19-year-old Caucasian male

GP is a 19-year-old Caucasian male. Before his all terrain vehicle accident (ATVA) he stood 68 inches tall and weighed 175 pounds. GP layed concrete for a living in the Middletown/Franklin area. GP’s childhood illnesses consisted of chicken pox before grade school, yearly flu since he was 10, and croup, which he had intermittently between the ages of 2-6. Prior to the ATVA he had only one major accident, which was a broken right wrist, which he injured falling backward on his rollerblades. He has never had any serious or chronic illnesses diagnosed that have not been mentioned. He did however have a case of either histoplamosis or cancer, which he said is what the doctor said. GP said that no surgery or procedure was done because it cleared up on its own. This was also around the age of 6. GP has been hospitalized few times before. A few times for croup, and also for removal of his tonsils.

GP states his, MMR, Tetanus, and TB test are all up to date. He has allergies to rondec, morphine, iodine, and IVP dye. He does not drink alcohol, and about once every other day drinks caffeine. He smokes about a pack every two days. Before the ATVA he was not on any medications. GP last had an eye and hearing exam approximately 2 years ago, a complete physical 6 months ago and doe not perform any self-examination.

GP was a healthy 19-year-old male who is now recovering from trauma from an ATVA. He was admitted to Miami Valley Hospital on 10-25-02 where he underwent a tracheotomy because of a compromised airway. He was admitted with the diagnosis of throat trauma. GP is recovering with great speed. On 11-5-02 he can speak with minimal pain and can produce an effective, strong cough. He is energetic and welcomes visitors and company. He understands why he is in the hospital and what needs to be accomplished before he is discharged. He has strong support from his mother, maternal grandmother and girlfriend. Patient appeared to be uncomfortable when asked about the health of his father and replied, “my dad is just an alcoholic, he is not in the picture.” GP wants to leave but understands why he cannot.

Pathophysiology of Diabetes Mellitus Type Two “Pathophysiologic factors of diabetes mellitus type two include (1) decreased tissue responsiveness to insulin as a result of receptor or postreceptor defects; (2) overproduction of insulin early in the disease, but eventual decreased secretion of insulin from B-cell exhaustion; (3) abnormal hepatic glucose regulation” (Lewis 1370). There are many factors that may lead to the development of type two diabetes. The following are risk factors that can be controlled: sedentary lifestyle, metabolism, hypertension, and hyperglycemia (Miller 5). Some people may think diabetes is only caused by decrease insulin production for the amount of glucose the person eats. Though this may be a cause, another cause is an increase in insulin resistance.

Factors that my influence greater insulin resistance are race, obesity, sedentary lifestyle, chronic diseases, and exposure to drugs such as glucocorticoids and diuretics (Miller 2). Preventing diabetes is an important part of elderly care. Complications that may arise in diabetes patient are the following: macroangiopathy, microangiopathy, congestive heart failure, peripheral vascular disease, retinopathy, nephropathy, and neuropathy are just a few. Some of the organs and tissues that do not require insulin may develop and increased intracellular glucose, which is metabolized to sorbitol (Robbins 467). Sorbitol is the reason of the decline of the organs and tissues (Robbins 467).

This is backed by Miller who said the following. “Evidence supports the hypothesis that hyperglycemia per se, either directly or indirectly, is indeed related to the development and/or progression of diabetes-specific complications” (Miller 3). Lisa O’Rourke also says the following in her study:  “There is reason to believe that reduction of blood glucose concentration to average levels below these glycemic thresholds will lead to reduced complications” (Miller 3). Some complications that may be avoided by maintainment of blood glucose level are macrovascular disease, nephropathy, neuropathy, and visual impairment.

Macroangiopathy “Macroangiopathy, or disease of large and medium-sized blood vessels, is essentially atherosclerosis and arteriosclerotic vascular disease characterized by a higher frequency and earlier onset than in the nondiabetic population” (Lewis 1398). The atherosclerotic plaque formation seems to be promoted by the altered lipid metabolism common to diabetes (Lewis 1398). Macroangiopathy may lead to cerebrovascular, cardiovascular, and peripheral vascular disease (Lewis 1398). Because of the complications with macroangiopathy, congestive heart failure may develop (Miller 2).

Congestive Heart Failure Microangiopathy “Microangiopathy is the result of thickening of the basement membranes in capillaries and arterioles, a highly characteristic concomitant of long-term diabetes mellitus” (Lewis 1399). The areas, which are most, affected are the following: eyes, kidneys, and the skin (Lewis 1399). Neuropathy “Mononeuropathic conditions are theorized to develop from microangiopathy, whereas the more diffuse neuropathic conditions are attributed to metabolic defects and the accumulation of by-products in the nerve tissue” (Lewis 1400). “The result is reduced nerve conduction and demyelinization” (Lewis 1400). Symptoms of neuropathy include “pain described as burning, cramping, crushing, or tearing” (Lewis 1401).

Nephropathy “The kidneys are the most severely damaged organ in diabetics, and renal failure is a major cause of mortality” (Robbins 468). The kidneys begin to fail and their glomerular filtration rate starts to decline eventually leading to acute renal failure and then chronic renal failure. Nursing Care Plan Nursing Diagnoses 1. Ineffective airway clearance related to presence of yellow, thick secretions in the lungs as manifested by scattered rhonchi. 2. Pain related to throat trauma as manifested by patient stating his neck hurts. 3. Altered nutrition related to altered diet as manifested loss of 20 pounds between the dates of 10-25-02 to 11-11-02 4. Risk of Aspiration related to pain of swallowing as manifested by distorted speech after swallowing a small sip of water and swallowing evaluation.

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