143199402 FINAL CASE STUDY of Diabetes Mellitus

8/17/2019 143199402 FINAL CASE STUDY of Diabetes Mellitus

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BULACAN STATE UNIVERSITY

COLLEGE OF NURSINGCity of Malolos, Bulacan

A study on t! cas! of MRS"LV dia#nos!d $it Ty%! & 'ia(!t!s

M!llitus

SUBMITTE' BY) BSN*+C Gou%-. SUBMITTE' TO)

Ali%io, /oana Mai! E" LEVEL T0REE INSTRUCTORSA1ado, Ei2a 3aticia B"Antonio, Sunsin! V"An!do, Mai F!Bal#os, Ana Ma#aita M"Balta4a, Alona N"Bautista, /!nna V"B!li4aio, Ma5oi! Ann! M"Ca(al, Ro1!o A"

Cuanico, '!a 6a!ll F"Matsuo2a, Mi#u!l

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The incidence o diabetes is growing around the world. t is in the top ten leading causes o deaths. ;ilipinos are

not an ee#ption to this incidence as #ore and #ore ;ilipinos are a7ected by the disease.


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II" OB/ECTIVES

STU'ENT* CENTERE'

GENERAL OB/ECTIVES

The purpose o this case study is to gi)e the #uch needed 'nowledge and awareness to the nursing students who ha)e or

#ight ha)e handled cases o Type Diabetes Mellitus associated with Hrinary Tract nection.

S3ECIFIC OB/ECTIVES8STU'ENT*CENTERE'9

6NO:LE'GE)

• To be able to ha)e a better understanding at the case o the patient ha)ing a type 2 Diabetes Mellitusassociated with Hrinary Tract nection and the occurrence o its signs and sy#pto#s.

• To be able to 'now the disease process through its pathophysiology.

• To be able to be 'nowledgeable about the patient drug study.

S6ILLS)

• To be able to or#ulate nursing care plans based on the prioriti&ed health needs o the client.

• To be able to discuss about the pathophysiology o the disease process.

• To be able to a#iliari&e on the aggra)ating actors and speci-c inter)entions to pre)ent co#plications

o Type 2 diabetes Mellitus and Hrinary Tract nection.

ATTITU'E)• To be able to change any #isconception about the said disease o the patient.

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• To be able to de)elop awareness in the proper care #anage#ent or type 2 diabetes #ellitus and urinary

tract inection.• To be able to ser)e our uture client4s with a higher le)el o holistic understanding as well as

indi)iduali&ed care.

8CLIENT*CENTERE'9GENERAL OB/ECTIVES

Tis cas! study i1%li!s 2no$l!d#! and a$a!n!ss to %!o%l! $o a;! o 1i#t (! at is2 of t! said

dis!as! !#adin# it


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III" NURSING ASSESSMENT

A" Bio#a%ic 'ata

a#e: "lient LV


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Hpon seeing the patient last March 5, 2%13, he was able to co##unicate to us, has no #aniestation o hyperglyce#ianor hypoglyce#ia. During our clinical rotation we seen our client with the ollowing drugs Au#ulin =%3%, Lantus 16 units,V


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March

2,

2%13

1 bowl

Lugaw*2=5

#l+

1 cup

tea*25%#L+

1 pc. 8 -sh

-llet

cup o

rice

1 glass o

water*25%#l+

1 pc. 8

-sh -llet

cup o

rice

1 cup

tea*25%#L+


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inta'e. 9he also added that she was also li#iting hersel in eating sweet

oods. 8ur client stated that she drin's a lot e)eryday approi#ately 1

liters, she )erbali&ed >uhaw na uhaw a'o palagi?.


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• Sl!!% = R!st 3att!n

Fith Diabetes Mellitus


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person

Le)el / JeGuires assistance ro# another person and

de)ice

Le)el V/ s Dependent and doesn4t participate

• Rol! = R!lationsi% 3att!n

Fith Diabetes Mellitus The "lient eels sad and happy. 9ad because she was not able to

things that #ay trigger her condition and happy because her a#ily

is )ery supporti)e and concern about her present condition.

• Co#niti;!*3!c!%tual 3att!n

Fith Diabetes Mellitus9he is nor#al in cogniti)e pattern. n ter#s o perceptual pattern sherated her condition as @ out o 1%*1% being the highest and 1 is the

lowest+. The client was also diagnosed beore ha)ing an early

cataract related to DM retinopathy.

