NURSING CARE PLAN Diabetes Mellitus PDF

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NURSING
CARE PLAN
ON
DIABETES MELLITUS
NURSING ASSI PRO. MR.JITENDRA BARDE

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NURSING
CARE PLAN
DM
SUBMITTED TO : SUBMITTED BY :
MR. JITENDRA BARDE MS.
(ASS .PROFESSOR) BSC 3d
YEAR STUDENT
.
SUBMISSION DATE

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HISTORY-TAKING
&
PHYSICAL-
EXAMINATION
DEMOGRAPHIC DATA:
NAME :-Mr. Shrikant kisan Chavan

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AGE :-49 Year
SEX :-Male
ADDRESS :-Sr No -1,Mandan Nagar,Anant Nivas,Pune-33
IP NUMBER :-23451
EDUCATION :- B.A.
OCCUPATION :- Peon in corporation
INCOME :-15000/Month
MARITAL STATUS : - Married
RELIGION :-Hindu
MOTHER TONGUE:- Marathi
WARD :-MICU
DATE OF ADMISSION: -03/01/2020
DIAGNOSIS :- Diabetes mallitus with DKA with hypotension with l-5
rediculopathy.
HISTORY-TAKING
CHIEF COMPLIANTS: -
Sweating and gidiness since 1 day
Genralised weakness since 2 days
Pain in the back since 2 days
Weakness in right lower limb since 2 days
PRESENT HISTORY OF ILLNESS:-
Patient was apparently all right, asymptomatic1 day before when he developed sweating and
gidiness, pain in the back radiating to the right foot since 2 days, he experienced this while

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walking, following which he developed weakness of right lower limb which is sudden in onset
associated with loss of balance and falling in a front posture on the knee.
Difficulty in walking
Difficulty in getting up from sitting
positionH/O Loss of balance
PAST HISTORY OF ILLNESS:-
MEDICAL HISTORY: -Patient is a known case of diabetes mallitus-2 since 4 years not on
regular tretment with tab glimepride gp half tablet, before meal. not taken since last 5 days.
SURGICAL HISTORY: -Patient is operated for inguinal hernia 12 years back.
MENSTRUAL HISTORY [FEMALE] - Not applicable
FAMILY HISTORY:-
NAME AGE SEX OCCUPATION RELATIONSHIP HEALTH
STATUS
MR. SHRIKANT
KISAN CHAVAN
49 YEARS Male BA./PEON Himself Sick
MRS. SAVITA S. C. 45 YEARS Female HOUSEWIFE Wife Healthy
MR. RAHUL S.C. 23 YEARS Male B.COM
/STUDENT
Son Healthy
MRS.RENUKA K.
C.
43 YEARS Female HOUSEWIFE Sister DM-2
PERSONAL HISTORY:-
HABITS : Non-alcoholic, non-smoker
DIET : Non- vegetarian, 4 times/day.appetite incresed, excessive thirst.
SLEEPING HABITS : Patient sleeps 1 hrsat day time and 8 hrs at night time,
currentlysleep pater distrubed
ALLERGY : No history of allergy to any food/medications given by
patient.BOWEL AND BLADDER HABITS: Bowel movement normal&polyurea -
present.
SOCIO- ECONOMIC STATUS:-
Condition of the house:pakka house& adequate ventilation 2room&1 window, kitchen

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WATER SUPPLY: Corporation water
DRAINAGE SYSTEM: Closed drainage
SURROUNDING ENVIRONMENT: The environment is clean around the house.
PHYSICAL EXAMINATION
GENERAL APPEARANCE:
CONSTITUTION : Well-build
STATE OF NUTRITION : Obesity
PERSONAL APPEARANCE :Fair
POSTURE: NORMAL
SKIN AND HAIR : Skin is dried & cold, colour, and no any infection &
hyperpigmented skin lesions seen on medial aspect of the thigh.
EMOTIONAL STATE : Anxious
CO-COOPERATIVENESS : Patient is co-operative
HEIGHT AND WEIGHT:
HEIGHT : 5.0 Feets
WEIGHT : 69kg
VITAL SIGNS:
TEMPERATURE : 98.0F
PULSE : 105B/ Minute
RESPIRATION : 28/Minute
BLOOD PRESSURE : 90/50Mm Hg
HEAD AND FACE:
SKULL: Round in shape
SCALP: Clean, no dandruff, scar present

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HAIR: No hair
FACE: Symmetrical
NODE: Not palpable
EYES:
EYEBROWS: Symmetrical
EYELASHES: Equally distributed and there is no infection, lesion present.
EYELID : Intact, no discharge, discoloration, and lids close symmetrically
EYEBALLS: Both eyes coordinated; move in unison with parallel alignment.
CONJUNCTIVA : No redness and lesion
SCLERA: White
PUPIL: Reactive to light
LENS: Dilated
VISION: Patient has good visual capacity; he can read and saw easily.
EARS:
EXTERNAL STRUCTURE: No any tenderness
CANAL : No any discharge from ears.
TYMPANIC MEMBRANE : Intact
HEARING: Weber test- patient hear equal in both
RINNIE TEST- Sound conducted by air is heard is more sound conducted by bone.air
conduction is more than bone conduction.
NOSE:-
EXTERNAL STRUCTURE – Symmetric and straight
SEPTUM - No deviated nasal septum
MUCOUS MEMBRANE -Moist
OLFACTORY SENSE -Present

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PATENCY –Patent
MOUTH AND PHARYNX:
LIPS- Pink color
TEETH- No dental caries,shiny tooth enamel present.
GUMS -Healthy (no bleeding)
PALATES – Smooth and soft palate
VOICE – Soft and clear.
BREATHE – No any bad smell present.
TASTE –Good
NECK:
LYMPH NODES - Not palpable
MUSCLES –Muscles are in equal in both size and head in centered.
TRACHEA -Centrally situated and space are equal in both side.
THYROID GLAND -Not palpable
RANGE OF MOTION- Present
BREAST AND AREA NODES: -
INSPECTION:-NOT Applicable
PALPATION:-NOT Applicable
CHEST:
CHEST SHAPE: - Symmetrical shape
TYPE OF RESPIRATION: - Rhythmic and effortless respiration.
EXPANSIONS -Chest is bilatraly equally expanded during respiration.
INSPECTION- No any tender scar, mass, node present
PALPATION- Bilateral
PERCUSSION-No any dull sound present and not present any fluid.

