Health And Fitness Fans: Nursing care process for patients, with a medical diagnosis of type II diabetes mellitus

https://cdn.steemitimages.com/DQmUoRq1r1SAso9RyRTpubfHKusZqAaCDjaeE6MWtk3dGSP/food-3344057_960_720.jpg

Steemit scientific community receive my greeting, below I present a clinical case of a patient with diabetes mellitus.

[Public Domain Image](https://pixabay.com/es/photos/alimentos-el-medidor-de-glucosa-3344057/)

Type 2 diabetes mellitus is a metabolic disorder of multiple etiologies characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin; which is a hormone produced by the pancreas responsible for regulating blood sugar levels, insulin provides the cells, circulating glucose, from food, so that it is later transformed into energy. The classic symptoms of this condition are excessive thirst, frequent urination, constant hunger and weight loss. This condition represents about 90% of diabetes cases, with the other 10% mainly due to type 1 diabetes mellitus and gestational diabetes. Obesity is thought to be the primary cause of type 2 diabetes among people with a genetic predisposition to the disease. Diabetes is initially controlled with increased exercise and dietary changes. If blood glucose does not fall properly with these measures, medications such as metformin or insulin may be necessary. In patients treated with insulin, there is typically a requirement to routinely check blood glucose. In this case, a 36-year-old male patient with an IDX of type 2 diabetes mellitus is presented, who is in the internal medicine department, applying the nursing process in its five stages, who in the assessment does not show any alteration of the systems, only in the area of the lower extremities by edematization, and the elevation of the temperature, in which he was diagnosed with a risk of unstable blood glucose level related to weight loss, and deterioration of skin integrity among others, establishing Thus, by the doctor, a treatment based on its improvement during the stay at the health center and after discharge, as is the NPH insulin scheme, was also assessed by the doctor where he decides to be practiced a surgical act (AP of the left toe), also individualized plans were developed according to their human needs and the disease in order to improve their health, through the control of vital signs and glycemia, daily cure of diabetic foot, irrigation with physiological solution, preparation of a diet according to its pathology (hypoglycoside and hypo sodium) for good nutrition, and guidance through educational talks to his relatives on how to take the disease situation and motivate him to continue with the treatment. Therefore it is waiting for the surgical act while gathering the materials for this procedure. To finalize the plans established for the patient, they are in the process of improvement and others were achieved during their stay at the health center. ### Personal data of the patient Name and surname: C.C Natural: Barinas Venezuela From: December 1st District Marital status: Concubinage Age: 36years Male gender Reason for admission: enter due to elevated blood glucose. Medical Diagnosis: Type 2 diabetes mellitus. ### family background The patient reports that his parents and grandparents suffer from diabetes. Hypertensive mother

