The document provides information about diabetes nephropathy, including a patient's profile and physical assessment. It discusses the liver, biliary system, and pancreas structures and functions. The patient profile is for a 47-year-old male with a history of smoking, alcohol use, and sexually active lifestyle. His physical assessments over three days show jaundice and signs of a gallbladder issue. The document also provides anatomy and physiology sections on the liver, biliary system, and pancreas.

1. Bataan Peninsula State University
Balanga, Campus
Balanga, Campus
Diabetes Neprophaty
Prepared by:
Nuguid, Camille F.
Paragiison, Ralp Roentgen
Cunanan, Mark Joseph
Salvador, Marry Joyce
Bartolome, Dazel
Gamiao, Joebert
Mallari, Apple
Lisay, Cristine
Abalos, Leslie
Pingul, Philip
Roman, Lea

2. INTRODUCTION

4. PATIENT’S PROFILE
Client’s name: Mr. C
Age: 47
Birthday: September 15, 1962
Address: Tapulao, Orani, Bataan
Gender: Male
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: Beautician
Clinical impression: To consider viral hepatitis rule out
cholecystitis vs cholelithiasis
Attending Physician: Dr. June G. Reyes
FAMILY HEALTH HISTORY
According to Mr. C regarding their herido-familial
history, his father had a hypertension and his mother had
hypotension. His parents were both deceased.
PAST HEALTH HISTORY
The patient was born on September 15, 1962. He was a
permanent resident of Tapulao, Orani Bataan.
The patient stated that he was the youngest among his
siblings. He lives together with the family of his brother under
one roof with four different partitions. He said that he was a
smoker; he takes 1-2 packs of cigarette per day. He was also an

5. alcohol drinker; he can take 6 to 8 bottles of beer and 1 bottle
hard in a day. He also said that he always lacks of sleep because
he enjoys night life. He enjoyed eating salty and fatty foods and
also fond of buying street foods. Being a beautician, he was
good in doing ear piercing, so after doing the piercing in his
client, he used the needle to pierce himself. He also admitted
that he was sexually active with multiple male partners.
Last 2003 he was confined at Bataan General Hospital
with the diagnosis of cholelithiasis. He wasn’t able to have the
operation because his income as a beautician is not much.
PRESENT ILLNESS:
A case OF Mr. C, 47 years old, male, confined at Orani
District Hospital with a clinical impression of viral hepatitis rule
out cholecystitis vs cholelithiasis.
SOCIAL HISTORY
Mr. C is a gay beautician with on and off income. He was
the one who sustains for the education of his niece and
nephews. Sometimes his income is not sufficient because of his
underlying disease.
ACTIVITIES OF DAILY LIVING
Activities Before During
hospitalization hospitalization
Cigarette >Takes 1 to 2 packs > Restriction of
smoking of cigarette per day cigarette smoking
Alcohol drinking >Drinks 6 to 8 > Restriction of
bottles of beer and alcohols
1 to 2 bottles of

6. hard drinks
Nutrition >Likes to eat foods > Increase nutritious
rich in cholesterol foods
such as chicharon > Low fat diet
>He wasn’t able to
eat on time
>Always eats street
foods such as “isaw
and barbecue
Exercise >Doesn’t have time > Range of motion
to exercise or do
physical activities
Sexual activity >He used to go out > Abstinence
together with his
gay friends to hunt
boys and play with
them
Rest and sleep >He doesn’t have > Have adequate rest
adequate rest and and sleep.
sleep because he
always goes out
during the night
together with his
gay friends.
Livelihood >He is a beautician > He can’t perform
with an on and off his job due to
income hospitalization.
> He doesn’t have
enough money for
his hospitalization

7. PHYSICAL ASSESSMENT
February 11, 2010
Part to be Technique Result Interpretation
examine used
Skin Inspection >skin color: >increase
with jaundice bilirubin level
noted >normal
Palpation >clean skin >normal
>warm to
Head Inspection touch >normal
Palpation >normal
>round

