NCS-DM Type 2 for Case Presentation

1

|College of Nursing

UNIVERSITY OF ST. LA SALLE-BACOLOD |March 12, 2010

Diabetes Mellitus Type 2

A NURSING CASE STUDY

Submitted by:

Liza, Juan PaoloLucot, Marie Joan

Magno, PamelaMartinez, Astrid Lyn

Oligo, Cherish YenPalma, Ann Margareth

Perez, AnalizaRiofrer, John Eric

Roquim, Glenda Mae

Group 3_BN3C

2

Table of Contents

INTRODUCTION 3

OBJECTIVES

GENERAL OBJECTIVES

SPECIFIC OBJECTIVES

4

ANATOMY AND PHYSIOLOGY 5

BASELINE DATA 9

NURSING HISTORY (GORDON’S FUNCTIONAL HEALTH PATTERN) 9

HEALTH HISTORY 12

PHYSICAL ASSESSMENT 13

LABORATORY AND RADIOLOGY 16

PATHOPHYSIOLOGY 18

NURSING CARE PLAN

IMPAIRED TISSUE INTEGRITY

INEFFECTIVE PERIPHERAL TISSUE PERFUSION

RISK FOR ACTIVITY INTOLERANCE

19

DRUG STUDY 20

HEALTH TEACHING METHOD 43

DEFINITION OF TERMS 47

Introduction

3

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or action, or both. Type 2 diabetes mellitus (formerly called non-insulin-dependent diabetes mellitus (NIDDM) is a group of disorders characterized by hyperglycemia and associated with microvascular (ie, retinal, renal, possibly neuropathic), macrovascular (ie, coronary, peripheral vascular), and neuropathic (ie, autonomic, peripheral) complications. Unlike patients with type 1 diabetes mellitus, patients with type 2 are not absolutely dependent upon insulin for life, even though many of them are ultimately treated with insulin.

In type 2 diabetes, the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin (released from the pancreas) takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications.

Type 2 diabetes is determined primarily by lifestyle factors and genes. A number of lifestyle factors are known to be important to the development of type 2 diabetes. In one study, those who had high levels of physical activity, a healthy diet, did not smoke, and consumed alcohol in moderation had an 82% lower rate of diabetes. When a normal weight was included the rate was 89% lower. Obesity has been found to contribute to approximately 55% type 2 diabetes. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 increases risks of developing type 2 diabetes very substantially.

Mr. G.G., Jr., is a 64year old, male whose diabetes type 2 has been diagnosed in the year 1995 when he was hospitalized in Bacolod Adventist Medical Center. Mr. G.G., Jr.’s diabetes was acquired through genetic predisposition where his father also had diabetes. With regards to his lifestyle, client is a non-smoker and an occasional alcohol drinker. Mr. G.G., Jr., was admitted at Bacolod Our Lady of Mercy Specialty Hospital last January 25, 2009 with chief complaint of infected wound @ right foot. Significant physical remarks of Mr. G.G. Jr. include gouty arthritis at his right elbow and both knee joints, phalanges, carpals, metacarpals, metatarsals and tarsal joints.

This Nursing Case Study which focuses on Diabetes Mellitus Type 2 provided an opportunity for us, as student nurses, to have a thorough and in depth understanding of the DM Type 2. Through this NCS, we were able to enhance our assessment skills and as well as critical thinking skills as the group relate the actual signs and symptoms of DM type 2 exhibited by Mr. G.G. Jr. and the abnormal physiological changes which have caused these changes. Also, this NCS allowed us to profoundly understand the interconnectedness of an imbalance in a certain hormone and it’s variety of effects to the body.

Objectives

4

|General Objective:

This nursing case study aims to;

Develop students’ ability to perform assessment and identify the priority needs and health problems of clients with Diabetes Mellitus Type 2 and formulate appropriate nursing interventions to address the client’s individual needs.

|Specific Objectives

After 4 days of nursing case study, the student nurse will be able to;

Outline biologic and physical manifestations of DM Type 2 correlating it with the underlying abnormalities and physiologic disturbances present in the client.

Obtain client’s functional health pattern, history of present illness, past health history and family/social history.

Identify the complications manifested by clients with DM type 2 through cephalocaudal and systems assessment.

Identify the deviations from normal in the laboratory and radiologic tests brought about by DM type 2.

Trace the nature and cause of client’s condition through the pathophysiology of DM type 2.

Select 2 actual priority nursing problems and 1 risk nursing problem and formulate Nursing Care Plans for each.

Focus on the nursing responsibilities and interventions specified to medications administered to the client.

Construct a Health Teaching Plan that will address client’s knowledge needs.

Apply values of concerns and empathy in providing care in order to achieve optimum health for patients with DM type 2.

Anatomy and Physiology

5

The endocrine system is made up of glands that produce and secrete hormones. These hormones regulate the body's growth, metabolism (the physical and chemical processes of the body), and sexual development and function. The hormones are released into the bloodstream and may affect one or several organs throughout the body.

Hormones are chemical messengers created by the body. They transfer information from one set of cells to another to coordinate the functions of different parts of the body.

The major glands of the endocrine system are the hypothalamus, pituitary, thyroid, parathyroids, adrenals, pineal body, and the reproductive organs (ovaries and testes). The pancreas is also a part of this system; it has a role in hormone production as well as in digestion.

The endocrine system is regulated by feedback in much the same way that a thermostat regulates the temperature in a room. For the hormones that are regulated by the pituitary gland, a signal is sent from the hypothalamus to the pituitary gland in the form of a "releasing hormone," which stimulates the pituitary to secrete a "stimulating hormone" into the circulation. The stimulating hormone then signals the target gland to secrete its hormone. As the level of this hormone rises in the circulation, the hypothalamus and the pituitary gland shut down secretion of the releasing hormone and the stimulating hormone, which in turn slows the secretion by the target gland. This system results in stable blood concentrations of the hormones that are regulated by the pituitary gland.

Hormone Pituitary Stimulating Hormone Hypothalamic Releasing Hormone

Thyroid hormones T4, T3

Thyroid-stimulating hormone (TSH) Thyrotropin-releasing hormone (TRH)

Cortisol Adrenocorticotropin hormone (ACTH)

Corticotropin-releasing factor (CRF)

Estrogen or testosterone

Follicle-stimulating hormone (FSH), luteinizing hormone (LH)

Luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH)

Insulin like growth factor-I (IGF-I)

Growth hormone Growth hormone-releasing hormone (GHRH)

THE PANCREAS

6

The pancreas is a pinkish white glandular organ found in vertebrates near the stomach and small intestine. The pancreas is the second largest gland that is connected to the digestive tract, after the liver.

The pancreas is one of the few organs that have both an exocrine and an endocrine function. Exocrine glands are glands that secrete their products into ducts (duct glands). Endocrine glands are glands that secrete their product directly into the blood rather than through a duct. The pancreas' exocrine function involves the secretion of bicarbonate and digestive enzymes into the small intestine. Its endocrine function involves the regulation of blood sugar levels by secreting the hormones insulin, glucagon, and somatostatin directly into the blood. The endocrine portion of this organ consists of about 1 million islets of Langerhans, amounting to only 1-3 percent of the organ weight. The majorities of cells are exocrine and secrete one to three liters of digestive fluid per day.

The pancreas is an important organ for digestion and the control of circulating levels of glucose. This organ is an excellent example of an intricate, well-tuned organ that functions in harmony with other parts of the body, providing a service to the body while receiving the nutrients and removal of wastes necessary for its survival. For example, in terms of its function in the digestive system, it is one of several parts of the body that work together, involving cooperative giving and receiving, including the stomach, intestines, liver, pancreas, heart, brain, and so forth.

|AnatomyIn human beings, the pancreas is a 6-10 inch

elongated organ weighing 65 to 160 grams and lying in the abdominal cavity. It lies posterior to the stomach, anterior to the kidneys, and empties into the duodenum portion of the small intestine.

The human pancreas can be divided into five regions: (1) the head, which touches the duodenum, (2) the body, which lies at the level of second lumbar vertebrae of the spine, (3) the tail, which extends towards the spleen, (4) the uncinate process, and (5) the pancreatic notch, which is formed at the bend of the head and body.

|Blood Supply

The pancreas is supplied arterially by the pancreaticoduodenal arteries:

the superior mesenteric artery feeds the inferior pancreaticoduodenal arteries

• the gastroduodenal artery feeds the superior pancreaticoduodenal artery

|Nerve Supply

The pancreas receives neural innervation from the vagus (cranial X). This is part of the autonomic parasympathetic supply. The role of the vagus is to stimulate secretion of the pancreatic digestive juices.

Autonomic sympathetic nerves to the pancreas derive from the celiac ganglionic plexus, the superior mesenteric plexus, and the hepatic plexus. These plexuses lie outside the pancreas and send postganglionic fibers into the pancreatic cells. These sympathetic nerves inhibit the production of digestive enzymes (Berne et al. 1996).

The innervation of the pancreas is comprised of both an intrinsic component that consists of many intrapancreatic ganglia and an extrinsic component made of neurons lying outside the digestive tract and belonging to the sympathetic and parasympathetic systems

Many different neurotransmitters have been found within the pancreas including acetylcholine, epinephrine, norepinephrine, serotonin, nitric oxide, and others (Salvioli et al. 2002).

