NCS-DM Type 2 For Case Presentation

Diabete
s
Mellitus
Type 2
A NURSING CASE STUDY
Submitted by:
Liza, Juan Paolo

Lucot, Marie Joan
Magno, Pamela
Martinez, Astrid Lyn
Oligo, Cherish Yen
Palma, Ann Margareth
Perez, Analiza
Riofrer, John Eric
Roquim, Glenda Mae
| College of Nursing
Group 3_BN3C
UNIVERSITY OF ST. LA SALLE-BACOLOD |

March 12, 2010
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Table of Contents
INTRODUCTION 3
OBJECTIVES 4
GENERAL OBJECTIVES
SPECIFIC OBJECTIVES
ANATOMY AND PHYSIOLOGY 5
BASELINE DATA 9
NURSING HISTORY (GORDON’S FUNCTIONAL HEALTH PATTERN) 9
HEALTH HISTORY 12
PHYSICAL ASSESSMENT 13
LABORATORY AND RADIOLOGY 16
PATHOPHYSIOLOGY 18
NURSING CARE PLAN 19
IMPAIRED TISSUE INTEGRITY
INEFFECTIVE PERIPHERAL TISSUE PERFUSION
RISK FOR ACTIVITY INTOLERANCE
DRUG STUDY 20
HEALTH TEACHING METHOD 43
DEFINITION OF TERMS 47
Introduction
Diabetes mellitus is a group of metabolic diseases characterized by high blood

sugar (glucose) levels that result from defects in insulin secretion, or action, or both.
Type 2 diabetes mellitus (formerly called non-insulin-dependent diabetes mellitus
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(NIDDM) is a group of disorders characterized by hyperglycemia and associated with
microvascular (ie, retinal, renal, possibly neuropathic), macrovascular (ie, coronary,
peripheral vascular), and neuropathic (ie, autonomic, peripheral) complications. Unlike
patients with type 1 diabetes mellitus, patients with type 2 are not absolutely
dependent upon insulin for life, even though many of them are ultimately treated with
insulin.
In type 2 diabetes, the cells ignore the insulin. Insulin is necessary for the body to
be able to use glucose for energy. When you eat food, the body breaks down all of the
sugars and starches into glucose, which is the basic fuel for the cells in the body.
Insulin (released from the pancreas) takes the sugar from the blood into the cells.
When glucose builds up in the blood instead of going into cells, it can lead to diabetes
complications.
Type 2 diabetes is determined primarily by lifestyle factors and genes. A number
of lifestyle factors are known to be important to the development of type 2 diabetes.
In one study, those who had high levels of physical activity, a healthy diet, did not
smoke, and consumed alcohol in moderation had an 82% lower rate of diabetes.
When a normal weight was included the rate was 89% lower. Obesity has been found
to contribute to approximately 55% type 2 diabetes. There is also a strong inheritable
genetic connection in type 2 diabetes: having relatives (especially first degree) with
type 2 increases risks of developing type 2 diabetes very substantially.
Mr. G.G., Jr., is a 64year old, male whose diabetes type 2 has been diagnosed in
the year 1995 when he was hospitalized in Bacolod Adventist Medical Center. Mr.
G.G., Jr.’s diabetes was acquired through genetic predisposition where his father also
had diabetes. With regards to his lifestyle, client is a non-smoker and an occasional
alcohol drinker. Mr. G.G., Jr., was admitted at Bacolod Our Lady of Mercy Specialty
Hospital last January 25, 2009 with chief complaint of infected wound @ right foot.
Significant physical remarks of Mr. G.G. Jr. include gouty arthritis at his right elbow
and both knee joints, phalanges, carpals, metacarpals, metatarsals and tarsal joints.
This Nursing Case Study which focuses on Diabetes Mellitus Type 2 provided an
opportunity for us, as student nurses, to have a thorough and in depth understanding
of the DM Type 2. Through this NCS, we were able to enhance our assessment skills
and as well as critical thinking skills as the group relate the actual signs and symptoms
of DM type 2 exhibited by Mr. G.G. Jr. and the abnormal physiological changes which
have caused these changes. Also, this NCS allowed us to profoundly understand the
interconnectedness of an imbalance in a certain hormone and it’s variety of effects to
the body.
Objectives
|General Objective:
This nursing case study aims to;
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 Develop students’ ability to perform assessment and identify the priority needs
and health problems of clients with Diabetes Mellitus Type 2 and formulate
appropriate nursing interventions to address the client’s individual needs.
|Specific Objectives
After 4 days of nursing case study, the student nurse will be able to;
 Outline biologic and physical manifestations of DM Type 2 correlating it with the

underlying abnormalities and physiologic disturbances present in the client.
 Obtain client’s functional health pattern, history of present illness, past health
history and family/social history.
 Identify the complications manifested by clients with DM type 2 through

cephalocaudal and systems assessment.
 Identify the deviations from normal in the laboratory and radiologic tests
brought about by DM type 2.
 Trace the nature and cause of client’s condition through the pathophysiology of
DM type 2.
 Select 2 actual priority nursing problems and 1 risk nursing problem and
formulate Nursing Care Plans for each.
 Focus on the nursing responsibilities and interventions specified to medications

administered to the client.
 Construct a Health Teaching Plan that will address client’s knowledge needs.
 Apply values of concerns and empathy in providing care in order to achieve

optimum health for patients with DM type 2.
Anatomy and Physiology
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The endocrine system
is made up of glands that
produce and secrete
hormones. These hormones
regulate the body's growth,
metabolism (the physical and
chemical processes of the
body), and sexual
development and function.
The hormones are released
into the bloodstream and may
affect one or several organs
throughout the body.
Hormones are
chemical messengers created
by the body. They transfer
information from one set of
cells to another to coordinate
the functions of different
parts of the body.
The major glands of
the endocrine system are the
hypothalamus, pituitary,
thyroid, parathyroids,
adrenals, pineal body, and the
reproductive organs (ovaries
and testes). The pancreas is
also a part of this system; it
has a role in hormone
production as well as in
digestion.
The endocrine system is regulated by feedback in much the same way that a thermostat
regulates the temperature in a room. For the hormones that are regulated by the pituitary gland, a
signal is sent from the hypothalamus to the pituitary gland in the form of a "releasing hormone," which
stimulates the pituitary to secrete a "stimulating hormone" into the circulation. The stimulating
hormone then signals the target gland to secrete its hormone. As the level of this hormone rises in the
circulation, the hypothalamus and the pituitary gland shut down secretion of the releasing hormone and
the stimulating hormone, which in turn slows the secretion by the target gland. This system results in
stable blood concentrations of the hormones that are regulated by the pituitary gland.
Hormone Pituitary Stimulating Hormone Hypothalamic Releasing Hormone
 Thyroid hormones T4, Thyroid-stimulating hormone (TSH) Thyrotropin-releasing hormone (TRH)

T3
 Cortisol Adrenocorticotropin hormone Corticotropin-releasing factor (CRF)
(ACTH)
 Estrogen or Follicle-stimulating hormone (FSH), Luteinizing hormone-releasing
testosterone luteinizing hormone (LH) hormone (LHRH) or gonadotropin-
releasing hormone (GnRH)
 Insulin like growth Growth hormone Growth hormone-releasing hormone

factor-I (IGF-I) (GHRH)
THE PANCREAS
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The pancreas is a pinkish white glandular organ found in vertebrates near the stomach and small
intestine. The pancreas is the second largest gland that is connected to the digestive tract, after the
liver.
The pancreas is one of the few organs that have both an exocrine and an endocrine function.
Exocrine glands are glands that secrete their products into ducts (duct glands). Endocrine glands are
glands that secrete their product directly into the blood rather than through a duct. The pancreas'
exocrine function involves the secretion of bicarbonate and digestive enzymes into the small intestine.
Its endocrine function involves the regulation of blood sugar levels by secreting the hormones insulin,
glucagon, and somatostatin directly into the blood. The endocrine portion of this organ consists of about
1 million islets of Langerhans, amounting to only 1-3 percent of the organ weight. The majorities of cells
are exocrine and secrete one to three liters of digestive fluid per day.
The pancreas is an important organ for digestion and the control of circulating levels of glucose.
This organ is an excellent example of an intricate, well-tuned organ that functions in harmony with other
parts of the body, providing a service to the body while receiving the nutrients and removal of wastes
necessary for its survival. For example, in terms of its function in the digestive system, it is one of several
parts of the body that work together, involving cooperative giving and receiving, including the stomach,
intestines, liver, pancreas, heart, brain, and so forth.
|Anatomy
In human beings, the pancreas is a 6-10 inch
elongated organ weighing 65 to 160 grams and lying
in the abdominal cavity. It lies posterior to the
stomach, anterior to the kidneys, and empties into
the duodenum portion of the small intestine.
The human pancreas can be divided into five
regions: (1) the head, which touches the duodenum,
(2) the body, which lies at the level of second lumbar
vertebrae of the spine, (3) the tail, which extends
1: Head of pancreas
towards the spleen, (4) the uncinate process, and (5)
2: Uncinate process of pancreas
the pancreatic notch, which is formed at the bend of 3: Pancreatic notch
the head and body. 4: Body of pancreas
5: Anterior surface of pancreas
|Blood Supply 6: Inferior surface of pancreas
7: Superior margin of pancreas
The pancreas is supplied arterially by the pancreaticoduodenal 8: Anterior margin of pancreas
arteries: 9: Inferior margin of pancreas
10: Omental tuber
 the superior mesenteric artery feeds the inferior 11: Tail of pancreas
pancreaticoduodenal arteries 12: Duodenum
• the gastroduodenal artery feeds the superior
pancreaticoduodenal artery
|Nerve Supply
The pancreas receives neural innervation from the vagus (cranial X). This is part of the
autonomic parasympathetic supply. The role of the vagus is to stimulate secretion of the pancreatic
digestive juices.
Autonomic sympathetic nerves to the pancreas derive from the celiac ganglionic plexus, the
superior mesenteric plexus, and the hepatic plexus. These plexuses lie outside the pancreas and send
postganglionic fibers into the pancreatic cells. These sympathetic nerves inhibit the production of
digestive enzymes (Berne et al. 1996).
The innervation of the pancreas is comprised of both an intrinsic component that consists of
many intrapancreatic ganglia and an extrinsic component made of neurons lying outside the digestive
tract and belonging to the sympathetic and parasympathetic systems
Many different neurotransmitters have been found within the pancreas including acetylcholine,
epinephrine, norepinephrine, serotonin, nitric oxide, and others (Salvioli et al. 2002).
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|Microscopic Anatomy
When the pancreas is sliced, stained, and then viewed with a microscope, it is easy to distinguish
many different types of cells that correspond to different pancreatic functions. The microscopic
appearance of the pancreas shows a series of islands (the Islets of Langerhans) consisting of small cells
packed closely together, surrounded by much larger and less dense acinar cells. The islands have an
endocrine function and the surrounding cells have an exocrine function.
Appearance Region Function

 centralized islands endocrine pancreas secretes hormones that
(islets of Langerhans) regulate blood glucose levels
 surrounding acinar cells exocrine pancreas produces enzymes and
bicarbonate
| Endocrine Function
Name of cells Product % of islet cells Representative function
beta cells Insulin and Amylin 50-80% lower blood sugar
alpha cells Glucagon 15-20% raise blood sugar
delta cells Somatostatin 3-10% inhibit endocrine pancreas
gamma cells Pancreatic polypeptide 1% inhibit exocrine pancreas
There are four main types of cells in the islets of Langerhans. They all look similar when using
standard staining techniques, but when special stains are used they can be classified into four different
types:
The islets are a compact collection of endocrine cells arranged in clusters and cords that are
crisscrossed by a dense network of capillaries. The capillaries are lined by layers of endocrine cells in
direct contact with them by either cytoplasmic processes or by direct apposition. The cells release their
hormones, without ducts, directly into the capillaries.
HORMONES PRODUCED BY THE PANCREAS

