case study in dm

Diabetes MellitusType II

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INTRODUCTION

WHAT IS DIABETES MELLITUS?

Diabetes is a disease in which the body doesn't produce or properly use insulin.

Insulin is a hormone produced in the pancreas, an organ near the stomach. Insulin is

needed to turn sugar and other food into energy. When you have diabetes, your body

either doesn’t make enough insulin or can’t use its own insulin as well as it should, or

both. This causes sugars to build up too high in your blood.

Diabetes mellitus is defined as a fasting blood glucose of 126 milligrams per

deciliter (mg/dL) or more. “Pre-diabetes” is a condition in which blood glucose levels

are higher than normal but not yet diabetic. People with pre-diabetes are at increased risk

for developing type 2 diabetes, heart disease and stroke, and have one of these conditions:

impaired fasting glucose (100 to 125 mg/dL)

impaired glucose tolerance (fasting glucose less than 126 mg/dL and a glucose

level between 140 and 199 mg/dL two hours after taking an oral glucose tolerance

test)

EPIDEMIOLOGY

The World Health Organization (WHO) estimates that more than 180 million

people worldwide have diabetes. This number is likely to more than double by

2030.

In 2005, an estimated 1.1 million people died from diabetes.1

Almost 80% of diabetes deaths occur in low and middle-income countries.

Almost half of diabetes deaths occur in people under the age of 70 years; 55% of

diabetes deaths are in women.

WHO projects that diabetes deaths will increase by more than 50% in the next 10

years without urgent action. Most notably, diabetes deaths are projected to

increase by over 80% in upper-middle income countries between 2006 and 2015

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TYPES OF DIABETES:

Type 1 diabetes (previously known as insulin-dependent or childhood-onset) is

characterized by a lack of insulin production. Without daily administration of

insulin, Type 1 diabetes is rapidly fatal.

Symptoms include excessive excretion of urine (polyuria), thirst

(polydipsia), constant hunger, weight loss, vision changes and fatigue.

These symptoms may occur suddenly.

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results

from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of

people with diabetes around the world, and is largely the result of excess body

weight and physical inactivity.

Symptoms may be similar to those of Type 1 diabetes, but are often less

marked. As a result, the disease may be diagnosed several years after

onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now

also occurring in obese children.

Gestational diabetes is hyperglycaemia which is first recognized during

pregnancy.

Symptoms of gestational diabetes are similar to Type 2 diabetes.

Gestational diabetes is most often diagnosed through prenatal screening,

rather than reported symptoms.

Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia (IFG) are

intermediate conditions in the transition between normality and diabetes. People with

IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not

inevitable.

Causes of Type 1 Diabetes:

Autoimmune response: For unknown reasons, in some people the immune system

mistakenly destroys the insulin producing cells (called beta cells) in the pancreas.

It is thought that some people inherit genes that mistakenly tell the body to

recognize its beta cells as foreign invaders; then, when one gets the flu or some

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type of virus, as the body is busy killing the foreign virus, it also kills its own beta

cells because it mistakenly thinks the beta cells are invaders as well. Researchers

have learned that there are certain types of gene combinations that predispose

some people to type 1 diabetes.

Oxygen free radicals: These are formed as a by-product of chemical reactions in

the body, from exposure to smoke, air pollution, diet, and other things. Some

researchers believe that oxygen free radicals could contribute to the destruction of

pancreatic cells.

Chemicals and drugs: There are certain rare drugs that can cause diabetes.

Causes of Type 2 Diabetes:

Genetics

Insulin resistance: Researchers are still looking for the cause of insulin resistance,

but in essence either there are not enough receptors on the cell, or the receptors

aren't responding properly.

Aging, obesity, and lifestyle: Obesity is much more common in diabetes, and

there may be a genetic cause for obesity. We know from recent results of the

Diabetes Prevention Trial that lifestyle changes (modest weight reduction and

moderate regular exercise) can prevent the development of type 2 diabetes in

some people. Age is also a factor, partly due to the fact that as people age, they

might become more overweight and more sedentary, although that is not always

the case; some people simply inherit the defect that causes their pancreas to

decrease insulin production as they age.

Causes of Gestational Diabetes

Hormones: During pregnancy, the placenta produces hormones important for the

baby's growth; but these hormones cause some insulin resistance and make the

body resemble that of a person with type 2 diabetes.

