A Case Study of Mr

7/31/2019 A Case Study of Mr

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NONINSULIN

DEPENDENT DIABETESMELLITUS


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GrandpaU


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U(+)

Grandpa

(+)

98-age

U(+)

U(+) DM

Father

(+)

88-age

Mother80

42

48

54

58

(+)TB

38DM

Patient44

4650

525660 (+)

hepatitis

Female

male

deceased

Unknown


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Complete blood Count


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Hypoglycemic

coma


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Route and Dosage IndicationsIV/IM: ADULTS, ELDERLY: 1.2-1.8 g/day in 2-4 divided doses. CHILDREN: 25-40mg/kg/day in 3-4 divided doses.Maximum: 4.8 g/day.

PO: ADULTS, ELDERLY: 150-450 mg/doseq6-8h. CHILDREN: 10-30 mg/kg/day in 3-4divided doses. Maximum: 1.8 g/day.

Bacterial VaginosisIntravaginal: ADULTS: One applicatorful atbedtime for 3-7 days or 1 suppository at

bedtime for 3 days.

PO: ADULTS, ELDERLY: 300 mg 2 times/dayfor 7 days.

Acne VulgarisTopical: ADULTS: Apply thin layer 2

times/day to affected area.

Treatment of respiratory

tract, skin or soft tissue,

chronic bone or joint

infections; septicemia; intra-abdominal, female

genitourinal infections;

bacterial vaginosis;

endocarditis. Can be used

for acne vulgaris.Clindamycin is used for

treatment of malaria, otitis

media, Pneumocystis carinii

pneumonia, and

toxoplasmosis.

Action Containdications


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Action Containdications

Bacteriostatic.

Clindamycin binds tobacterial ribosomal

receptor sites.

Topically, it decreases

fatty acid

concentration on skin.

It inhibits protein

synthesis of bacterialcell wall and prevents

outbreak of acne

vulgaris.

Containdicated with

allergy toclindamycin,

lactation.

Use cautiously in

newborns and infantsdue to benzyl alcohol

content(associated

with gasping

syndrome) and in

patients with tartrazine

sensitivity or hepatic

or renal impairment.

Sid Eff t Ad Eff t


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Side Effects Adverse Effects

Abdominal pain

Nausea and VomitingDiarrhea

Vaginitis and itching

Dry scaly skin

Phlebitis,thrombophlebitis with IVadministration

Pain, induration, at the IMinjection site

Allergic reaction,urticaria, pruritus

Headache and dizziness

Contact dermatitis

Hypersensitivity reaction

Antibiotic-associated

colitis (Severe abdominalpain, tenderness, fever,watery and severediarrhea)

Blood dyscrasias(Leukopenia andthrombocytopenia)

Nephrotoxicity(Proteinuria, azotemia,

oliguria)


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Store capsules at room temperature After reconstitution, oral solution is stable for 2

weeks at room temperature.

Do not refrigerate oral solution to avoid thickening. Give with 8 oz water.

Question patient for history of allergies, particularlyto clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking

agents. Monitor bowel activity, stool consistency; report

diarrhea promptly due to potential for seriouscolitis. Assess skin for rash with topical application. Assess for superinfection: severe diaarhea,

genital/anal pruritus, increase fever, and change

of oral mucosa.


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Route and Dosage IndicationsADULTS

Epilepsy: Starting dose is300 mg PO tid, then titrated up

as needed. Maintenance: 9001,800 mg/day PO in divideddoses tid PO; maximum intervalbetween doses should notexceed 12 hr. Up to 2,4003,600 mg/day has been used.Postherpetic neuralgia: Initialdose of 300 mg/day PO;300 mg bid PO on day 2;300 mg tid PO on day 3.

Adjunctive therapy in thetreatment of partial seizureswith and without secondary

generalization in adults andchildren 312 yr with epilepsyOrphan drug use: Treatment ofamyotrophic lateral sclerosisManagementof postherpeticneuralgia or pain in the areaaffected by herpes zoster afterthe disease has been treatedUnlabeled uses:Tremors ofMS, neuropathic pain, bipolardisorder, migraine prophylaxis


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Action Contraindications

Mechanism of actionnot understood;

antiepileptic activity

may be related to its

ability to inhibitpolysynaptic

responses and block

posttetanic

potentiation.

Contraindicated with

hypersensitivityto gabapentin.

