dmr power point
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Diabetic Diabetic Retinopathy OURetinopathy OU
with Retinal with Retinal Detachment OSDetachment OS
Presented by:Presented by:Ma. Vanessa P. Pineda, Ma. Vanessa P. Pineda,
R.N.R.N.
I n t r o d u c t i o nI n t r o d u c t i o n
What is Diabetes Mellitus?What is Diabetes Mellitus? United States StatisticsUnited States Statistics Philippine StatisticsPhilippine Statistics Effects of DMEffects of DM What is Diabetic What is Diabetic
Retinopathy?Retinopathy?
T h e N u r s i n g P r T h e N u r s i n g P r o c e s so c e s s
A.A. Personal DataPersonal Data “ “ Ms. Minchin”Ms. Minchin” March 20, 1950March 20, 1950 Sta. Ines, Mabalacat, Sta. Ines, Mabalacat,
PampangaPampanga Roman CatholicRoman Catholic
Pertinent Family Pertinent Family HistoryHistory
Paternal SidePaternal Side- Grandfather (+) DM- Grandfather (+) DM- Youngest Uncle (+) DM- Youngest Uncle (+) DM- Father (+) DM- Father (+) DM
Maternal SideMaternal Side- Grandmother (+) DM- Grandmother (+) DM- Eldest sister of Mother (+) DM- Eldest sister of Mother (+) DM- Mother (+) DM- Mother (+) DM
History of Past History of Past IllnessIllness
Occasional coughsOccasional coughs ColdsColds FeverFever
History of Present History of Present IllnessIllness
Diagnosed when she was 35 Diagnosed when she was 35 years oldyears old
FBS: 240 mg/dlFBS: 240 mg/dl Medications given:Medications given:
Glucophage 500 mg/tab, 1 tab Glucophage 500 mg/tab, 1 tab TIDTID
Diamicron 80 mg/tab, ½ tab BIDDiamicron 80 mg/tab, ½ tab BID
History of Present History of Present IllnessIllness
June 2006 - blurring of vision OUJune 2006 - blurring of vision OU July 2006 – client undergone Laser July 2006 – client undergone Laser
TherapyTherapy October 2006 – blurring of vision OSOctober 2006 – blurring of vision OS November 2006 – (+) bleeding vessels November 2006 – (+) bleeding vessels
OUOU
- performed Laser Therapy- performed Laser Therapy December 2006 – diagnosed of Diabetic December 2006 – diagnosed of Diabetic
Retinopathy Retinopathy
History of Present History of Present IllnessIllness
March 2007 - (+) hypertensionMarch 2007 - (+) hypertension
- blurring of vision OU- blurring of vision OU April 2007 – client undergone April 2007 – client undergone
VitrectomyVitrectomy August 2007 – blurring of vision August 2007 – blurring of vision
ODOD September 2007 – performed September 2007 – performed
Vitrectomy ODVitrectomy OD
History of Present History of Present IllnessIllness February 20, 2008 – client February 20, 2008 – client
complained of seeing black color complained of seeing black color in the corner of her left eye. She in the corner of her left eye. She was diagnosed of Retinal was diagnosed of Retinal Detachment.Detachment.