8. >no
Scalp Inspection tenderness >normal
noted
Hair Inspection >normal
>oily >normal
>due to the
>black production of
>thick sebum
>oily >normal
Eyebrows Inspection
>properly >normal
distributed
Eyes Inspection
>symmetrical >normal
and in line >normal
with each >due to
other increase
Ears Inspection bilirubin level
>symmetrical
Palpation >black iris >normal
Nose Inspection >yellow sclera >due to
lifestyle
>normal
Palpation >bean-shaped >normal
>with piercing
Lips Inspection noted >normal
>firm cartilage >normal
>located at
Mouth Inspection the midline >due to

9. >patent nares frequent
>firm cartilage smoking
Teeth Inspection
>dry and dark >normal
Tongue Inspection >normal
Chest Inspection >symmetrical >due to
>kept moist acquired
by saliva nicotine
>normal
>yellowish to
white >normal
Palpation
Auscultation >kept moist >normal
by saliva
Abdomen Inspection
>sternum is at >normal
the midline >normal
>moves >normal
Auscultation symmetrically
when >normal
Percussion breathing
Palpation >RR: 20bpm >due to
>no increase
Upper Inspection tenderness intake of
extremities >HR:72 bpm alcohol
>normal
>skin color is bowel sound
Inspection uniform >normal

10. Lower >distended >normal
extremities
>borborygmi >normal
noted >normal
Inspection >normal
>tympany
Nails Palpation noted >normal
>no masses >normal
noted >due to
Inspection previous burns
>symmetrical
General >proportional >normal
appearance >no lesions >due to poor
noted hygiene
>normal
>symmetrical
>proportional >normal
>with lesion
on the right >due to
lower leg restlessness
>160˚ angle
>dirty
>capillary
refill: after 1
second
>conscious
and coherent

11. >sleepy
appearance
February 12, 2010
Part to be Technique Result Interpretation
examine used
Skin Inspection >skin color: >increase
with jaundice bilirubin level
noted >normal
Palpation >clean skin >normal
>warm to
Head Inspection touch >normal
Palpation >normal
>round
>no
Scalp Inspection tenderness >normal
noted
Hair Inspection >normal
>oily >normal
>due to the
>black production of
>thick sebum
>oily >normal
Eyebrows Inspection
>properly >normal

12. distributed
Eyes Inspection
>symmetrical >normal
and in line >normal
with each >due to
other increase
Ears Inspection bilirubin level
>symmetrical
Palpation >black iris >normal
Nose Inspection >yellow sclera >due to
lifestyle
>normal
Palpation >bean-shaped >normal
>with piercing
Lips Inspection noted >normal
>firm cartilage >normal
>located at
Mouth Inspection the midline >due to
>patent nares frequent
>firm cartilage smoking
Teeth Inspection
>dry and dark >normal
Tongue Inspection >normal
Chest Inspection >symmetrical >due to
>kept moist acquired
by saliva nicotine
>normal
>yellowish to

13. white >normal
Palpation
Auscultation >kept moist >normal
by saliva
Abdomen Inspection
>sternum is at >normal
the midline >normal
>moves >normal
symmetrically
Auscultation when >normal
breathing
Percussion >RR: 18bpm >due to
Palpation >no increase
tenderness intake of
>HR:82 bpm alcohol
Upper Inspection >due to pain
extremities >skin color is >normal
uniform bowel sound
>distended >normal
Inspection >with >presence of
Lower guarding stones in the
extremities behavior gallbladder
noted
>borborygmi >normal
Inspection noted >normal
>normal
Nails Palpation >tympany
noted >normal
>with masses >normal

14. Inspection noted >due to
previous burns
General
appearance >symmetrical >normal
>proportional >due to poor
>no lesions hygiene
noted >normal
>symmetrical >normal
>proportional >due to pain
>with lesion >due to pain
on the right
lower leg
>due to
>160˚ angle restlessness
>dirty
>capillary
refill: after 1
second
>conscious
and coherent
>weak in
appearance
>with
guarding
behavior in
the abdomen
>sleepy

15. appearance
February 13, 2010
Part to be Technique Result Interpretation
examine used
Skin Inspection >skin color: >increase
with slight bilirubin level
jaundice
Palpation noted >normal
>clean skin >normal
>warm to
Head Inspection touch >normal
Palpation >normal
>round
>no
Scalp Inspection tenderness >normal
noted
Hair Inspection >normal
>oily >normal
>due to the
>black production of
>thick sebum
>oily >normal
Eyebrows Inspection
>properly >normal
distributed
Eyes Inspection
>symmetrical >normal
and in line >normal
with each >due to

