Patients name : Patient T.

Age : 59 years old

Civil Status : Married

Nationality : Filipino

Religion : Roman Catholic

Date of birth : April 05,1949

Place of Birth : Sangkol, Dipolog
City, Zamboanga del Norte

Vital Signs : T-38.0C P-39bpm

Admitting Diagnosis : Sepsis vs. Metabolic R-36cpm BP: 100/60 mmhg
Encephalopathy, Type II Diabetes
Mellitus uncontrolled , Electrolyte
Imbalance; Oral Thrush

Chief Complains : One month severe thirst

with insomnia and fever; few hours prior to
admission, unable to stand slurred speech
GORDON’ S FUNCTIONAL
HEALTH PATTERN
CLIENT PROFILE
Patient T is a 59-year old, Filipina, born on
April 5, 1949 in the small barangay of Sangkol, Dipolog
City. Speaks in the vernacular and understands national
language. Of Malay origin and a Roman Catholic since
birth. A high school graduate and still lives in
Sangkol, Dipolog City. Her admitting diagnoses were
“Sepsis vs. Metabolic Encephalopathy; Uncontrolled
Type II Diabetes Mellitus; Electrolyte Imbalance
and Oral Thrush”. He was admitted on the 27th day of
July, 2010 on 6:15 in the evening. She denies of any
familial diseases and any allergies from food, drink
and medication. She is on a SOFT diet.
DEVELOPMENTAL HISTORY
I. Developmental Level: Middle - age adulthood :
Generativity vs . Stagnation ( Erikson ) (Stresses
that she wants to see her children as successful
before she leaves this world).
II. Does not talk much about childhood. Describes it as a
difficult time for her since they’re financially
hard-up. She has 3 daughters and lives with their
husband. Describes their relationship as “ok ra man
pud” and refuses to elaborate. Owns their house and
lot in Sangkol, Dipolog City, Zamboanga del Norte.
Always been active in church and a member of GKS as
well. Voices openly about financial concerns.
HEALTH - PERCEPTION – HEALTH -
MANAGEMENT PATTERN

Client ’ s Rating of Health :

vScale : 10 – best ; 1 – worst
v2 years ago : 4
vNow : 2
vRefuses to believe that she has this kind of
condition, and states, “wala man ko aning sakita, wala
sad ko kadungog nga naa ni sa akong pamilya, ambot
bitaw kung wala ko madala diri di man main-an.”
BEFORE HOSPITALIZATION :
1.Persistent on own beliefs on health condition.
States misconceptions on present health
condition, “Sus, dili man ganahan ta mukaon di ta
pakan-on, lugaw ra sige, mao sig eta ug luya”.
Denies use of alcohol and tobacco.
2.
3.Patient does not seek health care at all. States
that she only visits “quack doctors” whenever she
or any of her family members feels ill. Does not
usually use pharmacologic regimen, only resorts
to traditional herbal medication.
4.
5.Patient does not have any regular scheduled
exercises, states that her daily work in their
farmland serves as her exercise.
DURING HOSPITALIZATION :
1.Presently, patient is on Insulin therapy, no oral
hypoglycemic agents given. She complains of the
drugs making her weak every day.
2.Patient states that she is becoming weaker each
day, she can’t move freely because she feels dizzy
and lightheaded.
3.
4.

NURSING DIAGNOSIS : Knowledge Deficit related to

lack of exposure, lack of knowledge on the signs and
symptoms of the disease and medical management.
NUTRITIONAL - METABOLIC PATTERN
BEFORE HOSPITALIZATION :
üPrior to hospitalization, client has no restriction on
her diet, meal pattern as follows: Eats breakfast at
around 5 o’clock in the morning, usually with 1-2
servings of rice, 1 serving of fish or 1 serving of
dried fish and a cup of coffee. Eats “law-oy”
(vegetable stew)3 servings with or without fish and
rice. Eats lunch at 12 noon. Typical meal includes 1
serving of fish and 2-3 servings of rice (same
serving as stated above). Dinner usually at 6 o’clock
in the evening. Drinks large amount of waters every
day, 1-2 glasses per meal equivalent to 400cc-500cc
per meal and drinks water frequently in between
meals. No reported food and medication allergies.
Does not wear any dentures. Does not submit herself
to dental exams. Denies problem of mastication and
regurgitation until a week before admission. Usually
brushes teeth at morning only.
üSkin and scalp are dry and presence of dandruff was
noted.
üNails were dirty and brittle.

DURING HOSPITALIZATION :
I. Diet ordered by physician is SOFT. Follows hospital
meal distribution schedule. Usually includes, rice
porridge and fish “inon-on”. Patient still drinks 1-2
glasses of water per meal and sips small amounts of
water in between meals but complains of pain when
swallowing .” Di man ko ganahan mukaon, usahay di sad
ko pakan-on sige ra ug lugaw,” as stated.
II. Skin and scalp are still dry and presence of dandruff
was noted.
III. Nails were still dirty and brittle.
•
NURSING DIAGNOSIS 1 : Altered nutrition: less than body
requirements related to decreased appetite, painful chewing, and
swallowing , insulin deficiency and presence of infection.
NURSING DIAGNOSIS 2 : Acute Pain
ELIMINATION PATTERN
BEFORE HOSPITALIZATION :

I. Bowel Habits – medium to hard in form and brown in color,

usually defecates only once or twice a day
II. Bladder Habits – voids 6-5 times daily, clear or very pale
yellow in color, reports problem in urination: polyuria,
dysuria and nocturia.
•
DURING HOSPITALIZATION :

I. Bowel Habits – within the shift no bowel elimination reported

and noted
II. Bladder Habits – patient is currently on indwelling catheter
with urinary output of 400-600 cc per shift

