2nd year-coronary artery disease related to dm( ihm- mrs. cordenillo

8/8/2019 2ND YEAR-Coronary Artery Disease Related to DM( IHM- Mrs. Cordenillo

1/20


2/20

I. Introduction

Diabetes mellitus is a group of metabolic diseases characterized by high

blood sugar (glucose) levels that result from defects in insulin secretion, or
http://www.medicinenet.com/script/main/art.asp?articlekey=17467http://www.medicinenet.com/script/main/art.asp?articlekey=17467


3/20

predisposition. The rapid modernization and industrialization allows the

individual more time for leisure thus lessening physical activity. This leads to

increasedfood consumption leading to weight gain and obesity.

DM is associated with a markedly increased risk of coronary artery

disease. In the Framingham study, the incidence of coronary artery disease

was increased in diabetic subjects. While the most common cardiac

manifestation in diabetic patients is coronary artery disease, DM also

appears to be strongly linked to heart failure (HF).

Approximately 15 to 25% of patients with HF are diabetics and it has been

suggested that DM may play an important role in the pathogenesis,

prognosis, and response to treatment of HF. The increased risk of


4/20

b. Specific

Upon the completion of this case study, the student shall have:

Described and explained Diabetes Mellitus, Coronary Artery Disease and

Congestive Heart Failure.

Reviewed the anatomy and physiology of the organs involved.

Identified the risk factors contributing to the occurrence of the condition.

Expounded on the laboratory and diagnostic procedures done with the

patient, their purposes, and specific nursing responsibilities before, during

and after the procedure.

Enumerated the different medications administered for the condition, their

i di ti d ifi i ibiliti


5/20

Every cell in the human body needs energy in order to function. The

bodys primary energy source is glucose, a simple sugar resulting from thedigestion of foods which contains carbohydrates (sugars and starches).Glucose from the digested food circulates in the blood as a ready energysource for any cells that need it. Insulin is a hormone or chemical producedby cells in the pancreas, an organ located behind the stomach. Insulin bondsto a receptor site on the outside of cell and acts like a key to open a doorwayinto the cell through which glucose can enter. Some of the glucose can be

converted to concentrated energy sources like glycogen or fatty acids andsaved for later use. When there is not enough insulin produced or when thedoorway no longer recognizes the insulin key, glucose stays in the bloodrather entering the cells.

Anatomy of the pancreas:The pancreas is an elongated, tapered organ located across the back

of the abdomen, behind the stomach. The right side of the organ (called thehead) is the widest part of the organ and lies in the curve of the duodenum(the first section of the small intestine). The tapered left side extends slightlyupward (called the body of the pancreas) and ends near the spleen (calledthe tail).


6/20

The Exterior of the HeartThe heart is the muscle in the lower half of the picture. The heart has

four chambers. The right and left atria are shown in purple. The right and leftventricles are shown in red. Some of the main blood vesselsarteries andveinsthat make up the blood circulatory system are directly connected to


7/20

the heart's left ventricle. The coronary arteries are located on the heart'ssurface at the beginning of the aorta. The coronary arteries carry oxygen-rich

blood to all parts of the heart.

The Interior of the Heart

The SeptumThe right and left sides of the heart are divided by an internal wall of

tissue called the septum. The area of the septum that divides the atria (the

two upper chambers of the heart) is called the atrial or interatrial septum. Thearea of the septum that divides the ventricles (the two lower chambers of theheart) is called the ventricular or interventricular septum.

Heart ChambersThe two upper chambers of the heart are called atria. The atria receive

and collect blood. The two lower chambers of the heart are called ventricles.

The ventricles pump blood out of the heart into the circulatory system to otherparts of the body.

Blood FlowThe arrows in the drawing show the direction that blood flows through

the heart.


8/20

Final Diagnosis: Hypertension, Hypertensive, Coronary Artery Disease

CHF class II w/ pericardial and pleural effusion

Attending Physician: Dr. Belasoto

V. Clinical Assessment

a. Nursing History

Pt is a diagnosed DM for >5 years. A month PTA, had met postprandial

vomiting preceded by dizziness (+) on and off grade 1 bipedal nonpitting edema,

(+) blurring of vision.

b. Past Health Problem/ Status

Diabetic >5 yrs

Nonhypertensive

nonasthmatic

VI. BRIEF SOCIAL, CULTURAL AND RELIGIOUS BACKGROUND

Educational Background:

Unrevealed.


9/20

With equal pulses

No edema

No cyanosis

Cephalocaudal Assessment:Vital Signs:

BP- 140/80 mmHg; T- 36.6C; PR- 78 bpm; RR- 19 rpmGeneral Appearance:

Mrs. M.B was seen lying on her bed with an IV fluid of PNLSS 1l x KVOin the left metacarpal veins and regulated at10 cc/hr.

