Running Head: CASE STUDY 1
Case Study: Week 5
Ashley Sweeney
Chamberlain College of Nursing
NR601-10901 Primary Care of the Maturing and Aged Family
June 2019
,CASE STUDY 2
Case Study: Week 5
The purpose of this assignment is to review a case study involving the patient, Mrs. Wong, who
is a 59 year-old female of Asian descent presenting to the clinic to follow up for her prior diagnosis of
arthritis of the right knee. This extensive review includes multiple topics including primary, secondary,
and differential diagnosis, management and treatment plans of each of these diagnosis, diagnostic
testing, medication review and prescription, patient education, as well as consultations and referrals
and follow up care for the patient. In addition, we will also discuss contributing factors such as
medication cost for prescription as well as over the counter medications, possible barriers to treatment,
and will also include a clinical chart SOAP note for this patient.
Assessment
As previously stated, miss Wong is a 59 year-old Asian female who was recently diagnosed
with arthritis in her right knee. She has returned for a 3 month follow up and, though she states that she
is having less knee pain an increased mobility with the previous treatment plan, she has developed
some new symptoms which she wants to discuss today. Her concerns today include difficulty losing
weight despite weight loss attempts, increased hunger, polydipsia, and recent 4-pound weight gain. She
is also having increased fatigue over the last 2 months. Mrs. Wong is four years post menopause and
utilizes is a gym membership to exercise multiple times weekly including cardio as well as light
weightlifting. Despite her weight loss attempts she continues to have difficulty losing weight and has,
in fact, recently gained weight.
Although Mrs. Wong is returning for follow up on a previous diagnosis of arthritis in her right
knee, range of motion in both knees is within normal limits, knees are non-tender, and gate is normal.
Therefore, the previous diagnosis of right knee arthritis, other than possibly effecting any treatment
plan exercises or activities, will likely not factor into the diagnosis and differential list for this case
study review.
, CASE STUDY 3
Mrs. Wong is 5’1.5” and weighs 165 pounds which give her a body mass index (BMI) of 30.7.
This BMI indicates that Mrs. Wong is obese (Calculate Your BMI, n.d.). She is also having difficulty
losing weight despite weight loss attempts, is complaining of increased hunger and thirst, and has a
blood glucose of 127 with an HgbA1C of 6.6%. Based on these subjective and objective findings,
primary diagnosis for Mrs. Wong is Diabetes Mellitus type 2 (DM2), with secondary diagnosis of
hyperlipidemia, and differential diagnosis of vitamin D deficiency, and metabolic syndrome.
Primary Diagnosis: Diabetes Mellitus Type 2 (E11.9)
Pathophysiology: DM2 is a metabolic disorder which affects the body's ability to use insulin
properly resulting an insulin resistance and often leading to hyperglycemia (Goroll & Mulley, 2014).
Individuals with this condition have a higher risk for developing vascular and neurologic deficits,
especially if the disease is not managed, as well as multi-organ damage. Symptoms associated with
DM2 include hyperglycemia, polyurea, polydipsia, polyphagia, fatigue, weight gain, slow healing
wounds, blurred vision, and numbness or tingling in the hands/feet (Diabetes Symptoms, n.d.).
Pertinent Positives: Mrs. Wong has several pertinent positives which indicate possible DM2.
She is presenting with increased hunger and thirst, fatigue, obesity, and failure to lose weight despite
weight loss attempts. Mrs. Wong is also of Asian descent which puts her at an increased risk for
development of DM2 as this is common in people of this ethnicity (Kennedy-Malone, Plank, & Duffy,
2019). In addition, Mrs. Wong also has a fasting glucose of 127, and an HgbA1C of 6.6%. According
to the American Diabetes Association, diagnosis of DM2 may be made based on fasting glucose of
greater than 126, a random glucose of 200 or greater, and may also be indicated by HgbA1C greater
than 6.5% (2018). Mrs. Wong also has a past history of smoking, current alcohol use, and 1+ glucose
in her urine. Glycosuria is associated with DM2 but may also be caused by hyperthyroidism, liver
cirrhosis, high sugar diet, renal insufficiency, or may even be benign (Hung et al., 2016). Whatever the
cause, this reading warrants further investigation and, based on the other presenting symptoms, is most
likely due to diabetes. Although Mrs. Wong’s lab values are only slightly above the threshold for
Case Study: Week 5
Ashley Sweeney
Chamberlain College of Nursing
NR601-10901 Primary Care of the Maturing and Aged Family
June 2019
,CASE STUDY 2
Case Study: Week 5
The purpose of this assignment is to review a case study involving the patient, Mrs. Wong, who
is a 59 year-old female of Asian descent presenting to the clinic to follow up for her prior diagnosis of
arthritis of the right knee. This extensive review includes multiple topics including primary, secondary,
and differential diagnosis, management and treatment plans of each of these diagnosis, diagnostic
testing, medication review and prescription, patient education, as well as consultations and referrals
and follow up care for the patient. In addition, we will also discuss contributing factors such as
medication cost for prescription as well as over the counter medications, possible barriers to treatment,
and will also include a clinical chart SOAP note for this patient.
