ENDO-DM Case

Bella, 68 years old female admitted because fever and weakness.

3 years PTA, patient experience severe throbbing headache accompanied by nape pain,
vomiting and chest heaviness. She was brought to UST CD- ER where BP was documented to be
210/100. She was given Clonidine 75mcg/SL and was advised admission. Due to financial
constraits, she was discharge against medical advise. No maintenance medication taken.

2 years PTA, she noted passage of bubbly urine and progressive edema. Because of
these and persistent hypertension, she consulted a GP and was found out to be diabetic as well.
She was given Gliclazide, metformin and amlodipine as maintenance medication. She’s unable
to take her medication regularly.

1month PTA, while finishing her laundry, she tripped sustaining bruises and punctured
wound on her L ankle from a misplaced wire. There was no significant pain so she just continued
her laundry.

2 weeks PTA, she noted bluish discoloration on her L ankle with numbness. She applied
liniment hoping that it is just a simple “pasma”. 4 days PTA, she started to have intermittent
fever with increasing numbness on the L leg with necrotic area surrounding the puncture site.
She self medicate with amoxicillin.

Few hours PTA, she had vomiting, severe headache with weakness more on the Left
side. This prompted consult and subsequent admission.

PE on admission: Conscious, coherent, slurred speech. BP 210/100, CR 120, RR 28 T 39

C. Height 5 feet, weight 170 Lbs. Supple neck with bruit on the left side. Dynamic pre-cordium,
AB 6th LICS AAL, Flabby abdomen AC 36 inches, (+) 2/5 MMT L upper and Lower extremities, 40%
sensory deficit same side. (+) 2x3 inches necrotic, foul smelling wound on the L foot.

Menopause at age 48 years, (+) FHX : DM and HPN- father, CAD- mother.

CXR: cardiomegaly with atheromatous aorta, 2D echo: concentric LVH, Cholesterol

280mg/dl, triglyceride 180, LDL 180, HDL 25, FBS 18 mg/dl, CBC: hgb 110/hct 0.29/wbc 28 with
bandemia, U/a: SG 1.030, pH 6.0, PUS over 100/hpf, RBC 20/hpf, (+) 4 glucosuria and
proteinuria, (-) urine Ketones, serum crea 8.9, Na 123, K 2.7

1. Identify terms and define.

2. List down all identified medical problems.
3. Which among the medical problem are considered acute/chronic and why?
4. What complications can be identified in the case?
5. Assume that you were the nurse who assisted on her consultation 2 years ago,
provide health teaching that can help Bella minimize these complications.
6. Accomplish your pathophysiology
7. Provide 5 NCPs and present according to priority.