IX.

Ecologic Model

A. Hypothesis

Diabetes Mellitus is a condition in which the pancreas can no longer

produce enough insulin or cells stop responding to the insulin that is
produced, so that glucose in the blood cannot be absorbed in the ells of the
body.
In the case of our patient, the form of diabetes she has is Type 2; it
sometimes called age-onset or adult- onset diabetes. She is aged 43 years
old and lives a sedentary lifestyle by being a vendor on their little store,
sitting the whole day. Our client was also diagnosed with Coronary Artery
Disease and some other complications.

B. Predisposing Factors

Host
-Female
-43 years old
-sedentary lifestyle
-Coronary Artery Disease

Agent
-Chemical- glucose (and any type of sugar)

Environment
-living conditions
-economic level

C. Ecologic Model

HOST

ENVIRONMENT
AGENT
 D. Analysis

The agent-host-environment model is primarily use in predicting illness

rather than promoting wellness, although identification of risk factors that
result from the interactions of agent, host, and environment are helpful in
promoting and maintaining health. Because each of the agent-host-
environment factors constantly interacts with others, health is an ever
changing state. Health is seen when all three elements are in balance while
illness is seen when one, two, or all three elements are not in balance.
(Fundamentals of Nursing by Kozier)

Type 2 Diabetes Mellitus, previously called NIDDM or adult-onset

Diabetes Mellitus, is a disorder involving both genetic and environmental
factors. Type 2 Diabetes Mellitus is the most common type of Diabetes
Mellitus, affecting 90% of all people who have the disease. In addition, the
prevalence of Coronary Artery Disease in people with DM is twice that in non-
diabetic population. (Medical-surgical nursing by Black)

E. Conclusion and Recommendations

We therefore conclude that our client is suffering from Type 2 Diabetes

Mellitus, probably due to her age, sedentary lifestyle, as well as her
predisposition to coronary artery disease. Other risk factors may also involve
such as age and the way of living.

Recommendations would include health promotion in assisting the

client and family to understand DM and the necessary lifestyle changes such
as regular and well-balanced diet.
 DISCHARGE PLAN

M – Medications to take at home

*Refer to the drug study
E – Exercise

Teach the client that a program of planned physical activity is a crucial

part of the treatment plan. Physical activity lowers blood glucose level by
increasing carbohydrate metabolism, fosters weight reduction and
maintenance, increases insulin sensitivity, increases high-density
lipoprotein(HDL) levels, decreases triglyceride levels, lowers blood pressure,
and reduces stress and tension.

Clients with diabetes mellitus must start a new activity at a well-

tolerated intensity level and duration, with gradual (over a period of weeks or
months) increases in intensity and duration until preset exercise goals are
reached. Exercise should include warm-up and cool-down periods before and
after the activity. Regular exercise should be three to five times weekly.

T – Treatments

Medical management for patients with diabetes mellitus type 2

includes restoring and maintaining blood glucose levels to as near as normal
as possible by balancing diet, exercise, and the use of oral hypoglycaemic
agents. All these are discussed throughout the discharge plan.

H – Health Teachings

Before hospital discharge, the client and family must have a basic
understanding of diabetes mellitus and its management with blood glucose
monitoring, foot care, nutrition, and exercise. Because diabetes mellitus is a
chronic disorder, teach the client that she needs to adapt to as well as learn
about the many changes that are occurring. The client should be encouraged
to anticipate a usual day at work, school, how to monitor blood glucose level
and what types of food to eat.

Health promotion activities for type 2 DM include the following:

• Following the diet regimen
• Avoiding foods high in refined sugar
• Maintaining ideal body weight
• Exercising regularly

Health maintenance activities involve the following:

 • Maintaining blood glucose at levels as normal as possible
• Preventing hypoglycaemia and hyperglycemia with stress, illness, or
exercise by closely monitoring blood glucose levels and taking early
action
• Performing daily foot care
• Preventing complications of DM by removing or treating coexisting
factors such as smoking, hypertension, and hyperlipidemia

Health restoration actions include the following:

• Prompt treatment of foot abrasions or infections
• Teach meal planning and physical activity programs to reduce obesity
• Treatment of previously described risk factors
• Control of angina and peripheral vascular disease

O – Out patient follow up

Clients require consistent follow-up, updating, and reinforcement.

Assessment of client’s level of acceptance of personal responsibility is
necessary. This guides the practitioner to appropriate teaching and
behavioural techniques to encourage a higher level of acceptance on the
client’s part.

Chronic changes that result from DM should also be assesses on an

ongoing basis by checking the client’s vision, kidney function, degree of
neuropathy, blood pressure, and skin condition. Follow-up visits should be
referred upon the physician’s orders and is needed to asses for
complications of DM and reinforcement of learning needs.

D – Diet

Dietary management is an essential component of diabetic care and

management. Emphasize to the client and family members that they are not
eating a “diabetic diet” but, rather, are following a balanced meal plan.

Calories – Moderate caloric reduction is described as a reduction of 250 to

500 calories per day less than usual. Reduction of fat calories may be a good
initial modification.

Protein – At present, the lower end of the recommended scale for protein
intake (about 10% of daily calories) is sufficiently restricted. Clients who
have DM have same protein requirements as to people who do not have.
Fats – The general recommendation is to decrease total dietary fat to 30% or
less of total calories, with saturated fat being decreased to less than 10%.

Carbohydrates – Clinical guidelines suggest that 50% to 60% of diet should

include carbohydrates, in either simple or complex form.

Fiber – Clients with DM are urged to consume 20-35 g of fiber per day.