Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

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Introduction

The patient under consideration is Mr. LW, a 75-year-old male diagnosed with Type 2 Diabetes Mellitus (DM), primary hypertension (HT), and a recent episode of Non-ST Elevated Myocardial Infarction (MI). This case study will provide an overview of his clinical profile, diagnosis, pathophysiology of DM, prescribed medications, and a treatment plan.

Actual Diagnosis and Co-Morbidities

In our presented case study, the primary diagnosis is Type 2 Diabetes Mellitus. Primary Hypertension and Non-ST Elevated Myocardial Infarction (MI) are the Co-Morbidities Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

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The Chief Complainant and The Clinical Presentation

Mr. LW attended the family medical clinic for a checkup before undergoing surgery to remove the cataract in the left eye. It would indicate that his overall health is good, considering his age. His vitals are somewhat higher, but they still show signs of distress: a heart rate of 98 beats per minute, a blood pressure of 125 mm Hg, and a respiratory rate of 20 breaths per minute that is slightly elevated.Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

Patient History and Presentation

Mr. LW presents as a generally healthy individual, exhibiting normal ambulation, activity levels, and full orientation. It is noteworthy that he has chosen not to receive vaccinations. The patient carries a diagnosis of Type 2 Diabetes Mellitus and presents with concurrent conditions including Primary Hypertension and a recent Non-ST Elevated Myocardial Infarction.

The patient’s primary reason for seeking medical attention revolves around his desire to secure medical clearance for an upcoming cataract surgery on his left eye. Within the realm of diagnostic possibilities, consideration is given to three potential scenarios: the presence of a cataract in the left eye, the manifestation of Diabetic Retinopathy, and the likelihood of Essential Hypertension as contributory factors to his ocular health Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

Pathophysiology of Primary Diagnosis (Diabetes Mellitus)

Diabetes Mellitus is characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. In Type 2 Diabetes, there is insulin resistance and relative insulin deficiency. Insulin resistance primarily occurs in muscle, adipose tissue, and the liver, leading to decreased glucose uptake and increased hepatic glucose production (Zhang et al., 2021)Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus. This results in chronically elevated blood glucose levels, contributing to the commonly noted clinical manifestations of polyuria, polydipsia, polyphagia, and potential complications such as diabetic retinopathy.

Differential Diagnosis

Age-Related Macular Degeneration (AMD)

Age-related macular degeneration is a common eye condition in elderly individuals like Mr. LW. It can cause vision loss in the center of the visual field. Given his age and the presence of cataracts in the left eye, it is essential to consider AMD as a potential differential diagnosis alongside diabetic retinopathy.

Open-Angle Glaucoma

Open-angle glaucoma is another eye condition that can affect elderly patients. It often develops slowly and is characterized by increased intraocular pressure, leading to optic nerve damage and vision loss. It is important to rule out glaucoma as a possible contributor to Mr. LW’s ocular health.

Hypertensive Retinopathy

Hypertensive retinopathy can occur in individuals with uncontrolled hypertension, like Mr. LW. It can lead to damage to the blood vessels in the retina, affecting vision. Given his history of primary hypertension, it is crucial to consider hypertensive retinopathy as a potential diagnosis alongside diabetic retinopathy.

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Prescribed Medications

Empagliflozin 10 mg once daily

Empagliflozin’s mechanism of action involves reducing the reabsorption of glucose by the kidneys. This leads to an increase in the excretion of glucose through urine, ultimately resulting in the lowering of blood glucose levels (Sen & Heerspink, 2021). However, like many medications, this medication can bring about certain side effects. Among these are genitourinary infections, which affect the urinary and reproductive systems, as well as the possibility of experiencing volume depletion and low blood pressure (hypotension)Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus. Individualized assessments are crucial when managing empagliflozin, especially with regard to vigilant observation for indications of reduced hydration resulting from elevated glucose elimination via urination, which may affect the body’s fluid equilibrium.