Assessment:Skin

Dry and warm to touch-With fair skin complexion-With pallor

Head With short hair, black and equally distributedEyes

With dark brown iris

With pale palpebral conjunctivaEars


10/20

contraction.

1/14/10 Differential count1/15/10

Glucose 6.16 mmol/L 4.10-5.90 AbnormalIt indicates thatdont have enoughinsulin in yourbody.

cholesterol 6.49 0-5.20LDL 4.80 1.71-4.60 Abnormal

A cholesterol thatcirculates in the

blood. It canslowly build up inthe inner walls of

the arteries thatfeed the heart andbrain. It indicates

form plaque, athick, hard deposit

that can narrow


11/20

malignant tumor.

Date 1/20/10

Chest PA

Xray findings:

Follow up study done, as compared with the previous chest x-ray taken

12/17/09 shows haziness in both lung bases obliterating the hemidiaphragm andcostophillic sulci.

There is a regression of haziness in the ( R ) upper lung field. The rest of

the findings are unchanged.

Impression:

Bilateral pleural effusionAtherosclerotic Aorta

Bibasal pneumonia

Cardiomegaly, borderline


12/20

Hyperglycemia

Dyslipidemia

Atherosclerosis

Deposition of Fats in

the Aorta

Narrowing and

Blockage of the Aorta

Chronic High Blood

Glucose

Increase Osmotic

Pressure

Fluid Goes to

vascular space

High Blood Volume

Hypertension

Viscous Blood

Poor Circulation

Low Blood Supply

Nerve Damage

NeuropathyLow Blood to

Coronary Artery

Peripheral Nervous


13/20


14/20

Trade


15/20

Names

&

Dosage

Generic

Name

Classification Action Indication Side Effect Contraindication Nursing

Responsibility

140 mg.

ODsimvastatin cholesterol-

lowering drug

antihyperlipidermic

reduces cholesterolby inhibiting anenzyme in the liver(HMG-CoAreductase) that isnecessary for theproduction ofcholesterol.In the blood,statins(HMG-CoAreductase) lowertotal and LDL("bad") cholesterolas wellas triglycerides

In patients withcoronary heartdisease,diabetes,peripheral vesseldisease, or historyofstroke or othercerebrovasculardisease andnonfatalmyocardialinfarction (heartattack)

headache,nausea,vomiting, diarrhea, abdominalpain, muscle pain,and abnormalliver test.Mostserious potentialside effects areliver damage andmuscleinflammation orbreakdown.

Pregnantwomen, fungalbyproducts,lactation

Ask the pt. if theyare allergic to it.Limit alcoholicbeverages of thept.Give in theevening; thehighest rates ofcholesterolsynthesis arebetween midnightand 5 am

10 mg

t

a

b

O

D

Norvasc Antianginal

Antihypertensive

Calcium channel

blocker

Decreases cardiacoxygenconsumption,Increased deliveryof oxygen tocardiac cells, blockthe transport of

calcium into thesmooth musclecells lining thecoronary arteriesand other arteriesof the body.

Chronic stableangina, alone or incombination withother drugs.Essentialhypertensive,alone or in

combination withotherantihypertensives

Allergies toamlodipine, heartblock,lactation,use cautiously withheart failure

headache andedema (swelling) of the lowerextremities,dizziness

Assess skinlesions, edema,baselineECG,ausculation,GI normal output.

Monitor patient

carefully(BP,cardiacrhythm andoutput)

40 mg Clexane Anticoagulants,

Antiplatelets &

-treats blood clots

-treats certain types

renal impairment:

