Final Case Study Of Diabetes Mellitus

BULACAN STATE UNIVERSITY COLLEGE OF NURSING City of Malolos, Bulacan

A study on the case of MRS.LV diagnosed with Type 2 Diabetes Mellitus

SUBMITTED BY: BSN-3C Group#1 Alipio, Joana Marie E. Amado, Erika Patricia B. Antonio, Sunshine V. Arnedo, Mari Fe Balgos, Ana Margarita M. Baltazar, Alona N. Bautista, Jenna V. Belizario, Marjorie Anne M. Cabral, Romeo A. Cuanico, Dea Karell F. Matsuoka, Miguel

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SUBMITTED TO: LEVEL THREE INSTRUCTORS

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 patient’s 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. Patient’s 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 learning’s 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: • 4 |Page

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

•

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 client’s 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 it’s 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 patient’s 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:

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•

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.

III. NURSING ASSESSMENT A. Biographic Data Name: Client LV Address: Poblacion San Ildefonso Bulacan Gender: Female Birthday: October 12, 1956 Age: 56 years old Civil Status: Married Religion: Roman Catholic Educational Attainment: College Undergraduate - Accountancy Date of Consultation: March 5, 2013 Admitting Diagnosis: Type 2 Diabetes Mellitus Final 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 some household 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 initial assessment with positive weakness and pale, hyperlycemia with a blood pressure of 130/60, Respiratory rate of 29cpm, and pulse rate of 107bpm. Part of the confirmation of the disease, the following test was requested to be done such as Capillary Blood 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. 7 |Page

D. Past Health History According to the client, he experienced common diseases like fever, cough and colds. She also had Urinary Tract infection last December and was given medication like Bactrim Forte. According to client she was also confined in the ICU for 1 week because of hyperglycemia associated by hypertension. He is also a hypertensive patient. E. Family Health History According 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 Mellitus

According to the client she feels ill and weak whenever her sugar level increased. She also added that she feels sad because she wasn’t 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 Mellitus

BREAKFAST March 2, 2013

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1 bowl Lugaw(275 ml) 1 cup

LUNCH

1 pc. Of fish fillet ¼ cup of rice

DINNER

1 pc. Of fish fillet ½ cup of rice

TOTAL INTAKE

Approximat ely: 1050mL

tea(250mL)

March 3, 2013

1 bowl of lomi(275mL ) 1 glass of water(250 mL)

March 4, 2013

½ bowl of Quaker oats(125mL ) 1 glass of water(250 mL)

1 glass of water(250m l) ½ bowl of binagoonga ng baboy(150 mL) ½ cup rice 1 glass of water(250m L)

½ cup of rice ½ serving of adobong manok 1 glass of water(250m L)

1 cup tea(250mL) ½ bowl of binagoonga ng baboy(150 mL) 1 cup rice 1 glass of water(250 mL) 1 pc Indian mango 1 sachet of skyflakes 1 cup tea(250mL)

Approximat ely: 1350mL

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 ½ liters, she verbalized “uhaw na uhaw ako palagi”. According to the approximate 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.

•

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Elimination Pattern

With Diabetes Mellitus URINATION FREQUEN CY Marc h 2, 2013 Marc h 3, 2013 Marc h 4, 2013

9times(ap prox. 625mL) 6times(ap prox. 530mL per shift) 8times(ap prox.600)

BOWEL ELIMINATION

COLOR/TR ANPAREN CY Dark Yellow

DISCOMFO RT

FREQUENCY

COLO R

NONE

once

Dark Yellow

NONE

once

NOT RECAL L NOT RECAL L

Dark Yellow

NONE

once

NOT RECAL L

The client’s 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.

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•

Sleep – Rest Pattern With Diabetes Mellitus

According 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 doesn’t take nap because she is busy watching television. •

Activity – Exercise Pattern

With Diabetes Mellitus 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- HOME MAINTENANCE 0- DRESSING 0- TOILETING N/A- SHOPPING MOBILITY

0- BED MOBILITY 0- BATHING 0- COOKING 0- GROOMING 1- GENERAL

LEGEND: Level 0- Full self Care Level I- Requires Use of Equipment Level II- Requires assistance or supervision from another person 12 | P a g e

Level III- Requires assistance from another person and device Level IV- Is Dependent and doesn’t participate •

Role – Relationship Pattern With Diabetes Mellitus

The 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 With Diabetes Mellitus

She is normal in cognitive pattern. In terms of perceptual pattern she rated 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

With Diabetes Mellitus The client stated that she feels good when he see and feel the presence of her family in the hospital. • 13 | P a g e

Self Perception/Self Concept Pattern With Diabetes Mellitus

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.

