CANOSSA COLLEGE – SAN PABLO CITY INC.

COLLEGE OF NURSING
SAN PABLO CITY

CASE PRESENTATION:
UNCONTROLLED TYPE II DIABETES
MEDICAL SURGICAL WARD | 2FW

Bachelor of Science in Nursing III | Group 4

Members:
Agawin, Lyneth G.
Bacay, Vnyz Ardeyn M.
Capistrano, Daniel M.
Dacanay, Kurt Daniel O.
De La Cruz, Rozzete Anne Lyne B.
delos Reyes, Althea Jean P.
Marasigan, Daisylyn P.
Quinton, Hana Andrea Nixie F.
Reyes, Jose Gabriel T.

Clinical Instructor:
Ms. Gladeys De Mesa, RN
 TABLE OF CONTENTS

Introduction………………………………………………………………………………………1
Objectives…………………………………………………………………………………….…...1
Patient’s Profile…………………………………………………………………...………….......2
History of Illness……………………………………………………………….……...…………2
Gordon’s Functional Pattern………..…………………………………………………………..2
Physical Assessment
Vital Signs…………………………...…………………………………………………………4
CBG Monitoring………...…………………………………………………..…………………4
Nursing Interventions and Progress……………………………………………………………5
Laboratory Results
Chest Posterior Anterior (PA)…….………………………………………………………….6
Hematology……..……………………………………………………………………………7
Chemistry……………………………….……………………………………………………9
Urinalysis…………………………….………………………………………………………10
Disease Condition…………………………………………………….…………………………10
Anatomy and Physiology……………..…...……………………………………………………10
Etiology…………………………………….……………………………………………………11
Signs and Symptoms………………………..……………………...…………………………...12
Pathophysiology…………………………………….…………………………………………..12
Drug Study……………………………………………………………………………..…….…14
Nursing Care Plans……………………………………………………………...……………..30
Theory Application……………………………………………………………….………........34
Health Education and Discharge Plan……………………………………………………….34
References……………………………………………………………………………………..35
 CASE PRESENTATION: TYPE II DIABETES

INTRODUCTION/BACKGROUND:

According to the World Health Organization, diabetes is considered as a chronic,

metabolic disease which causes high levels of blood sugar for an individual. The elevation of
blood glucose can soon result in great damage to an individual's eyes, heart, kidney, blood
vessels, and nerves. Type 2 diabetes was considered as the most common type of the disease in
which one’s body becomes insulin resistant or worse it does not produce enough insulin.

According to the International Diabetes Federation (2022), there is a continuous global

increase in the prevalence of diabetes. This finding proves that diabetes is a major challenge that
affects the health and well-being of individuals, families, and even communities. In 2021, about
537 million people ages 20-79 are living their life with diabetes and this equates to 1 in 10
individuals having the disease. It is expected for this number to rise in the year 2030 where 643
million individuals will live with diabetes and there will be 738 million in 2045. Diabetes was
more prevalent in low- and middle-income countries. Diabetes was considered responsible for
the 6.7 million deaths in 2021 where there is 1 death in every 5 seconds globally.

In the Philippines, it was found that diabetes is the 4th leading cause of death along with
cardiovascular disease, cerebrovascular disease, and cancer for the year 2022. About 6.5% which
equate to 13,437 cases of deaths was recorded from the month of January to May 2022
(Philippine Statistics Authority, 2022). In addition, about 6.3% of Filipino people have diabetes,
according to the International Diabetes Federation (IDF). That means that about 4 million of the
63 million adults in our country have diabetes in the year 2021. Unfortunately, there were high
figures of documented diabetes but there is also a possibility that there could be undocumented
cases of the disease (Bunag, 2021). These data call for immediate attention to be given in cases
such as diabetes.

As future nurses and advocates of health who aim to promote health and prevent diseases
for the people, it is vital to tackle this specific disease to raise awareness about diabetes. This
condition can be prevented and be well managed if every individual has the right amount of
knowledge about the possible treatments and ways on how they can control the disease which
can lead to a better and healthier life.

OBJECTIVES:

● To establish deeper understanding about Type II Diabetes

● To emphasize the role of early evaluation and management for Type II Diabetes
● To emphasize the patient’s overall disease etiology and possible interventions to be done.
● To discuss the anatomy, pathophysiology, and etiology of Type II Diabetes

1
PATIENT’S PROFILE:

1. Identification Data:
Patient: DGL
Sex: Male
Age: 33 years old
Date of admission: February 15, 2023
Date of discharge: N/A
Diagnosis: Type II Diabetes (Uncontrolled)
Surgery (if any): N/A
Date of Surgery: N/A

2. History of Illness:
Chief complaints: Epigastric Pain and Vomiting
History of Present Illness: On the day of admission the patient is with epigastric pain, and
vomiting more than 5 times; (-) fever, (-) edema, (-) cough
Present surgical history: N/A
Past medical history: N/A
Past surgical history: N/A

3. Gordon's Functional Pattern

Health Perception and Health Management Pattern

Before During

● Family History of Diabetes from ● Takes prescribed medicines (Insulin,

Mother and Father’s side Trajenta, Domilium, Lansoprazole)
● 8 years history of Diabetes ● Monitors Vital Signs and Capillary
● No allergies to any drug/food Blood Glucose regularly
● Doesn’t take any prescribed medicines
once he forgets (Metformin, Insulin,
Atorvastatin)
● Monitors Capillary Blood Glucose at
home seldom

Nutrition and Metabolic Pattern

Before During

● Frequently Thirsty ● On NPO upon admission

● Always eats sweets, junk foods and ● On General Liquid Diet on Feb. 17,
soft drinks 2023
● Favorite food to eat is everything with
soup
● Good Appetite in terms of eating (eats
everything including those foods that

2
 are not allowed for him)
● Drinks beers and liquors occassionally

Elimination Pattern
Before During

● Bowel Movement of 2x a week–solid ● No Bowel Movement

stool with no difficulty ● Urine output is two times only within
● Long and frequent yellowish urine the days of student nurse’ assistance.
output (5-10 mins), shows signs of
ants swarming, no odor, foamy/bubbly
appearance and no discharge.

