NURS6531 week 10 discussion latest 2018 September Week 10 discussion Discussion: Examining Endocrine, Metabolic, and Hematologic Disorders
Discussion: Examining Endocrine, Metabolic, and Hematologic
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
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
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.