1anursing Care Study Jasin (1)

8/3/2019 1anursing Care Study Jasin (1)

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NURSING CARE STUDY:

DIABETES MELLITUS

NAME: NORFAZILAH BINTI AHMAD IBRAHIM

I/C NUMBER: 841029-01-6222

POST BASIC GERONTOLOGY


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ACKNOWLEDGEMENTS

I would like to take this opportunity to express my appreciation and thanks to my

lecturers, Puan Rodhiah binti Mohd Yasin for the guidance and cooperation given for me to

complete the study Diabetes Mellitus. I also would like to thanks to Pengarah Kolej

Kejururawatan, Melaka, and the librarian for permitting me to use the facilities in finishing the

case of my study. My appreciation and sincere thanks to all of those individuals at 2B (Hospital

Jasin, Melaka) who were very helpful and supportive.

Besides that, I would like to give my special thanks to all my course mates, who

always motivate and help me to do some references together and sharing their knowledge and

ideas.


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LITERATURE REVIEW

Diabetes is a chronic disease, which occurs when the pancreas does not produce enough

insulin, or when the body cannot effectively use the insulin it produces. This leads to an

increased concentration of glucose in the blood (hyperglycaemia).

Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes) is

characterized by a lack of insulin production.

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by

the bodys ineffective use of insulin. It often results from excess body weight and physical

inactivity.

(WHO) http://www.who.int/topics/diabetes_mellitus/en/

Diabetes is a disease in which the body doesn't produce or properly use insulin. Insulin is a

hormone produced in the pancreas, an organ near the stomach. Insulin is needed to turn sugar

and other food into energy. When you have diabetes, your body either doesnt make enough

insulin or cant use its own insulin as well as it should, or both . This causes sugars to build up

too high in your blood.


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Diabetes mellitus is defined as a fasting blood glucose of 126 milligrams per deciliter (mg/dL)

or more. Pre-diabetes is a condition in which blood glucose levels are higher than normal

but not yet diabetic.

People with pre-diabetes are at increased risk for developing type 2

diabetes, heart disease and stroke, and have one of these conditions:

y impaired fasting glucose (100 to 125 mg/dL)y impaired glucose tolerance (fasting glucose less than 126 mg/dL and a glucose levely between 140 and 199 mg/dL two hours after taking an oral glucose tolerance test)

AMERICAN HEART ASSOCIATIONhttp://www.americanheart.org/presenter.jhtml?identifier=4546

Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high

because the body does not produce enough insulin to meet its needs.

THE MERCK MANUALS ONLINE MEDICAL LIBRARY (http://www.merckmanuals.com/home/sec13/ch165/ch165a.html)

Diabetes is a chronic disease that has no cure. Diabetes is a disease in which the body does not

produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other

food into energy needed for daily life. The cause of diabetes is a mystery, although both

genetics and environment appear to play roles.

MALAYSIAN DIABETES ASSOCIATION (http://www.diabetes.org.my/article.php?aid=5)


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CONTENT

NO TOPIC


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1.TOPIC

1.1. WHAT IS DIABETES MELLITUS?

DIABETES MELLITUS (DM) is metabolic syndrome characterized by hyperglycaemia that

results from an impairment of insulin action and/or secretion.

Type I or Insulin-Dependent Diabetes Mellitus

- Is the result of pancreatic islet cell destruction and a total deficit of circulating insulin.When beta cells are destroyed, insulin is no longer produced

- This disorder is characterized by hyperglycaemia (elevated blood glucose levels), abreakdown of body fats and proteins, and the development of ketosis (an accumulation of

ketone bodies produced during the oxidation of fatty acids)

Type II or Non-Insulin-Dependent Diabetes

- Is the result from insulin resistance with a defect in compensatory insulin secretion.- Is a condition of fasting hyperglycaemia that occurs despite the availability of

endogenous insulin (Porth, 2002).

- It can occur at any age, but it is usually seen in middle age and older people .


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1.2. WHAT CAUSES OF DIABETES MELLITUS?

