Assignment: FNP NR507 Week 6 Diabetes Case Study

Assignment: FNP NR507 Week 6 Diabetes Case Study

Assignment: FNP NR507 Week 6 Diabetes Case Study

Week 6: Case Study

Purpose

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.

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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)

Due Date: Sunday by 11:59 PM MT of Week 6
Total Points Possible: 100
Requirements:

Content Criteria:

Read the case study listed below.
Refer to the rubric for grading requirements.
Utilizing the Week 6 Case Study Template

Links 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-resources

Links 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
Wt. 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

Potassium

3.7

3.5-5.0 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

Category Points % Description

Pathophysiology & Clinical Findings of the Disease

45 

45%

The student:

Identifies the likely diagnosis based on exam and lab findings.
Explains the pathophysiology associated with the chosen disorder.
Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).
Identifies at least three subjective findings from the case.
Identifies at least three objective findings from the case.

(5 Required Elements)

Management of the Disease

45

45%

The student:

Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.
Identifies two (2)“Evidence A” recommendedmedicationclassesfor the treatment of the condition and provides an example (drug name) for each.
Identifies two (2) “Evidence A” recommended non-pharmacological treatment options for the condition.
Describes the mechanism of action for each of the medication classes identified above.

(4 Required Elements)

90

90%

Total CONTENT Points= 90 pts

Assignment Format

Category

Points

%

Description

Organization, spelling, grammar & APA format

10

10%

The student:

Uses the week 6case study template for case study responses.
Provides correct in-text citations for responses which match the reference page.
Has minimal spelling, grammar & APA format errors.

 

100

100%

Total FORMAT Points= 10 pts

ASSIGNMENT TOTAL=100 points
Rubric
NR507 Week 6 Diabetes Case Study
NR507 Week 6 Diabetes Case Study
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Pathophysiology & Clinical Findings of the Disease
The student:
– Identifies the correct type of diabetes

– Explains the pathophysiology associated with the chosen disorder.

– Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).

– Identifies at least three subjective findings from the case.

– Identifies at least three objective findings from the case.

(5 Required Elements)

45 pts
All 5 required elements are present.

41 pts
1 required element is missing.

37 pts
2 required elements are missing

23 pts
3-4 required elements are missing.

0 pts
All 5 required elements are missing.

45 pts
This criterion is linked to a Learning Outcome Management of the Disease
The student:

– Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.

– Identifies two (2) “Evidence A” recommended medication classes for the treatment of the condition and provides an example (drug name) for each.

– Identifies two (2) “Evidence A” recommended non-pharmacological treatment options for the condition.

– Describes the mechanism of action for each of the medication classes identified above

(4 Required Elements)

45 pts
All 4 elements are present

41 pts
1 required element is missing

37 pts
2 required elements are missing

23 pts
3 required elements are missing

0 pts
All 4 required elements are missing

45 pts
This criterion is linked to a Learning Outcome Organization, spelling, grammar & APA format
The student:

– Uses the week 6 case study template for case study responses.

– Provides correct in-text citations for responses which match the reference page.

– Has minimal spelling, grammar & APA format errors.

10 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 0-2 errors in spelling, grammar or APA format.

9 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 3-5 errors in spelling, grammar or APA format.

8 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 6-8 errors in spelling, grammar or APA format.

5 pts
Case study template is not used for responses OR In-text citations are incorrect or do not match the reference page AND There are 0-5 errors in spelling, grammar or APA format.

0 pts
Case study template is not used for responses AND/OR In-text citations are incorrect or do not match the reference page AND There are 6 or more errors in spelling, grammar or APA format.

10 pts
This criterion is linked to a Learning Outcome Late penalty deductions
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy.

0 pts
Manual Deductions

0 pts
Manual Deductions

0 pts

Assignment: FNP NR507 Week 6 Diabetes Case Study Sample

Healthcare aims to improve quality of life, and healthcare professionals must assess patients to diagnose and treat their conditions accurately. Nurses utilize their knowledge and skills to evaluate patient cues and perform a physical examination to aid diagnosis. Clinical presentations can point to a clinical decision, but laboratory findings are essential in distinguishing and developing a definitive diagnosis. This essay focuses on the presentations of a patient diagnosed with diabetes and evaluates the condition’s pathophysiology, clinical presentations, and management of the disease.

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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?

The patient in this case study has type 2 diabetes. There are no ketones in the urine. Little insulin in the blood prevents the breakdown of fat hence ketones in the blood, unlike in type 1, where there is an absolute insulin deficit (Galicia-Garcia et al., 2020). There are no definite tests/FDA or ADA-approved tests that can help differentiate these related conditions

2. Explain the pathophysiology associated with the chosen diabetes diagnosis.

The problem results from abnormalities in fat and carbohydrate metabolism. The pathologies in type 2 diabetes result from persistently high blood glucose levels with little or no glucose uptake into the cells. Two etiologies are linked to the problem: insufficient insulin production and the inability of the insulin-sensitive tissues to respond to insulin (Galicia-Garcia et al., 2020). The insulin produced (even in small quantities) prevent fat breakdown hence the absence of ketones but high blood glucose levels. The abnormalities cause abnormally high blood sugar levels and subsequent high osmolarity in the blood hence loss of glucose in urine. Glucose in urine leads to urgency and frequency, thus disturbing sleep patterns due to frequent urination. Glucose does not access the cells hence less energy production and subsequent fatigue and activity limitation (Galicia-Garcia et al., 2020). The major risk factors include lifestyle and physical inactivity, and obesity is a significant risk factor for type 2 diabetes. Controlling blood sugar levels, increasing glucose uptake into cells, and preventing complications are the priority in controlling the disease.

