DEMOGRAPHIC DATA

NAME OF THE PATIENT:

AGE: 52 years old

GENDER: Male

IP NO: 240808/000025

MARITAL STATUS: Married

RELIGION: Hindu

EDUCATION: Class 12 passed

OCCUPATION: Businessman

INCOME: Mr. Kula is the source of income in his family. He earns around Rs 40,000-50,000 per month.

DIAGNOSIS: Type Ⅱ Diabetes Mellitus with Hypertension

DATE OF ADMISSION: 31/08/2024 at 6:50 pm

DATE OF OPERATION: Nil

ADDRESS: Barpeta, Assam

DATE OF DISCHARGE -

CHIEF COMPLAINTS
Mr Kula Ram Basumatary, 46 years old, was admitted on 31/08/2024 at 6:50 pm with the chief complaints
of :

 Dizziness for 3 days

 Weakness for 3 days
 Vertigo for 3 days
 Blurred vision for 2 days
 Headache since 2 days
 High fever on & off since 3 days.

HISTORY OF PRESENT ILLNESS

The patient is a known case of Type Ⅱ Diabetes mellitus with Hypertension, which was diagnosed 3 years
back and was on medication. The patient had previously been admitted to GMCH Hospital in Bhangaghar,
Guwahati and was treated for several weeks but his health was not improved. That is why his family
members brought him to GNRCH, North Guwahati for further treatment.

He came with the chief complaint of dizziness, weakness, vertigo, blurred vision, and headache also
sometimes with the high fever. On admission, the vital signs were assessed, the finding were BP -
140/90mmHg, Respiratory – 22 breath/min, Pulse Rate – 92b/min, Spo2 – 96% and temperature – 98.9°F.
Also the past RBC test was seen with value of 280 mg/dl.
SOCIO-ECONOMIC CONDITION
The patient is sociable and co-operative. The social status is middle class. The relationship with the neighbor
is good. The source of income is from the patient and his 2 sons.

His earning is 40,000 to 50,000 per month.

PHYSICAL ENVIRONMENT HISTORY OF THE PATIENT

Mr. Kula Ram Basumatary, 54 years old lives in Barpeta town, Assam in his own house. His home is made
up of concrete. There is proper ventilation in her house and water supply is adequate, they have their own
well. Adequate electricity supply is available in their house. Their house consists of an open drainage system
and they have their own latrine facilities.

FAMILY HEALTH HISTORY

Mr. Kula Ram Basumatary has a total of 6 members in his family which is a nuclear family. He had a
arranged type of marriage. There is no significant of family health history. His family members do not have
any communicable disease, hypertension, diabetes mellitus, cancer, etc.

FAMILY STRUCTURE

SL AGE/SEX RELATI EDUCATIO MARITAL HEALTH

NAME OCCUPATION
NO ONSHIP N STATUS STATUS

1. Mr. Kula
Class-12
Ram 52yrs/M Patient Businessman Married Unhealthy
passed
Basumatary
2. Mrs. Sabita Class 10
basumatary 49yrs/F Wife House-wife Married Healthy
passed
3. Mr. Rahul
Basumatary 28yrs/M Son B A passed Businessman Married Healthy

4. Mrs. Dipili Daughter-

27yrs /F Bsc passed Teacher Married Healthy
Basumatary in-law
5. Mr. Mantu
Basumatary 26yrs/M Son Btech passed Engineer Unmarried Healthy

6 Miss
Bsc
Bondona 21yrs/F Daughter Student Unmarried Healthy
Agriculture
Basumatary
FAMILY PEDIGREE
PAST MEDICAL HISTORY
My patient has no significant of childhood disease history. 3 years ago, Mr. Kula Ram Basumatary was
previously hospitalized for hypertension and T2DM and was on continuous medication. Patient had LSCS
24 years back and no other surgery. The patient was diagnosed with T2DM since 3 years back and is on
regular medication.

OTHER RELEVANT HISTORY

Mr. Kula Ram Basumatary is a non-vegetarian. She is anti-hypertensive and anti-diabetic diet. She is taking
low salt, low fat diet. Her habits like sleeping pattern is irregular and more disturbed during her
hospitalization. She used to chew betel nut before her being diagnosed as T2DM. Regarding her menstrual
history, she has attained the menopausal age.

She has no significant history of allergy to any drug or item. Her bowel and bladder pattern are regular.

PHYSICAL EXAMINATION MALE

ANTHROPOMETRIC EXAMINATION

Weight- 60 kgs
FEMALE
Height- 168 cms

BMI- 21.26 kg/m2

HAIR: PATIENT

Presence of thinning of hair, grey color

Present of dandruff

SKIN :

It is warm to touch

Temperature - 100°F
Index
EYES:

Eyebrows-Present and symmetrical in nature

Vision- Blurred Vision

Eye discharge-Absent

Eye movement- Absent of cross-eyes

Lens- Opacity
EARS:

Absence of ear discharge

Absence of crumen impaction

Absence of hearing loss

Ears are symmetry

NOSE:

Absence of nasal discharge and no nasal deviation is present

Normal sense of smell is present

MOUTH & PHARYNX:

There is present of oral thrust and the lips are crack.

Absence of tonsil enlargement and bleeding gums

Absence of redness and swelling

TEETH:

Teeth are well aligned

Dental carries present

No bleeding gums.

NECK:

Normal range of motion

Absence of lymph node enlargement

Absence of rigid neck

CHEST:

On inspection: Chest symmetrical equal on both sides.

On palpation: Absence of chest pain and chest discomfort

On auscultation: S1 & S2 heart sound present.

ABDOMEN:

On inspection: There is no skin rashes/scar seen in the abdomen.

On palpation: Abdomen is soft on palpation

On percussion: Normal resonance sound is heard.

On auscultation: Normal bowel sound heard.

UPPER & LOWER EXTREMITIES

Upper limbs- Movement is Normal

Nail is clean and no lesion or rashes seen.

Lower limbs- Movement is Normal

No foot infection is seen

GENITALIA:

No injury in the genitalia

Frequent urination.

