Purdue University Northwest

College of Nursing

Online RNBSN Program

 

PATIENT CASE STUDY

The case study provides you an opportunity to apply what you have learned in the course to a patient experiencing abnormalities in the endocrine, cardiovascular, renal, pulmonary and neurological systems. Throughout the case, you will be following the same patient Loretta, and will be building on the information provided in each module. Each week, one part of the case study based on the weekly content is due. You may use your textbook, slides and scholarly journals of your choosing to answer the questions.

DIRECTIONS:

· Please answer the questions within the case study with comprehensive answers.

· You may work directly on this document, inserting answers in a narrative or table format.

· Make sure to use adequate spacing when adding answers so the document is easily readable.

· You need to include at minimum two references in your reference list: one can be your textbook and the other is your choice whether it be an article or another textbook.

· Some questions will require an in-text citation if you are elaborating and using a source other than your lecture notes/slides. Responses on medications or labs do not require a citation.

· Citations and reference list are to be in APA format and included with each submission

· Please feel free to contact your faculty member or coach with any questions or if you need clarification.

 

Case Study Week 1: Diabetes

Chief Complaint: Hyperglycemia

History of Present Illness: Loretta is a 66-year-old female with a history of Type 2 DM, hypertension, chronic atrial fibrillation, dyslipidemia and obesity who presented to her primary care provider for a routine diabetes f/u. She admits that she has not been paying too much attention to her diabetes for the last few months. Although she “lost a few pounds”, her feet are swollen, which concerns her. She also reported being very thirsty and urinating often. Fasting labs were ordered. Loretta received a call the next day from the nurse practitioner with the lab results and was instructed to go directly to the hospital for a glucose of 520mg/dl.

Past Medical History: Diabetes Mellitus Type II diagnosed at age 45. Atrial fibrillation diagnosed at age 55, Hypertension diagnosed at age 46, Hyperlipidemia diagnosed age 45. Has struggled with her weight since a teen.

Family History: Hypertension- mother and father; Lung cancer- mother; diabetes- mother / sister

Social History: Tobacco dependence 1/2 pack per day for the last 46 years. Last cigarette this morning at 9am. Denies alcohol use. Denies illicit drug use.

Allergies: Penicillin

Medications: Glucophage 1000mg po bid; Victoza 1.2 mg daily; Levemir 20 units at HS; Lisinopril 10mg po daily; Hydrochlorothiazide 25 mg po daily; Xarelto 20 mg daily; atorvastatin 10 mg daily

Immunizations : Up to date on pneumonia and influenza vaccines. Has been fully Covid vaccinated.

 

Review of Systems:

Constitutional Symptoms: Has lost 5 pounds in the last month. Complains of fatigue. Has been thirsty and urinating frequently

Integumentary: Color changes in lower extremities due to venous stasis. No lesions, rashes.

HEENT: Eyes: Vision blurred this week. No floaters, loss of visual field. Wears glasses.; Ears: No hearing changes, ear pain. Nose: Denies nasal discharge. Throat: Denies sore throat or dysphagia.

Cardiovascular: Blood pressure has been at target –has not checked lately. Denies chest pain, palpitations, dizziness, syncope. Has noticed swelling in her lower legs the last few weeks. She has been compliant with medications

Respiratory: Dyspnea with minimal exertion for the past month, +sputum, +wheezing. Smokes 1/2 pack per day of cigarettes.

Gastrointestinal: Appetite has been poor. No nausea, vomiting, diarrhea.

Genitourinary: Positive for polyuria, polydipsia; denies polyphagia. Denies dysuria, hematuria, burning, urgency

Musculoskeletal: Denies joint pain, swelling, arthritis.

Neurological: Denies memory loss, tremors, numbness. Sensation in feet is intact.

Endocrine: Has not been checking regularly but last week the glucometer readings were 170-190/dl. Polyuria and polydipsia.

Psychiatric: Denies depression, anxiety, substance abuse.

Physical Exam

Vital Signs: T: 98.2; HR: 84; R: 24; B/P: 148/89; O2 sat: 95% on room air; Ht: 5’6’; Wt: 278; Waist circ: 48

Constitutional: Obese female. Alert, cooperative, good historian. Appears older than stated age.

Integumentary: Pink, warm, dry, and intact. Bilateral lower extremities with stasis dermatitis.

HEENT: Normocephalic, PERRLA, moist mucus membranes, neck supple, no thyromegaly

Cardiovascular: Irregular rate/rhythm controlled Afib, no murmur/rub/gallop. Carotids full and equal. No JVD. Edema 2+ pitting B/L lower extremities. Pulses 2+.

Respiratory: Tachypnea, slightly labored with scattered expiratory wheezes.

Gastrointestinal: Abdomen obese, soft, nontender, nondistended, with active bowel sounds.

Genitourinary: Urine is clear, pale yellow.

Musculoskeletal: Normal and equal motor/strength/ROM.

Neurological: Awake, alert, oriented x 3. Cranial nerves 2-12 grossly intact. Cognition normal. Gait steady. No loss of sensation in feet.

Psychiatric: Calm, cooperative

 

 

 

 

Labs and Diagnostics: Table 14.2 Laboratory Blood Test Results

URNALYSIS:

Appearance: Pale yellow / clear (-) Nitrate (-) Bilirubin (+) Protein (-) Microalbuminuria

pH 5.8 Specific gravity 1.015 (+) Ketones (+)Glucose (-) Microscopy

CBC/CMP/LIPID PANEL

Na 133 meq/L WBC 10.8 x 103/mm3 Alb 3.2 g/dL

K 5.1 meq/L Hb 13.6 g/dL Protein, total 6.8 g/dL

Cl 109 meq/L Hct 45% Total Chol 266

HCO3 16 meq/L Plt 355 x 103/mm3 LDL 170mg/dl

BUN 40 mg/dL AST 14 IU/L Mg 2.5 mg/dL HDL 32mg/dl

Cr 1.28 mg/dL ALT 31 IU/L Triglycerides 356mg/dl

Ca 8.8 mg/dL Alk phos 78 IU/L

Glu, fasting 420 mg/dL Bilirubin, total 0.3 mg/dL

PO4 4.8 mg/dL PT 24.2 sec INR 2.3

CXR = Cardiomegaly is noted. Lungs clear with no evidence of consolidation or atelectasis

 

______________________________Case Study Part 1: Diabetes___________________________

 

 

Answer the following questions based on the information above:

1) What are the similarities and differences between diabetes mellitus type I and diabetes mellitus type II. (8 points)

 

  Type 1 DM Type 2 DM
Cause

 

    
Onset

 

    
Symptoms

 

    
Treatment

 

    

 

 

 

 

2) One of the medications Loretta is on for her diabetes is Victoza, a GLP-1 receptor agonist. What is GLP-1 and how does it affect blood sugar? (2 points) In addition to glycemic control, what additional benefits are seen with this drug class in2the treatment of T2DM? (1 point)

 

 

 

 

 

3) What are the criteria for metabolic syndrome and how does this patient align with those criteria? (4points)

 

Criteria Patient Loretta
   
   
   
   
   

 

 

 

 

4) Despite being a type 2 diabetic, the patient is experiencing the complication of diabetic ketoacidosis. Explain the process of this complication. What lab results/UA results support this diagnosis? (4 points)

 

 

 

 

 

 

5) Three common clinical manifestations of diabetes are polyuria, polydipsia and polyphagia. Explain the pathophysiology behind each of these 3 manifestations. (3 points)

 

 

 

 

APA 1 point Scholarly Work 1 point Total points 24