...States and the resultant health problems are leading to visits to physicians’ offices and hospitals more than ever before. Diabetic neuropathy, a debilitating nerve disorder which can affect almost any part of the nervous system, occurs in nearly 50 percent of patients with diabetes. Diabetic peripheral neuropathy is found in 12 percent of insulin dependent diabetics and 32 percent of those who are not, equaling approximately 3 million people in the United States. (Chen et al. 2007) The number of patients with other neuropathies, such as autonomic, proximal, and focal, comprises the other 1 million diabetic neuropathy patients, most of whom suffer in pain from the dysfunction of the nervous system. (Chen et al. 2007) This disorder’s elusive nature is such that it can not only present in any part of the body but it can be completely without symptoms that the average patient would report to their physician. Since the patients themselves are less likely to naturally disclose their suffering through their assumption that their symptoms are not relevant to their diabetic condition, the physician’s role in the diagnosis and recognition of this disorder is even more critical. II. Definition and Types of Diabetic Neuropathy The most common type of diabetic neuropathy is peripheral, considered, more generally, sensorimotor. Peripheral neuropathy causes pain or loss of feeling in the toes, feet, legs, hands, and arms. (NIDDKD 2002) Specifically, distal symmetric polyneuropathy...
Words: 2326 - Pages: 10
...brought about behaviour that appeared analogous to human neuropathic pain conditions (Bennett and Xie, 1988). The pathological mechanism behind neuropathic pain is thought to be spontaneous activity in damaged sensory neurones. Chahine et al (2005) found that the release of hyperalgesic pro-inflammatory agents can result in changes in either expression or inappropriate regulation of sensory Nav channels, suggesting that Nav channels have an important rcontribution to neuropathic pain Central neuropathic pain Experienced as a symptom of CNS disorders such as stroke and multiple sclerosis. Peripheral neuropathic pain Experienced as a symptom of disorders associated with peripheral nerve damage such as mechanical injury, diabetic neuropathy, (Usual Treatment) Anti-depressants 1) tricyclic anti-depressants 2) Selective Serotnin re-uptake inhibitors Anti-convulsants Ion channel blockers (anti-dysrythmics) (Structure/function of opiod receptors) Discovered in 1973, confined to nervous tissue (Pert and Synder 1973) Areas of neuronal membrane which opiods bind to resulting in inhibition of the cell. Opiods refers to a substance that produces morphine like effects Four distinct types (Why targeting particular gpcr would be affective) Opiods excite neurons in the periagueductal gray-gate control theory...
Words: 306 - Pages: 2
...Guillain-Barre Syndrome is a rare disorder in which your body's immune system attacks your nerves. It often begins with tingling and weakness that starts in your feet and legs and spreads to your upper body and arms. In about 10 percent of people with the disorder, symptoms begin in the arms or face. As it progresses muscle weakness can evolve into paralysis. Signs and symptoms may include: Prickling, "pins & needles" sensations in your fingers, toes, ankles or wrists Weakness in your legs that spreads to your upper body Unsteady gait or an inability to walk or climb stairs Difficulty with eye or facial movements, including speaking, chewing or swallowing Severe pain that may feel achy or cramp-like and may be worse at night Difficulty with bladder control or bowel function Rapid heart rate Low or high blood pressure Difficulty breathing (a potentially fatal complication) Guillain-Barre Syndrome is a medical emergency & Most people with the condition must be hospitalized for treatment. Although there's no known cure, the sooner treatment is started, the better the chance for recovery. The most significant weakness begins within two to four weeks after symptoms start & recovery usually begins two to four weeks after the weakness plateaus. Although the exact cause is unknown, it often precedes an infectious illness such as a respiratory infection or the stomach flu. The disorder usually appears within days or weeks...
Words: 671 - Pages: 3
...OF THE DRUG | GENERAL ACTION | SPECIFIC ACTION | INDICATIONS | CONTRAINDICATIONS | ADVERSE EFFECTS | NURSING INTERVENTIONS | Isoniazid200mg/5mL, 5.5mL OD, 30 minutes before meals | Antitiberculotic | Bactericidal: interferes with lipid and nucleic acid biosynthesis in actively growing tubercle bacilli. | * TB, all forms in which organisms are susceptible. * Prophylaxis in specific patient who are tuberculin reactors or household members of recently diagnosed tuberculars or who are considered to be high risk. | * Contraindicated with allergy to Isoniazid, Isoniazid-associated hepatic injury or other severe adverse reactions to isoniazid, acute hepatic disease. * Use cautiously with renal impairment. | * CNS: peripheral neuropathy, seizures, toxic encephalopathy, optic neuritis and atrophy, memory impairment, toxic psychosis. * GI: nausea, vomiting, epigastric distress, bilirubinemia, bilirubinuria, elevated AST, ALT levels, jaundice, hepatitis. * Hematologic: Agranulocytosis, hemolytic or aplastic anemia, thrombocytopenia, eosinophilia, pyridoxine deficiency, pellagra, hyperglycemia, metabolic acidosis, hypocalcemia, hypophosphatinemia due to altered vitamin D metabolism. * Hypersensitivity: fever, skin eruptions, lymphadenopathy, vasculitis. * Others: gynecomastia, rheumatic syndrome, SLE syndrome | Assessment * History: allergy to Isoniazid, Isoniazid-associated adverse reactions; acute hepatic disease; renal impairment * Physical: skin color, lesions;...
