Management of Hyperglycemia in Type 2 Diabetes Essay Paper

Management of Hyperglycemia in Type 2 Diabetes Essay Paper

CHIEF COMPLAINT:

A new patient who presented generalized abdominal pains and diarrhoea for three days

HISTORY OF PRESENT ILLNESS (HPI)

JR is a 47-year-old white male who presented with generalized abdominal pain. It was acute on the onset, not radiating, and it occurred throughout the day. There are no aggravating and relieving factors. The patient reports that the pain was so severe during the first day, but it is gradually reducing. The patient has not taken any medication. The patient reports of diarrhoea that was of acute onset, many episodes, it was yellow containing food content. It was not bloodstained. It was associated with nausea without a history of vomiting, no history of weight loss no history of flatulence, reflux, and hematochezia. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

 

PAST MEDICAL HISTORY

The patient is known to have hypertension, diabetes and GI bleeding and has been on treatment for four years and has been on Lisinopril 10 mg, amlodipine 5 mg, metformin 1000mg, and, Lantus 10 units. No history of known food and drug allergy. No record of major and minor surgery and no history of blood transfusion.

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PAST SURGICAL HISTORY

No major or minor surgical history

SOCIAL HISTORY

JR is a 47-year-old white male who is married in a monogamous marriage, with three children, one girl, and two boys. He regularly attends church and is an active member of the church choir and ushering team. She denied illicit drug use and tobacco smoking. She is a social drinker, 4-5 bottles of beer every month during social gatherings.

FAMILY HISTORY

The patient has several siblings and parents, both alive and well.  His father has hypertension and diabetes type two. The patient’s mother suffers from hypertension, diabetes type two, hyperlipidemia, and GERD. No family history of colon cancer.

REVIEW OF SYSTEMS:

General, the patient presented to the office independently. He denied recent changes in weight, appetite, nausea, and vomiting.

Cardiovascular: patient denies chest pain, palpitations, dyspnea, and paroxysmal nocturnal dyspnea Management of Hyperglycemia in Type 2 Diabetes Essay Paper

CNS: The patient denies dizziness, headaches, memory loss, confusion, lightheadedness, syncope, tingling in the lower and upper extremities

Respiratory: The patient denies chest pain, difficulty in breathing, cough, wheezing, shortness of breath, exposure to TB, or second-hand smoke. Up to date with flu immunization.

HEENT: The patient denies headaches, head trauma, epistaxis, changes in vision, hearing loss, ringing in the ears, eye, and ear discharge. She refuses difficulty in swallowing food, pain in eating food. The last dental exam was three months ago.

Musculoskeletal: The patient denies joint pains, stiffness, back pains, and muscle pain.

Emotional: The patient denies low mood, sadness, anxiety, or depression.

Objective Data

General exam: Obese, middle-aged male in generally fair condition.

Vital Signs: Blood Pressure 160/86mmHg, RR-16, Temperature99.8, PR 68, Height 5’10 Weight-248lbs (BMI-33.8 obese)

Physical Examination

Respiratory: symmetric chest expansion, diaphragm moves with respiration. On percussion, the lungs are resonant. On auscultation, the lungs are clear with no wheezes, rubs, or rhonchi.

Cardiovascular: heart rate 92 with a regular rhythm, no rubs or murmurs, normal S1, and S2 and the apex beat is at the fifth intercostal space

CNS: Patient is oriented, can move all the extremities, all cranial nerves are intact, sensory; the patient is typical to tough and pinprick, no tremors or Babinski sign, the reflexes symmetrical +1 through-out.

GIT: On inspection, the abdomen is flat with no scars. On auscultation, there are hyperactive bowel sounds. On palpation, the belly is soft and tender at the left lower quadrant. There is also no splenomegaly and no hepatomegaly. On percussion, the liver span is 10 cm.

HEENT: Eyes-clear conjunctiva, no discharge, PEBRL, Ears-the tympanic membranes are well visualized, Nose-no discharge, midline septum, Mouth- normal gag reflex, no exudates

Musculoskeletal: skin warm and smooth, no edema to the ankle joint. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

Diagnostic Test

Stool test to rule out h. pylori, Amoebic blood glucose levels.

A complete blood count and urinalysis to rule out a urinary tract infection-pending. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

A lipid profile to examine the triglyceride levels and the total LDL and HDL cholesterol-pending.

Kidney function test to rule out any kidney injury as a result of volume loss through diarrhea.

Blood sugar test to rule out hyperglycemia.

