Introduction
blood sugar (glucose) levels that result from defects in insulin secretion, or
or cells stop responding to the insulin that is produced, so that glucose in the
blood cannot be absorbed into the cells of the body. Early signs are lethargy,
extreme thirst, frequent urination, gum disease, blurred vision and hunger.
The most common form of diabetes is Type II. This is also known as age-
onset or adult-onset diabetes, and this form of diabetes occurs most often in
people who are overweight and who do not exercise. Type II is considered a
over the course of several years) and because it usually can be controlled
with diet, oral medication and daily injections of insulin. In some cases,
uncontrolled and untreated Type II diabetes are just serious like Type 1. This
misleading. There are lots of people with diabetes that could control the
condition with diet and oral medications. The three main factors that
determine the presence of the disease are lifestyle, diet and genetic
predisposition. The rapid modernization and industrialization allows the
individual more time for leisure thus lessening physical activity. This leads to
II. Objectives
a. General Objectives
At the end of the Individual Case study, the students will gain a lot and
to the topic that will be used in broadening our knowledge in the condition of
the patient not only in the clinical area and during duty hours but everywhere
and anytime upon discussing the focused disease and other related topics.
Upon the completion of this case study, the student shall have:
Endocrine tissue
The endocrine tissue, which consists of the islets of Langerhans,
secretes hormones into the bloodstream.
The hormones secreted by the endocrine tissue in the pancreas are insulin
and glucagon (which regulate the level of glucose in the blood), and
somatostatic (which prevents the release of the other two hormones).
The Septum
The right and left sides of the heart are divided by an internal wall of
tissue called the septum. The area of the septum that divides the atria (the
two upper chambers of the heart) is called the atrial or interatrial septum. The
area of the septum that divides the ventricles (the two lower chambers of the
heart) is called the ventricular or interventricular septum.
Heart Chambers
The two upper chambers of the heart are called atria. The atria receive
and collect blood. The two lower chambers of the heart are called ventricles.
The ventricles pump blood out of the heart into the circulatory system to other
parts of the body.
Blood Flow
The arrows in the drawing show the direction that blood flows through
the heart.
The light blue arrows show that blood enters the right atrium of the heart from
the superior and inferior vena cavae. From the right atrium, blood is pumped
into the right ventricle. From the right ventricle, blood is pumped to the lungs
through the pulmonary arteries. The light red arrows show the oxygen-rich
blood coming in from the lungs through the pulmonary veins into the heart's
left atrium. From the left atrium, the blood is pumped into the left ventricle.
The left ventricle pumps the blood to the rest of the body through the aorta.
For the heart to work properly, the blood must flow in only one direction. The
heart's valves make this possible. Both of the heart's ventricles have an "in"
(inlet) valve from the atria and an "out" (outlet) valve leading to the arteries.
Healthy valves open and close in very exact coordination with the pumping
action of the heart's atria and ventricles. Each valve has a set of flaps called
leaflets or cusps that seal or open the valves. This allows pumped blood to
pass through the chambers and into the arteries without backing up or
flowing backward.
V. Clinical Assessment
a. Nursing History
Pt is a diagnosed DM for >5 years. A month PTA, had met postprandial
vomiting preceded by dizziness (+) on and off grade 1 bipedal nonpitting edema,
(+) blurring of vision.
Educational Background:
Unrevealed.
Occupational Background:
She is aunapplicable
Religious Practices:
She is a Roman Catholic.
Economic Status:
She is supported by himself and his family.
A. Physical Assessment
Admission
Vital Signs:
BP- 130/80mmHg; T- 36.4ºC; PR- 78 bpm; RR- 23 bpm
Assessment:
Skin:
• Pallor is noted
Head-EENT:
− Pale palpebral conjunctiva
-Sluggish capillary refill
Chest:
• Lungs: (+) Rales
Abdomen:
• Flabby, normal abdominal bowel sounds, soft, non-tender, hematoma
noted in the abdomen in both right and left
Extremities:
• With equal pulses
• No edema
• No cyanosis
Cephalocaudal Assessment:
Vital Signs:
BP- 140/80 mmHg; T- 36.6°C; PR- 78 bpm; RR- 19 rpm
General Appearance:
Mrs. M.B was seen lying on her bed with an IV fluid of PNLSS 1l x KVO
in the left metacarpal veins and regulated at10 cc/hr.