Words: 349 - Pages: 2
...A. Which symptoms that Nick has described so far are relevant to the nervous system? Are his symptoms sensory, motor, or both? a. The pains in his feet and the dizziness in when he stands or sits. b. His symptoms are both sensory and motor. B. Do you think the symptoms Nick describes are likely to be caused by peripheral nerve damage? Could they be caused by damage to the central nervous system? c. His symptoms are caused by peripheral nerve damage. Peripheral nerve damage causes numbness and pain normally in the hands and feet. d. No damage to the central nervous system would lead to a possible stroke but they both share similar symptoms. C. Diabetic neuropathies damage peripheral nerves. Which component of the reflex arc is most likely to be damaged in Nick’s situation? e. The integrating sensor is more likely to be damaged because the integrating sensor is a single synapse between a sensory neuron and a motor neuron. D. Which division of the autonomic nervous system would be affected and would be causing Nick’s GI tract symptoms? f. The division that would be affected would be the parasympathetic system. E. Nick’s light-headedness is cause by a condition known as orthostatic hypotension, a rapid drop in blood pressure upon standing up. Based on what you have learned so far, how does the autonomic nervous system control blood pressure? g. The autonomic nervous system senses a rise or fall in the blood pumping...
Words: 658 - Pages: 3
... This case presents a diabetic patient with right calf cramping after walking one block. The pain is relieved after cessation of walking for a few minutes. The patient is then able to walk approximately the same distance. These signs and symptoms are similar to that of a patient with intermittent claudication. The term claudication comes from the Latin word “to limp”. Claudication can refer to an impairment in walking, pain, discomfort, numbness, or tiredness in the legs that occurs during walking or standing. According to Aronow (2012), “peripheral arterial disease may cause intermittent claudication which is pain or weakness with walking that is relieved with rest” (p. 375). PAD is a chronic arterial occlusive disease of the lower extremities caused by atherosclerosis. Just distal to the arterial obstruction is usually where the muscle pain or weakness may occur after exercise. PAD is a type of peripheral vascular disease, which also includes carotid artery disease, renal artery disease, aortic disease, and venous problems. An appropriate exam that may be ordered for these symptoms is an ankle-brachial index (ABI). Intermittent claudication caused by peripheral arterial disease is typically diagnosed with this exam. With the patient in a supine position, the sonographer will measure the systolic blood pressure in both arms. After taking the systolic pressures in both arms the sonographer will put blood pressure cuffs on four different locations on each leg. A Doppler will...
Words: 651 - Pages: 3
...Diabetic neuropathy is a peripheral nerve disorder triggered by diabetes or poor blood sugar control. The most common categories of diabetic neuropathy lead to complications with sensation in the feet. It can develop sluggishly after many years of diabetes or might occur early in the disease. Diabetes-related nerve impairment can be excruciating, but it isn't severe pain in maximum cases. There are four categories of diabetic neuropathy: peripheral, autonomic, proximal and focal. Symptoms Symptoms of this disease are: • Feeling full after eating only a trivial quantity of food • Heartburn and bloating • Nausea, constipation or diarrhea • Swallowing glitches • Throwing up food you have eaten some hours after a meal • Tingling or burning in the arms and legs might be an initial sign of nerve damage. These feelings often begin in your toes and feet. You might have deep pain, often in the feet and legs. The symptoms are numbness, pain or stinging in the feet or lower legs. Causes Nerve damage is likely because of a blend of factors: • metabolic factors such as high blood glucose, long period of diabetes, atypical blood fat levels and perhaps low levels of insulin • neurovascular factors leading to impairment to the blood vessels that carry oxygen and nutrients to nerves •...
