Clinical Reasoning Case Study #77 Endocrine Disorders

949 Words Jun 30th, 2015 4 Pages
Case study 76 Endocrine Disorders
1. Interpret Y.L.'s laboratory results
• HbA1C is elevated at 8.8% and the goal for diabetics is to keep that value below 7%
Hemoglobin A1c. Her number is concerning because it indicates that her blood sugar has been way too high over the past few months. The A1c is an indication of glycosylation in the body which is damaging to the blood vessels and peripheral nerves. It causes thickening of the basement membrane which will impair oxygen transport to the tissues and carbon dioxide removal.
• High BP
• Total Cholesterol is elevated at 256mg/dL, normal value is below 200mg/dL
• Fasting glucose is high at 184mg/dL, normal value is below 126mg/dL
• Triglycerides are elevated at 346 mg/dL, normal
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What is the rationale for starting Y.L. on metformin (Glucophage) and glipizide (Glucotrol)?
7. What teaching do you need to provide to Y.L. regarding oral hypoglycemic therapy?
8. What potential benefits could Y.L. receive from encouragement to exercise?
9. Which of the symptoms that Y.L. reported today led you to believe she has some form of neuropathy?
• c/o burning feet with the sensation of pins pricking in them
10. What findings in Y.L.'s history place her at increased risk for the development of other forms of neuropathy?
11. How would you educate Y.L. about neuropathy?
• Explain, that diabetes is the most common cause of neuropathy. Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms.
• Explain signs and symptoms if neuropathy worsens.
• Educate patient of proper foot care
• Educate patient about the importance of managing blood sugar and maintaining a healthy lifestyle.
12. Because Y.L. already has symptoms of neuropathy, placing her at risk for foot complications, you realize you need to instruct her on…