DM

1.3. RISK FACTORS?

1.4. SIGN AND SYMPTOMS OF DM?

- Type I - symptomatic hyperglycemia or DKA.y o plasma glucose glucosuria osmotic diuresis (Polyuria) dehydration

(polydipsia /weight loss).

y blurred vision,fatigue,nauseay fungal and bacterial-vaginal candidiasis

- Type II frequency routine medical examination - asymptomaticy Glucose molecules accumulate in the circulating blood, resulting in

hyperglycaemia.

1.5. WHAT ARE THE EFFECTS OF DM?

- Progressive complications Hyperglycaemia

Diabetic ketoasidosis Hyperglycaemic hyperosmolar nonketotic coma

Hypoglycaemia- Late complications

y Neurologic


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Somatic neuropathies Paresthesias, pain, loss of cutaneous sensation, loss of fine motor

control.

Visceral neuropathies Sweating dysfunction, pupillary constriction, fixed heard rate,

constipation, diarrhoea, incomplete bladder emptying, sexuality

dysfunction

y Sensory Diabetic retinopathy, cataracts, glaucoma

y Cardiovascular Orthostatic hypotension, Accelerated atherosclerosis Coronary artery disease Cerebrovascular disease (stroke) Peripheral vascular disease Blood viscosity and platelet disorder

y Renal Hypertension, albuminuria, oedema, chronic renal failure

y Musculoskeletal Joint contractures

y Integumentary Foot ulcers, gangrene of the feet, atrophic changes.

y Immune system Impaired healing, chronic skin infections, periodontal disease, urinary

tract infections, lung infections, vaginitis


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1.6. HOW IS A DIABETIC DIAGNOSE?

- Oral Glucose Tolerance Test(OGTT)- the client is given a specified amount of glucose(either 75g or 100g) as a lemon flavour or glucola liquid after fasting blood and urine

samples are taking.

- Fasting Blood Sugar(FBS)- this test often ordered, especially if the client isexperiencing symptoms of hyperglycaemia and hypoglycaemia.

- Glycosylated haemoglobin(c) HbA1C- this test determines the average blood glucoselevel over approximately the previous 2-3months. When the glucose is elevated or

control of glucose is erratic, glucose attaches to the haemoglobin molecule and remains

attached for the life of the haemoglobin, which is about 120 days.

- Urine glucose and ketone levels- these are not as accurate in monitoring changes in blood glucose as blood levels. The presence of glucose in the urine indicates

hyperglycaemia. Ketonuria (the presence of ketones in the urine) occur with the

breakdown of fats and is an indicator of DKA; however, fat breakdown and ketonuria

also occur in stages of less than normal nutrition.

- Serum cholesterol and triglyceride levels- these are indicator of artherosclerosis and anincreased risk of cardiovascular impairments.

- Serum electrolytes- levels are measured in clients who have DKA or HHs to determineimbalances.


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1.7. MANAGEMENT?


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ABSTRACT

This nursing care study is about a male patient Mohd Salleh @Yahya bin Nikmat who is 69

years old he lives in Taman Damai, Bemban, Jasin, Melaka. He was admitted to the Jasin

Hospital on 04 Mei 2011 after he was complaining of dizziness and abdominal discomfort.

He retired as a Post Officer, and was very active and hardworking but he was so depressed

after the death of his wife on the 7th

Mac 2011.

He was hospitalised for eleven days.

Since diabetes is a chronic disease which occurs when the pancreas does not produce enough

insulin or when the body cannot effectively use the insulin it produces. This leads to an

increased concentration of glucose in the blood (hyperglycemia) and no cure to this.

The insulin theraphy was introduced to him in order to stabilized his blood sugar level and later

when he was discharged he currently be treated as an outpatient . A frequent routine medical

examination is recommended.


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ASSESSMENT


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2.0 ASSESSMENT

2.1. BIOGRAPHIC DATA

NAME: MOHD SALLEH @ YAHYA BIN NIKMAT

I/C NUMBER: 421121-04-5113

AGE: 69 YEARS OLD

SEX: MALE

RACE: MALAY

RELIGION: ISLAM

ADDRESS: 4957, JALAN RIA, TMN DAMAI, BEMBAN, 70000

TEL.NUMBER: 017-2054944

MARITIAL STATUS: WIDOW

2.2. INTRODUCTION: MR S

Mr S is a 3rd

son in the sibling of 6th

. His parents passed away due to old age disease.

