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NEW Gero Unfolding Project - Coggle Diagram
NEW Gero Unfolding Project
Samantha Chapman
Olivia Doolittle
Alyssa Dufault
Reagan Richards Malia Stoneman
Libby Thomas
Pathophysiology
Diabetes Mellitus Type 2
Over time, high blood glucose levels damage the small blood vessels that supply the nerves within the body.
Decreased blood vessel function depletes nerve function which stops essential nutrients reaching the nerves leading to weakness, numbness and pain, otherwise known as neuropathy.
Neuropathy targets sensory axons of neurons inhibiting ability to have sensation in lower extremities and heal
Decreased blood flow to lower extremities caused by type 2 diabetes.
High blood glucose levels ( >110 ) increases the buildup of substances such as cholesterol, glucose, and fat which deposits in the blood vessels
Diabetic Retinopathy ---> Abnormal blood vessels grow out of retina and block fluid from draining out of the eye ---> glaucoma ---> difficulty with vision
Diabetes patients are at an increased risk for dyslipidemia and CAD as in the bodies insulin resistance fat cells (DM) there is an increase in fatty acid which in turn increases alolipoprotein B and VLDL
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age
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Snellen eye exam
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Latanoprost (Xalatan): 1 drop each eye daily prostaglandin analog: reduces intraocular pressure
Which in turn--> decreases wound healing in lower extremities and feet as there is not enough blood flow from the chronic inflammation caused by the fatty deposits that slows the healing process
poor nutrition
has lost 20 pounds since easter
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"drinks a lot of soda"
"no fun cooking for one"
Hemoglobin A1C Ranges: Diabetic Indication: >6.5% Pre-diabetic Indication: 5.7-6.4% Patient: 8.0 (indicates diabetes)
decreased wound healing - diabetic ulcer
uncontrolled or high blood sugar levels
Ulcer is on L planter surface foot
Hydrocodone (Vicodin) 5mg/400 mg PO Q8 hrs PRN Pain**
Normal White Blood Cell Count Range: 3.5-10.5 Patient Value: 4.2 (low end of normal range)
Clindamycin: 400mg PO BID: for infection Antibiotic- Lincosamide Antibiotic
Med name: dose/route: Acidophilus (Culturelle) PO 100 mg q AM
Probiotic
Patient is taking Clindamycin 400mg PO BID which can decrease WBC Counts. Monitor patients lab values each day. Is at stable level currently.
COQ10 100 mg PO daily can help with immune function
lives by himself - less people to help and check for him or give reminders
Skin assessment - would see the ulcer and be sure to chart the measurement and appearance or characteristics
Check pulses bilaterally
Ulcer is on L planter surface foot
Wound measure 4 cm x 4 cm x 1 cm deep
Check skin temperature and color
Toes on BLE are pale and cool to touch
Patients blood glucose - 148
Normal White Blood Cell Count Range: 3.5-10.5 Patient Value: 4.2 (low end of normal range)
Diabetes is a disease that affects the immune system and decreases its overall function.
Decreased immune function can lead to an inability for the body to fight infection and decreased WBC.
With decreased WBCs, the body is more susceptible to infection and also less likely to heal when infected (diabetic ulcer).
Patient is missing med for neuropathy S&S!!consult physician. Gabapentin? Lyrica?
increased glucose, decreased albumin, decreased WBC/RBC/platelets contributes to decreased wound healing
Normal Sodium Level: 135-145 Patient Value: 136 (within normal limits)
Helps maintain normal nerve function
Prozac he's taking may decrease this level
hypertension
uncontrolled diabetes
depression
wife passed away
*St Johns Wort
300 mg capsules Q pm
Fluoxetine (Prozac): 40mg PO Daily
Chlordiazepoxide (Librium) 10mg PO QAM
unhealed foot ulcer
Assess and check patients glucose upon arrival!
Patients blood glucose - 148
lives alone
Sodium helps maintain normal blood pressure, but when blood pressure is high, then tissue perfusion is decreased, therefore worsening wound healing
Hydrochlorothiazide (Microzide): 12.5 mg PO Daily
Thiazide Diuretic: inhibits NaCl transportation in distal convoluted tubule, more Na and fluid excreted DISCONTINUE
Discontinue hydrochlorothiazide
Normal Blood Glucose Range: 70-110 Patient Value: 148 (high value)
High blood glucose contributes to decreased blood flow and damaged nerve vessels because of the increased glucose in the blood stream. Increased glucose levels cause poor circulation thus leading to susceptibility for infection and later diabetic ulcers. The poor circulation decreases wound healing.
Hemoglobin A1C Ranges: Diabetic Indication: >6.5% Pre-diabetic Indication: 5.7-6.4% Patient: 8.0 (indicates diabetes)
Diabetic is a test that tests HgA1C levels over the course of the past three months. His average A1C level high and thus indicative of diabetes. This high level is caused by consistently high blood sugars that are uncontrolled. (--> diabetic ulcers, diabetic retinopathy --> Glaucoma, etc)
Benadryl may decrease these levels!
