DIABETES MELLITUS

INTRODUCTION
In the modern and improved technological world of medicine
there are some people who are still home care of the treatment
modalities . For such people they need awareness regarding the
approach for treatment . In that aspect Community Health Nursing
plays on integral past this identifies the needs and problems and
initiates treatment.
Diabetes is the second most common endocrine disorders. It is
the major Non Communicable disease of the society. Govt of India
created awareness to control Non Communicable disease via NCD
clinics 70% of the diabetes can be controlled by life style
modifications. So I have selected Diabetes mellitus.
Diabetes mellitus is the condition in which carbohydrates
metabolism disturbed due to insufficient secretion of insulin
hormones. It is characterised by triad features polyuria, polyphagia,
polydypsia.

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NEED FOR STUDY

We are the 7th batch Post Basic B.sc (N) II Year were posted
to undertake survey in Kollapatti (rural health post) as post of our
training program in community health nursing .I was posted in
S.Kollapatti area in Thalavaipatti yeri colony.

I have been asked to all the family folder for new families . I
selected the diabetes mellitus client Mrs.Vadivukarasi 32 years old .I
focused my attention of that particular person and gave care during
the every next visit .I have also selected the family for my family
care study in the community health nursing .

Home visit strengthens the ties that bind the family sickness
through community health guidance and services that is provided
orally by the community health nurse.

In the care study the family diabetic mellitus client in adequate

knowledge about the health problem and health maintenance and
they expect more information from me, so that I selected the family
for my family care study.

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LEARNING OBJECTIVES
 To promote and maintain the health of the members
 To remove anxiety and fear associated diabetes.
 To learn the future complaints about hyper glycemic condition
to improve their activities.
 To describe the relationships among diet exercise and
medication for people with diabetes
 To learn about the detailed study about diabetes mellitus.
 To know about physical and psychological changes.
 To know about health status of the client
 To develop knowledge about disease condition.
 To know the complaints.

REASON FOR SELECTING THE FMILY

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 In human content a family is an exclusive group who share a
close relationship unit typically or traditionally compose of couples
and these dependent children in co-residence .Families creat
generation each of which gain in maturity and self sufficiency such as
to create and provide for subsequent generation.

Extended from the human family units by affinity economy

culture honour and friendship or concept of family that metaphorical
or that grow increasingly inclusive extending to nation hood and
humanism.

To provide promotive, preventive and curative services to the

family members.The family members take of knowledge about
nutrition balanced diet does not how to take care during the
hypoglycaemic state.

So in order to provide comprehensive care their health status, so

I selected this family for my family care study.

COMMUNITY PROFILE:
EDUCATION : Government and private

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HIGHER SECONDARY SCHOOL : 1
HIGH SCHOOL :2
MIDDLE SCHOOL :2
PRIMARY SCHOOL :2
ICDS :1
WATER SUPLY : Tap Water
NO OF OVER HEAD TANKS : 2 TANKS
NO. OF BORE WELL :2
MARKET : Weekly market on
Saturday S.kollapatti.
LATERINE : RCA type of latrine
DRAINAGE : Closed and open drainage
facilities available
REFUSE DISPOSAL :Disposal in bins open
/closed by panjayat worker.
Burial of refuse also present
DISPOSAL OF DEAD:
This is done in germ yard sanitation of the area, is supervised
and maintained by Health inspection.

CLIENT PROFILE:

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NAME : Mrs. Vadivukkarasi.
AGE : 33years.
SEX : Female.
OCCUPATION : House wife
EDUCATION STATUS : Diploma
INCOME : --
CLASSIFICATION : Adult with diabetes mellitus.
ADDRESS : W/O Jagadesh,
NO:5/330 Thalavaipatti yericolony,
S.kollapatti,
Salem.

SOCIO ECONOMIC STATUS:

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DESCRIPTION OF THE HOUSE SURROUNDING:

TYPE OF HOUSE : Concrete house

NUMBER OF ROOMS &HOW USED : 5
LIGHTING : Available & adequate
STORAGE OF WATER : Safe
WATER SUPPLY : Tap water
WASHING PKLACE FOR VESSELS : kitchen
BATHING AREA LOCATION TYPE : Bath room
LATERINE : RCA type
DISPOSAL OF WASTE WATER : open drainage
SOUROUNDING : Clean &Neat

LAY OUT OF CLIENT HOUSE:

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Toilet

KITCHEN BEDROOM BEDROOM

OFFICE ROOM
HALL

WASHING AREA

ENTERANCE

FAMILY HEALTH BELIEF AND PRACTICES WITH

REGARD TO:

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 A)Cause and spread of common disease
B) Type of medical heap sought : PHC
C) Immunization : Given
D) Food-Hot : Cold

HISTORY COLLECTION

Patient has been suffering from leg pain and weakness.