•

Sexuality/ReproductivePattern

With Diabetes Mellitus We don’t ask about this topic to him.

•

Value – Belief Pattern

With Diabetes Mellitus According to the client her faith in God increase and the only person that she could ask for help is God.

IV. GROWTH AND DEVELOPMENT

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Freud's Psycho-sexual Theory

Erickson's Psycho-social Theory

Piaget’s Theory of Cognitive

Kohlberg’s Theory of Moral

GENITAL Puberty-Death

Generativity vs. Stagnation

Formal Operational 12 - Adulthood

Post Conventional -Universal Ethics

Orientation

Middle Adulthood: 35 to 55 or 65

DEFINITION

During final stage, the individual develops a strong sexual interest in the opposite sex. This stage begins during puberty but last throughout the rest of person's life.

Adults need to create/nurture things that will outlast them, often by having children/creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.

Can think logically about abstract propositions and test hypothesis systematically, becomes with hypothetical future and ideological problems.

Few people operate at this stage all the time. It is based on abstract reasoning and the ability to put oneself in other people's shoes. At this stage, people have principled conscience and will follow universal ethical principles regardless of what the official laws and rules are. .

RESOLUTION

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The client was successfully met the psychosexual stage not only because she was able to have children with her husband but also in genital stage affords the person the ability to confront and resolve her remaining psychosexual childhood conflicts.

The client achieves this stage because she knows that she gave back to the society through raising her children and being productive as being a mother to her children.

The client thinks rationally and logically. As a mother and wife she was able to solve the problems by communicating to her children and husband.

She lives autonomously and defines the moral personal identification with group values and principle that are universally agreed on the considers appropriate that for life. She makes decision according to what her conscience dictates.

V. THEORY THEORY

THEORIST

DESCRIPTION A health promoting behavior is an end point or action outcome directed toward attaining positive health outcomes such as optimal well being, personal fulfillment, and productive living.

Health Promotion Model can help the client to attain positive health outcomes by eating of healthy diet, exercise regularly, managing stress, gaining adequate rest, spiritual growth and building positive relationships. In this theory suggests that patients recover quicker and more effectively when 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 care and to help client to attain self-care.

1. Health Promotion Model

Nola J. Pender

2. Self-Care Deficit Theory of Nursing

Dorothea E. Orem

The central idea of the theory of self-care deficit is that the requirements of persons for nursing are associated with subjectivity of mature and maturing persons to health-related or health care-related action limitations

3. Core, Care and Cure Model

Lydia Hall

Focusing on the notion that centers around three components of Care, Core and Cure. Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s orders. Core and cure are

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APPLICATION OF THEORY TO THE PATIENT

We use this theory as a guide for our care plan to the client because the major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core. Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing.

shared with the other health care providers.

•

PHYSICAL ASSESSMENT

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ASSESSMENT

TECHNIQUE

NORMAL FINDINGS

ACTUAL FINDINGS

ANALYSIS/INTERPRET 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-ALLHYGIENE BODY AND BREATH ODOR SIGNS OF DISTRESS

INSPECTION

Clean and neat appearance

Clean and neat appearance

Normal

INSPECTION

No body and breath odor

No body and no breath odor

Normal

INSPECTION

No signs of distress

Weak in appearance

Deviation from Normal due to aging

OBVIOUS SIGN OF HEALTH OR ILLNESS

INSPECTION

No signs of illness or disease

Obvious signs of illness or disease

Deviation from Normal due to the presence of the disease.

INSPECTION

Conscious and coherent

Conscious and coherent

Normal

INSPECTION

Oriented to time, place, situation

Oriented to time, place, situation

Normal

MENTAL STATUS LEVEL OF CONSCIOUSNE SS ORIENTATION

BODY PART INTEGUMENTARY a.) SKIN

b.)

NAILS

TECHNIQUE INPECTION PALPATION

INSPECTION PALPATION

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NORMAL FINDINGS

ACTUAL FINDINGS

ANALYSIS

Uniform in color, no presence of edema ,no skin lesions, normal temperature, long skin turgor, dry skin

Dry skin and there’s presence of skin pigmentations on the body

Deviation from Normal due to hydration status & melatonin deficiency of the client.

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.

Deviation from Normal due to decrease of oxygen in the tissue cells.

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 OF ACTIONS

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

Decreases blood glucose by transport of glucose into cells; conversion of glucose to glycogen .