Words: 432 - Pages: 2
...A patient presents with an extremely painful corn on the sole of their foot. The corn is located directly under the first metatarso-phalangeal joint. What gait pattern would be expected? What would the effects of their condition be on various parts of the gait cycle? antalgic gait a limp adopted so as to avoid pain on weight-bearing structures, characterized by a very short stance phasehttp://medical-dictionary.thefreedictionary.com/antalgic+gait. Antalgic gait refers to the way one walks, usually with a limp, to avoid pain. It’s a form of gait abnormality where the stance phase is shortened relative to the swing phase. There are many types of gait, but antalgic gait is the result of pain. The patient tries to minimize the amount of weight placed on the painful leg, knee, ankle or foot while walking or running. The stride is shortened on the injured side, affecting the posture or style of the patient’s normal gait cycle. Antalgic gait can come on suddenly or gradually due to a disease or damage to the nerve or musculoskeletal system. It can be mild, moderate or severe, temporary or permanent. Antalgic gait can affect anyone at any age, but seniors and athletes seem to suffer from it more often and it is seen in men more than women. http://www.footanklehealth.com/health/antalgic-gait.html A limp is a type of asymmetric abnormality of the gait. When due to pain it is referred to as an antalgic gait which has a shortened duration in which the foot is in contact with...
Words: 317 - Pages: 2
...WALKING 1. How many times you walking in a day? (hours) Below 2 6 – 8 2 – 4 Others _____________ 4 – 6 2. How many distance you walking in a day? (meters) 0 – 200 800 – 1000 200 – 400 Others _____________ 600 – 800 3. At what part of your body feel the pain mostly while walking in a day? Ankle No pain Knee Others______________ Waist 4. How long do you need to rest the body from muscular paint? ½ hours two 2 hours 1 hour Others_____________ 5. What is other activity that you do to overcome the muscular pain? Massages Exercise / Cool down Go to spa / Sauna Massage oiling Sleep Others____________ BENDING FORWARD 1. How many times per hours your body bending forward? 1 – 5 times 10 – 15 times 6 – 10 times More than 15 times 2. For how long your body bending? (average) State: hours minutes 3. Which part on your body experience muscular pain? Waist Back ...
Words: 385 - Pages: 2
...Ever experience muscle tingling, muscle weakness, or paralysis? If so we need to talk. Guillain-Barre Syndrome is a disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system (Guillain-Barre Syndrome, 2009). This leads to nerve inflammation that causes muscle weakness. If you are experiencing any of these symptoms, we need to get you informed on what could be the possible diagnosis. Guillain-Barre Syndrome has several symptoms can present themselves very quickly but weakness increasing over several days is common (Guillain-Barre Syndrome, 2009). Muscle weakness or paralysis happens on both sides of the body, starting in lower extremities and traveling upwards. Clumsiness or tingling of hand or foot is one of the first symptoms to arise. If the diaphragm is affected additional help breathing could be needed. Symptoms include loss of reflexes, muscle weakness, loss of muscle function, decreased sensation, numbness, sensation changes, tenderness, muscle pain, uncoordinated movement, blurred vision, falling, difficulty moving facial muscles, palpitations, and muscle contraction. Watch for symptoms that need emergency attention like breathing stops, can’t take a deep breath, difficulty breathing or swallowing, drooling, fainting, or feeling light heading (Guillain-Barre Syndrome, 2009). Guillain-Barre Syndrome occurs at any age but average is between 30-50 years of age. At this time there in no known cause. Possible triggers...
Words: 649 - Pages: 3
...Type 1 Diabetes has many negative effects some of the major ones include pregnancy complications, nephropathy, heart and blood vessel diseases, and neuropathy. All of these complications can be prevented and most cured or treated. Pregnancy complications are one of the negative effects of Type 1 Diabetes. Maternal death is recorded as such if it happens during the pregnancy or up to forty two days after delivery. In 1980, of all the diabetic pregnant women one half a percent of them died from maternal death. Although since 1980 there have been developments in treatment and obstetric management; this meaning that the percentage has decreased. Between 1975 and 1997 at the University Central Hospital in Helsinki, Finland, 972 women mean to deliver but they all died. All these deaths were caused by something. Hypoglycemia is an abnormal decrease of sugar in the blood which can and has caused the death of many diabetic women. Ketoacidosis is another disease that causes death. ketoacidosis is when...
Words: 907 - Pages: 4
...Case study 76 Endocrine Disorders 1. Interpret Y.L.'s laboratory results • HbA1C is elevated at 8.8% and the goal for diabetics is to keep that value below 7% Hemoglobin A1c. Her number is concerning because it indicates that her blood sugar has been way too high over the past few months. The A1c is an indication of glycosylation in the body which is damaging to the blood vessels and peripheral nerves. It causes thickening of the basement membrane which will impair oxygen transport to the tissues and carbon dioxide removal. • High BP • Total Cholesterol is elevated at 256mg/dL, normal value is below 200mg/dL • Fasting glucose is high at 184mg/dL, normal value is below 126mg/dL • Triglycerides are elevated at 346 mg/dL, normal levels are below 150mg/dL. Y.L. indicates levels that are high. • LDL levels are elevated at 155mg/dL and ideal values are below 100mg/dL; LDL is the value you want to be the lowest. • HDL levels are low and the HDL levels need to be high, 40-60mg/dL is desired. • Urine Analysis indicates that Y.L. is spilling glucose into her urine. 2. Identify the three methods used to diagnose DM. - Fasting blood glucose of > 126 mg/dl - Random Glucose Level >200 mg/dl (plus presence of other symptoms) - A1C > 6.5% 3. Identify three functions of insulin. • regulates glucose metabolism • stimulates lipogenesis • stimulates growth 4. Describe the major pathophysiologic difference between type 1 and type 2 DM. • Type 1 diabetes,...
