F. L.

Vargas College
College of Nursing
Tuguegarao city

A Case Presentation

In partial fulfillment of the course requirements in

Related Learning Experiences

Prepared by:

Salem, Dindo G.
Utanes, Clarence R.
Angalao, Charlotte
Padilla, Leonardo II
Lucero, Rammil G.
Dilag, Christopher
Castillo, Kaiza
Contillo, Jackielou

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 February 19, 2009
GENERAL OBJECTIVE:

After four hours of presenting this case, we will be able to enhance both our
knowledge and to our audience about the disease which is the diabetes mellitus, type II.

SPECIFIC OBJECTIVES:
At the end of the case presentation, the audience will be able to:
• Know the definition, signs and symptoms of diabetes mellitus, type II.
• Understand the disease process and its causes.
• Do proper nursing care interventions for the disease
• Be able to identify the different drugs to manage the disease.
• Have an over view of the pathophysiology of the disease.

SCOPE AND DELIMITATION:

• There was an order for the patient to undergo dialysis to treat anasarca but they
cannot afford.
• Intake and output and patient’s weight was not able to get.

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INTRODUCTION

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. The treatment includes changes in diet,
oral medications.
Diabetes mellitus is a chronic disease that causes serious health complications
including renal failure, heart disease, stroke, and blindness.
Every cell in the human body needs energy in order to function. The body's
primary energy source is glucose which from the digested food that circulates in the
blood as a ready energy source for any cells that need it. Insulin is a hormone or chemical
produced by cells in the pancreas. Insulin bonds to a receptor site on the outside of cell
and acts like a key to open a doorway into the cell through which glucose can enter. Some
of the glucose can be converted to concentrated energy sources like glycogen or fatty
acids and saved for later use. When there is not enough insulin produced, now the glucose
stays in the blood rather entering the cells.
Type II is considered a milder form of diabetes because of its slow onset because
it usually can be controlled with diet and oral medication. This form is also called non-
insulin-dependent diabetes, a term that is somewhat misleading. However, insulin
injections are sometimes necessary if treatment with diet and oral medication is not
working. The pancreas may produce enough insulin, however, cells have become
resistant to the insulin produced and it may not work as effectively.

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PATIENT’S PROFILE
NAME: …………………………………………………F.P.
AGE: ……………………………………………………72 years old
DATE OF BIRTH: …………………………………….July 29 1936
CIVIL STATUS: ………………………………………Married
EDUCATIONAL ATTAINMENT: …………………..High school graduate
OCCUPATION: ………………………………………N/A
MONTHLY INCOME: …………………………….…N/A
NATIONALITY: ………………………………………Filipino
RESIDENCE: …………………………………………Buntun, Tuguegarao city
ADMITTING DIAGNOSIS: …………………….……Diabetes Mellitus, type II
ADMITTING PHYSICIAN: …………………….……Dr. T. Uy
DATE OF ADMISSION: ……………………….….…February 10, 2009 @ 3:30 PM
DATE OF DISCHARGE: ……………………....….…February 12, 2009
NURSING INFERENCE: …………………………… Diabetes Mellitus, type II
INFORMANT: ………………………………….……Patient and sister
RELIABILITY: ………………………………………100%

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FAMILY BACKGROUND

The family of FP has been residing at Buntun, Tuguegarao city for almost 5
decade, living on their own house. The husband of FP is a High school graduate like her.
They raise their only son by the help of their relatives from abroad that’s the reason why
their son makes his best to finish his engineering course at CSU and he made it, now their
son is working abroad and he is the one sending money to his parents till now. FP is
living with her husband together with her younger sister and 3 relatives from Piat,
Cagayan.
Both the couple is dominant in terms of decision making in the family, in terms of
money or budgeting, FP is doing the tasks, but it doesn’t say that she is the one going to
the market, but with the help of their “katulong” and sometimes the relatives living with
them.
The family seems to have a cordial relationship even their son is at abroad they
still consider that he is just around with the help of internet. However, there were times of
petty quarrels and arguments between the people (relatives @ house) and even to their
son because of the attitude of a person in aging, but because they (their relatives or son)
already consider those as a normal for an adult thus they just let this pass but sometimes
they resolve it by simple conversation.

