Case Study related to diabetes

Please review all 3 attachments in order to verify if this assignment is a good fit for you. Must be done APA 6th edition. Scholar papers within the last 5 years (2015 to present). Please use the provided template accordingly to the rubric. The case study will be under attachment. Pay attention to the due date, please. Preferably someone familiar with nursing 

Mrs. G, a 55 year old Hispanic female, presents to the office for her annual exam. She

reports that lately she has been very fatigued and just does not seem to have any

energy. This has been occurring for 3 months. She is also gaining weight since

menopause last year. She joined a gym and forces herself to go twice a week, where

she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact

she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states

that exercise seems to make her even more hungry and thirsty, which is not helping her

weight loss. She wants get a complete physical and to discuss why she is so tired and

get some weight loss advice. She also states she thinks her bladder has fallen because

she has to go to the bathroom more often, recently she is waking up twice a night to

urinate and seems to be urinating more frequently during the day. This has been

occurring for about 3 months too. This is irritating to her, but she is able to fall

immediately back to sleep.

Current medications: Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin

PMH: Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to

date.

GYN hx: G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No

history of abnormal Pap smear.

FH: parents alive, well, child alive, well. No siblings. Mother has HTN and father has

high cholesterol.

SH: works from home part time as a planning coordinator. Married. No tobacco history,

1-2 glasses wine on weekends. No illicit drug use

Allergies: NKDA, allergic to cats and pollen. No latex allergy

Vital signs: BP 129/80; pulse 76, regular; respiration 16, regular

Height 5’2.5”, weight 185 pounds

General: obese female in no acute distress. Alert, oriented and cooperative.

Skin: warm dry and intact. No lesions noted

HEENT: head normocephalic. Hair thick and distribution throughout scalp. Eyes without

exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light

reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx

moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior

cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small

and firm without palpable masses.

CV: S1 and S2 RRR without murmurs or rubs

Lungs: Clear to auscultation bilaterally, respirations unlabored.

Abdomen- soft, round, nontender with positive bowel sounds present; no

organomegaly; no abdominal bruits. No CVAT.

Labwork:

CBC: WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC

34 g/dl RDW 13.8%

UA: pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small

protein; negative for ketones

CMP:

Sodium 139

Potassium 4.3

Chloride 100

CO2 29

Glucose 95

BUN 12

Creatinine 0.7

GFR est non-AA 92 mL/min/1.73

GFR est AA 101 mL/min/1.73

Calcium 9.5

Total protein 7.6

Bilirubin, total 0.6

Alkaline phosphatase 72

AST 25

ALT 29

Anion gap 8.10

Bun/Creat 17.7

Hemoglobin A1C: 6.9 %

TSH: 2.35, Free T 4 0.7

Cholesterol: TC 230 mg/dl, LDL 144 mg/dl; VLDL 36 mg/dl; HDL 38mg/dl, Triglycerides

232

EKG: normal sinus rhythm

Requirements:

 

The assignment is a paper, which is to be written in APA format using the provided assignment template. The paper shall not exceed 10 pages, excluding title page and references.  

NR601 _week 5 case study paper template_Nov 19 x

Case Study Patient – March 2020

Review the provided patient visit information. You are provided with the subjective and objective exam findings. As the provider, you are to diagnose the case study patient and develop the management plan for this case study patient.  Keep in mind this is a complex patient who has more than one diagnosis, which is common in primary care.  

Use the provided case study template for your paper. Review the APA Manual to adhere to APA formatting.  

Introduction: briefly discuss the purpose of this paper.  (no more than 5 sentences)  

Assessment:  review the provided case study information.  

Identify the primary and secondary diagnosis for the patient. Each diagnosis will include the following information:  

1. ICD 10 code. 

2. A brief pathophysiology statement which is no longer that two sentences, paraphrased and includes common signs and symptoms of the diagnosis and proper citation. 

3. The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement, which links the subjective and objective findings (including lab data and interpretation). 

