MACROVASCULAR COMPLICATIONS 
Is a disease of any large blood vessels in the body
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pathophysiology
sorbitol and fructose are enzymes that normally convert glucose into other sugars to lower blood glucose
sorbitol , fructose and glucose accumulate in the basement membrane of the cell
sustained increases in glucose levels affect the substrates that are used for the formation of cell membranes
resulting inadequate oxygenation , nutrition and waste disposal
causing intracellular oedema , which affects cell function
the thickened basement membrane increases the distance
over which nutrients and waste products must travel into and from the cell
signs and symptoms
pain at rest
ischemic ulcers
hyperglycemia
Oedema
stable or unstable angina pectoris
definition
diet therapy
take moderate portion of poultry , eggs , cheese and yoghurt
take fish and seafood at least two times per week
take less sweats and meat
base every meal on fruits and vegetables olive oil
drink water
nursing care plan
causes
cardiovascular diseases
peripheral vascular diseases
cerebrovascular diseases
volume excess liquid.
decreased cardiac output increased vascular resistance.
unstable blood glucose level.
acute chest pain related to myocardial to ischemia secondary to obstruction.
asses skin condition and perfusion protect edematous skin from lesions and offer support for swollen areas when needed .
.encourage patient to change position every two hours.
.advice the client to take adequate bed rest especially when the blood glucose level is more than 250g/dl
monitor the vital signs , ECG ,oxygen saturation and pain score regulary
.to reduce the fluid volume.
.to determine possible problem.
.to identify the imbalance in glucose level
to identify baseline data and cause of pain
.reduced fluid volume
.improved venous returns
.the blood glucose of the client decreased as evidenced
..client pain was relieved as evidenced as decreased in score pain and verbalizing comfort
expected outcome
rationale
nursing intervention
nursing diagnosis
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Beckman JA , Creager MA ,Libby epidemiology , pathophysiology and management 2002
hypertension in diabetes study [HDS] INCREASED RISK cardiovascular complications J Hyperten 1993
Pells D alonzo A factors associated wit long term survival of diabetes J .AM . Med .Assoc . 1970
references