NON INSULIN DEPENDENT DIABETES MELLITUS

U (+)
Father (+) 88-age

U (+)

Grandpa (+) 98-age

Mother 80

U (+) DM

58 (+) TB 60 (+) hepatitis 56

54

50

46

42 Patient 44 38 DM

52

48

Female

deceased Unknown

male

 Complete blood Count

Hypoglycemic coma

Route and Dosage

IV/IM: ADULTS, ELDERLY: 1.2-1.8 g/day in 24 divided doses. CHILDREN: 25-40 mg/kg/day in 3-4 divided doses. Maximum: 4.8 g/day.
PO: ADULTS, ELDERLY: 150-450 mg/dose q6-8h. CHILDREN: 10-30 mg/kg/day in 3-4 divided doses. Maximum: 1.8 g/day. Bacterial Vaginosis Intravaginal: ADULTS: One applicatorful at bedtime for 3-7 days or 1 suppository at bedtime for 3 days. PO: ADULTS, ELDERLY: 300 mg 2 times/day for 7 days. Acne Vulgaris Topical: ADULTS: Apply thin layer 2 times/day to affected area.

Indications
Treatment of respiratory tract, skin or soft tissue, chronic bone or joint infections; septicemia; intraabdominal, female genitourinal infections; bacterial vaginosis; endocarditis. Can be used for acne vulgaris. Clindamycin is used for treatment of malaria, otitis media, Pneumocystis carinii pneumonia, and toxoplasmosis.

Action Bacteriostatic. Clindamycin binds to bacterial ribosomal receptor sites. Topically, it decreases fatty acid concentration on skin. It inhibits protein synthesis of bacterial cell wall and prevents outbreak of acne vulgaris.

Containdications Containdicated with allergy to clindamycin, lactation. Use cautiously in newborns and infants due to benzyl alcohol content(associated with gasping syndrome) and in patients with tartrazine sensitivity or hepatic or renal impairment.

Side Effects
Abdominal pain Nausea and Vomiting Diarrhea Vaginitis and itching Dry scaly skin Phlebitis, thrombophlebitis with IV administration Pain, induration, at the IM injection site Allergic reaction, urticaria, pruritus Headache and dizziness Contact dermatitis Hypersensitivity reaction

Adverse Effects
Antibiotic-associated colitis (Severe abdominal pain, tenderness, fever, watery and severe diarrhea) Blood dyscrasias (Leukopenia and thrombocytopenia) Nephrotoxicity (Proteinuria, azotemia, oliguria)

Store capsules at room temperature After reconstitution, oral solution is stable for 2 weeks at room temperature. Do not refrigerate oral solution to avoid thickening. Give with 8 oz water. Question patient for history of allergies, particularly to clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking agents. Monitor bowel activity, stool consistency; report diarrhea promptly due to potential for serious colitis. Assess skin for rash with topical application. Assess for superinfection: severe diaarhea, genital/anal pruritus, increase fever, and change of oral mucosa.

Route and Dosage

ADULTS Epilepsy: Starting dose is 300 mg PO tid, then titrated up as needed. Maintenance: 900 1,800 mg/day PO in divided doses tid PO; maximum interval between doses should not exceed 12 hr. Up to 2,400 3,600 mg/day has been used. Postherpetic neuralgia: Initial dose of 300 mg/day PO; 300 mg bid PO on day 2; 300 mg tid PO on day 3.

Indications
Adjunctive therapy in the treatment of partial seizures with and without secondary generalization in adults and children 312 yr with epilepsy Orphan drug use: Treatment of amyotrophic lateral sclerosis Managementof postherpetic neuralgia or pain in the area affected by herpes zoster after the disease has been treated Unlabeled uses: Tremors of MS, neuropathic pain, bipolar disorder, migraine prophylaxis

Action Mechanism of action not understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block posttetanic potentiation.

Contraindications Contraindicated with hypersensitivity to gabapentin. Use cautiously with pregnancy, lactation.

Adverse Effects

Interaction

CNS: Dizziness, insomnia, nervousness, fati Drug-drug Decreased gue, somnolence, serum levels with ataxia, diplopia, tremor Dermatologic: Pruritus, antacids abrasion Drug-lab test GI: Dyspepsia, vomiting, False positives nausea, constipation, dry may occur mouth with Ames NReapiratory: Rhinitis, phar Multistix yngitis Other: Weight gain, facial SG dipstick test edema, cancer, for protein in the impotence

urine

Assessment History:

Physical:

Interventions

Route and Dosage

Adults 100 mg PO bid taken at least 30 min before or 2 hours after breakfast and dinner. Response may not be noted for 2-4 wk and may take up to 12 wk. Periatric Patients Safety and Efficacy not establised

Indications
Reduction of symptoms of intermittent claudication allowing increased walking distance.

Action
Reversibly inhibits platelet aggregation induced by a variety of stimuli including ADP, thrombin, collagen, shear stress, epinephrine, and arachidonic acid by inhibiting cAMP phosphodiasterase III; produces vascular dilatation in vascular beds with a specificity for femoral beds; seems to have no effect on renal arteries.