PAST HEALTH HISTORY

FP was not able to receive any immunization due to the fact that EPI was just
started by the year 1976. FP experienced some of the common childhood illnesses like
cough, colds, diarrhea, chicken pox, and mumps during her childhood years. But she had
no history of any major medical operation, accident, or major injuries that brought her to
any hospital.
According to FP her menarche was when she is on her grade five and her
menopause was on her 38 years of age. FP has no known allergies to food and drugs.

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FAMILY HEALTH HISTORY
GENOGRAM

LEGEND:
Male Decease Dx. with DM Hypertension

Female Our patient No known Asthma

major illnesses

-
CHIEF COMPLAINT
Body weakness

PRESENT HEALTH HISTORY

A day prior to admission, FP suffered from dizziness and body weakness. FP has
taken Alaxan (500mg PO) after she ate her lunch (February, 10 2009) but the drug was
not able to relieve her problem. Her husband and her sister decided to run FP to
Tuguegarao City Peoples General Hospital at around 3:30 PM of February 10, 2009.

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DEVELOPMENTAL DATA

Since patient FP is already 72 years old, he belongs to Erickson theory of Ego

Integrity VS. Ego Despair. This is the final stage of Erickson’s theory. The patient, as an
individual experiences a sense of mortality. How he responds to retirement, or how he
accepts the final crisis of her life whether it is positive or negative resolution.
Ego integrity is viewed as the key to harmonious personality development; the
individual views their whole life with satisfaction and contentment. The ego quality that
emerges from a positive resolution is wisdom. Conversely, despair is the negative
resolution or lack of resolution of the final life crisis. The negative resolution manifests
itself as a fear of death, a sense that life is too short, and depression. Despair is the last
dystonic element in Erickson’s THEORY.
Patient FP learned to accept positively the final crisis of her life, she believed that
her purposes are being met, she enjoyed spending quality time with her husband, and she
has seen how her son achieved his personal goal in life. She is now satisfied and no
resentment in life, inspite of her condition.

PATTERNS OF FUNCTIONING
BEFORE ILLNESS DURING ANALYSIS
HOSPITALIZATION
A.EATING PATTERN
• “Karaniwang kinakain ko yung On diabetic diet but she Since when she
tinolang manok,o di naman gulay na verbalized that “ halos admitted to the
kalabasa at repolyo o pechay pero magkasing dami lang ang hospital her
mas marami parin ang kanin ko, ika kinakain ko sa bahay choice of diet
nga nila mas nakakabusog parin ang kumpara dito” changed.
kanin”.
• “Kumakain naman kami ng tatlong
beses sa isang araw, pero sa mga
nakalipas na araw eh napapadalas ang
pagkain ko (meryenda)”
**“Coke at tinapay lang pero halos hapon
hapon”

B. DRINKING PATTERN

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• “Mahilig kaming uminom ng coke “Halos nakakaubos ako ng Decrease
lalo na sa hapon habang nanonood 2 litro ng tubig kasama na intake of fluid
kami sa bahay”. yung pag-inom ko ng intake.
• “Tuwing kumain ako halos gamot ko”
nakakaubos ako ng 3 baso (aprox.
250 ml), Iba pa yong iniinom ko lalo
na sa tanghali kasi sa init ng panahon
(additional 3-4 glass (250 ml))”
C. SLEEPING
• Nakakatulog naman ako ng maayos, Okay lang naman matulog Feels like no
nasanay na akong matulog dito, parang nasa bahay change on her
pagkatapos ng balita, at may mga lang ako. environment in
pagkakataon na di ako dinadalaw ng terms of
antok kaya ang ginagawa ko lang sleeping
umupo sa sala at manuod at yun di ko
namamalayan na makakatulog na ako
sa sofa.
• Natutulog ako pag sa hapon pero
sandali lang.
D. BATHING PATTERN
• Karaniwan, 2 beses akong naliligo sa Pinupunasan nalang ako ng Due to the
isang araw. kapatid ko oh di naman weakness
ung mga nars kung
nilalaganat ako.
E. ELIMINATION
__Urine __Urine
• Yan nga problema ko eh kc minsan Medyo komunti ang naiihi Developed
lagi lagi akong naiihi. ko ngayon. edema
__Stool
• 2-3 beses lang sa loob ng isang lingo, __Stool
mabaho sya syempre at buo na 2 beses palang akong Limited food to
brown. nagbawas dito; ganun din digest.
ang kulay at amoy.