NURSING DIAGNOSIS 1 : Decrease gastric motility secondary to

increased Blood Glucose Levels and present condition as evidenced
by no fecal elimination per shift
NURSING DIAGNOSIS 2 : Fluid Volume Deficit related to osmotic
diuresis secondary to increased blood glucose levels
ACTIVITY - EXERCISE PATTERN
BEFORE HOSPITALIZATION :

I. Activities of Daily Living ( ADLs ) prior to admission :

Wakes up at 4 o’clock in the morning. Eats breakfast at 5:30 in
the morning and goes to their farmland at 6:30 o’clock in the
morning. Goes home at 11 o’clock in the morning for lunch and
goes home before 6 5:30 in the afternoon and then takes dinner
at 6pm. Sleeps at 8 or 8:30 in the evening.
II. Showers once daily
III. Occupational Activities : Works as a farmers in the field 1
kilometer from home
 DURING HOSPITALIZATION :
I. Activities of Daily Living ( ADLs ): Wakes
up before 6 o’clock in the morning, tosses
and turns in bed for hours and waits for
lunch at around 11:00 o’clock in the morning
with rest periods in between. Medications
per subcutaneous route in between as well.
Usually sleeps at 9 o’clock in the evening.
Repositions every now and then but complains
pain.
II. Has not taken shower yet since admission.
III. “kapoy man ug lihok-lihok naa pa jud ning
catheter naku” as verbalized.
NURSING DIAGNOSIS 1 : Fatiguerelated to decreased metabolic
energy production from decreased appetite ; altered body
chemistry: insufficient insulin; increased energy demands: presence
of infection .
NURSING DIAGNOSIS 2 : Self-Care Deficit related to Present
Condition
SEXUAL AND REPRODUCTION PATTERN
BEFORE HOSPITALIZATION :

•Contraception: never used any form “maka

daot man na”, as stated
•Sexual Activities : not assessed
•Special Problems : Denies any history of
STIs but manifests symptoms of Candidiasis

DURING HOSPITALIZATION :
•The client has oral thrush

NURSING DIAGNOSIS : Knowledge Deficit

related to Lack of Education regarding
Contraceptives as evidenced by Statements of
Misconception
SLEEP AND REST PATTERN
BEFORE HOSPITALIZATION :
•Wakes up at 4 o’clock in the morning. Usually
takes naps and siesta during afternoon. Sleeps
at 8 or 8:30 in the evening.

DURING HOSPITALIZATION :
•Wakes up before 6 o’clock in the morning,
tosses and turns in bed for hours with rest
periods in between. Usually sleeps at 9 o’clock
in the evening.
•
NURSING DIAGNOSIS : Altered Sleep Pattern
related to Hospitalization and Change of
Environment
SENSORY - PERCEPTUAL PATTERN
BEFORE HOSPITALIZATION :
1 ) Vision: Uses eye glasses. Reports blurring
of vision, itching, and eye dryness.
2 ) Hearing : Denies hearing problems at normal
voice tone and level. Able to report words
whispered. Denies pain and discharges or
trauma to ears.
3 ) Smell : Reports no smelling difficulties,
pain and postnasal drip.
4 ) Touch : Reports no tactile problems
5 ) Taste : No difficulty in tasting foods, no
pain reports when swallowing until a week
before admission
6 ) Pain : No oral pain reported until a week
before admission, with Pain Scale of 5 out of
10
 DURING HOSPITALIZATION :
1 ) Vision: Still uses eye glasses. Still reports
blurring of vision, itching, and eye dryness.
2 ) Hearing : Hears spoken words clearly at a
meter distance
3 ) Smell : Still reports no smelling difficulties,
pain and postnasal drip.
4 ) Touch : Still reports no tactile problems
5 ) Taste : Pain is reported when swallowing, Pain
Scale of 7 out of 10
6 ) Pain : Pain is reported when swallowing, Pain
Scale of 7 out of 10
1)

NURSING DIAGNOSIS : Acute Pain related to Present

Condition as evidenced by verbalization of pain
Cognitive Pattern ( BEFORE
HOSPITALIZATION and AFTER HOSPITALIZATION )

Patient is alert, awake, and aware of self and

environment, speech is slurred and stuttered. Ideas
and feelings expressed when asked. Can tell events
prior to admission however, can’t specify dates.
Role - Relationship Pattern
BEFORE HOSPITALIZATION :
•Patient is married. Lives with daughters and husband
in Sangkol, Dipolog City. They’ve been together for
almost 27 years. Their eldest child is 26 years old.
Has casual relationship with neighbors.
•
DURING HOSPITALIZATION :

•Present medical condition greatly affects her role

as one of the family provider.

NURSING DIAGNOSIS : Ineffective Role Performance

secondary to present condition
Self - Perception and Self - Concept
Pattern
BEFORE HOSPITALIZATION :

•Identifies herself as a normal person. Hardworking and

responsible.
DURING HOSPITALIZATION :

•Still identifies herself as a normal person.

Hardworking and responsible. Believes that her
responsibilities to her family are jeopardized because
of her present condition. Patient verbalized, “Sayang
ang kwarta na ako unta kita-on kay naa ko diri”.

NURSING DIAGNOSIS : Ineffective Role Performance

related to Financial Factors
Coping - Stress Tolerance Pattern
BEFORE HOSPITALIZATION :

•Significant others verbalized that, whenever they have

family problems, they to consult and help each other

DURING HOSPITALIZATION :

•Patient verbalized that current condition does not

weigh her down although she identified this as a
current stressor. She tries to endure pain he feels as
much possible. She always pray and has always believes
in God.
•
NURSING DIAGNOSIS : Ineffective Coping related to
Financial Factors
 Value - Belief Pattern ( Before
and During Hospitalization )
Religious affiliation is Roman Catholic. She’s a
devout member of the church and does pray every day.
She has been active in church activities.

