Chief Complaint
J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.
History of Present Illness
J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.
Past Medical History
Hypertension
Hyperlipidemia
Obesity
Family History
Both parents deceased
Brother: Type 2 diabetes
Social History
Denies smoking
Denies alcohol or recreational drug use
Landscaper
Allergies
No Known Drug Allergies
Medications
Lisinopril 20 mg once daily by mouth
Atorvastatin 20 mg once daily by mouth
Aspirin 81 mg once daily by mouth
Multivitamin once daily by mouth
Review of Systems
Constitutional: – fever, – chills, – weight loss.
Neurological: denies dizziness or disorientation
HEENT: Denies nasal congestion, rhinorrhea or sore throat.
Chest: (-)Tachypnea. Denies cough.
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
General Physical Exam
Constitutional: Alert and oriented male in no acute distress
Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
Wt. 240 lbs., Ht. 5’8", BMI 36.5
HEENT
Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.
Ears: Tympanic membranes intact.
Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.
Neck/Lymph Nodes
Neck supple without JVD.
No lymphadenopathy, masses or carotid bruits.
Lungs
Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart
S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs.
Integumentary System
Skin warm, dry; Nail beds pink without clubbing.
Labs
Test Patient’s Result Reference
Glucose (fasting)
132
60-120 mg/dL
BUN
20
7-24 mg/dL
Creatinine
0.8
0.7-1.4 mg/dL
Sodium
141
135-145 mEq/L
Sodium
141
135-145 mEq/L
Chloride
97
95-105 mEq/L
HCO3
24
22-28 mEq/L
A1C
7.2
Urinalysis
Protein
Glucose
Ketones
Negative
Positive
Negative
Oral glucose tolerance test (OGTT)
220 mg/dL
J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
Explain the pathophysiology associated with your chosen diagnosis
Identify at least three subjective findings from the case which support the chosen diagnosis.
Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
Identify two (2) "Evidence A" recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
Describe the mechanism of action for each of the medication classes identified above.
Identify two (2) "Evidence A" recommended non-pharmacological treatment options for this patient.
Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations
Pathophysiology & Clinical Findings of the Disease
The student:
– Identifies the correct type of diabetes
– Explains the pathophysiology associated with the chosen disorder.
– Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).
– Identifies at least three subjective findings from the case.
– Identifies at least three objective findings from the case
– Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.
– Identifies two (2) “Evidence A” recommended medication classes for the treatment of the condition and provides an example (drug name) for each.
– Identifies two (2) “Evidence A” recommended non-pharmacological treatment options for the condition.
– Describes the mechanism of action for each of the medication classes identified above
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