Janettealtenbernt.weebly.com



Diabetes Case Study AssignmentJanette Altenbernt Chamberlain College of NursingNR601: Primary Care of the Maturing and Aged FamilyNovember 2019Diabetes Case Study AssignmentDiabetes mellitus is a lifelong chronic disease affecting millions of individuals of all ages in the America. The American Diabetes Association (ADA) developed guidelines for practitioners to provide safe adequate care to reduce the risk of complications (American Diabetes Association, 2019). This paper will review week five case study, along with providing a primary diagnosis, subsequent diagnosis, and brief explanation of type 2 diabetes mellitus. Followed by the plan of care, assessment of comorbidities, and the cost of recommended medications. Assessment Primary Diagnosis Type 2 diabetes mellitus (E11)Pathophysiology Kahn et al., (2014) discusses type two diabetes mellitus occurs when adequate amounts of insulin is not able to be released by B-cell resulting in insulin resistance. Individuals with type two diabetes report symptoms of increase thirst, fatigue, as well as frequent urination, which can be diagnosed with a fasting plasma glucose that is 126mg/dL or higher or an A1C greater than or equal to 6.5% (American Diabetes Association, 2019). pertinent positive findings- American Diabetes Association (2019) discloses polyuria and polydipsia are the significant initial signs of diabetes. Additionally, once individuals experience further increase in blood glucose, they may report symptoms of reduced energy. Furthermore, laboratory testing revealing an A1C at least 6.5% or fasting plasma glucose 126mg/dL or greater is diagnostic evidence of type two diabetes (American Diabetes Association, 2019). pertinent negative findings- American Diabetes Association (2019) reports if the patient does not present with obvious hyperglycemic life-threatening conditions, diagnostic clarification must be established. Additionally, patients will likely report weight loss without trying. Likewise, persons with type two diabetes with elevated blood glucose levels may show signs of confusion as well as vision or hearing disturbances (Mouri &, Badireddy, 2019).rationale for the diagnosis- Mr. Jones’s subjective symptoms include fatigue as well as nighttime urination along with increase urination during the day. Additionally, he reports increase thirst and hunger along with weight gain despite working out. Moreover, recent fasting lab values reveal elevated plasma glucose of 135 and hemoglobin A1C 6.9 %, and an abnormal urine analysis 1+ glucose. American Diabetes Association (2019) guidelines report type two diabetes is diagnosed with two abnormal diagnostic testing including a fasting plasma glucose of 126mg/dL or greater and A1C 6.5% or higher.Secondary Diagnosis Hyperlipidemia (E78.5)Pathophysiology- Hyperlipidemia is described as an elevated cholesterol in the blood as well as high triglycerides or a combination of both (Karr, 2017). Hyperlipidemia puts individuals at risk for cardiovascular incidents due to the plaque that forms with in the arteries. pertinent positive findings- American Diabetes Association (2019) guidelines discuss triglyceride level of 175-499mg/dL indicates hypertriglyceridemia and must be addressed (American Diabetes Association, 2019). The Guideline on the Management of Blood Cholesterol (2019) demonstrate persons age 40 to 75 old with an LDL level that is 70mg/dL or greater and diagnosed with diabetes mellitus should be treated with statin therapy. pertinent negative findings- The Guideline on the Management of Blood Cholesterol (2019) identifies lab values of triglycerides 175 mg/dL or higher and LDL that is 70mg.dL or above reveals hyperlipidemia. Significantly, the patients reported lab findings are consistent with the guidelines. rationale for the diagnosis- Mr., Jones reports a past medical history of hyperlipidemia and is currently taking Simvastatin, 10 mg daily. Mr. Jones’s objective information reveals fasting labwork including Cholesterol 202 mg/dL, LDL 134 mg/dL, HDL 32 mg/dL, and Triglycerides 225. Baer (2017) shares the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines designate individuals are at extreme risk for cardiovascular disease with an HDL 80 mg/dL or less. The Guideline on the Management of Blood Cholesterol (2019) illustrate hyperlipidemia is diagnosed for results of triglycerides greater than 175 mg/dL or LDL that is 70mg.dL or higher. PlanDiagnosticsLab test (#1) hemoglobin A1C in three months rationale: American Diabetes Association (2019) reports The American Diabetes Association Standards of Medical Care in Diabetes guidelines recommend providers obtain a hemoglobin A1C biannually for individuals who maintain glycemic stability. Likewise, should the patient experience difficulty staying within the goal glycemic range or change in dose hemoglobin A1C monitoring every three months