BIOPHYSICAL MEASUREMENT
BP- 160/100 mmHg

T- 100° F

Pulse-92 b/m

RR- 24 bpm
RBS – 260mg/dl

GCS-E4V4M6 (15/15)
INVESTIGATIONS

PATIENT NORMAL
DATE INVESTIGATIONS DONE REMARKS
VALUE VALUE
KFT/RFT PROFILE
Urea 35 13-43 mg/dl Normal
Creatinine 2.10 0.55-1.10 mg/dl High
Uric acid 6.0 2.5-6.0 mg/dl Normal
Sodium 140.2mmol/l 135-145 mmol/L Normal
31/08/2024 Potassium 4.75 3.5-5.5 mmol/L Normal
Calcium 8.57 8.4-10.2 mg/dl Normal
Magnesium 2.0 1.6-2.3 mg/dl Normal
Phosphorus 2.82 2.50-4.50 mg/dl Normal
Chloride 98 98-107 mmol/L Normal

TEST PROFILE
CRP 1.0 0-6 mg/dl Normal
TSH 4.563 0.340-5.60mIu/L Normal
Haemoglobin 11.7 14 – 16 mg/dl Low
TLC 10,200 4000 -10,000 Slight high
ESR 95mm 5-15 mm High

LIPID PROFILE
31/08/2024
Cholesterol 225 150 – 250 mg/dl Normal
Triglycerides 276 40-150 mg/dl High
Direct HLDL 47.1 40 – 60 mg/dl Normal
LDL 12 0- 130 mg/dl Normal
VLDL 55 15 – 30 mg/dl High
RBS 260 60 – 140 mg/dl High
HbA1C 7.1 % <5% High

1/09/2024  ECG  Show normal sinus rhythm.

 MEDICATIONS
RO INDICATIONS &
NURSES
DRUG NAME DOSE UT FREQUENCY ACTION CONTRAINDICATION SIDE-EFFECTS
RESPONSIBILITIES
E S
1. Tab Metformin 500mg PO OD PC -Assess BP, pulse,
Inhibits hepatic glucose Indications: CNS: lying, standing
production and increases Type2 Diabetes mellitus Headache rhythm quality if
sensitivity of peripheral also treating for Fatigue severe hypotension
tissue to insulin. polycystic ovary Dizziness occurs.
syndrome (PCOS) Fatigue -Baseline of renal
studies before
Contraindications: GI: therapy begins.
Creatinine ≥1.5mg/ml Diarrhea -Observe any edema
(male) diabetic Nausea in feet and leg daily.
ketoacidosis. Vomiting
Metallic taste. Evaluate:
Therapeutic response,
CV: decreased BP.
Heart failure
Teach patient/family:
ENDO: To comply with
Lactic acidosis dosage schedule,
hypoglycemia even if feeling better
to take medication at
HEMA: the same time daily.
Thrombocytopenia
Decreased Vit B12
level.

INTEG:
Rash
2. Tab nicardia
20 mg PO OD HS
retard Inhibits calcium ion influx Indication: CNS: -Assess for angina
(Nifedipine) across cell membrane Headache pain , serious skin
during cardiac Hypertension, Fatigue disorders.
depolarization, relaxes Hypertensive Drowsiness. - During
coronary vascular smooth emergencies, administration, do
muscle, dilates coronary Chronic stable angina. CV: not break , crush or
arteries, increase Dysrhythmias, chew extra tablet
myocardial oxygen Contraindication: Edema, without regard to
delivery in patient with Hypotension. meal.
vasospastic angina , dilates Hypersensitivity. - Avoid grape juice.
peripheral arteries. Acute MI , GI:
Hypotension, Nausea, Patient/family
Cardiogenic shock. Vomiting, education
Diarrhea - To Avoid hazardous
activities until
GU: stabilizes on product.
Nocturia. - To limit caffeine
polyuria consumption.
-To notify prescriber
HEMA: of dyspnoea, edema
Bruising of extremities, nausea
bleeding and vomiting.

INTEG:
Rash.

MISC:
Cough ,
Fever
 -Assess for
Orally neutralize gastric Indication CNS: sensitivity STS.
3. Tab. Sobisis 500mg PO BD
acid, which forms water, -Acidosis(metabolic), Irritability, -Obtain culture and
(Sodium
Nacl, Co2 , increases -Cardiac arrest , Headache, sensitivity sample
Bicarbonate)
plasma bicarbonate which -Alkalinezation(systemic/ Confusion, before starting.
buffers H+ ions urinary), Tremors . -Bowel pattern.
concentration , reverse -antacid (PO) -Severe diarrhea,
acidosis IV. CVS: product should be
Contraindication Irregular pulse, stopped.
-Respiratory / Metabolic Water retention -Check site for
--Hypochloremia, Edema. extravasation
-Hypocalcemia phlebitis.
GI: -To notify diarrhea.
Flatulence,
Distension . Evaluate: Chance of
infection.
GU:
Calcium.

META:
Alkalosis.

MS:
Muscular twitching ,
Tetany
Irritability
[Link] Volibo 3mg PO TDS before It Inhibits the hydrolase Indication Hypoglycemia, -Assess for any
(Voglibose) each meal (Alpha- Glucosidase) Improvement of Delay indigestion and chronic intestinal
(AC) Enzyme for disaccharides postprandial absorption of diasease
into monosaccharide in the hyperglycemia in DM disaccharides , accompanied by a
intestine. when sufficient effect has Abdominal pain and disturbance
not been obtained in swelling increased indigestion and
patients who have been flatus, pathological
using oral hypoglycemic Diarrhea , condition.
drugs. Blurred Vision
Weakness,
Fatigue. ADMINISTER:
Contraindication: 3 times a day just
Severe ketosis or in a before each meal.
state of diabetic coma or
pre-coma, sever infection,
hypersensitivity.
 DISEASE PROCESS
INTRODUCTION

Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person
has high blood sugar, either because the body does not produce enough insulin, or because cells do not
respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria
(frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

HISTORY OF DIABETES

The first complete clinical description of diabetes was given by the Ancient Greek physician Aretaeus of
Cappadocia (fl. 1st century CE), who noted the excessive amount of urine which passed through the kidneys
and gave the disease the name "diabetes.

