PATIENT E’S TYPE 2 DIABETES MELLITUS

A Case Study
Presented to the Faculty of the
Nursing Program of Lourdes College
Cagayan de Oro

In Partial Fulfillment
Of the Requirement for the
NCM 101: Health Assessment in Nursing

By:
Apor, Andrea Krisjoana Kaye
Auditor, Ilsid Clyde
Libres, Jessie Allen
Morgadez, Blessy Aliza Mae
Perez, Kyle Angel Marie
Salo, Redeemer
Sarip, Hanifa
Torayno, Luisa Hubert

July 18, 2023

1
 INTRODUCTION

Holistic well-being has been the central focus of the healthcare team

throughout the decades. It became an avenue for achieving a disease-free world

where the causative factors do not threaten people’s lives. National Health Care

Institute (NHCI) has defined health as a condition of being sound in body, mind,

or spirit encompassing the wellness of the psychological, physical, mental, social,

and emotional aspects. Learning the concept of health has become a necessity

for all mankind for them to thrive and live a life where illness doesn’t hinder their

activities of daily living (ADL).

In the era of globalization, individuals’ ADLs have become more

advanced, however abrupt, resulting in chaotic scenarios such as the emergence

of sickness and diseases. Miscellaneous forms of illness arose as well as their

specific treatment. Nevertheless, some are still incurable and insuperable.

Several factors are known as the core reason contributing to the

emergence of various diseases in humans, particularly their actions themselves.

According to the study of Bohol Island State University (BISU), people do

negative things that are hostile to their health even if they already have

knowledge about the harm it may cause. To name a few, too much oily food

intake may result in hypertension, tobacco use may lead to pulmonary

complications, too much alcohol intake may result in liver problems, and over

screen exposure may lead to retinal damage. Individuals have the knowledge to

think since we have the ability to be rational as supported by our own neurologic

capacity. Hence, they lack support in controlling activities that are not beneficial

2
in maintaining their external and internal equilibrium. This case is somewhat

connected to the condition of Patient E who is experiencing Diabetes Mellitus.

World Health Organization (WHO) defines diabetes as a lifelong metabolic

disorder characterized by high levels of blood glucose (or blood sugar), which

causes long-term damage to the heart, blood vessels, eyes, kidneys, and nerves.

It has three types, namely: Type I DM, Type II DM, and Gestational DM. The first

type is hypothesized to be caused by an autoimmune reaction (in which the body

accidentally targets itself). This response prevents the human body from

generating insulin. With type 2 diabetes, your body does not utilize insulin well

and cannot maintain healthy glucose amounts, and pregnant women who have

never had diabetes acquire the third type which is gestational diabetes.

In the case of Patient E who has had type 2 diabetes, her body was not

able to secrete enough amount of insulin due to a damaged pancreas which

makes her acquire the mentioned disease. Her past behaviors had resulted in

the presence of diabetes mellitus in her body and that includes too much sugar

intake from sweat delicacies and beverages with high sugar content.

The concept of health assessment projected the behavior to evaluate an

individual’s tasks completely, both positive and negative, to effectively provide

specific, measurable, attainable, realistic, and timely interventions for people

having disrupted homeostasis.

Nursing has played an important part in the management and education of

individuals with diabetes for more than 30 years. Diabetes education provided by

nurses has spread beyond the hospital bedside and into a range of healthcare

3
settings. Among the disciplines involved in diabetes education, nursing has

played a critical role in the diabetes team management paradigm.

Health education performed by the healthcare team most specifically by

the nurses has a very significant impact on the management of type 2 diabetes. It

has the ability to influence people to do things that are aligned with the concept

of health, such as exercising for at least 20 minutes daily and eating healthy

foods.

