St.

Paul University Manila

(St. Paul University System)

College of Nursing and Allied Health Sciences

NURSING CARE STUDY
(Application of Nursing Process)

I. ASSESSMENT
A. General Information
This is the case of L.D., female, 49 years old, married. She was born on November 15,
1962 at Muntinlupa City. She is a Filipino Roman Catholic. She works as a ”manghihilot” and a
“komadrona” in her neighborhood while her husband sells “taho” for a living. Prior to being
admitted at the hospital, the client is a known diabetic for 6 years. She also has a non-healing
wound at her left foot since August of 2008. For her diabetes she takes Metformin, 500mg 1tab
for maintenance.
One day prior to admission, she went to the drugstore to get her blood sugar checked. She
was then informed (by the drugstore) that she had a high level of blood sugar, therefore, she went
to her diabetic neighbor and told her about it. Then, her neighbor suggested her to take insulin
injection as it has been effective for her neighbor. She took the insulin given by her neighbor
with an unknown dose. She also took half tablet of her Metformin. After 2 minutes, the patient
complained of dizziness, weakness, diaphoresis with associated chest pain. Then the day after,
July 24, 2009, she was brought to Ospital ng Muntinlupa by her husband.

Upon arrival last July 24, 2009, 11:55 pm at Ospital ng Muntinlupa’s ER, the client was
admitted and interviewed by the on duty physician and nurses. The client’s admitting vital signs
were: temperature= afebrile, PR= 84bpm, RR= 24cpm and blood pressure of 160/100 mmHg
with a chief complaint of general body weakness. She is 5’2 and 170 pounds and has a BMI of
31. Her admitting GCS was 10/15 (E=2,V=2,M=6). The admitting diagnosis given was
hypoglycemia secondary to self-injection of insulin, DM2. Her initial capillary blood glucose,
taken at 12 midnight, was 55mg/dL. Patient was immediately given D5050, 1 vial. At 2:30 am,
the patient’s CBG, again, decreased, having a value of 25 mg/dL. She was again given 1 vial of
D5050.

Patient was also hooked to 2-3 lpm of O2 therapy via nasal cannula. She was transferred
to female medical ward with the final diagnosis of Non-Healing wound, left secondary to
Diabetic neuropathy, DM II with ordered medications of Ciprofloxacin, NaCl, Ceftriaxone,
Clindamycin, Isosorbide Mononitrate, Ranitidine, Trental, Furosemide Isordil and Clonidine.
Laboratory tests ordered by the physician were hematology, urinalysis, clinical chemistry of
BUN, Creatinine, Sodium, Potassium, and Chloride, CBG, Erythrocyte sedimentation rate and
C-Reactive Protein.

B. Nursing History (Based on the Functional Health Pattern by Gordon)

HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

1.1 Client’s description of her/his health:

Before admission, the client perceives her health as well. She feels that she is strong for
her age. The client said that she would take daily baths, brush her teeth after eating, and wash
her hands regularly. She said that whenever she would be sick, she would rest for a day and
wouldn’t consult a “quack doctor”; but, instead, she would self-medicate. When diagnosed with
Diabetes, she was given Metformin for maintenance but she was not able to comply fully with
the medication regimen because of financial constraints.

At present, the client feels weak and inadequate since she is unable to perform her usual
tasks and activities of daily living and unable to afford medications and laboratory tests needed
for her treatment.

Health Management:
The client verbalized that the interventions she would do to relieve her symptoms
whenever she would be sick were: adequate rest and sleep, and drinking of medications as
prescribed.

History of present illness:

Client is a known diabetic – maintained on Metformin, 500 mg 1 tab. She also has a non-
healing wound on her left leg since last August 2008. Client sought consult and got her blood
sugar tested at a drug store which revealed high blood sugar.

1 day prior to admission after coming from the drugstore, patient injected herself with
insulin, with an unknown dose after learning from a diabetic-neighbor that it was effective for
DM. 2 minutes after injection, patient noted diaphoresis with associative chest pain. Prior to
admission, signs and symptoms persisted with increasing severity which prompted consult at ER
OSMUN.
 Past illnesses:

Illness Medications taken

PTB DOTS (6months)

Fever Biogesic

Cough and
Neozep
colds

Table 1.0: Tabulation of Past illnesses

According to the client, she had Pulmonary Tuberculosis in 2004 and had undergone
DOTS for 6 months.

According to the client, she had experienced periods of fever, and cough and colds
wherein she self-medicates with Neozep or Biogesic.

History of hospitalization (when, where and why):

Client was diagnosed to have Diabetes Mellitus type 2 at Quezon City Hospital after
experiencing increased urination and thirst.

Moreover, according to the client, she experienced being hospitalized before due to TB in
Quezon City Hospital and underwent DOTS.

According to the client, she had undergone debridgement of her right foot due to necrosis
at Ospital ng Muntinlupa on November 2008. She was hospitalized for three days that time. The
client was also hospitalized at Ospital ng Maynila and brought to ER for half a day due to the
wound on her left foot.

History of illness in the family:

The client said that her father and mother are positive for DM and her sister, as well as
her mother died because of DM.

Expectations of hospitalization:
According to the client, her expectation is to regain the health that she had before she was
hospitalized. If not similar, it would be best that she will still be able to function in her activities
of daily life as well as the pursuit of her wishes as a person. She expects that the hospital will
ensure the recovery and satisfaction of her needs.

Anticipation of problem with caring, for self upon discharge:

 According to the client, her problem right now is the financial constraints since she is not
able to afford the laboratory examinations, treatments and some medications needed for her
medical care.

1.9 Knowledge
The client is knowledgeable about the condition, treatment plan and prognosis.
According to the client, the medical team handling her frequently provides information regarding
her condition and the procedures to be undergone.

0 Reaction to above prescriptions:

The client does not have any reactions regarding the prescriptions given. The main
concern is for the client fast recovery. Furthermore, she is entrusting her health and medical
management to the medical health team especially the health care providers.

2. NUTRITION AND METABOLIC PATTERN

2.1 Usual food intake (before admission)

BREAKFAST LUNCH DINNER

Before 1 cup of rice and 1 cup of rice and 1 cup of rice and
viand usually fish viand of meat: viand which
of any kind or chicken, comprises of
processed meat. malunggay vegetables, meat:
chicken, fish.
2-3 glasses of water 2-3 glasses of 2-3 glasses of water
water
After Lugaw Inihaw na tilapia Lugaw
2-3 glasses of water lugaw 2-3 glasses of water.
2-3 glasses of
water
Table 1.1 Food Intakes during Breakfast, Lunch and Dinner

2.2 Usual fluid intake (type, amounts)

Type of Fluid Amount

Before
Water 12-15 glasses per day
admission

Upon
Water 8 glasses per day
admission
Table 1.3. Usual fluid intake of client before admission and at present

Preferences:

The client prefers water as her usual source of fluids.

2.3 Any food restrictions:

Before admission, the client said that she could eat everything she wanted or liked and
she had no food restrictions.

After admission, the client said that she is on a soft diet today.