LEVELS OF COMPETENCIES
BEFORE ILLNESS DURING ANALYSIS
HOSPITALIZATION
A. PHYSICAL
• FP activities done by her at their FP has a poor range of Activity
house is to sprinkle their plants at motion, FP is also weak. intolerance and
their backyard, she is doing these impaired skin
every other day using a hose. integrity

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• She rarely cooks food for them and
clean the house that day only depends
to their “katulong”.
B. MENTAL
• Most of the time FP can’t hear nor She does the same during It seems that
understand immediately what her the interview but with the she is in the
companion tells to her and sometimes help of her sister which good aura on
she easily forget things. helps to give some info’s. the time of the
interview
C. EMOTIONAL
• FP enjoys watching telenovela which Emotions regarding to her She is very
plays about love, betrayal and drama. condition; she understand it cooperative
FP loves to with their apo’s especially and seems she accept it as client and a
when they are on vacation; she said a part of going older. She cheerful one.
that she’s no easily be hurt by often smile during the
emotion. interview
D. SOCIAL
• FP rarely attends to social gatherings, FP can’t make it to attend Even she’s not
even birthdays of their relatives. any social gathering attending any
because she is still weak to socialization;
• Never attends to any meeting / walk on her own. she is still a
assembly to their barangay. She is not participative on
also a member of any organization in what to ask for
the city. her.
E. SPIRITUAL
• FP rarely attends mass, but she Still she prays at night She believes in
regularly sends offerings to the before she sleeps; a thing the existence of
church by her sister. she asks is for her GOD and His
• She often says a prayer before going immediate recovery. ability which
to sleep, which she believes that it is a she giving her
way to communicate to God. trust regarding
• Believes also in some albularyo. on her problem
in health.
F. SEXUAL
• FP Had her menarche during her She doesn’t missed her
grade 6 study; she has an irregular husband in terms of
pattern and consumes three pads a intimacy
day. FP had her menopause when she
is 38 years old.
• At these years she is not sleeping
beside her husband.

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 PHYSICAL ASSESSMENT

GENERAL SURVEY:
• Physical appearance
The patient is endomorph in size, lying on bed and awake, with ongoing
IVF on her right arm.

• Vital sign
February 12, 2009
TEMP: 37.8 degree Celsius
PR: 103 bpm
RR: 27 cpm
BP: 140/100 mmHg

HEAD TO TOE ASSESSMENT

Area Assessed Techniques Normal Actual Findings Analysis
Use Findings
Skin: Inspection Light to deep Fair complexion;
Color brown reddened on her
scapular part
hair distribution Inspection Equally Fairly distributed
distributed
Moisture Inspection Slightly moist moist
Texture Inspection/ smooth Rough and
palpation saging on some
areas of her body.
Turgor Palpation Recedes Returned slowly Decrease elastin in
immediately the skin and
ANASARCA
Temperature Palpation normothermic warm to touch Due to the fever
Hair: Inspection black black
Color
Distribution Inspection Evenly Evenly
distributed distributed
Texture Palpation Soft, silky and coarse
smooth
Oiliness Palpation Neither Dry hair
excessively dry
nor oily