The healthcare team has a very important part in spreading awareness

towards the control of disease emergence. They have the most power to educate

and inform the public about the negative influences of their negative behaviors,

including the dangers they may cause. Medical doctors perform a very significant

role in providing medications to cure life-threatening conditions, nutritionists and

dieticians have the task to prepare meal plans that are not against the concept of

achieving health and wellness, and pharmacists have the special work to hand-

ordered medications for people who need it. Most especially, the umbrella of the

healthcare team, nurses have played a deeply prestigious duty to provide

individuals the basic to major knowledge about everything they should know to

live a healthier life.

Nursing students’ competencies are honed to be effective and efficient

health educators. Through this case study, student nurses will be able to uplift

positive behaviors that will enhance public awareness of health and wellness,

thus making the world a conducive place to live through the power of health

assessment.

4
 ACKNOWLEDGMENT

This endeavor could not have been made successful without the help of

numerous individuals whose names may not all be cited, the student nurses

sincerely thank them all.

In spite of that, the student nurses extend their deepest thanks and

gratitude to their Health Assessment Clinical Instructors: Mr. Roy Neri, Jr., Mr.

Arsenio Poral, Jr., and Mrs. Marites Alma Christiansen for providing their

knowledge and expertise to hone the student nurses’ health assessment skills.

They would also like to thank Miss Ezel Gonzales for always being

supportive whenever they need something in the Nursing Arts Laboratory.

To their families and friends who constantly shared their holistic support to

finish this case study, the student nurses thank them all.

The student nurses project their deepest gratitude to Patient E who

generously gave her valuable time, effort, and participation just to collect the

necessary data for them to complete this case study.

Most importantly, the student nurses would like to express their deepest

thanks and praise to the ever-loving and gracious Almighty Father for bringing

together those individuals who literally shared their abundance of resources,

talents, skills, time, and effort for the accomplishment of this case study and for

giving the student nurses significant abilities and enough knowledge to analyze

Patient E’s case.

5
 TABLE OF CONTENTS

Chapters Page

1. Introduction 2

2. Acknowledgment 5

3. Table of Contents 6

4. Objective of the Study 7

4.1 General Objective

4.2 Specific Objective

5. Scope and Limitation of the Study 9

6. Patient’s Health Profile 10

6.1 Biographic Data

6.2 Chief Complaint

6.3 History of Present Illness

6.4 Medical History

6.5 Surgical History

6.6 Family History

6.7 Social and Personal History

6.8 Obstetrical History

6.9 Review of Systems

7. Anatomy and Physiology of the Affected System 13

8. Nursing Care Management 15

8.1 Nursing Care Plan

9. Evaluation 18

10. Recommendation 18

11. Appendix 20

12. References 21
4. OBJECTIVE OF THE STUDY

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 This chapter presents the general and specific objectives of this case

study. Setting objectives and goals is an important part of the study for student

nurses to have a guide regarding what needs to be achieved.

4.1 General Objective

After completing this case study, the student nurses will be able to

determine cues, both subjective and objective, that lead to diabetes

mellitus and how to prevent it beforehand. They will be able to implement

actions that are not just beneficial to the patient they are studying but also

to the community going to the whole wide world, in general. This case

study also aims to raise awareness regarding the distractive effects of

diabetes on the human body and how it can be a fatal reason for a

terminal illness.

4.2 Specific Objective

This study aims to keep blood glucose levels as close to normal as

safely possible. Since diabetes may greatly increase the risk for heart

disease and peripheral artery disease, measures to control blood pressure

and cholesterol levels are an essential part of diabetes treatment as well.

Modifying eating habits and increasing physical activity are typically the

first steps toward reducing blood sugar levels. Therefore, at the end of this

case study, the student nurses will be able to:

a) Faith: Believe in their potential capacity to influence people

regarding the negative effects of diabetes;

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 b) Faith: Build a stronger relationship between the other

student nurses (healthcare team) since unity is an important

component for successful nursing practice;

c) Excellence: Understand the concept of diabetes, including

its causative factors and its adverse effects;

d) Excellence: Develop a nursing care plan that will address

the patient’s nursing needs;

e) Excellence: Perform a thorough analysis regarding the case

of Patient E to effectively understand the cause and effects

of her condition, and how are they interrelated; and

f) Service: Apply the nursing process in delivering a holistic

approach to meet the patient’s and the people’s needs.

