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Posted: October 31st, 2023
Type II Diabetes Mellitus Case Study Questions . M. K. is a 45-year-old female measuring 5'5" and weighing 225 lbs. M. K. has a history of smoking about 22 years along with a poor diet. She has a history of type II diabetes mellitus along with primary hypertension. M. K. has recently been diagnosed with chronic bronchitis. Her current symptoms include chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increased urination at night. Her current medications include Lotensin and Lasix for the hypertension along with Glucophage for the type II diabetes mellitus. The following are lab findings that are pertinent to this case:
Vitals
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BP
158/98 mm Hg
CBC
Hematocrit
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57%
Glycosylated hemoglobin (HbA1c)
7.3 %
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Arterial Blood Gas Assessment
PaCO₂
52 mm Hg
PaO₂
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48 mm Hg
Lipid Panel
Cholesterol
242 mg/dL
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HDL
32 mg/dL
LDL
173 mg/dL
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Triglycerides
184 mg/dL
For your signature assignment, compose a 3- to 4-page case analysis, written in APA format with a title page and at least 3 references, with one non-Internet reference. Organize your analysis with headings that thoroughly answer the following prompts. Support your opinions with evidence from your readings and research. Review the rubric for complete grading criteria.
In your introduction, summarize the case.
What clinical findings correlate with M. K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M. K.’s chronic bronchitis?
Which type of heart failure would you suspect with M. K.? Explain the pathogenesis of how this type of heart failure develops. Include an overview of the disease and it's effects in the U.S. population.
According to the BP. value, what stage of hypertension is M. K. experiencing? Explain the rationale for the current medications for her hypertension.
According to the lipid panel, what other condition is M. K. at risk for? According to this case study, what other medications should be given and why? What additional findings correlate for both hypertension and type II diabetes mellitus?
Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function.
Provide a conclusion that summarizes your findings and discusses the effects of this disease in the U.S. population.
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Case study questions on M.K.'s condition:
This case study analyzes the condition of M.K., a 45-year-old female patient with a history of smoking, poor diet, type 2 diabetes mellitus, primary hypertension, and recently diagnosed chronic bronchitis. M.K.'s symptoms include chronic cough, sputum production, lightheadedness, distended neck veins, peripheral edema, and increased nighttime urination. Her current medications target her hypertension and diabetes. This paper will interpret M.K.'s lab results and clinical findings, diagnose the type of heart failure and hypertension she likely experiences, and make recommendations for treatment and additional medications based on her condition.
Clinical Findings and Treatment for Chronic Bronchitis
Several of M.K.'s clinical findings correlate with her chronic bronchitis diagnosis. Chronic cough and sputum production, especially in the mornings, are hallmark symptoms (Global Initiative for Chronic Obstructive Lung Disease, 2021). Her distended neck veins and peripheral edema suggest right-sided heart failure, which is commonly associated with chronic lung diseases like chronic bronchitis that cause pulmonary hypertension (National Heart, Lung, and Blood Institute, 2019). Appropriate treatment for M.K. would include bronchodilators, such as inhaled beta-agonists or anticholinergics, to open her airways and make breathing easier (Global Initiative for Chronic Obstructive Lung Disease, 2021). She should also receive inhaled corticosteroids to reduce airway inflammation (Global Initiative for Chronic Obstructive Lung Disease, 2021). Lifestyle changes including smoking cessation, a low-sodium diet, and exercise would further benefit M.K. (National Heart, Lung, and Blood Institute, 2019).
Type of Heart Failure
Based on M.K.'s distended neck veins and peripheral edema, she likely experiences right-sided heart failure. This occurs when the right ventricle cannot pump sufficiently due to increased afterload, usually from pulmonary hypertension (McCance et al., 2014). Chronic lung diseases like chronic bronchitis damage the lungs over time, narrowing the pulmonary blood vessels and elevating pulmonary artery pressure—a classic cause of pulmonary hypertension (National Heart, Lung, and Blood Institute, 2019). In the United States, heart failure affects over 6 million people and leads to over 65,000 deaths annually (Benjamin et al., 2019). It disproportionately impacts women and is increasing in prevalence due to an aging population and improved treatment of coronary artery disease (Benjamin et al., 2019).
