Polytechnic College of Davao del Sur, Inc.

MacArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur, Philippines 8002

In partial fulfillment of the Requirement in NCM 109

Type 2 Diabetes Mellitus

A Case Study

Presented by:

Pilapil, Dave Cyril Paul

Saman, Jonaelaine

Serina, Chriezyl Jake G.

Sultan, Zophia Mae

Sumarinas, Joshua N.

Sumugat, Joan Mae

Talye, Rea S.

Tan, Glenn Joy G.

Tungal, Jenny Lenor

Uy, Crizle Joy S.

Presented to:

Mdm. Lolita E. Cabasug, RN

Clinical Instructor
 Acknowledgement

First and foremost, praises and thanks to God, the Almighty, for his showers of blessings,
and giving us the strength, courage and knowledge throughout the researchers work and many
individuals were responsible for the accomplishment of the humble manuscript. Such help and
cooperation they imparted is deeply appreciated. For this reason, the researchers would like to
extend their heartfelt gratitude to all the people who helped in making this study possible:

We would like to express our special thanks of gratitude to our Clinical Instructor Ma’am
Lolita E. Cabasug, who gave us golden opportunity to do this wonderful case presentation of
Nursing.

To Digos Doctors Hospital (DDH), for giving the researchers the chance and the
opportunity to get the case of the patient who was the prospect of the case study.

The group is very grateful to the respondent to this study, the researcher was thankful for
this case assessment that has not been possible without the involvement and helping-hand of
your family and its member.

To the dear groupmates who have been extending all out help and for being cooperative
during hard times. For each efforts, hard work and dedication to the prospect case study is highly
appreciated, And last but not the least, we are extremely thankful for our parents and our family
for their love, support, caring, guidance, sacrifices, and prayers for educating and preparing us
for our future.

Regards,

GROUP 4
 TABLE OF CONTENTS

I. Cover Page………………………………………………………………page 1
II. Acknowledgement………………………………………………………page 2
III. Table of Contents………………………………………………………..page 3
IV. Introduction……………………………………………………………..page 4
V. Objectives of the Case…………………………………………………...page
VI. Identification of the Case ………………………………………………..page
a.) Personal Data………………………………………………………...page
b.) Clinical Data…………………………………………………………page
c.) Background History………………………………………………….page
d.) Medical History………………………………………………………page
e.) History of Present Illness…………………………………………….page
VII. Anatomy and Physiology………………………………………………...page
VIII. Pathophysiology……….………………………………………………...page
IX. Etiology and Symptomatology………………………………………......page
a.) Predisposing Factors…………………………………………………page
b.) Symptomatology……………………………………………………..page
X. Medical Management……………………………………………………..page
a.) Ideal………………………………………………………………….page
Actual………………………………………………………………...page
XI. Laboratory Findings……………………………………………………..page
XII. Nursing Theory…………………………………………………………..page
XIII. Nursing Assessment……………………………………………………...page
XIV. Nursing Management…………………………………………………….page
a.) Nursing Care Plan…………………………………………………....page
b.) Drug Study…………………………………………………………...page
XV. Health Teachings…………………………………………………………page
XVI. Discharge Plan……………………………………………………………page
XVII. Prognosis…………………………………………………………………page
XVIII. Evaluation………………………………………………………………..page
XIX. Implication of the Study………………………………………………….page
XX. References………………………………………………………………..page
 INTRODUCTION

Diabetes Mellitus is a chronic metabolic disorder characterized by high blood sugar

levels over a prolonged period. The condition occurs due to either insufficient production of

insulin by the pancreas or the body’s inability to effectively utilize the insulin produced. There

are 2 main types of Diabetes: Type 1 and Type 2

Type 1 diabetes is an autoimmune disorder that occurs when the body’s immune system

attacks the insulin-producing cells in the pancreas, resulting in little or no insulin production. It is

usually developing during childhood or adolescence.

Type 2 diabetes is the most common form of diabetes and typically develops in

adulthood. It occurs when the body becomes resistant to insulin, and the pancreas gradually loses

its ability to produce enough insulin to maintain normal blood sugar levels

Symptoms of diabetes can include frequent urination, excessive thirst, hunger, fatigue,

blurred vision, and slow wound healing. Treatment for diabetes involves managing blood sugar

levels through a combination of medication, diet, exercise, and regular monitoring of blood sugar

levels. It’s essential to maintain a healthy lifestyle, avoid smoking, and control other risk factors

like high blood pressure and high cholesterol to prevent complications.

A person living with type 2 diabetes may or may not need insulin. In many cases,

medication along with changes in exercise and diet can help manage the condition. Anyone,

including children and adults, can develop type 2 diabetes. The most common risk factors for

type 2 diabetes include 45 years of age or older person; overweight and person who is diabetic in

their family. With type 2 diabetes, insulin resistance takes place gradually. This is why doctors

often recommend making lifestyle changes in an attempt to slow or reverse this cycle.