Genetics: Researchers suspect that the genes responsible for type 2 diabetes and

gestational diabetes may be similar.

Obesity: Gestational diabetes is more common in women who are obese.

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SIGNS AND SYMPTOMS of hyperglycemia:

1. Frequent urination ( the body tries to rid itself of excess sugar through urine )

2. Thirst (to flush the system of the excess sugar).

3. Weight loss (the body breaks down stored fats to use as energy).

4. Constant hunger (trying to meet the body’s need for energy).

5. Feeling weak and tired (cells are starving, not receiving sugar for energy).

6. Itchy or dry skin

7. Blurry eyesight

8. Skin or bladder infections

9. Slow healing of cuts/bruises

10. Some people show no signs at all

Hypoglycemia also called: Low blood sugar/Insulin reaction/insulin shock/too little

sugar/too much insulin/too many diabetic pills. Low blood sugar usually comes on

quickly sometimes in minutes.

Causes of low blood sugar:

1. Skipping a meal or snack

2. Too much or wrong type of insulin or diabetic pills

3. Injecting insulin into or near muscles

4. Prescription or nonprescription medications can lower blood sugar

Signs and symptoms of hypoglycemia

1. Headache

2. Sweat

3. Feeling hungry

4. Tired/sleepy

5. Behavior change, irritable or cross

6. Blurry vision

7. Passing out (syncope)

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WHAT ARE COMMON CONSEQUENCES OF DIABETES?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Diabetic retinopathy is an important cause of blindness, and occurs as a result of

long-term accumulated damage to the small blood vessels in the retina. After 15

years of diabetes, approximately 2% of people become blind, and about 10%

develop severe visual impairment.

Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up

to 50% of people with diabetes. Although many different problems can occur as a

result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or

weakness in the feet and hands.

Combined with reduced blood flow, neuropathy in the feet increases the chance of

foot ulcers and eventual limb amputation.

Diabetes is among the leading causes of kidney failure. 10-20% of people with

diabetes die of kidney failure.

Diabetes increases the risk of heart disease and stroke. 50% of people with

diabetes die of cardiovascular disease (primarily heart disease and stroke).

The overall risk of dying among people with diabetes is at least double the risk of

their peers without diabetes.

EXAMS AND TESTS

If the patient is having symptoms but are not known to have diabetes, evaluation

should always begin with a thorough medical interview and physical examination. The

healthcare provider will about symptoms, risk factors for diabetes, past medical

problems, current medications, allergies to medications, family history of diabetes or

other medical problems such as high cholesterol or heart disease, and personal habits and

lifestyle.

A number of laboratory tests are available to confirm the diagnosis of diabetes.

Finger stick blood glucose: This is a rapid screening test that may be performed

anywhere, including community-based screening programs. Fingerstick blood glucose

values may be inaccurate at very high or very low levels, so this test is only a preliminary

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screening study. This is the way most people with diabetes monitor their blood sugar

levels at home.

Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours

before having blood drawn (usually first thing in the morning). If the blood glucose level

is greater than or equal to 126 mg/dL without eating anything, they probably have

diabetes. If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then

the patient has what is called impaired fasting glucose, or IFG. This is considered to be

pre-diabetes. The patient does not have diabetes, but they are at high risk of developing

diabetes in the near future.

Oral glucose tolerance test: This test involves drawing blood for a fasting plasma

glucose test, then drawing blood for a second test at two hours after drinking a very sweet

drink containing 75 grams of sugar. If the blood sugar level after the sugar drink is

greater than or equal to 200 mg/dL, the patient has diabetes. If the blood glucose level is

between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is

also a pre-diabetic condition.

Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high

blood sugar levels have been over about the last 120 days (the average life-span of the red

blood cells on which the test is based).

HOW CAN THE BURDEN OF DIABETES BE REDUCED?

Without urgent action, diabetes-related deaths will increase by more than 50% in the next

10 years.

To help prevent type 2 diabetes and its complications, people should:

Achieve and maintain healthy body weight.

Be physically active - at least 30 minutes of regular, moderate-intensity activity

on most days. More activity is required for weight control.

Early diagnosis can be accomplished through relatively inexpensive blood testing.