Insulin is a polypeptide containing two chains of amino acids joined together by two disulfide
bridges, and contains a total of 51 amino acids.
* helps to transport glucose into skeletal muscle and liver.
* is produced when blood sugar exceeds 50 mg/deciliter.
* has an average production of 1.0 to 2.5 mg/day.
* stimulates skeletal muscle and liver to convert glucose to a storage form called glycogen.
* stimulates fat cells to synthesize fat.
* acts on the hypothalamus to reduce appetite.
Amylin is another polypeptide secreted by the beta cells. It is slightly smaller than insulin with 37
amino acids. It works to supplement the actions of insulin.
* inhibits the secretion of glucagon.
* lowers the level of glucose in the blood.
* slows the emptying of the stomach into the intestine.
* sends a signal of satiety to the brain.
Glucagon is a polypeptide containing 29 amino acids.

* is released into the blood in response to a blood glucose level falling below 80 mg/deciliter
* acts primarily on the liver to stimulate glucose production by breaking down glycogen and
converting protein and fat into glucose
* secretion is inhibited by amylin (Bowen 2002).
Somatostatin
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Purpose: Regulate the production and excretion of other endocrine tumors
Action: Slows down production of insulin, glucagon, gastrin, and other endocrine tumors
Secreted in response to: High levels of other endocrine hormones
Secretion inhibited by: Low levels of other endocrine hormones
Disease due to deficient action: Poorly defined
Disease due to excess action: Diabetes, gallstones, and dietary fat intolerance
Tumor called: Somatostatinoma
The endocrine function of the pancreas is to produce important hormones including insulin,
glucagon, and somatostatin and export them to the blood supply on demand.
Pancreatic polypeptide is secreted by the gamma cells and consists of 36 amino acids. It is
produced in response to chewing and swallowing food. It probably acts to reduce appetite (Taylor et al.
1982).
| Insulin
Insulin is a hormone that has profound effects on metabolism. Insulin causes cells in the liver,
muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle,
and stopping use of fat as an energy source. When insulin is absent (or low), glucose is not taken up by
body cells, and the body begins to use fat as an energy source, for example, by transfer of lipids from
adipose tissue to the liver for mobilization as an energy source. As its level is a central metabolic control
mechanism, its status is also used as a control signal to other body systems (such as amino acid uptake
by body cells). In addition, it has several other anabolic effects throughout the body.
When control of insulin levels fails, diabetes mellitus will result. Consequently insulin is used
medically to treat some forms of diabetes mellitus. Patients with Type 1 diabetes mellitus depend on
external insulin (most commonly injected subcutaneously) for their survival because the hormone is no
longer produced internally. Patients with Type 2 diabetes mellitus are insulin resistant, and because of
such resistance, may suffer from a relative insulin deficiency. Some patients with Type 2 diabetes may
eventually require insulin if other medications fail to control blood glucose levels adequately, though
this is somewhat uncommon.
Insulin also influences other body functions, such as vascular compliance and cognition. Once insulin
enters the human brain, it enhances learning and memory and in particular benefits verbal memory.
Insulin is a peptide hormone composed of 51 amino acids and has a molecular weight of 5808 Da. It
is produced in the islets of Langerhans in the pancreas. The name comes from the Latin insula for
"island". Insulin's structure varies slightly between species of animal. Insulin from animal sources differs
somewhat in 'strength' (in carbohydrate metabolism control effects) in humans because of those
variations. Porcine (pig) insulin is especially close to the human version.
Baseline Data
Name: G.G. Jr.
Address: Calumangan, Bago City
Age: 64 years old
No. of dependents: 6
Birth Date: 12-12-1945
Birth Place: Bago City
Gender: Male
Marital Status: Married
Religion: Roman Catholic
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Nationality: Filipino
Educational Attainment: High School Graduate
Occupation: Laborer
Person Next to Kin: G.G. III
Date of Admission: 01-25-2010
Time of Admission: 2:35 pm
Attending Physician: Dr. Jessielyn Doromal, MD
CC: Infected Wound Right Foot
Diagnosis: DM II Controlled
Nursing History
|Health Maintenance Pattern
Patient G.G. Jr. fortunately is a nonsmoker and just an occasional drinker. Prior to
admission, January 22, 2010, patient G.G. Jr. drank with his other 2 co-workers a minimum
of 2 Tanduay long neck whiskies which, according to him was just a form of socialization. He
has been taking maintenance drugs for his Gouty Athritis namely Colchicine (500mg) and
Depenax (50mg). However, the patient consumes these drugs only when he feels pain due
to his arthritis which deviates from the prescribed dosage of the said drugs (prescribed
dosage by AP was unrecalled by patient). Furthermore, the client divides his Cochicine tablet
(which is not a scored tablet) into two and takes half of the tablet as a relief for his arthritic
pain. Also, he takes Euglucon (5mg), taken after breakfast, for his diabetes. He has been
taken this medication since his first hospitalization in the year 1995. With regards to the
patient’s infected wound, patient mentioned that he utilizes “bayabas” leaves decoction to
cleanse his wounds and amoxicillin powder (from the amoxicillin capsule) as his medication
to his wound. The said amoxicillin was only a suggested intervention that was not prescribed
by a medical practitioner. According to him, he only changes his dressings once everyday
due to economic constraints. Patient has no allergy to medications, food , tapes or dyes.
Generally, patient has minimal knowledge regarding the importance of proper
compliance to medications and the importance of hygiene especially with his wound.
Though Mr. G.G. Jr. consumes the correct medications, he has not been following the
correct amount, frequency and dosage of these medications.
| Nutrition-Metabolic Pattern
Prior to admission, client eats rice, vegetables and fish regularly. According to him, he
seldom eats pork and chicken. Client observes restrictions in sugar and salt and he rarely
eats fruits approximately only 3-5 times a month. He had normal appetite and no
fluctuations in weight for the last 6 months. However, client stated that he is previously not
as thin as he is now. There was weight loss but it gradually occurred in years. No difficulty of
swallowing was expressed by the patient and has no presence of dentures. As a
complication of his DM type 2, client has retarded wound healing and has undergone
ungiectomy, (nail, big toe, right foot) last July 2008. Client has 2 diabetic ulcerations in the
body, one at his left elbow (almost healed) and one at his right foot phalanges area.
According to him, his wounds started last September 2009 and until now remains an open
wound and unfortunately became infected. Poor skin turgor and dryness is also noted in the
patient’s skin.
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| Elimination Pattern
Patient G.G. Jr. has a regular bowel movement prior to admission. According to him, he
defecates once a day yellow to brown colored formed stool and seldom experiences
constipation/diarrhea. He urinates approximately 4 times a day, approximately more than
220cc per voiding. No urine/ bowel incontinence was expressed by the client.
| Activity-Exercise Pattern
Client is independent in performing self care activities prior to admission such as
bathing, grooming, toileting and eating. According to him, his wound does not disturb his
activities especially in his work as a laborer. Though there is pain, it is tolerable. He also
emphasized that he can climb the stairs independently and ambulates without assistance.
Mr. G.G. Jr. attends his work in the morning at around 8am and returns home by 5pm.
During weekends, Mr. G.G. Jr. spends this time relaxing at home or doing some simple
household repairs. Mr. G.G. Jr. does not use any assistive devices (e.g. canes, walker, and
crutches) though stiffness in his joints in the lower extremities is present. Patient has no
exercise pattern, according to him, his exercise is already included in his work as a manual
laborer.
| Sleep- Rest Pattern

Mr. G.G. Jr. sleeps for 10- 11 hours per day. According to him, he goes to bed early at 7-
7:30pm and wakes up at 6 am. He has no schedules of AM or PM nap because of his work in
the field. He also expressed that he feels rested after his sleep. He does not have any trouble
sleeping prior to admission.
|Cognitive- Perceptual Pattern

Patient G.G. Jr. is alert, oriented and has normal speaking ability prior to and during
admission. He speaks Ilonggo and a few Tagalog. He can comprehend to simple English
terms but is not that acquainted with the language. He had only finished high school in their
local high school in Bago which reflects a poor knowledge level of the patient. Patient is able
to communicate and comprehend effectively and has appropriate interactive skills. Patient
has undergone cataract extraction in the year 2008 and is presently using corrective glasses
(grade unrecalled). Client has not expressed any abnormalities in hearing. He expressed light
alteration in taste (food is slightly tasteless) but no alteration in the sense of taste reported.
Patient expressed experience of chronic pain as a result of his infected wound at right
foot area and several arthritic pain episodes. When asked about the level of pain, he
responded a score of 6 from a scale of 1-10 in the pain scale (10 being the highest
score/extreme pain). To manage this pain, patient G.G. Jr. takes Colchicine and Depenax for
his arthritis and relaxes his feet to relieve pain due to his wound.
|Self- Perception/ Self-Concept Pattern