PAST HISTORY

Patient has been suffering from diabetes mellitus since 2

years taken drugs regularly.

FAMILY HISTORY

No family history of hypertension

Family history of diabetes mellitus
No family history of seizure disorder

FAMILY COMPOSITION

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S/n Name of the family Marital Relationship Health
Age Sex Education Occupation
o memers status with client status

1 Mrs.govindammal 51 y F ------ house wife Marrie mother healthy

d
2 Mr.Jegadhesh 37 y M 10 th PVT married Husband healthy
3 Mrs.Vadivukkarasi 33y F Diploma house wife married Client Diabetes
mellitus
4 Master.utharabala 9y mch 5th - - son Healthy
5 Master 8y mch 3rd - - son healthy

FAMILY PEDIGREE

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 Key notes: Client-----------
Male-------------
Female ----------
Death male------

PERSONAL HISTORY
- No Tobacco Chewing
- Mixed Diet
- Sleep 8 hours night
- Good interpersonal relationship with others
- Watching television

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MENSTURAL HISTORY
-Menarche at the age of 12 years
- Irregular cycle 3-5 /35 days
- Normal flow

MARITAL HISTORY
- Married since 11 year before
- Non consanguineous marriage

OBSTERTICAL HISTORY:
- Ist – LSCS- Placenta previa –Salem medical center Pvt clinic
14 yrs back

- IInd –LSCS-12 yrs back Family planning done

PHYSICAL ASSESSMENT:
GENERAL APPEARANCE:
- Conscious
- Moderately built
HEAD
- Normal Size

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 - B lack In Colour Of Hair
NOSE
- No septal deviation
- Sense of smell
EAR
- Symmetrical
- Normal hearing
- No wax
MOUTH
- Lips moist
- No dental carries
- No staining teeth
NECK:
- No neck stiffness
- Thyroid gland is not enlargement
ABDOMEN
- Soft no organomegaly
- Bowel sounds are norma
- Normal range of motion
CHEST
- Symmetrical movement of chest
- Bilateral air empty present

SYSTEMIC ASSESSMENT
CENTERAL NERVOUS SYSTEM:
- Client Conscious
- Oriented do place ,person, time
CARDIO VASCULAR SYSTEM:
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 - S1 s2 Heard
- Pulse rate 76/min
- Bp-120/80 mm/hg
RESPIRATORY SYSTEM:
- Bilateral air entry
- Respiratory rate 20/min
GASTTRO INTESTINAL SYSTEM:
- Abdomen soft
- Bowel sounds heard
GENITO URINARY SYSTEM:
- Frequency of urinary function
- No urethral discharge
MUSCULO SKELETAL SYSTEM:
- Upper extremities ,lower extremities normal
- Normal range of motion
INTEGUMENTRY SYSTEM:
- Skin turgor good
- Temperture:98.4 F
- No skin colour changes
- No rashes

VITAL SIGNS:
- Temperature :98.4 F
- Pulse :76/mt
- Respiration :20/mt
- Blood pressure :120/80 mm hg

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 NUTRITIONAL ASSESSMENT:
- Height :160cm
- Weight :68 kg
- Body Mass Index :Weight in kg/Height in ( m2 )
- BMI :26
- Obese

Time Cooked QTY CHO Protein Iron Fat Calci Calorie

Food (gm) (gm) (gm) (mg) (mg) Kcal

Coffee 200 65
6AM 4.9 3.5 3.7 0.4 0.12
biscuit ml 20

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 Idli 4 78.9 604 0.4 2.2 0.01 345
8AM Sambar 100 15 6 0.26 2.2 0.005 8
withdhall ml 30 10.4 2.8 4.5 0.03 185

Rice
Dhallsamba 2cup 15.8 12.8 0.8 4.4 0.02 690
2PM r 100ml 30 10.4 2.8 4.5 0.03 185
With beans 100gm 10.0 4.5 0.1 1.6 0.01 59
poriyal