1: Head of pancreas2: Uncinate process of pancreas3: Pancreatic notch4: Body of pancreas5: Anterior surface of pancreas6: Inferior surface of pancreas7: Superior margin of pancreas8: Anterior margin of pancreas9: Inferior margin of pancreas10: Omental tuber11: Tail of pancreas12: Duodenum

7

|Microscopic Anatomy

When the pancreas is sliced, stained, and then viewed with a microscope, it is easy to distinguish many different types of cells that correspond to different pancreatic functions. The microscopic appearance of the pancreas shows a series of islands (the Islets of Langerhans) consisting of small cells packed closely together, surrounded by much larger and less dense acinar cells. The islands have an endocrine function and the surrounding cells have an exocrine function.

Appearance Region Function centralized islands

(islets of Langerhans)endocrine pancreas secretes hormones that

regulate blood glucose levels surrounding acinar cells exocrine pancreas produces enzymes and

bicarbonate

| Endocrine FunctionName of cells Product % of islet cells Representative function

beta cells Insulin and Amylin 50-80% lower blood sugaralpha cells Glucagon 15-20% raise blood sugardelta cells Somatostatin 3-10% inhibit endocrine pancreas

gamma cells Pancreatic polypeptide 1% inhibit exocrine pancreasThere are four main types of cells in the islets of Langerhans. They all look similar when using

standard staining techniques, but when special stains are used they can be classified into four different types:

The islets are a compact collection of endocrine cells arranged in clusters and cords that are crisscrossed by a dense network of capillaries. The capillaries are lined by layers of endocrine cells in direct contact with them by either cytoplasmic processes or by direct apposition. The cells release their hormones, without ducts, directly into the capillaries.

HORMONES PRODUCED BY THE PANCREASInsulin is a polypeptide containing two chains of amino acids joined together by two disulfide

bridges, and contains a total of 51 amino acids. * helps to transport glucose into skeletal muscle and liver. * is produced when blood sugar exceeds 50 mg/deciliter. * has an average production of 1.0 to 2.5 mg/day. * stimulates skeletal muscle and liver to convert glucose to a storage form called glycogen. * stimulates fat cells to synthesize fat. * acts on the hypothalamus to reduce appetite.

Amylin is another polypeptide secreted by the beta cells. It is slightly smaller than insulin with 37 amino acids. It works to supplement the actions of insulin.

* inhibits the secretion of glucagon. * lowers the level of glucose in the blood. * slows the emptying of the stomach into the intestine. * sends a signal of satiety to the brain.

Glucagon is a polypeptide containing 29 amino acids. * is released into the blood in response to a blood glucose level falling below 80 mg/deciliter * acts primarily on the liver to stimulate glucose production by breaking down glycogen and converting protein and fat into glucose * secretion is inhibited by amylin (Bowen 2002).

Somatostatin

8

Purpose: Regulate the production and excretion of other endocrine tumorsAction: Slows down production of insulin, glucagon, gastrin, and other endocrine tumorsSecreted in response to: High levels of other endocrine hormonesSecretion inhibited by: Low levels of other endocrine hormonesDisease due to deficient action: Poorly definedDisease due to excess action: Diabetes, gallstones, and dietary fat intoleranceTumor called: Somatostatinoma

The endocrine function of the pancreas is to produce important hormones including insulin, glucagon, and somatostatin and export them to the blood supply on demand.

Pancreatic polypeptide is secreted by the gamma cells and consists of 36 amino acids. It is produced in response to chewing and swallowing food. It probably acts to reduce appetite (Taylor et al. 1982).

| Insulin

Insulin is a hormone that has profound effects on metabolism. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle, and stopping use of fat as an energy source. When insulin is absent (or low), glucose is not taken up by body cells, and the body begins to use fat as an energy source, for example, by transfer of lipids from adipose tissue to the liver for mobilization as an energy source. As its level is a central metabolic control mechanism, its status is also used as a control signal to other body systems (such as amino acid uptake by body cells). In addition, it has several other anabolic effects throughout the body.

When control of insulin levels fails, diabetes mellitus will result. Consequently insulin is used medically to treat some forms of diabetes mellitus. Patients with Type 1 diabetes mellitus depend on external insulin (most commonly injected subcutaneously) for their survival because the hormone is no longer produced internally. Patients with Type 2 diabetes mellitus are insulin resistant, and because of such resistance, may suffer from a relative insulin deficiency. Some patients with Type 2 diabetes may eventually require insulin if other medications fail to control blood glucose levels adequately, though this is somewhat uncommon.

Insulin also influences other body functions, such as vascular compliance and cognition. Once insulin enters the human brain, it enhances learning and memory and in particular benefits verbal memory.

Insulin is a peptide hormone composed of 51 amino acids and has a molecular weight of 5808 Da. It is produced in the islets of Langerhans in the pancreas. The name comes from the Latin insula for "island". Insulin's structure varies slightly between species of animal. Insulin from animal sources differs somewhat in 'strength' (in carbohydrate metabolism control effects) in humans because of those variations. Porcine (pig) insulin is especially close to the human version.

Baseline Data

Name: G.G. Jr. Address: Calumangan, Bago City Age: 64 years old No. of dependents: 6 Birth Date: 12-12-1945Birth Place: Bago City Gender: MaleMarital Status: Married Religion: Roman Catholic

9

Nationality: FilipinoEducational Attainment: High School Graduate Occupation: LaborerPerson Next to Kin: G.G. IIIDate of Admission: 01-25-2010Time of Admission: 2:35 pm Attending Physician: Dr. Jessielyn Doromal, MDCC: Infected Wound Right Foot Diagnosis: DM II Controlled

Nursing History

|Health Maintenance Pattern

Patient G.G. Jr. fortunately is a nonsmoker and just an occasional drinker. Prior to admission, January 22, 2010, patient G.G. Jr. drank with his other 2 co-workers a minimum of 2 Tanduay long neck whiskies which, according to him was just a form of socialization. He has been taking maintenance drugs for his Gouty Athritis namely Colchicine (500mg) and Depenax (50mg). However, the patient consumes these drugs only when he feels pain due to his arthritis which deviates from the prescribed dosage of the said drugs (prescribed dosage by AP was unrecalled by patient). Furthermore, the client divides his Cochicine tablet (which is not a scored tablet) into two and takes half of the tablet as a relief for his arthritic pain. Also, he takes Euglucon (5mg), taken after breakfast, for his diabetes. He has been taken this medication since his first hospitalization in the year 1995. With regards to the patient’s infected wound, patient mentioned that he utilizes “bayabas” leaves decoction to cleanse his wounds and amoxicillin powder (from the amoxicillin capsule) as his medication to his wound. The said amoxicillin was only a suggested intervention that was not prescribed by a medical practitioner. According to him, he only changes his dressings once everyday due to economic constraints. Patient has no allergy to medications, food , tapes or dyes.

Generally, patient has minimal knowledge regarding the importance of proper compliance to medications and the importance of hygiene especially with his wound. Though Mr. G.G. Jr. consumes the correct medications, he has not been following the correct amount, frequency and dosage of these medications.

| Nutrition-Metabolic Pattern

Prior to admission, client eats rice, vegetables and fish regularly. According to him, he seldom eats pork and chicken. Client observes restrictions in sugar and salt and he rarely eats fruits approximately only 3-5 times a month. He had normal appetite and no fluctuations in weight for the last 6 months. However, client stated that he is previously not as thin as he is now. There was weight loss but it gradually occurred in years. No difficulty of swallowing was expressed by the patient and has no presence of dentures. As a complication of his DM type 2, client has retarded wound healing and has undergone ungiectomy, (nail, big toe, right foot) last July 2008. Client has 2 diabetic ulcerations in the body, one at his left elbow (almost healed) and one at his right foot phalanges area. According to him, his wounds started last September 2009 and until now remains an open wound and unfortunately became infected. Poor skin turgor and dryness is also noted in the patient’s skin.

10

| Elimination Pattern

Patient G.G. Jr. has a regular bowel movement prior to admission. According to him, he defecates once a day yellow to brown colored formed stool and seldom experiences constipation/diarrhea. He urinates approximately 4 times a day, approximately more than 220cc per voiding. No urine/ bowel incontinence was expressed by the client.

| Activity-Exercise Pattern

Client is independent in performing self care activities prior to admission such as bathing, grooming, toileting and eating. According to him, his wound does not disturb his activities especially in his work as a laborer. Though there is pain, it is tolerable. He also emphasized that he can climb the stairs independently and ambulates without assistance. Mr. G.G. Jr. attends his work in the morning at around 8am and returns home by 5pm. During weekends, Mr. G.G. Jr. spends this time relaxing at home or doing some simple household repairs. Mr. G.G. Jr. does not use any assistive devices (e.g. canes, walker, and crutches) though stiffness in his joints in the lower extremities is present. Patient has no exercise pattern, according to him, his exercise is already included in his work as a manual laborer.

| Sleep- Rest Pattern

Mr. G.G. Jr. sleeps for 10- 11 hours per day. According to him, he goes to bed early at 7-7:30pm and wakes up at 6 am. He has no schedules of AM or PM nap because of his work in the field. He also expressed that he feels rested after his sleep. He does not have any trouble sleeping prior to admission.

|Cognitive- Perceptual Pattern

Patient G.G. Jr. is alert, oriented and has normal speaking ability prior to and during admission. He speaks Ilonggo and a few Tagalog. He can comprehend to simple English terms but is not that acquainted with the language. He had only finished high school in their local high school in Bago which reflects a poor knowledge level of the patient. Patient is able to communicate and comprehend effectively and has appropriate interactive skills. Patient has undergone cataract extraction in the year 2008 and is presently using corrective glasses (grade unrecalled). Client has not expressed any abnormalities in hearing. He expressed light alteration in taste (food is slightly tasteless) but no alteration in the sense of taste reported.

