[ANSWERED 2023] V G is a 47 year old African American male with type 2 diabetes diagnosed two years ago

Written By: Dan Palmer, RN

V G is a 47 year old African American male with type 2 diabetes diagnosed two years ago

V G is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities

Examining Endocrine, Metabolic, and Hematologic Disorders

V G is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use.

SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.

To prepare:

  • Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
  • Review the patient case study and reflect on the information provided about the patient.
  • Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
  • Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
  • Reflect on a possible diagnosis for the patient.
  • Think about potential treatment options for the patient.

Post a an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis

Expert Answer and Explanation

Examining Endocrine, Metabolic, and Hematologic Disorders

Primary Diagnosis

Type 2 Diabetes 

The primary diagnosis for this condition is poorly controlled type 2 diabetes. Type 2 diabetes is a medical condition that happens when a patient’s body produces less insulin as needed or resists produced insulin (American Diabetes Association, 2018). According to the association, some of the clinical symptoms of type two diabetes include blurred vision, unintended weight loss, increased thirst, tingling of the lower body and hands, and increased sores that hardly heal.

A person suffering from poorly controlled diabetes is a patient who does not follow clinical instructions to control diabetes. It is highly likely that the patient suffers poorly controlled diabetes because he experiences increased tingling to the lower extremities and is obese.

Differential Diagnosis

  1. Multiple Sclerosis 

Multiple sclerosis is a medical condition that can damage a patient’s central nervous system. People with multiple sclerosis can experience the following symptoms. They include fatigue, blurred vision, tingling of one or multiple body parts, sexual problems, lack of coordination, Lhermitte sign, and prolonged double vision (Briggs et al., 2018). This disease has been included in the differential diagnosis because the patient complains of tingling of the lower parts of the body.

  1. Latent Autoimmune Diabetes 

Latent autoimmune diabetes is an illness that happens when a patient’s body does not produce enough insulin as required. Low insulin level, increased thirst, tingling of hands and feet, fatigue, and vision problems are signs of the disease. The patient complains of tingling of the body parts, and that is why the disease has been included in the diagnosis.

  1. Brachial Plexus Injury 

Brachial plexus injury is a medical condition that affects one’s nerves. It occurs when a patient’s nerves are overstretched, ripped, and compressed. Glenn et al. (2016) note that the tingling of the body parts is among the symptoms of the disease, and that is why it has been included in the diagnosis.

Role of Patient History and Physical Examination

Patient history and physical examination were so significant during diagnosis. For instance, through the patient’s medical history, the nurse found that the patient was under Januvia 50mg QD, Lipitor 40mg QD, and Lisinopril 20mg prescriptions. This information would be vital when prescribing drugs for the patient to prevent drug interaction. The current patient’s medical history provided a symptom that was used to provide the primary diagnosis.

The patient’s history provided risk factors that were used to decide the actual diagnosis for the patient. It was found that the patient was obese through medical history, type 2 diabetes, HTN, and dyslipidemia. Physical examination also provided great insight into the patient’s condition. Through physical examination, the nurse found that the patient was obese and had HBP. The information would help the nurse provide better medications that can improve the patient’s health.

Potential Treatment Options

Both medical and non-medical approaches should treat this patient. The current medications should be adjusted accordingly because the patient does not show signs of improvement. Khan et al. (2017) note that Lipitor 40mg per day should be increased to 60mg per day, and the patient monitored for two weeks.

Januvia can also be increased to 100 mg once per day. Lisinopril 20mg can be increased to 30 mg per day. The patient should be checked after two weeks to monitor his progress. The patient should also be advised to observe a balanced diet and exercise often to improve the effects of the medication.

References

American Diabetes Association. (2018). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes care, 41(Supplement 1), S13-S27. https://doi.org/10.2337/dc18-S002

Briggs, M. S., Rethman, K. K., & Lopez, M. T. (2018). Clinical decision making and differential diagnosis in a cyclist with upper quarter pain, numbness, and weakness: a case report. International journal of sports physical therapy, 13(2), 255. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063071/

Glenn, B., Drum, M., Reader, A., Fowler, S., Nusstein, J., & Beck, M. (2016). Does liposomal bupivacaine (exparel) significantly reduce postoperative pain/numbness in symptomatic teeth with a diagnosis of necrosis? A prospective, randomized, double-blind trial. Journal of endodontics, 42(9), 1301-1306. https://doi.org/10.1016/j.joen.2016.05.018

Khan, S. I., Saha, S. K., Poddar, S. K., Bachar, R., & Shoyaib, A. A. (2017). Bioequivalence studies and pharmacokinetic properties of atorvastatin 40mg tablet in healthy bengali subjects. MOJ Bioequiv Availab, 4(2), 00064. https://d1wqtxts1xzle7.cloudfront.net

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FAQs

Diabetic Neuropathy vs. Diabetic Polyneuropathy: Understanding the Differences

Diabetes is a condition that affects millions of people worldwide. One of the common complications of diabetes is neuropathy, which is damage to the nerves that causes a range of symptoms. Two types of neuropathy associated with diabetes are diabetic neuropathy and diabetic polyneuropathy. In this article, we will explore the differences between these two conditions, including their causes, symptoms, and treatment options.

