Z Diabetes case stydy- case studies for Med/surge -1
Diabetes Mellitus Patient Profile
T.A., a 45-year-old Hispanic man, presented to the emergency department with shortness of breath, fever, and a cough
that has lasted several days. T.A. is being admitted to the medical unit for treatment of pneumonia. He has a history of
hypertension and type 2 diabetes mellitus (T2DM). He has been taking the following medications:
Metformin 500 mg PO BID; last dose last night
Lisinopril 20 mg PO daily; last dose yesterday morning
Subjective Data
Reports that home glucose results have been “higher than normal”
Smokes one pack of cigarettes a day
Has sharp pain in the right lower chest upon inspiration. Rates pain as a 6 on a scale of 1 to 10
Objective Data
Physical Examination
Temperature 101.4˚F, pulse 108, respirations 26, blood pressure 150/92
Oxygen saturation 91% on room air
Awake and alert, oriented x 4
Body mass index (BMI) 33 kg/m2 with waist circumference 44 inches
Respirations symmetrical, slightly labored on any exertion, coarse crackles right lower lobes
Cough productive of thick yellow sputum
Diagnostic Studies
Lab values
Glucose 388 mg/dL
Hemoglobin A1C 7.9%
Chest radiography: infiltrates right lower lobe
Interprofessional Care
IV of 5% dextrose in 0.45% sodium chloride at 75 mL/hr
Oxygen at 2 L per nasal cannula
Regular Insulin subcutaneously per sliding scale four times a day
Levofloxacin 750 mg IV daily
Albuterol 2.5 mg nebulizer treatment every 6 hours
Discussion Questions
1. Describe the factors placing T.A. at an increased risk of infection.
One of the things about T.A. that puts him at risk for infection is his excessive glucose
level. Infection and poor recovery can result from high blood glucose. Additionally,
smoking might cause poor wound healing.
2. What further assessment do you need to perform?
In order to determine his serum creatinine and BUN levels as well as his electrolyte
values, we will also want to obtain a CMP. It is also possible to perform a urinalysis,
regular nuero checks, skin assessment and examine his feet for any injuries or
breakdowns.
3. What are priority interventions in caring for T.A.?
One of the first priorities will be giving him some insulin to bring down his blood sugar. In
Diabetes Mellitus Patient Profile
T.A., a 45-year-old Hispanic man, presented to the emergency department with shortness of breath, fever, and a cough
that has lasted several days. T.A. is being admitted to the medical unit for treatment of pneumonia. He has a history of
hypertension and type 2 diabetes mellitus (T2DM). He has been taking the following medications:
Metformin 500 mg PO BID; last dose last night
Lisinopril 20 mg PO daily; last dose yesterday morning
Subjective Data
Reports that home glucose results have been “higher than normal”
Smokes one pack of cigarettes a day
Has sharp pain in the right lower chest upon inspiration. Rates pain as a 6 on a scale of 1 to 10
Objective Data
Physical Examination
Temperature 101.4˚F, pulse 108, respirations 26, blood pressure 150/92
Oxygen saturation 91% on room air
Awake and alert, oriented x 4
Body mass index (BMI) 33 kg/m2 with waist circumference 44 inches
Respirations symmetrical, slightly labored on any exertion, coarse crackles right lower lobes
Cough productive of thick yellow sputum
Diagnostic Studies
Lab values
Glucose 388 mg/dL
Hemoglobin A1C 7.9%
Chest radiography: infiltrates right lower lobe
Interprofessional Care
IV of 5% dextrose in 0.45% sodium chloride at 75 mL/hr
Oxygen at 2 L per nasal cannula
Regular Insulin subcutaneously per sliding scale four times a day
Levofloxacin 750 mg IV daily
Albuterol 2.5 mg nebulizer treatment every 6 hours
Discussion Questions
1. Describe the factors placing T.A. at an increased risk of infection.
One of the things about T.A. that puts him at risk for infection is his excessive glucose
level. Infection and poor recovery can result from high blood glucose. Additionally,
smoking might cause poor wound healing.
2. What further assessment do you need to perform?
In order to determine his serum creatinine and BUN levels as well as his electrolyte
values, we will also want to obtain a CMP. It is also possible to perform a urinalysis,
regular nuero checks, skin assessment and examine his feet for any injuries or
breakdowns.
3. What are priority interventions in caring for T.A.?
One of the first priorities will be giving him some insulin to bring down his blood sugar. In
