INTRODUCTION

Theoretical Foundation

Diabetes is a chronic disease and is increasing in both prevalence and incidence worldwide.
Diabetes exerts a major impact in third-world countries, particularly in the Philippines. It is said
that Asia will see the greatest increase in the number of people with diabetes by 2025 (World
Health Organization, 2004).

Diabetes occurs either when the pancreas does not produce enough insulin or when the
body cannot effectively use the insulin it produces whereas insulin is a hormone that regulates
blood sugar and may result to hyperglycemia, or increase in blood sugar from an uncontrolled
diabetes and over time leads to serious damage to many of the body's systems, especially the nerves
and blood vessels.

According to World Health Organization (2018), in 2014, 8.5% of adults aged 18 years and
older has diabetes. In 2016, diabetes was the direct cause of 1.6 million deaths and in 2012 high
blood glucose was the cause of another 2.2 million deaths. The number of people with diabetes has
risen from 108 million in 1980 to 422 million in 2014.

Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the

body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes
around the world, and is largely the result of excess body weight and physical inactivity. Symptoms
may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be
diagnosed several years after onset, once complications have already arisen.

Type 2 Diabetes Mellitus (T2D) is the most common type of diabetes in the Philippines. In a
study conducted by M.L. Soria et al. (2009), a cohort study derived from a larger population-based
investigation in 1998 was revisited and demonstrated a 9-year incidence rate of T2D in the
Philippines to be around 16.3% in a sense that this figures show an alarming growth rate of type 2
diabetes in the Philippines commensurate with an upward trend in worldwide prevalence.

In the year 2014, prevalence estimates published by the International Diabetes Federation,
it is estimated that there are 3.2 million cases of T2D in the Philippines with a 5.9% prevalence rate
in adults between the ages of 20 and 79 years.

Until recently, this type of diabetes was seen only in adults but it is now also occurring
increasingly frequently in children as it is a progressive condition in which the body becomes
resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough
insulin in the pancreas. Type 2 diabetes is associated with modifiable lifestyle risk factors. Type 2
diabetes also has strong genetic and family related risk factors.

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves
specifically the adults with diabetes that have a two- to three-fold increased risk of heart attacks
and strokes; combined with reduced blood flow, neuropathy (nerve damage) in the feet increases
the chance of foot ulcers, infection and eventual need for limb amputation. Diabetic retinopathy is
an important cause of blindness, and occurs as a result of long-term accumulated damage to the
small blood vessels in the retina, whereas 2.6% of global blindness can be attributed to diabetes.
Lastly, as diabetes is among the leading causes of kidney failure.

Type 2 diabetes can be diagnosed when the pancreas does not produce enough insulin
(reduced insulin production) and/or the insulin does not work effectively and/or the cells of the
body do not respond to insulin effectively (known as insulin resistance), this type of diabetes
usually develops in adults over the age of 45 years but is increasingly occurring in younger age
groups including children, adolescents and young adults. For some, the first sign may be a
complication of diabetes such as a heart attack, vision problems or a foot ulcer in which it could be
managed with a combination of regular physical activity, healthy eating and weight reduction. As
type 2 diabetes is often progressive, most people will need oral medications and/or insulin
injections in addition to lifestyle changes over time.

Symptoms of type 2 diabetes often develop slowly—over the course of several years—and
can be so mild that some might not even notice them. Many people have no signs of obvious
symptoms. Though, some people do not find out that they have the disease until they have
diabetes-related health problems, such as blurred vision or heart disease.

According to an article by WebMD (2019), the symptoms of type 2 diabetes can be so mild, it
is often inconspicuous. In fact, about 8 million people who have it do not know it. Symptoms include
increased thirst and urination, increased hunger, feeling tired, blurred vision, numbness or tingling
in the feet or hands, sores that do not heal and unexplained weight loss.

