Please enable JavaScript.
Coggle requires JavaScript to display documents.
Type II Diabetes - Coggle Diagram
Type II Diabetes
Assessment:
Vital signs
HR-98, BP 165/95, RR-15, SpO2=95% on RA, T=36.4
Oral
s/s of past metal fillings and partial dentures to right side, visual inspection reveals potential carries on back left molars, pt c/o poorly fitting dentures.
Neuro
A&Ox3, c/o NT to both feet (esp. my toes), c/o occasional dizziness. Gait steady.
Cardiac
HR=92, BP=165/95, pulses 2+BUE (bilateral upper extremities), pulses 1+, thready to BLE (bilateral lower extremities), toes pale & cool to touch. Non-edematous.
Respiratory
RR=15, even and unlabored, shallow. LS (lung sounds) diminished in BLL (bilateral lower lobes) otherwise CTA (clear to auscultation)
GI
BS x4. c/o Occasional stomach upset. “I get full so easy and my food takes forever to move and I get heartburn”.
GU
BPH, occasional urinary hesitancy.
Musculoskeletal
Steady but protective gait, slight limp to L foot due to “foot pain” per patient ranges 4-8 on scale of 10. c/o occasional joint pain to R knee (L knee replaced in 2009- denies pain). c/o generalized weakness, + bilateral Charcot foot
Integumentary
L plantar surface foot, Diabetic Foot wound measures 4cm x 4cm x 1cm deep. Wound bed with pink and small areas of slough circum- wound edges (2mmx4mm). Toes on BLE pale and cool to touch. Otherwise, skin generally thin, loose due to rapid recent weight loss and inelastic. Turgor reduced.
-
-
Labs:
BMP
Na: 136
Patient’s Na is within the normal limits, however it is on the lower side of normal. A decreased sodium level is not uncommon in patients with diabetes mellitus, especially if the diabetes is uncontrolled. Uncontrolled diabetes mellitus can also induce hypovolemic-hyponatremia because of osmotic diuresis. In addition, diabetic ketoacidosis ketone bodies can cause electrolyte losses through the urine and can kickstart renal sodium wasting.
K: 3.3
Patient's K level is decreased and outside of the normal range. This can be linked to his hyperglycemia through the function of the ATP-sensitive potassium channel within islet cells. Hypokalemia can be associated with his hyperglycemia by accounting for the impairment of potassium-dependent insulin releases in response to too much glucose.
Cl: 99
Patient's chlorine level is within the normal limits. While it is on the lower side of normal, it is still considered a healthy level. Certain diuretics, such as Lasix, can decrease chlorine levels in the body. He is currently taking Lasix, so this can explain why the value is on the lower side.
BUN: 29
Patient’s BUN level is elevated. This can be linked to the symptoms of dehydration he is exhibiting. His nutrition habits include drinking soda often, which is a diuretic and is proven to be dehydrating. In addition, he is urinating many times during the night, which could also be dehydrating to him.
Cr: 1.3
Patient’s Cr level is on the elevated side of normal. This can be associated with his hyperglycemia, as elevated glucose levels in the blood can cause damage to the kidneys. Kidney damage is reflected
in this elevated Cr lab value.
Glu: 148
Patient’s glucose level is elevated, which can be associated with his uncontrolled type two diabetes mellitus. He experiences hyperglycemia as a result of this condition, and that is reflected in his elevated blood glucose level.
Alb: 2.4
Patient’s Alb level is decreased. A side effect of type two diabetes mellitus is a decreased albumin synthesis and secretion, which is linked to an insulin resistance in the body. He experiences
insulin resistance, and his low Alb lab values reflect this.
- 1 more item...
CBC
WBC: 4.2
Patient’s white blood cell count has slightly decreased. This could be because of his diagnosis of Type 2 Diabetes Mellitus. He has high blood sugar levels, which add stress to his body and make nearly every system work harder, including the white blood cells of his immune system. This finding is exemplified by the patient’s foot ulcer being unable to heal in a timely fashion without medical
help.
RBC: 3.9
Patient’s red blood cells are also slightly low. This could be due to malnutrition or dehydration and indicate anemia. These symptoms can be seen in how the patient expressed that he wakes up 10 times
per night to urinate, and he has also lost 20 pounds over the past few months.
HgB: 13.8
Patient’s hemoglobin is technically within normal limits, it is on the lower side of normal. This could be due to his lack of RBCs. However, hemoglobin and hematocrit are correlated and are both within normal limits, so he shouldn’t be experiencing any major symptoms of a low
hemoglobin level.
HCT: 40
Patient’s hematocrit is within normal limits at 40%. This value is on the lower side, which could indicate dehydration or a low RBC count. He is exhibiting symptoms of dehydration because he urinates many times overnight and also drinks soda pop, which can dehydrate you further.
PLT: 120
Patient’s platelet count has also slightly decreased. This could be due to an infection in the body. He currently has a foot wound that his body is trying to fight, which could be decreasing his platelet levels.
INR: 1.1
Patient’s INR level is considered normal. This is because he is not taking any medications to increase the time it takes for his blood to clot. His platelets are slightly decreased, which could allow for slightly more time to clot, but his INR is within normal limits.
PT: 27
Patient’s PT is within normal limits. This is portrayed by his blood clotting in a normal amount of time. He has no symptoms of too fast or too slow blood clotting (excessive bleeding, chest pain,
discomfort).
Urinalysis
Color: Dark Yellow
Dark yellow urine often shows signs of dehydration. This would make sense in the patient’s case since he states that he drinks a lot of soda pop which can cause dehydration. Medications such as statins
to lower cholesterol can also darken urine. Also some liver and kidney disorders and some urinary tract infections can turn urine dark brown
Clarity: Hazy
There are a few things under the patient’s history that would make sense why he is experiencing hazy urine. Sometimes diabetes or diabetic kidney disease is the underlying cause of cloudy urine. The
body may be trying to remove excess sugar that it cannot process by sending it through the urine. Also prostatitis is an inflamed prostate that may cause cloudy urine. Infection or swelling of the prostate can cause this and he has BPH. Lastly, when more water leaves the body than the
amount that enters it, dehydration can result. This can cause cloudy urine.
Specific Gravity: 1.002 L
A decrease in urine specific gravity could be due to conditions such as excess water and drinking too much fluid, diuretics, hyposecretion of ADH (diabetes insipidus), and kidney failure. The patient is on Lasix which is a diuretic making you excrete urine more often which could be why his urine is
diluted.
pH: 7
A urine pH of 7.0 normally indicates a neutral pH level. This means that the urine's pH is neither acidotic or alkaline.
Blood: Negative
The patient has no blood in his urine which is a good thing. Blood in the urine may be due to a problem in your kidneys or other parts of the urinary tract
Leuko Esterase: Negative
The patient is negative for leuko esterase in the urine. Leukocyte esterase is a screening test used to detect a substance that suggests there are white blood cells in the urine. If positive, this may mean
you have a urinary tract infection, kidney stones, or pelvic tumor.
Nitrates: Negative
The patient is negative for nitrates in the urine. Nitrite-positive urine is a sign of a possible urinary tract infection. Healthy urine contains nitrates, a type of nitrogen chemical. When bacteria enter your urinary tract, the bacteria turn these nitrates into a different nitrogen chemical called nitrites.
- 1 more item...
-
-
-