2.4 Any problems with ability to eat:

The client has no problems with regards to ability in eating.

2.5 Any supplements (vitamins, feedings)

The client said that she is not taking any vitamins or supplements.

3. ELIMINATION PATTERN
3.1 Bladder:

Complaints on the
Frequency per Home
Color usual pattern of
day remedies
elimination

The client has no

No home
Before Clear Five to eight complaints or problems
remedies
Admissio yellow times a day on the usual pattern of
used
n urination.

Table 1.4 Bladder elimination pattern before admission

Before admission, the client urinated 5-8 times a day with clear yellow output. The client
had no complaints or problems on the usual pattern of urination; there were no home remedies
used.
 Complaints
Frequency on the usual Home
Color
per day pattern of remedies
elimination

Upon Slightly 1-2 times a The client No home

admission cloudy day has no remedies
complaints or used
problems on
the ususal
pattern of
urination

Table 1.5 Bladder elimination pattern at present

After the admission, the client urinates 1-2 times a day with slightly cloudy output. The
client has no complaints or problems on the usual pattern of urination; there are no home
remedies used.

3.2 Bowel:

Complaints of
Frequency per usual pattern
Color Consistency Remedies
day of bowel
movement
 Not- No home
brown Every day Semi-solid
Before constipation remedies

Not
At Present brown Everyday Semi solid None
constipated

Table 1.6 Bowel elimination pattern before admission and at present

The client verbalized that she defecates everyday with brown and semi-solid stool. The
client does not have constipation.

At present, the client defecates twice a week with semi-solid stool. She does not have any
constipation.

3.3 Any assertive device:

The client does not use any assertive devices..

3.4 Skin: (condition)

The client’s skin condition is slightly moist, uniformed but slightly pale in color all
throughout the body.

4. ACTIVITY EXERCISE PATTERN

Before admission, the client’s forms of exercise were walking around the neighborhood
from their residence, performing her activities of daily living such as doing household chores and
attending to the needs of her family members.

5. SLEEP-REST PATTERN

The client’s usual bedtime is at 7 pm. She usually has 7 hours of sleep at night. The client
sleeps with two pillows. Her sleep routine is brushing of teeth, and praying before bed. The
client usually takes a nap for 1-2 hours. According to the client, she has been experiencing a
problem in sleeping upon admission. She said that she can’t sleep and she only takes a nap for 2-
3 hours.

6. COGNITIVE-PERCEPTUAL PATTERN
6.1 Any deficits in sensory perception (hearing, sight, touch)
The client has no deficit in hearing or sight; but, feels numbness on her lower extremities.
6.2 Ability to read and write. Any difficulty in learning?
The client is capable of reading and writing.
6.3 Any complaints? (e.g. pain)
Patient did not complain of any pain.
6.4 Memory

According to the client, she has a good memory of things and events. She is able to
recognize familiar faces and can remember recent events that happened.

7. SELF-PERCEPTION PATTERN

7.1 What the client is most concerned about

According to the client’s family, they are most concerned about the client’s health, her
recovery, and the hospital bill that they will face after discharge.

7.2 Present health goals

The client’s family said that their present health goal for the client is to be totally relieved
of her illness and be healthy again.

7.3 Effect of present illness to self:

The effects of the present illnesses to the client are sadness and great worry from the
family, anxiety and pressure for the family due to the hospital bill.

7.4 How does the client see/feel about self?

According to the client, she feels sad about her condition because somehow she cannot
support her family at the moment.

8. ROLE-RELATIONSHIP PATTERN
8.1 Language spoken

The client’s spoken language is Filipino (tagalog). She speaks the language fluently.

8.2 Manner of Speaking

The client speaks in a soft-modulated voice.

8.3 Significant person to client

For the client, the significant people in her life is her family.
8.4 Complaints regarding family

The client has no complaints regarding family matters. The family of the client seemed
very nice and caring to the client.

9. SEXUALITY-SEXUAL FUNCTION
9.1 Anticipated change in sexual relations because of illness

The client verbalized decrease in sexual relation due to her present condition.

9.2 Knowledge of sexual functioning

The client has knowledge of sexual functioning because she already has a family of her
own.

10. COPING-STRESS MANAGEMENT PATTERN

10.1 Decision making ability

The client has firm decision making abilities and if she cannot decide for it, she seeks for
help.

10.2 Any significant stress in the past year

The client mentioned that she suffered from stress after one of her children was taken by
DSWD for three years.

10.3 Management of stress

The client used praying and spending more time with the family as a form of coping for
all stressors in life.

10.4 Expectations from nurses to provide comfort and security during hospitalization

The client’s family mentioned that they expect the nurse to care for their mother and
attend to her needs all the time. They also mentioned that they want a caring and assistive nurse
for their mother to assist her in the activities needed to be done.

11. VALUE BELIEF SYSTEM

11.1 Source of strength or meaning:

The client’s source of strength or meaning in her life is her faith in God and the presence
of her family especially her children.

11.2 Importance of God to client:

According to the client God is very important because he the savoir of all mankind.
11.3 Religious practices (type and frequency):

The client goes to church every Sunday.

12. DEVELOPMENTAL TASKS (Assess for achievement of developmental tasks)

Sigmund Freud’s Psychosexual Development

Genital stage

Characteristics:

Energy is directed toward full sexual maturity and function and development of skills needed to
cope with the environment. There is an achievement of independence and decision-making.

The patient had her menarche at 14 years of her age and had her first coitus at her 19 years of
age. At her 22 years of age she develop independence and she always watching her mother in
delivering a baby so that she can also do the same when she is at the right year of age. Now she
is a “komadrona”.

Erik Erikson’s Psychosocial Development

Generativity vs. Stagnation

Characteristics:

(Indicators of positive resolution) creativity, productivity and concern for others.

(Indicators of negative resolution) self-indulgence, self-concern, lack of interests and
commitments.

According to the patient she still tries to be productive as much as possible for her family. She
will do household choirs again after she gets well. She feels complete when she is serving the
needs of his family.

Jean Piaget’s Cognitive Development

Formal Operations Phase

 Characteristics:

Uses rational thinking. Reasoning is deductive and futuristic.

According to the patient, she consults her husband in making decisions. They talk it over
until they find the best solution to their problem. If they can’t solve the problem she seeks
guidance form God. If there is still no solution, they just let it go.

Westerhoff’s Four Stages of Faith

Owned Faith

Characteristics:

Puts faith into personal and social action and is willing to stand up for what the individual
believes even against the nurturing community.

According to the patient, she puts God in the center of everything. She considers Him as
the superior one. She prayed to God when she feels alone, to seek comfort regarding to her and
her family’s problem.

PHYSICAL ASSESSMENT
Date performed: July 26, 2009

General Survey:

Received patient awake sitting on bed, conscious and coherent during the assessment. She is
cooperative. With O2 via nasal cannula @ 6LPM intact. With IVF#2 PNSS IL x 12 hrs at left
metacarpal vein intact and infusing well. The patient’s body temperature is 36 taken from axillae.
Pulse rate is 95 beats/min. Respiratory rate is 28 breaths/min. Blood pressure is 150/100 mmHg.
The patient’s body build is fair. The patient’s voice in terms of tone is soft while in terms of
strength is weak. The patient has no body odor. The patient’s skin varies from light to brown but
pale. With GCS of 15/15 (E=4, V=5, M=6).