Introduction

Neuropathy is a condition that results from damage to the nerves. Diabetes is one of the conditions that can lead to neuropathy. Diabetic neuropathy and diabetic polyneuropathy are two types of neuropathy associated with diabetes. Although these two conditions share some similarities, they differ in various ways.

What is Diabetic Neuropathy?

Diabetic neuropathy is a type of nerve damage that occurs in people with diabetes. It can affect any part of the body, but it mostly affects the feet and legs. The condition develops over time, and the symptoms may not appear until several years after the onset of diabetes.

Causes of Diabetic Neuropathy

The exact cause of diabetic neuropathy is not clear. However, researchers believe that high blood glucose levels, high blood pressure, and high levels of blood fats (lipids) may damage the nerves and blood vessels that supply them. Other risk factors for diabetic neuropathy include smoking, alcohol abuse, and being overweight.

Symptoms of Diabetic Neuropathy

The symptoms of diabetic neuropathy depend on the type of nerve damage and the affected body part. Common symptoms include tingling, numbness, burning, and pain. People with diabetic neuropathy may also experience muscle weakness, loss of balance, and difficulty walking.

Types of Diabetic Neuropathy

There are four main types of diabetic neuropathy, including peripheral neuropathy, autonomic neuropathy, proximal neuropathy, and focal neuropathy. Peripheral neuropathy is the most common type and affects the feet and legs. Autonomic neuropathy affects the nerves that control the involuntary functions of the body, such as digestion and blood pressure. Proximal neuropathy affects the hips, thighs, and buttocks, while focal neuropathy affects a specific nerve or group of nerves.

Diagnosis of Diabetic Neuropathy

To diagnose diabetic neuropathy, a doctor will conduct a physical examination and review the patient’s medical history. The doctor may also perform tests, such as nerve conduction studies and electromyography (EMG), to evaluate the nerve function.

Treatment of Diabetic Neuropathy

The treatment of diabetic neuropathy depends on the type and severity of the condition. Treatment options may include medications to control pain, physical therapy to improve muscle strength and balance, and blood glucose control to prevent further nerve damage. In severe cases, surgery may be necessary.

What is Diabetic Polyneuropathy?

Diabetic polyneuropathy is a type of nerve damage that affects multiple nerves throughout the body in people with diabetes. Unlike diabetic neuropathy, which affects a specific nerve or nerve group, diabetic polyneuropathy affects the nerves in the arms, legs, and sometimes the trunk. The condition can develop over time and may not cause any symptoms until several years after the onset of diabetes.

Causes of Diabetic Polyneuropathy

The exact cause of diabetic polyneuropathy is not fully understood, but it is believed to be related to prolonged high blood sugar levels in people with diabetes. Other factors that may contribute to the development of diabetic polyneuropathy include high blood pressure, high cholesterol levels, and obesity.

Symptoms of Diabetic Polyneuropathy

The symptoms of diabetic polyneuropathy can vary depending on which nerves are affected. Common symptoms include numbness, tingling, and pain in the hands and feet, as well as weakness in the muscles. Some people may also experience digestive issues, such as nausea, vomiting, and constipation, as well as sexual dysfunction.

Diagnosis of Diabetic Polyneuropathy

Diagnosing diabetic polyneuropathy typically involves a physical exam and a review of the patient’s medical history. In some cases, additional tests, such as nerve conduction studies and electromyography, may be needed to confirm the diagnosis.

Treatment of Diabetic Polyneuropathy

There is no cure for diabetic polyneuropathy, but there are a number of treatments that can help manage the symptoms. These may include medications, such as pain relievers, antidepressants, and anticonvulsants, as well as lifestyle changes, such as improving blood sugar control and engaging in regular exercise.

Differences between Diabetic Neuropathy and Diabetic Polyneuropathy

The main difference between diabetic neuropathy and diabetic polyneuropathy is the area of the body that is affected. Diabetic neuropathy typically affects a single nerve or nerve group, while diabetic polyneuropathy affects multiple nerves throughout the body. Additionally, diabetic neuropathy often affects the feet and legs, while diabetic polyneuropathy can affect the arms, legs, and sometimes the trunk.

