Discussion: Examining Endocrine, Metabolic, and Hematologic Disorders

Discussion: Examining Endocrine, Metabolic, and Hematologic Disorders

In the United States, 256 million adults age 20 years or older have diabetes (American Diabetes Association, 2011) If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes

For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders

Case Study 1

An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily There are no known drug allergies The physical exam reveals a 5’2” older female Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98% Further examination reveals the following:

Eyes: + pallor conjunctiva

Cardiac: irregular rhythm No S3 S4 or M NO JVD

Lungs: CTA w/o rales, wheezes, or rhonchi

Abdomen: soft, BS +, + epigastric tenderness No organomegaly, rebound, or guarding

Rectal: no stool in rectal vault

Case Study 2

A 78-year-old female presents to the emergency room after a fall 3 days ago She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals There are no known drug allergies The physical exam is negative and x-rays reveal no acute injuries Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24 The MCV is normal

Case Study 3

VG is a 47 year old African American male with type 2 diabetes diagnosed two years ago He is for a follow up and complaining of increased tingling to the lower extremities PMH: obesity, dyslipidemia, HTN He quit smoking smoking two years ago Denies any alcohol use SH: lives with alone in a subsidized housing He is a veteran and relies on food stamps and welfare Works occasionally MEDS: he lost his medications and hasn’t taken any in about a week His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415