Contraindications
Contraindicated with allergy to cilostazol, heart failure of any severity, active bleeding, hemostatic disorders. Use cautiously with pregnancy, lactation, renal dysfunction

Route and Dosage

Ophthalmic Bacterial or fungal conjunctivitis, blepharitis, keratitis. and other infective eye conditions Adult: As a 1% ocular ointment: Apply 4-5 times daily. Topical/Cutaneous Prevention and treatment of infection in severe burns Adult: Apply a 1% cream onto affected area.

Indications
Bacterial or fungal conjunctivitis, blepha ritis, keratitis. Prevention and treatment of severe burns.

Action
Silver sulfadiazine has broad antimicrobial activity; it is active against gram-positive and gram-negative bacteria as well as some yeasts and fungi. The silver salt acts mainly on the cell wall and membrane to disrupt its intergrity thus allowing it to impair the essential enzymes, bacterial DNA and RNA leading to cell death. Absorption: Slowly releases sulfadiazine when it comes into contact with wound exudates. Up to 10% of sulfadiazine may be absorbed.

Contraindications
Hypersensitivity to sulphonamides; porphyria; premature infants and infants <2 mth; pregnancy and lactation

Route and Dosage

General guidelines, 0.5-1U/kg/dy. The number ang size of daily doses, times of administration, and type of insulin preparation are determined after close medical screening of the patients blood and urine glucose, diet, exercise and intercurrent infections and other stresses. Usually given subcutaneously. Insulin injection concentrated may be given subcutaneously or IM but do not administer IV. Adults with type 2 DM requiring basal insulin 10U/day. Range,2-100 U/day or 0.1-0.2 U/kg subcutaneously in the evening or 10 U one or twice a day

Indications
Tx of type 1 Dm Tx of type 2 DM that cannot controlled by diet or oral drugs Tx of hypokalemia with infusion of glucose to produce shift of K+ into cells. Highly purified and human insulins promoted for short courses of therapy, newly diagnosed pts., pts. With poor metabolic control, and pts. With GD.

Action
Insulin is a hormone secreted by beta cells of the pancreas that, by receptor-mediated effects, promotes the storage of the bodys fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids.

Contraindications
Contraindicated

with allergy to pork products; history of smoking or lung disease (inhaled insulin) Use cautiously with pregnancy (keep patients under close supervision; rigid control is desired; following delivery ,requirements may drop for 24-72 hr, rising to normal levels during next 6 week); lactation(monitor mother carefully; insulin requirements may decrease during lactation)

Oral, suppositories CNS: Headache, dizziness, somnolence, insomia Dermatologic: Rash GI:Nausea, dyspepsia, constipation, GI bleed IV preparation GI: vomiting, GI bleeding Hematologic: Increased bleeding problems Respiratory: apnea, exacerbation of pulmonary infection

Ensure uniform dispersion of Insulin suspensions by rolling the vial between hands; avoid vigorous shaking. Give maintenance doses subcutaneously, rotating injection sites regularly to decrease incidence of lipodystrophy; give regular insulin IV or IM in severe ketoacidosis or diabetc coma Monitor patients receiving insulin IV carefully; plastic IV infusion sets to have been reported to remove 20-80 % of the insulin; dosage delivered to the patient will vary. Do not give insulin injection concentrated IV; severe anaphylactic reactions can occur. Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage. Inform patient to avoid alcohol; serious reactions can occur. Inform patient to report ferver, sore throat, vomiting, hypoglycemic reactions, rash

Assessment
Subjective data:

Diagnosis
Impaired skin integrity : delayed wound healing related to impaired protein synthesis, decreased tissue perfusion

Planning
After 2 hrs of nusing intervention, the client will be able to: a. Verbalize understandin g of condition and causative factors. b. Participate in prevention and measure of further infections c. Identify interventions appropriate for condition.

Interventions
Place client in semi- to high fowlers position. Promote physical and emotional rest Encourage to maintain lifestyle changes, such as smoking and alcohol cessation Admiistered medication to reduce further infection according to physicians order Perform and discuss proper ways in wound dressing, dry feet thoroughly after Teach client the measures to prevent further infection by maintaining the wound covered every after wound dressing

Rationale
-- To maintain adequate systemic tissue perfusion -- Smoking causes an increase in mucuos production and impairs ciliary function

Evaluation
Goal is Met, After 2 hrs of nusing intervention, the client was able to verbalize understanding condition and its causative factors; participated in measures to avoid prevention; and was able to identify interventions appropriate for condition

The patient verbalized Nagkadako man ni akong samad, wala nay ayu-ayo

Objective data: Destruction of skin layers at the left and right foot noted Non-healing wound at left foot 100mm in length; 80mm in width ; depth 1mm noted Non-healing wound at right foot 20mm in diameter; depth 0.5mm Purulent discharge (-) pain pitting edema

-- To reduce risk for further infection

Assessment
Subjective Data: The patient verbalized magliponglipong man ko usahay labaw nag udto Objective Data: Grade 2 pitting edema noted Weak, rapid pulse noted PR- 122bpm Serum sodium level is 132 mmol/L noted Urine specific gravity is 1.030 noted

