Analysis

CASE STUDY 2

Case Study

Raven Jinks

Chamberlain University

NR 601: Primary Care of the Maturing and Aged Family

November 27, 2020

Case study

Mrs. G, a 55-year-old Hispanic female presents with several health complications. Some of her complaints are weight gain, increased fatigue, polydipsia, polyphagia, polyuria, and nocturia. From the collection of the presented findings I have decided to diagnose Mrs. G with type 2 diabetes as the primary diagnosis and hyperlipidemia as the secondary diagnosis. This paper aims to gather the objective and subjective findings from the patient’s chief complaint, then come up with a proper diagnosis and development plan by utilizing an evidence-based approach. The paper will also provide the pathophysiology of the disease process, proper medication treatment, and patient education.

Assessment

Primary Diagnosis: The diagnosis ICD 10 Code is E11.9, which represents type 2 diabetes mellitus.

Pathophysiology

Pathophysiology of type 2 diabetes mellitus is characterized by defective insulin secretion by the pancreatic cells, impaired sensitivity of the tissue’s response to insulin, or decreased hepatic glucose production (Galicia- Garcia et al., 2020).

Pertinent positive findings

Fatigue, weight gain, obesity, polyuria, polydipsia, and polyphasia (Romesh, 2020). Hemoglobin A1C level at 6.9% (Shen et al., 2020). +1 glucose in urine, and a small amount of protein in the urine.

Pertinent negative findings

No numbness, no family history, no blurry vision (Pippitt &Gurgle, 2016).

Rationale for diagnosis

Pertinent findings include the hemoglobin A1C of 6.9%, the A1C normal range is considered anywhere between 5.7 to 6.4%. Continuous weight gain, frequent urination, and fatigue are subjective findings that justify the diagnosis of diabetes type 2 (Dheir et al., 2019).

Secondary diagnosis: Hyperlipidemia ICD code E78.5

Pathophysiology

This is characterized by an increase of lipids in the bloodstream. The elevated concentrations of lipids/ fats in the body causes blockage to the blood vessels.

Pertinent positive finding

The total cholestrel levels were at 230mg/dl, LDL 114mg/dl, VLDL 36 mg/dl, and triglycerides 232.

Pertinent negative finding

Neither smoking nor hypertensive (Hill & Bordoni, 2020).

Rationale for diagnosis

The total level of cholesterol is above the recommended level. For instance, the patient’s cholesterol was 230mg/dl, LDL 114mg/dl, VLDL 36 mg/dl, and triglycerides 232. The normal level of cholesterol is total cholesterol 170mg/dL, LDL less than 100mg/dL and HDL more than 45mg/dL (Hill & Bordoni, 2020). HDL was above the recommended level. Chronic pain was the major subjective findings that provided justification for the disease. The tendon inflammation of Mrs. G's knee determines the rationale for this diagnosis.

Management Plan

Diagnostics

Lab test 1: Cholesterol levels

Rationale: Hyperlipidemia is one of the major causes of heart diseases among many patients. The major test will involve obtaining a lipid panel which includes many different tests for coronary heart disease.

Lab test 2 Hemoglobin AIC

Rationale: Hemoglobin A1C was conducted to test for the presence of sugar in the blood. The presence of sugar in the blood can be tested for diabetes (Sherwani et al., 2018). Hemoglobin AIC test measures glucose tolerance over a three-month period. Fasting is not required or needed for accuracy. From the case study, the AIC level of the patient is 6.9% that is a good indication that the client is suffering from diabetes illness (Pippitt & Gurgle, 2017).

Medication 1: Prescription of Metformin 500 mg taken daily for diabetes mellitus type 2 (Moin et al., 2018)

Metformin 500 mg by mouth

Take 1 tablet daily with breakfast

Disp: #90

Refills: 0

Rationale: The function of Metformin is to stimulate glucose production in the liver by increasing the body’s response to insulin. Through this medication, the body will maximize the use of insulin effectively (Moin et al., 2018).

Medication 2: Atorvastatin 10mg taken orally a single tablet a day.

Atorvastatin 20 mg tablet

Sig. take one tablet PO before bed

Disp. #30

Refill x2

Rationale: Administration of a statin medication will lower the cholesterol levels in the body. The medication works for hyperlipidemia by reducing the lipid concentration in the blood vessels, a decrease in lipids in the body will also reduce the incidences of stroke among the patient.

Education

Diagnoses

The rationale for testing the patient's hemoglobin A1C is to establish a plan for the management of the disease. Insulin treatment is the primary management caregivers prescribe to patients with type 2 diabetes. Maintaining the blood sugar and understanding the signs and symptoms, and how to treat is important factors the patient must understand while being treated.

Medications

Metformin has been the primary treatment for type 2 diabetes over the years. Its efficiency in managing type 2 diabetes is of great outcomes. The side effects that may be experienced during management care using metformin include vomiting, abdominal pain, diarrhea, and nausea. Severe complications that result from the medication are hypotension, shortness of breath, gastrointestinal diseases, and impaired mental status. Mrs. G is required to follow proper instructions as prescribed by the provider for better health outcomes.

Atorvastatin is a medicine recommended for lipid treatment. The side effect of the atorvastatin includes memory loss, burning sensations, leg cramping, muscle pain, and joint pain. Symptoms such as anxiety, irritability, and depression may occur.

