Diagnosis, Symptom and Illness Management
1) Minimum 5 full pages
Part 1: minimum 1 pages
Part 2: minimum 2 page
Part 3: minimum 2 page
Submit 1 document per part
2)¨******APA norms, please use headers
All paragraphs must be narrative and cited in the text- each paragraphs
Bulleted responses are not accepted
Dont write in the first person
Dont copy and pase the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
3) It will be verified by Turnitin and SafeAssign
4) Minimum 3 references not older than 5 years
3 references per part
5) ******************* Identify your answer with the numbers, according to the question.
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
_______________________________________________________________
Part 1:
L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.
Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.
Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.
One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.
Questions
What are the effects of controlling BP in people with diabetes?
What is the target BP for patients with diabetes and hypertension?
Which antihypertensive agents are recommended for patients with diabetes?
Part 2:
You should consult File 1. In this document is the case that you must address to answer the questions. All responses should be case-based, refrain from giving your opinion and personal connections.
Critical Thinking Questions
1. What is the cardinal sign of Lyme disease? (always on the boards)
2. At what stages of Lyme disease are the IgG and IgM antibodies elevated?
3. Why was the ESR elevated?
4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.
Part 3:
You should consult File 2. In this document is the case that you must address to answer the questions. All responses should be case-based, refrain from giving your opinion and personal connections.
Critical Thinking Questions
1. What was the cause of this patient’s pain and cramping?
2. Why was there decreased hair on the patient’s right leg?
3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation?
4. What would be the treatment of intermittent Claudication for non-occlusion?
Lyme Disease
Case Study
A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints
of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s
symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his
thigh immediately after the trip. The following studies were ordered:
Studies Results
Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi
(normal: low)
Erythrocyte sedimentation rate
(ESR),
30 mm/hour (normal: ≤15 mm/hour)
Aspartate aminotransferase
(AST),
32 units/L (normal: 8-20 units/L)
Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL)
Hematocrit (Hct), 36% (normal: 42%-52%)
Rheumatoid factor (RF), Negative (normal: negative)
Antinuclear antibodies (ANA), Negative (normal: negative)
Diagnostic Analysis
Based on the patient’s history of camping in the woods and an insect bite and rash on the
thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific
immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing
Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen
early in this disease. RF and ANA abnormalities are usually absent.
Critical Thinking Questions
1. What is the cardinal sign of Lyme disease? (always on the boards) 2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 3. Why was the ESR elevated? 4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.
Peripheral Vascular Disease
Case Studies
A 52-year-old man complained of pain and cramping in his right calf caused by walking two
blocks. The pain was relieved with cessation of activity. The pain had been increasing in
frequency and intensity. Physical examination findings were essentially normal except for
decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial
pulses were markedly decreased compared with those of his left leg.
Studies Results
Routine laboratory work Within normal limits (WNL)
Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg;
posterior tibial: 88 mm Hg; dorsalis pedis: 88
mm Hg (normal: same as brachial systolic
blood pressure)
Arterial plethysmography Decreased amplitude of distal femoral, popliteal,
dorsalis pedis, and posterior tibial pulse waves
Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh
level
Arterial duplex scan Apparent arterial obstruction in the superficial
femoral artery
Diagnostic Analysis
With the clinical picture of classic intermittent claudication, the noninvasive Doppler and
plethysmographic arterial vascular study merely documented the presence and location of the
arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography
to document the location of the vascular occlusion. The patient underwent a bypass from the
proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.
Critical Thinking Questions
1. What was the cause of this patient’s pain and cramping? 2. Why was there decreased hair on the patient’s right leg? 3. What would be the strategic physical assessments after surgery to determine the
adequacy of the patient’s circulation?
4. What would be the treatment of intermittent Claudication for non-occlusion?
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