Case Study: Managing Type 2 Diabetes in a 48-year-old Male, Exams of Nursing

Download Case Study: Managing Type 2 Diabetes in a 48-year-old Male and more Exams Nursing in PDF only on Docsity! 1 Diabetes Case Study Chamberlain College of Nursing NUR 507 Advanced Pathophysiology 2 Diabetes Case Study Scenario Chief Complaint J.T. is a 48-year-old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite. History of Present Illness J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than four times per night. Past Medical History • Hypertension • Hyperlipidemia • Obesity Family History • Both parents deceased • Brother: Type 2 diabetes Social History • Denies smoking. • Denies alcohol or recreational drug use. • Landscaper Allergies • No Known Drug Allergies Medications • Lisinopril 20 mg once daily by mouth • Atorvastatin 20 mg once daily by mouth • Aspirin 81 mg once daily by mouth • Multivitamin once daily by mouth Review of Systems • Constitutional: - fever, - chills, - weight loss. • Neurological: denies dizziness or disorientation • HEENT: Denies nasal congestion, rhinorrhea, or sore throat. • Chest: (-) Tachypnea. Denies cough. • Heart: Denies chest pain, chest pressure or palpitations. • Lymph: Denies lymph node swelling. General Physical Exam • Constitutional: Alert and oriented male in no acute distress • Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20 • Wt. 240 lbs., Ht. 5'8", BMI 36.5 HEENT • Eyes: Pupils equal, round, and reactive to light and accommodation, normal conjunctiva. 5 3. Identify at least three subjective findings from the case which support the chosen diagnosis. Three subjective findings that support the diagnosis are fatigue, increased thirst, and frequent urination. 4. Identify at least three objective findings from the case which support the chosen diagnosis. Objective findings that support the diagnosis are an A1C of 7.2, oral glucose tolerance test of 220, fasting blood glucose of 132, and recent weight loss. Management of the Disease *Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations. 1. Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations. Once the patient is symptomatic and has been diagnosed with type 2 diabetes prompt action is required to keep the disease from progressing. Diabetic and nutritional counseling need to occur as soon as possible. That way the patient can make dietary and fitness lifestyle changes and begin to combat the condition. Metformin also needs to be started until lifestyle changes start to have effect on glycemic control. 2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each. When it comes to treating type 2 diabetes, the ADA recommends that a Glucagon- like peptide 1 receptor agonist (GLP-1) over the use of insulin (ADA, 2022). One GLP-1 receptor agonist is Dulaglutide also known as Trulicity. It is a once-a-week injection of 0.75-4.5 mg. It has been shown to improve glycemic control and reduce the risk of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke in type 2 diabetic patients (Vallerand & Sanoski, 2022). Biguanides is another class of drugs that the ADA recommends for the treatment of type 2 diabetes (ADA, 2022). An example of a drug in the biguanide class of drugs is Metformin also known as Glucophage. It is an oral anti-diabetic that can range from 500 mg twice daily up to 2550 mg daily dived into three doses. It has been shown to help maintain blood glucose homeostasis and help in weight loss (Vallerand & Sanoski, 2022). 3. Describe the mechanism of action for each of the medication classes identified above. Glucagon-like peptide 1 receptor agonists increases the intracellular cyclic AMP (cAMP) in the body. This leads to increased release of insulin when blood glucose levels are elevated. When blood glucose levels return to normal the increased insulin production is stopped. It has also been shown to slow gastric emptying and slow glucagon secretion (Vallerand & Sanoski, 2022). Biguanides decrease glucose production in the liver by preventing the liver from converting fats and amino acids into glucose. They also decrease the absorption of glucose in the GI tract. Biguanides also activate an enzyme called AMP-activated protein 6 kinase (AMPK). When AMPK levels are increased sensitivity to insulin in the body is increased. The increased sensitivity to insulin increases glucose uptake, thus reducing blood glucose levels (Vallerand & Sanoski, 2022). 4. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient. Non-Pharmacological treatments recommended by the ADA include nutritional counseling, weight management, physical activity, and smoking cessation. It is recommended that patients be counseled on how foods affect their blood glucose and what changes they can make to eat healthier for their condition. Patients should participate in 60 mins of vigorous physical activity at least three times a week (ADA, 2022). The dietary changes and increased physical activity should help the patient lose weight. Reduction in the amount of adipose in the body will increase sensitivity to insulin. 7 References American Diabetes Association. (2022). Standards of care in diabetes—2023. Clinical Diabetes, 41(1), 4–31. https://doi.org/10.2337/cd23-as01 Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275 Goyal, R., & Jialal, I. (2023). Type 2 Diabetes. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513253/ McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby. Vallerand, A. H., & Sanoski, C. (2022). Davis's drug guide for nurses (Eighteenth ed.). F.A. Davis Company.