4. An evidence-based rationale statement, which summarizes why the diagnosis was chosen.   

5. Do not include quotes, paraphrase all scholarly information and provide an in-text citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.  

Plan: (there are five (5) sections to the management plan)

1. Diagnostics. List all labs and diagnostic test you would like to order. Each test includes a rationale statement following the listed lab, which includes the diagnosis requiring the test, the purpose of the test and how the test results will contribute to your management plan. Each rationale statement is cited.  Include all future follow up labs for each listed diagnosis.  

2. Medications: Each medication is listed in prescription format. Each prescribed and OTC medication is linked to a specific diagnosis and includes a paraphrased EBP rationale for prescribing.  

3. Education: section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. All education steps are linked to a diagnosis, paraphrased, and include a paraphrased EBP rationale. Review the NR601 Clinical SOAP note guideline for more detailed information.  

4. Referrals: any recommended referrals are appropriate to the patient diagnosis and current condition, is linked to a specific diagnosis and includes a paraphrased EBP rationale with in text citation. Review the ADA guidelines for specific follow up recommendations. 

5. Follow up: Follow up includes a specific time, not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation.  

Assessment of Comorbidities: in this section students will review the ADA Standards of Medical Care in Diabetes (the guidelines) Assessment of Comorbidities section on comorbidities subsection and choose one listed comorbidity.  Students will discuss the significance of and the relationship between the patient’s primary diagnosis and the chosen comorbidity, explaining how one diagnosis affects the other diagnosis.  Any recommended screening, diagnostic testing, and referrals are also included.   

Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications that you have prescribed and that the patient is currently taking that you would like to continue.  Students may use Good Rx, Epocrates or another resource (students may use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.  

 

ASSIGNMENT CONTENT 

Category 

Points 

% 

Description 

Assessment: Primary diagnosis    

24  

15  

Presentation of the case study patient’s primary diagnosis includes the following required elements:  
Diagnosis is consistent with the cited guideline recommendations or scholarly reference, ICD10 code is listed, rationale statement includes a one to two sentence paraphrased pathophysiology statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to the case study patient. Pertinent lab results are included and interpreted within the rationale statement.  

Assessment: Secondary diagnosis (es)   

16  

10  

Presentation of the case study patient’s secondary diagnosis (es) include (s)the following required elements:  
Diagnosis is consistent with the cited guideline recommendations or scholarly reference, ICD10 code is listed, rationale statement includes a one to two sentence paraphrased pathophysiology statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to the case study patient. Pertinent lab results are included and interpreted within the rationale statement.  

Evidence-Based Practice (EBP)  

40  

25  

National guidelines are used to support all diagnoses and develop the management plan.   
The American Diabetes Association Standards and Medical Care in Diabetes-2019 or later, (or article related to 2019 or later Guidelines) are used to support the primary diagnosis and develop the management plan.   
Every diagnosis rationale must include an in-text citation to a scholarly reference as listed in the Reference Guidelines document. Each action step or order within all plan sections includes an in-text citation to an appropriate reference as listed in the Reference Guidelines document. Reference interpretation is accurate.  

Plan: Diagnostics  

8 

5 

All ordered diagnostics tests are linked to a diagnosis listed in the assessment section and include a paraphrased EBP rationale with citation and include date when test should be performed (ie: today, 1 week, 1 month). Further testing/diagnostics for the differential diagnosis is included. Plans are consistent with the cited guideline recommendations or scholarly reference.   

