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I. Introduction

This case study tackles about the disease, diabetes mellitus type II. I have chosen this case since this is one of the most common diseases nowadays and many people from different age groups will be benefited with this case study. Before scanning through other pages, let me first give you a brief overview of what Diabetes Mellitus is. I have specifically focused on Type II Diabetes Mellitus since this is the case of my patient.

Diabetes mellitus is a common disease in which the body cannot use sugar normally. The body of a diabetic person is slow in using glucose (sugar), and so glucose builds up in the blood. The kidneys discharge some of the excess glucose into the urine. In severe cases of diabetes, fats and proteins also cannot be used normally.

Most physicians once believed that all cases of diabetes were caused by a lack of the hormone insulin. Insulin, which is produced by the pancreas, enables the body to use and store glucose quickly. Some diabetics do lack insulin. This form of the disease is called Type I diabetes (also known as insulin-dependent diabetes or juvenile-type diabetes). However, many diabetics--especially those who become diabetic after the age of 40--have normal or even above-normal production of insulin. Their bodies do not respond efficiently to the insulin. Doctors call this form of the disease Type II diabetes (also known as non-insulin-dependent diabetes or adult-type diabetes).

Symptoms of Diabetes include excessive urination, great thirst, hunger, and loss of weight and strength. These symptoms may appear gradually--and even be unnoticed--in Type II diabetes, which is most common in overweight individuals over the age of 40. Many cases of Type II diabetes can be controlled by a diet that is low in calories. Some Type II diabetics whose condition cannot be controlled by diet alone use insulin or take oral drugs that reduce the level of glucose in the blood.

Diabetes can lead to serious complications. For example, it may cause changes in the blood vessels of the retina. This condition is called diabetic retinopathy. In advanced form, it is a major cause of blindness. Diabetes may cause similar changes in the blood vessels of the kidneys. This condition, called diabetic nephropathy, may lead to kidney failure. The nerves may also be affected by diabetes. This complication, known as diabetic neuropathy, can result in loss of feeling or abnormal sensations in different parts of the body. Various treatments can control many cases of diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Diabetes can also lead to atherosclerosis, a form of arteriosclerosis (hardening of the arteries) that may cause a stroke, heart failure, or gangrene.

Since you already have an idea of what diabetes mellitus is, I hope you’ll be encouraged to continue reading this case study and be able to implement as well as impart what you have learned in order to lessen or if possible, eradicate the occurrence of disease.

II. Objectives

General Objectives

After 2 days of giving holistic nursing care to the patient who have Diabetes Mellitus type II, the nurse will be able to gain adequate knowledge, attitude and skills in taking care of a patient who is suffering from this disease condition.

Specific Objectives

After 8 hours of giving holistic nursing care, the student nurse will be able to:

1. relate the patients history and level of growth and development

2. explain the significance of the diagnostic results

3. review the anatomy and physiology of the pancreas relating it with insulin

4. explain the disease process and organ involved

5. compare the chart in classical and clinical symptoms of the disease process

6. formulated appropriate nursing care plan based on identified problem of patient

7. impart health teachings to the patient and significant others on Diabetes Mellitus

After 8 hours of giving holistic nursing care, the patient and significant others will be able to:

1. gain trust with the nurse

2. verbalize physiologic manifestation as a result of the disease

3. explain the disease process in their own level of understanding

4. relate health history with his present condition.

5. enumerate the different signs and symptoms that needs to be watched for.

6. identify factors that could aggravate his condition.

7. show willingness in the implementation of planned nursing care

8. state some health promotion activities of diabetes mellitus type II.

III. Nursing Assessment

1. Personal History

1.1Patient’s Profile

Name: Mrs. Soria, Fe F.

Age: 67 years Old

Sex: Female

Civil Status: Married

Religion: Roman Catholic

Date of Admission: January 23, 2006

Room number: 233

Complaints: Frequent Urination, High Blood Sugar and a Lump on her Right

Breast

Impression/Diagnosis: Type II Diabetes Mellitus

Physician: Dr. Armando Tan

Hospital Number: 187908

1.2 Family and Individual Information, Social and Health History

A case of Mrs. Fe F. Soria, 67 year old, female, Filipino and a Roman Catholic. She is retired government employee from Bacolod City was admitted at Chong Hua Hospital for the first time.