Patient G.G. Jr. is contented of whatever he has now and is thankful to God that still he
was able to attend to his medical needs besides their financial instability. Mr. G.G Jr. has a
good body image of himself and maintains a happy disposition and optimistic outlook about
the future. He expressed a positive spirit towards wellness.
|Role- Relationship Pattern
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Mr. G.G. Jr. is married for 33 years and has 6 children- 5 boys and 1 girl. His eldest is
already 32 years old and has already a family of his own while his youngest is 19 years old.
Prior to admission, patient G.G Jr. works as a laborer under the City Engineering Office of
Bago and has been working for the city government for more than 20 years already. Patient
G.G. Jr. has a good relationship with his family members especially with his wife who
accompanied him in the hospital since his first day of admission. Also, he is frequently
visited by his children. Patient G.G. Jr. expressed his concern regarding his role as the
provider of their household since his wife is unemployed. He worries about the added
expenses from the hospital and their expenses at home.
|Sexuality- Reproductive Pattern

Patient G.G. Jr. was circumcised when he was 9 years old. Patient did not express any
problems with his sexuality and patient expressed contentment with his wife as his partner.
Also he expressed contentment of having 6 children. Patient G.G. Jr. also expressed that he
and his wife did not engaged in any family planning method as family method was not yet
well advocated and promoted during the young years of their marriage.
|Coping- Stress Pattern

As expressed by Mr. G.G Jr., his major concern regarding his hospitalization and his
illness are the expenses of his stay in the hospital and his medications. Other concerns
include the unprovided needs of his family in their household and his absence from work.
Patient emphasized that one of his stressors in life is their family’s financial instability which
is also the reason why he continuously goes to work as a laborer besides his condition.
Nonetheless, patient G.G. Jr. expressed that life should still go on and they should not lose
hope for these are only challenges in his journey. Strong emotional support from his wife
and children also empowers Mr. G.G. Jr. to continuously be strong. Also, patient exhibited
strong faith in God as he said that everything that has happened is according to God’s will
and decision.
|Value- Belief Pattern

Patient G.G. Jr. is a Roman Catholic and has no religious restrictions. He often goes to
church with his wife and always expressed his strong faith in God as his healer and provider.
Patient G.G. Jr. is contented of what God has provided them and surrenders everything
according to God’s will.
Health History
|History of Present Illness
Client was diagnosed with Diabetes Mellitus in the year 1995 when he had his
hospitalization at Bacolod Adventist Medical Center. He was then prescribed to take
Euglucon as his maintenance medication for diabetes and takes this drug religiously. Four
months prior to admission, patient had wounds at his left elbow (almost healed) and right
foot, and yet did not take appropriate actions to treat the said wounds and latter became
infected. One day prior to admission, patient noted wound at right foot to have purulent
and watery discharges with tenderness associated with fever. Morning prior to admission,
patient G.G. J. consulted his attending physician and was advised for admission. Upon
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admission, patient is conscious and coherent. His blood pressure is normal at 120/70,
RR=17cpm, PR=63bpm and temperature of 36.2 oC. Erythema and tenderness is noted at
patient’s infected wound at his right foot.
|Past Health History
Childhood Illness
As a child, patient G.G. Jr. went through chickenpox at 5 years old, and latter on the
same year experienced mumps. No immunizations were undertaken by patient when he
was young and claimed no allergy or hypersensitivity to any food or medication. According
to patient G.G. Jr., he seldom experienced colds and cough when he was young. No other
childhood illnesses were expressed by the client.
Patient G.G. Jr. has a family history of Diabetes Mellitus.
Past Hospitalization
In the year 1995, patient G.G. Jr. was hospitalized at Bacolod Adventist Medical Center
and was diagnosed with Diabetes Mellitus Type 2. This present admission was only the
second hospitalization of Mr. G.G Jr. due to one of the complications of his diabetes which is
delayed wound healing.
No other previous hospitalizations occurred.
Serious Illness
Patient G.G. Jr. had been diagnosed of Gouty Arthritis in the year 2007 through a
consultation in their Local City Health Office at Bago. He was prescribed with Colchicine and
Depenax as his maintenance medications. Also, patient has Diabetes Mellitus Type 2 which
was diagnosed in the year 1995.
Previous Surgery
In the year 2008, patient G.G. Jr. has undergone cataract extraction for both right and
left eye done by Dr. Eusebio at Riverside Medical Hospital. On July of the same year, patient
underwent ungiectomy (nail, big toe, right foot) at Bacolod Adventist Medical Center.
Physical Assessment
|General Appearance
Patient G.G. Jr. is small built and weighs approximately 45 kg. He is 5’3’’ tall. He has dark
brown complexion and visibly has wrinkled skin due to his age. He has mixed white and gray
hair and the front part of his scalp is already bald. He has gray mustache and scattered
eyebrows. He has incomplete teeth but does not have dentures. The patient has a slightly
offensive smell and wears a pale yellow shirt and blue maong pants upon assessment. The
patient is resting on bed on supine position with the right foot positioned away from left
foot. Patient exhibited mild body weakness.
|Vital Signs
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Initial vital signs of the patient are as follows: BP= 120/70, RR=17cpm, PR=63bpm and
temperature= 36.2oC. Blood pressure was taken at patient’s right arm while lying on bed and
pulse rate was palpated at right radial artery. Pulse of the patient is weak, slow with regular
rhythm.
DAY and Day 1 Day 2 Day 3 Day 5

DATE 01-25-2010 01-26-2010 01-27-2010 01-29-2010
VITAL SIGNS 4pm 8pm 4pm 8pm 4pm 8pm 4pm 8pm
Blood Pressure 120/70 120/70 120/70 120/70 120/70 120/80 110/70 120/70
mmHg mmHg mmHg mmHg mmHg mmHg mmHg mmHg
Pulse Rate 63 bpm 66bpm 72bpm 68bpm 68bpm 71bpm 71bpm 68bpm
Respiration Rate 17cpm 18cpm 16cpm 16cpm 17cpm 18cpm 16cpm 16cpm
Temperature 36.2oC 36.4 oC 36.5 oC 36.4 oC 36.5 oC 36.4 oC 37.2 oC 37 oC
|Integumentary
Patient’s skin is cool to touch at his upper and lower extremities. Lower extremities are
also pale. Patient has dark brown complexion, and has dry skin. Patient has pale nail beds
and nails on toes appear cracked. There is presence of wound at left elbow and an infected
wound at right foot metatarsal area. Erythema, tenderness and purulent discharges were
noted on patient’s infected wound at right foot. Significant physical remarks of my client
includes gouty arthritis at his right elbow joint, both knee joints, phalanges, carpals,
metacarpals, metatarsals and tarsal joints. Darkening of stiffed joints was also noted.
Patient’s lower extremities are pale and cool to touch, and have poor skin turgor.
|Cardiovascular
Patient has a weak, slow palpable pulse of 63bpm, rhythm regular palpated at right
radial artery. Patient’s BP is 120/70 mmHg taken at right arm in supine position. Patient has
poor capillary refill more than 3 second.
|Respiratory
Patient is breathing spontaneously to room air and has symmetrical rise and fall of the
chest. No retractions and presence of cough noted. No adventitious breath sound was heard
upon auscultation. Patient’s respiration rate is 17cpm.
|Abdomen
Patient’s abdomen is flat, soft and non tender. No mass noted. Color of the abdomen is
of the same tone with parts of the body. No abdominal pain was expressed by the client.
|Gastrointestinal Tract
Patient is on a diabetic diet comprised of 3 meals and 2 snacks per day. Patient has poor
appetite and has no difficulty of swallowing expressed. However, patient expressed that he
usually feels full even though it is already meal time which results to decreased satisfaction
after food intake. Patient has not defecated upon assessment and has normoactive bowel
sound of 17 upon auscultation.
|Genitourinary
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Client is voiding freely and has voided to an amber colored urine approximately 360cc
upon assessment.
24- Hour Intake and Output Record

TOTAL TOTAL
Intake Output
Day 1 2140 cc 1975 cc
Day 2 2545 cc 2100 cc
Day 3 2715 cc 1880 cc
Day4 870 cc 1750 cc
| HEENT
Head: Patient’s head is symmetrical. Wrinkled skin on his face is noted due to his age.
Eyes: Patient has pale conjunctiva and anicteric sclera. Eyebrows are symmetrically aligned
and eyes are proportional to the face with few watery discharges suspended inside.
Patient’s right pupil has minimal response to light upon assessment, shape is vertically
elongated. On the other hand, left pupil is round and reactive to light and
accommodation. The patient’s eyes move in conjugate fashion.
Ears: Patient’s ears are symmetrical and non-tender. No unusual discharges noted. The
patient has no hearing difficulty and ear pains claimed. Color of the ears is the same
with facial skin. Ear hygiene is not maintained.
Nose and sinuses: Nose is symmetrical. Nose is non tender upon palpation. Client has no
olfactory problems. No nasal discharges noted.
Mouth and throat: Lips are dry with symmetrical contour. Tongue is moist, moves freely,
non tender. There is no presence of mouth lesions, bleeding gums and dentures.
There is mild alteration in taste (food slightly tasteless). Mucous membranes are pale
and intact. Client expressed no difficulty in swallowing, no difficulty of speaking noted.
|Musculoskeletal
Patient moves without assistance but ambulates with assistance. Poor muscle tone can
be observed on the patient. There is significant stiffness and deformity noted at his right
elbow joint, both knee joint, phalanges, carpals, metacarpals, metatarsals and tarsal joints
due to gouty arthritis. Swelling and erythema at right metatarsal area was also noted.
Patient expressed pain when moving his right elbow joint and both knee joints.
|Neurological
Patient’s memory is intact. Patient is conscious and has coherent, spontaneous speaking
ability. Patient is oriented to persons and place. He is responsive to both verbal and non
verbal stimuli. Patient has mild anxiety brought by being hospitalized as evidenced by his
low tone and volume of voice. Patient exhibited facial expressions, can feel temperature
changes by mouthing, “kagin-ot”. No paralysis was noted in any of patient’s body parts.
Patient was very cooperative and responsive during the entire assessment.
|Endocrine
Patient G.G. Jr. does not experience flushing upon assessment. He also does not
experience polydipsia, polyphagia and polyuria which are classical signs of diabetes inclusive
in the endocrine system physical assessment. There is no abrupt change in weight over the
14
past 6 months. Darkening was noted on patient’s stiffed joints and skin is dry to touch.
Patient has decreased body hair especially in the lower extremities have poor muscle tone.
Laboratory and Radiology

|January 25, 2010
A. Potassium and Creatinine
Result Verified: January 25, 2010 8:17:07 PM
EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATIO IMPLICATION
N
Renal Failure, Acidosis,
Potassium 5.73 3.6-5.1 mg/dL Above normal Cell lysis, tissue
breakdown or
hemolysis
Creatinine 4.90 0.6-1.3 mg/dl Extremely Above Nephritis
Normal Chronic Renal Disease
15
B. Complete Blood Count
Result Verified: January 25, 2010 3:50:51 PM
EXAMINATION RESULT NORMAL VALUES INTERPRETATION IMPLICATION
Hemoglobin 88 120.00-170.00 g/L Extremely below normal Anemia
Hematocrit 0.26 0.40-0.54 Extremely below normal Anemia
RBC 2.82 4.60-6.00x10ˆ12/L Extremely below normal Anemia, hemorrhage
WBC 8.0 5.00-10.00x10ˆ9/L Normal Normal
Eosinophils 0.02 0.00-0.05 Normal Normal
Lymphocytes 0.20 0.20-0.40 Normal Normal
C. Radiologic Report
Result Verified: January 25, 2010
Remarks: PTB Minimal, Undetermined activity
|January 27, 2010

