JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
NURSING CARE OF TYPE II DIABETES MELLITUS PATIENTS
1 Triya Yestika Saleha,2*Yanti Cahyati,3Unang Arifin Hidayat.
1Poltekkes Kemenkes Tasikmalaya.
Tasikmalaya.
Indonesia,triyayestika20@gmail.
2Poltekkes Kemenkes Tasikmalaya.
Tasikmalaya.
Indonesia,yantinaufal@gmail.
3Poltekkes Kemenkes Tasikmalaya.
Tasikmalaya.
Indonesia, unangarifinh@gmail.
ARTICLE INFORMATION
Received: Month.
Date.
Year Revised: Month.
Date.
Year Available online: Month.
Date.
Year
KEYWORDS
Diabetes Mellitus Type II.
Nursing care
CORRESPONDENCE
ABSTRACT
Background: Type II Diabetes Mellitus is a chronic disease with a high prevalence in Indonesia.
As nursing care providers, nurses have an essential role in managing patients with type II Diabetes Mellitus.
Purpose: Get an overview of the implementation of nursing care in patients with Type II Diabetes Mellitus.
Methodology: A case study was conducted on Mrs.
D in Dahlia Room RSUD Ciamis on 27 - 30 June 2022.
Results: The results of the nursing evaluation obtained: ineffective peripheral perfusion, acute pain, nutritional deficits, impaired skin integrity, unstable blood glucose levels, impaired physical mobility, and disturbed sleep patterns are partially resolved, and the risk of hypovolemia has been determined.
Conclusion:
Nursing care carried out can overcome the problems experienced by patients.
Correspondence writer: Yanti Cahyati Affiliation:
Poltekkes Kemenkes Tasikmalaya Indonesian country Email: yantinaufal@gmail.
This is an open access article under the CC BY-ND license Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
PRELIMINARY
International Diabetes Federation states that cases of diabetes mellitus in the world have reached up to 285 blood glucose, blood pressure, weight, and lipid profile, through holistic patient management by teaching self-care and behavior change.
million people out of 7.
53 billion people worldwide Conceptually, the nursing problems that may arise in (CHO.
Nam H.
, et al.
, 2.
In comparison.
Indonesia patients with diabetes mellitus are ineffective peripheral has some incidents of type II diabetes mellitus, currently perfusion, acute pain, nutritional deficits, unstable blood 3 million people.
It is expected to experience glucose levels, activity intolerance, impaired skin/tissue a very drastic increase to a range of 16.
7 million people in integrity, impaired physical mobility, disturbed sleep 2045 (Riskesdas, 2018 in Renaldi.
, et al.
, 2022 ).
patterns, risk of hypovolemia, and risk of infection (Tim Type II diabetes mellitus is a chronic disease with Pokja SDKI, 2.
metabolic disorders characterized by high blood glucose Seeing the many impacts of DM disease that interfere levels associated with the abnormal metabolism of with patients' basic needs, it should get attention from all carbohydrates, fats, and protein that can cause a decrease groups, including nurses.
The author conducts Nursing in insulin secretion or a reduction of adequate insulin Care for Type II Diabetes Mellitus patients held at the CHO.
Nam H.
, et al.
, 2.
Ciamis District Hospital.
The purpose of writing is to get More than half of the disease burden is Diabetes an overview of the implementation of nursing care in Mellitus due to an unhealthy lifestyle (CHO.
Nam H.
patients with Type II Diabetes Mellitus, starting from the , 2.
Other causes include age, obesity, family assessment stage to the evaluation.
history, and smoking (Militia.
Handayani, and Setiaji.
METHOD Diabetes mellitus can cause several nursing problems This study uses the case study method with a nursing that interfere with basic human needs.
So that care process approach, including assessment, data comprehensive care is needed (Sudoyo, 2.
analysis, diagnosis, planning, action implementation, and Acute symptoms of Type II DM patients consist of A case study was conducted on a patient polyuria .
requent urinatio.
, polydipsia .
lways wanting medically diagnosed with Type II Diabetes Mellitus at to drin.
, polyphagia .
ating mor.
, weight loss, malaise Ciamis Hospital.
or weakness, tingling, cramps, thick feeling on the skin.
Data was collected through anamnesis, physical drowsiness, blurry eyes, itching around the genitals, examination, and documentation studies.
