Exam (elaborations) NR 601 Week 5 Case Study Assignment (NR601)
Week 5 Case Study
Lucretia D
Professor Schroetter
NR 601
August 11,
... [Show More] 2018
Introduction
The purpose of this paper is to examine the subjective and objective information using
the national diabetes guidelines to diagnose and formulate a management plan for a case study
patient.
NR 601 Week 5 Case Study
Assignment
Week 5 Case Study 2
Assessment
Primary Diagnosis:
Type 2 Diabetes Mellitus (ICD- 10 E11). I chose DM type 2 as my primary diagnosis
based on the American Diabetes Association’s Guidelines (ADA). DM2 is a decline in insulin
secretion because of impaired B-cell function (ADA, 2018) a diagnosis of diabetes can be made
contingent on s criterion of the fasting glucose, the 2-h plasma glucose value in a glucose
tolerance test or an A1C criteria (ADA, 2018). My patient’s fasting blood glucose of 126 (H) and
her Hgb A1C of 6.9 (H), confirmed the diagnosis because they are two definitive values that are
over the threshold (ADA, 2018).
My reason for selecting DM2 also included the patient’s signs and symptoms, risk factors
such as her age (56), ethnic background (Hispanic) and she previously delivered a nine-pound
two-ounce baby which is indicative of gestational diabetes.
Diabetes signs and symptoms include fatigue, frequent urination, blurred vision, feeling
hungry, pain and tinging in hands and feet as well wounds and cuts that heal slowly (ADA,
2018).
Those living a sedentary lifestyle, older age, obesity women previously diagnosed with
gestational diabetes, Hispanics and blacks and those with high cholesterol and hypertension are
all at a higher risk for type 2 diabetes (ADA, 2018). Mrs. R has been experiencing fatigue,
weight gain, hung and thirst and frequent urination, she is overweight with a BMI of 29.7 which
places her in the overweight category.
Many individuals with non-insulin dependent diabetes are overweight and extra weight
effects insulin resistance (ADA,2018). This patients abnormal lab values are as follows a blood
glucose of 126(H), Hgb A1C 6.9 (H), LDL 144 (H), HDL 38 (L), Triglycerides 232(H) , and a
Week 5 Case Study 3
small amount of protein in her urine with 1+ glucose , warrants further investigation into her
health need.
Plan
Diagnostics
I am going to order a Hgb A1C for the DM2 diagnoses. Hgb A1C is a test that measures
an individual’s blood glucose level for 3 months it is a measure of glycemia average (ADA,
2018). This test is also a prediction of value and detects glycemic targets (A1C is most effective
when used along with CGM), (ADA, 2018). My patient’s A1C is 6.9 (H), individuals not
previously diagnosed with DM with an A1C greater than 5.7, an abnormal glucose tolerance and
an abnormal fasting glucose are ideal for diabetes prevention (ADA, 2018). This test should be
obtained on the first visit and should continue throughout treatment (ADA, 2018). American
Diabetes Association (ADA) Guidelines recommend that A1C levels be obtain every three
Months until optimal levels have been reached or sustained (ADA, 2018). Results of the Hgb
A1C will provide me with the opportunity to treat as indicated. Glycemic targets vary depending
on patient’s specific needs (ADA, 2018). I am also going to order a Fasting Glucose because it is
a predicting factor of DM2 (ADA, 2018).
Medications
I choose metformin as the initial pharmacotherapy treatment for this patient. Metformin
is the first line therapy of DM2 in older people if not contraindicated, this medication is proven
to be the best indicated for prolonged use, safety and cost effectiveness (ADA, 2018). Metformin
is prevalent in the reduction of cardiovascular episodes and death (ADA, 2018). I am going to
Week 5 Case Study 4
continue patient on her multivitamin, vitamins are used to prevention of vitamin and mineral
deficiencies (ADA, 2018). Since my patient has knee pain I will keep her on Tylenol as needed.
Tylenol is an analgesic which can be purchased OTC, my patient may continue her current
dosage (ADA, 2018).
Rx; Metformin (Epocrates,2018).
Sig: 500 mg tabs by mouth bid
Disp: 180
Refills: 3
Rx: multivitamin (Animi-3) (Epocrates,2018).
Sig: I tab by mouth daily
Disp: 30
Refills: 3
Rx: Tylenol (Epocrates,2018).
Sig: 500 mg tab daily by mouth as needed for pain
Disp: 30
Refills: 0
Education
Metformin is a drug used for DM2 that lowers hepatic glucose production and speeds up
insulin sensitivity (ADA, 2018). The side effects of metformin can cause nausea, vomiting,
diarrhea, indigestion and abdominal discomfort and weakness. I want patients to be aware of
Week 5 Case Study 5
these adverse reactions so that they know when to stop taking the drug and seek medical
attention if reactions occur or become severe (ADA, 2018).
When a patient has diabetes and are overweight to prevent further complications your
health. It is important to adhere to some lifestyle modifications (ADA, 2018) Maintaining weight
loss and meal planning can benefit diabetic patients by lowering the blood pressure and
producing favorable lab results (ADA, 2018). A five-pound weight loss or greater is ideal for
DM2 patients who are overweight (ADA, 2018). When newly diagnosed with type 2 DM it is
suggested that patients have an eye exam by an ophthalmologist to detect any issues with vision
(ADA, 2018). Meticulous foot care is important because Individuals with diabetes can sustain
serious injuries to their feet because of neuropathy which is related to nerve damage (ADA,
2018).
Referrals
Diabetic patients need to see an ophthalmologist for a comprehensive dilated eye exam to
detect any visual disturbances (ADA, 2018). Since weight and healthy eating play an important
role in weight reduction and combating high cholesterol levels it is important to also refer to a
nutritionist for meal planning and helping to eat healthy meals to lower cholesterol, blood
glucose and reduce weight (ADA, 2018). Meticulous foot care is important because Individuals
with diabetes can sustain serious injuries to their feet because of neuropathy which is related to
nerve damage (ADA, 2018).
Follow up
This patient is to follow up with me in 3 months to have Her A1C levels checked. AIC
levels should be checked because it is prevalent in diabetes management (ADA, 2018).
Assessment
Week 5 Case Study 6 [Show Less]