16. other increase
Ears Inspection bilirubin level
>symmetrical
>black iris >normal
Nose Palpation >slight >due to
Inspection yellowish lifestyle
sclera
>normal
Palpation >bean-shaped >normal
>with piercing
Lips Inspection noted >normal
>normal
>firm cartilage
Mouth Inspection >located at >due to
the midline frequent
>patent nares smoking
Teeth Inspection >firm cartilage
>normal
Tongue Inspection >dry and dark >normal
Chest Inspection >due to
>symmetrical acquired
>kept moist nicotine
by saliva >normal
>yellowish to >normal
Palpation white
Auscultation >normal
>kept moist

17. Abdomen Inspection by saliva
>normal
>sternum is at >normal
the midline >normal
Auscultation >moves
symmetrically >normal
Percussion when
Palpation breathing >due to
>RR: 17bpm increase
Inspection >no intake of
Upper tenderness alcohol
extremities >HR:75 bpm >normal
bowel sound
Inspection >skin color is >normal
uniform >normal
Lower >distended
extremities >normal
>borborygmi >normal
Inspection noted >normal
Palpation >tympany >normal
Nails noted >normal
>no masses >due to
Inspection noted previous burns
General >symmetrical >normal
appearance >proportional >due to poor
>no lesions hygiene
noted >normal

18. >symmetrical >normal
>proportional
>with lesion
on the right
lower leg
>160˚ angle
>dirty
>capillary
refill: after 1
second
>conscious
and coherent
ANATOMY AND PHYSIOLOGY

19. A. Structures
1. Liver

20. a. The liver is the largest organ in the body ,
weighing 3 pounds. It is encase in a fibrous
capsule and lies in the upper right quadrant of
the abdomen.
b. The liver is composed of four lobes containing
lobules that are the functioning units of the liver.
The four lobes are: the right, left, caudate and
quadrate.
c. Each lobule is composed of hepatocytes (liver
cells) and its own blood supply called sinusoids.
The phagocytic Kupffer cels are located within
the sinusoids.
d. The main blood supply to the liver is transported
via the hepatic artery and the portal vein
emptying into the inferiof vena cava via the
hepatic veins.
e. The hepatic artery receives blood directly from
the aorta and the portal vein drains the blood
from the spleen and intestines.
f. Fibers from the vagus (parasympathetic) and
celiac plexus (sympathetic) comprise the liver’s
nerve supply.
2. Biliary system
a. Hepatic lobules are the functional unit of the
liver. The lobules consist of a network of small
ducts called canaliculi.
b. The hepatic duct receives bile via the canaliculi
that join to create larger bile ducts.
c. The common bile duct is formed by the joining of
the hepatic and cystic ducts located in the liver
and gallbladder respectively. The liquid contents

21. of these ducts drain into the duodenum via the
sphincter of the Oddi.
d. Relaxing of the Sphincter of Oddi permits the
passage of bile into the duodenum
e. The gallbladder is a pear-shaped hollow organ, 3
to 4 inches long, located on the undersurface of
the right lobe of the liver.
f. Normal bile capacity is approximately 50 to
75ml.
3. Pancreas
a. The pancreas is a long, slender organ,
approximately 6 to 9 inches in length, which is
situated behind the stomach and consist of three
segments: head, body and tail.
b. The organ is composed of lobules that form
lobes.
c. The lobules have enzyme-producing acini that
release their secretions into the duct of Wirsung
or pancreatic duct.
d. The pancreas produces exocrine and endocrine
secretion. The exocrine secretions are via the
acini cells of digestive purposes. The endocrine
secretions are associated with the islets of
Langerhans whose cells are involved in the
regulation of carbohydrate metabolism.
A. Functions
1. Liver

