Please enable JavaScript.

Coggle requires JavaScript to display documents.

T2 DIABETES, RISK FACTORS, DIABETIC RETINOPATHY, Impaired wound healing,…

- - - - Not enough insulin or decreased insulin sensitivity to keep up with high blood glucose levels.
- - - - Vision problems / total blindness
  - - - micro-aneurysm formation
        
        capillary occlusion
        
        retinal ischemia and hypoxia
- - - - functional anatomic changes
        
        development if high pressure zones on plantar foot
        
        repetitive trauma with walking
- - - - A risk that could occur due to low potassium levels would be cardiac arrhythmias such as atrial fibrillation, superventricular tachycardia, ventricular tachycardia, or ventricle fibrillation.
        
        We would want to further monitor George's potassium levels and place him on a continuous cardiac monitor to ensure any arrhythmias are noticed right away.
      - George also takes Hydrochlorothiazide 12.5 mg q PO daily. This is also a potassium wasting diuretic that could also be contributing to his low potassium levels.
- - - - HYPOGLYCEMIA
        
        PATHOPHYSIOLOGY
        
        Decreased sensitivity of body cells to insulin
        
        Insulin is required to take up glucose into the body cells for storage and energy. Insulin is made within the Pancreas by Beta cells
        
        Body's feedback loop of insulin and glucagon secretion are impaired
        
        Beta cells are unable to provide the amount of insulin that the body requires
        
        Blood glucose levels rise
        
        Because the glucose is heavily concentrated within the blood, cells do not receive an adequate amount to function properly
        
        2 more items...
        
        Target cells do not correctly respond to insulin, and do not take up glucose into tissue
        
        Glucose stays in bloodstream and levels rise
        
        increased insulin levels are needed to uptake glucose in to the cells
        
        Pancreas tries to compensate for cellular insensitivity by secreting more insulin
        
        inadequate insulin therapy
        
        stimulation of hormone glucagon to release glucose into blood stream
        
        increases in blood glucose
        
        Blood glucose <65 mg/dl
        
        S&S: shaky, sweating, lightheadedness,confusion, blurred vision, fainting
      - GI discomfort
        
        metformin can change the composition and amount of gut bacteria
        
        commonly causes diarrhea
    - - RENAL INSUFFICIENCY OR DISEASE
        
        COMPLICATIONS
        
        DKA
        
        Lack of insulin leads to severe hyperglycemia
        
        High glucose damages micro-vasculature that supplies peripheral nerves
        
        Insufficient blood supply to tissues
        
        4 more items...
        
        Labs indicate that George's glucose is 148 mg/dL which is high. With his glucose being so high he is at an even more increased risk for these issues listed
        
        2 more items...
        
        No energy leads to fat breakdown and the release of ketones
        
        Leads to metabolic acidosis
        
        Life threatening
        
        DIABETIC FOOT ULCER
        
        Poor glycemic control
        
        Poor Circulation
        
        Insufficient blood supply to tissues
        
        Dry Skin
        
        Chronic Kidney Disease
        
        George has had weight loss and states “I get full so easy and my food takes forever to move and I get heartburn”.  
        
        1 more item...
        
        S&S: n/v
        fatigue and weakness
        urinating more
        muscle cramps
        
        George has increased need to pee at night, waking up appx 10 times a night.
        
        Diminished lung sounds in bilateral lower lobes
        
        Lead to complications such as anemia
        
        1 more item...
        
        Can lead to increased BUN and CR
        
        1 more item...
        
        High blood glucoses can damage the kidneys and impair their function
        
        1 more item...
        
        High A1C
        
        Georges A1c was 8.0
        
        1 more item...
        
        A normal A!C is below 5.7
        
        Knowledge Deficit
        
        Improper foot care
        
        Infection
        
        1 more item...
        