During Hospitalization:
Prays 5 times a day or so. Believes her faith
keeps her going with her present condition.” Dako
man akong pagtoo sa Ginoong Dios,” as stated.
 Coping Stress Tolerance Pattern
( Before and During
Hospitalization )
Religious affiliation is Roman Catholic. She’s a
devout member of the church and does pray every day.
She has been active in church activities.
 PHYSICAL
ASSESSMENT
 GENERAL SURVEY
• Client is alert, awake and aware of both self and the
environment, responds to external stimuli.
• With an on going IVF of PLR 1 liter hooked at (R) cephalic vein
• Facial grimacing/guarding behaviors upon movement observed
• Signs of pain expressed verbally
• Speech is stuttered and slurred
• Uses eyeglasses when reading
• Needs assistance when repositioning
• Vital Signs upon reception:
T – 38 °C
 P – 110 bpm
 R – 36 cpm
 BP – 100/60 mmHg
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Integumentary System Skin tone is light and Mild erythema is related
mild erythema is noted on to oral thrush (involved
the left side of lips. in the inflammation
  process).
Skin dry and warm to  
touch. The client has fever (the

  inflammatory process
  dictates CALOR or heat ).
 Skin slowly returns to  
normal appearance when This indicates

pinched indicating that dehydration and the

the patient has poor skin normal aging process. In
turgor. DM there is cellular
  dehydration from increase
urination.
Small and irregular  
light brown patches noted The patches may be
on skin surfaces (face related to frequent sun
and arms) exposed to exposure.
sunlight .
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Hair , Scalp and Head Hair is dry, thin and Dry hair is related to

shiny in texture, light dehydration, minimal gray

brown in color and hair strands signifies
minimal gray hair strands nutritional deficiency.
noted near the hair line.  
   
Minimal dandruff is Presence of dandruff

noted. indicates malnutrition.

   
  Any abrasions and

No head abrasions, lesions are signs of

lesions observed. impaired skin integrity
or an underlying
condition.
 
   
Lightheadedness and Lightheadedness and

headache are reported headache are determinants

when repositioning. of hypoglycemia and
dehydration (orthostatic
hypotension).
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Eyes , Eyebrows , Eye Both pupils are This indicates that the
lashes and Vision sensitive to light; both patient cranial nerve III
pupils are equal in is intact.
size( 4 mm) and  
constricts and dilates  
during assessment (using  
a penlight).  
  The use of eyeglasses is
Uses eyeglasses when an evidence of the
reading (food labels and patient’s blurry vision.
written words).  
  This indicates
Left lower lid is a bit inflammation.
swollen.  
  Any deviation like
Eye brows are black, dandruff or thinning of
symmetrical, thin and no eyebrows indicates
presence of dandruff. malnutrition and
  underlying disease
condition.
PHYSICAL ASSESSMENT
BODY FINDINGS INTERPRETATION
Eyes , Eyebrows , Eye Symmetrical, black in color.
 Any deviation as hair loss


lashes and Vision  in the eyebrows or presence

 of dandruffs is a sign of
 chronic malnutrition.
Conjunctiva is transparent, Increasing fluid loss

dry, with numerous blood results to dryness.

vessels. Sclera is usually china

Sclera is dirty white in white in color and any

color changes in color may be
 related to lack of sleep and
 prolong exposure to the sun.
 Cornea is basically

Cornea is transparent, shiny transparent, normally shiny

and smooth and smooth.



Iris appears flat, round with Iris is normally flat and

even color distribution round with even color
 distribution
No deviations.
PHYSICAL ASSESSMENT
BODY FINDINGS INTERPRETATION
Eyes , Eyebrows , Eye 

lashes and Vision 

Eyes are able to converge

 EOMs are normally performed

and follow the six directions by client without difficulty.

of gaze. CN 3, 4, and 6 intact.
 

 

 A normal finding. A person



Approximately 17 voluntary
 blinks voluntarily at 17
blinks per minute. blinks per minute.
 

Presence of discharges,
No discharges, no masses, no masses, and lesions indicates
lesions underlying condition as
 infection or inflammation.

PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Ears and Hearing Auricles are level with A normal finding. Deviation

each other, upright point is would mean a disturbance

lateral to the outer canthus with patient’s physical
of the eye development at one point in
his life.
Symmetrical and same color There should be no
with face asymmetrical features
  regarding color and shape as
  this signifies disturbances
with physical development.


Smooth, no deformities, no
 Presence of nodules,
nodules, no tenderness tenderness or deformities is
abnormal.
Ear canal is uniformly pink This is the usual color of

with tiny hair. the ear canal and it is

  normal that minimal hair is
present.
Has plenty of cerumen and 

appears dry. The cerumen acts as

  protective barrier to the

ears.
The patient does not usually
Able to repeat words clean her ears.
whispered
Unable to do so would mean

decreased hearing sensation.

PHYSICAL ASSESSMENT
BODY FINDINGS INTERPRETATION
Nose and Sinuses Smooth in midline, The nose is normally smooth
symmetrical to other in midline, symmetrical to
features, and same color other features as color of
with face the face. There
No tenderness should be no tenderness.
Nasal bone is firm and The nasal bone is normally

stable firm and stable.

Any external physical

No external physical
 abnormalities signifies an
abnormalities noted. underlying condition.
  

Elevated moles are unusual



Small elevated mole is

 and indicates disturbance in
noted near the upper right physical development or an
nose bridge. underlying condition.
  