Patient expressed experience of chronic pain as a result of his infected wound at right foot area and several arthritic pain episodes. When asked about the level of pain, he responded a score of 6 from a scale of 1-10 in the pain scale (10 being the highest score/extreme pain). To manage this pain, patient G.G. Jr. takes Colchicine and Depenax for his arthritis and relaxes his feet to relieve pain due to his wound.

|Self- Perception/ Self-Concept Pattern

Patient G.G. Jr. is contented of whatever he has now and is thankful to God that still he was able to attend to his medical needs besides their financial instability. Mr. G.G Jr. has a good body image of himself and maintains a happy disposition and optimistic outlook about the future. He expressed a positive spirit towards wellness.

|Role- Relationship Pattern

11

Mr. G.G. Jr. is married for 33 years and has 6 children- 5 boys and 1 girl. His eldest is already 32 years old and has already a family of his own while his youngest is 19 years old. Prior to admission, patient G.G Jr. works as a laborer under the City Engineering Office of Bago and has been working for the city government for more than 20 years already. Patient G.G. Jr. has a good relationship with his family members especially with his wife who accompanied him in the hospital since his first day of admission. Also, he is frequently visited by his children. Patient G.G. Jr. expressed his concern regarding his role as the provider of their household since his wife is unemployed. He worries about the added expenses from the hospital and their expenses at home.

|Sexuality- Reproductive Pattern

Patient G.G. Jr. was circumcised when he was 9 years old. Patient did not express any problems with his sexuality and patient expressed contentment with his wife as his partner. Also he expressed contentment of having 6 children. Patient G.G. Jr. also expressed that he and his wife did not engaged in any family planning method as family method was not yet well advocated and promoted during the young years of their marriage.

|Coping- Stress Pattern

As expressed by Mr. G.G Jr., his major concern regarding his hospitalization and his illness are the expenses of his stay in the hospital and his medications. Other concerns include the unprovided needs of his family in their household and his absence from work. Patient emphasized that one of his stressors in life is their family’s financial instability which is also the reason why he continuously goes to work as a laborer besides his condition. Nonetheless, patient G.G. Jr. expressed that life should still go on and they should not lose hope for these are only challenges in his journey. Strong emotional support from his wife and children also empowers Mr. G.G. Jr. to continuously be strong. Also, patient exhibited strong faith in God as he said that everything that has happened is according to God’s will and decision.

|Value- Belief Pattern

Patient G.G. Jr. is a Roman Catholic and has no religious restrictions. He often goes to church with his wife and always expressed his strong faith in God as his healer and provider. Patient G.G. Jr. is contented of what God has provided them and surrenders everything according to God’s will.

Health History

|History of Present Illness

Client was diagnosed with Diabetes Mellitus in the year 1995 when he had his hospitalization at Bacolod Adventist Medical Center. He was then prescribed to take Euglucon as his maintenance medication for diabetes and takes this drug religiously. Four months prior to admission, patient had wounds at his left elbow (almost healed) and right foot, and yet did not take appropriate actions to treat the said wounds and latter became infected. One day prior to admission, patient noted wound at right foot to have purulent and watery discharges with tenderness associated with fever. Morning prior to admission, patient G.G. J. consulted his attending physician and was advised for admission. Upon

12

admission, patient is conscious and coherent. His blood pressure is normal at 120/70, RR=17cpm, PR=63bpm and temperature of 36.2oC. Erythema and tenderness is noted at patient’s infected wound at his right foot.

|Past Health History

Childhood Illness

As a child, patient G.G. Jr. went through chickenpox at 5 years old, and latter on the same year experienced mumps. No immunizations were undertaken by patient when he was young and claimed no allergy or hypersensitivity to any food or medication. According to patient G.G. Jr., he seldom experienced colds and cough when he was young. No other childhood illnesses were expressed by the client.

Patient G.G. Jr. has a family history of Diabetes Mellitus.

Past Hospitalization

In the year 1995, patient G.G. Jr. was hospitalized at Bacolod Adventist Medical Center and was diagnosed with Diabetes Mellitus Type 2. This present admission was only the second hospitalization of Mr. G.G Jr. due to one of the complications of his diabetes which is delayed wound healing.

No other previous hospitalizations occurred.

Serious Illness

Patient G.G. Jr. had been diagnosed of Gouty Arthritis in the year 2007 through a consultation in their Local City Health Office at Bago. He was prescribed with Colchicine and Depenax as his maintenance medications. Also, patient has Diabetes Mellitus Type 2 which was diagnosed in the year 1995.

Previous Surgery

In the year 2008, patient G.G. Jr. has undergone cataract extraction for both right and left eye done by Dr. Eusebio at Riverside Medical Hospital. On July of the same year, patient underwent ungiectomy (nail, big toe, right foot) at Bacolod Adventist Medical Center.

Physical Assessment

|General Appearance

Patient G.G. Jr. is small built and weighs approximately 45 kg. He is 5’3’’ tall. He has dark brown complexion and visibly has wrinkled skin due to his age. He has mixed white and gray hair and the front part of his scalp is already bald. He has gray mustache and scattered eyebrows. He has incomplete teeth but does not have dentures. The patient has a slightly offensive smell and wears a pale yellow shirt and blue maong pants upon assessment. The patient is resting on bed on supine position with the right foot positioned away from left foot. Patient exhibited mild body weakness.

|Vital Signs

13

Initial vital signs of the patient are as follows: BP= 120/70, RR=17cpm, PR=63bpm and temperature= 36.2oC. Blood pressure was taken at patient’s right arm while lying on bed and pulse rate was palpated at right radial artery. Pulse of the patient is weak, slow with regular rhythm.

DAY and DATE

Day 1 01-25-2010

Day 201-26-2010

Day 301-27-2010

Day 501-29-2010

VITAL SIGNS 4pm 8pm 4pm 8pm 4pm 8pm 4pm 8pm

Blood Pressure 120/70mmHg

120/70mmHg

120/70mmHg

120/70mmHg

120/70mmHg

120/80mmHg

110/70mmHg

120/70mmHg

Pulse Rate 63 bpm 66bpm 72bpm 68bpm 68bpm 71bpm 71bpm 68bpm

Respiration Rate 17cpm 18cpm 16cpm 16cpm 17cpm 18cpm 16cpm 16cpmTemperature 36.2oC 36.4 oC 36.5 oC 36.4 oC 36.5 oC 36.4 oC 37.2 oC 37 oC

|Integumentary

Patient’s skin is cool to touch at his upper and lower extremities. Lower extremities are also pale. Patient has dark brown complexion, and has dry skin. Patient has pale nail beds and nails on toes appear cracked. There is presence of wound at left elbow and an infected wound at right foot metatarsal area. Erythema, tenderness and purulent discharges were noted on patient’s infected wound at right foot. Significant physical remarks of my client includes gouty arthritis at his right elbow joint, both knee joints, phalanges, carpals, metacarpals, metatarsals and tarsal joints. Darkening of stiffed joints was also noted. Patient’s lower extremities are pale and cool to touch, and have poor skin turgor.

|Cardiovascular

Patient has a weak, slow palpable pulse of 63bpm, rhythm regular palpated at right radial artery. Patient’s BP is 120/70 mmHg taken at right arm in supine position. Patient has poor capillary refill more than 3 second.

|Respiratory

Patient is breathing spontaneously to room air and has symmetrical rise and fall of the chest. No retractions and presence of cough noted. No adventitious breath sound was heard upon auscultation. Patient’s respiration rate is 17cpm.

|Abdomen

Patient’s abdomen is flat, soft and non tender. No mass noted. Color of the abdomen is of the same tone with parts of the body. No abdominal pain was expressed by the client.

|Gastrointestinal Tract

Patient is on a diabetic diet comprised of 3 meals and 2 snacks per day. Patient has poor appetite and has no difficulty of swallowing expressed. However, patient expressed that he usually feels full even though it is already meal time which results to decreased satisfaction after food intake. Patient has not defecated upon assessment and has normoactive bowel sound of 17 upon auscultation.

|Genitourinary

14

Client is voiding freely and has voided to an amber colored urine approximately 360cc upon assessment.

| HEENT

Head: Patient’s head is symmetrical. Wrinkled skin on his face is noted due to his age. Eyes: Patient has pale conjunctiva and anicteric sclera. Eyebrows are symmetrically aligned

and eyes are proportional to the face with few watery discharges suspended inside. Patient’s right pupil has minimal response to light upon assessment, shape is vertically elongated. On the other hand, left pupil is round and reactive to light and accommodation. The patient’s eyes move in conjugate fashion.

Ears: Patient’s ears are symmetrical and non-tender. No unusual discharges noted. The patient has no hearing difficulty and ear pains claimed. Color of the ears is the same with facial skin. Ear hygiene is not maintained.

Nose and sinuses: Nose is symmetrical. Nose is non tender upon palpation. Client has no olfactory problems. No nasal discharges noted.

