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I. INTRODUCTION
This case study is all about L.V, a 56 year old patient who diagnose with a Type 2 Diabetes Mellitus along with a
urinary tract infection at Bulacan Medical Center on December 19, 2012, with a chief complain of dizziness, weakness
and difficulty in breathing.
Diabetes Mellitus or simply diabetes, is a group of metabolic diseases characterized by increased levels of
glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action or both. Diabetes has its
major classification which varies in cause, clinical course, and treatment. These are the type 1 DM, type 2 DM,
gestational diabetes, and diabetes mellitus associated with other conditions or syndromes.
Type 2 diabetes mellitus or commonly known as Non- insulin dependent or an adult onset type described as a
relative deficiency of insulin production and a decreased insulin action and/or increased insulin resistance. It occurs
more commonly among people who are older than 30 years of age and obese although its incidence is rapidly
increasing in younger people that is because of the growing epidemic of obesity in children, adolescence and young
adults.
The clinical manifestations are depending on the patients level of hyperglycemia. It includes polyuria (increased
urination) and polydipsia (increased thirst) occurs as a result of excess loss of fluid associated with osmotic dieresis.
Patients also suffers polyphagia (increased appetite) that is the results from the catabolic state induced by insulin
deficiency and the breakdown of proteins and fats. Other manifestations such as fatigue, weakness, sudden vision
changes, tingling or numbness in hands or feet, dry skin and recurrent infections are noted.
Several procedures like fasting plasma glucose, random plasma glucose and glucose level two hours after
receiving glucose (2- hour postload) may indicate an abnormally high blood glucose level which is considered to be the
basic criterion for the diagnosis of diabetes. The major goal of the diabetes treatment is to normalize the insulin activity
and blood glucose level to reduce the development of vascular and neuropathic complications without patient
experiencing hypoglycemia: nutritional therapy, exercise, monitoring, pharmacologic therapy and education which are
the essential components of diabetic regimen.
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The incidence of diabetes is growing around the world. It is in the top ten leading causes of deaths. Filipinos are
not an exemption to this incidence as more and more Filipinos are affected by the disease. According to the survey
conducted by the Philippine Cardiovascular outcome study on Diabetes Mellitus in 2007 found out that 20.6 percent of
adults aged 30 and above were found to be diabetic. In 1998 only 3.9 percent of Filipinos living in the Philippines had
diabetes. On the other hand, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey)
study is 4.8%.
REASONS OF STUDY
The group chose type 2 diabetes mellitus as our case study because aside from it is still fresh in our minds;
our group was interested in studying this. We are willing to do this case to challenge our own minds in analyzing the
problem and to enhance our knowledge, as well as to gain new experiences which could bring new learnings for the
group. This case study will also help the group in understanding the disease process of the patient. It would also
help the group in identifying the primary needs of the patient with a type 2 Diabetes Mellitus. By identifying such
needs and health problems arise the group can now formulate an individualized Nursing care plan for the patient
that would address these needs and problems effectively. Management of the identified problem will help the
patient to recover faster and maintain holistic sense of wellness. This will also equip the group with knowledge, skills
and attitude on how to manage future patient with the same disease.
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II. OBJECTIVES
STUDENT- CENTERED
GENERAL OBJECTIVES
The purpose of this case study is to give the much needed knowledge and awareness to the nursing students who have or
might have handled cases of Type II Diabetes Mellitus associated with Urinary Tract Infection.
SPECIFIC OBJECTIVES
(STUDENT-CENTERED)
KNOWLEDGE:
To be able to have a better understanding at the case of the patient having a type 2 Diabetes Mellitus
associated with Urinary Tract Infection and the occurrence of its signs and symptoms.
To be able to know the disease process through its pathophysiology.
To be able to be knowledgeable about the patient drug study.
SKILLS:
To be able to formulate nursing care plans based on the prioritized health needs of the client.
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To be able to discuss about the pathophysiology of the disease process.
To be able to familiarize on the aggravating factors and specific interventions to prevent complications
of Type 2 diabetes Mellitus and Urinary Tract Infection.
ATTITUDE:
To be able to change any misconception about the said disease of the patient.
To be able to develop awareness in the proper care management for type 2 diabetes mellitus and
urinary tract infection.
