Week 4 Case study

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 Case week 4

Subjective

The patient is a 64 years old Hispanic male who adheres to his medication but

sugars in the morning range between 150-190. The patient is active and walks 3 to 5

days a week. The patient observes carbohydrate intake between 75 g to 100g a day. The

patient is on 1000mg of metformin BID and 5 mg of Glipizide daily. The patient takes a

regular eye exam and reports intermittent foot-burning sensation.

Objective: ht 6’2”, at 200 pounds, BP 118/72. Pulse 72, RR 17, HgB A1C 7.4.

the patient has clear lungs and regular cardiac rhythm. The monofilament test does not

reveal any decreased sensation in the feet.

Assessment: Diabetic neuropathy is associated with morning blood sugars that

are not well managed, as seen in the elevated A1c levels and patient symptoms.

Therefore, the patient is most likely to be suffering from diabetic neuropathy.

Plan

The plan for this patient is therapeutics, education, and consultation.

Therapeutics: the current medication appears ineffective at producing the desired

results. The drug can be increased to 850mg and taken twice daily to control blood sugar.

The medication can be improved within weeks up to 2550mg a day if the previous dose

does not produce the required outcomes. Additionally, the patient can have regular

checkups for A1C within two weeks.

Education: patient education should be based on adherence to medication and the

effects of overdose and under-dose. Additionally, the patient should be taught to adhere

to an active and healthy lifestyle and report any improvements during the medication.
The importance of taking a balanced diet and regulated carbohydrates should be

emphasized (Shea et al., 2019).

Consultation: The patient should be on regular A1C follow-ups with the

physician to monitor and regulate blood sugar levels before causing unnecessary

complications that would lead to increased healthcare costs (Shea et al., 2019).

Reference

Shea, K. E., Gerard, S. O., & Krinsley, J. S. (2019). Reducing hypoglycemia in

critical care patients using a nurse-driven root cause analysis process. Critical

Care Nurse, 39(4), 29–38. https://doi.org/10.4037/ccn2019876 .