Mouth and throat: Lips are dry with symmetrical contour. Tongue is moist, moves freely, non tender. There is no presence of mouth lesions, bleeding gums and dentures. There is mild alteration in taste (food slightly tasteless). Mucous membranes are pale and intact. Client expressed no difficulty in swallowing, no difficulty of speaking noted.

|Musculoskeletal

Patient moves without assistance but ambulates with assistance. Poor muscle tone can be observed on the patient. There is significant stiffness and deformity noted at his right elbow joint, both knee joint, phalanges, carpals, metacarpals, metatarsals and tarsal joints due to gouty arthritis. Swelling and erythema at right metatarsal area was also noted. Patient expressed pain when moving his right elbow joint and both knee joints.

|Neurological

Patient’s memory is intact. Patient is conscious and has coherent, spontaneous speaking ability. Patient is oriented to persons and place. He is responsive to both verbal and non verbal stimuli. Patient has mild anxiety brought by being hospitalized as evidenced by his low tone and volume of voice. Patient exhibited facial expressions, can feel temperature changes by mouthing, “kagin-ot”. No paralysis was noted in any of patient’s body parts. Patient was very cooperative and responsive during the entire assessment.

|Endocrine

Patient G.G. Jr. does not experience flushing upon assessment. He also does not experience polydipsia, polyphagia and polyuria which are classical signs of diabetes inclusive in the endocrine system physical assessment. There is no abrupt change in weight over the

24- Hour Intake and Output RecordTOTAL Intake

TOTAL Output

Day 1 2140 cc 1975 ccDay 2 2545 cc 2100 ccDay 3 2715 cc 1880 ccDay4 870 cc 1750 cc

15

past 6 months. Darkening was noted on patient’s stiffed joints and skin is dry to touch. Patient has decreased body hair especially in the lower extremities have poor muscle tone.

Laboratory and Radiology

|January 25, 2010

A. Potassium and Creatinine Result Verified: January 25, 2010 8:17:07 PM

EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATION

IMPLICATION

Potassium 5.73 3.6-5.1 mg/dL Above normalRenal Failure, Acidosis,

Cell lysis, tissue breakdown or

hemolysisCreatinine 4.90 0.6-1.3 mg/dl Extremely Above

Normal Nephritis

Chronic Renal Disease

16

B. Complete Blood Count Result Verified: January 25, 2010 3:50:51 PM

EXAMINATION RESULT NORMAL VALUES INTERPRETATION IMPLICATIONHemoglobin 88 120.00-170.00 g/L Extremely below normal AnemiaHematocrit 0.26 0.40-0.54 Extremely below normal Anemia

RBC 2.82 4.60-6.00x10ˆ12/L Extremely below normal Anemia, hemorrhageWBC 8.0 5.00-10.00x10ˆ9/L Normal Normal

Eosinophils 0.02 0.00-0.05 Normal Normal

Lymphocytes 0.20 0.20-0.40 Normal Normal

C. Radiologic Report Result Verified: January 25, 2010

Remarks: PTB Minimal, Undetermined activity

|January 27, 2010

A. Fasting Blood SugarResult Verified: January 27, 2010 8:08:46 AM

EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATION IMPLICATIONBlood Sugar 29 75-115 mg/dl Extremely Below

NormalHyperinsulinism

|January 28, 2010

A. Complete Blood Count Result Verified: January 28, 2010 11:35:03 AM

EXAMINATION RESULT NORMAL VALUES INTERPRETATION IMPLICATIONHemoglobin 111 120.00-170.00 g/L Below Normal AnemiaHematocrit 0.32 0.40-0.54 Below Normal Anemia

RBC 3.45 4.60-6.00x10ˆ12/L Below Normal Anemia, hemorrhageWBC 10.9 5.00-10.00x10ˆ9/L Above Normal Acute Infectious

DiseaseLymphocytes 0.18 0.20-0.40 Below Normal Agranulocytosis,

increased risk for infection

B. Creatinine Result Verified: January 28, 2010 12:46:16 AM

EXAMINATION RESULT (c.u.) NORMAL VALUES (c.u) INTERPRETATION IMPLICATIONCreatinine 4.57 0.6-1.3 mg/dl Extremely Above

Normal Nephritis

Chronic Renal Disease

|IDEAL LABORATORY TESTS

17

Hemoglobin A1C test (A1C) — (Glycosysated Hemoglobin Level) The A1C blood test measures the average blood glucose level during the past two to three months. It is used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes. Normal values for A1C are 4 to 6 percent. The test is done by taking a small sample of blood from a vein or fingertip.

Oral glucose tolerance test — Evaluates insulin response to glucose loading. FBS is obtained before ingestion of a 50- t0 200- gram glucose load (usual amount, 75g), and blood samples are drawn at ½ , 1, 2 and 3 hours.

Random blood glucose test — for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the person last ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher in persons who have symptoms of high blood glucose suggests a diagnosis of diabetes.

C-Peptide Assay – Cleaved from the proinsulin molecule during its conversion to insulin, C-peptide acts as a marker for endogenous insulin production.

Glycosylated Albumin Level- Glucose also attaches to proteins, primarily albumin. The concentration of glycosylated albumin (fructosamine) represents the average blood glucose level over the previous 7-10 days. This measurement is useful when short-term determinations of average blood glucose level are desired. The reliability and clinical applicability continue to be evaluated.

Urinalysis- Urine levels of ketones can be tested by client’s use of dipstrips or tablets. The presence of ketones in the urine (ketonuria) indicates that the body is using fat as a major source of energy, which may result in ketoacidosis. Test results are indicated by the presence of ketones. All aliens with diabetes mellitus should test their urine for ketones during acute illness or stress, when blood glucose levels are elevated (>240 mg/dl).

PREDISPOSING FACTORSGenetic Predisposition

Age> 40 yrs oldGender: Female

PRECPITATING FACTORS StressObesity

Viral InfectionAuto Immune Disorder

Destruction of alpha and beta cells of the pancreas

Production of excess glucagon

Production of glucose from protein and fat stores

Wasting of lean body mass

Increased Ketones

Acidosis Acetone Breath

Fatigue

Weight Loss

Failure to produce insulin and / or insulin resistance

Hyperglycemia

Chronic elevations in blood glucose Increased blood osmolarity due to glucose

PolyphagiaPolyuriaPolydipsia

Weight loss

Glycoprotein cell wall deposits

Small Vessel DiseaseAccelerated AtherosclerosisImpaired Immune Function

Diabetic Retinopathy Diabetic Nephropathy Diabetic Neuropathy

Autonomic Neuropathy Symmetrical loss of protective sensation Numbness and tingling in the extremitiesWasting of intrinsic muscles Charcot changing in joints

Diabetic Foot Ulceration

End stage Renal Failure

Dry cracked skin Gastroparesis Impotence Neurogenic Bladder

Blurred Vision Blindness Cataract Hypertension Increased LDL levels

Coronary Artery Disease

Infection Delayed Wound Healing

Pathophysiology

Clinical Manifestations

18

Pathophysiology

Source: Black and Hawks, Medical Surgical Nursing Udan, Josie., Medical Surgical Nursing Concepts and Clinical Application

19

NURSING CARE PLANS

Actual Problem # 1 Impaired Tissue Integrity

Actual Problem # 2Ineffective Peripheral Tissue Perfusion

Risk Problem Risk for Activity Intolerance

20

DRUG STUDY

Standing Meds STAT Meds

Norvasc (Amlodipine) Lasix (Furosemide)

Calcium Tums (Calcium carbonate) Benadryl (Diphenhydramine Hydrochloride)

Colchicine Transderm- Nitro (Nitroglycerin )

Dolcet (Tramadol + paracetamol) Tetavax

Eroxmit (Cefuroxime)

Calmoseptine (Zinc Oxide)

Humulin R (Insulin Regular)

Iberet with folic acid (Multivitamins + Folic Acid)Sodium Bicarbonate

Qinosyn (Ciprofloxacin)

NAME OF DRUG/ CLASSIFICATION

DOSAGE,FREQUENCY,

ROUTE

MECHANISM OFACTION

INDICATION CONTRAINDICATION ADVERSE REACTIONS NURSING RESPONSIBILITIES

21

Norvasc

Amlodipine Besylate

Calcium Channel- blocker

AntianginalAntihypertensive

5mg/ 1 tab

OD

PO

Drug works by relaxing (dilating) your

blood vessels, lowering blood pressure, and

decreasing heart rate, which lowers the workload on the

heart. It also dilates coronary arteries

increasing blood flow to the heart.

Angina pectoris due to coronary artery spasm.

Chronic stable angina, alone or in combination with other agents.

Indicated for the treatment of confirmed or suspected vasospastic angina

Essential hypertension, alone or in combination with other antihypertensives.

Contraindicated with allergy to amlodipine, impaired hepatic or renal function, heart block.

Use cautiously with CHF

Cardiovascular: arrhythmia (including ventricular tachycardia and atrial fibrillation), bradycardia, chest pain, hypotension, peripheral ischemia, syncope, tachycardia, postural dizziness, postural hypotension, vasculitis.

Central and Peripheral Nervous System: hypoesthesia, neuropathy peripheral, paresthesia, tremor, vertigo.

Gastrointestinal: anorexia, constipation, dyspepsia, dysphagia, diarrhea, flatulence, pancreatitis, vomiting, gingival hyperplasia.

Musculoskeletal System: arthralgia, arthrosis, muscle cramps, myalgia

Respiratory System: dyspnea, epistaxis.

Skin and Appendages: angioedema, erythema multiforme, pruritus, rash, rash erythematous, rash maculopapular.

Special Senses: abnormal vision, conjunctivitis, diplopia, eye pain, tinnitus.

Urinary System: micturition frequency, micturition disorder, nocturia.