The purpose of this case study is to explore the management of an infected wound on the

left big toe of a patient with type 2 diabetes mellitus. This case study aims to provide an

overview of the patient's background, the clinical manifestation of the wound, and the treatment

plan used to manage the wound.

 The patient is a 63-year-old male with type 2 diabetes mellitus. He presented to the

emergency department with a wound on his left big toe that had become infected. The patient

reported experiencing pain, swelling, and redness around the wound site. On examination, the

wound was found to be deep and infected, with purulent drainage.

The patient was immediately started on empiric antibiotic therapy and a wound culture

was obtained. The wound culture revealed the presence of methicillin-resistant Staphylococcus

aureus (MRSA). As a result, the antibiotic regimen was adjusted to target MRSA. The patient

was also referred to a wound care specialist for further management. The wound care specialist

recommended debridement of the wound to remove any necrotic tissue and promote healing. The

patient also received advanced wound dressings and was instructed on proper wound care

techniques. The patient's blood glucose levels were closely monitored, and adjustments were

made to his diabetes medication regimen as needed.

Over the course of several weeks, the patient's wound gradually improved, and he was eventually

discharged from the hospital. Follow-up appointments were scheduled to monitor the patient's

progress and ensure that the wound had completely healed.

The rationale behind this case study is to highlight the importance of proper wound care

management in patients with diabetes mellitus. Diabetes can impair wound healing, and infected

wounds can lead to serious complications such as osteomyelitis or even amputation. Therefore, it

is crucial to promptly identify and manage infected wounds in diabetic patients to prevent

adverse outcomes.

This case study is important as it emphasizes the need for a multidisciplinary approach to

managing infected wounds in diabetic patients. The involvement of various healthcare

professionals, such as wound care specialists and diabetes educators, is critical in achieving

optimal outcomes. Furthermore, this case study highlights the importance of proper wound care

techniques, appropriate antibiotic therapy, and glycemic control in promoting wound healing in

diabetic patients.
 OBJECTIVES

General Goals

The purpose of this case study is to present a general intervention for diabetes mellitus
through effective patient interaction and relevant researches with critical, component and
collaborative application of the nursing process. And also, for them to have a deeper
understanding of what diabetes mellitus is. Thus, to give an idea how they could give proper
nursing care for patients with this condition.

Specific Goals

 Define diabetes mellitus type 2 and its classifications

 To be able to address the client’s health problems
 Identify the signs and symptoms and the possible complications associated with the
disease
 Understand the pathophysiology of diabetes mellitus based on the signs and symptoms
manifested by the client
 Identify possible complications associated with this disease
 Predict possible outcome when diabetes mellitus occurs
 To be able to gain improved depth of insight and perspective on patients with regard to
their affliction for the purpose of gaining functional and applicable and proper nursing
interventions.
 IDENTIFICATIONS OF THE CASE

A.) PERSONAL DATA

Name: Patient Celso

Age: 63 years old

Sex: Male

Birthday: March 23, 1959

Birth Place: Digos City

Address: Chapter 5 Aplaya, Digos City

Religion: Roman Catholic

Nationality: Filipino

Tribe: Cebuano

Civil Status: Married

Occupation: Farmer
B.) CLINICAL DATA

Date of Admission: March 10, 2023 @ 2:46 A.M

Tentative Diagnosis: 2 Days non-healing infected wound

on left big toe; Infected Diabetic Left
Foot; possible Diabetes Mellitus

Final Diagnosis: Diabetes Mellitus Type 2

Hospital: Davao del sur Provincial Hospital

(DSPH), Digos City

Ward: Nurse Station 4

Attending Physician: Dr. Reyes; Dr. Hernandez

Source of Information: Patient’s Chart

C.) BACKGROUND HISTORY

Patient Celso, is a 63-year-old Filipino male, who is a Roman Catholic. He was born
on March 23, 1959. He is a non-smoker and a non-alcoholic person. His tribe is Cebuano. He
is married and currently not working. The patient and her family are currently residing at
Chapter 5 Aplaya, Digos City.

D.) MEDICAL HISTORY

Patient has no medical history of the following: Allergy, Asthma, Blood Dyscrasis,
Hypertension, Sexually Transmitted Infections, Thyroid Disease, Cancer, Tuberculosis,
Heart Disease and Seizure disorder prior to her present illness.
E.) FAMILY HISTORY

Heart
Cancer Hypertension Diabetes Mental Disorder Asthma
Disease
x x x √ x x

Patient Celso’s family had no history of Cancer, Heart Disease, Hypertension, Mental
disorder and Asthma and there’s a history of Diabetes.