Conclusion

In conclusion, diabetic neuropathy and diabetic polyneuropathy are two types of nerve damage that can occur in people with diabetes. While they share some similarities, they differ in several important ways, including the areas of the body they affect. If you are experiencing symptoms of nerve damage, it is important to talk to your healthcare provider to determine the best course of treatment.

How Long Does Diabetic Neuropathy Take to Develop?

Source: Care Options for Kids

Diabetic neuropathy is a type of nerve damage that occurs in people with diabetes. It is a common complication of diabetes and can affect various organs and systems in the body. But how long does diabetic neuropathy take to develop? In this article, we will explore this question and provide insights into the development of this condition.

What is diabetic neuropathy?

Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes. It is a complication of diabetes and can affect various organs and systems in the body, including the digestive system, urinary system, and cardiovascular system. Diabetic neuropathy is caused by high blood sugar levels over a long period of time, which can damage the nerves in the body.

Types of diabetic neuropathy

There are several types of diabetic neuropathy, including:

  • Peripheral neuropathy: This is the most common type of diabetic neuropathy and affects the feet and legs first, then the hands and arms.
  • Autonomic neuropathy: This type of neuropathy affects the autonomic nervous system, which controls the body’s functions that are not under conscious control, such as heart rate, blood pressure, and digestion.
  • Proximal neuropathy: This type of neuropathy affects the hips, thighs, and buttocks.
  • Focal neuropathy: This type of neuropathy affects a specific nerve or group of nerves and can cause sudden weakness or pain in one area of the body.

What causes diabetic neuropathy?

Diabetic neuropathy is caused by high blood sugar levels over a long period of time. When blood sugar levels are high, they can damage the nerves in the body, causing them to malfunction or die. Other factors that can contribute to the development of diabetic neuropathy include:

  • High blood pressure
  • High cholesterol
  • Smoking
  • Obesity
  • Sedentary lifestyle

Symptoms of diabetic neuropathy

The symptoms of diabetic neuropathy can vary depending on the type of neuropathy and the nerves that are affected. Some common symptoms of diabetic neuropathy include:

  • Tingling or burning sensations in the hands, feet, or legs
  • Numbness or loss of sensation in the hands, feet, or legs
  • Sharp pains or cramps in the legs, feet, or hands
  • Loss of balance or coordination
  • Weakness in the muscles
  • Digestive problems, such as nausea, vomiting, constipation, or diarrhea

Risk factors for diabetic neuropathy

Some factors that can increase the risk of developing diabetic neuropathy include:

  • Poorly controlled blood sugar levels
  • Long duration of diabetes
  • High blood pressure
  • High cholesterol
  • Smoking
  • Obesity
  • Sedentary lifestyle

Diagnosis of diabetic neuropathy

Diabetic neuropathy is a condition that affects the nerves in individuals with diabetes. It can cause a variety of symptoms, such as numbness, tingling, and pain in the feet, legs, hands, and arms. Diagnosis of diabetic neuropathy typically involves a physical examination, medical history, and various tests to assess nerve function.

During a physical examination, a doctor will assess the individual’s ability to feel sensations in their feet and hands, check their reflexes, and look for any signs of muscle weakness or atrophy. The doctor may also ask about symptoms such as pain or tingling and their duration.

Medical history is also essential in the diagnosis of diabetic neuropathy. The doctor will ask about the individual’s medical history, including any previous diagnoses of diabetes, the duration of the disease, and blood sugar control over time. A history of other medical conditions, such as kidney disease or high blood pressure, may also be relevant.

Nerve function tests, including electromyography (EMG) and nerve conduction velocity (NCV) tests, may be performed to assess nerve function. These tests involve the insertion of small needles into the muscles and the application of mild electrical shocks to the nerves to measure their response.

A doctor may also order blood tests to check for specific markers of nerve damage, such as elevated levels of certain enzymes.

In some cases, a skin biopsy may be necessary to confirm the diagnosis of diabetic neuropathy. During this procedure, a small sample of skin is taken from the leg or foot and examined under a microscope to look for changes in the nerves.

If diabetic neuropathy is diagnosed, treatment options are available to manage symptoms and prevent further nerve damage.

Treatment options for diabetic neuropathy

The treatment of diabetic neuropathy focuses on managing symptoms, slowing or stopping the progression of nerve damage, and addressing any underlying medical conditions that may be contributing to the neuropathy.

Medications are often used to manage the symptoms of diabetic neuropathy. Pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids may be prescribed for mild to moderate pain. Antidepressants and anticonvulsants can also be used to treat neuropathic pain.

Other medications that may be used include topical creams, such as capsaicin and lidocaine, which can provide relief for localized pain.