A. Fasting Blood Sugar
Result Verified: January 27, 2010 8:08:46 AM
EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATION IMPLICATION
Blood Sugar 29 75-115 mg/dl Extremely Below Hyperinsulinism
Normal
|January 28, 2010

A. Complete Blood Count
EXAMINATION RESULT NORMAL VALUES INTERPRETATION IMPLICATION

Hemoglobin 111 120.00-170.00 g/L Below Normal Anemia
Hematocrit 0.32 0.40-0.54 Below Normal Anemia
RBC 3.45 4.60-6.00x10ˆ12/L Below Normal Anemia, hemorrhage
WBC 10.9 5.00-10.00x10ˆ9/L Above Normal Acute Infectious
Disease
Lymphocytes 0.18 0.20-0.40 Below Normal Agranulocytosis,
increased risk for
infection
B. Creatinine
EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATION IMPLICATION

Creatinine 4.57 0.6-1.3 mg/dl Extremely Above Nephritis
Normal Chronic Renal
Disease
|IDEAL LABORATORY TESTS
16
Hemoglobin A1C test (A1C) — (Glycosysated Hemoglobin Level) The A1C blood test
measures the average blood glucose level during the past two to three months. It is used to
monitor blood glucose control in people with known diabetes, but is not normally used to
diagnose diabetes. Normal values for A1C are 4 to 6 percent. The test is done by taking a
small sample of blood from a vein or fingertip.
Oral glucose tolerance test — Evaluates insulin response to glucose loading. FBS is obtained
before ingestion of a 50- t0 200- gram glucose load (usual amount, 75g), and blood samples
are drawn at ½ , 1, 2 and 3 hours.
Random blood glucose test — for a random blood glucose test, blood can be drawn at any
time throughout the day, regardless of when the person last ate. A random blood glucose
level of 200 mg/dL (11.1 mmol/L) or higher in persons who have symptoms of high blood
glucose suggests a diagnosis of diabetes.
C-Peptide Assay – Cleaved from the proinsulin molecule during its conversion to insulin, C-
peptide acts as a marker for endogenous insulin production.
Glycosylated Albumin Level- Glucose also attaches to proteins, primarily albumin. The
concentration of glycosylated albumin (fructosamine) represents the average blood glucose
level over the previous 7-10 days. This measurement is useful when short-term
determinations of average blood glucose level are desired. The reliability and clinical
applicability continue to be evaluated.
Urinalysis- Urine levels of ketones can be tested by client’s use of dipstrips or tablets. The
presence of ketones in the urine (ketonuria) indicates that the body is using fat as a major
source of energy, which may result in ketoacidosis. Test results are indicated by the
presence of ketones. All aliens with diabetes mellitus should test their urine for ketones
during acute illness or stress, when blood glucose levels are elevated (>240 mg/dl).
17
PREDISPOSING FACTORS
Genetic Predisposition PRECPITATING FACTORS
Pathophysiology Age> 40 yrs old
Gender: Female
StressObesity
Viral InfectionAuto Immune Disorder
Destruction of alpha and beta cells of the pancreas

Pathophysiology
Increased Ketones
Failure to produce insulin and / or insulin resistance Production of excess glucagon
Clinical Manifestations Acetone
Acidosis
Breath
Hyperglycemia Production of glucose from protein and fat stores
Fatigue
Increased blood osmolarity due to glucose Chronic elevations in blood glucose Wasting of lean body mass
Weight Loss
Polyuria Polyphagia Glycoprotein cell wall deposits

Polydipsia
Weight loss Small Vessel DiseaseAccelerated AtherosclerosisImpaired Immune Function
Infection Delayed Wound Healing
Diabetic NeuropathyDiabetic NephropathyDiabetic Retinopathy
mmetrical loss of protectiveand

Numbness sensation Wasting
tingling in the of intrinsicCharcot
extremities muscleschanging in joints
Autonomic Neuropathy End stage Renal Failure Hypertension Increased LDL levels
Blurred Vision Blindness Cataract
Dry cracked skin Gastroparesis Impotence Neurogenic Bladder

Diabetic Foot Ulceration
Coronary Artery Disease
Source:
 Black and Hawks, Medical Surgical Nursing
 Udan, Josie., Medical Surgical Nursing Concepts and Clinical Application
NURSING CARE PLANS
Actual Problem # 1
Impaired Tissue Integrity
Actual Problem # 2
Ineffective Peripheral Tissue Perfusion
Risk Problem
Risk for Activity Intolerance
DRUG STUDY
Standing Meds STAT Meds
Norvasc (Amlodipine) Lasix (Furosemide)

Calcium Tums (Calcium carbonate) Benadryl (Diphenhydramine Hydrochloride)
Colchicine Transderm- Nitro (Nitroglycerin )
Dolcet (Tramadol + paracetamol) Tetavax
Eroxmit (Cefuroxime)
Calmoseptine (Zinc Oxide)
Humulin R (Insulin Regular)
Iberet with folic acid (Multivitamins + Folic Acid)
Sodium Bicarbonate
Qinosyn (Ciprofloxacin)
DOSAGE,
NAME OF DRUG/ MECHANISM OF INDICATION CONTRAINDICATION ADVERSE REACTIONS NURSING
FREQUENCY,
CLASSIFICATION ACTION RESPONSIBILITIES
ROUTE
Norvasc  Cardiovascular: arrhythmia  Monitor patient
5mg/ 1 tab Drug works by  Angina pectoris  Contraindicated (including ventricular tachycardia
with allergy to carefully (BP, cardiac
Amlodipine Besylate relaxing (dilating) your due to coronary and atrial fibrillation), bradycardia,
rhythm and output)
OD blood vessels, artery spasm. amlodipine, chest pain, hypotension, peripheral
ischemia, syncope, tachycardia, while adjusting drug
Calcium Channel- lowering blood impaired
postural dizziness, postural to therapeutic dose;
PO pressure, and hepatic or renal
blocker  Chronic stable hypotension, vasculitis. use special caution if
Antianginal decreasing heart rate, function, heart  patient has CHF.
angina, alone or Central and Peripheral Nervous
Antihypertensive which lowers the block. System: hypoesthesia, neuropathy  Administer drugs
in combination
workload on the with other peripheral, paresthesia, tremor, without regards to
heart. It also dilates  Use cautiously vertigo. meals.
agents.  Gastrointestinal: anorexia,
coronary arteries with CHF  Take with meals if
constipation, dyspepsia, dysphagia,
increasing blood flow upset stomach
 Indicated for the diarrhea, flatulence, pancreatitis,
to the heart. occurs.
treatment of vomiting, gingival hyperplasia.
 Musculoskeletal System: arthralgia,  Patient may
confirmed or
arthrosis, muscle cramps, myalgia experience these
suspected
 Respiratory System: dyspnea, side effects: nausea,
vasospastic angina
epistaxis. vomiting (have SFF),
 Skin and Appendages: angioedema, and headache.
 Essential erythema multiforme, pruritus,  Instruct patient to
hypertension, rash, rash erythematous, rash report irregular
alone or in maculopapular. heartbeat, shortness
 Special Senses: abnormal vision, of breath, swelling
combination with
conjunctivitis, diplopia, eye pain, of the hands or feet,
other tinnitus.
antihypertensives pronounced
 Urinary System: micturition
dizziness,
. frequency, micturition disorder,
nocturia. constipation.
 Metabolic and Nutritional:
hyperglycemia, thirst.
DOSAGE,
NAME OF DRUG/ MECHANISM OF NURSING
CLASSIFICATION FREQUENCY, ACTION INDICATION CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES
ROUTE
Calcium Tums  Cardiovascular: slowed heart  Instruct patient to

500mg/ 1 tab Reduces total acid load  Symptomatic  Contraindicated
in GI tract, elevates rate, tingling, “heat waves”, take drugs between
Calcium Carbonate relief of upset with allergy to
gastric pH to reduce peripheral vasodilation, local meals and at
TID stomach calcium, renal
pepsin activity, burning, drop in BP. bedtime.
Electrolyte associated with calculi,
strengthens gastric  This drug must not
Anatacid PO hyperacidity hypercalcemia,  Local: Local irritation, severe be taken with other
mucosal barrier, and
and ventricular necrosis, sloughing and abscess oral drugs.
increases esophageal
fibrillation formation. Absorption of those
sphincter tissue
during cardiac medication can be
resuscitation.  Metabolic: Hypercalcemia blocked; take other
(anorexia, nausea, vomiting, oral medications at
 Use cautiously constipation, abdominal pain, least 1-2 hrs after
with renal dry mouth, thirst, polyuria), calcium carbonate.
dysfunction. rebound hyperacidity.  Record amount and
consistency of stool.
Manage constipation
with laxatives or
stool softeners.
 Monitor calcium
level, especially
patient with mild
renal failure
 Watch for evidence
of hypercalcemia
( nausea, vomiting
headache, confusion
and anorexia.
DOSAGE,
NAME OF DRUG/ FREQUENCY, MECHANISM OF INDICATION CONTRAINDICATION ADVERSE REACTIONS NURSING
CLASSIFICATION ROUTE ACTION RESPONSIBILITIES
Colchicine  CNS: Peripheral neuritis,  Monitor for relief of

