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Introduction:

Diabetes mellitus is a group of metabolc dieseas characterized by


elevated level of glucose in the blood reffered to us as hyperglycemia, thus
resulting from defects in insulin secretion, insulin action or both. Normally a
certain amount of glucose circulates in the blood. The major source of this
glucose are absorption of ingested food in the GI tract and formation of
glucose by the liver from food substance.

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 daibetic state, the cells may stop responding to insulin or the pancreas
may stop producing insulin entirely. This lead to hyperglycemia, which
result in acute metabolic complications such as Diabetic ketoacidosis,
hyperglycemic hyperosmolar nonletonic syndrome

Diabetes mellitus type 2 (previously reffered to as “non-insulin-


dependent diabetes mellitus.) is one of the classification of diabetes.
Approximately 90% to 95% of people with diabetes have type 2 daibetes,
which result from decrease sensitivity to insulin(called insulin resistance)
and impaired beta cells funtioning, resulting to decrease insulin production .
The two main problems related to insulin in type 2 daibetes are insulin
resistance and inpaired insulin secretion. Insulin resistance reffered to a
dcrease tissue sensitivity to insulin. Normally insulin binds to a special
receptor on cell surface and initaites a series of reactions involved in
glucoes metabolism. In type 2 diabets this intracellular reactions are
diminished, thus rendereing insulin less effective at stimulating glucose
uptake by the tissue and at regulating glucose release by the liver. The
exact mechanism that lead to insulin resistance and impaired insulin
secretion in type 2 diabetes are unknown, although genetic factors are
thought to play a role. Type two diabetes occurs most commonly in people
older than 30 years who are obese, although its incidence is increasing in
younger adults because it is assocaited with a slow, progressive glucose
intolerance, the onset of type 2 diabetes may go undetected for many
years. If symptoms is experienced they are frequently mild and may include
fatigue, irritability, polyuria, polydypsia, skin wounds that heal poorly,
vaginal infections or blurred vision.
Patient profile:

Name: patient XY

Sex: male

Age : 54 yaers old

Birthdate: May 5,1956

Birth palace: Lower kalanganan Pantar Lonao del Norte

Occupation: self employed

Religion: Islam

Nursing health history:

 Chief complain: Dyspnea, fatigue

 History of present illness:

1 week prior to admission patient suffered from difficulty of


breathing associated with cough and fever, fatigue and weakness.

 Past history

 Childhood illness

-The patient experienced having a measels at the age of 7.

 Childhood immunization

-Unrecalled.

 Allergies and type of reaction that occurs

- patient is allergic in perfumes and dust.

 Accidents and injuries

- no accidents and injury recalled except for minor cuts, scalds and
bruises

 past hospitalization

- during his teenage years the patient undergone appendectomy.


Physical Assessment

The patient was observed lying on bed, patient is conscious but his
not able to communicate. Vitals signs were noted; BP-100/70, HR-
132, RR-14, and temp 36.2oC

Skin: Generally has uniform piigmentation except in areas around his


neck and areas exposed to the sun. have a warm and good skin
turgor.

Hair: variable, no infestation, well distributed hair

Nails: has smooth texture, highly vascular and pink in color and intact
epidermis.

Head: normocephalic, and smooth skull contour, absence of nodules


and symmetric facial features.

Eyes: eyebrows symmetrically aligned and equally movement, skin


intact,no discharges no discoloration. Eye lids close symmetrically
approximately 15-20 involuntary links per minute, positive reaction to
light and accomodation.

Ears: color is same as facial skin, symmetric posistion, firm, has


smooth texture and no signs of discharges.

Nose: symmetric and striaght, no discharges, has uniform color, not


tender and no lession.

Mouth and bucal cavity: uniform pink color, no retraction of gums,


tounge is central posistion.

Neck: muscles equal in size, head centered, coordinated..

Lungs and thorax: chest is symmetrical, skin intact, wheezing sound


noted, respiratory rate of 40 cpm.

Peripheral vascular system: full of pulsation, symmetric pulse


volumes, extremeties shows no signs of redness, tenderness and
edema.

Breast nad axillae: skin is uniform in color, it is also smooth nad


intact, no lesions and absence of discharges. No presence of
tenderness and masses.
Abdomen: unblemished skin,uniform in color, soft skin, no rashes or
skin lessions, scar noted on the right lower quadrant due
appendectomy he undergone during his teenage years.