Abdominal pelvic ultrasound to rule out diverticulitis

OGD to rule out any gastric ulcer

 

Assessment

Differential Diagnoses

Diagnosis for the patient during this visit is acute gastritis in a patient known to have diabetes and hypertension. He was currently complaining of generalized abdominal pain, diarrhoea, and nausea. He is on Lisinopril 10 mg, amlodipine 5 mg, metformin 1000mg and, Lantus 10 units for four years and has not been on follow up.

 

Acute gastritis-the patient is well-known to have been treated for UGIB four years ago and is presenting with abdominal pain, diarrhoea, and nausea.

 

Diabetic gastropathy- The patient is obese and well-known diabetic on medications who presented with abdominal pain, diarrhoea, and nausea. It is usually a result of low sugar control.

 

The diverticulitis-the patient has abdominal pain that very severe for three days associated with diarrhoea and nausea. On abdominal palpation, there is tenderness on the left lower quadrant.

Final Diagnosis: Gastritis in a patient with a previous history of UGIB, hypertension, and diabetes mellitus.

Plan

Pharmacologic

Lisinopril 10 mg,

Amlodipine 5 mg,

Metformin 1000mg

Lantus 10 units

Loperamide 4mg stat then 2mg after every loose stool

buscopan 10 mg twice daily

 

Health Education/Referral

Oral education on the importance of routine physical activity and healthy dietary habits to lose excess weight and maintain reasonable glycemic and blood pressure control to prevent cardiovascular risks (Inzucchi et al., 2015). He will also be educated on medication adherence for long-term blood pressure and glycemic control to avoid complications, the long-term and short-term complications of diabetes and hypertension and blood sugar, and blood pressure self-monitoring. Referral to a dietician to assist in constructing a healthy dietary plan would be appropriate.  Management of Hyperglycemia in Type 2 Diabetes Essay Paper

Follow-Up Instructions

The patient was advised to report to the nearest health centre in case the symptoms of abdominal pain, diarrhoea, and nausea. He was also asked to return after three months for the HBA1C test, which will help to determine the effectiveness of the current pharmacological and non-pharmacological interventions on glycemic control (Gosmanov, Gosmanova & Kitabchi, 2018). He was advised to do a routine kidney function test and cholesterol levels.

Lessons learned from this Experience.

This Experience provided the author with more significant insights on the impact of a patient’s financial status in the management of chronic diseases, primarily type 2 DM and hypertension. Patients with a low income have trouble in purchasing drugs or observing scheduled physician visits. This can potentially contribute to poor medication adherence and ultimately, low glycemic and blood pressure control. Therefore, when prescribing medications to patients with chronic illnesses, it is advisable to consider a patient’s financial status and prescribe affordable medications to promote adherence.  Alternatively, referring such patients to assistance programs is commendable. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

What To Do Differently

The author would do nothing differently in regards to diagnosing, managing or educating this patient. The author felt that it was appropriate to obtain the patient’s random blood glucose test first, before instituting any interventions increasing or decreasing the dosage of any medications. Especially is the blood pressure and blood glucose levels were within the required range. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

In this Assessment 1 Assignment, you will analyze an Episodic Note case study that describes abnormal findings in patients seen in a clinical setting. This is in a scholarly paper format and not SOAP format this week. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Follow the rubric…..Be sure to use APA format…..and upload by Day 7. Subjective:•CC: “My stomach hurts, I have diarrhea and nothing seems to help.”•HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.•PMH: HTN, Diabetes, hx of GI bleed 4 years ago •Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs•Allergies: NKDA•FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD •Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Objective:•VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs•Heart: RRR, no murmurs•Lungs: CTA, chest wall symmetrical•Skin: Intact without lesions, no urticaria •Abd: soft, hyperactive bowel sounds, pos pain in the LLQ•Diagnostics: None Assessment:•Left lower quadrant pain •Gastroenteritis PLAN: This section is not required for the assignment.

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Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen. In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. To Prepare Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study. With regard to the Episodic note case study provided: Review this week’s Learning Resources, and consider the insights they provide about the case study. Consider what history would be necessary to collect from the patient in the case study. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. The Assignment Analyze the subjective portion of the note. List additional information that should be included in the documentation. Analyze the objective portion of the note. List additional information that should be included in the documentation. Is the assessment supported by the subjective and objective information? Why or why not? What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis? Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

References

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centred approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care38(1), 140-149.

Gosmanov, A. R., Gosmanova, E. O., & Kitabchi, A. E. (2018). Hyperglycemic crises: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). In Endotext [Internet]. MDText. Com, Inc.

Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure. Nature Reviews Cardiology13(6), 368-378. Management of Hyperglycemia in Type 2 Diabetes Essay Paper

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