DM

Chapter 1
INTRODUCTION
Diabetes mellitus (DM) is a group of metabolic diseases in

which a person has high blood sugar, either because the body does
not produce enough insulin, or because cells do not respond to the
insulin that is produced. This high blood sugar produces the classical
symptoms of polyuria, polydipsia, and polyphagia. When the glucose
concentration in the blood is raised beyond its renal threshold (about
10 mmol/L), 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.
Type 1DM results from the body's failure to produce insulin, and
presently requires the person to inject insulin (Also referred to as
insulin-dependent diabetes mellitus (IDDM) or "juvenile" diabetes).
Type 2 DM results from insulin resistance, a condition in which cells
fail to use insulin properly, sometimes combined with an absolute
insulin deficiency (formerly referred to as noninsulin-dependent
diabetes mellitus (NIDDM) or "adult-onset" diabetes). If the amount
of insulin available is insufficient, if cells respond poorly to the effects
Diabetes Mellitus with Hypertension (A Case Analysis) Page 1

of insulin (insulin insensitivity or resistance), or if the insulin itself is
defective, then glucose will not have its usual effect, it will not be
absorbed properly by those body cells that require it, nor will it be
stored appropriately in the liver and muscles. The net effect is
persistent high levels of blood glucose, poor protein synthesis, and
other metabolic derangements, such as acidosis.
Type 2 Diabetes is a chronic disease that affects an estimated

16 million or more Americans. Studies show that the number of
people suffering from Type 2 Diabetes is increasing in almost every
country around the globe. Every year more than 3 million people
worldwide die of Type 2 Diabetes. Globally, as of 2010, an estimated
285 million people have type 2 diabetes, making up about 90 percent
of all diabetes cases.
The glucose level in the body in Type 2 Diabetes patients is

higher than in normal people who do not suffer from this condition.
Generally after eating, the food reaches the stomach where it breaks
down into a sugary substance known as glucose. This glucose is then
carried through the blood stream to all the cells in the body. In Type 2
Diabetes patients the insulin, which is the substance that does the
work of converting glucose into energy, is produced in insufficient
quantities. Because of this, cells found in the body's fat, liver and
muscles are unable to utilize the glucose that is present leading to a
drastic increase in the glucose level of the blood while cells that need
glucose to function properly are deprived of it. This has very severe
consequences and after a period of time the blood vessels and
nerves could get seriously affected and lead to other related illnesses

including blindness, nerve problems, kidney disease, and heart
attacks. In extreme cases, drastic action including amputation of
limbs is called for.
Diabetes mellitus and hypertension are common diseases that

coexist at a greater frequency than chance alone would predict.
Diabetic nephropathy is an important factor involved in the
development of hypertension in diabetics. The hallmark of
hypertension in type I and type II diabetics appears to be increased
peripheral vascular resistance. Increased exchangeable sodium may
also play a role in the pathogenesis of blood pressure in diabetics.
There is increasing evidence that insulin resistance/ hyperinsulinemia
may play a key role in the pathogenesis of hypertension in both
subtle and overt abnormalities of carbohydrate metabolism.
Population studies suggest that elevated insulin levels, which often
occurs in type II diabetes mellitus, is an independent risk factor for
cardiovascular disease. Other cardiovascular risk factors in diabetic
individuals include abnormalities of lipid metabolism, platelet function,
and clotting factors.
Chapter 2
HEALTH HISTORY
A. Biographical Data

Patient X is 59 years old, married and was born on December
31, 1952 at Tagbilaran Bohol. She is a Catholic. Her permanent
residency is in Matalbis Masinloc, Zambales,with her husband and
their six kids. She is unemployed.
B. Present Health History
Two days prior to admission, Patient X had facial edema.
Prior to admission, Patient X complained of having facial

edema and body weakness. She sought consultation at President
Ramon Magsaysay Memorial Hospital and the doctor referred her
immediately. She was admitted on June 20, 2012 at 10:35 pm. Her
admitting diagnosis was Hypertension I and Diabetes Mellitus.
C. Past Health History
Patient X had no vaccinations during childhood. She has no

known allergies to food or drugs. She has six children that were all
normal deliveries. After the birth of her last child, she’s been getting a
recurrent hypertension
In the past, the patient X has been admitted in the hospital two
times. In 1989 she was admitted with the diagnosis of Pulmonary TB
and on 2009 for the disarticulation of one of her right toe.
D. Family Health History
Patient X is the third child out of four. Her father died when she
was 28 years old due to hypertension. He was an avid smoker and
had a history of asthma and high blood. Her mother is still alive at the

age of 78, and has a history of stroke and Diabetes Mellitus. She
was also an avid smoker for 62 years. She doesn’t know if any of her
siblings have any health complications.
E. Psychosocial Health History
Patient X owns a house in Masinloc. It’s a cemented house,

with one room and one bathroom. Her third child resides with them
and is financially dependent.
F. Dietary Health History
Patient X had body weakness on the day of her admission.