After the data especially in women, loose and loose teeth, and decreased was collected, the authors grouped the data obtained from sexual ability (Fatimah, 2.
The short-term goal of DM the results of the assessment and the physical examination management is to eliminate DM signs and symptoms, results, then analyzed it so that a nursing diagnosis was maintain a sense of comfort and achieve blood glucose obtained according to the patient's condition.
The control targets.
Long-term: preventing and delaying the progress of microangiopathy, macroangiopathy, and interventions, actions, and evaluation processes to be neuropathy complications.
At the same time, the ultimate carried out.
The case study was carried out for three days goal of DM management is to reduce DM morbidity and of treatment .
-30 June 2.
To achieve this goal, it is necessary to control Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
because it seems to pee frequently.
BAK more or less 14 x in 24 hours = 4400 cc.
The patient can mobilize independently but is sometimes assisted by the family.
RESEARCH RESULT
The patient is a woman aged 60 years and nine months.
movement is limited to the right lower extremity.
The her last education is junior high school.
the patient is a patient complains of difficulty moving the right lower housewife medical diagnosis of Diabetes Mellitus Type II.
extremity and pain when moving the right leg.
The patient came to the hospital on June 27, 2022, with At the time of physical examination of the digestive complaints of a non-healing wound on the right leg.
system, the mouth looks dry, the mucous membranes are Patients also complain of weakness, lethargy, dizziness.
On the integumentary system, there is a wound on difficulty sleeping, and polyuria.
The patient said he had the right leg .
with a length of 5 cm and a width of 1 lost weight for 2 weeks from 50 kg to 44 kg.
In addition, with the primary color of the wound not being red, the patient complains of frequent tingling.
there is damage to the skin layer on the right lower During the assessment on Tuesday.
June 28, 2022, at The results of the assessment of muscle 00 WIB, the main complaint was pain in a gangrenous strength of the upper extremity 4, lower left extremity 4, wound in the lower right leg.
the pain felt like being and lower right extremity 3.
stabbed by a sharp object, the pain felt in the lower right Laboratory data showed Hb 8.
6 g/dL.
HCT 24.
extremity, pain scale 6 .
, intermittent pain, pain WBC 15.
6 mg%.
Neutrophils 84%, lymphocytes 10%, especially when the leg is moved.
fasting blood sugar 378 mg/dL, and creatinine 1.
The patient had Type II DM 2 years ago and had three mg/dL.
Patients received therapy with ceftriaxone, toes amputated, and the patient said he had never Metronidazole.
Ranitidine.
RL Ketorolac infusion, and exercised regularly.
The patient said none of his members Apidra .
had ever had/suffered from Type II DM/other genetic Nursing care The Nursing Diagnosis 1: Ineffective peripheral perfusion occasionally grimaces is restless, and has diaphoresis.
related to hyperglycemia Examination of vital signs showed: Blood pressure 130/90 Implementation: Check pulse, identify risk factors for mmHg.
ABI index 0.
76, pulse rate 121 x/minute, circulatory disorders, monitor heat, redness, pain, or respiratory rate 21 x/minute, temperature 36.
5THEC.
SpO2 swelling in the extremities, put infusions, take blood 96%.
BB 44 kg, height = 155 BMI = 18,314 (Les.
specimens, clean the outside of the wound.
Buerger Allen The patient did not finish the food served, but Exercise.
complained of hunger, drank 2200 cc of mineral water Nursing Diagnosis 2: Acute pain related to a physical with complaints of frequent thirst in the middle of the injurious agent night, slept only 2 hours at night in 24 hours, had difficulty Implementation:
sleeping because of pain and frequent vomiting, took half characteristics, frequency, intensity, scal.
, identifying an hour of naps, had difficulty sleeping because of pain non-verbal pain responses, providing deep breathing and complaints sleep dissatisfied.
Rest is not enough even relaxation techniques, advising rest, collaborating to though it is lying down, and sleeping seems complicated continue ketorolac drug therapy 1 g drip on RL infusion.
Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa Identifying .
JKM : Mahardika Health Journal Vol.