To be able to serve our future clients with a higher level of holistic understanding as well as
individualized care.
(CLIENT-CENTERED)
GENERAL OBJECTIVES
This case study implies knowledge and awareness to people who have or might be at risk of the said
disease regarding its fatality and detection.
SPECIFIC OBJECTIVES
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KNOWLEDGE:
To be able to impart knowledge regarding type 2 Diabetes Mellitus and Urinary Tract Infection.
To be able to determine signs and symptoms and its complications.
To be able to familiarize on the appropriate interventions with its rationale to improve patients condition.
SKILLS:
To facilitate patient in taking necessary actions to solve and prevent the identified problems on her own.
To be able to explain the different factors that may cause type 2 diabetes mellitus and Urinary Tract
Infection and its danger.
To be able to participate in her plan of care.
ATTITUDE:
To help the patient in motivating her to continue the health care provided by the health workers.
To be able to complies with the treatment protocol and prevention strategies.
To be able to identify different measures to prevent further aggravation of the condition.
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III. NURSING ASSESSMENT
A. Biographic Data
Name: Client LVAddress: Poblacion San Ildefonso Bulacan
Gender: FemaleBirthday: October 12, 1956Age: 56 years oldCivil Status: MarriedReligion: Roman CatholicEducational Attainment: College Undergraduate - AccountancyDate of Consultation: March 5, 2013Admitting Diagnosis: Type 2 Diabetes MellitusFinal Diagnosis: T/C DKA, Type 2 Diabetes Mellitus
B. Chief complaint: Nahihilo kasi ako, tsaka nanlalata nahihirapan pa akong huminga as verbalized by the client.
C. History of Present Illness
Prior to consultaion, the client was experiencing weakness and she stated that she feels tired easily doing somehousehold chores. The night before she decided to go to hospital, she experienced difficulty of breathing and weakness,which cause her inability to sleep. On the following day at 7:00AM, she seeks consultation at Bulacan Medical Center.
In the Out Patient Department the patient was diagnosed already of Type 2 Diabetes Mellitus and did an initialassessment with positive weakness and pale, hyperlycemia with a blood pressure of 130/60, Respiratory rate of 29cpm, andpulse rate of 107bpm. Part of the confirmation of the disease, the following test was requested to be done such as CapillaryBlood Glucose and certain blood test.
Upon seeing the patient last March 5, 2013, he was able to communicate to us, has no manifestation of hyperglycemia
nor hypoglycemia. During our clinical rotation we seen our client with the following drugs Humulin 70/30, Lantus 16 units,VAsalat 10mg, Micardis Plus 80mg and Catapress her blood pressure reaches 150.
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D. Past Health History
According to the client, he experienced common diseases like fever, cough and colds. She also had Urinary Tractinfection last December and was given medication like Bactrim Forte. According to client she was also confined in the ICU for1 week because of hyperglycemia associated by hypertension. He is also a hypertensive patient.
E. Family Health HistoryAccording to the patient, her family has a history of Asthma, diabetes Mellitus and Hypertension on the paternal
side.
F. Functional health pattern
Health Perception Health Management Pattern
With Diabetes MellitusAccording to the client she feels ill and weak whenever her sugar
level increased. She also added that she feels sad because she
wasnt able to do things that he used to do before like doing chores
in a longer period of time but the client has a positive outlook in life,
she stated that kahit na may diabetes ako at maraming bawal,
pagpapatuloy ko ang aking buhay.