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AUSCULTATION -During auscultation normal boncho-vesicular sound present
CARDIOVASCULAR SYSTEM:-
RATE AND RHYTHM: - Regular &weak pulse felt
APICAL AND RADIAL:-105/M And regular
CAROTID PULSE: - Full pulsation present and no bruit sound.
JUGULAR VENOUS DISTENSION: -No distended jugular vein
DESCRIPTION OF PERIPHERAL PULSES:-
BRACHIA
L
RADIAL FEMORAL POPLITEA
L
DORSAL
PEDIAL
POST TIBIAL
RATE 105/m 105/m 102/m 102/m 102/m 102/m
RHYTHAM Regular Regular Regular Regular Regular Regular
ABDOMEN AND INGUINAL AREAS:-
CONTOUR AND TONE : - Convex, no any tenderness present
SCAR : - No any scar present
LIVER: - Not palpable and no hepatomegaly
SPLEEN: - Not palpable and no spleenomegaly
KIDNEY: - Not palpable
BLADDER: -Not distended
MASSES : - Mass is palpable in left L.H.C. area.
PALPATION : - There is no tenderness, relax abdomen with consistent tension.
PERCUSSION : - Tympany sound present, no sign of ascitis or fluid collection.
AUSCULTATION : - Audible bowel sound present.
GENITALS AREA:
RECTAL EXAMINATION: - It’s smooth and not tender.
MUSCULOSKELETAL SYSTEM:

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UPPER EXTREMITIES : No any deformity, normal rom present
LEFT LOWER EXTREMITIES : No any deformity, normal rom present
RIGHT LOWER EXTREMITIES :No any deformity, normal rom present (slow).
JOINT EVALUATION : No tenderness, no any crepitation, nodules etc
MUSCLE STRENGTH: - Grade-2, 25% of normal strength of right lowers limb -present
MUSCLE MASS : No any mass present
NODE: NOT PRESENT
RANGE OF MOTION : Decresed due to pain
VERTEBRA: - Back pain radiating to right leg.
NERVOUS SYSTEM:-
MENTAL STATUS:- Patient is oriented to time , place and person.
He can calculate the normal value like 12+17=29
He has good judgment quality.
Patient has good immediate, recent and recall memory.
CRANIAL NERVES: - Present the sensory and motor response of the nerves.
DEEP TENDON REFLEX: - Deep tendon reflex present, bicep’s, triceps, patellar, brachio-
radialis and planter reflex etc.
SUPERFICIAL SENSORY REFLEX:-The reflex is reactive to light, pain, vibration, and touch.
INVESTIGATION:-
TYPE PATIENT REPORT NORMAL VALUES IMPRESSION
HEMOGRAM
HB 11.5 MG/DL 13-18 MG/DL Decresed

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TLC 11300/ CUMM 4000-11000/CUMM Increased
PLATELET COUNT 4.0 LAKH/CUMM 1.5-4.5 LAKH/CUMM Normal
BSL PROFIL
BSL RANDOM
BSL-FASTING 350 MG/DL UPTO 150 MG/DL Hypergycemia
BSL-PP-1 243 MG/DL 70-100MG/DL
BSL-PP-2 268 MG/DL
316MG/DL
HBA1C
8.5 % 4.5-6.3% Poor diebetic control
LFT
SR.BILURUBINE
TOTAL 0.4 0.2-1.0 GM% Normal
DIERECT 0.2 0-0.3 GM% Normal
SR.PROTIEN 5.3 6.2-8.0 GM%
ALBUMIN 3.0 3.5-4.6 GM%
GLOBULIN 2.0 2.3-3.2 GM% Hypoprotinemia
SGPT 18 0-40 Normal
SGOT 46 18-112 Normal
SERUM
ELECTROLYTE
SERUM SODIUM 137 meq/l 135-145meq/l Normal
SERUM 5.8 meq/l 3.5-5.5 meq/l Normal
POTASSIUM
RFT
BLOOD UREA 48 mg% 15-50mg%
SERUM 1.4 mg% 0.6-1.4 mg% Normal
CREATININE
Normal
URINE
SUGAR ABSENT Indicating high blood
PRESENT glucose level
ALBUMIN ABSENT
PRESENT
KETONE ABSENT Indicating dka
PRESENT
LIPID PROFILE

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TEST
S.CHOLESTEROL
S.TRIGLYCERIDES
S. HDL
S VLDL
S.LDL
235 MG/DL
210 MG/DL
42 MG/DL
35 MG/DL
112 MG/DL
130-200
LESS THAN 150
LESS THAN 40
UPTO 34.0
LESS THAN 100
Patient is in
hyperlipidemic status.
NCV STUDY:-Ascornal sensory-motor peripheral neuroparhy.
MRI STUDY: - Posterior disc pertusion at c3-c4, c4-c5 &c5-c6 level, compressing anteriorneural
sac & spinal.
L-5 Rediculopathy is present.
MEDICATION:-
DRUG NAME ROUT DOSE FREQUENCY TIME
INJ HUMINSULINE-R SC 2 ML/HR CON INFUSION 24 HRS.
TAB.GLYCOMET GP-1 PO BD 8AM, 8PM.
TAB.PREGBA-M PO 75MG OD 9PM
TAB ATORE-F PO OD 9PM
TAB.SHELCAL PO 500 MG OD 3 PM
TAB.NEUROBION
FORTE
PO OD 10AM
TAB.MYOSPAS FORTE PO SOS 11AM
TAB.PAN PO 40 MG O.D 10 AM
CAP.MVBC PO OD 10 AM
DEFINITIONS:-
DIABETES MELLITUS: - Diabetes mellitus is a group of metabolic diseases characterized by
elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin
secretion, insulin action, or both. [ada].

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INSULIN:-A hormone produced by the pancreas, controls the level of glucose in the blood by
regulating the production and storage of glucose. in the diabetic state, the cells may stop re-
sponding to insulin or the pancreas may stop producing insulin entirely.
HYPERGLYCEMIA:-Elevated blood glucose level—fasting level greater than 110 mg/dl and
2-hour postprandial level greater than 140 mg/dl
HYPOGLYCEMIA: - Low blood glucose level (less than 60 mg/dl ).
CLASSIFICATION OF DIABETES:-
CURRENT
CLASSIFICATION
PREVIOUS
CLASSIFICATIONS
CLINICAL CHARACTERISTICS AND CLINICAL
IMPLICATIONS
TYPE 1 (5%–10%
OF ALL DIABETES)
Juvenile diabetes.
Juvenile-onset diabetes.
:-onset at any age, usually younger(less than 30 yr)
:-usually thin at diagnosis; with recent weight loss

