Introduction:

Type II Diabetes is the most common form of Diabetes Mellitus it is

sometimes called age-onset, adult-onset diabetes or non-insulin dependent.
DM type II is a metabolic disorder characterized by the relative deficiency of
insulin production and a decreased insulin action.

In our country 3 out of 5 adults are already diabetic or on the verge of

developing diabetes, 20.6% of adult population on the age of 30 and above
suffers from diabetes. The causes of DM are unclear; however it seems to be
that age, family history of diabetes and obesity which is considered as the chief
risk factor for developing type II diabetes because 80-90% of people with this
disease are obese because obesity causes insulin resistance, that’s the reason
why obese people need very large amounts of insulin to maintain normal blood
sugar levels.

Symptoms of Type II diabetes can begin so gradual that a person may not
know that he or she has it. Early signs are lethargy, extreme thirst, and frequent
urination. Other symptoms may include sudden weight loss, slow wound
healing, urinary tract infections or blurred vision.

The case focuses on a 72 year old male, Mr.GG who was admitted last January
30, 2010 at Veterans Memorial Medical Center and has an admitting diagnosis
of DM type II, CHF, HASCVD, CKD secondary to DM nephropathy, anemia,
CAP-MR. The patient was handled by the 3rd year nursing student with the
supervision of Prof. Gemma Lana.

This case study covers a wide variety of significant and relevant information
such as the demographic profile, nursing history, pathophysiology,
laboratory/diagnostic study and also the drug study that is needed for the case
analysis.
Goals and Objectives:

General:

The study intends to discuss and elaborate the client’s present health
condition to the readers and to apply knowledge and skills learned and gained
from related learning experience in approaching to patient with Diabetes
Mellitus.

Specific:

Knowledge:

1.) To raise the awareness regarding the disease, most especially to those
who are at risk of the condition.

2.) To understand the nature of the disease.

3.) To identify and analyze signs and symptoms manifested by the patient in
order to fully understand the nature of the disease.

Skills:
1.) To provide proper nursing interventions in providing care to the patient.

Attitude:
1.) To help the patient as well as his family to cope up with the disease.
 NURSING HEALTH HISTORY

BIOGRAPHIC DATA

A. Biographic Data

Name: Mr. GG

Address: Pasay City

Age: 72 years old

Sex: Male

Race: Filipino

Marital Status: Married

Occupation: Retired Airforce

Religious Orientation: Roman Catholic

Health Care Financing and Usual source of Medical Care: Family

Admitting Diagnosis: DM Type II, CHF, HASCVD, CKD secondary to DM

nephropathy, Anemia, CAP-MR

Date of admission: January 30, 2010

Room #: 265

NURSING HISTORY

A. Chief Complaint or Reason for Visit

The client was brought to the hospital due to the swelling and presence of non
healing wound on his right leg/ foot. He also complains of on and off fever.

B. History of Present Illness

Two months prior to admission, Mr. GG accidentally stepped on a staple wire

that caused a small wound on his right foot but no consultation was done. The client
did not take any medications. Few days later, the patient noticed that his right foot’s
wound doesn’t heal; instead it grew larger which causes pain to the client. He noted
 gradual swelling and redness on the right leg and foot but still no consultation was
done.

Three days prior to admission, the client had an on and off fever accompanied
by body and muscle weakness, anorexia, productive cough with intermittent dyspnea.
The patient was then admitted to the institution on January 30, 2010.

C. Past history

As recalled by the patient, he never had a disease when he was still a child
except for fever, common cold and cough. He has no known allergy to drugs and
foods. The client had appendicitis at the age of 27. The client also has been
diagnosed to have kidney stones in 2002 and had Extracorporeal Shock Wave
Lithotripsy. He is known to be hypertensive and diabetic since year 2000. He
maintains Irbesartan 150 mg/tab and and Humulin N 42 ‘u” in morning, and 28 ‘u” at
night (Subcutaneous).

