FNP NR507 - Week 6 CS - Diabetes
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Chamberlain University College of Nursing *
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Apr 29, 2024
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Week 6 Case Study - Diabetes
Pathophysiology & Clinical Findings of the Disease
1.
Based on the review of the history, physical and lab findings what is the most likely diabetes
diagnosis for this patient? Based on the review of the case study information regarding the history, physical and lab findings outline for this patient, the most likely diabetes diagnosis for this patient is Type 2 diabetes based on:
Age: 48 yrs.
PMH: HTN, HDL, Obesity
familial history (brother)
OGTT = 220
HbA1C = 7.2
Glucosuria
Signs and symptoms: weight loss, fatigue, extreme thirst, fruity breath
2.
Explain the pathophysiology associated with the chosen diabetes diagnosis.
Since diabetes type 2 develops slowly and gets worse over time, it is known as "adult diabetes" (Galicia-Garcia et al., 2020). The pancreas is prompted to create and release more insulin when
blood glucose levels are high. By attaching itself to the receptors on organ cells, insulin tries to lower blood glucose levels. The insulin does not enter the cells or function properly through the insulin receptors that typically bind to the insulin. The prolonged period of elevated blood glucose levels stems from this phenomenon, as the glucose is not absorbed and transferred to the cells (ElSayed et al., 2023; Galicia-Garcia et al., 2020). The pancreas receives this information and begins producing and secreting even more insulin. The kidneys will then eliminate the glucose that is in the blood, resulting in glucosuria, which can lead to osmotic diuresis. Frequent urination (polyuria) leads to dehydration. The brain has been primed to indicate the need for more fluid if this persists. Less energy is being produced in the muscle cells as a result of the circulating glucose that typically supplies the organs. The brain receives signals from the organs when they are deficient in nutrition and energy. This makes you feel exhausted and extremely hungry. The pancreas eventually stops reacting to the cue to produce
more insulin as this cycle continues, which causes the blood's level of glucose to keep rising (Galicia-Garcia et al., 2020).
3.
Identify at least three subjective findings from the case which support the chosen diagnosis.
The case study presents the following three of the many subjective findings to support the chosen diagnosis:
Fatigue
Weight loss
Polyuria (> 4 X per night)
(Galicia-Garcia et al., 2020)
Week 6 Case Study - Diabetes
4.
Identify at least three objective findings from the case which support the chosen diagnosis.
The case study presents the following three of the many objective findings to support the chosen diagnosis:
Fruity breath odor
Urinalysis: Glucosuria
A1C: 7.2
(Galicia-Garcia et al., 2020).
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
1.
Identify two (2) “Evidence A”
recommended medication classes
for the treatment of this condition and provide an example (drug name) for each.
The goal of “Evidence A” recommended pharmacological treatment regimen should include medications with adequate efficacy that will reduce cardiorenal risk and be seamless to maintain. One of the drug classifications is glucagon-like peptide 1 (GLP-1), either oral form or injection. Another drug classification is sodium-glucose co-transporter-2 (
SGLT2
inhibitors) (ElSayed et al., 2023; Practice guidelines resources, 2023
)
The GLP-1 agonist drug example is Ozempic (semaglutide) and the SGLTs inhibitors drug example Empagliflozin (Jardiance w/metformin) (ElSayed et al., 2023;
Practice guidelines resources, 2023
).
2.
Describe the mechanism of action
for each of the medication classes identified above.
The mechanism of action for the GLP-1 agonist drug Ozempic (semaglutide) works by binding to the
GLP-1 receptors in the pancreas and then stimulating the pancreas to release
insulin,
reduced glucagon release-responses which lowers blood sugar. These effects can help manage blood sugar and decrease blood sugar spikes by inhibiting gastric motility and secretion (
Practice guidelines resources, 2023
).
SGLT-2 inhibitor drugs are administered in oral form and its mechanism of action depends on the individual’s kidney function. This drug class reduces the amount of glucose being absorbed in the kidneys by preventing the action of SGLT2 cotransporters in the kidney. Further explanation, SGLT-2 reduces renal tubular
glucose reabsorption,
which produces a reduction in blood glucose without stimulating
the pancreas to produce and release insulin (ElSayed et al., 2023;
Practice guidelines resources, 2023
)
3.
Identify two (2) “
Evidence A
” recommended non-pharmacological treatment
options for this
patient.
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1.
2.
3.
4.
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Done
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RX:
Morphine liquid 1 mg/mL
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Use within 1 month
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Morphine Suspension (1 mg/mL)
One of your long-term patients who you have known for many years has progressed to end-stage prostate cancer and been placed on a palliative care program. The currently commercially available morphine liquids he has been using contain a flavouring agent that makes him nauseous. His Physician has requested you compound a morphine liquid for him without flavour as his pain is well controlled on this medication and he does not want to change to another pain reliever. Your pharmacy team and the Physician would like to make his end-of-life process as comfortable as possible. A formulation for a suspension appears to be a good option to try.