 
Nose (internal)  
Discharges are usually

No discharges
 symptoms of upper or lower
respiratory tract
infections.
Patent nares
 Polyps and inflammation

from URTI or LRTI usually

blocks airways.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Mouth Lips are dry, brownish
 Dry lips are signs of
with cracks and lesions dehydration. Cracks and
  lesions may be related to
this.
Gums are pink to pale Gums are normally pinkish
pink in color.
Teeth are yellowish white The client usually does
  not brush her teeth.
A normal finding.
No missing teeth, no Weakened dentition and
dental caries. enamel usually results to
  dental caries.
  These white patches are
Small white patch on manifestations of oral
tongue about 1.5cm candidiasis infection and
located centrally usually there is pain on
the oral cavity site
affected.
White patches, 2 on left  Infection and usually

buccal area and 3 on there is pain on the oral

right cheek cavity site affected.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Mouth Halitosis is noted The client is never
Pain during mastication religious to tooth
and swallowing brushing.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Neck  Symmetrical, no scars, no A normal finding. There
enlargements of parotid should be no asymmetry on
glands the neck structures and
no enlargements as well.
No nodules and lymph Lymph nodes are usually
nodes are not easily and normally not easily
palpable palpated except in cases
  of infection or other
  conditions are they
 enlarged, rendering it
 palpable.
Trachea located midline This is the normal
of neck above landmark of the trachea.
suprasternal notch  
Thyroid not visible on The thyroid is only
inspection visible when it is
  inflamed. The patient is
 female, her thyroid should
Ascends during swallowing not be visible.

A normal finding. Normally

the thyroid moves up on
the action swallowing.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Neck Carotid pulse palpable, The carotid artery is
with regular pulses in located bilaterally from
rate and rhythm the thyroid. Normal pulses
  are expected to be in
  normal rate and rhythm.
 
No structural neck It is an abnormal finding
abnormalities noted when there are structural
  abnormalities as with
goiter.

No pain when moving one’s

neck Pain is usually a sign of
an underlying condition.
No stiffness reported
It is a deviation from
normal if stiffness of
neck is noted.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Thorax and Lungs Respiratory rate is 36 The normal respiratory
cpm, deep and uses rate is 16-20 cpm,
accessory muscles effortless and requires
no use of accessory
Difficulty breathing is muscles on respiration.
reported occasionally An abnormal finding.
Usually results from
upper and lower
respiratory airway
No adventitious breath blockage secondary to
sounds disease conditions.
Adventitious breath
sounds are symptoms of
lower respiratory system
infections.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Cardiovascular Apical pulse rate is 102 The normal pulse rate is


bpm regular in rate and 60-100 bpm. It should be

rhythm regular in rate and
No reported chest pains rhythm.
Chest pains are usually

symptoms of
Both left and right cardiovascular diseases.
radial pulse are weak and Both radial pulses are
thready= 96 bpm weak and thread as they
 are located distally and
Right brachial pulse is is a sign of fluid loss.
strong and bounding A normal finding.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Gastrointestinal Dry with minimal to
 Skin is dry due to
( Abdomen ) none perspiration. increasing fluid loss.

Less audible bowel sound With aging, gastric

(6 bowel sound per motility is decreased and
minute). doubled with DM and her
present condition,
peristalsis is decreased.

A normal finding.
No abrasions noted.  
A normal finding.
No external shape
abnormality and deformity
The client showed signs
Mild gastric pain on of anorexia and that her
right upper quadrant as eating pattern is
reported by the patient affected by her oral
thrush; gastric
irritation is possible.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Urinary On Foley bag catheter,
 An indication of


urinary output of 800cc increased urination:

per shift. manifestation of
 hyperglycemia.
 Urine is pale yellow. 

 A yellow urine signifies



 urine dilution. Related

 to increased urinary
No pain when urinating
 output.
as confirmed by patient. 

Pain or difficulty when



urinating indicates an
underlying condition as
infection or internal
obstruction.
PHYSICAL ASSESSMENT
BODY FINDINGS INTERPRETATION
Genitourinary system Refused to be examined

Urinary output of 400-600

cc per shift. Manifestation of fluid
loss. The normal urine
Urine color is yellow. output is 30-60cc per
hour.
Urine is diluted from
increased urinary
output.
PHYSICAL ASSESSMENT

BODY FINDINGS INTERPRETATION

Musculoskeletal  Limited ROM when moving Patients with DM
or ambulating was noted. especially in the
 hypoglycemic stage are
 easily fatigued.
Needs assistance when 

changing positions. The patient is weak from

 hypoglycemia.
No joint swelling noted 

Weakness is reported. Hypoglycemia results to

weakness as there is not

enough glucose consumed
by cells.
Presenceof scars on both 

lower legs; 2x 3 cm on Indicates skin trauma

right and 1x2 cm on left
leg. in the past.
 

 No lesions, no injuries. 

Breaks on skin
integrity and presence
of lesions is not
normal.
Lab?
 HEMOCHROME
Date Ordered: June 28, 2010
Date Performed: June 28, 2010
Time Performed: 08:32 PM
Specimen Taken: Blood
Preparation: Explanation of the procedure to the patient, but instruct that no fasting is required. Explain
that the medical technologist would approximately collect 5-7 mL of blood in a top blue tube. Instruct to
apply pressure at the venipuncture site after the procedure.