Insulin Resistance
Impairs glucose absorption
compensatory increase in beta-cell insulin production
hyperinsulinemia
hyperglycemia
excess body fat/obesity
lack of physical activity
foot ulcer
family history of type 2 diabetes
Georges mother had type 2 diabetes
Hypertension
BP: 165/95
**COQ10 100 mg PO daily
Unhealthy diet
too much sugar, salt, and fat
"no fun cooking for one"
Drinks a lot of soda
Improper nutrition. Low albumin levels (2.4)
Has lost 20 pounds since Easter
Patients blood glucose -148
Metformin (Fortamet): 500 mg PO BID biguanide class: increases insulin sensitivity and lowers cAMP
Hemoglobin A1C Ranges: Diabetic Indication: >6.5% Pre-diabetic Indication: 5.7-6.4% Patient: 8.0 (indicates diabetes)
Diabetic is a test that tests HgA1C levels over the course of the past three months. His average A1C level high and thus indicative of diabetes. This high level is caused by consistently high blood sugars that are uncontrolled. (--> diabetic ulcers, diabetic retinopathy --> Glaucoma, etc)
Dementia
Dementia: accumulation of native proteins in the brain cause patient to not be able to adhere to medication orders and blood glucose checks due to poor memory, caused by the neurodegeneration (nerve cells in the brain lose function over time and ultimately die caused by the dementia) of the brain.
age
hypertension
depression
wife passed away
children live far
unable to take care of himself
isolated
lives on a farm by himself
lack of physical activity
diabetes
Neuro Assessment: A&Ox3, c/o NT to both feet (esp. my toes), c/o occasional dizziness. Gait steady. MoCA score 19
Assess cognitive function i.e. clock drawing test
High Blood Glucose - patients BG is 148 - elevated
If positive for certain infection - can increase confusion levels in patient as there can be inflammation of the brain. Not given in the labs but check what bacterium is in the wound
Does patients remember to check blood glucsoe levels? how often?
Malnutrition
Optimal wound healing requires adequate nutrition. Poor nutrition during the healing process can set back complete healing and damage wound strength which would make it more prone to future damage.
"no fun cooking for one"
wife passed away
"no fun cooking for one"
lack of social interaction
hyperglycemia
Mental health conditions :depression
Fluoxetine (Prozac): 40mg PO Daily
St Johns Wort
300 mg capsules Q pm
Vital Signs: HR-92, BP 165/95, RR-15, SpO2=95% on RA, T=36.4
Head to toe assessment, from altered results of this could go into more focused assessments, such as skin.
Patients wright 160.5 lbs
low albumin
Normal Albumin Range: 3.4-5.4 Patient Value: 2.4 (critical low value)
decreased protein intake that is related to malnutrition
Critical low levels of albumin can cause kidney disease.
assess how much patient eats with meal trays
has lost 20 pounds since easter
Normal White Blood Cell Count Range: 3.5-10.5 Patient Value: 4.2 (low end of normal range)
COQ10 100 mg PO daily can help with immune function
Barley Green 1 TBSP with orange juice or grapefruit juice Q AM
Multivitamin Injection qday
GUIDE:
orange = patho
red = risk factors
purple = meds
teal = labs
pink = chief complaints/assessments
causes =green
CC: Diabetic Foot Ulcer
Inspect foot and measure ulcer
Wound bed pink and small areas of slough circum
painful and smells, not healing
Wound measure 4 cm x 4 cm x 1 cm deep
unable to stay off his feet
has to do farm chores
check skin temp and color
toes on BLE are pale and cool to the touch
skin assessment: would see ulcer and be sure to chart the measurement, appearance, and characteristics
Ulcer on L planter surface of foot
check capillary refill for <2
check pulses bilaterally
Normal White Blood Cell Count Range: 3.5-10.5 Patient Value: 4.2 (low end of normal range)
risk for infection
Patient is taking Clindamycin 400mg PO BID which can decrease WBC Counts. Monitor patients lab values each day. Is at stable level currently.
COQ10 100 mg PO daily can help with immune function
1,4 benzoquinone
Tramadol HCL (ultram) 50 mg PO q6 hour (prn for pain)
opioid analgesic
DISCONTINUE PATIENT IS ALLERGIC
Med name: dose/route: Hydrocodone (Vicodin) 5mg/400 mg PO Q8 hrs PRN Pain
Opioid analgesic
osteoarthritis
Aspercreme with Lidocaine topical (prn for pain)
salicylates
Celecoxib (Celebrex) 200 mg PO Bid
NSAID
BPH
Med name: dose/route: Tamsulosin (Flomax) 0.4 mg PO q Day
selective alpha-1A adrenoceptor antagonist
Med name: diphenhydramine (Benadryl) 25 mg PRN Q Bedtime
Pharm Class: antihistamine
This is on BEERS criteria !! Consult physician for med change.