case study which needs to be completed by 12/2/at 1pm

CASE STUDY XIII Phina Jeannite

Dim Kuntong

Nabirye Abalinabyo

TABLE OF CONTENT

► Introduction ► Review of Systems ► Physical Assessment & Examination ► Medications ► Medications Educations Demonstrations ► Health Promotion ► References

Introduction:History of illness

★ Nancy Halpert (N. H.) is a 75-year-old African American female who comes in the office today for her physical annual exam. she has been diagnosed with :

★ uncontrolled diabetes mellitus type 2,

★ diabetic ketoacidosis,

★ obesity and possible depression.

Review of System

general overall health:N.H was diagnosed with type 2 diabetes mellitus

Subjective ● She denies any headaches, nausea, vomiting ● She reports Dysuria, ● she is “worried” and nervous about having to need insulin .

Physical Assessment and Examination

H: 5’2 wt: 235 lbs BMI: 43 snellen vision chart: No eye corrections Right eye: 20/20 Left eye:20/20 BP: 119/78 mmHg left arm, sitting position T: 98.7 F orally, P:96 bpm R: 16/min o2 Sat: 98%Miss Nancy is alert and

oriented X4. General appearance is appropriate for her age but there is noticeable obesity

Pain assessment: 0/10

Physical Exam

Skin: dry, good skin turgor

Head & face: symmetrical, no pain or tenderness, no lesions No lice.

Eyes: Nice and pink, symmetrical, reactive to light bilaterally

Nose: No discharge, tenderness, no nasal obstruction

Mouth: Oral mucosa pink, no gums bleeding, no toothache, gag reflex present

Throat: clear speech, no sore throat, no pain

Neck: trachea in midline, no lymphoedema, jugular veins pulse present, no bulging, no bruits- carotid pulse 2+

Physical Exam

Upper extremities: Full range of motion without pain, no abnormality noted

Chest and lungs: no SBO, bilaterally symmetric expansion of lungs, clear breathing sound,

posterior & anterior: no crackles, no wheezing symmetrically bilateral

Breast: bilaterally symmetrical, no pain or tenderness, no lump or rash

Heart: regular heart rate and rhythm, no murmurs, no extra sounds or bruits. no chest pain

Abdomen: symmetrical, flat, uniform in color, no tenderness, active bowel sound present in all four quadrant; no abdominal pain.

Physical Exam

Inguinal area: no enlargement of nodes.

Lower Extremities: no injury or pain, no dislocation, 2+ pulse is bilaterally present.

Neurological: no history of seizure, stroke, and no problem with coordination, difficulty speaking or swallowing

Musculoskeletal: no history of arthritis or limitation with movement.

Medication Rx: Metformin 500 mg po bid

THERAPEUTIC USE//MoA ADMINISTRATION CONSIDERATIONS Medications

Management of type 2 diabetes mellitus

Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin

sensitivity by increasing peripheral glucose uptake and utilization. With metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma

insulin response may decrease.

Follow dosage and schedule Take twice a day with the morning and evening meal Do not crush or chew the pill

ADVERSE EFFECTS PATIENT INSTRUCTIONS

Nausea, diarrhea, anorexia -Expect these effects to diminish as drug therapy continues -Lie down when feeling nauseated -Maintain adequate carbohydrate and fluid intake

INTERACTIONS

Drug- Drug (Rx 🡪 Rx) N/A

Drug- Condition (Rx 🡪 Dx) N/A

Drug-Food (Rx 🡪 Food/Herbal) Alcohol- Increase risk of lactic acidosis Garlic and Ginseng- increase hypoglycemic effects

APPOINTMENTS F/U Appt/Labs/Tests/Referral

Medications Education Demonstration

Health Promotions

References

https://www.rxlist.com/glucophage-drug.htm#clinpharm

https://www.obesityaction.org/community/article-library/obesity-in-the-elderly/