While there is currently no cure for type 2 diabetes, the condition can be managed through
lifestyle modifications and medication. Type 2 diabetes is progressive and needs to be managed
effectively to prevent complications as it is caused by several factors, including lifestyle factors and
genes, some of this includes:
Overweight, obesity, and physical inactivity

A person is more likely to develop Diabetes Mellitus Type 2 if their lifestyle is consist of
being sedentary and has risk for overweight or obesity. Extra weight sometimes causes insulin
resistance and is common in people with type 2 diabetes. The location of body fat also makes a
difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, heart and blood vessel
disease. Body Mass Index (BMI) chart can help to check if the weight is a risk for acquiring Diabetes
Mellitus type 2.

Insulin resistance

Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver,
and fat cells do not use insulin regularly. As a result, the body needs more insulin to help glucose
enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time,
the pancreas cannot make enough insulin, and blood glucose levels rise.

Genes and family history

In type 1 diabetes, certain genes may increase the chance of having a Type 2 Diabetes. It is
more likely to develop in people with a family history of type 2 diabetes or from particular ethnic
backgrounds such as African Americans, Alaska Natives, American Indians, Asian Americans,
Hispanics/Latinos, Native Hawaiians and Pacific Islanders where these genes can also increase the
risk of type 2 diabetes by increasing a person’s tendency to become overweight or obese.

Managing blood glucose, blood pressure, cholesterol, quitting smoking and other vices, are
important ways to manage type 2 diabetes. Lifestyle changes that include planning healthy meals,
limiting calories if in risk of overweight or obesity, and being physically active are also part of
managing this type of diabetes. So is taking any prescribed medicines. Collaborate with other health
care team to create a diabetes care plan that is efficient for the patient in preventing the disease.
Diabetes care in the Philippines continues to be a challenge for the primary care physicians of the
region as urbanization continues to augur a significant rise in disease prevalence over the next few
years. Philippine Practice Guidelines on the Diagnosis and Management of Diabetes Mellitus
recommends that Filipinos age 40 years and those at risk for developing diabetes should be tested
annually owing to the significant prevalence and burden of diabetes.
Objectives of the Case:

With all of these, cases of Diabetes Mellitus 2 nowadays are increasing day by day and
through this, the case presentation has the following objectives to address its one of the most
important factor in controlling and preventing Type 2 Diabetes in social mobilization. In line with
community engagement related to caregiving, this case presentation aims to:

1. Analyze and show the Nature and Pathophysiology of Diabetes Mellitus 2 through the use of
biographic data, Gordon’s functional health patterns, and physical assessment,
2. Examine the parts and functions of the regions affected by Diabetes Mellitus 2, and
3. Develop a care plan and health teaching for their selected client who experienced the said
disease.

CLIENT'S PROFILE
Biographical Data and Patient History

Patient A is a 40-year-old male living in Tondo, Manila who is married with four children.
Both of his parents have a history of Diabetes Mellitus (DM) in which his mother has Type 1
Diabetes Mellitus (T1D) and his father has Type 2 Diabetes Mellitus (T2D), and he is the third born
among his four siblings. Currently, Patient A is working as a Land Transportation Office (LTO)
Liaison with 7 years of service. Since his work requires quarterly check-ups, he scheduled an
appointment last January 2018 to which the nurse administered a Fasting Blood Sugar (FBS) test
and advised him to get a second opinion since it was shown in the results that his blood sugar level
went above the normal range, which is below 100. By that time, the patient gained weight because
of his increased appetite and was unconsciously suffering from frequent urination and thirstiness,
fatigue and sleepiness. Two weeks after his first check-up, Patient A decided to have a doctor's
second opinion at the University of Santo Tomas Hospital. The Endocrinologist who handled his
condition, performed another FBS test in which he found out that the patient has Diabetes Mellitus
Type 2. After being diagnosed by the doctor with the said disease, Patient A still experiences fatigue
and sleepiness. Currently, his diabetes is controlled because he takes prescribed maintenance
medicine and undergoes regular check-ups at the University of Santo Tomas Hospital. Last 9th of
October 2019, his blood pressure is 120/80 mmHg, pulse rate is 80, and the respiration rate is 22
rpm.
Gordon's Functional Health Patterns
PATTERN Description
1. Health Perception and Client’s perceived health & Subjective Data:
Health Management well-being and how health is ▪ When asked about the patient’s
managed. health perception, he said that
he now comes to realize that his
lifestyle before contributed a lot
for him to experience this
certain condition.

