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1. I. Introduction
Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson
syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused
by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic
syndrome and nodular glomerulosclerosis. It is due to longstanding diabetes mellitus, and
is a prime cause for dialysis in many Western countries. Discovered by British physician
Clifford Wilson (1906-1997) and German-born American physician Paul Kimmelstiel
(1900-1970) and was published for the first time in 1936.
Causes
The exact cause of diabetic nephropathy is unknown, but it is believed that
uncontrolled high blood sugar leads to the development of kidney damage. In some cases,
your genes or family history may also play a role. Not all persons with diabetes develop
this condition. Each kidney is made of hundreds of thousands of filtering units called
nephrons. Each nephron has a cluster of tiny blood vessels called a glomerulus. Together
these structures help remove waste from the body. Too much blood sugar can damage
these structures, causing them to thicken and become scarred. Slowly, over time, more
and more blood vessels are destroyed. The kidney structures begin to leak and protein
(albumin) begins to pass into the urine. Persons with diabetes who have the following
risk factors are more likely to develop this condition:
Signs & Symptoms
• Early signs and symptoms of kidney disease in patients with diabetes are typically
unusual. However, a vast array of signs and symptoms listed below may manifest
when kidney disease has progressed:
• Swelling, usually around the eyes in the mornings; later, general body swelling
may result, such as swelling of the legs
• Foamy appearance or excessive frothing of the urine
• Unintentional weight gain (from fluid accumulation)
• Fatigue Frequent hiccups
• General ill feeling
• Generalized itching
• Headache
• Nausea and vomiting
• Poor appetite
• Weakness, paleness, and anemia
• Ankle and leg swelling, leg cramps
• Going to the bathroom more often at night
• High blood pressure

2. III. Nursing Health Management
A. Biographical Data
NAME: Mr. A.
ADDRESS: Longos, Malabon
AGE: 9 years old
SEX: Male
NATIONALITY: Filipino
RELIGION: Roman Catholic
BIRTHDAY: June 22, 1939
STATUS: Married
OCCUPATION: Student
ADMISSION DATE: February 19, 2009
ADMISSION TIME: 10:34 am
B. Chief Complaint: fever, abdominal pain
Clinical Diagnosis: Dengue Fever Syndrome
C. History of Present Illness
A week Prior to Admission (PTA), at around 3 in the afternoon, the patient was
confined at Tondo General Hospital with a chief complaint of easy fatigability, back pain
and swelling of both legs and face and an admitting diagnosis of diabetic nephropathy
with severe anemia.
Few hours PTA, the patient suffered chest pain, dizziness and cough while she
was doing household chores (Sweeping, washing clothes, etc.). Thereafter, she took a
pain reliever medication to ease the pain and an “” applying it unto her chest. Her
sleeping pattern was also affected as she could not sleep well. However, easy fatigability,
back pain and swelling of her both legs & face worsen her condition. Thus, prompted her
family to confine her at said hospital.
Several tests (Hematology & Urinalysis) had been made and she was diagnosed with
Diabetic Nephropathy with severe anemia. Captropil 25 mg SL 1tab bid & furosemide

3. was given as her initial treatment. However, her condition persisted and she did not
respond to medication and treatment given to her while she was confined on the said
hospital. Thus, she was referred by her doctor to Eastern Samar Provincial Hospital for
further examination and treatment.
D. Past Medical History
Medical History
Sometime in 1994, as recalled by the patient, she was diagnosed with Diabetes
Mellitus Type 2 by a private Medical Doctor. Diamicron was given as her medication for
her everyday maintenance but she failed to follow the Doctor’s order. Last year on the
month of October she was confined at EVRMC due to swelling of her both legs and was
diagnosed with Diabetic Nephropathy. Her condition was temporarily relieved. Thus, her
physician permitted her to go home.
Surgical History
No surgery performed.
Obstetric/Gynecologic History
G-6 T-4 Pre-term-2 A-0 L-4
1952, as recalled by the patient, she had her first menstruation. Based on her it is
regular and an average of 3-4 days per period. She used 2-3 pads of sanitary napkin per
day.
E. Family History