3. Identify at least three subjective findings from the case which support the chosen diagnosis.

The patient is obese with a BMI of 36, has a history of hyperlipidemia, and has a family history/with a brother with type 2 diabetes. The patient presents with disturbed sleep patterns due to nocturia, fatigue, weight, and polydipsia, which are hallmarks of diabetes. The patient also presents with a fruity breath odor, which occurs with complicated disease. The patient also complains of eating more and is concerned about weight gain. Galicia-Garcia et al. (2020) note that most of these clinical presentations are also present in type 1 diabetes and additional laboratory tests are necessary for a definitive diagnosis.

4. Identify at least three objective findings from the case which support the chosen diagnosis

From the objective data, the lab results reveal a high blood sugar level, the oral glucose tolerance test is above 200 (220mg/dl), and the urinalysis reveals glycosuria. Urinalysis also eliminates ketonuria. The HbA1c test results are above 6.5% (7.2%), and a fasting blood glucose above 120mgdl (132mg/dl) indicates poor blood glucose control (Galicia-Garcia et al., 2022).

Management of the Disease

1. Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations

The American Diabetes Association clinical practice guideline dictates the care interventions for diabetes. The CPG is updated regularly to reflect evidence-based strategies and new research findings.

2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

Diabetes type 2 management involves insulin, medication, and non-pharmacologic interventions. LeRoith et al. (2019) state that the medications used in managing diabetes care are based on the etiology, including biguanides such as metformin and sulfonylureas such as Glibenclamide. These medications have varying mechanisms of action. Other classes of medications in type 2 diabetes, depending on the etiology, are meglitinide, thiazolidinedione (TZD), dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium-glucose cotransporter (SGLT2) inhibitors, and α-glucosidase inhibitors (LeRoith et al., 2019)

3. Describe the mechanism of action for each of the medication classes identified above.

Metformin and other biguanides do not affect insulin output, but their mechanism of action is poorly understood. However, they promote insulin uptake invivo, thus promoting glucose uptake into the cells, reducing blood glucose concentration, and preventing gluconeogenesis (Doyle-Delgado et al., 2020). sulfonylureas such as Glibenclamide have different mechanisms of action and affect insulin production and amount. They are vital in patients with type two diabetes resulting from insufficient insulin production. Sulfonylureas are vital medication in DM type 2, and they stimulate pancreatic beta cells responsible for insulin production, increasing insulin production and lowering blood glucose (Doyle-Delgado et al., 2020). Insulin formulations introduce insulin to the blood and promote glucose uptake in the cells. These medications, insulin, and non-pharmacologic interventions promote better patient outcomes in diabetes.

4. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

The American Diabetes Association (2020) recommends various non-pharmacologic interventions approved that include diet changes and exercises. It also highlights that these interventions should be patient-centered, with integrated patient participation—diet changes, including regulating the carbohydrate and protein intake while increasing the vegetables and fruit intake. Exercises approved include jogging, cardio exercises, yoga, and cycling, as tolerated by the individual (Magkos et al., 2020). Exercise has been a considerable part of the US Diabetes Prevention program interventions. Exercises increase insulin sensitivity, reduces fat, and prevents its build-up (associated with insulin resistance) and thus helps prevent and control diabetes. Dietary regulations help control blood sugar levels by consuming more nutritious foods and avoiding junk with high glucose and fat content that increase the blood sugar level exponentially (Draznin et al., 2022). Besides, these interventions are the first-line recommended interventions when used alone to manage prediabetes and gestational diabetes hence their significance in diabetes management and prevention.

Conclusion

Diabetes type 2 results from either insufficient or little insulin and insulin resistance hence fat and carbohydrate metabolism problems. The body may compensate for the glucose in cells by increasing fat breakdown. The increase in ketone levels and the high blood sugar are responsible for the subsequent pathologies associated with diabetes progression. Thus, interventions in diabetes management target lowering the high blood glucose level and step-up insulin production. In addition, non-pharmacologic interventions such as diet and exercise can produce better outcomes alongside insulin and medications.

References

American Diabetes Association. (2022). Introduction: Standards of medical care in diabetes—2022. Diabetes care, 45(Supplement_1), S1-S2. https://doi.org/10.2337/dc22-S002

Association, A. D. (2020). 1. Improving care and promoting health in populations: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement_1), S7-S13. https://doi.org/10.2337/dc20-S001

Doyle-Delgado, K., Chamberlain, J. J., Shubrook, J. H., Skolnik, N., & Trujillo, J. (2020). Pharmacologic approaches to glycemic treatment of type 2 diabetes: synopsis of the 2020 American diabetes association’s standards of medical care in diabetes clinical guideline. Annals of Internal Medicine, 173(10), 813-821. https://doi.org/10.7326/M20-2470

Draznin, B., Aroda, V. R., Bakris, G., Benson, G., Brown, F. M., Freeman, R., Green, J., Huang, H., Isaacs, D., Kahan, S., Leon, J., Lyons, S. K., Peters, A. L., Prahalad, P., Reusch, J. E. B., & Kosiborod, M. (2022). 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes-2022. Diabetes Care, 45(Supplement_1), S8-S16. https://doi.org/10.2337/dc22-S001

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., … & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal Of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275

LeRoith, D., Biessels, G. J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., Hirsch, I. B., McDonnell, M. E., Molitch, M. E., Murad, M. H., & Sinclair, A. J. (2019). Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1520-1574. https://doi.org/10.1210/jc.2019-00198

Magkos, F., Hjorth, M. F., & Astrup, A. (2020). Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nature Reviews Endocrinology, 16(10), 545-555. https://doi.org/10.1038/s41574-020-0381-5