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September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
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Nursing Diagnosis 3: Nutritional deficit related to the teach relaxation .
on-pharmacologica.
with Benson inability to absorb nutrients Implementation: Identify food allergies/tolerances, ask Nursing Diagnosis 8: Risk for hypovolemia related to about food intake, weigh weight, perform oral hygiene, active fluid loss.
provide food at the appropriate temperature, provide food Implementation: monitor pulse rate, respiration, and BP.
according to nutritional therapy (DM die.
, education, weigh weight.
check skin turgor and counterbalance provide antacids, consult nutrition.
fluids every 24 hours.
identify signs and symptoms of Nursing Diagnosis 4: Impaired skin integrity related to monitor the risk of hypovolemia.
peripheral vascular damage the purpose and monitoring procedures.
Implementation: Wound care .
leaning the wound with NaCl, cutting necrotic tissue, applying wound dressings DISCUSSION according to the type of wound, maintaining sterile Found eight nursing diagnosiskjmjmhn in patients technique when treating wounds, explaining signs and Mrs.
D, namely ineffective peripheral perfusion related to symptoms of infection, giving antibiotics hyperglycemia, acute pain related to physical injury Nursing Diagnosis 5: Unstable blood glucose levels agents, nutritional deficits related to an inability to absorb related to insulin retention.
nutrients, impaired skin integrity related to damage to Implementation:
Identify peripheral blood vessels, unstable blood glucose levels hyperglycemia, check GDS, monitor signs and symptoms related to insulin retention, impaired physical mobility of hyperglycemia, monitor intake and output fluids, associated with pain, disturbed sleep patterns associated anticipate with other nurses if there are signs of with lack of sleep control, and the risk of hypovolemia hyperglycemia symptoms again, recommend a DM diet, associated with active fluid loss (DPP PPNI Pokja Team, give insulin Apidra 3 x 10 units.
Nursing Diagnosis 6: Impaired physical mobility related According to Kusuma .
in Putri.
to pain Signs and symptoms in DM sufferers, namely, fast thirst.
Implementation: Ask about pain / other physical frequent urination .
, drowsiness, fast hunger, complaints, see the general condition of the patient, weight loss, unusual fatigue and weakness, blurred vision, whether there is a decrease in the condition / not, invite healing of old wounds or infections recurrence, and the family to help with movement, especially the right darkening of the skin.
Based on Mrs.
Hunger increases extremity, recommend ambulation such as sitting, because most of the calories are lost in the urine.
Because walking, practicing ROM.
of this, patients often felt very hungry, causing them to Nursing Diagnosis 7: Disturbed sleep pattern related to overheat, and it took them a long time to recover from lack of sleep control This is in line with research conducted by Implementation: Identify activity and sleep patterns.
Syahid .
in Putri.
, which states that identify sleep-disturbing factors, establish a routine sleep type II DM patients experience rapid thirst, frequent schedule, set a comfortable position for rest, explain the urination .
, fatigue, and drastic weight loss.
importance of getting enough sleep during illness, and However, appetite remains high, and wound healing time is prolonged.
Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
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September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
Therefore one of the nursing interventions is physical PERIPHERAL PERFUSION IS INEFFECTIVE Based on the assessment of subjective data that exercise Buerger Allen Exercise in type 2 diabetes mellitus patients with ineffective peripheral perfusion.
supports nursing diagnoses ineffective peripheral The implementation of nursing given to patients perfusion related to hyperglycemia (D.
The major regarding peripheral perfusion nursing problems could criterion which is a requirement for the appointment of have been more effective, namely greeting, introducing this nursing problem is found in the patient Mrs.
D in the oneself, explaining the aims and objectives of building a form of complaints of tingling in the upper right trusting relationship, and asking about the patient's The results of the examination showed that the Identify the patient's understanding of the acral felt cold, the skin color was pale, the skin turgor disease by using the leaflet that has been provided, decreased, wound healing seemed to slow down, the explaining physical exercises Buerger Allen Exercise muscle strength of the extremities decreased to 4 in the regarding the patient's condition with the SOP and upper extremity, 4 in the left lower extremity, and 3 in the explaining the ABI examination that will be carried out right lower extremity.
ABI index 0.
Based on these using the SOP.
data, this diagnosis was appointed as a nursing diagnosis for Ny.
D Salam & Laili's research, .
states that Buerger Allen Exercise is given once for 6 days with a duration of Ineffective peripheral perfusion problems can be 15 minutes for each meeting, showing the result of an experienced by DM patients.
