, S., PhD, RN, FNI. (Ed). (2018). NANDA Nursing Diagnoses:
Definitions and Classification 2018-2020 (11th ed.). New York, Stuttgart, Delhi, Rio de Janeiro: Thieme.
https://www.studocu.com/ph/document/central-mindanao-university/nursing/vera-sophia-areola-nursing-care-plan/
24162119
Kelley, J. (2021). Oral hypoglycemic drugs. Boulder Medical Center. Retrieved from
https://www.bouldermedicalcenter.com/oral-hypoglycemic-drugs/

Nemar, A., Cavalcante, T., Moreira, R., … Olieveira, L. (2020, May). Nursing diagnosis risk for unstable
blood glucose level in patients with diabetes mellitus. Wiley Online Library, 31(4), 240-245.
https://doi.org/10.1111/2047-3095.12282
A.13 Discharge Planning
M
E
T
H
O
D

A.14 Evidence Based Practice

-IT IS A METHOD BY WHICH PRACTITIONERS ACROSS THE

HEALTHCARE PROFESSIONS REVIEW AND ASSESS THE MOST
CURRENT,HIGHEST-QUALITY RESEARCH TO INFORM THEIR
DELIVERY OF CARE.ALTHOUGH THERE IS NO PRECISE STANDARD
FOR WHAT CONSTITUTES EVIDENCE BASED PRACTICE IN
NURSING,THE APPROACH CONSISTS OF THREE MAIN COMPONENTS
AND FIVE BASIC STEPS.

3 COMPONENTS OF EVIDENCE-BASED PRACTICE

1.BEST EXTERNAL EVIDENCE-Evaluate and implement the most

current,clinically relevant,and scientifically sound research.

2.INDIVIDUAL CLINICAL EXPERTISE-Draw on your personal experience of

what has worked and not worked in your clinical practice.
3.PATIENT VALUES AND EXPECTATIONS-Consider and value the
preferences of your individual patients.

TYPES OF RESEARCH ARE USED IN EVIDENCE-BASED PRACTICE

1.RANDOMIZED CONTROLLED TRIALS

2.EVIDENCE FROM COHORT,CASE-CONTROL,OR OBSERVATIONAL
STUDIES.
3.EXPERT OPINIONS THAT are supported by experience,studies or reports.
4.PERSONAL EXPERIENCE
5 STEPS OF EVIDENCE-BASED PRACTICE
1.ASK-Formulate answerable clinical questions about a
patient,problem,intervention,or outcome
2.ACQUIRE-Search for relevant evidence is high-quality and valuable.
3.APPRAISE-Determine wether or not the evidence is high quality and valuable.
4.APPLY-Make clinical decisions utilizing the best available evidence.
5.ASSESS-Evaluate the outcome of applying the evidence to the patients
situation.

BENEFITS TO THE FIELD OF NURSING INCLUDE:

1.Prioritizing the needs of patients

2.Better patient care decisions that also small nurses time.

Reference:

San Marcos, CA Campus

700 Windy Point Drive

The combined intervention of dietary changes and increased physical activity in

prediabetic adults reduces the risk of developing diabetes mellitus type 2 with a
number needed to treat of nine (SOR: B, meta-analysis of low-quality randomized
controlled trials [RCTs]).

..
Reference:
Lippincott Williams & Wilkins

Best practice for type 2 diabetes?

Treatment

● Healthy eating.
● Regular exercise.
 ● Weight loss.
● Possibly, diabetes medication or insulin therapy.
● Blood sugar monitoring.

EVIDENCE BASED DIET FOR DM TYPE 2

Diets rich in whole grains, fruits, vegetables, legumes, nuts, moderate in alcohol
consumption, and lower in refined grains, red/processed meats, and sugar-
sweetened beverages have demonstrated to reduce diabetes risk and improve
glycemic control and blood lipids in patients with diabetes.Feb 11, 2016

Reference:

nih.gov
https://www.ncbi.nlm.nih.gov › articles › PMC4751088