COMPONENT RESULT REFERENCE CLINICAL

INTERPRETATIO
HEMATOCRIT 34.6% 37 – 47% N
LOW: may indicate
vitamin and mineral
deficiency

MEAN CORPUSCOLAR 25.94 27 – 32 Pg LOW: may indicate

HEMOGLOBIN anemia

PLATELET 131 K/uL 150 – 400 K/uL LOW: may indicate

possible infection

NEUTROPHILS 2% 0-1% HIGH: may indicate

acute infection
 RANDOM BLOOD SUGAR
Specimen: Blood
Result: 549 mg/dL

Normal Range: 70 - 140 ml/dl (3.9 - 7.8 mmol/l)

Interpretation: above normal range; result indicates Diabetes

Medical Technologist: Dave Bermudo, RMT

Pathologist: Dr. Mary Ann R. Torregoza
MINERAL REPORT
Date Ordered: June 28, 2010
Date Performed: June 28, 2010
Time Performed: 08:40 PM
Specimen Taken: blood
Preparation: There are no fluid or food restrictions before collection of the specimen.
Medical Technologist: Cielito Junio
Pathologist: Dr. Mary Ann R. Torregoza

COMPONENT FLAGGING RESULT REFERENCE CLINICAL

INTERPRETATION

CREATININE Hi 0.7-1.2 mg/dL May indicate a disease

2.8 mg/dL or condition affecting
the kidney function.

SODIUM Hi 137-145 mmol/L Indicative of possible

146 mmol/L hypernatremia.

POTASSIUM Lo 3.5-5.1 mmol/L Indicative of possible

3 mmol/L hypokalema.

CHLORIDE Hi 107 mmol/L May indicate

109 mmol/L dehydration or
possible kidney
disease.
URINALYSIS
Date Ordered: June 28, 2010
Date Performed: June 28, 2010
Time Performed: 08:50 PM
Specimen Taken: Urine
Preparation: Patient is given appropriate instruction when urine specimen is
collected like cleaning the perineal area before getting the urine. Instructed to obtain
midstream urine.

COMPONENT RESULT REFERENCE CLINICAL

INTERPRETATION
COLOR Light Yellow Straw/Amber Light Yellow urine
indicates a dilute urine
where lots of water is
being excreted

TRANSPARENT Turbid Clear Presence of RBC, WBC

and Bacteria affects urine
clarity.
REACTION pH 6.0 4.6 – 8.0 Within normal range:
(below this range it
indicates acidosis and
above this range would
indicate alkalosis)
SPECIFIC GRAVITY 1.015 1.015 – 1.030 Within normal
range: (increase
urine specific gravity
indicates increase
concentration of
solutes in urine and
GLUCOSE Negative Negative Within
decrease normal
in level
range:
indicates decreasedof
(Presence
Glucose indicates
solute concentration
presence
in urine) of glucose
PROTEIN Positive Negative Indicates
in Urine orprotein in
urine or proteinuria
glycosuria)
PUS CELLS 3-6/hpf Absent Indicates underlying
infection
RED BLOOD CELLS Numerous Absent Indicates underlying
infection and may also be
contaminant due to an
improper sample collection
or menstruation

EPITHELIAL CELLS None None Normal Finding:

(Presence of such
indicates infection)

BACTERIA None None Normal Finding:

(Presence of such
indicates infection)

Medical Technologist: Dave Bermudo, RMT

Pathologist: Dr. Mary Ann R. Torregoza
CASE STUDY
Pancreas: Anatomy
& Physiology
 Gland with both exocrine and endocrine
functions
6-10 inch in length
60-100 gram in weight
Location: retro-peritoneum*, 2nd lumbar
vertebral level
Extends in an oblique, transverse
position
Parts of pancreas: head, neck, body and
tail

Pancreas
 Pancreatic Duct
• Main duct (Wirsung) runs the entire
length of pancreas
• Joins CBD at the ampulla of Vater
• 2 – 4 mm in diameter, 20 secondary
branches
• Ductal pressure is 15 – 30 mm Hg
(vs. 7 – 17 in CBD) thus preventing
damage to panc. duct
• Lesser duct (Santorini) drains
superior portion of head and
empties separately into 2nd portion
 Lymphatic Drainage
• Rich periacinar network that drain
into 5 nodal groups
– Superior nodes
– Anterior nodes
– Inferior nodes
– Posterior PD nodes
– Splenic nodes
 Innervation of Pancreas
• Sympathetic fibers from the
splanchnic nerves
• Parasympathetic fibers from the
vagus
• Both give rise to intrapancreatic
periacinar plexuses
• Parasympathetic fibers stimulate
both exocrine and endocrine
secretion
• Sympathetic fibers have a
Histology-Exocrine Pancreas
• Ductular system - network of
conduits that carry the exocrine
secretions into the duodenum
• Acinus  small intercalated ducts 
interlobular duct  pancreatic duct
• Interlobular ducts contribute to fluid
and electrolyte secretion along with
the centroacinar cells
 Histology-Endocrine
Pancreas
• Accounts for only 2% of the
pancreatic mass
• Nests of cells - islets of Langerhans
• Four major cell types
– Alpha (A) cells secrete glucagon
– Beta (B) cells secrete insulin
– Delta (D) cells secrete somatostatin
– F cells secrete pancreatic polypeptide
 Histology-Endocrine
Pancreas
• B cells are centrally located within
the islet and constitute 70% of the
islet mass
• PP, A, and D cells are located at the
periphery of the islet
 Physiology – Exocrine
Pancreas
• Secretion of water and electrolytes
originates in the centroacinar and
intercalated duct cells
• Pancreatic enzymes originate in the
acinar cells
• Final product is a colorless, odorless,
and isosmotic alkaline fluid that
contains digestive enzymes
(amylase, lipase, and trypsinogen)
 Physiology – Exocrine
Pancreas
• 500 to 800 ml pancreatic fluid
secreted per day
• Alkaline pH results from secreted
bicarbonate which serves to
neutralize gastric acid and regulate
the pH of the intestine
• Enzymes digest carbohydrates,
proteins, and fats
 Enzyme Secretion
• Acinar cells secrete isozymes
– amylases, lipases, and proteases
• Major stimulants
– Cholecystokinin, Acetylcholine,
Secretin, VIP
• Synthesized in the endoplasmic
reticulum of the acinar cells and are
packaged in the zymogen granules
• Released from the acinar cells into the
lumen of the acinus and then
transported into the duodenal lumen,
where the enzymes are activated.
Insulin
• Synthesized in the B cells of
the islets of Langerhans
• 80% of the islet cell mass
must be surgically
removed before diabetes
becomes clinically
apparent
• Proinsulin, is transported
from the endoplasmic
reticulum to the Golgi
complex where it is
packaged into granules
and cleaved into insulin
and a residual
connecting peptide, or C
peptide
 Insulin
• Major stimulants
– Glucose, amino acids, glucagon, GIP,
CCK, sulfonylurea compounds, β-
Sympathetic fibers
• Major inhibitors
– somatostatin, amylin, pancreastatin,
α-sympathetic fibers
 Glucagon
• Secreted by the A cells of the islet
• Glucagon elevates blood glucose levels
through the stimulation of
glycogenolysis and gluconeogenesis
• Major stimulants
– Aminoacids, Cholinergic fibers, β-
Sympathetic fibers
• Major inhibitors
– Glucose, insulin, somatostatin, α-
sympathetic fibers
 Somatostatin
• Secreted by the D cells of the islet
• Inhibits the release of growth
hormone
• Inhibits the release of almost all
peptide hormones
• Inhibits gastric, pancreatic, and
biliary secretion
• Used to treat both endocrine and
exocrine disorders
 DISEASE HISTORY

