STUDENT’S NAME: Jilkiah Mae A.

Campomanes

Name of the Patient: Lando Ramos Antigua Age: 70

Diagnosis: Diabetes Type 2

I. Brief Description of the Disease

A. Definition
Type 2 diabetes is an impairment in the way the body regulates and uses
sugar (glucose) as a fuel. This long-term (chronic) condition results in too
much sugar circulating in the bloodstream. Eventually, high blood sugar
levels can lead to disorders of the circulatory, nervous and immune systems.
In type 2 diabetes, there are primarily two interrelated problems at work.
Your pancreas does not produce enough insulin — a hormone that regulates
the movement of sugar into your cells — and cells respond poorly to insulin
and take in less sugar.

B. Risk factors
Factors that may increase your risk of type 2 diabetes include:
 Weight. Being overweight or obese is a main risk.
 Fat distribution. Storing fat mainly in your abdomen —
rather than your hips and thighs — indicates a greater risk.
Your risk of type 2 diabetes rises if you're a man with a waist
circumference above 40 inches (101.6 centimeters) or a
woman with a measurement above 35 inches (88.9
centimeters).
 Inactivity. The less active you are, the greater your risk.
Physical activity helps control your weight, uses up glucose
as energy and makes your cells more sensitive to insulin.
 Family history. The risk of type 2 diabetes increases if your
parent or sibling has type 2 diabetes.
 Race and ethnicity. Although it's unclear why, people of
certain races and ethnicities — including Black, Hispanic,
Native American and Asian people, and Pacific Islanders —
are more likely to develop type 2 diabetes than white people
are.
 Blood lipid levels. An increased risk is associated with low
levels of high-density lipoprotein (HDL) cholesterol — the
"good" cholesterol — and high levels of triglycerides.
 Age. The risk of type 2 diabetes increases as you get older,
especially after age 45.
 Prediabetes. Prediabetes is a condition in which your blood
sugar level is higher than normal, but not high enough to be
classified as diabetes. Left untreated, prediabetes often
progresses to type 2 diabetes.
 Pregnancy-related risks. Your risk of developing type 2
diabetes increases if you developed gestational diabetes
when you were pregnant or if you gave birth to a baby
weighing more than 9 pounds (4 kilograms).
 Polycystic ovary syndrome. Having polycystic ovary
syndrome — a common condition characterized by irregular
 menstrual periods, excess hair growth and obesity —
increases the risk of diabetes
 Areas of darkened skin, usually in the armpits and neck.
This condition often indicates insulin resistance.
C. Signs and Symptoms or Clinical Manifestation
Signs and symptoms of type 2 diabetes often develop slowly. In
fact, you can be living with type 2 diabetes for years and not know
it. When signs and symptoms are present, they may include:
 Increased thirst
 Frequent urination
 Increased hunger
 Unintended weight loss
 Fatigue Blurred vision
 Slow-healing sores
 Frequent infections
 Numbness or tingling in the hands or feet
 Areas of darkened skin, usually in the armpits and neck
D. Management/Nursing Interventions
1. Assess blood glucose levels before meals and bedtime
2. Monitor the patient’s HbA1c-glycosylated hemoglobin.
3. Weight daily.
4. Administer basal and prandial insulin.
5. Watch out for signs of morning hyperglycemia.
6. Teach the patient how to perform home glucose monitoring.
7. Instruct patient to take oral hypoglycemic medications as directed
8. Instruct patient to take insulin as directed
9. Instruct patient on the proper injection of insulin.
10. Educate patient on the correct rotation of injection sites when administering
insulin.
11. Stress the importance of achieving blood glucose control.