4. UNRECALLED DM CARDIOVASCULAR
ATTACT TB
DM HYPERTENSIVE
DM ASTHMA A+W
LEGENDS
--- DECEASE PATIENT
---MALE DM--- DIABETES MELLITUS
TB----TUBERCULOSI
A+W—ALIVE AND WELL
----FEMALE
F. Socio-economic History
Father
Grand Mother
Mother
Grand Mother Grand Father
Sibling Sibling Sibling
DIABETES
NEPHROPATHIC
PATIENT
Grand Father

5. Mrs. A has a small sari-sari store where she spends most of her time. This store is
there primary source of income. She’s fond of eating sweet foods. She is a smoker, she
begin smoking in her younger years. She can consume 3 sticks in a day just after eating
her meals. She also drinks tuba and beer occasionally. However she quitted smoking due
to diabetes mellitus.
G. Environmental History
Mrs. A and her husband lives in Tondo Manila. A sari-sari store is in their front
yard, this keeps her busy every day. Fruit trees are visible in their vicinity. Water supplies
for drinking, cooking, washing are taken from a communal faucet near at their comfort
room. Food preparation is usually done by her. They usually store their food in the
refrigerator. They have a pail flush type toilet located at the back of their house. They
throw their garbage in their compost pit located at their backyard before.
H. Gordon’s Typology of Eleven Functional Health Pattern
Functional Pattern Pre-illness State Illness State Analysis
Health Perception/ Health
Management
According to her,
health is just how
you treated
yourself and she
managed it by
maintaining her
personal hygiene.
Health is not only
based on taking
good care of your
hygiene but also
maintaining your
balance diet.
She realized that
her present
condition is due to
her wrong
perception and
management of
health.
Nutritional/Metabolic
Pattern She drinks 3
glasses of water
per day.
Break fast:
7:00am
According to her,
she usually eats
Pancit and 5pcs
of pandesal every
morning.
Lunch:
2 cups of rice and
viand.
She drinks 4-6
glass of water a
day.
Consider her
present condition
she eats small
amount of food.
Drinking of water
has been increase.
While her eating
pattern has been
decrease due to her
condition.

6. Dinner:
1 ½ cups of rice
and viand.
Elimination Pattern She defecates
once a day
usually every
morning.
She has
infrequent
urination.
She defecates
twice a day
usually every
morning and/or
after eating heavy
meal.
Because of her
increase fluid in
take such as
drinking water,
she usually
urinates 3x a day
or more.
Exercise Pattern According to her.
She often clean
their house every
morning
Based on her, she
usually jogs at
least 2m 3x a
week
She is more
conscious on her
physical fitness.
Cognitive Pattern She is well
educated and can
speak and
understand
English fluently
She is well
educated and can
speak and
understand
English fluently
Her cognitive was
not altered by her
decease
Sleep/rest Pattern Mrs. A sleeps at
around 5 – 7 pm
and
wakes up
around 4 – 6 am
Because of her
Condition He
cannot sleep well.
Sleeping
pattern has
been interrupted
due to the
recent condition
Self Perception Pattern She perceive her
self young
appealing woman
According to her,
she feels envy to
other aged woman
who is still
physically fit.
She has poor self-
esteem due to her
condition.

7. Relationship Pattern She is friendly
and social drinker
She quitted
drinking
Her relationship to
other does not
change
Sexual/Reproductive
Pattern
She perceive her
self as a
disciplinarian
mother and a
loving wife
She perceive her
self as a
disciplinarian
mother and a
loving wife
Her
sexual/reproductiv
e was not altered
by her decease
Coping/Stress Tolerance
Pattern
Her strength is
her family and
when they bond
she forgot all her
problems
She spent most of
her time with her
family
Her coping stress
tolerance was not
altered by her
decease
Values/Belief Pattern She believe in
God but she is not
religious.
She value his
family and now
has a great faith in
God.
She Knows that
God Can only help
Her
H. Review of System
General Survey:
“madali akong mapagod, di ko rin makain ang gusto ko lalu na pagbawal” as
verbalized by the patient
Skin:
“pawisin ako at paring ang dali kong masugatan” as verbalized by the patient
Head:
“madalas sumakit ang ulo ko” as verbalized by the patient
Eyes:
“Madalas manlabo ang mata ko” as verbalized by the patient
Ears:
The patient denies the onset of hearing problem.
Nose:
Colds and itchiness
Throat:
“maya’t maya akong lunok feeling ko kasi lagging tuyo ang lalmunan ko.
Malakas ako sa tubig” as verbalized by the patient
Neck:

