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Pathophysiology - Coggle Diagram

- - - - Look for weakness, fatigue, muscle cramps, & heart arrhythmias to see if the low K+ lvls is affecting them
  - - - Lab: 99 mEq/L
      - Patient range is normal. Cl Regulates amount of fluid and the nutrients going in and out of cells
  - - - this may be due to the fact that their SpO2 is 95% on room air & they have even non-labored respirations. However maybe it should be ordered to monitor the diminished lung sounds in BLL
  - - - Pt's BUN level of 29mg/dL is elevated so this lab should be monitored closely. This lab value represents the pt's current state of his kidneys. BUN levels are normally elevated is pt's with type 2 diabetes. This lab value is important to monitor throughout his hospital visit. The pt has also been taking Hydrochlorothiazide for a long period of time which is a diuretic that can effect the ability for the kidney's to secrete properly. The nurse should assess for edema, abnormalities within urination, and hydration levels.
  - - - Lab: 1.3 mg/dL
      - Patient is within normal limits but on right on the brink. This being on the high end could indicate dmage to kidneys. Since this is measures how well the kidneys are working at filtering blood
    - - Normal range: Male: 97 to 137 mL/min
        
        Low creatinine clearance levels indicate decreased kidney function or impaired filtration of the blood by the kidneys
  - - - Pt's Glucose level of 148mg/dL is elevated and should be closely monitored throughout the pt's stay. A high glucose level can be an indicator of a hyperglycemic episode the pt can be experiencing. The nurse will need to look out for effects of this lab such as weight loss, blurred vision, excessive thirst, and dry mouth. This lab is necessary to continue to follow up in order to monitor his dosage for the Metformin that he is prescribed. We would also want to refer to the pt's HgA1C levels a these measure the pt's blood glucose levels over the past 3 months
  - - - Lab: 2.4 g/dL
        
        Pt may be experiencing a from of malnutrition due to his cells not absorbing nutrients due to insulin deficiency from his Type 2 diabetes.
        
        Damage/impairment of the liver, as indicated by George's low creatinine clearance and high creatinine levels, may reduce the patient's ability to synthesis albumin (where it occurs primarily in the liver), leading to decreased albumin lab levels.
        
        Albumin loss in diabetic nephropathy reduces blood albumin levels, which are crucial for maintaining blood vessel oncotic pressure and preventing fluid leakage into tissues, potentially causing edema and fluid retention.
        
        George is taking a multivitamin that may help with his malnutrition due to his cells now absorbing enough nutrients.
        
        While taking this supplement, we may want to monitor b12 levels, complete blood count, etc. Assessment findings may include N/V, stomach pain, and diarrhea.
  - - - Lab: 8.0%
        
        Pt's HgA1C is a measure of the blood glucose levels over the past 3 months. Our pt's HgA1C is high which confirms his diagnosis of diabetes and also lets us know that over the past 3 months he hasn't been taken good care of his diabetes
        
        As the nurse we would want to provide education on what the lab value means and discuss what can be done to help our pt better manage his diabetes.
  - - - Lab: 4.2 x10^9
        
        Pt is on two immunosuppressives (hydrocodone and lidocaine). Also he is diabetic so his diet could be suppressing the production of WBC.
  - - - Pts RBC count is low which potentially could indicate anemia.
        
        Nurse should carry out any new orders by doctor to tx this. May be just uping the pts iron intake
    - - 1) Pallor: Anemia can cause paleness of the skin and mucous membranes, as there are fewer red blood cells to carry oxygen
        
        2)Cold Hands and Feet: Reduced blood flow and oxygen delivery may lead to cold extremities.
        
        3) Hydrochlorothiazide: is a K+ wasting diuretic which can cause hypokalemia w/ prolonged usage. K+ is essential for the proper function of bone marrow, where RBCs are produced. A deficiency in potassium can negatively affect RBC production and lead to anemia.
        
        4)Protonix (Pantoprazole): Long-term use of PPIs like Protonix can interfere with the absorption of vitamin B12. Vitamin B12 is essential for the development of healthy RBCs. A deficiency in vitamin B12 can lead to anemia, known as megaloblastic anemia.
        
        George is taking a multivitamin supplement that contains vitamin B12. This should help raise his vitamin b12 levels, therefore raising his red blood cell levels also.
        
        While taking this supplement, we may want to monitor b12 levels, complete blood count, etc. Assessment findings may include N/V, stomach pain, and diarrhea.
  - - - Lab: 13.8 g/dL
      - Pt's hemoglobin levels are within normal range but are close to being considered low. We would want to monitor Hgb levels and potentially encourage an iron supplement/iron rich foods.
        