Use cautiously

with pregnancy,

lactation.


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Adverse Effects Interaction

CNS: Dizziness,

insomnia, nervousness, fatigue, somnolence,ataxia, diplopia, tremor

Dermatologic: Pruritus,

abrasionGI: Dyspepsia, vomiting,nausea, constipation, drymouthReapiratory: Rhinitis, pharyngitis

Other: Weight gain, facialedema, cancer,impotence

Drug-drugDecreased

serum levels with

antacids

Drug-lab testFalse positives

may occur

with Ames N-

Multistix

SG dipstick test

for protein in the

urine


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AssessmentHistory:

Physical:

Interventions
http://nurseslabs.com/tag/assessment/http://nurseslabs.com/tag/history/http://nurseslabs.com/tag/interventions/http://nurseslabs.com/tag/interventions/http://nurseslabs.com/tag/history/http://nurseslabs.com/tag/assessment/


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Route and Dosage IndicationsAdults

100 mg PO bid taken atleast 30 min before or 2

hours after breakfast anddinner. Response may notbe noted for 2-4 wk andmay take up to 12 wk.

Periatric PatientsSafety and Efficacy not

establised

Reduction of symptomsof intermittentclaudication allowingincreased walkingdistance.


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Reversibly inhibits platelet

aggregation induced by avariety of stimuli includingADP, thrombin, collagen,shear stress, epinephrine,and arachidonic acid by

inhibiting cAMPphosphodiasterase III;produces vasculardilatation in vascular beds

with a specificity forfemoral beds; seems tohave no effect on renalarteries.

Contraindicated withallergy to cilostazol,

heart failure of any

severity, active

bleeding, hemostaticdisorders.

Use cautiously with

pregnancy, lactation,

renal dysfunction


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Route and Dosage Indications

OphthalmicBacterial orfungal conjunctivitis, blepharitis, keratitis.

and other infective eye conditionsAdult: As a 1% ocular ointment: Apply 4-5times daily.Topical/CutaneousPrevention and treatment of infection insevere burns

Adult: Apply a 1% cream onto affectedarea.

Bacterial orfungal conjunctivitis, blepharitis, keratitis.

Prevention and treatment ofsevere burns.
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Silver sulfadiazine has broad

antimicrobial activity; it isactive against gram-positiveand gram-negative bacteria aswell as some yeasts and fungi.The silver salt acts mainly on

the cell wall and membrane todisrupt its intergrity thusallowing it to impair theessential enzymes, bacterialDNA and RNA leading to celldeath.Absorption: Slowly releasessulfadiazine when it comes intocontact with wound exudates.Up to 10% of sulfadiazine maybe absorbed.

Hypersensitivity to

sulphonamides; porphyria;premature infants and infants


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Route and Dosage Indications

General guidelines, 0.5-1U/kg/dy.The number ang size of daily doses,times of administration, and type ofinsulin preparation are determinedafter close medical screening ofthe patients blood and urine

glucose, diet, exercise andintercurrent infections and otherstresses. Usually givensubcutaneously. Insulin injectionconcentrated may be givensubcutaneously or IM but do notadminister IV.Adults with type 2 DM requiringbasal insulin 10U/day. Range,2-100U/day or 0.1-0.2 U/kgsubcutaneously in the evening or

10 U one or twice a day

Tx of type 1 DmTx of type 2 DM that cannotcontrolled by diet or oral drugsTx of hypokalemia with infusion ofglucose to produce shift of K+ intocells.Highly purified and human insulinspromoted for short courses oftherapy, newly diagnosed pts., pts.With poor metabolic control, andpts. With GD.



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Insulin is a hormone

secreted by beta cells ofthe pancreas that, byreceptor-mediated effects,promotes the storage of

the bodys fuels,facilitating the transport ofmetabolites and ions(potassium) through cellmembranes and

stimulating the synthesis ofglycogen from glucose, offats from lipids, andproteins from amino acids.

Contraindicated with

allergy to pork products;history of smoking or lung

disease (inhaled insulin)

Use cautiously with

pregnancy (keep patients

under close supervision; rigidcontrol is desired; following

delivery ,requirements may

drop for 24-72 hr, rising to

normal levels during next 6

week); lactation(monitormother carefully; insulin

requirements may decrease

during lactation)


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Oral, suppositories

CNS: Headache, dizziness, somnolence, insomia

Dermatologic: Rash

GI:Nausea, dyspepsia, constipation, GI bleed

IV preparation

GI: vomiting, GI bleeding

Hematologic: Increased bleeding problems

Respiratory: apnea, exacerbation of pulmonary

infection


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Ensure uniform dispersion of Insulin suspensions by rolling the vialbetween hands; avoid vigorous shaking.