8. “madalas naakakaramdam ako ng pagsakit ng batok lalo na pag pagod” as
verbalized by the patient
Breast and Axillae:
The patient denies the masses or pain on her breast.
Respiratory:
“pag sobra akong pagod hinahabol ko ang hininga ko” as verbalized by the patient
Cardiovascular system:
“ganon din, sap ago parang aatakin ako ng altrapresyon” as verbalized by the
patient
Gastrointestinal:
“parang lagi akong gutom, gusto ko maya maya kain” as verbalized by the
patient
The patient denies difficulty in defcation.
Genitor Urinary:
“madalas akong umihi pero minsan patak patak at minsan sobrang dami tapos
nilalanggam” as verbalized by the patient
Musculoskeletal:
“naigagalaw ko naman ang mga kamay at paa ko , pwera lang pag my manas” as
verbalized by the patient
IV. Physical Assessment

9. Note: all of the details below are based upon assessment
General Survey: Mrs. A has a good body build. She has a good posture and gait. Her
hygiene was kept. Her voice was not too loud, it is clear and understandable.
Vital Signs:
Temp.: 37.7
˚C
BP: 180/90mmHg
RR: 21bpm
PR: 98cpm
Skin:
Color is good, warm to touch. Cyanosis is not presence and normal skin turgor.
Lesion or gangrene especially on the lower extremities is absence. Edema on the pedal
part w/ pitting of 22.4mm
Hair:
Oily thick and evenly distributed.
Nails:
The texture is smooth, no clubbing and slight cyanosis. Poor blanch test (return on
original color after 4sec.)
Head:
Normocephalic, symmetric, no lesion or lumps.
Eyes:
Symmetric eyebrow and eyelashes. No lesion or masses. Reddish conjunctiva and
sclera. Pupils are equally round but unreactive to light and accommodation. Retinal
pathology was not able to performed due to lack of instrument.
Ears:
Acuity is good to whispered voice. Its texture is smooth and has a good pinna
recoil. Weber Test and Rinne’s Test, tympanic membrane was mot able to assess due to
lack of instrument.
Nose:
No discharges and lesion. Nasal septum at the medline. Pink nasal mucosa no
sinusitis tenderness.
Oral Cavity:

10. Lips are pink and moist. No lesion and masses. Oral mucosa is pink an moist.
Presence of Kussmaul Breathing (fruity acetone breathing). Uvula at the midline. Good
gag reflex and Polyphagia.
Neck:
Trachea and Thyroid gland is located at the midline. Lymph nodes are non
palpable except t the submandibular.
Breast and Axillae:
No lesion, symmetric and w/o masses. Nipples are w/o discharge and lesion and
masses. Lymph nodes on the axillae are non palpable.
Thorax and Lungs:
Symmetric has a good expansion. No lesions and masses are present. Lungs is
resonant, and vesticular breath sound. Diaphragm descend 4cm bilaterally.
Cardiovascular system:
The jugular venous pressure is 3cm above the sternal angle. Strong Pulsation on
aortic, pulmonic, erg’s point, tricuspid, mitral. No heart murmur and normal peripheral
pulsation.
Abdomen:
Absence of lesion. Bubonic auscultation is good. Tympanic percussion is also
good. Masses are not palpable. Liver is 6cm in midsternal line and 10cm in right
midclavicular line.
Musculoskeletal:
Good ROM on the upper extremities. Edema is present on the lower extremities.
Neurologic:
Level of Consciousness: Upon assessment, Mrs. A is oriented in time, place and
her personal identity
Glasgow Coma Scale: she has a total score of 15; it indicates that she is aware
and conscious.
Reponses Evaluation
Eye Response Mrs. A has a grade of 4. She is
spontaneous and alert. (upon assessment)
Verbal Response Mrs. A has a grade of 5. She is oriented and
converse on what is happening. (upon
assessment)
Motor Response Mrs. A has a grade of 6. She is alert on
verbal command and can follow instruction
easily. (upon assessment)

