FINAL CASE STUDY of Diabetes Mellitus

7/30/2019 FINAL CASE STUDY of Diabetes Mellitus

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I. INTRODUCTION

This case study is all about L.V, a 56 year old patient who diagnose with a Type 2 Diabetes Mellitus along with a

urinary tract infection at Bulacan Medical Center on December 19, 2012, with a chief complain of dizziness, weakness

and difficulty in breathing.

Diabetes Mellitus or simply diabetes, is a group of metabolic diseases characterized by increased levels of

glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action or both. Diabetes has its

major classification which varies in cause, clinical course, and treatment. These are the type 1 DM, type 2 DM,

gestational diabetes, and diabetes mellitus associated with other conditions or syndromes.

Type 2 diabetes mellitus or commonly known as Non- insulin dependent or an adult onset type described as a

relative deficiency of insulin production and a decreased insulin action and/or increased insulin resistance. It occurs

more commonly among people who are older than 30 years of age and obese although its incidence is rapidly

increasing in younger people that is because of the growing epidemic of obesity in children, adolescence and young

adults.

The clinical manifestations are depending on the patients level of hyperglycemia. It includes polyuria (increased

urination) and polydipsia (increased thirst) occurs as a result of excess loss of fluid associated with osmotic dieresis.

Patients also suffers polyphagia (increased appetite) that is the results from the catabolic state induced by insulin

deficiency and the breakdown of proteins and fats. Other manifestations such as fatigue, weakness, sudden vision

changes, tingling or numbness in hands or feet, dry skin and recurrent infections are noted.

Several procedures like fasting plasma glucose, random plasma glucose and glucose level two hours after

receiving glucose (2- hour postload) may indicate an abnormally high blood glucose level which is considered to be the

basic criterion for the diagnosis of diabetes. The major goal of the diabetes treatment is to normalize the insulin activity

and blood glucose level to reduce the development of vascular and neuropathic complications without patient

experiencing hypoglycemia: nutritional therapy, exercise, monitoring, pharmacologic therapy and education which are

the essential components of diabetic regimen.

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The incidence of diabetes is growing around the world. It is in the top ten leading causes of deaths. Filipinos are

not an exemption to this incidence as more and more Filipinos are affected by the disease. According to the survey

conducted by the Philippine Cardiovascular outcome study on Diabetes Mellitus in 2007 found out that 20.6 percent of

adults aged 30 and above were found to be diabetic. In 1998 only 3.9 percent of Filipinos living in the Philippines had

diabetes. On the other hand, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey)

study is 4.8%.

REASONS OF STUDY

The group chose type 2 diabetes mellitus as our case study because aside from it is still fresh in our minds;

our group was interested in studying this. We are willing to do this case to challenge our own minds in analyzing the

problem and to enhance our knowledge, as well as to gain new experiences which could bring new learnings for the

group. This case study will also help the group in understanding the disease process of the patient. It would also

help the group in identifying the primary needs of the patient with a type 2 Diabetes Mellitus. By identifying such

needs and health problems arise the group can now formulate an individualized Nursing care plan for the patient

that would address these needs and problems effectively. Management of the identified problem will help the

patient to recover faster and maintain holistic sense of wellness. This will also equip the group with knowledge, skills

and attitude on how to manage future patient with the same disease.

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II. OBJECTIVES

STUDENT- CENTERED

GENERAL OBJECTIVES

The purpose of this case study is to give the much needed knowledge and awareness to the nursing students who have or

might have handled cases of Type II Diabetes Mellitus associated with Urinary Tract Infection.

SPECIFIC OBJECTIVES

(STUDENT-CENTERED)

KNOWLEDGE:

To be able to have a better understanding at the case of the patient having a type 2 Diabetes Mellitus

associated with Urinary Tract Infection and the occurrence of its signs and symptoms.

To be able to know the disease process through its pathophysiology.

To be able to be knowledgeable about the patient drug study.

SKILLS:

To be able to formulate nursing care plans based on the prioritized health needs of the client.

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To be able to discuss about the pathophysiology of the disease process.

To be able to familiarize on the aggravating factors and specific interventions to prevent complications

of Type 2 diabetes Mellitus and Urinary Tract Infection.