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Head: Palpation Normocephalic Normocephalic
Size and shape
Texture Inspection/ Nodules not No nodules
palpation palpable palpated
Face: Inspection symmetrical symmetrical
Symmetry
Facial movements Inspection symmetrical symmetrical

Skin color Inspection Consistent with Consistent with

skin color skin color
Eyes: Inspection Consistent with Gen. consistent ANASARCA
Skin integrity skin with the facial
color
Per orbital edema
Movements Inspection No extra skin No extra skin
movement movement
Position and alignment Inspection Parallel to each Parallel to each
other other;
Eyelids Inspection Skin intact Slightly close Decrease elastin in
the skin.
Hair Distribution Inspection Equally Equally
distributed distributed
Eyelashes: Inspection Evenly Evenly
Hair distribution distributed distributed
Direction of curls Inspection outward outward

Conjunctiva: Inspection Light pink Light pink

Color
Texture Palpation Glossy smooth Lightly Glossy,
smooth
Pupils: Inspection black Light brown
Color
Shape Inspection round Round

Reaction to light Inspection Bilaterally when Bilaterally when

illuminated with illuminated with
light light
Symmetry Inspection symmetrical symmetrical

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Ears: Palpation Elastic with no negative
Texture and elasticity tenderness tenderness
Discharge Inspection Minimal With dry
discharges Cerumen
Symmetry Inspection Symmetrical Symmetrical

Position Inspection Upper part level Aligned to the

to the lateral level of the outer
cantus cantus
Cerumen Inspection Wet or dry With dry
Cerumen Cerumen
Hearing acuity Inspection Able to hear Needs to repeat Poor hearing acuity
clearly the word and in
louder one
Nose: Inspection symmetrical symmetrical
Symmetry
Discharge Inspection No discharges No discharges

Nares Inspection Oval, symmetrical

symmetrical
Texture Palpation Smooth Lightly rough Decrease elastin in
the skin
Teeth: Inspection whitish False teeth
Color (yellowish)
number of teeth Inspection 32 Complete false
teeth
Tongue: Inspection Pinkish with Pinkish with
Color covering numerous white
coating
Position Inspection Central position Centrally
position
Symmetry Inspection symmetrical symmetrical

Mobility Inspection Moves freely Moves freely

with out
tenderness
Neck: Inspection Moves in full Moves in full
Range of motion range of motion range of motion
without without
tenderness tenderness

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Mobility Inspection Freely movable Freely movable

Trachea palpation Midline at the Midline at the

suprasternal suprasternal
notch notch
Nails: Inspection pinkish pinkish
Color of nails beads
Capillary refill time Palpation 1 to 3 sec Return in 3
seconds
Texture Palpation smooth smooth

Shape Palpation Convex Convex curvature

curvature
HEART: Auscultation 60- 100 bpm 103 bpm
Heart rate
Rhythm Auscultation Regular regular

Sound Auscultation S1 and S2 S1 and S2

Thorax: Inspection elliptical elliptical

Shape & configuration
Skin color Inspection Consistent with Consistent with
body color body color
Texture Palpation smooth Slightly rough

Symmetry of chest Palpation symmetrical symmetrical

excursion
Breath sounds Auscultation no adventitious no adventitious
breath sounds breath sounds
(anterior)Shape and Inspection elliptical elliptical
configuration
Skin color Inspection Consistent with Dark on her
body skin color armpit
Abdomen:
Distention Palpation No tenderness No tenderness
Contour Inspection Elliptical elliptical

Color Inspection Consistent with Consistent with

body skin color body skin color

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Bowel sound Auscultation Audible bowel 7 bowel sounds
sound
Tone Percussion Tympanic Tympanic
(stomach) (stomach);
Palpation No tenderness Not tender

Extremities: Moves in full Moves in full The patient is weak

Range of motion range of without range of without
tenderness tenderness
(passively)
NEUROLOGIC: interaction Consistent and Alert and
Level of consciousness responsive participative
Mental status Inspection Oriented to time, Oriented to time,
person and place person and place
Coordination Inspection Can coordinate Can coordinate

