Modifaible: Smoking, DM, Dyslipidemia, Hypertension, lifestyle, Unhealthy dietary habits, Excess alcohol intake, Psychosocial stress, Obesity, HTN

Non modifaible: Age, Gender, Ethnicity

Based on the knowledge gap of the patient, uncontrolled blood sugar will establish damaging the blood vessels and the nerves. this occurs due to the glucose remaining in the bloodstream, building up with the RBC leading to further complications such as a blockage. DM is also associated with metabolic syndrome such asHyperlipidimai ( LDL or cholesterol) and High triglycerides.

HTN is the pressure of blood pushing against the walls of the arteries. Uncontrolled bp can lead to damage in the blood vessels which makes them less elastic. Persistent high blood pressure can increase the risk of potential health-threatening conditions.

Diabetes: 1- Eat healthy. 2- Be active and aim healthy wieght. 3- Check your blood sugar regularly 4-Take your medicine regularly 5- Provide education program such as individual sessions, campaigns, group sessions, and enable the patient to care for herself, e.g teaching signs and symptoms of hypo/hyperglyccemia

Psychosocial stress: Maintaining the wellbeing of the patient's mental health such teaching the patient about positive self-talk, breathing techniques, meditation, identifying the patient's comfort zone.

HTN: reducing sodium intake, Stress management, checking BP reguraly, taking medications regularly, engaging with physical activity.

Obesity: Height, weight, and waist circumference should be measured and body mass index calculated for the patient. Maintenance of a healthy body weight (body mass BMI in normal range18.5-24.9). Set a goal with the patient determining the appropriate diet for the patient. encouraging the patient to perform exercises and based on the patient's progression, the intensity of the exercise will increase.

1- HbA1C LDL, cholesterol, BP screening, checking blood chemistry, creatinine level, Renin, BUN, calling 107 for setting appointments and follow up. 2- An electrocardiogram (ECG or EKG) to measure your heart’s electrical activity. . 3- An echocardiogram (echo) to examine how thick your heart muscle is and how well your heart pumps.

Subjective data: dyspnea, fatigue insomnia, headache

Objective data: Obese, abdominal distension, bruising, limited physical movement

Lab results / Vital signs: LBP: 140/67, WBC: L 2.0, RBC L 3.2, Hgb L3.2, Lymphocytes Auto L 4.7, Albumin L26, Creatinine 97, Urea 6.2, RBS 8.0

Q.M, 70yrs, Female, Asian

Phx DM2, HTN, CKD III

Wieght:103, Hieght 165, BMI:38

Curent Medications:Insulin Aspart, Insulin Gleugine,Bisoprolol, Furosemide, paracetamol