[Institution Title]
Introduction
According to the Center for Disease Control and Prevention (CDCP), there were approximately 29.1 million people who suffer from Diabetes Mellitus in 2014. 8.1 million of them are undiagnosed and are not receiving the proper treatment (Center for Disease Control and Prevention, 2015). These alarming statistics has led the health care profession to provide useful information that could help individuals learn more about diabetes mellitus and hopefully, manage if not complete eradicate the symptoms. This paper would provide a detailed discussion of Type 2 Diabetes Mellitus from the perspective of a 65-year-old male patient who was diagnosed 5-years ago but continue to exhibit symptoms of uncontrolled Type 2 DM. As per the NANDA Diagnosis, patient R.M. was diagnosed with Type 2 related to knowledge deficit particularly relating to the disease process . According to ICD-10, patient R.M.’s symptoms and manifestations can be classified as Secondary diabetes mellitus with unspecified complication, uncontrolled, Diagnosis Code 24991 . Diabetes Mellitus Note that the case study was a modification of an existing paper retrieved from an online source.
Information
R.M. is a retired 65-year-old broker with 7-years history of Type 2 DM. He was diagnosed very late after presenting symptoms of diabetes for more than 5-years. Initially in 2001, R.M. was diagnosed with hyperglycemia after a fasting blood glucose record of 117-126 mg/dl. His physician at that time said that he was manifesting indications of borderline diabetes. Nevertheless, he was simply advised to lose weight but no follow-up action has been taken.
Six months ago, RM. was forced by friends and family to see a specialist. About this time, patient R.M. has significantly increased in weight. He also presents suboptimal DM control, and pain in both lower extremities. While R.M. has tried to get back into shape through regular exercise but this doesn’t seem to work. R.M. even started taking glyburide, 2.5mg, which he took every morning. However, after 2 weeks of taking the drug, he stopped because he started experiencing dizziness. He even noted that since he started taking glyburide was sweating profusely and gets mildly agitated especially during late afternoon and early evening. Aside from the 2.5 mg of glyburide, R.M. also took 10 mg of atorvastatin for hypercholesterolemia on a daily basis for 3 months before he finally stopped. Alongside, R.M. also admitted having taken Gymnema Sylvestre, chromium picolinate, and a “pancreas elixir” believing that all these could help him control his blood sugar level. However, aside from self-medicating R.M. would just stop taking medication, regardless if it was prescribed by a physician if he does not see immediate positive results.
Both R.M.’s parents were diabetic. However, regardless of this fact, R.M. seemed to be clueless about what diabetes mellitus is and how to manage and control the progression of the disease. Furthermore, R.M. seemed to have a general misconception about DM, how one develops the disease, and how it can be effectively managed. R.M. does not believe that diet has anything to do with his problem. R.M.’s diet includes a high carbohydrate intake. He regularly consumes pasta and bread. He would always consume an average of 2 cups of pasta topped with either cream based sauce or tomato based sauce. On the side, he frequently has fish and chicken. For snacks, R.M. like to have fresh ripe fruits like apple, banana, oranges, and pineapple.