Give maintenance doses subcutaneously, rotating injection sites

regularly to decrease incidence of lipodystrophy; give regular

insulin IV or IM in severe ketoacidosis or diabetc coma

Monitor patients receiving insulin IV carefully; plastic IV infusion

sets to have been reported to remove 20-80 % of the insulin;

dosage delivered to the patient will vary.

Do not give insulin injection concentrated IV; severe

anaphylactic reactions can occur.

Monitor urine or serum glucose levels frequently to determine

effectiveness of drug and dosage.

Inform patient to avoid alcohol; serious reactions can occur.

Inform patient to report ferver, sore throat, vomiting,

hypoglycemic reactions, rash


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Assessment Diagnosis Planning Interventions Rationale Evaluation


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Subjectivedata:The patientverbalized

Nagkadakoman ni akong

samad, walanay ayu-ayo

Objectivedata:Destruction ofskin layers at

the left andright foot notedNon-healingwound at leftfoot 100mm inlength; 80mmin width ; depth1mm notedNon-healingwound at rightfoot 20mm indiameter;depth 0.5mmPurulentdischarge

(-) pain pitting edema

Impaired skinintegrity :delayedwound

healingrelated toimpairedproteinsynthesis,decreasedtissueperfusion

After 2 hrs of

nusing

intervention, theclient will be able

to:

a. Verbalize

understanding of condition

and causative

factors.

b. Participate inprevention

and measure

of furtherinfections

c. Identify

interventions

appropriatefor condition.

Place client in

semi- to high

fowlers position.

Promote physical

and emotional rest

Encourage to

maintain lifestylechanges, such as

smoking and

alcohol cessation

Admiistered

medication to

reduce furtherinfection according

to physicians order

Perform anddiscuss proper ways

in wound dressing,

dry feet thoroughly

afterTeach client the

measures to prevent

further infection by

maintaining thewound covered

every after wound

dressing

-- To maintain

adequate

systemic tissueperfusion

-- Smoking

causes anincrease in

mucuos

production

and impairsciliary function

-- To reduce

risk for further

infection

Goal is Met,

After 2 hrs of

nusingintervention,

the client was

able to

verbalizeunderstanding

condition and

its causative

factors;participated in

measures to

avoidprevention;

and was able

to identify

interventionsappropriate

for condition


S bj ti Aft 2 h f Assess for signs To Goal is Met


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SubjectiveData:The patientverbalizedmaglipong-

lipong man kousahay labawnag udto

ObjectiveData:Grade 2pitting edema

notedWeak, rapidpulse notedPR- 122bpmSerum sodiumlevel is 132mmol/L noted

Urine specificgravity is 1.030noted

Altered fluid

and

electrolyte

balance:

hyponatremi

a related to

excessive

sodium loss

After 2 hrs ofnursingintervention, theclient will be ableto:

a. Verbalizeunderstanding of causativefactors andpurpose oftherapeuticinterventions

b. Demonstratebehaviors tomonitor andcorrectdeficit, asindicated

Assess for signs

and symptoms of

hyponatremia:

- nausea- vomiting

- abdominal

cramps- weakness

- lethargy

- confusion

- seizure

Monitor serumelectrolyte results

Minimize clients

exposure toemotional and

physiological

stress

Advise pt. To eat

egg white per

meal

-- To

determine the

degree of

electrolytedeficiency

-- Stress

causes anincreased

output of

epinephrine,

norepinephrine, glucagon,

cortisol, all of

which

increasesblood sugar

-- egg white

contains

proteinalbumin which

increases

osmotic

pressure

Goal is Met,

After 2 hrs of

nursing

intervention,the client was

able to:

Verbalizeunderstanding

of causative

factors and

purpose of

therapeuticregimen

Maintained

eatingpatterns to

promote an

increase

inosmoticpressure and

in decreasing

blood sugar

levels.