5pm coffee 200ml 4.9 3.5 3.7 0.4 0.12 65

0.01
Idli 78.9 6.4 0.4 2.2 345
4 0.005
9pm Sambar 15 6 0.26 2.2 8
100ml 0.03
withdhall 30 10.4 2.8 4.5 185

Coffee 200 65
6AM 4.9 3.5 3.7 0.4 0.12
biscuit ml 20

Total 348.3 83.8 21.72 29.5 0.55 2245

24 HOURS RECALL FOR NUTRITIONAL ASSESSMENT

INTERPRETATION:

S.NO REQUIREMENT RDA ACTUAL DEFICI EXCESS

S INTAKE T

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 1875
1 Calorie 2245 Excess
Kcal
2 Protein 60gm 83.8 Excess
3 Fat 20gm 21.72 Excess
4 CHO 250gm 318.3 Excess
5 Iron 30mg 29.5 Deficit
6 Calcium 800mg 0.55 Deficit

INFERENCE:

Percentage calories supplied for Adult with normal body weight

Carbohydrate =40 %
Fat =40%
Protein =20%
Advised to add Ragi,Wheat,Millets,Sprouts in Diet.

RECOMMENDED MENU PLAN

Required Kcal: 1800 to 2000 Kcal

Time Cooked QTY CH Protein Iron Fat Calci Calorie
Food O (gm) (gm) (mg) (mg) Kcal
(gm)
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 Coffee
6 65
Without 200 ml 4.9 3.5 3.7 0.4 0.12
AM
sugar
Ragi
8 100gm 7.3 7.1 1.3 5.4 0.03 332
adaitomato
AM 100 ml 13.8 10.4 2.8 4.5 0.03 185
chutney
RICE
2cup 15.8 12.8 0.8 4.4 0.02 690
Dhallsambar
1 PM 100ml 30 10.4 2.8 4.5 0.03 185
With beans
100gm 10.0 4.5 0.1 1.6 0.01 59
poriyal
Vegetable
saled 50gm 2.9 0.9 0.05 1.1 0.01 14
4pm
Tomato 50gm 2.2 0.4 0.05 0.2 0.25 10
raddish
0.72
Chappathi 3 66.6 9.9 3.5 0.001 303
9pm 0.05
Dhall sambar 50ml 11.4 0.8 0.35 0.01 45

Total 250 60 20 30 0.90 1888

DIABETES MELLITUS

DEFINITION:

It is the condition in which disturbances of carbohydrate

metabolism due to insufficient secretion of insulin hormones. It
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 is characterised by triad features e.g: polyurea, polyphagia,
polydipsia.
- BRUNNER.

Diabetes is due to either the pancreas not producing

enough insulin (or) the cells of the body not responding properly
to the insulin produced.

- NEELAM KUMARI

INCIDENCE
As of 2014,an estimated 387 Million have diabetes worldwide,
with type 2 diabetes mellitus making up about 90% of cases, this
is e 8.3%Of the adult population, with equal rates in both
women and men. In the year 2012,2014 diabetes is estimated to

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 have resulted in 1.5 to 4.9 million deaths per year. Diabetes at
least doubles the risk of death.

TYPES OF DIABETUS MELLITES

1) IDDM (Insulin dependent Diabetes mellitus)

In this condition patient is unable to produce endogenous
insulin due to destruction of pancreatic beta cells by genetic
immunologic and environmental factors.
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 - About 5-10% cases above diabetes types I of total DM
- it has sudden onset, usually before the age of 30 years (mostly
young age)
- Insulin therapy is necessary

2) NIDDMC(Non Insulin Dependent Diabetes mellitus )

- In results from a decreased sensitivity to insulin (insulin resist)a

decreased amount of insulin production.
- type 2 Diabetes is first treated with diet and exercise and then
with hyperglycaemic agents is needed.
- About 90-95% of patient have types -2 DM
- About 80% cases due to obesity.
- There is no need of exogenous insulin. 3) Gestational DM

Gestational diabetes is characterized by any degree of

glucose in onset during pregnancy (second or third trimester)

ETIOLOGY /RISKFACTORS
1) Hereditary.
2) Obesity . mostly due to imbalance insulin level because
supply of insulin level because supply of insulin is less and
requirement is more in Obesity .
3) Old age (pancreatic function become slow)
4) Other systemic disease like