DEFINITION

 Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the
blood (hyperglycaemia) resulting from defects in insulin secretion, insulin action, or both.

 Type 2 Diabetes mellitus is a heterogeneous group of disorders characterized by variable degree of

insulin resistance, impaired insulin secretion and increased glucose production.
INCIDENCE

 Diabetes is the most common endocrine problem and is a major health hazard worldwide.
 Type Ⅰ DM or Insulin depending diabetes is most common in children. Peak age is 13 years.
 Type Ⅱ DM is mostly seen over 35 years. 80 to 90 patients with obesity.
 Incidence of Diabetes is alarmingly increasing all over the globe and in 2019, there were 2, 27,580
cases of childhood diabetes globally, Resulting in 5390 deaths.
 The estimates in 2019 showed that 77 million individuals had diabetes in India, which is expected to
rise to over 134 million by 2045. Approx 57% of these individuals remain undiagnosed.
 The prevalence of diabetes in the developing world is due to sedentary life style, with china and
India being the largest contributors to the world’s diabetes load.
RELATED ANATOMY AND PHYSIOLOGY
Anatomy of Pancreas

 Pancrease is an accessory organ of the abdomen.

 It has both exocrine and endocrine function.
 The exocrine part secretes the digestive pancreatic juice and the endocrine parts secretes hormone
Insulin.
Location

 It is located behind the stomach in the epigastric and left hypochondriac region of the abdomen.
 Anatomically, the pancreas is located along the transpyloric plane.
 The transpyloric plane is an imaginary line midway between the suprasternal notch (jugular notch)
and the upper border of the pubic symphysis at approx the level of the L1 vertebrae.

Parts

 The pancrease is divide into 5 main parts:

1. Head
2. Uncinate process
3. Neck
4. Body
5. Tail
 The head of the pancreas sits within the curve of the
Duodenum and the tail is located by the hilum of the
Spleen.
 The pancreas (except for the tail) is retroperitoneal –
This includes the head, neck and the body.
 The tail of the pancreas is intraperitoneal.

Blood supply of Pancreas:

 Pancreatic branches of splenic artery.

 Superior pancreaticcoduodenal artery.
 Inferior pancreaticoduodenal artery.
Nerve supply :

 The sympathetic fibres from splanchnic nerves (Vasomotor)

 The parasympathetic fibers from the vagus nerve (Control Pancreatic secretion).

Physiology of the pancreas

The pancreas has both exocrine and endocrine roles:

1. Exocrine Function :
 The pancreas produces digestive enzymes which are secreted into the duodenum via the main
pancreatic duct.
 Pancreatic digestive enzymes include lipase, amylase, and proteases (such as trypsin and
chymotrypsin).
 The pancreatic digestive enzymes aid in the digestion of the fats (lipase), carbohydrates
(amylase) and proteins (proteases).

2. Endocrine Function :
 The pancreas produces and secretes hormone into the bloodstream.
 The islets of Langerhans which are the ovoid collection of the cells represent the endocrine
part of the pancreas.
 Iselts of langerhans = clusters of pancreatic endocrine cells that release specific hormone.
 This is made-up of 3 main types of cells :
1) Alpha Cells = that release glucagon.
2) Beta cells = that release insulin
3) Delta cells = that release somatostatin.

 These hormones aid in glucose control.

Function of Insulin

 Insulin is produced and released by the beta cells of the pancreas.

 Insulin is an anabolic hormone.
 Insulin is responsible for the regulating blood glucose levels in the body by allowing the
movements of the glucose into the cells.
 Insulin is continuously released by the pancreatic beta cells at a low level throughout the day,
which helps to :
i. Maintain the resting blood glucose level at a healthy range between eating and during
the night.
 ii. Allow constant low-level uptake of glucose into cells for cellular processes, such as
cellular growth and DNA replication.

 Blood sugar rises after eating a meal and the beta cells release insulin in a biphasic pattern.
i. Firstly, beta cells rapidly release stored insulin from granules inside the cells.
ii. Secondly, beta cells increase insulin synthesis for a smaller, second phase release.
So how does it work?

 Once the beta cells of the pancreas release insulin into the blood , insulin binds to insulin
receptors on the surface of the body cells.
 The binding of insulin to insulin receptors on the cells activates a signalling cascade.
 This cascade increases the recruitment of the glucose transporter GLUT4 from within
intracellular storage vesicles to the plasma membrane of the cells
 GLUT4 is the major transporter responsible for the uptake of glucose from the bloodstream
and into the cell.
 A increase of GLUT4 glucose transporters at the plasma membrane will increase glucose
uptake into the cell.
 The cell can then use the glucose as energy or fuel to carry out its functions.

TYPES OF DM
BOOK PICTURE PATIENT PICTURE
[Link] Ⅰ Diabetes mellitus
- Also known as insulin depending diabetes  Absent
mellitus(IDDM) or Juvenile onset diabetes mellitus.
This is primary due to beta-cell destruction, usually
leading to absolute insulin deficiency.

2. Type Ⅱ Diabetes Mellitus  Present

-Formerly known as Non-insulin-dependent
diabetes mellitus (NIDDM) or adult- onset diabetes
mellitus ( may range from predominantly insulin
resistance with relative insulin decificiency to
predominantly a secretory defect with insulin
resistance)

3. Gestational Diabetes Mellitus  Absent

- a type of diabetes mellitus that develops during
pregnancy and typically resolves after giving birth.
it occurs when the body is unable to produce
enough insulin to meet the increased demands of
the pregnancy, leading to elevated blood sugar
levels.

RISK FACTORS
 BOOK PICTURE PATIENT PICTURE

1. MODIFIABLE :

I. Obesity - Absent

II. Overweight - Absent

III. Low physical activity - Physically active

IV. Unbalanced diet - He maintains a healthy diet as he was diagnosed 3

years back.

