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Transcript of Dm Grand Case Pres
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Republic of the Philippines
Southern Luzon State University
College of Allied Medicine
Lucban, Quezon
A.Y 2012-2013
CASE STUDY
DIABETES MELLITUS TYPE II UNCONTROLLED
Nephrolithiasis
Submitted to:
Mr. Marc Oneel Alvarez
(Clinical Instructor)
In Partial Fulfillment
Of the Requirements for the Subject
Related Learning Experience
Submitted by:
Ara Q. Maceda
(BSN IV- Group 2)
September 2012
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CHAPTER I
OBJECTIVES
1. General objective
The objective of this study is to broaden the knowledge of the students about
diabetes mellitus and its complications, and further evaluate the students learning
experience in the previous clinical exposure.
2. Specific objectives
After this study, the students will:
a. State well the learnt information about the disease such as its definition, signs and
symptoms, prevention, cure, and its pathophysiology.
b. Be able to give point of views about their handling experience with this kind of case.
c. Be able to connect the patients present history to his past and family history.
d. Be able to assess if they have used the physical assessment for the patients
properly.
e. Explain the appropriate nursing interventions to be implemented to patients having
diabetes mellitus
f. Evaluate the effectiveness of the nursing care plans that were implemented during
the clinical exposure.
g. State the different actions of the drugs being administered to the patient.
h. Interpret the different laboratory tests whether it is normal or there are abnormal
interpretation
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CHAPTER II
INTRODUCTION OF THE DISEASE
.
The term "diabetes mellitus" refers to a group of diseases that affect how your body uses
blood glucose, commonly called blood sugar.
Glucose is vital to your health because it's an important source of energy for the cells
that make up your muscles and tissues. It's your brain's main source of fuel.
If patient have diabetes, no matter what type, it means that they have too much glucose
in their blood, although the reasons may differ. Too much glucose can lead to serious health
problems.
Chronic diabetes conditions include type 1 diabetes (insulin dependent) and type 2
diabetes (non-insulin dependent). Potentially reversible diabetes conditions include
prediabetes when your blood sugar levels are higher than normal, but not high enough to
be classified as diabetes and gestational diabetes, which occurs during pregnancy.
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CHAPTER III
ANATOMY AND PHYSIOLOGY
Endocrine system includes cells, tissues, and organs collectively called endocrine
glands, that secrete hormones into the internal environment.
Hormones are substances that are secreted by the endocrine gland which transported
into the blood, and regulates body mechanisms.
Pancreas is an elongated, somewhat flattened organ posterior to the stomach and
behind the parietal peritoneum. It consists of two major types of secretory tissues. This
organization reflects the pancreas dual function as an exocrine gland that secretes digestive
juice and an endocrine gland that release hormones.
Islet of Langerhans (pancreatic islets) include two distinct type of cells the alpha
cells, which secrete the hormone glucagon, and beta cells, which secrete the hormone insulin.
Glucagon stimulates the liver to breakdown glycogen and converts certain
noncarbohydrates, such as amino acids, into glucose, raising blood sugar concentration. It
elevates blood glucose effectively.
Insulin stimulates the liver to form glycogen from glucose and inhibits conversion of
noncarbohydrates into glucose. It also has the special effect of promoting facilitated diffusion of
glucose across cell membranes that have insulin receptors, such as those of cardiac muscles,
adipose tissues, and resting skeletal muscles.
Glyconeogenesis is the formation of glucose from fats and proteins.
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Glycogenolysis is the breakdown of liver glycogen.
Normal Function of Glucagon and Insulin
Control Center
Beta cells secrete insulin
Receptors Effectors
Beta cells detect rise in blood Insulin: promotes movementsGlucose of glucose into certain cells and
stimulates formation of glycogenfrom glucose
Stimulus Response
Rise in blood glucose level Blood glucose drops toward
normal
Too high blood glucoselevel
Response Too low blood glucose levelBlood glucose level rises
towards normal
StimulusDrop in blood glucose level
Normal Blood
Glucose
Concentration
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Effectors Glucagon stimulates cells to
Breakdown glycogen into ReceptorsGlucose Alpha cells detect a drop in blood
glucose
Control Center
Alpha cells secrete glucagon
CHAPTER IV
OVERVIEW OF THE DISEASE
a. REVIEW OF RELATED LITERATURE
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.
Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first
identified as a disease associated with "sweet urine," and excessive muscle loss in the
ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of
glucose into the urine, hence the term sweet urine.
Normally, blood glucose levels are tightly controlled by insulin, a hormone
produced by the pancreas. Insulin lowers the blood glucose level. When the blood
glucose elevates (for example, after eating food), insulin is released from the pancreas to
normalize the glucose level. In patients with diabetes, the absence or insufficient
production of insulin causes hyperglycemia. Diabetes is a chronic medical condition,
meaning that although it can be controlled, it lasts a lifetime.
What is the impact of diabetes?
Over time, diabetes can lead to blindness, kidney failure, and nerve damage.
These types of damage are the result of damage to small vessels, referred to as
microvascular disease. Diabetes is also an important factor in accelerating the hardening
and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart
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the face of insulin resistance as discussed above. In many cases this actually means the
pancreas produces larger than normal quantities of insulin. A major feature of type 2
diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and
muscle cells).
In addition to the problems with an increase in insulin resistance, the release of
insulin by the pancreas may also be defective and suboptimal. In fact, there is a known
steady decline in beta cell production of insulin in type 2 diabetes that contributes to
worsening glucose control. (This is a major factor for many patients with type 2 diabetes
who ultimately require insulin therapy.) Finally, the liver in these patients continues to
produce glucose through a process called gluconeogenesis despite elevated glucose
levels. The control of gluconeogenesis becomes compromised.
Diabetes can occur temporarily during pregnancy. Significant hormonal changes
during pregnancy can lead to blood sugar elevation in genetically predisposed
individuals. Blood sugar elevation during pregnancy is called gestational diabetes.
Gestational diabetes usually resolves once the baby is born. However, 25%-50% of
women with gestational diabetes will eventually develop type 2 diabetes later in life,
especially in those who require insulin during pregnancy and those who remain
overweight after their delivery. Patients with gestational diabetes are usually asked to
undergo an oral glucose tolerance test about six weeks after giving birth to determine if
their diabetes has persisted beyond the pregnancy, or if any evidence (such as impaired
glucose tolerance) is present that may be a clue to the patient's future risk for developing
diabetes.
Manifestations
The early symptoms of untreated diabetes are related to elevated blood sugar
levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause
increased urine output and lead to dehydration. Dehydration causes increased thirst and
water consumption.
The inability of insulin to perform normally has effects on protein, fat and
carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages
storage of fat and protein.
A relative or absolute insulin deficiency eventually leads to weight loss despite an
increase in appetite.
Some untreated diabetes patients also complain of fatigue, nausea andvomiting.
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Patients with diabetes are prone to developing infections of the bladder, skin, and
vaginal areas.
Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated
glucose levels can lead to lethargy and coma.
Diagnosis
The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes.
It is easy to perform and convenient. After the person has fasted overnight (at least 8
hours), a single sample of blood is drawn and sent to the laboratory for analysis. This
can also be done accurately in a doctor's office using a glucose meter.
Normal fasting plasma glucose levels are less than 100 milligrams per
deciliter (mg/dl).
Fasting plasma glucose levels of more than 126 mg/dl on two or more tests
on different days indicate diabetes.
A random blood glucose test can also be used to diagnose diabetes. A
blood glucose level of 200 mg/dl or higher indicates diabetes.
When fasting blood glucose stays above 100mg/dl, but in the range of 100-
126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG do not
have the diagnosis of diabetes, this condition carries with it its own risks and concerns,
and is addressed elsewhere.
Oral Glucose Tolerance Test
Though not routinely used anymore, the oral glucose tolerance test (OGTT) is a
gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for
diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic
ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least
eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After
this test, the person receives 75 grams of glucose (100 grams for pregnant women).
There are several methods employed by obstetricians to do this test, but the one
described here is standard. Usually, the glucose is in a sweet-tasting liquid that the
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person drinks. Blood samples are taken at specific intervals to measure the blood
glucose.
Glucose tolerance tests may lead to one of the following diagnoses:
Normal response: A person is said to have a normal response when the
2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours
are less than 200 mg/dl.
Impaired glucose tolerance: A person is said to have impaired glucose
tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour
glucose level is between 140 and 199 mg/dl.
