Purpose
The purpose of this case study assignment is to :
- Analyze provided subjective and objective information to diagnose and develop a management plan for the selected case study patient.
- Apply national diabetes guidelines to a case study patient.
- Apply national guidelines to develop a management plan for all identified secondary diagnosis(es).
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
- Select appropriate health promotion and disease prevention strategies for patients with or at risk for a glucose metabolism disorder (WO5.1) (CO1,2,3,4,5)
- Demonstrate competence in the evaluation and management of patients with glucose metabolism disorders (WO5.2) (CO1,2,3,4,)
- Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO5.3) (CO1,2,3,4,5)
- Apply polypharmacy knowledge to medication reconciliation for selected case study patient.(WO5.4) (CO 6)
Due Date:
Sunday 11:59 p.m. MT at the end of Week 5
This assignment is submitted through Turn It In (TII).* Students are allowed two opportunities to submit. The first Turn It In submission allows the student to view the Turn It In Score and edit the assignment if necessary. The second submission is considered the final submission and will be graded. Any further Turn IT In submissions will not be considered for grading.
*due to the amount of common case study content it is not unusual that the TII may exceed 25%. It is the original work, such as rationale statements and treatment plans that are evaluated for similarity by the faculty.
Total Points Possible: 160
Requirements:
The assignment is a paper, which is to be written in APA format using the provided assignment template. The paper shall not exceed 10 pages, excluding title page and references.
NR601 _week 5 case study paper template_Nov 20.docx download
Case Study Patient – March 2020 download
Review the provided patient visit information. You are provided with the subjective and objective exam findings. As the provider, you are to diagnose the case study patient and develop the management plan for this case study patient. Keep in mind this is a complex patient who has more than one diagnosis, which is common in primary care.
Use the provided case study template for your paper. Review the APA Manual to adhere to APA formatting.
Introduction: briefly discuss the purpose of this paper. (no more than 5 sentences)
Assessment: review the provided case study information.
Identify the primary and secondary diagnosis for the patient. Each diagnosis will include the following information:
- ICD 10 code.
- A brief pathophysiology statement which is no longer that two sentences, paraphrased and includes common signs and symptoms of the diagnosis and proper citation.
- The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement, which links the subjective and objective findings (including lab data and interpretation).
- An evidence-based rationale statement, which summarizes why the diagnosis was chosen.
- Do not include quotes, paraphrase all scholarly information and provide an in-text citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.
Plan: (there are five (5) sections to the management plan)
- Diagnostics. List all labs and diagnostic test you would like to order. Each test includes a rationale statement following the listed lab, which includes the diagnosis requiring the test, the purpose of the test and how the test results will contribute to your management plan. Each rationale statement is cited. Include all future follow up labs for each listed diagnosis.
- Medications: Each medication is listed in prescription format. Each prescribed and OTC medication is linked to a specific diagnosis and includes a paraphrased EBP rationale for prescribing.
- Education: section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. All education steps are linked to a diagnosis, paraphrased, and include a paraphrased EBP rationale. Review the NR601 Clinical SOAP note guideline for more detailed information.
- Referrals: any recommended referrals are appropriate to the patient diagnosis and current condition, is linked to a specific diagnosis and includes a paraphrased EBP rationale with in text citation. Review the ADA guidelines for specific follow up recommendations.
- Follow up: Follow up includes a specific time, not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation.
Assessment of Comorbidities: in this section students will review the ADA Standards of Medical Care in Diabetes (the guidelines) Assessment of Comorbidities section on comorbidities subsection and choose one listed comorbidity. Students will discuss the significance of and the relationship between the patient’s primary diagnosis and the chosen comorbidity, explaining how one diagnosis affects the other diagnosis. Any recommended screening, diagnostic testing, and referrals are also included.
Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications that you have prescribed and that the patient is currently taking that you would like to continue. Students may use Good Rx, Epocrates or another resource (students may use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.
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Rubric
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Assignment Content Possible Points = 144 Points
Assessment of primary diagnosis
1)the ICD10 code is listed in parentheses next to diagnosis. 2) Diagnosis is consistent with the cited guideline recommendations or scholarly reference 3) Includes a one to two sentence paraphrased pathophysiology statement. 4) The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to your patient. Pertinent lab results are included and interpreted within the rationale statement (4 required elements) |
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Assessment of secondary diagnosis (es)
1) the ICD10 code is listed in parentheses next to diagnosis.
2) Diagnosis is consistent with the cited guideline recommendations or scholarly reference 3) includes a one to two sentence paraphrased pathophysiology statement. 4) The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to your patient. Pertinent lab results are included interpreted within the rationale statement. (4 required elements) |
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Evidence-Based Practice
National guidelines are used to support all diagnoses and develop the plan.
1) The American Diabetes Association Standards and Medical Care in Diabetes-2019 or later, (or article related to 2019 or later Guidelines) are used to support the primary diagnosis and develop the plan. 2) Every diagnosis rationale must include an in text citation to a scholarly reference as listed in the Reference Guidelines document. 3) Each action step or order within all plan sections includes an in text citation to an appropriate reference as listed in the Reference Guidelines document. 4) Reference interpretation is accurate (4 required elements) |
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Plan: Diagnostics
1) All ordered diagnostic test are presented individually
2) All ordered diagnostics tests are linked to a diagnosis listed in the assessment section 3) All ordered tests include a paraphrased EBP rationale with citation and include date when test should be performed (ie: today, 1 week, 1 month) 4) Plans are consistent with the cited guideline recommendations or scholarly reference (4 required elements) |
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Plan: Medications
Each listed medication
1) is linked to a diagnosis listed within the assessment section or a current patent medication 2) an OTC medication is included in recommended medications 3) includes a paraphrased EBP rationale for prescribing 4) written in prescription format ( 4 required elements) |
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Plan: Education
This section is written exactly how you would discuss the education to the patient. Use vocabulary which the patient can understand.