Treatment of diabetes involves lowering blood glucose and the levels of other known risk

factors that damage to blood vessels. Tobacco cessation is also important to avoid

complications.

Interventions that are both cost saving and feasible in developing countries include:

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Moderate blood glucose control. People with type 1 diabetes require insulin;

people with type 2 diabetes can be treated with oral medication, but may also

require insulin;

Blood pressure control;

Foot care.

Other costs saving interventions include:

Screening for retinopathy (which causes blindness);

Blood lipid control (to regulate cholesterol levels);

Screening for early signs of diabetes-related kidney disease.

These measures should be supported by a healthy diet, regular physical activity,

maintaining a normal body weight and avoiding tobacco use.

HOW IS DIABETES TREATED?

When diabetes is detected, a doctor may prescribe changes in eating habits, weight

control and exercise programs, and even drugs to keep it in check. It's critical for people

with diabetes to have regular checkups. Work closely with your healthcare provider to

manage diabetes and control any other risk factors. For example, blood pressure for

people with diabetes and high blood pressure should be lower than 130/80 mm Hg

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PATIENT’S PROFILE

Name: F.L.

Age: 57 years old

Gender: Female

Civil Status: Married

Nationality: Filipino

Religion: Roman Catholic

Address: Tagbilaran City, Bohol

Date Admitted: January 21, 2013

Chief Complain: Loss of motor strength

Attending Physician: Dr. Belonguel

Final Diagnosis: Diabetes Mellitus Type II

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NURSING HISTORY

Past Health History

According to the patient she has completed the different immunizations such as

DPT, BCG, OPV, TT and measles. She had experienced childhood illnesses such as

chickenpox, measles, colds, fever and cough.

Family Health History

According to the patient, their family has history of heart disease, hypertension,

arthritis and diabetes. There are no other diseases related aside the mentioned above.

Present Health History

Eight (8) days prior to admission, the patient had experienced body malaise with

weakness. She then had loss of motor strength a day after. The following day, she was

brought to Holy Name University at Bohol and was admitted. On January 21, 2013, she

was referred to Perpetual Succour Hospital for further management.

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GORDON’S 11 FUNCTIONAL PATTERN

1. Health Perception/Health Management Pattern

Before Hospitalization

The patient stated that being healthy is important to be able to do her activities.

She also put emphasis on the idea that giving importance to health should be made right

from the start. She manages her health by taking a bath once a day and brushing her teeth

once or twice a day.

During Hospitalization

The patient verbalized that since she is being hospitalized, there is really

something wrong with her health. She can not take a bath, brush her teeth, and even comb

her hair without assistance.

2. Nutritional-Metabolic Pattern

Before hospitalization:

The SO verbalized that the patient eats three meals a day (breakfast, lunch and

dinner) with snacks in the morning and in afternoon. She eats whatever food is served.

The patient also added that whenever she feel something bad, she just eat 5 spoons per

meal. She drinks 7-8 glasses of water and another glass of juice a day. Her weight was 75

kg.

During hospitalization:

The patient has a diabetic diet and she eats three times a day. She eats with the help

and assistance of the SO. She also drinks about 1, 120 ml of water during our shift. Her

weight was decreased to 70 kg.

3. Elimination Pattern

Before Hospitalization:

According to the SO, the patient usually defecates once a day with a color of

brown, consistency is semi- solid. She regularly voids three times during day time and

during night, the client’s arenola (medium size) is full, its color is yellow amber without

difficulty in urinating and defecating.

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The patient urinates four times during our shift about 480 ml, has a color of dark

yellow and she did not defecate.

4. Activity- Exercise Pattern


The patient could not perform any exercise due to body weakness. According to

the SO, she can not do any heavy works and she needs assistance in walking or when she

go outside their house. She stays at home spending 5-6 hrs. of sitting and the rest of the

time the patient perform simple activities such as watching TV, eating, lying on bed and

chatting with her children and grandchildren.


The patient is under CBR without BRP’s so she stays on her bed the whole day.

5. Cognitive-Perceptual Pattern


The client’s senses are at work except for her eyes, she experiences blurring

vision. Her sense of hearing is not impaired. As to her sense of taste, she has no problem.

She is well oriented with time, place, persons and events.


