Case Study: Mrs. Wong Chamberlain University, NR 601: Primary Care of the Maturing and Aged Family, Primary diagnosis: Diabetes Mellitus Type 2 (E11.9). Diabetes Mellitus Type 2

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Case Study: Mrs. Wong Chamberlain University NR 601: Primary Care of the Maturing and Aged Family The case study scenario introduces Mrs. Wong, a 59-year-old Asian female whose chief complaint in... volves increasing fatigue for the last two months and a gradual weight gain of four pounds since starting menopause four years ago. Mrs. Wong states she exercises twice a week as directed by walking on the treadmill for 30 minutes but has been unsuccessful in losing weight. In fact, she complains that exercising makes her more hungry and thirsty. Mrs. Wong also reports less knee pain and increased mobility for her recently diagnosed right knee arthritis. The purpose of this case study is to analyze the subjective and objective physical exam findings to provide a diagnosis and develop a management plan for Mrs. Wong. The paper will include an assessment of the primary, secondary and differential diagnoses for Mrs. Wong; a management plan that contains the diagnostics, medication, education, referrals, and follow up appointment information; and a medications’ price assessment that includes the costs of all prescribed and OTC monthly medications. Lastly, this paper will apply national diabetes guidelines to Mrs. Wong’s treatment plan and show proficiency of SOAP note writing. Assessment The information provided by Mrs. Wong shows she is concerned about the following symptoms: extreme fatigue, inability to lose weight despite exercising, increased thirst and hunger. Mrs. Wong’s height is 5’1.5” at a weight 165 pounds. According to the National Heart, Lung and Blood Institute (NHLBI) BMI calculator, Mrs. Wong’s BMU is 30.7, which indicates she is obese. Her urinalysis indicates her SpGr urine specific gravity results are 1.010, which indicates mild dehydration (Stephens, 2018). The higher the number, the more dehydrated the patient is (Stephens, 2018). The urine pH level is 5, which indicates her urine is close to the acidic range; this indicates an environment conducive to kidney stones (Nall, 2016). Her HgbA1C is 6.6% and her fasting glucose is 127 mg/dL, which meets the conditions for the diagnosis of diabetes. Normal ranges for HgbA1C in people without diabetes falls between 4 % and 5.9%. Patients with A1C greater than 6.5% are diagnosed as having Type 2 diabetes mellitus (T2DM) (Goyal & Jialal, 2019). Mrs. Wong’s CBC, TSH, and Free T4 levels were all within normal range, which clears her for hypothyroidism and hyperthyroidism. Her lipid panel reveals a total cholesterol (TC) level of 215 mg/dl, which shows she has high cholesterol, indicating a secondary diagnosis of hyperlipidemia. Karr (2017) states that raised cholesterol present increased risk for stroke and cardiovascular disease. Primary diagnosis: Diabetes Mellitus Type 2 (E11.9). Diabetes Mellitus Type 2, also referred to as noninsulin-dependent diabetes or adult-onset diabetes, accounts for 90% of all diabetes cases (ADA, 2019). This condition is characterized by high blood glucose levels (hyperglycemia), insulin deficiency and resistance; complications of type 2 are diabetic retinopathy, kidney disease, diabetic neuropathy, and macrovascular problems (ADA, 2019). [Show More]

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