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Ketosis-prone diabetes.
brittle diabetes.
Insulin-dependent
diabetes mellitus
(IDDM).
:-etiology includes genetic, immunologic, or
Environmental factors (eg, virus).
:-often have islet cell antibodies.
:-often have antibodies to insulin even. Before insulin
treatment.
: - little or no endogenous insulin.
:-need insulin to preserve life.
:-ketosis-prone when insulin absent.
:-acute complication of hyperglycemia: diabetic
ketoacidosis.
TYPE 2 (90%–95% Adult-onset diabetes. :-onset any age, usually over 30 years.
OF ALL DIABETES: Maturity-onset :-usually obese at diagnosis.
OBESE— 80% OF diabetes. :-causes include obesity, heredity, or environmental factors.
TYPE 2; Ketosis-resistant :-no islet cell antibodies.
NONOBESE—20% diabetes. :-decrease in endogenous insulin, or increased with insulin
OF TYPE 2) Stable diabetes. Non– resistance.
insulin-dependent :- most patients can control blood glucose through weight
diabetes (NIDDM). loss if obese.
:-oral antidiabetic agents may improve blood glucose levels
if dietary modiﬁcation and exercise are unsuccessful.
:- may need insulin on a short- or long-term basis to prevent
hyperglycemia.
:-ketosis rare, except in stress or infection. :-acute
complication: hyperglycemic hyperosmolar nonketotic
syndrome.
RISK FACTORS FOR DIABETES MELLITUS:-
BOOK PICTURES PATIENT PICTURES
1. Family history of diabetes (parents or siblings
with diabetes).
Present

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2. Obesity (if, ≥20% over desired body weight or
bmi ≥27 kg/m2).
Present
3. Race/ethnicity (eg, african americans, hispanic
americans, native americans, asian americans,
pacific islanders).
Absent
4. Age≥45 years. Present
5. Previously identified impaired fasting glucose or
impaired glucose tolerance.
Absent
6. Hypertension (≥140/90 mmhg),hdl cholesterol
level ≤35 mg/dl (0.90 mmol/l) and/or tri-
glyceride level ≥250 mg/dl (2.8 mmol/l).
Absent
7. History of gestational diabetes or delivery of
babies over 9 lbs
Absent
DESTRUCTIONS OF β-CELLS OF THE PANCREAS
INABILITY TO SECREAT INSULIN FROMβ-CELLS OR TISSUE RESISTANCE TO
INSULIN
ACUTE ELIVATION IN BLOOD GLUCOSE LEVEL BUT LESS IN THE CELLS

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INCREASED OSMOLARITY OF BLOOD PRODUCING EXCESS
GLUCAGONE
LEADES TO GLYCOSUREA PRODUCTION OF MORE GLUCOSE FROM
PROTIEN &FAT
CHRONIC ELIVATION IN BLOOD GLUCOSE LEVEL WEIGHT LOSS
DIABETIC NEUROPATHY ANGIOPATHY RETINOPATHY NEPHROPATHY
CLINICAL MENIFASTATION:-
BOOK PICTURES
PATIENT PICTURES
Polyuria (increased urination) Present
Polydipsia (increased thirst).
Occur as a result of the excess loss of fiuid associated
with osmotic diuresis.
Present

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Polyphagia (increased appetite) resulting from the
catabolic state induced by insulin deficiency and the
breakdown of proteins and fats.
Absent
Fatigue and weakness, Present
Sudden vision changes, Absent
Tingling or numbness in hands or feet, Absent
Dry skin,
Skin lesions or
Wounds that are slow to heal,
Present
Absent
Absent
Recurrent infections. Absent
The onset of type-1diabetes may also be associated
with
Sudden weight loss or
Nausea, vomiting,
or abdominal pains, if dka has developed.
Absent
Absent
Absent
DIAGNOSTIC FINDINGS:-
CRITERIA FOR THE DIAGNOSIS OF DIABETES MELLITUS:-
BOOK PICTURES PATIENT PICTURES
Symptoms (polyuria, polydipsia, and unexplained
weight loss.) Plus bsl-randome more than 200 mg/dl.
Symtoms(polyuria, polydipsia) plus
bsl-randome is 350 mg/dl
Fasting blood glucose greater than or equal to 100
mg/dl
Bsl- fasting is 243 mg/dl
2-hour postload glucose equal to or greater than 200
mg/dl, during an oral glucose tolerance test.
Patient’s pp-1 is 268mg/dl and pp-2 is 316 mg/dl.

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Hba1c more than 6.3% 8.5 % poor diebetic control
Fasting lipid profile values increased Present
Microalbuminuria, Present
Urinalysis
Glycosuria
Ketonurea
Present
Present
DIABETES MANAGEMENT:-there are five components of diabetes management:-
• nutritional management
• exercise
• monitoring
• pharmacologic therapy
• education
NUTRITIONAL MANAGEMENT:-
MEAL PLANNING:-
CALORIC REQUIREMENTS:-
Calorie-controlled diets are planned by first calculating the individual’s energy needs and caloric
requirements based on the patient’s age, gender, height, and weight. An activity element is then
factored in to provide the actual number of calories required for weight maintenance. To promote
a 1- to 2-pound weight loss per week, 500 to 1,000 calories are subtracted from the daily total.
CALORIC DISTRIBUTION:-

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A diabetic meal plan also focuses on the percentage of calories to come from carbohydrates,
proteins, and fats. in general, carbohydrate foods have the greatest effect on blood glucose
levels because they are more quickly digested than other foods and are converted into glucose
rapidly.
CARBOHYDRATES:-
Currently, the ada and the american dietetic association recommend that for all levels of caloric
intake, 50% to 60% of calories should be derived from carbohydrates.
FATS:-
The recommendations regarding fat content of the diabetic diet include both reducing the total
percentage of calories from fat sources to less than 30% of the total calories and limiting the
amount of saturated fats to 10% of total calorie.
Additional recommendations include limiting the total intake of dietary choles terol to less than
300 mg/day.
FIBER:-
The use of fiber in diabetic diets has received increased attention as researchers study the effects
on diabetes of a high- carbohydrate, high-fiber diet. This type of diet plays a role in low- ering
total cholesterol and low-density lipoprotein cholesterol in the blood. Increasing fiber in the diet
may also improve blood glucose levels and decrease the need for exogenous insulin.
SWEETENERS:-
There are two main types of sweeteners: nutritive and non-nutritive. The nutritive sweeteners
contain calories, and the non-nutritive sweeteners have few or no calories in the amounts
normally used.
NUTRITIVE SWEETENERS INCLUDE:-
Fructose (fruit sugar), sorbitol, and xylitol they are not calorie-free; they provide calories in
amounts similar to those in sucrose, they cause less elevation in blood sugar levels than sucrose
and are often used in “sugar-free” foods. Sweeteners containing sorbitol may have a lax- ative
effect.
NON-NUTRITIVE SWEETENERS:-
Have minimal or no calories they are used in food products and are also available for table use.
They produce minimal or no elevation in blood glucose levels and have been approved by the
food and drug administration as safe for people with diabetes.
EXERCISE:-

