LORMA COLLEGES

COLLEGE OF NURSING
CARLATAN, CITY OF
SAN FERNANDO, LA UNION
IN PARTIAL FULFILLMENT
IN NCM 106 RLE
A CASE STUDY ON
DIABETES MELLITUS TYPE II

PRESENTED TO:
Mrs, Fe nisperos
PRESENTED BY:
Chester paolo d ordinario

CHAPTER I
INTRODUCTION

We live in our world today where everything seems to be in a fast face. As it

Is we cannot deny that things change over or in a certain period of time. Its just like having a
new mode of socialization, culture, beliefs, perception, adaptation to life and environment with
all of these, one aspect of human being which are greatly affected and the one which we have to
be most concern of would be in the side of our health and well being.
In the Philippines there are many diseases illness arising because of environmental changes
that may be caused by human activities and geographical conditions. It is considered as one of
the tropical country and so disease can spread throughout the country.
One of these diseases is what we call the Diabetes Mellitus. Diabetes mellitus is a group of
metabolic diseases characterized by increased levels of glucose in the blood resulting from
defects in insulin secretion, insulin action or both. (American Diabetes Association [ADA],
2009), according to Mosbys pocket dictionary diabetes mellitus is a complex disorder
carbohydrate, fat and protein metabolism that is primarily a result of a deficiency or complete
lack of insulin secretion by the beta cells of the pancreas or resistance to insulin. There are two
types of diabetes mellitus; type 1 diabetes mellitus which is cause by autoimmune process,
dependent on insulin to prevent ketosis. This group was previously called type 1, insulindependent diabetes mellitus (IDDM), and the type 2 diabetes mellitus are those previously
designated as having type 2 non-insulin-dependent diabetes mellitus(NIDDM), maturity-onset
diabetes, adult-onset diabetes. (Med-surgical nursing, 12th edition).
Diabetes is becoming more common in US, from1980 to 2002, and the number of Americans
with diabetes more than doubled and increased in all age groups. Currently, the estimated
number of new cases of diagnosed diabetes among people ages 20 years or older, by age group,
about 1.9 million people in 2010. (National Health Interview, 2010). Globally diabetes was the
seventh leading cause of death based on US death certificates in 2007. This ranking is based
on the 71,382 death certificates in 2007 in which diabetes was the underlying cause of death.

Diabetes was a contributing cause of death in an additional 160,022 death certificates for a
total of 231,404 certificates in 2007in which diabetes appeared as any-listed cause of death.
In Asia, India and china are, and will remain the leading countries in terms of the number of
people with diabetes mellitus in the year 2025. Among the 10 leading countries in this respect,
five are in Asia. Although only a moderate increase in the total population in china is expected
in the next 25 years, china is estimated to contribute almost 38 million people to the global
burden of diabetes in the year 2025. In la union, Diabetes Mellitus is one of the leading causes
of morbidity in the year 2006.there are 631 cases in the year 2003; 126 in 2004, 257 in 2005;
and 655 in 2006.

Thus, Diabetes Mellitus captures our interest because of its increasing cases not only here in
Asia but also to the whole world. Through this case study, we had able to apply those learning
we have learned in Medical Surgical Nursing and Community Health Nursing.

Objectives
The following objectives below were established that serve as a guide in the completion
of the case study on Diabetes Mellitus.
Patient-Centered Objectives:

The patient will be able to receive effective nursing interventions in order to aid his
recovery.

The patient will not manifest any complications that may occur during stay in the
hospital such as infection with our help.

The patient will be able to demonstrate lifestyle modification based on proper knowledge
on factors that may predispose to the disease condition and progression of the disease
process.

Family-Centered Objectives:

The family members will be able to gain independence and self reliance in delivering
care to the patient through appropriate health teachings regarding proper nutrition,
coping mechanisms and prevention of further infections.

The family will be able to understand the occurrence of the disease and be able to use
this knowledge in making necessary modification on health practice.

I.

Patients Profile
A. Personal History

Patient valdez is a 83 years old male adult client. He is a native Filipino. At present,
he lives at Rubio,galimuyod, ilocos sur candon city . He was married and has 4 children .He
classified their living condition as middle class.

Present Health History

Patient valdez submitted his self to have a check -up at Lorma Hospital last august
2014. He complained that he feels dizzy and had a headache, and was found out of having
elevated blood pressure prior to admission.

B. Past Health History

Patient valdez has no history of diabetes on both father and mothers side. His mother
was diagnosed of having a hypertension and died of stroke.

C. Socio-economic status/ cultural background

Lifestyle

Patient valdez loves to eat fried foods and drink soda 1 liter per day, then never controlled
intake of sugar which led to his having DM.

Sleep and rest pattern.

Patient valdez prior to admission she stated that she only had 4 hours of sleep because of his
migraine that causes headache

Elimination: Patient valdez has no irregular elimination.Voids freely

III.