Nutritional-Metabolic Pattern
With Diabetes MellitusBREAKFAST LUNCH DINNER TOTAL
INTAKEMarch
2,2013
1 bowl
Lugaw(275ml)
1 cup
1 pc. Of fish
fillet cup of
rice
1 pc. Of
fish fillet cup of
rice
Approximat
ely:1050mL
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tea(250mL) 1 glass of
water(250m
l)
1 cup
tea(250mL)
March
3,
2013
1 bowl of
lomi(275mL
)
1 glass of
water(250
mL)
bowl of
binagoonga
ng
baboy(150
mL)
cup rice
1 glass of
water(250m
L)
bowl of
binagoonga
ng
baboy(150
mL)
1 cup rice
1 glass of
water(250
mL)
1 pc Indian
mango
Approximat
ely:
1350mL
March
4,
2013
bowl of
Quaker
oats(125mL)
1 glass of
water(250
mL)
cup of
rice
servingof adobong
manok
1 glass of
water(250m
L)
1 sachet of
skyflakes
1 cuptea(250mL)
Approximat
ely:
1325mL
According to the client she has restriction on his diet. If we noticed her intake
in the span of 3 days, she limits her carbohydrates intake as well as fat
intake. She also added that she was also limiting herself in eating sweet
foods. Our client stated that she drinks a lot everyday approximately 1
liters, she verbalized uhaw na uhaw ako palagi. According to theapproximate Total intake per day it is normal, because the normal Total
intake is 2500mL per day. And in the 72-hour diet recall it is shown that her
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intake is minimal, compare to her statement prior to her condition.
Elimination Pattern
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With Diabetes Mellitus
The clients frequency of urination is increase because of her
condition; she verbalized ihi ako ng ihi. The color of her urine varies
on the drugs that she was taking and according to the client the odor
of her urine was like a smell of medications.
URINATION BOWEL ELIMINATION
FREQUEN
CY
COLOR/TR
ANPAREN
CY
DISCOMFO
RT
FREQUENCY COLO
R
Marc
h 2,
2013
9times(ap
prox.
625mL)
Dark
Yellow
NONE once NOT
RECAL
LMarc
h 3,
2013
6times(ap
prox.
530mL
per shift)
Dark
Yellow
NONE once NOT
RECAL
L
Marc
h 4,
2013
8times(ap
prox.600)
Dark
Yellow
NONE once NOT
RECAL
L
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Sleep Rest Pattern
With Diabetes MellitusAccording to the client she sleeps at 2:00AM, she verbalized
nahihirapan akong kunin yung tulog ko ba, kaya nanunuod na lang
ako ng tv, pero kapag natulog na ako tuloy-tuloy na and she wakes
up at 6:00 in the morning. She doesnt take nap because she is busywatching television.
Activity Exercise Pattern
With Diabetes Mellitus
According to the client, she was unable to do the things she
usually does because of her condition. Now that she has
diabetes mellitus she gets easily tired and feels weak.
0- FEEDING 0- BED MOBILITY
0- HOME MAINTENANCE 0- BATHING
0- DRESSING 0- COOKING
0- TOILETING 0- GROOMING
N/A- SHOPPING 1- GENERAL
MOBILITY
LEGEND:
Level 0- Full self Care
Level I- Requires Use of Equipment
Level II- Requires assistance or supervision from another
person
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Level III- Requires assistance from another person and
device
Level IV- Is Dependent and doesnt participate
Role Relationship Pattern
With Diabetes MellitusThe Client feels sad and happy. Sad because she was not able to
things that may trigger her condition and happy because her family
is very supportive and concern about her present condition.
Cognitive-Perceptual Pattern
With Diabetes Mellitus
She is normal in cognitive pattern. In terms of perceptual pattern sherated her condition as 8 out of 10(10 being the highest and 1 is the
lowest). The client was also diagnosed before having an early
cataract related to DM retinopathy.
Coping/Stress Tolerance Pattern
With Diabetes Mellitus
The client stated that she feels good when he see and feel the
presence of her family in the hospital.
Self Perception/Self Concept Pattern
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According to her, she became a stronger person because of his faith
in God and she was more motivated to do follow the proper regimen
for diabetes mellitus.
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Sexuality/ReproductivePattern
Value Belief Pattern
IV. GROWTH AND DEVELOPMENT
Freud's Psycho-sexual
Theory
Erickson's Psycho-social
Theory
Piagets Theory of Cognitive Kohlbergs Theory of
Moral
STAGES GENITALPuberty-Death
Generativity vs.Stagnation
Formal Operational12 - Adulthood
Post Conventional-Universal Ethics
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With Diabetes Mellitus
We dont ask about this topic to him.
With Diabetes Mellitus
According to the client her faith in God increase and the only
person that she could ask for help is God.
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Middle Adulthood: 35 to 55 or 65 Orientation
DEFINITION
During final stage, theindividual develops astrong sexual interest
in the opposite sex.This stage beginsduring puberty butlast throughout therest of person's life.
