Week 5 Case Study Assignment NR 602: Primary Care of the Maturing and Aged Jennifer Ervin Chamberlain College of Nursing

Introduction

The purpose of this paper is to analyze the provided subjective and objective information to diagnose and develop a management plan for the case study patient. Through this assignment, I should be able to apply appropriate health promotion guidelines and disease prevention strategies in the management of mature and aging individuals and families.

Assessment

Primary Dx: Type 2 Diabetes Mellitus without complications (E11.9) Diabetes is a complex metabolic disorder usually related to insulin resistance and/or insulin deficiency, which results in microvascular and macrovascular disease (Zaccardi, Webb, Yates, & Davies, 2015).

Secondary Dx: Mixed Hyperlipidemia (E78.2) Cholesterol is a naturally occurring substance that is necessary to synthesize bile and steroid hormones to maintain healthy cells. Multiple factors (serum lipids, inflammatory cells at the site of lipid deposition, etc.) contribute to the development of atherosclerosis (Taskinen & Boren, 2015).

Differential Diagnosis:

Hypothyroidism (E03.9) The patient’s pertinent positive findings to confirm the diagnosis of diabetes are subjective findings of 3 lbs weight gain, fatigue, polyphagia, polydipsia, and polyuria. The diagnostics that confirm this diagnosis are the presence of 1+ glucose and small protein in her urine, a fasting plasma glucose of 126, and a Hemoglobin A1C of 6.9%. According to ADA diagnostic criteria, Type 2 DM is diagnosed if A1C is >6.5% and FPG >126 (American Diabetic Association, 2014). Mrs. K’s BMI is 29.7, which is a risk factor for DM with a BMI >25. Mrs. K did not report blurred vision or multiple vaginal infections.

The patient’s pertinent positive findings to confirm the diagnosis of cholesterol issues are a family history of cholesterol (father) and lab values of TC 230 mg/dL, LDL 144 mg/dL, VLDL 36 mg/dL, HDL 38 mg/dL, and Triglycerides 232 (Stone et al., 2014). Upon physical examination, no xanthoma, xanthelasma, corneal arcus, or bruits were noted. She also has no reports of chest pain, or history of chest pain, heart attack, or stroke.