Three months prior to admission patient suffered Polyuria and Polydipsia until it progressed into nausea, feeling nervous or jittery; cold, clammy, wet skin; excessive sweating not caused by exercise, tachycardia, tingling sensation of the fingertips lips thus patient was hospitalized. Laboratory works done and was diagnosed with Type II Diabetes Mellitus.

Also one month prior to admission, patient noted 2 cm firm, movable, circular non tender mass at left upper outer part of her left breast while taking a bath. Mammography confirmed the mass and biopsy was done. It revealed calcification at right breast category IV and MRM was advised. She is scheduled for MRM.

1.3 Level of Growth and Development

1.3.1 Normal Development of an Older Adult (65 and above)

Physical

Integumentary System

The skin losses resilience and moisture. The epithelial layer thins, and elastic collagen fibers shrink and become rigid. Wrinkles of the face and neck reflect lifelong patterns of muscle activity and facial expressions, the pull of gravity on tissue and diminished elasticity. Skin has spotty pigmentation in areas exposed to the sun. It is also dry and scaly. There is also decreased fat distribution on extremities and increase amount on abdomen. There is also thinning and graying on scalp; often, decreased amount of axillary and pubic hair and hair in extremities; decreased facial hair in men; possible chin and upper lip hair in women

Head and Neck

Head is sharp and angular nasal and facial bones; loss of eyebrow hair in women. Eyes are having decreased visual acuity; decreased accommodation; reduced adaptation to darkness; and sensitivity to glare. Ears are having decreased pitch discrimination; diminished light reflex; decreased sense of smell; mouth and pharynx may use dentures; decreased sense of taste; atrophy of papillae of lateral edges of tongue. Neck may have nodular thyroid gland; slight tracheal deviation resulting from muscle atrophy.

Thorax and Lungs

There is significant increase in systolic pressure with slight increase in diastolic pressure; usually insignificant changes in heart rate at rest; common diastolic murmurs; easily palpated peripheral pulses; weakened pedal pulses and colder lower extremities, especially at night.

Breast

Decreased muscle mass, tone, and elasticity result in smaller breast in older women. In addition, the breast sag. Atrophy of the glandular tissue, coupled with more fat deposits, results in a slightly smaller, less dense, and less nodular breast. Gynecomastia, enlarged breast in men, may be due to medication side effects, hormonal changes, or obesity. Both men and women are at risk of breast cancer development.

Gastrointestinal System

Decreased salivary secretions, which may make swallowing more difficult; decreased peristalsis; decreased production of digestive enzymes, including hydrochloric acid, pepsin, and pancreatic enzymes; constipation; reduced motility.

Reproductive System

Changes in the structure and function of the reproductive system occur as the result of hormonal alterations. Female menopause is related to a reduced responsiveness of the ovaries to pituitary hormones and a resultant decrease in estrogen and progesterone levels. In men, there is no definite cessation of fertility associated with aging. Spermatogenesis begins to decline during the fourth decade but continues into the ninth. The change in reproductive structure and function, however do not affect libido. Less frequent sexual activity can result from illness, death of a sexual partner, decreased socialization, or loss of sexual interest.

Urinary System

Decreased renal filtration and renal efficiency; subsequent loss of protein from kidney; nocturia; decreased bladder capacity; increased incontinence.

Female

Urgency and stress incontinence resulting from decrease in perineal muscle tone.

Male

Urinary frequency and retention resulting from prostatic enlargement.

Musculoskeletal System

Decreased muscle mass and strength; bone demineralization; shortening of trunk as result of intervetebral space narrowing; decreased joint mobility; decreased range of joint motion; enhanced bony prominences.

Neurological System

Decreased rate of voluntary or automatic reflexes, decreased ability to respond to multiple stimuli; insomnia; shorter sleeping periods.