Adults need tocreate/nurture things thatwill outlast them, often by
having children/creating apositive change thatbenefits other people.Success leads to feelingsof usefulness andaccomplishment, whilefailure results in shallowinvolvement in the world.
Can think logically aboutabstract propositions andtest hypothesis
systematically, becomeswith hypothetical future andideological problems.
Few people operate atthis stage all the time. Itis based on abstract
reasoning and theability to put oneself inother people's shoes. Atthis stage, people haveprincipled conscienceand will follow universalethical principlesregardless of what theofficial laws and rulesare.
.
RESOLUTION
The client wassuccessfully met thepsychosexual stagenot only because shewas able to havechildren with herhusband but also ingenital stage affordsthe person the abilityto confront andresolve her remaining
psychosexualchildhood conflicts.
The client achieves thisstage because she knowsthat she gave back to thesociety through raising herchildren and beingproductive as being amother to her children.
The client thinks rationallyand logically. As a motherand wife she was able tosolve the problems bycommunicating to herchildren and husband.
She lives autonomouslyand defines the moralpersonal identificationwith group values andprinciple that areuniversally agreed onthe considersappropriate that for life.She makes decisionaccording to what herconscience dictates.
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V. THEORY
THEORY THEORIST DESCRIPTION APPLICATION OF THEORY TO
THE PATIENT
1. Health PromotionModel
Nola J. PenderA health promoting behavior
is an end point or actionoutcome directed towardattaining positive healthoutcomes such as optimal wellbeing, personal fulfillment, andproductive living.
Health Promotion Model can helpthe client to attain positive healthoutcomes by eating of healthy diet,exercise regularly, managingstress, gaining adequate rest,spiritual growth and buildingpositive relationships.
2. Self-Care DeficitTheory of Nursing
Dorothea E. Orem The central idea of thetheory of self-care deficit isthat the requirements of
persons for nursing areassociated with subjectivity ofmature and maturing personsto health-related or healthcare-related action limitations
In this theory suggests that patientsrecover quicker and more effectivelywhen they are allowed to meet their
own basic needs, such as eating,grooming, and using the restroom.We use it as a guide to provide careand to help client to attain self-care.
3. Core, Care and Cure
Model
Lydia Hall Focusing on the notion that centersaround three components of Care, Core
and Cure. Care represents nurturanceand is exclusive to nursing. Core
involves the therapeutic use of self andemphasizes the use of reflection. Cure
focuses on nursing related to thephysicians orders. Core and cure are
We use this theory as a guide for our care planto the client because the major purpose of care
is to achieve an interpersonal relationshipwith the individual that will facilitate the
development of the core. Client is composedof body, pathology, and person. People set
their own goals and are capable of learningand growing.
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shared with the other health careproviders.
PHYSICAL ASSESSMENT
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ASSESSMENT TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS/INTERPREATION
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ATION
GENERAL APPEARANCE
BODY BUILT INSPECTION Proportionate, varies with lifestyle Proportionate ( mesomorph ) Normal
POSTURE INSPECTION Not on an Erect posture Not on an erect posture Normal
OVER-ALL-HYGIENE
INSPECTION Clean and neat appearance Clean and neat appearance Normal
BODY ANDBREATH ODOR
INSPECTION No body and breath odor No body and no breath odor Normal
SIGNS OFDISTRESS
INSPECTION No signs of distress Weak in appearance Deviation from Norma
due to aging
OBVIOUS SIGNOF HEALTH ORILLNESS
INSPECTION No signs of illness or disease Obvious signs of illness or
disease
Deviation from Norma
due to the presence of
the disease.
MENTAL STATUS
LEVEL OFCONSCIOUSNESS
INSPECTION Conscious and coherent Conscious and coherent Normal
ORIENTATION INSPECTION Oriented to time, place, situation Oriented to time, place, situation Normal
BODY
PART
TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS
INTEGUMENTARYa.) SKIN
INPECTION
PALPATION
Uniform in color, no presence of
edema ,no skin lesions, normal
temperature, long skin turgor, dry
skin
Dry skin and theres presence
of skin pigmentations on the
body
Deviation from Norma
due to hydration statu
& melatonin deficiency
of the client.
b.) NAILS INSPECTION
PALPATION
Convex curvature about 160,
smooth in texture, have an intact
epidermis tissue surrounding the
nails, less than 4 sec. returning to
its normal color (pink) when
performing blanch test
Convex curvature about 160,
smooth in texture, have an intact
epidermis tissue surrounding the
nails, having a normal blanch test
with pale color of nail beds. &
presence of dead toe nail.