is suggested (American Diabetes Association, 2019).Lab test (#2) Lipid Panel in four weeks rationale: American Diabetes Association (2019) guidelines suggest providers evaluate lipid panel when a statin is started and repeat in four to twelve weeks. Once tolerance has been established lipid profile evaluation can be obtained annually or sooner as the provider determines necessary (Last et al., 2017).Lab test (#3) Vitamin B12 in three months rationale: American Diabetes Association (2019) guidelines demonstrate evaluating vitamin B12 levels routinely for persons receiving metformin treatment of type two diabetes. Noteworthy, metformin can lower vitamin levels and should be obtained one year after treatment or sooner if clinical findings suggest. Medications Medication (#1) - Simvastatin 40 mgDISP# 30 tablets Sig: Take one tablet daily RF#1Rationale- The American Diabetes Association (2019) guidelines noted persons with diabetes should receive treatment of a statin at highest does tolerated. Individuals with an LDL higher than 70 mg/dL should receive treatment of Simvastatin 40mg to lower the potential for negative cardiovascular occurrence (American Diabetes Association, 2019).Medication (#1) - Metformin 500mg DISP# 60Sig: 1 tablet two times daily with meals RF#1Rationale- Metformin is primary choice treatment for type two diabetes due to the safety, low cost, and reliability of the medication (American Diabetes Association, 2019). Metformin can be prescribed two times daily using the immediate release or the extended release with a onetime daily dose. Medication (#2) OTC Aspirin 81 mgDISP# 30 tablets Sig: Take one tablet daily RF#1Rationale- The American Diabetes Association (2019) guidelines recommends aspirin daily for persons with diabetes as an option to reduce cardiovascular illness. Providers should consider the lowest dose when considering aspirin therapy, 81 mg is widely used in the United States. Education Diagnoses. Type 2 diabetes mellitus- The diagnosis for type 2 diabetes has been made based on the diagnostic findings of elevated plasma glucose of 135 and hemoglobin A1C 6.9 %, and an abnormal urine analysis 1+ glucose per the guidelines from The American Diabetes Association (American Diabetes Association, 2019). When individuals take part and personalize their treatment, they are more likely to avoid further heath concerns and experience a higher quality of life. This is why I would like to discuss your preferences in treatment and selfcare.Hyperlipidemia- The diagnosis of hyperlipidemia is established as a result of the recent lab findings including Cholesterol 202 mg/dL, LDL 134 mg/dL, HDL 32 mg/dL, and Triglycerides 225. American Diabetes Association (2019) indicates chronic disease such as elevated cholesterol, triglycerides and diabetes can contribute to cardiovascular disease. Considering this information, it is important to increase your statin therapy. Medications. Simvastatin 40 mg – Prior to today’s visit you were taking Simvastatin 10mg, however The American Diabetes Association (2019) guidelines report when persons have diabetes and an LDL higher than 70 mg/dL should receive treatment of Simvastatin 40mg daily. This increased dose of Simvastatin will provide you with the best outcome regarding cardiovascular disease. Metformin 500 mg- Newly diagnosed diabetics should be started on Metformin for initial treatment as it safely reducing blood sugar and is cheap (American Diabetes Association, 2019). Metformin 500mg is a low dose and can be increased should you not be able to maintain good control of your blood sugars. Aspirin 81 mg- Low dose aspirin daily reduces your risk for cardiovascular illness as you at increase risk with having type 2 diabetes (The American Diabetes Association, 2019).Diet.Changes in diet can reduce weight, improve glycemic control, as well as improve hyperlipidemia. American Diabetes Association (2019) guidelines discusses nutritional advisement should be patient specific while including weight loss and meal prep intent. Taking this into consideration I would suggest using the diabetes plate method. The diabetes plate allows for individuals to use visual aids on recommendations for proper potion size, carbohydrates, vegetables, and calorie management of 1,500–1,800 kcal/day (American Diabetes Association, 2019). Additionally, ADA guidelines recommend diabetics limit alcohol to two drinks daily for men. Exercise. American Diabetes Association (2019) guidelines indicate a 5% weight loss has been found to improve lipids, blood sugar, as well as blood pressure by burning 500-700 kcal/day. It is recommended to lose 10.5 lbs to achieve the 5% weight loss. Exercising daily or preventing 2 days in a row of non-activity is recommended. ADA (2019) guidelines report engaging in a minimum of 150 min/week of aerobic activity such as moderate speed on the treadmill for at least 30 min/day, along