Area to Assess Modes of Normal Findings Actual Findings

Assessment

Head and Neck

1. Cranium o Inspection Rounded; Head is round with

smooth skull smooth skull contour;
contour no nodules or masses
palpated
Smooth,
o Palpation
uniform
consistency;
absence of
nodules or
masses

2. Hair o Inspection Evenly Hair is dry, evenly

distributed; distributed and color is
black color black but has some
white hair.

3. Neck muscles o Inspection Muscle equal Muscles are equal in

in size; head size and the head is
centered aligned in the center.

4. Lymph Nodes o Palpation Not palpable Lymph nodes are not

palpable.

5. Thyroid Gland o Inspection Not visible It is not visible for

for inspection inspection and

Lobes may lobes may not be

not be palpated
o Palpation
palpated

6. Face o Inspection Symmetric Symmetrical in shape.

facial Face is pale in color.

7. Temporal Arteries o Inspection Temporal arteries are

o Palpation not visible but
palpable.

Eyes

1. External Eye o Inspection Hair evenly Hair is evenly

Structure distributed; distributed; skin is
(eyebrow, skin intact; intact; symmetrically
eyelashes, eyelid)
symmetrically aligned; no discharge
aligned; no noted; dark circle
discharge around the eyes
(eyebags)

2. Palpebral o Inspection Transparent; Transparent; sclera

 Conjuctiva sclera appears appears white
white

3. Bulbar Conjuctiva o Inspection Shiny, smooth Pale conjunctiva

and pink or
red

4. Pupil o Inspection Black in Black in color, equal

color, equal in in size; round, iris flat
size; round, and round
iris flat and
round Contricts w/ light, and
dilates w/o light. 3mm
Contricts w/ in size
light, dilates
w/o light

Ears

1. External Ear o Inspection Color same as Color is same as facial

Structure facial skin; skin; symmetrical
symmetrical
o Palpation Mobile, firm
Mobile, firm

2. Hearing o Inspection Normal voice Normal voice tone

tone audible audible

3. Internal Ear o Inspection Dry cerumen, Dry cerumen

Structure grayish-tan
color

Nose

1. External Nose o Inspection Symmetric Symmetric and

Structure and straight; straight; uniform color
uniform color
o Palpation Not tender; no lesions
Not tender; no
lesions

2. Sinus o Palpation Not tender Not tender

3. Nasal Cavity o Inspection Mucosa pink; No discharges

clear watery
discharge

Mouth

1. Lips o Inspection Uniform pink Uniform brown in

color; soft, color; soft, slightly
moist, smooth moist
texture

2. Teeth and Gums o Inspection Smooth, White tooth enamel

white, shiny
 tooth enamel

Pink gums

3. Tongue o Inspection Central Central position;

position; raised papillae;
raised slightly pink color
papillae; pink
color

4. Uvula (CN X & o Inspection Position in Position in midline of

XII) and Palates midline of soft palate
soft palate
slight pink (soft
Light pink palate); slighter pink
(soft palate); (hard palate)
lighter pink
(hard palate)

Anterior Chest

1. Chest wall o Palpation Chest wall Chest wall intact; no

intact; no tenderness; no masses
tenderness; no
masses

2. Precordium o Inspection No pulsations No pulsations

and
Palpation
3. Carotid Artery o Palpation Symmetric Palpable carotid
pulse arteries
volumes, full
pulsations

4. Jugular Veins o Inspection Not visible Not visible

5. Breathing Pattern o Inspection Quiet, Patient’s respiration

rhythmic and is shallow and with
effortless RR of 28 cpm
respirations

6. Capillary Refill o Inspection Immediate Immediate return of

time return of color color within 2-3
seconds

Pale nailbeds

Breast and Axillae

1. Breast o Inspection Skin uniform N/A

o Palpation in color

No tenderness
or masses

2. Areola and o Inspection Color varies N/A

Nipple
 widely, from
light pink to
dark brown

Round, equal
in size

Back

1. Posterior Thorax o Inspection Chest Chest symmetric

o Palpation symmetric
Skin intact; uniform in
Skin intact; temperature
uniform in
temperature

2. Spine alignment o Inspection Spine Spine vertically

vertically aligned
aligned

Abdomen

1. External abdomen o Inspection Uniform color Uniform color

Structure o Palpation
No tenderness No tenderness

2. Abdominal o Inspection Symmetric Symmetric movements

movement movements caused by respiration
caused by
respiration

Upper and Lower

Extremities

1. Musculoskeletal o Inspection Equal size in Equal size in both

Structures both sides of sides of body with
body presence of skin
o Palpation
lesions in lower
Normally firm extremities.
Diminished pulse on
Left foot and weak
pulse, with PR of 50,
on right foot.

Normally firm

2. Muscle strength o Inspection Equal strength Muscle strength of lower

on each body extremities 3/5
side Muscle strength of upper
extremities 4/5
3. Bones o Inspection No No deformities
deformities

Integument
 1. Skin o Inspection Varies from light to Skin is slightly pale in color
deep brown; from
ruddy pink to light Nearly uniform in color except
pink: from yellow areas exposed to sun.
overtones to olive.
Moisture in skin folds and
Generally uniform axillae.
except areas exposed
Temperature is with the normal
to sun.
range =36 oC.
No edema, freckles,
With pitting edema grade 3
birthmarks, abrasions
on left lower extremity, warm
or other lesions
to touch (the affected area
only) Diameter of affected
area 28 cm, unaffected 23 cm
Moisture in skin
folds and axillae

Lower extremities (except

edematous area) cool to touch
Uniform; within
normal range With ulcer on left foot (2.5 cm
in diameter, 1 cm in depth
with surrounding necrotic
tissue with pus)
When pinched, skin
springs back to
previous state.
o Palpation

2. Nails o Inspection Smooth Smooth texture; intact

texture; intact epidermis, however
epidermis nails are pale

3. Hair o Inspection Skin intact; Skin intact; evenly

evenly distributed hair
distributed
hair

SUMMARY OF ABNORMAL FINDINGS:

• Face is pale in color.

• Pale conjunctiva.

• Dark circle around the eyes (eyebags)

• Shallow respiration with Respiratory Rate =28.

• Pale nailbeds.

• presence of skin lesions in lower extremities. Diminished pulse on left foot and weak
pulse, with PR of 50, on right foot.
• With pitting edema grade 3 on left lower extremity , warm to touch (the affected
area only), Diameter of affected area 28 cm, unaffected 23 cm
 • Lower extremities (except edematous area) cool to touch

• With ulcer on left foot (2.5 cm in diameter, 1 cm in depth with surrounding necrotic
tissue with pus)

• Muscle strength of lower extremities 3/5

• Muscle strength of upper extremities 4/5

DATA FROM THE TEXTBOOK

Diabetes Mellitus
Refers to a group of metabolic disease characterized by an elevation in blood glucose
levels (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both.
Normally a certain amount of glucose circulates in the blood. The major sources of this glucose
are absorption of ingested food in the gastrointestinal tract and formation of glucose by the liver
from food substances.