Plan: Medications 

8 

5 

The plan includes both prescribed and OTC medications written in prescription format.  The plan includes a minimum of one OTC medication. Each prescribed and OTC medication is linked to a diagnosis listed in the assessment section   
Diagnosis is clearly stated in the rationale statement. And includes a paraphrased rationale EBP rationale  

Plan: Education 

8 

5 

All education steps are linked to a diagnosis, paraphrased, and include an EBP rationale.   
 This section is written exactly how you would discuss the education to the patient. Use vocabulary which the patient can understand, not medical terminology.  
Section includes personalized detailed education on diagnoses, medications, diet, exercise and any warning signs.  Personalized diet and exercise recommendations are appropriate for the case study patient and include specific instructions for the case study patient such as a specific exercise- length of time to exercise and frequency/week. Any published diet recommendations, such as a Mediterranean diet, will include a rationale statement as to why this recommendation is beneficial for the case study patient.   
Plans are consistent with the guideline recommendations or scholarly reference.  

Plan: Referrals  

8 

5 

All recommended referrals are appropriate for the patient diagnoses:  
each referral is linked to a specific diagnosis each which was listed in the assessment section and includes a paraphrased EBP rationale.  All referrals related to the primary diagnosis are obtained from the ADA guidelines. 
Plans are consistent with the cited guideline recommendations or scholarly reference  

Plan: Follow up  

8 

5 

Follow up includes a specific time/date to return to PCP office. EBP rationale with in text citation is included.  Only follow up information is listed in this section. Additional information, such as future testing, education or referrals are not listed in follow up but within the appropriate paper sections. Plans are EBP and consistent with the guideline recommendations. 

Assessment of comorbidities   

16 

10 

The ADA guidelines includes a Comprehensive Medical Evaluation and Assessment of Comorbidities section which includes comorbidities that providers should consider when managing disorders of glucose metabolism.   
Choose one of the listed comorbidities from the ASSESSMENT OF COMORBIDITIES subsection*    
Explain the significance of and the relationship between your primary diagnosis and your chosen comorbidity. Explain how one diagnosis affects the other diagnosis in no more than 3-5 sentences. Include any recommended screening, diagnostic testing, and referrals in no more than 2-3 sentences.   
* the chosen comorbidity cannot be any secondary diagnosis already discussed in your paper’s assessment section.  

Medication costs 

8 

5  

All monthly medication costs are calculated, including the current medications the patient may be already taking.  
A total cost for all the month’s medication is included.   
All medications including OTCs are included.   
Medication cost reference source is included.  Summary/reflection statement regarding medication costs and any medications changes based on cost  or polypharmacy concerns is included.  

 

 

 

Total CONTENT Points= [144 pts] 

CASE STUDY TITLE

2

Assignment Title

Title page per APA format

Running head: CASE STUDY

CASE STUDY 3

· This assignment template serves as a paper template to develop the week 5 case study and may not be all inclusive. You must also refer to the assignment rubric for specific requirements for this assignment. Your paper is graded to the rubric requirements. *

CCK 4/19

Title matches title on title page

The introductory paragraph is written here. Remember to remove all instructions from your paper. These are in red ink.

Assessment

Primary Diagnosis
diagnosis (ICD10 code)

pathophysiology A brief pathophysiology statement which is no longer that two sentences, paraphrased and includes common signs and symptoms of the diagnosis. Includes citation to an approved source (author, year). Review the Reference Guidelines for FNP Case Study document. This applies to all sections of this paper.

pertinent positive findings includes citation to an approved source (author, year). Review the Reference Guidelines for FNP Case Study documents. This applies to all sections of this paper.

pertinent negative findings includes citation to an approved source (author, year). Review the Reference Guidelines for FNP Case Study documents. This applies to all sections of this paper.

rationale for the diagnosis includes a brief 1-2 sentence statement, which links the subjective and objective case study findings including provided lab data and interpretation of the labs. Include a statement linking those lab results to your ADA guideline reference. Includes citation to the ADA guideline used to determine this diagnosis.