F.) HISTORY OF PRESENT ILLNESS

2 days prior to admission (PTA) patient had a none healing of infected wound at Left
Big Toe/ following Debridement.
 ANATOMY AND PHYSIOLOGY

Anatomy

The foot consists of bones, joints, muscles, tendons, and ligaments. The normal foot has a

well-cushioned sole, a good arch, and a layer of fat that helps protect the bones and joints. The

diabetic foot, on the other hand, can have structural changes such as a loss of fatty tissue, muscle

atrophy, deformities like hammer toes, and changes to the skin and nails.

Physiology

The normal foot has a rich blood supply and good nerve function, which allows it to feel

sensations such as pain, temperature, and pressure. This helps protect the foot from injury and

prevent complications. In contrast, diabetes can cause damage to the blood vessels and nerves in
the foot, leading to reduced blood flow, reduced sensation, and increased susceptibility to injury

and infection.

In diabetic feet, reduced sensation and blood flow can lead to a range of complications including:

 Neuropathy: Diabetes can cause damage to the

nerves, which can lead to loss of sensation in the feet, making it difficult for the patient to

feel pain, temperature, and pressure. This can make them prone to unnoticed injury and

infection.

i)  With type 2 diabetes, your body doesn't make or use insulin well. Without enough

insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in

your blood and causes high blood sugar levels. Foot problems can happen over time

when high blood sugar damages the nerves and blood vessels in the feet. The nerve

damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of

feeling in your feet. When you lose feeling in your feet, you may not feel a pebble

inside your sock or a blister on your foot, which can lead to cuts and sores.

ii) There are two categories of diabetic neuropathy: Sensory and motor neuropathy and

Autonomic neuropathy

(1) Symptoms of neuropathy include: (a) Pain, numbness, and tingling

of hands and feet (b) Muscle weakness such as foot drop, double vision, trouble

climbing stairs and getting out of a chair (c) Stomach symptoms including

bloating, nausea, vomiting of undigested food many hours after a meal, feeling

full without eating much food. This is also referred to as gastroparesis. (d) Bowel

trouble such as episodes of diarrhea especially at night (e ) Difficulty with bladder

emptying (f)Sexual dysfunction (g) Dizziness and lightheadedness from a very

 fast heart rate and trouble keeping the blood pressure high enough when sitting or

standing up.

 Ulcers: Reduced sensation and

blood flow can also increase

the risk of developing ulcers, which are open sores on the feet. If left untreated, these

ulcers can become infected and lead to further complications.

 Infection: Reduced blood flow and the

presence of high glucose levels in diabetic feet

create an environment that is favorable for bacterial

growth, leading to an increased risk of infection.

 Charcot Foot: Diabetic neuropathy can also

affect the bones and joints, leading to a

condition known as Charcot foot. In Charcot

foot, the bones in the foot become weakened

and can fracture easily, leading to deformities

and complications.
In summary, the anatomy and physiology of the normal foot and diabetic foot differ significantly.

Diabetes can lead to structural changes, nerve damage, and reduced blood flow, which increases

the risk of developing complications such as neuropathy, ulcers, infections, and Charcot foot.

PATHOPHYSIOLOGY

The pathophysiology of Diabetes Mellitus Type 2 (DM 2) involves a complex interplay

of genetic and environmental factors that lead to insulin resistance and impaired glucose

regulation.

 Insulin

Resistance:

Insulin

resistance

occurs when the

body's cells

become less responsive to insulin, the hormone that helps glucose enter the cells for

energy. Adipose tissue, muscle, and liver cells are particularly important in glucose

regulation. In DM 2, adipose tissue releases proinflammatory cytokines that interfere

with insulin signaling in these cells. Additionally, obesity and physical inactivity can

worsen insulin resistance.

 Beta-Cell

Dysfunction:

Beta cells in the

pancreas are

responsible for
 producing and secreting insulin. In DM 2, these cells may not produce enough insulin to

compensate for the insulin resistance, leading to hyperglycemia. Over time, beta cells can

also become damaged, leading to further insulin deficiency.

 Impaired Glucose

Regulation: When insulin

resistance and beta-cell

dysfunction occur together,

glucose regulation becomes

impaired. Excess glucose

accumulates in the

bloodstream, leading to hyperglycemia. The liver also produces excess glucose through a

process called gluconeogenesis.

 Hyperglycemia: Chronic hyperglycemia can lead to a variety of complications in DM 2.

Over time, high blood glucose levels can damage blood vessels and nerves, leading to

complications such as neuropathy, retinopathy, nephropathy, and cardiovascular disease.