Insulin
A hormone produced by the pancreas, controls the level of glucose in the blood by
regulating the production and storage of glucose. In the diabetic state, the cells may stop
responding to insulin or the pancreas may stop producing insulin entirely. This leads to
hyperglycemia, which may result in acute metabolic complications such as diabetic ketacidosis
and hyperglycemic hyperosmolar non-ketotic syndrome. Long-term effects of hyperglycemia
contribute to macrovascular complications (CAD, CVD, peripheral vascular disease), and
chronic microvascular complications (kidney and eye disease), and neuropathic complications
(diseases of the nerves).

Risk factors:
Non-modifiable:
• Family history of diabetes
• Race and ethnicity
• Age (45 years and above)
• Previously identified impaired fasting glucose or impaired glucose tolerance
• History of gestational diabetes or delivery of babies over 9 lbs.

Modifiable:
• Obesity
• Hypertension (140/90 mmHg and above)
• Hyperlipidemia

Classification of Diabetes:
Gestational diabetes:
Also known as diabetes of pregnancy — this form of diabetes usually disappears after the
baby is born.

Type 1 diabetes:
It is characterized by destruction of the pancreatic beta cells. It is thought that combined
genetic, immunology, and possible environmental factors (e.g. viral) contribute to beta cell
destruction. Although the events that lead to beta cell destruction are not fully understood, it is
generally accepted that a genetic susceptibility is a common underlying factor in the
development of type 1 diabetes. People do not inherit type 1 diabetes itself; rather, they inherit a
genetic predisposition, or tendency toward developing type 1 diabetes. This genetic tendency has
been found in people with certain human leukocyte antigen types or HLA. HLA refers to the
cluster of genes responsible for transplantation antigens and other immune processes.
There is also evidence of autoimmune response in type 1 diabetes. This is an abnormal
response in which antibodies are directed against normal tissues of the body, responding to these
tissues as if they are foreign. Autoantibodies against islet cells and against endogenous (internal)
insulin have been detected in people at the time of diagnosis and even several years before the
development of clinical signs of type 1 diabetes. In addition to genetic and immunologic
components, environmental factors, such as viruses or toxins, that may initiate destruction of the
beta cell are being investigated.
Regardless of the specific etiology, the destruction of the beta cells results in decreased
insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. In
addition, glucose derived from food can’t be stored in the liver but instead remains in the
bloodstream and contributes to postprandial (after meals) hyperglycemia. It the concentration of
glucose in the blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL, the
kidneys may not reabsorb all of the filtered glucose; the glucose then appears in the urine.

Type 2 diabetes:
 The two main problems related to insulin in type 2 are insulin resistance and impaired
insulin secretion. Insulin resistance refers to a decrease in tissue sensitivity to insulin. Normally,
insulin binds to special receptors on cell surfaces and initiates a series of reactions involved in
glucose metabolism. In type 2 diabetes, these intracellular reactions are diminished, this
rendering insulin less effective at stimulating glucose uptake by the tissues and at regulating
glucose release by the liver. The exact mechanisms that lead to insulin resistance and impaired
insulin secretion in type 2 diabetes are unknown, although genetic factors are thought to play a
role.
To overcome insulin resistance and to prevent the buildup of glucose in the blood,
increased amounts of insulin, the glucose level rises, and type 2 diabetes develop.
Despite the impaired insulin secretion that is characteristic of type 2, there is enough
insulin present to prevent the breakdown of fat and the accompanying production of ketone
bodies. Therefore, DKA doesn’t typically occur in type 2 diabetes. Uncontrolled type 2 diabetes
may, however, lead to another acute problem, HHNS.
Type 2 diabetes is also called adult-onset diabetes or non-insulin-dependent diabetes.
Type 2 diabetes runs in families, and it commonly affects people who are older than 45. With the
rise in obesity, type 2 diabetes increasingly is being seen in younger people, particularly African-
Americans, Hispanics, and American Indians. Obesity, especially central obesity, greatly
increases the risk of diabetes. Central obesity occurs when more fat accumulates around the
waist than in the hip area. This is the fat pattern that often is associated with insulin resistance
and a condition known as metabolic syndrome.

SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS SIGNIFICANCE

FOUND IN THE BOOK MANIFESTED BY THE
CLIENT
Polyuria
Is caused by excess loss of
Polydipsia / fluid associated with osmotic
diuresis.
Polyphagia
Blurred vision
If peripheral neuropathy
causes numbness, the person
will not feel an irritation or
pressure point in the foot. The
Non-healing wound /
skin can break down and form
an ulcer. Also, blood
circulation can be poor,
leading to slow healing.
This is nerve damage. The
most common type is
peripheral neuropathy. The
longest nerves in the body, the
Numbness of legs / ones to the legs, are damaged
first causing pain and
numbness in the feet. This can
advance to cause symptoms in
the legs and hands.
Insulin cannot break down
Fatigue/ Body weakness / glucose therefore cannot
produce glycogen for energy.
Recurring infection / The blood becomes viscous
therefore the blood flow to and

Decreased peripheral pulses
from the site of injury is
slower, thus, healing time is
also lengthened.
Associated with fat buildup in
the artery walls. This can
/
impair blood flow to parts
farther from the heart.

When people with type 2 diabetes take medications to reduce blood sugar, sugar levels
may drop below the normal range and cause hypoglycemia (low blood sugar). Symptoms of
hypoglycemia include sweating, trembling, dizziness, hunger and confusion. Hypoglycemia that
you do not recognize and correct can lead to seizures and loss of consciousness. You can correct
hypoglycemia (raise blood-sugar levels) by eating or drinking something with carbohydrates.

ANATOMY AND PHYSIOLOGY OF AFFECTED PARTS

Endocrine System

The endocrine system is a system of glands that involve

the release of extracellular signaling molecules known as
hormones. The endocrine system is instrumental in regulating
metabolism, growth, development and puberty, and tissue
function and also plays a part in determining mood.[1] The
field of study that deals with disorders of endocrine glands is
endocrinology, a branch of the wider field of internal medicine.

The endocrine system is an information signal system

much like the nervous system. However, the nervous system
uses nerves to conduct information, whereas the endocrine
system mainly uses blood vessels as information channels.
Glands located in many regions of the body, for example the
testis, release into the bloodstream specific chemical
messengers called hormones. Hormones regulate many
functions of an organism, including mood, growth and development, tissue function, and
metabolism.

The endocrine system is one of the body’s main systems for communicating, controlling
and coordinating the body’s work. It works with the nervous system, reproductive system,
kidneys, gut, liver, pancreas and fat to help maintain and control the following:

* body energy levels

* reproduction

* growth and development

* internal balance of body systems, called homeostasis

* responses to surroundings, stress and injury

The endocrine system accomplishes these tasks via a network of glands and organs that
produce, store, and secrete certain types of hormones. Hormones are special chemicals that move
into body fluid after they are made by one cell or a group of cells. Different types of hormones
cause different effects on other cells or tissues of the body.