Metabolic and Nutritional: hyperglycemia, thirst.

Monitor patient carefully (BP, cardiac rhythm and output) while adjusting drug to therapeutic dose; use special caution if patient has CHF.

Administer drugs without regards to meals.

Take with meals if upset stomach occurs.

Patient may experience these side effects: nausea, vomiting (have SFF), and headache.

Instruct patient to report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

NAME OF DRUG/ DOSAGE,

MECHANISM OF NURSING

22

CLASSIFICATION FREQUENCY,ROUTE

ACTION INDICATION CONTRAINDICATION ADVERSE REACTIONS RESPONSIBILITIES

Calcium Tums

Calcium Carbonate

Electrolyte Anatacid

500mg/ 1 tab

TID

PO

Reduces total acid load in GI tract, elevates gastric pH to reduce

pepsin activity, strengthens gastric

mucosal barrier, and increases esophageal

sphincter tissue

Symptomatic relief of upset stomach associated with hyperacidity

Contraindicated with allergy to calcium, renal calculi, hypercalcemia, and ventricular fibrillation during cardiac resuscitation.

Use cautiously with renal dysfunction.

Cardiovascular: slowed heart rate, tingling, “heat waves”, peripheral vasodilation, local burning, drop in BP.

Local: Local irritation, severe necrosis, sloughing and abscess formation.

Metabolic: Hypercalcemia (anorexia, nausea, vomiting, constipation, abdominal pain, dry mouth, thirst, polyuria), rebound hyperacidity.

Instruct patient to take drugs between meals and at bedtime.

This drug must not be taken with other oral drugs. Absorption of those medication can be blocked; take other oral medications at least 1-2 hrs after calcium carbonate.

Record amount and consistency of stool. Manage constipation with laxatives or stool softeners.

Monitor calcium level, especially patient with mild renal failure

Watch for evidence of hypercalcemia ( nausea, vomiting headache, confusion and anorexia.

DOSAGE,

23


FREQUENCY,ROUTE

MECHANISM OFACTION


Colchicine

Colchicine

Antigout Drug

1.2 mg/1 tab TID x 6 doses

PO

Exact mechanism unknown; decreases

deposition of uric acid; inhibits kinin

formation and phagocytosis, and

decreases inflammatory reaction

to urate crystal deposition.

Pain relief of acute gout attack; also used

between attack as prophylaxis.

Contraindicated with allergy to colchicine; blood dyscrasias, serious GI disorders, liver, renal or cardiac disorders.

Use cautiously with elderly.

CNS: Peripheral neuritis, purpura, myopathy

Dermatologic: Dermatoses, loss of hair, purpura.

Gastrointestinal: nausea, vomiting, abdominal pain, or diarrhea may be particularly troublesome in the presence of peptic ulcer or spastic colon.

Hematologic: Bone marrow depression, elevated alkaline phosphatase, AST levels

Locals: Thrombophlebitis at IV sites.

Hypersensitivity: urticaria.

Monitor for relief of pain, signs and symptoms of gout attack, usually abate within 12 hr and are gone within 24-48 hr.

Monitor total dose received.

Administration should begin at the first sign of an acute attack; delay can decrease drug’s effectiveness in alleviating symptoms of gout.

Stop drug at first sign of nausea, vomiting, stomach pain or diarrhea.

Patient may experience these side effects: nausea, vomiting, loss of appetite (eat small frequent meals) loss of fertility (reversible), loss of hair (reversible).

DOSAGE,

24


FREQUENCY,ROUTE

MECHANISM OFACTION


Dolcet

Tramadol Hydrochloride

+Paracetamol

A. Tramadol Hydrochloride

Analgesic, Centrally Acting

325mg

1 tab BID x 4 doses

PO

Binds to mu-opioid receptors and inhibits

the reuptake of nor epinephrine and serotonin; causes

many effects similar to the opiods –

dizziness, nausea, constipation –but does not have the

respiratory depressant effect.

Relief of moderate to moderately severe

pain.

Contraindicated with allergy to tramadol or opiods or acute intoxication with alcohol, opiods or psychoactive drugs.

Use cautiously in renal dysfunction or hepatic impairment.

CNS: sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, anxiety, seizures

CV: hypotension, tachycardia, bradycardia

Dermatologic: Sweating, pruritus, rash, pallor, urticaria

GI: Nausea and vomiting, dry mouth, constipation

Special Senses: Visual disturbance.

Urogenital: Menopausal symptoms, Urinary frequency, Urinary retention.

Others: anaphylactic reactions

Limit use in patients with past or present history of addiction or dependence on opiods.

Inform patient that he may experience these side effects: dizziness, sedation, impaired visual acuity, nausea, loss of appetite.

Control environment (temperature, lighting) if sweating or CNS effects occur.

25

B. Paracetamol

Acetaminophen

AntipyreticAnalgesic (Nonopiod)

Reduces fever by acting directly on the hypothalamic heat-regulating center to

cause vasodilation and sweating, which helps

dissipate heat.

Arthritis and rheumatoid disorders

involving musculoskeletal pain.

Contraindicated with allergy to acetaminophen

Acetaminophen tablets are contraindicated in any situation where opioids are contraindicated, including acute intoxication with any of the following: alcohol, hypnotics, narcotics, centrally acting analgesics, opioids or psychotropic drugs.

Use cautiously with impaired hepatic function.

CNS: Headache

CV: Chest pain, dyspnea, myocardial damage

GI: Hepatic Toxicity and failure, jaundice

GU: Acute kidney failure, renal tubular necrosis

Hematologic: cyanosis, hemolytic anemia, hematuria, anuria, neutropenia, leucopenia, thrombocytopenia, hypoglycemia.

Hypersensitivity: rash, fever

Do not exceed recommended dose; do not take for more than 10 days.

Take the drug only for complaints indicated; it is not an inflammatory agent

Avoid the use of over the counter preparations. They may contain acetaminophen, and serious overdose can occur.

Report rash, unusual bleeding or bruising, yellowing of the skin or eyes, changes in voiding pattern.

DOSAGE,

26


FREQUENCY,ROUTE

MECHANISM OFACTION


Eroxmit

Cefuroxime

Antibiotic

750mg

Q8h

IVTT

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell

death.

Treating bacterial infections (sinus, skin, lung, urinary tract, ear, and throat).

Used for treating dermatologic infections, including impetigo, cause by S. aureus and S. pyogenes.

Contraindicated with allergy to cephalosporins or penicillin.

Use cautiously with renal failure.

Contraindicated if you have diarrhea, a stomach or intestinal infection, or a blood clotting problem.

CNS: headache, dizziness, lethargy, paresthesias.

GI: nausea and vomiting, diarrhea, anorexia, abdominal pain, flatulence, liver toxicity

GU: Nephrotoxicity Hematologic: bone marrow

depression, decreased WBC, decreased platelets, decreased Hct.

Local: Pain, abscess at injection site, inflammation at IV site.

Other: Superinfections

Take full course of drug therapy.

This drug is specific for this infection and should not be used to self-treat other problems.

These side effects may occur; stomach upset or diarrhea.

Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur.

27


DOSAGE,FREQUENCY,

ROUTE

MECHANISM OFACTION


Calmoseptine Ointment

Menthol/Zinc Oxide

Analgesic, Antiseptic, Antipruritic, Skin

Protectant combination

Epicutaneous

TID

For preventing and treating minor skin

irritations caused by cuts, scrapes, itching,

wound drainage.

Calmoseptine ointment works by temporarily relieving itching and pain. It also decreases moisture in affected area.

Menthol has been shown to cause vasodilation. This may increase circulation to an area and aid in healing.

Mild antiseptic ingredients may help prevent secondary bacterial and

Contraindicated if patient is allergic to any ingredient in calmoseptine ointment.

Not used in treating a deep wound or puncture wound.

Dermatologic: rash, hives, itching, swelling of the mouth, face, lips or tongue

Respiratory: difficulty of breathing, tightness in the chest

Nurse should be aware that calmoseptine ointment is for external use only. Must not let into the eyes, nose or mouth of the patient. If drug was got in contact with any of these areas, rinse at once with cool water.

Calmoseptine ointment is to be used only by the patient for whom it is prescribed. It should not be shared with other people.

Calmoseptine should be stored at room temperature. Store away from heat, moisture and light. Do not store in the bathroom. Keep out of reach of children and away from pets.

Calmoseptine will not

28

fungal infections of the skin.

treat bacterial or fungal infection.


DOSAGE,FREQUENCY,

ROUTE

MECHANISM OFACTION


29

Humulin R

Insulin Regular

Anti Diabetic Hormone

8 units

TID ac

SQ

Humulin R (Concentrated) is a

fast-acting form of the hormone insulin. It

works by helping your body to use sugar

properly. This lowers the amount of glucose

in the blood, which helps to treat

diabetes.

Treatment of Type 2 (non-insulin dependent) diabetes that cannot be controlled by diet or oral drugs

Contraindicated with allergy to pork products

If patients is having an episode of low blood sugar

If patient is taking oral diabetes medication.

Hypersensitivity: rash, anaphylaxis or angioedema.

Local: Allergy –local reactions at injection site –redness, swelling, itching, lipodystrophy, pruritus.

Metabolic: Hypoglycemia (sweating, drowsiness, dizziness, sleep disturbance, palpitations, anxiety, tremor, blurred vision, hunger, slurred speech, restlessness.) ketoacidosis

Ensure uniform dispersion of insulin by rolling the vial gently between hands; avoid vigorous shaking.