All siblings are still alive accept the eldest brother, Mr I, was died at the age 70 years old due


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to diabetes mellitus. His eldest sister Mrs H was in KL, 72 years old. His two sisters, Mrs J, 67

years old and Mrs K, 62 years old were staying in Melaka and his brother Mr L, 60 years old

was at Johor Bahru. His sister Mrs J had a hypertension and diabetes and now she is under

treatment.

Mr S was studying until primary six. Worked as a Post Officer about 30 years and he

had retired at the age 55 years old. Married with Mrs B and have seven children, four daughters

and three sons. Their eldest daughter is 49 years old, married and as a housewife. She had three

children. Second son is 44 years old, married and had four children. Work as a teacher and he

had diabetes. Their third son 42 years old, married and had five children. Work as Postmen.

Fourth daughter 39 years old, married and had two children. Work as Staff Nurse and had a

hypertension. Fifth son is 37 years old, married and had three children. Work as a Clerk. Sixth

daughter is 28years old, married and had two children. Work as Project Manager. Lastly, their

seventh son is 27years old and not married yet . Work as Lorry Driver. (see Figure 1: Mr S

family tree).

According to his daughter Mrs A, Mr S is an active and hardworking person.

After

retired he always do some chores and likes to do gardening and farming . He always said to his

daughter that he felt he was in healthy and energetic; no need to go to clinic for check-up.

According to his daughter, since 3 month ago, he looked very sad and unhappy because

his wife passed away at 07.03.2011 due to DM. He always be pensive and become quite,

sometimes he cried when he remember his wife and felt lonely and lost. He is very secretive

with his children but sometimes he shared his sadness with his friends.

2.3. SOCIAL AND ENVIRONMENT ASSESSMENT


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Currently, Mr S lives in his single storey house,four bedrooms, and two bathroom with

a squatting and sitting toilet. There is no hand railing in his home. His house is near the mosque

and grocery shop.

Mr S stayed with his eldest daughter who is housewife and look after him. Besides that,

he also shared the home with his son-in-law and three grandchildren. His economic is stable.

He got some money from his children about RM500 per month. He also got pension money

about RM800 per month.

Mr S has a good social interaction with neighbour and friend. Always go to the mosque

for prayig and attended religious activities.

2.4. COMMUNICATION ASSESSMENT

Mr S can only understand and communicate in Bahasa Melayu and simple English. He

was good in communication and answer the entire question relevant and appropriately.

However, his eyesight has developed some changes about 4-5years ago because he

claimed having problems when reading newspapers. He wore spectacle when he was reading.

2.5. DIETARY ASSESSMENT

Mr S likes to eat all types of food. He did not like to eat outside food but he always eats

his wife cook. He does not have a problem with swallowing.

Breakfast roti canai/nasi lemak/fried bihun/rice/bread/coffee. Lunch rice/chicken

curry/seafood/meat/vegetable. Tea tea/milo/coffee/nescafe/local cakes/fried banana/biscuit.

Dinner rice/chicken curry/seafood/meat/vegetable. Supper coffee/milk/biscuit.


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2.6. HABIT ASSESSMENT

2.6.1 CIGARETTE SMOKING :

Mr S used to smoke 1pack of cigarette per day. He smokes since he was 20 years old

until now. Lately, he has stopped smoking because he was hospitalized.

2.6.2 ALCOHOLIC BEVERAGES CONSUMPTION:

He does not drink alcoholic beverages.

2.7. SLEEP AND REST ASSESSMENT

Mr S has a good sleep and have enough rest.

He used to sleep at 11.

00pm till 6.

00am in the

morning. After that he was going to the mosque for Subuh prayer. However, since he was

admitted in the hospital he sleeping was disturbed.

2.8. INCONTINENCE ASSESSMENT

Mr S dont have a urinary or bowel problem.