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BENEFITS:-
1. Exercise lowers the blood glucose level by increasing the uptake of glucose by body muscles
and by improving insulin utilization.
2. It also improves circulation and muscle tone.
3. Resistance (strength) training, such as weight lifting, can increase lean muscle mass, thereby
increasing the resting metabolic rate. These effects are useful in diabetes in relation to losing
weight, easing stress, and maintaining a feeling of well-being.
EXERCISE PRECAUTIONS:-
Patients who have blood glucose levels exceeding 250 mg/dl, and who have ketones in their
urine should not begin exercising until the urine tests negative for ketones and the blood glucose
level is closer to normal. Exercising with elevated blood glucose levels increases the secretion of
glucagon, growth hormone, and catecholamines. The liver then releases more glucose, and the
result is an increase in the blood glucose level
Patients who take insulin is at risk for hypoglycemia that occurs many hours after exercise. To
avoid post exercise hypoglycemia, especially after strenuous or prolonged exercise, the patient
may need to eat a snack at the end of the exercise session
People with diabetes should exercise at the same time (preferably when blood glucose levels are
at their peak) and in the same amount each day. Regular daily exercise, rather than sporadic
exercise, should be encouraged.
Exercise recommendations must be altered as necessary for patients with diabetic complications
such as nephropathy, autonomic nephropathy, somatosensory nephropathy, and cardiovascular
disease
MONITORING:-
Self-monitoring of blood glucose (smog) levels by patients has dramatically altered diabetes
care. Frequent smog enables people with diabetes to adjust the treatment regimen to obtain
optimal blood glucose control.
1. SELF MONITORING BLOOD GLUCOSE:-
CANDIDATES FOR SMBG:-
Everyone with diabetes, smbg is useful for managing self- care. It is a key component of
treatment for any intensive insulin therapy regimen (including two to four injections per day or
in- insulin pumps) and for diabetes management during pregnancy. It is also recommended for
patients with:

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• Unstable diabetes
• A tendency for severe ketones or hypoglycemia
• Hypoglycemia without warning symptoms
FREQUENCY OF SMBG:-
Most patients who require insulin, smbg is recommended two to four times daily (usually before
meals and at bedtime).
For patients who take insulin before each meal, smbg is required at least three times daily before
meals to determine each dose.
Patients not receiving insulin may be instructed to assess their blood glucose levels at least two
or three times per week, including a 2-hour postprandial test.
2. GLYCOSYLATED HEMOGLOBIN:-
Glycosylated hemoglobin (referred to as hgba1c or a1c) is a blood test that reflects average blood
glucose levels over a period of approximately 2 to 3 months. When blood glucose levels are
elevated, glucose molecules attach to hemoglobin in the red blood cell. The longer the amount of
glucose in the blood remains above normal, the more glucose binds to the red blood cell and the
higher the glycosylated hemoglobin level.
3. URINE TESTING:-
Glucose before smbg methods were available, urine glucose testing was the only way to monitor
diabetes on a daily basis. Today its use is limited to patients who cannot or will not perform
smbg.
4. TESTING FOR KETONES:-
Ketones (or ketone bodies) in the urine signal that control of type 1 diabetes is deteriorating, and
the risk of dka is high. When there is almost no effective insulin available, the body starts to
break down stored fat for energy. Ketone bodies are byproducts of this fat breakdown, and they
accumulate in the blood and urine.
PHARMACOLOGIC THERAPY:-
1. INSULIN THERAPYAND INSULIN PREPARATIONS:-
TIME
COURSE
AGENT ONSET PEAK DURATION INDICATIONS

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Rapid-acting Lispro
(humalog)
Aspart
(novolog)
10–15
min
10–15
min
1 h
40–50 min
3 h
4–6 h
Used for rapid reduction of glucose
level,
To treat postprandial hyper-
glycemia, and/or
To prevent nocturnal hypoglycemia
Short-acting Regular
(humalog-r,
novolin-r,
Iletin ii regular)
1Ú2–1 h 2–3 h 4–6 h Usually administered 20–30 minutes
before a meal;
May be taken alone or in
combination with longer- acting
insulin
Intermediate-
acting
Nph (neutral
protamine
hagedorn)
(humulin-
n,novolin-n
[nph])
2–4 h
3–4 h
6–12 h
6–12 h
16–20 h
16–20 h
Usually taken after food
Long-acting Ultralente (“ul”) 6–8 h 12–16 h 20–30 h Used primarily to control fasting
glucose level
Very long-
acting
Glargine (lantus 1 h Continuous
(no peak
24 h Used for basal dose
ORALANTIDIABETIC AGENTs:-
MECHANISUM OF ACTION:-
SULFONYLUREAS: -
The sulfonylureas exert their primary action by directly stimulating the pancreas to secrete
insulin. Therefore, a functioning pancreas is necessary for these agents to be effective, and they
cannot be used in patients with type 1 diabetes. These agents improve insulin action at the
cellular level and may also directly decrease glucose production by the liver.
BIGUANIDES: -

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Metformin (glucophage) produces its antidiabetic effects by facilitating insulin’s action on
peripheral receptor sites. Therefore, it can be used only in the presence of insulin. Biguanides
have no effect on pancreatic beta cells.
ALPHA GLUCOSIDASE INHIBITORS:-
Acarbose (precose) and miglitol (glyset) are oral alpha glucosidase inhibitorsused in type 2
diabetes management. They work by delaying the absorption of glucose in the intestinal system,
resulting in a lower postprandial blood glucose level. As a consequence of plasma glucose
reduction, hemoglobin a1c levels drop.
THIAZOLIDINEDIONES: -
Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion
from the beta cells of the pancreas,they are indicated for patients with type- 2 diabetes who take
insulin injections and whose blood glucose control is inadequate (hemoglobin a1c level greater
than 8.5%). They have also been approved as firstline agents to treat type-2 diabetes, in
combination with diet.
MEGLITINIDES:-
Lowers the blood glucose level by stimulating insulin release from the pancreatic beta cells. Its
effectiveness depends on the presence of functioning beta cells. Therefore, repaglinide is
contraindicated in patients with type 1 diabetes. Repaglinide has a fast action and a short
duration. It should be taken before each meal to stimulate the release of insulin in response to
that meal. It is also indicated for use in combination with metformin in patients whose
hyperglycemiacannot be controlled by exercise, diet, and either metformin or repaglinide alone.
ORALANTIDIABETIC AGENTs:-
S.N
.
DRUG NAMES DAILY DOSE MAXIMUM
DOSE
DURATION
OF
ACTION
1 FIRST-GENERATION SULFONYLUREAS:-
➢ ACETOHEXAMIDE
➢ CHLORPROPAMIDE
➢ TOLAZAMIDE
➢ TOLBUTAMIDE
250–1500 (D)
100–500 (S)
100–750 (D)
500–2000 (D)
1,500
750
1,000
3,000
12–24
60
12–24
6–12
2 SECOND-GENERATION SULFONYLUREAS:-

