I.

Introduction

Diabetes mellitus often referred to simply as diabetes—is a condition in which

the body does not produce enough, or properly respond to, insulin, a hormone produced
in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy. In
diabetes, the body either doesn't respond properly to its own insulin, doesn't make
enough insulin, or both. This causes glucose to accumulate in the blood, often leading
to various complications.

PREDISPOSING FACTORS AND RISK FACTORS

The nurse should be acquainted with the factors and circumstances that
commonly predispose the person to Diabetes Mellitus. Hence, the nurse is able to
identify the patient at high risk and to engage in anticipatory and preventive nursing.

Diabetes Risk Factors: Type 1 Diabetes

• Genetics and family history. Having family members with diabetes is a major
risk factor.
• Diseases of the pancreas. Injury or diseases of the pancreas can inhibit its
ability to produce insulin and lead to type 1 diabetes.
• Infection or illness. A range of relatively rare infections and illnesses can
damage the pancreas and cause type 1 diabetes.

Incidence Rate of Diabetes Mellitus in the Philippines

No. and Rate/100,000 Population as of 2004

14.1 deaths /100,000 Population as of 2000

CLINICAL MANIFESTATIONS

 Includes the three P’s:

- Polyuria
- Polydipsia
- Polyphagia
 Fatigue and weakness
  Increased blood pressure
 Sudden vision changes
 Tingling or numbness in hands or feet
 Dry skin
 Skin lesions or wounds that are slow to heal
 Recurrent infections

Prevention

Research continues on ways to prevent diabetes and to detect those at risk for
developing diabetes. While the onset of Type I diabetes is unpredictable, the risk of
developing Type II diabetes can be reduced by maintaining ideal weight and exercising
regularly. The physical and emotional stress of surgery, illness, pregnancy, and
alcoholism can increase the risks of diabetes, so maintaining a healthy lifestyle is critical
to preventing the onset of Type II diabetes and preventing further complications of the
disease.

NURSING MANAGEMENT

 Nursing management of patients with diabetes can involve treatment of a wide

variety of physiologic disorders, depending on the patient’s health status.
 Address any underlying factors (eg. knowledge deficit, self- care deficit, illness).
 Adjust the treatment regimen to patient requests (eg. adjust diet or insulin
schedule to allow increased flexibility in meal content or timing).
 Establish a specific plan or contact with each patient with simple, measurable
goals.
 Provide positive reinforcement of self-care behaviors performed instead of
focusing on behaviors that were neglected
(eg. positively reinforce blood glucose tests that were performed instead of
focusing on the number of missed tests).
 Help the patient identify personal motivating factors rather than focusing on
wanting to please physicians or nurses.
 Encourage the patient to pursue life goals and interests, and discourage an
undue focus on diabetes.
 II. OBJECTIVES

A. General Objectives:
At the end of the study, the group will be able to formulate an
effective nursing care management and implement interventions to clients
with Diabetes Mellitus.

B. Specific Objectives
• Assess the patient with Diabetes Mellitus
• Understand the nature of the disease
• Identify its causative/ precipitating factors
• Understand its Pathophysiology
• Enumerate signs and symptoms of Diabetes Mellitus
• Identify treatment or ways of preventing its occurrence
• Formulate an effective nursing care plan unique to our client’s
condition
 III. NURSING HISTORY

1. Personal Data

a. Name: Mr. W.A

b. Age: 75 yrs. Old
c. Sex: Male Status: Married
d. Address: J.P. Rizal Makati City
e. Occupation: Businessman
f. Religion: R. Catholic
g. Date and time of admission: August 5, 2009 at around 9:10pm
h. Admitting Physician: Dr. J.L

2. Chief Complaint:

Increase blood sugar and body malaise.

3. History of Present Illness:

Two days before hospitalization, the patient experienced frequent urge to

urinate that enables him to get up of bed frequently at night and disrupts his
sleep. He also emphasized that he is experiencing polydipsia.

4. Past Medical History:

Year 2005 and 2007 – Patient had experience two strokes on those years
and was hospitalized to Manila Doctor’s Hospital.

5. Family Medical History

 Both on the parent’s sides are positive for diabetes mellitus and
hypertension.
 Only on the father’s side is positive for cancer disease.

6. Clinical Impression

Diabetes mellitus type 1.