February 22, 2008 – scheduled for February 22, 2008 – scheduled for Scleral buckling, (+) HPN & Scleral buckling, (+) HPN & unstable blood sugar levelsunstable blood sugar levels
February 25, 2008 – the client February 25, 2008 – the client undergone Scleral bucklingundergone Scleral buckling
Physical ExaminationPhysical Examination(Performed on February 24, (Performed on February 24,
20082008)) VS: BP- 140/90, T- 37, PR- 86, RR- 20VS: BP- 140/90, T- 37, PR- 86, RR- 20 Head : round shape, no tenderness, Head : round shape, no tenderness,
swelling or lesions noted upon swelling or lesions noted upon palpation, no abnormal configuration palpation, no abnormal configuration notednoted
Hair & Scalp : hair is evenly distributed, Hair & Scalp : hair is evenly distributed, thick, black, dry and wavy up to the thick, black, dry and wavy up to the shoulder, no lice or dandruff noted shoulder, no lice or dandruff noted upon inspection, no lesions or massesupon inspection, no lesions or masses
Face & Skull : symmetrical facial Face & Skull : symmetrical facial movement, smooth skull, no nodules movement, smooth skull, no nodules or depressionsor depressions
Skin : brown complexionSkin : brown complexion
skin warm to touchskin warm to touch
skin brings back to previous skin brings back to previous stat after stat after pinching pinching
no edema or lesions notedno edema or lesions noted
no pigmentationno pigmentation
Eyes : eyebrows symmetrically Eyes : eyebrows symmetrically aligned with aligned with equal equal movements, eyebrows & eyelashes movements, eyebrows & eyelashes are evenly distributed are evenly distributed
OD - clear cornea, pupil react to OD - clear cornea, pupil react to light and accommodation, can read light and accommodation, can read newspaper print, bold and small font newspaper print, bold and small font at a distance of 12” from the tip of the at a distance of 12” from the tip of the nosenose
OS – hazy cornea, pupil not OS – hazy cornea, pupil not reactive to light and accommodation, reactive to light and accommodation, cannot read newspaper printcannot read newspaper print
Ears : symmetrical in shape, not Ears : symmetrical in shape, not tender, recoils after it is folded; no tender, recoils after it is folded; no lesions, symmetrical with the lesions, symmetrical with the outer cantus of the eyesouter cantus of the eyes
Nose : no discharge, lesions & Nose : no discharge, lesions & tendernesstenderness
air moves freely through air moves freely through the naresthe nares
Lips : no blisters/ cracks noted, Lips : no blisters/ cracks noted, moist, smooth and glisteningmoist, smooth and glistening
Teeth and Gums : pink, not swollen, Teeth and Gums : pink, not swollen, slightly yellowish teethslightly yellowish teeth
Tongue : no lesions, can move freely and Tongue : no lesions, can move freely and smoothlysmoothly
Neck : no unusual mass noted upon Neck : no unusual mass noted upon palpationpalpation
no enlargement of the lymph no enlargement of the lymph nodesnodes
no distention of the jugular veinsno distention of the jugular veins
Thorax and Lungs : spine is Thorax and Lungs : spine is vertically aligned, no tenderness, vertically aligned, no tenderness, pain or lesions upon palpation; pain or lesions upon palpation; present tactile fremitus, with clear present tactile fremitus, with clear breath soundsbreath sounds
Heart & Breast : heart has regular Heart & Breast : heart has regular rhythmrhythm
no tenderness, masses or no tenderness, masses or lesions noted lesions noted on on the breasts the breasts
Abdomen : uniform in color, no Abdomen : uniform in color, no swelling or lump noted, tympanic swelling or lump noted, tympanic sound heard upon auscultationsound heard upon auscultation
Extremities : no edema, Extremities : no edema, deformities, tenderness noted; deformities, tenderness noted; has symmetrical upper and lower has symmetrical upper and lower extremities; clean finger and extremities; clean finger and toenails; Blanch test of <3 secs.toenails; Blanch test of <3 secs.
Diagnostics & Laboratory Diagnostics & Laboratory ProceduresProcedures
Urinalysis (February 22, 2008)Urinalysis (February 22, 2008)color : yellowcolor : yellowtransparency : slightly cloudytransparency : slightly cloudypH : 8pH : 8specific gravity : 1.005specific gravity : 1.005Albumin : (+)4Albumin : (+)4Sugar : positiveSugar : positivePus Cells : 2-4Pus Cells : 2-4RBC : 3-5RBC : 3-5
Complete Blood Count (CBC)Complete Blood Count (CBC)
Hgb : 122 mg/dlHgb : 122 mg/dl
WBC : 6.4WBC : 6.4
Hct : 0.40Hct : 0.40 Serum Creatinine : 1.7 mg/dlSerum Creatinine : 1.7 mg/dl Serum Potassium : 5.2 mEq/LSerum Potassium : 5.2 mEq/L Serum Sodium : 148 mEq/LSerum Sodium : 148 mEq/L
FBS :FBS : 325 mg/dl (Feb.22, 2008) 325 mg/dl (Feb.22, 2008) 122 mg/dl (Feb. 24, 2008)122 mg/dl (Feb. 24, 2008)
RBS:RBS: 229 mg/dl (Feb. 20, 2008)229 mg/dl (Feb. 20, 2008)190 mg/dl (6am of Feb. 21, 190 mg/dl (6am of Feb. 21,
2008)2008)185 mg/dl (12 noon)185 mg/dl (12 noon)287 mg/dl (6 pm)287 mg/dl (6 pm)200 mg/dl (6am of Feb. 22, 200 mg/dl (6am of Feb. 22,
2008)2008)298 mg/dl (12 noon)298 mg/dl (12 noon)170 mg/dl (6 pm)170 mg/dl (6 pm)
RBS :RBS : 150mg/dl150mg/dl (12mn, Feb. 23, (12mn, Feb. 23, 2008)2008)
98mg/dl98mg/dl (6am)(6am)260mg/dl260mg/dl (12noon)(12noon)180mg/dl180mg/dl (6pm)(6pm)175mg/dl175mg/dl (12mn, Feb.24, (12mn, Feb.24,
2008)2008)100mg/dl100mg/dl (6am)(6am)365mg/dl365mg/dl (12noon)(12noon)115mg/dl115mg/dl (6pm)(6pm)125mg/dl125mg/dl (6am, Feb. 25, 2008)(6am, Feb. 25, 2008)88mg/dl88mg/dl (12noon)(12noon)
Chest X-rayChest X-ray
- no active parenchymal - no active parenchymal infiltrate. The heart is infiltrate. The heart is markedly enlarged. markedly enlarged. Pulmonary vascularity is Pulmonary vascularity is within normal. No remarkable within normal. No remarkable findings.findings.
