DIABETES

MELLITUS
TYPE II

INTRODUCTION
Diabetes, a life long disease which is caused by reduced production of
insulin, or by decreased ability to use insulin. Insulin, the hormone produced by the beta
cells in the pancreas, allows blood sugar (glucose) cells to be able to use blood sugar.
This hormone is necessary for glucose to go from the blood to the inside of the body
cells. With inadequate insulin, glucose builds up in the bloodstream instead of going into
the cells. The body is unable to use glucose for energy despite the high levels of glucose
in the bloodstream. This causes the excessive thirst, urination, and hunger, which are the
most common symptoms of diabetes. The excess sugar remains in the blood and is then
removed by the kidneys. This disease occurs in several forms, but the most common are
Type I Diabetes or Juvenile Onset Diabetes or Insulin-Dependent Diabetes Mellitus
(IDDM), Type II or Non Insulin-Dependent Diabetes Mellitus (NIDDM), and
Gestational.
In Type 1 diabetes, the classic symptoms are excessive secretion of urine
(polyuria), thirst (polydipsia), weight loss and tiredness. These symptoms may be less
marked in Type 2 diabetes. In this form, it can also happen that no early symptoms appear
and the disease is only diagnosed several years after its onset, when complications are
already present.
Prevalence. Recently compiled data show that approximately 150 million people
have diabetes mellitus worldwide, and that this number may well double by the year
2025. Much of this increase will occur in developing countries and will be due to

population growth, ageing, unhealthy diets, obesity and sedentary lifestyles. By 2025,
while most people with diabetes in developed countries will be aged 65 years or more, in
developing countries most will be in the 45-64 year age bracket and affected in their most
productive years.
Diagnosis. WHO has published recommendations on diagnostic values for blood
glucose concentration. The diagnostic level of fasting blood glucose concentration was
last modified in 1999.
Most complications are the result of problems with blood vessels. Glucose levels
that remain high over a long time cause both the small and large blood vessels to narrow.
The narrowing reduces blood flow to many parts of the body, leading to problems. There
are several causes of blood vessel narrowing. Complex sugar-based substances build up
in the walls of small blood vessels, causing them to thicken and leak. Poor control of
blood glucose levels also tends and decreased blood flow in the larger blood vessels.
Atherosclerosis leads to heart attacks and strokes. Atherosclerosis is between 2 and 6
times more common and tends to occur at a younger age in people with diabetes than in
people who do not have diabetes.
Over time, elevated levels of glucose in the blood and poor circulation can harm
the heart, brain, legs, eyes, kidneys, nerves, and skin, resulting in angina, heart failure,
strokes, leg cramps during walking (claudication), poor vision, kidney failure, damage to
nerves (neuropathy), and skin breakdown.
Poor circulation to the skin can lead to ulcers and infections and causes wounds to
heal slowly. People with diabetes are particularly likely to have ulcers and infections of

the feet and legs. Too often, these wounds heal slowly or not at all, and amputation of the
foot or part of the leg may be needed.
Prognosis. The prognosis in patients with diabetes mellitus is strongly influenced
by the degree of control of their disease. Chronic hyperglycemia is associated with an
increased risk of microvascular complications, as shown in the Diabetes Control and
Complications Trial (DCCT) in individuals with type 1 diabetes and the United Kingdom
Prospective Diabetes Study (UKPDS) in people with type 2 diabetes.
Epidemiology. A 2011 Centers for Disease Control and Prevention (CDC) report
estimated that nearly 26 million Americans have diabetes. Additionally, an estimated 79
million Americans have prediabetes.
Race-related demographics. The prevalence of type 2 diabetes mellitus varies
widely among various racial and ethnic groups. The image below shows data for various
populations. Type 2 diabetes mellitus is more prevalent among Hispanics, Native
Americans, African Americans, and Asians/Pacific Islanders than in non-Hispanic whites.
Indeed, the disease is becoming virtually pandemic in some groups of Native Americans
and Hispanic people. The risk of retinopathy and nephropathy appears to be greater in
blacks, Native Americans, and Hispanics.

Prevalence of type 2 diabetes

mellitus in various racial and ethnic groups in the United States (2007-2009 data).
Complications. People with diabetes may experience many serious, long-term
complications. Some of these complications begin within months of the onset of diabetes,
although most tend to develop after a few years. Most of the complications gradually
worsen. In people with diabetes, strictly controlling the levels of glucose in the blood
makes these complications less likely to develop or worsen.
Treatment and Prevention. The goal of diabetes management is to keep blood
glucose levels as close to normal as safely possible. Since diabetes may greatly increase
risk for heart disease and peripheral artery disease, measures to control blood pressure
and cholesterol levels are an essential part of diabetes treatment as well. People with
diabetes must take responsibility for their day-to-day care. This includes monitoring
blood glucose levels, dietary management, maintaining physical activity, keeping weight
and stress under control, monitoring oral medications and, if required, insulin use via
injections or pump. To help patients achieve this, UCSF's Diabetes Teaching Center
offers self-management educational programs that emphasize individualized diabetes
care. The program enables patients to make more consistent and appropriate adjustments
in their therapy and lifestyle.