Endocrine glands make hormones that are used inside the body. Other glands make
substances like saliva that reach the outside of the body. Endocrine glands and endocrine-related
organs are like factories. They produce and store hormones and release them as needed. When
the body needs these substances, the bloodstream carries the proper types of hormones to
specific targets. These targets may be organs, tissues, or cells. To function normally, the body
needs glands that work correctly, a blood supply that works well to move hormones through the
body to their target points, receptor places on the target cells for the hormones to do their work,
and a system for controlling how hormones are produced and used.

Endocrine system diseases and disorders happen when one or more of the endocrine
systems in your body are not working well. Hormones may be released in amounts that are too
great or too small for the body to work normally. These irregularities are also called a hormone
imbalance. There may not be enough receptors, or binding sites, for the hormones so that they
can direct the work that needs to be done. These hormone imbalances may be the result of a
problem with the system regulating the hormones in the blood stream, or the body may have
difficulty controlling hormone levels because of problems clearing hormones from the blood. For
example, a hormone imbalance may occur if a person's liver or kidneys are not working well,
resulting in a hormone level in the bloodstream that is too high.

Pancreas

The pancreas is an elongated organ located toward the back of the abdomen behind the
stomach. The pancreas has digestive and hormonal functions. One part of the pancreas, the
exocrine pancreas, secretes digestive enzymes. The other part of the pancreas, the endocrine
pancreas, secretes hormones called insulin and glucagon. These hormones regulate the level of
glucose (sugar) in the blood.

The pancreas is made up of two types of tissue:

• Exocrine tissue – secretes digestive enzymes.

These enzymes are secreted into a network of
ducts that join the main pancreatic duct, which
runs the length of the pancreas.
• Endocrine tissue – consists of the islets of
Langerhans, secretes hormones into the
bloodstream.

Functions of the pancreas:

The pancreas has digestive and hormonal functions:

• The enzymes secreted by the exocrine tissue in the pancreas help break down
carbohydrates, fats, proteins, and acids in the duodenum. These enzymes travel down the
pancreatic duct into the bile duct in an inactive form. When they enter the duodenum,
they are activated. The exocrine tissue also secretes a bicarbonate to neutralize stomach
acid in the duodenum.
• The hormones secreted by the endocrine tissue in the pancreas are insulin and glucagon
(which regulate the level of glucose in the blood), and somatostatin (which prevents the
release of the other two hormones).
References:
Bullock, B. L., & Henze, R. L. (2000). Focus on Pathophysiology. Lippincott Williams &
Wilkins.

Smeltzer, S. C., & Bare, B. G. (2004). Brunner & Suddarth’s Textbook of Medical Surgical
Nursing – 10th edition. Lippincott Williams & Wilkins.

Diabetes mellitus. (2009). Wikipedia: the free encyclopedia. Retrieved July 27, 2009, from
http://en.wikipedia.org/wiki/Diabetes

Mrotek, J., & Chase, C. (2003). The endocrine system: diseases, types of hormones & more.
(July 26, 2009), from http://owl.english.purdue.edu/owl/resource/560/10/
LABORATORY EXAMINATIONS

HEMATOLOGY
COMPONENT REFERENCE UNIT RESULT SIGNIFICANCE NURSING RESPONSIBILITY
RANGE JULY 25, 2009
Hemoglobin 125-160 g/l 64 Decreased Hemoglobin composed of a Before the procedure:
pigment (heme), which
contains iron, and a protein 1. Explain the purpose and procedure
(globin). to the client and his relatives.
2. Inform the client that a blood
Decreased in hemoglobin sample will be taken from him.
may indicate blood loss, 3. Inform the client that about 5ml of
hemolytic anemia, bone blood would be taken from the
marrow suppression, or client.
sickle cell anemia. 4. Observe site for bleeding.

Hematocrit 0.38-0.50 % 0.21 Decreased Hematocrit or packed cell

volume (Hct, PCV, or crit) is
a fast way to determine the
percentage of RBCs in the
plasma. The Hct is reported
as percentage because it is
the proportion of RBCs to
the plasma.
A decreased in hematocrit
may indicate blood loss,
overhydration, dietary
deficiency, or anemia.
WBC count 5-10 10^9/L 8.14 Normal WBC count help diagnose
infection and inflammation
as well as determine the need
for further test.
Neutrophils 0.40-0.60 % 0.74 Increased The increased in the
After the procedure:
1. Apply pressure to the extraction site
to prevent bleeding.
2. Observe for pallor, cyanosis and
coolness of extremity. These signs
may indicate compromised
circulation.
3. Encourage to increase oral fluid
intake to promote venous return and
ensure sufficient urine production.
4. Monitor patient’s laboratory results
of CBC.
 neutrophil count maybe due
to inflammation and tissue
injury
Eosinophils 0.01-0.06 % 0.02 Normal
Basophils 0-0.07 % 0 Normal
Lymphocyte 0.2-0.4 % 0.14 Decreased The decreased lymphocyte
may indicate the presence of
bacterial infection.
Monocyte 0.02-0.08 % 0.10 Increased Increased monocyte may
indicate inflammation on the
tissues.
Reticulocyte 5-15 10^4/L 0 Decreased
RBC count 4.5-5-5 10^12/L 2.67 Decreased
Platelet Count 150-350 10^9/L 388 Increased Platelet count determines the
clotting factor of the blood.
Increased platelet count may
have a tendency to stick
forming clumps that can
block blood vessel that cause
damage including death due
to thromboembolism
MCV 86-100 fl 77 Decreased Mean Corpuscular Volume
which is an expression of the
volume occupied by a single
RBC.
 CLINICAL CHEMISTRY

COMPONENT REFERENCE UNIT RESULT SIGNIFICANCE

RANGE
JULY 25, 2009

BUN 1.7-8.9 Mmol/L 12.11 Increased A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that
comes from the waste product urea. Urea is made when protein is broken down in
your body. Urea is made in the liver and passed out of your body in the urine.

Increased in BUN may indicate substantially reduced renal function.

CREATININE 44-80 Umol/L 103.22 Increased Increased in creatinine may indicate a diminished renal function.

SODIUM 135-153 Umol/L 127.4 Decreased A decrease in sodium indicates that nerve impulses do not transmit normally

POTASSIUM 3.5-5.3 Mmol/L 4.09 Normal Potassium regulates cardiac impulse transmission and muscle contraction

CHLORIDE 95-111 Mmol/L 99.2 Normal Chloride buffers in oxygen – carbon dioxide exchange in RBCs

COMPONENT REFERENCE UNIT RESULT SIGNIFICANCE

 RANGE JULY 25, 2009

TIME

GLUCOSE 80-120 Mg/dL 12 am 55 Decreased The decrease in glucose was due to the effect
of insulin that the patient had administered to
herself

12:55 am 68 Decreased

2:30 am 25 Decreased

4:40 am 124 Increased Increase in glucose indicates that there had

been increased insulin resistance resulting into
the inability to convert glucose into its active
form. Increase in glucose can also result in the
increase in the viscosity of the blood.

