case study Health Assessment, Health History, and Nursing Diagnosis
In this second submission of your Course Project, you will be completing a health history, physical assessment of your client, and determining their nursing diagnoses. This written assignment should include the following:
A brief medical/health history
Summary of laboratory diagnostic results related to the illness/condition and what they mean
Summary of a head to toe physical assessment
Your nursing diagnosis
7 Endocrine Di
Diabetes Case Study
Y.L., a 34-year-old Southern Asian woman, comes to the clinic with complaints of chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with over-the counter medication. She works full time as a clerk in a loan company and states she has difficulty reading numbers and reports, resulting in her making frequent mistakes. She says, “By the time I get home and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn or feel like there are pins in them.” She has a history of gestational diabetes and reports that after her delivery she went back to her traditional eating pattern, which is high in carbohydrates. In reviewing Y.L.’s chart, you note she last saw the provider 6 years ago after the delivery of her last child. She has gained considerable weight; her current weight is 173 pounds. Today her blood pressure (BP) is 152/97 mm Hg, and a random plasma glucose level is 291 mg/dL. The provider suspects that Y.L. has developed type 2 diabetes mellitus (DM) and orders the laboratory studies shown in the chart.
Chart View
Laboratory Test Results
Fasting glucose 184 mg/dL
Hemoglobin A1c (HbA1c) 8.8%
Total cholesterol 256 mg/dL
Triglycerides 346 mg/dL
Low-density lipoprotein (LDL) 155 mg/dL
High-density lipoprotein (HDL) 32 mg/dL
Urinalysis (UA) +glucose, -ketones
Read and understand the case study. Analyze the labs using the Rasmussen lab values. Complete a concept map using the template attached to this assignment.
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