Muscoskeletal system;

• Upper extremities: has an equal size on both side of the body,


no contractures, no tremors, normally firm

• Lower extremities: bilaterally symmetrical and equal, skin


color is the same as the other part of the body, presence of
wounds notedon the left leg,

Neurologic system: concious but cannot able to interact because of


discomfort.

Male genitals and reproductive tract: the family of the patient


refused to assess the genitourinary organs of their patient.
Gordons functional health pattern

Health perception- health


management pattern
 data collection is focused on
-patient is admmited due to his the persons percieved level of
complain of difficulty of breathing, health and well-being and on
fatigue and weakness. practices for maintaining
health
-patient is not aware about his  habits that may be detrimental
health beacause he does not to health are also evaluated,
maintained his prescribed including smoking and alcohol
medication on diabetes or drug use.
 actual or potential problems
-patient is a smoker and does he is related to safety and health
also diagnosed that he has a COPD. management may be identified
as well as needs for
modificaions in the home or
needs for continued care in the
home

Nutritional metabolic pattern

-patient usally eat 3x a day and has  is focused on the pattern of


good appetite.. food and fluid consumpion
relative to metabolic need
-he drinks about 5-6 glasses of  the adequacy of local nutrient
water a day supply
 the actual potential problem
-patient does not drink alcholic related to fluid balance, tissue
beverages. integrity, nad host defense
may be identified as well as
-when his cough started he does not problem with the
want to eat. Thus resulting to his gastroentestinal system.
weight loss about 3lbs.

A. USUAL DAILY MENU

Patient is an islam so he never


eats pork. his usual daily menu
for breakfast is bread and
coffee, for lunch he eats
rice,fish and veggies, for
dinner he eats rice and
vegetables.
B. DENTITION

Patient has a complete set of


teeth in the upper portion. but
in the lower portion there no
lateral incisors there is a
presence of tartar on his
molars.

C. METABOLIC

patient’s weight has been


decreasing that led him to be
malnourished. Prior to his
admission his weight looses
about 3 pounds.

Elimination pattern  data collection is focused on


excretiry oattern(bowel,
A. BOWEL bladder, skin)
 excretory problems such as
Patient usually defacates 3x a incontinence, constipation,
week with normal color and dairehea and urinary retention.
texture.

B. BLADDER

Patient doesn’t have any


problem in urination. He urinates
about 5 glasses per day,

Activity-Excercise pattern
 assessment focused on the
A. SELF-CARE ABILITY activities of daily living
requiring energy expenditture,
-Patient works as a farmer. He including self-care activities,
managed his own farm.\ exercise and leisure activities.
 The status of major body
-He often cleans the house but system involved with activity
cooks for his family when he has and exercise is evaluated
spare time. including the respiratory,
cardiovascular and
-He likes to converse with his musculoskeletal.
friends and neighborhood.

-He takes a bath once a day. He


wears slippers as for protection
on his feet.

-She washes her hands regularly


but not always using soap.

Sleep and rest pattern  It is focused on the persons


sleep, rest pattern and
Patient usually sleeps for about 6-8 relaxation practices.
hours, he sleeps at 12 mid night and
wakes up at 8am in the morning.  dysfunctional sleep pattern,
Usually he sleep in the afternoon for fatigue, and responses to seep
about 3-4 hours. deprivation may be identified.

Cognitive-perceptual pattern  data collection is focused on


the ability to comprehend and
-patient is a college level. use information and sensory
-He uses reading glasses for him to functions.
able to read.  data pertaining to neurologic
-patient needs further explaination function are collected to aid
for him to be able to understand. this process.
-He can only speak tagalog and  sensory experience such as
muslim language. pain and altered sensory input
may be identified.

Self-perception-self-concept
pattern
 it is focused on the persons
-patient feels that there is something attitude toward self, including
wrong in his health and body identity, body image and sense
beacause of many discomfort he of self-worth.
feels, like fatigue, weekness and to
his wounds that are slow to heal.  the persons level of self-
esteem and response tp
-as a father it feels sad bacause he threats to his or her self-
cant do the previous things bacause concept may be identified.
of his sickness, he managed his
farm and worked hard for his family.
His strength is his family.

Rele relationship pattern

-patient performing a typical  assessment focused on the


responsibilities as a father. He is person’s roles in the world
baing cared by his family who is very and relationship with others.
supportive to him. He has  satisfaction with roles, role
harmonious relationship with his strain or dysfunctional
family and can perform a healthy relationship may be further
relationship with others. evaluated.

