TPL PPL Assessment Planning

Diagnosis Therapy Monitoring Education

ANAMNESIS - Diabetes Diabetes 1. Tolerance Glucose Oral 1. Non-Pharmacology 1. Monitoring blood  Regulate blood sugar levels
Current Medical Histor Mellitus Type 2 Mellitus Type 2 Test (TTGO) - Do sports/physical exercise sugar properly.
y - Pre- To measure the body's ability (min. 30 minutes, 5x/week) 2. HbA1c monitoring  Routinely check blood sugar
- Male, 56 years old hypertension to absorb glucose so that it - Set a diet with a healthy 3. IMT monitoring levels at least once a month.
- Disturbed vision in - Obesity can be used to diagnose diet 4. Monitoring eating  Eat a balanced diet that is low
both eyes since 2 - Xerosis diabetes. patterns with a in calories and fat and high in
months ago 2. Pharmacology healthy diet fiber. Reduce intake of sugar
- Visible dark spots and a. Oral Antihyperglycemic 5. Monitoring physical and salt.
halos Drugs : activity  Number, type, schedule,
- Legs feel tingling with - Insulin secretagogue distance of drug
pain when walking boosters: sulfonylureas, administration
Past Medical History glinids.  Do sports or physical activity
- DM type 2 since 5 year - Insulin sensitivity for 30 minutes / day (5 times
s ago enhancers (insulin a week)
senitizer): metformin  Lose weight if you are obese
PHYSICAL and thiazolidendione  Quit smoking or drinking
EXAMINATION - Alpha glucosidase alcohol
- Blood Pressure : 130/9 inhibitors: acarbose and
0 mmHg miglitol
- Weight: 80 kg - Dipeptidyl peptidase-4
- Height: 165 cm enzyme inhibitor
- IMT: 29,4 k/m2 - Sodium glucose co-
- Abdominal transporter enzyme
circumferencen: 108 c inhibitor 2
m b. Injectable
- Skin feels dry Antihyperglycemic Drugs
- -Sensory examination - Insulin
with Semmes - Agonis GLP-1 (incretin
Weinstein mimetic)
monofilament 10g:
pain - Diabetes Retinophaty 1. Fundus Photos 1. Non- Pharmacology 1. Monitoring the state  Routine check-ups for
- Ankle Brachial Index: Mellitus Type 2 Diabetic To document disease - Laser Photocoagulation of Diabetes Mellitus diabetes mellitus
0,9 - Pre- progression and response to Increases oxygen tension in 2. Monitoring the  Routine treatment of Diabetes
Funduscopy: hypertension therapy. the inner layers of the retin treatment of Mellitus
microaneurysms and - Obesity a. The fired laser is absorbe Diabetes Mellitus  Routinely perform retinal
hemorrhages in the retina - Xerosis 2. Fluorescein Angiography d by the melanin pigment i 3. Monitoring the examinations to determine
- Diabetic To distinguish whether macu n the retinal pigment epithe patient's vision progress
SUPPORTING retinopathy lar swelling is caused by diab lium (RPE) layer and cause - Retina color  Regularly in the
INVESTIGATION etes or due to other macular s a coagulation effect on R - -Retinal edema administration of diabetic
- GDP: 256 mg/dl diseases. FA can identify are PE cells and nearby photore - Retinal vessels retinopathy drugs
- GD 2 JPP: 345 mg/dl as of nonperfusion in the ma ceptors.
- HbA1c: 10,2 cular fovea or even the entire
- Protein urin: +3 macular area. FA can also de - Virectomy
tect nonperfused retinal capil Providing access to
laries that cannot be treated a perform laser
fter scatter laser surgery photocoagulation in cases

3. Optical Coherence Tomogr
aphy (OCT)
Produce high-resolution ima
ges that depict cross-sectiona
l retinal layers in vivo so that
they can describe retinal thic
kness, see macular edema, an
d can identify the presence of
vitreomacular traction
4. USG (Ultrasonography)
Investigations in diabetic
patients with cloudy media
(commonly due to cataract or
vitreous hemorrhage) and
tractional retinal detachment
of vitreous turbidity due to
vitreous hemorrhage.
- Administration of
intravitreal anti-Vascular
Endothelial Growth
Factor (VEGF).
Inhibits the progression of
diabetic retinopathy and
improves visual acuity by
treating macular edema.
- Give Intravitreal Steroids
To treat macular edema in
diabetic retinopathy. The
corticosteroid groups used
were triamcinolone
acetonide, dexamethasone,
and fluocinolone acetonide.

