nursing care plan 9:05ull ?DoneCASE SCENARIO ON ELDERLYPATIENT WITH IMPAIRED RENAL FUNCTIONAn 84-year-old man with type 2 diabetes is admitted to the hospital with alteredmental status and hypoglycemia. He had experienced recurring episodes of mildhypoglycemia over the previous week, which were managed with food. With thisepisode, however, he could not be aroused, so the family called EMS. His pastmedical history includes chronic lymphocytic leukemia, gout, hypertension, andatrial fibrillation. Approximately 6 weeks ago, his serum creatinine increasedfrom 1.6 mg/dL to 2.4 mg/dL following a bout of pneumonia. He had been takingglimepiride 4 mg twice daily. He admitted that he sometimes skipped the doseentirely because of hypoglycemia, and when he did so, his glucose was 200mg/dL. His glycosylated hemoglobin (HbA1c) is 6.9%. Information and laboratoryvalues collected at the hospital are as follows:•Height, 5'9"•Weight, 198 Ib•BMI, 28•BP, 114/73 mm Hg•Current medications, glimepiride 4 mg BID and atorvastatin 10 mg QD •HBA1C,6.9%• Lipids, LDL-C 45 mg/dL; HDL-C 55 mg/dL; Total-C 109 mg/dL; triglycerides 47mg/dL •Serum creatinine 1.94 mg/dLDIAGNOSISThe patient is found to have acceptable glycemic control, but unacceptableepisodes of severe hypoglycemia. His worsening renal dysfunction and pooroverall health status were likely responsible for the hypoglycemia, since he hadtolerated glimepiride in the past. Hypoglycemia with his current treatmentregimen was a particular concern given his age, concomitant renal disease, andother comorbidities.TREATMENTWhile in the hospital, the patient required a small dose of Insulin Glargine tocontrol his blood glucose, 16 units.This patient is elderly and has other comorbidities, including moderate renalimpairment. Developing a treatment plan that helps maintain normal glucoselevels with little or no associated hypoglycemia as well as limited complexity isimportant for this elderly patient.1 Since this patient has moderate renalimpairment, it is important to consider medications that are not cleared renallyand do not require dose adjustment based on serum creatinine or kidneyfunction. Lastly, renal dysfunction and advanced age are two key risk factors forhypoglycemia.1-At discharge, the decision was made to discontinue insulin glargine and initiateoral therapy with a dipeptidyl peptidase-4 inhibitor, given the low rates ofhypoglycemia associated with this class and ease of use (ie, oral administration).Linagliptin 5 mg/day was prescribed at hospital discharge, and a follow-up visitwas scheduled in 2 weeks. At the follow-up appointment, the patient reportedthat he was feeling well and eating better. He stated that his glucose rangedfrom 140 mg/dL to 210 mg/dL. His serum creatinine had increased to 2.4 mg/dL.He has had no hypoglycemic episodes since leaving the hospital. At this time, asmall dose of insulin glawering regiment (8 9:05ull ?•Lipids, LDL-C 45 mg/dL; HDL-C 55 mg/dL; Total-C 109 mg/dL; triglycerides 47mg/dL •Serum creatinine 1.94 mg/dLDIAGNOSISThe patient is found to have acceptable glycemic control, but unacceptableepisodes of severe hypoglycemia. His worsening renal dysfunction and pooroverall health status were likely responsible for the hypoglycemia, since he hadtolerated glimepiride in the past. Hypoglycemia with his current treatmentregimen was a particular concern given his age, concomitant renal disease, andother comorbidities.TREATMENTWhile in the hospital, the patient required a small dose of Insulin Glargine tocontrol his blood glucose, 16 units.This patient is elderly and has other comorbidities, including moderate renalimpairment. Developing a treatment plan that helps maintain normal glucoselevels with little or no associated hypoglycemia as well as limited complexity isimportant for this elderly patient.1 Since this patient has