### Physiology The endocrine system is the set of organs and tissues, which secrete a type of substances called hormones, which are released into the bloodstream and regulate some body functions. Within the organs that make up this system we find the pancreas. The pancreas is a mixed gland, it contains exocrine tissue made up of acinar cells producing digestive enzymes; and also presents endocrine tissue composed of the islet cells of Langerhans, which produce hormones that maintain glucose homeostasis. The pancreas is covered by a layer of connective tissue, rich in mesotolial cells, with fine partitions that divide the gland into lobes. Adult endocrine tissue contains four different cell types, with greater density in the tail area. These are: insulin or β producing cells, which represents 70%; glucagon or ɑ producing cells, represent 20%; somatostatin or ǫ producing cells, which represent between 5 to 10% and pancreatic or PP polypeptide producing cells, covering about 2%. Its characteristic is of an elongated shape of 15 centimeter in length and 100 grams of weight, it is located in the abdominal cavity immediately behind the stomach. Its peculiar location very posterior in the abdomen, but at the same time close to the liver, causes it to be in intimate contact with vital vascular structures. It has a pancreatic head which is the widest part and is located in the curve of the duodenum, which is the first portion of the small intestine, also in it is the final part of the bile duct, conduit responsible for conducting bile of the liver to the intestine The part called the body of the pancreas is narrow and extends slightly upwards and ends at the part called the tail, which is near the spleen. This gland has two fundamental functions for the organism, the first is exocrine which is fundamental in the process of digestion. The pancreas secretes enzyme (amylase and lipase) whose function is to chemically break down fats and protein ingested into small portions that can be absorbed by the intestine. Therefore one of the first consequences of processes that affect the correct excretion of these enzymes, are pancreatic tumors or chronic pancreatitis which are caused by the lack of absorption of fats and proteins. And the second function is endocrine called hormone production, the most important being insulin, which is essential for the regulation of blood sugar levels. When the pancreas suffers alterations or loss of this function; It causes diabetes mellitus type I and II. ### Pathophysiology Type 2 diabetes mellitus is due to insufficient insulin production from pancreatic islets in the context of insulin resistance. The latter, which is the inability of cells to respond adequately to normal insulin levels, occurs mainly in the muscles, liver and adipose tissue. In the liver, insulin normally suppresses the release of glucose. However, due to insulin resistance, the liver inappropriately releases glucose into the blood. The ratio between insulin resistance and beta cell dysfunction differs among individuals. Some have mainly insulin resistance and only a minor defect in insulin secretion; and others have a slight insulin resistance and fundamentally a lack of insulin secretion. ### Etiological factors. It is a disease caused by the malfunction of the pancreas, almost necessarily related to the condition of obesity, poor physical activity and unhealthy feeding, also almost includes insulin resistance (IR), but additionally a deterioration of function is required of the pancreatic β cell. It most often affects people suffering from high blood pressure, dyslipidemia (abnormal blood cholesterol) and obesity of the middle part of the body; It includes a component of metabolic syndrome. It has a tendency to occur in families, but it is a complex disorder caused by mutations of several genes and also by environmental factors. ### Signs and symptoms The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger) and weight loss. Other symptoms that commonly occur in diagnosis include a history of blurred vision, itching, peripheral neuropathy, recurrent vaginal infections and fatigue. Many people, however, have no symptoms during the first years and are diagnosed on routine exams. ### Treatment. Type 2 diabetes control includes: • Weight loss: Losing weight can lower blood sugar. Controlling portions and eating healthy foods are simple ways to start losing weight. • Healthy nutrition:  Fewer calories  Less refined carbohydrates, especially sweet ones  Fewer foods that contain saturated fats  More fruits and vegetables  More foods with fiber A certified nutritionist can help you make a plan of meals that suits your health goals, your preferences Food and your lifestyle. • Exercise regularly for at least 30 to 60 minutes of Moderate aerobic exercise (or 15 to 30 minutes of intense exercise) most days of the week. A combination of exercises (aerobic exercises, such as walking or dancing, most days, combined with resistance training, such as weightlifting or yoga, twice a week) offers more benefits than any of these exercises alone. • Diabetes medications:  Metformin (Glucophage, Glumetza). Metformin is generally the first prescription drug for type 2 diabetes. It works by decreasing the production of glucose in the liver and increasing your body's sensitivity to insulin, so that the The body can take advantage of it more effectively. Some possible side effects of metformin are nausea and diarrhea. These side effects may go away as your body gets used to the medication or if you take the medication along with the food.  Sulfonylureas. These medications help your body secrete more insulin.  Insulin: Insulin injection is a class of medications called hormones. It is used to take the place of insulin that the body normally produces. It works by helping to move blood sugar to the other tissues of the body where it is used for energy. It also prevents the liver from producing more sugar. All types of insulin that are available work this way. Insulin types differ only in how quickly they start working and how long they continue to control blood sugar. • Blood sugar control. ### Prevention Through proper nutrition and regular exercise. Intensive lifestyle measures can reduce more than half of the risk.

the-level-of-sugar-in-the-blood-3310318_960_720 (1).webp

[Public Domain Image](https://pixabay.com/es/photos/el-nivel-de-az%C3%BAcar-en-la-sangre-3310318/)