She felt weak and had poor appetite. But on any other normal day
she likes to eat 2 cups of rice, 2 pieces of tuyo, tinapa or daing,
coffee, a glass of water and sweets for breakfast. She doesn’t have
snacks between breakfast and lunch. At lunch time, she likes to eat 2
cups of rice, tu, a glass of water and a soft drink. For her afternoon
snack, she eats 2 pieces of bread, cup of soft drink and glass of
water. For dinner, she likes to eat 2 cups of rice, tuyo and a glass of
water.
Patient X doesn’t drink enough water daily. At the most, she

drinks only five cups of water a day as opposed to 12 cups that’s
recommended daily. She tries to balance what she eats by eating a
serving of vegetables and fruit at least once a day.

Chapter 3
PHYSICAL ASSESSMENT
GENERAL NORMAL ACTUAL INTERPRETATION

APPEARANCE FINDINGS FINDINGS
Inspection
> Body built, > Proportionate > slightly > Generally
height, weight varies with weak and appearance shows
in relation to lifestyle fat some abnormal
client’s age, result, due to her
lifestyle and condition
health
> Relaxed, > Able to sit
> Posture and erect posture; but cannot
gait, standing, coordinated walk and
sitting and movement stand alone
walking
> Clean and > fair
> Over all neat hygiene
hygiene and
grooming
> No body odor, > No body
> Body and or minor body odor
breath odor odor related to

work or
exercise; no
breath odor
> Signs of > Healthy > Generally
health and appearance uniform in
illness color of
skin, slightly
weak
> Client’s > Cooperative,
attitude able to follow > slightly
instruction cooperative
> Client’s mood > appropriate >

according to Appropriate
situation to situation
> Quantity,
quality, and > > Slow
organization of understandable, pace, soft
speech moderate pace,
clear tone and
infection:
exhibits thought
association
PROCEDURE NORMAL VITAL SIGN ASSESSMENT

BP <120 / <80 140/80 High
PR 60-100 85 Normal
RR 16-20 19 Normal
Temp 36.5-37.5 37.1 Normal
NORMAL ACTUAL INTERPRETATI

BODY/ORGAN
FINDINGS FINDINGS ON

SKIN
INSPECTION
 Skin Color > Varies from Light to deep Skin is not
light to deep brown normal due to
brown; from edema
ruddy pink to
light pink;
generally
uniform except
 Skin in areas With scars
Lesions exposed to the and striae
sun
> Freckles,
some
birthmarks,
PALPATION some flat and Dry
 Skin raised nevi; no
Moisture abrasion and
other lesions Temp: 37.1
C
 Skin > Moisture in
Temperatur skin folds in
e axilla Skin springs
back late
 Skin Turgor > Within the
normal range
With
 Presence of > When facial/extrem
Edema pinched, skin ity edema
springs back to
previous state
(+) Edema
HEAD

INSPECTION
 Skull >Normocephali Normocepha Skull of the client
c lic is normal sized.
>(-) (-)
 Scalp Tenderness Tenderness Normal
>Lighter in Lighter in
color color
>Moist/Oily Moist
>(-) Lice, nits (-) Lice, nits
and dandruff and dandruff
>(-) Lesions (-) Lesions
 Hair >(-) (-) White hair
Tenderness Tenderness normally occurs
nor masses nor masses during adulthood
> Black, brown Black with

or burgundy scanty
> Evenly amount of
distributed white hair
>Thick or thin Evenly
> Brittle nor distributed
dry Thin
Dry
FACE
INSPECTION > Shape may Rounded Face is rounded
 Eyes be oval or because client is
rounded Symmetrical slightly fat
> Face is (-)
symmetrical involuntary
> (-) muscle
involuntary movement
muscle
movement Evenly

placed and
> Evenly in line
placed and in
line Not
protruding
 Eyebrows > Not Equal
protruding palpebral
> Equal tissue
palpebral
tissue Symmetrical
and in line
> Symmetrical
 Eyelashes and in line
Black and
evenly
> May be black distributed
or brown
> Evenly Black and
distributed evenly
distributed
>Color
depends on It covers
race small portion
 Eyelids > Evenly of the iris, (-) Drooping of
distributed cornea, and the eyes
sclera when
> Upper eyes are
eyelids cover open
small portion of
 Conjunctiva the iris, (-) PTOSIS Conjunctiva is
cornea, and Meets pale due to
sclera when completely insufficient blood
eyes are open when the supply
eyes are
 Cornea >(-) PTOSIS closed

>Meets Symmetrical
completely Pale
when the eyes Moist
 Iris are closed (-) Ulcers
>Symmetrical (-) Foreign
objects
>Pinkish or red (-)
> Moist Irregularities
 Pupils > (-) Ulcers in the
> (-) Foreign surface
objects
> (-) Looks