D. Family History of Illness

The patient’s mother died because of Tuberculosis. His father is known to be

diabetic and died due to hypertension. One of Mr. GG’s siblings is diagnosed to have
Diabetes Mellitus.

FATHER
MOTHER
-with Diabetes
Mellitus and -with TUBERCULOSIS
HYPERTENSION

1st child 2nd child MR. GG 4th child 5th child

-with DM -not -with DM -not -not
diagnose & HPN diagnose diagnose
d d d

PATTERNS OF FUNCTIONING
E. Functional Health Problem

1. Health Perception and Health Management Pattern

According to the patient, his condition is much better now compared to his condition
prior to hospitalization. The most important thing done to keep and maintain his health is
through eating green leafy vegetables, and exercising. The client is a non-smoker but admits
that he is a heavy alcohol drinker. He started drinking alcohol at the age of 13. According to
the patient, he drinks alcohol almost every day with his friends and they can consume 3
cases of beers. The client’s wife states that the patient has difficulty in following the nurses’
and doctors’ order. The client believes that the possible cause of his illness was genetically
associated.

INTERPRETATION: The client does not comply with the orders of the medical team for
proper health management.

ANALYSIS: Ill client may experience behavioral and emotional changes, changes in self-
concept and body image, and lifestyle. Behavioral and emotional changes associated with
short-term illness are generally mild and short lived. (Fundamentals of Nursing 7 th edition by
Kozier p. 183)

2. Cognitive – Perceptual Pattern

The client has decreased visual acuity and uses eyeglasses in reading. He also has
decreased hearing acuity. He is able to recall things happened in the past. The patient had a
formal education and finished college studies. He is able to read and write and has no
difficulty on understanding things and answering questions.

INTERPRETATION: The client has some deviations regarding his physical health. He can
understand things without difficulties.

ANALYSIS: If the aging person’s senses are impaired, the ability to perceive and react with
the environment is diminished. Changes in cognitive structures occur as the person ages.
(Fundamentals of Nursing 7th edition by Kozier et al. p.648)

3. Self – Perception and Self – Control Pattern

 The client becomes moody since he has been admitted to the hospital. According to
him, since the wound on his right foot worsen, he started having difficulty walking and doing
things he usually does. The disease of the client affects his self perception, because most of
the time he feels weak. His condition doesn’t affect his relationship with his family.

INTERPRETATION: Client's self perception and frame of mind may change due to some
changes in his body functions.

ANALYSIS: Image of physical or body image, is how a person perceives the size,
appearance, and functioning of the body and its parts. (Fundamentals of Nursing 7 th edition
by Kozier et al. p. 959)

4. Role – Relationship

The patient lives in his own house together with his wife. He states that he gets
along with his family and is open with each other. According to him, there are no major
conflicts in his family. If there’s a problem, they just talk about it and find a way to resolve it.
He never feels lonely because his wife is very supportive and is always there for him. He also
belongs in a “Konsilyo” wherein they are actively participating in activities in their church.

INTERPRETATION: The client’s family is close to each other because they still communicate
with one another and they can easily resolved family problems with the help of each family
member.

ANALYSIS: Interaction is a way of expressing feelings to others. Openness is significant to

individual. (Fundamentals of nursing 7th edition by Kozier et al. p. 193)

5. Sexuality – Reproductive Pattern

There are no significant changes in client’s sexual relations with his partner.

INTERPRETATION: The client is still sexually healthy. Not only basing on the frequency of
sexual contact but more especially with sexual relationship with other members of the family
aside from the husband. Being able to express self through love and care is even considered
as characteristic of healthy sexual relations.
ANALYSIS: Elders may define sexuality far more broadly and include their definition such
things as touching, hugging, romantic gestures, comfort, warmth, dressing-up, joy, spirituality
and beauty. (Fundamentals of Nursing 7th edition by Kozier et al. p. 1022)

6. Coping – Stress Tolerance Pattern

His family is the one considered to be the most important thing to him. His wife is
recognized as the person the most available to him since his son doesn’t live with them
anymore. He handles stressful situation in his life by confiding his problem to his wife and by
praying to God. When he talks, he establishes eye contact and the gestures, body language,
and tone of voice compliments with his emotions.

