NUR1125 Case 2 Grp E&F by Eugene Macalinga https://padlet.com/eugene22_md/tisv18hln3em0vea en-us 2023-09-04 05:40:57 UTC 2025-01-24 02:23:14 UTC hello@padlet.com Group 1 eugene22_md https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2682998768 Subjective:
Frequent urination
Fatigue
Blurry vision
Frequent Headaches

Objective:
Right toe wound infection
BMI 25
Temp 38.2
BP 127/85
HR 102bpm
SPO2 98% on room air
RR 21 bpm
Capillary refill +ve 3s 
Weak foot pulse on Dorsalis Pedis (right)
Right foot reduced ability to feel pain]]> 2023-09-04 06:23:03 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2682998768 Grp 2 🫶🏻 https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683009422 risk factors:
-BMI 25
-Alcohol
-Hypertension
- Sedentary lifestyle 
- smoking for the past 25 years/20 sticks a day
- Age 
- Gender (male)

]]> 2023-09-04 06:31:28 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683009422 Group 7 e1186175 https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683012388 Postprandial plasma glucose - the level of sugar in your blood measured 2 hours after meal -> very high value of 23 mmol/L - indicating he does not control what he eat or drinks. -> If he frequently eat high-carbohydrate meals and snacks, his body can stay in a state of elevated postprandial glucose, requiring the body to regularly release insulin, which can lead to insulin resistance. 

Random glucose is a blood test taken at a random time. Normal range is 4-8 mmol/L, and more than 11 is high for patient with history of DM. A high blood glucose of 18mmol/L could be due to recent food intake but more likely indicates a sign of infection, as a body mechanism to fight the infection.

HbA1c: Used to diagnose T2 diabetes. Red blood cells live for an average of 120 days, so HbA1c gives an indication of how much sugar there has been in your blood over the past few months.

Fasting plasma glucose: blood test taken from patient who have fasted for 6-8hrs]]> 2023-09-04 06:34:01 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683012388 grp 5 (b2) https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683015155 Diabetes can affect the peripheral nerves, causing diabetic neuropathy which causes a decreased sensation in the toes and fingers, delaying the recovery time period for the right toe wound, causing it to be infected easily. ]]> 2023-09-04 06:36:32 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683015155 Group 9 https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683015475 Complication
- Neuropathy 
- Nephropathy
-Retinopathy 
-Hyperosmolar-Hyperglycemic State ( increase Urination ]]> 2023-09-04 06:36:48 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683015475 Group 4 :) [B1] https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683017757 - Temperature of 38.2 - fever indicative of infection
- Weak pulse and reduced sensation of pain - early complication of diabetic neuropathy 
- Slightly elevated HR, BP, RR - may be due to discomfort from fever/infection/foot
- Fatigue
- Peripheral capillary refill on the higher side of normal range.]]> 2023-09-04 06:38:20 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683017757 Group 8 (D1) https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683020170 Treatment
1) Metformin 
- reduce glucose production by the liver (lesser absorption by the intestines and stomach)
- improves insulin sensitivity

2) Injection Mixtard
- lower blood glucose


3) lifestyle modifications (being more active, diet changes) ]]> 2023-09-04 06:40:13 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683020170 group 3 https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683021403 QN A3: 

S/S polyuria -->  classic symptom of DM, kidney is unable to excrete excess sugar as it remains in the blood stream thus requiring more water filtration to pass the excess sugar out, hence the urge to urinate more.   

Symptoms of microvascular complications, Due to the damage of tiny blood vessels throughout the body. 
- neuropathy (peripheral) 
- retinopathy

 

Neuropathy 

-      Peripheral neuropathy--> Weak foot pulse on the right DP, feel pain on right foot + capillary refill (more than normal 2sec or less), right toe infection --> poor wound healing
-      Foot ulcer: Microvascular damage + neuropathy



-      Blurry vision, conjunct = potential retinopathy 
]]> 2023-09-04 06:41:09 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683021403 C1 https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683021904
- WBC high due to wound infection and fever 
- Low RBC due diabetes causing anemia through reducing absorption of iron 
- Glycemic counts elevated - indicating uncontrolled DM 

Other inx: 
- oral glucose tolerance test 
- Doppler ultrasound or CT scan to see damage to vessels 
- Eye check - for retinopathy 
- Urinalysis to check for ketones and glucose

]]> 2023-09-04 06:41:30 UTC https://padlet.com/eugene22_md/tisv18hln3em0vea/wish/2683021904