c) Schematic Diagram (client – based)

Non – modifiable Risk Factors: Modifiable Risk Factors:

-68 y/o and above -Familial history of DM type 2 -Sedentary lifestyle -Previously known Impaired
- Pacific Islander -Familial history of - Emotional Stress Fasting glucose
hypertension -↑consumption of fatty, salty
& sweet food

Insulin resistance and desensitization

↑Insulin
demand

Β cell
exhaustion
11-26-09 FBS= ↓insulin production ↑glucagon Fats and Proteins breaks
192.91mg/dl Release down to glucose
HGT
11-25-09 309mg/dl,
159mg/dl
11-26-09 179,148,156 ↑blood Impaired glucose Cellular Activation of
mg/dl glucose level absorption starvation satiety Easy fatigability
11-28-09 153, center Complaint on his
140mg/dl check up 5 years ago.
Polyphagia
↑osmolality As verbalized by the patient,
started 5 years ago until prior
Chronic glucose to admission
elevation
Fluid shifts HbA1c 11-25-09
10.9% ↑ Blood
from IC to IV viscosity

Sluggish blood Glycoprotein cell

Cellular dehydration ↑blood volume flow wall deposits

Thirst center activation ↑GFR

Narrowing of
blood vessel
Polydipsia Polyuria
As verbalized by the As verbalized by the
patient, started 5 years patient, started 5 years
ago until prior to ago until prior to blood vessel occlusion
admission admission

↓ perfusion
 Small Accelerated ↑LDL
atherosclerosis June 27,
vessel
2009
disease 187 g/dl

Diabetic Hypertension Coronary Artery Disease

130 – 150/ 70 -90 mmHg
retinopath as verbalized by his
y daughter (usual BP prior
to admission) Plaque rupture
Blurring of vision 11-25-09 190/130 mmHg
Eyeglass power
of L- 250 R- 240 Exposure of subendothelial matrix

Platelet activation

Change in Platelet ↑ Expression of

platelet shape degranulation
Platelet GP IIb/IIIa

Platelet Release of Thromboxane Enhanced affinity

adhesion to A2, Serotonin and other to fibrinogen
subendothelial platelet aggregatory agent
matrix

Platelet aggregation

↓ Arterial lumen Plasma Coagulation

System activation

Formation of thrombin

Enhances platelet
Converts aggregation
fibrinogen to
fibrin
Stabilization
of fibrin clot

Backflow
Impaired
of blood
Productive
Adventitious Pulmonar repolarization Blood pooling
Release of ↓ Irregular
Myocardi
cough y in the
the ↓cardiac HR, and O2heart
Fatigu ↓ BreathDOB of
Lactic
Anaerobic
ECG
Angina
acid lysosomal
on left Vasospasm
Ischemia
↑ ventricular
Impaired
Myocardial
of the
Coronary
tissue
↓ supplied by ↑BP,
cardiac
dislodges
cell vasocontricti
SNS al
 Nidus of
rethrombosis

Re-establishment of the
endothelium with fibrotic

Hardening of the
coronary arteries

Vasospasm dislodges thrombus

Coronary occlusion

Impaired cardiac perfusion

Anaerobic glycolysis Ischemia of the tissue supplied by the artery

Angina Lactic acid production Myocardial cell death ↓ Serum Mg

11-25-09 level
11-25-09

Impaired Release of ↓cardiac contractility Myocardial

repolarization of lysosomal enzymes 2D – echo 11-27-09 irritability
the myocardium thinned out akinetic entire
interventricular septum from
mid to apex, severe
↑ CKMB hypokinesia of all left Irregular heart beats
ECG changes 11/25/09 ventricular segments Afib RVR (11/25/09
Adventitious Breath sounds ST Depression 9:30pm)
47.4
Crackles 11/25-30/09 (11/25/09
mg/dL ↓ ventricular
9:00pm)
function
2D echo 11-27-09
Productive cough left ventricular
11/25-30/09 systolic function is
Backflow of severely depressed
Pulmonary blood in the Blood pooling on
Fatigue congestion left ventricle
↓ oxygenation lungs ↓ CO
11/25- CXR result
2d echo 11-27-09
28/09 11/25/09
calculated ejection fraction of
DOB 34% by cube method and 25 +/-
11/25-28/09 2 LPM O2 25% by visual estimated method
supplementation