Diabetes case study

The paper will endeavor to analyze various nursing treatment interventions such as medical treatment, referrals, health education among others. The paper will also summarize the patient's data in a subjective Objective assessment and plan (SOAP) note for the patient. Assessment The primary diagnosis of Mrs. G is diabetes type 2 (ICD-10-CM E11. Diabetes mellitus type 2 results from either, insulin insensitivity by the body tissues which reduces the uptake of insulin in the body tissues which results in increased accumulation of insulin in the blood (hyperglycemia) or poor production of insulin production by the beta cells of the pancreases which leads to reduced regulation of blood glucose uptake, conversion for storage and regulation of gluconeogenesis leading to hyperglycemia (Lee & Halter, 2017). The condition develops gradually and can be exacerbated by weight bearing, age among others.

The patient presents with pain on the knee for which she takes Tylenol. Knee pain is a positive indicator for osteoarthritis of the knee considering the patient’s age and weight (Nazari, 2017). The rationale for choosing this as the secondary diagnosis is that the diagnosis is occurring as a comorbidity to the main diagnosis for which the patient reported to the clinic. Differential diagnosis Type 1 diabetes (ICD-10-CM E10). The symptoms observed in the patient such as high urine output and increased thirst are possible indicators of diabetes insipidus (Malve et al. Negative guide for the ruling out of diabetes insipidus includes the occurrence of glycosuria in the patient and patient assessment findings of high cholesterol, LDL, and triglycerides with obesity which are more indicative of diabetes mellitus.

Diagnostics To establish a definitive diagnosis of diabetes, I will order the following diagnostic tests: A glycated hemoglobin test (A1C test); the A1C test is a test that provides an indication of the amount of glucose in the hemoglobin. It is a good indicator of the amount of glucose in the blood for the past three months hence providing a reasonable basis for the management of the patients. An A1C level above 6. A random blood glucose test of 200mg/l or 11. 1mmol/L accompanied by other positive signs of diabetes is indicative of diabetes mellitus. Fasting blood glucose test is done after fasting for over 12 hours. A test result of 125 mmol/l or more in two separate occasions is indicative of diabetes and management should be commenced immediately.

Oral blood glucose tolerance is tested two hours following an intake of high sugar diet if the test on separate occasion is above 200mmol/l the test is indicative of diabetes. In managing Mrs. G I will order medications that will aim at managing not only diabetes but also the secondary diagnosis of knee arthritis to ensure a holistic approach to care. The ADA guidelines for the management of diabetes mellitus can constitute of monotherapy management with metformin once daily dosage more so for initiation therapy in patients with A1C levels below 10%. In patients where the A1C level exceeds 10% insulin is preferred to lower the blood glucose levels (ADA, 2017). Dual therapy is also prescribed for patients where prescription of two hypo-glycemic medications are prescribed and a triple therapy in some patients with poorly managed diabetes (ADA, 2017).

Refill once. Take up to 4g dosage per day. Nurse’s name: Rocchio FPN; license Number: XXX342 Signature………………………………………………. Tylenol is a medication that relieves pain. The Osteoarthritis Research Society International (OARSI) guidelines for management of knee arthritis recommend up to 4 g of Tylenol as first-line management for knee osteoarthritis (McAlindon et al. A combination of fibrates, niacin and a n-3 fatty acid is indicated as a recommended management for the management of hypertriglyceridemia (Shrikrishna, Wong, Maw, Tahir & Choudry, 2016). The combination therapy is used as it produces higher reductions in the triglyceride levels in patients. Patient education Patient education is critical in managing patients newly diagnosed with diabetes as it helps them to understand the disease, its management plan, and prognosis. This understanding is key to ensuring that the patients participate in their own care and have a positive experience of the care.

I will educate her on diabetes, its cause and comorbidities such as hyperglyceridemia and the management both medical and nonmedical approaches (Zullig et al. Her dietary intake ought to be a balanced diet with a recommended intake of leafy vegetables, legumes, low salt and sugar contents in food. She should incorporate her diet, exercise, and medications as a holistic approach to managing her blood glucose levels. Warning signs education in diabetes for Mrs. G I will educate her to take precautions and keenly observe for any signs of deterioration in eyesight (retinopathy) or kidney functions. She also should be keen on the shoes she wears to avoid any injuries and ulcerations of the feet which may lead to diabetic foot and slowed healing of wounds (ADA, 2017).