ATTITUDE:

To be able to change any misconception about the said disease of the patient.

To be able to develop awareness in the proper care management for type 2 diabetes mellitus and

urinary tract infection.

To be able to serve our future clients with a higher level of holistic understanding as well as

individualized care.

(CLIENT-CENTERED)

GENERAL OBJECTIVES

This case study implies knowledge and awareness to people who have or might be at risk of the said

disease regarding its fatality and detection.

SPECIFIC OBJECTIVES

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KNOWLEDGE:

To be able to impart knowledge regarding type 2 Diabetes Mellitus and Urinary Tract Infection.

To be able to determine signs and symptoms and its complications.

To be able to familiarize on the appropriate interventions with its rationale to improve patients condition.

SKILLS:

To facilitate patient in taking necessary actions to solve and prevent the identified problems on her own.

To be able to explain the different factors that may cause type 2 diabetes mellitus and Urinary Tract

Infection and its danger.

To be able to participate in her plan of care.

ATTITUDE:

To help the patient in motivating her to continue the health care provided by the health workers.

To be able to complies with the treatment protocol and prevention strategies.

To be able to identify different measures to prevent further aggravation of the condition.

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III. NURSING ASSESSMENT

A. Biographic Data

Name: Client LVAddress: Poblacion San Ildefonso Bulacan

Gender: FemaleBirthday: October 12, 1956Age: 56 years oldCivil Status: MarriedReligion: Roman CatholicEducational Attainment: College Undergraduate - AccountancyDate of Consultation: March 5, 2013Admitting Diagnosis: Type 2 Diabetes MellitusFinal Diagnosis: T/C DKA, Type 2 Diabetes Mellitus

B. Chief complaint: Nahihilo kasi ako, tsaka nanlalata nahihirapan pa akong huminga as verbalized by the client.

C. History of Present Illness

Prior to consultaion, the client was experiencing weakness and she stated that she feels tired easily doing somehousehold chores. The night before she decided to go to hospital, she experienced difficulty of breathing and weakness,which cause her inability to sleep. On the following day at 7:00AM, she seeks consultation at Bulacan Medical Center.

In the Out Patient Department the patient was diagnosed already of Type 2 Diabetes Mellitus and did an initialassessment with positive weakness and pale, hyperlycemia with a blood pressure of 130/60, Respiratory rate of 29cpm, andpulse rate of 107bpm. Part of the confirmation of the disease, the following test was requested to be done such as CapillaryBlood Glucose and certain blood test.

Upon seeing the patient last March 5, 2013, he was able to communicate to us, has no manifestation of hyperglycemia

nor hypoglycemia. During our clinical rotation we seen our client with the following drugs Humulin 70/30, Lantus 16 units,VAsalat 10mg, Micardis Plus 80mg and Catapress her blood pressure reaches 150.

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D. Past Health History

According to the client, he experienced common diseases like fever, cough and colds. She also had Urinary Tractinfection last December and was given medication like Bactrim Forte. According to client she was also confined in the ICU for1 week because of hyperglycemia associated by hypertension. He is also a hypertensive patient.

E. Family Health HistoryAccording to the patient, her family has a history of Asthma, diabetes Mellitus and Hypertension on the paternal

side.

F. Functional health pattern

Health Perception Health Management Pattern

With Diabetes MellitusAccording to the client she feels ill and weak whenever her sugar

level increased. She also added that she feels sad because she

wasnt able to do things that he used to do before like doing chores

in a longer period of time but the client has a positive outlook in life,

she stated that kahit na may diabetes ako at maraming bawal,

pagpapatuloy ko ang aking buhay.