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➢ GLIPIZIDE 5–25 (D) 40 10–24
➢ GLIPIZIDE 5 (S) 10 24
➢ GLYBURIDE 2.5–10 (D) 20 12–24
➢ GLIMEPIRIDE 1–2 (S) 8 24
3 BIGUANIDES:-
➢ METFORMIN (GLUCOPHAGE
GLUCOPHAGE XL)
➢ METFORMIN WITH GLYBURIDE
+
1,500 (D) 2,500 10–16
4 ALPHA GLUCOSIDASE INHIBITORS :-
➢ ACARBOSE
1,500 (D) 2,500 8
5 THIAZOLIDINEDIONES:-
➢ PIOGLITAZONE
➢ ROSIGLITAZONE
15–30 (S)
4 (S or D)
45
8
?
?
6 MEGLITINIDES:-
➢ REPAGLINIDE
➢ NATEGLINIDE
0.5–4 (D)
180–360 (D)
16
360
2
4
ACUTE COMPLICATIONS OF DIABETES:-
1. HYPOGLYCEMIA (INSULIN REACTIONS):-Hypoglycemia (abnormally low blood
glucose level) occurs when the blood glucose falls to less than 50 to 60 mg/dl (2.7 to 3.3
mmol/l).
CAUSES:-
1. High insulin or oral hypoglycemic agents,
2. Too little food, or
3. Excessive physical activity.
4. Hypoglycemia may occur at any time of the day or night. It often occurs before meals,
especially if meals are delayed or snacks are omitted.
CLINICAL MANIFESTATIONS:-
MILD HYPOGLYCEMIA:-
Sweating, tremor, tachycardia, palpitation, nervousness, and hunger.
MODERATE HYPOGLYCEMIA:-

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Inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the
lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or
combative behavior, double vision, and drowsiness.
SEVERE HYPOGLYCEMIA:-
Disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.
MANAGEMENT:-
The usual recommendation is for 15 g of a fast-acting concentrated source of carbohydrate such
as the following, given orally:
• Three or four commercially prepared glucose tablets
• 4 to 6 oz of fruit juice or regular soda
• 6 to 10 life savers or other hard candies
• 2 to 3 teaspoons of sugar or honey
INITIATING EMERGENCY MEASURES:-
Patients who are unconscious and cannot swallow, an injection of glucagon 1 mg can be
administered either subcutaneously or intramuscularly.
2. DIABETIC KETOACIDOSIS:-
A metabolic derangement in type- 1 diabetes that results from a deficiency of insulin. Highly
acidic ketone bodies are formed, resulting in acidosis; usually requires hospitalization for
treatment and is usually caused by nonadherence to the insulin regimen, concurrent illness, or
infection.three main feature include:-
• Hyperglycemia
• Dehydration and electrolyte loss
• Acidosis
CLINICAL MANIFESTATIONS:-
1. The hyperglycemia of dka leads to polyuria and polydipsia (increased thirst).

lOMoARcPSD|24626089
2. Orthostatic hypotension (drop in systolic blood pressure of 20 mm hg or more on
standing).
3. Frank hypotension with a weak, rapid pulse.
4. GI symptoms such as anorexia, nausea, vomiting, and abdominal pain. the abdominal
pain and physical findings on examination can be so severe that they resemble an acute
abdominal disorder that requires surgery.
5. Patients may have acetone breath (a fruity odor), which occurs with elevated ketone
levels.
6. Hyperventilation (with very deep, but not labored, respirations) may occur.
ASSESSMENT AND DIAGNOSTIC FINDINGS:-
1. Blood glucose levels may vary from 300 to 800 mg/dl
2. Low serum bicarbonate (0 to 15 meq/l) and
3. Low ph (6.8 to 7.3) values.
4. A low pco2 level (10 to 30 mm hg) reflects respiratory compensation for acidosis.
5. Ketone bodies is reflected in blood and urine ketone measurements.
6. Sodium and potassium levels may be low, normal, or high, depending on the amount of
water loss (dehydration).
MANAGEMENT:-
REHYDRATION:-
Initially, 0.9% (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 l per hour
for 2 to 3 hours.
0.45% normal saline solution may be used for patients with hypertension or hypernatremia or
those at risk for heart failure.
0.45% n.s. can be continues 250-500 ml/hrs for several hours.
RESTORING ELECTROLYTES:-
Potassium replacement up to 40 meq per hour may be needed.
REVERSING ACIDOSIS:-

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The acidosis that occurs in dka is reversed with insulin, which inhibits fat breakdown, thereby
stopping acid buildup.
Insulin is usually infused intravenously at a slow, continuous rate (eg, 5 units per hour). Hourly
blood glucose values must be measured.
Iv fluid solutions with higher concentrations of glucose, such as normal saline (ns) solution (eg,
d5ns or d50.45ns), are administered when blood glucose levels reach 250 to 300 mg/dl (13.8 to
16.6 mmol/l) to avoid too rapid a drop in the blood glucose level.
3). HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNS):
A metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an
intercurrent illness that raises the demand for insulin; associated with polyuria and severe
dehydration.
NURSING MANAGEMENT:-
ASSESSMENT:-
HISTORY:-
➢ History of symptoms related to the diagnosis of diabetes, hyperglycemia, hypoglycemia,
if present than their frequency, timing, severity.
➢ History of blood glucose monitoring status, symptoms, and management of chronic
complications of diabetes.
➢ History of eye; kidney; nerve; genitourinary and sexual, bladder, and gastrointestinal
cardiac; peripheral vascular; foot complications associated with diabetes compliance with
prescribed dietary management plan.
➢ History of prescribed exercise regimen
➢ History of compliance with prescribed pharmacologic treatment (insulin or oral
antidiabetic agents)
➢ History of use of tobacco, alcohol, and prescribed and over-the-counter
medications/drugs
➢ History of lifestyle, cultural, psychosocial, and economic factors that may affect diabetes
treatment
PHYSICAL EXAMINATION:-
➢ Blood pressure (sitting and standing to detect orthostatic changes)