 Heart disease
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  MI
 Stroke

5) Renal disease
6) Viruses (coxsackie –B, Strepto)
7) Africans and Asians are more susceptible

SIGNS AND SYMPTOMS

 Untreated diabetes are weight loss
 Increased urination –poly urea
 Increased thirst –poly dipsia
 Increased hunger-poly phagia

OTHER MINOR SYMPTOMS

 Blurring of vision
 Head ache
 Fatigue
 Slow healing of cuts
 Itching skin
 Diabetic dermatomes
 Glucose absorption is the lens of the eye
PATHO PHYSIOLOGY

Destruction or inflammation of β-cells of langerhans of pancreas

Decrease secretion of Insulin

Insulin requirement is not sufficient for total body

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 Obstruction or disturbance in carbohydrate metabolism

Increase blood sugar level (hyper glycaemia)

Increase glycogen level and decrease energy patient feels

fatigue

Weight loss due to improper carbohydrates metabolism and also

increase appetite

DIAGNOSIS:
 Fasting plasma glucose level
 Postprandial glucose level
 Glycated albumin
 Urine sugar
 Urine albumin
 Electro cardiogram
 Ultra sonogram glucose tolerance test
 Glucose tolerance test
 Symptoms of Hypoglycaemia and causal plasma glucose

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MANAGEMENT
There are two categories
1) Oral hypoglycaemic
2) Insulin therapy
ORAL HYPOGLYCAEMICS
There are 2 types of tablet used sulphonyl urea tablets are in
common use to bring down blood sugar these compounds stimulate
the pancreas to produce more insulin and this explains why they are
ineffective in the more severe type of diabetes where the pancreas is
incapable of protecting any insulin at all.
 Glypizide have a short duration action and are normally taken
twice a day.

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 Glibenclamide has an immediate strength of action

 Chlorprapamide and tolazamide have a longer action and once a

day effected

 All these tablets are well tolerated and seldom give rise to
hypoglycaemia other ill effects

 Unfortunately they become ineffective if the diet is not adhered

to and should not be

 used as an excess to over act they often give rise to an increase

in weight
 Metformin is a biguanide and probably to lower the blood sugar
by reducing the peripheral sensitivity to insulin it’s not affective
as the sulphonyl ureas and often causes nausea and stomach
upsets. However, metformin helps to keep the weight down and
is often prescribed in patients who are overweight.
OVERWEIGHT DIABETES

These patients usually need neither tablets nor insulin

provided they are willing to reduce their weight by restricting
their food intake, over eating produces strain on the pancreas,
and if the supply of insulin is limited, diabetes will result. Hence
the diet must be so restricted that the patient loss weight.
Depending on the degree of obesity the diet will vary from
as little at 3500 KJ day 5000 KJ a day. Once the weight is
reduced the blood sugar falls to normal, the urine becomes free
from sugar, and the symptoms disappear, the patient must
always keep to a diet, thought not necessary as severe as the
original one.

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INSULIN THERAPY
There are 4 types
 Soluble insulin
 The medium (or) intermediate
 The long acting insulin
 Ready mixed combinations

SOLUBLE INSULIN
This is clear insulin
And its effects last about 6 hours in order to control
diabetes on its own it must be given at least twice a day. It can be
given Intravenously in the treatment of diabetic coma .Human
actrapid are preparations of soluble Insulin.

THE MEDIUM (OR) INTER MEDIATE INSULIN:

If injected in the morning before breakfast exert their
maximum effect at lunch time and early afternoon, the effect is less
marked overnight, consequently a second injected is often necessary
before the evening meal.
LONG ACTING INSULIN
Such as ultratard (or)protamine zinc are useful as single
injection ,in the morning . they are suitable for diabetes who are have
easily controlled blood sugar and do not need a large doses.
READY MIXED
The comdination of short and long acting insulin are also
available .These have a wide range of duration of action depending on
the proportion.