Speech Clarity Inspection Clear clear

Emotional Status Inspection Relax restless

ONGOING APPRAISAL

• February 12, 2009

7am-3pm

Received sitting on bed with an ongoing IVF of PNSS one liter at the level of
600cc regulated at 20 gtts per minute infusing well at the right arm. She was feverish
with a temperature of 37.8 ‘C and on diabetic diet. TSB rendered. Provided safety for the
client. Instructed patient to eat only non- sweet foods; provided rest and a well ventilated
area. Stressed the important of taking medicine on time (oral meds).

• February 13, 2009

7am-3pm

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 Still on IVF of PNSS with same regulation at the level of 300cc, Seen and
examined by the ROD and order her to may go home and orders her homes medicine.

LABORATORY WORKS

BLOOD CHEMISTRY
Reference Actual Analysis
• Glucose random 7.7 – 9.9 mmol/L 13.4 mmol/ L Elevated due to mal
absorption of glucose by the
cells
• BUN 2.5 – 6.5 mmol/L 8.53 mmol/L Elevated due to kidneys mal
functioning of filtering
wastes
• Creatinine 53 – 97 mmol/L 138 mmol/L Elevated due to kidney
dysfunction

HEMATOLOGY
Reference Actual Analysis
• WBC 3.5 – 10 X 10^3/ 20. 5 X 10^3/ mm^3 Elevated due to underlying
mm^3 infection
• RBC 3.8 – 5.8 10^6/ 4.27 X 10^6/ mm^3
mm^3
• Hgb 11 – 16.5 X 9/ dL 13.6 X 9 dL
• Hct 35 – 50 % 39.7 %
• Platelets 150 – 390 X 10^3/ 191 X 10^3/ mm^3
mm^3

• Complete blood count test is performing by obtaining a blood sample directly

from the patient. The skin is wiped with an alcohol and then a needle is inserted
through the area of cleansed skin into patient’s vein (one that can be visualized
from the skin) the blood is then pulled from the needle by a syringe or b a
collection vacuumed vial where it is collected. And it is send immediately to the
hospital.
• Indication: To confirm the medical diagnosis given by the doctor; to identify any
complications on the client; to check the severity of condition of the patient; to
check for further intervention for the patient.
URINALYSIS
Reference Actual Analysis

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• Color Yellow amber Yellow
• Albumin Negative TNTC r/t dec. glomerular filtration
rate
• WBC Negative Negative
• Sugar Negative TNTC r/t dec. glomerular filtration
rate
• Spec. 1.010- 1.030 1.015
Gravity

• Urinalysis is a microscopic examination of urine. It involves a number of tests to

detect and measure various compounds that pass through the urine.

• Indication: To confirm the medical diagnosis given by the doctor; to identify any
complications on the client; to check the severity of condition of the patient; to
check the needs for further interventions for the patient and to check the integrity
of the bladder to filtrates urine.

ANATOMY AND PHYSIOLOGY

Endocrine system

Once a hormone is secreted,

it travels from the endocrine gland
that produced it through the
bloodstream to the target cells which
designed to receive message. Along
the way to the target cells, special
proteins bind to some of the
hormones. These proteins act as
carriers that control the amount of
hormone that is available for the
cells to use. The target cells have
receptors that latch onto only specific hormones, having its own receptor, so that each
hormone will communicate only with specific target cells that have receptors for that

16
hormone. When the hormone reaches its target cell, it locks onto the cell's specific
receptors and these hormone-receptor combinations transmit chemical instructions to the
inner workings of the cell.
When hormone levels reach a certain normal amount, the endocrine system helps
the body to keep that level of hormone in the blood. For example, if the thyroid gland has
secreted the right amount of thyroid hormones into the blood, the pituitary gland senses
the normal levels of thyroid hormone in the bloodstream. Then the pituitary gland adjusts
its release of thyrotropin, the hormone that stimulates the thyroid gland to produce
thyroid hormones.