10 am 153 Increased

2 pm 128 Increased

8 pm 104 Normal

JULY 25, 2009

 URINALYSIS

COMPONENT RESULT SIGNIFICANCE

COLOR LIGHT YELLOW Light yellow urine indicates that the patient is well-hydrated.

APPEARANCE SLIGHTLY TURBID

PH 5.5 Measured to determine the relative acidity or alkalinity of urine and assess the
client’s acid-base status.

SPECIFIC GRAVITY 1.020 Indicator of urine concentration, or the amount of solutes present in the urine.

PROTEIN POSITIVE 1 Protein molecules normally are too large to escape from glomerular capillaries
into the filtrate. If glomerular membrane has been damaged it allows protein to
escape.

MICROSCOPIC

PUS CELLS TOO NUMEROUS COUNT Indicates infection

RBC 3.4/hpf

EPITHELIAL CELLS FEW

BACTERIA MANY Increased presence of bacteria may indicate inflammation on the tissues.

MUCUS THREADS FEW

CRYSTAL

AMORPHOUS URATES FEW

JULY 26, 2009

MISCELLANEOUS
 TEST RESULT SIGNIFICANCE

CRP POSITIVE Serve as a general marker for infection and inflammation but not used to diagnose particular disease.

A high or increasing amount of CRP in your blood suggests that you have an acute infection or
inflammation.

JULY 26, 2009

HEMATOLOGY

COMPONENT REFERENCE UNIT RESULT SIGNIFICANCE

RANGE

ESR 4-17 Mm/hr 138 Nonspecific test used to diagnose conditions associated with acute
and chronic inflammation

A very high ESR usually has an obvious cause, such as a marked

increase in globulins that can be due to a severe infection.

NURSING CARE PLAN

Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Objective: Ineffective peripheral  After 4 days of duty, Independent: The patient’s peripheral
tissue perfusion related the patient should pulse increased to 58
 Decreased peripheral demonstrate  Elevate feet when up  Minimizes
to decreased arterial flow bpm but still has cool
pulses = 50 bpm increased perfusion in chair. Avoid long interruption of blood
as evidenced by feet.
(right foot), as evidenced by periods with feet flow. Reduces venous
diminished decreased peripheral increased peripheral dependent. pooling.
peripheral pulses on pulses pulses of 55-60 bpm
left foot and warm feet.
 Skin of lower  Instruct client to  Compromised
extremities, cool to avoid constricting circulation and
touch clothing or socks. decreased pain
 Decreased sensation may
hemoglobin = 64g/L precipitate or
aggravate tissue
breakdown.

 Do passive ROM  To avoid venous

exercises to stasis.
unaffected extremity
every 2-4 hours.

Dependent:

 Administer oxygen
5-6 lpm as  To increase
prescribed oxygenation.

Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Impaired Skin Integrity At the end of the 8-hour Independent: Patient was able to keep
shift at Ospital ng
“Itong sugat ko sa paa, related altered circulation Muntinlupa, Medical  Assess patient’s  serves as baseline data wound clean and
matagal na ito, matagal and sensation on lower Ward, patient will be extremities for to see effectiveness of demonstrate proper foot
gumaling, kaya ganito, extremities able to keep wound redness, blisters, interventions and to and wound care.
clean and demonstrate fissures, calluses, check for possible
Last year pa nga ito eh.
proper foot and wound ulcerations, changes in progression
Kapag kasi nasusugatan, care skin temperature (aggravation) of
wala ako masyadong regularly wound
nararamdaman” as
verbalized by the patient
 Assess patient’s
wound – length,
width, depth
Objectives:

 With wound on
left foot, 2.5 cm in
diameter, 1 cm in
depth
 with surrounding  Inspect also
necrotic tissues (from surrounding skin
the wound) (from wound)
 Neutrolphils =
0.74%
 with presence of  Assess peripheral
yellowish pus on pulse
wound
 weak peripheral
pulse upon palpation,
PR of 50bpm right
foot, diminished
pulse on left foot  to prevent further
 Perform wound care infection and promote
 with skin lesions daily wound healing
present on lower
extremities
numbness present on  to promote circulation
feet  Encourage adequate and improve
rest and place patient oxygenation by
on a semi-fowler’s promoting maximum
position lung expansion

 Emphasize proper  because moisture

bathing, drying and potentiates skin
lubrication of feet, breakdown
taking care not to
allow moisture to
accumulate between
the toes

 encourage early  to promote circulation

ambulation (as and reduce risks
tolerated) associated with
immobility

Dependent:
 Given medications are
 Administer the antibiotics needed to
following prevent further
medications: infection

Ciprofloxacin, 200 mg,  broad-spectrum

q12  antibacterial agent
that interferes with
DNA gyrase and
 topoisomerase IV.
 broad-spectrum
Ceftriaxone, 2g, TIV,  interfere with a final
q12 step in the formation
of the bacterial cell
wall, resulting in
unstable cell
membranes that
undergo cell lysis

 suppresses protein
Clindamycin, 600 mg, synthesis by
TIV, q6 microorganisms

Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Fluid volume excess  After 4 day rotation, Independent: The patient was not able
related to inflammatory patient will be able to reduce edema of
“Namamanas ‘tong to decrease edema  Monitor I&O and  To serve as baseline
kaliwang paa ko” as response mechanism (from grade 3 to 2) Vital Signs data to see affectd area
verbalized by the patient accurately as well as effectiveness of
the measurement of intervention or to
affected area observe possible
complications.
Objective:
 Elevate extremities  To promote venous
 Pitting edema grade using 2 pillows return and reduce
3 edema formation
 With pus on affected
area
 Skin (on affected
area) warm to touch  Evaluate edematous
 Diameter of affected extremities. Change  To reduce tissue
foot – 28 cm; position frequently. pressure and skin
diameter of breakdown.
unaffected foot – 23
cm  Encourage early
ambulation.  To prevent risks of
associated
complications with
prolonged
immobility such as
diminished
functioning of
affected area.

Dependent:
 Acts as loop diuretic,
 Administer inhibiting the
Furosemide as reabsorption of
ordered. sodium and chloride
Furosemide 40mg IV resulting in the
excretion of these
 PRN electrolytes

Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Impaired Gas Exchange After 8 hours of duty, the Independent: The patient was able to
related decreased patient will be able to participate in treatment
“Minsan hinahapo ako” perfusion secondary to participate in treatment  Assess patient’s  Serves as baseline regimen such as
as verbalized by the respiratory status data
impaired blood flow regimen such as breathing exercises.
patient. breathing exercises  Place patient on semi-  To promote optimal
fowler’s position. chest expansion.

Objective:
 Provide adequate  To promote relaxation
 RR= 28 cpm ventilation and calm to the patient.
 Pale conjunctive environment.
 Pale capillary
beds
 Teach patient  To promote optimal
breathing exercises chest expansion.