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NURSING MANAGEMENT
ASSESSMENT:
 We should get baseline information (eg)
 3P s Symptoms
 Polyurea
 Poly phagia
 Polydipsia
 Take family history of DM
 Assess knowledge level of patients and family
 Perform to physical assessment
 Assess anxiety level patient

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COMPLICATION
 Kidney disease
 Albuminuria
 High BP
 Neuropathy
 Pain in legs
 Sexual impotency
 Retrograde ejaculation
 Sweating
 Muscle damage
 Arteriosclerosis
 Infection
 Tonsillitis
 Pneumonia
 Appendicitis
 Pyelitis

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PREVENTION AND CONTROL
EDUCATION

PHARMACOLOGICAL
THERAPY

PATIENT

M ONITORING NU TRITIONAL

EXERCISE

PREVENTION IS DEPENDS UPON THREE FACTORS

 Dietary management
 Exercises
 Insulin therapy

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CLINICAL MANIFESTATIONS

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 SN CLIENT PICTURE
BOOK PICTURE
O
1 Polyuria Present

2 Polyphagia Absent

3 Polydypsia Absent

4 Slow healing of cuts Absent

5 Blurring of vision Absent

6 Fatigue Present

7 Itching Absent

8 Weight loss Absent

9 Skin becomes dry & Present

rough
10 Nocturia Present

11 Paresthesia Absent

12 Cramps in legs Present

INVESTIGATION

S.NO INVESTIGATION BOOK CLIENT REMARKS

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 PICTURE PICTURE
1 Random blood 80- 172mg/dl Increased
sugar 120mg/dl

2 Haemoglobin 12-14gm/dl 9gm/dl Decreased

3 Urine Albumin Nil Nil Normal

4 sugar Nil Nil Normal

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NITGHTINGALE’S THEORY
ENVIRONMENTAL THEORY
 Florence Nightingale considered as the first nurse theorist defined
nursing as “the act of utilising the environment of the patient to
assist him in recovery”
o Pure or fresh air
o Pure water
o Efficient drainage
o Cleanness
o Light
PATIENT
 Refers to as individual or person who is responsible creative in
control of his eye and death patient can be ached by the nurse or
affected by the environment
HEALTH
 Using ones power to the fullest as a stage of well being.
ENVIRONMENT
 Refers to the external to the persons but affecting the health
of both sick and well persons.
 Nightingale also stressed upon the importance of keeping the
client warm, maintaining a noise free environments, attending
the client’s diet in term of assessing intake time less of food.
 It also includes fresh air ventilation, quiet, warmth,
cleanliness and light
ILLNESS
Defined as the reaction of nature against the conditions in which
we have placed ourselves.

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NURSING
 Means to have change of the personal health of some body and
what nursing has to do it put the patient in the least condition of
nature to act upon him
 This includes appropriate nursing, nutrition, hygiene, light
comfort, socialization and hope
 Health maintenance and health restoration are the nurses goals.
 Nightingale theory a frame work for the nurses to think and
focuses on the patient and the environment

PRINCIPLES OF THEORY
 According to this Nightingale theory “poor environment is one
is one of the main factor affecting of the health of the people”
 There is water stagnation is front of my clients house. no proper
disposal of waste.
 According to Nightingale’s theory effective drainage “all while
the sewage may be nothing but a laboratory from which
epidemic disease and ill health being installed in to the house”
 Any deficiency in environmental factors could lead to impaired
functioning of life process of diminished health status.

NURSING DIAGNOSIS

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1. Leg pain related to long term hyper glycaemia

2. Sleeping pattern disturbance related to frequency of micturation

3. Imbalance nutrition less than body requirements related to poor

intake of food

4. Anxiety and fear related to long term illness

5. Risk for injury related to hypoglycaemia

6. Knowledge deficit regarding to the diabetic diet pattern

7. Fluid volume deficit related to less intake of fluid

8. Risk for infection related to poor immune status.

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 DAY -1

TIME PLAN
DATE:19.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Self introduction done

8.10AM Rapport established with the client

with all the family members

8.20AM Arrange place for procedure taking

Patient data collection

8.30AM Socio economic status assessed All the family

members co operated
9.00AM History collection done well with me doing
the home visit
9.30AM Vital signs checked and recorded
Temperature :98.6 F
Pulse :76/mts
Respiration :20/mt
Blood pressure :120/80 mmhg
11.00AM
Health education given about
personal hygiene
12NOO
N Replace the articles

36
 DAY -2

TIME PLAN
DATE: 20.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport

8.30AM Arrange place for procedure taking

9.00AM Physical assessment done

9.10AM Systemic assessment done

10.00AM Height and weight checked &

recorded BMI calculated

10.30AM Blood pressure checked with the

help of BP apparatus

Well co operate
doing collection of
11.00AM Vital signs checked and recorded the history of the
Temperature :98.6 F family members
Pulse :76/mts
Respiration :20/mt
Blood pressure :120/80 mmhg