High glucose levels cause increase in lower extremity perfusion, namely the ABI obstacles in blood circulation, including to the peripheral The results of this study are certainly in line with area, so patients experience signs that lead to decreased the results of research conducted by Amalia .
, which circulation in the peripheral area.
clearly states that there is a very significant and effective The nursing interventions provided refer to Indonesian change in improving the peripheral circulation of the nursing intervention standards: circulation care (I.
lower extremities in diabetes mellitus patients by The activities carried out are checking the pulse, increasing the ABI value in the patient's limbs.
risk factors On day two, on December 29, 2022.
WIB obtained monitoring heat, redness, pain, or swelling in the subjective data: Mrs.
D said the patient said pain in the extremities, placing infusions, taking blood specimens, right extremity on a scale of 5, and tingling was reduced.
cleaning the outside area of the wound, and Buerger Allen Then the objective data: the acral feels warm, the skin Exercise.
color is no longer pale, the skin turgor is improving, there The arterial or peripheral narrowing can be assessed are no significant signs of wound healing, the muscle and measured through non-invasive examinations, one of strength of all extremities is 4, and the ABI index is which is by examination ankle brachial index (ABI) Assessment: peripheral perfusion diagnosis partially which functions to detect clinical signs and symptoms of Planning: continue the intervention.
a decrease in peripheral perfusion which can then result in angiopathy and diabetic neuropathy (Anugrah & Sari.
ACUTE PAIN Based on the results of the assessment of subjective data that supports nursing diagnoses, acute pain Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
associated with an agent of physical harm (D.
On December 29, 2022.
WIB obtained subjective data characterized by Subjective data: p: the patient says pain on day two: Mrs.
D said the patient says the pain scale is because there is a gangrened wound in the right lower at number 5 .
Then Objective data: grimacing extremity, q: pain feels like being stabbed by a sharp decreased, the patient is no longer restless, difficulty object, r: pain feels in the right lower extremity, s: the sleeping decreased, pulse = 117 x / min.
BP = 130/90 client's pain scale is 6 .
- .
, t: intermittent pain, with mmHg, respiration = 19 x / min, the patient is no longer pain when moving the right leg.
Objective data: the patient Assessment: acute pain diagnosis partially looks grimacing and agitated and seems difficult to sleep Planning: continue the intervention.
because he often pees.
pulse = 121 x / minute.
BP = 130/90 mmHg, respiration = 21 x / minute.
the patient looks NUTRITION DEFICIT Then the goal of nursing is pain level (L.
with Based on the assessment of subjective data that the outcome criteria: complaints of pain decreased on a supports nursing diagnoses, nutritional deficit related to scale of 4 .
, grimacing decreased, the patient was no the inability to absorb nutrients (D.
is longer restless .
, difficulty sleeping decreased, characterized by subjective data: the patient said he did pulse frequency improved in the range of 80-120 x / not want the porridge, so he ate only a little but minute.
BP improved in the range of TDS 120- 130 complained of hunger.
Objective data: BB = 44 kg.
BMI mmHg.
BP = 80-85 mmHg, breathing patterns improved = 18.
3, pale mucous membranes, hair loss, bowel sounds in the range of 16-20 x/minute, and the patient was no 17 x / minute.
longer diaphoretic.
The Then the goal of nursing is the nutritional status (L.
with the outcome criteria: The food pattern that management (I.
, namely by identifying pain has been measured is spent.
BB has improved to 45-46 kg, .
ocation, characteristics, frequency, intensity, scal.
BMI has improved to > 18.
4, mucous membranes are no identifying non-verbal pain responses, providing deep longer pale, hair is no longer falling out, noises improve in the range of 3-16 x/minute.
collaborating to continue ketorolac drug therapy 1 gram drip on RL infusion.
The nursing interventions provided are nutrition management (I.
, namely by identifying food Neuropathy and vascular disorders are the main allergies/tolerances, asking about food intake, weighing factors contributing to the incidence of injuries.
weight, doing oral hygiene, giving food at the appropriate that occur in diabetic patients are related to the influence temperature, giving food according to nutritional therapy of nerves in the feet or hands, known as peripheral (DM die.
, education, giving antacids, consulting neuropathy, which can cause patients to feel pain in these Hamiddum .
0 ).
The intervention aims to Nursing actions are given to Mrs.