Dietary Management and Physical Activity. Modifying eating habits and

increasing physical activity are typically the first steps toward reducing blood sugar
levels. At UCSF Medical Center, all patients work with their doctor and certified dietician
to develop a dietary plan. Our Teaching Center conducts workshops that provide patients
with information on food nutrient content, healthy cooking and exercise.
Insulin Therapy. People with type 1 diabetes require multiple insulin injections
each day to maintain safe insulin levels. Insulin is often required to treat type 2 diabetes
too. Using an insulin pump is an alternative to injections. The pump is about the size of a
pager and is usually worn on your belt. Insulin is delivered through a small tube
(catheter) that is placed under the skin (usually in the abdomen).

PATIENTS PROFILE
Name:

CS

Age:

55 y/o

Birthday:

September 20, 1960

Gender:

Female

Civil Status:

Married

Address:

Gibraltar Baguio City Benguet

Educational Attainment:

College Graduate

Occupation:

Fast Food Crew

Religion:

Roman Catholic

Chief Complaint:

Dizziness and Body weakness

Mode of Arrival:

Via wheelchair

Date and Time of Admission: August 20, 1015

Admitting Physician:

Dr. Karka Rhea Posadas

Admitting Diagnosis:

Diabetes Mellitus, Type 2

Final Diagnosis:

Diabetes Mellitus, Type 2

Sources of Information:

Patient, patients SO., Patients Chart

PRESENT HEALTH HISTORY

March 2015, patient CS experienced body weakness, dizziness, and nape pain.
She then went to her private medical doctor for consultation. Upon getting her blood
pressure, it was 140/100 mmHg. Laboratory Exams were also done such as CBC and
Serum Electrolytes. Results were within normal range. Her Doctor checked her blood
sugar, and it was documented to 170 mg/dL. She was advised to have her Fasting Blood
Sugar test the next day at same clinic. NPO post midnight was instructed until after blood
extraction in the morning.
The next day, Fasting Blood Sugar result showed 7.8. She was told that she has
Diabetes Mellitus. Home Medications were given to her as her maintenance such as
Metformin (Glumet) 500mg/tab OD after breakfast and Amlodipine 5 mg/tab OD. She
was advised to check her blood sugar early in the morning and to document it.
After two weeks, she went for her follow-up check up at same Doctor. Her doctor
observed that she has consistent high blood sugar base on her record. She was prescribed
with Humalin R Insulin to be injected subcutaneously, 8 units pre feeding. CBG
monitoring was continued pre feeding.
2 hours prior admission, she experienced dizziness, severe body weakness,
numbness of extremities and blurring of vision. This prompted her to go to Emergency
Room of Notre Dame de Chartres Hospital. Blood sugar revealed 220mg/dL. Humalin R
insulin 10 units SQ was given to her immediately. Blood pressure was 150/90 mmHg.
She was then admitted under the service of her private medical doctor, Dr. Black with a
diagnosis of Dibetes Mellitus ,Type II.

PAST HEALTH HISTORY

Ms. CS childhood illnesses were mumps when she was 9 y/o, chicken pox when she was
12 y/o and measles but she cant remember what age it occurred. She can not recall if
what childhood immunization was given to her. Whenever she experiences minor
illnesses like headache, muscle pains and fever she take over the counter drugs such as
alaxan and paracetamol.
She never been hospitalized to any acute care setting. She has no history of
accident and surgery. She doesnt have any allergies on foods, drugs and animal dander.

FAMILY HEALTH HISTORY

According to her, her mother has Diabetes Mellitus that was diagnosed when she
was 40 years old and has also her maintenance. Her husband also has prostate cancer that
was diagnosed 3 years ago. Her youngest son has Asthma. They do not have history of
hypertension, cancer and heart diseases.

