Type 2 Diabetes Mellitus

By: Elisa Penaranda

Introduction
R.M a 42 years old male with medical history of hemoptysis was diagnosed with PTB Cat II (returned after default) not completed treatment (5months) 2011 Feb. and Diabetes mellitus type 2 for 3 years. His hyperglycemia has been treated with metformin 500mg TID, glibenclamide 50mg BID and regular insulin. For PTB, he takes tranexamic acid 500mg 1tab TID and anti kocks. the patient has claimed to have loss of weight for past the 2weeks and relates the weight loss to beginning of productive cough with yellowish sputum with associated night sweats and back pain. This symptoms limits his ability to exercise. He also has heplock for IV medx administration.

Pathophysiology
Pulmonary Tuberculosis is caused by bacteria and an infectious disease that involves the lungs but may spread to other organs. You can get PTB by breathing in air droplets from a cough or sneeze of an infected person. Most people who develop symptoms of TB infection first became infected in the past. However, in some cases, the disease may become active within weeks after the primary infection. Some study suggest that the primary stage of TB usually doesnt cause symptoms. However, the people that are in higher risk for Tb are elderly, infants and people with weakened immune system and you are at risk having TB if you are in frequent contact with people who have TB and if you have poor nutrition.

Pathophysiology
Type 2 diabetes is due to primarily to lifestyle factors and genetics and usually has a slow onset and may remain undiagnosed for years. Approximately half of those who have type 2 diabetes are unaware of their disease. Some studies suggest that Diabetes may be caused by the Genetic defects of -cell function, Genetic defects in insulin processing or insulin action, Exocrine pancreatic defects, Infections, Drugs. There are, however, risk factors for who is more likely to get Diabetes, as follows; obesity, sedentary lifestyle, unhealthy eating, habits, family history, high blood pressure and cholesterol and the history of DM.

History
A 42 year old male named Ronald Montes who lives at Nueva Gracia, Loreto Agusan Del Sur was diagnosed of PTB Cat II; Type 2 DM poorly controlled and previously admitted at CGEASH last 11 January 2013.He stated that it was already 3years when he diagnosed with Type 2 DM. When he was admitted to the hospital he was inserted a heplock for IV meds administration and meds for anti Kocks (Tranexamic acid), antidiabetes (Metformin, Glibenclamide) and regular insulin.

Nursing Physical Assessment

The patient was conscious, coherent, not in respiratory distress head normocephalic, pink conjunctiva, anicteric sclera, dry lips and buccal mucosa, no tonsillopharyngeal congestion, pink pharyngeal wall, no neck vein engorgement, no mass, symmetrical chest expansion, vesicular breath sounds, clear breath sounds, normal heart rate, regular rhythm, murmurs, the abdomen is soft, non tender, extremities are no gross deformity, with full and equal pulses vital signs: Blood Pressure: 110/80 (normal), Temperature: 36.6 Celcius, Respiratory Rate: 18 cpm, Pulse Rate: 97 bpm.

Related Treatments
The doctor ordered to infuse insulin trough subcutaneous in the lower right abdomen. He was given Metformin 500mg TID is an oral diabetes medicine that helps control blood sugar levels it should not use by the patient that are in a state of diabetic ketoacidosis, Glibenclamide 50mg BID a insulin-dependent diabetes in adults with partially preserved synthesis of insulin, in patients with resistance to other antidiabetic medicines and regular insulin on sliding scale. Patient Ronald Montes has no medicine for tuberculosis drugs ordered.

Evaluation
After 3 days of nursing interventions for diabetes the patient has been responding well to the medication that the doctors ordered. His weight has also increase accordingly to his height.

Recommendations
Every nurse must follow the doctors order, every move should have a rationale, one mistake may cause an innocent life to perish. They should be considerate to the situation of each patient they handle in this same case. They should always monitor the patients vital signs, securing also what they feel physiologically like headache or dizziness and also their emotional needs.

Thank You!
Dr. Florina S. Ferriol AFPMC, Clinical Instructor