Assessment:
Skin
−Dry and warm to touch
-With fair skin complexion
-With pallor
Head
− With short hair, black and equally distributed
Eyes
− With dark brown iris
−With pale palpebral conjunctiva
Ears
−Pinna recoils after folding
− Absence of discharge
Mouth and Throat
− With pale lips
Neck
− Without palpable masses
Abdomen
− Flabby
1/14/10
Test Result Normal Range Significance
sodium 136.6 mmol/L 137-145 Low
Indicates chronic
heart failure, lung
disease, liver
disease, and
cancer.
potassium 2.97 mmol/L 3.50-5.10 Abnormal
It constitutes the
predominant
intracellular
excitability and
muscle
contraction.
Date 1/20/10
Chest PA
Xray findings:
Follow up study done, as compared with the previous chest x-ray taken
12/17/09 shows haziness in both lung bases obliterating the hemidiaphragm and
costophillic sulci.
There is a regression of haziness in the ( R ) upper lung field. The rest of
the findings are unchanged.
Impression:
Bilateral pleural effusion
Atherosclerotic Aorta
Bibasal pneumonia
Cardiomegaly, borderline
VIII. Pathophysiology
Atherosclerosis
Increase Osmotic Poor Circulation
Pressure
Deposition of Fats in
Low Blood Supply
Fluid Goes to the Aorta
vascular space
Hypertension Neuropathy
Low Blood to
Coronary Artery
Peripheral Nervous
System/ Sensory
Low Blood to Heart
• Pain
Myocardial Ischemia
COMPLICATIONS
• Angina
• Chest
• CHF
Pain
• Weakness
• Dyspnea
• Nausea
• Vomitting
Trade
Names
Generic Classification Action Indication Side Effect Contraindication Nursing
&
Name Responsibility
Dosage
140 mg. simvastatin cholesterol- reduces cholesterol In patients with headache, Pregnant Ask the pt. if they
OD lowering drug by inhibiting an coronary heart nausea, women, fungal are allergic to it.
antihyperlipidermic enzyme in the liver disease,diabetes, vomiting, diarrhea byproducts, Limit alcoholic
(HMG-CoA peripheral vessel , abdominal lactation beverages of the
reductase) that is disease, or history pain, muscle pain, pt.
necessary for the of stroke or other and abnormal Give in the
production of cerebrovascular liver test.Most evening; the
cholesterol. disease and serious potential highest rates of
In the blood, nonfatal side effects are cholesterol
statins(HMG-CoA myocardial liver damage and synthesis are
reductase) lower infarction (heart muscle between midnight
total and LDL attack) inflammation or and 5 am
("bad") cholesterol breakdown.
as well
as triglycerides
10 mg ½ Norvasc Antianginal Decreases cardiac Chronic stable Allergies to headache and Assess skin
Antihypertensive oxygen angina, alone or in amlodipine, heart edema (swellin lesions, edema,
t consumption, combination with block,lactation,us g) of the lower baseline
Calcium channel
a Increased delivery other drugs. e cautiously with extremities, ECG,ausculation,
blocker
b of oxygen to Essential heart failure dizziness GI normal output.
cardiac cells, block hypertensive,
O
the transport of alone or in Monitor patient
D calcium into the combination with carefully
smooth muscle other (BP,cardiac
cells lining the antihypertensives rhythm and
coronary arteries output)
and other arteries
of the body.
40 mg Clexane Anticoagulants, -treats blood clots renal impairment: Haemorrhage, • major Assess for tingling
Antiplatelets & -treats certain types Treatment of thrombocytopenia blood weakness,
IX. Nursing Management (NCP)
Problem 1
>Provide skin
care by keeping the skin
dry,
linens dry and
wrinkle free.
Problem 2