 Instruct patient to  To provide good

wear comfortable ventilation.
clothes.

Dependent

 Provide patient
supplemental oxygen  To provide adequate
as ordered (and as oxygenation.
necessary)

Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Knowledge deficit After 8 hours of duty, the Independent: The patient was able to
regarding disease patient should be able to gain adequate
“Sabi kasi noong process, treatment and gain adequate  Assess patient’s  Serves as baseline information about
kapitbahay ko na may knowledge about data
individual care needs information about disease condition
diabetes, okay ung disease condition.
related to unfamiliarity disease condition
insulin kaya nag-inject with information
ako tapos ininom ko ung  Discuss to patient the  For patient to
kalahaing tabletas nung disease process in understand her
Metformin ko” as simple terms condition, it’s cause
verbalized by the patient. and process

 Teach patient different

ways to manage  For patient to assist
condition (nutritional herself in managing
needs, activity, her condition and to
medication). prevent herself from
developing other
complications

 Evaluate patient’s
knowledge after
interventions done

Nursing Care Plan

 Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Sleep disturbance related After 8 hours of duty, the Independent: The patient was not able
to prolonged physical patient should be able to to achieve at least 4-5
“Simula nung mapunta discomfort. achieve at least 4-5 hours  Position the patient in  To promote equal hours of sleep.
ako ditto, puro idlip lang an orthopneic position. chest expansion.
of sleep.
ng isa hanggang
dalawang oras ang
 Provide adequate  To promote relaxation
nagagawa ko.”, as
ventilation and calm to the patient.
verbalized by the patient. environment.

 Encourage patient to
Objective:
visualize scenic views.
 Restlessness
 Dark circles  Instruct patient to
around eyes wear comfortable
clothes.
 To provide good
ventilation.

 Encourage patient to
verbalize feelings of
concerns.
 To further understand
the client’s feelings.

DRUG STUDY
 NAME AND ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
CLASSIFICATION RESPONSIBILITIES
OF DRUG

Ciprofloxacin, 200  antibacterial Acute sinusitis, acute Hypersensitivity to Headache, nausea - Note reasons for therapy
mg, q12, agent that interferes uncomplicated cystitis, quinolones, Lactation and vomiting,
Fluoroquinolones with DNA gyrase chronic bacterial diarrhea, restlessne - Monitor patient’s vital
and topoisomerase prostatitis, urinary ss, rash signs
IV.
tract infections, skin - Instruct patient that
and skin structure medication may be taken
infection with meals ; however,
avoid taking medication
with dairy products alone
such as milk

- Tell patient to drink

plenty of luids (for the
day) to keep the urne
acidic and minimize risk
for crystalluria

- Encourage patient to
report any untowards
reaction

- Emphasize to patient
strict compliance with
medication schedule

 Sodium is the Prophylaxis of heat Congestive heart failure, Excessive NaCl - Note reasons for therapy,
major cation of the prostration or muscle severely impaired renal may lead to Monitor electrolyte levels
NaCl tab, 1 tab, body’s extracellular cramps; chloride function, hypernatremia, hypopotassemia
 TID fluid. It plays a deficiency due to fluid retention; Use with and acidosis, of patient
crucial role in dieresis or salt caution in CV, cirrhotic, or overdose signs
maintaining the fluid restriction; prevention renal disease, in presence of include nausea and - Observe signs and
and electrolyte symptoms of
or treatment of hyperproteinemia, vomiting,
balance. Excess hypernatremia, flushed
retention of sodium extracellular volume hypervolemia, urinary tract abdominal cramps,
depletion obstruction, and CHF diarrhea, edema skin, elevated
results in
temperature, rough dry
overhydration,
which is often tongue, and edema.
treated with diuretics
- Monitor vital signs and
intake and output

- Instruct patient to take

tablet with a glass of water

- Encourage patient to
report lack of response,
swelling of extremities, or
other adverse side effects

Ceftriaxone, 2 g,  interfere with a Lower respiratory tract Diarrhea, rash, - Note reasons for therapy,
TIV, q12, final step in the infections, skin and nausea, pain characteristics of signs
Cephalosporin formation of the skin structure and symptoms
bacterial cell wall, infection, UTIs,
resulting in unstable - Note for any past allergic
Uncomplicated
cell membranes that reaction to mediation
undergo cell lysis cervical/urethral and
rectal gonorrhoea, - Monitor vital signs and
bacterial septicemia intake and output

- If also prescribed with

other antibiotic, give
cephalosporin 1 hour
 before bacteriostatic
antibiotics as these keep
bacteria from growing by
decreasing cephalosporin
uptake by bacterial cell
walls

- Note that parenteral

solutions infused too
rapidly may cause pain
and irritation

Clindamycin, 600  suppresses Serious respiratory Hypersensitivity to Diarrhea, - List/Note reasons for
mg, TIV, q6, protein synthesis by infection, serious skin medication; systemic use pseudomembranous therapy
Antibiotic, microorganisms and soft tissue may cause severe and colitis, tinnitus,
Lincosamide infections, possibly fatal colitis, nausea and - Describe and note down
septicaemia, intra- vomiting, skin skin and soft tissue
abdominal infections, rashes infections
infections of the - With IV therapy, observe
female pelvis and for hypotension, keep in
genital tract bed for 30 minutes
following infusion; bitter
taste may be evident

- Observe closely for skin

rash, Gi disturbances such
as abdominal pain,
diarrhea, nausea and
vomiting
 Isosorbide  Thought to Treatment of angina To abort acute angina Dizziness, - Note reasons for therapy,
Mononitrate, reduce cardiac pectoris, prophylaxis attacks, Lactation and in headache, cardiac history
30mg/tab, OD oxygen demand by of angina pectoris clients who may be volume hypotension,
decreasing preload caused by coronary depleted or who are already nausea and - Monitor patients vital
Coronary and afterload. Drug signs
artery disease hypotensive vomiting, increased
Vasodilator also may increase
blood flow through cough, allergic - Encourage patient to
the collateral reaciton take plenty of fluids to
coronary vessels. ensure adequate hydration

- Inform patient that drug

may cause dizziness or
light-headedness

- Monitor vital signs

before and after drug
administation

Ranitidine, 50 mg  Competitively Short term and Cirrhosis of the liver, Headacge, - List reasons for therapy,
TIV, q8 inhibits gastric acid maintenance treatment impaired renal or hepatic abdominal pain, onset/ characteristics of
secretion by of duodenal ulcer; function constipation, signs and symptoms
Histamine H2 blocking the effect pathologic diarrhea, nausea
Receptor antagonist of histamine or - Assess stomach pain,
hypersecretory and vomiting
histamine H2 noting characteristics,
receptor. conditions; short term
treatment of active frequency of occurrence,
benign gastric ulcers triggers, things that
and maintenance alter/relieve
treatment after healing -Monitor patient’s vital
of the acute ulcer signs

- Instruct patient to report

any evidence of yellow
 discoloration of skin or
eyes, or diarrhea. Maintain
adequate hydration

