CASE PRESENTATIONDIABETIC THYPE II

BY :1.ERRICK ENDRA CITA2.NOVI LASMADASARI3.DIAN MIFTAHUL MIZAN4.SRI SUPARTI5.PODO YUWONO6.HENDRI TAMARA YUDA

PATIENT BIBLIOGRAPHYNAME : Mr. XAGE : 34 Years OldSEX : MALERELIGION : -MARTIAL STATUS : MARRIEDOCCUPATION : Goverment OfficerDATE ADMISSION : 20 / 3 / 2013 PROVISIONAL DIGANOSIS : DIABETIC THYPE II

PRESENTING COMPLAINTClient said that he feel still : 1.Fatique2.Polidpsi3.Poliuria4.Polifagia5.Felt tisrtyTwo days after he amdmitted he felt sweating, palpitation, fatique dan he got hipoglicemia

HISTORY OF ILLNESSHISTORY OF PRESENT ILLNESSHe has felt fatique, polidpsi, poligia, poliuria since 1 year ago until know then he admited his self in guanxi medical university with diabetes millitus thype II (blood glucose 4,8 mmol/L) and then he charge in hospitalHISTORY OF PAST ILLNESShe was first time charge in hospital with diabetes militus thype II, he denail got hipertention, he denail got TBC, he denail Hearth dieases, he didn’t have algergic for anything.FAMILY HISTORYClient said his family didn’t have DM, Hipertention, TBC and Hearth diseases

DESCRIPTION OF DISEASESDIABETES MELLITUS THYPE II

WHAT WENT WRONG?Our body converts certain foods into glucose, which is the body’s primary energy supply. Insulin from the beta cells of the pancreas is necessary to transport glucose into cells where it is used for cell metabolism. Diabetes mellitus occurs when beta cells either are unable to produce insulin (Type I diabetes mellitus) or produce an insufficient amount of insulin (Type II diabetes mellitus). As a result, glucose does not enter cells but remains in the blood. Increased glucose levels in the blood signal to the patient to increase intake of fluid in an effort to flush glucose out of the body in urine.

Related Anatomy and PhysiologiThe pancreas is composed of two major types of tissues, as shown in :1. the acini, which secrete digestive juices into the duodenum, and2. the islets of Langerhans, which secrete insulin and glucagon directly into the blood.

Related Anatomy and Physiologi

ETIOLOGY & RISK FACTORDiabetes mellitus is caused by an absolute or relative lack of insulin that, among other consequences, leads to an increase in plasma glucose.1.Family history of diabetes (ie, parents or siblings with diabetes)2.Obesity (ie, ≥20% over desired body weight or BMI ≥27 kg/m2)3.Race/ethnicity (eg, African Americans, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders)4.Age ≥45 years5.Previously identified impaired fasting glucose or impaired glucose tolerance6.Hypertension (≥140/90 mm Hg)7.HDL cholesterol level ≤35 mg/dL (0.90 mmol/L) and/or triglyceride level ≥250 mg/dL (2.8 mmol/L)8.History of gestational diabetes or delivery of babies over 9 lbs

PHATOPYHISIOLOGY

Late Complications of Diabetes Mellitus

CLINICAL FEATURESType II:1.Slow onset because some insulin is being produced2.Increased thirst (polydipsia) from the body attempting to rid itself of glucose3.Increased urination (polyuria) from the body attempting to rid itself of glucose4.Candidal infection as bacteria feeds on the excess glucose5.Delayed healing because elevated glucose levels in the blood hinder the healing process

Physical Examination of Patient Physical Examination of Patient 1.Body weight didn’t loss, Fatique2.Eye : He can see clear (retinopati -)3.Lung : RR 19 times/minute, regular, no present andvantages sound of lung, not present cusmaoul breating4.Heart : Heart sound S1 and S2 (in expeted range), blood presure 126/88 mmHg, pulse 68 times/minute, pheriperal artery pulse si strong (dorsalis pedis artery)5.Neurology : monofilamen test normal (He can feel someting touched his feet)6.Increased urination (polyuria)7.Increased thirst (polydipsia)

Clinical Feature present in the book present

1.Blood Pressure 126/88 mmHg2.Increased urination (polyuria)3.Increased thirst (polydipsia)4.Fatique

INTERPRETING TEST RESULTSUrin protein level (+ 1 )

Fasting plasma blood glucose test with a serum glucose level of 19,1 mmol/L

Cholesterol level 8,43 mmol / L

MANAGEMENTThe therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia and without seriously disrupting the patient’s usual lifestyle and activity.

OBJECTIVE OF NURSING CARE PLANThere are five components of diabetes management• Nutritional management• Exercise • Monitoring • Pharmacologic therapy• Education

TREATMENTINSULIN............