A 72 y/o female presents to the clinic with a swollen, inflamed great toe on her right foot. She had gout 5 years ago and was on allopurinol. She recently stopped taking the allopurinol without telling her provider, stating, “I don’t have gout anymore.” Her other medications include simvastatin 40 mg nightly for hyperlipidemia, 20 mg lisinopril daily, and hydrochlorothiazide 25 mg daily.
Questions:
1) First, discuss why this patient feels she does not have gout any longer?
2) Discuss how the NP would educate this patient
3) After careful review of her medications, would you make any changes or add anything to her regimen?
4) Whats the take away thought from this case? Do you think this is common?
Your new patient is a 69 year old retired male presenting with uncontrolled HTN, uncontrolled DM Type 2, and complaints of moderate to severe pain in both feet that he states feels like "burning and tingling".
The patient states "I hate taking medicine"
During the past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and a “pancreas elixir” in an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results. He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.”
In the past year, he has gained 25 lbs and has been unsuccessful in losing this weight. He states he loves to eat pasta and further states he drinks 8 ozs of white wine every night with dinner.
Fasting glucose while in the office is 188. BP 160/88, HR 78, RR 18.
Objective Assessment:
- Eyes: corrective lenses, pupils equal and reactive to light and accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy
- Thyroid: nonpalpable
- Lungs: clear to auscultation
- Heart: Rate and rhythm regular, no murmurs or gallops
- Vascular assessment: no carotid bruits; femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally
- Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle
Lab Results
Results of laboratory tests (drawn 5 days before the office visit) are as follows:
- Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl)
- Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl)
- Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl)
- Sodium: 141 mg/dl (normal range: 135–146 mg/dl)
- Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl)
- Lipid panel
- • Total cholesterol: 162 mg/dl (normal: <200 mg/dl)
- • HDL cholesterol: 43 mg/dl (normal: ≥40 mg/dl)
- • LDL cholesterol (calculated): 84 mg/dl (normal: <100 mg/dl)
- • Triglycerides: 177 mg/dl (normal: <150 mg/dl)
- • Cholesterol-to-HDL ratio: 3.8 (normal: <5.0)
- AST: 14 IU/l (normal: 0–40 IU/l)
- ALT: 19 IU/l (normal: 5–40 IU/l)
- Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l)
- A1C: 10.1% (normal: 4–6%)
- Urine microalbumin: 50 mg (normal: <30 mg)
Discuss:
1) Discuss at least 2 differentials and your definitive diagnosis
2) What does his objective assessment tell you and what's your plan of care to include medications and follow-up?
3) What do his lab values indicate
4) Discuss patient education
Answers
Status NEW
Posted 03 Jul 2017 01:07 AM
My Price 7.00
-----------
Attachments
file 1499044734-Solutions file.docx preview (51 words )
S-----------olu-----------tio-----------ns -----------fil-----------e
-----------Hel-----------lo -----------Sir-----------/Ma-----------dam-----------
T-----------han-----------k y-----------ou -----------for----------- yo-----------ur -----------int-----------ere-----------st -----------and----------- bu-----------yin-----------g m-----------y p-----------ost-----------ed -----------sol-----------uti-----------on.----------- Pl-----------eas-----------e p-----------ing----------- me----------- on----------- ch-----------at -----------I a-----------m o-----------nli-----------ne -----------or -----------inb-----------ox -----------me -----------a m-----------ess-----------age----------- I -----------wil-----------l b-----------e q-----------uic-----------kly----------- on-----------lin-----------e a-----------nd -----------giv-----------e y-----------ou -----------exa-----------ct -----------fil-----------e a-----------nd -----------the----------- sa-----------me -----------fil-----------e i-----------s a-----------lso----------- se-----------nt -----------to -----------you-----------r e-----------mai-----------l t-----------hat----------- is----------- re-----------gis-----------ter-----------ed -----------on-----------th-----------is -----------web-----------sit-----------e
-----------Tha-----------nk -----------you-----------
-----------
Not Rated(0)