DM II and Pain with acute cellulitis

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DM II and Pain with acute cellulitis by Mind Map: DM II and Pain with acute cellulitis

1. Pathophysiological process

1.1. DM II

1.1.1. decreased insulin production

1.1.1.1. insulin resistence

1.1.2. catecholamines

1.1.2.1. glucose production

1.1.2.1.1. cortisol and glucagon

1.1.3. blood glucose

1.1.3.1. polyuria

1.1.3.1.1. polydipsia

1.2. Cellulitis

1.2.1. bacterial infection

1.2.1.1. redness, pus, pain, warmth,

1.2.1.1.1. gangrene, amputation

1.2.2. streptococcus, staphylococcus

1.2.2.1. exudate from immune response

1.3. Diabetic Neuropathy

1.3.1. microvascular impairment

1.3.1.1. damaged nerve endings

1.3.2. from increased blood sugar and smoking

1.3.2.1. inflammatory mediators cytokines and chemokines

2. Prognosis

2.1. DM II

2.1.1. Chronic disease education

2.1.1.1. diet, exercise, blood sugar monitoring, insulin education

2.2. Cellulitis

2.2.1. Resolution with ABX

2.2.1.1. wound care education

2.2.2. slow healing wound

2.2.2.1. Parathesia

2.2.2.1.1. recurrent infections

2.3. Diabetic Neuropathy

2.3.1. Increase dose of Gaba to 900mg

2.3.1.1. Refer to pain clinic

2.3.2. smoking cessation

2.3.2.1. exercise

3. Risk Factors

3.1. smoker 1/2 pack/day

3.1.1. vasoconstrictiion

3.1.1.1. insulin resistance

3.2. ETOH +

3.2.1. interfers with DM 2 Meds

3.2.1.1. Can cause spikes and drops in blood sugar.

3.3. Couch Potato

3.3.1. increased body fat and bad cholesterol

3.3.1.1. CAD, CVA risks

3.4. Family history of DM II

3.4.1. Increased risk of DM II complications

3.5. BMI > 30

3.5.1. Obesity category

3.5.1.1. risks for DMII complications

3.5.1.1.1. CAD, CKD, Retinopathy

4. Unitary Caring Science

4.1. Authentically present

4.1.1. Pay attention, see the patient

4.2. Develop helping & trusting relationship

4.2.1. Create space for transpersonal caring

4.3. Practice all ways of knowing

4.3.1. Think outside the box

4.3.1.1. Patient needs help with chronic disease management.

4.4. Share teaching and learning

4.4.1. Involve patient in care decisions

4.5. Create a healing environment

4.5.1. Promote healing and recovery

5. Pharacological interventions

5.1. Tylenol 650mg q6 prn

5.1.1. Analgesic and Antipyretic

5.1.1.1. pain

5.1.1.1.1. Max 4gm daily

5.2. oxycodone 5mg/325mg q6 prn

5.2.1. narcotic analgesia

5.2.1.1. pain

5.3. Lidocaine patch 5% BID

5.3.1. Analgesic effect

5.3.1.1. pain

5.4. Gabapentin 300mg TID

5.4.1. DPN

5.4.1.1. pain

5.4.1.1.1. dose dependent

5.5. Insulins

5.5.1. maintain FSBS 70-120

5.5.1.1. healing time

5.5.1.1.1. Regular ISS

5.5.2. hyperglycemic oral meds

5.5.2.1. Blood sugar

5.6. ABX

5.6.1. Reduce inflammation

5.6.1.1. pain

5.6.1.1.1. Heal wound

6. Treatments

6.1. Smoking cessation program

6.1.1. wound healing time

6.1.1.1. diabetic neuropathy

6.2. physical therapy

6.2.1. weight

6.2.1.1. insulin effectiveness

6.2.1.1.1. diabetic co-morbidity

6.3. wound care

6.3.1. Sterile dressing changes

6.3.1.1. healing time

6.3.1.2. xeroform dressing

6.3.1.2.1. silver mepilex dressing antimicrobial

6.3.2. keep wound dry

6.3.2.1. elevate affected leg

6.3.2.1.1. improve circulation and healing

6.4. Dietary

6.4.1. reduce caloric intake

6.4.1.1. restrict saturated fats

6.4.1.1.1. cholesterol

6.4.2. High protein to increase healing

7. Non Pharmacological treatments

8. Green is a positive correlation

9. Red is a negative correlation

10. Diabetic pain