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    Case Study for Chronic Condition

    For this Assignment, you are to answer the questions regarding this case study. Please make sure to support your answers using evidence based practice.

    56 y/o Caucasian male presents to the primary care clinic with complaints of dizziness and nausea x 4 days. The patient reports he has not been able to get out of bed since the symptoms started. The patient reports symptoms are worse when he tries to get out of bed to stand. He denies any headaches or blurry vision. He states he is urinating more over the last few days and he has noticed an increase in thirst. He reports he just drank a large sweet tea before he came into the clinic.

    The patient reports that he is out of his Lantus and metformin because he cannot afford the refill until he gets his disability check. He is disabled after his second CVA that left him with generalized weakness. His medical history includes DM, HTN, CAD.

    Upon arrival at the clinic, the patient’s vital signs are as follows- Blood sugar 405, B/P 190/101, HR 102, R-20, T- 98.5.

    Using Evidence Based practice, answer the following questions thoroughly. Be sure to use APA formatting.

    What are the pertinent positive and negative findings in this patient assessment?
    Create a list of differentials with rationales for this patient?
    Discuss a medication regimen for this patient considering his financial status?
    What is the priority concern for this patient?
    How does this patient’s comorbid diagnosis impact his current symptoms?
    Discuss how the patient’s health beliefs, culture and behaviors impact the potential outcomes for the patient.




Subject Nursing Pages 6 Style APA


What are the pertinent positive and negative findings in this patient assessment?

One of the negative findings in this patient assessment is the drinking of the large sweet tea before the patient came for check-up. Patient with a history of diabetes type 2 do not have the luxury of consuming sugary foods. In fact, for these people the consumption of such foods is a contributor to the adverse health conditions that they are faced with. The bodies of such patients cannot cope with the increased sugar build-up in the body, and the consumption of the sweet tea for this patient 4 days after he has experienced the very first symptoms exacerbates the condition they are in, putting their lives in potential danger.

The second negative finding is the 405 Blood sugar level, a level that easily passes for high blood sugar level. Given the patient’s Diabetes Mellitus history, the build-up of blood sugar in the body to such heights is potentially life-threatening (Alam et al. 2018). Added to the fact that this patient has experienced the symptoms four days in a row, the medical team has to make the reduction of this sugar level a priority.

The discovery that the patient cannot afford his Lantus and metformin refill is both positive and negative. It is negative in the sense that without these two diabetes management drugs, then the rapid lowering of the blood sugar level is not possible. Sugar builds up to dangerous levels within the patient’s body. It is positive in the sense that the medical team can now understand the chief reason why the patient continues to deteriorate and present the many signs that they have.

The patient displays an above normal heart rate, and this is a negative finding. For any adult, a heart rate that is above 100 is abnormal and must be brought down if the body is to function normally. For this patient, the situation is made more acute by the fact that they have a history of hypertension and the cerebrovascular accident that has confined him to a disability. The patient is at a heightened risk of relapse into these conditions in case the heart rate is not managed immediately (Song et al 2018).

Create a list of differentials with rationales for this patient?

The nausea and dizziness that are the initial signs the patient presents for four days could be signs of many complications including vertigo, migraine or even low blood pressure. The low blood pressure option is eliminated though following the examination for blood pressure which shows that the patient has high blood pressure.

The frequent urination and increased thirst may be signals for a much more underlying problem. The most common cause tied to frequent urination and thirst is diabetes. The build-up of excess sugar in the blood causes the kidneys to overwork in attempting to absorb and filter the excess glucose (Jones et al. 2019). Consequently, much of this is passed through urine. With frequent urination, the fluid loss occasions extreme thirst.

The high heart rate and increased blood pressure may point at a relapse of the patient to the two comorbidities that are most closely linked with the conditions—coronary artery disease (CAD) and hypertension. The patient apparently has problems with their circulatory system. Consequently, an issue of high blood pressure may be a trigger for or a sign of the showing of these conditions.