12NOO Replace the articles and

N documentation

37
 DAY -3

TIME PLAN
DATE: 21.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport

8.30AM Arrange place for procedure taking

9.00AM Urine analysis done . urine sugar

result green colour

10.00AM Vital signs checked and recorded There were no other

Temperature :98.6 F abnormal findings is
Pulse :76/mts assessed in physical
Respiration :20/mt and systemic
Blood pressure :120/80 mmhg examination

11.00AM Health education given about

diabetic diet

Leg pain and leg

12NOO Replace the articles and weakness of leg
N documentation

38
 DAY -4
TIME PLAN
DATE:22.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport

8.30AM Arrange place for procedure taking

9.00AM Fasting blood sugar checked used Advice to take

by capillary blood glucose monitor regular treatment
result - 172mg/dl

9.30AM 24 hours recall nutritional

assessment done

10.00AM Recommended daily allowance for

diabetic diet

10.30AM Health education given about

diabetic foot care

11.00AM Height ,weight taken for the all

family members

12NOO Replace the articles and

N documentation

39
 DAY -5

TIME PLAN
DATE: 23.02.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport

8.30AM Arrange place for procedure taking

9.00AM Menu plan prepared

9.30AM High protein added in menu

High fibre diet advised reduce

Carbohydrate diet advised

The family members
co operated well and
asked many doubts
11.00AM Health education given about client listened well
diabetic do sprouted green gram , she said that she will
millets ,green leafy vegetables & follow the same in
fruits calcium rich diet advised future

12NOO Replace the articles and

N documentation

40
 DAY -6

TIME PLAN
DATE:01.03.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport

8.30AM Arrange place for procedure taking

9.00AM Haemoglobin blood test was done

used by haemoglobin meter

10.00AM Foot care given to the client

10.30AM Educate to the client further care of Result 9 gm advise

feet to take iron rich
diet .Teach the client
fresh vegetables and
11.00AM Advised to mild walking and green leafy
exercise vegetables

12NOO Replace the articles and

N documentation

41
 DAY -7

TIME PLAN
DATE:02.03.2018
TIME ACTIVITIES REMARKS
8.00 AM Maintain rapport

8.30AM Arrange place for procedure taking

9.00AM Health education was given to the

family members regarding the
nutritious diet

9.30AM Cleared all the doubts of the Result 9 gm advise

family members regarding the to take iron rich
health selected aspects diet .Teach the client
fresh vegetables and
10.00AM Health education about green leafy
environmental hygiene vegetables

11.00AM To avoid stagnant to water

surrounding home

11.30AM Educate to safety measures

12NOON Educate to the client further care

of feet

Replace the articles and

documentation

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HEALTH EDUCATION
PERSONAL HYGIENE
 Advised to maintain personal hygiene such as daily bathing and
washing and nail cutting, changing of dress etc.
NUTRITION
 Advised to maintain high protein, high fibre diet such as cereals,
pulses , green leafy vegetables , pulses cereals with fruits . It
has more fibre diet.
REGULAR MEDICATION
 Advised to maintain blood sugar level under controlled by
regular intake of hypoglycaemia drugs $ vitamins.
EXERCISE
 Advised to have regular walking cycling and day to day
activities to maintain normal nutritional status.
FOLLOW UP
 Regular check up of the blood glucose level in a available area
or nearby primary health centre.

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SUMMARY

Through this care study I provided care to the person with

suffering from diabetes mellitus. I gave more knowledge to client
about risk factor for diabetes mellitus dietary pattern, life style
modification and importance of taking drugs periodically, she is very
co-operate and listening the health advice.
An effective family health service provides for a study of the
family as a whole and the factors the affect the health and welfare of
each member.
During my visit to this home gained information and observes
home conditions which are essential for the intelligent analysis and
understanding for the basis forces that affect family health. Frequent
visit to the selected family may helpful to the family members, but
same time they are feeling uneasy and inconvenient Because that time
factors and the home situations that really expressed the happiness
for over nursing services to that family.
I collect 24 hours recall and recommended died menu as per
client’s requirements. Finally i have given health education to
prevent complication.
I would express my gratitude for the family members and also
my faculties.
So far I have presented about patient history, so it economic
condition personal history and about disease condition. it is very
useful for the client to improve the health status. it gained more
knowledge regarding disease condition would like to thank in our
faculties for giving this opportunities.