The patient has no problems with regards to her speaking capabilities even though

she delivers her statement in a very soft voice. She answers questions relevantly. She is

well oriented with time, place, persons around her and event.

6. Sleep-Rest Pattern


Her typical sleep hour is from 8pm to 8am, about 10-12 hrs. her usual nap time is

30 mins.after lunch.

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During Hospitalization:

The patient was not able to sleep at night because of the vital signs taking every 2

hrs. and drug administering.

7. Role-Relationship Pattern


Being a responsible mother, she proudly says that she was able to fulfill her duties

and responsibilities. She has a very good relationship with her family. She claims that her

family is her priority. She emphasized that since all of them do their tasks and perform

their responsibilities well, they have a strong family ties. The moment she had her illness

and other signs of aging, she started to think she could no longer perform her duty


The SO verbalized that though her mother is suffering from DM and other illness,

the patient still have a close relationship with her family .

8. Self- Perception Pattern


She views herself as a good mother and she added that she is strong woman who

can withstand the crisis she is currently facing in life. She believes that with the support

of her family, she could surpass whatever test of life comes her way.


She never changed her perception to herself. Though she felt being bed ridden

because she could not move that easily, with her family’s unending assistance, she gets

her strength from them not to give up no matter how painful her situation is.

9. Sexual- Reproductive Pattern


The patient verbalized that she lives with her family in a compound. She has 4

children: 2 boys and 2 girls. She had her menarche when she was in grade 6. Her

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menstruation period lasts at about 3 or 5 days and it was regular (monthly). Sometimes,

she was suffering from dysmenorrhea. She had menopause.


Due to old age and her condition, she is no longer sexually active.

10. Coping- Stress Pattern


She copes with stress by resting and sleeping. Whenever she thinks of her

condition, she prays to God to comfort herself.


The patient copes with stress by just merely talking to her daughter and she sleeps

when she feels drowsy. She also prays as her sign that she’ll never give up.

11. Value- Belief Pattern

The patient is a Roman Catholic. When the client was not yet suffering from DM,

they go to mass as a family but when she was diagnosed with this kind of disease and due

to aging; they could no longer attend mass; so they are just having their TV mass every

Sunday.

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LABORATORY RESULTS

Urinalysis – January 21, 2013

Microscopic Examination

BLOOD CHEMISTRY – January 21, 2013

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PARAMETERS RESULTS ANALYSIS

Color Yellow Normal

Transparency Turbid Due to increase urine concentration

Reaction 6 Normal

Specific Gravity 1.020 Normal

Sugar Trace Due to decrease renal threshold

Protein Trace Due to increase breakdowns of protein;

increased osmotic diuresis

PARAMETERS RESULTS ANALYSIS

Squamous Epithelial

Cells

Few Normal

Mucus Thread Few Due to infection as a result of increase

accumulation of sugar in the urine

Pus Cells 8-10 Due to infection as a result of increase

accumulation of sugar in the urine

RBC 3-4 Due to glomerular damage as a result of

renal strictures secondary to disease process

Armorp. Urates /

Phosphates

Few Normal

PARAMETERS NORMAL FINDINGSACTUAL

FINDINGSANALYSIS

Random blood sugar 70 – 120 md/dL 463 mg/dl Increased; due to

inability of the

body to utilize

glucose as a result

of impaired insulin

production

Creatinine F: 50-100 81.4 umol/L Normal

Sodium 135-155 mmol/L 131 mmol/L Decreased; due to

osmotic dieresis

Potassium 3.6-5.5 mmol/L 4.78mmol/L Normal

January 22, 2013

PARAMETERS NORMAL FINDINGSACTUAL

FINDINGANALYSIS

Random Blood Sugar 70 – 120 md/dL 487 mg/dl Increased; due to inability

of the body to utilize glucose

as a result of impaired

insulin production

Uric Acid 178-345 mmol/L 247 mmol/L Normal

Fasting Blood Sugar 3.89-5.84 mmol/dL 21.43 mmol/dL Increased; due to inability of