▪ The patient said that his mother

has Type 1 Diabetes Mellitus
and his father has Type 2
Diabetes Mellitus (T2D),
therefore both of parents have a
history of Diabetes Mellitus
which implies that he has a high
possibility rate of acquiring the
said disease. 

▪ Even before the patient was

diagnosed with T2D, he
undergoes quarterly check-up
that is provided by his work.
After he is diagnosed with the
said disease, he continuously
attends the quarterly check-up
to help him control and monitor
his T2D as well as protect his
health from further disease or
complications.
▪ For his medication, the patient
was prescribed by his physician
to take Xigduo Xr,
10mg/1000mg once a day
before breakfast as a
maintenance medicine for his
Type 2 Diabetes Mellitus (T2D).
This medication helps the body
to control the blood sugar levels.
He also has other maintenance
medicine that is not related to
the said disease. Before
diagnosed with T2D, the patient
is already taking Euthyrox
medicine every day with a
dosage of 150 mg every Monday
to Saturday, while 200 mg for
every Sunday. This drug helps
the body to provide thyroid
hormones for he has no thyroid
gland anymore, because he was
operated before due to benign
neoplasm of the thyroid gland;
naturally, the thyroid gland is
the one responsible for
providing thyroid hormones. 
▪ The patient indicated that he
every night, practices the
soaking of okra in water and
drink the liquid afterwards to
maintain his blood sugar. Okra
is said to be a counterpart of
insulin because it can also lower
the cholesterol level in the body.
Although, this practice is not
recommended by the doctor
since it is just some information
he saw in a Facebook post.
2. Nutritional / This pattern describes food Subjective Data:
Metabolic and fluid consumption ▪ Before being diagnosed with
relative to metabolic need & T2D, patient usually eats white
pattern indicators of local rice, mostly with meat.
nutrient supply. Diet Recall:
o He eats at least 2-3 cups
of white rice every
breakfast, lunch and
dinner.
▪ After being diagnosed with T2D,
the patient is now practicing a
diet that consists mostly of fish
and vegetables. Additionally, he
only consumes 1 cup of white
rice for each meal. The patient is
prohibited to eat fatty, sour and
salty food, but if given a chance,
the amount of food
consumption is controlled.
Patient A also said that he is not
fond of sweets.
▪ Diet Plan:
o The patient strictly
follows 1 cup per meal,
which makes it 3 cups
for the whole day.
3. Elimination Pattern of excretory function Subjective Data:
(bowel, bladder, skin). ▪ The patient said that he urinates
5-10 times a day since he
intakes at least 5 tumblers (550
ml per tumbler) of water which
is equivalent to 11 cups of water
a day. He added that the color of
his urine is in between light
yellow to clear. Patient A also
stated that he does not
experience any discomfort or
pain while urinating.
▪ The patient said that he
defecates around 1-2 times a
day with normal consistency
and he does not perform
Valsalva maneuver.
4. Activity and Exercise Activity level, exercise Subjective Data:
program, and leisure ▪ Last 2016, the patient frequently
activities. goes out of the house to do some
activities like biking, specifically
every during Sundays, since it is
his rest day. However this 2019,
he was not able to continue this
routine.
▪ He goes to work by riding his
motorcycle and works for 8:30am
to 5:30 pm during his working
days. After working, he prefers to
bond with his family during his
leisure time.
▪ The patient said that he used to
go to the gym. But after he was
 diagnosed, he prefers to rest and
play Mobile Legends for a
maximum of one hour and a
minimum of 10 to 20 minutes
instead due to tiredness at work.
5. Sleep and Rest Patterns of sleep, rest, and Subjective Data:
relaxation. ▪ The patient said that he usually
sleeps for 6 hours and 30
minutes. He consistently follows
the sleeping schedule his doctor
provided. He needs to sleep at
10:30 pm and wakes up at 5:00
am. Every Sunday, he tries to
complete 8 hours of sleep as
much as possible because it is his
rest day. Also, he does not feel any
discomfort with his sleeping
schedule.
Objective Data:
▪ The patient has visible eye bags
even though he completes his
sleep cycle of more than 6 hours
per day.
▪ The patient does not usually
yawn, he is attentive, and has
energy during the interview.
6. Cognitive and Perceptual Ability of the individual to Subjective Data:
understand and follow ▪ The patient said that he has
directions, retain 20/25 vision but has
information, make decisions, Astigmatism. He has a pair of
and solve problems. Also eyeglasses for eye correction
assesses the five senses. but he usually does not wear it
because he feels like the
 eyeglasses blur his vision more,
which makes him
uncomfortable. However, even
without wearing his eyeglasses,
he sometimes feels dizzy
whenever he stands up after
sitting for too long.
7. Self-Perception and Client's self-worth, comfort, Subjective Data:
Self-Concept body image, feeling state. ▪ The patient recognized his
physical changes in terms of
body weight even before his
diagnosis. Patient also added
that the nurse in his workplace
advised him to engage more in
exercise to maintain his blood
sugar level after finding out in
the Fasting Blood Sugar (FBS)
test that the patient has a high
level of blood sugar. Otherwise,
the doctor will give him another
dose of medicine if he fails to
maintain his blood sugar level to
normal.
▪ The patient said that after he
was diagnosed with T2D, he
does not feel any complications
and that his current state is still
normal.