Management of DM 2 involves lifestyle modifications, such as healthy diet and regular

exercise, as well as medications that improve insulin sensitivity or stimulate insulin secretion.

Targeting insulin resistance and beta-cell dysfunction is critical in managing DM 2 and reducing

the risk of complications.

 ETIOLOGY AND SYMPTOMATOLOGY

A.) ETIOLOGY

Predisposing factors Present Absent Justification

Age ✓ A review of literature published in the

journal Diabetes Research and Clinical
Practice found that aging is associated
with a progressive decline in beta-cell
function and insulin sensitivity, leading
to an increased risk for diabetes (Yki-
Järvinen, 2014).

B.) SYMPTOMATOLOGY

Symptoms Present Absent Justification

Increased thirst and ✓ The increased thirst and urination are

urination
present because excess glucose, a
form of sugar, accumulates in your
blood when you have diabetes. Your
kidneys must exert extra effort to filter
and absorb the extra glucose. You get
dehydrated when your kidneys can no
longer handle the excess glucose
discharged into your urine and fluids
from your tissues.

(Mayo Clinic, 2023).

Fatigue ✓ Mostly patient with diabetes mellitus
experienced fatigue due to the body's
inability to use glucose properly,
damage to blood vessels and nerves.
Proper management of blood sugar
levels can help alleviate fatigue in
people with diabetes.

Unexplained weight ✓ Although insulin levels are high in

loss
DM2, in which glucose is stored as
fat; the patient had not experienced
sudden weight loss prior to admission
 (PTA).
Blurred Vision ✓ Damage to the retina due to high
blood sugar levels causes vision
problems such as blurry vision,
distorted vision, and difficulty seeing
in low lit conditions.

But as for the patient, an eye

assessment cleared out this symptom
since the patient is able to see clearly
with no problems as of now.

Slow-healing ✓ Wounds heal slowly due to high blood

wounds or infections
sugar levels, nerve damage high levels
caused, and is also due to reduced
immune system function resulting to
longer healing time and may
complicate to infections.

(Geisinger, 2021)
Tingling or ✓ Nerve damage caused by high blood
numbness in the
sugar is the most common cause of
hands or feet
numb or tingly hands and feet.
Untreated diabetes may have other
symptoms, too. You might feel thirsty,
pee a lot, or your breath may smell
fruity. Your doctor can test your blood
to see if you have diabetes.

(Swiner, C. MD, 2021)

Dry skin or skin ✓ Patient with diabetes mellitus

infections
encounter dry skin and skin infection
because of high levels of glucose in
the blood that can cause dehydration
which can lead to dry skin. When
blood sugar levels are consistently
high, it can affect the body's ability to
produce enough natural oils to keep
the skin moisturized. This can result in
dry, itchy and flaky skin that is more
susceptive to cracking and infections.
 of the skin.

Erectile dysfunction ✓ Erectile dysfunction in men because

in men
of high blood sugar over a long period
can damage the nerves and blood
vessels. This damage causes problems
with getting or keeping an erection
firm enough for sex. Also, it causes
problems with the nerves. So, nerve
damage leads to decreased sensation
in the penis and decreased arousal;
reduced erections cause artery issues.

(Mayo Clinic, 2022)

 MEDICAL MANAGEMENT

A.) Ideal

Glucose level tests such as the glycated hemoglobin (A1C) is used to diagnose DM2. This

blood test indicates your average blood sugar level for the past two to three months. Below 5.7%

is normal; 5.7% to 6.4% is diagnosed as prediabetes; 6.5% or higher on two separate tests

indicates diabetes.

 Prompt diagnosis:

The healthcare provider should promptly diagnose the patient's diabetes mellitus

type 2 and the infected wound on the left big toe. This would involve a thorough medical

history, physical examination, and laboratory tests, including blood glucose levels and

wound culture.

 Wound care:

The healthcare provider should provide appropriate wound care to prevent further

infection and promote healing. This may include cleaning the wound, removing any dead

tissue, and applying a dressing that is appropriate for the wound type.

 Glycemic control:

The healthcare provider should work with the patient to achieve and maintain

tight glycemic control. This may involve lifestyle modifications such as a healthy diet

and regular exercise, and medication adjustments such as insulin therapy or oral

hypoglycemic agents.

 Antibiotic therapy:

The healthcare provider should prescribe appropriate antibiotic therapy to treat the

infection. The choice of antibiotic should be based on the type and severity of the

infection, as well as any underlying medical conditions the patient may have.

 Pressure relief:

The healthcare provider should provide appropriate footwear or orthotics to

reduce pressure on the affected area and promote wound healing.

 Education:
 The healthcare provider should educate the patient on diabetes management, foot

care, and prevention of further complications. This may involve instruction on proper

footwear, skin care, and blood glucose monitoring.