RX:
Morphine liquid 1 mg/mL
Sig: Take 1-2 mL q1h prn
Mitte: 100 mL
Formulation:
Morphine HCl 10 mg
Glycerol 1 mL
Compound Hydroxybenzoate Solution 0.1 mL
Purified water to 10 mL
Use within 1 month.
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Can he prescribe refills over the…
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2.Administer the iron through a straw.
3. Mix the iron with cereal to administer.
4. Add the iron to formula for easy administration
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Diltiazem and Levothyroxine.
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Skin: decreased turgor; dry mucous membranes
Laboratory Results:
Digoxin level
Electrolytes
●
• Mag+
CI-
BUN
CBC
Na+
K+
ABG
● RBC
● WBC
●
Creatinine
Glucose
CO2
Hemoglobin
Hematocrit
Platelets
pH
PaO2
PaCO2
HCO3-
1.0 ng/ml
134 mEq/L
2.5 mEq/L
1.2 mEq/L
88 mEq/L
42 mg/dL
0.9 mg/dL
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NURSING CORRECT ANSWERS
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Mr. Jackson was hospitalized today for heart failure. The physician orders a loading dose of digoxin 0.75 mg to be given intravenously. The digoxin is available in a solution of 0.5 mg/mL. (Learning Objectives 2, 4, 6) 1. How many milliliters should the nurse prepare? 2. What should the nurse do before administering the IV dose? 3. If digoxin toxicity develops, what signs or symptoms might Mr. Jackson have? 4. How often should Mr. Jackson be monitored for signs of digoxin toxicity? 5. What conditions might increase Mr. Jackson’s likelihood of exhibiting digoxin toxicity?.
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a. State at least FIVE questions that you would ask in analyzing Mr. Amoah’s pain
b. Identify all;…
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The following four patients all have severe edema for different reasons. Your challenge is to explain the cause of the edema. In each case, try to explain the edema in terms of either an increase or a decrease in one of the four pressures that cause bulk flow at capillaries. A picture may be useful.
Patient 1: Mr. Taylor
Mr. Taylor is a 66 year old alcoholic who has been drinking for years. During the past month he has gained over 25 pounds due to water retention. He exhibits swelling in all areas of the body. He has recently been admitted to the hospital and diagnosed with end stage liver failure.
What is the connection between the liver failure and his edema?
Which capillary pressure is altered and how does it cause edema? Hint: consider the functions of the liver, particularly the ones that affect blood composition.
Patient 2: Mrs. So
Mrs. So is a 28 year old visiting her OB in the 26th week of her pregnancy. She is experiencing varicose veins and…
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mto a dlabetic coma (C) or for someone who is more likely to slip into insulin shock (S).
1. Confused and disoriented
2. Headache
3. Gradual onset
4. Skin is pale, cool, and clammy
5. Drowsiness
6. Thirst is intense
7. Fruity odor from the mouth
8. Pulse is full and pounding
9. Low blood sugar
10. High blood sugar
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2. Define essential fatty acids and give examples.
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Related Questions
- Case Study, Cardiovascular Disorders Gloria Gonzales is a 56-year-old Hispanic female with a history of type 2 diabetes mellitus, obesity, and hypertension. She was admitted to the medical unit 2 days ago with chest pain that was unrelieved with three nitroglycerin sublingual. She has had the following lab work: CK, LDH, AST, troponin, lipid levels, and an ECG stress test. She is scheduled to have a cardiac catheterization in the morning 3. According to Mrs. Gonzales’ medical history, what has contributed to her myocardial infarction? 4. What should the nurse anticipate doing to prepare Mrs. Gonzales to be discharged?arrow_forwardCase study 9 Miss Owusuaa was diagnosed with acromegaly, excess production of growth hormones. There are two ways to investigate it. Insulin growth factor -1 (IGF-1) test. a. State the other and how is it done. b. Classify the following (I) patient - 1 glucose from 0-2 hrs level : 134mg/dl (II) patient - 2 glucose from 0-2 hrs level :185mg/dl (III) patient -2 glucose from 0-2 hrs Level : 201mg/dlarrow_forwardCase Study, Cardiovascular Disorders Gloria Gonzales is a 56-year-old Hispanic female with a history of type 2 diabetes mellitus, obesity, and hypertension. She was admitted to the medical unit 2 days ago with chest pain that was unrelieved with three nitroglycerin sublingual. She has had the following lab work: CK, LDH, AST, troponin, lipid levels, and an ECG stress test. She is scheduled to have a cardiac catheterization in the morning 1.Explain the rationales for the laboratory tests and ECG stress test. 2. What should the nurse do to prepare for the cardiac catheterization that is scheduled?arrow_forward