Nutritional-Metabolic Pattern

With Diabetes MellitusBREAKFAST LUNCH DINNER TOTAL

INTAKEMarch

2,2013

1 bowl

Lugaw(275ml)

1 cup

1 pc. Of fish

fillet cup of

rice

1 pc. Of

fish fillet cup of

rice

Approximat

ely:1050mL

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tea(250mL) 1 glass of

water(250m

l)

1 cup

tea(250mL)

March

3,

2013

1 bowl of

lomi(275mL

)

1 glass of

water(250

mL)

bowl of

binagoonga

ng

baboy(150

mL)

cup rice

1 glass of

water(250m

L)

bowl of

binagoonga

ng

baboy(150

mL)

1 cup rice

1 glass of

water(250

mL)

1 pc Indian

mango

Approximat

ely:

1350mL

March

4,

2013

bowl of

Quaker

oats(125mL)

1 glass of

water(250

mL)

cup of

rice

servingof adobong

manok

1 glass of

water(250m

L)

1 sachet of

skyflakes

1 cuptea(250mL)

Approximat

ely:

1325mL

According to the client she has restriction on his diet. If we noticed her intake

in the span of 3 days, she limits her carbohydrates intake as well as fat

intake. She also added that she was also limiting herself in eating sweet

foods. Our client stated that she drinks a lot everyday approximately 1

liters, she verbalized uhaw na uhaw ako palagi. According to theapproximate Total intake per day it is normal, because the normal Total

intake is 2500mL per day. And in the 72-hour diet recall it is shown that her

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intake is minimal, compare to her statement prior to her condition.

Elimination Pattern

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With Diabetes Mellitus

The clients frequency of urination is increase because of her

condition; she verbalized ihi ako ng ihi. The color of her urine varies

on the drugs that she was taking and according to the client the odor

of her urine was like a smell of medications.

URINATION BOWEL ELIMINATION

FREQUEN

CY

COLOR/TR

ANPAREN

CY

DISCOMFO

RT

FREQUENCY COLO

R

Marc

h 2,

2013

9times(ap

prox.

625mL)

Dark

Yellow

NONE once NOT

RECAL

LMarc

h 3,

2013

6times(ap

prox.

530mL

per shift)

Dark

Yellow

NONE once NOT

RECAL

L

Marc

h 4,

2013

8times(ap

prox.600)

Dark

Yellow

NONE once NOT

RECAL

L


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Sleep Rest Pattern

With Diabetes MellitusAccording to the client she sleeps at 2:00AM, she verbalized

nahihirapan akong kunin yung tulog ko ba, kaya nanunuod na lang

ako ng tv, pero kapag natulog na ako tuloy-tuloy na and she wakes

up at 6:00 in the morning. She doesnt take nap because she is busywatching television.

Activity Exercise Pattern


According to the client, she was unable to do the things she

usually does because of her condition. Now that she has

diabetes mellitus she gets easily tired and feels weak.

0- FEEDING 0- BED MOBILITY

0- HOME MAINTENANCE 0- BATHING

0- DRESSING 0- COOKING

0- TOILETING 0- GROOMING

N/A- SHOPPING 1- GENERAL

MOBILITY

LEGEND:

Level 0- Full self Care

Level I- Requires Use of Equipment

Level II- Requires assistance or supervision from another

person

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Level III- Requires assistance from another person and

device

Level IV- Is Dependent and doesnt participate

Role Relationship Pattern

With Diabetes MellitusThe Client feels sad and happy. Sad because she was not able to

things that may trigger her condition and happy because her family

is very supportive and concern about her present condition.

Cognitive-Perceptual Pattern


She is normal in cognitive pattern. In terms of perceptual pattern sherated her condition as 8 out of 10(10 being the highest and 1 is the

lowest). The client was also diagnosed before having an early

cataract related to DM retinopathy.

Coping/Stress Tolerance Pattern


The client stated that she feels good when he see and feel the

presence of her family in the hospital.

Self Perception/Self Concept Pattern

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According to her, she became a stronger person because of his faith

in God and she was more motivated to do follow the proper regimen

for diabetes mellitus.


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Sexuality/ReproductivePattern

Value Belief Pattern

IV. GROWTH AND DEVELOPMENT

Freud's Psycho-sexual

Theory

Erickson's Psycho-social

Theory

Piagets Theory of Cognitive Kohlbergs Theory of

Moral

STAGES GENITALPuberty-Death

Generativity vs.Stagnation

Formal Operational12 - Adulthood

Post Conventional-Universal Ethics

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We dont ask about this topic to him.


According to the client her faith in God increase and the only

person that she could ask for help is God.