5. SCOPE AND LIMITATION OF THE STUDY

8
 The student nurses had exclusively chosen the case of Patient E as the

central focus of their case study. It ventured into the condition of Patient E who is

51 years old, married, and a resident of Barangay Baikingon who has had type 2

diabetes mellitus for more than one year. Patient E also has other diseases being

elaborated on in her medical abstract. However, this case study only focuses on

the diabetes mellitus disease of the patient and doesn’t involve any other medical

diagnosis provided on her medical record.

Prior to that, the student nurses comprehensively discussed the best case

for their case study and came up with Patient E’s Type 2 Diabetes Mellitus. They

thoroughly assessed her illness inside the parameter of Lourdes College Higher

Education.

Furthermore, the student nurses were supervised by their clinical

instructors and were given specific instructions to be followed during the conduct

of their case study provided that all information to be given is simply basic and

won’t be digging dipper much into the real form of case study since this is only a

preparation for the next level of their nursing journey.

Additionally, student nurses are given the parameter to only provide three

nursing care plans under nursing management that will meet specific patient

needs as instructed by their clinical instructors.

6. PATIENT’S HEALTH PROFILE

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 This chapter presents the assessment of the patient in terms of (a)

biographic data, (b) chief complaint, (c) history of present illness, (d) family

history, (e) social and personal history, and (f) review of systems.

6.1 Biographic Data

The patient was given the name “Patient E” for confidentiality

purposes. She is a 51-year-old married Filipina who’s a member of the

Assembly of God Church. She has one sibling who is living far from her.

Patient E lives in Barangay Baikingon, Cagayan de Oro City, and formerly

worked at the Misamis Oriental Provincial Hall (Capitol) which she

believes is the reason why she got diabetes.

6.2 Chief Complaint

Patient E’s chief complaint is acute chest pain caused by the

tightening of the chest wall and her shortness of breath (bradypnea)

caused by chest pain.

6.3 History of Present Illness

Three days prior to hospital admission, the patient experiences on-

and-off abdominal pain with shortness of breath.

6.4 Family History

The patient’s father died at the age of 58 due to a myocardial

infarction. On the other hand, her mother died at the age of 67 because of

hypertension. She has one sibling who is also hypertensive. Both maternal

and paternal genes had a history of hypertension and diabetes mellitus.

10
Most of the members of the family tree died because of hypertension or

high blood pressure.

6.5 Social and Personal History

The patient lives in Brgy. Baikingon, an area located in the

highlands of Cagayan de Oro City. She has one daughter who is a city hall

employee and a husband who is the chairman of the mentioned barangay.

The patient previously works at the Provincial Capitol which she described

as the core of why she got Diabetes Mellitus. “Kada adlaw me mag-snack

ug sweats sama sa cakes and paresan dayun namo ug ingana kadak-a

nga coke (pointed to 1.75 liter gallon) or usahay kay coffee nga hulog-

hulog singko,” as verbalized by the patient. Also according to her, the

usual practice lasted for five years.

6.6 Review of Systems

Three days prior to hospital admission, the patient experiences on-

and-off abdominal pain with shortness of breath.