- Presentation on type 2 diabetes 1 introduction and cause 2. Causes and diagnosis 3. Nursing intervention and conclusionsarrow_forwardCASE STUDY: PRIMARY HYPOTHYROIDISM Connie, age 28, has been hospitalized for 2 days for symptoms leading to the diagnosis of primary hypothyroidism. 1. What tests does the nurse know will assist with the confirmation of diagnosis of primary hypothyroidism for Connie? 2. What clinical manifestations that are consistent with Connie’s diagnosis should be monitored? 3. What comfort measures can the nurse include in Connie’s care?arrow_forwardPLEASE ANSWER write diagnostic statement for each ques 1. A hypertensive client states that she hasn't been taking her medication because it doesn't make her feel any better . Also, she says she has difficulty remembering to take it. 2. An elderly patient with left side paralysis has a red, broken area in the skin over his coccyx. The patient cannot turn himself in bed. 3. The client is 45 pounds overweight . He states that he is in a high stress job and doesn't have time to cook regular meals - he tends to eat fast food and snacks a lot . His job is sedentary , and he does not engage in any type of physical exercise or sport . Fo fun, he likes to " eat at a nice restaurant "arrow_forward
- Case Study 3 – Congestive Heart Failure Dottie is a 78-year old CHF patient. She has been exercising with your facility for several years now. She had a CABGx3 in 2020. She came in today with a 5 lb. weight gain since yesterday when she weighed on her home scale this morning. Her meds include- Lipitor, Procardia, and Lasix. (Cholesterol, Calcium channel blocker Hypertension, and Diuretic, respectively) Her blood pressure is 132/88 and her HR = 102; Her weight is 196, up from 191 when last measured. She is a pleasant, overweight individual who enjoys walking on the treadmill and visiting with other members of your facility. 1. What are specific considerations for someone with CHF and exercise? How is the exercise prescription any different from the apparently healthy adult prescription? 2. What is your biggest concern with Dottie today and how would you handle this concern(s)?arrow_forwardPatient C., 32 y/o, complains of excessive weight, shortness of breath, defective memory, performance decrement, feeling cold, emotional retardation. It is known from the case history that the patient is suffering from primary hypothyroidism. Objectively: the skin is dry, waxlike, swollen, periosteal reflexes are lowered, body mass index: 33.5 kg/cubic meter, TSH (thyroid-stimulating hormone) – 25 µU/dL (norm 0.5 -5.0). Obesity is homogenous. Arterial pressure: 150/100 mm column ob mercury. What type of obesity can be suspected?A. Endocrine hypothyroidB. Endocrine accompanying dysfunctions of hypothalamopituitary systemC. Alimentary constitutionalD. HypothalamicE. Androidal with the developed symptoms of metabolic syndromearrow_forwardPLEASE ANSWER asap write diagnostic statement 3. The client is 45 pounds overweight . He states that he is in a high stress job and doesn't have time to cook regular meals - he tends to eat fast food and snacks a lot . His job is sedentary , and he does not engage in any type of physical exercise or sport . Fo fun, he likes to " eat at a nice restaurant "arrow_forward
- John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Preventing complications of surgery is an important part of all surgical patient care. What preoperative While Mr. Doe is in the Operating Room, what considerations will be taken to ensure Mr. Doe’s safety and positive outcome? Identify 2 IntraOp nursing diagnoses for Mr. Doe teaching does Mr. Doe require in order to prevent complications? Give 3-4 examples)arrow_forwardMAKE SHORT TERM GOAL AND 5 OBJECTIVES FOR THIS DX. Main Dx: Imbalanced nutrition less than body requirements related to Lacto-Ovo vegetarian diet as evidenced by lack of essential minerals & nutrients (Iron, Zinc & Omega Fatty-acids) SHORT TERM GOAL: OBJECTIVES: 1. 2. 3. 4. 5. SCENARIO: Aubrey, 19 years old, an incoming college freshman student went to Ateneo De Manila Health Services for physical examination. The nurse gathered the following information: Height: 5 ft Weight: 48 kg Vital signs: Temp 37.2C, Pulse rate: 95 beats per minute, Respiration rate: 12 breaths per minute, and BP: 100/70mmHg. Family History of illness: Father (+) Hypertension (HPN), and Diabetes Mellitus (DM) Present Health History: Aubrey never experienced to get hospitalized as far as she can remember. Her mother ensures that she takes daily supplemental vitamins such as vitamin C and B complex, and every year she gets flu vaccine from their family doctor. During the interview with the nurse,…arrow_forwardQuestions for the Case Study:1. Make a table of the medications prescribed to the patient. Include the indication, mechanism of action, standard dose, and frequency. 2. Analyze the case and identify the adverse reaction/s that occurred. What type of ADR happened? 3. What should be done to avoid the type of adverse reaction that happened to the patient?arrow_forward
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