Assignment—Case Study for Chronic Condition
For this Assignment, you are answer the questions regarding this case study. Please make sure to support your answers using evidence based practice.
56 y/o Caucasian male presents to the primary care clinic with complains of dizziness and nausea x 4 days. The patient reports he has not been able to get out of bed since the symptoms started. The patient reports symptoms are worse when he tries to get out of bed to stand. He denies any headaches or blurry vision. He states he is urinating more over the last few days and he has noticed increase in thirst. He reports he just drank a large sweet tea before he came into the clinic.
The patient reports that he is out of his Lantus and metformin because he cannot afford the refill until he gets his disability check. He is disabled after his second CVA that left his with generalized weakness. His medical history includes DM, HTN, CAD.
Upon arrival at the clinic, the patient’s vital signs are as follows- Blood sugar 405, B/P 190/101, HR 102, R-20, T- 98.5.
Using Evidence Based practice, answer the following questions thoroughly. Be sure to use APA formatting.
- What is the pertinent positive and negative findings in this patient assessment?
- Create a list of differentials with rationales for this patient?
- Discuss a medication regimen for this patient considering his financial status?
- What is the priority concern for this patient?
- How does this patient’s comorbid diagnosis impact his current symptoms?
- Discuss how the patient’s’ health beliefs, culture and behaviors impact the potential outcomes for the patient.
Expert Solution Preview
Introduction:
This case study presents a 56-year-old Caucasian male with complaints of dizziness and nausea. The patient reports an increase in thirst and urination and is out of his Lantus and metformin medications due to financial constraints. The patient has a medical history of diabetes, hypertension, and coronary artery disease. The following questions aim to explore the pertinent positive and negative findings of the patient assessment, create differentials, discuss a medication regimen, identify priority concerns, examine co-morbid diagnoses, and evaluate the impact of the patient’s health beliefs, culture, and behaviors on potential outcomes.
1. What is the pertinent positive and negative findings in this patient assessment?
The pertinent positive findings in this patient assessment are dizziness, nausea, increased thirst and urination, and a high blood sugar level of 405 mg/dL. The patient’s blood pressure is also elevated at 190/101 mmHg. The pertinent negative findings are no headaches, and blurry vision.
2. Create a list of differentials with rationales for this patient?
Differential diagnoses include hyperosmolar hyperglycemic state (HHS), diabetic ketoacidosis (DKA), hypoglycemia, and hypertension-related syncope. HHS and DKA are possible due to the patient’s high blood sugar and symptoms of nausea and increased thirst. The patient’s disorientation, weakness, and inability to stand suggest hypoglycemia. Hypertension-related syncope is possible due to the patient’s elevated blood pressure.
3. Discuss a medication regimen for this patient considering his financial status?
Due to the patient’s financial constraints, the medication regimen may need to be altered. Metformin is typically a first-line medication for diabetes management, and Lantus is a long-acting insulin. Low-cost generic medications may be an option, such as glimepiride and insulin NPH. Additionally, lifestyle modifications, such as diet and exercise, may be implemented.
4. What is the priority concern for this patient?
The priority concern for this patient is to stabilize his blood sugar and treat any acute condition that may be present, such as HHS or DKA.
5. How does this patient’s comorbid diagnosis impact his current symptoms?
The patient’s comorbid diagnoses of diabetes, hypertension, and coronary artery disease contribute to his current symptoms and potential conditions. Diabetes can lead to HHS or DKA, hypertension can cause syncope, and coronary artery disease is associated with chest pain and shortness of breath.
6. Discuss how the patient’s health beliefs, culture, and behaviors impact the potential outcomes for the patient.
The patient’s health beliefs, culture, and behaviors can impact potential outcomes for care. Cultural beliefs may affect the patient’s acceptance of certain medications or lifestyle modifications. Health behaviors, such as diet and exercise, may also impact the patient’s diabetes control. Financial constraints may impact adherence to medications and follow-up care. Therefore, it is important to address these factors in developing a care plan that is culturally sensitive, patient-centered, and feasible for the patient.
