PATHOPHYSIOLGY

Predisposing Factors: 83 y/o History of DM & HPN Obesity Faulty Diet Asian Race Insulin Resistance Hyperglycemia Precipitating Factors: Heart disease Prolonged Tobacco used systemic O2 demand Exposure to air pollution Recurrent respiratory infection

blood osmolality Fluid shift to extracellular Space (edema) DHN (unicellular) Thirst sensation Polydipsia

blood sugar excess renal threshold Glycosuria osmotic dieresis urine output polyuria

Cellular starvation sensation of hunger Polyphagia

Gluconeogenesis CHON breakdown muscle wasting & poor wound healing

Lyposlysis Accumulation of by product

Fatty acid

Atherosclerosis

Ketones Metabolic acidosis

Narrowing of blood Vessels oxygenation HR, CO

Micropathy

Ketonuria Diabetic Ketoacidosis

neuropathy nephropathy weakness ESRD Activity Intolerance

Elasticity of blood vessels and formation of plaques Narrowing of the blood vessels Necrosis and scarring of the vascular endothelium Impecliment of blood flow Workload of the heart Dilation of ventricles and increase in preload Stretching of myocardial muscle Oxygen demand of cardiac muscles, thus, there are is a contraction of the heart Cardiac output and systemic perfusion Stimulation of neurohormonal to circulating blood vessels Cardiac remodelling Stroke volume and Wall tension and pulmonary pressure Impaired left ventricular relaxation Diastolic pressure exceeding osmotic pressure in the pulmonary capillaries Capillary pressure in the lungs Fluid shift Pulmonary congestion Bilateral crackles Lung expansion Dyspnea Orthopnea output blood filling CAD

Inadequate perfusion Pallor Blood flow to the kidneys RAAS Na and water retention Periorbital edema, ascites Conversion of aerobic metabolism to anaerobic, thus, decrease in adenosine Lactic acid production Chest pain Cardiac contractility Bradycardia Pulmonary pressure Fatigue and weakness Perfusion in the coronary arteries ( supply of nutrients) Ischemia

Chronic irritation to the airflows in the lungs

Irritation of lymphocytes, macrophages, and polymorpnonuclear lymphocytes in the mucosal area Vasodilation and congestion, edema of bronchial mucosa Thickening due to excessive mucous plug formation and rigidity of bronchi Narrowing of nasal passages Chronic Bronchitis

Destruction of elastin and fiber network of the alveoli Enlargement of wall of alveoli Consistent destruction of alveoli and alveolar walls Enlargement of acini Reduction of the alveolar diffusing space and some tissue changes Pulmonary Emphysema COPD

Malformation of RAAS

Hypertension vascular resistance O2 renal perfusion GFR Na retention, K excretion Water retention

160/100

Edema Heart Failure Hypertension

prodn of erythropoietin Anemia (RBC= 2.93) (HGB=110)

Periorbital edema

Ineffective tissue perfusion

Edema

Ineffective peripheral tissue perfusion

Pulmonary congestion

Oliguria