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PREDISPOSING FACTOR                                                                               PRECIPITATING FACTORS
     -  AGE: 80 yrs. Old                                                                                -   DIET: eating foods rich in sugar, carbs, and fats
     -  Family History of DIABETES                                                                      -   LIFESTYLE: smoking, drinking alcohol
     -  Hereditary                                                                                      -   Compliance: no maintenance of meds. for DM


                                                             Exhaustion of beta cells occurs


                                                          Altered pancreatic insulin production

                                                             Decreased insulin production


                                                    Decreased absorption of glucose by the cells


                                                           Glucose is unable to enter the cells


                                                          Glucose remains in the blood stream

                                                                                                                    HYPERGLYCEMIA (304
                                                             Increased serum glucose level                           mg/dl, 13.2 mg/dl)




 Sluggish flow of                 Serum osmolarity                            Tissue perfusion                     Osmotic                    Glucose     Glucose intake
      blood                                                                                                       pressure in             concentration      of cells
                                                                                  of kidney                         blood                    in urine
                                     Blood viscosity
Impaired delivery                                                                                                                                             ATP
    of blood                                                             Impaired          Failure to            H20 from cell            Reabsorption     production
  components                         Blood flow to the                  removal of           initiate            towards the              of glucose in
                                  organs and extremities                  waste          erythropoietin             blood                 renal tubule      Energy for
                                                                                                                                                           normal cells
   Inadequate
                                    Tissue perfusion in                                                                                                     functions
  inflammatory                                                          Impaired         Stimulation of          Dehydration                Osmotic
    response                              nerves
                                                                       removal of           the bone                                        pressure           Cells
                                                                       waste from         marrow fails                                                      starvation
                                      Nerve hypoxia                                                             Stimulation of
 Microorganism                                                            blood                                                               H20             occurs
                                                                                                                osmoreceptors
 would enter the                                                                                                                          reabsorption
                                       Segmental                                             RBC
body at any route                                                                                                                                         Stimulation of
                                      demyelization                   Glucose level       production                 thirst                                the hunger
                                                                      exceeds renal       decreased                                       Urine output
                                                                                                                                                           mechanism
                                                                        threshold
 Infection occurs                    Nerve damaged                                                                 POLYDIPSIA
                                                                                               RBC                                          POLYURIA      Hunger occurs
                                                                     Impaired renal            (4.5)
    WBC (14.4),                   Excessive glucose is
                                                                          Fnx
    eusinophils                 converted into SORBITOL                                                                                                     POLYPHAGIA
       (7%)                     w/c accumulate in nerves                                                                                     Fatigue
                                                                      Permeability
                                                                      of the renal
           Inadequate               Sorbitol impairs
                                                                        cell wall
            nutritional              motor nerve
             support                  conduction
                                                                      Filtration of
                                                                      macro cells &
                   Poor                    Paresthesia,                 particles
                  wound                     numbness
                  healing

                                                                         Sugar+2,
                                                                        protein+2,
                                            Decreased                  blood+5, RBC
                                           PR (60 bpm)                   >100/hpf




                                                                        DIABETES MELLITUS
                  Pathophysiology of BPH
Thickening of the cardiac blood vessels
                 wall

       Plaque formation begins


 Occlusion of the blood vessels occurs


        Blockage of blood flow


      Myocardial ischemia occurs                    + TROPONIN T
                                                                               Half of the bundle of his
                                                        ST-T                       loss its function
                                                     abnormality
   Decreased myocardial O2 supply
                                                                              Left fascicular block occurs

       Increased cellular hypoxia
                                                                                        Mild left
                                                                                          axis
Increased lactic acid production release             CHEST PAIN                         deviation
            of metabolites


   Altered cell membrane functions



MYOCARDIAL INFARCTION
       (ACS)


 Ineffective       Reduced right            Decreased            Backflow of              Shifting of
                                                                                                                 Grade 2
    right           ventricular              cardiac           blood into the             fluids into           edema @
 ventricular         pumping                 output           right atrium and            interstitial            lower
                                                                                                               extremities
contractility         ability                                    peripheral                 spaces
                                                                 circulation


                                              SINUS                                                              DOB,
                                           BRADYCARDIA                                                       fatigue, with
                                                                                                              rales upon
                                                                                                             auscultation




 Ineffective        Reduced left            Decreased               Backflow of
     left            ventricular             cardiac               blood into the         Pulmonary          Pulmonary
 ventricular          pumping                output               left atrium and         congestion           edema
contractility          ability                                          lungs



                                               HEART FAILURE
PREDISPOSING FACTORS                                                        PRECIPITATING FACTORS
   -   AGE: 80 yrs. Old                                                        -    SMOKING
   -   FAMILY HISTORY OF BPH                                                   -    WITH DM, HF, AND MI
   -   NORMAL BODY CHANGES



  As man’s age increased               Deterioration of the blood vessel in the
 prostate gland increased                             prostate


         Androgen                       Blood flow becomes abnormal and 02
                                                  supply impaired