Objective Data:
▪ The patient looked calm and
answered the questions without
any hesitations regarding his
 current state and changes due
to the disease.
8. Roles and Relationships Client's relationship with self, Subjective Data:
family, friends and partners. ▪ The patient is married with four
children and he is the third born
among his four siblings.
▪ The patient said that there are
no family problems that he is
currently experiencing. He said
his family knows his current
state and is supportive of his
health, since they always remind
him to maintain a proper diet
considering the disease that he
has.
9. Sexuality and Client’s reproductive system
Reproductive and related issues and
challenges.
10. Coping and Stress Patient’s coping mechanism Subjective Data:
Tolerance and limits in terms of ▪ The patient said that cleaning
tolerance to stress. their car and riding his
motorcycle during his rest day is
his stress reliever. Sometimes,
he prepares the food for his
family and plays Mobile Legends
on his leisure time.
▪ One factor that stresses him the
most is work-related matter,
when he does not get paid on
the right time. He is able to stay
calm but his coping mechanism
is through occasional drinking
of alcohol.
 11. Values and Beliefs Describe the patients belief Subjective Data:
system in terms of ▪ The patient said that he wants
spirituality, philosophy, to explore more in the future by
religion, etc. the means of having a good
motivation in life since he wants
to overcome his indolence. He
plans to exercise and go back to
his old routine, wherein he gets
to exercise at least 2 hours
thrice a week, especially since
his doctor recommended to do
at least 2 hours of exercise
every day that would help him
be more active and healthy.
▪ According to the patient,
religion does not help him
during difficult times.

Physical Assessment
Integument
Skin The client's skin is fair complexion. Absence of
blemishes, wrinkles, and freckles. He has a
normal body temperature which is 36.8°C, and
no presence of foul odor.
Hair Client has natural black hair but he constantly
shaves his hair due to the occurrence of
alopecia.
Nails The client has white colored nails. It is round,
smooth, flat, intact, has no free edge and free
from inflammation. The nails return to its
original color when pressed between the
fingers.
Head
Head The client's head is round.

Skull When palpated, it was determined that the

skull is normocephalic and symmetrical.

Face The face is free from pimples, pimple marks,

and moles. However, there is a presence of
small dark sports (hyperpigmentation) on both
sides of the cheeks.

