Week 5 Case Study
In this case study I will be looking at the overall health of Mrs. G, a 55 year old Hispanic
women. She is coming into the office with multiple health complaints. After reviewing her history and doing
...
Week 5 Case Study
In this case study I will be looking at the overall health of Mrs. G, a 55 year old Hispanic
women. She is coming into the office with multiple health complaints. After reviewing her history and doing my physical exam I have decided to diagnose Mrs. G with type 2 diabetes. This
case study goes over this diagnosis, other secondary diagnoses, differential diagnoses, a treatment plan, as well as education I would provide to the patient.
Assessment
Primary Diagnosis- Type 2 diabetes with unspecified complications (E11.8)
Pathophysiology- Type 2 diabetes is a chronic, multisystem, metabolic syndrome
of gradual onset characterized by an insufficient body tissue response to insulin and impaired pancreatic production of insulin. Signs and symptoms of type 2 diabetes are fatigue, recurrent infections, prolonged wound healing, polyuria, polydipsia, weight
changes, and polyphagia (Schub & Parks-Chapman, 2018).
pertinent positive findings- Pt endorses polydipsia, polyphagia, weight gain,
polyuria, fatigue. Physical exam shows obesity, +1 glucose in urine, small protein in
urine, A1C of 6.9% (Schub & Parks-Chapman, 2018).
pertinent negative findings- Glucose 95, no history of prediabetes, no family
history of diabetes (Schub & Parks-Chapman, 2018).
With the patient’s subjective findings and the A1C level of 6.9%, this patient
meets the clinical diagnosis of type 2 diabetes (Schub & Parks-Chapman, 2018).
rationale for the diagnosis- Because of the strong pertinent positives and associated lab work with this patient, I would definitely diagnoses her with type 2 diabetes. Her
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