Introduction

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects

in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with

long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves,

heart, and blood vessels.

Several pathogenic processes are involved in the development of diabetes. These range from

autoimmune destruction of the -cells of the pancreas with consequent insulin deficiency to

abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate,

fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin

action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or

more points in the complex pathways of hormone action. Impairment of insulin secretion and defects in

insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either

alone, is the primary cause of the hyperglycemia.

Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with

polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also

accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are

hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.

"Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb

amputation" -WHO.

There are two(2) Types of diabetes, Type 1 diabetes (previously known as insulin-dependent,

juvenile or childhood-onset) is characterized by deficient insulin production and requires daily

administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with

current knowledge. Symptoms include excessive excretion of urine(polyuria), thirst(polydipsia),

constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.

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 Introduction

Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the bodys

ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the

world, and is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the

disease may be diagnosed several years after onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly

frequently in children.(World Health Organization)

Globally, The number of people with diabetes has risen from 108 million in 1980 to 422

million in 2014. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another

2.2 million deaths were attributable to high blood glucose in 2012. Almost half of all deaths

attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will

be the seventh leading cause of death in 2030 (World Health Organization)

In the Philippines, At least six million Filipinos all over the country have been diagnosed to

have diabetes (Philippine Daily Inquirer. Aug 13 2016) Dr. Augusto Litonjua, president of the

Philippine Center for Diabetes Education Foundation, warned that this figure could double to 12

million or even more by 2040 because of undiagnosed diabetes cases.

"We are losing the war againts diabetes because diabetes keeps increasing in prevalence around

the world." -Dr. Litonjua

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 Introduction

Diabetes Mellitus indeed is a very deadly and scary disease which could be 1 of the leading

causes of death in the near future if we don't act today, but even diabetes is very deadly we can prevent

through our lifestyle, Lifestyle plays a very important role in maintaining our health, even the simplest of

exercise can reduce the risk of developing diabetes, Diet which is also very vital in preventing the

occurence of diabetes mellitus, As said by Dr. Litonjua we should avoid the "Ks" which is

Katakawan(Gluttony), Katamaran(laziness), Katabaan(Obesity) to increase our defense against this

deadly disease.

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 Personal Information

PERSONAL DATA

Patient's Name : Ladica, Elizer Calanday

Religion: Roman Catholic

Nationality: Filipino

Address: Calandagan, Aracelli

Birthday: 1/ 25/1960

Age: 57

Contact Person: Ester Ladica (Grandson)

Physician: Dr. Ladica

Date of Admission: August 13, 2017

Final Diagnosis: Diabetic Foot (R), Sever anemia, Acute Renal Failure 2 infection of CKD 2 DM

nephropathy, S/P BKA

PRESENT MEDICAL HISTORY

Mr. E.L is a 57 year old male admitted on Aug. 13, 2017 with a past medical history of DM who present

himself today complaining of non-healing wound. The wound has been gradually worsening over the

past months. on Aug. 14 Mr. E.L undergone the procedure insertion of Intra Jugular Catheter. August 15

Mr. E.L undergone his first Hemodialysis . August 18 Mr. E.L undergone another Hemodialysis. August

19 Mr. E.L undergone BKA or Below Knee Amputation to control the necrosis of the skin. August 20

Client undergone another Hemodialysis. August 22 Mr. E.L was ordered of MGH.

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 Personal Information

PAST MEDICAL HISTORY

Mr. E.L was hospitalized on 2011 due to DM foot(L) but was able to save the foot and didn't

undergone any amputation. Mr. E.L recalled that his parents doesn't have any history of the disease and

verbalized that it was his lifestyle that caused the said illness as he was very fond of eating sweet foods

prepared by his wife. Mr. E.L is the Eldest among 9 siblings and could not remember any immunizations

he was able to take. He verbalized that he experience colds, lbm , measles, chicken pox before when he

was young. His wife is monitoring his blood glucose in their house as they have their own glucometer.

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 Physical Assesment

Integument

Skin: The clients skin is yellowish in color, both Right and Left lower leg skin is dark, dry and shiny.

presence of foul odor on right foot.

Hair: The hair of the client is thin, hair is no evenly distributed and most part of the scalp is bald with

presence of hair in parietal region.