Irregularities in smooth
the surface Clear
> Looks
smooth
>Clear and/or (-) Visible

transparent materials
> (-) Visible Black
materials
>Color is Equally
black, blue, round
brown or green Constrict
depending on briskly when
the race light is
 Sclera directed to
>Equally round the eye
>Constrict
briskly when Dilates when
light is directed looking at
to the eye distant

object
>Dilates when Constricts
looking at when
distant object looking at
near objects
>Constricts White in
when looking color
at near objects
> Sclera is (-) yellowish

white in color discoloration
>(-) yellowish (-) capillaries
discoloration visible
> Some
capillaries
maybe visible
EARS > Earlobes are Bean
INSPECTION bean shaped, shaped,
parallel, and parallel, and
symmetrical symmetrical
Ear is normally
> Earlobe is Parallel to placed and in
parallel to the the outer size
outer canthus canthus of
of the eye the eye
>Skin is the Skin is the

same color as same color
in the in the
complexion complexion
(-) Lesions
> (-) Lesions
Auricles has
> Auricles has a firm Cerumen serves

a firm cartilage cartilage as protection of
the ears against
> Ear canal dirt
has normally With some
some cerumen cerumen
PALPATION >(-) Discharge
or lesions >(-)
Discharge or
> (-) pain or lesions
tenderness
when palpated (- ) pain or
tenderness
when
palpated
NOSE
INSPECTION >Nose in the In midline Nose is normally
midline (-) placed with no
> (-) discharges discharge
discharges Both nares
> Both nares are patent
are patent (-)
> (-) Tenderness
Tenderness Nasal
> Nasal mucosa is
mucosa is pinkish
pinkish to red
MOUTH
INSPECTION >With visible With visible
margin margin
> Symmetrical Symmetrical
in appearance in
and movement appearance
and

> Pinkish in movement
color Pinkish
 Gums >(-) Edema (-) Edema Dental loss,
dental fillings
> Pinkish in Pinkish and/or dental
color (-) Gum carries normally
 Teeth > (-) Gum bleeding seen during
bleeding (-) receding adult because
>(-) Receding gums calcium level
gums 26 teeth decreases
White to
>32 teeth for yellowish in
adults color
 Tongue > White to (-) Halitosis
yellowish in
color Pinkish with
white taste
buds
> (-) Halitosis (-) Lesions
(+) Gag
> Pinkish with Reflex
white taste Able to
buds move freely
> (-) Lesions and with
 Uvula > (+) Gag strength
Reflex Surface of
> Able to move tongue is
freely and with rough
strength
> Surface of Positioned in

tongue is the midline
rough Pinkish
(-) swelling

>Positioned in or lesions
the midline
> Pinkish to
red in color
> (-) swelling
or lesions
NECK
INSPECTION > Straight and Straight and Lymph nodes
in mid line > in mid line may be a sign of
Symmetrical Symmetrical infection in head
PALPATION Trachea is area
> Trachea is palpated
palpated (-) Mass or
> (-) Mass or Lymph
Lymph nodes nodes
BREAST
INSPECTION > When Breast is Breast is normal
overlying the even when
breast should overlying
be even Not
> Not completely
completely symmetrical
symmetrical at at rest
rest Round and
> Areola is dark brown
round or oval in color
with same
color (pink to
dark brown) Rounded,
averted,
>Nipples are same size,
rounded, and equal in
PALPATION averted, same color

size and equal (-) Discharge
in color from the
>(-) Discharge nipples
from the
nipples (-) palpable
masses or
>(-) palpable lumps
masses or (-)
lumps Tenderness
> (-) upon
Tenderness palpation
upon palpation
ABDOMEN
INSPECTION > Skin color is Not uniform Presence of
uniform With striae striae and/or
> Some clients and scar scars are normal
have striae or
scar Rounded Peristalsis is
> Contour may Not visible only seen on thin
be flat, clients
rounded, or
scaphoid
> Visible
peristalsis
EXTREMITIES
INSPECTION > Both Equal in size Extremities are
extremities are not normal
equal in size Not equal in
> Has equal contraction
contraction (-)
and even Involuntary
PALPATION > (-) movement

Involuntary (+) Edema
movement Color is not
>(-) Edema even
>Color is evenTemperature
is warm and
> Temperature even
is warm and
even
LUNGS
&THORAX
INSPECTION
> Chest must Chest is Lungs are not
 Skin be symmetric; symmetric; normal
Integrity skin is uniform skin is
in temperature; uniform in
full and temperature;
symmetric full and
expansion symmetric
AUSCULTATION
> Quiet,
 Breathing effortless Breathing is
and Breath respiration not equal
sounds and
irregular,
presence of
wheezing
sounds
CARDIOVASCUL
AR
INSPECTION > Uniform in Uniform in Cardiovascular

 Skin Color color color is normal
 Veins >Chest veins Chest veins
are evenly are evenly
PALPATION distributed distributed
 Intercostal >Intercostal
space > Intercostal space and
space and clavicles are
clavicles are visible
 Masses visible No masses
AUSCULTATION > No masses

 Cardiac Murmurs are
sound absent
> Murmurs are
absent
MUSCOSKELET
AL
INSPECTION
 Equal in >Equal in Muscoskeletal is
 Muscle size size on size on the not normal
the both both side of
side of the body
the body
 Muscle  Equal >Equal
strength strength strength on
on each each body
body side
side
 Deformities  No >No
deformiti deformities,
es, no no bone
bone contracture
PALPATION contractu
re