This is a 36-year-old male patient from Barinas state, who is in the hospital in the area of internal medicine with an IDX: Type II Diabetes Mellitus decompensated in hyperglycemia, presenting. The physical examination shows NEUROLOGICALLY, conscious and oriented in its three planes time, space and person, RESPIRATORY with a frequency 23 rpm, without the presence of cough or secretions, audible vesicular murmurs in both lung fields without aggregates, CARDIOVASCULAR has a heart rate of 52 Px 'and blood pressure of 100/70 mmHg, present pulse of 52Px', expandable normal thorax, not painful on palpation, rhythmic heart sounds, with a capillary filling ≤ 2 seconds DIGESTIVE / NUTRITION with a prescribed hypoglycoside and hyposidic diet , with a usual diet of proteins and carbohydrates, without prescribed dietary supplements, swallowing present, wet oral mucosa, complete edentulous, with presence of caries in upper molars and in the presence of shoes, without halitosis, hydrocarbon noises present, with good appetite and a weight of 100kg, bowel movements present once a day. GENITO / URINARY anatomical aspect Within normal limits (DLN) without retention or pain, without presence of bladder catheters, or secretions, diuresis present 4 times a day, and not quantified, COGNOSTIVE / PERCEPTIVE alert and a level of mild anxiety, sight and DLN ear, without the presence of prostheses, or linguistic barriers and sensitivity present MOTOR with an independent, active care capacity and refers to rest throughout the night, stable gait, with force present in upper and lower extremities CUTANEOUS INTEGRITY with oral and conjunctive mucosa DLN moisturized brown skin with a temperature of 39 ˚C, dirty hair, well implanted, is evidenced peripherally (wrist) in the right upper limb and hematoma by filtration of the fold. ### Nursing diagnoses according to the American Association of Nursing Diagnostics.  Risk of unstable blood glucose level R / C weight loss Domain 2: Nutrition Class 4: Metabolism No. 00179  Impaired skin integrity R / C destruction of the skin layer (dermis) E / P thumb of lower left limb. Domain 11: Security / Protection Class 2: Physical Injury No. 00046  Ineffective thermoregulation R / C mild chills E / P temperature (39˚C). Domain 11: Security / Protection Class 6: Thermoregulation No. 00008  Ineffective protection R / C impaired healing Domain 11: Security / Protection Class 2: Physical Injury No. 00048  Acute pain R / C damaging agents (biological) E / P pathology Domain 12: Comfort Class 1: Physical comfort No. 00132  Risk of contamination R / C surface coating E / P dressing Domain 11: Security / Protection Class 4: Environmental hazards No. 00180  Excess volume of liquids R / C edema E / P lower limbs Domain 2: Nutrition Class 5: Hydration No. 00026  Risk of low situational self-esteem R / C physical illness Domain 6: Self-perception Class 2: Self-Esteem No. 00153  Sedentary R / C lack of interest E / P physical condition Domain 4: Activity / Rest Class 2: Activity / Exercise No. 00168  Risk of deterioration of liver function R / C substance abuse (alcohol). Domain 4: Nutrition Class 4: Metabolism No. 00178  Risk of injury R / C malnutrition Domain 11: Security / Protection Class 2: Physical Injury No. 00035  Recreational activity deficit R / C environment devoid of recreational activities E / P prolonged hospitalization Domain 4: Activity / Rest Class 2: Activity / Exercise No. 00097  Willingness to improve the management of one's own health R / C desires to handle the treatment of the disease E / P verbal manifestation Domain 1: Health Promotion Class 2: Health Management No. 00162  Willingness to improve nutrition R / C adequate food intake M / P desire to improve nutrition. Domain 1: Health Promotion Class 2: Health Management No. 00163  Risk of dysfunctional gastrointestinal motility R / C diabetes mellitus. Domain 3: Elimination and Exchange Class 2: Gastrointestinal Function No. 00197

State of consciousness: Oriented in its three planes (time, space and person) March: Wander Head: Normocephalic, well implanted hair. Face: Symmetrical eyes isocoric pupils, reactive to light. Symmetrical ears, normal anatomical configuration, nostrils implanted nasal septum, permeable. Moist mouth, complete edentulous, waxy oral mucosa with presence of halitosis. Neck: No adenopathies, carotid pulse present. Chest: Symmetric normoexpansible, vesicular murmurs audible to auscultation. Abdomen: Flat abdomen without tumor and without pain. Genitals: Not explored. Upper Extremities: Symmetrical with insufficient strength and muscle tone, capillary filling in 2 sg, hydrated skin is seen permeable in the upper right limb at the level of the palmar arch with 0.9% parenteral hydration. Lower Extremities: Symmetrical muscle strength and tone present, hydrated skin, normal-looking nails and configuration, presence of ulcers in the right lower limb due to diabetes specifically in the right foot. ### General nursing care for patients with diabetes • Nurse-patient relationship. • Control of vital signs. • Measurement of daily capillary glycemia. • Apply prescribed insulin scheme. • Guide the patient the importance of consuming enough fluids and a balanced diet • Review and reinforce the patient's knowledge about his condition. • Maintain permeable pathways. • Daily cure with clean and dry dressing. • Daily wound inspection. • Irrigate with physiological serum. • Do not use dressing with powerful adhesive • Apply treatment according to the characteristics and degree of evolution of the lesion. • Guide the patient to avoid pressure on the area of injury.

In the present case, a nursing care plan was developed for a 36-year-old male patient with a diagnosis of type 2 diabetes mellitus, where plans were prepared according to his pathology, with the aim of preventing or delaying the onset of late complications of the disease, decrease mortality and maintain a good quality of life. In which they were characterized by establishing a relationship of nurse - patient, control of vital signs and glycemia, daily cure of the diabetic foot, orientation to the patient and family on food, specifically treatment of the application of the insulin scheme, care, and support emotional. In last they are through open and continuous communication, in the same way the empowerment to socialize with their therapeutic environment. To finalize 70% of the individually established plans, they are in the process of achieving the objective and in 30% the expected result was obtained through nursing interventions planned for improvement. He wrote for you @felixrodriguez