Deviation from Norma
due to decrease of
oxygen in the tissue
cells.
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SUMMARY OF SIGNIFICANT FINDINGS:
Weak in appearance due to aging
Dry skin and poor skin turgor due to hydration status of the cliet.
Presence of skin pigmentation over the body due to melatonin deficiency.
Obvious sign of illness or disease because of his resent condition.
Paleness of lip/ buccal mucosa caused by decreased oxygen in the tissue cells.
Presence of dentures
Visual acquity with the grade of 250 in both eyes.
Nails are pale in color due to decreased oxygen supply in the tissue cells and dead toe nail.
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VIII. DRUGS/MEDICATIONS
DRUG NAME MECHANISM OFACTIONS
INDICATION CONTRAINDICATION
SIDE EFFECTS NURSINGRESPONSIBILITIE
S
Generic Name:HUMULIN 70/30Classification:Antihyperglycemic /AntidiabeticRoute/Dosage:Subcutaneous;10ml
Decreases bloodglucose bytransport of glucoseinto cells;conversion ofglucose to glycogen.
Management oftype 2 Non-dependentdiabetes mellitus
Hypoglycemia andhypersensivityreactions
Lipodystrophy;insulin resistance;allergic reactions;hypoglycemia
Obtain patiencehistory, includingdrug history andany knownallergies.Monitor fastingblood glucose, 2hrsafter meals.Monitor urineketones duringillness.Monitor body
weightMonitor forhypoglycemic/hyper glycemicreactions.
Generic Name:SimvastatinClassification:Antihyperlipidemicagent/HMG-CoAreductase inhibitor
Route/Dosage:40mg/tab OD
Inhibits HMG-CoAreductase enzyme,which reducescholesterolsynthesis
Treatment ofHyprlipidemias
Pregnancy andHypersensitivity toany components ofpreparation.
Abdominal pain;constipation;headache;dizziness
Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liver
functions testsbefore therapybegins.
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During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergicrteactions monitorblood pressure.
Generic Name:Telmisartan(micardis)Classification:Angiotensin IIantagonist/
AntihypertensiveRoute/Dosage:80mg/tab OD
Blocks thevasoconstrictiveand aldosterone-secreting effects ofangiotensin II byselectively
blocking thebinding ofangiotensin II to theAT1 receptor inmany tissues
Treatment forHypertension
Pregnancy andlactation. Biliaryobstructivedisorder.hypersensivity
Diarrhea;headache; fatigue;Urinary tractinfection
Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liver
functions testsbefore therapybegins.During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergic
rteactions monitorblood pressure.
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Generic Name:AmlodipineClassification:AntihypertensiveagentRoute/Dosage:10mg/tab ODsublingual
Decreasespheripheralvascular resistanceof smooth muscle(decrease bloodpressure)
Treatment forhypertension
Palpitations;headache;dizziness; fatigue;
Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liverfunctions testsbefore therapybegins.During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergic
rteactions monitorblood pressure.
Generic Name:ValsartanClassification:Angiotensin IIreceptor blocker /AntihypertensiveagentRoute/Dosage:80mg OD
Blocks thevasoconstrictiveand aldosterone-secreting effects ofangiotensin II byselectivelyblocking thebinding ofangiotensin II to the
AT1 receptor inmany tissues.
Treatment forHypertension
Hypersensivity tothe components
Headache;dizziness; fatigue
Prior:
Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liverfunctions testsbefore therapy
begins.During:Assess for
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symptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergic
rteactions monitorblood pressure.