Assessment
As previously stated, miss Wong is a 59 year-old Asian female who was recently diagnosed
with arthritis in her right knee. She has returned for a 3 month follow up and, though she states that she
is having less knee pain an increased mobility with the previous treatment plan, she has developed
some new symptoms which she wants to discuss today. Her concerns today include difficulty losing
weight despite weight loss attempts, increased hunger, polydipsia, and recent 4-pound weight gain. She
is also having increased fatigue over the last 2 months. Mrs. Wong is four years post menopause and
utilizes is a gym membership to exercise multiple times weekly including cardio as well as light
weightlifting. Despite her weight loss attempts she continues to have difficulty losing weight and has,
in fact, recently gained weight.
Although Mrs. Wong is returning for follow up on a previous diagnosis of arthritis in her right
knee, range of motion in both knees is within normal limits, knees are non-tender, and gate is normal.
Therefore, the previous diagnosis of right knee arthritis, other than possibly effecting any treatment
plan exercises or activities, will likely not factor into the diagnosis and differential list for this case
study review.
, CASE STUDY 3
Mrs. Wong is 5’1.5” and weighs 165 pounds which give her a body mass index (BMI) of 30.7.
This BMI indicates that Mrs. Wong is obese (Calculate Your BMI, n.d.). She is also having difficulty
losing weight despite weight loss attempts, is complaining of increased hunger and thirst, and has a
blood glucose of 127 with an HgbA1C of 6.6%. Based on these subjective and objective findings,
primary diagnosis for Mrs. Wong is Diabetes Mellitus type 2 (DM2), with secondary diagnosis of
hyperlipidemia, and differential diagnosis of vitamin D deficiency, and metabolic syndrome.
Primary Diagnosis: Diabetes Mellitus Type 2 (E11.9)
Pathophysiology: DM2 is a metabolic disorder which affects the body's ability to use insulin
properly resulting an insulin resistance and often leading to hyperglycemia (Goroll & Mulley, 2014).
Individuals with this condition have a higher risk for developing vascular and neurologic deficits,
especially if the disease is not managed, as well as multi-organ damage. Symptoms associated with
DM2 include hyperglycemia, polyurea, polydipsia, polyphagia, fatigue, weight gain, slow healing
wounds, blurred vision, and numbness or tingling in the hands/feet (Diabetes Symptoms, n.d.).
Pertinent Positives: Mrs. Wong has several pertinent positives which indicate possible DM2.
She is presenting with increased hunger and thirst, fatigue, obesity, and failure to lose weight despite
weight loss attempts. Mrs. Wong is also of Asian descent which puts her at an increased risk for
development of DM2 as this is common in people of this ethnicity (Kennedy-Malone, Plank, & Duffy,
2019). In addition, Mrs. Wong also has a fasting glucose of 127, and an HgbA1C of 6.6%. According
to the American Diabetes Association, diagnosis of DM2 may be made based on fasting glucose of
greater than 126, a random glucose of 200 or greater, and may also be indicated by HgbA1C greater
than 6.5% (2018). Mrs. Wong also has a past history of smoking, current alcohol use, and 1+ glucose
in her urine. Glycosuria is associated with DM2 but may also be caused by hyperthyroidism, liver
cirrhosis, high sugar diet, renal insufficiency, or may even be benign (Hung et al., 2016). Whatever the
cause, this reading warrants further investigation and, based on the other presenting symptoms, is most
likely due to diabetes. Although Mrs. Wong’s lab values are only slightly above the threshold for