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➢ Body mass index (height and weight)
➢ Fundoscopic examination foot examination (lesions, signs of infection, pulses)
➢ Skin examination (lesions and insulin-injection sites)
➢ Neurologic examination vibratory and sensory examination using monofilament deep
tendon refiexes
➢ Oral examination.
NURSING DIAGNOSIS:-
1. Risk for fluid volume deficit related to polyuria and dehydration secondary to D.M.
INTERVENTION:-
1. Intake and output measurement.
2. Iv fluids and electrolytes are administration as prescribed,
3. Oral fluid intake is encouraged when it is permitted.
4. Serum electrolytes (especially sodium and potassium) are monitoring.
5. Vital signs are monitored for signs of dehydration (tachycardia, orthostatic
hypotension).
2. IMBALANCED NUTRITION RELATED TO IMBALANCE OF INSULIN, FOOD,
AND PHYSICALACTIVITY SECONDARY TO D.M.
INTERVENTION:-
1. Identify the patient’s lifestyle, cultural background, activity level, and food preferences.
2. Plan appropriate caloric intake to achieve and maintain the desired body weight.
3. The patient is encouraged to eat full meals and snacks as prescribed per the diabetic diet.
4. Arrangements are made with the dietitian for extra snacks before increased physical
activity.
3. ANXIETY RELATED TO LOSS OF CONTROL, FEAR OF INABILITY TO
MANAGE DIABETES, MISINFORMATION RELATED TO DIABETES, FEAR
OF DIABETES COMPLICATIONS SECONDARY TO D.M.

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INTERVENTION:-
1. The nurse provides emotional support and sets aside time to talk with the patient who
wishes to express feelings.
2. Any misconceptions the patient or family may have regarding diabetes should be
clarified.
3. The patient and family are assisted to focus on learning self-care behaviors
4. The patient is encouraged to perform the skills such as self injection or lancing a finger
for glucose monitoring is performed for the first time, anxiety will decrease.
5. Positive reinforcement is given for the self-care behaviors attempted.
4. KNOWLEDGE DEFICIT RELATED TO COMPLICATIONS, SELF –CARE
SECONDARY TO D.M.
INTERVENTION:-
1. Tech patient regarding the disease condition.
2. Teach skills, how to take injections, drugs at home.
3. Advice to have regular follow-up and monitoring.
4. Advice to give immediate attention on foot injury, eye care, altered peripheral sensations
etc.

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Downloaded by Jitendra bhargav bhargav (jitendrabardebarde98@gmail.com)
NAME OF
DRUG
DOSAGE/
ROUTE
MODE OF ACTION SIDE EFFECTS NSG RESPONSIBILITY
TAB,
GLYCOMET
GP-1
ADULT:
PO per tab
contains
glimepiride
1 mg and
metformin
250 mg or
glimepiride
2 mg and
metformin
500 mg.
Glimepiride stimulates the
insulin release from
functioning pancreatic β-
cells and inhibits
gluconeogenesis at hepatic
cells. It also increases insulin
sensitivity at peripheral
target sites. Metformin
decreases hepatic
gluconeogenesis, decreases
intestinal absorption of
glucose and improves insulin
sensitivity (increases
peripheral glucose uptake
and utilisation).
• Diarrhoea, vomiting,
• Metallic taste,
• Rash, isolated transaminase elevations,
cholestatic jaundice,
• Allergic skin reactions,
• Photosensitivity reactions,
• Leukopaenia,
• Agranulocytosis,
• Thrombocytopaenia,
• haemolytic anaemia,
• aplastic anaemia,
• Pancytopaenia,
• Blurred vision.
potentially fatal:
• lactic acidosis.
• Monitore for renal and
hepatic impairment.
• Advice patient to avoid
alcohol consumption.
• Monitoring of bsl for
preventon the hypoglycaemic
episodes.

NAME OF
DRUG
DOSAGE/
ROUTE
MODE OF ACTION SIDE EFFECT NSG RESPONSIBILITY
TAB.
PREGBA-M
75 MG./PO Pregabalin is an analog of
the neurotransmitter gaba. It
binds potently to the α2-δ
subunit resulting in
modulation of ca channels
and reduction in the release
of several neurotransmitters,
including glutamate,
norepinephrine, serotonin,
dopamine, calcitonin gene-
related peptide and substance
Somnolence, dizziness, headache, diplopia,
blurred vision, vertigo, fatigue, irritability,
arthralgia, muscle cramp, back and limb pain,
cervical spasm, disorientation, insomnia,
nasopharyngitis, ataxia, tremor, dysarthria,
amnesia, paraesthesia, hypoaesthesia, lethargy,
sedation, oedema, peripheral oedema, dry mouth,
constipation, diarrhoea, vomiting, nausea,
flatulence, abdominal distension, increased
appetite, wt gain, euphoria, confusion, reduced
libido, erectile dysfunction; attention, memory,
coordination and gait disturbances; fall, feeling
drunk, abnormal feeling. Rarely, stevens-johnson
syndrome, rhabdomyolysis, breast enlargement,
gynaecomastia.
Potentially fatal: angioedema.
Patient w/ history of angioedema
episodes, severe cv disease, renal
impairment. Avoid abrupt
withdrawal. Pregnancy and
lactation. Patient counselling may
impair ability to drive, operate
machinery or engage in hazardous
activities. Monitoring parameters
monitor visual disturbances. Closely
observe for clinical worsening,
suicidality and unusual changes in
behaviour.

NAME OF
DRUG
DOSAGE/
ROUTE
MODE OF ACTION SIDE EFFECT NSG RESPONSIBILITY
TAB.
NEUROBIO
N FORTE
133
MG./PO
Thiamine mononitrate 10
mg, riboflavin 10 mg,
pyridoxine hydrochloride 3
mg, cyanocobalamin 15 mcg,
nicotinamide 45 mg, calcium
pantothenate 50 mg.
Act as
nootropics &
neurotonics/neurotrophics / v
itamin b-complex / with c
Indicated for peripheral
neuropathy, neck &
shoulders nerve pain & vit
b12 deficiency.
MILD DIARRHEA;
NAUSEA; STOMACH UPSET.
Severe allergic reactions
(rash; hives; itching; difficulty breathing;
tightness in the chest; swelling of the mouth, face,
lips, or tongue);
Feeling of swelling of the entire body;
Numbness or tingling of the skin.
FOLLOW THE SIX RIGHTS OF
DRUG ADMINISTRATION.
Monitore patent for serum vitamin
or mineral level.
monitore patient for improvement in
the neurological functions.