2.9. PAST ILLNESS HISTORY

In 2006, Mr S has done for haji screening. Since then he was diagnosed DM and

Hypertension. He was under treatment for a few months only and he missed the TCA and the


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treatment for almost 5 years. He always said to his daughter that he felt he was in healthy and

energetic condition and no need to go to clinic for check-up.

On the other hand, he has never undergone any forms of surgical intervention and

hospital admission till now. He also does not have any known allergies to neither drug nor

food.

2.10. HISTORY OF PRESENT ILLNESS

2.10.1 ADMISSION HISTORY:-

On 04/05/2011 at 9.00am, Mr S was complaint of dizziness, on and off abdominal

discomfort at home and bilateral lower limb edema. He went to Klinik Kesihatan Daerah Jasin

for check-up. B/P: 135/71mmhg, RBS: 21.4mmol/L, urine for ketone: 1+. Doctor gave the

instruction, if possible for admission and for further management.

At 02.52pm, Mr S went to OPD of Jasin Hospital. G/M was HI. Inj Actrapid 12 stat

was given. Mr S was informed to be admitted to Wad 2B.

2.10.3 MR S PROGRESS IN WARD?

04/05/2011 In ward, Mr S look alert and comfortable. He still has mild pedal oedema

bilaterally. Vital sign was taken, B/P: 121/82mmHg, Pulse: 64/min, SPO: 98%R/A,

Temperature: 37C, G/M: 18.9mmol/L. Dr Zawani planned to give S/C Humulin R 10 TDS,


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S/C Humulin N 10 ON, continue anti-hypertension drug: T . Captopril 12.5mg TDS, T.

Amlodipine 5mg OD, withhold T. Metformin, G/M QID, vital sign monitoring every 4hourly.

05/05/[email protected]: Mr S was seen by Dr Amudra. She planned an asked pharmacist

to collect back all metformin which he consumed from other sources, advised family

members to buy G/M, S/C Humulin R 12 TDS, if G/M >10 to add 2 and if G/M >14 to add

4, S/C Humulin N 14 ON. At 12.00pm: Seen by Diabetic Nurse (M/A M. Hafiz bin

Sulaiman). Diabetic counselling was given to Mr S. Then he was referred to Counsellor about

complication of diabetic, blood glucose control, insulin injection, and self-monitoring blood

glucose. At 4.00pm: Mr S was conscious but have mild lethargic . RIB. He complained of

giddiness, cold and clammy. He took one glass of sweet drink and two pieces of bread. Vital

sign was taken, B/P: 93/51mmHg, Pulse: 42/min, SPO: 95%R/A, G/M: 3.1mmol/L. Dr

Zawani was noted and ordered to give I/V Dextrose 5%/24hrs. At 4.45pm: B/P 119/65mmHg,

Pulse: 51/min, SPO:98%R/A, G/M: 13.2mmol/L. At 05.45pm: Seen by Pharmacist, Miss Fan

Siew Kim. She was consulted Mr Ss daughter about hypoglycaemia attack. Mr Ss daughter

claimed that shell buy glucometer herself. All the medications was taken by pharmacist and

plans for switch the dosage of insulin to BD once Mr S discharge.

06/05/[email protected]: Seen by Dietician. Mr S claimed giddiness and not feeling well. Planned

to review Mr S Tuesday or as outpatient if discharge and ward staff to indent low soft diabetic

diet for Mr S.

07/05/[email protected]: Mr S still had lethargic and giddiness. His condition was very labile

during the first three days. His temperature fluctuates ranging 39.1C 37.5C. T.PCM 1gm

was given and IVD 3 Normal Saline in progress. Besides that, his blood sugar level was not

controlled, ranging from 14.0 23.8mmol/L. G/M QID and insulin therapy was introduced in

order to stabilize Mr Ss blood sugar level. (Refer appendix: Blood Sugar Chart). However,


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there were two incidents, where Mr S had hypoglycaemia episode. This related to loss of

appetite.

09/05/2011: Mr S still complained of headache on and off and redness at right hand, cough,

nausea and vomiting for four times. Dr Zawani was diagnosed as thrombophlebitis at dorsum

right hand. She was ordered I/V Cloxacillin 1mg QID, T. PCM 1gm QID, T. Maxalon 10mg

BD and off IVD.