6.6.1 Eyes

a) No changes in vision

b) No double vision

c) Cannot read very small words

6.6.2 Eyes, Ears, and Nose

a) Does not wear hearing aids

b) Clear hearing pathway

6.6.3 Skin and Breast

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 a) Dry skin

b) Itching

c) Peripheral Edema

d) Skin redness

6.6.4 Cardiovascular

a) Tachycardia

b) Chest pain

c) Heart palpitations

6.6.5 Pulmonary

a) Shortness of breath

6.6.7 Endocrine

a) Decreased insulin value

b) Pancreas is unable to secrete enough insulin hormone

6.6.8 Gastrointestinal

a) Abdominal pain

6.6.9 Genitourinary

a) No increased frequency or pain in urination

6.6.10 Musculoskeletal

a) Decrease muscle strength

6.6.11 Neurologic

a) Forgetful

6.6.12 Psychology

a) No changes in mood

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7. ANATOMY AND PHYSIOLOGY OF THE AFFECTED SYSTEM

Diabetes Mellitus is a disease condition classified under the endocrine

system—one of the most important body systems in response to humoral, neural,

or hormonal stimuli to regulate homeostasis of the body. The endocrine system is

further subdivided into a number of glands, particularly: the hypothalamus,

pituitary gland, pineal gland, thyroid gland, parathyroid, thymus, adrenal glands,

pancreas, ovaries (for females), and testes (for males).

The organ that is disrupted when the patient has diabetes is the pancreas.

It is an elongated, tapered organ located across the back of the belly, behind the

stomach. The tapered left side extends slightly upward—called the body of the

pancreas—and ends near the spleen—called the tail. The pancreas is made up

of 2 types of glands: (1) exocrine, which secretes digestive enzymes that are

secreted into a network of ducts that join the main pancreatic duct, and (2)

endocrine, which consists of the islets of Langerhans which secrete hormones

into the bloodstream. The main hormones secreted by the endocrine gland in the

pancreas are insulin and glucagon, which regulate the level of glucose in the

blood, and somatostatin, which prevents the release of insulin and glucagon.

Glucose is a ubiquitous source of energy for every organism in the world

and is essential to fuel both aerobic and anaerobic cellular respiration. The

enzymes secreted by the exocrine gland in the pancreas help break down

carbohydrates, fats, proteins, and acids in the duodenum. These enzymes travel

down the pancreatic duct into the bile duct in an inactive form. When they enter

the duodenum, they are activated. The exocrine tissue also secretes a

13
bicarbonate to neutralize stomach acid in the duodenum. This is the first section

of the small intestine.

Going back to insulin and glucagon, the main hormones of the pancreas,

insulin regulates the level of sugar (glucose) in the blood and that is produced by

the beta cells of the islets of Langerhans in the pancreas. Insulin is secreted

when the blood glucose level rises—as after a meal. Glucagon, on the other

hand, is a hormone that makes glucose rise to provide energy to the human

being.

To dig deeper into the concept, if an individual eats too much food with

high sugar content for almost every hour or day for almost a year or more, the

blood sugar level will rise every time an individual takes the sugar-rich food. In

connection, the pancreas will work harder to secrete insulin for the regulation of

glucose in the blood. To highlight the case, if the individual performs this usual

behavior for a very long period of time, the pancreas will be damaged due to

overusing and none can replace the job to regulate blood sugar levels. This

explains the emergence of diabetes mellitus due to a damaged pancreas.

8. NURSING CARE MANAGEMENT

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 This chapter presents the management of nursing care including the

generation of the nursing care plan to meet specific nursing needs of the patient.

8.1 Nursing Care Plan

a) Breathing Difficulty

Name: Patient E Age: 51 y.o. Gender: F Diagnosis: DM Type 2

NURSING NURSING
CUES OBJECTIVES RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subject Ineffective Short-Term Independent The goal

Cue: breathing Plan: Intervention: has been
pattern met as
● “Naglisud related to The patient ● Place the ● Semi- evidenced
ko’g acute chest will show an patient in a fowler’s is by the
ginhawa,” pain. effective semi- the patient
as breathing fowler’s position of being able
verbalized pattern within position. choice for to establish
by the one hour of a patient a normal
patient. nursing having breathing
intervention. breathing pattern.
difficulties.