Sexuality-reproductive pattern

-bacause of aging patient interest to  data collected is focused on


sexual is decreasing. He is more persons satisfaction or
focused on giving fanancial supports dissfaction with sexuality
to his family. patterns and reproductive
He dressed appropriately based on functions.
his gender and also able to express  Concerns with sexuality may
his masculine attitude. he identified.

Coping stress pattern


 is focused on the persons
-patient whenever he has a problem perception of stress and on his
he smoke, he consumed 5-6 sticks or her coping strategies.
per day.  copping mechanism which are
bahaviors used to decreased
stress and anxiety.

Value-belief pattern
 it is focused on the persons
-patient is an islam he attend mass values and belief including the
ocassionally whenever there are spiritual beliefs or the goals
Muslim events he participates to the that guide his or her choices or
avtivity like ramadan. Patient decisions.
strongly believed Allah, he and his
family always ask guidance and
protection
DISEASE PROCESS

 ANATOMY AND PHYSIOLOGY

The pancreas, located close to the stomach in the abdominal cavity,


is a mixed gland. Probably the best hidden endocrine gland in the
body are the pancreatic islet, formerly called the islet of langerham.
These little masses of hormone producing tissue are scattered
among the enzyme-producing acinar tissue of the pancreas .the
exocrine (enzyme producing) part of the pancreas. Which acts as part
of the digestive system, will be discussed later; onl the pancreatic
islets wilol be considered here.

Althoug there are more than million islets, separated by exocrine


system, each of these tiny clumps of cells busilt manufactures its
hormones and works like organ within an organ. Two important
hormones produced by the islets cells are insulin and glucagon. The
islets also produce small amounts of other hormones, but those will
not be discussed here.

High levels of glucose in the blood stimulate the release of


insulin from the beta cells of the islets. Insulin acts on just about all
body cells and increases their ability to transport glucose across their
plasma membranes. Once inside the cells, glucose is oxidized for
energy or converted to glycogen or fat for storage. These activities
also speeded up by insulin. Since insulin sweeps the glucose out of
blood, its effect is saqid to be hyperglycemic. As blood glucose levels
fall, the stimulus for insulin release ends-another classic case of
negative feedback control. Many hormones have hyperglycemic
effects (glucagon, glucocorticoids, and epinephrine, to name a few),
but insulin is the only hormone that decreases blood glucose levels.
Insulin is absolutely necessary for use of glucose by the body cells.
Without it, essentially no glucose can get into the cells to be used.

Glucagon acts as an antagonist of insulin; that is, it helps to regulate


blood glucose levels but in an way oppositeto that of insulin. Its
release by the alpha cells of the islets is stimulated by low blood
levels of glucose. Its action is basically hyperglycemic. Its primary
targets organ is liver, which ios stimulates to break down stored
glycogen to glucose and to release the glucose in the blood. No
important disorders resulting from hypo- or hypersecretion of
glucagon are known.

HEMEOSTATIC IMBALANCE

Without insulin, blood levels of glucose (which normally range from


80-120mg/100 ml of blood) rise to dramatically high levels ( for
example, 600 mg/100 ml of blood). In such instances, glucose begins
to spill into the urine because the kidney tubule cells cannot reabsorb
if fast enough. As glucose flushes from the body,water follows,
leading to dehydration. The clinical name for this condition is diabetes
mellitus, which literally means that something sweet is passing
through or siphoning from the body. 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 diabetes must be careful with their hygiene and in
caring for even small cuts and bruises. When large amounts of fats
(instead of sugars) are used for energy, the blood becomes very
acidic (acidosis) as ketones (intermediate products of fat breakdown)
appear in the blood. On the basis of cause, this condition of acidosis
is reffered to as ketosis. Unless corrected, coma and death result.
The three cardinal signs of diabetes mellitus are 1. polyuria –
excessive urination to flush out the glucose and ketones 2.
Polydipsia-excessive thirst resulting from water loss and 3.
Polyphagia- hunger due to inability to use sugars and the loss of fat
and proteins from the body.

Those with mild cases of diabetes mellitus (most cases of type


II, or adult-onset, diabetes) produce insulin, but for some raeson their
insulin receptors are unable to respond to it, a situation called insulin
resistance. Type II diabetics are treated with special diets or oral
hypoglycemic medications that prod the sluggish islets into action and
increase the sensitivity of the target tissues to insulin and of beta cells
to the stimulating effects of glucose. To regulate blood glucose levels
in the more severe type I (juvenille, or brittle) diabetic, insulin is
infused continously by an insulin pump worn externally, or a regimen
of carefully planned insulin insulin injections is administered
throughout the day.

