Posted: February 28th, 2022

Case Study 1 The 82-year-old female

Case Study 1

Examining Endocrine, Metabolic, and Hematologic Disorders
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Paper instructions:
o prepare:

Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Discussion.
Review the patient case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an Assessment.
Consider types of physical exams and diagnostics that might be appropriate for Assessment of the patient in the study.
Reflect on a possible diagnosis for the patient.
Think about potential treatment options for the patient.

Examining Endocrine, Metabolic, and Hematologic Disorders
In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.

For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders.

Case Study 1
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault

Case Study 2
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
Case Study 3
V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.

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Case Study 1

The 82-year-old female in Case Study 1 is presenting with a number of symptoms that are consistent with anemia, including fatigue, dizziness, weakness, and dyspnea on exertion. Her physical exam reveals pallor of the conjunctiva, which is a sign of anemia. Her cardiac exam reveals an irregular rhythm, which could be due to atrial fibrillation. Her lungs are clear to auscultation, which suggests that there is no pneumonia or other lung disease. Her abdomen is soft and non-tender, with no organomegaly. Her rectal exam is negative for stool.

The laboratory results in Case Study 1 are consistent with anemia. The white blood cell count is normal, which suggests that there is no infection. The hemoglobin (Hgb) is 8 grams per deciliter (g/dL) and the hematocrit (Hct) is 24%. These values are low, consistent with anemia. The mean corpuscular volume (MCV) is normal, which suggests that the anemia is not due to a microcytic or macrocytic process.

The most likely diagnosis in Case Study 1 is anemia due to chronic disease. This type of anemia is common in older adults, and it is often caused by conditions such as heart disease, hypertension, and chronic kidney disease. The patient’s past medical history of atrial fibrillation, hypertension, and hyperlipidemia makes her a good candidate for this diagnosis.

The treatment for anemia due to chronic disease is aimed at treating the underlying condition. In the patient’s case, this would involve treating her atrial fibrillation, hypertension, and hyperlipidemia. She may also need to be treated with iron supplements to improve her hemoglobin levels.

Case Study 2

The 78-year-old female in Case Study 2 is presenting with pain in her left leg after a fall. She has a past medical history of RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Her current medications include quinapril, Lantus, and Humalog.

The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count, Hgb of 8, and Hct of 24. The MCV is normal.

The most likely diagnosis in Case Study 2 is acute pain due to a fall. The patient’s age, past medical history, and physical exam findings are all consistent with this diagnosis.

The treatment for acute pain due to a fall is aimed at relieving the pain and preventing further injury. The patient may be given pain medication, such as ibuprofen or acetaminophen. She may also be instructed on how to prevent falls, such as using a cane or walker.

Case Study 3

The 47-year-old African American male in Case Study 3 has Type 2 diabetes and is complaining of increased tingling to the lower extremities. He has a past medical history of obesity, dyslipidemia, and HTN. He quit smoking two years ago and denies any alcohol use. He lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. He works occasionally.

His current medications are Lisinopril, Januvia, and Lipitor. He lost his medications and hasn’t taken any in about a week. His physical exam reveals a BP of 160/100 and an RBG of 415.

The most likely diagnosis in Case Study 3 is diabetic neuropathy. This type of neuropathy is a complication of diabetes that causes damage to the nerves. The patient’s symptoms of tingling and numbness are consistent with this diagnosis.

The treatment for diabetic neuropathy is aimed at preventing further nerve damage. The patient may be given medication to control his blood sugar levels. He may also be given physical therapy to help him manage his symptoms.

In all three cases, it is important to educate the patient about their condition and how to manage it. This includes teaching them about their medications, diet, and exercise. It is also important to monitor the patient’s condition closely and make adjustments to their treatment plan as needed.

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