Pathophysiology Longterm high blood glucose levels may cause damage of the vagus nerve which controls gastric emptying Delayed nutrient absorption by food remaining in stomach potentiates this cycle causing further GI damageissues ID: 276244
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Gastrointestinal Complications of Diabetes
Pathophysiology
Long-term high blood glucose levels may cause damage of the
vagus
nerve which controls gastric emptying. Delayed nutrient absorption by food remaining in stomach potentiates this cycle causing further GI damage/issues.
RecommendationsContinue PPI with sucralfate for erosive esophagitis.Diabetic nutritional consult/support. Repeat pyloric Botox injections.Assess home support system.
Present Illness24 hour episode of emesis with bloodUpper abdominal pain since emesis
Pharmacology
Assessment FindingsVitals: Temp- 98.4, HR- 86, RR- 18, BP- 114/64, O2 Sat- 96% room air, Pain- 0/10.
Loreal Brown, Nurs 807 Spring 2015
Past Medical History60 yo FemaleHeight 65in, Weight 114.4kg, BMI 40.1History of:40 Year Smoking History Recreational Drug Use: 19 years cleanObesityDiabetesGERD, Gastroparesis, Gastritis Pyloric sphincter Botox injections 2012HyperlipidemiaFatty Liver DiseaseHypokalemiaFamily History:Father died 71yo; diabetes related illness Mother died 52yo; asbestosisSister died 53yo; diabetic renal failure
Drug
Dose/Route
FrequencyClassification/ActionRationaleInsulin Lisprosliding scale SC INJBefore meals & HISFast Acting InsulinGlucose ControlInsulin NPH/REG 70/3028units SC INJOnce DailyCombination InsulinDiabetes ManagementPantoprazole Sodium40mg POOnce DailyProtein-Pump InhibitorGERD/Erosive esophagitisSucralfate1G=10mL POBefore meals & HISAluminum Salt ComplexErosive esophagitisAcetaminophen500mg POOnce DailyPara-aminophenol Derivative Analgesic Mild knee painEnalapril Maleate5mg POOnce DailyAntihypertensive: ACE InhibitorHTNEscitalopram Oxalate10mg POOnce DailySSRI Antidepressant DepressionMagnesium Gluconate250mg POOnce DailyDietary SupplementHypomagnesemiaPotassium Chloride400mL IV (100mL/hr over 4hrs)Once Dietary SupplementHypokalemia
4/19/154/20/15Glucose165 H272 HSodium141142Potassium2.3 CL2.6 CLChloride91 L96 LCO239 H41 CHAnion Gap115Creatinine Enz0.60.61BUN6 L10Calcium7.9 L8.0 LBUN/Creatinine1016.4Cap Glucolse188 H340 HWBC8.57.1RBC4.74.45HGB14.513.5HCT41.539.6MCV88.488.9MCH30.930.4MCHC3534.2RDW13.213.2PLT172166Auto Neut67.758.4Auto Lymp24.231.8Auto Mono7.38Abs Neut5.74.1
ReferencesAschenbrenner, D. S., & Venable, S. J. (2012). Drug therapy in nursing (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.American Diabetes Association. (2014, June 27). Gastroparesis. Retrieved April 25, 2015, from http:// www.diabetes.org/living-with-diabetes/ complications/gastroparesis.html
EGD w/ biopsy: severe erosive esophagitis throughout mid-esophagus.Abdomen: soft, non-tender, bowl sounds present in all quadrants.No nausea or vomiting, tolerating diet.
http://www.familyhealthonline.ca/fho/diabetes/DI_gastroparesis_MDb09.asp
http://
www.lgmpharma.com
/blog/
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