Week 5 Case Study: Mrs. R. Rea A. Colby Chamberlain University NR 601: Primary Care of the
Maturing and Aged Family July 2018
WEEK 5 CASE STUDY 2 Week 5 Case Study: Mrs. R. The case study scenario introduced the
class to Mrs. R., a 56-year old Hispanic female who reported to the office clinic with complaints
of extreme fatigue and experiencing a gradual weight gain. The onset of her symptoms started
three months ago. She exercises twice a week by walking on the treadmill for 30 minutes in an
attempt to lose weight but has been unsuccessful. The intention of this paper is to examine the
analysis of the subjective and objective findings that was collected to diagnose and create a
management plan for Mrs. R. In addition, the application of national diabetes guidelines will be
included into the patient’s management plan. This paper will also discuss the assessment of the
primary, the secondary, and the differential diagnoses for Mrs. R., as well as the management
plan for treatment of the primary, the secondary, and the differential diagnoses, which consists of
diagnostics, medications, education, referrals, and follow-up care. This paper also includes a
discussion on medication costs of all prescribed and over-the-counter (OTC) medications.
Assessment According to the information provided by Mrs. R., she has symptoms of major
concerns, which includes extreme fatigue, the inability to lose weight regardless of her attempts
to exercise, her increase in thirst, hunger, and urination. Per the Center for Disease Control and
Prevention BMI calculator (CDC) (2015), her calculated BMI of 29.7 showed that she is
overweight for her given height. The result from her urine analysis showed glucose and small
concentration of protein. Her HgbA1C is 6.9% and her fasting glucose is 126 mg/dL, which
according to the American Diabetes Association (ADA) (2018), she meets the conditions for the
diagnosis of diabetes. Mrs. R’s CBC values, TSH and Free T4 levels were unremarkable, which
WEEK 5 CASE STUDY 3 ruled out hypothyroidism and anemia. Her lipid panel results revealed
she has hyperlipidemia. Her elevated cholesterol places her at risk for a stroke and
cardiovascular disease (AACE, 2017). Primary diagnosis Diabetes Mellitus Type 2 (DM2)
(E11.9). Type 2 diabetes or DM2 is referred to as adult-onset diabetes and is indicated by
hyperglycemia, insulin deficiency, insulin resistance that can lead to the development of vascular
and neurologic complications (American Diabetes Association [ADA], 2018). According to
Goroll (2014), there is an insufficient amount of insulin being excreted by the pancreas to meet
the metabolic needs of the body causing hyperglycemia. Goroll (2014) also states that the disease
is more apparent later in life in most cases, with fatigue as the leading sign. Manifestations of
DM2 consist of polyuria, polydipsia, polyphagia, and weight gain (Goroll, 2014). Some pertinent
positives include: extreme thirst (polydipsia), extreme hunger (polyphagia), frequent urination
during the day (polyuria), extreme fatigue, difficulty losing weight regardless of exercise,
obesity, her age, and Hispanic ethnicity.
Introduction The purpose of this paper is to examine the subjective and objective information
using the national diabetes guidelines to diagnose and formulate a management plan for a case
study patient.
Week 5 Case Study 2 Assessment Primary Diagnosis: Type 2 Diabetes Mellitus (ICD- 10 E11). I
chose DM type 2 as my primary diagnosis based on the American Diabetes Association’s
Guidelines (ADA). DM2 is a decline in insulin secretion because of impaired B-cell function
(ADA, 2018) a diagnosis of diabetes can be made contingent on s criterion of the fasting glucose,
the 2-h plasma glucose value in a glucose tolerance test or an A1C criteria (ADA, 2018). My
, patient’s fasting blood glucose of 126 (H) and her Hgb A1C of 6.9 (H), confirmed the diagnosis
because they are two definitive values that are over the threshold (ADA, 2018). My reason for
selecting DM2 also included the patient’s signs and symptoms, risk factors such as her age (56),
ethnic background (Hispanic) and she previously delivered a nine-pound two-ounce baby which
is indicative of gestational diabetes. Diabetes signs and symptoms include fatigue, frequent
urination, blurred vision, feeling hungry, pain and tinging in hands and feet as well wounds and
cuts that heal slowly (ADA, 2018). Those living a sedentary lifestyle, older age, obesity women
previously diagnosed with gestational diabetes, Hispanics and blacks and those with high
cholesterol and hypertension are all at a higher risk for type 2 diabetes (ADA, 2018). Mrs. R has
been experiencing fatigue, weight gain, hung and thirst and frequent urination, she is overweight
with a BMI of 29.7 which places her in the overweight category. Many individuals with non-
insulin dependent diabetes are overweight and extra weight effects insulin resistance
(ADA,2018). This patients abnormal lab values are as follows a blood glucose of 126(H), Hgb
A1C 6.9 (H), LDL 144 (H), HDL 38 (L), Triglycerides 232(H) , and a
Week 5 Case Study 3 small amount of protein in her urine with 1+ glucose , warrants further
investigation into her health need. Plan Diagnostics I am going to order a Hgb A1C for the DM2
diagnoses. Hgb A1C is a test that measures an individual’s blood glucose level for 3 months it is
a measure of glycemia average (ADA, 2018). This test is also a prediction of value and detects
glycemic targets (A1C is most effective when used along with CGM), (ADA, 2018). My
patient’s A1C is 6.9 (H), individuals not previously diagnosed with DM with an A1C greater than
5.7, an abnormal glucose tolerance and an abnormal fasting glucose are ideal for diabetes
prevention (ADA, 2018). This test should be obtained on the first visit and should continue
throughout treatment (ADA, 2018). American Diabetes Association (ADA) Guidelines
recommend that A1C levels be obtain every three Months until optimal levels have been reached
or sustained (ADA, 2018). Results of the Hgb A1C will provide me with the opportunity to treat
as indicated. Glycemic targets vary depending on patient’s specific needs (ADA, 2018).