        PT does have a diabetic foot ulcer and pale skin which could be possible s/s of bleeding.
  - - - Lab: 40%
      - Pt's Hct is within normal range for males, but is on the cusp of being low. We would want to monitor this and encourage our pt to eat foods rich in Vitamin C to help with iron absorption. Hct measures the percentage of red blood cells in the blood.
        
        Pt could be on the cusp of being low due to lack of protein and iron in his diet.
  - - - Lab: 12 seconds
      - Pt's Partial Thromboplastin Time (PTT) is within normal ranges. PTT is the time that it takes for a blood clot to form.
  - - - Prothrombin Time (PT) is also used to test how long it takes for a blood clot to form in the blood. Patient is within normal PT ranges.
      - Lab: 27 seconds
  - - - Lab: 1.1
      - x≤1.1
        
        Patient's INR is within normal ranges, and the INR measures how long it takes for a patient's blood to clot
  - - - Lab: 120 platelets/mcl
      - Pt's platelet count was below the normal reference range. This could be caused by his hydrochlorothiazide medication, which can cause thrombocytopenia as a side effect. Excessive consumption of aspartame in diet soda has also been linked to cause a low platelet count
        
        Pt is also on Clindamycin which is an antibiotic that is shown to reduce platelet count after 10 days of use. Pt takes 400 mg BID.
        
        The exact mechanism by which certain antibiotics cause this reaction isn't always clear, but it's thought to be an immune-mediated response where the body's immune system mistakenly attacks and destroys platelets.
    - - Normal Range for males: 97 to 137 ml/min
        
        George's low creatinine clearance could be an indication of kidney damage, which could be a result from hypertension or from diabetic nephropathy.
        
        Lab: 45 ml/min
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    - - Low MoCA score could potentially indicate Alzheimers disease. Father also had this condition. While its not a hereditary condition, it does increase risk of getting condition
    - - Benadryl is used occasionally at bedtime to help insomnia by Competes with histamine for H1-receptor sites, thus preventing histamine-
        mediated responses, especially in the bronchial tubes, GI tract, uterus, and blood vessels, although it does not reverse them once they have occurred
  - - - CoQ10 can neutralize harmful free radicals in his body which can help hypertension
  - - - Pt reports, "I get full so easy and my food takes forever to move and I get heartburn."
        
        George is taking Famotidine to treat his heartburn and trouble with decreasing gastric acid that is building up in his stomach. Famotidine is a H2-receptor antagonist that inhibits action of parietal cells that decrease this acid. Famotidine is eliminated through the kidneys and we know that George may have underdeveloped kidney function. This is a medication we need to keep an eye on. Specifically, we as nurses need to be watching kidney function.
        
        Pantoprazole is used to inhibit the H+/K+ ATPase pump that is responsible for it's crucial role in gastric acid production, decreases acidity of stomach contents
  - - - Insulin resistance is a hallmark of type 2 diabetes. Can lead to higher levels of insulin and insulin-like growth factor 1 (IGF-1) in the bloodstream. Elevated IGF-1 levels may contribute to prostate cell growth, potentially increasing the risk of BPH.
  - - - Hydrocodone is used and acts as a full agonist primarily at the my opioid receptor, binding to and activating opioid receptors at various sites in the CNS to produce. Used to manage severe pain that develops from osteoarthritis
      - Tramadol is used PRN for pain. This can be due to being an older adult and the aches and pains that come with it as well as managing severe pain sue to osteoarthritis. Tramadol binds to opioid receptors and inhibit reuptake of norepinephrine and serotonin.
    - - Celecoxib is used to inhibit prostaglandin synthesis, impeding cyclooxyrgenase-2, to produce anti inflammatory, analgesic, and antipyretic effects
        
        Aspercreme with Lidocaine Max is used to relieve joint pain by blocking nerve signals to the brain.Blocks Na+ channels which blocks the action potential & stops inhibits the ability of nerve cells to transmit pain signals to the brain
        
        When administering lidocaine, it is important to assess blood pressure and cardiac monitoring prior to administration and during use.
  - - - Diabetic foot wound measures 4cm x 4cm x 1cm deep
      - Wound bed with pink and small areas of slough circus -wound edges (2mmx4mm)
- - - - Having reducing sugars in the urine, such as glucose, galactose, lactose, and fructose, is known as having glycosuria.
        