 Multidisciplinary approach:

The healthcare provider should work with a team of healthcare providers,

including wound care specialists, podiatrists, and diabetes educators, to provide

comprehensive care and prevent further complications.

 Follow-up care:

The healthcare provider should schedule regular follow-up appointments to

monitor the patient's progress and make any necessary adjustments to their treatment

plan.

B. Actual

Date and Time Orders Rationale

Ordered
March 10, 2023  Admit patient to NS4  To monitor closely and
to ensure that client’s
2:46 AM concern will be
addressed immediately
with proper
interventions.

 Secure care consent  To establish rapport

between the healthcare
provider and client by
ensuring understanding
and to give approval to
medical treatment.

 IVF:
- No.1 D5LR IV
@120cc/hr  For Fluid and electrolyte
replacement and easy IV
access for medication.

Labs:

 With possible history of

5 AM | 8AM   RBS Diabetes due to evident
diabetic foot from
admission complaint
with 2 days non-healing
infected wound.
 Hba1C
  To measure average
glucose levels for the
past 2-3 months in
confirmation of a long-
standing history of
diabetes mellitus 2.
 OGTT

 To measure the glucose

levels before and after
drinking liquid that
contains glucose.

 Lipid Profile (VLDL,

HDLC, LDL,
 To measure the amount
Triglycerides)
of cholesterol fats in the
blood and screen for
cardiovascular disease.
 URIC, [Link]

 To diagnose kidney
disease and see if
kidneys are still working
normally.

 ALTV
 To measure the amount
of ALT in the
bloodstream. ALT in
bloodstream may
indicate liver disease.

 ECG
 A test that detects
cardiac (heart)
abnormalities by
measuring the electrical
activity generated by the
heart as it contracts.

 Medications:  used to control

- Insulin Glargine 20 hyperglycemia in
units OD SC
diabetes mellitus.
 - Empagliflozin  To lower blood sugar
Linagliptin 10mg/5mg levels in type 2 diabetes
1 tab OD

- Atorvastatin 80mg 1
tab OD  Lower cholesterol and
triglyceride levels in the
blood.

- Ceftriaxone IVTT OD
 Used to treat bacterial
infections in many
different parts of the
body.

- Clindamycin 300mg  Alternative to

IVTT q8 ceftriaxone; an antibiotic
used to treat various
infections.

PRN:

- Paracetamol 500mg 1-
 Antipyretic and NSAIDs
tab q4
used to treat fever and
- Tramadol + para TID
pain.

 Doctor’s order:
- Admit to NS4

 DIET:
- Non-diabetic diet  To avoid possible
complications from diet.

 To obtain baseline data

 - VSq4 ; InO q shift and track
 oral/intravenous fluid
intake.

 Doctor’s order:
 Foley catheter helps
- Insert foley catheter
attach to urobag patient empty bladder

- Monitor I & O q shift

 Monitoring of I&O is to
ensure proper intake of
fluid and other nutrients
and monitoring of
output helps to
determine if there is
adequate output of
urine as well as normal
defecation.

- Document every order

and administration

- Refer for any

unusuality
LABORATORY FINDINGS

Laboratories DATE RESULT Normal

TIME Range
CHOLE 03/10/2023 5.8 0 – 5.20

HDLC 03/10/2023 .4 0.9 – 1.6

LDL 03/10/2023 4.42 0 – 2.59

TRIGLYCERIDES 03/10/2023 1.45 0 – 1.70

VLDL 03/10/2023 .66 0.1 to 1.7

RBS 03/10/2023 4.85 3.89 – 5.83

5am
03/10/2023 9.2 3.89 – 5.83
8am
ALTV 03/10/2023 20 7 – 35

URIC 03/10/2023 397 150 - 350

HBA1C 03/10/2023 11.9% 7% or less

FBS 03/10/2023 11.73 3.89 – 5.83

SCrea 03/10/2023 102.84 53 - 97

ECG 03/10/2023 121

 NURSING THEORY

Dorothea Orem’s “Self-Care deficit” Theory

Orem describes a nursing system as an action system or action and sequence of actions

performed for purpose. This is composite to all the nurses’ concrete actions completed for or

with a Self-care agent to promote life, health, and well-being. The composite of actions and their

sequence produced by the dependent care agent to meet the therapeutic dependent Self-care

demand is termed a dependent care system (Parker, M.E., 2010, p. 126)

These actions are related to three types of subsystems:

1. Interpersonal The interpersonal sub system include all necessary actions or operations

such as entering into and maintaining effective relationship with the patient and/or family or

other involved in care

2. social/contractual the social/ contractual sub system relates to all nursing

actions/operations to reach agreement with the patient and other related to information necessary

14 to determine the therapeutic Self-care demand and Self-care agency of an individual and

caregivers.

