NURS MISC CASE STUDY EXAM:CARE OF PATIENTS WITH DIABETES
2023 A+ SATIFACTORY GUARANTEED
Case Study:
Mr. Black age 63, has a history of peripheral arterial occlusive disease (2 years) hypertension,
hypercholesterolemia, type 2 diabetes, and smoking. He eats low-fat foods and has cut back on
smoking to half a pack of cigarettes a day. His home-monitored blood glucose levels range from 180 to
215 mg/dL. Because he has severe calf pain after walking, he now walks only two blocks a day – one
block from home and one block back. He now receives medical treatment for a nonhealing ulcer on the
planter aspect of his left foot. He questions why he is told that he should walk when it causes pain and
wonders how it may affect healing of his ulcer.
MEDICAL DIAGNOSIS: Diabetes Mellitus
DEFINITION:
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood
glucose levels, in which the body cannot metabolize carbohydrates, fats, and proteins
because of a lack of, or ineffective use of, the hormone insulin.
ETIOLOGY/PATHOPHYSIOLOGY
Diabetes is tightly associated with obesity. The condition has two hallmark features:
• insulin resistance, defined here as an impaired ability of the hormone to
suppress hepatic glucose output and to promote peripheral glucose disposal and
• Compromised function of the pancreatic β-cell such that insulin secretion is
insufficient to match the degree of insulin resistance.
It is characterized by:
• A decreased ability to use the insulin produced in the pancreas
• Decreased insulin secretion in response to glucose Levels
• Insulin resistance blocking cells from absorbing glucose
• Excess production of glucose because of defective insulin secretory response
CARE SETTING:
Depending on the severity of patient’s condition, Diabetes Mellitus may be managed in any
setting but, severe metabolic imbalance requires inpatient acute care on a medical unit.
,NURS MISC CASE STUDY EXAM:CARE OF PATIENTS WITH DIABETES
2023 A+ SATIFACTORY GUARANTEED
COMMON SIGNS AND SYMPTOMS
• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections
POTENTIAL COMPLICATIONS
Usually, in the early stage of the disease, the patirnt may feel fine and ignore the situation.
But it gradually affects affects many major organs, including the heart, blood vessels,
nerves, eyes and kidneys. If untreated over a long term, the condition can eventually be
disabling or even life-threatening. Some of the potential complications of diabetes
include:
• Heart and blood vessel disease, e.g. stroke, high blood pressure and narrowing of
blood vessels (atherosclerosis).
• Nerve damage (neuropathy)
• Kidney damage.
• Eye damage.
• Slow healing of cuts and wounds which can lead to infections, and eventual toe,
foot or leg amputation.
• Hearing impairment.
• Skin conditions. Diabetes may leave you more susceptible to skin
problems, including bacterial and fungal infections.
• Sleep apnea.
, NURS MISC CASE STUDY EXAM:CARE OF PATIENTS WITH DIABETES
2023 A+ SATIFACTORY GUARANTEED
• Diabetes mellitus seems to increase the risk of Alzheimer's disease, though it's
not clear why. The worse your blood sugar control, the greater the risk appears to
be.
HEAD TO TOE PHYSICAL ASSESSMENT
Name: Mr. Black Age: 63
Gender: Male
Reason for the visit: Nonhealing ulcer on the planter aspect of his left foot.
Home monitored blood glucose levels: 180 – 215 mg/dL
ACTIVITY/REST
Subjective (Reports)
Occupation: None
Leisure activity: walks only two blocks a day – one block from home and one block back.