 IV. GORDON’S FUNCTIONAL PATTERN
Patterns of Before During / After Analysis
Functioning Hospitalization Hospitalization
1. Health “Aware siya sa mga “Kahit ngayon tanung The client even
Perception nangyayari sa pa din siya ng tanung though he is sick
katawan niya,” as tungkol sa mga still has the
verbalized by the ginagawa sa kanya awareness about
client’s wife. dito sa ospital,” as his health condition.
verbalized by the
client’s wife.
2. Nutritional / “Hindi siya mahilig “Wala siyang gana The client’s food
Metabolic Pattern kumain ng isda at kumain dito dahil intake decreased
gulay pero magana matigas at matabang when he began his
naman siyang daw ang pagkain,” as confinement.
kumain. Chicken at verbalized by the
kahit anong soup client’s wife.
ang paborito niyang
pagkain,” as
verbalized by the
client’s wife.
3. Elimination “Sobrang madalas “Nakadiaper na siya There is a change
Pattern siyang umihi. Minsan ngayon. Hindi nga in the frequency of
nga hindi na siya lang siya makadumi his bowel
nakakapagsabi, dahil wala nga movement due to
umiihi nalang siya sa siyang kinakain decreased food
kama. Normal masyado dito,” as intake.
naman ang pagdumi verbalized by the
niya. Isang beses sa client’s wife.
isang arawa, ” as
verbalized by the
client’s wife.
4. Activity / “Ang tamad niya, lagi “Dito lagi namansiya There is no change
Exercise Pattern na lang siyang nakaupo tsaka naka in client’s activity
nakaupo sa bahay higa kasi ang daming since he is not
habang nanunood ng nakatusok sa kanya.” engaged in any
t.v. at pag nasa As verbalized by the kind of activities.
canteen din sya. client’s wife.
Kahit man lang
maglakad lakad
ayaw niya,” as
verbalized by the
client’s wife.
5. Sleep / Rest “Halos di siya “Mahimbing na The client can now
Pattern makatulog dahil siyang matulog. Oras sleep well in the
maya’t maya siyang oras nga siyang tulog hospital because
umiihi,” as verbalized dito di tulad nung he knows that he is
 by the client’s wife. nasa bahay,” as receiving treatment
verbalized by the for his condition
client’s wife. and that there are
nurses who can
assist him.
6. Cognitive- “Nakatapos yan ng “Namimiss daw nya The client’s
Perceptual Pattern college pero iba ang ang pagbabasa ng cognitive-
hilig. Magaling yan dyaryo at pagsagot perceptual pattern
magluto kaya ng puzzle,” as changed in terms of
pagkain din ang verbalized by the his reading and
business naming. client’s wife. thinking exercise.
Mahilig din yan
magbasa ng dyaryo
at sumagot ng
crossword,” as
verbalized by the
client’s wife.
7. Self- “Palakaibigan yan “Medyo naging The client’s self
perception / Self dun sa canteen lalo irritable yan ngayon perception/concept
Concept Pattern na sa mga taong at ilag sa mga tao,” changed because
kumakain,” as as verbalized by the of his condition.
verbalized by the client’s wife.
client’s wife.
8. Role- “Kahit may sakit siya, “Madalas kaming Due to his
relationship naasikaso at nalalaro dalawa lang condition, he is
Pattern pa din niya ung mga magkasama dito sa irritable and
apo namin kapag kwarto at may isa uncomfortable with
dumadalaw sila sa lang siyang the some of the
bahay,” as verbalized nagustuhan na people that he
by the client’s wife. magasikaso sa sees.
kanya at isa yun sa
mga student nurse
nyo,” as verbalized
by the client’s wife.
9. Sexuality- “Wala na kaming “Wala na kaming The client can not
Reproductive oras para diyan. Isa oras para diyan. Isa perform sexual act
Pattern pa matatanda na pa matatanda na because of his age
kami,” as verbalized kami,” as verbalized and decreased
by the client’s wife. by the client’s wife. libido.
10. Coping / “Yung sakit niya ang “Ngayon mas The client feels
Stress Tolerance pinaka problema niya dumami pa ung more stressful upon
Pattern tapos marami pang iniisip niya kasi hospitalization
pinagbabawal eh maraming because of many
mahilig pa naman ginagawang tests sa factors like financial
kumain yan lalo na kanya tapos baka and physical
pag problemado, ” as wala na daw kaming stressors.
 verbalized by the pera,” as verbalized
client’s wife. by the client’s wife.
11. Value Belief “Hindi na kami “Walang t.v dito kaya The client though
Pattern nagsisimba pero baka din a kami being ill has done
nanunuod na lang makanuod ng efforts to fulfill his
kami ng mass sa t.v. Sunday mass,” as spiritual needs.
tuwing Linggo,” as verbalized by the
verbalized by the client’s wife.
client’s wife.
List of Nursing Diagnosis (NANDA) – prioritized
Nursing Diagnosis
Imbalanced nutrition: less than body
requirements related to loss of appetite
Risk for Deficient Fluid Volume
Risk for Infection
Deficient knowledge related to disease
condition
Fatigue related to disease condition
Interpretation
The patient’s intake of food is
insufficient to meet his daily nutritional
needs because of lack of appetite to
hospital food.
The risk for deficient fluid volume is
another problem. Since the patient is
suffering from polyuria, it may lead to
dehydration if not prevented.
It is another problem because the
patient is at risk for infection; therefore
it may lead to other problems and
complications.
The patient needs further health
teaching regarding on his disease
condition in able to help in maintaining
and restoring health.
The patient often feels fatigued due to
his condition. The client is encouraged
to take adequate rest.