22. a. The liver is the first organ to receive blood
carrying the final products of digestion and
decomposition products.
b. From this blood the liver begins its enormous
role in maintain normal body functions.
2. Major liver function
a. Maintains normal serum glucose levels by means
of glycogenesis, glycogenelysis, and
glucogenesis.
b. Deaminizes amino acids, forming ammonia that
is then converted into urea. Synthesizes
nonessential amino acids, plasma proteins
(albumin0, vitamin a, and coagulation factors
(fibrinogen, prothrombin), and is the source of
heparin, an anticoagulant.
c. Breaks down triglycerides and fatty acids and
stores and synthesizes excess fats. Also
synthesizes cholesterol, lipoprotein,
phospholipid and excess fat.
d. Serves as a storage place for the fat-soluble
vitamins A, D, E, K and B12, iron, and trace
elements.
e. Detoxifies potentially harmful substances, eg.,
alcohol, poisons, and various toxic substances
produced by the body. Metabolizes drugs and
excretes their breakdown products.
f. Continuously secretes and excretes bile.
3. Bile components:
a. Bile is composed of bilirubin, cholesterol, mucin,
electrolytes, bile salts, fatty acids, lecithin, water
and various inorganic and organic substances.

23. b. Biliverdin: oxidation of bilirubin forming the
greenish color in the bile.
c. Bilirubin: pigment from phagocytosed
haemoglobin removed from the blood and
chemically modified by conjugation to glucoronic
acid and formed by the hepatocytes into the
bile.
d. Bile salts: synthesized from cholesterol,
conjugated with amino acid for fat
emulsification; recycling is achieved by
reabsorption through the ileal mucosa and into
the portal circulation for transport to the liver.
4. Biliary system
a. Bile from the hepatocytes is transported to the
gallbladder via an intricate drainage system.
b. Cholecystokinin, a duodenal hormone,
stimulates the gallbladder to contract, thereby
relaxing the sphincter Oddi and releasing bile for
digestion.
5. The pancreas is composed of two basic cell types,
endocrine and exocrine. Functions of the pancreatic
exocrine cells (acini) include:
a. Production of a watery pancreatic juice rich in
enzymes for digestion and bicarbonate to
neutralize the acidic chime.
b. Production of enzymes for digestion, consisting
of amylase (hydrolyzes starch), trypsin
(proteolytic enzyme that catalizes the hydrolysis
of the petite bonds), and lipase (breaks
triglycerides into fatty acids and glycerol).

24. PATHOPHYSIOLOGY OF HEPATITIS B
Non- modifiable factor
Modifiable factors
>Age
>sexually active with multiple partners
>Gender
>cigarette smoking
>alcoh
olic

25. >ear
piercing
>
Unhealthy diet
Exposure to Hepa B virus
HBV enters the liver through the blood
Invasion of HBV in the liver
Inflammatory & immune response initiated
Deterioration & necrosis Enlargement of the
of the hepatocytes Kuffer cells
Enlargement of the liver
Pain at the causing stomach
Formation of the fibrous scar tissue in the liver
RUQ of the compression
abdomen
Obstruction of the vascular & Nausea and vomiting
biliary networks
Impedes excretion Reduction of the
Impaired amount of bile entering
of bilirubin
Carbohydrate, lipids & the intestine
protein metabolism
Jaundice, stool becomes light
in color, urine becomes darker Indigestion, anorexia
Fatigue, Malaise
LABORATORY EXAMINATIONS
HEPATITIS B
Laboratory Tests: Hematology
Name: Mr. C
Age: 47 y/o
Date examined: February 10, 2010

26. Test Result Normal Interpretation
CBC Values
Hemoglobin 162.5 gm/l 140-170g normal
m/l
Hematocrit 0.49 0.37-0.47 High hematocrit
level can be seen
in people living
at high altitudes
and chronic
smokers. It
causes lung
disease tumors,
and disorder of
the bone
marrow.
WBC Count 7.9x10⁹/l 5-10x10⁹/l normal
Segmenters 0.48 0.55-0.65 normal
Lymphocytes 0.52 0.25-0.35 Indicates a viral
infection
Blood type: O
Rh: (+)
Urinalysis
Date examined: February 10, 2010
Result
Color yellow
Glucose negative
pH 5.0
Specific gravity 1.015
Protein negative
RBC 0-2
WBC 1-3
Calcium oxalate few

27. DRUG STUDY
Generic Classification Action Dosage/Route Indication Ingredients Nursing Consideration
Name
Sylmarine Herbal anti- Protects the 1cap PO TID Nutritionally Each capsule >Administer to right person,
oxidant liver by support healthy contains 125mg of time, route and dosage
strengthening liver function pure Milk Thistle
the outer extract, Lecithin,
membranes of Bees wax, Capsule-
the liver cells, Gelatin.
thereby
preventing the
toxins from
entering the
cells.

