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case2

A 77-year-old male patient presents with painful sensations in his hands and feet, alongside a history of smoking and alcohol consumption. He has elevated blood sugar levels indicating type 2 diabetes, hypertension, dyslipidemia, and chronic kidney disease, with a psychosocial diagnosis of substance abuse and social isolation. A comprehensive assessment and management plan focusing on diabetes education, lifestyle changes, and regular monitoring are recommended.

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3 views12 pages

case2

A 77-year-old male patient presents with painful sensations in his hands and feet, alongside a history of smoking and alcohol consumption. He has elevated blood sugar levels indicating type 2 diabetes, hypertension, dyslipidemia, and chronic kidney disease, with a psychosocial diagnosis of substance abuse and social isolation. A comprehensive assessment and management plan focusing on diabetes education, lifestyle changes, and regular monitoring are recommended.

Uploaded by

argellivaldez02
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Case No.

2
• WG, 77-year-old, male, came in to the clinic complaining of
painful pricking sensation on both hands and feet for 1 month
causing him to have sleeping disturbances.
• He denies polyuria, polydipsia, and he gained weight of 2 kg
in the past year. He drinks 5 bottles of beer daily after dinner
and smokes 1 pack of cigarettes daily for the past 30 years.
He lives with the family of his daughter. He used to be a
barangay captain and now works as a volunteer in the OSCA
in their barangay. Since the time he developed the painful
pricking sensation on both hands and feet, he rarely goes out
of the house. His older brother has Type DM and died of MI 1
year ago
• Physical examination
Height: 150 cm Weight: 68 kg
WC: 38 inches, HC: 37 inches
VS: BP 150/90, HR 95/min, RR 20/min, Temp 37 C
Laboratory results: FBS 130 mg/dl, HBA1c 8%
Total Cholesterol 280 mg/dl, LDL 180 mg/dl, HDL 34
mg/dl, Triglycerides 220 mg/dl, Creatinine 2.0 mg/dl eGFR
24 ml/min, BUA 8.5 mg/dl
Salient features
Subjective Objective

(+) Painful pricking sensation on both (+) Height 150cm and weight 68kg (IBW of
hands and feet causing sleeping 47 kg, BMI of 30, obese)
disturbances (+) Waist 38 inches and hip 37 inches (WHR
(+) Family history of MI (CVD) of 1.02)
(+) Weight gain 2kgs in the past year (+) Elevated BP 150/90
(+) alcohol beverage drinker (+) Elevated FBS of 130 mg/dl and HbA1c
(+) smoker 30 pack years of 8%
(+) lives with family of daughter (+) Elevated Total cholesterol of 280, LDL of
180, tryglycerides of 220, low HDL of 34
(+) Elevated creatinine of 2 mg/dl, egfr of
24
(+) Elevated uric acid of 8.5 mg/dl
• The basis for the diagnosis and classification of diabetes
- The basis of the diagnosis of diabetes mellitus type 2
would be the elevated FBS of 130 and HbA1c of 8%

Classification and Diagnosis of Diabetes:


Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
• Modifiable risk factors of this case
- Alcohol drinking, smoking, diet, physical activity,
obesity, elevated BP, blood sugar, cholesterol, and uric
acid

• Tests needed for confirmation


- FBS and HbA1c
• Target glycemic goals for this case
- Target is HbA1c is <8%

Older Adults: Standards of Care in Diabetes—2024. Diabetes Care, 47(Supplement_1), S244–


S257. https://doi.org/10.2337/dc24-s013
1) Identify the missing data to complete the assessment of
the case
- Missing data for this case would be the patient’s
educational level, reading ability, health literacy, barriers to learning,
participation and change, lifestyle practices, use of healthcare delivery
system, and family dynamics -in order to facilitate the knowledge,
skill, and ability necessary for diabetes self-care.
- Also needed are the physical examination of the extremities,
assessment for diabetic retinopathy, & peripheral edema,
past medical history, previous and current use of
medications, nutrition history or dietary pattern of the
patient, history of painful joints, history of frothy urine
and urine output
American Association of Diabetes Educators (AADE) 7
diabetes self-care behaviors

• Being active
• Healthy eating
• Taking medications
• Monitoring blood glucose
• Problem solving
• Reducing risk of diabetes complications
• Healthy coping

An effective model of diabetes care and education: the ADCES7 Self-Care BehaviorsTM. The Science of Diabetes Self-Management and Care, 47(1), 30–53.
https://doi.org/10.1177/0145721720978154
2) What further assessment will you do to complete the
data?
- To complete the data, engage with the patient to assess
behavior, type of learner, willingness to change, and
any other psychosocial issues. Involve the family in as
well.
- Clinically, further physical assessment like sensory
physical examination of the fingers and toes should be
done. Also request for laboratory tests like liver
enzymes and whole abdominal ultrasound to check for
fatty liver. For the elevated creatinine, whole abdominal
ultrasound, BUN, and urinalysis can be done to check
the renal parenchyma and hydration status.
3) Impression: Diabetes mellitus type 2; Hypertension
stage 2; Dyslipidemia; Diabetic peripheral neuropathy;
CKD stage 4 secondary to DKD and HPNSS;
Hyperuricemia

Psychosocial diagnosis: Substance abuse (alcoholism and


smoking), poor coping and social isolation, r/o impaired
family process
4) Plan:
• Start pharmacologic management
• Once patient’s type of learning is identified, develop a teaching plan
on diabetes education and involve the patient and his family in
managing his diabetes.
• Using the transtheoretical model, determine which stage the
patient is in with regards to stopping his alcohol drinking and
smoking. Once patient is ready to learn and empowered, start
healthy lifestyle and behavior change (stop smoking & alcohol,
healthy food choices/ eating patterns, physical activity/exercise,
weight management).
• Promote cbg monitoring, bp monitoring, & daily diabetes foot care.

5) Monitoring:
Together with the diabetes care team, follow up patient and monitor
for weight changes, diet changes (food diary), physical activity
changes, and medication adherence if the patient was able to change
6) Evaluation:
• Teach-back method to find out if the patient and or
significant others understood the information
• Test behavior change
• Inquire about educator’s performance and skill
demonstration
• Repeat laboratory tests to note for
changes/improvements and identify necessary
adjustments

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