• Co%in#?St!ss Tol!anc! 3att!n

Fith Diabetes Mellitus The client stated that she eels good when he see and eel the

presence o her a#ily in the hospital.

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• S!lf 3!c!%tion?S!lf Conc!%t 3att!n

•

S!>uality?R!%oducti;!3att!n

• Valu! = B!li!f 3att!n

IV" GRO:T0 AN' 'EVELO3MENT

Freud's Psycho-sexual

Theory

Erickson's Psycho-social

Theory

Piaget’s Theory of Cognitive Kohlberg’s Theory of

Moral

T!"E IBT


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#EF$%$T$&%

During -nal stage, theindi)idual de)elops astrong seual interestin the opposite se.

This stage beginsduring puberty but

last throughout therest o persons lie.


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T*E&+ T*E&$T #EC$PT$&% !PP($C!T$&% &F T*E&+ T&

T*E P!T$E%T

." 0!alt 3o1otion

Mod!l

ola Q. Pender< health pro#oting beha)ior

is an end point or action

outco#e directed towardattaining positi)e healthoutco#es such as opti#al wellbeing, personal ul-ll#ent, andproducti)e li)ing.

Aealth Pro#otion Model can helpthe client to attain positi)e health

outco#es by eating o healthy diet,eercise regularly, #anaging stress,gaining adeGuate rest, spiritualgrowth and building positi)erelationships.

&" S!lf*Ca! '!@citT!oy of Nusin#

Dorothea B. 8re# The central idea o thetheory o sel/care de-cit is thatthe reGuire#ents o persons ornursing are associated withsubecti)ity o #ature and

#aturing persons to health/related or health care/relatedaction li#itations

n this theory suggests that patientsreco)er Guic'er and #ore e7ecti)elywhen they are allowed to #eet theirown basic needs, such as eating,groo#ing, and using the restroo#.

Fe use it as a guide to pro)ide careand to help client to attain sel/care.

, Core. Care and Cure

Model

Lydia Hall Focusing on the notion that centers

around three components of Care, Coreand Cure. Care represents nurturance

and is eclusi!e to nursing. Corein!ol!es the therapeutic use of self and

emphasi"es the use of reflection. Curefocuses on nursing related to the

physician#s orders. Core and cure areshared $ith the other health care

pro!iders.

%e use this theory as a guide for our care plan

to the client &ecause the ma'or purpose of careis to achie!e an interpersonal relationship

$ith the indi!idual that $ill facilitate thede!elopment of the core. Client is composed

of &ody, pathology, and person. (eople settheir o$n goals and are capa&le of learning

and gro$ing.

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SIGNS OF'ISTRESS

9PB"T8 o signs o distress Fea' in appearance De)iation ro#

due to aging

OBVIOUS SIGNOF 0EALT0 ORILLNESS

9PB"T8 o signs o illness or disease 8b)ious signs o illness or

disease

De)iation ro#

due to the presen

the disease.

MENTAL STATUS

LEVEL OFCONSCIOUSNESS

9PB"T8 "onscious and coherent "onscious and coherent or#al

ORIENTATION 9PB"T8 8riented to ti#e, place, situation 8riented to ti#e, place, situation or#al

BO'Y

3ART

TEC0NIUE NORMAL FIN'INGS ACTUAL FIN'INGS ANALYSIS

INTEGUMENTARY a.+ S6IN

PB"T8

P


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S6ULL 9PB"T8

P


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c" Ey!lids

d" Con5uncti;a

!" Con!a

f" Laci1al#land,laci1al sacandnasolaci1al duct

#" 3u%ils

9PB"T8

9PB"T8

9PB"T8

9PB"T8

9PB"T8

P


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" VisualFi!lds

i" Ocula1o;!1!nts

5" VisualAcuity

9PB"T8

9PB"T8

9PB"T8

9PB"T8

near obects and pupil dilates when

loo'ing at ar obects.

on illu#inated eye constricts and

illu#inated eye also constricts.

PBJJL< *pupil eGually round and

react to light and acco##odation+

The client can see obect in the

periphery when loo'ing straight

ahead.

!oth eyes coordinated.

Mo)es in unison.

n parallel align#ent.

