The purpose of this assignment is to apply endocrine pathophysiological concepts to explain assessment findings of a patient with Diabetes. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
- Examine the case scenario and analyze the exam and lab findings results to determine the patient’s type of diabetes. (CO1)
- Explain the pathophysiology of the type of diabetes. (CO1)
- Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)
- Apply evidence-based practice guidelines to develop an appropriate treatment plan. (CO1, CO5).
Preparing the Assignment
Requirements
Content Criteria
- Read the case study listed below.
- Refer to the rubric for grading requirements.
- Utilizing the Week 6 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.
- You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
- You must use the current Clinical Practice Guideline (CPG) for the Standards of Medical Care in Diabetes -Abridged for Primary Care Providers provided by the American Diabetes Association to determine the patient’s type of diabetes and answer the treatment recommendation questions. The most current guideline can be found at the following web address: https://professional.diabetes.org/content-page/practice-guidelines-resourcesLinks to an external site.At the website, locate the current year’s CPG for use.
- Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.
Case Study Scenario
Chief Complaint
J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.
History of Present Illness
J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.
Past Medical History
- Hypertension
- Hyperlipidemia
- Obesity
Family History
- Both parents deceased
- Brother: Type 2 diabetes
Social History
- Denies smoking
- Denies alcohol or recreational drug use
- Landscaper
Allergies
- No Known Drug Allergies
Medications
- Lisinopril 20 mg once daily by mouth
- Atorvastatin 20 mg once daily by mouth
- Aspirin 81 mg once daily by mouth
- Multivitamin once daily by mouth
Review of Systems
- Constitutional: – fever, – chills, – weight loss.
- Neurological: denies dizziness or disorientation
- HEENT: Denies nasal congestion, rhinorrhea or sore throat.
- Chest: (-)Tachypnea. Denies cough.
- Heart: Denies chest pain, chest pressure or palpitations.
- Lymph: Denies lymph node swelling.
General Physical Exam
- Constitutional: Alert and oriented male in no acute distress
- Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
- 240 lbs., Ht. 5’8″, BMI 36.5
HEENT
- Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.
- Ears: Tympanic membranes intact.
- Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
- Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.
Neck/Lymph Nodes
- Neck supple without JVD.
- No lymphadenopathy, masses or carotid bruits.
Lungs
- Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart
- S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs.
Integumentary System
- Skin warm, dry; Nail beds pink without clubbing.
Labs
| Test | Patient’s Result | Reference |
| Glucose (fasting) | 132 | 60-120 mg/dL |
| BUN | 20 | 7-24 mg/dL |
| Creatinine | 0.8 | 0.7-1.4 mg/dL |
| Sodium | 141 | 135-145 mEq/L |
| Sodium | 141 | 135-145 mEq/L |
| Chloride | 97 | 95-105 mEq/L |
| HCO3 | 24 | 22-28 mEq/L |
| A1C | 7.2 | |
| Urinalysis
Protein Glucose Ketones |
Negative Positive Negative |
|
| Oral glucose tolerance test (OGTT) | 220 mg/dL |
J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
- Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
- Explain the pathophysiology associated with your chosen diagnosis
- Identify at least three subjective findings from the case which support the chosen diagnosis.
- Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
- Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
- Describe the mechanism of action for each of the medication classes identified above.
- Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
- Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations
