Sample Solution

Wound healing is slowed when the patient is diabetic. Macrovascular and microvascular changes are due to elevated blood sugar levels that can cause fatty deposits to stick to the endothelial lining of vessels and cause narrowing and then blockage of circulation. Narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level also decreases the function of RBCs that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, the wound would heal slowly.
Diabetic neuropathy is when the nerves in the body are affected and the patient develops a loss of sensation because their blood glucose levels are uncontrolled. The elevated blood glucose over time affects the myelin sheath surrounding the nervers and degrades the sheath, exposing the nerves. Sometimes, patients do not feel the blister, infection, or wound problem, which may lead to increased severity and complications. Pt has uncontrolled Type 2 DM which interferes with his non-healing wound.
(Osborn, 2014 p1896; Porth, 2011)
CAD
CAD is a chronic process that affects the arteries perfusing the heart, brain, and kidneys. CAD includes arteriosclerosis(thickening, reduced elasticity, and calcification of the arterial wall), atheroschlerosis(type of arteriosclerosis that causes reduced myocardial blood flow), and arteritis(inflammation of the arterial wall, usually due to infection or auto-immune response). Atherosclerosis causes reduced blood flow to the myocardium because of buildup of plaque like cholesterol, lipids, and cellular debris infiltrating the intimal lining of the arterial wall. The myocardium normally extracts 75% of available oxygen from the coronary arteries. If the oxygen requirement is not met, then the myocardial blood flow needs to be increased. However, the arteries in CAD are not able to dilate because of the plaque buildup and calcification. As a result the heart needs to increase force of contraction in order to increase blood flow, and thus increasing cardiac output. “The result of all the unmet oxygen needs is the shift to anaero