V. Prediabetes – Higher than normal -Not present

blood sugar , but not enough to be
type 2 diabtes.

2. NON- MODIFIABLE

I. Family History : - Not present

 A family history of type 2 diabetes increases
the likelihood of developing the condition,
especially if one or both parents are
affected.

1. Age :
- He is 52 years old.
 The risk increase with age older than 45 yrs,
due to a decline in insulin sensitivity.

2. Ethnicity :
 Certain ethnic groups are more prone to
- Indian
type 2 diabetes, in including African
Americans Hispanics, South Asian
ethnicity. - Absent

-Absent
3. Low Birth Weight

4. Gestational Diabetes : -Absent

 Women who develop gestational diabetes
during pregnancy have a higher risk of
developing type 2 diabetes later in life.

5. Hypertension :
 Hypertension is often linked to the insulin
- Present. BP – 160 / 100 mmhg
resistance and metabolic syndrome,
increasing the risk of type 2 diabetes.

6. History of cardiovascular disease : - Absent

 Individuals with a history of heart disease or
 stroke are at an increased risk of developing
type 2 diabetes.

ETIOLOGY
BOOK PICTURE PATIENT PICTURE
1. Cause by a combination of insulin resistance and
relative insulin deficiency- Some individuals have
predominantly insulin resistance, whereas other has - Patient is insulin resistance.
predominantly insulin deficient insulin secretion
with little insulin resistance.

2. Obesity- Adipose tissue promotes insulin - Absent

resistance through inflammatory mechanism

3. Lack of exercise -Sedentary life style

4. Found primarily in adults over age 30 , however -Patient’s age is 52 years

may be seen in younger adults and adolescent who
are overweight.

5. High blood pressure -BP – 160/100 mmHg

6. Poor Diet -Patient is on diabetic diet.

7. Genetics – Abnormal gene functioning can lead -Absent

to insulin resistance and/or pancreatic beta cells
dysfunction.

PATHOPHYSIOLOGY
 DUE TO ETIOLOGICAL FACTORS (GENETIC OR
ENVIRONMENTAL FACTOR SUCH AS OBESITY)

INSULIN RESISTANCE

PROGRESSIVE FAILURE OF THE BETA CELLS

HYPERGLYCEMIA

TYPE 2 DIABETES MELLITUS

Effect On the Liver

  The combination of insulin resistance and inadequate insulin secretion leads to a further increase in
blood glucose levels by the liver.
 As insulin is not recognised by insulin receptors on the liver, the liver can no longer take glucose up
from the blood to store it.
 This causes the liver to inappropriately respond as if the blood sugar is low (when in fact it is
actually high), resulting in increased gluconeogenesis and glycogenolysis.
 Gluconeogenesis is the formation of glucose in the liver.
 Glycogenosis is the breakdown of stored glycogen in the liver, released as glucose into the blood.
 Both the processes increase blood glucose levels.

CLINICAL MANIFESTATION
BOOK PICTURE PATIENT PICTURE
1. Polyuria - Present

2. Polydispia - Absent

[Link] - Absent

[Link] loss and fatigue - Fatigue is Present

[Link] Vision - Present

[Link] Wound Healing - Absent

7. Weakness, Numbness in Hands and Feet, dry - Weakness is present & dry skin.
skin.

8. Recurrent Infection - Absent

9. Tingling Sensation - Absent

DIAGNOSTIC STUDIES
BOOK PICTURE PATIENT PICTURE

1. LABORATORY TEST
- Fasting lipid profile, test for microalbuminuria, - Serum cretinine level is done, electrocardiogram
serum creatinine level, urinalysis, is done.
electrocardiogram.

2. BLOOD GLUCOSE
- Blood Glucose: Fasting blood sugar, Random
blood sugar, Post Pradial blood Sugar. - Done
-HbA1C (AIC),
3. ORAL GLUCOSE TOLERANCE TEST
- Evaluates insulin response to glucose loading. - Not done

4. Glycated Hemoglobin ( Glycohemoglobin – - Done.

HbA1C )

5. C- Peptide Assay (connecting peptide assay) - Not Done

6. Fructosamine Assay -Not done.

7. Lipid profile - Done

MANAGEMENT OF DIABETES MELLITUS.

A. PHARMALOGICAL TREATMENT
BOOK PICTURE PATIENT PICTURE

1. Oral diabetes medications are routinely used

before insulin for the treatment of type 2 diabetes, - Tab Metformin 500 mg PO ODAC given
Who do not achieve glucose with diet and exercise
only.
Examples of oral diabetes medications include:
i. Biguanides
ii. Thiazolidinediones
iii. Silfonylures
iv. SGLT-2 Inhibitors
v. DPP -4 inhibitors
vi. GLP-1 Mimetics/agonists
vii. Meglitinides/Glinides
viii. Alpha-Glucosidase inhibitors.

2. Insulin therapy :
If diet, exercise, lifestyle modifications and oral - Not Given
diabetes medications are not sufficient to treat
type2 diabetes and maintain target glucose levels ,
then insulin therapy may be required.
In some instances, insulin may be recommended
first as an initial treatment.

SURGICAL MANAGEMENT
BOOK PICTURE PATIENT PICTURE

1. Gastric Bypass and Biliopancreatic Diversion - Not done

- A two type of surgeries used to treat severe
obesity by altering the digestive system to limit
food intake and nutrient absorption.

2 Pancreatic transplantation : -Not done

- A surgical procedure where a healthy pancreas
from a donor is transplanted into a person whose
pancreas is no longer functioning properly.
This surgery is Most commonly seen in patient with
Type1 DM.

[Link] cell transplantation : -Not done

- A surgical procedure in which clusters of insulin-
producing cells called islets from donor pancreas
are transplanted into diabetic patient.