        Clindamycin
        
        400 mg PO BID
        
        antibiotic, used to treat infections
        
        1 more item...
        
        side effects
        
        thrombocytopenia
        
        jaundice
        
        abdominal pain
        
        diarrhea
        
        blistering, peeling, loose skin, red lesions
        
        CARDIOVASCULAR DISEASE (macrovascular problems
        
        Damaging blood vessels and the nerves that control your heart due to high blood sugar levels
        
        Raising cholesterol levels and increasing atherosclerosis
        
        Over time, hardening of the arteries occurs
        
        1 more item...
        
        ATHEROSCLEROSIS
        
        Endothelial cells of arteries take damage due to high blood glucose levels
        
        This damage causes for inflammation to the site of injury
        
        1 more item...
        
        Many patients with Type 2 Diabetes can also experience dyslipidemia
        
        Atorvastatin
        
        4 more items...
        
        George has low levels of potassium, being at 3.3 mg/dL. This could lead to decreased cardiac output.
        
        Hyperglycemia
        
        Capillaries become hyperpermeable and lose albumin protein more easily
        
        When albumin is able to leak from the bloodstream into the urine, this can lead to glomerular damage
        
        Glomerular basement membrane (GBM) thickens and develops atherosclerotic changes
        
        Can lead to glomerular hypertension and glomerular capillary lumens are slowly destroyed
        
        Leading to renal dysfunction and raises blood pressure
        
        glomerular capillaries vasodilate
        
        high glomerular capillary hydraulic pressure
        
        glomerulosclerosis
        
        BUN
        
        George's BUN level is 29 mg/dL. The normal range is between 6-24 mg/dL.
        
        A high BUN is a sign that the kidneys are not properly filtering waste.
        
        BUN levels can be elevated due to dehydration. George may not be consuming enough fluids, and he is taking two diuretic medications.
        
        Urinary tract infections and urinary obstructions are two possible causes that could be contributing to increased BUN.
        
        2 more items...
        
        We would want to further monitor and assess George for potential acute kidney injury. This could potentially be causing his increased BUN levels.
        
        George has a family history of Chronic Renal Failure. Some risk factors for CRF that apply to George are hypertension and diabetes mellitus.
        
        BUN is Blood Urea Nitrogen. Urea nitrogen is a waste product made when the liver metabolizes protein.
        
        The kidneys filter the urea nitrogen in the blood through glomerular filtration in the nephrons and excrete it in the urine.
        
        BUN and creatinine levels can be increased due to long-term use of diuretics.
        
        Furosemide
        
        increase excretion of sodium and water by kidneys to lower BP
        
        lowers blood pressure, may lead to orthostatic hypotension
        
        2 more items...
        
        diuretic
        
        check potassium levels prior to administration
        
        may lead to hypokalemia due to increased urine output
        
        CREATININE
        
        George's creatinine level was measured as 1.3 mg/dL. While this is in the normal range, it is on the high end. Paired with his high BUN level, this may potentially become a concern.
        
        The normal range for creatinine is 0.7-1.3 mg/dL.
        
        We would want to monitor his creatinine, for it is a more reliable indicator of renal function than BUN because it is less influenced by other factors such as diet and hydration.
        
        Creatinine is the product of muscle tissue breakdown and is supposed to be filtered in the nephrons of the kidney through glomerular filtration and excreted in the urine.
        
        George has low RBCs and WBCs which could be caused by an underlying renal insufficiency
        
        When there is a renal disease it decreases the kidney's ability to make enough erythropoietin
        
        Low EPO levels cause the rbc to drop which can cause anemia to develop.
        
        George's hemoglobin and hematocrit levels are within range, but on the lower side.
    - - lower levels of glucose circulating in blood
    - - increased glucose uptake and use peripherally
  - - - inadequate glucose uptake in to cells
        
        increased glucose in blood stream
        
        If uncontrolled can lead to DKA (diabetic ketoacidosis)
        
        high mortality
        
        treat with regular insulin IV drip, rehydration, and normal saline
        
        fat breakdown leading to metabolic acidosis.
        
        deep, labored breathing, fruity breath
  - - - Typical range for blood glucose is 70-100 mg/dl