Diabetes: A person has diabetes when two diagnostic tests done on
different days show that the blood glucose level is high.
Gestational diabetes: A woman has gestational diabetes when she has
any two of the following: a 100g OGTT, a fasting plasma glucose of more than 95
mg/dl, a 1-hour glucose level of more than 180 mg/dl, a 2-hour glucose level of
more than 155 mg/dl, or a 3-hour glucose level of more than 140 mg/dl.
Hemoglobin A1c (A1c)
To explain what an hemoglobin A1c is, think in simple terms. Sugar sticks, and
when it's around for a long time, it's harder to get it off. In the body, sugar sticks too,
particularly to proteins. The red blood cells that circulate in the body live for about three
months before they die off. When sugar sticks to these cells, it gives us an idea of how
much sugar is around for the preceding three months. In most labs, the normal range is
4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patientsit's less than 7.0% (optimal is
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9 240
10 275
Medications
a. Insulin Secretagogs 2nd generation sulfonylureas
Glipizide, Glyburide, Glicazide, Glimepiride (Glucotrol, Glynase,Amaryl)
o Stimulate insulin secretion
o For lean elderly person
o Causes hypoglycemia
b. Meglitinides
Repaglinide (Prandin), Nateglinide (Starlix)o Stimulate insulin secretion for a short interval
o Rapid onset and offset of action
o Used as preprandial agents
o No effect upon fasting glucose
c. Insulin sensitizers
Thiazolidinediones Pioglitazone (Actos), Rosiglitazone (Avandia)
o Improve insulin sensitivity primarily at muscle and adipose tissue
o Liver function should be monitored q 2 months
o Can cause weight gain & edema
o Contraindicated for CHF
d. Biguanide
Metformin
o Improves insulin sensitivity primarily at the liver
o Generally preferred for obese patients
o Often aides weight loss
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o Diarrhea, dyspepsia, nausea are common
o Lactic acidosis is rare
o Contraindicated in renal disease (CR CL
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hospital intensive care unit. Dehydration can be very severe, and it is not unusual to
need to replace 6-7 liters of fluid when a person presents in diabetic ketoacidosis.
Antibiotics are given for infections. With treatment, abnormal blood sugar levels, ketone
production, acidosis, and dehydration can be reversed rapidly, and patients can recover
remarkably well.
Hypoglycemia means abnormally low blood sugar (glucose). In patients with
diabetes, the most common cause of low blood sugar is excessive use of insulin or other
glucose-lowering medications, to lower the blood sugar level in diabetic patients in the
presence of a delayed or absent meal. When low blood sugar levels occur because of
too much insulin, it is called an insulin reaction. Sometimes, low blood sugar can be the
result of an insufficient caloric intake or sudden excessive physical exertion.
The major eye complication of diabetes is called diabetic retinopathy. Diabetic
retinopathy occurs in patients who have had diabetes for at least five years. Diseased
small blood vessels in the back of the eye cause the leakage of protein and blood in the
retina. Disease in these blood vessels also causes the formation of small aneurysms
(microaneurysms), and new but brittle blood vessels (neovascularization). Spontaneous
bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal
detachment, thus impairing vision.
Kidney damage from diabetes is called diabetic nephropathy. The onset ofkidney
disease and its progression is extremely variable. Initially, diseased small blood vessels
in the kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their
ability to cleanse and filter blood. The accumulation of toxic waste products in the blood
leads to the need fordialysis. Dialysis involves using a machine that serves the function
of the kidney by filtering and cleaning the blood. In patients who do not want to undergo
chronic dialysis, kidney transplantation can be considered.
Nerve damage from diabetes is called diabetic neuropathy and is also caused by
disease of small blood vessels. In essence, the blood flow to the nerves is limited,
leaving the nerves without blood flow, and they get damaged or die as a result (a term
known as ischemia). Symptoms of diabetic nerve damage include numbness, burning,
and aching of the feet and lower extremities. When the nerve disease causes a complete
loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to
properly protect them. Shoes or other protection should be worn as much as possible.
Seemingly minor skin injuries should be attended to promptly to avoid serious infections.
Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor
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foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating
surgical amputation of toes, feet, and other infected parts.