11. Cranial Nerve Assessment
I - Olfatory Sensory: the patient is able to
differentiate the smell of a perfume and
coffee
II- Optic Sensory: the patient has a poor visual
acuity. She is nearsightedness prove by 5
inches distance in 12 size Times New
roman font
III-Occulomotor Motor: she has a good medial ocular
movement
IV-Troclear Motor: she has a good downward and
inward deviation
V-Trigeminal Sensory: good blink reflex
Motor: good eyebrow resistance
VI-Abducens Motor: she has a good lateral deviation
VII-Facial Sensory: good sense of taste by
differentiating the vinegar from soy
sauce
Motor: she can smile, puff her cheeks
and smile
VIII-Acoustic Sensory
Vestibular: Has a Good balancing base
on Romberg’s test
Cochlear: good hearing acuity and
IX-Glossopharyngeal Sensory: has a good sense of taste on the
posterior 1/3 of the tongue
Motor: the patient has a good gag reflex
X-Vagus Sensory: the patient has a good gag
reflex
Motor: the patient has no difficulty in
swallowing
XI-Accesory Motor: the patient has a strong resistance
on
XII-Hypoglossal Motor:
Motor Reflexes:
The patient as good relflexes
VI- Anatomy and Physiology

12. THE ENDOCRINE SYSTEM
The nervous system sends electrical messages to control and coordinate the body.
The endocrine system has a similar job, but uses chemicals to “communicate”. These
chemicals are known as hormones. A hormone is a specific messenger molecule
synthesized and secreted by a group of specialized cells called an endocrine gland. These
glands are ductless, which means that their secretions (hormones) are released directly
into the bloodstream and travel to elsewhere in the body to target organs, upon which
they act.
Function
The Endocrine system is an information signal system much like the nervous
system. However, the nervous system uses nerves to conduct information, whereas the
endocrine system mainly uses blood vessels as information channels. Glands located in
many regions of the body release into the bloodstream specific chemical messengers
called hormones. Hormones regulate the many and varied functions of an organism, e.g.,
mood, growth and development, tissue function, and metabolism, as well as sending
messages and acting on them.
Role in disease
Diseases of the endocrine system are common, including diseases such as diabetes
mellitus, thyroid disease, and obesity. Endocrine disease is characterised by dysregulated
hormone release (a productive Pituitary adenoma), inappropriate response to signalling
(Hypothyroidism), lack or destruction of a gland (Diabetes mellitus type 1, diminished
erythropoiesis in Chronic renal failure), or structural enlargement in a critical site such as
the neck (Toxic multinodular goitre). Hypofunction of endocrine glands can occur as
result of loss of reserve, hyposecretion, agenesis, atrophy, or active destruction.
Hyperfunction can occur as result of hypersecretion, loss of suppression, hyperplastic, or
neoplastic change, or hyperstimulation. Endocrinopathies are classified as primary,
secondary, or tertiary. Primary endocrine disease inhibits the action of downstream
glands. Tertiary endocrine disease is associated with dysfunction of the hypothalamus
and its releasing hormones.
Cancer can occur in endocrine glands, such as the thyroid, and hormones have
been implicated in signalling distant tissues to proliferate, for example the Estrogen
receptor has been shown to be involved in certain breast cancers. Endocrine, Paracrine,
and autocrine signalling have all been implicated in proliferation, one of the required
steps of oncogenesis.
VII-Pathophysiolgy

13. Diabetic
Nephropathy
Diabetic
Nephropathy
Thickening in
the Glomerulus
Tissue resistance to
insulin
Glucose cannot enter
target cell
Insulin production by
pancreas/hyperinsulinemia
Impaired insulin
Production
Diabetic
Nephropathy
Pressure of the
blood vessel in the
urine
Ineffective
insulin
Chronic kidney
Failure
Stress kidney
filtration
mechanism
Diminished intracellular
Reaction
Peripheral resistance to
insulin
Glucose accumulation
in blood
stream/hyperglycemia
Altered pancreas
insulin secretion
Increase
production of
glucose in the liver
Production of glucose in
the liver
Diabetes Mellitus

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