Diet

What we consume says a lot about our health. Obesity is one of the primary causes of diabetes. Obesity results from the consumption of high calorie and fat intake. To lower the risk of obesity, the patient should avoid the consumption of food with too much sugar, alcohol, fat, and added oil. Diabetic patients should be placed on healthy diets that will improve the quality of their health. Therefore, Mrs. G. should be encouraged to increase her intake of vegetables and fresh fruits. Vegetables and fruits are good sources of vitamin C, which aid in the proper functioning of the body's immune system (Weickert & Pfeiffer, 2018). Also, she should increase her intake of whole-grain foods with packed nutrients to reduce the risk of heart diseases, type 2 diabetes, and obesity (Weickert & Pfeiffer, 2018).

Exercise

Exercising regularly has a number of health benefits. It helps control one's weight, reduce the risk of heart diseases, manage blood sugar as well as insulin levels, and improve mental health and mood (Kirwan et al., 2017). Therefore, a physical exercise plan is essential for Mrs. G's care plan to help her maintain a healthy lifestyle.

Warning signs and symptoms

Metformin is associated with kidney disease. Metformin causes lactic acidosis, especially in cases of overdose. Lactic acidosis causes extreme fatigue, muscle cramps, loss of appetite, body weakness, and abdominal discomfort. Rhabdomyolysis is a life-threatening condition that is caused by overtime use of atorvastatin. Patients with this condition may face muscle weakness, fever, bruises, abnormal urine color, and fatigue. These patients should contact the provider immediately if they notice any of these symptoms. Also, signs of hypoglycemia should be monitored in patients taking Metformin, hypoglycemia is when the blood sugar falls to low. Some of the symptoms of hypoglycemia include dizziness, anxiety, headache, and lethargy.

Referral

Due to a variety of complications that may arise from type 2 diabetes and hyperlipidemia, a multidisciplinary approach will be significant. The approach will allow patients to see nutritionist, ophthalmologist, and nephrologist. Often, diabetes type 2 patients are required to visit an ophthalmologist annually for eye checkups. In cases where the kidney has been damaged as a result of overmedication, the patient can be referred to a nephrologist.

Follow up

Health institutions conduct follow up on diabetes patients to ensure they follow the plan as recommended. Often, the follow up is done quarterly in a year.

Assessment of Comorbidities

The primary comorbidity of type 2 diabetes is hypertension. Most of the patients who die from diabetes is due to cardiovascular complications, which are attributed to high blood pressure. Over time diabetes damages the blood vessels causing the walls to stiffen, which increases pressure inside of the vessel leading to high blood pressure (Ward et al., 2020). Such pressure increases the risk of stroke or heart attack among patients with type 2 diabetes.

Nephropathy is also another comorbidity of type 2 diabetes. Continuous treatment of diabetes damages the blood vessels (Ohiuddin, 2018). The damaged blood vessels clusters in the kidneys, which are meant to filter waste from the blood. This leads to kidney failure and causing high chances of developing high blood pressure (Ohiuddin, 2018).

Medication costs

It is important to consider the price for patient medication to ensure patient compliance. In cases where patients cannot afford certain brands of medication, ones with a similar function will be recommended to cut cost. According to GoodRx, 500 mg of metformin drug cost around $4- $5 for 30 days. Atorvastatin 10mg costs about $8-$12 for 30 days at local pharmacies. In Mrs. G case her monthly prescription would cost her about $17-$20.

Conclusion

To conclude, the paper provides a diagnosis of the patient’s conditions and rationales for the diagnosis of diabetes type 2 and hyperlipidemia. High blood sugar and hyperlipidemia control are essential since their advancement leads to fatal cardiac diseases. The paper provides the appropriate medication and evidence-based interventions that will allow the patients follow to live a lifestyle without further complication. This case study helped me gain further knowledge into both disease processes. Furthermore, it allowed me to assess, properly diagnose the patient, and further educate the patient of the disease.

References

Dheir, I. M., Abu Mettleq, A. S., Elsharif, A. A., Abu Al-qumboz, M. N., & Abu-Naser, S. S. (2019). Knowledge-Based System for Diabetes Diagnosis Using SL5 Object.

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International journal of molecular sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275

GoodRx (2020). Retrieved from https://www.goodrx.com/

Hill, M. F., & Bordoni, B. (2020). Hyperlipidemia. StatPearls [Internet].

Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84(7 Suppl 1), S15.

Moin, T., Schmittdiel, J. A., Flory, J. H., Yeh, J., Karter, A. J., Kruge, L. E., ... & Walker, E. A. (2018). Review of metformin use for type 2 diabetes prevention. American journal of preventive medicine, 55(4), 565-574.

Ohiuddin, A. K. (2018). Domination of Nephrotic Problems among Diabetic Patients of Bangladesh. Archives of Pharmacology and Therapeutics, 1(1).

Pippitt, K., Li, M., & Gurgle, H. E. (2016). Diabetes Mellitus: Screening and Diagnosis. American Family Physician, 93(2).

Romesh Khardor 2020 Type 2 Diabetes Mellitus. Medscape

Shen, Y., Shi, L., Nauman, E., Katzmarzyk, P., Price-Haywood, E., Bazzano, A., ... & Hu, G. (2020). Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes. Journal of stroke, 22(1), 87.

Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016). Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker Insights, 11, BMI-S38440.

Ward, R., Weeda, E. R., Bishu, K. G., Axon, R. N., Taber, D. J., & Gebregziabher, M. (2020). An Evaluation of Statin Use Among Patients with Type 2 Diabetes at High Risk of Cardiovascular Events Across Multiple Health Care Systems. Journal of Managed Care & Specialty Pharmacy, 26(9), 1090-1098.

Weickert, M. O., & Pfeiffer, A. F. (2018). Impact of dietary fiber consumption on insulin resistance and the prevention of type 2 diabetes. The Journal of nutrition, 148(1), 7-12.