the categories of (1) RBC production disorders, (2) RBC destruction disorders, and (3) anemia from blood loss enables a clear understanding of the pathophysiology of this disease. The presentation of anemia can be variable, depending on the acuteness of onset and the ability of the cardiopulmonary system to compensate. If the patient is healthy and the onset of anemia is gradual, there are few signs or symptoms until the hemoglobin value falls below 7.5 g/dL. Patients may initially experience fatigue, malaise, headache, dyspnea, irritability, and a mild decrease in exercise tolerance. Further declines in hemoglobin concentration may be associated with a markedly reduced exercise capacity, resting tachycardia, and dyspnea requiring supplemental oxygen. Other nonspecific findings that can accompany long-term, moderate to severe anemia include wide pulse pressure, midsystolic or pansystolic murmur, confusion, lethargy, brittle nails, glossitis, angular cheilitis, and spoon-shaped nails.Pallor of the mucous membranes, lips, conjunctivae, nail beds, and palmar creases is a common sign of anemia.When palmar creases are as pale as the surrounding skin, the patient usually has a hemoglobin value of less than 7 g/dL. Overall appearance suggestive of decreased stamina and energy could suggest fatigue secondary to anemia, or anemia related to another chronic illness. Increased heart or respiratory rate or the presence of a systolic murmur may be related to anemia. Special attention should be paid to characteristics of the integumentary system to evaluate for pallor, nail integrity, and signs of angular cheilitis. Also, symptoms of increased bruising may be a clue to a potential bleeding disorder contributing to blood loss and iron deficiency. DM2 – assessment, diagnosis, treatment: The patient with type 2 diabetes may have no symptoms or only subtle symptoms that may persist for weeks, months, or even years before detection. Unfortunately, during this time, the vascular and neuropathic complications may begin to develop and progress before the diagnosis is made. The symptoms include polyuria, polydipsia, blurred vision, fatigue, slowly healing wounds, and frequent infections. Some individuals may experience polyphagia and weight loss or numbness or tingling of feet and hands. In patients with new type 2 diabetes, examination should be performed for early evidence of vascular and neuropathic complications as well as for persistent infections. The purpose of periodic examination of patients with known diabetes is threefold: (1) to evaluate blood glucose control because poor control leads to end-organ complications; (2) to assess for the presence or progression of end-organ damage; and (3) to assess for associated diseases, such as other autoimmune disorders and cardiovascular risk factors. Annual examinations. Periodic visits, every 3 months for patients with type 1 diabetes and those with type 2 diabetes who have one or more complications, should be conducted to assess end-organ involvement
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- Summer '16