Long-Term ● Advise the ● Pursed-lip

Objective Plan: patient to do breathing
Cues: breathing is a good
After receiving techniques method to
● PR: 117bpm nurse care for such as breathe
one to two pursed-lip effectively
● RR: 22cpm days, the breathing. through
patient would the mouth.
be able to use
breathing ● Auscultate To identify the
strategies to the chest to character
improve assess of the
breathing breathing breath
patterns and sounds. sounds.
be free of
respiratory
distress. Dependent
Intervention:
● Elixophyllin
Administer promotes
Elixophyllin bronchodil
as ordered. ation.

b) Chest Pain

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 Name: Patient E Age: 51 y.o. Gender: F Diagnosis: DM Type 2

NURSING NURSING
CUES OBJECTIVES RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subject Acute Short-Term Independent The goal

Cue: chest pain Plan: Intervention: has been
related to met as
● “Sakit myocardial The patient Perform pain This is to evidenced
kaayu tissue will display assessment. identify the by the
akong ischemia. chest pain frequency, patient
dughan,” relief within an duration, being able
as hour of intensity, to show
verbalized nursing and chest pain
by the intervention. location of relief.
patient. the pain.

● “Agay Long-Term Encourage Timely

agay,” as Plan: immediate interventio
verbalized reporting of ns can
by the After receiving pain for reduce
patient. nurse care for prompt oxygen
one to two administratio consumpti
days, the n of on and
Objective patient would medications myocardial
Cues: be able to as indicated. workload
display and may
● PR: 117bpm complete minimize
chest pain cardiac
● RR: 22cpm relief. Dependent complicati
(shallow & Intervention: ons.
irreg.)
Administer Nitroglycerin
● PIS: 8/10 nitroglycerin is the
as ordered. standard
● Grimacing for treating
and
preventing
anginal
pain.

c) Hypertension

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 Name: Patient E Age: 51 y.o. Gender: F Diagnosis: DM Type 2

NURSING NURSING
CUES OBJECTIVES RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subject Hypertensi Short-Term Independent The goal

Cue: on related Plan: Intervention: has been
to met as
● “Kusog myocardial The patient’s Monitor vital This is to evidenced
kaayo ischemia. blood signs every identify the by the
mupitik pressure will after 5-8 condition patient
akong decrease after minutes. of the being able
kasing- 30 mins. of patient’s to show
kasing,” as nursing hypertensi chest pain
verbalized intervention. on. relief.
by the
patient. Educate the For the
Long-Term client about patient to
Plan: the risk be aware
Objective factors of the
Cues: After receiving leading to contributin
nurse care for high blood g factors.
● PR: 117bpm one to two pressure.
(+3) days, the
patient would Observe skin Delayed
● BP: be able to color, capillary
130/90mmHg display normal moisture, refill time
blood temperature, may be
pressure. and capillary due to
refill time. peripheral
vasoconstr
iction and
decreased
output.

Provide calm, This is to

restful promote
surrounding. relaxation.

Dependent
Intervention:

Administer This reduces

metolazone blood
as ordered. pressure.

9. EVALUATION

17
 The student nurses were able to understand the concept of diabetes and

how it affects a certain individual. After a thorough assessment of Patient E’s

case, they were able to evaluate her activities which contributes to the

emergence of her Diabetes Mellitus, especially the negative ones.

The student nurses have found out that Patient E is fond of eating sugar-

rich foods and drinking sodas with high sugar content. They knew that Patient E

previously works at the Provincial Hall of Misamis Oriental which she believes

was the core reason why she got diabetes. Additionally, the student nurses also

found out that Diabetes and Hypertension are common cases in Patient E’s

family where they knew that both her parents died because of comorbidities

relating to the mentioned hereditary illnesses.

The student nurses were also able to determine actions and interventions

that will prevent the disease from emerging or at least minimize its degrading

effects if it already emerged where they could satisfy their role as health

educators who have sufficient knowledge to make the lives of the people more

robust, comfortable, and disease-free.