 Muscle
tonicity Slightly firm
 Normally
firm
Crani Name Type Function Assessment

al
Nerv
es
I Olfactory Sensory Smell Client is able to
identify different
aromas
II Optic Sensory Vision & Clients can
Visual fields identify different
objects
III Oculomotor Motor Extra ocular Client can move
eye her eyes in
movement(E different directions
OM);
movement of
sphincter of
pupil;
movement of
ciliary
muscles of
lens
IV Trochlear Motor EOM; Client can move
specifically her eyes
moves downward and
eyeball laterally

downward
and laterally
V Trigeminal Sensory Sensation of Client’s eye
Opthalmic cornea, skin normally reacts
branch of face, and and client can also
nasal identify light and
Sensory mucosa deep palpation
Maxillary
branch
Sensation of
Motor and skin of face
Sensory and anterior
Mandibular oral cavity
branch (tongue and
teeth)
Muscles of
mastication;
sensation of
skin of face
VI Abducens Motor EOM; moves Client can move
eyeball eyeball laterally
laterally
VII Facial Motor and Facial Client can do
Sensory expression; different facial
taste expressions and
(anterior two- able to raise her
birds of eyebrows and
tongue) close eyes tightly
VIII Auditory Sensory Equilibrium Client can hear
Vestibular Sensory Hearing and identify
branch different sounds
Cochlear
branch

IX Glossophar Motor and Swallowing Client can move
yngeal Sensory ability, her tongue
tongue horizontally and
movement, laterally
test(posterior
tongue)
X Vagus Motor and Sensation of Client can talk

Sensory pharynx and clearly
larynx;
swallowing;
vocal cord
movement
XI Accessory Motor Head Able to move her
movement; shoulder against
shrugging of resistance of the
shoulders eye
XII Hypoglossal Motor Protrusion of Client can move
tongue; her tongue side to
moves side
tongue up
and down
and side to
side
NEUROLOGI NORMAL ACTUAL INTERPRETA

C FINDINGS FINDINGS TION
MENTAL
STATUS
>Should be able > Not able to Result shows
1. Orientation to orient to date, remember the not normal

time place and date of findings
reason for being admission (Dahil
hospitalized dito sa sakit
(Q: “Alam nyo kong diabetes
po ba kung ano kaya ako nalipat
ang dahilan dito galing San
kung bakit kayo Marcelino, pero
nandito? At di’ko na alam
alam nyo rin po kung ilang araw
ba kung ilang na ako dito, at di
araw na kayo ko rin kasi alam
dito at kung kung anong oras
2. Memory anong araw at na ngayon.)
oras ngayon?)
 Immediate Result shows
recall normal findings
>Able to answer >Able to answer
questions being questions being
asked (Q:”Ano asked (A: “
ang pangalan Monina”)
 Recent pong pangalan Result shows
memory nyo?”) normal findings
>Able to recall >Able to recall

recent recent memories
 Remote memories (Q: (A: “ Hindi pa Result shows
memory “Uminom ka na eh”) normal findings
po ba ng gamot
nyo?”)
> Able to answer
> Able to questions that
answer happened a long
3. Level of questions that time ago (A: Result shows
Consciousn happened a “25”) normal findings
ess long time ago
(Q: “ ilang taon
po kayo ng
nabuntis kayo”) > Best eye
opening
>Score should response:4
be 15, inactive (opens
of the persons spontaneously),
alertness, best verbal
responsive and response:5
being oriented (oriented),best
motor response:
6 (obeys verbal
command)
GCS=15
BASIS:
0 No reflex respond
+1 Minimal activity
(hypoactive)
+2 Normal responses
+3 More active than
normal
+4 Maximal activity
(hyperactive)
REFLEXES ASSESSMENT FINDINGS

A. Biceps Reflex +2 Normal Response
B. Triceps Reflex +2 Normal Response
R +1 Minimal Activity
C. Patellar Reflex (Hypoactive)
L +2 Normal Response
R +1 Minimal Activity
D. Achilles Reflex (Hypoactive)
R +0 No reflex respond
E. Plantar Reflex
ASSESSMENT NORMAL FINDINGS DEVIATIONS FROM

NORMAL
(+) repeatedly and
Finger to nose
rhythmically touches Gives slow response
test
the nose
Alternating
(+) Can alternately Performs with slow
supination and
supinate and pronate irregular timing of
pronation of
hands in rapid pace movements
hands on knees
Finger to nose (+)Performs with
Moves slowly and often
and to the Nurse coordination and
misses the hand
finger rapidity
(+)Performs with
Moves slowly and not able
Finger to finger coordination and
to touch finger continuously
rapidity
Rapidly touches
Slow movement of hand
Finger to thumb each finger to thumb
and uncoordinated
with each hand
(+) Able to identify
Some areas have reduced
Pain sensation sharp and dull
sensation
sensation
(+) Able to indentify
Temperature Some areas have a
hot and cold
Sensation reduced sensation
sensation
(+) Can readily
Position or
determine the Slowly identifies the
kinaesthetic
position of fingers position of fingers and toes
sensation
and toes
Stereognosis
(+) Recognize
(ability to identify Unable to identify common
common objects
objects by objects
touching them)
Chapter 4
LABORATORY FINDINGS

