Article | MANAGING CHRONIC DISORDERS.

Running Head: MANAGING CHRONIC DISORDERS 1
MANAGING CHRONIC DISORDERS
Name
Institution

MANAGING CHRONIC DISORDERS 2
Introduction
Mr. M is a 73-year-old retired engineer admitted to a hospital medical ward, Mr. M lives
with his wife in an apartment on a fourth floor, and has two adult children who live nearby. He is
diagnosed with type II diabetes, cardiovascular disease, and has been experiencing dyspnea,
frequent cough and edema in the legs over the last five weeks. For this reason, M is prescribed to
take Furosemide 250 mg BD to reduce the level of lung edema. During the previous five years,
M is said to have been infected by myocardial infarction, forcing him to sleep his head elevated
on three pillows. He has been experiencing high blood pressure and is instructed to take
Perindopril 8 mg daily to improve the condition. Moreover, M's kidney problem has been so
severe, leading him to a vascular surgeon referral and pre-dialysis multidisciplinary clinic.
Therefore M chronic disorders need urgent attention.
Dyspnoea, frequent cough over the last five weeks and Skin cool and diaphoretic
M had fluid in the lower lung fields, and the last five weeks, he had dyspnea and frequent cough
and a cooling skin with over sweating. From the mentioned signs, M may be suffering from
Pulmonary Edema. Pulmonary edema is an accumulation of fluid in the lungs, which usually
happens when excess fluid builds up in the alveolus, increasing the gap between oxygen and
carbon dioxide molecules, taking longer to transfer the respiratory gases to the bloodstream.
Increasing fluid in the air sacks, it grows in pressure in the air sacks beyond the normal range of
10mm Hg. Correspondingly insufficient oxygen in the bloodstream leads to shortness of breath
and respiratory distress by the patient ("Pulmonary edema - Symptoms and causes," 2019) M has
breathing distress in the ward, and he requires Oxygen 6 L/min which his lungs cannot produce

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until helped by Hudson mask. Pulmonary edema is associated with heart problems; it is unable to
pump blood to the blood vessels leading some of the heart problems such as heart attack,
hypertension, and even kidney failure (Ijaz & Adrish, 2015). Last five years, Mr. M had a
myocardial infarction. Also, in the objective data, there is a feeling of a heart murmur as a result
of heart failure, which later resulted in pulmonary edema.
Edema in Legs over the Last 5 Weeks
Legs edema is a presentation nephrotic syndrome, a conscious manifestation of kidney disease.
Reduction of oncotic suppression causes over filtration intravascular space fluid to space in the
interstitial, leading to excess sodium retention, hypervolemia, and impairment of renal
autoregulation. Continuous overfilling of the fluid leads to excess sodium retention, causing
edema (Siddall & Radhakrishnan, 2012). Referring to the diagnostic study from Mr. M, the
Creatinine level is 390 μmmol/L indicating clearly that his kidneys are unable to remove the
excess Creatinine in the body. Besides, serum test results suggest that the body is dehydrated due
to a high concentration of sodium concentration. Nephrotic syndrome causes a decline of protein
synthesis albumin, which is responsible for removing extra fluids in the body; therefore, albumin
reduction in the body causes fluid accumulation in the body and leads to swelling of the legs
(NIDDK 2019).
Venous leg ulcer on the left ankle and bloated abdomen
A venous foot ulcer is one of the common complications that occur in infected diabetic
individuals if not well controlled. It is due to poor glycemic control associated with neuropathy
and known to cause osteomyelitis and amputation of the foot. Ulcers occur after continuous
trauma and pressure exerted on the foot that occurs in three stages. The first stage is callus

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development resulting in neuropathy (Madmoli et al., 2019). Neuropathy is the leading cause of
foot ulcers in diabetic patients seeing that neuropathy loses nerves sensation when the pressure is
exerted on foot, causing foot micro-trauma or breakdown of the foot tissue. Neuropathy may
affect sensory nerves for detecting pain and temperature; therefore, no pain is felt when the skin
tissue is torn or worn out, leading to a motor imbalance of extensor muscle, causing foot
deformities like claw toes and metatarsal heads (Forsythe & Hinchliffe, 2016).
Gastrointestinal (GI) complication, which causes bloating, is most common to people
with a prolong diabetes complication though not easily noticed. When the smooth fibers in the
esophagus are affected continuously by neuropathy found in diabetes patients, it causes
peristalsis, contraction and reduces esophageal sphincter tones. Continuous contraction of soft
tissues results in esophageal dysmotility and gastroesophageal reflux (Krishnan, 2013).
Symptoms of gastrointestinal complications may be bloating and bowel syndrome. Bloating
occurs as a feeling of accumulated gas in the abdomen, full belly, and upset abdomen. Mr. M
may have been experiencing poor appetite and getting full quickly when eating which may be as
a result bloating.
The disorders mainly occur in diabetes mellitus patients. Diabetes type 11 is a chronic
disorder caused by persistence hyperglycemia or inadequate insulin secretion from the pancreas
leading to irregular levels of glucose in the blood (Jialal & Singh, 2018). Hyperglycemia and
other metabolic abnormalities cause damage to the organ system leading to health complications
such as neuropathy, retinopathy, and Osteoarthritis. M is instructed to take Atorvastatin 10mg
daily to reduce the level of fats and cholesterol and fats in the body. Cholesterol and fats are
associated with obesity in the body. Obesity in diabetic individuals increases insulin resistance
and B-cells malfunctioning. Therefore fat people are less insulin sensitive and reduced B- cell