Management of type 2 Nondependent diabetes mellitus

Generic Name: Simvastatin Classification: Antihyperlipidemic agent/HMG-CoA reductase inhibitor Route/Dosage: 40mg/tab OD

Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis

Treatment of Hyprlipidemias

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INDICATION

CONTRAINDICATI ON

SIDE EFFECTS

NURSING RESPONSIBILITIE S

Hypoglycemia and hypersensivity reactions

Lipodystrophy; insulin resistance; allergic reactions; hypoglycemia

Obtain patience history, including drug history and any known allergies. Monitor fasting blood glucose, 2hrs after meals. Monitor urine ketones during illness. Monitor body weight Monitor for hypoglycemic /hyper glycemic reactions.

Pregnancy and Hypersensitivity to any components of preparation.

Abdominal pain; constipation; headache; dizziness

Prior: Assess BP and apical pulse before the initial dose Monitor baseline for renal, liver functions tests before therapy begins.

During: Assess for symptoms of CHF ,edema,dyspnea wet rales. BP weight gain, report significant changes. After: Note for allergic rteactions monitor blood pressure. Generic Name: Telmisartan (micardis) Classification: Angiotensin II antagonist/ Antihypertensive Route/Dosage: 80mg/tab OD

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Blocks the Treatment for vasoconstrictive Hypertension and aldosteronesecreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues

Pregnancy and lactation. Biliary obstructive disorder. hypersensivity

Diarrhea; headache; fatigue; Urinary tract infection

Prior: Assess BP and apical pulse before the initial dose Monitor baseline for renal, liver functions tests before therapy begins. During: Assess for symptoms of CHF ,edema,dyspnea wet rales. BP weight gain, report significant changes. After: Note for allergic rteactions monitor blood pressure.

Generic Name: Amlodipine Classification: Antihypertensive agent Route/Dosage: 10mg/tab OD sublingual

Decreases pheripheral vascular resistance of smooth muscle (decrease blood pressure)

Generic Name: Valsartan Classification: Angiotensin II receptor blocker / Antihypertensive agent Route/Dosage: 80mg OD

Blocks the Treatment for vasoconstrictive Hypertension and aldosteronesecreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues.

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Treatment for hypertension

Hypersensivity to the components

Palpitations; headache; dizziness; fatigue;

Prior: Assess BP and apical pulse before the initial dose Monitor baseline for renal, liver functions tests before therapy begins. During: Assess for symptoms of CHF ,edema,dyspnea wet rales. BP weight gain, report significant changes. After: Note for allergic rteactions monitor blood pressure.

Headache; dizziness; fatigue

Prior: Assess BP and apical pulse before the initial dose Monitor baseline for renal, liver functions tests before therapy begins. During: Assess for

symptoms of CHF ,edema,dyspnea wet rales. BP weight gain, report significant changes. After: Note for allergic rteactions monitor blood pressure. Generic Name: Clonidine Classification: AntiHypertensive agent Route/Dosage: 750mcg/Tab BID

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Stimulates central alpha-adrenergic receptors to inhibit symphatetic cardioaccelerator and vasoconstrictor centers

Management of all grades of hypertension

Hypersensitivity to clonidine

Drowsiness, dry mouth, headache, urinary retention hypotension

Prior: Assess BP and apical pulse before the initial dose Monitor baseline for renal, liver functions tests before therapy begins. During: Assess for symptoms of CHF ,edema,dyspnea wet rales. BP weight gain, report significant changes. After: Note for allergic rteactions monitor blood pressure.

IX. LABORATORY/DIAGNOSTIC PROCEDURE Laboratory procedure

Date Indication/ purposes ordered/ date result Hematology December • I t provides 19, 2012 valuable information about the blood and some extent the bone marrow, which is the blood forming tissue. It is used for the following purposes: • To ensure both adequate oxygen carrying capacity and 24 | P a g e

Analytes

Result

Normal

Interpretation

Nursing responsibilities

White Blood Cell

14.7

4.1-11.1

The result is above normal it indicates: • there is a presence of leukocytosis infection

Lymphocytes% 14.1

16.0-46.0

The result is below normal it indicates : • Presence of autoimmune disease.

Prior to examination:  Check the doctors order.  Explain the procedure to the client.  Assess for the presence of hematophobia.  Check the medications of the patient that may affect the result. During:  Provide comfort to lessen patients anxiety while waiting for the result. After:  Secure laboratory result to the chart of the patient. ( refer result to the physician)

Monocytes %

2.3-8.5

Within normal result

2.9

hemostasis. • To identify persons who may have an infection. • To identify acute and chronic illness, bleeding tendencies.and number of circulating white blood cells.