A. HEMATOLOGY
Date: June 20, 2012

Time: 10: 25 am
TEST RESULT NORMAL ANALYSIS &

VALUES INTERPRETATION
WBC 8.85x 10’9/L 5-10,000 Normal
cells cubic
cm
NEUTROPHILS 0.695 0.45-0.73 Normal
LYMPHOCYTES 0.233 20-40 Decreased. May
indicate aplastic
anemia.
MONOCYTES 0.015 2-5 Decreased. May be
due to use of
medication
(corticosteroid)
EOSINOPHILS 0.052 1-4 Decreased. May
indicate viral
infection, bone
marrow
suppression.
RBC 5.14x10’12/L 4.0-4.9 Normal.
HGB 93g/L 12-16 Increased. May be
due to transfusion

reaction and
intravascular
hemolysis.
HCT 24.3% 33-47 Decreased. May
indicate massive
anemia.
PLATELET 282 150,000- DECREASED: May
450,000 indicate decreased
platelet production,
increased platelet
destruction
B. URINALYSIS
Date: June 20, 2012

Time: 10: 25 am
TEST RESULT NORMAL ANALYSIS

FINDINGS &INTERPRETATION
COLOR yellow Amber Concentrated urine due
yellow/ to dehydration.
pale
yellow
TRANSPARENCY Turbid Clear to May be due to pus in the
slightly urine.
hazy

Ph 5.0 3.35-7.45 Normal
Specific gravity 1.030 1.015- Hypersthenuria.increased
1.025 concentration of solutes
in the urine
Rbc Plenty Negative May indicate hematuria.
or rare
Pus cells Plenty 0-8 May indicate pyuria
C. HEMATOLOGY
Date: June 20, 2012

Time: 10:25 am
TEST RESULT NORMAL ANALYSIS &

VALUES INTERPRETATION
RBS 204 mg/dl 200 mg/dl Slightly elevated.
May indicate
diabetes mellitus due
to damage of the
blood vessels.

Chapter 5
ANATOMY AND PATHOPHYSIOLOGY

The endocrine system is the system of glands, each of which
secretes a type of hormone directly into the bloodstream to regulate
the body. The endocrine system is in contrast to the exocrine system,
which secretes its chemicals using ducts. It derives from the Greek
words "endo" meaning inside, within, and "crinis" for secrete. The
endocrine system is an information signal system like the nervous
system, yet its effects and mechanism are classifiably different. The
endocrine system's effects are slow to initiate, and prolonged in their
response, lasting from a few hours up to weeks. The nervous system
sends information very quickly, and responses are generally short
lived. Hormones are substances (chemical mediators) released from
endocrine tissue into the bloodstream where they travel to target
tissue and generate a response. Hormones regulate various human
functions, including metabolism, growth and
development,tissue function, and mood. The field of study dealing
with the endocrine system and its disorders is endocrinology, a
branch of internal medicine.
Features of endocrine glands are, in general, their ductless

nature, their vascularity, and usually the presence of intracellular
vacuoles or granules storing their hormones. In contrast, exocrine
glands, such as salivary glands, sweat glands, and glands within the
gastrointestinal tract, tend to be much less vascular and have ducts
or a hollow lumen.
In addition to the specialized endocrine organs mentioned

above, many other organs that are part of other body systems, such
as the kidney, liver, heart and gonads, have secondary endocrine
functions. For example the kidney secretes endocrine hormones such
as erythropoietin and renin.
The endocrine system is made of a series of glands that

produce chemicals called hormones. A number of glands that signal

each other in sequence are usually referred to as an axis, for
example, the hypothalamic-pituitary-adrenal axis.
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 houses two distinctly different tissues. The bulk

of its mass is exocrine tissue and associated ducts, which produce an
alkaline fluid loaded with digestive enzymes which is delivered to the
small intestine to facilitate digestion of foodstuffs. Scattered
throughout the exocrine tissue are several hundred thousand clusters
of endocrine cells which produce the hormones insulin and glucagon,
plus a few other hormones.
Insulin and glucagon are critical participants in glucose

homeostasis and serve as acute regulators of blood glucose
concentration. From a medical perspective, insulin in particular is
enormously important - a deficiency in insulin or deficits in insulin
responsiveness lead to the disease diabetes mellitus.