LIFESTYLE
According to her, in the morning she does household chores, helps her children in
preparing for school and goes to work fro 8 hours. She eats 3 times a day. Her 24 hour
dietary intake includes: her breakfast consists of 2 cups of rice, instant noodles, egg and 1
glass of milk, her lunch is usually consist of 2 cups of rice, fried chicken, spaghetti and
coke that is usually served in her work place, her supper is 2-3 cups of rice, fried fish,

vegetables and a glass of water. She doesnt smoke and drinks alcohol. Her husband is the
one who purchases their meal and shes the one who prepares it. She considers her
activities of daily living as her exercise. She sleeps at night for about 6-8 hours without
any interruptions. According to her she is well rested. She finds herself good and
contented. There were no difficulties in performing her self-care activities prior to
hospitalization. She usually spends her free time caring and playing with her children and
sometimes talking to their neighbor. She has a good relationship with her husband,
children, relatives and neighbors.
SOCIAL BACKGROUND
CS is 55 years old. She is a mother of three. She and her husband finance the family. But
now that she is hospitalized her husband and her eldest child help in the finances. She
also stated that she has a good relationship with her family, neighbors and co-workers.

GORDONS 11 FUNCTIONAL PATTERN

I.

HEALTH PERCEPTION- HEALTH MANAGEMENT PATTERN

BEFORE HOSPITALIZATION:
According to the patient, Health is the state of having no signs and symptoms of illness
and also the state wherein she can do her work without easily getting tired. She stated
that she uses herbal medicines when she got wound such as Kutsay. She also stated
that, she uses over the counter drug such as Paracetamol, Neozep and Amoxicillin
whenever she experienced minor illness such as muscle pain, colds, cough, fever, and
head ache. And when those medicines didnt cure her illness and her condition worsens
that the time that she will seeks medical advice.
DURING HOSPITALIZATION:
The patients perception on health did not change. She states that general state of
her health is fine. She noticed slight changes to her body while she was at hospital. mas
tumaba pa nga ako ngayong naconfine ako as verbalized by the patient. However, she
displays signs of weakness on exertion and ability to conduct usual activities is impaired.
She manages her health by following doctors orders and responding to every nurses
interventions.
II.

NUTRITIONAL METABOLIC PATTERN

BEFORE HOSPITALIZATION:
She eats 3 times a day. Her 24 hour dietary intake includes: her breakfast consists
of 2 cups of rice, instant noodles, egg and 1 glass of milk, her lunch is usually consist of 2

cups of rice, fried chicken, spaghetti and coke that is usually served in her work place,
her supper is 2-3 cups of rice, fried fish, vegetables and a glass of water. She doesnt
smoke and drinks alcohol. Her husband is the one who purchases their meal and shes the
one who prepares it.
DURING HOSPITALIZATION:
She eats three times a day that were served from dietary section which consists of
1 cup of rice, main dish and unsweetened dessert. She drinks 5-6 glasses of water a day.
She was hooked to Intravenous Fluid PNSS 1L x 12 hours.
III.

ELIMINATION PATTERN

BEFORE HOSPITALIZATION:
According to the patient, she voids 8-10 times a day without experiencing any
pain, approximately 1500-2000 ml per day as verbalized. She had a bowel elimination of
1-2 times a day without any difficulties and pain. Her stool is semi-formed and the color
is golden brown. She doesnt use enema or suppositories.
DURING HOSPITALIZATION:
She urinates 8-9 times a day, approximately 1800-2000 ml per day without any
difficulties and discomfort characterized as yellowish to clear urine and verbalized
mapanghi. She defecates 2-3 times a day with semi formed, brownish stool without any
discomfort.

IV.

ACTIVITY- EXERCISE PATTERN

BEFORE HOSPITALIZATION:
Her activities in a normal day were doing the household chores, helping her
children prepares for school and goes to work for 8 hours. After the work whenever she
had a free time, her leisure activities were watching T.V and sometimes having a
conversation with her neighbours. She is the one who prepares their food and wash their
dishes after eating. She considers her ADLs as her form of exercise and dont complaint
any difficulties of doing it.

DURING HOSPITALIZATION:
She can walk and has no activity restrictions. She does her ADLs independently
without any difficulties but her husband assists her when she goes to CR. She considers
walking around her room and doing her ADLs as her form of exercise.

V.

SLEEP-REST PATTERN

BEFORE HOSPITALIZATION:
She has no difficulty getting sleep. She sleeps 6 to 8 hours at night usually from 9
pm to 5 am, and it is sometimes interrupted because she has the urge to void but gets her
sleep back easily. According to her, even though her sleep pattern is sometimes

interrupted, she feels rested upon awakening the next day. She doesnt take any medicines
that aid her to sleep aside from taking a glass of milk every night before getting to bed.
DURING HOSPITALIZATION:
According to the patient, she sleeps about 8-10 hours at night and it is usually
interrupted due to the hospital routines like vital signs taking, and drug administration.
Parang kulang pa rin ang tulog ko pag gabi kasi paputol putol dahil sa pagvavital signs
at pagbibiga ng mga gamot. She does not take any sleeping aid or pills.

VI.

