Scenario based questions.
1. During a home visit, you met a family where Mr. Mohan
Das aged 45 years is head of the family living with his wife
Mrs. Sunita Das and one elder son Master Amit Das and a
daughter Ms. Avantika Das. While taking history collection,
Mr. Das complained about continuous thirst, hunger and
frequent urination since one month but he has not visited
hospital and taken any treatment.
a) What care as a nurse you will perform on Mr. Mohan
Das?
b) What are the articles used and its rationale in that
procedure?
c) What health education you will provide to the client?
Answer
a) Ans: Procedure to be performed on Mr. Mohan Das:
Urine Testing (In order to test the blood sugar levels).
b) Ans: Articles to be used
Articles Rationale
1. Container 1. To collect the urine
specimen.
2. Litmus paper 2. To check the pH of
urine
3. Test tube 3. To boil the urine.
4. Test tube holder 4. To hold the urine.
5. Benedict’s solution 5. To conduct the test.
6. Syringe
7. Dropper
8. Match box
9. Spirit lamp
10.Kidney tray To discard the
11.Paper bag waste.
12.Test tube brush
c) Ans: HEALTH EDUCATION
DIABETES MELLITUS
Diabetes is a group of metabolic diseases characterized
by increased levels of glucose in the blood resulting from
defects in insulin secretions, insulin action or both.
Types of diabetes
I. Type I Diabetes Mellitus (Insulin Dependent DM)
Pancreas does not secrete any insulin thus the insulin
has to be injected. So, it is called insulin dependent
diabetes.
It is more common in children, thus, also known as
Juvenile Diabetes.
II. Type II Diabetes Mellitus (Non-Insulin Dependent DM)
The pancreas secrete insulin, but, are insulin
resistance and impaired insulin.
Its resistance makes the glucose in blood to build
up, thus, increasing the level of blood glucose.
III. Gestational diabetes
It occurs due to pregnancy because of change in
hormones and usually disappears after
pregnancy.
IV. Other type: Secondary DM
It results as a consequence of other medical
condition such as chronic pancreatitis, pancreatic
cancer, Cushing syndrome, etc.,
Pathophysiology
Etiology
Genetic: The genetic susceptibility is a common
underling factor in development of type 1 diabetes.
Immunologic: The abnormal autoimmune response by
the antibodies causes the destruction of normal body
tissues.
Environment: Factors such as virus or toxins, are also
considered important causes of DM.
Weight: Excessive weight or obesity is one of the factors
that contribute to type 2 DM because it causes insulin
resistance.
• Inactivity: Lack of exercise and a sedentary lifestyle can
also cause insulin resistance and impaired insulin
secretion.
Signs and symptoms
Laboratory findings
• Hypoglycemia may occur suddenly in a patient
considered hyperglycemic because their blood glucose
levels may fall rapidly to 120 mg/dL or even less.
• Serum glucose: Increased 200–1000 mg/dL or more.
• Serum acetone (ketones): Strongly positive.
• Fatty acids: Lipids, triglycerides, and cholesterol level
elevated.
• Serum osmolality: Elevated but usually less than 330
mOsm/L.
• Glucagon: Elevated level is associated with conditions
that produce:
- actual hypoglycemia,
- relative lack of glucose (e.g., trauma, infection), or
- lack of insulin.
• Therefore, glucagon may be elevated with severe DKA
despite hyperglycemia.
• Thyroid function tests:
- Increased thyroid activity can increase blood glucose and
insulin needs.
• Urine:
- Positive for glucose and ketones; specific gravity and
osmolality may be elevated.
• Cultures and sensitivities:
- Possible UTI, respiratory or wound infections.
Prevention
• Appropriate management of lifestyle.
• Standard lifestyle recommendations, metformin, and
placebo for people who are at high risk for type 2
diabetes.
• Behaviour modification strategies i.e. weight reduction
of greater than 7% of initial body weight and physical
activity of moderate intensity.
8 steps of diabetic foot care.
Include