Distance )ision:

2%2% )ision on 9nellen chart

Pupil constricts when loo'ing in

near obects and pupil dilates

when loo'ing at ar obects.

on illu#inated eye constricts

and illu#inated eye also

constricts.

PBJJL< *pupil eGually round and

react to light and

acco##odation+

The client can see obect in the

periphery when loo'ing straight

ahead.

!oth eyes coordinated.

Mo)es in unison.

n parallel align#ent.

!oth Byes has a grade o 25%

or#al

or#al

or#al

or#al

De)iation ro# no

due to aging and

disease process.

EARS

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a" Auicl!s

(" E>t!nal !a

9PB"T8

P


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!" Tonsils and

oo%ayn>

f" Ga# !!>

9PB"T8

Pin' and s#ooth

Present Present

or#al

NEC6 a" Ly1% nod!s

(" Tac!a

c" Tyoid

#land

9PB"T8

P


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Lobes #ay not be palpable but not )isible

Lobes are not be palpable

3OSTERIOR T0ORAa" 3ost!io

toa>

(" R!s%iatoy!>cusion

c" Vocal tactil!f!1itus"

d" 3!cussion

!" Auscultation

9PB"T8

P


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(" R!s%iatoy

!>cusion

c" 3!cussion

9PB"T8

P


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d" Auscultation


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c" /u#ula;!ins

9PB"T8

Veins are not )isible

o sound heard on auscultation

Veins are not )isible

or#al

BREAST

a" Ni%%l!s and

A!ola

9PB"T8

P


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#asses, presence o breast #il'

AB'OMEN 9PB"T8


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M"L: 6 0 12c#

M9L: C 0 @c#

o tenderness, relaed abdo#en

with s#ooth consistent tension.

Li)er: no enlarge#ent #ay not be

palpable

Iall bladder:

o distention

o tenderness, relaed abdo#en

with s#ooth consistent tension.

The li)er is not enlarged.

There is no distention in the gall

bladder when palpated.

or#al

or#al

or#al

U33ER ETREMITIESa" Sould!s,

a1s, !l(o$s,$ists andsand @n#!s

9y##etrical

o redness, swelling, deor#ities,

#asses and tenderness

9y##etrical

o redness, swelling, deor#ities,

#asses and tenderness

or#al

(" Sould!s anda1s)1o;!1!nt andfoc!

Btent o orward eion should be

1@% degreesE hyperetension, 5%

degreesE adduction, 5% degrees and

abduction 1@% degrees

The client can e, etend,

adduct, abduct and hyperetend

without pain and with eGual

orce.

or#al

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c" El(o$s)1o;!1!nt andfoc!

or#al ranges o #otion are 16%

degrees o eionE 1@% degrees o

etension, $% degrees o pronation,

$% degrees o supination.

The client can e, etend, and

hyperetend without pain and

with eGual orce.

or#al

d" :ists)1o;!1!nt andfoc!

or#al ranges o #otion are $%degrees, eion =% degrees,

hyperetensionE 55 degrees, ulnar

de)iationE and 2% degrees, radial

de)iation

9hould ha)e ull J8M against

resistance

The client can e, etend, andhyperetend without pain

There is ull range o #otion

against resistance

or#al

!" 0ands and

@n#!s)1o;!1!nt andfoc!

or#al ranges are 2% degrees o

abduction, ull adduction o -ngers,

$% degrees o eion and 3%

degrees o hyperetension

The thu#b should easily #o)e

away ro# other -ngers and 5%

degrees o thu#b eion is nor#al

9hould ha)e ull J8M against

resistance

The client can e, etend,

adduct, abduct and hyperetend

without pain.


against resistance

or#al

LO:ER ETREMITIES

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a" 0i%s, 2n!!s,an2l!s andf!!t)

9y##etrical, o redness, swelling,

deor#ity

Muscles are ully de)eloped

9y##etrical, o redness,

swelling, deor#ity

Muscles are ully de)eloped

or#al

(" 0i%s)1o;!1!nt andfoc!

or#al J8M: $% degrees o hipeion with 'nee straight and 12%

degrees o hip eion with the 'nee

bent and the other leg re#aining

straight

;ull J8M against resistance

The client can e, 'nees bentand the other leg re#aining

straight.


against resistance.

or#al

c" 6n!!s)1o;!1!nt andfoc!

or#al ranges: 12% degrees to 13%

degrees o eionE % degrees o

etension to 15 degrees o

hyperetension

;ull J8M against resistance

The client can e, etend and

hyperetend.


against resistance.

or#al

d" An2l!s andF!!t)1o;!1!nt andfoc!

or#al ranges:

2% degrees dorsieion o an'le

and ootE C5 degrees plantar eion

o an'le and oot

2% degrees o e)ersion 3% degrees

o in)ersion

1% degrees o abductionE 2%

The client can peror#

dorsieion, plantar eion,

e)ersion, in)ersion,abduction,

adduction, eion and etension

without pain.


against resistance.

or#al

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degrees o adduction

C% degrees o eionE C% degrees o

etension

;ull J8M against resistance.