SECRETED FROM
EFFECT
HORMONE CELLS
Intake of glucose,
Insulin (Primarily) β Islet cells glycogenesis and
glycolysis in liver and musclefro
m blood
intake of lipids and synthesis
of triglycerides in adipocytes. O
ther anabolic effects.
Glucagon (also α Islet cells Glycogenolysis and gluconeog
primarily) enesis in liver
increases blood glucose level.
Somatostatin δ Islet cells Inhibits release of insulin,
inhibits release of glucagon and
suppresses the exocrine
secretory action of pancreas.
Chapter 6
PATHOPHYSIOLOGY
Modifiable Factor Non-modifiable

Factor
Love to eat sweets Obese
With history of DM
Insulin Resistance
Hyperglycemia
Decrease Blood Blood sugar Gluconeogenesis

Osmolality exceeds renal activation
threshold
Glycosuria
Fluid shifting from
Glucose cannot
enter cell
Cellular Lipolysis
Starvation
Osmotic
Diuresis
Thirst Sensation
Polydipsia Increase Blood Favors

viscosity bacterial
growth
Decrease
Blood Flow
Decrease
Tissue Edema
Perfusion
Decrease
Wound Healing

Chapter 7
DRUG STUDY
SIDE
EFFECT/
NURSING
ADVERS
DRUGS ACTION INDICATION CONSIDERA
E
TION
REACTI
ON
Generic Angiotensin Treatment of None ->Take vital
name: II receptor hypertension signs for the
Combizar antagonist/ ; for patients baseline data.
diuretic/ in whom
Brand antihyperten combination >Determine if
name: sive. therapy is the client has
Hyzaar appropriate. allergies to
medication.
Date and
Time >Check right
ordered: patient, right
6/20/12 @ dosage, right
10:50 am time and
frequency,
Dosage and right route.
Frequency:
100
mg/25mg 1
tab OD
Generic A loop For the None >Take vital
name: diuretic, treatment of signs for the
Furosemid inhibits edema baseline data.
e water associated
reabsorption with >Determine if
Brand in the congestive the client has
name: nephron by heart failure, allergies to
Lasix blocking the cirrhosis of medication.
sodium- the liver, and
Date and potassium- renal >Check right
Time chloride disease, patient, right
ordered: cotransporte including the dosage, right
6/20/12 @ r (NKCC2) nephrotic time and
10:05 am in the thick syndrome. frequency,
ascending Also for the right route.
Dosage and limb of the treatment of
Frequency: loop of hypertension >Give the
40mg IV q8 Henle. alone or in medicine
combination through IV
with other slowly.
antihyperten
sive agents. >Clean the
port with the
antiseptic or
alcohol swab.
Generic Works by Used in the None >Take vital

name: inhibiting treatment of signs for the
Glibenclam ATP- type 2 baseline data.
ide sensitive diabetes.
potassium >Determine if
Brand channels in the client has
name: pancreatic allergies to
Daosin beta cells. medication.
Date and >Check right

Time patient, right
ordered: dosage, right
6/20/12 @ time and
10:05 am frequency,
right route.
Dosage and
Frequency:
5mg 1tab
BID 30
mins before
meals
Generic Inhibition of For relief and -None >Take vital
name: prostaglandi management signs for the
Celecoxib n synthesis of baseline data.
osteoarthritis
Brand (OA), >Determine if
name: rheumatoid the client has
Celebrex arthritis (RA), allergies to
ankylosing medication.
Date and spondylitis,
Time acute pain, >Check right
ordered: primary patient, right
6/21/12 @ dysmenorrhe dosage, right
8:00 am a and oral time and
adjunct to frequency,
Dosage and usual care right route.
Frequency: for patients
200 mg/ 1 with familial
cap OD adenomatou
s polyposis.
Generic Decreases For use as None >Take vital

name: blood an adjunct to signs for the
Metformin glucose diet and baseline data.
levels by exercise in
Brand decreasing adult patients >Determine if
name: hepatic (18 years the client has

Glucophag glucose and older) allergies to
e production, with NIDDM. medication.
decreasing May also be
Date and intestinal used for the >Check right
Time absorption management patient, right
ordered: of glucose, of metabolic dosage, right
6/21/12 @ and and time and
8:00 am improving reproductive frequency,
insulin abnormalities right route.
Dosage and sensitivity associated
Frequency: by with
500mg 1 increasing polycystic
tab peripheral ovary
glucose syndrome
uptake and (PCOS).
utilization.
Generic Inhibiting For the None >Take vital

name: the treatment of signs for the
Ceftriaxon mucopeptid the infections baseline data.
e e synthesis (respiratory,
in the skin, soft >Determine if
Brand bacterial cell tissue, UTI, the client has
name: wall ENT) caused allergies to
Aciphin by S. medication.
pneumoniae,
Date and H. >Check right
Time influenzae, patient, right
ordered: staphylococc dosage, right
6/21/12 @ i, S. time and
8:00 am pyogenes frequency,
(group A right route.
Dosage and beta-
Frequency: hemolytic
20 mg OD streptococci),
E. coli, P.
mirabilis,
Klebsiella sp,
coagulase-
negative
staph

