Diabetes Case Study

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Instructions Review the assessment data provided for Mary and address the discussion points located at the end of this document. It is expected that clinical practice guidelines and evidence reports... (provided in Modules 2 - 4) along with information from your course textbook, videos, journal articles and web resources be used to support your answers. Additional outside research is encouraged. The grading rubric for this assignment is included with this case study. At least three professional references (peer-reviewed articles, professional websites….) published within the past five years are required, and your paper should follow APA formatting guidelines. The body of the paper is limited to 3-5 pages, not including the title and reference pages. Module 4 Analysis Data Mary is a 44-year-old African American female who is reporting to her primary care provider for a follow-up visit for evaluation of her diabetes, hypertension and dyslipidemia. During her last visit 3 months ago, her provider increased the dosage of one anti-hypertensive medication and added a second anti-hypertensive medication to her regimen due to her blood pressures hanging around 160/100. A second agent to assist with the management of her diabetes was also added to her plan of care at that time because her blood sugars were averaging 250-300, and her HA1C was 10.4%. She had lab work drawn two days ago so that it would be available for this visit. Medical Diagnoses: Stage 2 hypertension, dyslipidemia, type 2 diabetes mellitus Current Medications: • Metformin (IR) 1000 mg by mouth twice daily • Exenatide 10 mcg subcutaneous twice daily • Captopril 25 mg by mouth three times daily • Indapamide 5 mg by mouth daily • Rosuvastatin 40 mg by mouth daily Review of Systems Subjective Data General: Denies excessive fatigue, fever or problems other than dizziness when getting out of bed in the morning or standing up too quickly Skin: Denies rashes or lesions but does report having dry skin, especially her extremities HEENT: Denies visual or hearing changes, allergies, dizziness, rhinorrhea, colds or respiratory changes Cardiac: Denies chest pain, tightness or palpitations; blood pressure readings at home 130s/80s Respiratory: Denies shortness of breath or breathing difficulties; denies infections or cough GI: Reports occasional bloating and GI upset GU: Denies pain, burning, hesitancy, blood or urgency with urination MS: Denies issues other than frequent leg cramps/pain in the evening time most days for the past couple of weeks. The pain seems to be getting more severe. Neuro: Denies weakness, paresthesias or changes in speech or memory Psych: Denies feeling depressed or down Physical Examination Ht: 60 inches, Wt: 170 pounds General: No acute distress BP 138/86, T 98.1°F, P 78, R 20 Heart: RRR, S1 and S2, no murmurs Lungs: Clear to auscultation bilaterally Abdomen: Soft, non-tender, no bruits; Normoactive bowel sounds x 4 Lower Extremities: Pedal pulses 1+ bilaterally; skin warm and dry; capillary refill 3 seconds Laboratory Results: • Basic Chemistry Panel Glucose: 188 Creatinine: 1.1 mg/dl Carbon dioxide: 28 mEq/L Chloride: 100 mEq/L Potassium: 3.0 mEq/L Sodium: 139 mg/dl Calcium: 9 mg/dl BUN 14 mg/dl • Urine Microalbumin 50 mg/24 hours eGFR 58 mL/min • HA1C: 8.2% • Lipid Panel TC: 200 TG: 150 HDL: 50 LDL: 120 • Vitamin B12: 180 pg/mL Module 4 Case Analysis Discussion Points 1. Discuss the relationship between the pathophysiology of type 2 diabetes to specific findings in Mary’s assessment data. Consider only the abnormal signs and symptoms that could be a direct result of diabetes. Include abnormal lab values, if applicable. When discussing lab values, relate Mary’s values to normal values and discuss their significance. Include references to support your discussion. 2. Discuss Mary’s prescribed drug therapy for her diabetes in relation to drug purpose, mechanism of action, metabolism and excretion, dosage and adverse effects. You only need to address the two drugs specific to the management of her diabetes in this section. Include references to support your discussion. 3. Are Mary’s pharmacological interventions congruent with recommendations outlined in the American Diabetes Association Standards of Medical Care in Diabetes – 2019? For this section, include an analysis of all of her prescribed medications - even those prescribed for her hypertension and dyslipidemia. Specific points to include in your analysis include first-line recommendations for treatment for type 2 DM as well as first-line recommendations for the management of hypertension and dyslipidemia in patients with diabetes. Provide rationale as to why. Lastly, determine if Mary’s plan of care is congruent with those recommendations. The standards are included in your learning module. Cite references. 4. Mary has been taking the prescribed medications for 3 months prior to this visit. Review her assessment data and discuss whether treatment is proving to be effective in treating her disorders. Support your analysis with information related to what the expected response would be if treatment were effective and pull in Mary’s data to support your analysis. Lastly, determine if Mary is experiencing any side effects associated with her medication regimen. If so, identify the side effect and briefly discuss what it is, which medication is causing it and how. Include references. [Show More]

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