COMPLICATIONS
 BOOK PICTURE PATIENT PICTURE
 Diabetic Retinopathy (eyes) - Just blurry vision

 Diabetic nephropathy (kidney) -Not present

 Diabetic neuropathy (Nerves) -Not present

 Cardiovascular disease - Not present

 Heart attack (MI) - Not present

 Stroke -Not present

 Peripheral vascular Disease(PVD) -Not present

 Gum Disease and other mouth problem. - Dental carries present

DIETARY ASSESSMENT & DIET PLAN

Diet is directly affects the Blood glucose level and the underlying cause of diabetes mellitus . Diabetes also
affect the blood cholesterol levels, body weight and blood pressure.

A nutritious and balanced diet helps to manage the blood glucose level and weight of the patient. It provides
energy for daily activity.

1. Patient history taken – Yes

2. Anthropometric measurement :

Height-168 cms

Weight-60 kgs

BMI- 21.26 kg/m2

Diet-My patient is non-vegetarian.

3. Dietary habit: On hospitalization, patient is advice to follow a well- balanced diet. And was adviced to
have diabetes diet i.e Sugar Free, low carbohydrate and low sodium diet for hypertension. Patient is non-
vegetarian.

4. No significant of any food allergies.

NUTRITIONAL REQUIREMENT :
Diet for the patient with the diabetes mellitus should include the following :

 Increase Omega- 3s from fatty fish or plants

 Saturated fats : <10% of total kcalories.

 Trans fats : minimized

 Cholesterol < 300milligram daily

 Protein rich food like egg

 Skimmed milk

 Fruits like mosumbi , guava

 Energy : 1600 -1800 Kcal

 Protein : 60 - 80gm/day
 CALORIE PROTEIN CALCIUM IRON
TIME FOOD ITEM QUANTITY CHO (gm/day) FAT (gm/day)
(Kcal/day) (gm/day) (gm/day) (mg/day)

 1 cup  2  0.05  0.2  0.08  0.06  0

Morning Tea
(150ml)
 Red tea
6:30 am
without sugar
 Biscuit
 2-3 pcs  30  2  2.2  0.1  0.2  0.01

Breakfast
 Roti
 2pcs  224.09  7.4  40.9  1.0  21.65  1.6
 Skimmed
 1  80  5  7  0.2  164  0.3
milk(low fat
cup(150ml)
milk)
9:00 am
 Egg
 1 whole  84.85  8.27  0  4.8  26.63  1.08
 Veg curry
 1 serve  90.87  2.0  16.67  1.94  30.5  0.6
( beans and
leafy and
potatoes)

Mid-Morning
 Fruit
11:00 am  1 59 0.2 13.4 0.5 1.0 0.66
(Mosumbi,
Guava)
Lunch  1 ½ bowl
 402  8.96  80.34  0.59  8.46  0.73
 Brown rice  1 bowl
 170.5  10.1  20.8  6.8  29.6  3.2
 Lentil dal
(Cooked)  1 serve
 85.5  12.4  0.8  1.6  0.1
2:00 pm  Veg curry
 2.0
( Mixed
cauliflower
and bean)  1 medium
 89  2.1  0.8  1.6  0.32  5.2
 Fish curry size fish
DIET PLAN : 24 HOURS DIETARY PLAN.
 CALORIE PROTEIN CALCIUM IRON
TIME FOOD ITEM QUANTITY CHO (gm/day) FAT (gm/day)
(Kcal/day) (gm/day) (gm/day) (mg/day)

Evening Tea  1 cup  15  1  2  0  38.7  0

 Milk tea (100ml)
4:00 pm without sugar

 Biscuit  2 pcs  30  2  2.2  0.1  0.2  0.01

Dinner
 Rice  1 bowl  287.3  6.4  63.1  0.42  6.4
 0.52
 Dal (Lentil)  1 bowl  170.5  10.1  20.1  6.8  29.6
9:00 pm  3.2
 Veg curry  1 serve  124  2.37  8.4  6.79  50.72
 0.82
(mixed)

TOTAL 1943.61 69.95 290.31 32.52 440.29 18.03

NURSING THEORY APPLICATION
ROY’S ADAPTATION

BIOGRAPHICAL SKETCH THE OF SISTER CALLISTA ROY

Sister Callista Roy, a member of sisters of Saint Joseph of Carondeler, A Nursing theorist, professor and the
author, was born on 14th Oct, 1939, in Los Angeles, California. She did a bachelor of arts in nursing in 1963
from mount Saint Mary’s College in Los Angeles and Master of Science in Nursing from the University Of
California At Los Angeles in 1966. After earning her nursing degrees, Roy began her education in
sociology, receiving both an M.A in sociology in 1973 and a PhD in sociology in1977 from the University
of California.

Roy had worked as a pediatric staff nurse and had noticed the great resiliency of children and their ability to
adapt in response to major physical and psychological changes.

Awards and Honors

Sr. Callista Roy has received numerous honors due to her work and contribution to the nursing profession.
In 2007, Roy was named a Living Legend by the American Academy of Nursing and the Massachusetts
Registered Nurses Association.
Roy is also a Sigma Theta Tau member, and she received the National Founder’s Award for Excellence in
Fostering Professional Nursing Standards in 1981.
Among her achievements include an Honorary Doctorate of Humane Letters from Alverno College in 1984,
honorary doctorates from Eastern Michigan University (1985), and St. Joseph’s College in main (1999).
HERE ARE SOME MORE OF HER AWARDS AND HONORS:

2013 – Distinguished Graduate Award, Bishop Conaty/Our Lady of Loretto High School

2013 – Honorary Doctoral Degree, Holy Family University

2013 – Alumni Award for Professional Achievement, UCLA

2013 – Excellence in Nursing, the University of Antioquia, Medellin Colombia

2011 – Nursing Science Quarterly Special Issue Honoring the work of Callista Roy, Vol. 24, Num. 4, Oct.
2011

2011 – Faculty Senior Scientist Poster Exemplar Award, Yvonne L. Munn Center for Nursing Research and
the Nursing Research Expo Committee, Massachusetts General Hospital

2011 – The Sigma Mentor Award, Sigma Theta Tau International Alpha Chi Chapter

2010 – University of Southern Alabama Picture Gallery of Theorist, University of Alabama

2010 – Inducted to Nurse Researcher Hall of Fame, Inaugural Class, Sigma Theta Tau International, Honor
Society of Nursing

2010 – “Sixty who have Made a Difference,” UCLA School of Nursing, 6th Anniversary

2010 – Inductee, Sigma Theta Tau International Nurse Researcher Hall of Fame

2007 – American Academy of Nursing Living Legend Award

ORIGIN OF THE MODEL:

While working towards her master’s degree, Roy was challenged in a seminar with Dorothy E. Johnson to
develop a conceptual model for nursing. Subsequently in1970 the “ROY ADAPTATION MODEL” was
born as a derivation of Bertalanfty (1968) general system theory and Harry Helson’s Adaptation level theory
(1964).

