NRNP 6540F Advanced Practice Care of Older Adults

Hypoglycemia in Older Adults Hypoglycemia can cause significant effects to older patients. Low blood sugar resulting from the use of hypoglycemic agents in managing diabetes is a worrisome complication and contributes to mortality and morbidity in geriatric diabetic patients. Aging also changes the cognitive, symptomatic, and counter-regulatory hormonal responses to low blood sugar ( MartinTimon & Del Canizo-Gomez, 2015). Due to the effects mentioned, it is important for nurse practitioners to ensure that they provide good assessment and care plan for the older adults with metabolic disorders that they will treat in their practice. The goal of this paper is to present a subjective, objective, assessment, and plan (SOAP) for an elderly female patient with a presenting symptom of low fasting blood sugar. The author also aims to discuss the differential diagnoses for this case and their associated treatments and teachings. The paper also aims to reflect on the learnings identified while reviewing the case study. SOAP Note Subjective Patient Information: Ms. L. 63-year-old, Female, Hispanic Chief Complaint: Ms. L comes in complaining a low fasting blood sugar in the morning for the last few weeks. 3 History of Present Illness: Ms. L is a 63-year-old Hispanic female who comes to the clinic complaining of a low fasting blood sugar in the morning. The low fasting blood sugar is as low as 50mg/dl in the morning for the last few weeks. Ms. L is a known diabetic and also has history of hypertension, hyperlipidemia, and chronic osteoarthritis. Ms. L also reports high blood pressures. Today’s blood pressure upon arrival to the clinic is 165/90. No other symptoms were reported. Current Medications: Women’s One A Day Multivitamin daily Chlorthalidone 25 mg daily Fish Oil 1 tablet daily Amlodipine 5mg PO daily Atorvastatin 40 mg PO at bedtime daily Novolog 10 units with meals TID Aspirin 81mg PO daily Lantus 25 units subcutaneous nightly Ergocalciferol 50,000 units PO once a month The Beers criteria recommends Aspirin to be used with caution for the primary prevention of cardiac events (Terrery & Nicoteri, 2016). The warning is primarily due to the 4 emerging evidence of increased risk of bleeding at an earlier age. The patient is also taking Atorvastatin, which is a statin. Statins are not listed as potentially inappropriate for geriatrics patients but there are concerns with its use in older patients, although there is no published evidence to support this claim (Barry, 2017). Ms. L is also currently taking Novolog, a shortacting insulin. Notice that the dosage of her insulin is fixed at 10 units with meals. The dosage is in compliance with the Beers criteria guidelines in avoiding the use of sliding-scale for rapid acting insulin due to the risk of hypoglycemia without the benefit of improvement in managing hyperglycemia (Terrery & Nicoteri, 2016). Allergies: Penicillin Lisinopril Past Medical History: Hypertension Hyperlipidemia Diabetes Mellitus Chronic Osteoarthritis Immunization status unknown Unknown last visit to the primary care physician Social and Substance History: 5 Unknown tobacco, alcohol, and drug use Unknown level of activity Family History: Family history unknown Surgical History: No surgical history reported Review of Systems: • General: Denies fever, chills or night sweats. Denies weakness, fatigue, weight loss or weight gain. • Head: Denies headache. Denies trauma. • Eyes: Denies eye pain, photophobia, diplopia, spots or floaters, discharge, itching, cataracts or glaucoma. • Ears, Nose, Mouth/Throat (ENT): Denies changes in or loss of hearing. Denies ear pain, tinnitus, ear drainage, history of frequent ear infections. Denies changes in or loss of sense of smell, nose bleed, polyps, rhinorrhea, itching, sneezing, and sinus problems. Denies ulcerations or lesions in tongue, bleeding gums, gingivitis, dentures or dental appliances. • Respiratory: Denies shortness of breath, cough, coughing up blood, mucus, wheezing, or