Exam (elaborations) NR 601 Week 5 Case Study Diabetes Care

Mrs. G Case Study The purpose of this case study is to interpret subjective and objective information in order to diagnose disease processes and develop a plan of care for the patient based on national, evidence-based clinical guidelines. Assessment After reviewing Mrs. G’s symptoms and evaluating her blood work, a few issues have been identified. Some of these issues need to be addressed right away, such as an elevated hemoglobin A1c (HgbA1c), obesity, and the abnormal lipid panel. Some of the identified issues are either a cause of or a result of the elevated HgbA1c and lipids, such as her being obese, her borderline hypertension, and her decreased GFR. There are other possible disease processes at play here based on her lab work, such as possible metabolic syndrome, pre-hypertension versus stage 1 hypertension, and her decreased free T4. These issues will be used as differential diagnoses; however, further lab work will be needed to be certain. Primary Diagnosis Mrs. G’s primary diagnosis is type 2 diabetes mellitus (T2D) (E11). T2D is a metabolic disease that is caused by deficiencies in the action of insulin, the secretion of insulin or from both; specifically, T2D is directly related to insulin resistance (Pippitt & Li, 2016). The signs and symptoms NR 601 Week 5 Case Study Diabetes Care one may see that are associated with diabetes mellitus, type 1 and 2, include fatigue, polyphagia, polydipsia, polyuria, wounds that do not heal, fluctuation in weight, blurry vision, proteinuria, a pins and needles sensation in the lower extremities, poor wound healing, nausea, delayed gastric emptying, impotence, and frequent yeast infections in women. (Kennedy- Malone, Fletcher, & Plank, 2014; Pippitt & Li, 2016) Mrs. G’s pertinent positive physical findings include fatigue, obesity based on a BMI of 35.7, excessive hunger and thirst, and polyuria. Mrs. G’s pertinent negative physical findings include no complaints of poorly healing wounds, blurry vision, pins and needles sensation, nausea, frequent yeast infections, or delayed gastric emptying. Mrs. G’s pertinent lab value findings include a hemoglobin A1c (HgbA1c) of 7.6%, a GFR of 88 mL/min/1.73L, and a urinalysis that is positive for glucose and protein. The HgbA1c expresses the percent of hemoglobin that is bound to glucose in the body over a 60 to 90 day period; it is part of the criteria needed for the diagnosis of diabetes (Cornelius, 2016). The provider wants their patient’s HgbA1c to be less than or equal to 6.5% and can base treatment plans on this result as long there is no debate of accuracy between levels of HgbA1c and serum blood glucose (ADA, 2017; Garber et al., 2017). The provider would notice Mrs. G’s GFR is decreased and would monitor this closely because diabetes