George Garcia, a 48-year-old Hispanic male, presents for his 3-month follow-up type-2 diabetes mellitus (T2DM) lab review. He is a long-term patient in your practice.

Patient Case Study: Diabetes Mellitus, Hypertension, Hyperlipidemia

 

This week you gained insight into diabetes, hypertension, and hyperlipidemia, and now it is time to apply your knowledge to complete a case study focused on a patient returning to review his labs.

 

As clinicians, it is essential to be aware of the two main evidence-based guidelines, the American Diabetes Association® (ADA) and the American Association of Clinical Endocrinologists® (AACE), to help you manage patients.

 

For this assignment, use the ADA evidence-based guidelines to answer the questions within the case study.

 

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Case Study: Diabetes Mellitus,

 

Hypertension, Hyperlipidemia

 

Complete the case study by answering the questions associated with the scenario.

 

DOB: 2/14/72

 

George Garcia, a 48-year-old Hispanic male, presents for his 3-month follow-up type-2 diabetes mellitus (T2DM) lab review. He is a long-term patient in your practice. He works as an interstate truck driver, so he admits he doesn’t get a chance to exercise, eats a lot of fast food, and drinks 3 cups of coffee and 2 beers/day. He was diagnosed with T2DM 2 years ago and has maxed out on his metformin, refused to start a statin for “fearing the side effects” despite our discussions at each office visit. He has been taking his meds as prescribed and needs refills on everything. His blood pressure was suboptimal at his last visit 3 months ago and his lisinopril was increased from 20mg to 40mg, and he complains of constant throat clearing and an annoying dry cough. He complained of a mild cough in the past and always attributed it to allergies but states this is not allergies. He verbalizes he wishes he had some ideas on how he could make some health changes but finds it hard with his job. He feels sluggish and has decided he wants to try that medicine for cholesterol we discussed in the past.

 

ROS is negative except for his dry cough

 

The exam is normal except has frequent dry hacky cough during the visit

 

ASCVD 10-year risk assessment is >15%.

 

Eye exam: Current: no retinopathy

 

Foot exam: Current: sensation intact to monofilament

 

PMH: HTN, T2DM, Erectile dysfunction.

 

FH: Father: T2DM, MI

 

 Mother: T2DM, obesity

 

 Sisters x 2: Obesity

 

Meds:

 

metformin XR 1000mg 2 tab with dinner

 

lisinopril 40mg 1-tab daily

 

Viagra® 100mg 1-tab prn

 

Allergies: NKDA

 

VS: BP 142/90 P 82 R 20 BMI 28

 

CBC: Normal

 

Case Study DM_HTN_HLP

 

NRP/507 v5

 

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CMP: glucose: 116

 

 GFR: 110

 

 Creatinine: 0.9

 

 BUN: 10

 

 K: 4.0

 

 LFTs: all normal urinary albumin-to-creatinine ratio normal

 

A1C: 7.5

 

Lipids: TC: 235

 

Trigs: 190

 

HDL: 32

 

LDL: 180

 

VLDL: 23

 

Part I: Hypertension (HTN)

 

Analysis of Blood Pressure Control

 

Using the most current ADA EBP guidelines, answer the following questions.

 

1. Using the information provided in the scenario, synthesize George’s overall social and medical history, clinical symptoms, and clinical assessment, and provide an analysis of his blood pressure control.

 

Plan of Care and Prescription Writing

 

2. Which medication would you use to treat him? Explain your rationale. Include the medication class, side effects, and any precautions or black box warnings in your explanation.

 

3. Using the Rx template provided, type the blood pressure prescription you have chosen to treat George’s blood pressure. Make sure to include all elements. Excellence in Health Care, LLC.

 

4. Outline 2 of the most common side effects of the medication you just prescribed, monitoring for appropriate follow-up labs and office visit, including time frames on both.

 

5. Discuss 5 specific, relevant, and realistic dietary interventions you would suggest to positively impact George’s blood pressure. One intervention needs to incorporate a complementary herb or supplement. Provide a rationale for each intervention using evidence-based support. (Use the National Institutes of Health Herbs at a Glance page to search for and locate evidence-based support for a complementary herb or supplement.)

 

Part II: Diabetes Mellitus (DM)

 

Using the most current ADA EBP guidelines, answer the following questions.

 

Analysis of Blood Sugar Control

 

1. Based on the information provided within the scenario, synthesize George’s overall social and medical history, clinical symptoms, and clinical assessment, and provide an analysis of whether his blood sugars are under control.

 

Plan of Care and Prescription Writing

 

2. Which medication changes would you make to treat him and explain your rationale? Include the medication class, side effects, and any precautions or black box warnings in your explanation.

 

3. Using the Rx templates, type the prescription(s) you have chosen to treat George’s blood sugar.

 

4. Outline your follow-up plan for labs and office visit, including time frames on both. List each lab and provide rationale.

 

5. Discuss 5 lifestyle interventions and explain specifically how they can impact George’s glycemic control.

 

Part III: Hyperlipidemia (HLP)

 

Analysis of Lipid Control

 

Using the most current ADA EBP guidelines, answer the following questions.

 

1. Based on the information provided within the scenario, synthesize George’s overall social and medical history, clinical symptoms, and clinical assessment, and provide an analysis of whether his lipids are under control.

 

2. Differentiate the mechanism of action between a hydrophilic statin and a lipophilic statin and provide an example of each. How is this information helpful to you as a clinician and specifically in treating George?

 

Plan of Care and Prescription Writing

 

3. Which medication would you use to treat George? Explain your rationale including the medication class, side effects, any precautions, or black box warnings in your explanation.

 

4. Using the Rx template, type the prescription you have chosen to treat George’s abnormal lipids.

 

 Excellence in Health Care, LLC.

 

Monitoring, Follow-up, and Patient Education

 

5. Outline monitoring for appropriate follow-up labs and office visit, including time frames on both.

 

6. Patient education is always essential and important. In this case, what imperative piece of information regarding a potential side effect of this lipid medication would you impart to George?

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