SUMMARY OF SIGNIFICANT FIN'INGS)

• Fea' in appearance due to aging

• Dry s'in and poor s'in turgor due to hydration status o the cliet.

• Presence o s'in pig#entation o)er the body due to #elatonin de-ciency.

• 8b)ious sign o illness or disease because o his resent condition.

• Paleness o lip buccal #ucosa caused by decreased oygen in the tissue cells.• Presence o dentures

• Visual acGuity with the grade o 25% in both eyes.

• ails are pale in color due to decreased oygen supply in the tissue cells and dead toe nail.

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VIII" 'RUGS?ME'ICATIONS

'RUG NAME MEC0ANISM OFACTIONS

IN'ICATION CONTRAIN'ICATION

SI'E EFFECTS NURSINGRES3ONSIBILITIE

S

Ieneric a#e: AHMHL =%3%

"lassi-cation:


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reactions.

Ieneric a#e:9i#)astatin"lassi-cation:


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#any tissues


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Valsartan"lassi-cation:


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,ede#a,dyspneawet rales. !Pweight gain, reportsigni-cant changes.


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marro$, $hichis the &loodforming tissue.+t is used forthe follo$ing

purposes:

• o ensure &oth

ade9uateoygencarryingcapacity andhemostasis.

• o identify

persons $homay ha!e aninfection.

• o identify

acute andchronic illness,

&leeding

tendencies.andnum&er of

circulating$hite &loodcells.

Chec7 the medications of t

patient that may affect theresult.

)uring:

(ro!ide comfort to lessen

patients aniety $hile

$aiting for the result.

After: ecure la&oratory result to

the chart of the patient.; refer result to the physician<

Lymphocytes= . 6.16.1 he result is &elo$normal it indicates :

• (resence of

autoimmunedisease.

Monocytes = 0./ 0.3>.5 %ithin normal result

?ranulocytes=

>3.1 >.4>.0 he result is a&o!enormal le!el itindicates:

• he patient

may de!elopan anemia

ed 2loodCells

.53 3./15.01 he result is $ithinnormal

Hemoglo&in 04 015 he result is $ithin

normal.

Hematocrit 1.344 1.361.61 he result is $ithinnormal.

MCHC;Meancorpuscular

hemoglo&inconcentration<

344 3>30 he result is a&o!e

normal it indicates:

• he patient

may sufferfrom anemia.

)%;red .4 ./. he result is a&o!e

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blood celldistribution

width)

normal it indicates:

• hat the

patientde!elopcardio!ascular disease.

(latelet 10 6/> he result is $ithinnormal.

M(@;mean platelet!olume<

6.4 4.11.5 he result is &elo$normal it indicatesthat :

• he patient

may de!elopleu7emia.

La&oratory

procedure

)ate ordered*

date result

+ndication*

purpose

Analytes esult -ormal +nterpretation -ursing

considerationrinalysis )ecem&er/,010

• +t is an

essential

procedurefor

patientsundergoin

g hospitaladmission

or physical

eaminati

on.

Color Light yello$ • (ale

yello$

toam&er

-ormal Prior:

1. Review

physicians

order.

2. Gather all

the

necessary

materials

needed.

3. Explain theprocedure to

ransparency lightlytur&id

• clear to

slightlyha"y

-ormal

CH8M+CAL8BAM+-A+-:

?lucose U1 -egati!e

(ositi!e result of

glucose in the urinemay indicate:

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• +t is a

useful

indicatorof a

healthy or diseased

state and

hasremained

anintegral

part of the patient

eamination.

• high &lood

glucose le!el

• undiagnosed or

uncontrolled

dia&etesmellitus

the patient.

4. 4 . Instruct

the patient

to void

directly into

a clean dry

container.