Activity and Exercise Pattern

Before During

● No exercise (Delivery Driver, morning ● No exercise, patient on bed

shift)
● Not a smoker

Cognition and Perception Pattern

Before During

● Conscious and Coherent ● Conscious and Coherent

Sleep and Rest Pattern

Before During

● Has a frequent Poor Sleeping habit (3- ● Has a good sleeping habit
5 hours of sleep) ● No sleeping pills taken
● Drinks beers and liquors to sleep ● Not hard to sleep
● No sleeping pills taken
● No signs of headache once awake

Roles and Relationship Pattern

Before During

● The wife is the one who decides ● The wife is the one who decides
mostly in the family and who he asks mostly in the family
for opinions ● The wife was the one looking after the
patient during admission

3
Sexuality and Reproductive Pattern
● Sexually active

Coping and Stress Tolerance Pattern

● Drinks beers and liquors once stressed or can’t sleep

Values and Belief Pattern

● Roman Catholic
● Doesn’t believe in Folk Healers

4. Physical Assessment

VITAL SIGNS

ADMISSION DAY 1 DAY 2

4:00 PM 8:00 PM 4:00 PM 8:00 PM

Blood Pressure 120/80 110/80 110/70 140/90 150/100

Pulse Rate 83 93 88 66 70

Respiratory Rate 21 18 19 21 20

Temperature 36.0 36.7 36.5 35.5 35.7

Oxygen 99% 95% 96% 97% 98%

Saturation

CAPILLARY BLOOD GLUCOSE

February 15, 2023 Admission 394 mg/dL

February 16, 2023 6:00 PM 136 mg/dL

10:00 PM 124 mg/dL

February 17, 2023 6:00 PM 246 mg/dL

Head: Symmetrical
Eyes: with glasses; PERRLA (3cm)
Mouth: Moist
Lips: Dry
Skin color: fair skinned
Skin moisture: moist and no presence of lesions
Capillary Refill (fingernails): 3 seconds
Capillary Refill (toenails): 3 seconds

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 NURSING INTERVENTIONS AND PROGRESS

FEBRUARY 15, 2023

● The patient is admitted to his room of choice (ROC) under the service of Dr. S
● The patient’s consent was obtained and secured
● Patient was placed under NPO (nothing by mouth) until the physician’s further notice
● With IVF PNSS 1L to run for 16 hours
● Continue maintenance medications:
- Metformin 500 mg BID
- Atorvastatin 10 mg OD

Therapeutics
● Plasil 1 ampule IV now then every 8 hours PRN (as needed) for vomiting
● Omeprazole (Risek) 40 mg IV now then OD
● Give 8 units regular insulin IV now; repeat CBG after 1 hour, if CBG is still > 200, the
patient may be given another 8 units regular insulin IV

11 AM:
● Repeat CBG after 1 hour if CBG is > 200 mg/dL give another 8 units Humulin R (HR)
IV

12:50 PM
● The patient vomited more than 4 times
● The patient is with abdominal pain few hours prior to admission

6:00 PM
● Patient’s CBG result is 226 mg/dL; give Insuget 70/30 10 units subcutaneously instead of
14 units

FEBRUARY 16, 2023

4:20 AM
● Hold Insuget while patient is unstable to eat
● Patient is placed in NPO temporarily because of vomiting

5:50 AM
● CBG result is 192 mg/dL; the patient was given Humulin R (HR) 4 units subcutaneously
● Insuget is on hold

10:30 AM
● Patient is still under NPO until further orders
● Stat CBG result is 191 mg/dL
● Inject insulin glargine 15 units subcutaneous (stat)
● Patient’s IVF shifted form PNSS to D5NSS 1L to run for 8 hours

5
 ● Give Humulin R 4 units IV (stat)
● Patient’s CBG result while on NPO is 94 mg/dL

4:00 PM - 10:00 PM
● Nursing students introduced themselves and started building rapport with the patient
● Patient’s vital signs were taken and recorded at 4:00 PM and 8:00 PM
● Capillary Blood Glucose (CBG) monitoring every 6:00 PM and 10:00 PM
● The patient was given Domilium at 6:00 PM
● Patient is still under NPO until the physician’s further notice
● Intake and output recorded at the end of the shift
● All the progress done was endorsed to the nurse on duty

FEBRUARY 17, 2023

5:30 AM
● Change diet to general liquid diet
● Give insulin glargine 15 units subcutaneously (stat)

10:00 AM
● Give the patient Humulin R as needed
● Patient’s IVF shifted from D5NSS to PNSS 1L to run for 8 hours

4:00 PM - 10:00 PM
● The nursing students introduced themselves to the patient and built rapport
● Vital signs are monitored and recorded at 4:00 PM and 8:00 PM
● Capillary Blood Glucose monitored every 6:00 PM and 10:00 PM
● Patient’s IVF is replaced and regulated
● Due medications are given to the patient
● Intake and output recorded at the end of the shift
● All the progress done was endorsed to the nurse on duty

5. Lab Result

Procedure: Chest Posterior Anterior (PA) - 2/15/2023

Both lungs are clear.

