Week 5: Case Study Assignment
Purpose
The purpose of this case study assignment is to:
- Analyze provided subjective and objective information to diagnose and develop a management plan for the selected case study patient.
- Apply national diabetes guidelines to a case study patient.
- Apply national guidelines to develop a management plan for all identified secondary diagnosis(es).
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
- Select appropriate health promotion and disease prevention strategies for patients with or at risk for a glucose metabolism disorder (WO5.1) (CO1,2,3,4,5)
- Demonstrate competence in the evaluation and management of patients with glucose metabolism disorders (WO5.2) (CO1,2,3,4,)
- Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO5.3) (CO1,2,3,4,5)
- Apply polypharmacy knowledge to medication reconciliation for selected case study patient.(WO5.4) (CO 6)
Due Date
The Late Assignment Policy applies to this assignment.
Sunday 11:59 p.m. MT at the end of Week 5
This assignment is submitted through Turn It In (TII).
Sample Answer
General Overview
The patient is an 87-year-old female, Mrs. Topanga Azaela Castle. Mrs. Topanga presents to the clinic today to review the lab results and to inquire about her weight gain. According to the patient, she has been gaining weight around her abdomen only. She does not take enough water, only one or two cups a day; she, however, takes 3-4 glasses of cranberry juice per week. When playing golf with friends, she takes a glass of wine together with friends. The patient does not follow a particular diet plan. She experiences bowel movements almost every day and urinates 8-10 times a day. Her vital signs include BP 166/86, indicating high blood pressure. Three months ago, her BP was 168/88, which was a slight drop. Body system examination results were unremarkable. However, laboratory results indicated increased blood sugar levels above the normal range, high total cholesterol and triglycerides levels, and slightly lower sodium levels.
Differential Diagnoses: Primary Diagnoses
Based on the data collected, the differential diagnosis for this patient includes diabetes mellitus type 2 (ICD10: E11.9); the diagnosis is based on laboratory test results HbA1c; 11.7%, urinary analysis which was positive for glucose, and the patient reported frequent urination every day and increased weight gain around the abdomen, which are common symptoms among patients with diabetes mellitus type 2. The age of the patient also suggests that it is likely she is suffering from diabetes type 2 (American Diabetes Association, 2021).
The patient is also likely to suffer from hypertension (ICD10: I10); the diagnosis is based on vital signs, which indicated that the patient’s blood pressure is 166/86 mmHg, which is higher than the normal blood pressure of 120/80 mmHg. Other vital signs were within the normal range.
Hyperlipidemia (ICD10: E78.5), The diagnosis is based on laboratory test results that showed total-c 248mg/dl, LDL-c, 188mg/dl, triglycerides-188mg/dl, which are above the normal limits, and HDL-c 50mg/dl, which is lower than the normal range.
Diagnosing Your Clinical Patient
The primary diagnosis for this patient is diabetes mellitus type 2. The diagnosis was based on lab results and patient symptoms. The physical exam was unremarkable for the diagnosis; however, the lab values including; urinalysis was positive for glucose, HbA1c; 11.7% and total cholesterol was very high, with HDL-50mg/dl, which is lower than the normal range and LDL -c 188mg/dl was higher than the normal range. Mrs. Topanga reported frequent urination and sudden weight gain around the abdomen, associated with type 2 diabetes. According to guidelines by the American Diabetes Association (2021), DM2 is more common among adults; the patient being elderly is thus likely to be diagnosed with DM2. The risk of developing DM2 increases with advancement in age, cardiovascular diseases such as hypertension, and physical inactivity. While the patient is physically active, she has advanced in age and has hypertension; 166/86. A patient with A1c greater than 6.5% is diagnosed as diabetic; Mrs. Topanga had HbA1c; 11.7%, hence the diagnosis (American Diabetes Association, 2021).
Pertinent Positives: They include frequent urination, age 87 years, weight gain around the abdomen, glucose 180, HbA1c; 11.7%, LDL -c 188mg/dl, total-c 248mg/dl, triglycerides-188mg/dl, and urinalysis was positive for glucose and hypertension.
Pertinent Negatives: Physically active; plays golf.
Interpret Abnormal Labs
#1, urinalysis; Glycosuria- elevated glucose levels in urine above 0.8mmol/L, which occurs due to type 1 or 2 diabetes; the patient’s glucose levels were positive, thus indicating the possibility of diabetes.
#2; na+134; normal values range from 135-145mEq/L, the patients were slightly lower. This could be pseudo hyponatremia due to high blood sugar or triglyceride observed.
#3; Glucose 180; the normal range is usually 130 above which the person is hyperglycemic.
#4; HbA1c 11.7%, the normal range is 6.5% or lower above which the patient should be diagnosed as diabetic (Galicia-Garcia et al., 2020).
Primary Diagnosis ICD10 Code: E11.9
Pathophysiology (cellular level) for primary diagnosis
The condition is caused by the malfunction of feedback loops between insulin action and secretion, leading to high sugar levels in the blood. Insulin production is diminished in the case of β-cell malfunction, restricting the body’s ability to maintain normal glucose levels. On the other hand, insulin resistance causes increased glucose synthesis in the liver and decreased glucose absorption in muscle, liver, and adipose tissue. β-cell dysfunction is usually more severe than insulin resistance, even though both processes occur early in the pathogenesis and contribute to the development of the disease (Galicia-Garcia et al., 2020).
What is the Secondary diagnosis for your patient?
The secondary diagnosis for this patient is hyperlipidemia. The diagnosis was based on laboratory findings; lipid panel analysis showed that the patient had elevated levels of low-density lipoproteins (188mg/dl), total cholesterol (248mg/dl), and triglycerides (188mg/dl) while lower levels of high-density lipoproteins (50mg/dl). The patient blood pressure 166/86, indicating hypertension which is typical among people with hyperlipidemia (Hill & Bordoni, 2021).
Pertinent Positives: low-density lipoproteins (188mg/dl) total cholesterol (248mg/dl) and triglycerides (188mg/dl). High-density lipoproteins (50mg/dl), blood pressure (166/86), high levels of glucose, and increased weight gain
Pertinent Negatives: No history of diabetes or hyperlipidemia, RR (16) and P (76). Cardiovascular normal reading,
Interpret Abnormal Labs
#1 LDL -c 188 mg/dl; normal levels are approximately less than 100mg/dl, while up to 129mg/dl are acceptable for a patient with no health issues above this level is a major concern for the patient with cardiovascular conditions such as hypertension. Higher levels of LDL associated with increased dep
#2 HDL- C -50 mg/dl, considered as good cholesterol high-density lipoprotein as it absorbs cholesterol back to the liver for breakdown, preventing its accumulation. The normal levels are 60mg/dl and above. The patient levels are considered borderline low, typical for an individual with high LDL levels and diabetes.
#3 Total -C 248 mg/dl, normal levels are 200mg/dl, and levels above the 240mg/dl are considered high and increase the risk of developing cardiovascular conditions.
#4 Triglycerides are 188 mg/dl; triglycerides are lipid circulating in the blood and provide energy. A high level of triglycerides is associated with the hardening of arteries, increasing the risk of cardiovascular conditions. Normal values range below 150mg/dl while values above are considered high; in this case, the patient levels were borderline high (Mosa et al., 2021).