Generic Name:ClonidineClassification:AntiHypertensiveagentRoute/Dosage:750mcg/Tab BID
Stimulates centralalpha-adrenergicreceptors to inhibitsymphateticcardioacceleratorand vasoconstrictorcenters
Management of allgrades ofhypertension
Hypersensitivity toclonidine
Drowsiness, drymouth, headache,urinary retentionhypotension
Prior:Assess BP andapical pulse beforethe initial doseMonitor baseline forrenal, liverfunctions testsbefore therapy
begins.During:Assess forsymptoms of CHF,edema,dyspneawet rales. BPweight gain, reportsignificant changes.After:Note for allergicrteactions monitorblood pressure.
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IX. LABORATORY/DIAGNOSTIC PROCEDURE
Laboratoryprocedure
Dateordered/
dateresult
Indication/ purposes Analytes Result Normal Interpretation Nursing responsibilities
Hematology December19, 2012
I t provides
valuableinformation
about the bloodand someextent the bonemarrow, whichis the bloodforming tissue.It is used forthe following
purposes:
To ensure both
adequate
oxygencarryingcapacity and
White BloodCell
14.7 4.1-11.1 The result is abovenormal it indicates:
there is a
presence ofleukocytosisinfection
Prior to examination:
Check the doctors order.
Explain the procedure to thclient.
Assess for the presence ofhematophobia.
Check the medications of tpatient that may affect the
result.During:
Provide comfort to lessen
patients anxiety whilewaiting for the result.
After:
Secure laboratory result to
the chart of the patient.( refer result to the physician)
Lymphocytes% 14.1 16.0-46.0 The result is belownormal it indicates :
Presence of
autoimmune
disease.
Monocytes % 2.9 2.3-8.5 Within normal result
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hemostasis.
To identify
persons whomay have aninfection.
To identify
acute andchronic illness,
bleedingtendencies.and
number ofcirculatingwhite bloodcells.
Granulocytes%
83.0 48.7-81.2 The result is abovenormal level itindicates:
The patient
may developan anemia
Red BloodCells
4.53 3.90-5.20 The result is withinnormal
Hemoglobin 127 120-151 The result is within
normal.
Hematocrit 0.377 0.364-0.460 The result is withinnormal.
MCHC(Meancorpuscularhemoglobin
concentration)
377 318-342 The result is abovenormal it indicates:
The patient
may sufferfrom anemia.
RDW(redblood celldistribution
width)
14.7 11.9-14.4 The result is above
normal it indicates:
That the
patientdevelopcardiovasculardisease.
Platelet 402 169-418 The result is withinnormal.
MPV(meanplatelet
volume)
6.7 7.0-10.5 The result is belownormal it indicates
that :
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The patient
may developleukemia.
Laboratory
procedure
Date ordered/
date result
Indication/
purpose
Analytes Result Normal Interpretation Nursing
considerationUrinalysis December
19,2012
It is an
essentialprocedure
forpatients
undergoing hospital
admissionor
physicalexaminati
on.
It is a
useful
indicatorof a
healthy ordiseased
state andhas
remainedan
integral
Color Light yellow Pale
yellow
to
amber
Normal Prior:
1. Review
physicians
order.
2. Gather all
the
necessary
materials
needed.
3. Explain the
procedure to
the patient.
4. 4 .Instruct
the patient
to void
directly into
a clean, dry
container.
Sterile,
disposable
Transparency Slightlyturbid
clear to
slightly
hazy
Normal
CHEMICAL
EXAMINATION:
Glucose +1 Negative
Positive result of
glucose in the urinemay indicate:
high blood
glucose level
undiagnosed or
uncontrolled
diabetesmellitus
Specific gravity 1.030 1.010-1.025 The result is abovenormal level itindicates that:Urine is concentrated
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part of thepatient
examination.
containers
are
recommend
ed. Women
should
always have
a clean-catch
specimen if
a
microscopic
examination
is ordered.
Feces,
discharges,
vaginal
secretions
andmenstrual
blood will
contaminate
the urine
specimen.
After:
1. Cover all
specimens
tightly, labelproperly and
send
MICROSCOPICEXAMINATION:
Amorphous urateFaint aromatic
RareThe result is abnormalit indicate that:
the patient eats
food cause
musty odor. Infected urine
Urine that have
glucose.
Bacteria Rare Negative Abnormal resultindicates:
Infection
process.
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The
process of
urinalysisdetermine
s theabnormal
constituen
tsrevealed
bymicrosco
picexaminati
on of theurine
sediment.
immediately
to the
laboratory.