3. professional technology. The professional – technology subsystem comprises

actions/operations that are diagnostic, prescriptive, regulatory, evaluate, and case management.

(Parker, M.E., 2010, p. 130)

With determination of real or potential self-care deficit or dependent care deficit, the nurse

develops one of three types of nursing system: (1) wholly compensatory, Nurse action :

accomplishes patient’s therapeutic Self-care, compensates for patients inability to engage in Self-

care, supports and protects patient (Parker, M.E., 2010, p. 134) (2) Partly compensatory The

partly compensatory nursing system is represented by a situation in which “both nurse and

perform care measures or other actions involving manipulative tasks or ambulation. the patient or

the nurse may have the major role in the performance of care measures. (Orem, 1991) nurse

action : performs some Self-care measures for patient, compensates for Self-care limitation of
patient , assists patient as required patient action : perform some Self-care measure, regulated

Self-care agency, accepts care and assistance from nurse (Parker, M.E., 2010, p. 134)

(3) supportive educative In the supportive-educative system also known as supportive-

developmental system, the person “is able to perform or can and should learn to perform required

measures of externally or internally oriented therapeutic self-care but cannot do so without

assistance. (Orem, 1991) nurse action: accomplishes Self-care patient action : accomplishes Self-

care, regulates the exercise and development of Self-care agency (Parker, M.E., 2010, p. 134)

Diabetes mellitus (DM) stands out among the chronic diseases due to its high prevalence

and its impact on morbidity and mortality indicators in the national and global contexts. The

concept of self-care in DM is related to a variety of factors, ranging from maintaining a healthy

diet, self-monitoring of blood glucose, use of medications, regular physical activity, foot care,

healthy coping and risk reduction. From this perspective, the implementation of strategies aimed

at the self-management of the disease and the encouragement of self-care is critical.

Structured education for the self-management of type 2 diabetes mellitus (DM2) is a

strategic resource to equip patients for making decisions in relation to the treatment. A review

study of the educational process showed positive results for the self-management of DM2. These

results relate to the support provided for the self-management of the disease and the continuous

monitoring in the control of blood glucose, as well as for the prevention of acute and chronic

complications.

It is recognized that the multidisciplinary health team should promote the development of

self-care skills in order to make people with DM co-responsible for the requirements of their

daily life, with regard to the treatment, modifying or maintaining healthy habits and

strengthening self-confidence. Thus, self-care should be understood as learned behavior that is

performed by individuals for their own benefit.

In this sense, the evaluation of self-care actions taken by patients with DM2 should be

integrated into the care provided by the health professionals. The use of instruments that measure

self-care actions constitutes a methodological tool that assists in the evaluation of the responses

of the patients to treatment, allowing the comparison of data over time and the understanding and

study of the problems observed, in addition to guiding behavior in the clinical practice.
 There are instruments for self-care assessment described in the literature, however, these

do not cover the multidimensionality of the disease, and are mostly directed toward the

evaluation of adherence to the medication therapy, not including seeking multidisciplinary care,

knowledge about the disease and discomforts of the treatment or the process of acceptance of the

disease. Systematic review studies have highlighted the lack of instruments for the assessment of

self-care behavior in people with DM2.

Given this gap and considering the lack of instruments based on the theoretical model of

self-care suggested by Dorothea Orem 9 , the development of an instrument based on the health

deviation self-care requisites was proposed. This theoretical model has been used as the

theoretical and philosophical basis to support the practice of Nursing in a variety of situations,

with an emphasis on the care of patients with chronic diseases. The Orem assumptions fit the

purpose of this study, as they cover promotion and education actions, with individuals

encouraged to take responsibility for the care of their own health.

The construction of a measurement tool based on the theoretical model of Orem 9 has

been shown to be relevant to enable health professionals to develop integral care strategies for

patients with DM2, through observation and transformation of the clinical practice, especially

affecting the planning of nursing care. Given the above, this study aimed to construct and

validate the contents of the Self-care Assessment Instrument for patients with type 2 diabetes

mellitus (INAAP-DM2).
 NURSING ASSESSMENT

 Height, weight, and BMI

 Vital Signs

 Skin Exam for poor healing injuries and signs of reduced circulation

 The deepness of the infected wound

 Reddish wound and foul odor

 Patient stiffness when touched

NURSING MANAGEMENT

A.) Nursing Care Plan

B.) Drug Study
 HEALTH TEACHING

PRIMARY

 Introduction: Introduce yourself to the patient and explain the purpose of the health

teaching session. Emphasize that the goal is to help them understand their condition

better, and provide them with the tools they need to manage their diabetes and infected

wound effectively.

