Nr 601 Week 5 Case Study

Week5: Mrs. W Case Study Amie Seitz Chamberlain College of Nursing NR 601: Primary Care of the Maturing and Aged Family Practicum March 2019 Week5: Mrs. W Case Study The following case study will follow Mrs. W, a 59-year old Asian female who is coming into the office for a three-month follow-up of right knee arthritis. During the visit, she reports new complaints that for the past three months she has experienced fatigue and weight gain. Since the last visit, she has gained 4lbs, and she reports that she has had steady weight gain for four years, despite reporting regular exercise that includes walking 30 minutes a day at least twice a week and weight lifting. She noticed the weight gain after since menopause four years ago. This patient has an increased body mass index (BMI) of 30.7, based off a height of 5’1.5’’ and weight of 165lbs, otherwise she has unremarkable vital signs. The physical exam was routine, except corrective vision through the use of contact lenses. Upon review of this morning’s fasting labs, the fasting plasma glucose of 127, hemoglobin A1C of 6.6%, and lipid panel with an LDL of 144, triglycerides 229 were abnormal. Otherwise, all other lab work was in the normal range. She also left a urine sample for urinalysis that came back normal, except for 1+ glucose. This paper will review the subjective interview and objective examination of Mrs. W. to provide an appropriate assessment and plan for the primary diagnosis, the secondary diagnosis, and the differential diagnoses that will include: diagnostics needed, medications, education materials, potential beneficial referrals, and essential follow-up care. Furthermore, an evaluation of the cost of the planned prescribed and over-the-counter (OTC) medications will help to maintain compliance with planned care. Assessment Primary Diagnosis Diabetes Mellitus Type 2(DM2) (E11.9) Pathophysiology Type II, often referred to as adult-onset diabetes, can be the cause of both genetic and environmental factors as it comes from a lack of insulin production from the pancreas or from the bodies inability to properly use insulin to move glucose into the cells (American Diabetes Association, 2017). The increase in free glucose will cause signs and symptoms such as fatigue, excessive thirst, and frequent urination (Dunphy et al., 2015). Pertinent positive findings The national guidelines state that a Hgb A1C greater than 6.5 is indicative of diabetes; Mrs. W. has a Hgb A1C of 6.6 along with a urine analysis that showed glucose in her urine that indicates diabetes (American Diabetes Association, 2018). Other positive findings are the patient's report of excessive thirst, frequent day and nighttime urination, fatigue, and hunger. Pertinent negative findings Mrs. W does not exhibit a sedentary lifestyle that is typically consistent with DM2 as she reports walking twice a week for 30 minutes along with light weight lifting (Dunphy et al., 2015). Additionally, there is no known family history of diabetes. Rationale for the diagnosis Subjective findings reported by Mrs. W. are fatigue lasting for 12-weeks, a 4 lbs weight gain, excessive thirst, increase in hunger, and frequent urination. Objective results consistent with type 2 diabetes are fasting plasma glucose, FPG, of 127, an A1C of 6.6%, and a BMI of 30.7. This diagnosis is the bases of many of her symptoms and relevant lab results. Current guidelines state a diagnosis of diabetes is sufficient for a person of Asian descent with a BMI greater than or equal to 23, FPG is larger than or equal to 126 mg/dL, and an A1C greater than or equal to 6.5% (American Diabetes Association, 2018). Secondary Diagnosis Hyperlipidemia (E78.5) Pathophysiology A complex metabolic disorder, hyperlipidemia is caused by genetics as well as lifestyle choices that leads to a build-up of cholesterol and low-density lipoproteins (LDL) along the vessels causing an inflammatory process causing either a partial or full occlusion of blood flow (Hendrani et al., 2016). Often hyperlipidemia is asymptomatic, however pertinent risk factors such as cardiac disease, diabetes, obesity, vascular disease, history of stroke, chest pain, xanthomas, arcus senilis, and elevated LDL labs can signify this condition (Hendrani et al., 2016).