ASSUMPTIONS OF THE MODEL:

1. Scientific Assumptions
 Systems of matter and energy progress to higher levels of complex self-organization.
 Consciousness and meaning are constructive of person and environment integration.
 Awareness of self and environment is rooted in thinking and feeling.
 Humans, by their decisions, are accountable for the integration of creative processes.
 Thinking and feeling mediate human action.
 System relationships include acceptance, protection, and fostering of interdependence.
 Persons and the earth have common patterns and integral relationships.
 Persons and environment transformations are created in human consciousness.
 Integration of human and environmental meanings results in adaptation.

2. Philosophical Assumptions
 Persons have mutual relationships with the world and God.
 Human meaning is rooted in the omega point convergence of the universe.
 God is intimately revealed in the diversity of creation and is the common destiny of creation.
 Persons use human creative abilities of awareness, enlightenment, and faith.
 Persons are accountable for the processes of deriving, sustaining, and transforming the universe.

Major Concepts of the Adaptation Model

The following are Callista Roy’s Adaptation Model’s major concepts, including the definition of the
nursing metaparadigm as defined by the theory.

1. Person
“Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which
they adjust effectively to changes in the environment and, in turn, affect the environment”. Based on
Roy, humans are holistic beings that are in constant interaction with their environment. Humans use a
system of adaptation, both innate and acquired, to respond to the environmental stimuli they experience.
Human systems can be individuals or groups, such as families, organizations, and the whole global
community.

2. Environment
“The conditions, circumstances and influences surrounding and affecting the development and behavior
of persons or groups, with particular consideration of the mutuality of person and health resources that
includes focal, contextual and residual stimuli”.

The environment is defined as conditions, circumstances, and influences that affect humans’
development and behavior as an adaptive system. The environment is a stimulus or input that requires a
 person to adapt. These stimuli can be positive or negative. Roy categorized these stimuli as focal,
contextual, and residual. Focal stimuli are that confront the human system and require the most attention.
Contextual stimuli are characterized as the rest of the stimuli present with the focal stimuli and
contribute to its effect. Residual stimuli are the additional environmental factors present within the
situation but whose effect is unclear. This can include previous experience with certain stimuli.

3. Health
“Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to
cope with them in a competent way.” Health is defined as the state where humans can continually adapt
to stimuli. Because illness is a part of life, health results from a process where health and illness can
coexist. If a human can continue to adapt holistically, they will maintain health to reach completeness
and unity within themselves. If they cannot adapt accordingly, the integrity of the person can be affected
negatively.

4. Nursing

“[The goal of nursing is] the promotion of adaptation for individuals and groups in each of the four
adaptive modes, thus contributing to health, quality of life, and dying with dignity.”
In Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s behaviors for
adaptation; promote positive adaptation by enhancing environment interactions and helping patients
react positively to stimuli. Nurses eliminate ineffective coping mechanisms and eventually lead to better
outcomes.

5. Adaptation

Adaptation is the “process and outcome whereby thinking and feeling persons as individuals or in groups
use conscious awareness and choice to create human and environmental integration.”

FOUR ADAPTATION MODES

The subsystem’s four adaptive modes are how the regulator and cognator mechanisms are manifested; in
other words, they are the external expressions of the above and internal processes.
 1. Physiological-Physical Mode
Physical and chemical processes are involved in the function and activities of living organisms. These are
the actual processes put in motion by the regulator subsystem.
This mode’s basic need is composed of the needs associated with oxygenation, nutrition, elimination,
activity and rest, and protection. This model’s complex processes are associated with the senses, fluid and
electrolytes, neurologic function, and endocrine function.
2. Self-Concept Group Identity Mode
In this mode, the goal of coping is to have a sense of unity, meaning the purposefulness in the universe, and
a sense of identity integrity. This includes body image and self-ideals.

3. Role Function Mode

This mode focuses on the primary, secondary, and tertiary roles that a person occupies in society and
knowing where they stand as a member of society.

4. Interdependence Mode
This mode focuses on attaining relational integrity through the giving and receiving of love, respect and
value. This is achieved with effective communication and relations.

CONCEPTUAL FRAMEWORK
PHYSIOLOGICAL FUNCTION

SELF-CONCEPT

COPING MECHANISM ROLE FUNCTION

STUMULI
ADAPATION LEVEL REGULATOR INDEPENDENCE
COGNATOR

ADAPTIVE AND
INEFFECTIVE RESPONSE

FEEDBACK
[Link]
STIMULI: COPING MECHANISM:
FUNCTION:
1. FOCAL STIMULI: 1. Medication: Tab Ⅰ. Oxygenation – No O2
-Diabetes Metformin, Tab Nicardia supplementation is needed.
-Hypertension
retard Patient is breathing in the room
2. CONTEXTUAL
2. Performing Light air.
STIMULI
Ⅱ. Nutrition - He is not taking
NURSING PROCESS
NURSING ASSESSMENT

 To assess the sleeping pattern: The patient sleeping pattern is disturbed.

 To assess the risk for infection: the patient has the chance of infection due to uncontrolled
hyperglycaemia.

 To assess fluid volume deficit: The patient has fluid deficiency as he is having polyuria.