2. Pharmacology
- Metformin 500 mg 3x1
- Vitrolenta (Potasium Iodide
5 mg + Sodium Iodide 10
mg) tetes mata 3x2 tetes
/day

- Diabetes Neurophaty 1. Tes Sensorik 1. Non- Pharmacology 1. Monitoring the state  Routine check-ups for
Mellitus Type 2 Diabetic To find out how the nerves - Electric stimulation of Diabetes Mellitus diabetes mellitus
- -Pre- respond to vibration and - Aerobic exercise 2. Monitoring the  Routine treatment of Diabetes
hypertension changes in temperature. The - Magnetic field therapy treatment of Mellitus
- -Obesity patient is diagnosed with ND Diabetes Mellitus  Take care not to hurt your
- -Xerosis if the result is Paresthesia. 2. Pharmacology 3. Monitoring the feet
- -Paresthesia - Amitriptilin: 10-100 mg se general condition of  If there is a wound on the
- -Peripheral 2. Electromiograpy belum tidur the patient's feet foot, immediately consult a
Artery Disease To record the electrical - Gabapenti : 300-1200 mg 3 4. Monitoring doctor
(PAD) activity of the muscles. The x/hari paresthesia by  Check with your doctor if the
- Diabetic result is abnormal if the - Capsaicin topical 0.075%: examining paresthesia persists
neuropathy EMG shows great electrical 4 kali sehari monofilament and
activity when the muscle is Ankle Brachial
relaxed. Index

3. Tes NCV (Nerve

Conduction Velocity)
Nerve conduction test to
measure the speed at which
electrical signals travel
through the peripheral
nerves. This test usually
coincides with the EMG. The
 result is abnormal if the
nerve velocity is less than 50-
60 meters per second.

- Diabetes Nefrophaty 1. Test Bun (blood Urea - ACE Inhibitor (captopril) or 1. Monitoring the state  Routine check-ups for
Mellitus Type 2 Diabetic Nitrogen) ARB/Angiotensin II Receptor of Diabetes Mellitus diabetes mellitus
- Pre- To measure the level of urea Blocker (irbesartan) 2. Monitoring the  Routine treatment of Diabetes
hypertension nitrogen in the blood. - Cholesterol-lowering drugs treatment of Mellitus
- Obesity 2. Creatinine test (statins) Diabetes Mellitus  Routinely check urine
- Xerosis To measure the level of - Insulin to lower blood sugar 3. Monitoring protein  Limit protein intake
- Proteinuria creatinine in the blood. levels levels in the urine  Reduce sodium intake to
3. Test GFR - Finerenone to reduce the risk 4. Monitor the patient's <1500-2000 mg/dL
To measure kidney function. of inflammation in the blood sugar  Limit consumption of foods
4. Test Mikroalbuminuria Uri kidneys high in potassium
ne  Limit consumption of foods
To see if there is albumin in high in phosphorus
the patient's urine
5. USG
to see the structure and size o
f the patient's kidney.
6. Kidney Biopsy
To take a tissue sample from
a patient's kidney

TPL PPL
 ANAMNESIS - Diabetes Mellitus Type 2
Current Medical History - Pre-hypertension
- Male, 56 years old - Obesity
- Disturbed vision in both eyes since 2 months ago - Xerosis
- Visible dark spots and halos - Diabetic retinopathy
- Legs feel tingling with pain when walking - Paresthesia
Past Medical History - Peripheral Artery Disease (PAD)
- DM type 2 since 5 years ago - Diabetic neuropathy
- Proteinuria
PHYSICAL EXAMINATION
- Blood Pressure : 130/90 mmHg
- Weight: 80 kg
- Height: 165 cm
- IMT: 29,4 k/m2
- Abdominal circumferencen: 108 cm
- Skin feels dry
- -Sensory examination with Semmes Weinstein monofilament 10g: pain
- Ankle Brachial Index: 0,9
Funduscopy: microaneurysms and hemorrhages in the retina

SUPPORTING INVESTIGATION
- GDP: 256 mg/dl
- GD 2 JPP: 345 mg/dl
- HbA1c: 10,2
- Protein urin: +3