Managing blood sugar levels is also an essential component of treating diabetic neuropathy. Good blood sugar control can help slow the progression of nerve damage and reduce symptoms. This can be achieved through diet and exercise, as well as medications such as insulin and oral hypoglycemic agents.

Lifestyle modifications, such as regular exercise and a healthy diet, can also help manage symptoms and prevent further nerve damage. Physical therapy can help improve muscle strength, balance, and coordination, reducing the risk of falls and other injuries.

For severe cases of diabetic neuropathy, more advanced treatments may be necessary. These include nerve blocks, which involve the injection of local anesthetics into specific nerves to provide pain relief, and spinal cord stimulation, which uses electrical impulses to interrupt pain signals.

In some cases, surgery may be necessary to remove pressure on nerves, such as in carpal tunnel syndrome.

It is essential to work with a healthcare provider to determine the best treatment options for diabetic neuropathy. Regular check-ups and monitoring are necessary to track the progression of the condition and make adjustments to treatment as needed.

Prevention of diabetic neuropathy

Prevention of diabetic neuropathy involves managing blood sugar levels, maintaining a healthy lifestyle, and identifying and treating any other medical conditions that may contribute to the development of neuropathy.

The most effective way to prevent diabetic neuropathy is to keep blood sugar levels within a healthy range. This can be achieved through a combination of medication, diet, and exercise. Monitoring blood sugar levels regularly and following the treatment plan recommended by a healthcare provider can help prevent nerve damage.

Maintaining a healthy lifestyle can also help prevent diabetic neuropathy. Regular exercise, a balanced diet, and maintaining a healthy weight can all help reduce the risk of developing neuropathy. Smoking cessation is also important, as smoking can cause blood vessels to narrow and reduce blood flow to the nerves.

Identifying and treating other medical conditions that may contribute to neuropathy is also essential. This includes conditions such as high blood pressure, high cholesterol, and kidney disease. Managing these conditions through lifestyle modifications and medications can help reduce the risk of developing neuropathy.

Regular check-ups with a healthcare provider are also essential for preventing diabetic neuropathy. A healthcare provider can monitor blood sugar levels, assess nerve function, and make recommendations for treatment and lifestyle modifications as needed.

It is essential to work with a healthcare provider to develop a comprehensive prevention plan for diabetic neuropathy. By managing blood sugar levels, maintaining a healthy lifestyle, and identifying and treating other medical conditions, it is possible to reduce the risk of developing neuropathy and prevent further nerve damage.

How long does it take for diabetic neuropathy to develop?

The development of diabetic neuropathy can vary from person to person. In some cases, neuropathy may develop within a few years of a diabetes diagnosis, while in others it may take several decades. The risk of developing neuropathy increases with the duration of diabetes, as well as with poor blood sugar control.

Factors that affect the development of diabetic neuropathy

Several factors can contribute to the development of diabetic neuropathy. These include:

  1. High blood sugar levels: High blood sugar levels can damage the nerves over time, leading to neuropathy.
  2. Duration of diabetes: The longer a person has diabetes, the higher their risk of developing neuropathy.
  3. Age: Older individuals are more likely to develop neuropathy.
  4. Smoking: Smoking can increase the risk of neuropathy and other complications of diabetes.
  5. Genetics: Some people may be genetically predisposed to developing neuropathy.

Complications of diabetic neuropathy

Untreated diabetic neuropathy can lead to several complications, including:

  1. Foot ulcers and infections: Nerve damage can cause a loss of sensation in the feet, making it difficult to detect cuts, blisters, and other injuries. This can lead to foot ulcers and infections.
  2. Charcot joint: Charcot joint is a condition where the bones and joints in the feet become weakened and can collapse, leading to deformities.
  3. Autonomic neuropathy: Autonomic neuropathy affects the nerves that control internal organs, leading to problems with digestion, bowel and bladder control, and sexual function.
  4. Neuropathic pain: Neuropathic pain can be severe and debilitating, making it difficult to perform daily activities and affecting quality of life.

Outlook for diabetic neuropathy

While there is no cure for diabetic neuropathy, early diagnosis and treatment can help slow the progression of the disease and manage symptoms. Treatment options include medications to control pain and other symptoms, as well as lifestyle modifications to manage blood sugar levels and maintain a healthy lifestyle.

Conclusion

Diabetic neuropathy is a common complication of diabetes that can cause significant pain and disability. The development of neuropathy can vary from person to person and is influenced by factors such as blood sugar control, duration of diabetes, and lifestyle factors. While there is no cure for diabetic neuropathy, early diagnosis and treatment can help manage symptoms and slow the progression of the disease.

By maintaining a healthy lifestyle, managing blood sugar levels, and seeking prompt medical attention for any symptoms, it is possible to reduce the risk of developing neuropathy and prevent further nerve damage.

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