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Diabetes Mellitus Type 2: metabolic disease characterized by hyperglycemia…

- - - - Paroxetine
        
        Used to treat depression and anxiety
        
        Paroxetine is a medication that is listed under the Beers Criteria list. This medication causes serious anticholinergic effects causing effects such as difficulty seeing and trouble with urination. The provider should be contacted and the medication should be changed.
      - St. Johns wort
        
        George should be advised to stop taking SJW as it has many negative interactions with medications like his antidepressants
      - Prozac
        
        increases levels of Serotonin in the brain
        
        side effects include: nausea, headaches, insomnia
        
        Nurse should confirm with George that he is taking his Prozac in the morning to prevent difficulty sleeping
      - Chlordiazepoxide
        
        anti-anxiety medication used to help with George's coping
        
        Side effects include: dizziness, nausea, headache, tremor, fatigue, balance disurbances
  - - - Risk Factors relating to George include poor diet, DLD, age, Diabetes, family hx, Depression, and Use of Antidepressants
        
        Upon assessment George's BP was 165/95, his HgBA1C was elevated at 8.0
        
        Possible complications relating to George = Atherosclerosis
        
        George reports numbness and tingling in the lower extremities, and upon assessment his lower extremities were pale and cool
        
        This complication likely contributed to George's diabetic foot ulcer due to decreased peripheral perfusion r/t his HTN
        
        This ulcer has caused George pain, and due to his HTN, atherosclerosis and DM.. delayed wound healing as evidenced by his foot ulcer 6 months later
        
        1 more item...
      - Result of the vasculature: decrease vessel compliance, increased plaque/buildup, increase calficiation
        
        result of this is increase pressure to move blood through the vessels if there is less space, less compliance (more stiffness), and increased calcification
      - result of endocrine: increase insulin, increase aldosterone/corticosteroids
        
        insulin, aldosterone, and corticosteroids will all increase water and sodium retention in the body. Insulin and corticosteroids will activate the sympathetic nervous system causing water and sodium retention
      - Renal Factors: and increase in renin-angiotension aldosterone system
        
        this system works to increase blood pressure with water reabsorption and blood vessel constriction, if this is out of balance, the body may be increasing BP when it shouldn't be
    - - Lasix -- loop diuretic
        
        Risk for dizziness, lightheadedness, headache, or blurred vision
        
        Educate George on risk for falls and difficulty seeing as a side effect of this drug
        
        Impaired vision puts him at an overall greater susceptibility for fall risk, gait imbalances,
        and mobility difficulties.
      - Hydrochlorothiazide
        
        Reduces the amount of fluid in the body by increasing urine flow
        
        Hydrochlorothiazide should not be taken with sleeping pills -- George's chronic use of Benadryl for night insomnia mixed with his use of Hydrochlorothiazide could be contributing to his bouts of dizziness
        
        Also caution with George's potassium levels
    - - Dietary changes, regular exercise, control DM and DLD, low saturated fat and low sodium diet, DASH diet provide medications, monitor Q1 month and take BP daily,
  - - - latanoprost
        
        this drug is used to treat glaucoma; it is in the form of eye drops for George.
        
        Glaucoma is high pressure of the eye which causes vision impairments; this drug works to lower the IOP of the eye.
        
        It works by restoring the flow of fluid to the eye to lower ocular pressure
        
        Possible adverse effects: blurred vision, burning and stinging, itching, conjunctival hyperemia
  - - - Atorvastatin
        
        Used for dyslipidemia
        
        Works by blocking an enzyme the body needs to make cholesterol and reduces the amount of cholesterol in the blood
        
        Most common side effects include: muscle pain, joint pain, and diarrhea.
        
        Possible side effects playing a role in George's knee pain
    - - Smoking
      - Sedentary lifestyle
      - Age
      - Unhealthy diet
      - unhealthy diet
      - excessive ETOH use
      - family history
      - history of chronic disease
    - - LDL is the 'bad' lipoprotein and is responsible for atherosclerosis and high cholesterol.
        
        metabolism of these lipoproteins depend on the liver and intestines, meaning that high LDL (dyslipidemia) could be a secondary cause of an underlying disease with the intestines and liver. It is also often a cause of intake of fats that is more than body requirements.
        
