Unit 4 Discussion 1- Diabetes Management | You are seeing a 64-year-old Hispanic male for his diabetes management.  He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range | Homework Solution

Unit 4 Discussion 1- Diabetes Management

You are seeing a 64-year-old Hispanic male for his diabetes management.  He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range.

• Last month his Hgb A1C was 7.4
• He is on Metformin 1000mg twice a day and Glipizide 5mg daily.
• He walks a couple miles three to five times a week.
• A dietary review reveals that his daily total carbohydrate intake is in the range of 75 to 100 grams.
• Last eye exam did not reveal any problems.  He wears reading glasses when needed.
• He does report some intermittent burning sensation in his feet.
• Ht 6’2”, Wt 200 lbs, BP 118/72, P 72, R 17
• Heart regular rhythm, without murmur or gallop
• Lungs clear Get Blue Haven Initiative Assignment Help!!
• Monifilament testing does not reveal any decreased sensation in the feet

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

Initial Post

Utilize the information provided in the scenario to create your discussion post.

Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).

Structure your ‘P’ in the following format:  [NOTE:  if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]

Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]

Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit

Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

Support the interventions outlined in your ‘P’ with scholarly resources.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Subjective (S):

The patient is a 64-year-old Hispanic male who came to the clinic for diabetes management. His capillary blood sugar readings in the mornings were reported to range from 150-190, and last month, his Hgb A1C. He lives a healthy lifestyle and walks a couple of miles three to five times a week. His dietary review showed that his daily total carbohydrate intake is 75 to 100 grams, and his last eye exam was normal, but he wears reading glasses when needed. He reports that he has some intermittent burning sensations in his feet. He is a known type II diabetic, and he is on Metformin 1000 mg BID and glipizide 5 mg daily.

Objective (O):

His vital signs were BP 118/72, P 72, R 17, Ht. 6’2”, and Wt. 200 lbs. His cardiovascular

exam revealed a regular rhythm, with no murmur or gallop. He had clear lung sounds, and

monofilament testing did not reveal any decreased sensations in the feet.

Assessment (A):

Uncontrolled diabetes mellitus with hyperglycemia

Plan (P):

Therapeutics: Goyal & Jialal (2018) highlighted that the goal of the therapy is to achieve a HbA1C of less than or equal to 7.0% and prevent other organs damage or progression of the damage. The patient is already on metformin and glipizide combined therapy, and he is already having symptoms of diabetic neuropathy. I would consider increasing the current metformin dosage to 1500 mg BID and revisiting the clinic after 14 days, where a HbA1C will be rechecked. The patient will be started on gabapentin or pregabalin to control the discomfort for the burning sensations in the feet.

Educational: The patient will be educated on the importance of continuing to exercise and continue his sugar and carbohydrate intake monitoring since he is overweight and some of the side effects of sulfonylureas are weight gain. The patient will be educated on the importance of continuous glucose monitoring. According to Kirwan et al. (2017), exercise and diet are very important in managing type 2 diabetes mellitus.

Consultation/Collaboration: The patient will be referred to a dietician and will require an endocrine consultation if the blood sugar continues to elevate.

Chief Complaint- Diabetes Management

HPI- 64 yo Hispanic male presents for a visit for diabetes management. His morning capillary blood sugar reading has been ranging 150-190. His Hgb A1C was 7.4 last month. His daily total carbohydrate intake is 75 to 100 grams.

PMH

Diabetes

Allergies- Unknown

Medications

Metformin 1000mg BID

Glipizide 5mg daily

Social History

He walks a couple miles three to five times per week.

Family History-Unknown

ROS:

HEENT- He wears reading glasses when needed.

PV-Reports intermittent burning sensation in his feet

Health Promotion- Last eye exam did not reveal any problems. He wears reading glasses when needed.

Physical Exam:

VS: BP 118/72, P 72, R 17, Ht 6’2”, Wt 200 lbs, BMI 25.7

Cardiac: Heart regular rhythm, no murmur or gallop

Respiratory: Lungs clear

PV: Monifilament testing does not reveal any decreased sensation in the feet

Assessment

1. E11.65 Diabetes Mellitus with hyperglycemia

Plan

Diagnostics Recommendations per (Practice Guidelines for Family Nurse Practitioners,2020).

• Fasting complete chemistry panel and lipid profile if indicated. Therapeutics Recommendations per (Practice Guidelines for Family Nurse Practitioners,2020).
• Discuss treatment goals and plan
• Review food plan and carbohydrate counting
• Discuss exercise and weight reduction plan; weight loss is indicated if BMI >25 kg/m
• Address possible causes of noninsulin agent failures before altering treatment
• Based upon shared decision making, adjust Glipizide to extended release (Glucotrol XL) 10 mg daily or maintain immediate-release, but increase dose to Glipizide 10mg daily. Dose adjustments of Glipizide based on blood glucose should not be done more frequently than every 7 days.
• May consider addition of third agent (oral or insulin) if blood glucose goals aren’t reached (Practice Guidelines for Family Nurse Practitioners,2020). Education Recommendations per (Practice Guidelines for Family Nurse Practitioners,2020).
• Notify the provider if there are any changes by the patient in the treatment plan; problems with adherence or medication dose adjustments
• Symptoms suggesting development of complications of DM and hypo/hyperglycemia symptoms
• Tips for effective SMBG; 1 or 2hr PP testing may be helpful 2 to 3 times per week to allow patient to see the effects of a particular type of food on blood glucose levels, record all test results so a day-to-day comparison can be made, the patient should know how to respond appropriately to SMBG results by making adjustments in the diet.
• Possible causes of noninsulin agent failures (overeating at night, poor compliance, stress, inadequate drug dosage, decreasing beta-cell function or increasing insulin resistance.
• Taking an “extra” dose to cover excess food intake is ineffective and may be harmful.
• Diet management is of utmost importance; poor eating habits will lessen or negate efforts to achieve lower blood glucose levels.

• Promote and support healthy eating habits (nutrient-dense foods and portions)
• Provide adequate calories to achieve and maintain healthy body weight
• Eat three balanced meals qd, 4 to 5 hours apart
• Include a bedtime snack
• Avoid high-sugar foods and drinks
• Appropriate adjustments for hyperglycemia, hypoglycemia, illness, and exercise

• Pre-prandial blood glucose goals should be 70 to 130 mg/dL unless otherwise specified
• Address cultural considerations; disease management, insulin use, treatment goals
• Insulin may eventually be required for patients who are not controlled on oral agents
• Recommend PPSV23 to all patients with DM 2-64 years of age (Practice Guidelines for Family Nurse Practitioners,2020). Consultation/Collaboration Recommendations per (Practice Guidelines for Family Nurse Practitioners,2020).
• Diabetes Education Program
• Follow-up office visit in 3 months
• Endocrinologist if unable to obtain glycemic control (Practice Guidelines for Family Nurse Practitioners,2020).

References

Cash, J., & Glass, C. (2018). Family Practice Guidelines. 4th ed. Springer Publishing. (Version 6.8.4625) [Mobile App].

Fenstermacher, K., & Hudson, B. T. (2020). Practice Guidelines for Family Nurse Practitioners (5th ed.). Elsevier.