Words: 949 - Pages: 4
...Case Study NSG/340 March 3, 2015 Sandra Gilderson, MSN/Ed, RN Case Study Y.L. laboratory result The fasting glucose is over the limits, fasting should be no more 126. HgbA1c is over limits and should be less than 6.5 or 7 the most. Her cholesterol demonstrates hyperlipidemia with low HDL. UA demonstrates glycosuria which represents a degree of damage in the kidneys. The lab result presented is not within normal range and patient is also at risk for heart disease. Methods for diagnosis First one can do a spot test using a fasting plasma glucose test and is found to be positive if it is greater than 126. Secondly, an order of two-hour glucose test known as oral glucose tolerance test greater than 200 is positive for diabetes. Lastly if the random glucose plasma level is tested and found to be greater than 200, with demonstrated symptoms such as polyuria, polydipsia, or polyphagia diabetes can be diagnosed. Functions of insulin Insulin is responsible for assisting the body in the storage of fat by taking lipids from blood into the cells. Additionally, it is responsible for the regulation of glucose by transporting glucose from the blood into the muscles, and liver. Insulin also aids in gluconeogenesis Type1 vs Type 2 DM Type 1 is known to be caused by the autoimmune destruction of the beta cells within the pancreas leading to diabetes. Type 2 is a progressive destruction of the beta cells due to increased glucose levels, leading to a decreased production of insulin...
Words: 1153 - Pages: 5
...diabetes; Retinopathy, Neuropathy, and Nephropathy. Here is some information about these diseases and steps to help prevent and to manage these complications, do research online and find an every site that will give them the information needed to obtain the first steps in working out this problem. Diabetic Retinopathy When the retina gets nerve damage by the diabetes it weakens the blood vessels. There are steps people can take to reduce their chance of vision loss from complications from diabetic retinopathy. ‘’Hyperglycaemia results in thickening of the basement membrane in the capillaries and loss of endothelial cell adhesion, leading to lose of integrity of these small vessels. This causes a change in blood vessel permeability and the leakage of water, blood, protein, and fat into the surrounding retinal tissue’’ (Shotliff, & Balasanthiran, 2009). They will have to know all of the warning signs and act accordingly. Some of the signs are blurry vision, black or gray spots, cobwebs or strings that move of float when they moves his eyes. Developing control of their sugar, blood pressure, and remove the intake of alcohol, cigarettes will give them a better chance to reduce the risk of getting Diabetic Retinopathy. [pic] Diabetic Neuropathy Occurs when the body has numbness in hands and feet, this is the nerves in their body are damaged, and send messages to the brain and other body parts. Gastroparesis is a type of neuropathy;...
Words: 738 - Pages: 3
...vasculitic autonomic neuropathy diagnosed at University of Michigan Hospital by nerve biopsy, presented to the ED with pain in his hands and feet for the last 2 days and flare up of "Chilblain" symptoms. No signs of swelling or change in color, no rash, no erythema, No lesion, no fever, and no change in his walking. He was admitted to the floor for IV steroid and pain management. When we received the sign-out from the ED doctor on this case; I was wondering what “chilblains” means and how I can manage it. The term chilblains is a descriptive word usually referring to an idiopathic medical condition, often cold-induced vasculopathy characterised by dusky red-purple nodules over skin of the hands and feet (Collins, Arnold, & Kissel, 2013). Chilblain is a clinical diagnosis; therefore, it is important to obtain a detailed history and do a comprehensive physical examination to exclude associated conditions, such as systematic disease or connective tissue disorder. Furthermore, full laboratory workup for a patient with chilblains should be done to exclude any systemic or autoimmune disorders, including the following lab tests: complete blood count with differentia, antinuclear antibody screen, cold agglutinin, cryoglobulin, cryofibrinogen and antiphospholipid antibody pane. Moreover, nerve biopsy is crucial for definitive diagnosis of a patient with suspected vasculitic neuropathy that leads to chilblains; a histologic diagnosis of definite vasculitic neuropathy requires inflammation...
Words: 607 - Pages: 3
