Pathophysiology to Therapeutic Strategies Discussion

APRN SOAP Note
Patient’s Details
Initials: M. J. Age: 72yo Gender: Male
Subjective
Chief Complaint: “Experiencing diabetic ketoacidosis due to a new onset of diabetes type 2 Mellitus (T2DM).”
History of Present Illness: The patient, M. J, is a 72yo male. The patient was hospitalized in the inpatient unit six months ago. The patient was diagnosed with a new onset T2DM associated with diabetic ketoacidosis. The patient’s blood glucose at admission was 543. He was put on insulin therapy. The patient had visited his Endocrinologist three months before hospitalization. His HgbA1C at that time was 8.8. The patient’s medication therapy was adjusted at the time of admission. Diabetes education was also incorporated into the patient’s treatment therapy. He reported that his blood glucose was elevated during the last visit to his endocrinologist a few weeks before the hospitalization. His blood glucose had not been reported despite adhering to the prescribed diet strictly. Additionally, M. J. was offered diabetes education during a telehealth clinic visit. Pathophysiology to Therapeutic Strategies Discussion

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Past Medical History: T2DM and Diabetic ketoacidosis
Childhood Illnesses: The patient denies a history of childhood medical issues.
Adult Illnesses: The patient was diagnosed with T2DM during his childhood.
Hospitalizations: The client was hospitalized six months ago due to a significant elevation in blood glucose levels.
Immunizations: M. J. received all recommended childhood immunizations. He received the flu vaccine on 23rd July 2023.
Trauma: The patient denies a history of traumatic events.
Psychiatric: M. J. denies a history of severe mood swings. He denies irritability or aggressive behaviors.
Reproductive: The patient has four children. He is currently sexually inactive. He denies a recent history of sexually transmitted diseases (STDs).
Meds: M. J. uses 3 ML Insulin Lispro, Protonix IV 4mg/ml, and Zofran 8mg orally daily to control his blood glucose level.
Allergies: M. J. denies known drug-related allergies.
Family History: His mother and father are not alive. His elder brother, aged 87 years, has a history of T2DM. He was recently diagnosed with a stroke that left him paralyzed. His four children are alive. Three of them are healthy without known medical issues. However, his lastborn son, aged 30 years, was diagnosed with opioid use disorder (OUD) nine months ago. He is currently undergoing therapy. The patient has five grandchildren without known health complications.
Psychosocial (HEEADSSSS):
Home Environment: The patient’s home is healthy and free from any pollutants, including smoke, dust, or molds.
Education/Employment: The patient has a master’s degree in medicine. He was working as a clinical officer till his retirement 15 years ago.
Eating/Exercise: The patient adheres to the diabetes diet to regulate his blood glucose. Activities/Friends: He performs mild to moderate exercises for about 90 minutes weekly. His preferred physical activities include jogging and walking. He has friends living in the neighborhood who serve as his support system.
Drugs/Smoking/Alcohol: The patient denies recent use of alcohol or illegal drugs, such as marijuana or cocaine. He stopped smoking ten years ago due to his rapidly deteriorating health. Pathophysiology to Therapeutic Strategies Discussion
Sexuality: He is heterosexual, with one wife that he married 42 years ago.
Suicide/Depression: He denies a history of suicidal thoughts.
Safety: He maintains his safety while traveling by fixing his shoulder belt. The belt prevents him from moving forward in a head-on crash.
Spirituality: The patient believes in compassion for others and life after death.
Lifestyle risk assessment: The client evaluates the risk of becoming obese by calculating his BMI score based on his current weight and height.
Health Maintenance: The patient maintains his health by attending his telehealth clinics regularly to allow his Endocrinologist to monitor his blood glucose sugar, recommend the most appropriate treatment therapy, and provide diabetes education.
Review of (Pertinent) Systems:
General: The patient denies a recent weight change.
HEENT: He denies severe headaches. He denies red or teary eyes. He denies blocked nostrils. The patient denies recent ear pain. He denies bitter taste.
Neck: Denies neck pain.
Respiratory: The patient denies audible breath sounds.
Cardiovascular: He denies past or recent edema.
Gastrointestinal: M. J denies recent abdominal pain.
Genitourinary: Denies the presence of blood stains in his urine.
Musculoskeletal: Denies recent joint pain.
Psychiatric: Denies recent mood swings Pathophysiology to Therapeutic Strategies Discussion
Neurological: Denies current dizziness.
Skin: She denies current skin ulcers
Hematologic: The patient denies recent anemia.
Endocrine: M. J. denies an incident of recent sweating.
Allergic: M. J. denies a history of hives.
Objective
Vital Signs: Blood glucose at admission was 543. BP 119/88mmHg; RR 19; Oxygen saturation 98%; Weight 70kgs; and Height 5 “4.”
Physical Exam:
HEENT: No swellings were seen on his head on examination. No tears were seen in his eyes on examination. No moist nasal was seen on examination.
Lungs: No breath sounds noted.
Heart: His heartbeat was regular without murmurs.
Abdomen: No mass was detected on examination.
Assessment: Pathophysiology to Therapeutic Strategies Discussion
Type 2 Diabetes Mellitus (T2DM): The patient has a history of T2DM. It is characterized by weight gain and blurred vision (Bramlage et al., 2019). The patient manages his blood glucose by adhering to the prescribed diet and medications. However, his blood glucose remains high despite sticking to the recommended diet. He also visits his Endocrinologist to enhance the management of his blood glucose. He also receives telehealth diabetes education to enhance the management of his glycemic level. Nonetheless, he has not succeeded in regulating his blood glucose level. His glycemic level three weeks before hospital admission was 8.8. However, his blood glucose at admission was 543. Thus, the patient was diagnosed with a new onset of T2DM.
Diabetic ketoacidosis (DKA): DKA is an acute life-threatening health condition associated with diabetes. It is characterized by uncontrolled hyperglycemia, decreased glucose utilization, metabolic acidosis, and hyperketonemia (Serlina, 2021). The most common symptoms include deep and fast breathing, headache, excess fatigue, and a fruity-smelling breath. The patient was diagnosed with DKA since his blood glucose level at the time of hospitalization was 543.
Hyperglycemia: This condition is mainly characterized by high blood sugar over 140 mg/dl (Mukhtar et al., 2020). Hyperglycemia symptoms develop slowly over time. The most Pathophysiology to Therapeutic Strategies Discussion