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Middle Adulthood: 35 to 55 or 65 Orientation

DEFINITION

During final stage, theindividual develops astrong sexual interest

in the opposite sex.This stage beginsduring puberty butlast throughout therest of person's life.

Adults need tocreate/nurture things thatwill outlast them, often by

having children/creating apositive change thatbenefits other people.Success leads to feelingsof usefulness andaccomplishment, whilefailure results in shallowinvolvement in the world.

Can think logically aboutabstract propositions andtest hypothesis

systematically, becomeswith hypothetical future andideological problems.

Few people operate atthis stage all the time. Itis based on abstract

reasoning and theability to put oneself inother people's shoes. Atthis stage, people haveprincipled conscienceand will follow universalethical principlesregardless of what theofficial laws and rulesare.

.

RESOLUTION

The client wassuccessfully met thepsychosexual stagenot only because shewas able to havechildren with herhusband but also ingenital stage affordsthe person the abilityto confront andresolve her remaining

psychosexualchildhood conflicts.

The client achieves thisstage because she knowsthat she gave back to thesociety through raising herchildren and beingproductive as being amother to her children.

The client thinks rationallyand logically. As a motherand wife she was able tosolve the problems bycommunicating to herchildren and husband.

She lives autonomouslyand defines the moralpersonal identificationwith group values andprinciple that areuniversally agreed onthe considersappropriate that for life.She makes decisionaccording to what herconscience dictates.

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V. THEORY

THEORY THEORIST DESCRIPTION APPLICATION OF THEORY TO

THE PATIENT

1. Health PromotionModel

Nola J. PenderA health promoting behavior

is an end point or actionoutcome directed towardattaining positive healthoutcomes such as optimal wellbeing, personal fulfillment, andproductive living.

Health Promotion Model can helpthe client to attain positive healthoutcomes by eating of healthy diet,exercise regularly, managingstress, gaining adequate rest,spiritual growth and buildingpositive relationships.

2. Self-Care DeficitTheory of Nursing

Dorothea E. Orem The central idea of thetheory of self-care deficit isthat the requirements of

persons for nursing areassociated with subjectivity ofmature and maturing personsto health-related or healthcare-related action limitations

In this theory suggests that patientsrecover quicker and more effectivelywhen they are allowed to meet their

own basic needs, such as eating,grooming, and using the restroom.We use it as a guide to provide careand to help client to attain self-care.

3. Core, Care and Cure

Model

Lydia Hall Focusing on the notion that centersaround three components of Care, Core

and Cure. Care represents nurturanceand is exclusive to nursing. Core

involves the therapeutic use of self andemphasizes the use of reflection. Cure

focuses on nursing related to thephysicians orders. Core and cure are

We use this theory as a guide for our care planto the client because the major purpose of care

is to achieve an interpersonal relationshipwith the individual that will facilitate the

development of the core. Client is composedof body, pathology, and person. People set

their own goals and are capable of learningand growing.

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shared with the other health careproviders.

PHYSICAL ASSESSMENT

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ASSESSMENT TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS/INTERPREATION


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ATION

GENERAL APPEARANCE

BODY BUILT INSPECTION Proportionate, varies with lifestyle Proportionate ( mesomorph ) Normal

POSTURE INSPECTION Not on an Erect posture Not on an erect posture Normal

OVER-ALL-HYGIENE

INSPECTION Clean and neat appearance Clean and neat appearance Normal

BODY ANDBREATH ODOR

INSPECTION No body and breath odor No body and no breath odor Normal

SIGNS OFDISTRESS

INSPECTION No signs of distress Weak in appearance Deviation from Norma

due to aging

OBVIOUS SIGNOF HEALTH ORILLNESS

INSPECTION No signs of illness or disease Obvious signs of illness or

disease

Deviation from Norma

due to the presence of

the disease.