Stage of Hypertension
With a blood pressure reading of 158/98 mmHg, M.K. has stage 2 hypertension according to JNC 8 guidelines (James et al., 2014). Stage 2 is defined as systolic BP of 160 mmHg or higher or diastolic BP of 100 mmHg or higher (James et al., 2014). The current medications Lotensin (benazepril) and Lasix (furosemide) target her hypertension through an ACE inhibitor and diuretic, respectively, which is appropriate first-line treatment according to JNC 8 guidelines (James et al., 2014). ACE inhibitors work by inhibiting angiotensin-converting enzyme and vasodilating blood vessels, while diuretics reduce blood volume and lower pressure (McCance et al., 2014).
Risk for Additional Condition and Medications
M.K.'s lipid panel results indicate she is at high risk for cardiovascular disease. Her total cholesterol is elevated at 242 mg/dL, and her "bad" LDL cholesterol is high at 173 mg/dL (American Heart Association, 2021). Meanwhile, her "good" HDL is low at 32 mg/dL (American Heart Association, 2021). These lipid abnormalities are common in patients with diabetes and hypertension and greatly increase heart attack and stroke risk (Grundy et al., 2019). M.K. should be prescribed a statin medication like atorvastatin to lower her LDL and risk of future cardiovascular events (Grundy et al., 2019). Her diabetes and hypertension medications should also be adjusted or supplemented as needed based on her HbA1c level and blood pressure readings.
Interpretation of HbA1c
M.K.'s HbA1c level of 7.3% indicates her average blood sugar has been elevated over the past 2-3 months but is not yet at the diabetes treatment goal of below 7% (American Diabetes Association, 2022). An HbA1c in this range reflects poor glycemic control and correlates with increased risk of diabetes complications like eye, kidney, and nerve damage over time if not addressed (American Diabetes Association, 2022). Her current diabetes medication, Glucophage (metformin), should be increased in dosage or another agent added to more effectively lower her blood glucose (Inzucchi et al., 2012). Close monitoring and medication adjustments are needed to protect M.K.'s health.
Conclusion
In summary, this case study analyzed M.K.'s chronic bronchitis, right-sided heart failure, stage 2 hypertension, diabetes, and high cardiovascular risk based on presented clinical and lab findings. Treatment recommendations included bronchodilators and steroids for her lung condition, as well as adjustments to her diabetes and hypertension regimens. Statins were also recommended to lower her risk of future cardiac events based on abnormal lipid levels. M.K.'s conditions reflect growing public health issues in the U.S. related to an aging population, smoking, obesity, and increasingly sedentary lifestyles. Comprehensive lifestyle counseling and medication management are needed to optimally control this patient's chronic conditions.
References
American Diabetes Association. (2022). Standards of medical care in diabetes—2022. Diabetes Care, 45(Suppl 1), S1–S264. https://doi.org/10.2337/dc22-S001
American Heart Association. (2021). Understanding your risk of high cholesterol. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/understanding-your-risk-of-high-cholesterol
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Jordan, L. C., Khan, S. S., Kissela, B. M., Knutson, K. L., ... Virani, S. S. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528. https://doi.org/10.1161/CIR.0000000000000659
Global Initiative for Chronic Obstructive Lung Disease. (2021). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2021 report. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. D., Orringer, C. E., Peralta, C. A., ... Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 139(25), e1046–e1081. https://doi.org/10.1161/CIR.0000000000000625
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., Matthews, D. R., & American Diabetes Association (ADA); European Association for the Study Bay of Diabetes (EASD). (2012). Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 35(6), 1364–1379. https://doi.org/10.2337/dc12-0413
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., Smith, S. C., Svetkey, L. P., Taler, S. J., Town
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