Running head: CASE STUDY 1
Week 5 Case Study
Christina Hinson
Chamberlain College of Nursing
NR 601: Primary Care of the Maturing and Aged Family Practicum
Summer, August 2018
,CASE STUDY 2
Week 5 Case Study
This case study implies to Mrs. G whom is a 56-year-old Hispanic female with
complaints of fatigue, weight gain, hunger, thirst, and frequent urination. A primary, secondary
and differential diagnoses for Mrs. G will be identified and discussed throughout the paper based
on symptoms and laboratory results. Specifically, diabetes mellitus type II (primary),
hyperlipidemia (secondary), and possible hormonal imbalance such as estrogen deficiency
(differential diagnosis) are among the specific diagnoses to be mentioned along with a brief
pathophysiology, pertinent positives, and pertinent negatives. Additionally, an assessment,
evidence-based practice, plan of diagnostics, medications, education, referrals, follow ups, and
medication cost will be included in the case study.
Assessment
Diabetes mellitus type II (E11) is a metabolic disorder characterized by hyperglycemia,
polyuria, polydipsia, polyphagia, weight loss or weight gain, blurred vision, dry skin, itchiness,
fatigue, poor wound healing, abdominal pain, and peripheral neuropathy. Type II diabetes
mellitus is insulin resistance and insufficient insulin production by pancreatic beta cells (Katsu et
al., n.d.). In the insulin resistance setting, the liver inappropriately releases glucose into the
blood, increases breakdown of fat, and leads to decreased glucose transported into muscle cells
(Zaccardi, Webb, Yates, & Davies, 2016). Pertinent positives presented by Mrs. G are fatigue for
three months, weight gain, polyuria, polyphagia, and polydipsia. Additional, pertinent positive
findings are a fasting glucose level of 126 mg/dL, a hemoglobin A1c of 6.9%, and presence of
glucose in urine. Pertinent negatives are complaints of blurred or changes in vision, no evidence
of poor wound healing, weight loss, peripheral neuropathy, and abdominal pain. Diabetes
mellitus type II was the selected primary diagnosis, because all the pertinent positives presented
, CASE STUDY 3
the disease and was supported with laboratory findings of hyperglycemia. According to Hirsch et
al. (2018), a hemoglobin A1c greater than 6.5% indicate diabetes.
Hyperlipidemia (E78.5) is abnormally elevated levels of serum total cholesterol, high
levels of triglycerides or reduced high-density lipoprotein (HDL) in the blood. A high fat diet,
being overweight, and hypothyroidism contribute to high cholesterol. Adipose lipolysis exceeds
the rate of clearance of plasma that causes the elevated levels of total cholesterol or triglycerides.
HDL is good, because it carries extra cholesterol back to the liver where it can be eliminated.
Low-density lipoprotein (LDL) is bad because it enables excess cholesterol to build up in the
blood leading to atherosclerosis. Triglycerides are a type of fat in the blood that have a strong
association with heart disease. A person with hyperlipidemia usually has no signs or symptoms.
Pertinent positives are being overweight with a BMI of 29.7, paternal family history, a high total
cholesterol level of 230 mg/dL, borderline high LDL level of 144 mg/dL, a decreased HDL level
of 38 mg/dL, and high triglyceride levels of 232 mg/dL. Pertinent negative is the absence of
hypothyroidism. Hyperlipidemia was selected as the secondary diagnosis as it is a present illness
and additional diagnosis (on top of diabetes mellitus) based on lab results. According to Last,
Ference, and Menzel (2017), the only way to detect and diagnose hyperlipidemia is by
performing a fasting lipid panel blood test.
Estrogen deficiency (E28.39) refers to low estrogen levels and primarily occurs after
menopause when the ovaries stop producing estrogen (Akbaba & Akbaba, 2015). Typical clinical
manifestations include hot flashes, headaches, lowered libido, breast atrophy, depression,
recurrent urinary tract infections, fatigue, weight gain, and amenorrhea. Pertinent positives are
fatigue, weight gain, urinary problems, and a last menstrual period (LMP) of 15 months ago.