The heart is not enlarged.
Diaphragm and sulci are intact.
Bony thorax is unremarkable
Impression: Normal Chest Study
Date signed: 2/16/2023

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 Hematology
Date Received: 2/15/2023 10:42 AM

Laboratory Test Result Normal Value Function Interpretation

White Blood cell 10.90 4.00-10.00 Measures the number High

of white blood cells in
your body. It may
also be called a
leukocyte test.

Hemoglobin 143.00 140-180 Measures the amount Normal

of hemoglobin in the
blood and is often used
to check for anemia.

Hematocrit 0.44 0.42-0.54 A simple blood test Normal

that measures the
percentage of red
blood cells in the
blood,

Platelet Counts 357.00 150.00 - 450.00 Measures the Normal

concentration of
platelets in the blood.

Differential Count

Neutrophil 0.83 0.5-0.7 Measures the High

percentage of
neutrophils in white
blood count.

Lymphocyte 0.13 0.2-0.4 Measures the levels of Low

the main types of
white blood cells in the
body.

Monocyte 0.03 0.0-0.14 Measurement of a Normal

particular type of
white blood cell.

Eosinophil 0.01 0.01-0.03 play active pathogenic Normal

roles in the

7
 inflammation
associated with
allergic disorders

Basophil 0.00 0.0-0.1 Assesses the degree of Normal

basophil activation
caused by an allergen.

RBC Indices

Red Blood cell 4.99 2.50-5.50 To find out if the Normal

number of red blood
cells you have is
normal or abnormal;
used to help diagnose
blood-related
conditions, such as
iron deficiency anemia
(where there are less
red blood cells than
normal).

MCV 89.00 80-94 Measures the average Normal

size of red blood cells.

MCH 28.70 26-38 To calculate the Normal

amount of hemoglobin
in an individual red
blood cell.

MCHC 32.20 33-37 Checks the average Normal

amount of hemoglobin
in a group of red blood
cells.

Chemistry
Date Received: 2/15/2023
Glycosylated Hemoglobin

Result Normal Value

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 14.2% 4.3-6.4%

Date Received: 2/15/2023 12:04 PM

Lab Test Result Normal Value Interpretation

Creatinine 0.61 0.73-1.18 mg/dL Low

Blood Uric Acid 5.70 3.5-7.2 mg/dL Normal

Serum glutamic-pyruvic 12.35 0-55 v/L Normal

transaminase/Alanine
aminotransferase
(SGPT/ALT)

Sodium 138.30 136 -145 mmol/L Normal

Potassium 3.82 3 - 5.1 mmol/L Normal

Chemistry
Date Received: 2/16/2023
Test Result Normal Value NeInterpretation
Total Cholesterol 165.94 0-200 mg/dL Normal
Triglycerides 73.59 0-100 mg/dL Normal
HDL Cholesterol 63.34 40-60 mg/dL High
LDL Cholesterol 87.88 0-100 mg/dL Normal
VLDL 14.72 5.00-40.00 mg/dL Normal

Clinical Microscopy (Urinalysis)

Date Received:2/15/2023 2:58 PM
Test Result Test Result
Colon Yellow Specific gravity 1.020
Transparency Slightly Turbid Ketone +3
Leukocyte Negative Bilirubin Negative
Nitrite Negative Glucose +3
urobilinogen Negative PUS Cells 0-1
Protein 0.2 RBC 0-1

9
pH 1+ Amorphous Urates Few
Blood Negative Epithelial Cells Few
Mucus Thread +1
Bacteria Few

6. Disease Condition / Surgery

DISEASE CONDITION: Type II Diabetes

Definition:
There are two main problems related to insulin in type 2 diabetes, the insulin resistance,
and impaired insulin secretion. An impaired tissue response to insulin is referred to as insulin
resistance. Usually, insulin attaches to distinct receptors on cell surfaces and starts a chain of
reactions vital to the metabolism of glucose. These intracellular processes are impaired in type 2
diabetes, making insulin less effective at promoting glucose absorption by tissues and regulating
glucose released by the liver. Although genetic factors are assumed to be involved, the precise
mechanisms that cause insulin resistance and decreased insulin production in type 2 diabetes are
unknown.

ANATOMY AND PHYSIOLOGY

Pancreas - The pancreas is an elongated,

tapered organ located across the back of the
belly, behind the stomach. It has both
exocrine and endocrine functions. The
exocrine functions include secretion of
pancreatic enzymes into the gastrointestinal
(GI) tract through the pancreatic duct. The
endocrine functions include secretion of
insulin, glucagon, and somatostatin directly
into the bloodstream. The islets of
Langerhans, the endocrine part of the
pancreas, are collections of cells embedded in
the pancreatic tissue. They are composed of
alpha, beta, and delta cells. The hormone produced by the beta cells is called insulin, the alpha
cells secrete glucagon, and the delta cells secrete somatostatin.

Pancreatic Duct - Pancreatic duct is the main duct which runs the length of the pancreas. It
drains the pancreatic fluid from the gland and carries it to the duodenum.