Chapter 8
NURSING CARE PLAN
ASSESSME DIAGNOS PLANNING INTERVENTI EVALUATI

NT IS ON ON
Subjective: Excess After 8 Independent: Goals met.
“Nagmaman fluid hours of 1. Compare After 8
as yung volume nursing current weight hours of
mukha at related to intervention with nursing
paa ko:, as excess , patient will admission or intervention
verbalized sodium verbalize previously patient
by the intake as understandi stated weight. reported
patient. evidenced ng of Rationale: To that pain is
by edema individual evaluate controlled
Objective: on face dietary and degree of from 5/10 to
1. Edema and lower fluid excess. 3/10. The
2. Blood extremetie restrictions. 2. Note patient also
pressure s. patterns and demonstrat
changes amount of ed use of
3. urination. relaxation
Decreased Rationale: To skills and
hematocrit evaluate diversional
4.Restlessne degree of activities, as
ss excess. indicated.
3. Evaluate
BP: 140/80 edematous
PR: 85 extremities or
RR: 19 change
T: 37.1 positions
frequently.
Rationale: To
facilitate
movement of
diaphragm,
thus
improving
respiratory
effort and
prevent
stasis.
Dependent:
1. Administer
medications,
as prescribed
by physician.
Rationale: To
eliminate
excess fluid.
Collaborativ
e:
1. Restrict
sodium and
fluid intake,
as indicated.
Rationale: To
eliminate
excess fluid.
2. Set an
appropriate
rate of fluid
intake or
infusion
throughout 24
hour period.
Rationale: To
prevent peaks
and valleys in
fluid level and
thirst.
3. Review
dietary
restrictions
and safe
substitutes for
salt (e.g.
lemon juice or
spices like
oregano).
Rationale: To
promote
wellness.

ASSESSME DIAGNOSI PLANNIN INTERVENTI EVALUATI
NT S G ON ON
Subjective: Fatigue After 4 Independent: Goals met.
“Nanghihina may be hours of 1. Assess After 4
po ang related to nursing vital signs. hours of
katawan ko,” decreased interventio Rationale: To nursing
as verbalized metabolic n, patient evaluate fluid intervention
by the energy will report status and s, patient
patient. production, improved cardiopulmon reported
as sense of ary response improved
evidenced energy. to activity. sense of
Objective: by 2. Review energy by
1. Lethargic overwhelmi medication identifying
2. Listless ng lack of regimen/use. basis of
3. Lack of energy, Rationale: fatigue and
energy and Certain individual
4. Eye bags listlessness medications areas of
. are known to control.
BP: 140/80 cause or
PR: 85 exacerbate
RR: 19 fatigue.
T: 37.1 3. Note daily
energy
patterns.
Rationale:
Helpful in
determining
pattern/timing
of activity.
4. Instruct in
methods to
conserve
energy (e.g.
to sit instead
of standing
during daily
care and
other
activities; take
frequent short
breaks during
activities;
asking for and
accepting
assistance).
Rationale: To
conserve
energy.
5. Discuss
routines that
promote
sleep.
Rationale: To
improve
stamina and
strength.
6. Assist
client to
identify
appropriate
coping
behaviors.
Rationale:
Promotes
sense of
control and
improves self-
esteem.
7. Establish
realistic
activity goals
with client and
encourage
forward
movement.
Rationale:
Enhances
commitment
to promoting
optimal
outcomes.
Dependent:
1. Discuss
therapy
regimen
relating to
individual
causative
factors.
Rationale:
Helps client
understand
relationship of
fatigue to
illness.
Collaborative
:
1. Encourage
nutritionally
dense, easy
to prepare
foods and
avoidance of
caffeine and
high-sugar
foods and
beverages.
Rationale: To
promote
energy.
2. Schedule
activities for
periods when
client has the
most energy.
Rationale: To
maximize
participation.
3. Encourage
client to do
whatever
possible (e.g.
self-care, sit
up in chair,
interact with
family).
Rationale: To
increase
activity level,
as tolerated.
4. Provide
diversional
activities.
Rationale:
Participating
in pleasurable
activities can
refocus
energy and
diminish
feelings of
unhappiness
and
worthlessness
that can
accompany
fatigue.

ASSESSME DIAGNOS PLANNIN INTERVENTI EVALUATI
NT IS G ON ON
Subjective: Disturbed After 4 Independent: Goals met.
“Nagmanana body hours of 1. Establish After 4
s ang mukha image nursing therapeutic hours of
ko. Ang related to interventio nurse-client nursing
pangit kung illness as n, patient relationship. intervention,
tignan”, as evidenced will Rationale: To patient
verbalized by by facial verbalize convey an verbalized
patient. edema. acceptanc attitude of relief of
e of self in caring and anxiety and
Objective: situation. developing adaption to
1. Monitoring sense of trust. altered
one’s body 2. Evaluate image.
2. Actual level of
change in client’s
structure anxiety
3.Intentional related to
hiding of face situation.
4. Change in Rationale:
social May indicate
acceptance or
involvement
non-
acceptance of
BP: 140/80
situation.
PR: 85
3. Observe
RR: 19
interaction of
T: 37.1
client with
significant
others.
Rationale:
Distortions in
body image
may be
unconsciously
reinforced by
family
members.
4. Listen to
client’s
comments
and
responses to
the situation.
Rationale:
Different
situations are
upsetting to
different
people,
depending on
individual
coping skills
and past
experiences.
5. Provide
assistance
with self-care
needs.
Rationale: To
promote
individual
abilities and
independence
.
6. Work with
client’s self-
concept,
avoiding
moral
judgment
regarding
client’s efforts
or progress.
Rationale:
Positive
reinforcement
encourages
client to
continue
efforts and
strive for
improvement.
Collaborative
:
1. Note signs
of grieving or
indicators of
severe or
prolonged
depression.
Rationale: To
evaluate need
for counseling
and
medications.
2. Visit client
frequently and
acknowledge
the individual
as someone
who is
worthwhile.
Rationale:
Provides
opportunities
for listening to
concerns and
questions.
3. Alert staff
to monitor
own facial
expressions
and other
non-verbal
behaviors.
Rationale:
They need to
convey
acceptance
and not
revulsion
when the
client’s
appearance is
affected.