DRUG STUDY

Generic name: Ramipril

Brand name: Altace
Classification: Antihypertensive, ACE inhibitor
Dosage: 5 mg OD po
Indication: Treatment of hypertension alone
Mechanism of action: this was given blocks ACE from converting angiotensin I to
angiotensin II leading to decrease blood pressure
Adverse effects:
• CNS: tachycardia, CHF and hypotension
• GI: gastric irritation, anorexia, constipation
• Hematologic: neutropenia, agranulocytosis, hemolytic anemia
Nursing considerations:
Assessment
• History: allergy to ramipril
• Physical: skin color, lesions, turgor
Interventions

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 • Discontinue diuretics for 2-3 days before beginning therapy to avoid hypotensive
effect.
• Monitor patient closely for falling BP secondary to reduction in fluid volume
• Reduce dosage in patients with impaired renal function

Generic name: Acetaminophen

Brand name: Paracetamol
Classification: Antipyretic
Dosage: 500mg PO every 4 hours prn for temp. greater than or equal 37.5 C
Indication: To relieve fever
Mechanism of action: This was given to reduce fever by acting directly on the
hypothalamic heat regulating center to cause vasodilatations and sweating which helps
dissipate heat.
Adverse effects: headache, chest pain, dyspnea, rash.
Nursing responsibility: Assessed allergy to acetaminophen, gave drugs with food if GI
upset occurs.

Generic name: Metformin hydrochloride

Brand name: Fortamet
Classification: Anti diabetic
Dosage: 500mg PO TID with meals
Indication: To lower blood glucose level in the blood with NIDDM patients
Mechanism of action: It increases peripheral glucose utilization, decreases hepatic
glucose production and alerts intestinal absorption of glucose.
Adverse effects:
• Endocrine: Hypoglycemia
• GI: anorexia, nausea and vomiting, epigastric discomfort.

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 • Hypersensitivity: Allergic skin reactions, urticaria,erythema
Nursing considerations:
Assessment
• History: allergy to Metformin
• Physical: peripheral sensation
Interventions
• Monitor the effectiveness of the drug by checking the glucose level
• Monitor vital signs closely
• Assess for felling of vomiting or epigastric discomfort
• Assess for feeling of headache and dizziness

Generic name: Cefuroxime Sodium

Brand name: Zinacef
Classification: antibiotic
Dosage: 750mg TIV every six hours
Indication: to treat infection of urinary tract/abdomen
Mechanism of action: inhibits cell wall synthesis promoting osmotic instability
Adverse effects:
• CNS: dizziness, H/A
• GI: anal pruritus
• GU: pruritus
Nursing considerations:
Interventions
• Monitor V/S
• Assess for any signs of adverse effects
• Assess skin integrity

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 NURSING CARE PLAN

CUES NURSING Dx SCIENTIFIC OBJECTIVE NURSING RATIONALE EVALUATION

INFERENCE INTERVENTION
Subj: P: Body After 3hrs > positioned > to Goal met
“nanghi Activity weakness of nursing comfortably promote
hina Intolera interventi > provided rest comfort
ako” as nce Decrease on, the > provided > to
verbali E: r/t energy pt. restful env’t restore
zed by body improved by decreasing energy
the pt. weakness Activity her body environmental > to
intolerance movement stimulus promote
Obj: as (noise) comfort
> poor evidenced
ROM by doing
personal
grooming
like
combing
her hair

CUES NURSING SCIENTIFIC OBJECTIVE NURSING RATIONALE EVALUAT

Dx INFERENCE INTERVENTION ION
Subj: P: Immobility After 8hrs > repositioned > to Goal
“hindi ako Impaired secondary to of nursing pt every 2hrs promote met
masyadong Skin body weakness interventio > provided circulation
nakakagalaw” Integrity n, the pt. wrinkled free > to
as verbalized E: r/t Pressure on the condition bed promote
by the pt. immobility bony areas of will not be > provided comfort
Obj: secondary the body worsened rest > to restore
> presence of to body body energy
reddened weakness Impaired blood
spots at the circulation
scapular area
Necrosis