Insulin 20 Units Daily

The next prescribed treatment entails the utilization of insulin. The insulin plan recommended for this individual entails using a particular type of insulin known as Insulin 70/30, which combines NPH (Neutral Protamine Hagedorn) and Regular insulin (Phillippe & Pogge, 2022)Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus. This medication works by offering a dual-action approach that is, provides both basal and prandial insulin coverage (regulating blood glucose levels consistently throughout the day). The potential side effects to be aware of include hypoglycemia, a condition where blood glucose levels drop too low, and some weight gain. Given the patient’s age, it is also crucial to take individualized considerations into account. In this case, it involves closely and regularly monitoring for hypoglycemia. This vigilant approach to managing blood sugar levels is especially important in elderly patients to ensure their safety and well-being.

Treatment Plan

As part of the recommended treatment plan, specific diagnostic assessments have been considered essential. These involve an ocular evaluation designed to assess the potential presence of certain visual issues and to establish approval for potential medical interventions (Miller et al., 2022)Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus. The justification for this examination has a dual purpose: first, to ascertain the potential need for medical intervention, and equally significant, to guarantee the patient’s well-being during any potential procedures.

Relevant laboratory assessments have been carried out. These encompass an A1C measurement resulting in a value of 7.6%, offering valuable information regarding the extended management of blood sugar levels. In conjunction with this, a fasting glucose level of 152 mg/dL has been detected in the patient (Su et al., 2019). These laboratory evaluations are vital for tracking glycemic regulation and facilitate the adaptation of therapeutic approaches as necessary to enhance the patient’s holistic well-being.

Nursing Goals

The overarching, the major long-term goal for delivering nursing care to Mr. LW revolves around managing and stabilizing the ideal management of his blood sugar levels. This plays a pivotal role in averting potential issues and fostering his general health.

Furthermore, in the immediate nursing care context, the first short-term goal encompasses educating Mr. LW about proper administration of his prescribed medications and emphasizing the significance of self-assessment for his blood sugar levels. The second short-term nursing treatment goal is to assess Mr. LW’s readiness and willingness to make necessary lifestyle modifications to manage his diabetes effectively. According to Powers et al. (2023)Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus, this includes providing education on dietary choices, exercise, and stress management, as well as collaborating with other healthcare professionals to create a personalized diabetes self-management plan tailored to his needs and preferences.

References

Miller, K. M., Oetting, T. A., Tweeten, J. P., Carter, K., Lee, B. S., Lin, S., … & Musch, D. C. (2022). Cataract in the adult eye preferred practice pattern. Ophthalmology, 129(1), P1-P126.

Phillippe, H., & Pogge, E. (2022). Part Two: Diabetes Part 2: A Review of Insulin Therapy in Older Patients. The Senior Care Pharmacist, 37(5), 181-190.

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., … & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Journal of the American Pharmacists Association, 60(6), e1-e18.

Sen, T., & Heerspink, H. J. (2021). A kidney perspective on the mechanism of action of sodium glucose co-transporter 2 inhibitors. Cell metabolism, 33(4), 732-739.

Su, W. Y., Chen, S. C., Huang, Y. T., Huang, J. C., Wu, P. Y., Hsu, W. H., & Lee, M. Y. (2019). Comparison of the effects of fasting glucose, hemoglobin A1c, and triglyceride–glucose index on cardiovascular events in type 2 diabetes mellitus. Nutrients, 11(11), 2838.

Zhang, H., Huang, Y., Chen, S., Tang, C., Wang, G., Du, J., & Jin, H. (2021). Hydrogen sulfide regulates insulin secretion and insulin resistance in diabetes mellitus, a new promising target for diabetes mellitus treatment? A review. Journal of advanced research, 27, 19-30. Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

THREADED CASE STUDY PART 1: PATIENT AND DIAGNOSIS:

• I am doing my clinicals at a family medicine clinic (outpatient clinic), it’s for MSN in education –this practicum is for specialty clinical -so please relate on this. They do not do any procedures here – fyi!

This course will include a case study of a patient of your choosing from your practicum experience that will be threaded throughout. This Threaded Case Study Assignment includes four parts—Part 1: Patient and Diagnosis, Part 2: Annotated Bibliography, Part 3: Care Plan, and Part 4: Safety and Quality of Care. You will submit each part of your Assignment throughout the course. However, you will incorporate the feedback you receive from your instructor and submit your final, revised Parts 1, 2, and 3, along with your final Part 4 in Week 10 of the course.