Diabetes is first recorded in English, in

the form diabete, in a medical text written
around 1425. In 1675, Thomas Willis added
the word mellitus, from the Latin meaning
"honey", a reference to the sweet taste of
the urine. This sweet taste had been
noticed in urine by the ancient Greeks,
Chinese, Egyptians, Indians, and Persians.
In 1776, Matthew Dobson confirmed that
the sweet taste was because of an excess
of a kind of sugar in the urine and blood of
people with diabetes.
resistance
 Diabetes Mellitus

Diabetes mellitus is a condition in

which the pancreas no longer produces
enough insulin or cells stop responding to
the insulin that is produced, so that
glucose in the blood cannot be absorbed
into the cells of the body. Symptoms
include frequent urination, lethargy,
excessive thirst, and hunger.
TYPE 1 DIABETES
Type 1 diabetes mellitus is characterized by loss of the insulin-
producing beta cells of the islets of Langerhans in the pancreas leading
to insulin deficiency. This type of diabetes can be further classified as
immune-mediated or idiopathic. The majority of type 1 diabetes is of the
immune-mediated nature, where beta cell loss is a T-cell mediated
autoimmune attack.
 Most affected people are otherwise
healthy and of a healthy weight when onset
occurs. Sensitivity and responsiveness to
insulin are usually normal, especially in the
early stages. Type 1 diabetes can affect
children or adults but was traditionally
termed "juvenile diabetes" because it
represents a majority of the diabetes cases
in children.
TYPE 2 DIABETES
Type 2 diabetes mellitus is characterized by insulin resistance which
may be combined with relatively reduced insulin secretion. The defective
responsiveness of body tissues to insulin is believed to involve the insulin
receptor. However, the specific defects are not known. Diabetes mellitus
due to a known defect are classified separately. Type 2 diabetes is the most
common type.
Type 2
 GESTATIONAL DIABETES
Gestational diabetes mellitus (GDM) resembles type 2 diabetes in
several respects, involving a combination of relatively inadequate
insulin secretion and responsiveness. It occurs in about 2%–5% of all
pregnancies and may improve or disappear after delivery. Gestational
diabetes is fully treatable but requires careful medical supervision
throughout the pregnancy. About 20%–50% of affected women
develop type 2 diabetes later in life.
complication
igns and symptoms
NURSING INTERVENTIONS:
1.Advice patient about the importance of an individualized meal plan in
meeting weekly weight loss goals and assist with compliance.
2.
3.Assess patients for cognitive or sensory impairments, which may
interfere with the ability to accurately administer insulin.
4.
5.Demonstrate and explain thoroughly the procedure for insulin self-
injection. Help patient to achieve mastery of technique by taking step
by step approach.
6.
7.Review dosage and time of injections in relation to meals, activity, and
bedtime based on patients individualized insulin regimen.
•Instruct patient in the importance of accuracy of insulin preparation and
meal timing to avoid hypoglycemia.

•Explain the importance of exercise in maintaining or reducing weight.

•Advise patient to assess blood glucose level before strenuous activity

and to eat carbohydrate snack before exercising to avoid hypoglycemia.

•Assess feet and legs for skin temperature, sensation, soft tissues
injuries, corns, calluses, dryness, hair distribution, pulses and deep
tendon reflexes.

•Maintain skin integrity by protecting feet from breakdown.

•Advice patient who smokes to stop smoking or reduce if possible, to

reduce vasoconstriction and enhance peripheral flow.
DIAGNOSTIC TEST:
Several blood tests are used to measure blood glucose levels, the primary test for
diagnosing diabetes. Additional tests can determine the type of diabetes and its
severity.