1) All education steps are linked to a diagnosis which was listed in the assessment section, paraphrased, and includes an EBP rationale. 2) Section includes personalized detailed education on diagnoses, medications, diet, exercise and warning signs. 3) Personalized diet and exercise recommendations which include specific instructions and are appropriate for the case study patient. 4) Plans are consistent with the cited guideline recommendations or scholarly reference ( 4 required elements) |
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Plan: Referral
1) each referral is linked to a specific diagnosis which was listed in the assessment section.
2) All referrals related to the primary diagnosis are obtained from the ADA guidelines. 3) each referral includes a paraphrased EBP rationale. 4) Referral plans are consistent with the cited guideline recommendations or scholarly reference ( 4 required elements) |
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Plan: Follow-Up
1) Includes a specific time frame or date to return to PCP office. A time range is not acceptable (i.e. 2-4 weeks)
2) Includes EBP rationale with in text citation for chosen follow up date 3) Plans are EBP and consistent with the cited guideline recommendations. 4) Only follow up information is listed in this section. ( 4 required elements) |
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Assessment of comorbidities
1) Comordidity chosen was listed within the listed comorbidities from the Assessments of comorbidities subsection*
2) Discussed significance of and the relationship between primary diagnosis and chosen comorbidity. 3) Explain how one diagnosis affects the other diagnosis in no more than 3-5 sentences. 4) Included any recommended screening, diagnostic testing, and referrals in no more that 2-3 sentences. * the chosen comorbidity cannot be any secondary diagnosis already discussed in your paper’s assessment section ( 4 required elements) |
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Medication Costs
All monthly medication costs are calculated
1 )All medications including current medications and OTCs are included. 2) Each medication cost is calculated individually 3) a total cost for the month’s medication is calculated 4) Summary/reflection statement is included regarding medication costs and any medications changes based on cost or polypharmacy concerns ( 4 required elements) |
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Assignment Format Possible Points = 16 Points
Grammar, Syntax, APA
APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one errors. 1) All referenced information is cited at the end of the phrase or sentence 2) All cited information is paraphrased, no quotes are included 3) “according to” or “per” is not used when citing a scholarly source |
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Organization
Paper is developed in a logical, meaningful, and understandable sequence
1) Provided assignment template is used to develop paper 2) Rationale length does not exceed template directions. 3) All required sections are included within the assignment 4) The paper length does not exceed 10 pages. (not including title page and references) |
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Late Penalty Deductions
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy.
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Total Points: 160
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SOLUTION
Case Study Analysis
While dealing with patients, multiple diagnoses can be made based on people’s health conditions. This situation also refers to Mr. W, who complains of feeling extremely tired and gaining weight. The paper will demonstrate that type 2 diabetes mellitus and coronary artery disease (CAD) can cause these symptoms. The case study analysis will also assess these diagnoses, present their management plans, mention comorbidities, and stipulate medication costs.
Assessment
Primary Diagnosis Type 2 diabetes mellitus (E11)
pathophysiology As a rule, two primary conditions contribute to diabetes mellitus. Galicia-Garcia et al. (2020) clarify that it occurs when pancreatic β-cells produce defective insulin and insulin-sensitive tissue fails to respond correctly to it.
pertinent positive findings The diagnosis is typically associated with fatigue, nocturia, and a decreased quality of life (Kabadi, 2017). Kabadi (2017) also admits that dehydration accompanies the symptoms, which makes the patient feel that he cannot get enough to drink.
pertinent negative findings No reported family history of diabetes mellitus of any type. Wu et al. (2018) state that heredity factors are significant predictors of the condition.
rationale for the diagnosis Increased glucose and hemoglobin A1C levels demonstrate that diabetes mellitus can be under consideration. According to the American Diabetes Association (ADA) (2021), an A1C level of 6.5% or higher indicates diabetes, and the patient’s laboratory result is 6.9%.
Secondary Diagnosis Coronary artery disease (I25.1)
pathophysiology The Centers for Disease Control and Prevention (CDC) (2019) stipulates that a CAD develops because arteries that supply blood to the heart are blocked with plaque. This substance consists of cholesterol deposits that attach to the artery walls and narrow them, preventing or blocking blood flow.
pertinent positive findings These include obesity, increased age, being a man, and disease family history. Hajar (2017) stipulates that these findings are typically associated with a CAD.
pertinent negative findings Normal blood pressure and EKG results and a healthy lifestyle can indicate that a CAD is not suitable (Hajar, 2017).
rationale for the diagnosis The lipid panel demonstrates that the patient has unhealthy cholesterol levels. Thus, HDL is lower than 60 mg/dl, TC is higher than 200 mg/dl, and LDL is higher than 100 mg/dl, and Shahid et al. (2020) claim that these levels lead to increased CAD risk.
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