Give maintenance doses SC, rotating injection sites regularly to decrease incidence of lipodystrophy

Store insulin in a cool dry place away from direct sunlight. Refrigeration is preferred. Do not freeze insulin.

Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage.

Instruct patient to avoid alcohol; serious reactions can occur.


DOSAGE,FREQUENCY,

ROUTE

MECHANISM OFACTION


30

Iberet- Folic 500

Multivitamins+

Folic Acid

500mg

1 tab

BID

PO

Simulates normal erythropoiesis and nucleoprotein synthesis.

helps your body produce and maintain new cells

anemia

provide vitamins and iron that are not taken in through the diet

used to treat iron or vitamin deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions

Contraindicated in patients with hypersensitive to drug.

if you have a long-term infection, seizure disorder (eg, epilepsy), or liver problems (eg, alcoholic cirrhosis), or if you are on kidney dialysis

GIT: stomach pain, nausea, vomiting, diarrhea, anorexia, abdominal distention, flatulence, bitter/ bad taste,

RESPI: bronchospasms, respiratory difficulty

SKIN: allergic reactions including rash, pruritus, and erythema

CNS: altered sleep pattern, general malaise, confusion, irritability, hyperactivity, over activity, mental excitement, confusion, impaired judgment,

Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin with iron.

Never take more than the recommended dose of a multivitamin.

Monitor patient for hypersensitivity reactions, especially if drug previously taken.

Keep supportive equipment and emergency drugs readily available in case of serious allergic response.


DOSAGE,FREQUENCY,

ROUTE

MECHANISM OFACTION


31

Qinosyn

Ciprofloxacin

Antibacterial

500mg/ 1 tab

BID

PO

Bactericidal interferes with DNA replication

in susceptible bacteria preventing cell reproduction

-for the treatment of infection caused by susceptible gram-negative bacteria including E-coli.

Contraindicated with allergy to Ciprofloxacin, Norfloxacin or other flouro-quinolones

-Use cautiously with renal dysfunction, seizures, tendonitis or tendon rupture associated with flouro-quinolones use.

CNS: headache, dizziness, insomnia, fatigue, depression, blurred vision

CV: arrythmias, hypotension, angina

GI: nausea, vomiting, dry mouth, diarrhea, abdominal pain

Hematologic: Elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase; decreased WBC, neutrophil count, Hct.

Other: fever.rash.

Renal and Urinary Disorders: micturition urgency, dysuria, urinary frequency, abnormal urine odor.

Skin/Subcutaneous Tissue Disorders: rash, photosensitivity/ phototoxicity reaction, pruritus, urticaria.

Inform client that if antacid is needed, take it at least 2 hours before or after dose

Drink plenty of fluids while taking this drug.

Inform patient that he may experience these side effects: nausea and vomiting, abdominal pain (eat frequent meals), diarrhea/ constipation; drowsiness, blurring of vision, dizziness

Instruct patient to inform nurse if rash, visual changes, severe GI problems, weakness, tremors

Encourage patient to complete full course of drug therapy.

Arrange for culture and sensitivity test before beginning therapy.


FREQUENCY, MECHANISM OF INDICATION CONTRAINDICATION ADVERSE REACTIONS NURSING

32

CLASSIFICATION ROUTE ACTION RESPONSIBILITIES

Sodium Bicarbonate

Acidifiers and Alkalinizers

300 mg 1 tab TID x 6 doses

PO

Restores buffering capacity of the body and neutralizes excess acid.

Upset stomach

Symptomatic relief of upset stomach associated with hyperacidity

you are allergic to any ingredient in Sodium Bicarbonate

you have appendicitis or a blockage of your bowel

you are on a low-salt diet

if you have a history of stomach or intestinal bleeding

GI: Gastric rupture following ingestion

Hematologic: systemic alkalosis, (nausea, irritability, weakness, tetany), hypokalemia

Local: Chemical cellulitis, tissue necrosis

Have patient chew tablet thoroughly before swallowing and follow them with a full glass of water.

Do not give oral sodium bicarbonate with 1-2 hour of other oral drugs to reduce risk of drug interactions.

Instruct patient to report irritability, headache, tremors, confusion, swelling of extremities, and difficulty of breathing, black or tarry stools.



33


Lasix

Furosemide

Diuretics

40 mg/ 1 tab

Pre BT

PO

And

20 mg/ 1 tab Post BT

a potent drug that inhibits sodium and

chloride reabsorption at the proximal and

distal tubules and the ascending Loop of

Henle

Hypertension Contraindicated to patients hypersensitive to drug and those with anuria

use cautiously in patients with hepatic cirrhosis and in those allergic to sulfonamides

CNS: vertigo, dizziness, headache, paresthesia, weakness, restlessness, fever

CV: orthostatic hypotension EENT: transient deafness,

blurred or yellowish vision, tinnitus

GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting

GU: nocturia, polyuria, frequent urination

Hematologic: agranulocytosis, aplitic anemia, leucopenia, anemia

Hepatic: hepatic dysfunction, jaundice

Metabolic: volume depletion and dehydration, impaired glucose tolerance, hypokalemia, hyperglycemia, hypocalcemia

Musculoskeletal: muscle spasm

Skin: dermatitis others: gout

To prevent nocturia, give PO preparations in the morning. Give second dose in early afternoon

Monitor weight, blood pressure, and pulse rate routinely with long term use and during rapid diuresis. Use can lead to profound water and electrolyte depletion.

Monitor fluid intake and output and electrolyte, BUN, and CO2 levels frequently

Monitor glucose level in diabetic patients.



34


Bendaryl

Diphenhydramine Hydrochloride

Antihistamine

50 mg/ 1 cap

Pre BT

PO

Competitively blocks the effects of

histamine at H1 receptor sites, has atropine-like, anti

pruritic and sedative effects.

Amelioration of allergic reactions to

blood or plasma

Contraindicated with allergy to any histamine.

Antihistamines should be used with considerable caution in patients with narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, or bladder-neck obstruction.

Diphenhydramine hydrochloride has an atropine-like action and, therefore, should be used with caution in patients with a history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease or hypertension. Use with caution in patients with lower respiratory disease including asthma.

General: Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dryness of mouth, nose, and throat

Cardiovascular System: Hypotension, headache, palpitations, tachycardia, extrasystoles

Hematologic System: Hemolytic anemia, thrombocytopenia, agranulocytosis

Nervous System: Sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesia, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, neuritis, convulsions

Gl System: Epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation

GU System: Urinary frequency, difficult urination, urinary retention, early menses

Respiratory System: Thickening of bronchial secretions, tightness of chest or throat and wheezing, nasal stuffiness

Instruct patient to take drug as prescribed.

Drug can be taken with food if GI upset occurs.

Avoid alcohol; serious sedation could occur.

These sideffects may occur; dizziness, sedation, drowsiness, epigastric distress, diarrhea, constipation, dry mouth, dryness of nasal mucosa.

Monitor patien’t response


DOSAGE,FREQUENCY, MECHANISM OF

ACTIONINDICATION CONTRAINDICATION ADVERSE REACTIONS NURSING

RESPONSIBILITIES

35

ROUTE

Transderm- Nitro

Nitroglycerin

Antianginals

5mg

Transdermal Patch

Nitrate that reduces cardiac oxygen

demand by decreasing left ventricular end-

diastolic pressure (preload) and to a

lesser extent, systemic vascular resistance (after load). Also,

increases blood flow through the collateral

coronary vessels.

Prophylaxis against chronic angina attacks

Acute angina pectoris, prophylaxis to prevent or minimize angina attacks before stressful events..

In patients with early M.I, severe anemia, increased intracranial pressure, angle-closure glaucoma, orthostatic hypotension, allergy to adhesives (transdermal) or hypersrnsitivity to nitrates.

CNS: headache, dizziness, weakness

CV: orthostatic hypotension, tachycardia, flushing, palpitations, fainting

EENT: SL burning

GI: N/V

Skin: cutaneous vasodilation, contact dermatitis, rash

Other: hypersensitivity reactions

Transdermal dosage forms can be applied to any nonhairy part of the skin except distal parts of the arms and legs (absorption wont be maximal at the distal sites). Patch may cause contact dermatitis.

When stopping transdermal treatment of angina, gradually reduce the dosage and frequency of application over 4-6 weeks.

Monitor BP and intensity & duration of drug response.

Drug may cause headaches, especially in the beginning of therapy. Dosage may be reduced temporarily, but tolerance usually develops. Treat headache with aspirin or acetaminophen.



36


Tetavax

Tetanous Toxoid Adsorbed Vaccine

Vaccine

0.5 ml

IM

It works by helping the body build up immune system against tetanus

Immunizing against tetanus

infection

Contraindicated with allergy to any ingredient of the vaccine, including the mercury-derived preservative thimerosal or latex rubber

Contraindicated to those who are sick with a fever or have an infection, have blood clotting problems or are taking medicines to thin the blood, have a weakened immune system, are receiving radiation therapy or chemotherapy, or have a history of seizures.

CNS: headache, dizziness, lethargy, fast heart beat

GI: closing of the throat

CV: paleness, weakness

Respiratory: Difficulty of breathing

Integumentary: swelling of the lips, tongue, or face, hives

Others: deep, aching pain and muscle wasting in the upper arms starting 2 days to 4 weeks after the shot, and lasting up to many months .