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NURSING DIAGNOSIS:-
1. Discomfort related to pain in leg and back secondary to l-5 rediculopathy.
2. Impared tissue perfusion related to hypotension,acidosis secondary to diabetis
mellitus
3. fluid volume deficit related to polyuria and dehydration secondary to d.m.
4. Activity intolrance related to right leg weakness secondary to l-5 rediculopathy.
5. Imbalanced nutrition related to imbalance of insulin, food, and physical activity
secondary to d.m.
6. Anxiety related to loss of control, fear of inability to manage diabetes, fear of
diabetes complications secondary to d.m.
7. Knowledge deficit related to complications, self –care secondary to d.m.
8. High risk for infection related to uncontroled hypergycemia,secondary to d.m.
9. High risk for impared skin integrity related to dry skin secondary to d.m.

Focal
Back pain radiating to right leg.
Polyurea
Polydepsia
Obesity
Spinal nerve compression
Right leg weakness.
Fatigue.
Physiological
Function
APPLICATION OF ROYS ADAPTATION MODEL:-
STIMLI EFFECTORS
Interdependence
Self-concept
Ineffective family coping related to financial
issue,
Residual
Male
Family history of dm.
Earning member of family
Peon-occupationally
Role-function
Knowledge deficit of home care
Anxiety related to diseases condition
Interventions
Fluid volume deficit
Discomfort related to pain
High risk for infection
Activity intolerance
High risk for impaired skin integrity
High risk for infection

ASSESSMENT NURSING
DIAGNOSIS
GOAL NURSING PLANING NURSING
INTERVENTION
RATIONAL EVALUATIO
N
Subjective
data: -
The patient says
that he is having
pain in the back
and radiating to
right leg.
Objective data:-
patient
facialexpression
shows that he is
having pain
Discomfort
related to pain in
leg and back
secondary to
L-5
rediculopathy.
The patient
will have
reduced pain
as
evidence by
facial
expression
and pain
scale0-3
Assess the general condition
of the patient
Give diversion therapy to
the patient
Give position to the patient
Assessed the general
condition of the patient,
nature, site and severity of
(level of pain 6)
Diversion therapy
given( allow relative to talk
with the patient)
Supine and Right lateral
position given alternately to
the patient
To plan for
further care
To reduce pain
To reduce pain
The EOC
partially met as
evidence by
reduced pain
by facial
expression and
pain scale =3
Pain scale rate is
=6
Give comfort devices to the
patient. Pillow for leg elevation
given To reduce pain
Patient look
restlessness
L-5 nerve
compression
Administer analgesic to the
patient as prescribed Analgesic administer as
prescribed
Tab. pregba-m75 mg ,OD
To reduce pain

Administer muscular
relaxant to reduce pain. Administered tab.myospas
forte to patient
To reduce pain
ASSESSMENT NURSING GOAL NURSING PLANING NURSING RATIONAL EVALUATIO

DIAGNOSIS INTERVENTION N
Subjective
data: -
The patient says
that he is feel
generalized
weakness during
activity
Objective data:-
L-5 nerve
compression
present.
Activity restricted
due to pain.
Right leg
weakness present.
Activity
intolerance
related to right
leg weakness
secondary to
L-5
rediculopathy.
The patient
will have
activity
tolerance as
evidence by
Reduction in
pain and
Improvement
In right leg
muscular
strength.
Assess the activity pattern
of the patient.
Administer nutritive
diabetic diet to the patient.
Advice patient to follow
regular exercise program.
Administer analgesic to
the patient as prescribed
Administer muscular
relaxant to reduce pain.
Assessed activity pattern of
the patient,-
Administered nutritive
diabetic diet to the patient as
prescribed.
Advised patient to follow
Analgesic administer as
prescribed
Tab. pregba-m 75 mg ,OD
Administered tab. myospas
forte to patient
To plan for
further care
To reduce fatigue
To improve
muscle strength.
To reduce
neurogenic pain
To reduce
musclecontractio
n.
The EOC
partially met as
evidence by
reduced inpain
and
Improvement
In right leg
muscular
strength from
g-2 to g-4.
Assist patient in doing
activities &give rest in
between continues activity. Assisted patient in doing
activities &give rest in
between continues activity.
To reduce fatigue
& prevent falls.
ASSESSMENT NURSING GOAL NURSING PLANING NURSING RATIONAL EVALUATIO

DIAGNOSIS INTERVENTION N
Subjective
data: -
The patient says
that he is feel
generalized
weakness.
Objective data:-
Activity restricted
due to pain.
Patient is obese.
Wt.-69 kg.
Uncontrolled
hyperglycemia.
Imbalanced
nutrition more
than body
requirement
related to
imbalance of
insulin, food,
physical
activity and
obesity
Secondary to
D.M.
The patient
will have
Normal
nutrition
asevidence by
Reduction in
weight, normal
BSL level and
Absence of
fatigue.
Assess the activity pattern
of the patient.
Administer nutritive
diabetic diet to the patient.
Upto-1850 kcal/day
Advice patient to follow
Administer OHG agents to
patient.
Administer supplemental
minerals and vitamins.
Assessed activity pattern of
the patient,-
Administered nutritive
diabetic diet to the patient as
prescribed.
Advised patient to follow
Administered tab
GYCOMET GP-1, BD, PO.
Administered TAB
NEUROBION FORTE,
TAB. MVBC.
To plan for
further care
To reduce fatigue
To improve
insulin secretion
and reduce
peripheral tissue
resistant.
To control
hyperglycemia
To improve
nutrition and
prevent fatigue.
The EOC
partially met as
evidence by
reduction
infatigue and
Improvement
In BSL.
Profile.

PATIENT NAME: - Mr. SHRIKANT KISAN CH
REDICULOPATHY
AGE:- 49 YEAR
SEX: - MALE
WARD:- MICU
AVAN NURSE’S NOTE- 1 DIAGNOSIS:-DM ,DKA, HYPOTENSION WITH L-5
D.O.A:- 03/01/2020
SURGERY:-NOT DONE
STUDENT NAME- SONALI VAIDHYA
DATE DIET MEDICATION TIME NURSING OBSERVATION NURSING CARE REMARK SIGN.
4/01/2020 9am
Breakfast:-
POHA
PLATE
Tea-50 ml
1
INJ
HUMINSULINE-R
2 ML/HR
INFUSION
TAB. GLYCOMET
GP-1 BD ,PO,8 AM,
8 PM.
9am Patient is oriented to time place,
person but has little confusion and
laziness.
Patient was not slept at last night
because of back pain and
hospitalization.
Patient has activity intolerance due
to pain&parasthesia in right foot.
Assessed the
general condition
of the patient
Patient was
operative
co- Sonali
Sonali
TAB.PREGBA-M
75 MG OD,PO, 10
PM.
Patient’s personal hygiene is
maintained
TAB SHELCAL 500
MG PO, OD, 3 PM.
Patient’s appetite is normal&
excessive thirst present.
TAB. NEUROBION
FORTE OD 10 AM.
Patient bowel movement is
normal& excessive urination is
present(10-12 episodes /day).
TAB MVBC. OD
PO, 3 PM. Patient bed looks unclean and
untidy
Bed making done Bed looks
and tidy.
clean Sonali