 To assess the nutritional intake: The patient is not able to take food properly.

NURSING DIAGNOSIS

1. Risk for unstable blood Glucose level related to the insufficient diabetes management as evidenced

by unstable values of blood glucose level.

2. Fluid volume deficit related to polyuria as evidenced by frequent urination

3. Risk of infection related to uncontrolled hyperglycaemia as evidenced by high fever (on and off).

4. Disturbed sensory perception related to increase blood sugar level as evidence by dizziness ,

headache.

5. Imbalance nutrition more than body requirements related to imbalance of insulin , food , physical
activity secondary to diabetes mellitus as evidenced by increase hunger.

6. High risk of injury related to decreased sensory (visual) sensation as evidenced by blurred vision.

7. Activity intolerance related to decreased energy production as evidenced by weakness and fatigue.
 NURSING IMPLEMENTATIO
ASSESSMENT GOAL PLANNING RATIONALE EVALUATION
DIAGNOSIS N

[Link] Data Risk for unstable To maintain the -To Assess the - To obtain baseline - Patient condition Blood Glucose level
blood glucose level blood glucose level condition of the data was assessed. is maintained within
Patient say that related to within the normal patient. the normal range to
“Iam having high insufficient diabetes range. some extent.
blood sugar level” management as - Monitor vital signs - To obtain the - Vital signs is
evidenced by baseline data. monitored.
Objective Data unstable value of BP- 160/100mmhg
glucose level. P- 92 b/min
On observation, RR- 22b/m
patient looks weak, -Monitor blood - To obtain normal -Blood Glucose level
fatigue and increase glucose level every range of the blood is monitored.
hunger. 4 hrly. glucose. RBS – 260mg/dl

-Provide a low -To maintain blood - Low Carbohydrate

carbohydrate for glucose level. diet is maintained.
meal and snack.

- Administer oral -To prevent from - T. Metformin

antidiabetic drug as hyperglycemia. 500mg OD PC is
prescribed by administered as
physician. prescribed by
physician.

NURSING CARE PLAN

 NURSING
ASSESSMENT GOAL PLANNING RATIONALE IMPLEMENTATION EVALUATION
DIAGNOSIS

2. Subjective Fluid volume To maintain -To assess the base - To obtain baseline - General condition of Fluid Volume i
data deficit related to fluid volume to line data of the data. the patient is assessed. maintained to
normal volume patient. some extent.
polyuria as
Patient says that
“Iam going for evidenced by - To Monitor the - To prevent - Blood glucose is
urinating frequent glucose level. hyperglycemic monitored.
frequently” urination
-Advice to drink water - To prevent fluid -Water is provided
Objective data frequently. deficit and maintain frequently.
hydration.
Patient look
drowsy - Advice to eat fruit - To maintain fluid -Fruit like mosumi is
like mosumi. volume. provided to the
patient.

- Monitor intake- - To maintain fluid - Intake and output of

output chart volume. the patient is assessed.
 NURSING IMPLEMENTATIO
ASSESSMENT GOALS PLANNING RATIONALE EVALUATION
DIAGNOSIS N

[Link] data : Risk of To Maintain the -To monitor -To obtain - Vital Signs were - The fever and the
The patient infection body vital signs. Baseline data. assessed. temperature of the
complaints that “I am related to temperature. Temp- 100°F body is decreased to
having fever on & off” Respiration = some extent.
uncontrolled
24Breath/min
Objective data : hyperglycaemia Pulse – 92 b/m
The patient’s body as evidenced by
temperature is high fever (on -To provide - To decrease - Cold sponging is
elevated and warm to and off). cold sponging. the body provided.
touch. temperature.
Temp=100°F
- To on the - To make the -AC is switch on and
. AC/Fan and to patient patient is asked to
remove extra comfortable and wear comfortable
clothing. to decrease body clothing’s and to
temperature. remove extra
clothing.

- To provide - To provide - The other patient

cool and calm comfortable. and attendants were
surrounding. asked to lower their
voice.

- To administer - To decrease - Inj PCM IM SOS is

antipyretic the fever. administered as the
medication as doctor’s order.
doctors
prescribe.
 NURSING
ASSESSMENT GOALS PLANNING RATIONALE IMPLEMENTATION EVALUATION
DIAGNOSIS
[Link] Data Disturbed To reduce -To assess -To obtain -Patient’s baseline Dizziness was
sensory dizziness and patient’s baseline data. data is assessed. reduced to some
Patient says that, perception headache. general extent.
“Iam feeling dizziness and related to condition. -To prevent - Random Blood
having sensation of increase blood from glucose is monitored.
whirling” sugar level as -To Monitor hyperglycemia
evidenced by blood glucose
Objective Data dizziness and level
headache. - Patient is advised to
On observation, patient -To reduce take rest.
looks weak and cannot stress and
walk without assistance. - To advice the exhaustion. -Calm and quiet
patient to take environment is
rest. -To improve maintained by
sensory lowering the curtains
-To maintain a perception and and well ventilation
calm and quiet relax. was provided.
environment.

- Psychological
support is provided
by educating about
-To reduce the the condition and
-To provide stress and prognosis of the
psychological headache. disease condition.
support.
- Loud noise was
reduced around the
patient by asking the
other patient and
- Avoid loud -To reduce attendants to lower
noise around Headache. their voice or mobile
the patient. sound inside the
ward.
 NURSING
ASSESSMENT GOALS PLANNING RATIONALE IMPLEMENTATION EVALUATION
DIAGNOSIS

[Link] Data Imbalance nutrition To Maintain To assess the To obtain the A vital sign of the Nutritional status is
nutritional vital signs of baseline data. patient is assessed. maintained to some
Patient complaints more than body
status. the patient. extent
that “Iam feeling requirements related
hungry frequently” To Monitor To prevent from Blood Glucose level
to imbalance of
blood glucose hypoglycaemia. was monitored.
insulin , food , level every
4hrly
Objective Data physical activity
secondary to To Provide To reduce Low carbohydrates
Patient look weak meal is low hunger. meal is provided,
diabetes mellitus as
and fatigue . carbohydrates, small amount and
evidenced by small amount frequently.
and frequently.
increase hunger.
To Encourage To control Food of the patient
the patient to hyperglycemia choice is provided a/c
take food of his to diabetic diet.
choice a/c to
diabetic diet.
 NURSING
ASSESSMENT GOALS PLANNING RATIONALE IMPLEMENTATION EVALUATION
DIAGNOSIS

