ST. PAUL UNIVERSITY DUMAGUETEGraduate School MAN/MSN Program

HEALTH ASSESSMENTA CASE OF PATIENT WITH DIABETES MELLITUS TYPE 2

Prepared by:Joralyn A. Pacres R.N

INTRODUCTION 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. Diabetes is a chronic metabolic disease that occurs when the human body is not able to produce enough of the hormone insulin or because cells do not respond to the insulin that is produced. With type 2 diabetes, it is a chronic condition that affects the way your body metabolizes sugar.In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance. 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 2010, there were 309,000 deaths related to non-communicable chronic diseases, including diabetes. Approximately a quarter of these deaths were people of working age (younger than 60 years). The Philippines is one of the worlds emerging diabetes hotspots. Ranked in the top 15 in the world for diabetes prevalence, Philippines is home to more than 4 million people diagnosed with the disease and a worryingly large unknown number who are unaware they have diabetes. In 2014, 9% of adults 18 years and older had diabetes. In 2012 diabetes was the direct cause of 1.5 million deaths. More than 80% of diabetes deaths occur in low- and middle-income countries.

Source: http://www.who.int/mediacentre/factsheets/fs312/en/ http://www.allaboutdiabetes.net/philippine-diabetes-statistics/ The study that is to be presented features a patient who has a type 2 diabetes mellitus. As a nurse I am involved in what nursing intervention I am going to apply to this kind of patient. And in order to help my patient in his current health status the first basic step to do as a nurse is to gather information or data from your patient in accordance with your health assessment.

ANATOMY AND PHYSIOLOGY

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PancreasThe pancreas is both an endocrine and exocrine gland. It is a wedge shaped elongated gland which lies in the abdominal cavity. Structurally, the pancreas can be divided into three (3) regions: the head, which lies over the vena cava in the C-shaped curve of the duodenum; the body, which lies behind the duodenum; and the tail, which is situated under the spleen. The pancreas is composed of two types of cell; exocrine and endocrine cells. Exocrine Functions: Pyramidal acinar cells are exocrine cells that compose the bulk of pancreatic tissue. Groups of acinar cells form an acinus, and groups of acini form grapelike lobules. The acini secrete the digestive enzymes of the pancreatic juice.Pancreatic enzymes - these enzymes are released from the pancreatic acinar cells and are involved in the digestion of foodstuffs.There are three main types of enzyme present in pancreatic juice:

1. Amylases, which break down carbohydrates into glucose and maltose.2. Lipases, which are important in the early stages of fat breakdown.3. Proteases, including trypsinogen, the precursor of proteolytic trypsin.

Endocrine FunctionEndocrine cells, or the islets of Langerhan, make up 1% of the pancreatic cells. They are most numerous in the tail region of the pancreas. They consist of clusters of cells surrounded by pancreatic acini. The major endocrine cells of the pancreas are alpha, beta and delta cells, which secrete glucagons, insulin and somatostatin, respectively.When the blood sugar level falls below normal levels, the alpha cells are stimulated to secrete glucagon, which accelerates the conversion of glycogen to glucose in the liver. When the blood sugar level is above normal, the beta cells secrete insulin, which promotes both the metabolism of glucose by tissue cells and the conversion of glucose to glycogen, which is then stored in the liver.

Insulin Beta cells have channels in their plasma membrane that serve as glucose detectors. Beta cells secrete insulin in response to a rising level of circulating glucose ("blood sugar").

Physiological effectsThe actions of insulin on the global human metabolism level include:- Control of cellular intake of certain substances, most prominently glucose in muscle and adipose tissue (about of body cells).

Increase of DNA replication and protein synthesis via control of amino acid uptake.Modification of the activity of numerous enzymes.The actions of insulin on cells include:1. Increased glycogen synthesis2. Increased fatty acid synthesis3. Increased esterification of fatty acids4. Decreased proteolysis5. Decreased lipolysis6. Decreased gluconeogenesis7. Decreased autophagy8. Increased amino acid uptake9. Increased potassium uptake10. Arterial muscle tone Increase in the secretion of HCl by Parietal cells in the stomach

REVIEW OF SYSTEM

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A: Demographic DataPatients name: Patient LVAddress: Balangay 11 Pob. Quezon BukidnonBirthday: October 8, 1963Age: 51Sex: FemaleReligion: Roman CatholicNationality: FilipinoCivil Status: MarriedOccupation: Housewife

B. HEALTH PATTERNS ASSESSMENT1. Health perception and Management PatternReason for hospitalization/ chief complaint: fever associated with cough, LBM, loss of appetite

History of present illness: 2 weeks prior to admission patient experienced on and off onset of fever for 3 days associated with cough. Taking mefenamic acid and apply body ointment and felt relieved after but fever came back. Loss of appetite noted after 3 days of fever and decided to seek bisaya treatment or manhihilot, then good appetite back and patient eat whatever she crave. A night after she complain of abdominal pain and voided 4 times with bloody stool noted hence decided to seek medical advice then admitted.

Previous Hospitalizations/surgeries: 10 years ago admitted at Bukidnon Provincial Hospital Maramag due to 8 months pregnant. She lost her baby and she discovered that she has a high blood pressure. 2000-2001: admitted at BPH Maramag and undergo Ceasarian Section with her youngest daughter 2007-2008 admitted 18 weeks pregnant and end up to miscarriage and undergo Dilation and Curettage (raspa).

Family Health History:

What other health problems have you had? ___________________________________

Things done to manage health: ____________________________________________

V: NURSING REVIEW OF SYSTEM1. General appearancePatient is conscious, coherent and responsive when being asked. Not restless and calm, not having fever or any unusualities.

2. SkinHas cold skin, brown in color, decrease of skin elasticity noted due to age. There are no signs of skin lesions and sores but scars on lower extremities noted. There is absence of rashes and itchiness and no change in skin color.

3. HeadPatient is normocephalic and head is proportion to the body. On and off onset of headache experienced 2 days prior to admission and relieved by taking mefenamic acid, but there is absence of headache upon admission. Thin hair noted and evenly distributed, slightly dry and presence of flakes noted. Facial movement is symmetrical and closed fontanels noted.

4. Eyes She has pale conjunctiva, blurry vision noted and wear eyeglasses. There is no eye infection noted. Normal pupil reaction. Peripheral vision is intact.

5. EarsThere is normal gross hearing, tympanic membrane is intact and there is no foul smell or any discharges noted in external canal.

6. NoseNose is at midline of the face, the mucosa is pinkish. No discharges noted and both are patent. Normal gross smell and no tenderness noted upon palpation of sinuses.

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7. MouthLips are pale but no lesions. Mucosa is pale, tongue is in midline. Does not wear any dentures, but oral cavity is noted. Missing teeth is noted and gums are pale. Tonsils are not inflamed and uvula is in midline.

8. NeckThere was no presence of neck stiffness or pain. Can turned head side to side. Thyroids are non-palpable and trachea is in midline.

9. AbdomenStraie noted with protuberant configuration of the abdomen. Bowel sounds is hyperactive with 37 clicks in a minute with loud prolonged gurgles. Abdomen is non-tender and soft, there is no guarding noted.

10. Cardiovascular/Respiratory statusNo complaint of chest pain, precordial area is flat. Heart sound is normal. Symmetrical peripheral pulses noted. Capillary refill of