II. Patient’s Signs and Symptoms or Clinical manifestations

 Elevated blood glucose of 175 mg/dL
 RR = 30
 ANATOMY AND PHYSIOLOGY

PANCREAS

Function/s:
A healthy pancreas produces the correct chemicals in the proper quantities, at the right times,
to digest the foods we eat. The endocrine component of the pancreas consists of islet cells
(islets of Langerhans) that create and release important hormones directly into the
bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood
sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is
crucial to the functioning of key organs including the brain, liver, and kidneys.
 Bile Duct - the duct that conveys bile from the liver and the gallbladder to
the duodenum.
 Accessory Pancreatic Duct - the main drainage duct of the dorsal
pancreatic bud in the embryo, entering the duodenum at the minor
duodenal papilla (MIP).
 Pancreatic Duct - a duct joining the pancreas to the common bile duct.
This supplies it with pancreatic juice from the exocrine pancreas, which
aids in digestion.

Reference/Source: https://columbiasurgery.org/pancreas/pancreas-and-its-
functions#:~:text=The%20pancreas%20is%20an%20organ,function%20that%20regulates
%20blood%20sugar.

DIABETES TYPE 2
PATHOPHYSIOLOGY
 PANCREAS

Risk Factors:
Etiology/Causative agent: Modifiable:
1. Smoking
Insulin resistance from its receptors 2. Unhealthy Lifestyle
________________________________ 3. Obesity
4. Inactivity
Nonmodifiable:
1. Age
2. Genetic/Inheritance
Hyperinsulinemia 3. Fat distribution
________________________ 4. Chronic disease
5. Hypertension
6. Race and Ethnicity
Compensated insulin due to
resistance
______________________________

Hyperglycemia
_________________________________________

SYMPTOMS

Glucosuria
(Osmotic Diuresis) Polyphagia Blurred Vision

Polyuria Polydipsia

Dehydration

Reference/Source: https://www.youtube.com/watch?v=W0KPwTy0W9k
LABORATORY/DIAGNOSTIC STUDIES
 Date/Exam Patient’s Normal Significance/Interpretation
Results Values
Hematology/Complete CBC is a blood test. It helps healthcare providers
Blood Count detect a range of disorders and conditions. It
         RBC 4.84 4.70 – 6.0 also checks your blood for signs of medication
         WBC side effects. Providers use this test to screen for
              Eosinophil 0.2 0-6 diseases and adjust treatments. A CBC
measures and counts your blood cells.
              Basophil 0.1 0-2.0
               INTERPRETATIONS:
Neutrophil 79.9 50-70 Hematocrit: A low hematocrit level means
there are too few red blood cells in the body.
         Platelet 170 150-450
          Neutrophils: A high neutrophil count may be
due to many physiological conditions and
Hemoglobin 139 135 - 180 diseases. In most cases, high neutrophils count
is commonly associated with an active bacterial
         Hematocrit 0.40 0.42 – 0.52 infection in the body.

Lymphocyte: Lymphocyte counts below the

normal range can also be temporary. They can
occur after a cold or another infection, or be
caused by intense physical exercise, severe
stress, or malnutrition.

Blood Glucose

HGT 175 mg/dL 14o mg/dL Elevated blood sugar. Patient is hyperglycemic.

Reference/Source: https://pubmed.ncbi.nlm.nih.gov/7634877/#:~:text=An%20increase%20in
%20serum%20lactate,a%20variety%20of%20extrapulmonary%20disorders.

DRUG STUDY
 Name of the Mechanism of Action Indications Side Effects Nursing
Drug Responsibilities
Generic name: Tazobactam inhibits ZOSYN is indicated
Piperacillin- beta lactamase and in adults for the CNS: Before:
Tazobactam prevents the treatment of Headache, Obtain history of
destruction of uncomplicated and insomnia, hypersensitivity to
Brand name: piperacillin. complicated skin agitation, penicillins,
Zosyn Therefore, and skin structure dizziness, anxiety, cephalosporins, or
tazobactam is given infections, including fever, pain. other drugs prior to
Classification: with piperacillin to cellulitis, cutaneous administration.
extended- enhance the activity abscesses and CV: hypertension,
spectrum of piperacillin in ischemic/diabetic tachycardia, chest Lab tests: C&S prior
penicillin/beta eradicating bacterial foot infections pain, edema. to first dose of the
-lactamase infections. caused by beta- drug
inhibitor, Piperacillin kills lactamase Hematologic:
antibiotic bacteria by inhibiting producing isolates leukopenia, During:
the synthesis of of Staphylococcus anemia, Administer drug
bacterial cell walls. aureus. eosinophilia, while results are
Dosage: thrombocytopenia. pending.
4.5 gm Contraindications
Severe allergic GI: After:
Frequency: reaction to any type diarrhea, nausea, Monitor
every 6H of cephalosporin constipation, hematologic status
antibiotic vomiting, with prolonged
Route: dyspepsia, stool therapy
IV drip changes,
abdominal pain. Monitor patient
Timing: carefully during the
first 30 min after
initiation of the
infusion for signs of
hypersensitivity