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common symptoms include increased thirst, hunger, and frequent urination. The patient qualifies for Hyperglycemia diagnosis since his blood glucose level at the time of hospital admission was 543 mg/dL.
Plan:
The clinician should order a complete blood count. Plasma glucose of 250 mg/dl or above characterizes severe DKA and chronic hyperglycemia. The patient’s blood glucose level during admission was 543 mg/dl, indicating severe DKA and hyperglycemia. The patient should be administered potassium supplements if his potassium level is less than 3.3 meq/L before initiating insulin therapy. Additionally, his medication therapy should be alternated since it is ineffective in regulating his blood glucose. The patient should be prescribed subcutaneous insulin. Specifically, insulin detemir (Levemir) 0.1 units/kg should be administered 2 hours before discontinuing IV insulin. This medication regimen was preferred due to the efficacy of a long-acting insulin therapy in reducing glycemic levels in elderly adults with T2DM-related hyperglycemia and ketosis.
References
Bramlage, P., Lanzinger, S., van Mark, G., Hess, E., Fahrner, S., Heyer, C. H., … & Holl, R. W. (2019). Patient and disease characteristics of type-2 diabetes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases. Cardiovascular Diabetology, 18(1), 1-12.
Hua, S., Liu, Q., Li, J., Fan, M., Yan, K., & Ye, D. (2021). Beta-klotho in type 2 diabetes mellitus: From pathophysiology to therapeutic strategies. Reviews in Endocrine and Metabolic Disorders, 22(4), 1091-1109.
Mukhtar, Y., Galalain, A., & Yunusa, U. (2020). A modern overview on diabetes mellitus: a chronic endocrine disorder. European Journal of Biology, 5(2), 1-14.
Serlina, D. (2021). Diabetic Ketoasidosis. KESANS: International Journal of Health and Science, 1(3), 211-220.

ACTIVITY DESCRIPTION
Jacob is a 72-year-old male hospitalized six months ago with new onset diabetes type 2 while experiencing diabetic ketoacidosis. His blood glucose was 543 on admission and he was started on insulin therapy. He saw the Endocrinologist three months ago, and his HgbA1C was 8.8. Medications were adjusted at that time and diabetes education was initiated. A few weeks ago, he returned to the endocrinologist and still had elevated blood glucose readings, despite being adamant that he is strictly following the prescribed diet. Today, Jacob has a telehealth visit with the diabetes education clinic. Pathophysiology to Therapeutic Strategies Discussion

Can you figure out what is going on with Jacob?

After reviewing the EHR chart:

How would you explain the problem to Jacob during his next visit?
What other healthcare disciplines and community organizations would you involve in the patient’s plan of care, and why?
Document your findings and plan of care in an Adult APRN note:
Subjective
Chief Complaint (Patient’s own words):
History of Present Illness (If applicable):
Past Medical History
Childhood Illnesses:
Adult Illnesses (Acute/Chronic/Recent):
Surgery/Hospitalizations:
Immunizations:
Accidents/Trauma:
Psychiatric:
OB/Gyn/Reproductive:
Meds:
Allergies:
Family History:
Psychosocial (HEEADSSSS)
Home Environment:
Education/Employment:
Eating/Exercise:
Activities/Friends:
Drugs/Smoking/Alcohol:
Sexuality:
Suicide/Depression:
Safety:
Spirituality:
Lifestyle risk assessment: Pathophysiology to Therapeutic Strategies Discussion
Health Maintenance:
Review of (Pertinent) Systems:
Objective
Vital Signs Reviewed (Required):
Physical Exam (Pertinent systems only for HPI):
Assessment (Each assessment must be associated with a plan)
Assessment:
Plan (Diagnostic tests, Meds, Pt Ed, Referral/Follow-up)
Plan: Pathophysiology to Therapeutic Strategies Discussion