MENTAL STATUS

LEVEL OFCONSCIOUSNESS

INSPECTION Conscious and coherent Conscious and coherent Normal

ORIENTATION INSPECTION Oriented to time, place, situation Oriented to time, place, situation Normal

BODY

PART

TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

INTEGUMENTARYa.) SKIN

INPECTION

PALPATION

Uniform in color, no presence of

edema ,no skin lesions, normal

temperature, long skin turgor, dry

skin

Dry skin and theres presence

of skin pigmentations on the

body


due to hydration statu

& melatonin deficiency

of the client.

b.) NAILS INSPECTION

PALPATION

Convex curvature about 160,

smooth in texture, have an intact

epidermis tissue surrounding the

nails, less than 4 sec. returning to

its normal color (pink) when

performing blanch test

Convex curvature about 160,

smooth in texture, have an intact

epidermis tissue surrounding the

nails, having a normal blanch test

with pale color of nail beds. &

presence of dead toe nail.


due to decrease of

oxygen in the tissue

cells.


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SUMMARY OF SIGNIFICANT FINDINGS:

Weak in appearance due to aging

Dry skin and poor skin turgor due to hydration status of the cliet.

Presence of skin pigmentation over the body due to melatonin deficiency.

Obvious sign of illness or disease because of his resent condition.

Paleness of lip/ buccal mucosa caused by decreased oxygen in the tissue cells.

Presence of dentures

Visual acquity with the grade of 250 in both eyes.

Nails are pale in color due to decreased oxygen supply in the tissue cells and dead toe nail.

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VIII. DRUGS/MEDICATIONS

DRUG NAME MECHANISM OFACTIONS

INDICATION CONTRAINDICATION

SIDE EFFECTS NURSINGRESPONSIBILITIE

S

Generic Name:HUMULIN 70/30Classification:Antihyperglycemic /AntidiabeticRoute/Dosage:Subcutaneous;10ml

Decreases bloodglucose bytransport of glucoseinto cells;conversion ofglucose to glycogen.

Management oftype 2 Non-dependentdiabetes mellitus

Hypoglycemia andhypersensivityreactions

Lipodystrophy;insulin resistance;allergic reactions;hypoglycemia

Obtain patiencehistory, includingdrug history andany knownallergies.Monitor fastingblood glucose, 2hrsafter meals.Monitor urineketones duringillness.Monitor body

weightMonitor forhypoglycemic/hyper glycemicreactions.

Generic Name:SimvastatinClassification:Antihyperlipidemicagent/HMG-CoAreductase inhibitor

Route/Dosage:40mg/tab OD

Inhibits HMG-CoAreductase enzyme,which reducescholesterolsynthesis

Treatment ofHyprlipidemias

Pregnancy andHypersensitivity toany components ofpreparation.

Abdominal pain;constipation;headache;dizziness

Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liver

functions testsbefore therapybegins.

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During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergicrteactions monitorblood pressure.

Generic Name:Telmisartan(micardis)Classification:Angiotensin IIantagonist/

AntihypertensiveRoute/Dosage:80mg/tab OD

Blocks thevasoconstrictiveand aldosterone-secreting effects ofangiotensin II byselectively

blocking thebinding ofangiotensin II to theAT1 receptor inmany tissues

Treatment forHypertension

Pregnancy andlactation. Biliaryobstructivedisorder.hypersensivity

Diarrhea;headache; fatigue;Urinary tractinfection

Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liver

functions testsbefore therapybegins.During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergic

rteactions monitorblood pressure.

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Generic Name:AmlodipineClassification:AntihypertensiveagentRoute/Dosage:10mg/tab ODsublingual

Decreasespheripheralvascular resistanceof smooth muscle(decrease bloodpressure)

Treatment forhypertension

Palpitations;headache;dizziness; fatigue;

Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liverfunctions testsbefore therapybegins.During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergic


Generic Name:ValsartanClassification:Angiotensin IIreceptor blocker /AntihypertensiveagentRoute/Dosage:80mg OD

Blocks thevasoconstrictiveand aldosterone-secreting effects ofangiotensin II byselectivelyblocking thebinding ofangiotensin II to the

AT1 receptor inmany tissues.

Treatment forHypertension

Hypersensivity tothe components

Headache;dizziness; fatigue

Prior:

Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liverfunctions testsbefore therapy

begins.During:Assess for

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symptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergic


Generic Name:ClonidineClassification:AntiHypertensiveagentRoute/Dosage:750mcg/Tab BID

Stimulates centralalpha-adrenergicreceptors to inhibitsymphateticcardioacceleratorand vasoconstrictorcenters

Management of allgrades ofhypertension

Hypersensitivity toclonidine

Drowsiness, drymouth, headache,urinary retentionhypotension

Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liverfunctions testsbefore therapy

begins.During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergicrteactions monitorblood pressure.