INTERPRETATION: The client values his family most. Whenever there is a problem, he
always seeks guidance from her family.

ANALYSIS: The coping mechanism can be viewed as an active method of problem solving
developed to meet life's challenges. (Fundamentals of nursing 7th edition by Kozier et al. p.
193)

7. Value Belief Pattern

The things important to the client are faith and love of family. Religion is very much
important to the client. According to him, he always goes to church every Sunday when he is
not yet admitted. Even though he can no longer go to church, his faith to God doesn’t fade.
Problems are handled through faith and praying to God.

INTERPRETATION: The client is very family oriented and values the family so much.

ANALYSIS: Most people derive values from the society in which they live. A person may
internalize some or all of these values and perceive them as a personal value. People need
societal values to feel accepted and they need personal values to individualize them.
(Fundamentals of nursing 7th edition by Kozier et al. p. 321)

8. Emotional Pattern
 During our first encounter with the patient, he was irritable and doesn’t want to have
conversation with other people because of his condition. Changes in the mood of the client
are very frequent. He admitted the feeling of being irritable because of his present condition.

INTERPRETATION: He experiences mood swings, primarily because of the illness requiring

a lot of control and discipline.

ANALYSIS: The manner in which a person handles trust throughout each phase of life will
influence the way the person reacts to illness. (Fundamentals of Nursing by Perry and Potter,
p. 95)

9. Cultural Pattern

Family gatherings such as birthdays, Christmas and New Year celebrations have been
one of the traditions in the family wherein the chance of mingling and getting together with
other relatives is done.

INTERPRETATION: The client gives time and importance of being involved in family
gatherings.

ANALYSIS: Culture and social interactions influence how a person perceives, experiences,
and copes with health and illness. Each culture has ideas about health, and these are often
transmitted from parents to children. Cultural rules, values, and beliefs give people a sense
of being stable and predict outcomes. (Fundamentals of nursing 7th edition by Kozier et al. p.
178)

10. Recreational Pattern

The client watches television shows and listening to the radio at times he’s alone.
During his spare time, he is fond of walking along the streets.

INTERPRETATION: The client enjoys being at rest, watching television, and walking along
the streets before hospitalization.

ANALYSIS: Recreation can be beneficial force. It can provide common goals and
measurable experiences that strengthen bonds. On the other hand, it can also be a negative
force if it draws apart for extended periods if they participate in differently. (Health Promotion:
Concepts, Assessment and Intervention p.217)
11. Environment

The client lives in a comfortable place. As verbalized by the client, their house is
enough for them to live in. There are no noises or odors in the environment. They have no
pets in their house.

INTERPRETATION: The client is favorable and comfortable with their environment and
doesn’t have any problem with it.

ANALYSIS: Environment is all of the conditions, circumstances and influences surrounding

and affecting the development of an organism or person. (Fundamentals of Nursing 7 th
edition by Kozier et al. p. 1451)

12. Hygiene

Since admission, the client doesn’t have much time for his personal hygiene the way
he used to have before but with the help of his wife ensures his own hygiene.

INTERPRETATION: The client is still hygienic during his stay at the hospital.

ANALYSIS: Health and Energy, ill people may not have the motivation or energy to attend to
hygiene. (Fundamentals of Nursing 7th edition by Kozier p. 698)

Activities of Daily During Interpretation Analysis/

Living Hospitalization Reference
Nutrition-Metabolic Patient eats food The client eats less The client had
Pattern high in cholesterol than his usual food
and salt like fried meal. He had food restrictions.
meats and chicken restrictions such as
but he eats low salt, low fat and Individual's
nonconventional low cholesterol health status
food that he meals and has a greatly affects
prepares himself. limited fluid intake eating habits
Fluid intake was of 1000-1500 ml and
approximately 1000 per day. nutritional
ml/day. There are status.
no food restrictions. (Fundamental
s of Nursing
by Kozier et
al. p. 1178)