Bile Duct - Bile ducts are tiny canals that connect some of the organs in our digestive system.
Their purpose is to carry bile between these organs. The body uses bile for several purposes, and
bile ducts are the ones that carry it safely from one organ to another.

10
Duodenum - Duodenum’s primary function is to begin the digestive process of breaking down
and absorbing nutrients needed by the body.

ETIOLOGY

Type 2 Diabetes Mellitus (T2DM) is a common metabolic disorder caused by defective

insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond
appropriately to insulin. This disorder is also known as “adult-onset diabetes”, however, there is
increasing prevalence in younger patients, including children. Besides having a family history of
DM, unhealthy eating habits and/or having a sedentary lifestyle, significantly increases the risk
or possibility to acquire the disease. Studies have also discovered that simple carbohydrate-rich
diets, diets involving heavily processed carbohydrates and processed foods are known to increase
the risk of acquiring T2DM.

In the patient’s context, a multitude of factors brought about the manifestation of T2DM.

 The patient has a family history of diabetes mellitus (both his mother’s and father’s side).
 The patient does not have any physical activity outside of home activities and work. He
also expresses that he has an undesirable sleep schedule (3-5 hours of sleep most of the
time).
 The patient is a truck driver on a hectic schedule, so he tends to eat what is affordable and
readily available.
• Notably, the patient is on a diet that involves a lot of rice and soft drinks (although
he still has a healthy variety of dishes).
• In the patient’s residence, there was a narrated lack of drinking water supply, and
concurrently, they also have a sari-sari store, to which, when the patient would
become thirsty, he would take soft drinks or juice from their own stock to drink.
• The patient directly expressed that he is very fond of sweets, sweet drinks, salty
snack foods, and the occasional beer.

The patient only discovered that he had uncontrolled T2DM when he was hospitalized. His
condition may have been aggravated due to the following factors:

• He was prescribed maintenance medication, however, he only takes it “when he

thinks he needs it”, instead of taking it on its prescribed schedule.
• He knows how to check his blood glucose but rarely performs it.
• The patient occasionally continues the same diet despite the doctor's advice.

SIGN AND SYMPTOMS

The following are the signs and symptoms of Diabetes Mellitus. The highlighted ones are the
signs and symptoms present in the patient.

11
 ● Increased Thirst
● Frequent Urination
● Increased Hunger
● High levels of blood glucose
● Unintended Weight Loss
● Fatigue
● Blurred Vision
● Slow Healing Sores
● Frequent Infections
● Numbness in Hands or Feet
● Visible Areas or Darkened Skin

PATHOPHYSIOLOGY

The patient has a family history of diabetes from both mother and father side. Patient was living
a sedentary lifestyle and following an unbalanced diet which is mostly composed of sweets.
Patient is a male and 33 years of age which makes him more susceptible to having diabetes.
Moreover, the patient has a maintenance medication atorvastatin for managing his high
cholesterol levels. All of which are risk factors of having insulin resistance which leads to the
increased work of beta cells to secrete insulin. As time passes by the situation of insulin
resistance worsens which keeps beta cells to work and worse be overworked and this results in
decreased insulin secretion. Sooner or later beta cells deteriorate which causes insulin to not be
produced and this leads to having type 2 diabetes where the patient needs insulin injections and
anti-diabetic maintenance medications. The signs and symptoms that can be observed in our
diabetic patient are increased thirst, frequent urination, increased hunger, high levels of blood
glucose, blurred vision, numbness in hands or feet.

12
13
 DRUG STUDY: METFORMIN
Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: Metformin Adjunct to diet &  Hypersensitivit  Nausea  Verify patient’s
Metformin Hydrochloride is an exercise to improve y to any  Diarrhea identity by
antihyperglycemic glycemic control in component of  gastric pain, stating the
Brand Name: agent which patients w/ type II the drug. constipation complete name.
Normax improves glucose diabetes.  Vomiting  Educate the
tolerance in  Contraindicated  metallic taste in patient about
Therapeutic NIDDM (Type 2 Normax for those with the mouth the name of the
Classification: diabetes mellitus) (Metformin Type I diabetes  Rash medication as
Anti-diabetic subjects, lowering hydrochloride  Pruritus well as its
both basal extended-release  Renal or hepatic  Urticaria indication.
Dosage: postprandial plasma tablets USP) is oral failure  erythema &  Instruct the
500 mg 1 tab BID glucose. Its antihyperglycemic flushing patient to take
pharmacological drug used in the  headache & the medication
Route: mechanisms of management of dizziness in high fowlers
Oral (tablet) action are different type 2 diabetes.  Impaired GI position in
from those of absorption of order to prevent
sulfonylureas. vit B12 & folic aspiration.
acid  Instruct the
patient to take
the medication
with meals.
 Instruct patient
to do not crush
or chew the
medication.
 Monitor the
capillary blood
glucose of the
patient.