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IX. LABORATORY/DIAGNOSTIC PROCEDURE

Laboratoryprocedure

Dateordered/

dateresult

Indication/ purposes Analytes Result Normal Interpretation Nursing responsibilities

Hematology December19, 2012

I t provides

valuableinformation

about the bloodand someextent the bonemarrow, whichis the bloodforming tissue.It is used forthe following

purposes:

To ensure both

adequate

oxygencarryingcapacity and

White BloodCell

14.7 4.1-11.1 The result is abovenormal it indicates:

there is a

presence ofleukocytosisinfection

Prior to examination:

Check the doctors order.

Explain the procedure to thclient.

Assess for the presence ofhematophobia.

Check the medications of tpatient that may affect the

result.During:

Provide comfort to lessen

patients anxiety whilewaiting for the result.

After:

Secure laboratory result to

the chart of the patient.( refer result to the physician)

Lymphocytes% 14.1 16.0-46.0 The result is belownormal it indicates :

Presence of

autoimmune

disease.

Monocytes % 2.9 2.3-8.5 Within normal result

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hemostasis.

To identify

persons whomay have aninfection.

To identify

acute andchronic illness,

bleedingtendencies.and

number ofcirculatingwhite bloodcells.

Granulocytes%

83.0 48.7-81.2 The result is abovenormal level itindicates:

The patient

may developan anemia

Red BloodCells

4.53 3.90-5.20 The result is withinnormal

Hemoglobin 127 120-151 The result is within

normal.

Hematocrit 0.377 0.364-0.460 The result is withinnormal.

MCHC(Meancorpuscularhemoglobin

concentration)

377 318-342 The result is abovenormal it indicates:

The patient

may sufferfrom anemia.

RDW(redblood celldistribution

width)

14.7 11.9-14.4 The result is above

normal it indicates:

That the

patientdevelopcardiovasculardisease.

Platelet 402 169-418 The result is withinnormal.

MPV(meanplatelet

volume)

6.7 7.0-10.5 The result is belownormal it indicates

that :

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The patient

may developleukemia.

Laboratory

procedure

Date ordered/

date result

Indication/

purpose

Analytes Result Normal Interpretation Nursing

considerationUrinalysis December

19,2012

It is an

essentialprocedure

forpatients

undergoing hospital

admissionor

physicalexaminati

on.

It is a

useful

indicatorof a

healthy ordiseased

state andhas

remainedan

integral

Color Light yellow Pale

yellow

to

amber

Normal Prior:

1. Review

physicians

order.

2. Gather all

the

necessary

materials

needed.

3. Explain the

procedure to

the patient.

4. 4 .Instruct

the patient

to void

directly into

a clean, dry

container.

Sterile,

disposable

Transparency Slightlyturbid

clear to

slightly

hazy

Normal

CHEMICAL

EXAMINATION:

Glucose +1 Negative

Positive result of

glucose in the urinemay indicate:

high blood

glucose level

undiagnosed or

uncontrolled

diabetesmellitus

Specific gravity 1.030 1.010-1.025 The result is abovenormal level itindicates that:Urine is concentrated

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part of thepatient

examination.

containers

are

recommend

ed. Women

should

always have

a clean-catch

specimen if

a

microscopic

examination

is ordered.

Feces,

discharges,

vaginal

secretions

andmenstrual

blood will

contaminate

the urine

specimen.

After:

1. Cover all

specimens

tightly, labelproperly and

send

MICROSCOPICEXAMINATION:

Amorphous urateFaint aromatic

RareThe result is abnormalit indicate that:

the patient eats

food cause

musty odor. Infected urine

Urine that have

glucose.

Bacteria Rare Negative Abnormal resultindicates:

Infection

process.

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The

process of

urinalysisdetermine

s theabnormal

constituen

tsrevealed

bymicrosco

picexaminati

on of theurine

sediment.

immediately

to the

laboratory.