moderate renalimpairment, it is important to consider medications that are not cleared renallyand do not require dose adjustment based on serum creatinine or kidneyfunction. Lastly, renal dysfunction and advanced age are two key risk factors forhypoglycemia.1-At discharge, the decision was made to discontinue insulin glargine and initiateoral therapy with a dipeptidyl peptidase-4 inhibitor, given the low rates ofhypoglycemia associated with this class and ease of use (ie, oral administration).Linagliptin 5 mg/day was prescribed at hospital discharge, and a follow-up visitwas scheduled in 2 weeks. At the follow-up appointment, the patient reportedthat he was feeling well and eating better. He stated that his glucose rangedfrom 140 mg/dL to 210 mg/dL. His serum creatinine had increased to 2.4 mg/dL.He has had no hypoglycemic episodes since leaving the hospital. At this time, asmall dose of insulin glargine was added to his glucose-lowering regiment (8units), with adjustments made on an outpatient basis.At a 6-month follow-up, the patient's HbA1c was 6.6%. He reported that hisglucose ranges from 110 mg/dL to 155 mg/dL, and he had not experienced anyhypoglycemia. His serum creatinine was 1.99 mg/dL. Information and laboratoryvalues collected during the 6- month follow-up visit are summarized here:•Weight, 186 Ib•BP, 112/70 mm Hg•Current medications, Linagliptin 5 mg/d; Insulin Glargine 10-14 units/day;Atorvastatin 10 mg QD•HBA1C, 6.6%•Lipids, LDL-C 28 mg/dL; HDL-C 38 mg/dL; Total-C 103 mg/dL; triglycerides 73mg/dL •Serum creatinine 1.99 mg/dLOver the next 2 years, the patient's serum creatinine fluctuated from 1.7 mg/dLto 2.5 mg/dL. He required additional chemotherapy for chronic lymphocyticleukemia with small cell lymphoma. His diabetes remained stable on the sameregimen of linagliptin 5 mg/day and insulin glargine 10 to 14 units/day.

Question

nursing care plan 9:05ull ?DoneCASE SCENARIO ON ELDERLYPATIENT WITH IMPAIRED RENAL FUNCTIONAn 84-year-old man with type 2 diabetes is admitted to the hospital with alteredmental status and hypoglycemia. He had experienced recurring episodes of mildhypoglycemia over the previous week, which were managed with food. With thisepisode, however, he could not be aroused, so the family called EMS. His pastmedical history includes chronic lymphocytic leukemia, gout, hypertension, andatrial fibrillation. Approximately 6 weeks ago, his serum creatinine increasedfrom 1.6 mg/dL to 2.4 mg/dL following a bout of pneumonia. He had been takingglimepiride 4 mg twice daily. He admitted that he sometimes skipped the doseentirely because of hypoglycemia, and when he did so, his glucose was >200mg/dL. His glycosylated hemoglobin (HbA1c) is 6.9%. Information and laboratoryvalues collected at the hospital are as follows:•Height, 5'9&#34;•Weight, 198 Ib•BMI, 28•BP, 114/73 mm Hg•Current medications, glimepiride 4 mg BID and atorvastatin 10 mg QD •HBA1C,6.9%• Lipids, LDL-C 45 mg/dL; HDL-C 55 mg/dL; Total-C 109 mg/dL; triglycerides 47mg/dL •Serum creatinine 1.94 mg/dLDIAGNOSISThe patient is found to have acceptable glycemic control, but unacceptableepisodes of severe hypoglycemia. His worsening renal dysfunction and pooroverall health status were likely responsible for the hypoglycemia, since he hadtolerated glimepiride in the past. Hypoglycemia with his current treatmentregimen was a particular concern given his age, concomitant renal disease, andother comorbidities.TREATMENTWhile in the hospital, the patient required a small dose of Insulin Glargine tocontrol his blood glucose, 16 units.This patient is elderly and has other comorbidities, including moderate renalimpairment. Developing a treatment plan that helps maintain normal glucoselevels with little or no associated hypoglycemia as well as limited complexity isimportant for this elderly patient.1 Since this patient has