Gangrene
Gangrene is a term that describes dead or dying body tissue(s) that occur
because the local blood supply to the tissue is either lost or is inadequate to keep the
tissue alive. Gangrene has been recognized as a localized area of tissue death since
ancient times. The Greeks used the term gangraina to describe putrefaction (death) of
tissue. Although many laypeople associate the term gangrene with a bacterial infection,
the medical use of the term includes any cause that compromises the blood supply that
results in tissue death. Consequently, a person can be diagnosed with gangrene but
does not have to be "infected."
There are two major types of gangrene referred to as dry and wet. Many cases of
dry gangrene are not infected. All cases of wet gangrene are considered to be infected,
almost always by bacteria. The most common sites for both wet and dry gangrene to
occur are the digits (fingers and toes) and other extremities (hands, arms, feet, and
legs).
CHAPTER V
CASE STUDY PROPER
a. Patients Profile
Case No. 20114643
Name: Patient X
Address: Golden Meadows Subd. Brgy. Bucal Pagbilao, Quezon
Age: 44 years old
Sex: male
Civil Status: Married
Religion: Catholic
Nationality: Filipino
Place of birth: Pagbilao, Quezon
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Date of birth: August 5, 1969
Name of Father: Ferrarin Musa
Name of Mother: Yolanda Musa
Name of Spouse: Lyn Musa
Chief Complaint: Loss of consciousness and vomiting
Admission Date: August 9,2012
Admission Time: 3:30 pm
Admitting Physician: Dr. Lacerna
Final Diagnosis: Diabetes Mellitus type II uncontrolled Nephrolithiasis
b. Physical assessment
General Condition
Conscious and coherent
Afebrile; T=36.0C
With guarding behavior
With episodes of vomiting
Head
With hair equally distributed on the scalp
With good hair texture
Eyes
With whitish sclera With pale conjunctiva
With conjugate eye movements
With pupil equally round and reactive to light accommodation
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Ears
No ear discharges noted
Easily recoil when folded
Nose
Without nasal discharges; No nasal flaring
Mouth and Teeth
With pale and dry lips
With good dentition
Neck
Without palpable mass noted
With palpable carotid pulse
Without distended vein noted upon palpation
Chest and Lungs
With normal chest expansion upon breathing
With clear breath sounds heard on both lung fields upon auscultation
Cardiovascular
Without papitatons noted
With fluctuating blood pressure
With normal cardiac rate and rhythm upon auscultation
Abdomen
With soft and non-tender abdomen upon palpation
With normoactive bowel sounds of 19 BS/min.
Genitourinary
Dysuria
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Voids freely
With increase in frequency of urination
With yellowish urine; moderate in amount
With non-healing scrotal wound with abscess noted
Extremities
With IV inserted at right metacarpal vein
Without redness or swelling on the IV insertion site
With muscle wasting
With Thin and flaccid muscle tone
Limited range of motion
With pale nailbeds
Skin
With fair skin turgor
With poor skin turgor
pallor
Vital signs:
Day 1 Day 2 Day 3
Temperature 36.0C 36.0C 36.4C
Respiration rate 23bpm 18bpm 25bpm
Pulse rate 79bpm 80bpm 73bpm
BP (mmHg) 130/80 110/80 120/80
b. History of Present Illness
The patient was admitted at QMC on September 8,2012 at around 3:30 in the
afternoon. The patient was sent to the hospital due to a episodes of vomiting and
flaccidity of extremities The patient then was brought to the room of choice and
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underwent such procedures. He is continuously taking insulin for the management of her
diabetes. Also, he took medications for treatment of hyperlipidemia.
c. Past Medical History
The patient was a known diabetic. He is taking antidiabetic medications for
several years. He has no known other diseases except from her diabetes. He only
experienced symptoms like fever, cough, colds, etc but they were managed at home.
d. Family Health History
The family has a history of diabetes mellitus and hypertension. Other than that
they have no family history of other chronic diseases like tuberculosis, cancer, etc.
e. Personal and Social History
The patient is a food lover ever since. He loves to eat foods that He wanted. He
also drinks alcoholic beverages occasionally. He is a smoker. He loves to hang out with her
family. He also has a good relationship to her neighbors according to his significant other.