       Testosterone


      Dihydrosterone


     Binds to nuclear
    androgen receptors


  Signals growth factors                      Stimulation of cell growth




                                                  HYPERPLASIA


  Encroaches upon the
                                             Increased size of prostate                    Overwhelms the detrusor
  bladder neck occurs
                                                                                           muscles ability to ensure
                                                                                               effective bladder
                                                                                           evacuation by micturition
 Reduced ability to funnel
in response to micturition


      UTI (1-2 PUS
        CELLS),                                  Obstruction occurs                              Increase urethral
      HEMATURIA
                                                                                                     resistance



                                                                                                      LUTS



                                          Feeling of
                       Dribbling of                         Increased daytime          URGENCY            NOCTURIA
                                         incomplete
                          urine                             voiding frequency
                                         emptying of
                                         the bladder

                                                                 POLYURIA




                                      BENIGN PROSTATIC HYPERPLASIA

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Pathophysiology of diabetes mellitus

  • 1. PREDISPOSING FACTOR PRECIPITATING FACTORS - AGE: 80 yrs. Old - DIET: eating foods rich in sugar, carbs, and fats - Family History of DIABETES - LIFESTYLE: smoking, drinking alcohol - Hereditary - Compliance: no maintenance of meds. for DM Exhaustion of beta cells occurs Altered pancreatic insulin production Decreased insulin production Decreased absorption of glucose by the cells Glucose is unable to enter the cells Glucose remains in the blood stream HYPERGLYCEMIA (304 Increased serum glucose level mg/dl, 13.2 mg/dl) Sluggish flow of Serum osmolarity Tissue perfusion Osmotic Glucose Glucose intake blood pressure in concentration of cells of kidney blood in urine Blood viscosity Impaired delivery ATP of blood Impaired Failure to H20 from cell Reabsorption production components Blood flow to the removal of initiate towards the of glucose in organs and extremities waste erythropoietin blood renal tubule Energy for normal cells Inadequate Tissue perfusion in functions inflammatory Impaired Stimulation of Dehydration Osmotic response nerves removal of the bone pressure Cells waste from marrow fails starvation Nerve hypoxia Stimulation of Microorganism blood H20 occurs osmoreceptors would enter the reabsorption Segmental RBC body at any route Stimulation of demyelization Glucose level production thirst the hunger exceeds renal decreased Urine output mechanism threshold Infection occurs Nerve damaged POLYDIPSIA RBC POLYURIA Hunger occurs Impaired renal (4.5) WBC (14.4), Excessive glucose is Fnx eusinophils converted into SORBITOL POLYPHAGIA (7%) w/c accumulate in nerves Fatigue Permeability of the renal Inadequate Sorbitol impairs cell wall nutritional motor nerve support conduction Filtration of macro cells & Poor Paresthesia, particles wound numbness healing Sugar+2, protein+2, Decreased blood+5, RBC PR (60 bpm) >100/hpf DIABETES MELLITUS Pathophysiology of BPH
  • 2. Thickening of the cardiac blood vessels wall Plaque formation begins Occlusion of the blood vessels occurs Blockage of blood flow Myocardial ischemia occurs + TROPONIN T Half of the bundle of his ST-T loss its function abnormality Decreased myocardial O2 supply Left fascicular block occurs Increased cellular hypoxia Mild left axis Increased lactic acid production release CHEST PAIN deviation of metabolites Altered cell membrane functions MYOCARDIAL INFARCTION (ACS) Ineffective Reduced right Decreased Backflow of Shifting of Grade 2 right ventricular cardiac blood into the fluids into edema @ ventricular pumping output right atrium and interstitial lower extremities contractility ability peripheral spaces circulation SINUS DOB, BRADYCARDIA fatigue, with rales upon auscultation Ineffective Reduced left Decreased Backflow of left ventricular cardiac blood into the Pulmonary Pulmonary ventricular pumping output left atrium and congestion edema contractility ability lungs HEART FAILURE
  • 3. PREDISPOSING FACTORS PRECIPITATING FACTORS - AGE: 80 yrs. Old - SMOKING - FAMILY HISTORY OF BPH - WITH DM, HF, AND MI - NORMAL BODY CHANGES As man’s age increased Deterioration of the blood vessel in the prostate gland increased prostate Androgen Blood flow becomes abnormal and 02 supply impaired Testosterone Dihydrosterone Binds to nuclear androgen receptors Signals growth factors Stimulation of cell growth HYPERPLASIA Encroaches upon the Increased size of prostate Overwhelms the detrusor bladder neck occurs muscles ability to ensure effective bladder evacuation by micturition Reduced ability to funnel in response to micturition UTI (1-2 PUS CELLS), Obstruction occurs Increase urethral HEMATURIA resistance LUTS Feeling of Dribbling of Increased daytime URGENCY NOCTURIA incomplete urine voiding frequency emptying of the bladder POLYURIA BENIGN PROSTATIC HYPERPLASIA