D according to the reduce the level of pain felt by the Pokja DPP PPNI Team, management of type 2 diabetes mellitus according to Hamiddum .
applied breathing relaxation Damayanti .
in Renaldi.
, et al.
, .
techniques to manage cases, significantly reducing pain levels to increase comfort and relaxation.
monitoring, and pharmacological therapy.
Education is .
Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa .
JKM : Mahardika Health Journal Vol.
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September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
education or training regarding knowledge and skills in Then the goal of nursing is skin and tissue integrity managing diabetes mellitus given to each patient with (L.
with the outcome criteria: pain complaints diabetes mellitus.
Providing education includes basic decreased to a scale of 4, decreased tissue damage, knowledge about diabetes mellitus, meal planning, decreased skin layer damage.
physical activity, and foot care.
Furthermore, nutritional The nursing interventions provided are: wound care or diet therapy can be carried out with the 3J principle, (I.
, namely by wound care .
leaning the wound namely the right amount, schedule, and type.
with NaCl, cutting necrotic tissue, applying wound The implementation of nursing care actions carried out dressings according to the type of wound, maintaining is to carry out a diet therapy program for clients, which is sterile technique when treating wounds, explaining signs carried out for two days, accompanied by daily GDS and symptoms of infection, giving antibiotics.
Ignorance of diet is one of the efforts to Diabetic neuropathy is nerve damage with a focal or achieve treatment goals in type 2 diabetes mellitus diffuse nature that occurs due to exposure to chronic patients, so the health education is needed in type 2 DM hyperglycemia, which has signs and symptoms of Renaldi.
, et al.
, 2022 ).
tingling, pain, numbness, and numbness (Kengne, 2.
According to Damayanti .
in Renaldi.
, et Anugrah and Sari, 2.
Neuropathy complications can , .
2 The purpose of meeting the nutritional needs of develop into diabetic ulcers.
Diabetic ulcers are open clients with diabetes mellitus is to maintain or achieve wounds on the skin's surface and are accompanied by local body weight within normal limits or A 10% of ideal body tissue death.
Declinesensibilityis one of the leading causes weight, maintain blood glucose and lipid levels close to of ulcers.
(Sulistiari, 2013in Anugrah and Sari, 2.
normal, prevent acute and chronic complications and improve quality of life.
Wound care is caring for wounds and applying bandages to prevent cross-infection .
ntering through the Evaluation on day two on December 29, 2022.
WIB woun.
and speed up the wound-healing process obtained subjective data: Mrs.
D said the food that was (Delmafildasari, 2.
in Hidayah.
Astuti, & Kartika, measured out.
Then objective data.
BB = 44.
5 kg.
BMI = Therefore the most essential nursing action is 5, mucous membranes are no longer pale, hair does not wound care (Pokja DPP PPNI Team, 2.
Wound care .
leaning the wound with NaCl, cutting x/minute.
Assessment: partially resolved nutritional deficit necrotic tissue, applying wound dressings according to the Planning: continue the intervention.
type of wound, maintaining sterile technique when SKIN INTEGRITY DISORDERS treating wounds, explaining signs and symptoms of Based on the assessment of subjective data that supports nursing diagnoses, impaired skin integrity infection, and giving antibiotics (Pokja DPP PPNI Team, related to peripheral vascular damage (D.
Hidayah.
Astuti, & Kartika .
implementing one characterized by Subjective data: The patient says pain in of the implementations that can reduce the risk of the right lower extremity with a scale of 6 .
infection, namely wound care with 0.
9% NaCl.
Normal Objective data: there is a wound on the right leg with a saline (NS) fluid or 0.
9% sodium chloride .
9% NaC.
is length of 5 cm and a width of 1 cm.
There is damage to a liquid that is recommended as a wound cleanser because the skin layer on the right lower extremity.
Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
normal saline fluid has the same composition as blood monitoring signs and symptoms of hyperglycemia, plasma so it is safe for the body (Arsianty, 2.
monitoring intake and output fluids, anticipating with As Kristiyaningrum & Suwarto .
in Hidayah, other nurses if there are signs of hyperglycemia symptoms Astuti, & Kartika, .
opinion, the solution that is again, recommend a DM diet, give insulin Apidra 3 x 10 often used to treat diabetes mellitus wounds is 0.
9% NaCl.