        When there is too much LDL it builds up in the bloodstream and eventually deposits inside the arteries. This leads to atherosclerosis and damages the blood vessels causing decreased perfusion and the plaques can cause stiffness and HTN.
  - - - Taking Tamsulosin to reduce uncomfortable symptoms and improve overall urine flow
        
        May increase feelings of drowsiness and dizziness. Greater risk for hypotension.
- - - - Triglycerides
- - - - Used for heartburn and GERD
        
        George takes 20 mg at HS to likely prevent nighttime heartburn or indigestion
        
        Famotidine is a medication that is listed on the Beers Criteria list and should be evaluated. Consult provider to see if there is a different medication that George can take with lower risks.
    - - used to treat infections caused by bacteria in the body (George's foot infection)
    - - Used to help promote the growth of good bacteria in the body
        
        Probiotic
    - - Used to treat BPH
        
        Works by relaxing the muscle around the bladder and prostate making it easier to urinate
        
        Major side effect is dizziness, important to educate George on this topic and his increased risk for falls
    - - used to treat pain in foot caused by diabetic ulcer
        
        Side effect -- dizziness -- educate on fall risk
    - - used to treat foot pain
        
        side effects include dizziness and low energy
    - - Used to treat Osteoarthritis
        
        reduces inflammation and pain in the body
        
        Monitor for signs of GI ulcers or bleeding
    - - Used to treat GERD, heartburn, and stomach ulcers
  - - - George uses occasionally at HS
        
        George reports "doing this for years"
        
        This can lead to increased risk of dementia, short-term memory loss, confusion, and impaired cognitive function
    - - Used PRN for R knee pain
    - - 500 mg PRN for pain
        
        George should be educated on not exceeding 4 g or even better 3200 mg due to risk of liver injury.
  - - - George should be advised to stop using Grapefruit juice as it can have a negative reaction with his dislipidemia medications
      - Taking Barley Green with his diabetes medications may cause hypoglycemia
    - - Can cause hypoglycemia and effect blood sugar levels
- - - - Sugar can not get into to the cells to be used for energy
        
        Decreased glucose to the nephron --> decreased renal function --> dehydration
        
        POLYDIPSIA
        
        Gluconeogenesis: the body breaks down muscle tissue and adipose tissue to use as energy
        
        Weight Loss
        
        Weight loss alter's body homeostatic system, which controls appetite, energy intake, and energy expenditure.
      - Hyperglycemia: high blood sugar levels
        
        Increased glucose at the nephron
        
        Kidneys cannot reabsorb all the glucose, so it is excreted in the urine
        
        GLUCOSURIA
        
        glucose presence in the nephron acts an osmotic pull for water, preventing the absoroption of water
        
        POLYURIA
        
        loss of water and loss of electrolytes
        
        dehydration
        
        hyperosmolar state
        
        George expresses "I wake up about 10 times a night to go pee" this is a result of his DM II.
        
        Increased blood sugar and fat levels leading to promotion of oxidative stress
        
        Production of free radicals can damage blood vessels
        
        Limited vascular supply causing hypoxic damage to nerve cells
        
        Neuropathy
        
        Limited joint mobility, increased risk for pressure and shear
        
        Damaged blood vessels results in decreased perfusion to the skin
        
        Development of foot ulcer
        
        George presents with chronic foot wounds throughout his hospital stays and his long term care admission
        
        2 more items...
        
        dry skin, poor tissue perfusion, blood may pool and sit in the area (arterial insufficiency) this is seen as a result of Georges atherosclerosis. This also contributes to Georges foot wound.
        
        George's HgBA1C = 8.0 with normal being < 5.6
- - - - Side effects of Metformin include: nausea, vomiting, diarrhea, and loss of appetite... possible contributor to George's weight loss and loss of appetite