Running head: WEEK 5 CASE STUDY 1
Week 5 Case Study Assignment
Chamberlain University
NR601: Primary Care of the Maturing and Aged Family
April 2019
Week 5 Case Study Assignment
The intent of this paper is to examine subjective and objective findings of a case study
patient to appropriately ...
Week 5 Case Study Assignment
Chamberlain University
NR601: Primary Care of the Maturing and Aged Family
April 2019
Week 5 Case Study Assignment
The intent of this paper is to examine subjective and objective findings of a case study
patient to appropriately diagnose and formulate an individualized management plan that utilizes
evidence-based practice guidelines. The case study patient is a 55-year-old Hispanic female who
presents to the office for her annual exam complaining of fatigue, weight gain, polyuria,
polydipsia, and polyphagia for the past 3 months. This paper will identify applicable primary,
secondary, and differential diagnoses; and apply national guidelines from the American Diabetes
Association’s (ADA) 2019 Standards of Medical Care in Diabetes to develop a management
plan that will include the appropriate diagnostics, affordable medications, education, referrals,
and follow-up.
Assessment
,WEEK 5 CASE STUDY 2
Primary Diagnosis
Type 2 diabetes mellitus without complications (E11.9).
Pathophysiology. Type 2 diabetes mellitus (T2DM) is characterized by high levels of
plasma glucose due to a decreased function of pancreatic beta cells, which causes insulin
The most common manifestations of T2DM include the following: fatigue, polyuria (increased
urination), polydipsia (increased thirst), polyphagia (increased appetite) with weight loss
(Dunphy et al., 2015).
Pertinent positive findings. Very fatigued and low energy, increased hunger and thirst
with exercise, increased urination at night and more frequently during the day; which all have
been occurring for the past 3 months and a weight gain of 3 pounds (subjective). Mrs. G is 55
years old, Hispanic, and obese according to the calculated BMI of 33.3 kg/m2; elevated
hemoglobin A1C of 6.9%, urinalysis showed 1+ glucose and small protein, and dyslipidemia
according to lipid panel (objective) (Dunphy et al., 2015).
Pertinent negative findings. No family history of diabetes and exercising twice a week
for at least 30 minutes (subjective). Glucose 95 and urinalysis negative for ketones (objective)
(Dunphy et al., 2015).
Rationale for the diagnosis. T2DM was selected as the primary diagnosis based on the
aforementioned pertinent positive findings, which include the following: fatigue, polyuria,
polyphagia, and polydipsia; along with several risk factors for T2DM, such as age, Hispanic
ethnicity, obesity (BMI ≥25), and lack of physical activity (ADA, 2019). Additionally, the
laboratory results showed conflicting results, a normal FPG of 95 and an elevated A1C of 6.9%.
Therefore, according to the criteria for diagnosing diabetes, an A1C ≥6.5% with obvious signs
and symptoms of hyperglycemia can confirm the diagnosis of T2DM without repeat testing
(ADA, 2019). Lastly, the urinalysis showed 1+ glucose and small protein (albumin), which is an
, WEEK 5 CASE STUDY 3
indication of diabetes and/or early sign of kidney disease; as well as, an indication for
dyslipidemia, a common condition associated with T2DM (Dunphy et al., 2015; ADA, 2019).
Secondary Diagnosis.
Hyperlipidemia, unspecified (E78.5).
Pathophysiology. Hyperlipidemia is an acquired or genetic metabolic condition
comprising of various lipids and lipoproteins that increase the risk of atherosclerosis, or plaque
sticking to the inner walls of arteries (Dunphy et al., 2015). Lipoproteins are molecules that carry
cholesterol in the bloodstream and are separated by the following groups: VLDL, LDL, and
HDL; and triglycerides are large lipid molecules from dietary fats (Dunphy et al., 2015).
Characteristically, patients do not exhibit manifestations of hyperlipidemia, but often this
condition occurs concurrently with hypertension, T2DM, and coronary artery disease (Dunphy et
al., 2015). A carotid bruit, corneal arcus, xanthomas (yellowish skin deposits of cholesterol), or
xanthelasma (deposits around the eyelids) may be found on physical examination (Dunphy et al.,
2015).
Pertinent positive findings. T2DM, obesity, family history of hypercholesterolemia
(father), elevated blood pressure of 129/80, and lipid profile showing the following results: TC
(low), and TG 232 mg/dL (high) (Dunphy et al., 2015; Bibbins-Domingo et al., 2016).
Pertinent negative findings. No tobacco history, no past medical history of
atherosclerotic cardiovascular disease, and has been exercising twice a week for at least 30
minutes (Bibbins-Domingo et al., 2016).
Rationale for the diagnosis. Hyperlipidemia was selected as a secondary diagnosis
based on the laboratory results of the lipid profile and the primary diagnosis of T2DM.
According to Stone et al. (2014), hyperlipidemia is very prevalent among Hispanics, and is
characterized by a low HDL level, an elevated LDL, and high triglyceride levels; most likely as a
result of insulin resistance within this ethnic group. Based on Mrs. G’s LDL 144 mg/dL and HDL
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