28. NURSING CARE PLANS
Assessment Diagnosis Planning Interventions Rationale Evaluation
S:” Masakit tagiliran Pain related to After series of >Assess patient for signs >Assessment allows for The patient will
ng tiyan ko” as distended abdomen nursing and symptoms of pain. care plan modification as decrease pain
verbalized. secondary to hepatic interventions, the needed. from a pain scale
>pain scale of 6 disease as evidenced patient will decrease >Encourage >To assist client in dealing of 6 to2 (where
(where 0 is the by a pain scale of 6 pain from a pain verbalization of pain with pain 0 is the lowest
lowest and 10 is the (where 0 is the scale of 6 to2 (where >Include client and >To limit focusing on pain and 10 is the
highest) lowest and 10 is the 0 is the lowest and significant others in highest)
highest) 10 is the highest) establishing pattern of
O: discussing pain
>conscious >Provide comfort >To provide non
>coherent measures such as pharmacologic pain
>distended abdomen repositioning and deep management.
>facial grimace breathing exercise.
>weak and pale in >Encourage diversional >To divert client’s
appearance activities such as reading attention to pain.
>guarding behavior magazines or texting
>Encourage adequate >To prevent fatigue.
rest periods.

29. Assessment Diagnosis Planning Interventions Rationale Evaluation
S:” Nanlalambot ang Limited body After series of >Discuss with patient >Which will improve The patient will
aking katawan” as movements related nursing interventions the need for activity. physical and psychosocial perform self
verbalized. to body weakness as the patient will well-being. care activities to
evidence by verbal perform self care >Identify activities that >To enhance their positive tolerance level.
O: report of fatigue or activities to tolerance patient considers impact.
>weak in appearance weakness. level. desirable and
>irritable at times meaningful.
>limited body >Encourage patient to >Participation in planning
movements help plan activity helps ensure patient
progression, being sure compliance.
to include activities he
considers essential.
>Encourage to increase >Carbohydrate is energy-
foods rich in giving.
carbohydrates.
>Instruct and help to >To reduce body’s oxygen
alternate periods of rest demand and prevent
and activity. fatigue.
>Teach the patient >which will improve
exercises for increasing breathing and gradually
strength and endurance. increase activity.
>Perform active or >This exercise foster
passive ROM exercise to muscle strength and tone,
all extremities every 2 to maintain joint mobility and
4 hours. prevent contractures.

30. Assessment Diagnosis Planning Interventions Rationale Evaluation
S:” Parang wala na Situational low self- >After series of >Encourage patient to >Self exploration >The patient will
akong silbi dahil sa esteem related to nursing interventions express feelings about encourages patient to voice feelings
dumapong sakit sa unexpected change the patient will self (past and present). consider future change. related to
akin” as verbalized. in health status. verbalize feelings >Assess patient’s mental >If anxiety resulting from current situation
related to current status through interview self rejection becomes and its effect on
O: situation and its and observation at least severe, patient may self-esteem.
>weak in appearance effect on self- once per day. experience disorientation
>irritable at times esteem. and psychotic symptoms.
>poor concentration >Involve patient in >To combat ambivalence
>difficulty making decision making. and procrastination
decisions associated with low self
>agitated esteem.
>Provide patient with >This gives patient feelings
positive feedback for of significance, approval
verbal reports or and competence, which
behavior that indicate a can help him core
return to positive self effectively with stressful
appraisal. situations.

32. Bataan Peninsula State University
Dinalupihan Campus
Dinalupihan, Bataan
A case Study of
Hepatitis B
Presentedby:
BSN Group J
Marie John Cabrera
Dhonalyn May Campo
Romina Joyce Canlas
Elaine Casupanan
Jim Francis Cayanan
Mark Joseph Cunanan
Katrina de Jesus
Philip Pingul
~February 2010~