Reference/Source:
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/P053.html

Name of the Drug Mechanism of Indications Side Effects Nursing

Action (by system) Responsibilities
Generic name: Reversibly binds Pneumonia, lower
 Azithromycin to the 50S respiratory tract CNS: Before:
ribosomal subunit infections, Headache, Assess
Brand name: of susceptible pharyngitis/tonsilli dizziness, hypersensitivity to
Zithromax organisms and tis, gonorrhea, insomnia azithromycin,
consequently nongonococcal erythromycin, or
Classification: inhibits protein urethritis, skin and GI: any macrolide
Anti-infective, synthesis. skin structure Diarrhea, antibiotic;
macrolide infections due to nausea, gonorrhea or
antibiotic susceptible vomiting, syphilis,
organisms, otitis stomach pseudomembranou
Dosage: media, Mycobacte pain, s colitis, hepatic or
500mg/tap, 1 tap rium avium– constipation, renal impairment,
intracellulare com lactation
Frequency: plex infections,
Once daily acute bacterial Culture site of
infection
sinusitis.
Route:
Oral Contraindications During:
Hypersensitivity to Administer on an
Timing: azithromycin, empty stomach 1
erythromycin, or hr before or 2–3
any of the hr after meals.
macrolide
After:
antibiotics.
Monitor for and
report loose stools
or diarrhea

Reference/Source:
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/A092.html

https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/azithromycin/

Name of the Mechanism of Indications Side Effects Nursing

Drug Action (by system) Responsibilities
Generic name: Long-acting Dexamethasone and
Dexamethasone synthetic ciprofloxacin otic suspension is CNS: Before:
adrenocorticoid indicated for bacterial Headache, Assess for
Brand name: with intense infections with inflammation in dizziness, hypersensitivity.
Decadron, antiinflammatory acute otitis media and acute insomnia,
Dexamethason (glucocorticoid) otitis externa. Intramuscular depression, During:
e Intensol, activity and and intravenous injections are anxiety
Dexasone, minimal indicated for a number of
Solurex, mineralocorticoid endocrine, rheumatic, collagen,
Baycadron activity. dermatologic, allergic, CV: After:
Antiinflammatory ophthalmic, gastrointestinal, Monitor for S&S of
Classification: action: Prevents respiratory, hematologic, RESPI: a hypersensitivity
Corticosteroids accumulation of neoplastic, edematous, and reaction
, Anti- inflammatory other conditions. Oral tablets GI:
inflammatory cells at sites of are indicated for the treatment Upset
agents infection; inhibits of multiple myeloma. An stomach, Monitor and report
phagocytosis, intravitreal implant is indicated stomach S&S of Cushing's
Dosage: lysosomal for some forms of macular irritation, syndrome
6mg enzyme release, edema and non-infectious vomiting,
and synthesis of posterior uveitis affecting the nausea,
Frequency: selected chemical posterior of the eye. Various bloating
Once Daily mediators of ophthalmic formulations are
inflammation; indicated for inflammatory
Route: reduces capillary conditions of the eye.
IVTT dilation and
permeability. Contraindications
Timing: Immunosuppressi Systemic fungal infection, acute
on: Not clearly infections, active or resting
understood, but tuberculosis, vaccinia, varicella,
may be due to administration of live virus
prevention or vaccines (to patient, family
suppression of members), latent or active
delayed amebiasis. Ophthalmic use:
hypersensitivity Primary open-angle glaucoma,
immune reaction. eye infections, superficial
ocular herpes simplex, keratitis
and tuberculosis of eye. Safe
use during pregnancy (category
C), lactation, or in children is
not established.