REFERENCES
1. Medical-Surgical Nursing 12th Edition; Brunner and

Suddarth
2. Nurse’s Pocket Guide; Marilynn E. Doenges, Mary Frances
Moorehouse, Alice C. Murr
3. Principles of Internal Medicine
4. Fundamentals of Nursing 8th Edition; Kozier & Erb
5. Essentials of Human Anatomy & Physiology; Elaine N.
Marieb, R.N., Ph.D
6. The Merck Manual of Medical Information 2nd Edition
7. Mosby’s PDQ for RN; Jean Foret Giddens, Rae W.
Langford
8. Oxford Minidictionary for Nurses 6th Edition
9. Burton’s Microbiology for the Health Sciences 8th
Edition; Paul G. Engelkirk, Gwendolyn R. W. Burton
10. Pharmacology for Nursing Care 7th Edition; Richard A.
Lehne
11. Internet:www.Nursingcrib.com
12. Internet: www.Medplus.com
13. Internet: www.youtube.com
14. Internet: www.Wikipedia.com
15. Internet: www.Nursing Department.com
16. Internet: www.Nursingfornurses.com


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Chapter 1

Diabetes mellitus (DM) is a group of metabolic diseases in

Diabetes Mellitus with Hypertension (A Case Analysis) Page 1

Type 2 Diabetes is a chronic disease that affects an estimated

The glucose level in the body in Type 2 Diabetes patients is

Diabetes Mellitus with Hypertension (A Case Analysis) Page 2

Diabetes mellitus and hypertension are common diseases that

Diabetes Mellitus with Hypertension (A Case Analysis) Page 3

B. Present Health History

Two days prior to admission, Patient X had facial edema.

Prior to admission, Patient X complained of having facial

C. Past Health History

Patient X had no vaccinations during childhood. She has no

D. Family Health History

Diabetes Mellitus with Hypertension (A Case Analysis) Page 4

E. Psychosocial Health History

Patient X owns a house in Masinloc. It’s a cemented house,

F. Dietary Health History

Patient X had body weakness on the day of her admission.

Patient X doesn’t drink enough water daily. At the most, she

Diabetes Mellitus with Hypertension (A Case Analysis) Page 5

GENERAL NORMAL ACTUAL INTERPRETATION

Diabetes Mellitus with Hypertension (A Case Analysis) Page 6

> Client’s mood > appropriate >

PROCEDURE NORMAL VITAL SIGN ASSESSMENT

NORMAL ACTUAL INTERPRETATI

Diabetes Mellitus with Hypertension (A Case Analysis) Page 7

Diabetes Mellitus with Hypertension (A Case Analysis) Page 8

> Black, brown Black with

Diabetes Mellitus with Hypertension (A Case Analysis) Page 9

Diabetes Mellitus with Hypertension (A Case Analysis) Page 10

> (-) Looks

>Clear and/or (-) Visible

Diabetes Mellitus with Hypertension (A Case Analysis) Page 11

> Sclera is (-) yellowish

>Skin is the Skin is the

Diabetes Mellitus with Hypertension (A Case Analysis) Page 12

Diabetes Mellitus with Hypertension (A Case Analysis) Page 13

> Surface of Positioned in

Diabetes Mellitus with Hypertension (A Case Analysis) Page 14

Diabetes Mellitus with Hypertension (A Case Analysis) Page 15

Diabetes Mellitus with Hypertension (A Case Analysis) Page 16

Diabetes Mellitus with Hypertension (A Case Analysis) Page 17

AUSCULTATION > No masses

Diabetes Mellitus with Hypertension (A Case Analysis) Page 18

Crani Name Type Function Assessment

Diabetes Mellitus with Hypertension (A Case Analysis) Page 19

Diabetes Mellitus with Hypertension (A Case Analysis) Page 20

X Vagus Motor and Sensation of Client can talk

NEUROLOGI NORMAL ACTUAL INTERPRETA

Diabetes Mellitus with Hypertension (A Case Analysis) Page 21

>Able to recall >Able to recall

REFLEXES ASSESSMENT FINDINGS

ASSESSMENT NORMAL FINDINGS DEVIATIONS FROM

Diabetes Mellitus with Hypertension (A Case Analysis) Page 23

Diabetes Mellitus with Hypertension (A Case Analysis) Page 24

Date: June 20, 2012

TEST RESULT NORMAL ANALYSIS &

Diabetes Mellitus with Hypertension (A Case Analysis) Page 25

Date: June 20, 2012

TEST RESULT NORMAL ANALYSIS

Diabetes Mellitus with Hypertension (A Case Analysis) Page 26

Date: June 20, 2012