Case Study On Hypertension And Diabetes Discussion
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Write My Essay For Me73-year-old Caucasian male with history of Hypertension, Diabetes Mellitus type 2 (managed with oral medications) Osteoarthritis in both knees and back, and Hyperlipidemia presented to your primary clinic for follow-up after being hospitalized for acute kidney injury in a local hospital about a week ago. He reports that he has been doing better but was told by the hospitalists to follow-up with his primary care provider. Today in the clinic he continues to report dark colored urine with foul smelling odor even after drinking at least eight gallons daily. He reports nocturia at least 3-4 times at night and urinary frequency. He also reports right sided flank pain that began about a week ago, but he thinks that this might be related to his Osteoarthritis. He denies any fever, chills, abdominal pain, or nausea with vomiting episode. His vital signs during the office visit are: Case Study On Hypertension And Diabetes Discussion
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Temperature 98.4, Pulse 78, BP 121/78, O2 saturations 99%
He also presented with his list of medications which included:
Naproxen 500mg BID take with food for Osteoarthritis
Amlodipine 10 mg take daily for high blood pressure
Jardiance 25mg take every morning for diabetes Mellitus
He also presented to the clinic with the last lab results taken while he was admitted in the local hospital. CBC, Urinalysis, Lactic acid results were all normal at the time of discharge. The following lab results were noted to be abnormal Case Study On Hypertension And Diabetes Discussion
CMP
BUN – 45
Creatinine- 2.14
Sodium -131
24-hour urine collection showed 200mg of protein in the urine. On the spot urinalysis was normal at the time of discharge.
Questions
As the Primary care NP seeing this patient, what other questions would you ask to elicit a good history and narrow down your differentials?
What other differentials would you consider with this patient? What is your actual diagnosis? Include subjective and objective data that made you decide that is your actual diagnosis.
What diagnostic imaging or laboratory tests would you consider with this patient?
What medications would you treat this patient with and state the reason for your choice of medications with reference? Also write out the prescription with the appropriate dosage, timing, and number of days you are prescribing the medication for?
What patient education or referral would you consider for this patient. Case Study On Hypertension And Diabetes Discussion
Additional History Questions
It is important to clarify the patient’s fluid intake to narrow down the diagnosis: “When you said that you consume eight gallons daily, are you talking about eight glasses or more?” Further, more specifics about the urinary patterns are important: “When did you first note the dark and foul-smelling urine? Has it increased?” Pain history is also important: “What flank pain do you have? Is it a sharp or a dull one? Does it get worse with movements?” Additionally, asking about past urinary infections or kidney stones provides key context: “Has the patient experienced these symptoms before?”
Differential Diagnoses
Several differential diagnoses should be considered. A urinary tract infection is highly probable due to the dark-coloured, foul-smelling urine, nocturia and flank pain. Diabetes is a condition that puts the patient at risk of infections, and the recent hospitalization might have made him more susceptible. Another differential is acute on chronic kidney disease (CKD), supported by the patient’s increased BUN and creatinine, indicating that the patient’s kidney function decline is related to hypertension and diabetes. Flank pain makes pyelonephritis, an upper urinary tract infection, possible, but the absence of fever is unusual. Flank pain may be due to nephrolithiasis (kidney stones), and drug-induced nephropathy with Naproxen may worsen his kidney injury Case Study On Hypertension And Diabetes Discussion .
Actual Diagnosis
The most likely diagnosis is pyelonephritis, caused by a urinary tract infection. The patient presented with signs and symptoms consistent with kidney infection, including dark and foul-smelling urine, nocturia, urinary frequency and flank pain. His BUN (45) and creatinine (2. 14) indicated the kidneys were affected. It is, therefore, notable that older adults do not present typical fever and chills characteristic of pyelonephritis. This makes him prone to infections, especially if he has diabetes and has been recently hospitalized.
Diagnostic Imaging and Laboratory Tests
A clean, caught midstream urine sample is required to exclude a UTI and determine the pathogen involved. A renal ultrasound would exclude kidney stones or other anatomical causes of the patient’s symptoms (Davidson, 2022) Case Study On Hypertension And Diabetes Discussion . The kidney function tests will be repeated to evaluate the kidney damage, and urine protein to creatinine ratio will also be done to assess the proteinuria. These tests are important in managing the patient since they help evaluate kidney function.
Medications
Ciprofloxacin 500 mg PO BID for seven days is given for treatment since it has been found to treat gram-negative organisms that are prevalent in UTIs and have a high concentration in the urinary tract (Xue et al., 2021). The prescription is as follows: The prescription is as follows:
Ciprofloxacin 500 mg, one tablet, must be taken twice daily for seven consecutive days. Dispense 14 tablets. No refills. Since the patient is suffering from kidney injury, Naproxen should not be used as it is toxic to the kidneys, particularly in patients with kidney problems. Other remedies, like using acetaminophen, should be used in the treatment of osteoarthritis instead of using NSAIDs.
Patient Education and Referral
Patient education should be directed on the need to take the full course of antibiotics as this will prevent reoccurrence or worsening of the infection (Lee et al., 2021). The patient should also be informed that it is optional to drink a lot of water, which is eight gallons a day; six to eight glasses a day are enough unless otherwise advised. One should look for signs of deteriorating condition, such as an increase in flank pain, fever, or change in the amount of urine produced, and consult a doctor promptly if any of these are observed. They should refer their patient to a nephrologist for further assessment and management of his renal status. Also, dietary changes, which include regulating blood pressure, blood glucose, and cholesterol, are crucial for the overall well-being of kidneys Case Study On Hypertension And Diabetes Discussion .
References
Davidson, N. J. (2022). Ultrasound of the Renal Tract. Abdominal Ultrasound E-Book: Abdominal Ultrasound E-Book, 185. https://books.google.com/books?hl=en&lr=&id=vER3EAAAQBAJ&oi=fnd&pg=PA185&dq=renal+ultrasound+would+exclude+kidney+stones+or+other+anatomical+causes+of+the+patient%E2%80%99s+symptoms&ots=NyDI8DddLt&sig=2-IYkg1OeOF4ZJFkrYPnnkTnrw8
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Lee, R. A., Centor, R. M., Humphrey, L. L., Jokela, J. A., Andrews, R., Qaseem, A., & Scientific Medical Policy Committee of the American College of Physicians*. (2021). Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians. Annals of internal medicine, 174(6), 822-827. https://www.acpjournals.org/doi/abs/10.7326/m20-7355
Xue, Z., Xiang, Y., Li, Y., & Yang, Q. (2021). A systematic review and meta-analysis of levofloxacin and ciprofloxacin in the treatment of urinary tract infection. Annals of Palliative Medicine, 10(9), 9765771-9769771. https://apm.amegroups.org/article/view/79944/html Case Study On Hypertension And Diabetes Discussion
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