1.2 mg/1 tab Exact mechanism Pain relief of acute  Contraindicated
purpura, myopathy pain, signs and
Colchicine TID x 6 doses unknown; decreases gout attack; also used with allergy to symptoms of gout
deposition of uric between attack as colchicine; attack, usually abate
blood  Dermatologic: Dermatoses, within 12 hr and are
PO acid; inhibits kinin prophylaxis.
dyscrasias, loss of hair, purpura. gone within 24-48 hr.
Antigout Drug formation and
 Monitor total dose
phagocytosis, and serious GI
disorders, liver,  Gastrointestinal: nausea, received.
decreases  Administration should
renal or cardiac vomiting, abdominal pain, or
inflammatory reaction begin at the first sign
disorders. diarrhea may be particularly of an acute attack;
to urate crystal
troublesome in the presence delay can decrease
deposition.
 Use cautiously of peptic ulcer or spastic drug’s effectiveness in
colon. alleviating symptoms
with elderly. of gout.
 Stop drug at first sign
 Hematologic: Bone marrow of nausea, vomiting,
depression, elevated alkaline stomach pain or
phosphatase, AST levels diarrhea.
 Patient may
experience these side
 Locals: Thrombophlebitis at
effects: nausea,
IV sites. vomiting, loss of
appetite (eat small
 Hypersensitivity: urticaria. frequent meals) loss of
fertility (reversible),
loss of hair
(reversible).
DOSAGE,
Dolcet
325mg
Tramadol
Hydrochloride 1 tab BID x 4
+ doses
Paracetamol
PO
Binds to mu-opioid Relief of moderate to  Contraindicated  Limit use in patients

 CNS: sedation, dizziness or
A. Tramadol receptors and inhibits moderately severe with allergy to with past or present
vertigo, headache, confusion,
Hydrochloride the reuptake of nor pain. tramadol or history of addiction
dreaming, sweating, anxiety,
epinephrine and opiods or acute or dependence on
seizures
Analgesic, Centrally serotonin; causes intoxication opiods.
 CV: hypotension, tachycardia,
Acting many effects similar with alcohol,  Inform patient that
bradycardia
to the opiods – opiods or he may experience
 Dermatologic: Sweating,
dizziness, nausea, psychoactive these side effects:
pruritus, rash, pallor, urticaria
constipation –but drugs. dizziness, sedation,
 GI: Nausea and vomiting, dry
does not have the mouth, constipation impaired visual
respiratory  Use cautiously acuity, nausea, loss
 Special Senses: Visual
depressant effect. in renal of appetite.
disturbance.
dysfunction or  Control environment
 Urogenital: Menopausal
hepatic (temperature,
symptoms, Urinary frequency,
impairment. lighting) if sweating
Urinary retention.
 Others: anaphylactic reactions or CNS effects occur.
B. Paracetamol Reduces fever by Arthritis and  CNS: Headache  Do not exceed
acting directly on the rheumatoid disorders  Contraindicated recommended dose;
Acetaminophen hypothalamic heat- involving with allergy to  CV: Chest pain, dyspnea, do not take for more
regulating center to musculoskeletal pain. acetaminophen myocardial damage than 10 days.
Antipyretic cause vasodilation and
Analgesic (Nonopiod) sweating, which helps  Acetaminophen  GI: Hepatic Toxicity and failure,  Take the drug only
dissipate heat. tablets are jaundice for complaints
contraindicated indicated; it is not an
in any situation  GU: Acute kidney failure, renal inflammatory agent
where opioids
tubular necrosis
are
 Avoid the use of
contraindicated,
including acute  Hematologic: cyanosis, over the counter
intoxication with hemolytic anemia, hematuria, preparations. They
any of the anuria, neutropenia, may contain
following: leucopenia, thrombocytopenia, acetaminophen, and
alcohol, hypoglycemia. serious overdose can
hypnotics, occur.
narcotics,  Hypersensitivity: rash, fever
centrally acting  Report rash, unusual
analgesics, bleeding or bruising,
opioids or yellowing of the skin
psychotropic
or eyes, changes in
drugs.
voiding pattern.
 Use cautiously
with impaired
hepatic
function.
DOSAGE,
750mg Bactericidal: Inhibits  Treating bacterial  Contraindicated  CNS: headache, dizziness,  Take full course of
Eroxmit
synthesis of bacterial infections (sinus, with allergy to lethargy, paresthesias. drug therapy.
Q8h cell wall, causing cell skin, lung, urinary cephalosporins  GI: nausea and vomiting,  This drug is specific
Cefuroxime
death. tract, ear, and or penicillin. diarrhea, anorexia, for this infection and
IVTT throat). abdominal pain, flatulence, should not be used
Antibiotic
 Use cautiously liver toxicity to self-treat other
 Used for treating with renal  GU: Nephrotoxicity problems.
dermatologic failure.  Hematologic: bone marrow  These side effects
infections, depression, decreased may occur; stomach
including  Contraindicated WBC, decreased platelets, upset or diarrhea.
impetigo, cause if you have decreased Hct.  Avoid alcohol while
by S. aureus and diarrhea, a  Local: Pain, abscess at taking this drug and
S. pyogenes. stomach or injection site, inflammation for 3 days after
intestinal at IV site. because severe
infection, or a  Other: Superinfections reactions often
blood clotting occur.
problem.
DOSAGE,
FREQUENCY,
ROUTE
Calmoseptine   Dermatologic: rash, hives,  Nurse should be aware

For preventing and  Calmoseptine Contraindicated
Ointment Epicutaneous if patient is itching, swelling of the that calmoseptine
treating minor skin ointment works
mouth, face, lips or tongue ointment is for external
irritations caused by by temporarily allergic to any
use only. Must not let
Menthol/Zinc Oxide TID cuts, scrapes, itching, relieving itching ingredient in
 Respiratory: difficulty of into the eyes, nose or
wound drainage. and pain. It also calmoseptine mouth of the patient. If
Analgesic, Antiseptic, ointment. breathing, tightness in the
decreases drug was got in contact
Antipruritic, Skin chest
moisture in with any of these areas,
Protectant combination  Not used in rinse at once with cool
affected area.
treating a deep water.
 Menthol has wound or  Calmoseptine ointment
been shown to puncture is to be used only by the
wound. patient for whom it is
cause
prescribed. It should not
vasodilation. This
be shared with other
may increase people.
circulation to an  Calmoseptine should be
area and aid in stored at room
healing. temperature. Store
away from heat,
Mild antiseptic moisture and light. Do
ingredients may not store in the
help prevent bathroom. Keep out of
secondary reach of children and
bacterial and away from pets.
 Calmoseptine will not
fungal infections treat bacterial or fungal
of the skin. infection.
DOSAGE,
FREQUENCY,
ROUTE
 Ensure uniform
Humulin R  Hypersensitivity: rash, dispersion of insulin by
8 units Humulin R  Treatment of  Contraindicated
with allergy to anaphylaxis or angioedema. rolling the vial gently
(Concentrated) is a Type 2 (non-
between hands; avoid
TID ac fast-acting form of the insulin pork products
Insulin Regular  Local: Allergy –local vigorous shaking.
hormone insulin. It dependent)  Give maintenance
reactions at injection site –
SQ works by helping your diabetes that  If patients is doses SC, rotating
Anti Diabetic Hormone redness, swelling, itching,
body to use sugar cannot be having an injection sites
lipodystrophy, pruritus.
properly. This lowers controlled by diet episode of low regularly to decrease
the amount of glucose or oral drugs blood sugar incidence of
 Metabolic: Hypoglycemia
in the blood, which lipodystrophy
 If patient is (sweating, drowsiness,  Store insulin in a cool
helps to treat
dizziness, sleep disturbance,
diabetes. taking oral dry place away from
palpitations, anxiety, tremor, direct sunlight.
diabetes
blurred vision, hunger, slurred Refrigeration is
medication.
speech, restlessness.) preferred. Do not
ketoacidosis freeze insulin.
 Monitor urine or
serum glucose levels
frequently to
determine
effectiveness of drug
and dosage.
 Instruct patient to
avoid alcohol; serious
reactions can occur.
DOSAGE,
FREQUENCY,
ROUTE
Iberet- Folic 500 
500mg  Simulates normal  anemia  Contraindicated
GIT: stomach pain, nausea,  Do not take this
vomiting, diarrhea, medication with milk,
Multivitamins erythropoiesis and in patients with other dairy products,
anorexia, abdominal
+ 1 tab nucleoprotein  provide vitamins hypersensitive to calcium supplements,
distention, flatulence,
Folic Acid synthesis. and iron that are drug. or antacids that contain
bitter/ bad taste, calcium. Calcium may
BID not taken in
make it harder for your
 helps your body through the diet  if you have a
 RESPI: bronchospasms, body to absorb certain
PO produce and long-term ingredients of the
respiratory difficulty
maintain new cells  used to treat iron infection, seizure multivitamin with iron.
or vitamin disorder (eg,
 SKIN: allergic reactions  Never take more than
deficiencies epilepsy), or liver
including rash, pruritus, and the recommended dose
caused by illness, problems (eg,
erythema of a multivitamin.
pregnancy, poor alcoholic
nutrition, cirrhosis), or if  Monitor patient for
 CNS: altered sleep pattern,
digestive you are on kidney hypersensitivity
general malaise, confusion,
disorders, and dialysis reactions, especially if
irritability, hyperactivity,
many other drug previously taken.
over activity, mental
conditions
excitement, confusion,  Keep supportive
impaired judgment, equipment and
emergency drugs readily
available in case of
serious allergic
response.
DOSAGE,
FREQUENCY,
ROUTE
Qinosyn  CNS: headache, dizziness,  Inform client that if
500mg/ 1 tab Bactericidal interferes -for the treatment  Contraindicated
with allergy to insomnia, fatigue, depression, antacid is needed,
Ciprofloxacin with DNA replication of infection caused
blurred vision take it at least 2
BID in susceptible bacteria by susceptible Ciprofloxacin,
hours before or after
Antibacterial preventing cell gram-negative Norfloxacin or
 CV: arrythmias, hypotension, dose
PO reproduction bacteria including other flouro- angina  Drink plenty of fluids
E-coli. quinolones while taking this
 GI: nausea, vomiting, dry mouth, drug.
 -Use cautiously diarrhea, abdominal pain  Inform patient that
with renal he may experience
dysfunction,  Hematologic: Elevated BUN, these side effects:
seizures, AST, ALT, serum creatinine and nausea and vomiting,
tendonitis or alkaline phosphatase; decreased abdominal pain (eat
tendon rupture WBC, neutrophil count, Hct. frequent meals),
diarrhea/
associated with
 Other: fever.rash. constipation;
flouro-
drowsiness, blurring
quinolones use.  Renal and Urinary Disorders: of vision, dizziness
micturition urgency, dysuria,  Instruct patient to
urinary frequency, abnormal inform nurse if rash,
urine odor. visual changes,
severe GI problems,
 Skin/Subcutaneous Tissue weakness, tremors
Disorders: rash,  Encourage patient to
photosensitivity/ phototoxicity complete full course
reaction, pruritus, urticaria. of drug therapy.
Arrange for culture and
sensitivity test before
beginning therapy.
DOSAGE,
FREQUENCY,
Sodium Bicarbonate  GI: Gastric rupture following 

