Assignment Details

Diabetes Case Study

Chief Complaint

“My left foot feels weak and numb. I have a hard time pointing my toes up.”

History of Present Illness

D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.

Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.

Past Medical History

• Seasonal allergic rhinitis (since her early 20s)
• Breast biopsy positive for fibroadenoma at age 30
• Gestational diabetes with second child 10 years ago
• Multiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bath
• Hypertension for 10 years

Past Surgical History

C-section 14 years ago

OB-GYN History

• Menarche at age 11
• Last pap smear 3 years ago

Family History

• Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.
• Mother alive and well
• Father has COPD
• Two other siblings alive and well
• All three children are alive and well

Social History

• Married 29 years with 3 children; husband is a school teacher
• Family lives in a four bedroom single family home
• Patient works as a seamstress
• Smokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per week
• Denies illegal drug uses
• Never exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.

Allergies

NKDA

Medications

• Lisinopril 10 mg daily
• Loratadine 10 mg daily

Review of Systems

General

Admits to recent onset of fatigue

HEENT

Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking

Cardiac

Denies chest pain, palpitations, and difficulty breathing while lying down

Lungs

Denies cough, shortness of breath, and wheezing

GI

Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation

GU

Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence

EXT

Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tingling or numbness in arms or legs prior to this episode

Neuro

Has never had a seizure and denies recent headaches

Derm

Has a rash under her bilateral breast and in groin area

Endocrine

Denies a history of goiter and has not experienced heat or cold intolerance

Vital Signs

BP 165/100, T 98 F, P 88 regular, HT 5 feet 4 inches, RR 20 non labored, WT 210 lbs

What you need to do:

• Develop an evidence-based management plan.
• Include any pertinent diagnostics.
• Describe the patient education plan.
• Include cultural and lifespan considerations.
• Provide information on health promotion or health care maintenance needs.
• Describe the follow-up and referral for this patient.
• Prepare a 3–5-page paper (not including the title page or reference page).

Format

The paper should be no more than 3–5 pages (not including the title page and reference pages.

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

Your writing Assignment should:

• follow the conventions of Standard American English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 6th Edition format as outlined in the APA Progression Ladder.

Discussion Questions

By the due date assigned, post your response to the assigned discussion questions in the below Discussion Area. It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. Include the South University Online Library in your research activities utilizing not only the nursing resource database, but also those pertaining to education, business, and human resources.

No later than by the end of the week, review and comment on the discussion question responses posted by at least two of your peers. Always use constructive language. All comments should be posted to the appropriate topic in this Discussion Area.

Discussion Question

Formulating the Research Question, Problem Statement, Research Purpose

In the Week 1 discussion forum you had an opportunity to present a potential problem and an innovative solution specific to your role specialization. In addition, you have reviewed the literature to identify qualitative and quantitative research articles and submitted annotated bibliographies to provide evidence supporting the problem.

Considering the feedback provided to you by the faculty member it is now time to prepare your problem statement, research purpose, and research question.

First share your refined problem and proposed solution (given your review of literature this may have changed depending on the evidence you were able to provide). Next, follow the steps to help define your research question.

1. Craft the problem statement and research purpose.
2. Design your research question aimed at solving (a part of) the problem and include the following components which will focus the literature review.

PICOT Question:

Patient, Population or Problem

1. What are the characteristics of the patient or population?
2. What is the condition or disease you are interested in?

Intervention or exposure

1. What do you want to do with this patient (e.g. treat, diagnose, observe)?

Comparison

1. What is the alternative to the intervention (e.g. placebo, different drug, surgery)?

Outcome

1. What are the relevant outcomes (e.g. morbidity, death, complications)?
2. Ensure that the research question is answerable, feasible and clinically relevant

The next step in Submissions Area will be to develop a research hypothesis from the research question.