Be aware that anyone who had a life-threatening allergic reaction after a dose of tetanus vaccine should not get another dose

Advice patient to consult doctor if he/she is receiving cancer treatment with x-rays, radiation, or medication

37

DRUG STUDY- CHECK FORMAT

Standing Meds STAT Meds

Norvasc (Amlodipine) Lasix (Furosemide)

Calcium Tums (Calcium carbonate) Benadryl (Diphenhydramine Hydrochloride)

Colchicine Transderm- Nitro (Nitroglycerin )

Dolcet (Tramadol + paracetamol) Tetavax

Eroxmit (Cefuroxime)

Calmoseptine (Zinc Oxide)

Humulin R (Insulin Regular)

Iberet with folic acid (Multivitamins + Folic Acid)Sodium Bicarbonate

Qinosyn (Ciprofloxacin)

38

DRUGS Classification How do you know that it is effective?

Exact Amount Client Teaching Key Nursing Responsibility

A. Norvasc (Amlodipine)

Calcium Channel- blockerAntianginal

Antihypertensive

Lowered BP 5 mg Caution patient to continue taking drugs even when feeling better;

Instruct patient that he/ she may feel the following side effects: nausea, vomiting and headache and report if irregular heartbeat and shortness of breath occurs.

Monitor patient carefully (BP, cardiac rhythm and output) while adjusting drug to therapeutic dose; use special caution if patient has CHF.

B. Calcium Tums (Calcium Carbonate)

Electrolyte Anatacid

acid indigestion is reduced and there is no more

stomach upset

500 mg Instruct patient to take drugs between meals and at bedtime.

Also, educate patient that this drug must not be taken with other oral drugs. Absorption of those medications can be blocked; take other oral medications at least 1-2 hrs after calcium carbonate.

Record amount and consistency of stool. Manage constipation with laxatives or stool softeners.

Monitor calcium level, especially patient with mild renal failure

Watch for evidence of hypercalcemia (nausea, vomiting headache, confusion and anorexia)

39

C. Colchicine Antigout Drug Pain is relieved during gout attacks and reduced

frequency of gout attacks. Also, quality of pain due to

arthritis is reduced.

1.2 mg Inform patient of the following side effects: nausea, vomiting, loss of appetite (eat small frequent meals) loss of fertility (reversible), loss of hair (reversible).

advise patient to avoid using alcohol while taking drug.

tell patient with gout to limit intake of foods high in purine, such as anchovies, liver, sardines, kidneys, sweetbreads, peas, and lentils.

obtain baseline laboratory test results, including CBC, before therapy and periodically throughout therapy.

Administration should begin at the first sign of an acute attack; delay can decrease drug’s effectiveness in alleviating symptoms of gout.

D. Dolcet (Tramadol Hydrochloride + Paracetamol)

Analgesic, Centrally Acting+

AntipyreticAnalgesic (Nonopiod)

there is a relief of pain arthritis and

rheumatoid disorders involving musculoskeletal pain are not suffered by the patient

bacterial infections with pain and fever are prevented

325 mg Tramadol tell patient to take

drug as prescribed and not to increase the dose or dosage interval unless ordered by physician

warn patient not to stop the drug abruptly

Nurse should be aware that the use of this drug should be limited in patients with past or present history of addiction or dependence on opiods.

40

Paracetamol warn patient that long

term use can cause liver damage

advise patient that drug is only for short pain

E. Eroxmit (Cefuroxime)

Antibiotic If there is no longer an infection present.

WBC is within the normal range of values.

750 mg Instruct patient that he/she must take full course of drug therapy.

Inform patient that the following side effects may occur: stomach upset or diarrhea.

Instruct patient to avoid alcohol while taking this drug.

Nurse should be aware that this drug is specific for the patient and should not be used to self-treat other problems.

If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for signs and symptoms of super infection.

F. Calmoseptine Ointment ( Menthol/Zinc Oxide)

Analgesic, Antiseptic, Antipruritic, Skin Protectant

combination

Reduced itching and pain on skin irritation/ wound.

There is progressive wound healing.

Apply in ample amount Instruct patient that Calmoseptine is for external use. . Must not let into the eyes, nose or mouth of the patient. If drug was got in contact with any of these areas, rinse at once with cool water.

Nurse should be aware that Calmoseptine will not treat bacterial or fungal infection and should only be administered to the patient for whom it was prescribed.

Calmoseptine should be stored at room temperature. Store away from heat, moisture and

41

light. Do not store in the bathroom. Keep out of reach of children and away from pets.

G. Humulin R(Insulin)

Anti Diabetic Hormone Blood glucose are lowered/ controlled

8 units Advise patient to seek emergency medical attention if he/she thinks he/she have used too much of this medicine

-Advise patient to report any signs of allergy

Instruct patient to avoid alcohol; serious reactions can occur.

Administer insulin in correct amount, correct route and correct kind of syringe.

Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage

H. Iberet- Folic Acid (Multivitamins + Folic Acid )

Multivitamins increase in , or normalized RBC, Hct, and Hgb levels

500 mg teach patient about proper nutrition to prevent recurrence of anemia

stress importance of follow-up visits and laboratory studies

teach patient about foods that contain folic acid: liver, oranges, whole wheat, broccoli, Brussels sprouts

Monitor patient for hypersensitivity reactions, especially if drug previously taken.

Keep supportive equipment and emergency drugs readily available in case of serious allergic response.

I. Qinosyn Antibacterial Bacterial reproduction was 500mg Inform client that if Arrange for culture and

42

(Ciprofloxacin) prevented/reduced through the results of the

CS tests.

antacid is needed, take it at least 2 hours before or after dose

Drink plenty of fluids while taking this drug.

sensitivity test before beginning therapy.

Encourage patient to complete full course of drug therapy.

J. Sodium Bicarbonate

Acidifiers and Alkalinizers Relief of upset stomach 300 mg Instruct patient to chew tablet thoroughly before swallowing and follow them with a full glass of water.

Do not give oral sodium bicarbonate with 1-2 hour of other oral drugs to reduce risk of drug interactions.

K. Lasix (Furosemide)

Diuretics Decrease in BP 40 mg Inform patient that blood glucose levels may become temporarily elevated in patient with Dm after starting this drug.

Monitor weight, blood pressure, and pulse rate routinely with long term use and during rapid diuresis. Use can lead to profound water and electrolyte depletion.

Monitor fluid intake and output and electrolyte, BUN, and CO2 levels frequently

L. Benadryl ( Diphenhydramine Hydrochloride)

Antihistamine Cessation of allergic symptoms such as itching , rashes. No allergic effects

post BT.

50 mg Drug can be taken with food if GI upset occurs.

Avoid alcohol; serious sedation could occur.

Inform patient that sugarless gum, candy or

Monitor patient for Dizziness, excessive sedation, syncope, toxicity, paradoxical stimulation and hypotension are more

43

ice chips may relieve dry mouth.

Warn patient of possible photosensitivity reactions. Advise use of sunblock.

likely to occur in the elderly.

M. Transderm- Nitro (Nitroglycerin)

Antianginals .

Reduced angina pain. 5mg Teach patient how to give the prescribed form of nitroglycerin.

To minimize dizziness when standing, tell patient to rise slowly.

When stopping transdermal treatment of angina, gradually reduce the dosage and frequency of application over 4-6 weeks.

Monitor BP and intensity & duration of drug response.

N. Tetavax ( Tetanous Toxoid

Adsorbed Vaccine )Vaccine patient does not get

tetanus infection0.5ml

Inform patient that there are no restrictions on food, beverages, or activity before or after receiving the tetanus toxoid vaccine

Be aware that anyone who had a life-threatening allergic reaction after a dose of tetanus vaccine should not get another dose

44

HEALTH TEACHING PLAN

MEDICINES EXERCISE TREATMENT HYGIENE OUTPATIENT REFERRAL DIET

45

Educate the patient and significant others regarding the medicines that the patient had been taking specifically the indication of the drug. Compliance to full course of drug therapy must also be emphasized. A. Amlopidine Besylate

(5mg 1 tab PO OD)- Calcium Channel Blocker- Antianginal drug- Antihypertensive Indicated to Angina pectoris due to

coronary artery spasm. For chronic stable angina, essential hypertension, given alone or in combination with other antihypertensives.

Drug should be taken with meals if upset stomach occurs.

Instruct patient to report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

B. Humulin R (8 units SQ TID ac)

- Antidiabetic For treatment of type 2 (non-insulin

dependent) diabetes that cannot be controlled by diet or oral drugs.

Store drug in the refrigerator or in cool place out of direct sunlight; do not freeze insulin.

Avoid alcohol; serious reactions can occur.

C. Eroxmit(750 mg IVTT q8h) [Cefuroxime]

- Antibiotic- Cephalosporin (second generation) Bactericidal: Inhibits synthesis of

Exercise should be scheduled regularly to promote utilization of carbohydrates, assist with weight control, enhance the action of insulin and improve cardiovascular fitness.

ROM Exercises - ROM exercises are

recommended to improve or maintain joint function and to improve or maintain muscle tone and strength.

- To do this, the patient moves each of his joint through complete range of movement maximally stretching all muscle groups within each plane over each joint.

- Leg exercises or extremity exercise should be done to facilitate venous return to the heart.

- Wrist: flexion, extension, circumduction.

- Hand and fingers: flexion, extension, abduction, adduction.

- Leg: lift one leg off the bed and draw big circles with your toes, then

Blood Creatinine Level - Measures the level of the

waste product creatinine in your blood and urine. Used to tell how your kidneys are working. Increased levels indicate chronic renal disease or nephritis.