Because 0.
9% NaCl solution is also an adequate Diabetes is a disturbance in metabolism marked by physiological fluid for wound care because it matches the body's salt content.
The function of 0.
9% NaCl for wound carbohydrate, lipid, and protein consequences, declined care can also moisturize the wound bed to keep it moist.
secretion of insulin or declined insulin sensitivity, or both Evaluation on day two on December 29, 2022.
WIB of which raises complications chronic, microvascular, obtained subjective data: Mrs.
D said the pain scale is 5.
macrovascular, and neuropathy.
(Tjokroprawiro, 2.
Then objective data: tissue damage has decreased with a Based on this, there is no gap between real cases and wound length of 4.
8 cm and a wound width of 1 cm, and the theory of diabetes mellitus and nutritional theory.
skin layer damage has not decreased.
Assessment:
Theoretically, the signs and symptoms of diabetes are diagnosis of impaired skin integrity is partially blood sugar levels that exceed normal limits so that Planning: continue the intervention.
sometimes clients react weakly and dizzy.
(Renaldi.
et al.
, 2022 ).
Step One Monitor fluid intake and output.
The importance of monitoring nutrition and performance to INSTABILITY OF BLOOD GLUCOSE LEVELS determine the type and amount of food eaten daily as well Based on the results of the assessment of subjective as nutritional needs Nutrition is a specific way to regulate data that supports nursing diagnoses, unstable blood the amount, type, and intake of food to maintain health, glucose levels related to insulin retention (D.
nutritional status, and the healing process to prevent or characterized by subjective data: patients complain of dizziness, patients complain of lethargy, patients This is in line with the results of research by Susanti complain of hunger, patients say they often feel thirsty in and Bistara .
in (Hasanuddin.
that diet the middle of the night.
Objective data: dry mouth, amount plays an important role, especially in DM patients who of urine = 3000 cc, fasting blood sugar level = 378 mg/dL.
cannot regulate their diet properly based on 3J.
this causes Then the goal of nursing is Blood Glucose Stability an increase in blood sugar levels in sufferers.
Therefore, (L.
with the outcome criteria: decreased dizziness, food intake for DM sufferers needs to be considered.
The second intervention is to control blood sugar.
decreased thirst complaints, no longer dry mouth.
DM sufferers, changes in blood glucose levels can occur decreased urine output to 200-2500 cc/day, decreased anytime and dictate the patient's planned calorie blood sugar levels in the range of 125-280 mg/dL.
(Tarwoto.
Wartona, taufiq, & Muliati, 2012in The nursing interventions provided are management Hasanuddin.
, 2.
of hyperglycemia (I.
, namely by identifying The third intervention is counseling on diet programs.
possible causes of hyperglycemia, checking GDS.
Based on the research of Susanti and Bistara .
, if you Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
do a diet program using the 3J principles .
chedule, type, neurological or physical injuries.
ROM (Range Of and amoun.
regularly, this causes blood glucose to be Motio.
exercises are repeatedly performed on the ankles within the normal range (Hasanuddin.
of patients with diabetes mellitus and muscle weakness.
On day two, on December 29, 2022.
WIB obtained Following RAMLI Research.
application subjective data: Mrs.
D said the patient said he still had of passive Range Of Motion (ROM) joint movement in dizziness, and lethargy, still said he was often hungry, and older adults with diabetes mellitus with nursing problems complaints of thirst had decreased.
Then objective data:
with physical mobility disorders at UPT Panti Tresna the mouth is not dry, amount of urine 525 cc/ 5 hours.
Wardha Hargo Dedali Surabaya with the results obtained GDS = 310 mg/dL.
Assessment: diagnosis of unstable after implementing Range Of Motion exercises (ROM) for blood glucose levels is partially resolved.
Planning:
three days inpatient one and patient two limb muscle continue the intervention.
strength in both patients increased considerably.
Namely.
Mrs.
D, on a scale of 3 .
, can move against
PHYSICAL MOBILITY IMPROVEMENTS
gravity, and 4 .
can move with maximum load.
Based on the assessment of subjective data that While at Mrs.
I on the left lower extremity, on a scale of supports nursing diagnoses.
Impaired physical mobility 3 .
able to move against gravity, to 4 .
able related to pain (D.
is characterized by subjective to move with maximum load.