2. If a urine
sample is
obtained
from anindwelling
catheter, it
may be
necessary
to clamp the
catheter for
about 15-30
minutes
before
obtaining
the sample.Clean the
specimen
port with
antiseptic
before
aspirating
the urine
sample with
a needle
and a
syringe.
3. Observe
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standard
precautions
when
handling
urine
specimens.
4. If the
specimen
cannot be
delivered to
the
laboratory or
tested within
an hour, it
should be
refrigerated
or have an
appropriate
preservative
added.
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X. NURSING PRIORITIZATION
NURSING PROBLEM JUSTIFICATION
1. Altered Tissue Perfusion We consider this problem as our first priority because diabetes
mellitus has a primary feature of constricted blood vessels which
caused by an inadequate oxygenated blood circulate in the body
which is the reason of having a fatigue in relation to the decrease
muscle strength
2. Fatigue We choose the fatigue as our 2nd priority because it is more
important than the deficient knowledge and considered to be a
physiologic needs of an individual.
3. Deficient Knowledge We consider the deficient knowledge as the 3 rd priority because it
is very important to know the care, course and the treatment of
her condition, for her to be aware in her body.
4. Risk for Activity Intolerance Intolerance of activity is our 4th priority because if we resolved the
problems in the circulation or the fluid volume, fatigue and the
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possible unstable blood glucose level, our client will have a
capacity to tolerate activities just like before because our client
has a sufficient energy to perform desired activities.
XI. NURSING CARE PLAN
ASSESSMENT NURSING
DIAGNOSIS
PLANNING
NURSING
INTERVENTION/SRATIONALE EVALUATION
OBJECTIVE CUES:
- Verbalizationof theproblem
- Statement of misconception
Vital Signs:
Ineffective tissue
perfusion related
to weakening due
to vasoconstriction
of blood vessels
After 8 hours of
nursing
intervention, the
patient will be
able to achieve a
normal circulation
in the peripheral.
Teach the patient
to mobilize.
Teach about the factors
which can increase blood
flow :
Elevate feet slightlylower than the
the mobilization improves blood
circulation
To increase blood flow through so
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BP: 130/70 mmHg
RR: 29cpm
heart (the position
of elevation at
rest), avoid
crossing legs,
avoiding tight
bandage, avoid the
use of pillows,
hamstrings and so
forth.
Teach about the
modification of risk
factors such as:
Avoid a diet high
in cholesterol, relax
ation
techniques, smokin
g cessation, and
drug use
vasoconstriction.
Collaborate with other
health team in giving
vasodilators and checking
blood sugar regularly
that does not happen edema.
High cholesterol can accelerate
the occurrence of atherosclerosis;
smoking can cause
vasoconstriction of blood vessels,
relaxation to reduce the effects of
stress.
Giving vasodilators will increase
the dilation of blood vessels so
that tissue perfusion can be
improved, while checking blood
sugar regularly to know the
progress and state of the patient.
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SUBJECTIVE:
OBJECTIVE:
- generalized
weakness
- increased
respiratory
rate of 25cpm
- bodyweakness
- weight loss
- fatigue
- -limited ROM
- inability to
perform ADL
- altered VS
- altered
sensorium
Fatiguerelated todecreasemusclestrength
LONG TERM GOAL:After 3 days of nursing
interventions, the patient
will be free from signs of
fatigue
SHORT TERM GOAL:
After 2-3 hours of nursing
interventions, the patient
will be able to identify
measures to conserve and
increase body energy.
- Assess
response to
activity
- Asses
muscle
strength of
patient and
functional
level of
activity.
- Discuss with
patient the
need foractivity
- Response to an
activity can be
evaluated to achieve
desired level of
tolerance.
- To determine the
level of activity
- Education may
provide motivation
to increase activity
level even though
patient may feel too
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- Alternate
activity with
periods of
rest/
uninterrupte
d sleep.
- Monitor
pulse,
respiration
rate and
blood
pressure
before/after
activity
- Perform
activity
slowly with
frequent rest
periods
- Promote
energy
weak initially
- Prevents excessive
fatigue.
- Indicates
physiological
levels of tolerance.