Eyes and Vision

Eyebrow Eyebrows are black and symmetrical. The client
can raise his eyebrows at the same time but he
cannot lift it individually.
Eyelashes Eyelashes appeared to be long and equally
distributed.
Eyelids Discharges and inflammation were not present
in client's eyelids. Blinking is approximately 18
blinks per minute.
Eyes The color of iris is brown, and there is no tear
in cornea. Both eyes are equal in size and has a
20/25 visual acuity with acuity. Eyebags are
visible and develops wrinkles under the client's
eyes.

Ear and Hearing

Auricle Color is even to facial complexion. It is
symmetrical and elastic.
External Ear canal Without impacted cerumen.
Hearing activity Voice sound is clearly heard.

Nose, Mouth and Neck

Mouth The client’s mouth has a pinkish color. It is firm
and does not have any presence of mouth ulcer.
Lips are rosy pink. Buccal Mucosa appears to be
moist, smooth, and pink with no signs of mouth
sores.
Tongue The client has a minimal whitish coating in his
tongue.
Teeth Client has a missing tooth on the upper right
molar due to tooth decay.
Uvula Uvula and tonsil are both pinkish in color and
have no signs of inflammation.
Gag Reflex Client experienced gagging with the use of
tongue depressor.
Neck Normal without sensitivity to pain and it is in
the median line
Head movement The client’s head movement is normal. He can
easily move and do head rotation without
feeling any pain and cramps
Lymph nodes The client does not have swollen lymph nodes.

Thorax and Lungs

Posterior Thorax The client’s chest is symmetrical.

Spinal Alignment Client’s spine and spinal column are properly

positioned to be upright. Both shoulders and
hips are identical in terms of height.
Breath Sound Breathing sounds are normal with a respiration
rate of 22 rpm

Motor Function
Walking Gait Straight body position with both hands on the
side swaying and performs a normal gait.
Standing with one foot with eyes closed Can maintain balance for 5 seconds both left
and right foot.
Heel toe walking Effortlessly walks on a straight line.

Finger to nose test Simultaneously touching the nose.

Finger to thumb test Effortlessly walks on a straight line.

Mental Status
Language Able to communicate and speak clearly.

Orientation Able to communicate and speak clearly.

Attention span The client can focus and understand course of

actions being given.
Level of consciousness Responsive and scored 15 in Glascow’s Coma
Scale.

Abdomen and Extremities

Abdomen Skin is unblemished and even color; does not
feel any discomfort or pain in any regions of the
abdomen.
Abdominal movements Simultaneously moving due to breathing.
Auscultation of bowel sounds Distended and has gurgling sounds.

Upper Extremities Complete fingers on upper extremities with a

minor scar on the left metacarpal hand.
Lower Extremities Complete toes and no scars and lesions on
lower extremities.
Laboratory Examination and Results

LABORATORY ANCILLARY PROCEDURES AND THERAPIES PROVIDED

CPT DESCRIPTION

HB1C (Glycosylated hemoglobin)

(FBS) FASTING BLOOD SUGAR

(TSH) THYROID STIMULATING HORMONE

LIPID PROFILE

DIAGNOSIS

BLOOD CHEMISTRY RESULT RANGE INTERPRETATION

TEST

Fasting Blood Sugar 136.20 mg/dL <100 HIGH

Cholesterol 232.90 mg/dL 131-239 NORMAL

Triglycerides 145.20 mg/dL 0-210 NORMAL

HDL-Direct 59.70 mg/dL 30-90 NORMAL

LDL-Direct 153.50 mg/dL 66-178 NORMAL

Creatinine 0.94 mg/dL 0.67-1.17 NORMAL

HBA1C 7.11 HIGH % 4.8-5.9 HIGH

NON-INSULIN-DEPENDENT DIABETES MELLITUS: Non-insulin-dependent diabetes mellitus

without complications

Date: September 18, 2019

 BENIGN NEOPLASM OF THYROID GLAND: Benign neoplasm of thyroid gland

Date: September 20, 2019

TEST SPECIMEN: REULTS REFERENCE RANGE INTERPRETATION

SERUM

CHEMILUMINESCENT
MICROPARTICLE
IMMUNOASAE

THYROID
STIMULATING
0.37 ulU/mL 0.35-4.94 NORMAL
HORMONE

ANATOMY AND PHYSIOLOGY

Organ Anatomical Location Function

Pancreas Located in the abdomen, - Blood glucose regulation. Pancreas
posterior to the stomach is responsible in producing insulin
and glucagon.

