NU341 Unit 4 Assignment Worksheet Winningham’s Critical Thinking Cases in Nursing: Case Study 76: “Endocrine Disorders”

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NU341 Unit 4 Assignment Worksheet Winningham’s Critical Thinking Cases in Nursing: Case Study 76: “Endocrine Disorders” Scenario: Y.L., a 34-year-old Southern Asian Woman, comes to the clinic... with complaints of chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with over-the-counter medication. She works full time as a clerk in a loan company and states she has difficulty reading numbers and reports, resulting in her making frequent mistakes. She says, “By the time I get home and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn or feel like there are pins in them.” She has a history of gestational diabetes and reports that after her delivery she went back to her traditional eating pattern, which is high in carbohydrates. In reviewing Y.L.’s chart, you note she last saw the provider 6 years ago after the delivery of her last child. She gained considerable weight; her current weight is 173 pounds. Today her blood pressure (BP) is 152/97mm Hg, and a random plasma glucose level is 291 mg/dL. The provider suspects that Y.L. has developed type 2 diabetes mellitus (DM) and orders the laboratory studies shown in the chart. Chart View Laboratory Test Results: Fasting glucose 184 mg/dL Hemoglobin A1c (HbA1c) 8.8% Total cholesterol 256 mg/dL Triglycerides 346 mg/dL Low-density lipoprotein (LDL) 155mg/dL High-density lipoprotein (HDL) 32 mg/dL Urinalysis (UA) +glucose, -ketones Answer the following questions and statements. 1 ● Each question is assigned a point value. ● Submit the completed worksheet to the Dropbox no later than Day 7 of Unit 4. ● Your instructor will post the grade for this Assignment in the Gradebook no later than Day 7 of Unit 5. 1. Interpret Y.L.’s laboratory results. (4 points) 2. Identify the three methods used to diagnose DM. (6 points) 3. Describe the functions of insulin. (4 point) 2 4. Describe the major pathophysiologic difference between type 1 and type 2 DM. (6 points) 5. Name six risk factors for type 2 DM. Place a star or asterisk next to those that Y.L. exhibits. (8 points) Scenario progresses: Y.L. is diagnosed with type 2 DM. The provider starts her on metformin (Glucophage) 500 mg and glipizide (Glucotrol) 5 mg orally each day at breakfast and atorvastatin (Lipitor) 20 mg orally 3 at bedtime. She is referred to the dietitian for instructions on starting a 1200-calorie diet using an exchange system to facilitate weight loss and lower blood glucose, cholesterol, and triglyceride levels. You are to provide education regarding pharmacotherapy and exercise. 6. How can you incorporate Y.L.’s cultural preferences as you develop her education plan? (5 points) This patient is from southern Asia. Teaching this patient about diabetes, you’ll need to keep her cultural background in mind. Assessing how well she speaks and understands English is important. If the patient has minimal understanding, then an appropriate interrupter needs to be present. Understand the patient dietary intake is important, finding foods that are low in carbohydrates. Does this patient treat her conditions with any herbal remedies? If so, you’ll need to make sure the patient discusses this with her healthcare provider. Some herbal medications can interfere with western medications. Does this patient see a healer or practice any rituals you may need to be aware of? 7. What is the rationale for starting Y.L. on metformin (Glucophage) and glipizide (Glucotrol)? (4 points) Oral agents ae mainly used for type 2DM to help improve the mechanisms by which insulin and glucose are produced and used by the body. Both Metformin and Glipizide help the body cope with high blood glucose levels. Glipizide stimulates the release of insulin form that pancreas, directing the body to store the glucose. Metformin works in three separate ways, first it slows the absorption of glucose in the small intestine, it also stops the liver from converting stored glucose into blood glucose, last is helps the body use the natural insulin the body procures more efficiently [Deg15] 8. Outline the teaching you need to provide to Y.L. regarding oral hypoglycemic therapy. (5 points) Teach the patient about how oral medications will help keep blood glucose controlled and help prevent serious short term and long term complications of diabetes Teach that along with the use of oral medication diet and exercise are important to maintain Teach patient to take medication as prescribed 4 Teach patient about the prevention, signs and symptoms and management of hypo and hyperglycemia. Teach patient to contact their health care provider if any changes occur [Ack141]. 9. What benefits should Y.L. receive from encouragement to exercise? (5 points) 1. the management of blood glucose levels 2. improve the cardiovascular function 3. weight loss and weight control 4. improve general health Scenario progresses: Y.L. comments, “I’ve heard many people with diabetes lose their toes or even their feet.” You take this opportunity to teach her about neuropathy and foot care. 10. Which of the symptoms that Y.L. reported today led you to believe she has some form of neuropathy? (5 points) The fact that the patient is having issues with her feet. Patient stating “her feet hurt; they often “burn or feel like there are pins in them.” References 5 Ackley, B. J., & Ladwig, G. B. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (10th ed.). Maryland Heights, Missouri: Mosby Elsevier. Broyles, B. E., Reiss, B., & Evans, M. (2007). Pharmacological Aspects of Nursing Care (7th). Clifton Park: Delmar. Deglin, J. H., Vallerand Hazard, A., & Sanoski, C. A. (2015). Davis's Drug Guide for Nurses (14th ed.). philadelphia: F.A. Davis Company. Huether, S. E., & McCance, K. L. (2014). Understanding Pathophysiology (5th ed.). St. Louis: Elsevier Mosby. Pagana, K. D., & Pagana, T. J. (2013). Mosby's Diagnostic & Laboratory Test Reference (11 ed.). St. Louis: Elsevier, Mosby. 6 7 11. What other findings in Y.L.’s history place her at increased risk for developing neuropathy? (4 points) 12. What would you teach Y.L. about neuropathy? (5 points) 13. Because Y.L. has symptoms of neuropathy, placing her at risk for foot complications, you realize you need to instruct her on proper foot care. Outline what you will include when teaching her about proper diabetic foot care. (5 points) 14. What monitoring will Y.L. need regarding nephropathy and retinopathy? (4 points) 8 9 [Show More]

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