with resistance training 2 days a week (American Diabetes Association, 2019). Warning Signs for diagnoses and mediationsHypoglycemia is a result of low blood sugar and is life threatening. If you are experiencing low blood sugar you may experience agitation, racing heart rate, trembling, confusion. Persons are more likely to experience low blood sugar when they haven’t eaten in a while, drinking alcohol, vigorous activity, or unable to eat diagnostic study (American Diabetes Association, 2019). It is important to be aware when blood sugar reads 70 mg/dL ingesting foods high in carbohydrates in necessary. Monitoring feet for any signs of infections or open wounds in important and if identified to seek treatment to avoid complications (American Diabetes Association, 2019). Hyperlipidemia puts you at increase risk for Atherosclerotic Cardiovascular Disease (ASCVD) (American Diabetes Association, 2019). If you experience chest pain, stroke symptoms, or a headache that does not go away seek immediate medial attention as these are potentially signs of serious cardiovascular injury. Metformin side effects include diarrhea, stomach pain, and lactic acidosis if a large amount was received (American Diabetes Association, 2019). Simvastatin in high doses can cause muscle pain, if experience contact clinic immediately do not just stop taking medication (American Diabetes Association, 2019). ADA (2019) guidelines indicate Aspirin has a risk of bleeding in the stomach, eyes, or brain and should seek immediate medial attention if noticed (American Diabetes Association, 2019).ReferralSpecialty practice or service Ophthalmologist rationale: American Diabetes Association (2019) guidelines recommend individuals when diagnosed with type 2 diabetes receive an extensive eye examination with dilation (American Diabetes Association, 2019). Follow upInitial follow up would be in 3 months. American Diabetes Association (2019) guidelines support providers evaluate patients every three to six months, unless clinically determined different. Assessment of comorbidities Obstructive sleep apnea should be considered if individuals complain of extreme tiredness especially during the day as well as partners reporting snoring during sleep. Screening while the patient sleeps can diagnosis obstructive sleep apnea (American Diabetes Association, 2019). OSA can negatively affect a person with diabetes as it reduces energy to be able to exercise as well as increase risk for cardiovascular disease to which diabetes is already a risk factor. Medication Cost Metformin 800mg $4, Simvastatin 40 mg $9, Aspirin 81 mg $5.97, Tylenol 500 mg $4.92A total monthly cost for Mr. Jones is $23.89 according to Walmart $4/ (., 2019). At this time there is no concern for polypharmacy for Mr. Jones. The total monthly cost for Mr. Jones medication does seem to manageable even for a person on a fixed income. Conclusion To summarize diabetes mellitus is a lifelong chronic disease affecting millions of individuals of all ages in the America. Laboratory testing revealing an A1C at least 6.5% or fasting plasma glucose 126mg/dL or greater is diagnostic evidence of type two diabetes (American Diabetes Association, 2019). Metformin is primary choice treatment for type two diabetes due to the safety, low cost, and reliability of the medication (American Diabetes Association, 2019). Changes in diet can reduce weight, improve glycemic control, as well as improve hyperlipidemia. Providers should educate regarding hypoglycemia, diabetic foot care, and maintaining follow up appointments with providers. ReferencesAmerican Diabetes Association. (2019). American Diabetes Association Standards of Medical Care in Diabetes - 2019.?Diabetic Care?,?42, S1–S193. Retrieved from , J. (2017). AACE and EAS Lipid Guidelines. Retrieved from . T., Mechanick, J., Brett. E., Garber. A., Hurley. D., Jastreboff. A., Nadolsky. Pessah-Pollack. R., Plodkowski. R., and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines (2016) AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocrine Practice: July 2016, Vol. 22, No. Supplement 3, pp. 1-203. Guideline on the Management of Blood Cholesterol. (2019).?2018 Guideline on the Management of Blood Cholesterol. Retrieved from , S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future.?Lancet (London, England),?383(9922), 1068–1083. doi:10.1016/S0140-6736(13)62154-6Karr, S. (2017). Epidemiology and management of hyperlipidemia.?The American Journal Of Managed Care,?23(9 Suppl), S139–S148. Retrieved from , A. R., Ference, J. D., & Menzel, E. R. (2017). Hyperlipidemia: Drugs for Cardiovascular Risk Reduction in Adults. Retrieved from MI, Badireddy M. Hyperglycemia. (2019). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.?Available from: . (2019). $4 Prescriptions. Retrieved from $4-prescriptions/1078664. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download