- Due to insulin resistance, the

pancreas releases more insulin that
builds up in the blood and causes high
blood glucose level.
Blood Vessels Deep to the skin and can - It transports blood throughout the
be found throughout the body.
body
- Blood vessels are vital for the body
and play a key role in diabetes
helping to transport glucose and
insulin.
- High blood sugar level caused
damage in the blood vessels that
supply the nerves with oxygen and
nutrients.
- 3 kinds of blood vessels:
● Arteries - carry oxygenated
blood away from the heart
and carries it to capillaries.
Also it contains a strong,
muscular middle layer that
helps pump blood through
the body.
● Capillaries - connect the
arteries to veins. It then
delivers the waste-rich blood
to the veins for transport
back to the lungs and heart.
● Veins - carry the blood back
to the heart. Valves also help
blood travel back to the
heart.
Kidneys Dorsal to abdominal - Waste excretion. The kidneys are
cavity, posterior to responsible in filtering out the toxins
ribcage and lateral to in the blood that comes from food.
the spine on both sides. Urea and Uric Acid are the two
compounds that the kidneys get rid
 of inside the body. Kidney has a tiny
blood vessel called nephrons which
filters waste products while keeping
the useful substances in the
bloodstream.

- Due to high amount of glucose

accumulated in the blood, the kidney
increases the production of urine to
eliminate extra sugar from the body,
which causes polyuria and polydipsia.

- Reabsorption of nutrients. One of the

vital roles of kidneys is to reabsorb
nutrients from the blood and
transport them to where they would
best support health.

- Blood pressure regulation. Kidneys

adjust long-term pressure in the
arteries by causing changes in the
extracellular fluid outside of cells.
This fluid changes occur after the
release of a vasoconstrictor called
angiotensin II. Vasoconstrictors are
hormones that cause blood vessels
to narrow.

- Red blood cell regulation. When the

kidneys don’t get enough oxygen,
they send out a distress call in the
form of erythropoietin, a hormone
that stimulates the bone marrow to
 produce more oxygen-carrying red
blood cells.

- Water level balancing. As the kidneys

are key in the chemical breakdown
of urine, they react to changes in the
body’s water level throughout the
day. As water intake decreases, the
kidneys adjust accordingly and leave
water in the body instead of helping
excrete it.

- Acid regulation. As cells metabolize,

they produce acids. Foods we eat can
either increase the acid in our body
or neutralize it. If the body is to
function properly, it needs to keep a
healthy balance of these chemicals.

Bladder Located in the pelvic - It is a temporary storage for urine.

cavity, superior to the
uterus, and medial to - The bladder stores urine, allowing
the kidney. urination to be infrequent and
controlled. The bladder is lined by
layers of muscle tissue that stretch
to hold urine

- This is where the urine, intended to

release glucose from the body,
temporarily stays.
Nerves It can be found all - The sensory function of the
throughout the body. nervous system involves collecting
information from sensory receptors
that monitor the body's internal and
external conditions. These signals
are then passed on to the
central nervous system (CNS) for
further processing by afferent
neurons (and nerves)

- It transmits impulses of sensation to

the brain or spinal cord, and
impulses from these to the muscles
and organs

- Due to damaged blood vessels

supplying the nerves with oxygen and
nutrients, the nerves do not function
well and nerves supplying the eyes
were affected.

Eyes Located within the - Vision. It contributes to our body’s

orbits of the skull ability to see.
superior to the nose.
- Eyes constantly adjusts the amount
of light it lets in, focuses on objects
near and far, and produces
continuous images that are instantly
transmitted to the brain.