300 mg 1 tab Restores buffering  Upset stomach  you are Have patient chew
capacity of the body and allergic to any ingestion tablet thoroughly
TID x 6 doses
neutralizes excess acid. before swallowing
Acidifiers and ingredient in
 Symptomatic  Hematologic: systemic and follow them with
Alkalinizers PO Sodium
relief of upset alkalosis, (nausea, irritability, a full glass of water.
Bicarbonate
stomach weakness, tetany),
associated with  Do not give oral
 you have hypokalemia
hyperacidity sodium bicarbonate
appendicitis or a with 1-2 hour of
blockage of your  Local: Chemical cellulitis, other oral drugs to
bowel tissue necrosis reduce risk of drug
interactions.
 you are on a
low-salt diet
report irritability,
headache, tremors,
 if you have a confusion, swelling
history of stomach of extremities, and
or intestinal difficulty of
bleeding breathing, black or
tarry stools.
DOSAGE,
FREQUENCY,
ROUTE
 CNS: vertigo, dizziness,
Lasix headache, paresthesia,  To prevent
40 mg/ 1 tab a potent drug that Hypertension  Contraindicated weakness, restlessness, fever nocturia, give PO
inhibits sodium and to patients  CV: orthostatic hypotension preparations in the
Furosemide Pre BT chloride reabsorption hypersensitive to  EENT: transient deafness, morning. Give
at the proximal and drug and those blurred or yellowish vision, second dose in
Diuretics PO distal tubules and the with anuria tinnitus early afternoon
ascending Loop of  GI: abdominal discomfort and  Monitor weight,
Henle  use cautiously in pain, diarrhea, anorexia, blood pressure, and
patients with nausea, vomiting pulse rate routinely
And hepatic cirrhosis  GU: nocturia, polyuria, with long term use
and in those frequent urination and during rapid
allergic to  Hematologic: diuresis. Use can
20 mg/ 1 tab sulfonamides agranulocytosis, aplitic lead to profound
Post BT anemia, leucopenia, anemia water and
 Hepatic: hepatic dysfunction, electrolyte
jaundice depletion.
 Metabolic: volume depletion  Monitor fluid intake
and dehydration, impaired and output and
glucose tolerance, electrolyte, BUN,
hypokalemia, hyperglycemia, and CO2 levels
hypocalcemia frequently
 Musculoskeletal: muscle  Monitor glucose
spasm level in diabetic
 Skin: dermatitis patients.
 others: gout
DOSAGE,
FREQUENCY,
ROUTE
Bendaryl  Contraindicated with  General: Urticaria, drug rash,  Instruct patient to take
Competitively blocks Amelioration of allergy to any anaphylactic shock,
drug as prescribed.
50 mg/ 1 cap the effects of allergic reactions to histamine. photosensitivity, excessive
 perspiration, chills, dryness of  Drug can be taken
Diphenhydramine histamine at H1 blood or plasma Antihistamines
should be used with mouth, nose, and throat with food if GI upset
Hydrochloride receptor sites, has occurs.
considerable caution  Cardiovascular System:
Pre BT atropine-like, anti in patients with Hypotension, headache,  Avoid alcohol; serious
pruritic and sedative narrow-angle palpitations, tachycardia, sedation could occur.
glaucoma, stenosing
Antihistamine effects. peptic ulcer,
extrasystoles  These sideffects may
PO pyloroduodenal  Hematologic System: Hemolytic occur; dizziness,
obstruction, or anemia, thrombocytopenia, sedation, drowsiness,
bladder-neck agranulocytosis epigastric distress,
obstruction.  Nervous System: Sedation,
diarrhea, constipation,
 Diphenhydramine sleepiness, dizziness, disturbed
hydrochloride has an coordination, fatigue, confusion, dry mouth, dryness of
atropine-like action restlessness, excitation, nasal mucosa.
and, therefore, nervousness, tremor, irritability,  Monitor patien’t
should be used with insomnia, euphoria, paresthesia, response
caution in patients
blurred vision, diplopia, vertigo,
with a history of
bronchial asthma, tinnitus, acute labyrinthitis,
increased intraocular neuritis, convulsions
pressure,  Gl System: Epigastric distress,
hyperthyroidism, anorexia, nausea, vomiting,
cardiovascular diarrhea, constipation
disease or  GU System: Urinary frequency,
hypertension. Use difficult urination, urinary
with caution in retention, early menses
patients with lower
 Respiratory System: Thickening of
respiratory disease
including asthma. bronchial secretions, tightness of
chest or throat and wheezing,
nasal stuffiness
DOSAGE,
FREQUENCY,
ROUTE
Transderm- Nitro
5mg Nitrate that reduces  Prophylaxis  In patients with  CNS: headache, dizziness,
 Transdermal dosage
Nitroglycerin cardiac oxygen against chronic early M.I, weakness forms can be applied to
Transdermal demand by decreasing angina attacks severe anemia, any nonhairy part of the
Antianginals Patch left ventricular end- increased  CV: orthostatic skin except distal parts
diastolic pressure  Acute angina intracranial hypotension, tachycardia, of the arms and legs
pressure, angle- flushing, palpitations, (absorption wont be
(preload) and to a pectoris, maximal at the distal
lesser extent, systemic prophylaxis to closure fainting sites). Patch may cause
vascular resistance prevent or glaucoma, contact dermatitis.
(after load). Also, minimize angina orthostatic  EENT: SL burning  When stopping
increases blood flow hypotension, transdermal treatment
attacks before
allergy to  GI: N/V of angina, gradually
through the collateral stressful events.. reduce the dosage and
coronary vessels. adhesives frequency of application
(transdermal) or  Skin: cutaneous over 4-6 weeks.
hypersrnsitivity vasodilation, contact  Monitor BP and intensity
to nitrates. dermatitis, rash & duration of drug
response.
 Drug may cause
 Other: hypersensitivity headaches, especially in
reactions the beginning of therapy.
Dosage may be reduced
temporarily, but
tolerance usually
develops. Treat
headache with aspirin or
acetaminophen.
DOSAGE,
FREQUENCY,
ROUTE
Tetavax 
0.5 ml It works by helping  Contraindicated Be aware that
Immunizing  CNS: headache, dizziness,
with allergy to anyone who had a
Tetanous Toxoid the body build up against tetanus
any ingredient of lethargy, fast heart beat life-threatening
Adsorbed Vaccine immune system infection the vaccine, allergic reaction
IM against tetanus  GI: closing of the throat after a dose of
including the
Vaccine mercury-derived tetanus vaccine
preservative  CV: paleness, weakness should not get
thimerosal or another dose
latex rubber  Respiratory: Difficulty of
breathing  Advice patient to
 Contraindicated consult doctor if
to those who are  Integumentary: swelling of the he/she is receiving
sick with a fever lips, tongue, or face, hives cancer treatment
or have an with x-rays,
infection, have  Others: deep, aching pain and radiation, or
blood clotting muscle wasting in the upper medication
problems or are arms starting 2 days to 4 weeks
taking medicines after the shot, and lasting up to
to thin the blood, many months .
have a weakened
immune system,
are receiving
radiation therapy
or
chemotherapy,
or have a history
of seizures.
DRUG STUDY- CHECK FORMAT
Standing Meds STAT Meds
Norvasc (Amlodipine) Lasix (Furosemide)

Calcium Tums (Calcium carbonate) Benadryl (Diphenhydramine Hydrochloride)
Colchicine Transderm- Nitro (Nitroglycerin )
Dolcet (Tramadol + paracetamol) Tetavax
Eroxmit (Cefuroxime)
Calmoseptine (Zinc Oxide)
Humulin R (Insulin Regular)
Iberet with folic acid (Multivitamins + Folic Acid)
Sodium Bicarbonate
Qinosyn (Ciprofloxacin)
Classification How do you know Exact Amount Client Teaching

DRUGS that it is effective?
Key Nursing
Responsibility
A. Norvasc Calcium Channel- blocker Lowered BP 5 mg  Caution patient to  Monitor patient