COGNITIVE AND SENSORY-PERCEPTUAL PATTERN

BEFORE HOSPITALIZATION:
The patient is College Graduate. She can understand English, Ilokano and
tagalong. She can understand instructions and can communicate well. She is able to
decide on her own, but sometimes, she seeks the opinion of her husband. According to
her, her five senses were functioning well. She did not have any problem in her vision,
hearing, ability to feel, taste and smell. She does not use any prosthesis to aid her senses.
DURING HOSPITALIZATION:
She is oriented to time, place and is able to communicate well and can understand
instructions. According to patient her, she does not have any problem in her vision,
hearing, ability to feel taste, and smell. . He responds to both verbal and non-verbal
stimuli.

VII.

SELF- PERCEPTION- SELF- CONCEPT PATTERN

BEFORE HOSPITALIZATION:
According to the patient, she is a jolly and a friendly person .She describes herself
as an individual who contributes to the happiness of the family. She considers herself as
being optimistic but sometimes pessimistic. She also mentioned that she is contented in
her life because of the love and support given by her family. She also said that shes
satisfied on the way she looks, and she has no plan of changing her physical appearance.
DURING HOSPITALIZATION:
She verbalized, Medyo mahina ako ngayon, pero kayang kaya ko pa namang
gawin yung

mga dati kong ginagawa bago ako maospital. She tries her best to

maintain her hygiene. Gagaling din ako, kailangan ko lang sundin ang mga sinasabi ng
doctor at mga nurse ko.
VIII. ROLE-RELATIONSHIP PATTERN
BEFORE HOSPITALIZATION:
The patient is the fourth child of her parent. She lives with her husband together
with her three children. According to her, she has a good relationship among the members
of the family. She also stated she does her best to be a good wife, and a mother to her
children.

During Hospitalization
According to her, she is thankful because she has a good family that are always
there to support her. She stated that when she will be discharge she will do her job being a
good mother, husband and member of the family. She still involves herself in decision
making. According to her, their relationship among the members of the family became
stronger when was hospitalized.
IX.

SEXUALITY-REPRODUCTIVE PATTERN

BEFORE HOSPITALIZATION:
She experienced her first menstruation at the age of 14 years old with a duration
of usually 3-4 days. She never had noticed any bleeding between her menstrual cycles.
She sometimes experience dysmenorrhea. Her coitarch was with her husband when she
was 23 years old. She uses Contraceptive pills as a form of their family planning.
According to her, she is contented to her husband thats why she does not engage to any
sexual relationship outside marriage.
DURING HOSPITALIZATION:
She shows affection to her husband by hugging and kissing. Her condition doesnt
seem affected on how they show love and care to each other. Moreover, this binds them
more as family.

X.

COPING-STRESS TOLERANCE PATTERN

BEFORE HOSPITALIZATION:
She stated that when she has a problem she usually keep silent and usually think
that everything will be alright instead of doing things or wasting her time for nonsense
thing which can not help in solving the problem. But when she cant tolerate it anymore
thats the time that she will cry and ask for help. She stated that she asked help first to
God, then to her husband and family. She solves the problem without giving up
.During Hospitalization
She considers her condition right now as the most stressful event happened in her
life. She uses the same coping mechanism.
XI.

VALUE-BELIEF PATTERN

BEFORE HOSPITALIZATION:
The patients religious affiliation is Roman Catholic. She is attending mass with
her family often. She recognized God as source of strength and her also expresses her
faith and concerns to deceased person through atangs. She also believes in the power of
albularyos thats why she seeks some alternative medicines for sometimes. Her family
is the most important person in her life.

DURING HOSPITALIZATION:
According to the patient she shows communication to God through his prayers
and asks for recovery. She always prays before she sleeps. She still recognized God as
her source of strength.

LABORATORY AND DIAGNOSTIC EXAMINATIONS

COMPLETE BLOOD COUNT (CBC)
DATE: August 20, 2015
PARAMETER

NORMAL

RESULT

FINDING
110-170 g/L

NORMAL

concentration (Hgb)
Erythrocyte Volume 0.472

0.37-0.480

NORMAL

Fraction (hct)
Erythrocyte number 4.82

3.5-5.0 x 109/L

NORMAL

Hemoglobin

ACTUAL

FINDING
Mass 155

ANALYSIS

concentration
(RBC)
THROMBOCYTE

180

150-450 x 109/L

NORMAL

(Platelet)
LEUKOCYTE

11

4.0 x 109/L

INCREASED

(WBC

Due to injury to
the

endothelial

wall caused by
increased
pressure in the
wall
to

secondary
sluggish

circulation.