Impaired skin
integrity

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CUES NURSING Dx SCIENTIFIC OBJECTIVE NURSING RATIONALE EVALUATION
INFERENCE INTERVENTION
Subj: P: Fluid Decrease After 8hrs of > evaluated edematous > to reduce Goal
“ang bigat Volume plasma protein nursing extremities, change tissue partially met
ng Excess intervention, the position frequently pressure
pakiramda E: r/t to Increase patients excess and risk
m ko” as decrease hydrostatic body fluid will for skin
verbalized plasma pressure be reduced as breakdown
by the pt. protein manifested by > provided quiet > to
Obj: Fluid shifting decreased environment provide
> anasarca from edema comfort
intracellular to > provided rest periods > to
interstitial restore
spaces energy

Fluid volume
excess

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CUES NURSING SCIENTIFIC OBJECTIVE NURSING RATIONALE EVALUATION
Dx INFERENCE INTERVENTIO
N
Subj: P: Infectious agent After 4hrs of > V/S taken > to evaluate Goal
“mainit Hyperther (pyrogens) nursing and recorded the degree of fully
ang mia intervention, hyperthermia mets
pakiramda E: r/t Monoctes the pt temp will > record all > to monitor
m ko” as increased be back within sources of and potentiate
verbalized pyrogens Pyrogenic the normal fluid loss fluid and
by the pt. in the cytokines range of 36.5C- such as urine electrolyte
Obj: body 37.4C as losses
>flushed Anterior manifested by > provided > to decrease
skin warm hypothalamus cool to touch, tepid sponge temp by means
to touch calm and bath through
>restlessn Elevated verbalization of evaporation and
ess thermoregulato the pt “di na conduction
>body ry set point ako mainit” > to replace loss
temp 38C of fluids in the
Increased heat > encouraged body and to
conservation increase fluid prevent
(vasoconstrictio intake dehydration
n/behavior
changes) > to reduce
metabolic
Increased heat > promoted demand/oxygen
production rest and sleep consumption
(involuntary
muscular
contractions)

fever

22
 PATHOPHYSIOLOGY Precipitating factors:
 Sedentary
Predisposing factors: lifestyle
Etiology
 age (35above)  Diet
 genetics  unknown
 Obesity

Altered function of beta cells

Receptor defect Receptor defect

Destruction of Beta cells Decrease # of insulin specific receptors

Delayed / insufficient insulin production Decrease binding of insulin to insulin specific receptors

Increase insulin demand Insulin resistance

Beta cells exhaustion and dysfunction

Cells starvation

A C
B 23
 A B C

Cellular hypoglycemia Glucogeneolysis Vascular hyperglycemia

Polyphagia Hemoconcentrated blood

FATS

PROTEIN Impaired blood Polydipsia

circulation
Lipolysis Weight loss
Ketone bodies formations Polyurea
 acetone breath Delayed mobility
of granulocytosis
 kausmauls respiration
Free fatty acids
In the
Impaired wound
RENAL SYSTEM Deposition to vessel walls healing

Potassium loss
Decrease GFR Atherosclerosis  weakness Dehydration
 malaise  shock
 fatigue  weight loss
Blood glucose reaches renal thresholds
Increase LDL Formation of
thrombi

Glycosuria Nephropathy

Increase BP Ischemia to small vessels

D
E 24
 D E

Alteration of the small blood vessels in the

kidneys Retinopathy Peripheral sensory neuropathy

Thickenings of the renal capillaries Atherosclerosis of the muscular

Microvasculature changes arteries

Blood has greater Molecules passing to the

Decrease renal filtration rate small vessels Necrosis

Bursting of the small vessels

Amputation of
the limb
Decrease colloid osmotic pressure Fluids shifts
Blurred vision

EDEMA Blindness

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