This study concludes that data: the patient complains of pain when moving the right there is an increase in passive ROM in patients with Objective data: limb muscle strength decreased to 4 diabetes mellitus with nursing problems and impaired upper extremities, 4 lower left extremities, and 3 lower physical mobility.
right extremities, limited movement in the right lower extremity, and the patient looked physically weak.
On day two, on December 29, 2022.
WIB obtained subjective data: Mrs.
D said pain decreased to a scale of 5 Then the goal of nursing is Physical Mobility (L.
Then objective data: it can be seen that there is an 05.
with the outcome criteria: Decreased pain, increase in limb movement and muscle strength of all 4 increased limb movement, increased limb muscle strength limbs, the patient's limited movement decreases, and to 5 in the upper extremity, 5 in the lower left extremity, weakness decreases.
Assessment: partially resolved the 4 in the right lower extremity, decreased limited diagnosis of movement, decreased physical weakness.
continue the intervention.
impaired physical Planning:
The nursing interventions provided are Ambulation Support (I.
namely by asking about pain / other SLEEP DISORDER physical complaints, seeing the general condition of the Based on the results of the assessment of subjective patient whether there is a decrease in the condition / not, data that supports nursing diagnoses of sleep pattern inviting the family to help with movement, especially the disturbance related to lack of sleep control (D.
right limb, recommending ambulation such as sitting, characterized by subjective data: Patients complain of walking, practicing ROM.
difficulty sleeping because of gangrene wound pain and Diabetes mellitus is a group of metabolic disorders frequent urination, patients complain of dissatisfied sleep, characterized by increased blood sugar, which can lead to patients complain of insufficient rest even though they are complications of neuropathy.
To avoid stiffness due to Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
lying down.
Objective data: visible patient activity assisted by the family.
HYPOVOLEMIA RISK
Based on the results of the assessment of subjective Then the goal of nursing is Sleep patterns (L.
data that supports nursing diagnoses risk of hypovolemia 05.
with the outcome criteria: decreased complaints of evidenced by active fluid loss (D.
are subjective difficulty sleeping, decreased complaints of sleep data: Patients say they often feel thirsty in the middle of dissatisfaction, decreased complaints of insufficient rest, the night.
Objective data: pulse = 121 x/min, blood and increased activity ability.
pressure 130/90 mmHg, respiratory rate 21x/min, pale The nursing interventions provided are: Sleep support (I.
, namely by identifying activity and sleep mucous membranes.
Hb 8.
6 mg/dL.
Ht 24.
8 g/dL.
BW = 44 kg.
patterns, identifying sleep-disturbing factors, setting a Then the goal of nursing is the fluid status (L.
routine sleep schedule, setting a comfortable position for with the outcome criteria: decreased thirst complaints, resting, explaining the importance of getting enough sleep increased skin turgor, pulse rate improved in the range of during illness, teaching relaxation .
on-pharmacologica.
80-120 x / minute.
BP improved in the range of 120-130 with Benson relaxation.
mmHg TDS.
BP = 80-85 mmHg, improved breathing Diabetes is characterized by typical symptoms, pattern in the range of 16-20 x/minute, mucous including polyuria and frequent urination at night.
membranes improve.
Hb levels improve between 10-12 often have to go to the toilet to urinate, causing patients to g/dL.
HT levels improve between 35-45 g/dL, body experience sleep disturbances.
Inadequate quality and weight improves to 44.
5-46 kg.
quantity of sleep in people with diabetes mellitus cause The nursing interventions provided are: fluid reduced insulin sensitivity, which causes an increase in monitoring (I.
namely monitoring pulse rate, blood sugar.
(WARDANI.
, 2.
BP, weighing weight, checking skin turgor.
One of the proper relaxation methods for overcoming counterbalance fluids every 24 hours.
identifying signs insomnia is the Benson relaxation technique because it and symptoms of hypovolemia, monitoring the risk of incorporates elements of the patient's beliefs so that it hypovolemia, explaining the purpose and monitoring creates a stronger relaxation response because it aims to calm mental strength so that it helps the patient's healing Regardless of the type of dehydration .
sosmotic, with research showing that the use of Benson hypoosmotic, or hyperosmoti.
, isotonic fluids should be relaxation can reduce sleep disturbances in diabetic the first fluid administered to promote effective perfusion.