DATE: August 22, 2015

PARAMETER

ACTUAL

NORMAL

RESULT

ANALYSIS

FINDING
110-170 g/L

NORMAL

concentration (Hgb)
Erythrocyte Volume 0.465

0.37-0.480

NORMAL

Fraction (hct)
Erythrocyte number 4.85

3.5-5.0 x 109/L

NORMAL

Hemoglobin

FINDING
Mass 150

concentration
(RBC)
THROMBOCYTE

186

150-450 x 109/L

NORMAL

(Platelet)
LEUKOCYTE

7.8

4.0 x 109/L

NORMAL

(WBC
BLOOD CHEMISTRY
August 20, 2015
PARAMETER

ACTUAL

NORMAL

RESULT

ANALYSIS

Sodium
Potassium

FINDING
140.5
2.8

FINDING
135-148mEq/L
3.5-5.30mEq/L

NORMAL
DECREASED

Due to frequent
urination,
potassium loss
occurs

Creatinine

0.70

0.50-0.90
mg/dl

URINALYSIS

NORMAL

August 20, 2015

Color: straw
Transparency: slightly turbid
Microscopic Examination
WBC 5-7hpf
RBC 0-2 hpf
Epithelial Cells : Rare
Amorphous Urates :Few
Mucus Thread :Rare
Bacteria: Few
Ph 5.0- Neutral
Specific Gravity : 1.015 (1.010-1.020)
Glucose +++
Ketones +
nitrite, urobilinogen, bilirubin : NEGATIVE

ECG READING AND INTERPRETATION

August 20, 2015

NORMAL SINUS RHYTHM

RADIOGRAPHIC STUDIES
Chest X-RAY AP
August 20, 2015

NO RADIOGRAPHIC ABNORMALITIES SEEN.

PHYSICAL ASSESSMENT
DATE OF ASSESSMENT: AUGUST 22, 2015
MENTAL STATUS
LEVEL OF CONCIOUSNESS: The patient is fully awake, alert, conscious, and coherent
and responds to question spontaneously.
ORIENTATION: The patient is oriented to person, time and place as she recognized other
persons and herself and is aware of when and where she presently is.
APPEARANCE AND BEHAVIOR: The patient is well- dressed and properly groomed.
She is cooperative and can follow instruction appropriately.
SPEECH: The patient can speak and express herself clearly.
VITAL SIGNS:
BP: 150/90 mmHg
RR: 21cpm
PR: 99bpm
Temperature: 37.8
AREA

TECHNIQUE

NORMAL

ACTUAL

ANALYSIS

ASSESSED
Head

USED
Inspection,

FINDING
Normocephalic,

FINDINGS
Normocephalic,

Normal

Palpation

symmetrical,

symmetrical, absence

absence of wound, of wound, growth,

growth,

dandruff, dandruff,

inflammation,
eruption
swelling.

inflammation,
and eruption
swelling.

and

Hair

Inspection

Evenly distributed, Evenly

distributed, Normal

finely

distributed,

distributed, finely

thin, straight and thin,

straight

and

without lice knits or without lice knits or

Face

Inspection

sores.
Symmetrical,

sores.
no Symmetrical,

no Normal

lesions

no lesions

no

and

edema.

and

edema.

Eyes
Eyebrows

Inspection

Hair

evenly Hair

evenly Normal

distributed, equally distributed,

aligned and equal aligned
Eyelids

Conjunctiva
Cornea/Sclera

movement.
Skin intact,

Palpation

discharges, redness discharges,

Inspection
Inspection

movement.
w/o Skin intact,

w/o Normal

redness

and nodules.
nodules.
Pinkish
Pinkish
Normal
Whitish, cornea is Whitish, cornea is Normal

and

shiny transparent,

smooth

positive
Inspection

equal

lesions swelling, lesions and

transparent,

Pupils

and

Inspection,

swelling,

equally

smooth

blinking positive

reflex.
Black

in

equal

in

reactive

and and

to

shiny
and

blinking

reflex.
color, Black in color, equal Normal
size, in size, reactive to
light, light, visual acuity is

visual

acuity

is normal,

can

see

in

the

normal,

can

see objects

objects

in

the periphery, EOM is

periphery, EOM is coordinated,

coordinated,

w/o

w/o congestion,

edema,

congestion, edema, inflammation, cyst or

inflammation, cyst growth.
Lacrimal gland

Inspection

or growth.
and No
edema

Ears

palpation
Inspection

tearing
and Color same as the Color same as the Normal

Palpation

or No edema or tearing

facial skin
Both

facial skin

ears

are Both

symmetrical,
Auricle
with

Normal

ears

are

symmetrical,

aligned Auricle aligned with

the

outer the outer cantus of

cantus of the eyes, the eyes, w/o lesions,

w/o

lesions, tenderness,

redness,

tenderness, redness, discharges or scaling

discharges

Nose

Inspection
palpation

or and clean. Has the

scaling

and ability to hear.