the body to utilize glucose as

a result of impaired insulin

production

Cholesterol 3.87- 6.71 mmol/dL 7 mmol/dL Increased; due to

metabolization of stored fats

as a result of free cholesterol

in the blood

HDL – C Female: >1.7 mmol/L 0.7 mmol/L Decreased; due to increased

dietary fat intake

LDL – C < 3.88 mmol/L 0.63 mmol/L Normal

Triglyceride Female: 0.46 – 1.6 1.50 Normal

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January 23, 2013

PARAMETERS NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

RANDOM BLOOD

SUGAR

70 – 120 md/dL 289 mg/dl Increased; due to

inability of the body

to utilize glucose as a

result of impaired

insulin production

SODIUM 135-155 mmol/L 140 mmol/L Normal

POTASSIUM 3.6-5.5 mmol/L 4.91mmol/L Normal

HEMATOLOGY – January 21, 2013

PARAMETERS NORMAL FINDING ACTUAL FINDING ANALYSIS

WBC 5 x 10 g/L 8.9 Normal

RBC: Hemoglobin

Hematocrit

Female: 12 – 16 g/dL

Female: 37 – 48%

11.4 g/dL

35%

Decreased; due to

inadequate oxygen

supply to cells as a

result of blood vessel

constriction

Decreased; due to

inadequate oxygen

supply to cells as a

result of blood vessel

constriction

Differential Count:

Segmenters

Lymphocytes

0.60 – 0.70

0.20 - .30

0.94

0.06

Increased; due to

inflammatory response

Decreased; due to

presence of infection

January 22, 2013

PARAMETERS NORMAL FINDING ACTUAL FINDING ANALYSIS

WBC 5 x 10 g/L 11.5 Increased; due to

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RBC: Hemoglobin

Hematocrit

Female: 12 – 16 g/dL

Female: 37 – 48%

13 g/dL

40%

Normal

Normal

Differential Count:

Segmenters

Lymphocytes

0.60 – 0.70

0.20 - .30

0.90

0.10

Increased; due


Decreased; due to

presence of infection

HEMOGLUCO TEST (HGT)

DATE TIMENORMAL

FINDING

ACTUAL

FINDINGANALYSIS

January 22,

2013

11:45 A.M.

1:00 P.M.

8:00 P.M.

80-120

80-120

80-120

408

333

307

Increased; due to increased secretion of

insulin

January 23,

2013

12:30 A.M.

2:30 A.M.

5:00 P.M

80-120

80-120

80-120

326

487

274

Increased; due to increased secretion of

insulin

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PATHOPHYSIOLOGY Precipitating: Predisposing

- Diet - Family history- Lifestyle - Age- Obesity

Number of insulin at receptor site

Insulin / zero insulin uptake in the cell

Metabolism Protein Metabolism Fat Metabolism

Lipolysis of adipose tissue Liver is to unable Glucose cannot CHON CHON to store glucose enter the cells of catabolism synthesis

muscle and adipose tissues ketone bodies hyperlipedimia

glycogenolysis fuel polyphagi amino acid -muscle weakness incomplete oxidation deposits lipid converted to -failure to grow in the lumen glucose

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A BC

D E

hyperglycemia lungs kidneys BP persistent BP

kidneys secreted acetone & CO2 acetone excretion bursting of small CVD excess glucose to retention capillaries in eyes restore balance S/SX: blurring vision

RR

dycosuria glucose in the urine acts as osmotic diuretic ketonuria Na retention osmotic pressure

urine output H2O loss

blood volumefluid volume deficit

C.O DEHYDRATION organ perfusion

SHOCK

severe tissue anorexia paradoxin of lactic acid

eyes (retinal neuropathy) peripheral neuropathy kidney neuropathy

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A B C D E

blindness tingling sensation poor ketones in the blood wound healing

ketosis

further in the nausea & vomiting H+; PH urine output

H2O loss metabolic acidosis H+ enters cellsdiabetic coma

polyuria K+ moves out of the cell going to the blood

dehydration

hypokalemia cardiacdysrythmias

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NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Objective Data:

-warm to touch

-flushed skin

- T= 37.7 o C

- RR= 34 cpm

Altered body

temperature:

Hyperthermia r/t

increased

production of

pyrogens in the

body

At the end of one

hour, the patient will

be able to obtain

body temperature

within normal range.

>Monitor vital signs & recorded

particularly temperature

>Provided the patient continues

TSB

>Positioned the patient in a

comfortable and safe position.