Weekk 5 Case Study The purpose of this case study is to present Mrs. R., a 56- year old Hispanic
female, follow up visit in the clinic with the chief complaint of fatigue and weight gain. The
onset of Mrs. R’s symptoms began three months ago. She reports going to the gym and
exercising twice a week, at the gym she walks on the treadmill for 30 minutes in the effort of
losing weight in which she has not lost any weight. The purpose of this case study is the analysis
of objective and subjective findings in order to diagnose and construct a plan of management of
Mrs. R’s chief complaint. To include the National Diabetes Guidelines which will be applied to
the patient’s management plan. This paper will comprise of primary diagnosis, secondary
diagnosis and differential diagnosis for Mrs. R, along with a plan for management and treatment
of the primary diagnosis, secondary diagnosis, and the differential diagnosis. Involving
diagnostics, medications, education, referrals and follow-up care. Furthermore, this paper will
include the discussion of medication cost of all prescribed and ( OTC) over- the- counter
medications. Assessment The following information provided by Mrs. R., reports does not
understand why she has weight gain despite working out twice a week on the treadmill for 30
minutes each time, fatigue, increased thirst, hunger, and urination. She is 5’2.5, and 165 pounds
according to the Center for Disease Control and Prevention BMI calculator (CDC) (2015), Mrs.
R’s BMI is 29.7indicating she is overweight for her height of 5’2.5. The outcome of her
urinalysis indicated 1+ glucose and a small amount of protein. Fasting glucose 126 mg/dl and
Maturing and Aged Family July 2018
WEEK 5 CASE STUDY 2 Week 5 Case Study: Mrs. R. The case study scenario introduced the
class to Mrs. R., a 56-year old Hispanic female who reported to the office clinic with complaints
of extreme fatigue and experiencing a gradual weight gain. The onset of her symptoms started
three months ago. She exercises twice a week by walking on the treadmill for 30 minutes in an
attempt to lose weight but has been unsuccessful. The intention of this paper is to examine the
analysis of the subjective and objective findings that was collected to diagnose and create a
management plan for Mrs. R. In addition, the application of national diabetes guidelines will be
included into the patient’s management plan. This paper will also discuss the assessment of the
primary, the secondary, and the differential diagnoses for Mrs. R., as well as the management
plan for treatment of the primary, the secondary, and the differential diagnoses, which consists of
diagnostics, medications, education, referrals, and follow-up care. This paper also includes a
discussion on medication costs of all prescribed and over-the-counter (OTC) medications.
Assessment According to the information provided by Mrs. R., she has symptoms of major
concerns, which includes extreme fatigue, the inability to lose weight regardless of her attempts
to exercise, her increase in thirst, hunger, and urination. Per the Center for Disease Control and
Prevention BMI calculator (CDC) (2015), her calculated BMI of 29.7 showed that she is
overweight for her given height. The result from her urine analysis showed glucose and small
concentration of protein. Her HgbA1C is 6.9% and her fasting glucose is 126 mg/dL, which
according to the American Diabetes Association (ADA) (2018), she meets the conditions for the
diagnosis of diabetes. Mrs. R’s CBC values, TSH and Free T4 levels were unremarkable, which
WEEK 5 CASE STUDY 3 ruled out hypothyroidism and anemia. Her lipid panel results revealed
she has hyperlipidemia. Her elevated cholesterol places her at risk for a stroke and
cardiovascular disease (AACE, 2017). Primary diagnosis Diabetes Mellitus Type 2 (DM2)
(E11.9). Type 2 diabetes or DM2 is referred to as adult-onset diabetes and is indicated by
hyperglycemia, insulin deficiency, insulin resistance that can lead to the development of vascular
and neurologic complications (American Diabetes Association [ADA], 2018). According to
Goroll (2014), there is an insufficient amount of insulin being excreted by the pancreas to meet
the metabolic needs of the body causing hyperglycemia. Goroll (2014) also states that the disease
is more apparent later in life in most cases, with fatigue as the leading sign. Manifestations of
DM2 consist of polyuria, polydipsia, polyphagia, and weight gain (Goroll, 2014). Some pertinent
positives include: extreme thirst (polydipsia), extreme hunger (polyphagia), frequent urination
during the day (polyuria), extreme fatigue, difficulty losing weight regardless of exercise,
obesity, her age, and Hispanic ethnicity.