Psychosocial Development

According to Erik Erikson, the developmental task at this time is Ego Integrity vs. Despair. People who attain ego integrity view in life with a sense of wholeness and derive satisfaction from past accomplishments. They view death as an acceptable completion of life. According to Erikson, people who develop integrity accept “one’s one and only life cycle.” By contrast, people who despair often believe they have made poor choices during life and wish they could live life over.

Cognitive Development

Piaget’s phases of cognitive development end with Formal Operations Phase. Changes in cognitive structures occur as a person ages. It is believed that there is progressive loss of neurons. In addition, blood flow to the brain decrease, the meninges appear to thicken, and brain metabolism slows. Older people need additional time for learning, largely because of the problem of retrieving information.

Moral Development

According to Kohlberg, moral development is completed in the early adult years. Most old people stay at Kohlberg’s conventional level of moral development and some are at the preconventional level. An elderly at the preconvetional level obeys rules to avoid pain and the displeasure of others. Elderly people at the conventional level follow society’s rules of conduct in response to the expectation of others.

Spiritual Development

According to Fowler and Keen, some people enter the sixth stage of spiritual development, Universalizing. People whose spiritual development reaches their level thinking and act in a way that exemplifies love and justice.

Sexual Development

Sex drives persist into 70’s, 80’s, and 90’s, provided that health is good and an interested partner is available. Interest in sexual activity in old age depends, in large measure, on interest earlier in life. However, sexual activity does become less frequent. Many factors may play a role in the ability of an elderly person to engage in sexual activity.

1.3.2 The Ill Person at a Particular Stage of Patient

The three most common causes of death in older adults are heart disease, cancer and stroke. Other frequently reported causes of death are lung disease, accidents/falls, diabetes, kidney disease, and liver disease. Heart disease is the leading cause of death in older adults. Common cardiovascular disorders are hypertension and coronary artery disease. Cancer or malignant neoplasm’s are the second most common cause of death among older adults. Cerebrovascular accidents, the third leading cause of death, occurring as brain ischemia or brain hemorrhage. Cigarette smoking has been recognized as a risk factor in the four most common cause of death for older adults: heart disease, cancer, stroke and lung disease. Dental carries, gingivitis, broken or missing teeth and ill-fitting or missing dentures may affect nutritional adequacy, cause pain, and lead to infection.

Older adults should be encouraged to maintain physical exercise and activity. The primary benefits of exercise include maintaining the strengthening functional ability and promoting a sense of enhanced well-being. Arthritis is also a common condition in older adults, especially in women. The degree to which the mobility of older adults is impaired depends on the extent of the disease and joint affected. Falls are a safety concern of many older adults, falls my lead to fear of additional falls, withdrawal from usual activities and loss of independence.

2. Diagnostic Results

|Diagnostic Test |Normal Values |Patient’s Result |Significance |

|Hematology | | | |

|Hemoglobin |11.5-16 g/dl |12.3 g/dl |Normal |

|Hematocrit |35-49 vol % |36.6 vol % |Normal |

|RBC |4.5-5.3x10^6/dl |3.98x10^6/dl |Normal |

|WBC |4.5-15.0x10^3/dl |5.41x10^3/dl |Normal |

|Platelets |150,000-450,000 cu/mm |267,000 cu/mm |Normal |

|Segmenters |54-62% |36% |Normal |

|Eosinophils |1-3% |02% |Normal |

|Lymphocytes |25-33% |54% |Elevated following surgery |

| | | |Source:Brunner and Suddarth’s |

| | | |Textbook of Medical – |

| | | |Surgical Nursing, 9th Ed. |

| | | |Smeltzer, Suzanne C. |

| | | |Bare, Brenda G., 1954 |

|Urinalysis | | | |

|Macroscopic | | | |

|Color |Yellow |Yellow |Normal |

|Appearance |clear |Slightly cloudy |Normal |

|Reaction |5.5-7.5 |6.0 |Normal |

|Specific gravity |1.001-1.045 |1.045 |Normal |

|Protein |Negative |Negative |Normal |

|Glucose |Negative |Negative |Normal |

|Ketones |Negative |Negative |Normal |

|Blood |Negative |Negative |Normal |

|Macroscopic | | | |

|RBC | ................
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