(Amlodipine) Antianginal continue taking drugs carefully (BP, cardiac
Antihypertensive even when feeling rhythm and output)
better; while adjusting drug to
therapeutic dose; use
 Instruct patient that
special caution if
he/ she may feel the
patient has CHF.
following side effects:
nausea, vomiting and
headache and report
if irregular heartbeat
and shortness of
breath occurs.
B. Calcium Tums Electrolyte acid indigestion is reduced 500 mg  Instruct patient to take  Record amount and
(Calcium Carbonate) Anatacid and there is no more drugs between meals consistency of stool.
stomach upset and at bedtime. Manage constipation
with laxatives or
 Also, educate patient stool softeners.
that this drug must  Monitor calcium
not be taken with level, especially
other oral drugs. patient with mild
Absorption of those renal failure
medications can be  Watch for evidence
blocked; take other of hypercalcemia
oral medications at (nausea, vomiting
least 1-2 hrs after headache, confusion
calcium carbonate. and anorexia)
C. Colchicine Antigout Drug Pain is relieved during gout 1.2 mg  Inform patient of the  obtain baseline
attacks and reduced following side effects: laboratory test results,
frequency of gout attacks. nausea, vomiting, loss including CBC, before
Also, quality of pain due to of appetite (eat small therapy and periodically
arthritis is reduced. frequent meals) loss throughout therapy.
of fertility (reversible),  Administration should
loss of hair begin at the first sign of
(reversible). an acute attack; delay
 advise patient to avoid can decrease drug’s
using alcohol while effectiveness in
taking drug. alleviating symptoms of
 tell patient with gout gout.
to limit intake of foods
high in purine, such as
anchovies, liver,
sardines, kidneys,
sweetbreads, peas,
and lentils.
D. Dolcet Analgesic, Centrally Acting  there is a relief of pain 325 mg Tramadol  Nurse should be aware
(Tramadol +  arthritis and  tell patient to take that the use of this drug
Hydrochloride + Antipyretic rheumatoid disorders drug as prescribed and should be limited in
involving not to increase the patients with past or
Paracetamol) Analgesic (Nonopiod)
musculoskeletal pain dose or dosage
present history of
are not suffered by interval unless
addiction or
the patient ordered by physician
 bacterial infections  warn patient not to dependence on opiods.
with pain and fever stop the drug abruptly
are prevented
Paracetamol
 warn patient that long
term use can cause
liver damage
 advise patient that
drug is only for short
pain
E. Eroxmit Antibiotic  If there is no longer 750 mg  Instruct patient that  Nurse should be aware
(Cefuroxime) an infection present. he/she must take full that this drug is specific
course of drug for the patient and
 WBC is within the therapy. should not be used to
 Inform patient that self-treat other
normal range of
the following side problems.
values.
effects may occur:  If large doses are given,
stomach upset or therapy is prolonged, or
diarrhea. patient is at high risk,
 Instruct patient to monitor patient for
avoid alcohol while signs and symptoms of
taking this drug. super infection.
F. Calmoseptine Analgesic, Antiseptic,  Reduced itching and Apply in ample amount  Instruct patient that  Nurse should be aware
Ointment Antipruritic, Skin Protectant pain on skin Calmoseptine is for that Calmoseptine will
( Menthol/Zinc Oxide) combination irritation/ wound. external use. . Must not not treat bacterial or
 There is progressive let into the eyes, nose fungal infection and
wound healing. or mouth of the patient. should only be
If drug was got in administered to the
contact with any of patient for whom it was
these areas, rinse at prescribed.
once with cool water.  Calmoseptine should be
stored at room
temperature. Store away
from heat, moisture and
light. Do not store in the
bathroom. Keep out of
reach of children and
away from pets.
G. Humulin R Anti Diabetic Hormone  Blood glucose are 8 units  Advise patient to seek  Administer insulin in
(Insulin) lowered/ controlled emergency medical correct amount, correct
attention if he/she route and correct kind
thinks he/she have of syringe.
used too much of this  Monitor urine or serum
medicine glucose levels
 -Advise patient to frequently to determine
report any signs of effectiveness of drug
allergy and dosage
avoid alcohol; serious
reactions can occur.
H. Iberet- Folic Acid Multivitamins increase in , or normalized 500 mg  teach patient about  Monitor patient for
(Multivitamins + Folic RBC, Hct, and Hgb levels proper nutrition to hypersensitivity reactions,
prevent recurrence of especially if drug
Acid )
anemia previously taken.
 stress importance of  Keep supportive
follow-up visits and equipment and
laboratory studies emergency drugs readily
 teach patient about available in case of
foods that contain serious allergic response.
folic acid: liver,
oranges, whole wheat,
broccoli, Brussels
sprouts
I. Qinosyn Antibacterial Bacterial reproduction was 500mg  Inform client that if  Arrange for culture and
(Ciprofloxacin) prevented/reduced antacid is needed, take sensitivity test before
through the results of the it at least 2 hours beginning therapy.
CS tests. before or after dose  Encourage patient to
 Drink plenty of fluids complete full course of
while taking this drug. drug therapy.
J. Sodium Acidifiers and Alkalinizers Relief of upset stomach 300 mg  Instruct patient to  Do not give oral sodium
Bicarbonate chew tablet bicarbonate with 1-2
thoroughly before hour of other oral drugs
swallowing and follow to reduce risk of drug
them with a full glass interactions.
of water.
K. Lasix Diuretics Decrease in BP 40 mg  Inform patient that  Monitor weight, blood

(Furosemide) blood glucose levels pressure, and pulse rate
may become routinely with long term
temporarily elevated use and during rapid
in patient with Dm diuresis. Use can lead to
after starting this profound water and
drug. electrolyte depletion.
 Monitor fluid intake and
output and electrolyte,
BUN, and CO2 levels
frequently
L. Benadryl Antihistamine Cessation of allergic 50 mg  Drug can be taken with  Monitor patient for
( Diphenhydramine symptoms such as itching , food if GI upset occurs. Dizziness, excessive
Hydrochloride) rashes. No allergic effects  Avoid alcohol; serious sedation, syncope,
post BT. sedation could occur. toxicity, paradoxical
 Inform patient that stimulation and
sugarless gum, candy or hypotension are more
ice chips may relieve dry likely to occur in the
mouth. elderly.
 Warn patient of possible
photosensitivity
reactions. Advise use of
sunblock.
.
M. Transderm- Nitro Antianginals Reduced angina pain. 5mg  Teach patient how to  When stopping
(Nitroglycerin) give the prescribed form transdermal treatment of
of nitroglycerin. angina, gradually reduce
 To minimize dizziness the dosage and frequency
when standing, tell of application over 4-6
patient to rise slowly. weeks.
 Monitor BP and intensity
& duration of drug
response.
N. Tetavax  Inform patient that  Be aware that anyone

( Tetanous Toxoid Vaccine patient does not get 0.5ml there are no who had a life-
tetanus infection restrictions on food, threatening allergic
Adsorbed Vaccine )
beverages, or activity reaction after a dose of
before or after tetanus vaccine should
receiving the tetanus not get another dose
toxoid vaccine
HEALTH TEACHING PLAN
MEDICINES EXERCISE TREATMENT HYGIENE OUTPATIENT REFERRAL DIET
Educate the patient and significant others Exercise should be scheduled Blood Creatinine Level Educate the client and Patient Education and Health Dietary control with
regarding the medicines that the patient had regularly to promote - Measures the level of the significant others basic Maintenance caloric restrictions of
been taking specifically the indication of the utilization of carbohydrates, waste product creatinine in hygiene practices and - Emphasize to client the carbohydrates and
drug. Compliance to full course of drug assist with weight control, your blood and urine. Used investigate living importance of saturated fats to
therapy must also be emphasized. enhance the action of insulin to tell how your kidneys are conditions that may completing the full maintain ideal body
A. Amlopidine Besylate and improve cardiovascular working. Increased levels further complicate the course of antibiotic weight.
(5mg 1 tab PO OD) fitness. indicate chronic renal client’s condition. therapy prescribed by
- Calcium Channel Blocker disease or nephritis. the doctor. Not finishing Meal Planning
- Antianginal drug ROM Exercises Blood Transfusion Foot Care Guidelines the entire course can Guidelines
- Antihypertensive - ROM exercises are - 1 unit 220cc PRBC, Bag #464, Emphasize to client lead to bacteria - Each meal
 Indicated to Angina pectoris due to recommended to B+, Exp. Date: March 2, 2010 proper foot care becoming resistant to should consist of a
coronary artery spasm. For chronic stable improve or maintain @ 15gtts/min. guidelines especially in antibiotics. balance of
angina, essential hypertension, given joint function and to - A blood transfusion is the properly dressing his - Drink plenty of fluids. carbohydrates,
alone or in combination with other improve or maintain transfer of blood or blood infected wound at his Six- 8oz of fluid every proteins and fats.
antihypertensives. muscle tone and products from one person right foot and left hour is recommended. If (Fats should be
 Drug should be taken with meals if upset strength. (donor) into another person's elbow. unable to eat, drink <10% of total
stomach occurs. - To do this, the patient bloodstream (recipient). This is - Keep the ulcer fluids that contain calories consumed.)
 Instruct patient to report irregular moves each of his joint usually done as a life saving clean and carbohydrates (fruit - Consistency in
heartbeat, shortness of breath, swelling of through complete range maneuver to replace blood bandaged. juices, regular soda.) timing of meals and
the hands or feet, pronounced dizziness, of movement maximally cells or blood products lost - Periodically - Never omit insulin amounts of food
constipation. stretching all muscle through severe bleeding, remove dead skin dosage. Check with eaten on a day-to-
B. Humulin R groups within each during surgery when blood loss when the health care provider day basis help
(8 units SQ TID ac) plane over each joint. occurs or to increase the blood bandages are about oral medication. regulates glucose
- Antidiabetic - Leg exercises or count in an anemic patient. changed. - Encourage the patient levels.
 For treatment of type 2 (non-insulin extremity exercise Complete Blood Count - Cleanse the for wellness or follow-up - Increase the
dependent) diabetes that cannot be should be done to - The complete blood count wound daily, check up to ensure intake of soluble
controlled by diet or oral drugs. facilitate venous return (CBC) is one of the most using a wound continuous monitoring and insoluble fiber.
 Store drug in the refrigerator or in cool to the heart. commonly ordered blood dressing or of serum blood glucose - Avoid salt
place out of direct sunlight; do not - Wrist: flexion, tests. The complete blood bandage. level. whenever possible.
freeze insulin. extension, count is the calculation of the - Do not walk - Give due importance to - Prepare foods
 Avoid alcohol; serious reactions can circumduction. cellular (formed elements) of barefoot. diet restrictions and to retain vitamins
occur. - Hand and fingers: blood. - Keep blood indications. and minerals and
C. Eroxmit flexion, extension, - A major portion of glucose levels reduce fats.
(750 mg IVTT q8h) [Cefuroxime] abduction, adduction. - the complete blood count is under tight
- Antibiotic - Leg: lift one leg off the the measure of the control.
- Cephalosporin (second generation) bed and draw big circles concentration of white blood - Exercise: Regular
 Bactericidal: Inhibits synthesis of with your toes, then cells, red blood cells, and exercise will - Do not fry
bacterial cell wall, causing cell death. repeat with the other platelets in the blood. improve bone and foods. Bake, boil or
 Emphasize to client to complete full leg. Chest X-Ray joint health in boil food and
course of drug therapy. - Ankle: plantar flexion, - A chest X-ray is a radiology test your feet and discard fats. Eat raw
 Avoid alcohol while taking this drug and dorsiflexion. that involves exposing the legs, improve fruits and
for 3 days after because severe reactions chest briefly to radiation to circulation to your vegetables or steam
often occur. produce an image of the chest legs, and will also vegetables to retain
 These side effects may occur: stomach and the internal organs of the help to stabilize fiber.
upset of diarrhea. chest. your blood sugar - Smaller, more
D. Qinosyn - Provides picture of the chest levels. frequent meals may
(500mg PO BID) [Ciprofloxcin] that shows your heart, lungs, - Keep pressure off enhance glucose
- Antibacterial airway, blood vessels, and the wound. To control in type 2
 Bactericidal: For the treatment of lymph nodes. help to facilitate DM.
infections caused by susceptible gram- - Shows the bones of your spine the healing - Unplanned
negative bacteria. and chest, including your process. activity may call for
 Instruct patient to take antacid if breastbone, ribs, collarbone, an additional snack
needed. Take it at least 2 hr before of and upper part of your spine. to avoid
after dose. Drink plenty of liquids while FBS(Fasting Blood Sugar) hypoglycemia.
taking this drug. - A method for learning how - Use alcohol only
 Side effects may occur: nausea and much glucose (sugar) there is in moderation.
vomiting, abdominal pain, diarrhea or in a blood sample taken after Always consume
constipation; drowsiness, blurring of an overnight fast. The fasting alcohol with food to
vision. blood glucose test is avoid hypoglycemia.
E. Calmoseptine Ointment commonly used in the
(TID) [Menthol/ Zinc Oxide] detection of diabetes mellitus.
- Analgesic, Antiseptic, Antipruritic, Skin The test is done in the morning
protectant combination before the person has eaten.
 It works by temporarily relieving itching Insulin Regime- NPH
and pain. It also decreases moisture in Only(Intermediate Acting)
the affected area. - Used alone in type 2 Diabetes
 Calmoseptine Ointment is for external Milletus when patients are
use only. Do not get it in your eyes, nose, capable of producing some
or mouth. If you get it in any of these exogenous insulin as a
areas, rinse at once with cool water. supplement for better glucose
control.
F. Vitanerv IV Therapy
(1 cap PO BID) [Vitamin B Complex/ - Bottle #2 PNSS x 60 cc/ hr.
Hydroxocobalamin crystalline] - an aqueous solution of 0.9
- Vitamin (Water Soluble) percent sodium chloride,
 Essential to growth, cell reproduction, isotonic with the blood and
hematopoiesis, nucleoprotein and tissue fluid, used in medicine
myelin synthesis. chiefly for bathing tissue and,
 Patient may experience these side in sterile form, as a solvent for
effects: mild diarrhea, rash, itching. drugs that are to be
 Drug is given with folic acid if needed. administered parenterally to
G. Iberet replace body fluids.
(1 tab PO BID) [Folic Acid/Folate] Serum Potassium Level
- Vitamin Supplement - Measures the amount of
 Required for nucleoprotein synthesis and potassium in your blood.
maintenance of normal erythropoiesis. - Helpful in evaluating disorders
 Instruct patient to report rash and DOB. of the heart, kidneys, adrenal
H. Calcium Carbonate Tums glands, muscles, and digestive
(1 tab PO TID) treatments.
- Electrolyte
- Antacid
 Symptomatic relief of upset stomach
associated with hyperacidity.
 Take drugs between meals and at
bedtime. Do not take with other oral
drugs. Absorption of those medications
can be blocked.
 Chew tablets thoroughly before
swallowing, and follow with a glass of
water or milk.
I. Sodium Bicarbonate
(1 tab PO TID)
- Antacid, Systemic Alkalinizer
 For minimization of uric acid crystalluria
in gout, with uricosuric agents.
 Symptomatic relief of upset stomach
from hyperacidity.
Definition of Terms
Acidosis- an abnormal condition of reduced alkalinity of the blood and tissues that is marked
by sickly sweet breath, headache, nausea and vomiting, and visual disturbances and is usually
a result of excessive acid production
Atherosclerosis- Atherosclerosis is a common disorder of the arteries. It occurs when fat,