Elimination Pattern The client usually He urinates 6-7 Client’s fluid

urinates 4-5 times a times per day and intake is
day and was is approximately limited. Color
approximately 600- 800-900 ml a day. of urine is
700 ml a day. Urine Urine is tea colored affected due
is yellow and there’s and there’s no to the side
no difficulty in difficulty in effect of the
urination. urination. Metronidazole
The client’ The client’s bowel . It causes
defecates once a elimination pattern dark urine
day. The color of is twice a week. output. The
stool is brown and client’s BM
he has no difficulty decreased
in bowel elimination. due to
immobility
and use of
medications
(Furosemide
and
Irbesartan,)

Elimination
patterns vary
at different
stages of life
circumstance
s of diet, fluid
intake and
output;
activity,
physiologic
factors,
lifestyle,
medications
and medical
procedures
 and disease
also affect
elimination.
(Fundamental
s of Nursing
7th Ed. By
Kozier et al.
p. 1228)

Activity-Exercise There is sufficient The client feels The client

Pattern energy for weak. There is no requires
completing desired sufficient energy for assistance in
activities such as completing task doing some of
household chores. and has no his activities.
Patient does not do exercise. He strolls His activities
exercise. The around the corridor are affected
patient is in full self of the ward using by his disease
case in all activities his wheelchair. The process.
in the house and patient is not
does not require completely Assistance
assistance from dependent but from others or
others. requires some the use of
assistance from his mechanical
family due to his aids is
wound on right foot. essential for
clients with
impaired
activity.
(Fundamental
s of Nursing
8th ed. By
Kozier et al.
p. 1160)
Sleep-rest Pattern The client usually There is no specific There is
sleeps at 8pm. He time the client change in
usually wakes up at sleeps at night. He client’s
3am to have some usually wakes up sleeping
exercise. He has a every 1 hour. pattern. He
usual 5-7 hours of Maximum hour of has difficulty
sleep. He takes 1-2 sleep he gets is in sleeping
hour of nap in the only 3 hours then during
afternoon. He has takes nap at the hospitalization
no difficulty in afternoon for 1 .
sleeping. hour. The client’s
sleep is not Illness that
continuous and has causes pain
difficulty in or physical
sleeping. distress can
Sometimes, he also result in sleep
becomes dyspneic problems
 at night. (Fundamental
s of Nursing
7th ed. By
Kozier et al.
p. 1029)

Substance Abuse The client doesn’t The client doesn’t The client is a
smoke but drinks smoke nor drink smoker but a
alcoholic alcoholic heavy alcohol
beverages. beverages. drinker.

Use of
alcohol,
cigarette
smoking, and
drugs/medica
tions may
affect the
lungs and
other body
systems,
which can
affect ones
health.
(Fundamental
s of Nursing
by Kozier et
al. p. 901)
 PREDISPOSING FACTORS:
PRECIPITATING FACTORS: Age – 72 years old
Obesity – BMI: 34 Family History
Sedentary Lifestyle Diabetes Mellitus
Hypertension

Risk for altered insulin secretions

Beta cells
Altered pancreatic insulin secretions dysfunction Resistance to action of

Insulin-stimulated
glucose uptake by
tissues
 Cell

Hyperglyce Fat & protein

mia breakdown to produce

Large doses of Pressure of Weak Impaired Level of

H2O in the blood vessel immune glucose plasma and
in kidney system triglycerides

Polyu Stressed kidney Ventricular

ria filtration Growth of Damage in gallop S3
microorganis peripheral
m
Thickening Risk for
Intracellul Pneumonia Poor
of
ar peripheral
glomerulus
dehydratio Pumping
Crackl Cou
DO
Diabetic gh ability of the
Polydips es B Poor
nephropat heart becomes
iaa wound
hy
healing
CKD Leads to
Wound / skin

Cellulitis (R) Side of

Reabsorptio Swelli heart is
n of glucose Peeling of ng
skin
Glycosu Peripheral
Skin Edema
ria
discoloration
(black)