clean.Has

the

ability to hear.
and No
discharges, No
ulceration, growth, ulceration,

discharges, Normal
growth,

nasal

polyps, nasal

polyps,

depression, mucous depression,

obstruction

mucous

and obstruction

and

tenderness. Has the tenderness. Has the

ability

to

smell. ability

Sinuses

Inspection

smell.

no Sinuses

tenderness
Lips

to

no

tenderness

No nasal flaring
No nasal flaring
Uniform, pink in Uniform, pink

in Normal

color, soft, moist color, soft, moist and

Mouth

and Inspection

and smooth
smooth
Tongue at midline Tongue at midline Normal

tongue

without lesion and without lesion and

Teeth

tenderness.
Complete,

Inspection

tenderness
white,
Complete,

white, Normal

shiny tooth enamel, shiny tooth enamel,

Neck

Inspection
palpation

free of debris
free of debris
and Negative neck vein Negative neck vein Normal
distention

distention

No masses

No masses

No tenderness

No tenderness

Able to flex and Able

to flex

and

extend

the

neck extend

without
RESPIRATORY
Chest and lungs

Inspection

the

any without

neck
any

discomfort

discomfort

Symmetric

chest Symmetric

chest Normal

expansion,

quiet, expansion,

quiet,

rhythmic

and rhythmic

and

effortless

effortless respiration

respiration

RR=12-20 cpm

RR=12-20 cpm.

Palpation

No tenderness and No tenderness and no Normal

no masses

Auscultation

(-)

masses

adventitious (-)

breath sounds

adventitious Normal

breath sounds

Cardiovascular

Auscultation

(-) abnormal heart (-) abnormal heart Normal

sounds,

regular sounds,

regular

rhythm and rate 60- rhythm and rate 60100bpm

Inspection
ECG

100bpm

using Normal heart rate Normal

and

rhythm.

abnormal
Abdomen

No and

heart

rate

rhythm.

No

ECG abnormal

Inspection

reading
Unblemished

Auscultation

and uniform color

and uniform color
Audible
bowel Audible
bowel Normal
sounds

reading
skin Unblemished

Palpation

sound
No

skin NORMAL

sounds

Absence of bruit Absence

of

bruit

sound
tenderness, No tenderness, relax Normal

relax abdomen
INTEGUMENTS

ECG

abdomen

Skin color

Inspection

Varies from light to Tan

Normal

dark brown

Skin

color Inspection

uniformity

General
except

uniform General
on

areas except

exposed to sun

Skin Turgor

Palpation

When

uniform Normal
on

areas

exposed to sun

pinched, When pinched, skin Normal

skin springs back to springs

back

to

previous state

previous state

Inspection

Convex

Convex

Normal

Inspection

Highly vascular and Pinkish

Normal

Nails
Fingers and toes
Nail bed color

pinkish
Texture
Extremeties

Palpation
Inspection
palpation

Smooth to touch
Smooth to touch
Normal
and No lesions, edema, Noted with wounds Due to

slug

numbness, tingling not yet healed

circulation, oxy

and weakness can

supply

move
can

freely

and

ambulate

independently.

(+) weakness

to

lo

extremities
decreases

cau

long tern healin

the wound

ANATOMY AND PHYSIOLOGY

Diabetes is a disorder that affects the amount of sugar in the blood. There are
many types of sugar. Some sugars are simple, and others are more complex. Table sugar
(sucrose) is made of two simpler sugars called glucose and fructose. Milk sugar (lactose)
is made of glucose and a simple sugar called galactose. The carbohydrates in bread, pasta,
rice, and similar foods are long chains of different simple sugar molecules. Sucrose,
lactose, carbohydrates, and other complex sugars must be broken down into their
component simple sugars by enzymes in the digestive tract before the body can absorb
them. Once the body absorbs simple sugars, it usually converts them all into glucose,
which is the main source of fuel for the body. Glucose is the sugar that is transported
through the bloodstream and taken up by cells. Blood "sugar" really means blood
glucose.
Insulin, a hormone released from the pancreas, controls the amount of glucose in the
blood. Glucose in the bloodstream stimulates the pancreas to produce insulin. Insulin
allows glucose to move from the blood into the cells. Once inside the cells, glucose is
converted to energy, which is used immediately, or the glucose is stored as fat or
glycogen until it is needed.
The levels of glucose in the blood vary normally throughout the day. They rise after a
meal and return to normal within about 2 hours after eating. Once the levels of glucose in
the blood return to normal, insulin production decreases. The variation in blood glucose
levels is usually within a narrow range, about 70 to 110 milligrams per deciliter (mg/dL)
of blood in healthy people. If people eat a large amount of carbohydrates, the levels may

increase more. People older than 65 years tend to have slightly higher levels, especially
after eating.
If the body does not produce enough insulin to move the glucose into the cells, or if the
cells stop responding normally to insulin, the resulting high levels of glucose in the blood
and the inadequate amount of glucose in the cells together produce the symptoms and
complications of diabetes.