14
  Instruct the
patient about
strict adherence
to diabetic diet.
 Document that
the drug was
given including
the time.

DRUG STUDY: ATORVASTATIN

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: Atorvastatin is in a Used to lower your  Hypersensitivit Common side  Verify patient’s
Atorvastatin class of cholesterol to help y to the drug effects: identity by
medications called protect your heart stating the
Brand Name: HMG-CoA and blood vessels  Active liver  Drowsiness complete name.
Lipitor reductase inhibitors from serious, and disease or  Dizziness  Educate the
(statins). It works even life- unexplained  Nausea patient about
Therapeutic by slowing the threatening, persistent  Constipation the name of the
Classification: production of medical problems, elevations of medication as
Antilipemic cholesterol in the such as heart attack serum Adverse effects: well as its
body to decrease or stroke) transaminases indication.
Dosage: the amount of  blurred vision;  Make sure that
10 mg ODHS cholesterol that  Active liver tinnitus; the patient is
may build up on the disease or abdominal following a
Route: walls of the arteries unexplained discomfort, standard low
Oral (tablet) and block blood persistent eructation; cholesterol diet.
flow to the heart, elevations of hepatitis,  Instruct the
brain, and other serum cholestasis; patient that the
parts of the body. transaminases urticaria; drug can be
exceeding 3x muscle fatigue, taken with or

15
the ULN neck pain; without meals.
malaise  Instruct the
patient to take
the medication
with full glass
of water and
strictly do not
take it together
with grapefruit
juice.
 Instruct the
patient to take
the medication
in high fowlers
position in
order to prevent
aspiration.
 Advice the
patient that the
medication can
cause
drowsiness so
avoid standing
up and going to
the restroom
alone if feeling
drowsy.
 Monitor vital
signs before and
after
administering
the drug.
 Document that

16
 the drug was
given including
the time.

DRUG STUDY: OMEPRAZOLE

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: Inhibits proton For short-term and  Hypersensitivity CNS: asthenia,  Verify patient’s
Omeprazole pump activity by maintenance to the dizziness, headache identity by
binding to treatment of medication stating the
Brand Name: hydrogen- duodenal and GI: abdominal complete name.
Risek potassium gastric ulcer,  Contraindicated pain, constipation,  Educate the
adenosine pathological in persons with diarrhea, flatulence, patient about
Therapeutic triphosphate, hypersecretory gastric nausea, vomiting, the name of the
Classification: located at secretory conditions; GERD, malignancy acid regurgitation medication as
Proton Pump surface of gastric NSAID-associated well as its
Inhibitor parietal cells, to gastric and Musculoskeletal: indication.
suppress gastric duodenal ulcers or back pain,  Check the
Dosage: acid secretion. erosions, acid weakness patency of the
40 mg + 10 mL related dyspepsia, IV line.
diluent amp OD and erosive Respiratory:  Clean the
esophagitis. cough, upper insertion site
Route: respiratory with a cotton
Intravenous (IV) infection soaked in
alcohol and
Skin: rash slowly infused
the medication
to avoid feeling
of pain for the
patient.
 Monitor

17
 improvements
in GI symptoms
(gastritis,
heartburn, etc.)
to help know if
drug therapy is
successful.
 Monitor other
CNS side
effects
(drowsiness,
fatigue,
weakness,
headache), and
report severe or
prolonged
effects.
 Advise patient
to avoid alcohol
and foods that
may cause an
increase in GI
irritation.
 Instruct patient
to report
bothersome or
prolonged side
effects,
including skin
problems
(itching, rash)
or GI effects
(nausea,

18
 diarrhea,
vomiting,
constipation,
heartburn,
flatulence,
abdominal
pain).
 Document that
the drug was
given including
the time.

DRUG STUDY: LINAGLIPTIN

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: Linagliptin is a Adjunct to diet and  Contraindicated CNS: headache  Verify the
Linagliptin dipeptidyl exercise to in patients with patient’s
peptidase-4 (DPP- improve glycemic hypersensitivity EENT: identity.
Brand Name: 4) inhibitor. control in adults to the drug. nasopharyngitis  Instruct and
Trajenta with type 2 inform the
Increases and diabetes as  Type-1 diabetes GI: diarrhea, patient about
Therapeutic prolongs active monotherapy or as mellitus constipation the indication
Classification: incretin levels, a combination of the
Antihyperglycemics thereby increasing therapy with an  Diabetic Metabolic: medication.
insulin release and insulin ketoacidosis hyperlipidemia,  Routinely
Dosage: decreasing secretagogue (such weight gain, monitor
5 mg OD PM glucagon levels in as sulfonylurea) or  Diarrhea, hypoglycemia patient’s CBG
the circulation in a insulin. gastroparesis, to see effect;
Route: glucose-dependent vomiting Musculoskeletal: look out for
Oral manner. (deferred while arthralgia, back hypoglycemia.
patient is under pain, myalgia  Advise patient

19
 NPO) to report for
Respiratory: upper
 Hypercortisolism cough, URI abdominal pain
, hyperglycemia, radiating from
hyperthyroidism the back.
(Possible
pancreatitis)
 Advise patient
to move slowly
when sitting up
or standing, as
drug may cause
dizziness or
weakness. In
patient context,
this drug is
given during
the evening
because patient
is bound to rest.
 Document that
the drug was
given including
the time.