Nails: The client has a light brown nails and has the shape of convex curve and slightly longer than the

normal height due to failure of cutting which is advised by the AP to avoid injury. When nails pressed

between the fingers (Blanch Test), the nails return to usual color in more than 3 seconds.

Head

Head: The head of the client is round in shape

Skull: There are no nodules or masses and depressions when palpated.

Face: The face of the client appeared smooth but saggy and has uniform consistency and with no

presence of nodules or masses.

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 Physical Assesment

EENT

Eyebrows: Hair is evenly distributed..

Eyelashes: Eyelashes appeared to be equally distributed and curled slightly outward.

Eyelids: There were no presence of discharges, no discoloration and lids close symmetrically with

involuntary blinks approximately 10-12 times per minute.

Eyes: The pupils of the eyes are black and equal in size. The iris is flat and round. PERRLA (pupils equally

round respond to light accommodation), sclera is in jaundice

Ears: The Auricles are symmetrical and has the same color with his facial skin. The client is able to hear

clearly

Nose: The nose appeared symmetric, straight and uniform in color. There was no presence of discharge

or flaring. When lightly palpated, there were no tenderness and lesions

Mouth: The lips of the client are uniformly pink; moist, symmetric and have a smooth texture.

Teeth and Gums: enamels light yellow in color, no retraction of gums, pinkish in color of gums. The

buccal mucosa of the client appeared as uniformly pink; moist, soft, glistening and with elastic texture.

The tongue of the client is centrally positioned. It is yellowish in color, moist and slightly rough. There is

a presence of thin whitish coating.

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 Physical Assesment

Neck: The neck muscles are equal in size. The client showed coordinated, smooth head movement with

no discomfort. The lymph nodes of the client are not palpable. The trachea is placed in the midline of

the neck. The thyroid gland is not visible on inspection and the glands ascend during swallowing but are

not visible.

Thorax, Lungs, and Abdomen

Lungs / Chest: The chest wall is intact with no tenderness and masses. Theres a full and symmetric

expansion and the thumbs separate 2-3 cm during deep inspiration when assessing for the respiratory

excursion. The client manifested crackles during respiration. Heart: There were no visible pulsations on

the aortic and pulmonic areas. There is no presence of heaves or lifts.

Abdomen: The abdomen of the client has a saggy skin and is uniform in color. The abdomen has a

symmetric contour. There were symmetric movements caused associated with clients respiration.

There is presence of Intra Jugular Catheter Attached to (R) Intra-Jugular Vein.

The extremities are symmetrical in size and length. After Aug. 19 2017, S/P BKA on (R) Leg the

extremities are non-symmetrical in size and length.

Muscles: The muscles are not palpable with the absence of tremors. (R) Lower leg is exhibiting necrosis

with dark, dry and shiny in appearance. After Aug. 19 2017, S/P BKA on (R) Leg exhibited tremors when

trying to lift the leg for wound dressing.

Bones: There were no presence of bone deformities before BKA procedure.

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 Anatomy and Physiology

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 Anatomy and Physiology

The human digestive system is a complex series of organs and glands that processes food. In order to

use the food we eat, our body has to break the food down into smaller molecules, and it also has to

excrete waste.

Most of the digestive organs (like the stomach and the intestines) are tube-like and contain the

food as it makes its way through the body. The digestive system is essentially a long, twisting tube that

runs from the mouth to the anus, plus few other organs (like the liver and pancreas) that produce or

store digestive enzymes.

THE DIGESTIVE PROCESS

The digestive process begins in the mouth. Food is partly broken down by the process of

chewing and by chemical action of salivary enzymes (these enzymes are produced by the salivary glands

and break down starches into smaller molecules

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 Anatomy and Physiology

After being chewed and swallowed, the food enters the esophagus. The esophagus is a long

tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements.

Then, food enters the stomach which is a large, sac-like organ that churns the food and bathes it

in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach

acids is called chyme.

After being in the stomach, food enters the jejunum, the duodenum and then the ileum of the

small intestine. In the small intestine, bile (produced in the liver and stored in the bladder), pancreatic

enzymes and other digestive enzymes produced by the inner wall of the small intestine help in the break

down of food.

