Case Study Overview Of Type II Diabetes Mellitus Discussion

Case Study:
DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and one instance of vomiting before presentation.
PMH: Vitals:
HTN Temp: 98.8oF
Type II DM Wt: 202 lbs
Gout Ht: 5’8”
DVT – Caused by oral BCPs BP: 136/82
HR: 82 bpm
Current Medications: Notable Labs:
Lisinopril 10 mg daily WBC: 13,000/mm3
HCTZ 25 mg daily Total bilirubin: 0.8 mg/dL
Allopurinol 100 mg daily Direct bilirubin: 0.6 mg/dL
Multivitamin daily Alk Phos: 100 U/L Case Study Overview Of Type II Diabetes Mellitus Discussion

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AST: 45 U/L
ALT: 30 U/L
Allergies:
Latex
Codeine
Amoxicillin
PE:
Eyes: EOMI
HENT: Normal
GI: Nondistended, minimal tenderness
Skin: Warm and dry
Neuro: Alert and Oriented
Psych: Appropriate mood

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan Case Study Overview Of Type II Diabetes Mellitus Discussion.

To Prepare
Review the case study assigned by your Instructor for this Assignment
Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
By Day 7 of Week 4
Write a 1-page paper that addresses the following:

Explain your diagnosis for the patient, including your rationale for the diagnosis.
Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples Case Study Overview Of Type II Diabetes Mellitus Discussion.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Case Overview

DC is a 46 years old female presenting with a 24-hour history of RUQ pain associated with large meals, vomiting, and nausea. She is known to have hypertension, type two diabetes mellitus, gout, and DVT due to BCPs. Her current medications are Lisinopril 10mg, HCTZ 25mg daily, allopurinol 100mg daily, and multivitamin daily. She is allergic to latex, amoxicillin, and codeine. Her vitals are the temperature at 98.8F, weight at 202Ibs, the height of 5’8, blood pressure at 136/82mmHg, and heart rate at 82bpm. On examination, she is alert and oriented with an appropriate mood. Her eyes are EOMI, HEENT is normal, GIT is non-distended with minimal tenderness, and the skin is warm and dry. Notable labs are WBC:13000/mm3, Total bilirubin 0.8 mg/dL, Direct bilirubin: 0.6 mg/dL, Alk Phos: 100 U/L, AST: 45 U/L, and ALT: 30 U/L. Case Study Overview Of Type II Diabetes Mellitus Discussion

Patient Diagnosis

Cholecystitis is the inflammation of the gallbladder due to cystic duct obstruction. Risk factors for cholecystitis are female gender, obesity, hormonal replacement therapy, increasing age, diabetes mellitus, and cardiac events. The presenting symptoms are nausea, vomiting, pain in the epigastric region and localizes to the right upper quadrant, fever, tachycardia, and jaundice (Mou, et al, 2019). The diagnostic tests may show high white blood cells, elevated ALT and AST, alkaline phosphate, and bilirubin levels may show obstruction and mildly elevated lipase levels. However, these tests may not be reliable in making the diagnosis. The patient has hypertension, is obese, diabetes mellitus, and gout. She presents with abdominal pain postprandial and peritoneal symptoms such as nausea and vomiting before the pain. Therefore, cholecystitis is the appropriate diagnosis for the patient. Case Study Overview Of Type II Diabetes Mellitus Discussion

Treatment Plan

1. Ciprofloxacin 500mg PO twice daily for 7 days
2. Metronidazole 400mg PO thrice daily for 7 days
3. Promethazine 25mg PO once daily for three days
4. Tylenol 1g PO thrice daily for three days
5. Sitagliptin 100mg PO twice daily
6. Lisinopril 10mg PO once daily
7. Allopurinol 100mg daily Case Study Overview Of Type II Diabetes Mellitus Discussion

Justification For The Recommended Therapy

The aim of treating a patient with cholecystitis includes relieving pain, stopping nausea, and treating infections. Promethazine is an anti-emetic to stop nausea and prevent vomiting and maintain the normal electrolyte balance in the body. Antibiotics provide coverage for infectious organisms both bacteria and protozoa. Ciprofloxacin has a broad activity on the gram positives and gram negatives, while metronidazole works on the anaerobic bacteria. Tylenol is the appropriate drug for relieving pain because the patient is allergic to codeine. NSAID co-administration with allopurinol has adverse reactions in the patient. Sitagliptin is an anti-diabetic that increases hormone activity to reduce glucagon secretion from the body. It is the appropriate drug for the patient because it reduces the BMI and the occurrence of hypoglycemia in diabetic patients (Smits, et al, 2021)Case Study Overview Of Type II Diabetes Mellitus Discussion. Lisinopril is an angiotensin-converting enzyme inhibitor that lowers blood pressure. Roush, et al, (2018), states that HCTZ is inappropriate for this patient because it increases hepatic insulin resistance and reduces lipid metabolism, thus, increasing the risk for hyperglycemia and hyperlipidemia.

References

Mou, D., Tesfasilassie, T., Hirji, S., & Ashley, S. W. (2019). Advances in the management of acute cholecystitis. Annals of gastroenterological surgery, 3(3), 247-253.

https://doi.org/10.1002/ags3.12240

Roush, G. C., Abdelfattah, R., Song, S., Ernst, M. E., Sica, D. A., & Kostis, J. B. (2018). Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium‐sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: a systematic review and meta‐analysis. The Journal of Clinical Hypertension, 20(10), 1507-1515.

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https://doi.org/10.1111/jch.13386

Smits, M. M., Fluitman, K. S., Herrema, H., Davids, M., Kramer, M. H., Groen, A. K., … & van Raalte, D. H. (2021). Liraglutide and sitagliptin have no effect on intestinal microbiota composition: A 12-week randomized placebo-controlled trial in adults with type 2 diabetes. Diabetes & metabolism, 47(5), 101223.

https://doi.org/10.1016/j.diabet.2021.101223 Case Study Overview Of Type II Diabetes Mellitus Discussion