Diet: Eats low-fat foods
Social life: He has cut back on smoking to half a pack of cigarettes a day
Objective (may exhibit)
• Tachycardia and tachypnea at rest or with activity
• Lethargy/disorientation
• Decreased muscle strength/tone
CIRCULATION
Subjective (reports)
• History of hypertension; , hypercholesterolemia,
• Leg ulcers, slow healing
• Pain after walking
Objective (may exhibit)
• Claudication, numbness, tingling of extremities (long-term effects)
• Tachycardia
• Postural BP changes; hypertension
2023 A+ SATIFACTORY GUARANTEED
Case Study:
Mr. Black age 63, has a history of peripheral arterial occlusive disease (2 years) hypertension,
hypercholesterolemia, type 2 diabetes, and smoking. He eats low-fat foods and has cut back on
smoking to half a pack of cigarettes a day. His home-monitored blood glucose levels range from 180 to
215 mg/dL. Because he has severe calf pain after walking, he now walks only two blocks a day – one
block from home and one block back. He now receives medical treatment for a nonhealing ulcer on the
planter aspect of his left foot. He questions why he is told that he should walk when it causes pain and
wonders how it may affect healing of his ulcer.
MEDICAL DIAGNOSIS: Diabetes Mellitus
DEFINITION:
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood
glucose levels, in which the body cannot metabolize carbohydrates, fats, and proteins
because of a lack of, or ineffective use of, the hormone insulin.
ETIOLOGY/PATHOPHYSIOLOGY
Diabetes is tightly associated with obesity. The condition has two hallmark features:
• insulin resistance, defined here as an impaired ability of the hormone to
suppress hepatic glucose output and to promote peripheral glucose disposal and
• Compromised function of the pancreatic β-cell such that insulin secretion is
insufficient to match the degree of insulin resistance.
It is characterized by:
• A decreased ability to use the insulin produced in the pancreas
• Decreased insulin secretion in response to glucose Levels
• Insulin resistance blocking cells from absorbing glucose
• Excess production of glucose because of defective insulin secretory response
CARE SETTING:
Depending on the severity of patient’s condition, Diabetes Mellitus may be managed in any
setting but, severe metabolic imbalance requires inpatient acute care on a medical unit.
,NURS MISC CASE STUDY EXAM:CARE OF PATIENTS WITH DIABETES
2023 A+ SATIFACTORY GUARANTEED
COMMON SIGNS AND SYMPTOMS
• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections
POTENTIAL COMPLICATIONS
Usually, in the early stage of the disease, the patirnt may feel fine and ignore the situation.
But it gradually affects affects many major organs, including the heart, blood vessels,
nerves, eyes and kidneys. If untreated over a long term, the condition can eventually be
disabling or even life-threatening. Some of the potential complications of diabetes
include:
• Heart and blood vessel disease, e.g. stroke, high blood pressure and narrowing of
blood vessels (atherosclerosis).
• Nerve damage (neuropathy)
• Kidney damage.
• Eye damage.
• Slow healing of cuts and wounds which can lead to infections, and eventual toe,
foot or leg amputation.
• Hearing impairment.
• Skin conditions. Diabetes may leave you more susceptible to skin
problems, including bacterial and fungal infections.
• Sleep apnea.
, NURS MISC CASE STUDY EXAM:CARE OF PATIENTS WITH DIABETES
2023 A+ SATIFACTORY GUARANTEED
• Diabetes mellitus seems to increase the risk of Alzheimer's disease, though it's
not clear why. The worse your blood sugar control, the greater the risk appears to
be.
HEAD TO TOE PHYSICAL ASSESSMENT
Name: Mr. Black Age: 63
Gender: Male
Reason for the visit: Nonhealing ulcer on the planter aspect of his left foot.
Home monitored blood glucose levels: 180 – 215 mg/dL
ACTIVITY/REST
Subjective (Reports)
Occupation: None
Leisure activity: walks only two blocks a day – one block from home and one block back.
Diet: Eats low-fat foods
Social life: He has cut back on smoking to half a pack of cigarettes a day
Objective (may exhibit)
• Tachycardia and tachypnea at rest or with activity
• Lethargy/disorientation
• Decreased muscle strength/tone
CIRCULATION
Subjective (reports)
• History of hypertension; , hypercholesterolemia,
• Leg ulcers, slow healing
• Pain after walking
Objective (may exhibit)
• Claudication, numbness, tingling of extremities (long-term effects)
• Tachycardia
• Postural BP changes; hypertension
