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The health of the population is the most valuable achievement of society, so the preservation and strengthening of it is an essential task in which everyone should participate without exception. Proper diagnosis and treatment of patients play a vital role in the profession of a nurse practitioner. A precise analysis of the available data will help correctly formulate the next steps in helping the patient and prevent complications.
The name of the patient chosen for the study is Doris Greek-Martin. She is a fifty-seven-year-old female with diabetes type 2, elevated blood pressure (HTN), and coronary artery disease (CAD). She says that she is constantly feeling tired and do not want to do much. This feeling has significantly intensified in the last few months. In addition to fatigue, the patient also experiences a loss of appetite. Moreover, the woman pointed out that she has slightly swollen legs. When studying the medical record, it turned out that the woman takes several medications. Every day she takes Januvia, Atorvastatin, Lisinopril, and ASA. Once a week, she takes Fosamax and medications such as Xanax for anxiety and Coreg.
Doris Greek-Martin’s preventive care shows immunization history. The patient’s last pap was two years ago, which had positive results. Her mammogram was two years ago and which also was normal. The woman had undergone colonoscopy five years ago without any harmful results. The patient’s Dexacan was done two years ago and concluded T scope of -2.3 in her left hip, which indicates the case of Osteopenia or thin bones. The presence of Osteopenia requires a change in lifestyle and the provision of a diet with sufficient calcium and vitamin D in the diet (Aggarwal & Bains, 2020). Treatment of the underlying disease that causes malabsorption may increase bone density.
Physical examination showed a generally alert obese female in no apparent distress. Pupils were in acceptable condition and reactive to light. Transcranial magnetic stimulation is normal bilaterally. Nares are patent, and the throat is without erythema or lesions. Respirations are appropriate rate and rhythm as well as cardiac. The skin has warm and dry, with spider angiomas present in the upper extremities and jaundice.
The skin of patients with diabetes often acquires a pronounced yellowish coloration. Laser correction is recommended for the treatment of spider angiomas (Zaouak et al., 2020). This is one of the preferred procedures, as it is not complex, fast, no side effects, and most importantly, painless. Laboratory examination showed that the patient’s complete blood count, thyroid-stimulating hormone, and comprehensive metabolic panel were normal, except for AST and ALT, which were both elevated. These are essential indicators of the state of various organs. An increase in these enzymes indicates damage to organs such as the liver, heart, muscles. Thus, a decrease in their level in the blood occurs independently when the underlying disease is eliminated.
I would screen the patient for type 2 diabetes, as a woman’s fatigue may be due to this disease. Then, based on the examination results, I would refer the patient to effective preventive measures. In addition to blood pressure control and weight loss, diet and physical activity are recommended for the primary prevention of type 2 diabetes. Moderate but regular motor activity increases the sensitivity of cells to insulin, so it can be considered as a preventive measure.
However, the patient complained of swelling of the legs, which can interfere with her physical activity. Edema is the accumulation of lymph in the muscle tissues due to a pathological process associated with a violation of the water-salt balance (Kim, 2019). In diabetic patients, fluid can largely linger in the body, leading to severe puffiness. In almost all cases of leg swelling in diabetes, treatment is complex. Medications are prescribed to normalize sugar levels, treat or relieve urinary system dysfunction, improve cardiovascular system activity and dietary nutrition.
Since the swelling in the leg area can affect the patient’s joints, I would order a second Dexascan. After it is performed, the doctor can compare the condition of the bone tissue; in other words, comparing the base scan with the second scan can show whether the bone density improves, worsens, or remains the same. In type 2 diabetes, nurse practitioners can limit hypoglycemic drugs if they have an effect, and the level of glucose level in the blood is not too high. Therefore, it is necessary to conduct a patient’s blood test, prescribe new drugs, or change the dosage of medications that the patient is already taking.
Diabetes mellitus is common in patients with hypertension and significantly increases the risk of cardiovascular disease. To prevent high blood pressure, the patient takes particular medications, such as Coreg. The pharmacological treatment of patients with hypertension and diabetes is controversial due to concerns about the metabolic effects of certain antihypertensive drugs (Fragasso et al., 2019). In diabetes, the use of antihypertensive therapy is recommended in cases where blood pressure remains at the level of 140/80 mm Hg even with lifestyle adjustments through diet and exercise. To reduce the cardiovascular risk, it is necessary to combat hyperdynamic, after which blood circulation is activated, the myocardium and vascular walls are strengthened, and the removal of harmful cholesterol is accelerated.
Medicine is one of the most important branches of human activity, which requires the involvement of enormous resources, including human resources. Therefore, the profession of a nurse practitioner is relevant, in-demand, and respected. This type of specialist can provide a timely diagnosis to patients and prevent the risks of complications in various diseases. This is especially important in the treatment of diabetes and its consequences. A precise examination and study of the patient’s tests in such cases is especially critical.
References
Aggarwal, R., & Bains, K. (2020). Protein, lysine and vitamin D: critical role in muscle and bone health. Critical Reviews in Food Science and Nutrition, 1-12.
Cummings, J. N., Butler, B., & Kraut, R. (2014). The quality of online social relationships. Communications of the ACM, 45(7), 103–108.
Fragasso, G., Margonato, A., Spoladore, R., & Lopaschuk, G. D. (2019). Metabolic effects of cardiovascular drugs. Trends in cardiovascular medicine, 29(3), 176-187.
Kim, E. J., Lin, W. V., Rodriguez, S. M., Chen, A., Loya, A., & Weng, C. Y. (2019). Treatment of diabetic macular edema. Current diabetes reports, 19(9), 1-10.
Zaouak, A., Bouhajja, L., Jrad, M., Jebali, A., Hammami, H., & Fenniche, S. (2020). Dermoscopic features of spider angioma in a healthy child. Our Dermatology Online, 11(1), 101-102.
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