- Interventions should
be directed at
delaying the onset of
fatigue and
optimizing muscle
efficiency.
- Symptoms of fatigue
are alleviated with
rest. Also, patient
will be able to
accomplish more
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conservation
techniques
by
discussing
ways of
conserving
energy while
bathing,
transferring
and so on.
- Provide
adequate
ventilation
- Providecomfort and
safety
- Instruct
patient to
perform
deep
breathing
exercises
- Instruct
client toincrease
with a decreased
expenditure of
energy.
- For proper
oxygenation
- To be free frominjury
- Promotes relaxation
For muscle strength
and tissue repair
- To prevent
weakness andpaleness
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Vitamins A,
C and D and
protein in
her diet.
- Instruct also
patient to
increase ironin diet
- Administer
oxygen as
ordered.
- To provide proper
ventilation
ASSESSMENT NURSING
DIAGNOSIS
PLANNING
NURSING
INTERVENTION/SRATIONALE EVALUATION
Encourage client to For the client to do
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OBJECTIVE CUES:
- Verbalizationof theproblem
- Statement of
misconception
Vital Signs:
BP: 130/70 mmHg
RR: 29cpm
Deficient knowledge
related to the
disease process due
to lack of
information or
information
misinterpretation
After 8 hours of
nursing
intervention, the
patient will be able
to verbalize
accurate
information, report
understanding ofcondition and
discuss process and
treatment.
do self monitoring of
her glucose level.
Provide
explanations of
reasons for the
procedure and the
preparation needed.
Identify individual
restrictions such as
too sugar in the
food.
Review the patient
to maintain an
optimal nutritional
status.
self monitoring of
her condition.
Information can
decrease the
anxiety of the
patient.
Any things that can
aggravate her
condition.
Promotes well beingof the patient and
her recovery
XII. CONCLUSION
At the end of our case study, our group learned things about Type II Diabetes Mellitus and Urinary Tract Infection that are
needed for us to know. We therefore conclude that we, as nursing students must give time in knowing disease or illness like our
case. These things would help us further in giving or disseminating information to people who are concerned or involved in this
condition.
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On the other hand, this case study is not only for nursing student but this can be also helpful to other professionals and
ordinary people. We studied about the risk factors, its sign and symptoms, treatment, medication for Type II Diabetes Mellitus
and Urinary Tract Infection. Hence, we learned that any individual is prone to this condition if their lifestyle puts them to a higher
risk. Thats why we must all be well-informed to prevent its occurrence.
Lastly, at the end of our case study we, student nurses apprehend all essential things about Type II Diabetes Mellitus and
Urinary Tract Infection. Avoid exposure, proper lifestyle, proper hygiene and proper nutrition is the best way to prevent the
acquiring of Type II Diabetes Mellitus and Urinary Tract Infection and any other diseases.
XII. BIBLIOGRAPHY
- Kozier B. et al: Fundamentals of Nursing 10th edition Pearson education Inc. New jersey Copyright 2004p.434
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- Moorhouse , Doenges, M.: Nurses Pocket Guide: Nursing Diagnoses with Interventions
- Brunner and Suddart: textbook of Medical and Surgical Nursing 12th edition, hippincott, Williams & Wilkins
- -http://www.justmommies.com/articles/anemia-during-pregnancy.shtml#ixzz1lN1GVpZL
- http://en.wikipedia.org/wiki/Pain#Management
- http://www.livestrong.com/article/202712-a-nursing-diagnosis-of-limited-mobility/
- http://nurseslabs.com/d5w-iv-fluid-study/\
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http://www.justmommies.com/articles/anemia-during-pregnancy.shtml#ixzz1lN1GVpZLhttp://en.wikipedia.org/wiki/Pain#Managementhttp://www.livestrong.com/article/202712-a-nursing-diagnosis-of-limited-mobility/http://nurseslabs.com/d5w-iv-fluid-study/%5Chttp://www.justmommies.com/articles/anemia-during-pregnancy.shtml#ixzz1lN1GVpZLhttp://en.wikipedia.org/wiki/Pain#Managementhttp://www.livestrong.com/article/202712-a-nursing-diagnosis-of-limited-mobility/http://nurseslabs.com/d5w-iv-fluid-study/%5C -
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