Care of the Patient With Endocrine Disease

Care of the Patient With Endocrine Disease

Jenrry is a56-year-old female who is scheduled for a routine primary care provider’s (PCP) visit to follow-up on her hypertension. She reports no signi-ficant complaints other than her vision being blurry; she states, “I need to go to the eye doctor to have my eyes checked.” At the conclusion of her visit, the PCP orders a basic meta- bolic panel (BMP) and complete blood count (CBC) to be drawn. Jenny receives a phone call 2 days later from her PCP’s office to schedule an appointment for later that day. Jenny is told that her blood sugar is elevated. At her appointment, Jenny and the nurse begin by reviewing Jenny’s risk factors for diabetes.

Exercise 6-lz Select øl.l tltøt øþþly Identify risk factors commonly associated with diabetes mellitus:

E Obesiry fl ege less than 45 years E Caucasianrace I Family history D History of gestational diabetes E History of delivering babies over 9 pounds

eResource 6-l: To review risk factors associated with diabetes, consult Epocrates Online: [Pathway: -+ hnpt//online.epocrates.com -> select the “diseases” tab -+ enter “Diabetes” into the search field -+ review content related to “risks”]

Jsnny reports that her mother and grandmother were diabetics. She is also over 45 years old and overweight at 5 feet 2 inches anld 2OO pounds. Jenny still finds it hard to believe that she could be diabetic since she is feeling okay; she asks the nurse to explain to her how diabetes occurs.

Anstpers to tbis cbapter begin on page 231 215

216 CHAPTTR 6: ENDOCRINE DISEASE

Exercise 6-22 Multiple-cltoí.ce question The nurse educating Jenny on type 2 diabetes determines that she understands tþs information when she states:

A. “I am not producing any insulin because of a problem with my immune system.”

B. “I will need to take insulin for the rest of my life.,’ c. “I’m not making enough insulin or my body isn’t as sensitive to it.,, D. “I won’t need to make any dietary changes if I take my medicine.”

Exercise 6-32 Møtcbing Match the type of diabetes in Column A with its typical characteristics in Column B Answers in Column A can be used more than once.

ColumnA Column B A. Type L diabetes Onset is usually under 30 years old B. Type 2 dial¡etes patient is often thin at time of diagnosis

Treated with diet, exercise, and oral agents

Patient is often obese at time of diagnosis

Antibodies are present in the body

Patients require insulin for life

G) ;ffi::i,””,’J ^ä¿’”äîîî#.”å:*t’#i;:lË:iffi,îå:ä. _enter “Type 2 Diabetes” into the search field -+ in the “overview,’section, select “pathophysiology” and review content]

By the time it is Jenny’s turn to see her PCP, she has a beginning understanding about diabetes. Her PCP sits with her and begins by reviewing hãr hboratory re- sults. Her fasting plasma glucose from her last visit was 236 mg/dL.The pCp lists some typical signs and symptoms of diabetes, and he asks Jenny if she is experi- encing any of them.

Exercise 6-4: Select ølt tbat øþpty Identify coÍunon clinical manifestations associated with diabetes mellitus

E rolyuria E Decreased appetite Q Decreased fluid intake E Vision changes fl natigue eResource 6-3: For more information regarrding clinical manifestations associated with diabetes mellitus, refer to the Merck Manual: fpathwayt www.merckmanuals.com + select “Merck Manual of Diagnosis and

o Answers to tbis cbapter begin on page 2J1

CFIAPTER 6: ENDOCRINE DISEASE Questions 217

o

Therapy” –> enter “Diabetes” into the search field + select “Diabetes Mellitus (DM)” -à select “Symptoms and Signs” and review content]

Jenny reports that her vision has been blurry, but she thought that she needed new glasses. She also recognizes that she has been drinking and urinating more than usual. Based on her symptoms and elevated fasting plasma glucose, the phy- sician suspects Jenny has type 2 diabetes.

Care of the Patient With Endocrine Disease