Pathophysiology

Diabetes Mellitus Type 2 is referred to as non-insulin dependent


diabetes mellitus (NIDDM), or adult onset diabetes mellitus
(AODM).In case our patient we classified the risk factor into two
categories the modifiable and non-modifiable. Under modifiable is the
diet because diet high in cholesterol increases number of adipose
tissue and this tissue are resistant to insulin therefore glucose uptake
by cell is poor and the stress because stress stimulates secretion of
epinephrine, norepinephrine and glucocorticoids and this
neurotransmitters increases glucose level. In the non-modifiable
factor hereditary because it can be transfer from parents to offspring.
In the case of our his father has a diabetes also. And the age with
strong heritability patterns which present as type 2 diabetes early in
life, usually before 30 years in the case of our patient he was
diagnosed at the age of 37 years old. In type 2 diabetes, can still
produce insulin, but do so relatively inadequately for their body's
needs, beta cells are primary affected and there is a poor production
of insulin. Insulin is also the principal control signal for conversion of
glucose to glycogen for internal storage in liver and muscle cells.
Lowered glucose levels result both in the reduced release of insulin
from the beta cells and in the reverse conversion of glycogen to
glucose when glucose levels fall. If the insulin is deficient the
intracellur and the intravascular space are affected. In the intracellular
space there is a failure of glucose to enter in the intracellular space
because there is a lack of insulin and insulin acts as the key to be
able the glucose to enter in the cell. And when this happened the
glucose supposed to be absorb by the cells are staying in the blood
and this term is hyperglycemia. If cell was not able to absorb the
sugar their will be intracellular and extracellular dehydration and body
will compensate and the person will have the urge to drink more
water it is term polydipsia. Also if cell has no glucose intake their will
be cellular starvation and the person will have the urge to eat and eat
and it is termed polyphagia.

In the intravascular area if the insulin is insufficient and glucose are not
absorb by the cell the glucose is staying in the blood stream and the
glucose level in the blood will increase as the sugar in blood increase the
blood circulation will become viscose. Prolonged high blood glucose level
leads to sluggish circulation and when the glucose concentration in the
blood is raised beyond its renal threshold, reabsorption of glucose in the
proximal renal tubuli is incomplete, and part of the glucose remains in the
urine (glycosuria). This increases the osmotic pressure of the urine and
inhibits reabsorption of water by the kidney, resulting in increased urine
production (polyuria) and increased fluid loss. Lost blood volume will be
replaced osmotically from water held in body cells and other body
compartments, causing dehydration and increased thirst. In a sluggish
circulation due to high blood content in blood the oxygen supply in the
peripheral site is insufficient and when this happened there is a proliferation
of microorganism in the case of our patient his wound doesn’t easily heal
due to poor oxygen delivery and microorganism take place and multiply.
Health teaching

 Nutritional management

Nutrition, diet, and weight control are the foundation of


diabetic management. The most important objctive in
dietary and nutritional management of diabetes is
control of total caloric intake to gain nad maintain a
reasonable body weight and control of bllod glucose
level.
 Execise

Exercise is extremly important in managing diabetes


because of its effect on lowering blood glucose and
reducing cardiovascular risk factors. Its also lower the
bllod glucose level by increasing the uptake of glucose
by body muscles and by improving insullin utilization.
 Teaching proper foot care.

-wearing closed toe shoes that fit well.


-treaming toenails straight across and filling sharp
corners to follow the contour of the toe.
 Proper self-administer insulin

With one hand satbilized teh skin by spreading it or


pinching up a large are.
Pick up syringe with the other hant and hold it as yppu
would a pencil. Insert straight into the skin.
To inject teh insulin, push the plunger all the way.
Pull nedle straiht out of the skin. Press cotton balls over
injection site foe several seconds.
Use disposable syringe only ones and discard it into a
harpd plastic container.

Evaluation, recommendation and prognosis

Diabetes mellitus is a group of metabolc dieseas characterized by elevated


level of glucose in the blood reffered to us as hyperglycemia, thus resulting
from defects in insulin secretion, insulin action or both. Type 2 daibetesis
first treated with diet and exercise. If elevated glucose level persist, diet
and exercise are suplemented with pral hypoglcemic agemts. In some
individual with type 2 daibetes ,oral agents do not control hypoglycemia,
and isnulin injection are required

The prognosis of the patient with type 2 daibetes varries considerably from
one another to another. It can be preveented or deleyed in persons at risk
for the disease trough weight reduction and increase participation in
moderate excercise.