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Granulocytes %

83.0

48.7-81.2

Red Blood Cells Hemoglobin

4.53

3.90-5.20

127

120-151

Hematocrit

0.377

0.364-0.460

MCHC(Mean

377

318-342

RDW(red blood cell distribution width)

14.7

11.9-14.4

Platelet

402

169-418

MPV(mean platelet volume)

6.7

7.0-10.5

corpuscular hemoglobin concentration)

The result is above normal level it indicates: • The patient may develop an anemia The result is within normal The result is within normal. The result is within normal. The result is above normal it indicates: • The patient may suffer from anemia. The result is above normal it indicates: • That the patient develop cardiovascular disease. The result is within normal. The result is below normal it indicates that :

• The patient may develop leukemia. Laboratory procedure Urinalysis

Date ordered/ date result December 19,2012

Indication/ purpose •

•

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It is an essential procedure for patients undergoin g hospital admission or physical examinati on. It is a useful indicator of a healthy or diseased state and has remained an integral

Analytes

Result

Color

Light yellow

Transparency

Slightly turbid

Normal •

•

Pale yellow to amber clear to slightly hazy

Interpretation

Nursing consideration

Normal

Prior: 1. Review

Normal

2. Gather all the necessary materials

CHEMICAL EXAMINATION: Glucose

Specific gravity

+1

1.030

Negative

1.010-1.025

physicians order.

Positive result of glucose in the urine may indicate: • high blood glucose level • undiagnosed or uncontrolled diabetes mellitus The result is above normal level it indicates that: Urine is concentrated

needed. 3. Explain the procedure to the patient. 4. 4 .Instruct the patient to void directly into a clean, dry container. Sterile, disposable

part of the MICROSCOPIC patient EXAMINATION: examinati on. Amorphous urate

Bacteria

containers are

Faint aromatic

Rare

Rare

Negative

The result is abnormal it indicate that: • the patient eats food cause musty odor. • Infected urine • Urine that have glucose. Abnormal result indicates: • Infection process.

recommend ed. Women should always have a cleancatch specimen if a microscopic examination is ordered. Feces, discharges, vaginal secretions and menstrual blood will contaminate the urine specimen. After: 1. Cover all specimens tightly, label properly and send

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•

The process of urinalysis determine s the abnormal constituen ts revealed by microsco pic examinati on of the urine sediment.

immediately to the laboratory. 2. If a urine sample is obtained from an indwelling 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

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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

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

OBJECTIVE CUES:

-

Verbalization of the problem Statement of misconceptio n

Vital Signs:

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NURSING DIAGNOSIS

PLANNING

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.

NURSING INTERVENTION/S

Teach the patient to mobilize.

RATIONALE

the mobilization improves blood circulation

Teach about the factors which can increase blood flow :

Elevate feet slightly lower than the

To increase blood flow through so

EVALUATION

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

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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.

SUBJECTIVE: OBJECTIVE: -

generalized weakness

-

increased respiratory rate of 25cpm

-

body weakness

-

weight loss

-

Fatigue related to decrease muscle strength

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.

fatigue

-

-limited ROM

-

inability to perform ADL

-

altered VS

-

altered sensorium

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-

Discuss with patient the need for activity

-

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

weak initially

-

Alternate activity with periods of rest/ uninterrupte d sleep.

-

Monitor pulse, respiration rate and blood pressure before/after activity

-

-

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Perform activity slowly with frequent rest periods

Promote energy

-

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

conservation techniques by discussing ways of conserving energy while bathing, transferring and so on.

-

Provide adequate ventilation

-

Provide comfort and safety

-

Instruct patient to perform deep breathing exercises

-

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Instruct client to increase

with a decreased expenditure of energy.

-

For proper oxygenation

-

To be free from injury

-

Promotes relaxation For muscle strength and tissue repair

-

To prevent weakness and paleness

Vitamins A, C and D and protein in her diet.

ASSESSMENT

NURSING DIAGNOSIS

PLANNING

-

Instruct also patient to increase iron in diet

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Administer oxygen as ordered.

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NURSING INTERVENTION/S

Encourage client to 36 | P a g e

To provide proper ventilation

RATIONALE

For the client to do

EVALUATION

OBJECTIVE CUES:

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Verbalization of the problem 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 of condition and discuss process and treatment.

do self monitoring of her glucose level.

self monitoring of her condition.

Provide explanations of reasons for the procedure and the preparation needed.

Information can decrease the anxiety of the patient.

Identify individual restrictions such as too sugar in the food.

Any things that can aggravate her condition.

Review the patient to maintain an optimal nutritional status.

Promotes well being of 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. That’s 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 2004 p.434

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

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

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

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

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

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

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