[Link] Data: High risk of To prevent -To assess the To obtain Patient condition is Risk from injury is
injury related to risk from patient baseline data. assessed. maintained to
Patient complaints injury condition. some extent.
decreased
that “Iam having
Blurred vision” sensory (visual)
sensation as -Monitor blood -To prevent from Blood Glucose level is
Objective Data: evidenced by glucose level. hypoglycemic. monitored.
Patient have a blurred vision.
difficulty in seeing
and continually -To advice not -To prevent -The Patient is advised
rubbing her eyes. to go alone if injury. to avoid going alone if
feeling dizziness he is feeling dizziness
or blurred or blurred vision.
vision.

-Advice to -To prevent from - Eye checkup is

checkup the eye retinopathy advised to check
regularly regularly.
PROGNOSIS

ON THE 1ST DAY , I met my Patient and he look weak and he said that he is feeling dizziness and
sensation of whirling and the look worried and anxious.

ON THE 2ND DAY, I assured him that he should not be worried about his illness and advised him
to take his medication regularly and he is going to improve.

ON THE 6TH DAY, The patient look better and the doctor advice him to get discharge and
continue the medication regularly and come for regular checkup regarding his blood glucose
level.

His prognosis is good, but he have to continue taking medication regularly as diabetes mellitus
is not a curable disease and he have to maintain the nutritional status.
HEALTH EDUCATION

SI NO. TOPIC CONTENT

1. FOR UNDERSTANING DIABETES  Explain the types (Type 1, 2 and gestational

diabetes) and how they affect blood sugar
levels.
 Importance of monitoring blood glucose
regularly.

2. DIET AND NUTRITION  Advice the patient to follow balanced diet

rich in fibre, low in refined sugars and fats.
 To teach portion control and carbohydrate
counting for better sugar management.
 Encourage regular meals and healthy snacks
to prevent spikes or drops in blood glucose.
 And to drink plenty of water.

3. EXERCISE AND PHYSICAL  Advice to perform light physical activities

ACTIVITY and not to strain himself.
 Engage in regular physical activity i.e. for at
least for 30 min most of days in a week, to
improve insulin sensitivity.
 Educate on the importance of monitoring
blood sugar before and after the exercise.

4. REST AND SLEEP  Advice to take proper sleep and rest.

 Advice to rest for 1-2 hrs in day time and 5-
6hrs at night time.

5. MEDICATION  To educate about the role of medications,

including insulin or oral hypoglycaemic
agents.
 To educate about the importance of
following the prescribed medication regimen
and not skipping doses.
6. BLOOD SUGAR MONITORING  Demonstrate how to use a glucose monitor
and the importance of regular checks.
 To educate how to recognise the signs of
high (hyperglycaemia) and low blood sugar
(hypoglycaemia) and how to manage both.
7. FOOT CARE  To encourage daily foot inspections for cuts,
 blisters or sores.
 To encourage patient to wear proper
footwear and keep feet clean and dry to
prevent infections.
8. STRESS MANAGEMENT  Discuss how stress can impact blood sugar
levels.
 Encourage relaxation techniques, adequate
sleep and support system.
9. COMPLICATION PREVENTION  To educate a long – term complications like
cardiovascular disease, kidney issues, nerve
damage and vision problems.
 Stress the importance of routine checkups
visits, eye exams and lab tests (HbA1c, lipid
profile).
10. LIFESTYLE MODIFICATION  To encourage the patient to avoid smoking
and excessive alcohol consumption.
 To maintain a healthy weight and work
towards sustainable habits.
11. EMERGENCY PLANNING  Teach how to manage diabetes during
illness, stress or travel.
 To educate the patient when to seek medical
help in case of severe hypoglycaemia or
hyperglycaemia.

CONCLUSION

After studying about Diabetes Mellitus Type 2, I gathered more information about the disease
process and management. So, I hopefully in future, if I will get a patient with same diagnosis
will gain more confident and have more knowledge to provide better nursing care for patient.
BIBLIOGRAPHY

BOOK REFERENCE :

1. Brunner and Suddarth’s , “Textbook of Medical – Surgical Nursing” , 12 th Edition (Volume - Ⅱ),
Published by Wolters Kluwer, India Pvt. Ltd. , New Delhi , page no : 1199 – 1921

2. Lewis’s “Medical Surgical Nursing” , 3rd South Asia Edition , Volume - Ⅱ , Published by Reed
Elseviser, India Pvt. Ltd , New Delhi , Page no: 1077-1098.

3 . Lippincolt , “Manual of Nursing Practice’’ , 9TH Edition , Wolters Kluwer , India Pvt . Ltd. , New
Delhi , Page no: 944 -961

4. Sethi and Rani’s , “Medical Surgical Nursing Ⅰ &Ⅱ” , 2nd Edition , Published by Jaypee Brothers
Medical Publisher Pvt Ltd , New Delhi , Page no : 346-350

5. Paulraj Seenidurai’s , “Medical Surgical Nursing Made Easy” 1 st Edition , Published by Jaypee
Brothers Medical Pvt. Ltd. , New Delhi , Page No : 80 – 83.

6. Mosby’s Nursing Drug Reference 2021, 26th Edition , Published by Elsevier , India Pvt. Ltd.

INTERNET REFERENCE :

 Cleveland Clinic ; Type 2 Diabetes ; Last Reviewed 11 August 2023. Available form :
[Link]

 EZmed ; Type 2 Diabetes Mellitus : Symptoms , Medications & Treatment ; June 24,
2024. Available form :
[Link]