>Provided proper room

ventilation by opening the fan &

window panes.

>Advised the patient’s SO to

change the patient’s clothing to

loose & light colored clothes.

>To determine basal body

temperature, to have baseline

data & to have a basis for

evaluating the effectiveness of

interventions.

>To promote surface cooling

and heat lose by evaporation

and conduction.

> Promote client safety & to

maintain patent airway to

address increased respiratory

rate.

>To promote surface cooling

& heat loss by convection.

>Loose clothing & light

colored clothing promotes

body surface cooling. Light

colored clothes are more

absorbent to address

diaphoresis.

>To replace fluids &

Goal met. The

patient was able to

obtain core body

temperature within

normal range.

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>Advised the patient to increase

fluid intake to 8-10 glasses/day.

>Instructed the client to maintain

bed rest.

>Administered antipyretics & due

medications intravenously as

ordered.

electrolyte to support

circulatory volume & tissue

perfusion and to prevent

dehydration.

>To reduce metabolic

demands & oxygen

consumption.

>To restore normal body

temperature & to treat

underlying conditions.


Subjective Data:

“Masakit ang katawan ko

kapag ginagalaw ko”, as

verbalized by the patient

- pain scale of 8/10

Objective Data:

facial grimace

expressive

behavior

Pain r/t musculoskeletal

impairment

At the end of the shift,

the patient will be able

to:

> report pain if

relieved/ controlled and

a decreased in pain

scale of 0/10

> Determined level of

pain from 8/10

> Positioned patient

comfortably on bed

> Provided patient

adequate rest

> Provided quiet

environment

> to be able to know

what particular

intervention to relieve

pain

> To promote wellness

> to prevent fatigue

> to be able to have

enough rest

> to alleviate pain

caused by pressure on

Goal partially met.

The patient reported

pain controlled and a

decreased in pain scale

of 5/10

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restlessness > Provided comfort

measures such as

changing the patient’s

position frequently

> Administered

analgesia as ordered

nerve endings

> to maintain

acceptable level of pain

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ASSESSMENT

DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective data:

“Madali akong mapagod

kahit na mag – iba lang ako

Activity

intolerance r/t

body weakness

At the end of the

shift , the patient

will be able to:

>Participate

> Monitored vital signs

every 2 hours

> to provide baseline data; to

evaluate the degree of

condition and the

effectiveness of the

Goal met.

At the end of the shift, the

patient was able to:

>Participate willingly in

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Subjective Data:

“Hindi ako mapakali

kasi sumasakit ang

katawan ko”, as

verbalized by the

patient.

Objective Data:

>Facial grimace

>Difficulty in turning

>Slowed movement

>Jerky movement

Impaired physical

mobility r/t

discomfort

At the end of the

shift, the patient

will be able to:

>verbalize

understanding of

situation and

individual

treatment regimen

and safety

measures

>increase strength

and function of

affected body part

> Determined diagnosis that

contribute to immobility such

as arthritis

> Assessed degree of pain by

listening to client’s

description and facial

expression

> Noted emotional or

behavioral responses to

problems of immobility

> Supported affected body

parts by using pillows

> to determine immediate

deviation or complication on

patient’s condition

> to provide necessary

intervention to lessen client’s

discomfort

> Feelings of

frustrations/powerlessness may

impede attainment of goals

> to maintain position of

function and reduce risk of

pressure on the affected area

Goal partially met.


the patient was able to

verbalized

understanding of

situation and

individual treatment

regimen and safety

measures but did not

increase d the strength

and function of

affected body part

ng pososyon”, as verbalized

by the patient.

Objective Data:

BP: 110/70 mmHg

RR: 24 cpm

PR: 104 bpm

Body weakness

willingly in

necessary

activities

> report

measurable

increase in

activity

intolerance

> Encouraged

expression of feelings

contributing to the

condition

> Planned care with rest

periods between

activities

> Involved client and

SO in planning of

activities as much as

possible

intervention

> to determine the necessary

intervention to be made for

the client’s condition

> to reduce fatigue and to

have enough rest periods.

> involvement of client and

SO during the plan of care

helps to attain goals

necessary activities

> report measurable

increase in activity

intolerance

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Subjective data:

“Paputol –putol ang

tulog ko dahil sa

pagbibigay ng gamut ko

at pagmonitor sa akin”,

as verbalized by the

patient.

