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:
Based on the given case study, this assignment aims to answer several questions related to the appropriate medical assessment, diagnosis, and treatment of a patient with dizziness, nausea, and other symptoms. Using evidence-based practice, the following questions will be addressed thoroughly.
1. What are the pertinent positive and negative findings in this patient assessment?
Answer: Pertinent positive findings in this patient assessment include dizziness, nausea, increased thirst, and elevated blood sugar levels. Pertinent negative findings include the absence of headaches, blurry vision, and chest pain. The patient also reports an inability to get out of bed and general weakness.
2. Create a list of differentials with rationales for this patient?
Answer: The differential diagnoses for this patient include Diabetic Ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), stroke, vertigo, and Meniere’s disease. DKA and HHS are the most likely diagnoses given the patient’s elevated blood sugar levels, increased thirst, and absence of other neurological symptoms like headache and blurry vision. Stroke is also a possible diagnosis given the patient’s history of two CVAs, generalized weakness, and inability to get out of bed. Vertigo and Meniere’s disease can also cause dizziness and nausea, but are less likely in this case given the patient’s medical history of DM, HTN, and CAD.
3. Discuss a medication regimen for this patient considering his financial status?
Answer: Given the patient’s financial status, a medication regimen that includes low-cost but effective medications should be prescribed. These may include Metformin, which helps in reducing blood sugar levels, and NPH insulin, which has been proven to be effective and affordable for patients with diabetes. Additionally, prescribing medications that offer discounts or are available in generic formulations will help reduce costs.
4. What is the priority concern for this patient?
Answer: The patient’s priority concern is to reduce his blood sugar levels to prevent the development of further complications associated with diabetes, such as kidney damage, blindness, and neuropathy.
5. How does this patient’s comorbid diagnosis impact his current symptoms?
Answer: The patient’s comorbid diagnosis, including DM, HTN, and CAD, predisposes him to develop complications, such as diabetic ketoacidosis, hyperosmolar hyperglycemic state, and stroke. These complications are leading causes of the patient’s current symptoms, including dizziness, nausea, and inability to stand.
6. Discuss how the patient’s health beliefs, culture, and behaviors impact the potential outcomes for the patient.
Answer: The patient’s health beliefs, culture, and behaviors can significantly impact the potential outcomes of his treatment. For instance, the patient’s belief that he cannot manage his diabetes due to financial constraints can lead to non-compliance with medications, which can worsen his condition. Therefore, healthcare providers must educate the patient on the importance of adherence to medication regimen, proper diet, and lifestyle changes to improve his condition. Additionally, understanding the patient’s cultural beliefs regarding healthcare can aid in the development of culturally competent care, ultimately improving treatment outcomes.
