see below
Read the following case study and answer the posed questions:
Case #1:
History: A 65 year old housewife complains of progressive weight gain of 40 pounds in 1 year, fatigue, dizziness, sluggish memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.
Physical examination: Vital signs: temperature 96.4oF, pulse 68/minute and regular, BP 108/60, weight 170 lbs, height 5 feet, puffy face, pale, cool, dry skin. The thyroid gland is not palpable, deep tendon reflex time is delayed.
Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.4 ug/dl (N=4.5-12.5), the serum TSH is 0.9 uU/ml (N=0.2-3.5), and the serum cholesterol is 275 mg/dl (N<200).
1. What is the likely diagnosis and what symptoms made you consider that diagnosis?
2. Which lab data supported the diagnosis?
3. Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship.
Case #2:
J.R. is a 58-year old man who presented with a 6-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed on day of his visit and was 359 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough or fevers. He had no prior history of diabetes and no family history of diabetes.
Admission non-fasting serum glucose 268 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN and creatinine were normal. Physical examination revealed weight of 190 pounds, height 5'6.5" . The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy.
1. What are the mechanisms of blurred vision which was part of his initial symptoms?
2. Are there correlations between his abnormal blood chemistries and his other symptoms?
3. Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient.
Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
Estimated time to complete: 2 hours
Discussion Peer/Participation Prompt [Due Sunday]
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least three of these prompts:
· Do you agree with your peers’ diagnosis?
· Take an opposing view to a peer and present an alternative approach.
· Share your thoughts on how you support their opinion and explain why.
· Present new references that support your opinions.
Rewrite this explanation below
Hyperglycemia, often known as high blood glucose, happens when there is an excess of sugar in the blood. This occurs when your body has insufficient insulin (the hormone that transfers glucose into the blood) or when your body is unable to effectively utilize insulin. The disease is frequently associated with diabetes. Hyperglycemia is defined as blood glucose levels of more than 125 mg/dL (milligrams per deciliter) when fasting (without eating for at least eight hours; a person with fasting blood glucose levels of more than 125 mg/dL has diabetes).
With a fasting blood glucose of 100 mg/dL to 125 mg/dL, a person has impaired glucose tolerance or pre-diabetes. If a person's blood glucose level is more than 180 mg/dL one to two hours after eating, they have hyperglycemia. If hyperglycemia is left untreated for an extended length of time, it can harm your nerves, blood vessels, tissues, and organs. Damage to blood arteries can raise your chance of having a heart attack or stroke, and nerve problems can result in vision loss, kidney damage, and non-healing wounds.
Are there correlations between his abnormal blood chemistries and his other symptoms?
Yes, his symptoms of polyuria, polydipsia, and impaired vision are all common indications of high blood glucose. The body is attempting to clear the extra sugar through the urinary tract. JR is continuously thirsty as a result of his high blood glucose levels. A high HbA1c level indicates the quantity of sugar bound to hemoglobin or blood. Because this is similarly increased, it would help to explain his symptoms.
J.R.'s electrolyte levels were normal, as were his BUN and creatinine values. This indicates that his renal function is normal. The A1C level was raised, indicating that his three-month blood glucose average was increased, and he ran an average of 229 mg/dL each day. His random glucose level was 359 mg/dL, when the predicted amount was less than 200 mg/dL. Despite the absence of a family history of diabetes, lab results indicate the development of the disease. Polydipsia, polyuria, polyphagia, weariness, impaired eyesight, and weight loss are all symptoms of diabetes (Freeman, 1958).
Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient.
JR exhibited 6 weeks of the most prevalent indications of hyperglycemia; the Three P's; in the history, physical, and supporting lab evidence. He has an increased WBG and BMI, as well as a slew of other symptoms. Aside from his WNL labs, obesity is a factor that tackles cardiovascular and microvascular risk. Heart disease, stroke, and impaired circulation are all cardiovascular risk factors. Vision issues, renal illness, and nerve damage are all microvascular risk factors.
Because of his weight, the patient is at a greater risk of developing insulin resistance, which will certainly result in an increase in blood glucose levels (Brashers et al., 2019). Because this guy may be insulin resistant as a result of his obesity, the body is compelled to break down adipose tissue for energy. This is most likely the reason for J.R.'s weight decrease. This will result in his having raised cholesterol and insulin levels, putting him at risk for cardiovascular comorbidities such as coronary artery disease and renal failure. On a microvascular level, inflammatory cytokines induce damage to the capillaries of the retina, resulting in visual abnormalities. Because he has clouded vision, he should be referred to an ophthalmologist.
Step-by-step explanation
Reference
Balaji, R., Duraisamy, R., & Kumar, M. P. (2019). Complications of diabetes mellitus: A review. Drug Invention Today, 12(1).
SHAH, R., SHAH, M., SHAH, S., SHAH, S. N., & SHAH, M. Presenting Clinical Features in Newly Diagnosed Type 2 Diabetic patients in our community. Age (years), 40(10.36), 24-65.
Yadav, L. K., & Prakash, B. Symptom and Mode of Presentation of Diabetes Mellitus Type 2 in Patients of Ajmer City.