!terile

disposa"le

containers

are

recommend

ed. #omen

should

always have

a clean$

catch

specimen i%

a

microscopic

examination

is ordered.

&eces

dischar'es

va'inal

secretions

and

menstrual

"lood will

contaminate

the urine

pecific gra!ity .131 .11.105 he result is a&o!enormal le!el itindicates that:rine is concentrated

M+CC(+C8BAM+-A+-:

Amorphous urateFaint aromatic

are

he result is a&normal

it indicate that:

• the patient eats

food causemusty odor.

• +nfected urine• rine that ha!e

glucose.

2acteria are -egati!e A&normal resultindicates:

• +nfection

process.

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specimen.

(%ter:

1. )over all

specimens

ti'htly la"el

properly and

send

immediately

to the

la"oratory.

2. I % a urine

sample is

o"tained

%rom an

indwellin'

catheter it

may "e

necessary

to clamp the

catheter %or

a"out 1*$3+

minutes

"e%ore

o"tainin'

the sample.

)lean the

specimen

port with

antiseptic

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• he

process of

urinalysisdetermine

s thea&normal

constituen

tsre!ealed

&ymicrosco

piceaminati

on of theurine

sediment.

"e%ore

aspiratin'

the urine

sample with

a needle

and a

syrin'e.

3. ,"serve

standard

precautions

when

handlin'

urine

specimens.

4. I% the

specimen

cannot "edelivered to

the

la"oratory or

tested within

an hour it

should "e

re%ri'erated

or have an

appropriate

preservative

added.

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" NURSING 3RIORITIDATION

NURSING 3ROBLEM /USTIFICATION

." Alt!!d Tissu! 3!fusion Fe consider this proble# as our -rst priority because diabetes

#ellitus has a pri#ary eature o constricted blood )essels which

caused by an inadeGuate oygenated blood circulate in the body

which is the reason o ha)ing a atigue in relation to the decrease

#uscle strength

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drug use

)asoconstriction.

"ollaborate with other

health tea# in gi)ing)asodilators and chec'ing

blood sugar regularly

the dilation o blood )essels so

that tissue perusion can be

i#pro)ed, while chec'ing blood

sugar regularly to 'now the

progress and state o the patient.

9H!QB"TVB:

8!QB"TVB:

/ generali&edwea'ness

/ increasedrespiratory

rate o 25cp#/ body

wea'ness

;atiguerelated todecrease#usclestrength

L8I TBJM I8


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/ weight loss/ atigue/ /li#ited J8M/ inability to

peror#


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reGuent rest

periods

/ Pro#oteenergy

conser)ation

techniGues

bydiscussing

ways o

conser)ing

energy while

bathing,

transerring

and so on.

/ Pro)ideadeGuate

)entilation/ Pro)ide

co#ort and

saety/ nstruct

patient to

peror#

deep

breathing

eercises/ nstruct

client toincrease

are alle)iated with

rest.


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Vita#ins


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o theproble#

/ 9tate#ent o#isconception

Vital 9igns:

!P: 13%=% ##Ag

JJ: 2$cp#

inor#ation or

inor#ation

#isinterpretation

to )erbali&e

accurate

inor#ation, report

understanding o

condition and

discuss process and

treat#ent.

Pro)ide eplanations

o reasons or the

procedure and the

preparation needed.

dentiy indi)idual

restrictions such astoo sugar in the

ood.

Je)iew the patient

to #aintain an

opti#al nutritional

status.

nor#ation can

decrease the

aniety o the

patient.


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and Hrinary Tract nection. Aence, we learned that any indi)idual is prone to this condition i their liestyle puts the# to a higher

ris'. That4s why we #ust all be well/inor#ed to pre)ent its occurrence.

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

Hrinary Tract nection. t(oo2 of M!dical and Su#ical Nusin# .&t !dition, i%%incott, :illia1s :il2ins

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*tt%)??$$$"5ust1o11i!s"co1?aticl!s?an!1ia*duin#*%!#nancy"st1l-i>44.lN.GV%DL tt%)??!n"$i2i%!dia"o#?$i2i?3ain-Mana#!1!nt tt%)??$$$"li;!ston#"co1?aticl!?&&H.&*a*nusin#*dia#nosis*of*li1it!d*1o(ility?

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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

Documents

143199402 FINAL CASE STUDY of Diabetes Mellitus