11/05/[email protected]: Mr S still having cough. He claimed that he had chest pain and SOB.

During the examination by Dr Amudha, he had crepts at lower site of lung and the implication:

Carers for hospitalization due to pneumonia TRO pulmonary embolism.

She planned to give

I/V Tazosin 4.5gm stat & TDS, repeat FBC/BUSE/ESR, chest X-ray, D-dimer and off OHA.

At 01.25pm: D-dimer result was positive 1.8. Dr Amudha planned for urgent CTPA at Malacca

General Hospital: if positive finding to admit Malacca General Hospital but if normal finding

to send back to Jasin. Dr Amudha was spoken to Dr Roza (Radiologist specialist) and planned

to refer Mr S to Malacca General Hospital. 03.30pm: Mr S gone to Malacca General Hospital

accompanied by SN Norazean and PPK Walid.

2.11. PHYSICAL EXAMINATION

1. GENERAL CONDITION: Mr S was alert and conscious but mild lethargic. Can dohis activities daily by himself.

2. VITAL PARAMETERS3. HAIR: Grey, clean and tidy

4. EYES :USED A GLASSES, hypermetropia5. EARS : no discharge and no hearing problem6. MOUTH AND THROAT: clean, used a dentures, no cough and sputum7. NECK: no lymph nodes enlargement/tender8. SKIN :redness at right hand9. NAILS:clean and short10.CHEST&HEART: C/O chest pain& SOB


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11.LUNGS : Crept+12.ABDOMEN: soft and tender13.GENITALIA :no enlarged prostate/hernias14.PERIPHERAL VASCULAR15.NEUROLOGICAL

2.12

.FUNCTIONAL ASSESSMENT

1.SELF-CARE ASSESSMENTThis nursing care study adopted from Barthel Index in assessing how well Mr S was able

to care for himself. (Refer appendix: Barthel Index). After a session of interview with Mr S,

Barthel Index revealed that Mr Ss ADL was mid dependent.

2.PSYCHOLOGICAL ASSESSMENTa) COGNITIVE FUNCTIONING

Cognitive assessment such as the ECAQ and the Mini-mental State Examination

shows that(Refer appendix: ECAQ & MMSE)

b) AFFECTIVE FUNCTIONINGMr S has demonstrated sign and symptoms of depression such as loss of interest

to do. Depression scale show that (Refer appendix: Depression scale)

3.SOCIAL ASSESSMENTIn this context, Mr S is taken care by his daughter. It is essential to assess his daughter for carer

assessment (Refer appendix: The Caregiver Strain Index)


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NURSING CARE

PLAN


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3.NURSING CARE PLAN: NURSING PROCESS

APPROACH

1) NURSING DIAGNOSA#1: Risk for impaired skin integrity related to diabetic process

GOAL: Patient will experience intact skin status, and skin will be free of irritation or trauma

especially at feet and lower extremities

INTERVENTION:

1) Conduct baselines and on-going assessment on the feet including:- Musculoskeletal assessment that includes foot and ankle joint range of motion,

bone abnormalities (bunions, hammertoes, overlapping digits), gait patterns, and

abnormal wear patterns on shoes.

- Neurologic assessment that includes sensations of touch and position, pain andtemperature

.

- Vascular examination that includes assessment of lower extremity pulses, capillary

refill, colour and temperature of skin, lesions and oedema .

- Hydration status, including dryness or excessive perspiration.- Lesions, fissures between toes, corns, calluses, cracks in the skin, plantar warts,

ingrown or overgrown toenails, redness, blisters, cellulitis or gangrene.

: Identifies potential circulatory insufficiency that may lead to skin breakdown as

perfusion of oxygen and nutrients are reduced


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2) Teach foot hygiene. Wash the foot daily with lukewarm water and mild hand soap; patdry, and dry well between the toes. Apply a very thin coat of lubricating cream if

dryness is present (but not between the toes)

: proper hygiene decreases the chance of infection. Temperature receptors may be

impaired, so the water should always be tested before use.

