Endocrine case study
CC/PMI: GB is a 65 year-old male who comes in for a check-up on the request
of his spouse. His last check-up was 10 years ago. He has no complaints other
than some leg numbness and tingling from time-to-time and feeling thirsty and
tired most of the time.
SH: no smoking or alcohol consumption
Physical Examination:GEN: well-nourished, slightly obese
male
VS: BP 170/100, Hr 70, RR 12, T 98.7, Wt 89kg, Ht 5’8″
HEENT:
PERRLA
COR: RRR, NMRG
CHEST: CTA
NEURO: monofilament test shows
decreased peripheral sensation
EXT: normal
Laboratory (fasting):
Na 140 | Cl 100 | BUN 32 | BG 250 |
K 3.7 | HCO3 24 | SCr 1.9 | |
ALT 35 | AST 40 | Alb 4.0 | |
Ca 9.0 | TP 7 | Cholesterol 250 |
UA: SG 1.012, pH 6.4, +++ protein
Questions
- What major problems can you identify with this patient?
- What is your assessment and plan for each problem?
- Provide pharmacological and nonpharmacological care (don’t forget to be
specific). Will you add any new medications? - How will you monitor each problem and each medication included in your plan?
- When will you suggest following up with the patient?
- Is there any laboratory monitoring that will need to be conducted to assure
the safety of the patient?
Expert Solution Preview
Introduction:
This case study presents a 65-year-old male with some chronic medical conditions. As a medical professor, it is essential to understand the major problems that the patient is facing and develop an assessment and plan for each problem. Additionally, understanding how to provide pharmacological and non-pharmacological care, monitoring problems and medications, suggesting follow-up appointments, and laboratory monitoring is crucial in managing chronic medical issues.
1. What major problems can you identify with this patient?
The patient presents with several major problems. Firstly, he has high blood pressure with a systolic blood pressure (SBP) of 170mmHg and diastolic blood pressure (DBP) of 100mmHg, which puts him at risk for complications such as cerebrovascular accidents. Secondly, he has peripheral neuropathy as evidenced by a decreased peripheral sensation. Thirdly, he has chronic kidney disease stage 3 indicated by elevated serum creatinine and blood urea nitrogen (BUN). Fourthly, he has hyperglycemia as indicated by a high blood glucose (BG) level of 250mg/dl, which suggests he may have diabetes mellitus. Finally, he has mild hyperlipidemia indicated by elevated cholesterol levels.
2. What is your assessment and plan for each problem?
For hypertension, the patient will need to be started on antihypertensive medication, such as an angiotensin-converting enzyme inhibitor (ACE inhibitor) or an angiotensin receptor blocker (ARB). Peripheral neuropathy will require symptom management, such as pain management and protection from injury. Management of chronic kidney disease will require evaluation of the patient’s medications and removal of any nephrotoxic agents, such as NSAIDs. Additionally, the patient may need a referral for renal specialist assessment. Hyperglycemia may require management with antidiabetic medication, lifestyle modification, and diabetes education. Lastly, for hyperlipidemia, lipid-lowering medication such as a statin should be considered.
3. Provide pharmacological and nonpharmacological care (don’t forget to be specific). Will you add any new medications?
Pharmacological care will involve the use of antihypertensive medication, such as an ACE inhibitor or ARB, to manage hypertension. For peripheral neuropathy, symptom management will require pain medication, vitamin supplementation, and education regarding the importance of foot care to avoid injuries. For chronic kidney disease, nephrotoxic agents such as NSAIDs will be discontinued, and ace inhibitors or ARBs will be offered, and a nephrology referral should be considered.
Management of hyperglycemia may require an oral antidiabetic medication such as metformin, lifestyle modifications such as diet, exercise, and diabetes education. For hyperlipidemia, the use of statin medication such as atorvastatin should be considered.
Nonpharmacological care may include lifestyle modifications such as smoking and alcohol cessation, dietary changes, and exercise.
4. How will you monitor each problem and each medication included in your plan?
Each problem and medication will be monitored through the evaluation of clinical signs and symptoms, laboratory monitoring, and regular follow-up visits with physicians. Blood pressure, kidney function, and blood glucose monitoring will be performed in the clinic regularly to evaluate the effectiveness of medication therapy. Additionally, patients will be routinely screened for side effects of medications.
5. When will you suggest following up with the patient?
Follow-up visits will depend on the severity of each problem and how well the patient responds to treatment. For hypertension, monthly follow-up visits may be required to optimize control, and similarly, for glycemic control, frequent follow-up visits will be necessary until the blood glucose level is within the target range. For chronic kidney disease, referral to a nephrologist may be considered.
6. Is there any laboratory monitoring that will need to be conducted to assure the safety of the patient?
Yes, laboratory monitoring for each medication plan is essential to evaluate each medication’s effectiveness and safety. Laboratory monitoring will include blood pressure monitoring, blood glucose level monitoring, and kidney function tests such as serum creatinine, estimated glomerular filtration rate (eGFR), and urine protein levels. Additionally, liver function tests and lipid levels may be measured to monitor statin medication’s effectiveness.