Reference/Source: https://go.drugbank.com/drugs/DB01234
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/D022.html
https://fadavispt.mhmedical.com/content.aspx?bookid=1873&sectionid=139007808

Name of the Mechanism of Action Indications Side Effects Nursing

Drug (by system) Responsibilities
 Generic Colchicine’s exact Prevent acute attacks
name: mechanism of action of gout as CNS: Before:
Colchicine is unknown, but it’s prophylactic or Sensory Assess for
involved in leukocyte maintenance motor hypersensitivity
Brand name: migration inhibition; therapy. neuropathy
Colcrys reduction of lactic Assess for kidney
acid production by Prevent attacks of GI: or liver problems
Classification: leukocytes, resulting gout in patients Diarrhea,
Anti-gout in decreased deposits undergoing surgery. nausea, During:
drug of uric acid; and vomiting, Administer oral
interference with Acute gout, acute abdominal drug with milk or
kinin formation. gouty arthritis. pain food to reduce
Dosage: Colchicine also possibility of GI
0.5g/tab, 1 reduces the Familial upset.
tab
inflammatory Mediterranean fever
response to deposited After:
Frequency: Amyloidosis Monitor for dose-
uric acid crystals and
Twice a day suppressant related adverse
diminishes
phagocytosis. effects
Route: Dermatitis
Oral herpetiformis Monitor for early
suppressant signs of
Timing: colchicine
Hepatic cirrhosis
toxicity
Primary biliary
cirrhosis Monitor I&O
ratio and pattern
Contraindications
Contraindicated in
patients
hypersensitive to
drug and in those
with blood
dyscrasias or serious
CV, renal, or GI
disease. Use
cautiously in
geriatric or
debilitated patients
and in those with
early signs of CV,
renal, or GI disease.

Reference/Source:
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C108.html

https://glowm.com/resources/glowm/cd/pages/drugs/c081.html

Name of the Mechanism of Action Indications Side Effects Nursing

 Drug (by system) Responsibilities
Generic name: One theory is that In general,
Paracetamol, acetaminophen acetaminophen is used CNS: Before:
Acetaminophe increases the pain for the treatment of Check that the
n threshold by mild to moderate pain patient is not
inhibiting two and reduction of CV: taking any other
Brand name: isoforms of fever. It is available over Low blood medication
Tylenol cyclooxygenase, COX- the counter in various pressure, fast containing
1 and COX-2, which forms, the most heartbeat paracetamol.
Classification: are involved in common being oral
Non-opioid prostaglandin (PG) forms. RESPI: During:
analgesic synthesis. Acetaminophen injectio Administer
Prostaglandins are n is indicated for the GI: tablets or caplets
responsible for management of mild to Nausea, whole or
Dosage: eliciting pain moderate pain, the stomach pain, crushed and give
500mg/tab, 1 sensations. management of loss of with fluid of
tab Acetaminophen does moderate to severe pain appetite patient's choice.
not inhibit with adjunctive opioid
Frequency: cyclooxygenase in analgesics, and the After:
Every 4hrs peripheral tissues reduction of fever. Monitor for
and, therefore, has Because of its low risk of S&S of:
Route: no peripheral anti- causing allergic hepatotoxicity
IVTT inflammatory effects. reactions, this drug can
Though acetylsalicylic be administered in
Timing: acid (aspirin) is an patients who are
irreversible inhibitor intolerant to salicylates
of COX and directly and those with allergic
blocks the active site tendencies, including
of this enzyme, bronchial
studies have shown asthmatics. Specific
that acetaminophen dosing guidelines should
(paracetamol) blocks be followed when
COX indirectly. administering
acetaminophen to
children.
Contraindications
Hypersensitivity to
acetaminophen or
phenacetin; use with
alcohol.