Diagnosis
Altered fluid and electrolyte balance: hyponatremi a related to excessive sodium loss

Planning
After 2 hrs of nursing intervention, the client will be able to: a. Verbalize understandin g of causative factors and purpose of therapeutic interventions b. Demonstrate behaviors to monitor and correct deficit, as indicated

Interventions
Assess for signs and symptoms of hyponatremia: - nausea - vomiting - abdominal cramps - weakness - lethargy - confusion - seizure Monitor serum electrolyte results Minimize clients exposure to emotional and physiological stress

Rationale
-- To determine the degree of electrolyte deficiency

Evaluation
Goal is Met, After 2 hrs of nursing intervention, the client was able to: Verbalize understanding of causative factors and purpose of therapeutic regimen Maintained eating patterns to promote an increase inosmotic pressure and in decreasing blood sugar levels.

Advise pt. To eat egg white per meal

-- Stress causes an increased output of epinephrine, norepinephrin e, glucagon, cortisol, all of which increases blood sugar -- egg white contains protein albumin which increases osmotic pressure

Assessment
Subjective: The patient verbalized Paliya ra akong kaunon walay kanon Kapoy man ilihok
Objective: Muscle wasting noted Weakness and fatigue noted Serum albumin is 2.65 g/dL Hct 0.26/L; Hgb- 84 noted

Diagnosis
Imbalanced nutrition: less than body requirements related to muscle weakness secondary to insulin deficiency

Planning
After 3 hrs of nursing intervention, the client will be able to: a. Verbalize understandin g of causative factors when known necessary interventions. b. Demonstrate behaviors, lifestyle changes to regimen and maintain appropriate weight

Interventions
Assess the client for signs and symptoms of malnutrition: - abnormal BUN - low serum albumin - low hct, hgb, cholesterol and lymphocte levels Monitor blood glucose levels

Rationale
-- To determine degree of condition

Evaluation
Goal is met, After 3 hrs of nursing intervention, the client was able to: Verbalize understanding of causative factors Change and maintained diet as advised.

-- To determine the diet needed to be ingested -- To reduce muscle wasting and to promote tissue growth and wound healing .

Advise patient to eat at least 1cup of rice with egg white per meal

Assessment
Subjective: The patient verbalized dili naman ko kaklaro sa akong pananaw, sumbol man ang dapit sa wala Objective: Presence of white patch covering the lens of the left eye noted Aks someone to read a reading material ; blurred vision noted

Diagnosis
Sensory perceptual alteration: visual related to lens changes

Planning
After 2 hrs of nursing intervention, the client will be able to: a. Recognize and compensate for sensory impairment b. Identify/ modify external factors that contribute to alterations in sensory/perc eptual abilities

Intervention s
Assess the visual acuity Perform actions to prevent hyperglycemia -diet modification - emotional and psychological stress reduction

Rationale
-- To determin the degree of condition. -Maintenance of blood sugar at a stable, near-normal level has been shown to reduce smal vessel and nerve involvement and prevent further metabolic cataract devt - For the client to understand the presence of such and manage self -- Client may misinterpret and believe references are to himself

Evaluation
Goal is met, After 2 hours of nursing intervention, the cliet was able to : -- recognize and compensate for sensory impairment by diet odification and reduction of stress --Identify and modified external factors that contributed to alterations in sensory ability

Informed the client about the disease process which contibute to the condition Minimize discussion of negatives within clients vison

Assessment
Subjective data: The ptatient verbalized ako nay mosunod sa akong mga maguwang ane

Diagnosis
Ineffective individual coping related to fear of complications and ability to manage them

Planning
After 6 hours of nursing intervention, the client will be able to: a. Identify effective and ineffective coping patterns b. Verbalize sense of control c. Report decrease in negative feelings d. Modify lifestyle as needed e. Willing to participate in treatment plan and sel-care activities.

Interventions
Provide an atmosphere of acceptance

Rationale
-- Recognizing problemsand sharing feelings is best brought about in an atmospere of warmth and trust --Factual information serves as a foundation to explore feelings and alternative coping strategies --Present and past coping status assists the pt and his support system on successful methods. -- open, nonthreatening discussions facilitate the identification of causative and contributing factors.

Evaluation
Goal is partially met, The client was able to: --Modify lifestyle as needed yet wasnt able to verbalize sense of control in the situation and presence of condition

Objective data: Deficit in participating and demonstrating necessary interventions noted Anxiety noted Alteration in social participation Destructive behavior towards self Inability to meet basic needs

Provide factual information concerning the diagnosis, treatment, and prognosis

Explore with his previous methods of dealing with life problems

Encourage verbalization of feelings, perceptions, and fears

Observe the degree of family support

--Assessing family interaction serves as a basis for identifying patients support systems or lack thereof. -- Family and friends are often willing but unsure how to help . Identifying specific strategies such as praise and encouragement will promote acceptance of change.

Discuss with concerned others how they can help