The follow-up visit will aim at assessing her medication, dietary and exercise adherence as well as checking her self-blood monitoring. The visit will also address any psychosocial issues arising following the diagnosis of diabetes. Medication costs Metformin (generic) 500 mg cost for 30 tablets $ 2. Metformin (brand) 500mg cost $ 34. 28 from Kroger pharmacy. In my future practice, I will use the pricing resources to estimate the costs of patient prescriptions so as to identify and establish the most affordable prices for the patients. SOAP NOTE Patient Information: Initials: Mrs. G Age: 52 Sex: Female Race: White Insurance: Unknown. SUBJECTIVE CC (chief complaint): The client states “she thinks her bladder has fallen", "she cannot lose much weight" and HPI: (History of presenting illness) Onset: The polyuria and polydipsia started a year ago.

Location: Pain in the knee joint Duration: unspecified, since last year after menopause. She denies smoking or any illicit drug use. She denies using the mobile phone when driving and always uses safety belts when driving. Family History She the only child in her family, her parents are alive and well. Her child is alive n well There is no history of chronic illness in the family. Vital signs: BP 130/82; pulse 80, regular; respiration 20, regular Height 5’2”, weight 195 pounds.   SKIN:  Denies tenderness, lesions, nodules, skin dryness, loss of sensation or scaliness of the skin. CARDIOVASCULAR:  Denies any chest pain or pressure. Denies having any palpations or swellings of extremities. Reports normal heart rate and rhythm. RESPIRATORY:  Denies any dyspnea or a cough.   HEENT: Head- Inspection, the head is normal cephalic, thick hair well distributed on the head with no hair loss.

Palpation hair is soft in texture, areas of tenderness not noted, no scaliness of the scalp, facial muscle tone is good with adequate facial expression. Eyes: Patient wears contacts, color vision test on Ichihara good, Eyes equal and symmetrical eyebrows thick with no lesions, no inversion of the eye rashes noted, no swellings or protrusion of the eyeballs. Pupils equal, reactive to light, and equally accommodative, sclera white, lens clear. Ears: The auricle tragus and external ear have non-tender, otoscope examination of internal ear reveals a normal grey tympanic membrane with no perforations, inflammation, no cerumen noted in the internal ear. Heart sounds S1 and S2 are clearly heard, no murmurs or additional heart sounds heard. No edema noted on the extremities.

RESPIRATORY:  Respiratory rate noted as 20 regular breaths per minute, Chest movements on breathing are symmetrical, no retraction of the chest. Auscultation of breath sounds reveals no adventitious breath sounds. GASTROINTESTINAL:   No abdominal distension or tenderness, bowel sounds present. Patient has good insight and has a sharp short and long-term memory. ENDOCRINOLOGIC:  She has increased thirst, hunger, urination. Patient random blood glucose levels 97mmol/l, the thyroid gland is of normal and firm. ALLERGIES:  No known allergies to foods or medications. Diagnostic results: Hemoglobin A1C: 7. A combination of fibrates, niacin and a n-3 fatty acid is indicated as a recommended management for the management of hypertriglyceridemia (Shrikrishna, Wong, Maw, Tahir & Choudry, 2016). The combination therapy is used as it produces higher reductions in the triglyceride levels in patients.

Tylenol is the medication that relieves pain. The Osteoarthritis Research Society International (OARSI) guidelines for management of knee arthritis recommend up to 4 g of Tylenol as first-line management for knee osteoarthritis (McAlindon et al. Educating her on the importance of diet and exercise in managing her condition. References American Diabetes Association. Introduction: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41(Supplement 1), S1-S2. http://dx. doi. 2337/dc15-0144 Goodrx. com.  Prescription Prices, Coupons & Pharmacy Information - GoodRx.  Goodrx. com. 1016/s0140-6736(13)62154-6 Lee, P. , & Halter, J. The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations. Diabetes Care, 40(4), 444-452. http://dx. Indian Journal Of Endocrinology And Metabolism, 20(1), 9. http://dx. doi. org/10. 172273 McAlindon, T. org/10. 1016/j. joca. 003 Nazari, G. Knee osteoarthritis. doi. org/10.