During R.M.’s hospital visit, the follow results were documented based on his physical assessment and laboratory assessment:
Physical Exam
Weight: 203 lbs; height: 5′4″; Body Mass Index: 34.8 kg/m2 (Center for Disease Control and Prevention, 2015)
Fasting capillary glucose: 168 mg/dl
Blood pressure: lying, 157/95 mmHg; sitting, 145/85 mmHg
Pulse: 87 bpm;
Eyes: wearing prescription glasses; pupillary reaction: equal and (+) to light and accommodation, Fundi-clear, negative for arteriovenous nicking, negative for retinopathy
Thyroid: non-palpable
Lungs: clear to auscultation
Heart: Normal rate and rhythm, negative for murmurs; negative for gallops
Vascular Assessment: negative carotid bruits; popliteal, dorsalis pedis, and femoral pulses 2+ bilaterally
Neurological Assessment: forefoot diminished vibratory sense, negative ankle reflexes, monofilament felt concentrated above the ankle (5.07 Semmes-Weinstein)
Glucose (fasting): 178 mg/dl
Creatinine: 1.0 mg/dl
Blood urea nitrogen: 18 mg/dl
Sodium: 141 mg/dl
Potassium: 4.3 mg/dl
Lipid panel
Total cholesterol: 162 mg/dl
HDL cholesterol: 43 mg/dl
LDL cholesterol (calculated): 84 mg/dl
Triglycerides: 177 mg/dl
Cholesterol-to-HDL ratio: 3.8
AST: 14 IU/l
ALT: 19 IU/l
Alkaline Phosphatase: 56 IU/l
A1C: 8.1%
Urine Microalbumin: 45 mg
Knowledge
R.M.’s reason for seeking medical attention was primarily his need to lose weight which he believes as the reason for his elevated blood glucose level. Nevertheless, the nurse practitioner who is responsible for providing care for the patient should prioritize what needs to be addressed, regardless of the patient’s purpose of visit. The patient’s assumption or chief complaint may not be as pressing as some of the symptoms that he is manifesting, as with the case of R.M. While R.M. may have a different reason, the primary issues that need to be taken cared of relates to his elevated blood glucose (fasting) level which was recorded at 178 mg/dl. The normal blood glucose level is 65–109 mg/dl (American Diabetes Association, 2015). Furthermore, patient’s A1C is also elevated at 8.1% with a normal rate ranging between 4-6%. This lab results verify the diagnosis of uncontrolled Type 2 Diabetes Mellitus. In addition, the second focus should be on the patient’s elevated blood pressure recorded at 157/95 mmHg, with normal blood pressure only at 130/80 mmHg (The American Heart Association, 2014). To manage the elevated blood pressure, the patient should seriously work on his lifestyle. R.M.’s eating habits and his dietary pattern should be modified. Furthermore, the patient should religiously take medication that is prescribed by his attending physician. Finally, the third issue of concern would be the patient’s weight issue. R.M. is obese with body mass index of 34.8 kg/m2.
Wisdom
The patient should get the proper knowledge about Type 2 Diabetes Mellitus. His lack of knowledge of how to control the problem is the primary reason why he is unable to control the elevation of his blood glucose level. He also needs dietary knowledge because his eating habits need to be modified. He may not be aware that by consuming bread and pasta, this converts to starch which in turn converts to sugar. The patient is not aware that even if he was not directly consuming sugar, he is still consuming a large quantity of sugar through starch found in bread and pasta. In addition, the fruit consumption also contributes to his elevated blood sugar level. Furthermore, the patient’s eating habit of munching on bread glazed in olive oil triggers the high cholesterol level. Lifestyle modification is strongly suggested to addresses all the three problems by improper nutrition.
The patient should also refrain from self-medicating. Not all medications that worked for another person would automatically work for everyone else. If any, it may even cause some serious repercussion. Self-medicating may compromise other medical condition or it may even aggravate the condition.
References
American Diabetes Association. (2015, June 17). Checking Your Blood Glucose. Retrieved from American Diabetes Association Website: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html?referrer=https://www.google.com.ph/
Center for Disease Control and Prevention. (2015, May 15). 2014 National Diabetes Statistics Report. Retrieved from Center for Disease Control and Prevention Website: http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html
Center for Disease Control and Prevention. (2015, May 15). About Adult BMI. Retrieved from Center for Disease Control and Prevention Website: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/
The American Heart Association. (2014, August 4). Understanding Blood Pressure Readings. Retrieved from The American Heart Association Website: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.VuurKuJ961s
Turchetto, M., & Viklund, A. (2013, February 28). Nursing Diagnosis related to Diabetes Mellitus (Type 1 and Type 2). Retrieved from NANDA Nursing Website: http://nandanursing.com/nursing-diagnosis-related-to-diabetes-mellitus-type-1-and-type-2.html
World Health Organization. (2015, December 28). ICD-10 Version:2016. Retrieved from World Health Organization Website: http://apps.who.int/classifications/icd10/browse/2016/en#/E10-E14