CHAPTER VIII
COURSE IN THE WARD
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At around 3:30 in the afternoon last August 8,2012, a 44 year old, married man
was admitted at Quezon Memorial Center with the chief complaint of loss of consciousness
and vomiting and flaccidity of extremities. He had been examined by Dr. Lacerna and then
decided to be confined for medical management.
DOCTORS ORDER: At the ER, the doctors order was with the patient which
was as follows: Please admit to Medicine ward, diabetic diet, PNSS 1 L x 6 hours
,RBS q 2 ,for stat Na, K and urine ketone ABS, crea, HgbA1c CBC, urinalysis, chest x-
ray, ECG. Included on the doctors order were medications such as fast drip of 300
cc IVF, metroclopramide 1 amp IV now then q 8, Omeprazole 40 mg IVP now, then
refer accordingly.
NURSING ACTIONS: Upon receiving the orders, the nurse at the ER made the
requests for the laboratories and secured consent for hospitalization. Chest xray,ECG,CBC
was done
PATIENTS RESPONSE: The wife signed the consent while the patient
cooperated during the blood extraction of the medical technologist on duty.
After being sent to the room RBS was taken with the reading of 406mg/dl and had
distended bladder with painful urination
DOCTORS ORDER:Give regular insulin 5 units IVP now then RBS after an
hour. Insert foley catheter
NURSING ACTIONS:. The NOD secured consent for catheriization and the
patients relative was instructed to facilitate the impending stat order for Na,K ,
hgba1C,crea with corresponding requests.The SNOD carried out the previous order and an
hour after the administration of the drug, the blood sugar became 213mg/dl.
August 9,2012
The patient was still in unstable condition of glucose tolerance and RBS at
around 6 am is read as Hi
DOCTORS ORDER: continue RBS monitoring IVF to flow is PNSS 1 L x 6
hours for 4 doses and fast drip of 300 cc to resent IVF
NURSING ACTIONS:. The at around 11am the result of CBC and urinalysis hadbeen referred with corresponding results hemoglobin 8.5, WBC 14 000 cumm, RBC in urine
is 4-6 (0-2) WBC over 100 ( )
DOCTORS ORDER: for blood transfusion of 2 u of PRBC with proper
blood typing and crossmatch and administer ciprofloxacin 500 mg 1 tab BID
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NURSING ACTION: The NOD give proper instruction regarding the facilitation of blood and
administered the prescribed dosage and medication
The RBS increased to 490mg/dl at 1pm
DOCTORS ORDER: Regular insulin 5 units SC now
NURSING ACTION: The drug was administered
August 10,2012
RBS result as of 6 am is read as Hi and the result of Na and K has been released with
results of Na- 126.8(135-145) K 3.74 (3.5-5)
DOCTORS ORDER: NaCl 1 tab TID and give Lantus 8 u SC now
NURSING ACTION: The Nod administered the prescribed dosage of meds
August 11,2012
At around 6 am RBS is 353 mg/dl with no alteration in vomiting
DOCTORS ORDER: New orders made were as follows: Start bladder
training and give Regular insulin SC injection 10 units now and decrease the RBS to 6
hours and discontinue metroclopramide
NURSING ACTION: The NOD carried out the orders and explained to the patient
what the doctor said.
PATIENTS RESPONSE: The patient cooperated while administering the drug
subcutaneously and started to have bladder training
At 8:30 pm RBS taken the result was 502mg/dl. The result was then relayed to
MROD
DOCTORS ORDER: The doctor prescribed to start Lantus 10 units SC OD
9pm, Apidra 6 units SC TID premeals and decrease RBS to TID
NURSING ACTION: The NOD administered the drug ordered and started give
Lantus at night
August 12,2012
At around 6am RBS reading is High
DOCTORS ORDER: Regular insulin 10 units IVP now and repeat Na,K
NURSING ACTION: The NOD administered it immediately after carrying out.