Pertinent negatives are no concerns or complaints of hot flashes, headache, breast changes, and
Week 5 Case Study
Christina Hinson
Chamberlain College of Nursing
NR 601: Primary Care of the Maturing and Aged Family Practicum
Summer, August 2018
,CASE STUDY 2
Week 5 Case Study
This case study implies to Mrs. G whom is a 56-year-old Hispanic female with
complaints of fatigue, weight gain, hunger, thirst, and frequent urination. A primary, secondary
and differential diagnoses for Mrs. G will be identified and discussed throughout the paper based
on symptoms and laboratory results. Specifically, diabetes mellitus type II (primary),
hyperlipidemia (secondary), and possible hormonal imbalance such as estrogen deficiency
(differential diagnosis) are among the specific diagnoses to be mentioned along with a brief
pathophysiology, pertinent positives, and pertinent negatives. Additionally, an assessment,
evidence-based practice, plan of diagnostics, medications, education, referrals, follow ups, and
medication cost will be included in the case study.
Assessment
Diabetes mellitus type II (E11) is a metabolic disorder characterized by hyperglycemia,
polyuria, polydipsia, polyphagia, weight loss or weight gain, blurred vision, dry skin, itchiness,
fatigue, poor wound healing, abdominal pain, and peripheral neuropathy. Type II diabetes
mellitus is insulin resistance and insufficient insulin production by pancreatic beta cells (Katsu et
al., n.d.). In the insulin resistance setting, the liver inappropriately releases glucose into the
blood, increases breakdown of fat, and leads to decreased glucose transported into muscle cells
(Zaccardi, Webb, Yates, & Davies, 2016). Pertinent positives presented by Mrs. G are fatigue for
three months, weight gain, polyuria, polyphagia, and polydipsia. Additional, pertinent positive
findings are a fasting glucose level of 126 mg/dL, a hemoglobin A1c of 6.9%, and presence of
glucose in urine. Pertinent negatives are complaints of blurred or changes in vision, no evidence
of poor wound healing, weight loss, peripheral neuropathy, and abdominal pain. Diabetes
mellitus type II was the selected primary diagnosis, because all the pertinent positives presented
, CASE STUDY 3
the disease and was supported with laboratory findings of hyperglycemia. According to Hirsch et
al. (2018), a hemoglobin A1c greater than 6.5% indicate diabetes.
Hyperlipidemia (E78.5) is abnormally elevated levels of serum total cholesterol, high
levels of triglycerides or reduced high-density lipoprotein (HDL) in the blood. A high fat diet,
being overweight, and hypothyroidism contribute to high cholesterol. Adipose lipolysis exceeds
the rate of clearance of plasma that causes the elevated levels of total cholesterol or triglycerides.
HDL is good, because it carries extra cholesterol back to the liver where it can be eliminated.
Low-density lipoprotein (LDL) is bad because it enables excess cholesterol to build up in the
blood leading to atherosclerosis. Triglycerides are a type of fat in the blood that have a strong
association with heart disease. A person with hyperlipidemia usually has no signs or symptoms.
Pertinent positives are being overweight with a BMI of 29.7, paternal family history, a high total
cholesterol level of 230 mg/dL, borderline high LDL level of 144 mg/dL, a decreased HDL level
of 38 mg/dL, and high triglyceride levels of 232 mg/dL. Pertinent negative is the absence of
hypothyroidism. Hyperlipidemia was selected as the secondary diagnosis as it is a present illness
and additional diagnosis (on top of diabetes mellitus) based on lab results. According to Last,
Ference, and Menzel (2017), the only way to detect and diagnose hyperlipidemia is by
performing a fasting lipid panel blood test.
Estrogen deficiency (E28.39) refers to low estrogen levels and primarily occurs after
menopause when the ovaries stop producing estrogen (Akbaba & Akbaba, 2015). Typical clinical
manifestations include hot flashes, headaches, lowered libido, breast atrophy, depression,
recurrent urinary tract infections, fatigue, weight gain, and amenorrhea. Pertinent positives are
fatigue, weight gain, urinary problems, and a last menstrual period (LMP) of 15 months ago.
Pertinent negatives are no concerns or complaints of hot flashes, headache, breast changes, and
