Diabetic Case Study
The University of Texas Arlington College of Nursing and Health Innovation
In partial fulfillment of the requirements of
N5334 Advanced Pharmacology for APNs
Mary Davis, DNP, APRN, ANP-BC, BC-ADM June 27, 2020
Case Study Format
Assessment: Marion is a 55-year old white female that was previously
treated for a UTI at an urgent care clinic. Her UA shows protein in the urine
and high glucose level. Her random plasma glucose level is 220 mg/dL.
Blood pressure reads 150/90. Her BMI is 30.0. She has a family history of
Diabetes type 2. Laboratory findings:
Fasting plasma glucose 180
mg/dL Total cholesterol 250
Triglycerides 350 mg/dL
HDL 35 mg/dL
LDL 164 mg/dL
HbA1c 7.5 %
Serum Creatinine 1.2
GFR >60
Thyroid studies within normal limits.
Marion meets the criteria for diagnosis of diabetes mellitus type 2,
hypertension, hyperlipidemia and obesity.
Plan: Lifestyle changes include healthy eating and increased physical
activity. Patient will be instructed on reducing saturated fat, reducing sodium
intake, eliminating trans-fat and increasing dietary fiber. Increase activity to
150 minutes/week of moderate intensity. Patient to start taking Metformin
PO 850 mg PO once a day with meals for 14 days.
After 14 days, Metformin will increase to 850 mg PO BID with meals. Patient
to begin taking OTC ASA 81 mg PO once a day. Patient to begin taking
Atorvastatin 40 mg PO once a day for high cholesterol and Lisinopril 10 mg
once a day for hypertension.
Patient will monitor blood glucose levels and blood pressure to ensure that
they are within normal limits while taking new medications. Patient to
receive diabetes education. Will provide patient with diabetes education
resources as well. Follow up to be scheduled 4 weeks from now.
Pharmacologic:
1. Metformin 850 mg PO once a day for fourteen days, then increase to 850
mg PO BID (Epocrates, Inc., 2020).
2. ASA 81 mg PO once a day (Epocrates, Inc., 2020).
3. Atorvastatin 40 mg PO once a day (Epocrates, Inc., 2020).
4. Lisinopril 10 mg PO once a day (Epocrates, Inc., 2020).
Provide rationale:
Healthy eating varies depending on caloric requirements and personal or
cultural food preferences. Overall recommendations include reducing the
intake of saturated fat, eliminating trans-fat, lowering sodium intake and
increasing dietary fiber (Wang, Hess, Hiatt & Goldfine, 2016). Aerobic or
resistance exercise helps to improve glucose control. Moderate-intensity
physical activity for 150 minutes/week is beneficial for decreasing blood
glucose levels. This amount of physical activity is associated with weight loss
(GC, Cadet, Hirani & Thomas, 2018). The initial drug of choice for type 2 DM
is Metformin. There is evidence of beneficial effects on A1C, decrease or
maintenance of weight and decreased cardiovascular mortality (Maruther et
al., 2016). The ADA recommends aspirin for primary prevention of CVD for
diabetic patients over the age of 50 with one major risk factor (Clinical
Resource, 2018). Hypertension is listed as a risk factor. Marion meets the
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