NR601 Week 5 Case Study Assignment Complete Solution
This paper will develop an accurate primary and secondary diagnosis for Mr. Jones utilizing the
... [Show More] subjective and objective data provided and will also include a brief discussion of the pathophysiology of the chosen diagnoses. It will include common signs and symptoms; pertinent positives and negatives as they relate to the patient and the disease processes. Additionally, it will include evidenced-based rationales to support the chosen diagnoses and a detailed management plan that is individualized; consisting of diagnostics, medications, education, referrals, as well as follow-up-care. This paper will include assessment and identification of one comorbidity; with a discussion on the significance and impact that comorbidity has on health outcomes. Anticipated monthly medication costs will be included for all prescription and over the counter (OTC)medications, as well as, where the patient can obtain medications for the best price, and end with a discussion of how this future nurse practitioner will utilize medication pricing resource in future practice.
Assessment
Mr. Jones is a 60-year-old African American male that presents to the clinic for a 6 month follow up for hyperlipidemia and weight loss. Although he reports that he has been going to the gym 3 to 4 times a week, walking on the treadmill, and lifting weights as recommended, and adhering to dietary modifications “as good as he could remember” he has not lost any weight and has gained 7 pounds. He reports increased fatigue for approximately 10 weeks, with increased hunger and thirst. Over the past 2 months he has been experiencing an increase of urinary frequency during the day, as well as having to get up during the night. He is concerned about his increase in fatigue and his inability to lose weight.
His vital signs are: BP: 119/77; P: 80 & regular; R: 16 & regular; Ht.: 5’9.5”, Wt.: 210 lbs., BMI: 30.6 (U.S. Department of Health & Human Services, n.d.). Pertinent laboratory findings include urinalysis with 1+ glucose; fasting blood glucose (FBG) 135, HgA1C of 6.9%, as well as total cholesterol of 202 mg/dl, LDL 134 mg/dl, HDL 32 mg/dl, and triglycerides of 225. He has a PMH significant for hyperlipidemia and osteoarthritis of the right knee. Based on the HPI, ROS, and objective findings an appropriate primary and secondary diagnosis can be determined.
Primary Diagnosis: new onset Type 2 Diabetes Mellitus (T2DM), ICD-10 (E11.9)
Pathophysiology T2DM is a chronic condition that impairs the way the body metabolizes glucose. In T2DM the body either resists the effects of insulin or does not produce enough insulin. Common signs and symptoms of T2DM include polydipsia, polyuria, polyphagia, as well as fatigue (ADA, 2020b).
Pertinent positive findings: Polyuria, polydipsia, polyphagia, increased fatigue, a 7-pound weight gain, as well as 1+ glucose in urine, FBG 135, and HgbA1C of 6.9% (ADA, 2020b). African American adults are 60% more likely to be diagnosed with T2DM than non-Hispanic white adults (U.S. Department of Helath & Human Services Office of Minority Health, 2019). Mr. Jones has a BMI of 30.6 and obesity is a known risk factor for the development of T2DM (ADA, 2020b).
Pertinent negative findings: He exercises regularly and tries to adhere to dietary restrictions; he does not have a sedentary lifestyle. Negative ketones on urinalysis and he has no known family history (ADA, 2020b). Skin is warm dry and intact with no evidence of yeast like rashes or acanthosis nigricans [Show Less]