PATHOPHYSIOLOGY
OF
DIABETES MELLITUS
TYPE II

PATHOPHYSIOLOGY OF DIABETES MELLITUS

PREDISPOSING FACTOR

ETIOLOGY: UNKNOWN

PRECIPITATING FACTOR
-Obesity

-Genetics

-Hypertension

-Age>45 years old

-Race: Caucasians, African American

-Diet
-Occupation

-Gender

-Sedentary Lifestyle
-Stress, Trauma, Surgery

INCREASED BLOOD GLUCOSE LEVEL (HYPERGYCEMIA)

SIGNALS HYPOTHALAMUS TO STIMULATE PANCREAS TO RELEASE INSULIN

DECREASE INSULIN (NOT ENOUGH

OR INSULIN RESISTANCE) TYPE 2

NO INSULIN PRODUCED- AUTOIMMUNE

DAMAGE OF THE PANCREAS- TYPE 1

FURTHER INCREASE IN BLOOD SUGAR

OSMOTIC DIURESIS

POLYDIPS
THIRST
IA

POLYPHAG

Potassium Loss

LIPOLYSIS

INCREASE VISCOSITY OF BLOOD

SLUGGISH CIRCULATION OF BLOOD

POLYURIA

wt.

GLUCOSURI

LOSS
CELLULAR DHN

CELLULAR STARVATION

POLYPHAGIA

LIPOLYSIS (FATS)

KETONE BODIES FORMATION

DIABETIC KETOACIDOSIS

DECREASE OXYGEN SUPPLY TO VITAL

ORGANS OF THE BODY

KIDNEY

ACTIVATION OF RAAS

WATER AND SODIUM

RETENTION

ACETONE BREATH

INCREASE PRESSURE IN BLOOD

VESSEL WALLS (HYPERTENSION)

KETONURIA
KUSSMAULS RESPIRATIONS

MACROVASCULAR
BLOOD VESSEL WALLA THICKEN SCLEROSE AND
OCCLUDED BY PLAQUE
Coronary Artery Disease
Cerebrovascular Disease
Peripheral Vascular Disease
>Diminished Peripheral Pulses
>Intermittent Claudication

MICROVASCULAR
EYES- Blurring of Vision->Blindness (DIABETIC
RETINOPATHY)
KIDNEY- Decrease Kidney Function
-Microalbuminuria
-Anemia, thirst, Fatigue, Frequent UTI
-(DIABETIC NEPHROPATHY)
NERVES- Paresthesia, Absent Reflexes, pain, weakness,
numbness and loss of sensation (DIABETIC NEUROPATHY)

NURSING CARE PLAN

ASSESSMENT
OBJECTIVE:

Temperature: 37.8

DIAGNOSIS

PLANNING

Altered body

At the end of the shift

temperature:

the patient body

hyperthermia related to

temperature will

INTERVENTION
Encouraged light dressing

EVALUATION
Goal met. Patients
body temp decreased

Promoted well ventilated

from 37.8 degree

degree celcius

increase pyrogen in the

decrease from 37.8-37

body

degree celcius.

room
Tepid sponge bath rendered.

Warm to touch skin

Subjective:
maiinit ang

Paracetamol given as
ordered.

pakiramdam ng paa
ko

IVF rate regulated properly

to promote hydration.

celcius to 37 degree
celcius.

ASSESSMENT
Weakness, easy

DIAGNOSIS
Activity intolerance

PLANNING
After 1 day of

fatigability, ,

related to sluggish

nursing

dizziness

circulation of the

intervention, the

BP=150/80 mmHg

blood resulting to

patient will be able

increase oxygen

to report

demand.

measurable increase

Subjective:
Nanghihina ako

in a activity
tolerance as
evidence by
patients
verbalization OK
na ako,hindi na ako
mahina, kaya ko ng

INTERVENTION
Assessed the baseline tolerance for
activity, ability to adapt to

patient demonstrated

limitations and restrictions to

active participation.

lifestyle
Instructed patient to avoid extending
activities beyond tolerances to
conserve energy and oxygen
demand.
Assessed for presence of factors
contributing to fatigue such as
presence of acute or chronic illness.
Promoted comfort measures by
assisting during ROM and provide
for relief of pain as prescribed to

enhance ability to participate.

gawin ang mga dati Planned care to carefully balance
kong ginagawa

EVALUATION
Goal met; the

rest period with activities.