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August 13,2012
RBS reading as of 6am is Hi and HgbA1C result is 7.4% (4.2-6.2%)
DOCTORS ORDER: increased Apidra 8 units SC TID premeals
Increase Lantus to 12 units SC OD PNSS 1 L x 8 3 doses
August 14,2012
DOCTORS ORDER: Regular insulin 10 u SC for repeat Na, K now PNSS 1
L x 6 for 4 doses
NURSING ACTION: The NOD gave request for Na,K and administered the
prescribed dosage of meds
August 15,2012
The results of Na is 137.0 (135-145) and K 2.95 (3.5-5)
DOCTORS ORDER: Give ketosteril 600 mg 2 tabs TID and for UTZ KUB
NURSING ACTION: The NOD gave request and proper instruction for the
examination to be done and administered the prescribed dosage of meds.
At around 12 nn RBS 131 mg/dl
DOCTORS ORDER: decrease Apidra to 5 units SC
August 16,2012
Potassium result is 2.95 and hemoglobin result of 9.2 (12-15)
DOCTORS ORDER: Give Kalium Durule 1 tab TID and for BT of 2 units of
PRBC
NURSING ACTION: The NOD facilitate the transfusion of blood
August 17,2012
Patient develops poor skin tugor
August 19,2012
Patient appears pale and weak and depletion of hemoglobin takes place hemoglobin 8 mg/dl so
the NOD facilitate blood transfusion of 1 u of PRBC
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August 20,2012
At around 6 am RBS reading is 367 mg/dl
DOCTORS ORDER: Give Humulin R 6 units Sc now
August 21,2012
RBS taken with result of 378 gm/dl even though apidra was given MROD ordered Regular
insulin 5 units SC now
August 22,2012
Patient develops a loose bowel movement and 5 consecutive passage drooling stool the MROD
ordered diatabs 2 tabs as stat order
August 24,2012
The patient develops swelling and abscess on the scrotal area and refered according to SROD
with order of wound care should be provided and Coamoxiclav 620mg 1 tab
August 25,2012
RBS taken 320 mg/dl regular insulin 6 u SC was given and the last unit of PRBC was
transfused
August 26,2012
RBS 192 mg/dl regular insulin 6 u SC was given
August 27,2012
The result of KUB has an impression of Nephrolithiases, bilateral and the patient
develops the sore on scrotal area
DOCTORS ORDER: for H and H stat and for repeat na, K and give Acalka 1
tab TID and sambong I tab TID and refer to SROD for scrotal abscess
NURSING ACTION: The NOD administered the prescribed meds and refer
accordingly to SROD
August 28,2012
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The SROD seen the client with scrotal abscess and swelling and tenderness
in the area and prescribed tramadol 50 mg I cap TID for reevaluation.
August 31,2012
The physician maintain the client on NPO for CP clearance and for incision
and drainage/ debridement BT 1 u PRBC prior to OR 1 u standby for OR use
NURSING ACTION: The NOD secured consent from the patient after giving
explanations about the procedure. The NOD also referred MROD the patient for CP
evaluation.
PATIENTS RESPONSE: The patient signed the informed consent and
understood the procedure. RBS 252 mg/dl
DOCTORS ORDER: regular insulin 16 units SC todays pre dinner only.
NURSING ACTION: The drug was administered subcutaneously.
PATIENTS RESPONSE: The patient participated effectively during drug
administration.
September 1, 2012
Patients appears sluggish and with pallor still on the process of facilitating BT due to
unavailability
CHAPTER VII
PATHOPHYSIOLOGY
Modifiable Risk Factors: Non-modifiable Risk Factors*Loves eating sweets and fatty foods *Age: 44 years old*engaged in alcohol drinking *Family history of DM: both sidesOccasionally
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*Laceration on the left foot
Destruction of beta cells of islets of Langerhans that secretes insulin
Decrease insulin production
Insulin insufficiency
Glucose cannot go to the cells
Glucose stays at the systemic blood circulation cell starvation
Hyperglycemia polyphagia RBS=406mg/dl
Increase blood glucose level exceeds increase blood increase peripheralOsmolarity renal threshold viscosity vascular resistance
Intracellular fluid glucose exerts high sluggish circulation decrease oxygen &Dehydration osmotic pressure within and proliferation blood supply to
the renal tubules of microorganisms distal extremities
osmotic dieresis occurs infection muscle wastingWBC=14 000/cumm
Polyuria increase decrease wound healing scrotal areaCapillary permeability
Extracellular fluid fever Dehydration glucose in the
Urine; urinalysis:Stimulates thirst Glucose =3+
Center of the brain
Polydipsia; increasethirst