Running head: WEEK 5 CASE STUDY 1
Week 5 Case Study: Mrs. R.
Chamberlain University
NR 601: Primary Care of the Maturing and Aged
Family
,WEEK 5 CASE STUDY 2
Week 5 Case Study: Mrs. R.
The case study scenario introduced the class to Mrs. R., a 56-year old Hispanic female
who reported to the office clinic with complaints of extreme fatigue and experiencing a gradual
weight gain. The onset of her symptoms started three months ago. She exercises twice a week
by walking on the treadmill for 30 minutes in an attempt to lose weight but has been
unsuccessful. The intention of this paper is to examine the analysis of the subjective and
objective findings that was collected to diagnose and create a management plan for Mrs. R. In
addition, the application of national diabetes guidelines will be included into the patient’s
management plan.
This paper will also discuss the assessment of the primary, the secondary, and the
differential diagnoses for Mrs. R., as well as the management plan for treatment of the primary,
the secondary, and the differential diagnoses, which consists of diagnostics, medications,
education, referrals, and follow-up care. This paper also includes a discussion on medication
costs of all prescribed and over-the-counter (OTC) medications.
Assessment
According to the information provided by Mrs. R., she has symptoms of major
concerns, which includes extreme fatigue, the inability to lose weight regardless of her attempts
to exercise, her increase in thirst, hunger, and urination. Per the Center for Disease Control and
Prevention BMI calculator (CDC) (2015), her calculated BMI of 29.7 showed that she is
overweight for her given height. The result from her urine analysis showed glucose and small
concentration of protein. Her HgbA1C is 6.9% and her fasting glucose is 126 mg/dL, which
according to the American Diabetes Association (ADA) (2018), she meets the conditions for the
diagnosis of diabetes. Mrs. R’s CBC values, TSH and Free T4 levels were unremarkable, which
, WEEK 5 CASE STUDY 3
ruled out hypothyroidism and anemia. Her lipid panel results revealed she has hyperlipidemia.
Her elevated cholesterol places her at risk for a stroke and cardiovascular disease (AACE, 2017).
Primary diagnosis
Diabetes Mellitus Type 2 (DM2) (E11.9). Type 2 diabetes or DM2 is referred to as
adult-onset diabetes and is indicated by hyperglycemia, insulin deficiency, insulin resistance
that can lead to the development of vascular and neurologic complications (American Diabetes
Association [ADA], 2018). According to Goroll (2014), there is an insufficient amount of
insulin being excreted by the pancreas to meet the metabolic needs of the body causing
hyperglycemia. Goroll (2014) also states that the disease is more apparent later in life in most
cases, with fatigue as the leading sign. Manifestations of DM2 consist of polyuria, polydipsia,
polyphagia, and weight gain (Goroll, 2014). Some pertinent positives include: extreme thirst
(polydipsia), extreme hunger (polyphagia), frequent urination during the day (polyuria), extreme
fatigue, difficulty losing weight regardless of exercise, obesity, her age, and Hispanic ethnicity.
Her lab results, which includes Hemoglobin A1c=6.9%, fasting plasma glucose=126, and
elevated cholesterol levels are indicative of diabetes mellitus type 2. Per Pippitt, Li, and Gurgle
(2016), DM2 can lead to blindness, renal failure, amputation of the limbs, vascular and cardiac
disease.
Rationale. The diagnosis of diabetes mellitus type 2 is chosen as the primary diagnosis
due to Mrs. R.’s symptoms of fatigue, her inability to lose weight regardless of incorporating
exercise in her lifestyle, her increased frequency of urination, and increased thirst and hunger.
Also, her lab results, which includes her HA1c, are indicative of the diagnosis of diabetes type 2.
Additional risk factors associated with Mrs. R. is her age, and her Hispanic ethnicity. According
to the ADA (2018), the factors, such as obesity, age, and certain racial/ethnic subgroups, which
Week 5 Case Study: Mrs. R.
Chamberlain University
NR 601: Primary Care of the Maturing and Aged
Family
,WEEK 5 CASE STUDY 2
Week 5 Case Study: Mrs. R.
The case study scenario introduced the class to Mrs. R., a 56-year old Hispanic female
who reported to the office clinic with complaints of extreme fatigue and experiencing a gradual
weight gain. The onset of her symptoms started three months ago. She exercises twice a week
by walking on the treadmill for 30 minutes in an attempt to lose weight but has been
unsuccessful. The intention of this paper is to examine the analysis of the subjective and
objective findings that was collected to diagnose and create a management plan for Mrs. R. In
addition, the application of national diabetes guidelines will be included into the patient’s
management plan.
This paper will also discuss the assessment of the primary, the secondary, and the
differential diagnoses for Mrs. R., as well as the management plan for treatment of the primary,
the secondary, and the differential diagnoses, which consists of diagnostics, medications,
education, referrals, and follow-up care. This paper also includes a discussion on medication
costs of all prescribed and over-the-counter (OTC) medications.
Assessment
According to the information provided by Mrs. R., she has symptoms of major
concerns, which includes extreme fatigue, the inability to lose weight regardless of her attempts
to exercise, her increase in thirst, hunger, and urination. Per the Center for Disease Control and
Prevention BMI calculator (CDC) (2015), her calculated BMI of 29.7 showed that she is
overweight for her given height. The result from her urine analysis showed glucose and small
concentration of protein. Her HgbA1C is 6.9% and her fasting glucose is 126 mg/dL, which
according to the American Diabetes Association (ADA) (2018), she meets the conditions for the
diagnosis of diabetes. Mrs. R’s CBC values, TSH and Free T4 levels were unremarkable, which
, WEEK 5 CASE STUDY 3
ruled out hypothyroidism and anemia. Her lipid panel results revealed she has hyperlipidemia.
Her elevated cholesterol places her at risk for a stroke and cardiovascular disease (AACE, 2017).
Primary diagnosis
Diabetes Mellitus Type 2 (DM2) (E11.9). Type 2 diabetes or DM2 is referred to as
adult-onset diabetes and is indicated by hyperglycemia, insulin deficiency, insulin resistance
that can lead to the development of vascular and neurologic complications (American Diabetes
Association [ADA], 2018). According to Goroll (2014), there is an insufficient amount of
insulin being excreted by the pancreas to meet the metabolic needs of the body causing
hyperglycemia. Goroll (2014) also states that the disease is more apparent later in life in most
cases, with fatigue as the leading sign. Manifestations of DM2 consist of polyuria, polydipsia,
polyphagia, and weight gain (Goroll, 2014). Some pertinent positives include: extreme thirst
(polydipsia), extreme hunger (polyphagia), frequent urination during the day (polyuria), extreme
fatigue, difficulty losing weight regardless of exercise, obesity, her age, and Hispanic ethnicity.
Her lab results, which includes Hemoglobin A1c=6.9%, fasting plasma glucose=126, and
elevated cholesterol levels are indicative of diabetes mellitus type 2. Per Pippitt, Li, and Gurgle
(2016), DM2 can lead to blindness, renal failure, amputation of the limbs, vascular and cardiac
disease.
Rationale. The diagnosis of diabetes mellitus type 2 is chosen as the primary diagnosis
due to Mrs. R.’s symptoms of fatigue, her inability to lose weight regardless of incorporating
exercise in her lifestyle, her increased frequency of urination, and increased thirst and hunger.
Also, her lab results, which includes her HA1c, are indicative of the diagnosis of diabetes type 2.
Additional risk factors associated with Mrs. R. is her age, and her Hispanic ethnicity. According
to the ADA (2018), the factors, such as obesity, age, and certain racial/ethnic subgroups, which