3) Conduct foot care teaching sessions as often as necessary.- Use proper shoes

y Shoe that allow to inch of toe room are best; there should be room for toesto spread out and wiggle. The lining and inside stitching should be smooth and

the insole soft.

y Do not wear open-toed shoes, sandals, high heels, or thongs; they increase therisk of trauma.

y Buy shoes late in the afternoon, when feet are at their largest; always buy shoesthat feel comfortable and do not need to be broken in

.

y Check the shoes before each wearing for foreign objects, wrinkled insoles and

cracks that might cause lesions.

---- Care of toenails

y Cut the toenails after washing, when they are softer and easier to trim.y Cut the nails straight across with a clipper and smooth edges and corners with

and emery board.

yDo not use razor blades to trim the toenails

.

- Check the feet daily for red areas, cuts, blisters, corns, calluses, or cracks in the

skin. Check between the toes for cracks or reddened area.

- Check the skin of the feet for dry or damp areas.- Use a mirror to check each sole and the back of each heel.- If you unable to inspect the feet daily, be sure that someone else does so.- Do not sit with the legs crossed at the knees or ankles.-

4) Instruct patient/family to avoid use of over-the-counter products for calluses and corns .: Some commercial products contain harsh chemicals that may injure already-

compromised skin.

5) Discuss the importance of maintaining blood glucose levels through prescribed diet,medication and exercise.

: Hyperglycaemia promotes the growth of microorganisms.

EVALUATIONS


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1) Patient will have intact skin that is free from redness, irritation, bruises and rashes.

1) NURSING DIAGNOSA#2: Deficient knowledge related to self-administration of insulin

GOAL: patient will obtain appropriate knowledge and able to maintain safety of self-

administration of insulin.

INTERVENTION:

1) Instruct patient the importance to take insulin2) Instruct patient in administration of insulin; name, action, peak, levels, dosage, how to

store, preparation and filling syringe, rotation sites, and procedure to inject insulin.

EVALUATIONS:

1) NURSING DIAGNOSA#3: Risk for injury related to decreased temperature sensation,

decreased tactile sensation and lack of awareness of environmental dangers.

GOAL: i) Patient will experience no injury, trauma or fall.

ii) Patient will avoid injury to extremities from environmental hazards

INTERVENTION:

1) Assess patients mobility and stability status, muscular weakness, cognitive limitations,balance, or gait difficulties, and factors related to disease process.

: Provides information for baseline data to establish plan care. Falls are common in

elderly patient and may result from muscle weakness and skeletal support dysfunction,

as well as decreased tactile and sensory status . Claudication may result at difference

times dependent on the weather, incline of walking, or rapidity with which the patient

ambulates.

2) Assess patients sensory deficits of visual, tactile, perceptual, and kinaesthetic changes.: May contribute to falls and other trauma because of insensitivity to pain,

temperature extremities or visual acuity.

3) Asses patients mentation, changes, in mental status, vertigo, syncope, and penchant forwandering

.

: Provide information regarding potential for falls and trauma.

4) Assess environment for safety hazards. Ensure lighting, pathways are cleared, beds arein lowest position and locked, hazardous object out of reach, and ability to summon

help, within reach.

: Safety hazard predispose patient to falls or serious injury. By ensuring that

hazardous objects are removed, patients environment is made safer.


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5) Provide night light as needed and ensure that pathways are clear, and floor is dry andnot slippery.

: Prevents bumping into objects or stumbling and falling.

6) Assist with ambulation as needed.: Promotes safety and prevents falls if patient is too weak or impaired to ambulate

alone.

7) Stay with patient if complaints of faintness or dizziness.

: Reduces anxiety and potential injury from fall if patient dose faint

8) Apply alarm system to bed or chair to alert caregivers that patient has wandered outsideof safe limitations.

: provide patient the opportunity to ambulate and wander about a safe distance rather

than use restrains or other confinement method, yet maintaining a safe environment

9) Instruct patient regarding need for extreme caution when caring for wounds or burnscause by disease process complications.

: Diabetic patient have poor wound healing that may take much longer than normal .