- It receives oxygen through the

aqueous.  Its function is to nourish
 the cornea, iris, and lens by carrying
nutrients, it removes waste products
excreted from the lens, and maintain
intraocular pressure and thus
maintains the shape of the eye.

- It detects light and convert it into

electro-chemical impulses in
neurons.
- Diabetes affects the eyes when
persistent high levels of blood
glucose cause leaks or blockages in
the capillaries which provide the
retina with a constant supply of
blood. This damages the retina and
stops it from working, thus affecting
your vision. If left untreated, it can
lead to total loss of sight.

- High blood glucose levels caused the

lens to change shape, which resulted
to astigmatism.
PATHOPHYSIOLOGY
CARE PLAN
Nursing Diagnosis Interventions
1. Risk for unstable blood glucose ● Monitor and assess if the medicine
prescribed by the physician is taken
regularly, specifically the intake of
Xigduo Xr 10mg/1000mg once a day
before breakfast. It is important because
it helps in controlling the blood sugar
levels in the body.
● Assist the patient in identifying eating
patterns that need to be modified. The
patient can undergo Mediterranean diet
because it has a higher proportion of
unsaturated to saturated fats, includes
plenty of fresh vegetables and depends
on largely unprocessed foods. The
patient can also refer to a registered
dietitian for individualized diet
instruction or meal plan.
● Assess the pattern of physical activity
that can help in lowering the blood
glucose. Especially the patient was
previously engaged in regular physical
activities such as biking and going to the
gym but stopped after being diagnosed
with diabetes.
● Assess for the risk of hyperglycemia
because the patient showed symptoms
of increased urination (polyuria) ,
 thirstiness (polydipsia), fatigue and
blurred vision which is the effect of
excess glucose in the blood.
2. Risk for infection ● Teach wound care and asepsis for
dressing when there is a wound or
injured to decrease the spreading of
pathogens.
● Wash hands thoroughly before taking
medications (Xigduo Xr and Euthyrox)
and preparing food.
● Use soft-bristled toothbrushes and stool
softeners to protect mucous membranes
that might provide an entry for
pathogens.
● Even though the patient’s job is
harmless, the patient must dress
appropriately and avoid harmful and
risky environment to prevent accidents
or wounds that may cause infection.
3. Risk for ineffective therapeutic regimen ● Inform patient about his diagnosis and
management health so he would be aware on the
treatments that would be given.
● Allow patient’s participation in planning
the treatment program like letting him
engage or decide on physical activities
that he truly wants such as biking and
exercising and participate on the diet
plan by having brown rice and oats that
he usually eat most of the time.
● Ascertain patient’s knowledge and
 ● understanding of condition and his
treatment.
● Teach the patient how to perform
procedures for blood glucose monitoring
and evaluate the patient’s
self-management skills.
● Assess the patient’s financial resources
for buying Xigduo Xr and Euthyrox for
his medications and for checkups.

HEALTH TEACHINGS

1. Keep a strict diet since lifestyle affects T2D. The said diet should consist mostly of low fat
food like fish and fresh vegetables. Instead of eating takeaways and processed food, start the
practice of eating home-cooked meals.
2. Implement portion control when eating high-carbohydrate food, such as white rice and
white bread to track your cholesterol and triglycerides levels.
3. If the patient has vices specifically in drinking alcohol and smoking, the consumption must
be controlled.
4. Weight should be controlled by losing 5 to 10 percent of the current weight to prevent or
delay diabetes. Also, exercising regularly can help in maintaining a healthy lifestyle.
5. See the doctor for regular check-ups to monitor levels of blood glucose, blood pressure, and
blood cholesterol. Also, schedule regular physical and eye exams to assure that there is no
further complications.
6. Control stress levels by engaging into recreational activities during leisure time and by
getting enough sleep.
7. Observe proper hygiene and make sure to clean any wounds or injuries to avoid infection
caused by bacteria and other microorganism.
8. Make sure to take the medications, as prescribed by the doctor, and make sure to follow the
guidelines on how and when to take it.
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