DRUG STUDY: METOCLOPRAMIDE

Drug Name Mechanism of Indication Contraindications Common Side Nursing

20
 Action Effects/Adverse Considerations
Effects
Generic Name: Stimulates motility Management of  Contraindicated in  Occasionally,  Verify the
Metoclopramide of upper GI tract, nausea and patients parkinsonism patient’s
increases lower vomiting hypersensitive to and tardive identification.
Brand Name: esophageal associated with drug and in those dyskinesia  Inform the
Plasil sphincter tone, and various GI with during patient about
blocks dopamine disorders, in pheochromocytoma prolonged the indication of
Therapeutic receptors at the GERD and gastric or other treatment in the medication.
Classification: chemoreceptor stasis. catecholamine- elderly.  Check for the
Antiemetics trigger zone. releasing  Restlessness patency of the
paragangliomas,  Drowsiness IV line.
Dosage: tardive dyskinesia,  Dizziness  Monitor
1 amp IV PRN or seizure  Headache patient’s bowel
now then q8 for disorders.  Bowel upsets sounds.
vomiting  Hypotension  Drug may cause
 In patients whom  Hypertension tardive
Route: stimulation of GI  Depression dyskinesia,
Intravenous (IV) motility might be  Hypersensitivity parkinsonian
dangerous (those reactions symptoms, and
with hemorrhage,  Urinary motor
obstruction, or incontinence restlessness.
perforation)  Monitor patient
for involuntary
movements of
face, tongue,
and extremities.
 Monitor patient
for fever, CNS
symptoms,
irregular pulse,
cardiac
arrhythmias or

21
 abnormal bp,
which may
indicate
neuroleptic
malignant
syndrome.
 Monitor patient
for dizziness,
headache, or
nervousness
after
metoclopramide
is stopped;
these may
indicate
withdrawal.
 Document that
the drug was
given including
the time.

DRUG STUDY: INSULIN GLARGINE

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations

22
 Effects
Generic Name: Lowers blood Control of  Contraindicated  Allergic  Verify the patient’s
Insulin Glargine glucose by hyperglycemia in to patient with reactions. identity.
stimulating glucose diabetic patients. hypersensitivity  Hypoglycemia,  Inform the patient
Brand Name: uptake in skeletal to insulin  hypokalemia. about the
Podevta muscle and fat, glargine and  Injection site indication of the
inhibiting hepatic hypoglycemia. reaction such as medication.
Therapeutic glucose production. rash, redness,  Clean the injection
Classification: irritation. site with alcohol
Anti diabetic swab, pinch the
skin and inject at a
Dosage: 45-degree angle.
10 units  Monitor signs of
allergic reactions.
Route:  Monitor for S&S
Subcutaneous of hypoglycemia
injection especially after
changes in insulin
dose or type.
 Monitor fasting
blood glucose and
HbA1C
periodically.
 Withhold drug and
notify physician if
patient is
hypokalemic.
 Report persistent
or repeated
episodes of
hypoglycemia to
the physician.
 Assess blood

23
 pressure
periodically.
 Document that the
drug was given
including the time.

DRUG STUDY: BIPHASIC ISPOPHANE INSULIN

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: It inhibits hepatic Treatment of  Hypersensitivity  Hypoglycemia  Verify the patient’s
Biphasic Isophane glucose production type 1 & 2 DM  Hypoglycemia,  Headache identity
Insulin and enhances & gestational patients in coma  Nausea  Educate the patient
peripheral glucose diabetes; due to  Palpitation about the
Brand Name: disposal thereby emergency hyperglycemia.  Local & indication of the
Insuget 70/30 reducing blood- management of generalized drug
glucose diabetic hypersensitivity  Advise the patient
Therapeutic concentration. It ketoacidosis. reaction that there would be
Classification: also inhibits a slight discomfort
Anti-Diabetic lipolysis thereby because of the
preventing the needle of the lancet
Dosage: formation of ketone  Clean the injection
30 mins pre-meal bodies. site in circular
26-0-14 units motion specifically
on the left upper
Route: quadrant of the
Subcutaneous abdomen
injection  Pinch the skin and
put the needle in at
a 45º angle.
 Push the plunger of
the syringe until all

24
 of the insulin is out
of the syringe.
 Quickly pull the
needle out. Do not
rub the injection
site.
 Continue to
monitor the
Capillary Blood
Glucose of the
patient
 Instruct the patient
about the needed
diet
 Document the
findings and the
medication given
 Document that the
drug was given
including the time.

DRUG STUDY: INSULIN HUMAN (rDNA)

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects

25
 Generic Name: The primary Patients w/ DM  Hypersensitivit  low blood  Verify the
Insulin Human activity of insulin, who require insulin y to the sugar; patient’s
(rDNA) including for the maintenance medication  swelling in your identity
HUMULIN R, is of glucose  Hypoglycemia. hands or feet;  Educate the
Brand Name: the regulation of homeostasis.  weight gain; or. patient about
Humulin R glucose  thickening or the indication of
metabolism. Insulin hollowing of the drug
Therapeutic lowers blood the skin where  Advise the
Classification: glucose by you injected the patient that
Anti-Diabetic stimulating medicine. there would be
peripheral glucose a slight
Dosage: uptake, especially discomfort
PRN at 12 nn only by skeletal muscle because of the
for CBG; and fat, and by needle of the
>180 = 4 units, inhibiting hepatic lancet
>200 = 6 units, glucose production  Clean the
>250 = 8 units injection site in
circular motion
Route: specifically on
Subcutaneous the left upper
injection quadrant of the
abdomen
 Pinch the skin
and put the
needle in at a
45º angle.
 Push the
plunger of the
syringe until all
of the insulin is
out of the
syringe.
 Quickly pull the

26
 needle out. Do
not rub the
injection site.
 Continue to
monitor the
Capillary Blood
Glucose of the
patient
 Instruct the
patient about
the needed diet
 Document that
the drug was
given including
the time.