Elderly patient usually have fragile skin that can easily be traumatized

10)Instruct patient/family regarding medication effects and side effects of medicationscurrently being taken, and regarding potential for causing injury.

: Promotes understanding of effect that medication have on well-being or that

medications can predispose patient to injury or trauma.

EVALUATIONS:

1) Patient will have safe environment maintained with absence of safety hazards.2) Patient will have no incident of falls or injury from dangerous objects .3) Patient will be able to ambulate and wander about in a safe environment.4) Patient/family will be able to maintain safety with medication administration and home

environmental safety

5) Patient/family will be able to accurately verbalize understanding of disease process asto how it affects safety within the environment.

1) NURSING DIAGNOSA#1:

a)

b)

OBJ:

INTERVENTION:

EVALUATIONS:


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CONCLUSION


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REFERENCING


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APPENDIX

1) FAMILY TREE


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Mr Ss father Mr Ss mother

Mr I Mrs H Mrs J Mrs K Mr L

Died at the age 72yrs 67yrs 62yrs 60yrs

of70yrs HPT & DM

DM

Mr. S Mrs. N

69yrs 62yrsPatient Died on 07.03.2011

Uncontrolled DM DM-amputation both leg since 5years ago &

all Right finger since Feb 2011.

Mrs. A Mr. B Mr. C Mrs. D Mr. E Mrs. F Mr. G49yrs 44yrs 42yrs 39yrs 37yrs 28yrs 27yrs

Housewife Teacher Postman Staff nurse Clerk Project manager Driver

Married Married Married Married Married Married Married

3 child 4 child 5child 2child 3child 2child

DM HPT

2) INVESTIGATIONS & FINDINGS(X-RAY)

- Diperihilar Haziness


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ECG

3) LABORATORY INVESTIGATION FINDINGSDATE 04/05/11

FBC:

- HB- TW- PLATELET

15.2mmol/L

7.61mmol/L

201mmol/L

BUSE:- UREA- SODIUM- POTASSIUM- CHLORIDE- CREATININE

8.3mmol/L

132.8mmol/L4.770mmol/L

92.8mmol/L

117mmol/L

FBS 9.0mmol/L

URINALYSIS:

- GLUCOSE- KETONES- SG- PH

56mmol/LNegative

1.015mmol/L5

LIPID PROFILE- CHOL- LDL- HDL- TRIGLYCERIDES

4.75mmol/L

3.21mmol/L

1.

11mmol/L

URINE ACETONE Negative

ABG:- PH- PCO- PO

7.332mmhg

46.1mmhg

34.6mmhg

D-DIMER Positive1.8ug/ml

CE:- AST- LDH- CK

26.08ul/L

555ul/L

178ul/LESR 64mm fall 1

st

hour


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4) BLOOD SUGAR PROFILEDATE/TIME BLOOD

SUGAR

PRE-BF

BLOODSUGAR

PRE-LUNCH

BLOODSUGAR

POSTLUNCH

BLOODSUGAR

PREDINNER

BLOODSUGAR

PRE BED

REMARKS/SIGNATURE

5) I/O CHART6) INTRAVENOUS FLUID THERAPY REGIMENT

DATE/TIME TYPE OF I/V SOLUTION AMOUNT

7) FEEDING REGIMENTENTERAL FEEDING CHART

DATE/TIME TYPES OF FEEDING AMOUNT

ORAL FEEDING CHART

DATE/TIME TYPES OF FEEDING AMOUNT

8) ELDERLY COGNITIVE ASSESSMENT QUESTIONNAIRE-ECAQ9) MMSE10)

BARTHEL INDEX

11)THE CAREGIVE STRAIN INDEX www.hartfordign.org12)NORTON SCALE13)ROM EXERCISE14)TECHNIQUES OF TRANSFERRING & LIFTING15)DRUG REFFERENCES

NAME OF

DRUG

ACTIONS OF

DRUG

INDICATIONS SIDE

EFFECT/

NURSING

INTERVENTION


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ADVERSE

REACTION

16)DRUG CHART NAME OF MEDICINE INSTRUCTION &

INDICATION OF

MEDICINE

SIDE EFFECTS

Documents

1anursing Care Study Jasin (1)