Blood Transfusion - 1 unit 220cc PRBC, Bag #464,

B+, Exp. Date: March 2, 2010 @ 15gtts/min.

- A blood transfusion is the transfer of blood or blood products from one person (donor) into another person's bloodstream (recipient). This is usually done as a life saving maneuver to replace blood cells or blood products lost through severe bleeding, during surgery when blood loss occurs or to increase the blood count in an anemic patient.

Complete Blood Count- The complete blood count

(CBC) is one of the most commonly ordered blood tests. The complete blood count is the calculation of the cellular (formed elements) of blood.

- A major portion of- the complete blood count is

the measure of the concentration of white blood cells, red blood cells, and

Educate the client and significant others basic hygiene practices and investigate living conditions that may further complicate the client’s condition.

Foot Care GuidelinesEmphasize to client proper foot care guidelines especially in properly dressing his infected wound at his right foot and left elbow.

- Keep the ulcer clean and bandaged.

- Periodically remove dead skin when the bandages are changed.

- Cleanse the wound daily, using a wound dressing or bandage.

- Do not walk barefoot.

- Keep blood glucose levels under tight control.

- Exercise: Regular exercise will

Patient Education and Health Maintenance

- Emphasize to client the importance of completing the full course of antibiotic therapy prescribed by the doctor. Not finishing the entire course can lead to bacteria becoming resistant to antibiotics.

- Drink plenty of fluids. Six- 8oz of fluid every hour is recommended. If unable to eat, drink fluids that contain carbohydrates (fruit juices, regular soda.)

- Never omit insulin dosage. Check with health care provider about oral medication.

- Encourage the patient for wellness or follow-up check up to ensure continuous monitoring of serum blood glucose level.

- Give due importance to diet restrictions and indications.

Dietary control with caloric restrictions of carbohydrates and saturated fats to maintain ideal body weight.

Meal Planning Guidelines- Each meal should

consist of a balance of carbohydrates, proteins and fats. (Fats should be <10% of total calories consumed.)

- Consistency in timing of meals and amounts of food eaten on a day-to-day basis help regulates glucose levels.

- Increase the intake of soluble and insoluble fiber.

- Avoid salt whenever possible.

- Prepare foods to retain vitamins and minerals and reduce fats.

- Do not fry foods. Bake, boil or boil

46

bacterial cell wall, causing cell death. Emphasize to client to complete full

course of drug therapy. Avoid alcohol while taking this drug and

for 3 days after because severe reactions often occur.

These side effects may occur: stomach upset of diarrhea.

D. Qinosyn(500mg PO BID) [Ciprofloxcin]

- Antibacterial Bactericidal: For the treatment of

infections caused by susceptible gram-negative bacteria.

Instruct patient to take antacid if needed. Take it at least 2 hr before of after dose. Drink plenty of liquids while taking this drug.

Side effects may occur: nausea and vomiting, abdominal pain, diarrhea or constipation; drowsiness, blurring of vision.

E. Calmoseptine Ointment(TID) [Menthol/ Zinc Oxide]

- Analgesic, Antiseptic, Antipruritic, Skin protectant combination

It works by temporarily relieving itching and pain. It also decreases moisture in the affected area.

Calmoseptine Ointment is for external use only. Do not get it in your eyes, nose, or mouth. If you get it in any of these areas, rinse at once with cool water.

F. Vitanerv (1 cap PO BID) [Vitamin B Complex/

repeat with the other leg.

- Ankle: plantar flexion, dorsiflexion.

platelets in the blood.Chest X-Ray

- A chest X-ray is a radiology test that involves exposing the chest briefly to radiation to produce an image of the chest and the internal organs of the chest.

- Provides picture of the chest that shows your heart, lungs, airway, blood vessels, and lymph nodes.

- Shows the bones of your spine and chest, including your breastbone, ribs, collarbone, and upper part of your spine.

FBS(Fasting Blood Sugar)- A method for learning how

much glucose (sugar) there is in a blood sample taken after an overnight fast. The fasting blood glucose test is commonly used in the detection of diabetes mellitus. The test is done in the morning before the person has eaten.

Insulin Regime- NPH Only(Intermediate Acting)

- Used alone in type 2 Diabetes Milletus when patients are capable of producing some exogenous insulin as a supplement for better glucose control.

IV Therapy - Bottle #2 PNSS x 60 cc/ hr.

improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels.

- Keep pressure off the wound. To help to facilitate the healing process.

food and discard fats. Eat raw fruits and vegetables or steam vegetables to retain fiber.

- Smaller, more frequent meals may enhance glucose control in type 2 DM.

- Unplanned activity may call for an additional snack to avoid hypoglycemia.

- Use alcohol only in moderation. Always consume alcohol with food to avoid hypoglycemia.

47

Hydroxocobalamin crystalline] - Vitamin (Water Soluble) Essential to growth, cell reproduction,

hematopoiesis, nucleoprotein and myelin synthesis.

Patient may experience these side effects: mild diarrhea, rash, itching.

Drug is given with folic acid if needed. G. Iberet (1 tab PO BID) [Folic Acid/Folate]

- Vitamin Supplement Required for nucleoprotein synthesis and

maintenance of normal erythropoiesis. Instruct patient to report rash and DOB.

H. Calcium Carbonate Tums(1 tab PO TID)

- Electrolyte- Antacid Symptomatic relief of upset stomach

associated with hyperacidity. Take drugs between meals and at

bedtime. Do not take with other oral drugs. Absorption of those medications can be blocked.

Chew tablets thoroughly before swallowing, and follow with a glass of water or milk.

I. Sodium Bicarbonate(1 tab PO TID)

- Antacid, Systemic Alkalinizer For minimization of uric acid crystalluria

in gout, with uricosuric agents. Symptomatic relief of upset stomach

from hyperacidity.

- an aqueous solution of 0.9 percent sodium chloride, isotonic with the blood and tissue fluid, used in medicine chiefly for bathing tissue and, in sterile form, as a solvent for drugs that are to be administered parenterally to replace body fluids.

Serum Potassium Level- Measures the amount of

potassium in your blood.- Helpful in evaluating disorders

of the heart, kidneys, adrenal glands, muscles, and digestive treatments.

48

Definition of Terms

Acidosis- an abnormal condition of reduced alkalinity of the blood and tissues that is marked by sickly sweet breath, headache, nausea and vomiting, and visual disturbances and is usually a result of excessive acid production

Atherosclerosis- Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques. Eventually, the plaques can make the artery narrow and less flexible, making it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms.

Autonomic Neuropathy- Autonomic neuropathy is a form of peripheral neuropathy. It is a group of symptoms, not a specific disease. Autonomic neuropathy involves damage to the nerves that run through a part of the peripheral nervous system. The peripheral nervous system includes the nerves used for communication to and from the brain and spinal cord (central nervous system) and all other parts of the body, including the internal organs, muscles, skin, and blood vessels.Damage to the autonomic nerves affects the function of areas connected to the problem nerve

Charcot Foot- Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Diabetic Nephropathy- Kidney damage from diabetes. If you have diabetes, your blood sugar levels are too high. Over time, this can damage your kidneys. Your kidneys are filters that clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body.

Diabetic Neuropathy- Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.

Diabetic Retinopathy- Diabetic retinopathy is a complication of diabetes that results from damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, however, diabetic retinopathy can result in blindness. In the United States, diabetic retinopathy is a leading cause of blindness in adults.

Gastroparesis- Gastroparesis is a condition in which the muscles in your stomach don't function normally. Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all. This prevents your stomach from emptying properly. Gastroparesis can interfere with digestion, cause nausea and vomiting, and play havoc with blood sugar levels and nutrition.

Glucagon- Glucagon is an important hormone involved in carbohydrate metabolism. Produced by the pancreas, it is released when blood glucose levels start to fall too low,

49

causing the liver to convert stored glycogen into glucose and release it into the bloodstream, raising blood glucose levels and ultimately preventing the development of hypoglycemia. The action of glucagon is thus opposite to that of insulin, which instructs the body's cells to take in glucose from the blood. However, glucagon also stimulates the release of insulin, so that newly-available glucose in the bloodstream can be taken up and used by insulin-dependent tissues.

Insulin Resistance- Insulin resistance is a condition in which cells, particularly those of muscle, fat, and liver tissue, display "resistance" to insulin by failing to take up and utilize glucose for energy and metabolism (insulin normally promotes take up and utilization of blood glucose from the blood stream). In its early stages, the condition is asymptomatic, but may develop into Type II Diabetes.

Neurogenic Bladder- Neurogenic bladder refers to dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition.

Osmolarity- is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per liter (L) of solution (osmol/L or Osm/L).

Small vessel disease- Small vessel disease, also known as coronary microvascular disease or small vessel heart disease, is a condition in which the small arteries in the heart become narrowed. Small vessel disease causes signs and symptoms of heart disease, such as chest pain (angina). Small vessel disease is usually diagnosed after a doctor checks for blockages in the main arteries of the heart that cause coronary artery disease, but finds little or no narrowing and your symptoms persist.

Vagus Nerve- Either of the tenth and longest of the cranial nerves, passing through the neck and thorax into the abdomen and supplying sensation to part of the ear, the tongue, the larynx, and the pharynx, motor impulses to the vocal cords, and motor and secretory impulses to the abdominal and thoracic viscera

Documents

NCS-DM Type 2 for Case Presentation