        It occurs when the proximal tubule is unable to reabsorb all of the glucose that the glomerulus filters. Glucosuria in healthy people can reach 0.25 mg/ml.
        
        Random fresh urine samples containing more than 0.25 mg/ml are deemed to have enhanced glucosuria, which may be brought on by either impaired renal glucose absorption or elevated plasma glucose.
        
        In unmanaged diabetes the renal tubules are unable to reabsorb all of the excessive glucose back into the bloodstream & BG surpasses the kidney's glucose threshold. This leads to excretion of glucose in the urine as body's mechanism of getting rid of the excess. This increased glucose in tubules draws in more water & thus produces more urine.
        
        George's HgA1C of 8.0 & the subjective data of nocturia is a sign of glucosuria. The lab value confirms abnormally high BG lvls for extended periods of time which eventually surpasses the kidney's glucose threshold. This explains the excessive nocturia he is experiencing as elevated renal glucose draws in more water and creates an overproduction of urine.
      - Hydrochlorothiazide is used to increase sodium and water excretion by preventing sodium and chloride reabsorption in the distal portion of the nephron
        
        Monitor for signs of fluid and electrolyte imbalances, hypotension, dizziness, and confusion.
      - Lasix is used. Inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle.
        
        Lasix can cause electrolyte imbalances due to excretion of sodium, potassium, and magnesium, which older adults may be more prone to. This medication can also lead to dehydration, which older adults are more susceptible to.
    - - Eye-related complications result in retinopathy with progression to blindness
        
        The high BG lvls damages blood vessels in the retina (a light-sensitive layer of cells in the back of the eye). The damaged blood vessels swell & leak causing blurred vision
        
        Contributes to open angle glaucoma
        
        Latanoprost. Expected to lower increased IOP by boosting aqueous humor output
    - - High blood serum glucose appears to lead to damaged small blood vessels, compromising oxygen and nutrients to the nerves.
        
        The distal sensory and autonomic nerve fibers are damaged first; the damage then continues with proximal progression leading to a gradual loss of protective sensation in both the skin and foot joints.
        
        Assessment findings of numbness & tingling bilaterally in feet & toes confirms distal sensory nerve damage due to prolonged elevated BG
      - Use neurovascular assessment to check this. Capillary refill should be < 2 sec
        Radial, dorsalis pedis, & posterior tibialis pulses should be even bilaterally & ideally all +2 pulse meaning they are easily identified
        
        George's feet are pale and cool to the touch. He also has reduced skin turgor. His BLE pulses are +1 and thready. Also presents with numbness & tingling within feet & toes. All of these assessment findings are conce
        
        Clindamycin is an antibiotic used to inhibit bacterial protein synthesis by binding to the 50S subunit of the ribosome. George is showing signs of a diabetic foot wound based on these assessments. An antibiotic is prescribed to treat any bacterial infection that may be occurring. Due to George's high glucose levels, his blood vessels can be damaged and be more prone to an infection. One of the main adverse effects of this antibiotic is severe diarrhea. As a nurse, we need to keep an eye on his stool situation.
        
        Due to his risk of developing antibiotic-related diarrhea as an adverse effect, George is prescribed an Acidophilus capsule. This is a gastrointestinal agent that works by replacing pathogenic organisms in the GI tract by interfering with the ability of pathogenic bacteria to adhere to intestinal mucosal cells. This medication is to be taken in the morning to work effectively to prevent George from developing antibiotic-related diarrhea.
      - Barley Green is used to provide sources of vitamins and minerals and helps control blood sugar
    - - Increased oxidative state leads to mitochondrial damage
    - - Education provided on Metformin. Take by mouth BID with meals. Educate on how to use blood glucose monitor properly. Check BG lvls before meals & before administering insulin to prevent hypoglycemia. To take BG lvls swab finger w/ alcohol swab & let it dry fully. Insert the lancet into the pad of the finger. Wipe away first blood drop with swab & then bring finger to monitor to assess lvls.
  - - - this leads to cellular starvation
        
        Alteration of lipid metabolism is a risk factor and characteristic feature of atherosclerosis.
        
        Alteration of the blood lipid profile in diabetes is linked to elevated hepatic production of triglyceride-rich lipoproteins, leading to the increased formation of atherogenic VLDL.
        
        This alteration can partially be corrected by insulin treatment.
        
        The build up of atherosclerosis (plaque) in the arterial walls of the kidney may lead to HTN
        
        Atorvastatin is used. HMG-CoA reductase inhibitors (antilipemics); block this enzyme, which is an early (and rate-limiting) stage in the synthesis of cholesterol
        
        Monitor liver function tests. Pt should have had liver function tests and a lipid panel taken before starting Atorvastatin to measure baseline levels.
        