After passing through the small intestine, food passes into the large intestines. Here, some of

the water and electrolytes are removed from the food. Many microbes (like Bacteroides, Lactobacillus

acidophilus, Escherichia coli and Klebsiella) in the large intestines help in the digestion process. The first

part of the large intestine is called cecum in which the appendix is connected, food

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 Anatomy and Physiology

then travels upward in the ascending colon, then travels across the abdomen in the transverse colon to

the descending colon then to the sigmoid colon.

Solid waste is then stored in the rectum until excreted via the anus.

The illustration above shows two cycles occurring separately to maintain homeostasis in the body. When

glucose levels are too high the pancreas secretes insulin to convert excess glucose to gycogen for

storage. When glucose levels are too low the pancreas produces glucagon to convert stored glycogen to

glucose, resulting in an increase in glucose levels.

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 Anatomy and Physiology

DIABETES MELLITUS

Diabetes Mellitus is a group of metabolic disorders characterized by elevated levels of blood

glucose (hyperglycemia) resulting from defects in insulin production or secretion, decreased cellular

response to insulin or both. Because cells cannot use glucose, fats and even proteins are broken down

and used to meet the energy requirements of the body. As a result, body weight begins to decline. Loss

of body proteins leads to a decreased ability to fight infections, so diabetics must be careful with their

hygiene and in caring for even small cuts and bruises.

TYPES OF DIABETES MELLITUS

TYPE I DIABETES MELLITUS

TYPE 1 Diabetes Mellitus also called Insulin Dependent Diabetes Mellitus starts in childhood

or adolescence is usually more severe than that beginning in middle or old age. Patients have little or no

ability to produce the hormone and are entirely dependent on insulin injections for survival.

TYPE II DIABETES MELLITUS

Type 2 Diabetes Mellitus also called adult-onset diabetes or Noninsulin Dependent Diabetes

Mellitus. This form of diabetes occurs most often in people who are overweight and who do not

exercise. Type II is considered a milder form of diabetes mellitus because of its slow onset and can

usually be controlled with diet and oral medication. In Type II diabetes, the pancreas may produce

enough insulin, however, cells have become resistant to the insulin produced and it may not work as

effectively. Symptoms can begin so gradually that a person may not know that he has it.

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 Bibliography

http://www.nejm.org/medical-research/diabetes(August. 26, 2017)

http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=78504 (August 26, 2017)

http://www.who.int/mediacentre/factsheets/fs312/en/ (August 26, 2017)

http://www.medindia.net/doctors/drug_information/vildagliptin.htm ( August 26, 2017)

http://www.mims.com/philippines (August 26, 2017)

https://davisplus.fadavis.com/3976/meddeck/pdf/insulinglulisine.pdf (August 24, 2017)

http://www.scirp.org/journal/jdm/ (August 25, 2017)

http://newsinfo.inquirer.net/805812/6m-pinoys-have-diabetes (August 26, 2017)

Books

Judith Hopfer Deglin PharmD, April Hazard Vallerand PhD, RN, FAAN

Cynthia A. Sanoski BS, PharmD, FCCP, BCPS. Davis Drug Guide 12th Edition (August 9, 2017)

Mark Anthony S. Castillo BSN, Chonamarie B. Butardo BSN. Type II Diabetes Mellitus

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 Table of Contents

I. Introduction 1

II. Patient's Profile 4

A. Personal Data

B. Present Medical History

C. Past Medical History

III. Physical Assessment 6

IV. Drug study 9

V. Laboratories 10

VI. Anatomy And Physiology 11

VII. Nursing Care Plan 16

VIII. Discharge Plan 17

IX. Bibliography 18
 Republic of the Philippines
Palawan Polytechnic College Inc.
Manalo Ext. Puerto Princesa City, Palawan

August 28, 2017

An Individual Case Study

on

Diabetes Mellitus S/P BKA

Submitted by:

Chris Denver Yap Bancale

Submitted to:

Hannah Joy Daraway Lobaton RN, MAN

 Republic of the Philippines
Palawan Polytechnic College Inc.
Manalo Ext. Puerto Princesa City, Palawan

August 28, 2017

An Individual Case Study

on

Ovarian CA

Submitted by:

Chris Denver Yap Bancale

Submitted to:

Hannah Joy Daraway Lobaton RN, MAN