 Instructed the patient to increased fluid intake. Increase thirst and urination is normal for

people with diabetes, increase fluid intake is a must to prevent dehydration.

 Emphasized to the patient the importance of taking and the right time intervals of the
drug to maximize its effects and avoid further complications.
 Instructed the client to have enough and proper rest.
 Encouraged client to have sufficient nutrient intake by eating nutritious foods and enough
fluid intake.
 Instructed the client to verbalize any unusuality and worries, especially about current
situation.

SECONDARY

 Explanation of the condition: Begin by explaining to the patient that diabetes mellitus

type 2 is a chronic condition in which the body cannot properly use insulin to regulate

blood sugar levels. High blood sugar levels can lead to a variety of health problems,

including nerve damage, poor circulation, and delayed wound healing. It is important to

explain that the patient's infected wound is a result of this condition.

 Emphasized to the significant others the importance of proper hygiene and having a

hygienic environment to promote wound healing.

 Educated the significant others the importance of a well-balanced diet, avoiding intake of

too much carbohydrates and sweet foods to maintain normal glucose levels.

TERTIARY

 Prior to patient’s discharge, advise the patient or significant others for strict compliance

of medications and all laboratory exams that are needed.

 Wound care instructions: Explain to the patient how to properly care for their wound to

prevent further infection and promote healing. This may include:

 Cleaning the wound with soap and water daily

  Applying an antibiotic ointment to the wound

 Covering the wound with a sterile dressing

 Avoiding tight-fitting shoes or socks that may rub against the wound

 Elevating the foot to reduce swelling and improve circulation

 Checking the wound daily for signs of infection, such as redness, swelling,

or discharge

 Importance of blood sugar control: Explain to the patient that controlling their blood

sugar levels is essential for promoting wound healing and preventing further

complications. This may include:

 Monitoring blood sugar levels regularly

 Following a healthy diet and limiting sugary or processed foods

 Exercising regularly

 Taking prescribed medications as directed

 Discussing any concerns or changes in blood sugar levels with their

healthcare provider

 Follow-up care: Emphasize the importance of regular follow-up appointments with their

healthcare provider to monitor the wound and ensure that blood sugar levels are under

control. Encourage the patient to seek medical attention immediately if they notice any

signs of infection or if the wound does not show signs of improvement.

 Foot care: Explain to the patient that good foot care is essential for preventing future

complications related to diabetes, such as foot ulcers or amputation. This may include:

 Inspecting the feet daily for any signs of injury or infection

 Keeping the feet clean and dry

 Wearing comfortable shoes that fit well and provide adequate support

 Avoiding going barefoot or wearing flip-flops

 Seeking medical attention for any foot problems

It is important to tailor the teaching plan to the patient's individual needs and preferences, and to

provide ongoing support and encouragement to help them manage their condition effectively.
 DISCHARGE PLAN

Medication:

 Educate patient and family the importance of taking the prescribed medicine at the right

time and right frequency.

 Explain the purpose of medication to the patient and family for further knowledge.

 Emphasize the importance of taking the full course of the medication and for the fast

recovery.

 Instructed patient with detailed instructions on how to take the medications, including

dosage and frequency, and how to properly store them.

 Encourage the patient to take pain relief and antibiotics medications prescribed by the

doctor to lessen discomfort and to treat infected wound.

 Explain to the patient the side effects and adverse effects of the drugs the patient is taking

by prescribing its manifestation.

 Encourage the patient to eat before taking medication to reduce side effects of stomach

irritation

 Encourage strict medication compliance and to take medication as directed.

Exercise/Environment

 Advised the patient to avoid putting pressure on the infected foot, and to keep it elevated

as much as possible.

 Advised patient on exercises he can do.

 Instructed patient with procedures to promote blood flow and healing without putting too

much pressure on the affected foot.

Treatment

 Instructed patient to keep the wound clean and dry, and to change their dressing

regularly.

 Instructed patient how to properly clean and dress the wound, and to monitor it for signs

of infection.
  Provided clear instructions on when the patient should seek medical attention if the

wound does not improve or if signs of infection worsen.

Hygiene

 Advised patient to keep their feet clean and dry, and to avoid wearing tight-fitting shoes

or socks that could irritate the wound.

 Advised to inspect their feet daily for any signs of injury or infection, and to seek

medical attention if they notice anything unusual.

Outpatient Order

 Emphasize importance of schedule follow-up appointments to monitor the patient's

wound and blood sugar levels.

 Provided the patient with a referral to a wound care specialist if necessary.

Diet

 Advised to follow a healthy diet that is low in sugar and carbohydrates, and high in fiber

and protein.

 Encouraged to eat plenty of fruits and vegetables, lean proteins, and whole grains.

 Referred the patient to a registered dietitian for personalized nutrition counseling.