TAB, MYOSPAS
FORTE SOS, PO, 11
AM. Sonali
TAB. ATOREF OD,
PO 10 PM.
Vital sign has to be check
Vital signs
checked
T -98F, BP-100/70
P -84/m ,RR-16/m
Patients vital are
within normal
ranges.
TAB.PAN 40 MG,
OD PO, 10 AM
Medication has to be give Medication given
to the patient.
No local
complication
occurred.
Sonali
Sonali
Patient has pain in back radiating
to right leg.
Tab myospas forte
is given.
Patient had mild
pain.
Patient is alone on bed, History taking and
physical
examination was
done
Patient is
cooperative.
Sonali

REDICULOPATHY
AGE:- 49 YEAR
SEX: - MALE
WARD:- MICU
D.O.A:- 03/01/2020
SURGERY:-NOT DONE
6/01/2020 9am
Breakfast:-
TAB. GLYCOMET
GP-1 BD ,PO,8 AM,
8 PM.
person.
Assessed the
general condition
of the patient
Patient was
operative
co- Sonali
POHA
PLATE
Tea-50 ml
1
TAB.PREGBA-M
75 MG OD,PO, 10
PM.
because of back pain and
hospitalization. Sonali
TAB SHELCAL 500
MG PO, OD, 3 PM.
to pain& parasthesia in right foot.
TAB. NEUROBION
FORTE OD 10 AM.
maintained
TAB MVBC. OD
PO, 3 PM.
TAB, MYOSPAS
FORTE SOS, PO, 11
AM.
present(10-12 episodes /day).
Sonali
TAB. ATOREF OD,
PO 10 PM.
Patient bed looks unclean and
untidy
and tidy.
clean

TAB.PAN 40 MG,
OD PO, 10 AM
Vital signs
checked
T -98F, BP-100/70
P -84/m ,RR-16/m
Patients vital are
within normal
ranges.
Sonali
to the patient.
No local
complication
occurred.
Sonali
to right leg.
Tab myospas forte
is given.
Patient had mild
pain.
SonaIi
Patient is alone on bed, health-education is
given to patient
Patient is
cooperative. Sonali

REDICULOPATHY
AGE:- 49 YEAR
SEX: - MALE
WARD:- MICU
D.O.A:- 03/01/2020
SURGERY:-NOT DONE
7/01/2020 9am
Breakfast:-
TAB. GLYCOMET
GP-1 BD ,PO,8 AM,
8 PM.
person.
Assessed the
general condition
of the patient
Patient was
operative
co- Sonali
POHA
PLATE
Tea-50 ml
1
TAB.PREGBA-M
75 MG OD,PO, 10
PM.
because of back pain is reduced
and hospitalization.
Sonali
TAB SHELCAL 500
MG PO, OD, 3 PM.
to pain& parasthesia in right foot.
TAB. NEUROBION
FORTE OD 10 AM.
maintained
TAB MVBC. OD
PO, 3 PM.
TAB, MYOSPAS
FORTE SOS, PO, 11
AM.
present(3-4) episodes /day).
TAB. ATOREF OD,
PO 10 PM.
Patient bed looks unclean and
untidy
and tidy.
clean Sonali

TAB.PAN 40 MG,
OD PO, 10 AM
Vital signs
checked
T -98F, BP-100/70
P -84/m ,RR-16/m
Patients vital are
within normal
ranges.
Sonali
to the patient.
No local
complication
occurred.
Sonali
to right leg.
Tab myospas forte
is given.
Patient had mild
pain.
Sonali

PROGRESS NOTE:-
My patient Mr.Shrikant kishan,49 year old male known case of diabetes mellitus with diabetic
ketoacidosis with hypotension came with complaints of pain in back radiating to right leg and
weakness in right leg and generalized fatigue, sweating and restlessness.
FIRST DAY:-
Patient has pain in back and leg and has decreased motor functions of right leg.
Patient has normal appetite, polyuria and excessive thirst and dry skin.
Patient’s vital signs are (BP-90/50, P-105/m, RR-28, temp.-98.0 f) and show hypotension
patient has hypergycemia and urine for ketone possitive
Patient is on insulin infusion &oral hypogycemic agents and planed for MRI spine and NCV
study.
Patient is on iv fluid 0.45% bicarbonate with 2 amp KCL is continues through infusion pump.
SECOND DAY:-
Patient still has pain in the back and weakness in the right leg.
Patient is posted for mri study of spine and ncv test.
Patient’s vital signs are (bp-100/70, p-88/m, rr-16, temp.-98.6 f) and within normal range.
Patient has uncotroled hypergycemia and started on inj. Mixtrad for acute management of
hypergycemia (bbf-24 iu, bd-12 iu.)
Urine for ketone is negative
THIRD DAY:-
Patient’s vital signs are (bp-100/70, p-88/m, rr-16, temp.-98.6 f) and within normal range.
Patient ‘s mri has shown posterior disc protusion and l-5 rediculopathy.
Patient started on the conservative management with tab myospas forte, tab pregb-m and tab
neurobion forte for neurological improvement.
Patient ‘s pain is reduced and motor function in improving (as muscle strength of right leg is
shifted from grade-2 to grade-4).

HEALTH-EDUCATION:-
DIETARY CHANGES:-Patient has advised to limit daily dietary intake upto 1850 kcal. and
reduce cho s in diet upto 40 %. consultation with diatician is done and menu planing is done.
EXERCISE: - Advice patient to follow a regular program of 30 min daily exercise in the
morning with some snacks to avoid the hypogycemia.
Advice patient to avoid streaching of the vertibral disc while exercising
MEDICATION: - Advised patient to continue with the regular medication and should not have
non-compliance of OHGs agents.
COMPLICATION:-Advice patient to wear proper shoes to prevent foot injury, adviced to do
regular assessment of extremities for injury or open wound ,if present than take immediate
treatment.
MONITORING:-Advice patient to do self glucose monitoring at least 3 times per week and
hba1c as per physician’s advice
FOLLOW-UP:- advice to patient to take regular follow up and check-up for neurological,
opthalmology, and renal functions.

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