Anatomy & PhysiologyAnatomy & Physiology
The Endocrine Hormones The Endocrine Hormones
and their Purposeand their Purpose
InsulinInsulin
GlucagonGlucagon
The Human EyeThe Human Eye
Parts of the EyeParts of the Eye ConjunctivaConjunctiva IrisIris PupilPupil LensLens Aqueous HumorAqueous Humor Vitreous HumorVitreous Humor RetinaRetina
Pathophysiology (Client-centered)
Synthesis of the Synthesis of the DiseaseDisease
Vision of a patient with Vision of a patient with Diabetic RetinopathyDiabetic Retinopathy
Vision of a Patient with Vision of a Patient with Retinal DetachmentRetinal Detachment
Medical ManagementMedical Management IVF : PNSS 1L x KVOIVF : PNSS 1L x KVO Drugs:Drugs:
Cefuroxime 750 mg IV Q8 (-) ANSTCefuroxime 750 mg IV Q8 (-) ANST
Metformin 500mg/tab, 1 tablet TIDMetformin 500mg/tab, 1 tablet TID
Glipizide 5mg/tab, 1 tablet BID PCGlipizide 5mg/tab, 1 tablet BID PC
Captopril 25mg/tab, 1 tablet BIDCaptopril 25mg/tab, 1 tablet BID
Clonidine 75mcg/tab, 1 tablet SL Clonidine 75mcg/tab, 1 tablet SL statstat
Humulin R sliding scale Humulin R sliding scale (Subcutaneous)(Subcutaneous)
160 to 200 : 4 units160 to 200 : 4 units
201 to 250 : 6 units201 to 250 : 6 units
251 to 300 : 8 units251 to 300 : 8 units
301 to 350 : 10 units301 to 350 : 10 units
<80 & >351 : refer to AP<80 & >351 : refer to AP
Diet :Diet : Soft, Diabetic dietSoft, Diabetic diet
NPO NPO
Activity:Activity: Complete bed rest Complete bed rest withwith
bathroom privilegesbathroom privileges
Surgical ManagementSurgical Management
Scleral BucklingScleral Buckling
Nursing ManagementNursing Management SoapieSoapie :: Risk for InjuryRisk for Injury NCPsNCPs
Prob. 1 : Disturbed visual sensory Prob. 1 : Disturbed visual sensory perception R/t decreased sensory perception R/t decreased sensory perception and changes in visual perception and changes in visual acuityacuity
Prob. 2 : Impaired physical mobility Prob. 2 : Impaired physical mobility R/T sensory perceptual impairmentR/T sensory perceptual impairment
Prob. 3 : Risk for injury R/T changes in Prob. 3 : Risk for injury R/T changes in visual acuityvisual acuity
Prob. 4 : Risk for infection R/t invasive Prob. 4 : Risk for infection R/t invasive procedureprocedure
Prob. 5 : Risk for impaired home Prob. 5 : Risk for impaired home management R/t visual limitations and management R/t visual limitations and activity restrictionsactivity restrictions
End of PresentationEnd of Presentation
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