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Subjective:

The patient

verbalized

Paliya ra

akongkaunon

walay kan-

on

Kapoy man

ilihok

Objective:

Muscle

wasting

noted

Weakness

and fatigue

notedSerum

albumin is

2.65 g/dL

Hct0.26/L;

Hgb- 84

noted

Imbalanced

nutrition: less

than body

requirements

related tomuscle

weakness

secondary to

insulin

deficiency

After 3 hrs ofnursingintervention, theclient will beable to:a. Verbalize

understanding ofcausativefactors whenknownnecessary

interventions.b. Demonstrate

behaviors,lifestylechanges toregimen andmaintainappropriateweight

Assess the clientfor signs and

symptoms of

malnutrition:

- abnormal

BUN- low serum

albumin

- low hct, hgb,cholesterol and

lymphocte levels

Monitor bloodglucose levels

Advise patient to

eat at least 1cup

of rice with egg

white per meal

-- To determinedegree of

condition

-- To determinethe diet

needed to beingested

-- To reduce

muscle wasting

and to promote

tissue growthand wound

healing .

Goal is met,After 3 hrs of

nursing

intervention,

the client was

able to: Verbalize

understanding

of causativefactors

Change and

maintaineddiet as

advised.

Assessment Diagnosis Planning Interventions

Rationale Evaluation


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Subjective:The patientverbalized dilinaman ko

kaklaro saakong panan-aw, sumbolman ang dapitsa wala

Objective: Presence of

white patchcovering thelens of the lefteye notedAks someoneto read areadingmaterial ;blurred visionnoted

Sensoryperceptualalteration:visual related

to lenschanges

After 2 hrs ofnursingintervention, theclient will be

able to:a. Recognizeandcompensatefor sensoryimpairment

b. Identify/modify

externalfactors thatcontribute toalterations insensory/perceptualabilities

Assess thevisual acuity

Perform

actions topreventhyperglycemia-dietmodification- emotionalandpsychological

stress reduction

Informed theclient aboutthe diseaseprocess whichcontibute tothe condition Minimizediscussion ofnegativeswithin clients

vison

-- To determinthe degree ofcondition.-Maintenance

of blood sugarat a stable,near-normallevel hasbeen shownto reducesmal vesseland nerve

involvementand preventfurthermetaboliccataract devt- For the clientto understandthe presenceof such andmanage self

-- Client maymisinterpretand believereferences are

to himself

Goal is met,After 2 hours of

nursing

intervention,

the cliet was

able to :-- recognize

and

compensatefor sensory

impairment by

diet odificationand reduction

of stress

--Identify andmodified

external factors

that

contributed toalterations in

sensory ability


Subjective data: Ineffective After 6 hours of Provide an Recognizing Goal is partially


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Subjective data:

The ptatient

verbalized ako

nay mosunodsa akong mga

maguwang

ane

Objective data:

Deficit in

participating

anddemonstrating

necessary

interventionsnoted

Anxiety noted

Alteration in

socialparticipation

Destructive

behavior

towards selfInability to

meet basic

needs

Ineffective

individual

coping related

to fear ofcomplications

and ability to

manage them

After 6 hours of

nursing

intervention, the

client will beable to:

a. Identify

effectiveand

ineffective

coping

patterns

b. Verbalizesense of

control

c. Reportdecrease in

negative

feelings

d. Modifylifestyle as

needed

e. Willing to

participatein treatment

plan and

sel-care

activities.

Provide an

atmosphere of

acceptance

Provide factual

information

concerning the

diagnosis,treatment, and

prognosis

Explore with his

previousmethods of

dealing with life

problems

Encourage

verbalization of

feelings,perceptions, and

fears

-- Recognizing

problemsand

sharing feelings

is best broughtabout in an

atmospere of

warmth andtrust

--Factual

information

serves as a

foundation toexplore

feelings and

alternativecoping

strategies

--Present and

past copingstatus assists

the pt and his

support system

on successfulmethods.

-- open,

nonthreatening

discussionsfacilitate the

identification of

causative and

contributingfactors.

Goal is partially

met,

The client was

able to:--Modify lifestyle

as needed yet

wasnt able toverbalize sense

of control in the

situation and

presence of

condition

Observe thedegree of familysupport

--Assessingfamilyinteraction


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pp

Discuss with

concerned

others how they

can help

serves as a basis

for identifying

patients supportsystems or lack

thereof.

-- Family and

friends are often

willing but

unsure how tohelp . Identifying

specific

strategies such

as praise andencouragement

will promote

acceptance of

change.

A Case Study of Mr

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