Above all, the inability of the patient to afford their medicines to manage the diabetes conditions is a clear pointer that the symptoms shown by the patient point at an exacerbation of their diabetic condition. The sugar build-up is made worse by the eating habit of the patient, having taken a large sweet tea on the day he is examined at the hospital. No wonder their sugar level is way above normal.


Discuss a medication regimen for this patient considering his financial status?

Financially, this patient is incapable of paying for the medication to lower their sugar levels. Lantus and metformin are usually quite costly for a person who depends on disability checks. The patient on the other hand needs the medication to lower their sugar level immediately if it will not be a threat to their normal body functions (Evans et al. 2019). The patient has to get fast acting insulin to immediately reduce the blood sugar. In addition, the food eaten by the student would have to be low in sugar. Doing this, with a plan to pay after the check is delivered, would help the patient reduce the frequent urination and thirst that they go through.

The patient can be given meclizine or dimenhydrinates which are antihistamines that would help reduce the nausea and dizziness. These drugs that can even be found over the counter are suitable for the patient given their financial status. Eliminating the nausea and dizziness would go a long way in providing the patient with a much needed stability.

In addition, Bumetanide can be used to bring down the blood pressure following the danger that the high blood pressure has to this patient based on his comorbid conditions. The reduction of blood pressure is an important part of the care plan. This drug would help reduce the heart rate as well which is required by the patient for normal kidney function.

What is the priority concern for this patient?

The priority concern for this patient is the lowering of the blood sugar level in their body. This patient cannot afford a refill of the drugs he needs for managing his diabetic condition. He also consumed food high in sugar (sweet tea). These factors combine to put his life in danger by promoting a build-up of sugar in his body (Alam et al. 2018). The sugar build-up causes the kidney to overwork, and the other organs are at a risk of shutting down following the increased blood pressure. Lowering the sugar level would ultimately cause a reduction in a majority of the symptoms that the patient is presented with.

 How does this patient’s comorbid diagnosis impact his current symptoms?

The patient comorbidity is first seen in the lifestyle choice that he makes. Consuming sweet tea contributes in making the blood sugar go even higher in addition to his lack of sugar reducing drugs. The CAD history and history with HTN  impacts on the treatment that the patient ought to get with regard to the high blood pressure and high heart rate that the patient shows. They make the management of these conditions essential. Above all, the DM history makes the reduction of sugar level a paramount undertaking. With this blood sugar high, the patient’s life is in danger.

Discuss how the patient’s health beliefs, culture and behaviours impact the potential outcomes for the patient.

The patient presented in this case study has no information on the beliefs or culture that may affect the outcomes that the patient gets. However, one of the behaviours that this patient does is a lifestyle choice, and this choice to eat sweet foods greatly affects their sugar balance. The patient has a history of DM, and still he goes ahead to consume foods rich in sugar. This blatant disregard negatively affects their health.

There are cultures that prefer the traditional methods of treatment as opposed to the Western medicine. These cultures determine how willing the people there are to cooperate with health officials to execute health plans. Cultural and religious beliefs shape the acceptance of some treatment methods among a particular people. Some cultures for example base their diagnoses on witchcraft and other misconceptions. Such influence the success of treatment methods.


Alam, F., Islam, M. A., Kamal, M. A., & Gan, S. H. (2018). Updates on managing type 2 diabetes mellitus with natural products: towards antidiabetic drug development. Current medicinal chemistry, 25(39), 5395-5431.

Evans, M., Ceriello, A., Danne, T., De Block, C., DeVries, J. H., Lind, M., … & Wilmot, E. G. (2019). Use of fast‐acting insulin aspart in insulin pump therapy in clinical practice. Diabetes, Obesity and Metabolism, 21(9), 2039-2047.

Jones, P. J., Ma, R., & McNally, R. J. (2019). Bridge centrality: A network approach to understanding comorbidity. Multivariate Behavioral Research, 1-15.

Song, K., Chang, S., Lee, J., Shin, S. A., & Lee, H. Y. (2018). Clinical characteristics of dizziness associated with acute peripheral facial palsy. Journal of audiology & otology, 22(3), 148.



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