NR 507 Case Study
Pathophysiology & Clinical Findings of the Disease
1. Based on the review of the history, physical and lab findings what is the most likely
diabetes diagnosis for this patient?
Looking through this case study and the information it is safe to say the patient has type II
Diabetes mellitus. Many things set type I and II apart. Going through the history and lab values it
was easy to exclude type I.
2. Explain the pathophysiology associated with the chosen diabetes diagnosis.
The patient is 48 years old. That is one flag that makes me think type II. Type I DM is usually
diagnosed in children were as Type II its in older adults. The patient’s urine was also negative
for ketones. If it was positive for ketones that would make me think type I. Type 2 diabetes is
due to a progressive loss of β-cell insulin secretion frequently on the background of insulin
resistance (McCance & Huether, 2019).
Criteria that leads to DM Type II diagnosis are as follow; Increased wait circumference, plasma
triglycerides above 150, hyperlipidemia, blood pressure above 130/85, and a fasting plasma
glucose above 100 (McCance & Huether, 2019). In this case the patient’s BP at the time of exam
was 136/80, BMI 36.5, fasting glucose of 132, pt has a HX of HTN and Hyperlipidemia.
The patient having a history of Hyperlipidemia can increase their risk for developing Diabetes.
This is due to excessive deposits of Triglycerides and cholesterol can interfere with intracellular
insulin signaling. In turn this can decrease the bodies response to insulin, promote inflammation,
and lead to beta cell death (McCance & Huether, 2019).
Pt experiencing fatigue is a sign as well, which is due to the metabolic changes resulting in poor
use of food products (McCance & Huether, 2019)
3. Identify at least three subjective findings from the case which support the chosen
diagnosis.
• Fatigue
• Polydipsia
• Polyuria
• Polyphagia
4. Identify at least three objective findings from the case which support the chosen
diagnosis
• Breathing deep with fruity breath smell
• Tachycardia
, • Dried lips
• Fasting Glucose 132 (hyperglycemia)
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment
recommendations.
1. Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment
recommendations.
First off, any treatment plan should always be individualized towards that patient. Yes,
we have general treatment plans that work for mostly everyone with certain diseases. But
if the plans do not appear to be individualized the patient might have a harder time
following plan of care, as they might feel the provider does not truly care about their
personal problems. Prevention is always the best medicine as well. If we as providers can
be proactive and prevent a problem before it starts or get control early on that makes the
patient’s life over all better. Testing for Type II DM should start after the age 45
regardless of obesity and BMI. Earlier testing can be done for certain at-risk individuals.
I feel prevention starting in the prediabetic stages are key. Even with early diabetes
weight loose and exercise should always be encouraged to better the persons quality of life.
Doing the following treatment options would be a great place to start.
Refer patients with prediabetes to an intensive lifestyle behavior change
program modeled on the Diabetes Prevention Program (DPP) to achieve and
maintain 7% loss of initial body weight and increase moderate-intensity
physical activity (such as brisk walking) to at least 150 minutes/week (Standards
of Medical Care in Diabetes, 2021).
2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this
condition and provide an example (drug name) for each.
A lot of patients with this disease use insulin to help control glucose. Some patients use
both long and short acting insulin. Insulin may be needed due to the loss of beta-cell
function. However, prevention and controlling BM type II with oral PO medications is
key. It is not best to start with insulin for every DM patient.
Some patients are able to control their glucose levels with PO medications such as
Biguanides like metformin. Some patients also use another PO medication class,
Sulfonylureas such as glipizide which can be used as well. These are great options to try
first before moving someone to insulin.
Pathophysiology & Clinical Findings of the Disease
1. Based on the review of the history, physical and lab findings what is the most likely
diabetes diagnosis for this patient?
Looking through this case study and the information it is safe to say the patient has type II
Diabetes mellitus. Many things set type I and II apart. Going through the history and lab values it
was easy to exclude type I.
2. Explain the pathophysiology associated with the chosen diabetes diagnosis.
The patient is 48 years old. That is one flag that makes me think type II. Type I DM is usually
diagnosed in children were as Type II its in older adults. The patient’s urine was also negative
for ketones. If it was positive for ketones that would make me think type I. Type 2 diabetes is
due to a progressive loss of β-cell insulin secretion frequently on the background of insulin
resistance (McCance & Huether, 2019).
Criteria that leads to DM Type II diagnosis are as follow; Increased wait circumference, plasma
triglycerides above 150, hyperlipidemia, blood pressure above 130/85, and a fasting plasma
glucose above 100 (McCance & Huether, 2019). In this case the patient’s BP at the time of exam
was 136/80, BMI 36.5, fasting glucose of 132, pt has a HX of HTN and Hyperlipidemia.
The patient having a history of Hyperlipidemia can increase their risk for developing Diabetes.
This is due to excessive deposits of Triglycerides and cholesterol can interfere with intracellular
insulin signaling. In turn this can decrease the bodies response to insulin, promote inflammation,
and lead to beta cell death (McCance & Huether, 2019).
Pt experiencing fatigue is a sign as well, which is due to the metabolic changes resulting in poor
use of food products (McCance & Huether, 2019)
3. Identify at least three subjective findings from the case which support the chosen
diagnosis.
• Fatigue
• Polydipsia
• Polyuria
• Polyphagia
4. Identify at least three objective findings from the case which support the chosen
diagnosis
• Breathing deep with fruity breath smell
• Tachycardia
, • Dried lips
• Fasting Glucose 132 (hyperglycemia)
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment
recommendations.
1. Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment
recommendations.
First off, any treatment plan should always be individualized towards that patient. Yes,
we have general treatment plans that work for mostly everyone with certain diseases. But
if the plans do not appear to be individualized the patient might have a harder time
following plan of care, as they might feel the provider does not truly care about their
personal problems. Prevention is always the best medicine as well. If we as providers can
be proactive and prevent a problem before it starts or get control early on that makes the
patient’s life over all better. Testing for Type II DM should start after the age 45
regardless of obesity and BMI. Earlier testing can be done for certain at-risk individuals.
I feel prevention starting in the prediabetic stages are key. Even with early diabetes
weight loose and exercise should always be encouraged to better the persons quality of life.
Doing the following treatment options would be a great place to start.
Refer patients with prediabetes to an intensive lifestyle behavior change
program modeled on the Diabetes Prevention Program (DPP) to achieve and
maintain 7% loss of initial body weight and increase moderate-intensity
physical activity (such as brisk walking) to at least 150 minutes/week (Standards
of Medical Care in Diabetes, 2021).
2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this
condition and provide an example (drug name) for each.
A lot of patients with this disease use insulin to help control glucose. Some patients use
both long and short acting insulin. Insulin may be needed due to the loss of beta-cell
function. However, prevention and controlling BM type II with oral PO medications is
key. It is not best to start with insulin for every DM patient.
Some patients are able to control their glucose levels with PO medications such as
Biguanides like metformin. Some patients also use another PO medication class,
Sulfonylureas such as glipizide which can be used as well. These are great options to try
first before moving someone to insulin.
