NURS 6531 Week 10: Evaluation and Management of Endocrine, Metabolic, and Hematologic Disorders

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NURS 6531 Week 10: Evaluation and Management of Endocrine, Metabolic, and Hematologic Disorders

Endocrine disorders such as diabetes often require extensive patient treatment and management. In the United States, over 17.4 million patients take medications to treat and manage their diabetes (CDC, 2012). Whenever treatment and management is involved, especially long-term treatment and management, patient education is critical. Through patient education and provider-patient collaboration, you can increase adherence to treatment and management plans, which is essential for patients with endocrine disorders such as diabetes. As the former surgeon general, C. Everett Koop, has said, “Drugs don’t work for patients who don’t take them” (Kocurek, 2009).

This week, as you study endocrine, metabolic, and hematological disorders, you examine the patient evaluation process. You also explore the diagnosis and treatment of patients with endocrine, metabolic, and hematological disorders.

Learning Objectives

By the end of this week, students will:

• Assess differential diagnoses for patients with endocrine, metabolic, and hematological disorders
• Analyze the role of patient information in differential diagnosis for endocrine, metabolic, and hematological disorders
• Evaluate patient treatment options for endocrine, metabolic, and hematological disorders
• Understand and apply key terms, concepts, and principles related to endocrine, metabolic, and hematological disorders
• Analyze pattern recognition in patient diagnoses

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Discussion: Examining Endocrine, Metabolic, and Hematologic Disorders

In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.

For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders.

Case Study 1

An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault

Case Study 2

A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.

Case Study 3

V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.

To prepare:

• Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
• You will either select or be assigned to a patient case study for this Discussion.
• Review the patient case study and reflect on the information provided about the patient.
• Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
• Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
• Think about potential treatment options for the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post a an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned to a different case than you. Respond to questions posed to you during the week.

More NURS 6531 Primary Care of Adults Across Lifespan Walden Essays :

NURS 6531 Week 1: Competencies of Advanced Nursing Practice

NURS 6531 Week 2: Evaluation and Management of Integumentary Disorders

NURS 6531 Week 3: Head, Eyes, Ears, Nose and Throat Disorders

NURS 6531 Week 4: Evaluation and Management of Cardiovascular Disorders

NURS 6531 Week 5: Evaluation and Management of Respiratory Disorders

NURS 6531 Week 6: Evaluation and Management of Gastrointestinal Disorders

NURS 6531 Week 7: Evaluation and Management of Renal and Genitourinary (GU) Disorders

NURS 6531 Week 8: Evaluation and Management of Musculoskeletal Disorders

NURS 6531 Week 9: Evaluation and Management of Neurologic Disorders

NURS 6531 Week 10: Evaluation and Management of Endocrine, Metabolic, and Hematologic Disorders

NURS 6531 Week 11: Evaluation and Management of Mental Health Disorders