2. If a urine

sample is

obtained

from anindwelling

catheter, it

may be

necessary

to clamp the

catheter for

about 15-30

minutes

before

obtaining

the sample.Clean the

specimen

port with

antiseptic

before

aspirating

the urine

sample with

a needle

and a

syringe.

3. Observe

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standard

precautions

when

handling

urine

specimens.

4. If the

specimen

cannot be

delivered to

the

laboratory or

tested within

an hour, it

should be

refrigerated

or have an

appropriate

preservative

added.

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X. NURSING PRIORITIZATION

NURSING PROBLEM JUSTIFICATION

1. Altered Tissue Perfusion We consider this problem as our first priority because diabetes

mellitus has a primary feature of constricted blood vessels which

caused by an inadequate oxygenated blood circulate in the body

which is the reason of having a fatigue in relation to the decrease

muscle strength

2. Fatigue We choose the fatigue as our 2nd priority because it is more

important than the deficient knowledge and considered to be a

physiologic needs of an individual.

3. Deficient Knowledge We consider the deficient knowledge as the 3 rd priority because it

is very important to know the care, course and the treatment of

her condition, for her to be aware in her body.

4. Risk for Activity Intolerance Intolerance of activity is our 4th priority because if we resolved the

problems in the circulation or the fluid volume, fatigue and the

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possible unstable blood glucose level, our client will have a

capacity to tolerate activities just like before because our client

has a sufficient energy to perform desired activities.

XI. NURSING CARE PLAN

ASSESSMENT NURSING

DIAGNOSIS

PLANNING

NURSING

INTERVENTION/SRATIONALE EVALUATION

OBJECTIVE CUES:

- Verbalizationof theproblem

- Statement of misconception

Vital Signs:

Ineffective tissue

perfusion related

to weakening due

to vasoconstriction

of blood vessels

After 8 hours of

nursing

intervention, the

patient will be

able to achieve a

normal circulation

in the peripheral.

Teach the patient

to mobilize.

Teach about the factors

which can increase blood

flow :

Elevate feet slightlylower than the

the mobilization improves blood

circulation

To increase blood flow through so

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BP: 130/70 mmHg

RR: 29cpm

heart (the position

of elevation at

rest), avoid

crossing legs,

avoiding tight

bandage, avoid the

use of pillows,

hamstrings and so

forth.

Teach about the

modification of risk

factors such as:

Avoid a diet high

in cholesterol, relax

ation

techniques, smokin

g cessation, and

drug use

vasoconstriction.

Collaborate with other

health team in giving

vasodilators and checking

blood sugar regularly

that does not happen edema.

High cholesterol can accelerate

the occurrence of atherosclerosis;

smoking can cause

vasoconstriction of blood vessels,

relaxation to reduce the effects of

stress.

Giving vasodilators will increase

the dilation of blood vessels so

that tissue perfusion can be

improved, while checking blood

sugar regularly to know the

progress and state of the patient.

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SUBJECTIVE:

OBJECTIVE:

- generalized

weakness

- increased

respiratory

rate of 25cpm

- bodyweakness

- weight loss

- fatigue

- -limited ROM

- inability to

perform ADL

- altered VS

- altered

sensorium

Fatiguerelated todecreasemusclestrength

LONG TERM GOAL:After 3 days of nursing

interventions, the patient

will be free from signs of

fatigue

SHORT TERM GOAL:

After 2-3 hours of nursing

interventions, the patient

will be able to identify

measures to conserve and

increase body energy.

- Assess

response to

activity

- Asses

muscle

strength of

patient and

functional

level of

activity.

- Discuss with

patient the

need foractivity

- Response to an

activity can be

evaluated to achieve

desired level of

tolerance.

- To determine the

level of activity

- Education may

provide motivation

to increase activity

level even though

patient may feel too

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- Alternate

activity with

periods of

rest/

uninterrupte

d sleep.

- Monitor

pulse,

respiration

rate and

blood

pressure

before/after

activity

- Perform

activity

slowly with

frequent rest

periods

- Promote

energy

weak initially

- Prevents excessive

fatigue.

- Indicates

physiological

levels of tolerance.

- Interventions should

be directed at

delaying the onset of

fatigue and

optimizing muscle

efficiency.