moderate renalimpairment, it is important to consider medications that are not cleared renallyand do not require dose adjustment based on serum creatinine or kidneyfunction. Lastly, renal dysfunction and advanced age are two key risk factors forhypoglycemia.1-At discharge, the decision was made to discontinue insulin glargine and initiateoral therapy with a dipeptidyl peptidase-4 inhibitor, given the low rates ofhypoglycemia associated with this class and ease of use (ie, oral administration).Linagliptin 5 mg/day was prescribed at hospital discharge, and a follow-up visitwas scheduled in 2 weeks. At the follow-up appointment, the patient reportedthat he was feeling well and eating better. He stated that his glucose rangedfrom 140 mg/dL to 210 mg/dL. His serum creatinine had increased to 2.4 mg/dL.He has had no hypoglycemic episodes since leaving the hospital. At this time, asmall dose of insulin glawering regiment (8 9:05ull ?•Lipids, LDL-C 45 mg/dL; HDL-C 55 mg/dL; Total-C 109 mg/dL; triglycerides 47mg/dL •Serum creatinine 1.94 mg/dLDIAGNOSISThe patient is found to have acceptable glycemic control, but unacceptableepisodes of severe hypoglycemia. His worsening renal dysfunction and pooroverall health status were likely responsible for the hypoglycemia, since he hadtolerated glimepiride in the past. Hypoglycemia with his current treatmentregimen was a particular concern given his age, concomitant renal disease, andother comorbidities.TREATMENTWhile in the hospital, the patient required a small dose of Insulin Glargine tocontrol his blood glucose, 16 units.This patient is elderly and has other comorbidities, including moderate renalimpairment. Developing a treatment plan that helps maintain normal glucoselevels with little or no associated hypoglycemia as well as limited complexity isimportant for this elderly patient.1 Since this patient has moderate renalimpairment, it is important to consider medications that are not cleared renallyand do not require dose adjustment based on serum creatinine or kidneyfunction. Lastly, renal dysfunction and advanced age are two key risk factors forhypoglycemia.1-At discharge, the decision was made to discontinue insulin glargine and initiateoral therapy with a dipeptidyl peptidase-4 inhibitor, given the low rates ofhypoglycemia associated with this class and ease of use (ie, oral administration).Linagliptin 5 mg/day was prescribed at hospital discharge, and a follow-up visitwas scheduled in 2 weeks. At the follow-up appointment, the patient reportedthat he was feeling well and eating better. He stated that his glucose rangedfrom 140 mg/dL to 210 mg/dL. His serum creatinine had increased to 2.4 mg/dL.He has had no hypoglycemic episodes since leaving the hospital. At this time, asmall dose of insulin glargine was added to his glucose-lowering regiment (8units), with adjustments made on an outpatient basis.At a 6-month follow-up, the patient's HbA1c was 6.6%. He reported that hisglucose ranges from 110 mg/dL to 155 mg/dL, and he had not experienced anyhypoglycemia. His serum creatinine was 1.99 mg/dL. Information and laboratoryvalues collected during the 6- month follow-up visit are summarized here:•Weight, 186 Ib•BP, 112/70 mm Hg•Current medications, Linagliptin 5 mg/d; Insulin Glargine 10-14 units/day;Atorvastatin 10 mg QD•HBA1C, 6.6%•Lipids, LDL-C 28 mg/dL; HDL-C 38 mg/dL; Total-C 103 mg/dL; triglycerides 73mg/dL •Serum creatinine 1.99 mg/dLOver the next 2 years, the patient's serum creatinine fluctuated from 1.7 mg/dLto 2.5 mg/dL. He required additional chemotherapy for chronic lymphocyticleukemia with small cell lymphoma. His diabetes remained stable on the sameregimen of linagliptin 5 mg/day and insulin glargine 10 to 14 units/day.

Accepted Answer

Hypoglycemia -- hypoglycemia define as low blood sugar level in the body. <70 gm/dl is concedered…