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A Concept Map on a 58-year-old Male with the diagnoses of:

 Hypovolemic Shock secondary to Upper Gastrointestinal Bleeding secondary to Bleeding Peptic Ulcer Disease secondary to
immediate aspirin use
 Cardiac Dysrhythmia- Ventricular Tachycardia secondary to Ischemia secondary top severe anemia
 Hypertensive Cardiovascular Disease
 Left Ventricular Hypertrophy
 Acute Coronary Syndrome, Non ST-segment elevation Myocardial Infarction
 Chronic Heart Failure Class IV
 Sepsis secondary to Left Diabetic Foot and Hospital Acquired Pneumonia
 Chronic Kidney Disease secondary to Diabetic Nephropathy
 Diabetes Mellitus Type 2, Insulin-Resistant, Non-Obese
 Peripheral Arterial Occlusive Disease
 S/P Above-the-Knee Amputation (June 2015),

Predisposing Factors Precipitating Factors:

 Age: 58 years old  Smoker (35 packs/year)


 Gender: Male  Alcohol drinker (4x/week) 60-100mL/day
 Race: Filipino (Asian)  Foot injury ( 2nd digit, left)
 Family History of Diabetes Mellitus
 Diabetes Mellitus Type 2 (15 years)
 Poor compliance to treatment

Glucose cannot enter


the cell

Fasting Blood Sugar = Increased blood


glucose level
264 mg/dL

- Beta cells produce


more insulin
Impaired beta cell
function

Impaired insulin
secretion

Continuous increase in
blood glucose level

Increase absorption of
glucose by the cell

Hyperglycemia

Increase viscosity of
blood

Capillary basement Abnormal retinal


membrane thickening vascular permeability

Decreased circulating Impaired/sluggish blood Scarring


blood volume flow

Glomerulosclerosis Diabetic Retinopathy

Proteinuria Decrease Glomerulus Blurring of vision


Filtration Rate
Diabetic Nephropathy

Diminished renal
reserve

Further loss of nephron


function

Renal insufficiency

Lab results
Increased Blood Urea
Creatinine:H 4.48 mg/dL
Nitrogen and Creatinine BUN: H 85.3 mg/dL

Nephron compensation

Filtration of more
concentrated blood by
the remaining nephrons

Hypertrophy of
nephrons

Further damage to
nephrons
Decreased renal
function due to direct Acute Renal Failure Ketosteril
cytokine effects
Impaired kidney
function Impaired Physical
Mobility
Reduction of renal
capillaries, scarring of
glomeruli and atrophy
and fibrosis of renal Fatigue,
tubules weakness

Nitrogenous wastes Decreased


impair platelet function erythropoietin
CBC result:
production
Platelet
count: Bleeding tendencies Chronic Kidney Disease Anemia
L 62 10^3/uL
Bleeding Peptic Ulcer CBC result:
Disease Hgb: L 11.3g/dL
Hemodialysis
Black tarry
Hct:L 33.0 %
Stool
Upper Gastrointestinal Decreased myocardial
Bleeding
Esomeprazole perfusion
Ineffective
Tranexamic Decreased blood Gastrointestinal Tissue
Acid volume Perfusion Cardiac dysrhythmia

Hypovolemia
ECG result:
Continuous decrease of Ventricular tachycardia
blood volume

Hypovolemic Shock
Lidocaine

Death (7/7/15, 12 noon)


Weight loss Increased breakdown of Sugar irritates nerves
fat

Increased fat content of Nerve demyelination


Pregabalin
the blood

Lab results:
Hyperlipidemia Paresthesia, numbness Diabetic Neuropathy
High LDL
High HDL tingling

Formation of fatty
Atorvastatin Risk for Injury Impaired pain sensation
deposits on the walls of
blood vessels

Tissue/skin breakdown
Lab results CXR: Atherosclerosis
Atherosclerotic aorta

Delayed wound healing


Narrowing of blood Impaired Skin Development of
vessels Integrity gangrene (L foot)
Decreased CBC result:
Cardiac Output WBC:
Infection H11.110^3/uL
Occlusion of plaque Increased blood Neutrophils:
pressure Meropenem H
83.4%Lymph
Inflammation response ocyte: L6.2%
Blood flow blocked Hypertension Furosemide
Above the
Knee
Phagocytosis Amputation

Myocardial ischemia Reduction in arterial


Trimetazidine
perfusion Acute Pain
Insufficient immune
response
Myocardial Infarction Peripheral Arterial Tramadol
Occlusive Disease
Systemic spread of Disturbed Sensory
infection Perception r/t
Acute Coronary Phantom Limb
Syndrome Sensation
Sepsis
Increased pumping
action of the heart Asmavent

Massive cytokine Combivent


Myocardial hypertrophy Lab result CXR release
N-acetylcysteine
Cardiomegaly

Increased whole-body
metabolic rate

Shortness of breath Hypoxic respiratory Hospital Acquired


failure Pneumonia
X-Ray, Tracheobronchitis
Sputum Culture

Tracheal colonization of
bacteria

Colonization of bacteria
in the airway

Prolonged hospital stay


Legend:

Predisposing Factor Laboratory Result Nursing Care Plan

Precipitating Factor Medical


Medical Diagnosis
Management

Clinical Manifestation Surgical


Management Death