Objective data:

dark circles

under eyes

frequent

yawning

restlessness

Sleep pastern

disturbance r/t

interruptions for

therapeutics and

monitoring


the patient will be able

to:

verbalize

understanding of

sleep disturbance

report improvement

in sleep or rest

pattern

report increased

sense of feeling

rested

>Obtained feedback from

Client and SO regarding usual

bedtime, number of sleep

hours, and time of arising

>Explained to the patient and

SO the importance of taking

VS and administering

medicines.

>Arranged care to provide for

uninterrupted periods for rest

>Provided quiet environment

and comfort measures

(arranging the bed)

> to determine usual

sleep pattern and provide

comparative baseline

>to gain cooperation

from the patient

>to provide adequate

sleep and rest periods

> to provide comfort to

the patient and have

adequate sleep

Goal met.


the patient was able to:

> verbalize

understanding of sleep

disturbance

>report improvement in

sleep or rest pattern

report increased sense

of feeling rested

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DRUG STUDY

1. Generic Name: Colchicine

Brand Name: Colsalide, Novocolchine

Classifications: Antigout

Action: Inhibits microtubule formation of lactic acid in leukocytes which decreases

phagocytosis and inflammation in joints.

Uses: Prevention or treatment for gout, gouty arthritis to arrest progression of neurologic

disability in multiple sclerosis

Contraindications: Hypersensitivity; serious GI, renal, hepatic, cardiac disorders; blood

dyscariasis

Side Effects:

Miscellaneous: myopathy, alopecia, reversible azoospermia, peripheral neuritis

GU: Hematuria, Oliguria, Renal Damage

HEMA: Anemia, thrombocytopenia

GI: nausea, vomiting, anorexia, malaise, metallic taste, cramps, peptic ulcer,

diarrhea

INTEGU: cdhills, dermatitis, pruritis, purpura, erythema

Route and Dosage: 1 tab every 1 hour

Nursing Implications:

Assessment: > Assess I and O ratio, observe for decrease in urinary output.

> Administer on empty stomach, only to facilitate absorption

Family / Client Teaching: > Instruct SO or family members to increase fluids to

3-4 L/day.

> Encourage patient or SO to report any pain, redness

hand area.

2. Generic Name: Omeprazole

Brand Name: Prilosec

Classifications: Proton Pump Inhibitor

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Action: Thought to be a gastric pump inhibitor in that it blocks the final step of acid

production by inhibiting the hydrogen, potassium, ATP system at the secretory surface of

the gastric parietal cell.

Uses: Used to treat ulcers, gastroesophageal reflux disease or heartburn

Contraindications: pain with swallowing; had heartburn for 3 months; frequent chest

pain

Side Effects: CNS: headache, dizziness, insomia, apathy

GI: diarrhea, constipation, anorexia

CV: chest pain, bradycardia, palpitation

Respi: URI, cough, bronchospasm

Derm: rash, severe generalized skin reaction including toxic epidermal

necrolysis

GU: UTI, urinary frequency, hematuria, glycosuria

Hema: thrombocytopenia, anemia

Musculo: Back Pain, Muscle Cramps and Weakness

Misc: fever, pain, gout, fatigue, malaise, weight gain

Route and Dosage: 40 mg ANST ( - )


Assessment: > Perform skin test

> Check for vital signs

> Monitor for any episodes of chest pain

Family / Client Teaching: > The capsule should be taken 30 minutes before

eating and is to be swallowed whole; it

should not be opened, chewed or crushed.

> Review drug associated side effects; report if

diarrhea persists. Report any changes in

urinary elimination or pain and discomfort.

3. Generic Name: Vigocid (Piperacillin Sodium + Tazobactam Sodium)

Action: Bactericidal in action by inhibiting septum formulation and cell wall synthesis of

susceptible bacteria

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Use: used as antibiotic

Contraindications: Patients with a history of allergic reactions to any of the penicillins,

cephalosporins, beta-lactamase inhibitors

Side Effects: nausea nad vomiting, diarrhea, constipation, rash, red skin, allergic reaction

(hives), difficulty in sleeping, headache, diaphoresis, eczema

Route and Dosage: 4.5 g / IV every 8 hours ANST ( - )


Assessment: > Document indications for therapy, symptom onset and weight

history

> Assess for other medical conditions that require careful

monitoring

Family / Client Teaching: > Take drug within ordered intervals to prevent

further aggravation

> Do not engage in activities that require mental

alertness.

