MICROVASCULAR COMPLICATIONS (Signs and symptoms (Retinopathy. Symptoms of…
The underlying driver of microvascular disease is tissue exposure to chronic hyperglycemia. Microvascular disease tends to occur predominantly in tissues where glucose uptake is independent of insulin activity (eg kidney, retina and vascular endothelium) because these tissues are exposed to glucose levels that correlate very closely with blood glucose levels. The development of disease is the result of a combination of direct glucose-mediated endothelial damage, oxidative stress due to super-oxide overproduction, and the production of sorbitol and advanced glycation end-products due to the prevailing state of hyperglycaemia.These metabolic injuries cause altered blood flow and changes in endothelial permeability, extra-vascular protein deposition and coagulation resulting in organ dysfunction. Current evidence demonstrates a clear relationship between blood pressure (BP) and progression of nephropathy and retinopathy. These are now established as independent risk factors for microvascular disease progression.
BP must be kept below 140/80 mm/hg or if recognised treated lower than 125/75 mm/hg
Administration of ACE Inhibitors
Microvascular complications of diabetes are those long-term complications that affect small blood vessels. These typically include retinopathy, nephropathy, and neuropathy.
Signs and symptoms
Retinopathy. Symptoms of retinopathy are minimal until advanced disease ensues with loss or blurring of vision. Signs of nonproliferative retinopathy include microaneurysms, venous loops, retinal hemorrhages, hard exudates, and soft exudates. Proliferative retinopathy can include new vessels in the eyes or vitreous hemorrhage.
Nephropathy. The earliest sign of nephropathy is hypertension, which often coincides with the development of microalbuminuria. As nephropathy worsens, patients can develop edema, arrhythmias associated with hyperglycemia, or symptoms related to renal failure.
Neuropathy. Signs and symptoms of neuropathy depend on the type of neuropathy that develops. Most commonly, patients develop symptomatic distal polyneuropathy. Signs include decreased or total loss of ankle jerk reflexes and vibratory sensation, with hyperalgesia and calf pain in some patients. These usually present in a "stocking and glove" distribution. Wasting of the small muscle of the hands and feet also can occur
Blood glucose levels in the normal range or as close to normal as is safely possible
Lipid and lipoprotein profiles that reduce risk for macrovascular disease
Blood pressure levels that reduce risk for vascular disease
Modify nutrient intake and lifestyle as appropriate to prevent and treat obesity, dyslipidemia, CVD, hypertension, and nephropathy
Basement membranes of the capillaries thicken due to the accummulation of sugars which impair the exchange of nutrients ,gases and wastes
Administer medication as prescribed
Tak to the patient regarding the end stage compications of diabetes
Emphasize adherence to check up appointments
Nursing Care Plan
Risk for Decreased Cardiac Output
Monitor vital signs and cardiac rhythm.
Monitor Blood Glucose Levels
Monitor and documents effects or adverse response to medications, noting BP, heart rate, and rhythm.
Glucose and bloop pressure shoud be within normal ranges
Inadequate blood pumped by the heart to meet metabolic demands of the body.
Report/display decreased episodes of dyspnea, angina, and dysrhythmias.
Risk for Unstable Blood Glucose
At risk for variation of blood glucose levels from the normal range that may compromise health.
Assess for signs of hyperglycemia
Assess feet for temperature, pulses, color, and sensation.
Patient has a blood glucose reading of less than 180 mg/dL; fasting blood glucose levels of less than <140 mg/dL; hemoglobin A1C level <7%.
Bood glucose levels should be normal