Secondary Diagnosis
diagnosis (ICD10 code)

*
You can have more than one secondary diagnosis. A minimum is required. Secondary diagnoses are additional diagnoses you have identified from the exam, lab findings today or the PMH*

Pathophysiology A brief pathophysiology statement which is no longer that two sentences, paraphrased and includes common signs and symptoms of the diagnosis (author, year).

pertinent positive findings as explained above (author, year).

pertinent negative findings as explained above (author, year).

rationale for the diagnosis
-includes a brief 1-2 sentence statement, which links the subjective and objective findings including any provided lab data and interpretation of the diagnostic testing. The rationale includes a citation to a scholarly reference (author, year)

Plan

Diagnostics

Lab test (#1) (each lab/diagnostic test is listed individually with rationale to follow AND is linked to a diagnosis listed in the assessment section of the paper. Include the timeframe of when the lab is to be drawn. *This is labs or tests you will order in the future, not an explanation of the labs that have already been completed.*

rationale: each rationale contains the EBP statement supporting the necessity of the test and includes the name of the diagnosis which is listed in the assessment section.* If this diagnosis is not listed in the assessment section then it must be added to order the diagnostic testing*. Includes a citation to an approved reference from the Reference Guidelines for FNP Case Study document which supports not only the test but the timing of the lab draw.

Lab test (#2)
includes same criteria. Do the same for each lab you want to order.

Medications
*each medication is linked to a diagnosis listed in the assessment section of the paper AND is listed individually with rationale, including the required OTC*

Medication (#1) –
written in prescription format (see NR 601 Resources)

Rationale. The rationale for each medication includes the diagnosis which is listed in the assessment section and contains the EBP statement supporting the necessity of the medication. If this diagnosis is not listed in the assessment section then it must be added to include any medication. Includes a citation to an approved reference from the Reference Guidelines for FNP Case Study document.

Medication (#2)
includes same criteria. Do the same for each medication listed

Education section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. You do not need an introduction paragraph. All education steps are linked to a listed diagnosis, paraphrased, and include a paraphrased EBP rationale. If this diagnosis is not listed in the assessment section then it must be added to include the education content here. Each education section includes a citation to an approved reference from the Reference Guidelines for FNP Case Study document

Diagnoses.

Includes personalized detailed education for each diagnosis listed in the assessment section. This includes specific information for this particular client. Education includes a citation to an appropriate reference. No listed education is common knowledge, all statements must include an in text citation to an appropriate reference.

Medications.

includes personalized detailed education for each medication listed in the medication section. Each medication is listed and then explained. No listed education is common knowledge, all statements must include an in text citation to an appropriate reference.

Diet.

includes personalized detailed education for dietary recommendations as determined by the listed diagnoses in the assessment section. This includes specific dietary information. A referral to cover this requirement is not sufficient. If weight loss is recommended then specific weight loss targets must be included. No listed education is common knowledge, all statements must include an in text citation to an appropriate reference.

Exercise.

includes personalized detailed education for exercise recommendations as determined by the listed diagnoses in the assessment section.. List specific exercises that are appropriate for this patient. No listed education is common knowledge, all statements must include an in text citation to an appropriate reference.

Warning Signs for diagnoses and mediations

includes personalized detailed education as determined by the listed diagnoses and medications. No listed education is common knowledge, all statements must include an in text citation to an appropriate reference.

Referral

Specialty practice or service (each referral is linked to a diagnosis listed in the assessment section of the paper and is listed individually with rationale to follow)

rationale: each rationale contains the EBP statement supporting the necessity of the referral and includes the name of the diagnosis which is listed in the assessment section. Includes a citation to an approved reference from the Reference Guidelines for FNP Case Study document. Any referrals for the listed primary diagnosis must be cited from the chosen ADA guideline.

Referral(#2)
includes same criteria. Do the same for each referral

Follow up

Follow up includes a specific time frame (1week, 1 month) , not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation. Refer to the rubric for full section requirements. Follow up does not include other upcoming plans. Diagnostics and referrals are discussed within that section above.

Assessment of comorbidities

See rubric for section requirements.

Medication Cost

See rubric for section requirements.

Conclusion

A summary paragraph no more than 5 sentences

References

Are listed on a separate page and formatted per APA guidelines.