        Type II DM causes systemic inflammation in body.This systemic inflammation is associated with an increase in inflammatory markers in the bloodstream, such as C-reactive protein (CRP).
        
        Chronic inflammation disrupts the normal function of endothelial cells (inner lining of blood vessels), making them less effective at regulating blood vessel tone and preventing the adhesion of immune cells.
        
        Immune cells, esp monocytes, are attracted to the inflammation in the arterial walls. These monocytes can transform into macrophages.
        
        Macrophages, once present in arterial walls, become activated and attempt to remove accumulated lipids (cholesterol) from the blood vessel walls. They engulf oxidized LDL cholesterol, creating "foam cells."
        
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      - CoQ10 can improve blood sugar control as it helps shuttle electrons between protein complexes in the inner mitochondrial membrane (oxidative phosphorylation), which generates ATP.
    - - Ketone bodies are produced by the liver during periods of low insulin levels, such as in uncontrolled diabetes, when glucose isn't being properly stored within the body. Elevated levels of ketone bodies in the blood can occur in individuals with unmanaged diabetes, leading to a condition known as diabetic ketoacidosis (DKA), which is a potentially life-threatening complication. Monitoring and managing blood sugar levels are crucial in diabetes care to prevent the excessive formation of ketone bodies and the onset of DKA.
        
        DKA can cause severe metabolic acidosis. Ketone bodies are acidic. In DKA we get excessive breakdown of fatty acids which causes an accumulation of ketone bodies that are acidic and as a result decrease the bodies pH, making it more acidic (which is metabolic acidosis)
- - - - As insulin resistance persists and beta cell function declines, blood sugar levels start to rise (hyperglycemia).
        
        Fasting blood glucose levels are >126mg/dL and pt A1C is >6.5%
        
        Leading to George's diagnosis of type 2 diabetes
        
        Treated with combo of Metformin and Latanoprost. Latanoprost and Metformin activates a protein called AMPK-activated protein kinase.
        
        AMPK helps to manage and lower blood sugar in type 2 diabetes by enhancing glucose uptake through the glucose transporter GLUT4. It also stimulates the breakdown of glucose through glycolysis and inhibits the production of glucose in the liver by suppressing gluconeogenesis through interference of the activity of enzymes such as glucose-6-phosphatase and phosphoenolpyruvate carboxykinase.
- - - - The urethra being compressed by the enlarged prostate causes bladder outlet obstruction. This obstruction makes it more difficult for the bladder to empty completely during urination. As a result, the bladder must work harder to push urine through the obstructed urethra.
        
        Since the bladder has to work harder this causes the bladde muscle over time to thicken and become stronger.
        
        That thickening of the bladder walls is called trabeculation. When your bladder walls get too thick, they lose the ability to expand and contract, making it hard for your body to expel all the urine in the bladder. This results in increased urinary frequency and BPH.
      - Tamsulosin targets the alpha-1 receptors of the smooth muscle of the prostate gland by binding to the receptors and inhibiting/blocking them, causing the smooth muscle in the prostate to relax. This leads to increased urinary flow and relieves some BPH symptoms.
- - - - Atorvastatin lowers triglyceride levels by inhibiting HMG-CoA reductase. By inhibiting this enzyme, atorvastatin reduces the production of very low-density lipoprotein (VLDL) particles by the liver. VLDL particles are rich in triglycerides, and by lowering their production, atorvastatin can decrease the triglyceride levels in the bloodstream.
      - Dyslipidemia can contributes to the development of atherosclerosis, a condition in which fatty deposits, such as cholesterol and triglycerides accumulate in the walls of arteries. This process leads to the formation of plaques that can narrow and harden the arteries.
        
        From atherosclerosis, the narrowed arteries clogged with increased levels of fatty deposits will lead to decreased blood flow in the arteries
        
        The narrowing of the coronary arteries that results in decreased blood flow can lead to the development of coronary heart/artery disease (CAD)
        
        This reduced blood flow can occurs in the peripheral arteries, often times in blood flow to the legs or feet. This results in peripheral artery disease.
        
        The reduced blood flow to the legs can cause a variety of symptoms, including gangrene in the form of a foot ulcer
    - - LDL particles are the main carriers of cholesterol in the blood, so an increase of VLDL being converted to LDL will cause increased levels of cholesterol in the blood due to the high levels of LDL