DRUG STUDY: DOMPERIDONE

Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: Acts as an Treatment for  Patient with  Dry mouth  Verify patient’s
Domperidone antiemetic and a nausea and severe hepatic  Dizziness identity before
prokinetic agent vomiting impairment  Chest pain giving the
Brand Name: through its effects  Patient with  Tiredness medication
Domilium on the cardiac diseases  Headaches  Educate the
chemoreceptor  Patient with patient about
Therapeutic trigger zone and electrolyte the side effects
Classification: motor function of disturbances and indication
Antiemetic the stomach and of the
small intestine. It medication
Dosage: increases the  Inform the
10 mg TID 30 mins movements or patient to take

27
 before meal contractions of the the medicine
stomach and bowel. before meals
Route: (suggested 15-
Oral 30 minutes
before meal)
 Inform the
patient not to
take medicine
with grapefruit
juice
 Instruct the
patient not to
engage to
activities like
walking and
getting up bed
to prevent
injury
 Encourage fluid
intake to relieve
dry mouth
 Monitor vital
signs of the
patient
Document that
the drug was
given including
the time.
DRUG STUDY: LANSOPRAZOLE
Drug Name Mechanism of Indication Contraindications Common Side Nursing
Action Effects/Adverse Considerations
Effects
Generic Name: Reduces acid Prescription  Hypersensitivit CNS: headache,  Verify patient’s

28
 Lansoprazole secretion in gastric lansoprazole is used y to dizziness identity before
parietal cells to treat the lansoprazole or giving the
Brand Name: through inhibition symptoms of other proton GI: abdominal medication
Ritemed of (H+, K+)-ATPase gastroesophageal pump pain, constipation,  Educate the
Lansoprazole enzyme system, reflux disease inhibitors. diarrhea, nausea patient about
inhibiting the final (GERD). the side effects
Therapeutic step in gastric acid and indication
Classification: production. of the
Proton Pump medication
Inhibitor  Advise patient
to avoid alcohol
Dosage: and foods that
30 mg 1 cap OD, may cause an
pre-breakfast increase in GI
irritation.
Route:  Inform the
Oral patient to drink
before meals.
Document that
the drug was
given including
the time.

29
 NURSING CARE PLAN #1

NURSING DIAGNOSIS: Ineffective Health Management related to Poor Adherence as evidenced

by Elevated Blood Sugar

DEFINITION Pattern of regulating and integrating into daily

living a therapeutic regimen for the treatment of
illness and its sequelae that is unsatisfactory for
meeting specific health goals.

DEFINING CHARACTERISTICS Failure to include treatment regimen in daily

living and take action to reduce risk factors

RELATED FACTORS Poor adherence to medication

ASSESSMENT

SUBJECTIVE DATA
 “May pangcheck ako ng blood sugar sa bahay pero hindi ako regular na nagchecheck” as
verbalized by the patient.
 “Umiinom lang ako ng maintenance ko kapag nararamdaman ko na parang tumataas na
sugar ko katulad ng ihi ako ng ihi at nararamdaman ko na yung laway ko ay malapot na” as
verbalized by the patient.
 “Alam ko na bawal sa akin ang matatamis pero yun ang hilig ko kainin, pag wala kaming
tubig ay softdrinks iniinom ko” as verbalized by the patient.

OBJECTIVE DATA
 CBG: 394 mg/dL (upon admission)
 CBG: 294 mg/dL at 6 PM 2/17/2023

PLANNING / OUTCOME CRITERIA

After the 8-hour shift, the patient will:

 express willingness to participate in activities improving health status.
 be able to identify appropriate resources and use them.

INTERVENTIONS RATIONALE

30
1. Assess for the Capillary Blood Glucose of the 1. To have a basis of the glucose levels and to
patient. know if interventions are needed to be applied

2. Educate the patient about the importance of

strictly adhering to diabetes maintenance
medications as well as its benefits for health.
2. To properly manage and control the disease

3. Educate the patient about the significance of

regularly monitoring the capillary blood glucose
level.

3. To properly manage the disease and to avoid

4. Instruct the client about the importance of aggravating the condition of the patient
adhering to diabetic mellitus diet.

4. To prevent continuous increase in blood

5. Promote client/caregiver/SO(s) participation in glucose levels that may affect the prognosis of
planning and evaluating process. the condition

5. This enhances commitment to the plan and

promotes competent self-management,
optimizing outcomes.

EVALUATION:
Was the desired goal achieved? ▢ Not met ▢ Partially met ▢ Completely met
 The patient verbalizes understanding about monitoring blood glucose level and adhering to
diabetic medications.

NURSING CARE PLAN #2

31
NURSING DIAGNOSIS: Unstable Blood Glucose Level Related to Lack of Diabetes Management
as Evidenced by Elevated Serum Glucose Level

DEFINITION Variation in serum levels of glucose from the

normal range, which may compromise health.

DEFINING CHARACTERISTICS Variations in blood glucose level

RELATED FACTORS Lack of Diabetes Management and Poor

Adherence to Medications

ASSESSMENT

SUBJECTIVE DATA
 “Umiinom lang ako ng maintenance ko kapag nararamdaman ko na parang tumataas na sugar ko
katulad ng ihi ako ng ihi at nararamdaman ko na yung laway ko ay malapot na” as verbalized by
the patient.
 “Alam ko na bawal sa akin ang matatamis pero yun ang hilig ko kainin, pag wala kaming tubig ay
softdrinks iniinom ko” as verbalized by the patient.
 “May pangcheck ako ng blood sugar sa bahay pero hindi ako regular na nagchecheck” as
verbalized by the patient.