Trental 400 mg,  Lowers blood Peripheral arterial Massive bleeding, extensive Hypotension, -Note reasons for therapy
TID viscosity and occlusive disease and retinal hemorrhage, cardiac arryhtmias,
improves erythrocyte arteriovenous pregnancy, lactation pruritus, urticaria, - Monitor vital signs
flexibility disorders of an flushes (especially blood pressure
arteriosclerotic or and pulse); Also note
diabetic in nature and peripheral pulses
trophic disturbances - Instruct patient report
any untowards reaction
from the drug

Furosemide, 40 mg,  Inhibits the Edema associated with Never use with ethacrynic Jaundice, tinnitus, - Note reasons for therapy
TIV, prn for reabsorption of CHF, nephritic acid. Anuria, hearing
congestion sodium and chloride syndrome, hepatic hypersensitivity to drug, impairment, - Monitor vital signs
in the proximal and cirrhosis and ascites severe renal disease, hypotension, (especially BP and pulse)
Loop Diuretic distal tubule as well and intake and output
associated with azotemia, water/electrolyte
as the ascending
loop of Henle; this and oliguria, hepatic coma depletion, - Note and assess patient
results in the associated with electrolyte pancreatitis, for edema
excretion of sodium, depletion, Lactation abdominal pain,
chloride, and to a dizziness, anemia - Give IV injection slowly
lesser degree, over 1-2 minutes
potassium and
bicarbonate ions - Tell patient to report any
untoward reactions

- Change positions from

lying to standing slowing
– since drug may cause
 BP to drop

Isordil 5 mg, tab,  Relaxes vascular Treatment of Angina Use with caution during Headache, light- - Note reasons for therapy;
SL, prn smooth muscle by Pectoris, prevention of lactation headedness, include onset, location,
stimulating angina by coronary hypotension characteristics of chest
Coronary production of artery disease pain, rate pain levels
Vasodilator intracellular cyclic
guanosine - Assess vital sign
monophosphate. (especially BP)
Dilation of
postcapillary vessels - Instruct to take tablet on
decreases venous empty stomach to
return of blood; thus,
facilitate absorption
LV end-diastolic
pressure (preload) is - Change position slowly
reduced
to avoid sudden drop in
blood pressure

Clonidine, 75 mcg,  Stimulates alpha- Alone or with a - Obstetric or perioperative Dry mouth, - Identify reasons for
SL, prn, adrenergic receptors diuretic or other pain, presence of an drowsiness, therapy
of the CNS, resulting antihypertensives to injection site infection dizziness, sedation,
Antihypertensive, in inhibition of the treat mild to moderate constipation - Monitor patient’s vital
centrally acting sympathetic signs (especially blood
hypertension
vasomotor centers pressure). Blood pressure
and decreased nerve decreases occur within 30-
impulses. Thus
60 minutes after
bradycardia and a
fall in both systolic administration and may
blood pressure and persist for 8 hours. Note
diastolic blood any fluctuation to
pressure occur determine whether to use
clondine alone or
concomitantly with a
diuretic

- Change positions slowly

to prevent sudden drop in
blood pressure and
associated dizziness
 Health Teaching Guide

Topic: Skin and Foot Care

Purpose: To promote and prevent further skin and foot lesions and infection

Time Allotment: 10 minutes

Objective Content Teaching Evaluation

strategy
After 10 minutes, the Teach the importance of Discussion The patient will be
client and her family keeping the skin integrity able to state the
will be able to since wound healing is importance of her
understand the need to impaired with patients compliance
protect her skin with diabetes: medication.
integrity. • Avoid skin to skin
friction
• Observe proper
hygiene and
frequent hand and
foot washing
• Use mild soaps
• Wear comfortable,
well fitted
footwear
• Take precautions
when handling
sharps like when
cutting nails or
slicing food
 Health Teaching Guide

Topic: Diabetes Mellitus Type 2 disease process

Purpose: To promote the understanding of the patient regarding the disease

Time Allotment: 10 minutes

Objective Content Teaching Evaluation

strategy
After 10 minutes, the Carbohydrates are Discussion The patient will be
client and her family metabolized in order to be Leaflet able to state the role
will know the disease used as energy in the of carbohydrates,
process of diabetes bodily processes in insulin, the cause of
mellitus type 2, Diabetes Mellitus Type 2 hypoglycemia and its
hypoglycemia and insulin is either not manifestations.
hyperglycemia and recognized by the cells or
regular check up and its production is not
blood sugar enough to metabolize
monitoring for their carbohydrates which
understanding. leads to hyperglycemia.
When left untreated, it
may lead to
complications.
Manifestations of diabetes
mellitus are polydipsia,
polyphagia and polyuria.
The patient has oral
hypoglycemic agents to
decrease the blood sugar.
If it is taken when the
blood sugar is decreased,
it may further decrease
leading to hypoglycemia
as manifested by cold
clammy extremities,
dizziness, difficulty of
breathing and body
weakness. Regular
monitoring of blood sugar
is very important as well
as routine check up is
important.
 Health Teaching Guide

Topic: Nutrition

Purpose: To promote the right nutrition for patient with diabetes mellitus

Time Allotment: 15 minutes

Objective Content Teaching Evaluation

strategy
After 5 minutes, the The proper diet with Discussion The patient will be
client and her family patients with diabetes Leaflet able to state the role
will be able to know mellitus is essential of proper nutrition for
the importance of the because it will enable the patients with diabetes
correct diet. patient to have the mellitus.
nutrition she needs as
well as prevent
complications and
hyperglycemia.
After 10 minutes, the Eating less salt, sugar, fat Discussion The patient will be
client and her family and cholesterol lessen the Leaflet able to recite the diet
will be able to know possibility of developing she needs.
the proper diet for the increased blood pressure.
patient. Carbohydrates are the
main source of energy but
it can raise the blood
sugar. Per meal, 1/3 cup
of cooked rice, ½ cup
cooked pasta, ½ cup
mashed potatoes or 2
slices of bread is
recommended for
carbohydrate intake.
 Health Teaching Guide

Topic: Exercise

Purpose: To enable patient to have a healthy lifestyle through exersice

Time Allotment: 15 minutes

Objective Content Teaching Evaluation

strategy
After 15 minutes, the Exercise can reduce Discussion The patient will be
client and her family weight, lower blood sugar Leaflet able to state the
will be able to know by using the importance of exercise
the importance of the carbohydrates as energy. in relation to her case.
exercise in relation to Have simple sugars ready
diabetes mellitus. in case symptoms of
hypoglycemia are
experienced.

Health Teaching Guide

Topic: Compliance to Medicaitons

Purpose: To promote maintenance of the blood sugar of the patient at normal range of 80-120
mg/dL

Time Allotment: 5 minutes

Objective Content Teaching Evaluation

strategy
After 5 minutes, the Taking of oral Discussion The patient will be
client and her family hypoglycemic is needed able to state the
will be able to know as maintenance of the importance of her
the importance of blood sugar at normal compliance
compliance to level since its action is to medication.
medication. stimulate the secretion of
insulin from the pancreas.