Introduction The purpose of this paper is to examine the subjective and objective information
using the national diabetes guidelines to diagnose and formulate a management plan for a case
study patient.
Week 5 Case Study 2 Assessment Primary Diagnosis: Type 2 Diabetes Mellitus (ICD- 10 E11). I
chose DM type 2 as my primary diagnosis based on the American Diabetes Association’s
Guidelines (ADA). DM2 is a decline in insulin secretion because of impaired B-cell function
(ADA, 2018) a diagnosis of diabetes can be made contingent on s criterion of the fasting glucose,
the 2-h plasma glucose value in a glucose tolerance test or an A1C criteria (ADA, 2018). My
, patient’s fasting blood glucose of 126 (H) and her Hgb A1C of 6.9 (H), confirmed the diagnosis
because they are two definitive values that are over the threshold (ADA, 2018). My reason for
selecting DM2 also included the patient’s signs and symptoms, risk factors such as her age (56),
ethnic background (Hispanic) and she previously delivered a nine-pound two-ounce baby which
is indicative of gestational diabetes. Diabetes signs and symptoms include fatigue, frequent
urination, blurred vision, feeling hungry, pain and tinging in hands and feet as well wounds and
cuts that heal slowly (ADA, 2018). Those living a sedentary lifestyle, older age, obesity women
previously diagnosed with gestational diabetes, Hispanics and blacks and those with high
cholesterol and hypertension are all at a higher risk for type 2 diabetes (ADA, 2018). Mrs. R has
been experiencing fatigue, weight gain, hung and thirst and frequent urination, she is overweight
with a BMI of 29.7 which places her in the overweight category. Many individuals with non-
insulin dependent diabetes are overweight and extra weight effects insulin resistance
(ADA,2018). This patients abnormal lab values are as follows a blood glucose of 126(H), Hgb
A1C 6.9 (H), LDL 144 (H), HDL 38 (L), Triglycerides 232(H) , and a
Week 5 Case Study 3 small amount of protein in her urine with 1+ glucose , warrants further
investigation into her health need. Plan Diagnostics I am going to order a Hgb A1C for the DM2
diagnoses. Hgb A1C is a test that measures an individual’s blood glucose level for 3 months it is
a measure of glycemia average (ADA, 2018). This test is also a prediction of value and detects
glycemic targets (A1C is most effective when used along with CGM), (ADA, 2018). My
patient’s A1C is 6.9 (H), individuals not previously diagnosed with DM with an A1C greater than
5.7, an abnormal glucose tolerance and an abnormal fasting glucose are ideal for diabetes
prevention (ADA, 2018). This test should be obtained on the first visit and should continue
throughout treatment (ADA, 2018). American Diabetes Association (ADA) Guidelines
recommend that A1C levels be obtain every three Months until optimal levels have been reached
or sustained (ADA, 2018). Results of the Hgb A1C will provide me with the opportunity to treat
as indicated. Glycemic targets vary depending on patient’s specific needs (ADA, 2018).
Weekk 5 Case Study The purpose of this case study is to present Mrs. R., a 56- year old Hispanic
female, follow up visit in the clinic with the chief complaint of fatigue and weight gain. The
onset of Mrs. R’s symptoms began three months ago. She reports going to the gym and
exercising twice a week, at the gym she walks on the treadmill for 30 minutes in the effort of
losing weight in which she has not lost any weight. The purpose of this case study is the analysis
of objective and subjective findings in order to diagnose and construct a plan of management of
Mrs. R’s chief complaint. To include the National Diabetes Guidelines which will be applied to
the patient’s management plan. This paper will comprise of primary diagnosis, secondary
diagnosis and differential diagnosis for Mrs. R, along with a plan for management and treatment
of the primary diagnosis, secondary diagnosis, and the differential diagnosis. Involving
diagnostics, medications, education, referrals and follow-up care. Furthermore, this paper will
include the discussion of medication cost of all prescribed and ( OTC) over- the- counter
medications. Assessment The following information provided by Mrs. R., reports does not
understand why she has weight gain despite working out twice a week on the treadmill for 30
minutes each time, fatigue, increased thirst, hunger, and urination. She is 5’2.5, and 165 pounds
according to the Center for Disease Control and Prevention BMI calculator (CDC) (2015), Mrs.
R’s BMI is 29.7indicating she is overweight for her height of 5’2.5. The outcome of her
urinalysis indicated 1+ glucose and a small amount of protein. Fasting glucose 126 mg/dl and