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Relevant review literature under health problems
Article:
Education and diabetes mellitus
By:
Marina kosti, Marina kanakari
Abstract:
Diabetes mellitus is a multi factorial disease that requires long-
term care since it involves major changes in both physical and
physiological dimension of each patient. Diabetes education is a
critical element of care that improves patient outcomes.
Aim:
The aim of the present study was to review the literature about the
education in diabetes mellitus management.
Method:
The method of this study included bibliographic research of the
literature from review and researches, which researches, mainly in the
pubmed data base, which referred to education in diabetes mellitus
management. Pubmed was searched using the following key search
terms “diabetes mellitus” , “self management” education while
research covered the period 1999-2012
Results:
According to the literature, education should not be a mere
transmission of information, but a dynamic ,holistic, planned care
based on individual’s need (patient –cantered approach)Further
more motes self-management and health related behaviour
modification. moreover, education should be consistent with
individual’ learning
Skills and psycho social state.. Diabetes education should be
reinforced after its completion and enhance in depth understanding
the significance of check up and follow-up. Last but not least

45
effective education requires good communication among diabetic
patients and health professionals.

CONCLUSIONS:
The overall goal of diabetes education is to help individuals and
their families gain the necessary knowledge, life skills resources and
support needed to achieve optimal health.
Key words:
Diabetes mellitus ,self management education.

ARTICLE
Diabetes mellitus –its complications, factors influencing
complications and prevention an over view.

BY
S.Rambhade,A.K.Chakkarabatorthy,U.k.PPatil,A.Rambhade.

ABSTRACT:
This review aims to summarize the major advances of the
proceeding year and to put them in to the context of current opinion
on diabetes mellitus. Despite the advent of prolonging insulin for the
treatment of diabetes, the appearance and progression of many of the
disabling complications associated with this disease cannot be
prevented through the administration of insulin clinically, the onset
and rate of progression of diabetic complications , including cataract,
corneal epitheliopathy, micro anjiopathy,appearto be dependent upon
both the duration and the severity of the diabetes .This review
summarizes the specific pathogenic mechanisms of micro vascular

46
complications for which clinical therapies have been developed,
including the poly ol path way, advanced glycation and
products,protein kinase C,vascular epithelium growth factor, and the
super oxide path way .The undergoing late-stage clinical trials.

KEY WORDS Diabetes ,diabetic complications poly ol path way,

oxidative stress, protein kinases.

47
BIBLIOGRAPHY:
 K.Park 201 “preventive and social medicine 21st Edition M/s
bterasides bharot publishes Jabalpur.

 K.Park 200, “ Essential of community health nursing” 3rd

Edition M/S bharasides bharot publishers Jabalpur

 Sundal lal at all 2011 text book of community medicine 3rd

Edition cbs published and distribute pvt .ltd New Delhi.

 DR.Mrs .Kasturi sundar rao “An introduction to community

Health nursing” 4th edition,Bombay brothrs publications pvt.ltd

 Neelamkumarai,2011. Essential community health nursing” Ist

Edition, Published by Pee Vee brothers medical Publication, Pvt
ltd.

 S. Kamalam 2005, “Essential in community health nursing

Practice” Ist Edition Japee brothers medical publishes pvt.ltd.

 Dr.swaminathan,2011 Hand book of Food and nutrition ,The

Bangalore press, Bangalore.

 Lippincott Williams & Wilkins,2011,”Text book of medical and

surgical Nursing”2th Edition Published by Pee Vee brothers
medical Publication, Pvt ltd.

 Louis,2011,”Text book of medical surgical Nursing” 8th Edition

Published by evolue.

 WWW.Wikipedia.com

48
CONCLUSION:

Through this care study I have gained more knowledge about

the how to do collect the history, assessment of the diabetes mellitus,
causes and risk factors, drug management ,nursing diagnosis and
nursing intervention for diabetes mellitus is home set up and health
education given to the community setting.

Here with I conclude my family care study, through this family

care study, through this family care study ,I achieved almost all my
objectives

And also i provided care and explained them to improve the

knowledge about the care of the diabetes mellitus

49