§RANDOM BLOOD GLUCOSE TEST — for a random blood glucose test, blood
can be drawn at any time throughout the day, regardless of when the person last
ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher in
persons who have symptoms of high blood glucose suggests a diagnosis of
diabetes.
§
§FASTING BLOOD GLUCOSE TEST — fasting blood glucose testing involves
measuring blood glucose after not eating or drinking for 8 to 12 hours (usually
overnight). A normal fasting blood glucose level is less than 100 mg/dL. A fasting
blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test
is done by taking a small sample of blood from a vein or fingertip. It must be
repeated on another day to confirm that it remains abnormally high.
HEMOGLOBIN A1C TEST (HbA1C) — The A1C blood test measures
the average blood glucose level during the past two to three months.
It is used to monitor blood glucose control in people with known
diabetes, but is not normally used to diagnose diabetes. Normal
values for A1C are 4 to 6 percent. The test is done by taking a small
sample of blood from a vein or fingertip.

ORAL GLUCOSE TOLERANCE TEST — Oral glucose tolerance
testing (OGTT) is the most sensitive test for diagnosing diabetes and
pre-diabetes. However, the OGTT is not routinely recommended
because it is inconvenient compared to a fasting blood glucose test.
TERMINOLOGIES

DIABETES MELLITUS- is a chronic disorder of carbohydrates, fat and

protein metabolism

qIt is due to inadequate insulin production or increased resistance to

insulin
q
qCause of DM is unknown
q
qThe predisposing factors to DM as follows:
q
qStress- it stimulates secretion of epinephrine, norepinephrine and
glucocorticoids, these hormones elevate glucose levels by glycogenesis
and glucogenesis
qHeredity- it is strongly assoc. with Type II DM
q
qObesity- Adipose tissues are resistant to insulin, therefore, glucose uptake
by the cells is poor
q
qViral Infection- Increase risk to autoimmune disorders that may affect the
pancreas
q
qAutoimmunity- it is more associated with Type II DM, This is because it is
the children who are more prone to viral infection
q
qPolyuria – excessive urination
q
qPolyphagia – excessive hunger
q
qPolydipsia – excessive thirst
 Diabetes Mellitus
TYPE 1 DM TYPE 2 DM

RISK FACTORS
Primary Treatment:
1 . Weight loss
FAMILY HISTORY OF DM 2.Exercise
Primary Treatment: (i.e., parents or siblings with diabetes) 3.OHA
1.Insulin injections OBESITY
RACE OR ETHNICITY 4.Diet modification
(Africans Americans, Hispanic Americans ) 5.Insulin injections in
AGE acute situations.
Previously identified impaired fasting glucose or 1.
impaired glucose tolerance
History of GDM or delivery of baby of babies over
9 lbs.
LIFE THREATENING
CRISIS:

Diabetic Ketoacidosis LIFE THREATENING

Assessments and diagnostic methods CRISIS:
High Blood Glucose levels 126mg/dl or more ( HHNS )
Random plasma Glucose levels more than 200mg/dl

Clinical Manifestations

Classic : 3 P ’ s
Polyuria (Increased Urination) and
Polydipsia( increased thirst) as a result of
excess fluid loss associated with osmotic
diuresis )
Polyphagia ( increased appetite resulting from
catabolic state induced by insulin deficiency
and breakdown of protein and fats.
Other symptoms :
Fatigue and weakness
 Insulin producing
pancreatic beta cells TYPE 1 DM TYPE 2 DM
are destroyed by
auto-immune process

Insulin resistant and impaired beta cell

functioning

Little or no Insulin
and requires insulin injections

Decreased insulin Results when beta cells cannot

production keep up with the increase
ETIOLOGY Insulin demand
Genetic
Immunologic
Environmental( Viruses or toxins)
Blood glucose rises
Risk Factors
Genetics
People older than 30 yrs of age
Destruction of beta cells Obesity First treated with diet
and exercise then OHA as
needed

Decreased insulin production

Unchecked glucose production by the Signs and Symptoms Associated with slow
liver •Fatigue
Fasting hyperglycemia ,progressive glucose
•Irritability intolerance
•Polyuria
Glucose from food cannot be stored in liver but •Polydipsia
remains in blood stream •Poorly healing skin
and postprandial hyperglycemia wounds Onset may go undetected
•Vaginal infections for many years
•Blurred visions
Glucose in blood excedes renal treshold Complications of
undetected DM 2:
1.Eye disease
Kidneys may not reabsorb filtered glucose 2.Peripheral Neuropathy
3.Peripheral vascular
disease
Glycosoria + Osmotic Diuresis Polydipsia 4.

Medical Management
1.)Treating Hyperglycemia
2.)Correcting dehydration
A .Patients may need 6-10L of IVF
(0.9%NSS at a high rate of
0.5 to 1L/ 2-3 Hrs.)
B .0.45% NSS 200-500 ML/ Hr.
C .Plasma Expanders to correct
hypotension
3.)restoring Electrolytes
A .Cautious Potassium replacement
to avoid dysrhythmia
4.)Reversing acidosis
Regular insulin ONLY is infuse
at a slow continuous
rate
ASSESSMENT AND DIAGNOSTIC
FINDINGS
Blood Glucose level:
300-800mg/dl
Low serum bicarbonate level: 0-
15 mEq/ L
Low pH: 6.8-7.3
Na and K levels may be low,
normal or high depending of
the amount of H2O loss
Elevated creatinine and
BUN,Hgb,Hct values maybe seen
with dehydration
Continued elevation in serum
creatinine and BUN levels
after rehydration in patients
with underlying renal
insufficiency
Diabetic KetoAcidosis
Conversion of fatty acids
CAUSES: into ketone bodies by the
Decreased or missed dose of insulin liver
Illness or infection.
Initial manifestation of undiagnosed or
untreated DM.
Absence or markedly in adequate amount of Increased ketone bodies
insulin . (KETOSIS )
Result:
Breakdown of fat (lypolysis) ACIDOSIS
into free fatty acids and
glycerol
Acetone breath
G.I Symptom as anorexia,
nausea, vomiting , abdominal
pain.
Mental status changes
(CNS DEPRESSION )
Hyperventilation (Kussmaul
Respiration)
If not promptly intervened
Nursing Management
1. Promoting fluid balanced
Respiratory Depression b.Administer fluids as ordered and monitor infusion carefully
Coma c.Monitor fluid volume status
Death d.Monitor I & O
e.Monitor for signs of fluid overload in elderly patients.
2. Promoting electrolyte
& Acid-Base balance
a.Observe frequently for signs of Hyperkalemia.
b.Obtain frequent potassium values
3. Teaching patients self care
 HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC
SYNDROME (HHNS)