4. Generic Name: Meloxicam

Brand Name: Mobic

Classifications: NSAID

Action: Reduces the production of prostaglandin that initiate the cause of inflammation

Uses: used to treat inflammation and pain of arthritis

Contraindications: with asthma attacks, hives or allergic reactions

Side Effects: GI: abdominal pain, diarrhea, dyspepsia, constipation, flatulence

CNS: dizziness, headache,

Route and Dosage: 15 mg / tab; 1 tab OD


Assessment: > Perform skin test

> Document indications for therapy, onset and characteristics of

disease, ROM.

> Determine any GI bleed or ulcer history, aspirin or other

NSAID-induced asthma, urticaria or allergic type reactions.

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Family / Client Teaching: > Take exactly as directed and at the same time each

day. May take with or without food.

> Avoid activities that require mental alertness until

drug effects realized; may cause dizziness or

drowsiness.

> Report any unusual or persistent side effects

including dyspepsia, abdominal pain, dizziness and

changes in stool or skin color.

5. Generic Name:Metformin HCl

Brand Name: Glocophage

Classifications: Antidiabetic

Action: Decreases hepatic glucose production, decreases intestinal absorption of glucose

and increases peripheral uptake and utilization of glucose.

Uses: Alone as an adjunct to diet to lower blood glucose in client having NIDDM whose

blood glucose cannot be managed satisfactorily via diet alone.

Contraindications: acute or chronic metabolic acidosis, including diabetic ketoacidosis,

with or without coma. Abnormal hepatic function.

Side Effects: GI: Diarrhea, abdominal bloating, flatulence, anorexia, unpleasant or

metallic state, abnormal stools, taste disorders

CNS: lightheadedness, headache

Misc: hypoglycemia, myalgia, chest discomfort, palpitation

Route and Dosage: 500 mg / tab (tab BID during meals)


Assessment: > Individualize dosage based on tolerance and effectiveness

> Give with meals starting at a low dose with gradual escalation.

This will reduce GI side effects and allow determination of the

minimal dose necessary for adequate control of blood glucose.

> Document age at diabetes onset, previous therapies utilized and

outcome.

Family / Client Teaching: > Take with food to decrease GI upset

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> Warn users that the inactive components in the

extended-release tablets may pass into the feces and

appear as a soft, hydrated mass.

6. Generic Name: Humulin - N

Brand Name: Isophane Insulin Human

Action: intermediate-acting insulin with slower onset of action that keep blood glucose at

a nearly normal level

Uses: indicated for treatment of patient with diabetes mellitus who require insulin for the

maintenance of glucose homeostasis

Contraindications: contraindicated during episodes of hypoglycemia; also patient with

hypersensitivity to human insulin

Route and Dosage: OD every 9 pm


Assessment: > Monitor VS particularly BP

> Be alert for signs of hypoglycemia, loss of glucose control,

kidney, eye or foot problems

Family / Client Teaching: > Do not take if without medical advise.

7. Generic Name: Paracetamol

Brand Name: Acephen, Campain

Classifications: Antipyretic

Action: Reduces fever by direct action on the hypothalamus, heat-regulating center with

consequent vasodilatation and sweating.

Uses: Fever reduction; temporary relief of mild to moderate pain. Generally, as substitute

for aspirin when it is not tolerated.

Contraindications: Renal insufficiency, anemia, cardiac or pulmonary disease

Side Effects: rash, anorexia, nausea and vomiting, diaphoresis, abdominal pain

Route and Dosage: 500 mg, 1 tab PRN for fever


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Assessment: > Do not exceed a dose of 4 g/ 24hr in adults and 75 mg/kg/day in

children.

> Do not take more than 5 days for pain in children, 10 days for

pain in adults, or more 3 days for fever in adults or children

without consulting Health care provider.

Family / Client Teaching:> Warn not to combine products containing

acetaminophen.

> Take only as directed and with food or milk to

decrease GI upset

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case study in dm

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