HOMEWORK GUIDE | The patient reports he has not been able to get out of bed since the symptoms started.

o 56 y/o Caucasian male presents to the primary care clinic with complains 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 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.
o He is disabled after his second CVA that left his with generalized weakness.
His medical history includes DM, HTN, CAD.
o 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:
• What are the pertinent positive and pertinent negative findings in this patient assessment?
o (More than 4 items addressed from the case study)
• Create a list of differentials with rationales for this patient
• Discuss a medication regimen with rationales 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.
• Develop a plan of care, including:
o diagnostic studies,
o meds,
o education,
o health promotion,
o developmental stages,
o ethical and cultural considerations,
o follow up, and
o referrals

MODEL ANSWER

One clear diagnosis in the above case is Diabetes Mellitus. The pertinent positives include confirmation of dizziness and nausea, tiredness characterized by a desire to continuously rest in bed. Increased urination, thirst, and sweet substances’ cravings are the main symptoms of Type 2 diabetes. The increased rate of urinating is a result of kidneys trying to reduce sugar level in the blood. This is achieved by way of releasing more water, which is passed as urine. The high blood sugar (405) is also a key pertinent positive finding that confirms Diabetes Mellitus. The patient …

On the other hand, the pertinent negatives, in this case, include the absence of headaches and blurred visions. The two symptoms are associated with diabetes mellitus.

Differential Diagnosis

            In the above case, the differential diagnoses would include hypertension, coronary artery disease, and hypoglycemia. Fatigue, dizziness and high B/P (190/101) are associated with hypertension. The high B/P is also a sign of coronary artery disease. In some cases, dizziness may indicate low blood sugar/hypoglycemia. Additionally, dizziness is one of the side effects associated with Lantus and…