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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