Significant Others

 Informed the family and significant other about the patient's condition and how to support

them in their care.

 Educated the family and significant other on the importance of wound care, blood sugar

control, and good foot hygiene, and encouraged to help the patient follow their treatment

plan.

 Advised the family to visit physician for regular follow-up appointments.

 Emphasized that communication with the healthcare team is essential for ensuring the

patient's ongoing care and recovery.

 PROGNOSIS

Criteria Good Fair Poor Justification

Patient has a family health history of diabetes which he is more
likely to have prediabetes and develop diabetes. Also, more
likely to get type 2 diabetes.
History
√
(Centers for Disease Control and Prevention: Retrieved from
[Link]

Patient lack exercise which causes his muscle cells to lose their
sensitivity to insulin, which controls levels of sugar in the blood.
Exercise helps control weight, lower blood pressure, lower
harmful LDL cholesterol and triglycerides, raise healthy HDL
Exercise cholesterol, strengthen muscles and bones, reduce anxiety, and
√ improve your general well-being.

(Harvard Health Publishing: Retrieved from

[Link]
of-exercise-when-you-have-diabetes)

Diet √ Patient has a poor diet which is a risk factor for diabetes and
other health problems. Diet (lifestyle modification) are
considered by all diabetes clinical guidelines to be the foundation
for diabetes management.

(Sami, et. al (2017). Effect of Diet on Type 2 Diabetes Mellitus.

International Journal of Health Sciences. Volume 11 (2), 65-71.)
Age The patient with T2DM at the age of >40 had the highest excess
risk for heart failure, and for coronary heart disease. All risks
attenuated progressively with each increasing decade at
diagnostic age;

(Sattar, et. al (2019). Circulation. AHA Journals. Volume 139 No.

√
19.)
Summary:

Good- 0/4 x 100 = 0%

Fair- 2/4 x 100 = 50%

Poor- 2/4 x 100 = 50%

The patient has a fair prognosis of 50% which includes the History and the Age wherein

Patient Celso was admitted. On the other hand, Exercise and Diet has a poor prognosis of 50%.
 EVALUATION

The researchers presented the case study covering all the relevant data and able to make

the study successful. The data was gathered using the patient’s chart in accordance with the

standardized case scenario. Moreover, they have also learned how to apply or use their

knowledge to their patients and able to give the proper care that the patient needed.

Researchers chose this study because they want to know what Diabetes is and what

nursing treatments and care should be provided to their patients. The researchers did this to

increase their knowledge of Diabetes Mellitus complications and what typical procedures

required to be performed so that they can apply it in their future career as nurses. The researchers

also hope to assist future student nurses, nurses, and hospitals in disseminating information about

this study.

Therefore, the researchers conclude that the patient has type 2 diabetes because of the

signs and symptoms that present to the patient and this further confirmed by the diagnosis of the

attending physician. Moreover, they provided nursing interventions that were appropriate for the

patient's condition. The researchers also consider the monitoring stage by understanding the

significance of the nurse's job and the support of a significant other. In addition, A key to many

diabetes management plans is learning how to count carbohydrates. Carbohydrates often have

the biggest impact on your blood sugar levels. For people taking mealtime insulin, it's important

to know the amount of carbohydrates in the food, to get the proper insulin dose. The significant

other received health education, and the researcher's assessment of Goal Met results in a

betterment of the patient's circumstances.

 IMPLICATIONS OF THE STUDY

Nursing Practice

The case study highlights the importance of wound care, glycemic control, antibiotic

therapy, pressure relief, education, a multidisciplinary approach, and regular follow-up care in

the management of diabetic foot ulcers. Nurses should be knowledgeable about the

pathophysiology of diabetes and its complications, and should have the necessary skills and

knowledge to provide appropriate care for patients with diabetic foot ulcers.

Nursing Profession

The case study emphasizes the importance of evidence-based practice in nursing. Nurses

should be aware of the current research on diabetic foot ulcers and should use this knowledge to

guide their practice. The case study also highlights the need for interdisciplinary collaboration

among healthcare professionals in the management of diabetic foot ulcers.

Nursing Research

The case study underscores the need for further research in the prevention and

management of diabetic foot ulcers. Research could focus on identifying risk factors for diabetic

foot ulcers, developing new treatment modalities, and improving patient outcomes. Nurses can

play a crucial role in conducting research related to diabetic foot ulcers and other complications

of diabetes.

Overall, the case study highlights the importance of nursing care in the prevention and

management of diabetic foot ulcers. As student nurses and future RNs, we should be

knowledgeable about the pathophysiology of diabetes and its complications, and should use

evidence-based practice to guide their care. The case study also underscores the need for further

research in the prevention and management of diabetic foot ulcers.

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