Treatment of

Haemorrhage,

thrombocytopenia

majorblood

Assess for tingling

weakness,
http://www.medicinenet.com/script/main/art.asp?articlekey=87976http://www.medicinenet.com/script/main/art.asp?articlekey=87976http://www.medicinenet.com/script/main/art.asp?articlekey=343http://www.medicinenet.com/script/main/art.asp?articlekey=2025http://www.medicinenet.com/script/main/art.asp?articlekey=2025http://www.medicinenet.com/script/main/art.asp?articlekey=489http://www.medicinenet.com/script/main/art.asp?articlekey=379http://www.medicinenet.com/script/main/art.asp?articlekey=379http://www.medicinenet.com/script/main/art.asp?articlekey=24719http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1908http://www.medicinenet.com/script/main/art.asp?articlekey=1908http://www.medicinenet.com/script/main/art.asp?articlekey=42077http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=12699http://www.mims.com/Page.aspx?menuid=mimssearch&searchcategory=THERAPEUTIC&searchstring=Anticoagulants%2C+Antiplatelets+%26+Fibrinolytics+(Thrombolytics)&CTRY=HKhttp://www.mims.com/Page.aspx?menuid=mimssearch&searchcategory=THERAPEUTIC&searchstring=Anticoagulants%2C+Antiplatelets+%26+Fibrinolytics+(Thrombolytics)&CTRY=HKhttp://www.medicinenet.com/script/main/art.asp?articlekey=87976http://www.medicinenet.com/script/main/art.asp?articlekey=87976http://www.medicinenet.com/script/main/art.asp?articlekey=343http://www.medicinenet.com/script/main/art.asp?articlekey=2025http://www.medicinenet.com/script/main/art.asp?articlekey=2025http://www.medicinenet.com/script/main/art.asp?articlekey=489http://www.medicinenet.com/script/main/art.asp?articlekey=379http://www.medicinenet.com/script/main/art.asp?articlekey=379http://www.medicinenet.com/script/main/art.asp?articlekey=24719http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1908http://www.medicinenet.com/script/main/art.asp?articlekey=1908http://www.medicinenet.com/script/main/art.asp?articlekey=42077http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=12699http://www.mims.com/Page.aspx?menuid=mimssearch&searchcategory=THERAPEUTIC&searchstring=Anticoagulants%2C+Antiplatelets+%26+Fibrinolytics+(Thrombolytics)&CTRY=HKhttp://www.mims.com/Page.aspx?menuid=mimssearch&searchcategory=THERAPEUTIC&searchstring=Anticoagulants%2C+Antiplatelets+%26+Fibrinolytics+(Thrombolytics)&CTRY=HKhttp://www.mims.com/Page.aspx?menuid=mimssearch&searchcategory=THERAPEUTIC&searchstring=Anticoagulants%2C+Antiplatelets+%26+Fibrinolytics+(Thrombolytics)&CTRY=HK


16/20
http://www.mims.com/Page.aspx?menuid=mimssearch&searchcategory=THERAPEUTIC&searchstring=Antispasmodics&CTRY=HKhttp://www.mims.com/Page.aspx?menuid=companionhome&ID=707http://www.mims.com/Page.aspx?menuid=companionhome&ID=2471http://www.mims.com/Page.aspx?menuid=companionhome&ID=1256http://www.mims.com/Page.aspx?menuid=companionhome&ID=520http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=1992http://www.medicinenet.com/script/main/art.asp?articlekey=373http://www.medicinenet.com/script/main/art.asp?articlekey=343http://www.medicinenet.com/script/main/art.asp?articlekey=453http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=370http://www.medicinenet.com/script/main/art.asp?articlekey=370


17/20


18/20

IX. Nursing Management (NCP)

Problem 1

Assessment Nursing Diagnosis Planning Intervention Evaluation

Objective

= 6.16 mmol/dL

(glucose)

> weakness

Risk for infection r/tglucose level

After 1 hour of nursing

interventions,

the patient will identify

interventions to prevent

risk of infection

Independent

>Stress proper handhygiene by washing handsand using sanitizers.

>Increase intake of Vit C> Observe for signs ofinfection and inflammation.

>Maintain aseptictechnique for IVinsertion procedure,administration ofmedications, andprovidingmaintenance and sitecare. Rotate IV sitesas indicated.

>Provide skincare by keeping the skin

dry,linens dry andwrinkle free.

After 1 hour of

nursing interventions,

the patient have

identified interventions

to prevent risk of infecti

like being aware of eati

foods that will decrease

the risk of infections.


19/20

Problem 2

Assessment Nursing Diagnosis Planning Intervention Evaluation

SubjectiveSadto matambok koya.Galing ky sangnagmaskit ko sangdiabetes nga ni gulpiakon pagniwang, asverbalized

ObjectiveWt. 110 lbs

Non-elastic skin

Imbalanced Nutrition:Less Than Body

requirements related toincreased metabolicneeds caused by the

disease

After the nursingintervention:The patient will be-encourage the patient toeat well balanced diet-maintain blood glucose

level-Achieve and maintainreasonable weight

Independent

>Discouraged beveragesthat are caffeinated orcarbonated> Encouraged low fat dietand high fiber foods

>Achieve and maintainreasonable weight>Practiced goodnutritionalhabits>Use less salt>Eat less sugar>Eat less fat>Eat more complexcarbohydrate

Goal partially met asevidenced by patient arethreatened by the factorsoccur. Avoided drinkingcarbonated drinks. Eatwell.


20/20

Problem 3

2nd year-coronary artery disease related to dm( ihm- mrs. cordenillo

Documents