Diabetes can also causes ulcers by decreasing the circulation in the lower extremities. This occurs due to the high amount of glucose circulating in the blood, which in turn damages arteries. The high amount of glucose in the blood causes plaque to build up in the arteries and slowly allows less and less blood through which causes decreased perfusion in the extremities ( Zheng, Y., Ley, S. H., & Hu, F. B., 2017) . The decreased blood flow, which causes the loss of feeling in the peripheral extremities, is also the reason that many diabetic ulcers may go un noticed for some amount of time. In this case it went un noticed for so long that an infection was able to fester in to the bone ( Zheng, Y., Ley, S. H., & Hu, F. B., 2017) . This wound could have also been caused by the patient’s diagnosis of chronic heart failure likely caused by right-sided atrial fibrillation. Right-sided atrial fibrillation occurs when the hearts third chamber on the right is not able to fully contract. This stagnancy of blood can allow clots to form and in turn, can allow these clots to travel anywhere in the body ( Catanese, L., & Hart, R. G., 2019) . The right-sided atrial fibrillation could also be a probable cause for his stroke that occurred four and a half years ago ( Catanese, L., & Hart, R. G., 2019) . Catanese, L., & Hart, R. G. (2019). Stroke and Atrial Fibrillation. Stroke Prevention in Atrial Fibrillation , 161–170. doi: 10.1016/b978-0-323- 55429-9.00013-3
Zheng, Y., Ley, S. H., & Hu, F. B. (2017). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology , 14 (2), 88–98. doi: 10.1038/nrendo.2017.151 Section C: Safety, Vital Signs, & Activities of Daily Living – No areas can be left blank in order to receive credit. Time Temp (F°) Pulse Resp. BP Pulse Oximetry (%) Currently infusing IV fluid or medication (with substance & rate) O 2 Device & Rate /Setting Pain Rating (0-10) & Location If your patient has pain, there should be a reassessment of patient’s pain level after each intervention. 8:00 99 68 18 155/78 97% None Room air 0/10 Time Intake (volume in ml) Output (volume in ml) Oral Feeding Tube IV Fluids IV Piggyback Medications Blood Urine BM Emesis Drains 470 none None None None 200 115 None None Shift Totals 470 n/a n/a n/a n/a 200 115 n/a n/a Safety Nutrition Tubes & Drains Hygiene/Activity ID Bracelet (yes/no): yes Allergy Bracelet: no Side Rails Up x 2 Brakes On & Bed Locked/Low: locked and low Call Bell in Reach: yes Restraints: none Extremity: Right___ Left___ Bilat___ Type: Vest___ Ankle/Wrist___ Mittens___ Waist Belt___ Monitor q2 Yes___ No___ Sitter: Isolation/Precautions (select all that apply) Standard: Diet order: Diabetic Liquid/Fluid Restrictions: none Thin/Regular: regular Thickened: Feeds Self: Yes Needs Assistance: N/A % of Meals Eaten Breakfast:100% Lunch: 98% Snacks: none Feeding Tubes: None PEG Tube: Peripheral IV: None Size: Location: Central IV Line: CVC/PICC: yes Port/Mediport:N/A Dialysis Access: yes Quinton/Groshong:N/A Other:N/A PCA Pump: N/A Medication: Settings: Surgical Drains:N/A Perineal Care: Yes Catheter Care: Yes Linen Change: Yes Gown Change: Yes Bath given: 10/30 @ 1400 Bath Type: Independent: no Needs Assist: yes Skid proof socks: yes Bed bath/complete: yes Oral care: yes Dentures: no Activity:
Contact: Was on 10/10-10/28 Droplet: Enteric: Organism & Location: Aspiration Risk: none HOB angle:
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