OBJECTIVE DATA
 394 mg/dL (upon admission 2/15/2023)
 236 mg/dL (12 noon, 2/15/2023)
 226 mg/dL (6 PM, 2/15/2023)
 192 mg/dL (6 AM, 2/16/2023)
 136 mg/dL (6 PM, 2/16/2023)
 154 mg/dL (6 AM, 2/17/2023)
 246 mg/dL (6 PM, 2/17/2023)

PLANNING / OUTCOME CRITERIA

After the 8-hour shift, the patient will:

 be able to acknowledge factors that lead to unstable blood glucose level.

32
 maintain glucose level within satisfactory range.

INTERVENTIONS RATIONALE

1. Assess for signs of hyperglycemia. 1. Hypoglycemia may occur when there is an

inadequate amount of insulin to glucose.

2. A lot of drugs can cause fluctuations in blood

2. Assess medications taken regularly.
glucose as a side effect.

3. Critical values for hypoglycemia are less than

3. Monitor blood glucose levels as fasting and 40 to 50 mg/dL. Critical values for
postprandial levels. hyperglycemia are greater than 400 mg/dL.

4. Blood glucose should be between 140 to 180

mg/dL.
4. Assess blood glucose level before meals and at
bedtime.
5. To make sure that the management of the
disease will be effective.
5. Assess the patient’s current knowledge and
understanding about the prescribed diet.
6. To identify and manage glucose variations.

6. Discuss home glucose monitoring according to

individual parameters

7. To provide a sense of control and enable the

7. Encourage the client to develop a system for client to follow his or her own progress and assist
self- monitoring with making choices.

EVALUATION:
Was the desired goal achieved? ▢ Not met ▢ Partially met ▢ Completely met
 The patient acknowledged the factors that can contribute to unstable blood glucose level.
 The patient’s blood glucose level at 6 PM of 2/17/2023 is 246 mg/dL.
THEORY APPLICATION:

33
The Theory of Goal Attainment by Imogene King

The Theory of Goal Attainment states that “Nursing is a process of action, reaction, and
interaction by which nurse and client share information about their perception in a nursing
situation” and “a process of human interactions between nurse and client whereby each perceives
the other and the situation, and through communication, they set goals, explore means, and agree
on means to achieve goals.”

The three interacting systems in the Theory of Goal Attainment

● The personal system concepts are perception, self, growth and development, body
image, space, and time.
● The concepts for the interpersonal system are interaction, communication, transaction,
role, and stress.
● The social system concepts are organization, authority, power, status, and decision-
making.

The patient in this case is aware that he has type II diabetes and that there are
precautionary measures he may undertake to safeguard his health, but before the admission, he
was not compliant, especially when it comes to taking his medications. He eats sweets, junk
foods, and soft drinks despite knowing that they are harmful for his health. Applying the theory
of goal attainment, the nurses communicate with the patient and set goals to help him maintain
his health so he can function in his role. Prior to admission, he recognizes that he must comply
with all of these in order to maintain his health such as limiting intake of food rich in sugar,
maintaining a balance between activity and rest, etc. With the help of others, including us,
nurses, and his spouse or another family member, he may manage his own needs while being
aware of the significance of these interventions and eventually change his behavior toward them.

HEALTH EDUCATION AND DISCHARGE PLAN

DIET AND LIFESTYLE:
● Inform the patient about dietary restrictions and importance of meal planning.
● Instruct the patient to eat foods that are high in fiber, low in fat, and with low glycemic
index.
● Do not skip meals; eat meals and snacks at the same time each day.
● Educate the patient about the importance of drinking water or low-calorie drinks, instead
of soft drinks.
● Advise the patient to lessen the consumption of processed food, and eat more foods rich
in nutrients.
● Advise the patient to only drink alcohol in moderation or occasionally.

34
 ● Advise the patient to perform some physical activities/exercise at least 30 mins to 1 hour
a day.
● Educate the patient about the importance of managing stress.

MEDICATION AND MANAGEMENT:

● Educate the patient on how to properly take the medication; whether to take it with or
without meals, before or after meals, or at bedtime.
● Instruct the patient about the strict adherence to maintenance medication.
● Instruct the patient to pay attention to their feet. High blood sugar can reduce blood flow
and cause damage to the nerves in the feet.
● Educate the patient on how to monitor blood glucose using glucometer, as well as its
importance.
● Advise the patient to have a logbook that contains CBG results to help detect patterns in
CBG results.
● Educate the patient about the importance of having regular check-ups.

REFERENCES:
 Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 15th Ed.
 https://diabetesatlas.org/
 https://psa.gov.ph/vital-statistics/id/168144
 https://hellodoctor.com.ph/diabetes/diabetes-statistics-in-the-philippines/
 https://medlineplus.gov/ency/article/000313.htm
 https://www.bcm.edu/healthcare/specialties/oncology/cancer-types/gastrointestinal-
cancers/pancreatic-cancer/pancreas-and-its-function#:~:text=The%20main%20duct%20is
%20the,part%20of%20the%20small%20intestine).
 https://my.clevelandclinic.org/health/body/24523-bile-duct
 https://nurseslabs.com/imogene-m-kings-theory-goal-attainment/
 https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-
management/art-20045803#:~:text=Make%20healthy%20eating%20and%20physical,by
%20your%20health%20care%20provider.
 https://www.nursingcenter.com/getattachment/Clinical-Resources/nursing-pocket-
cards/Discharge-Planning-for-Patients-with-Diabetes-Mell/Pocket-Card_Discharge-
Planning-for-Patients-with-Diabetes_November-2022.pdf.aspx

35