Assesment and Diagnostic Methods

1.Blood work, including blood
glucose, electrolytes, BUN, CBC,
serum osmolality, and ABG’s Precipitating Events
2.Clinical picture of severe a.Acute illness (pneumonia, MI, stroke)
dehydration b.Ingestion of medications known to Insulin resistance
provoke insulin deficiency
(thiazide diuretics, propranolol)
c.Therapeitic procedures ( peritoneal
Medical Management: dialysis or hemodialyis, Persistent
1.Start 0.9% or 0.45% NSS. hyperalimenation) hyperglycemia
2.CVP and Arterial pressure
monitoring
3.Add potassium to replacement
fluid
4.Insulin at a continuous low rate Clinical Manifestations
5.Dextrose is added to replacement Osmotic diuresis
1. Blood glucose level from 600
fluids when the glucose level to
decreases 2000 mg/dl
6.Treatment is continued until Water and
2. History of days to weeks electrolyte losses
metabolic abnormalities are of polyuria and polydipsia
corrected and neurologic 3. Hypotension and
symptoms clear (may take 3 to 5 tachycardia
days for neurologic symptoms to Dehydration
4. Profound dehydration
resolve). ( dry mucous membranes, poor skin
turgor) If not treated
5.Variable neurologic signs promptly
Nursing Management: ( alterations of sensorium,
1.Fluid volume and electrolyte seizures, hemiparesis) Neurologic deficits
status monitoring for
prevention of heart failure and
cardiac dysrhythmias. Hypovolemic shock
2.Health teaching on diet
modification,OHA’s and insulin
on acute hyperglycemic
condition. Seizures
NAME: HUMALOG R
CLASSIFICATION: SHORT-ACTING INSULIN
INDICATION:
USUALLY ADMINISTERED 20-30 MIN BEFORE MEAL;
MAY BE TAKEN ALONE OR IN COMBINATION WITH LONGER-ACTING INSULIN
ACTION: IN HYPERGLYCEMIA: FACILITATES BLOOD GLUCOSE TO ENTER THE CELLS
CONTRAINDICATION: HYPERSENSITIVITY, TO PREVENT INSULIN SHOCK;
CAUTIOUSLY USE WITH PREGNANCY(KEEP PATIENT UNDER CLOSE SUPERVISION)
NURSING MANAGEMENT:
TEST GLUCOSE LEVEL;
ADMINISTERED RIGT DOSE AND LOCATION;
INSTRUCT THE PATIENT TO TAKE MEALS AFTER 2-3 HOURS (PEAK OF THE DRUG)
ORAL HYPOGLYCEMIC AGENT
•SULFONYLUREAS - STIMULATES PANCREAS TO SECRETE INSULIN
℘SIDE EFFECT: HYPOGLYCEMIA; WEIGHT GAIN; SULFA ALLERGY
℘IMPLICATION: MONITOR BLOOD GLUCOSE; INSTRUCT PATIENT TO AVOID ALCOHOL
℘E.g., Glimepiride(Amaryl)
Glipizide(glucatrol XL)
Glyburide(glynase)
•BIGUANIDES- INHIB IT THE PRODUCTION OF GLUCOSE BY THE LIVER
℘SIDE EFFECT: LACTIC ACIDOSIS; GI DISTURBANCE; HYPOGLYCEMIA
℘IMPLICATION: MONITOR LACTIC ACIDOSIS AND HYPOGLYCEMIA; EVALUATE RENAL
FUNCTION
℘E.g., metformine(Glucophage)
•THIAZOLIDINEDIONE- S ENSITIZE BODY TISSUE TO INSULIN; STIMULATE THE INSULIN RECEPTOR
SITES TO LOWER THE BLOOD GLUCOSE AND IMPROVE ACTION OF INSULIN
℘SIDE EFFECT: ANEMIA; WEIGHT GAIN; EDEMA;
℘IMPLICATION: MONITOR BLOOD GLUCOSE; MONITOR LIVER FUNCTION TEST ; ARRANGE
DIETARY TEACHING
℘E.g., Rosiglitazone(Avandia)
Pioglitazone(Actos)
•Alpha GLUCOSIDASE INHIBITOR- DECREASE GLUCOSE ABSORPTION IN THE BLOOD VIA SMALL
INTESTINE
℘SIDE EFFECT: HYPOGLYCEMIA; GI SIDE EFFECTS( DISCOMFORT, DIARRHEA;
FLATULENCE)
℘IMPLICATION: MUST BE TAKEN WITH THE FIRST BITE OF FOOD TO BE EFFECTIVE;
MONITOR GI SIDE EFFECTS(DIARRHEA, ABDOMINAL DISTENTION); MONITOR FOR BLOOD
GLUCOSE; MONITOR LIVER FUNCTION STUDIES EVERY 3 MONTHS FOR 1 YEAR, THEN
PERIODICALLY
℘E.g., Acarbose(Precose)
Miglitol(Glyset)