- Symptoms of fatigue

are alleviated with

rest. Also, patient

will be able to

accomplish more

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conservation

techniques

by

discussing

ways of

conserving

energy while

bathing,

transferring

and so on.

- Provide

adequate

ventilation

- Providecomfort and

safety

- Instruct

patient to

perform

deep

breathing

exercises

- Instruct

client toincrease

with a decreased

expenditure of

energy.

- For proper

oxygenation

- To be free frominjury

- Promotes relaxation

For muscle strength

and tissue repair

- To prevent

weakness andpaleness

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Vitamins A,

C and D and

protein in

her diet.

- Instruct also

patient to

increase ironin diet

- Administer

oxygen as

ordered.

- To provide proper

ventilation

ASSESSMENT NURSING

DIAGNOSIS

PLANNING

NURSING

INTERVENTION/SRATIONALE EVALUATION

Encourage client to For the client to do

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OBJECTIVE CUES:

- Verbalizationof theproblem

- Statement of

misconception

Vital Signs:

BP: 130/70 mmHg

RR: 29cpm

Deficient knowledge

related to the

disease process due

to lack of

information or

information

misinterpretation

After 8 hours of

nursing

intervention, the

patient will be able

to verbalize

accurate

information, report

understanding ofcondition and

discuss process and

treatment.

do self monitoring of

her glucose level.

Provide

explanations of

reasons for the

procedure and the

preparation needed.

Identify individual

restrictions such as

too sugar in the

food.

Review the patient

to maintain an

optimal nutritional

status.

self monitoring of

her condition.

Information can

decrease the

anxiety of the

patient.

Any things that can

aggravate her

condition.

Promotes well beingof the patient and

her recovery

XII. CONCLUSION

At the end of our case study, our group learned things about Type II Diabetes Mellitus and Urinary Tract Infection that are

needed for us to know. We therefore conclude that we, as nursing students must give time in knowing disease or illness like our

case. These things would help us further in giving or disseminating information to people who are concerned or involved in this

condition.

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On the other hand, this case study is not only for nursing student but this can be also helpful to other professionals and

ordinary people. We studied about the risk factors, its sign and symptoms, treatment, medication for Type II Diabetes Mellitus

and Urinary Tract Infection. Hence, we learned that any individual is prone to this condition if their lifestyle puts them to a higher

risk. Thats why we must all be well-informed to prevent its occurrence.

Lastly, at the end of our case study we, student nurses apprehend all essential things about Type II Diabetes Mellitus and

Urinary Tract Infection. Avoid exposure, proper lifestyle, proper hygiene and proper nutrition is the best way to prevent the

acquiring of Type II Diabetes Mellitus and Urinary Tract Infection and any other diseases.

XII. BIBLIOGRAPHY

- Kozier B. et al: Fundamentals of Nursing 10th edition Pearson education Inc. New jersey Copyright 2004p.434

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- Moorhouse , Doenges, M.: Nurses Pocket Guide: Nursing Diagnoses with Interventions

- Brunner and Suddart: textbook of Medical and Surgical Nursing 12th edition, hippincott, Williams & Wilkins

- -http://www.justmommies.com/articles/anemia-during-pregnancy.shtml#ixzz1lN1GVpZL

- http://en.wikipedia.org/wiki/Pain#Management

- http://www.livestrong.com/article/202712-a-nursing-diagnosis-of-limited-mobility/

- http://nurseslabs.com/d5w-iv-fluid-study/\

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http://www.justmommies.com/articles/anemia-during-pregnancy.shtml#ixzz1lN1GVpZLhttp://en.wikipedia.org/wiki/Pain#Managementhttp://www.livestrong.com/article/202712-a-nursing-diagnosis-of-limited-mobility/http://nurseslabs.com/d5w-iv-fluid-study/%5Chttp://www.justmommies.com/articles/anemia-during-pregnancy.shtml#ixzz1lN1GVpZLhttp://en.wikipedia.org/wiki/Pain#Managementhttp://www.livestrong.com/article/202712-a-nursing-diagnosis-of-limited-mobility/http://nurseslabs.com/d5w-iv-fluid-study/%5C


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FINAL CASE STUDY of Diabetes Mellitus

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