ASSESSMENT
OBJECTIVE:

PLANNING
After 1 hour of nursing

INTERVENTION
Observed localize signs of

EVALUATION
Goal met; the

Presence of unhealed

interventions, the patient

infection particularly at

patient identified

open wound on lower

will be able to identify

lower extremities to assess

interventions to

extremities for 2

interventions to prevent

causative factors.
Stressed proper hand hygiene

prevent or reduced

weeks.

DIAGNOSIS
Risk for infection

or reduce risk of
infection.

SUBJECTIVE:
Parang mainit ang
pakiramdam ng
akong paa. Medyo
Makati din.

to client, relatives and all

health care providers directly
related to the care of patient
to prevent introduction of
microorganisms when
handling the area affected.
Cleaned the affected area
with betadine and changed
dressing as indicated using
aseptic technique to prevent
bacterial growth and prevent

risk of infection such

as proper hand
washing and
cleaning the affected
area with betadine.

cross contamination.
Stressed proper foot care for
easy and fast healing and
prevent infection.
Administered Cefazolin 1
gram/ IV, an antibiotic, as
ordered

DRUG STUDY

CEFAZOLIN
Classification: Anti- Infective
Therapeutic actions:
Interferes with bacterial cell wall synthesis, causing cell to rupture and die.
Indications:
To treat bacterial infections of the skin.
Contraindications:
Contraindicated to patient with hypersensitivity to cephalosporin or penicillin.
Nursing interventions:
Administer drug slowly, to promote comfort measures.
Provide thorough patient teaching, including measures to avoid adverse effects
and warning signs of problems.
Instruct patient to report reduce urinary output, bruising and bleeding.
Administer drug exactly as prescribed.
Review all other significant and life threatening adverse reactions, especially
those related to the drugs.

KETOROLAC
Classification: Analgesic, antipyretic, anti inflammatory, NSAIDs
Therapeutic Actions:
Interferes with prostaglandin synthesis by inhibiting cyclooxygenase pathway of
arachidonic acid metabolism.
Indications: Moderate to severe pain
Contraindications. Contraindicated in patients with hypersensitivity to drug or other
NSAIDs.
Advance renal impairment, risk for renal failure.
Nursing interventions:
Inform patient drug is meant only for short term pain management.
Instruct patient to report bleeding and adverse CNS reaction
Provide thorough patient teaching, including measures to avoid adverse effects and
warning signs of problems.

PARACETAMOL
Classification: Analgesic, Antipyretic
Therapeutic Actions:
Pain relief may result from inhibition of prostagaldin synthesis in CNS, with subsequent
blockage of pain impulses
Fever reduction may result from vasodilation and increase peripheral blood flow in
hypothhhalamus, which dissipates heat and lowers body temperature.
Indications: Mild pain or Fever
Contraindications: Contraindicated in patients with hypersensitivity to drug
Nursing interventions:
Assess type of pain and assess fever.
Assess hepatic, hematologic and renal function.
Provide thorough patient teaching, including measures to avoid adverse effects
and

warning signs of problems.

METFORMIN
Classification: Nonsulfonylureas
Therapeutic Actions: May increase the peripheral use of glucose, increase production of
insulin, decrease hepatic glucose production, and alter intestinal absorption of glucose
Indications: Adjunct to diet and exercise for the treatment of type II DM.
Contraindications: Contraindicated in patients with hypersensitivity to drug.
Nursing interventions:
Administer the drug as prescribed in the appropriate relationship to meals to
ensure therapeutic effectiveness.
Monitor nutritional status to provide nutritional consultation as needed.
Monitor response carefully, blood glucose monitoring is the most effective way to
evaluate dosage.
Monitor patients response to the drug (stabilization of blood glucose levels)
Monitor for adverse effects (Hypoglycemia, GI upsets)
Monitor the effectiveness of comfort measures and compliance to the regimen.

INSULIN
Classification: Replacement Insulin
Therapeutic Actions: Promotes the storage of bodys fuels, facilitates the transport of
various metabolites and ions across cell membranes, and stimulates the synthesis of
glycogen from glucose, of fats from lipids, and of proteins from amino acids.
Indications: Use to treat Type I DM, Type II DM in patients whose diabetes can not be
controlled by diet or other agents.
Contraindications: NO Contraindications because insulin is used as hormonal
replacement.
Nursing interventions:
Gently rotate vial and avoid vigorous shaking to ensure uniform suspension of
insulin.
Give insulin thru SQ and rotate injection sites regularly to avoid lipodystrophy.
Administer the drug as prescribed in the appropriate relationship to meals to
ensure therapeutic effectiveness.
Monitor nutritional status to provide nutritional consultation as needed.
Monitor response carefully, blood glucose monitoring is the most effective way to
evaluate dosage.
Monitor patients response to the drug (stabilization of blood glucose levels)

Monitor for adverse effects (Hypoglycemia)

Monitor the effectiveness of comfort measures and compliance to the regimen.