NR 601 Case study assignment .docx

NR 601 Case study assignment .docx Week 5 Case Study Lucretia D Professor Schroetter NR 601 August 11, 2018 Introduction The purpose of this paper is to examine the subjective and objective information using the nati ...

NR 601 Case study assignment .docx Week 5 Case Study Lucretia D Professor Schroetter NR 601 August 11, 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.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 aWeek 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 toWeek 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 ofWeek 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). AssessmentWeek 5 Case Study 6 Secondary Diagnosis: Hyperlipidemia (ICD-10 E78.5) is a disease that shows that there are high levels of fat particles in the patient’s blood (AHA, 2017). There are usually no signs and symptoms associated with hyperlipidemia, the condition can be confirmed by routine blood tests. Blood pressure and blood glucose are both affected by cholesterol levels (ADA, 2018). My patient has a cholesterol level of 230 which is a borderline high result, her triglycerides are 232(H), LDL 144 (H) and HDL 38 (L). I made my diagnosis of hyperlipidemia primarily based on this patient’s lab values and the fact that she is overweight with a BMI of 29.7 and she also has DM2 (ADA, 2018). Diagnostics I would order a fasting lipid panel to accurately monitor this patient’s cholesterol level, a blood glucose to ensure that the levels are within normal and are controlled and a liver function test this test is to determine if there is a issue with the liver (ADA, 2018) Medication Atorvastatin is a HMg-Coa Reductase inhibitors (statins) it is a medication which is responsible for the syntheses of cholesterol (Epocrates,2018). This medication is the first line treatment for lowering LDL levels. Dosing should be individualized according to the baseline cholesterol level and adjustments should be made in 2 to 4-week intervals (Epocrates,2018). This medication must be tailored to lipid profile results. Rx Atorvastatin Sig: 20 mg by mouth daily Disp: 30 Refills: 0Week 5 Case Study 7 Education This patient must drastically change her diet she is a diabetic (DM2) and is overweight (BMI 29.7), these things place her at a higher risk for cardiovascular disease (ADA, 2018) it is recommended that she starts on a healthy heart diet, I would also like Mrs., R to start on an exercise plan. I will recommend that she start with 10 to 15 minutes of cardio a day, then gradually increase to 30 minutes a day. It is also important to take medication as directed. Patients must be educated on signs, symptoms and adverse reactions to all medications prescribed. (ADA,2018). Referral It is recommended that this patient see a Nutritionist, a nutritionist will help this patient learn to make healthier food choices. The goal is to lower her cholesterol level and reduce her weight which is beneficial for hyperlipidemia and DM2 management (AHA, 2017) Follow up This patient will follow up with me in 1 month. She will return to the clinic at that time to have to have her cholesterol level drawn (AHA, 2017). Differential Diagnosis: Hypothyroidism (ICD-10 E03. 9), is a decrease in the parathyroid hormone secretion. PTH is associated with the control of serum ionized levels (ADA,2018). I chose this diagnosis because Mrs. R had complaints of fatigue and blurred vision these symptoms accompanied by anxiety are common complaints in individuals with hypoparathyroidism. I quickly ruled out this diagnosis because her labs are not indicative of this disease. My patient does not have any riskWeek 5 Case Study 8 factors that would confirm hypothyroidism, her calcium level is 9.7 which is in therapeutic range. There is no previous history or family history of any thyroid issues. Diagnostics No diagnostics at this time because this diagnosis has been ruled out concerning this patient. Education No education needed in regard to hypothyroidism, this disease is not associated with this patient as evidence by pertinent lab values, signs and symptoms, family history and past medical history (ADA,2018). Referral No referral indicated Follow up No follow up needed Medication Costs Metformin (DM2) $4.00 for a 30-day supply from Walmart pharmacy (Good Rx 2018). Tylenol (Knee pain) $3.05 a month (you can get a 30-day supply free if you download the coupon), (Good Rx, 2018). Atorvastatin (hyperlipidemia) $9.00 a month for a 30-day supply using Walmart pharmacy (Good Rx, 2018). Multivitamin (Prevent anemia and vitamin/mineral deficiencies) $3.15 for a 30-day supply at Kroger (Good Rx, 2018). The total cost of this patients’ medications per month using the Walmart pharmacy is $19.20Week 5 Case Study