Reference/Source: https://go.drugbank.com/drugs/DB00316

http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/A006.html
https://www.nursingtimes.net/archive/paracetamol-22-04-2004/

Name of the Mechanism of Action Indications Side Effects Nursing

Drug (by system) Responsibilities
 Generic name: Inhibition of DPP-4 by Sitagliptin is indicated
Sitagliptin sitagliptin slows DPP- for the management of CNS: Before:
4 mediated glycemic control in type Headache, Assess for
Brand name: inactivation of 2 diabetes mellitus drowsiness, hypersensitivity
Januvia incretins like GLP-1 along with diet and irritability,
and GIP. Incretins are exercise dizziness, During:
Classification: released throughout Contraindications confusion, Administer
Antidiabetics, the day and Sitagliptin is tablets or caplets
Dipeptyl upregulated in contraindicated in CV: whole or
Peptidase-IV response to meals as patients with a known Tachycardia, crushed and give
Inhibitors. part of glucose sitagliptin with fluid of
homeostasis. hypersensitivity, such as RESPI: patient's choice.
Dosage: Reduced inhibition of anaphylaxis, urticaria,
50mg/tab. 1 incretins increase angioedema, exfoliative GI: After:
tab insulin synthesis and dermatitis or other Hunger Monitor for and
decrease glucagon serious skin conditions report S&S of
Frequency: release in a manner (serious rash), including significant GI
Once Daily dependant on Stevens-Johnson distress,
glucose syndrome. including
Route: concentrations. NV&D.
Oral These effects lead to
an overall increase in Monitor for
Timing: blood glucose control S&S of
which is hypoglycemia
demonstrated by when used in
reduced glycosylated combination
hemoglobin (HbA1c) with a
sulfonylurea
drug or insulin.

Reference/Source: https://medpill.info/sitagliptin-1876.htm

NURSING CARE PLAN

Defining Nursing Scientific Analysis Goal of Care Nursing Rationale

Characteristics Diagnosis Interventions
Risk for There are different
Subjective Unstable kinds of sugars. After 3-4 Independent:
Cues: Blood “Glucose” is what hours of 1. Assess blood 1. Random blood
“Maglisod kog Glucose as our body utilizes appropriate glucose levels glucose test results
ginhawa.” evidenced by most. Other sugars nursing should be between
inadequate we eat, like intervention, 140 to 180 mg/dL.
blood fructose from fruit the patient Non-intensive care
glucose
or lactose from will achieve patients should be
monitoring,
Objective milk, are converted and maintained at pre-
inability to
Cues: follow into glucose in our maintain meal levels <140
 Blood diabetes bodies and use glucose in mg/dL.
Glucose management them for energy. satisfactory 2. Monitor the 2. This is a measure of
Level – Our bodies also range patient’s blood glucose over
175mg/dL break down HbA1c- the previous 2 to 3
starches, which are glycosylated months. A level of
sugars stuck hemoglobin. 6.5% to 7% is
together, into desirable.
glucose. Serum 3. Assess bowel 3. Hyperglycemia
glucose is sounds by disrupts gastric
transported from auscultation motility in the
the intestines or and note any stomach,
liver to body cells reports of duodenum, and
via the abdominal pain, jejunum and may
bloodstream and is bloating, affect the choice of
made available for nausea or interventions.
cell absorption via vomiting. 4. Airway clearance is
the hormone 4. Watch out for hindered with
insulin, produced signs of inadequate
by the body morning hydration and
primarily in the hyperglycemia. thickening of
pancreas. Insulin is secretions.
secreted by the 5. Teach the 5. Blood glucose is
beta cells of the patient how to monitored before
islets of Langerhans perform home meals and at
in the pancreas in glucose bedtime. Glucose
response to monitoring. values are used to
elevated level of adjust insulin doses.
blood glucose. This Dependent:
pancreatic 1. Administer 1. Adherence to the
hormone facilitates basal and therapeutic regimen
the movement of prandial promotes tissue
glucose across the insulin as perfusion. Keeping
cell membranes to ordered. glucose in the normal
be used for range slows the
metabolic activity. progression of
The alpha cells of microvascular disease.
the islets of
Langerhans secrete
glucagon when
blood glucose
 levels are low.
Reference/Source: https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/