(WARDANI.
, 2.
In this case.
Ringer's lactate.
Ringer's acetate, and 0.
Evaluation on day two on December 29, 2022.
WIB NaCl are often used (Prabowo.
, 2.
obtained subjective data: Mrs.
D said the patient says it is Intravenous (IV) therapy is used to provide fluids difficult to sleep occasionally, the patient says he is a little when the patient is unable to swallow, is unconscious, satisfied .
, still complains of insufficient rest, and dehydrated, or in shock, provides the salt needed to occasional activities are assisted by the family.
maintain electrolyte balance or glucose needed for Assessment:
metabolism, and administers drugs.
(Perry & Potter.
Planning: continue the intervention.
2006in BHAYANGKARA.
, & HASTUTI.
Yestika Saleha.
Triya, et al.
Nursing Care Of Type Ii Diabetes Mellitus Patientsa JKM : Mahardika Health Journal Vol.
No.
September 2023, pp 113 ISSN: 2355-0724.
DOI: 10.
54867/jkm.
Evaluation on day two on December 29, 2022.
WIB obtained subjective data: Mrs.
D said thirsty groans Then Objective data:, skin turgor improved, pulse = 117 x / min.
BP = 130/90 mmHg.
RR = 19 x / min.
Dalam Mengatasi Masalah Perfusi Perifer Tidak Efektif.
Well Being, 7.
, 34-42.
Aini, .
Teori Model Keperawatan:
Keperawatan (Vol.
UMMPress.
mucous membranes improved.
Hb = 9.
1 g/dL.
Ht = 33 Anugrah.
, & Sari.
Asuhan g/dL g/dL.
BW = 44.
5 kg.
Assessment: the risk of Keperawatan Perfusi Perifer Tidak Efektif Dengan hypovolaemia has been resolved.
Planning: stop the Pasien Perawtan Kaki (Foot Car.
Jurnal Ilmu Kesehatan Diabetes Melitus Melalui Manajemen Mandira Cendikia, 1.
, 32-38.
CONCLUSION
The author has conducted a study on Mrs.
D, which was carried out for 2 x 7 hours.
the steps used in the assessment Arsianty.
P .
Konsep Dasar Menejemen Perawatan Luka.
Jakarta: Kedokteran EGC.
Bhayangkara.
, & Hastuti.
Gambaran were the case study method with interviews, observation.
Tindakan Pemberian Monitor Hidrasi Untuk carrying out physical examinations, and documenting the Mengatasi Defisit Volume Cairan Pada Anak AuRAy .
Evaluation after carrying out nursing actions in Cho.
Shaw.
Karuranga.
Huang.
, da accordance with the nursing action plan, an evaluation is Rocha Fernandes.
Ohlrogge.
, & Malanda, carried out to find out and monitor progress and to assess .
IDF Diabetes Atlas: Global estimates of the level of success of the nursing actions that have been diabetes prevalence for 2017 and projections for carried out on Mrs.
The results of the evaluation carried Diabetes research and clinical practice, 138, out for two days ineffective peripheral perfusion related to partially resolved hyperglycemia, acute pain related to Djauhar, dkk.
Gambaran Perawatan Luka partial physical injury agents, nutritional deficit related to Diabetik Pada Pasien Diabetes.
iakses pada 12 an inability to absorb nutrients partially resolved.
Januari impaired skin integrity related to peripheral vascular http://ejournal.
id/index.
php/jikd damage partially resolved, unstable blood glucose levels associated with insulin retention partially resolved, impaired physical mobility associated with pain partially Fatimah.
Diabetes melitus tipe 2.
Jurnal Majority, 4.
(Fitria Rahmadani.
Studi Literatur: Asuhan resolved, disturbed sleep patterns associated with lack of Keperawatan sleep control partially resolved, and risk of hypovolemia Diabetes associated with fluid loss actively resolved.
So good and Keperawatan Kerusakan Integritas appropriate nursing care starting from assessment to Jaringan (Doctoral Universitas evaluation needs to be done properly, so that the patient's Muhammadiyah Ponorog.
recovery rate increases Pada Mellitus Pasien Dewasa Penderita Ganggren Dengan Masalah Hamiddum Majid.
Asuhan Keperawatan Pada Ny.
D Dengan Penerapan Terknik
REFERENCE