Case Study for Care Plan  Assignment:

A retired 69-year-old man “Mr. Casey” with a 5-year history of type 2 diabetes. Although he was diagnosed 5 years ago he had symptoms indicating hyperglycemia for 2 years before diagnosis. His fasting blood glucose values of 118–127 mg/dl, which was explained to him as “borderline diabetes.” He also states he has had past episodes of nocturia with large pasta meals and Italian pastries. At the time of diagnosis, he was advised to lose 10 lbs.

Referred by his family physician to the diabetes clinic, Mr. Casey presented with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.

Mr. Casey also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia. He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken OTC medications to try to control his diabetes. 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.

Mr. Casey states that he has “never been sick a day in his life.” He is retired and volunteers locally. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, Mr. Casey has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.

During the past year, Mr. Casey has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose.

Mr. Casey’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago.

The medical documents that Mr. Casey brings to his appointment indicate that his hemoglobin A1c(A1C) has never been <8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ≤130/80 mmHg for both cardiovascular and renal health.

Mr. Casey has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years.

Physical Exam

A physical examination reveals the following:

• Weight: 178 lb; height: 5′2″; body mass index (BMI): 32.6 kg/m2
• Fasting capillary glucose: 166 mg/dl
• Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg
• Pulse: 88 bpm; respirations 20 per minute
• 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: 8.1% (normal: 4–6%)
• Urine microalbumin: 45 mg (normal: <30 mg)

Please use the attached Care Plan outline for this assignment and post in the “Drop Box” under “Instructional”.

Credit of care study to: Geralyn Spollett, MSN, C-ANP, CDE

Reference: 

American Diabetes Association. (2003, January 1). Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. Retrieved from http://spectrum.diabetesjournals.org/content/16/1/32 

 

Lab Details

Watch the following videos, then complete the required assignment. Review the document in Course Resources for instructions on accessing the videos.

Lab 1

OSCE Clinical Skills

Chest Pain 14:53  

Upon completion of watching the video write up the scenario into a SOAP format. Is there anything you would do differently on your plan?  

Lab 2

OSCE Clinical Skills

Shortness of Breath 26:53

Upon completion of watching the video write up the scenario into a SOAP format. Is there anything you would do differently in your plan?

 
Assignment 6.1: Post-It Patterns

This assignment supports the following lesson objectives:

• 6.2 Demonstrate knowledge of efficient organizational methods and good form in speech writing
• 6.3 Prepare engaging speech content using standard practices and methods

Assignment Overview
This practice exercise explores the importance of organizing the main ideas of a speech into a pattern. It also provides you with the opportunity to practice arranging ideas into a pattern of organization.

Deliverables

• A two-page paper (12-point font, about 600 words) written in a word processor, such as MS Word

Assignment Details
In this activity, you will organize a series of statements into a cohesive structure that could be used as a framework on which to base a speech.

Perform the following tasks:

Step 1: Review the information presented in the lesson that covers concepts and issues related to efficient organizational methods.
Recall that the three main sections of a speech or presentation are the introduction, body, and conclusion.

Step 2: In a word processing document, write a brief definition or description for each of the following patterns of organization that can be used to structure the flow of information in a speech:
Topical Pattern
Temporal Pattern
Spatial Pattern
Problem-Solution Pattern
Cause-Effect Pattern
Monroe’s Motivated SequenceStep 3: Read the following list of statements about the topic of friendship.
Determine which of the patterns of organization might be useful to create a logical flow of information for the statements. Select one pattern of organization to use to organize the statements. It can be one of the six that you defined in Step 2 or another one from any of the lesson materials or another source.

Statements about Friendship*We develop an acquaintanceship.
Friendship is an interpersonal relationship between two persons that is characterized by mutual positive regard.
We meet.
In order to understand friendships, we need to see what a friendship is and its stages of development.
Friendship is one of the most important of our interpersonal relationships.
We develop an intimate friendship.
Friendships develop through various stages.
Friendships don’t develop full blown but rather go through various stages—from the initial meeting to intimate friendship.
We develop a casual friendship.
By understanding friendship we will be in a better position to develop and maintain productive and enjoyable friendships.
Friendship—an interpersonal relationship characterized by mutual positive regard—is one of our most important assets.
We develop a close relationship.
Friendship is vital to all of us.*These statements are from the Organizing a Scrambled Outline activity on the Course Compass website (Links to an external site.)

Step 4: Neatly write each statement about friendship on a separate Post-It note.
Stick the 13 separate Post-It notes to the edge of your desk or work table.

Step 5: Start arranging the Post-It notes to form a logical flow of the ideas represented by the statements.
Modify the arrangement as many times as needed to get it to fit into one of the organization patterns that you learned about in the lesson.

Step 6: Separate the Post-It notes into three groups: one group for the speech introduction, another for the body, and a final one for the conclusion.

Step 7: On the top of a sheet of blank paper, write the heading Introduction.
Determine which statements you would include in the speech introduction. Keeping them in order, stick the Post-It notes that contain these statements to the Introduction page.

Step 8: On the top of a second sheet of blank paper, write the heading Body.
Determine which statements you would include in the body of the speech. Keeping them in order, stick the Post-It notes that contain these statements to the Body page.

Step 9: On the top of a third sheet of blank paper, write the heading Conclusion.
Determine which statements you would include in the conclusion of the speech. Keeping them in order, stick the Post-It notes that contain these statements to the Conclusion page.

Step 10: Enter the information.
In your word processing document, enter the headings and associated statements.

Step 11: Copy and paste the questions below into your word processing document, and enter your answers.
Which pattern of organization did you use to structure the flow of statements?
Are there any other patterns that you could have potentially used? If so, which one(s)?
Based on your experience, do you think you will use the Post-It note technique to organize information for other assignments or projects? Why or why not?Step 12: Save and submit your document.
When you have completed the assignment, save a copy for yourself in an easily accessible place and submit a copy to your instructor using the drop box.

 

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

• Reflect on the concepts of informatics and knowledge work as presented in the Resources.
• Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.

By Day 3 of Week 1

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

four references not more than 5years

zero plagiarism

 

S.H., age 47, reports difficulty falling asleep and staying asleep. These problems have been ongoing for many years, but she has never mentioned them to her health care provider. She has generally “lived with it” and selftreated the problem with OTC Tylenol PM. Currently, she is also experiencing perimenopausal symptoms of night sweats and mood swings. Current medical problems include hypertension controlled with medications. Past medical history includes childhood illnesses of measles, chickenpox, and mumps. Family history is positive for diabetes on the maternal side and hypertension on the paternal side. Her only medication is an angiotensinconverting enzyme inhibitor and diuretic combination for hypertension control. She generally does not like taking medication and does not take any other OTC products.

Diagnosis: InsomnIa

1. List specific goals of therapy for S.H.

2. What drug therapy would you prescribe? Why?

3. What are the parameters for monitoring the success of the therapy?

4. Discuss specific patient education based on the prescribed therapy

5. List one or two adverse reactions for the selected agent that would cause you to change therapy.

6. What would be the choice for second-line therapy?

7. What OTC and/or alternative medicines might be appropriate for this patient?

8. What dietary and lifestyle changes might you recommend?

9. Describe one or two drug–drug or drug–food interactions for the selected agent.

 Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers.  All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page.