10. RECOMMENDATION

This case study highly recommends the following health teachings. It

improves physical, mental, emotional, and social health by increasing people's

knowledge and changing their attitudes toward taking care of their holistic well-

being. This empowers people and makes communities live healthier.

1. Maintain a healthy diet: Work with a trained dietitian or nutritionist to

develop a meal plan that meets your objectives for managing your

18
 diabetes. Put an emphasis on eating a range of nutrient-dense foods,

such as whole grains, lean proteins, healthy fats, and an abundance of

fruits and vegetables. To control blood sugar levels, watch your

carbohydrate consumption and spread it out throughout the day.

2. Use a blood glucose meter or continuous glucose monitor (CGM): to

check your blood sugar levels on a regular basis. You will have a better

understanding of how certain foods, exercises, medications, and other

elements might affect your blood sugar levels.

3. Take prescription medication as directed: Follow the directions on any

medication that your doctor has recommended. Injections of insulin, pills

taken orally, or other diabetes drugs may fall under this category.

4. Exercise frequently: Exercise frequently can help reduce weight,

enhance insulin sensitivity, and increase general health. To choose an

exercise program that is both safe and effective for you, speak with your

healthcare professional. Aim to combine strength training with aerobic

exercises like walking, swimming, or cycling.

5. Keep a healthy weight: If you're overweight or obese, lowering your

weight can greatly enhance your ability to control your diabetes. You may

acquire and keep a healthy weight with the help of a balanced diet and

frequent exercise.

6. Learn as much as you can about managing diabetes: Study how to

identify and control high or low blood sugar levels, the significance of

19
 medication adherence, and the possible diabetes-related problems. If

there are any available, go to diabetes education classes or seminars.

7. Keep hydrated by sipping on water frequently throughout the day:

Limit your intake of sweet drinks like soda and fruit juices because they

can raise your blood sugar levels.

8. Make routine appointments with your healthcare team: That includes

your primary care doctor, an endocrinologist, and any other specialists

engaged in your diabetes care, to get regular checkups. Regular

examinations allow monitoring of your general health and modification of

your high or low blood sugar levels.

11. APPENDIX
11.1 GENOGRAM

11.2 GENOGRAM EXPLANATION

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 The patient’s father died at the age of 58 due to a myocardial

infarction. On the other hand, her mother died at the age of 67 because of

hypertension. She has one sibling who is also hypertensive. Both maternal

and paternal genes had a history of hypertension and diabetes mellitus.

Most of the members of the family tree died because of hypertension or

high blood pressure.

Patient E’s husband doesn’t have any complications, including her

daughter.

12. REFERENCES

● Centers for Disease Control and Prevention. (2022, July 7). What is

Diabetes? Centers for Disease Control and Prevention.

https://www.cdc.gov/diabetes/basics/diabetes.html

● National Cancer Institute. (2011, February 2).

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/

pancreas.

● R.N, M. V. B. (2013, July 13). Angina Pectoris (Coronary Artery Disease)

Nursing Care Plans. Nurseslabs. https://nurseslabs.com/angina-pectoris-

chest-pain-nursing-care-plans/

● Society for Endocrinology. (2018, March). Pancreas | You and Your

Hormones from the Society for Endocrinology. Yourhormones.info.

https://www.yourhormones.info/glands/pancreas/

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● Vera, M. (2018). Hypertension Nursing Care Plans. Nurseslabs.

https://nurseslabs.com/hypertension-nursing-care-plans/

● Wagner, M. (2023, March 11). Tachycardia Nursing Diagnosis & Care

Plan. NurseTogether. https://www.nursetogether.com/tachycardia-nursing-

diagnosis-care-plan/

● World Health Organization. (2023). Diabetes. World Health Organization;

World Health Organization.

https://www.who.int/health-topics/diabetes#tab=tab_1

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