Discussion- Clinical Assessment Of Patient As APRN. Describe the assessment of a patient with a disease of your choice, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
Mention the health promotion intervention for this patient.
What did you learn that can be beneficial for you as an advanced practice nurse?
Support your plan of care with the current peer-reviewed research guideline.
Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Clinical Assessment of Patient with Diabetes Mellitus
Diabetes Mellitus (DM) is a chronic medical condition characterized by elevated blood sugar levels. It is a widespread disease, affecting approximately 34 million individuals in the United States alone. DM can be classified into type 1 and type 2, with type 2 accounting for the majority of cases. As an Advanced Practice Registered Nurse (APRN), it is crucial to have a comprehensive assessment of patients with DM to ensure proper management and prevent the progression of the disease.
Signs and Symptoms (S&S)
Patients with DM may present with symptoms such as frequent urination, excessive thirst, weight loss, blurred vision, slow wound healing, and fatigue. Some patients may also have symptoms such as skin infections, numbness or tingling in the extremities, and increased hunger. A physical examination may reveal signs of dehydration, poor skin turgor, and poor wound healing.
Assessment
The first step in the assessment of a patient with DM is to obtain a thorough medical history, including a review of symptoms and family history of the disease. A physical examination should be performed to assess for the presence of any complications, such as neuropathy or retinopathy. A comprehensive laboratory Assessment should be done to confirm the diagnosis and evaluate the severity of the disease. This should include a fasting blood glucose level, hemoglobin A1C, kidney function tests, lipid profile, and liver function tests.
Plan of Care
The management of DM is multi-faceted and tailored to the individual patient’s needs. The goals of treatment are to control blood glucose levels, prevent complications, and improve the patient’s quality of life.
For patients with type 2 DM, the first line of treatment is lifestyle modifications, including diet and exercise. A referral to a dietitian or nutritionist may be necessary to Help the patient in developing a healthy eating plan. Patients should also be encouraged to engage in regular physical activity, such as brisk walking or swimming, for at least 30 minutes per day.
Pharmacologic therapy may be necessary for patients who do not achieve their blood glucose goals with lifestyle modifications alone. Metformin is often the first-line oral agent used to control blood glucose levels in type 2 DM. Other agents, such as sulfonylureas and thiazolidinediones, may also be used.
In addition to lifestyle modifications and pharmacologic therapy, patients with DM should undergo regular monitoring for the development of complications, such as retinopathy, neuropathy, and nephropathy. Patients should also undergo regular foot and eye exams and be counseled on the importance of regular dental care to prevent infections.
Differential Diagnosis
Impaired glucose tolerance: Patients with impaired glucose tolerance (IGT) have higher than normal blood glucose levels but do not meet the criteria for DM. IGT may progress to DM over time, and these patients should be monitored closely.
Acromegaly: This condition is characterized by the overproduction of growth hormone, which can lead to elevated blood glucose levels and the development of DM.
Pancreatitis: Pancreatitis can lead to the destruction of the insulin-producing cells in the pancreas and result in the development of DM.
Health Promotion Intervention
Health promotion is an essential aspect of the management of patients with DM. Patients should be educated on the importance of healthy eating habits, physical activity, and regular monitoring of blood glucose levels. They should also be informed about the importance of regular monitoring for the development of complications, such as retinopathy, neuropathy, and nephropathy.
Benefits for APRN
As an APRN, it
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is important to stay up-to-date on the latest guidelines and treatments for DM to provide the best care for patients. In addition, conducting a comprehensive assessment, including a thorough medical history and physical examination, is crucial in the diagnosis and management of DM. An understanding of the differential diagnoses and the potential for progression to other diseases is also crucial in providing quality care.
Furthermore, promoting health and wellness, including lifestyle modifications and regular monitoring, can improve the patient’s quality of life and prevent the progression of the disease. As an APRN, it is essential to provide patients with education and resources to help them manage their disease and improve their overall health.
Support from Peer-Reviewed Research Guidelines
The American Diabetes Association (ADA) provides guidelines for the management of DM, which are based on the latest evidence-based research. The ADA recommends lifestyle modifications, such as a healthy diet and physical activity, as the first line of treatment for patients with type 2 DM. For patients who do not achieve their blood glucose goals with lifestyle modifications, the ADA recommends the use of oral agents, such as metformin, as the first-line pharmacologic therapy.
The National Institute for Health and Care Excellence (NICE) in the UK also provides guidelines for the management of DM. NICE recommends a comprehensive approach to the management of DM, including lifestyle modifications, regular monitoring, and pharmacologic therapy, as needed. NICE also recommends the use of metformin as the first-line oral agent for the management of type 2 DM.
Diabetes Mellitus is a chronic medical condition that requires a comprehensive assessment and a multi-faceted approach to management. As an APRN, it is important to conduct a thorough assessment, including a medical history and physical examination, to diagnose and manage DM effectively. Lifestyle modifications, including a healthy diet and physical activity, are the first line of treatment for patients with type 2 DM. Pharmacologic therapy, such as metformin, may also be necessary to achieve blood glucose goals. Regular monitoring and health promotion interventions, such as education and resources, can improve the patient’s quality of life and prevent the progression of the disease. The latest peer-reviewed research guidelines, such as those provided by the ADA and NICE, should be used to inform the management of patients with DM.