PHYSICAL ASSESSMENT

Patient:Valdez ,juan cartado

Date: September 2

Weight: 61kgs.
Height: 50

General Appearance
Patient valdez juan carlo is 83years old. Old male, conscious and cooperative.he has a fair
complexion and is well groomed. he has the following vital signs:
BP- 110/80
PR-72bpm
RR-19breaths per minute
T-36 C
02 Sat-98%
Integumentary
Patients skin is moist, warm and even. he has short, spoon shape nails and brownish
discoloration.
Hair
Patient has a black with white hair, short, fine and inconspicuous .
Eyes
Patients eyes are symmetrical, her eye color is black, conjunctiva is slightly pink, and his
sclera is white both eyes
Ears
Patients ears are equal in size and similar in appearance. Upon, palpating the ears, theres no
tenderness and the pinna recoils after it folded.
Mouth
The lips is pinkish in color , has ability to breathe in mouth. Lips are dry and elastic in texture.
Abdomen
There are no lesions noted.
Lower extremities
Patients extremities are no swelling.

Genitourinary
The patient goes to the bathroom whenever he wants to urinate and defecate He has a urine
output of 140 ml/ hour.
Musculoskeletal
Tingling sensation on upper extremities and numbness on lower extremities.

IV.

Anatomy and Physiology

Every
function.

The

cell

in

bodys

the

human

body

needs

energy

in

order

to

pr imary ener gy sour ce is glucose, a simple sugar

r esulting fr om t he digestion of f oods containing carbohydrates (sugars and starches).

Glucose from the digested food circulates in t he blood as a r eady ener gy sour ce f or any
cells t hat need it. Insulin is a hor mone or chemical produced by cells in the pancreas,
an organ located behind the stomach. Insulin bo nds t o a r ecept or site on t he out side of
cell and act s like a key t o open a door way int o t h e
glucose

can

enter.

Some

of

the

glucose

can

cell
be

through

which

converted

to

concentr at ed energy sour ces like glycogen or f att y acids and saved f or lat er use.

When t h e r e i s n o t e n o u g h i n s u l i n p r o d u c e d o r w h e n t h e d o o r w a y n o
l o n g e r r e c o g n i z e s t h e insulin key, glucose stays in the blood rather entering the cells.
Anatomy of the pancreas:
The pancreas is an elongated, tapered organ located across
t h e b a c k o f t h e abdomen, behind the stomach. The right side of the organ (called the
head) is the widest part of the organ and lies in t he curv e of t he duodenum (the
f ir st section of the small intestine). The tapered left side extends slightly upward (called
the body of the pancreas) and ends near the spleen (called the tail). The pancreas is made up of
two types of tissue:
Functions of the pancreas:
The pancreas has digestive and hormonal functions:
The enzymes secr et ed by t he exocr ine t issue in t he pancr eas help break down
car bohydrates, f at s, pr ot eins, and acids in the duodenum. These enzymes tr av el
down the pancr eatic duct int o t he bile duct in an inactiv e f orm. When they ent er
the duodenum, they are activated. The exocrine tissue also secretes bicarbonate to neutralize
stomach acid in the duodenum. The hor mones secr et ed by t he endocr ine t issue in t he
pancreas ar e insulin and glucagon (which r egulat e t he lev el of glucose in t he
blood).

Potasium
chloride
Brand
Name
Epiklor
Dosage
2O MEQ
100 CC
X 2HRS
EVERY 6
HRS
3
DOSES

Electrolytes
and
Replacement
Solutions

Hypokalemia.

Replaces
and
maintains
potassium
level..

Patients with
hyperkalemia
since a
further
increase in
serum
potassium
concentration
in such
patients can
produce
cardiac
arrest.

numbness
- leg
discomfort;
- difficulty
breathing

Use
cautiously
in patients
with cardiac
disease and
in
those
with renal
impairment
Alert: IV
use: Give by
infusion
only; never
give IV push
or IM. give
slowly
as
dilute
solution;
potentially
fatal
hyperkalemi
a
may
result from
too-rapid
infusion
Give
oral
potassium
supplement
s
with
extreme
caution
because
different
forms
deliver
varying
amounts of
potassium.
Never
switch
products
without
a
doctors
order.

CHAPTER IX
Evaluation

After rendering my interventions to my patient, He stressed her gratitude which clearly

showed a positive response to all measures of treatment employed to him. He manifests
efficient recovery and good sense of well- being. He, and his significant others showed positive
attitude.

Health teaching is important for patients having Diabetes Mellitus. Patient should be
taught on the importance of exercise, dietary changes, lifestyle, and medication regimen.
Patient should be discussed thoroughly about the disease condition. Simple pathophysiology
will do to increase patients knowledge about the disease condition.

Chapter VI
DIAGNOSTIC PROCEDURES
Diagnostic procedures such as complete blood count andurine studies are necessary
measures done to the patient.
Laboratory Results and Interpretation
Hematology studies
August 18, 2014
Result

Normal value

Interpretation

Examination
BUN

3.8

2.5 7.2 umol/L

BLOOD SUGAR

348

74-106 mg/dL

CREATININE

71.2

50.4

NORMAL
HYPERGLYCEMIA

98.1

NORMAL

umol/L
FASTING BLOOD

18.03

3.89-5.5 mmol/L

HYPERGLYCEMIA

11.9

4.2-6.5 %

HYPERGLYCEMIA

SUGAR
GLYCATED
HEMOGLOBIN

Result

Normal value

Interpretation

Examination
CHOLESTEROL

206.98

<200 mg

HIGH
CHOLESTEROL

HDL

36.29

40.2

59.8

NORMAL

mg/dL
LDL

155.11

66-178 mg/dL

TRIGLYCERIDES

0.88

0.00

NORMAL

NORMAL

1.6mmol/L
RISK FACTOR

5.7

3.43

HIGH RISK
FACTOR