cholesterol, and other substances build up in the walls of arteries and form hard structures
called plaques. Eventually, the plaques can make the artery narrow and less flexible, making
it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart
can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart
attack, and other symptoms.
Autonomic Neuropathy- Autonomic neuropathy is a form of peripheral neuropathy. It is a

group of symptoms, not a specific disease. Autonomic neuropathy involves damage to the
nerves that run through a part of the peripheral nervous system. The peripheral nervous
system includes the nerves used for communication to and from the brain and spinal cord
(central nervous system) and all other parts of the body, including the internal organs,
muscles, skin, and blood vessels.
Damage to the autonomic nerves affects the function of areas connected to the problem
nerve
Charcot Foot- Charcot foot is a condition causing weakening of the bones in the foot that can
occur in people who have significant nerve damage (neuropathy). The bones are weakened
enough to fracture, and with continued walking the foot eventually changes shape. As the
disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a
rocker-bottom appearance.
Diabetic Nephropathy- Kidney damage from diabetes. If you have diabetes, your blood sugar
levels are too high. Over time, this can damage your kidneys. Your kidneys are filters that
clean your blood. If they are damaged, waste and fluids build up in your blood instead of
leaving your body.
Diabetic Neuropathy- Diabetic neuropathy is a type of nerve damage that can occur if you
have diabetes. High blood sugar can injure nerve fibers throughout your body, but diabetic
neuropathy most often damages nerves in your legs and feet.
Diabetic Retinopathy- Diabetic retinopathy is a complication of diabetes that results from

damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At
first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually,
however, diabetic retinopathy can result in blindness. In the United States, diabetic
retinopathy is a leading cause of blindness in adults.
Gastroparesis- Gastroparesis is a condition in which the muscles in your stomach don't

function normally. Ordinarily, strong muscular contractions propel food through your
digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or
not at all. This prevents your stomach from emptying properly. Gastroparesis can interfere
with digestion, cause nausea and vomiting, and play havoc with blood sugar levels and
nutrition.
Glucagon- Glucagon is an important hormone involved in carbohydrate metabolism.

Produced by the pancreas, it is released when blood glucose levels start to fall too low,
causing the liver to convert stored glycogen into glucose and release it into the bloodstream,
raising blood glucose levels and ultimately preventing the development of hypoglycemia. The
action of glucagon is thus opposite to that of insulin, which instructs the body's cells to take
in glucose from the blood. However, glucagon also stimulates the release of insulin, so that
newly-available glucose in the bloodstream can be taken up and used by insulin-dependent
tissues.
Insulin Resistance- Insulin resistance is a condition in which cells, particularly those of

muscle, fat, and liver tissue, display "resistance" to insulin by failing to take up and utilize
glucose for energy and metabolism (insulin normally promotes take up and utilization of
blood glucose from the blood stream). In its early stages, the condition is asymptomatic, but
may develop into Type II Diabetes.
Neurogenic Bladder- Neurogenic bladder refers to dysfunction of the urinary bladder due to
disease of the central nervous system or peripheral nerves involved in the control of
micturition.
Osmolarity- is the measure of solute concentration, defined as the number of osmoles (Osm)
of solute per liter (L) of solution (osmol/L or Osm/L).
Small vessel disease- Small vessel disease, also known as coronary microvascular disease or
small vessel heart disease, is a condition in which the small arteries in the heart become
narrowed. Small vessel disease causes signs and symptoms of heart disease, such as chest
pain (angina). Small vessel disease is usually diagnosed after a doctor checks for blockages in
the main arteries of the heart that cause coronary artery disease, but finds little or no
narrowing and your symptoms persist.
Vagus Nerve- Either of the tenth and longest of the cranial nerves, passing through the neck
and thorax into the abdomen and supplying sensation to part of the ear, the tongue, the
larynx, and the pharynx, motor impulses to the vocal cords, and motor and secretory
impulses to the abdominal and thoracic viscera

NCS-DM Type 2 For Case Presentation

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Diabete

Liza, Juan Paolo

UNIVERSITY OF ST. LA SALLE-BACOLOD |

Diabetes mellitus is a group of metabolic diseases characterized by high blood

This nursing case study aims to;

 Outline biologic and physical manifestations of DM Type 2 correlating it with the

 Identify the complications manifested by clients with DM type 2 through

 Focus on the nursing responsibilities and interventions specified to medications

 Apply values of concerns and empathy in providing care in order to achieve

Anatomy and Physiology

Hormone Pituitary Stimulating Hormone Hypothalamic Releasing Hormone

 Thyroid hormones T4, Thyroid-stimulating hormone (TSH) Thyrotropin-releasing hormone (TRH)

 Insulin like growth Growth hormone Growth hormone-releasing hormone

Appearance Region Function

HORMONES PRODUCED BY THE PANCREAS

Glucagon is a polypeptide containing 29 amino acids.

| Sleep- Rest Pattern

|Cognitive- Perceptual Pattern

|Self- Perception/ Self-Concept Pattern

|Role- Relationship Pattern

|Sexuality- Reproductive Pattern

|Coping- Stress Pattern

|Value- Belief Pattern

|History of Present Illness

|Past Health History

DAY and Day 1 Day 2 Day 3 Day 5

24- Hour Intake and Output Record

Laboratory and Radiology

|January 27, 2010

|January 28, 2010

EXAMINATION RESULT NORMAL VALUES INTERPRETATION IMPLICATION

EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATION IMPLICATION

|IDEAL LABORATORY TESTS

Destruction of alpha and beta cells of the pancreas

Polyuria Polyphagia Glycoprotein cell wall deposits

Weight loss Small Vessel DiseaseAccelerated AtherosclerosisImpaired Immune Function

Infection Delayed Wound Healing

Diabetic NeuropathyDiabetic NephropathyDiabetic Retinopathy

mmetrical loss of protectiveand

Dry cracked skin Gastroparesis Impotence Neurogenic Bladder

Norvasc (Amlodipine) Lasix (Furosemide)

Calcium Tums  Cardiovascular: slowed heart  Instruct patient to

Colchicine  CNS: Peripheral neuritis,  Monitor for relief of

Binds to mu-opioid Relief of moderate to  Contraindicated  Limit use in patients

Calmoseptine   Dermatologic: rash, hives,  Nurse should be aware

Sodium Bicarbonate  GI: Gastric rupture following 

Standing Meds STAT Meds

Norvasc (Amlodipine) Lasix (Furosemide)

Classification How do you know Exact Amount Client Teaching

A. Norvasc Calcium Channel- blocker Lowered BP 5 mg  Caution patient to  Monitor patient

K. Lasix Diuretics Decrease in BP 40 mg  Inform patient that  Monitor weight, blood

N. Tetavax  Inform patient that  Be aware that anyone

Atherosclerosis- Atherosclerosis is a common disorder of the arteries. It occurs when fat,

Autonomic Neuropathy- Autonomic neuropathy is a form of peripheral neuropathy. It is a

Diabetic Retinopathy- Diabetic retinopathy is a complication of diabetes that results from

Gastroparesis- Gastroparesis is a condition in which the muscles in your stomach don't

Glucagon- Glucagon is an important hormone involved in carbohydrate metabolism.

Insulin Resistance- Insulin resistance is a condition in which cells, particularly those of

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