• To prepare: Select a patient and diagnosis in your specialty area of your practicum experience to develop your  Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

Part 1: Patient and Diagnosis-

(Mr. LW,75 yr male-Dx-Type2 Diabetes Mellitus, primary HT, Non ST elevated MI)

Vitals: height 5ft.4”, wt-280lbs, Bp-125/92, P-98, R-20

• Describe your patient and diagnosis in the specialty area for your case study. (Note: Do not include any identifiable information.) Patient History and Presentation: He is healthy looking, ambulatory, active, alert and oriented. He does not believe in vaccinations so has not had vaccinations.
• Age:75
• Diagnosis: DM
• Co-Morbidities:
• Patient presentation (clinical findings):
• History of present illness:
• Chief complaint: He came for a physical/clearance for cataract sx of left eye
• 2–3 differential diagnoses
• Pathophysiology of primary diagnosis: Describe common causes for changes on the cellular level and how these changes result in commonly noted clinical manifestations. Use the Learning Resources and/or the best available evidence from current literature to support your primary diagnosis.
• Identify two prescribed drugs for this patient that are commonly used to treat the primary disorder. For each, outline the following:( Jardiance 10 mg once daily, insulin 70/30- 20 units once daily, glipizide 5 mg bid)
• Mechanism of action
• Intended effects
• Common adverse effects/side effects
• Individualized considerations that take into account the age and condition of this patient

  Use the Learning Resources and/or the best available evidence from current literature to support your identified drug choice.

• Treatment Plan
• Relevant diagnostic studies:
• Identify at least one diagnostic test and the rationale for the order and explanation of the result.
• Identify at least two relevant laboratory tests, the rationale for the order, and the explanation for the result in this patient. A1C-7.6 Glucose- 152(fasting)
• Identify the major long-term nursing goal for treatment of this patient as well as two short-term nursing treatment goals.

  Use the Learning Resources and/or the best available evidence from current literature to support your treatment plan Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

LEARNING RESOURCES

Required Readings

• Bullard, (2019). Clinical judgement (medical profession)Links to an external site.. Salem Press Encyclopedia of Health.
• Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses’ clinical reasoning Links to an external site.. Nursing Education Perspectives, 38(2), 57–62.
• Lee, J., Lee, Y., Bae, J., & Seo, M. (2016). Registered nurses clinical skills and reasoning process: A think-aloud study Links to an external site.. Nurse Education Today, 46, 75-80
• Raterink, G. (2016). Reflective journaling for critical thinking development in advanced practice registered nurse students Links to an external site.. Journal of Nursing Education, 55(2), 101–104. https://doi.org/10.3928/01484834-20160114-08
• Vallente, R. U. (2018). Clinical reasoning. Salem Press Encyclopedia of Health Links to an external site..
• Victor-Chmil, J. (2013). Critical thinking versus clinical reasoning versus clinical judgment: Differential diagnosis Links to an external site.. Nurse Educator, 38(1), 34–36. Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

Required Media

Clinical Judgment

• In this media presentation, Dr. Pat Ebright and Dr. Mary Sitterding discuss how nurse educators use advanced knowledge on the 3Ps to improve their clinical judgment as well as the clinical judgment of those they teach. (8 m)

Credit: Provided courtesy of the Laureate International Network of Universities.

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Addressing Complexity of Nursing Practice

• In this media presentation, Dr. Pat Ebright and Dr. Mary Sitterding discuss the complexities of nursing practice. Specifically, they highlight how the principle of stacking can help both novice and experienced nurses make key workload decisions in the clinical environment. They also examine how nurse educators use advanced knowledge on the 3Ps to improve their clinical judgment as well as the clinical judgment of those they teach. (8 m)

Credit: Provided courtesy of the Laureate International Network of Universities.

https://waldenu.instructure.com/courses/84185/pages/week-3-learning-resources?module_item_id=2529451#:~:text=Required%20Media-,Clinical%20Judgment,Credit%3A%20Provided%20courtesy%20of%20the%20Laureate%20International%20Network%20of%20Universities., Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus

NURS_6341_Week4_Assignment_Part_1_Rubric

NURS_6341_Week4_Assignment_Part_1_Rubric

Case Study For Patient Diagnosed With Type 2 Diabetes Mellitus