Posted: May 31st, 2023

The patient presents with a complaint of increased fatigue,

Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Like many disorders affecting other systems, those related to endocrine, metabolic, and nutritional concerns have specific considerations for geriatric populations. Accurate history taking of symptoms associated with these disorders is essential for completing an assessment of the older adult, since onset of symptoms (for example, with some endocrine disorders) may appear more subtly than those in younger patients. It can also be difficult to determine onset and severity of illness in older adults.
Keep in mind special considerations for older adults as you complete your case analysis and SOAP note on endocrine, metabolic, and nutritional disorders.

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To prepare:
• Review the case study provided by your Instructor.
• Reflect on the patient’s symptoms and aspects of disorders that may be present.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
• Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
• Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
• Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
• Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
• Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.

Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Number of sources: 5
Paper instructions:
See the instructions listed for case study.

Use the additional diagnosis for the case study ,GERD and Obesity, meds are
Current Medications
Start DateDiscontinue DateMedication
05/21/2019NovoLOG FlexPen Subcutaneous 100 UNIT/ML 20 Three times a day with meal-Subq
ANTIDIABETICS03/04/2019Ozempic (0.25 or 0.5 MG/DOSE) ace my homework Subcutaneous 2 MG/1.5ML 2 once weekly till sample pen completed then start ozempic 1mg sub q weekly
ANTIDIABETICS(LS)amLODIPine Besylate Oral 10 MG 1 Tab(s) Daily By mouth
CALCIUM CHANNEL BLOCKERS(LS)Aspirin Oral 81 MG 1 Tab(s) Daily By mouth
ANALGESICS – NonNarcotic(LS)Carvedilol Oral 12.5 MG 1 Tab(s) Twice daily. By mouth
BETA BLOCKERS(LS)Furosemide Oral 40 MG 1 Tab(s) Twice daily. By mouth
DIURETICS(LS)Losartan Potassium-HCTZ Oral 100-25 MG 1 Tab(s) Daily By mouth
ANTIHYPERTENSIVES(LS)Tresiba FlexTouch Subcutaneous 100 UNIT/ML 100ml Take AM and PM 100u subcutaneous(SQ)
ANTIDIABETICS(LS)Potassium 20MG/By mouth/1(tab) Twice daily
MINERALS & ELECTROLYTES(LS)Celecoxib Oral 200 MG 1 Cap(s) Daily By mouth
ANALGESICS – ANTI-INFLAMMATORY(LS)Cholecalciferol Oral 125 MCG (5000 UT) 1 Cap(s) Daily By mouth
VITAMINS(LS)Meloxicam Oral 15 MG 1 Tab(s) Daily By mouth
ANALGESICS – ANTI-INFLAMMATORY(LS)Rosuvastatin Calcium Oral 40 MG 1 Tab(s) Daily By mouth
ANTIHYPERLIPIDEMICS

________________________________
SOAP Note Template:

Subjective:
The patient presents with a complaint of increased fatigue, weight gain, and frequent urination. The patient reports a history of present illness that includes gradual onset of symptoms over the past few months. The patient has a personal history of type 2 diabetes mellitus, hypertension, and hyperlipidemia. The patient is currently taking multiple medications, including NovoLOG FlexPen for diabetes, Ozempic, a calcium channel blocker, aspirin, carvedilol, furosemide, losartan potassium-HCTZ, Tresiba FlexTouch, potassium supplement, celecoxib, cholecalciferol, meloxicam, and rosuvastatin calcium.

Review of systems reveals the following:

Constitutional: Fatigue, weight gain
Endocrine: Polyuria
Cardiovascular: Hypertension
Musculoskeletal: Joint pain
Gastrointestinal: GERD
Neurological: No specific complaints
Skin: No specific complaints
Objective:
Physical assessment reveals an obese patient with a body mass index (BMI) of 35. The patient appears tired and reports tenderness in multiple joints. The patient’s blood pressure is 140/90 mmHg, and heart rate is 80 bpm. Laboratory tests show elevated fasting blood glucose levels, HbA1c levels within the target range, and elevated LDL cholesterol levels. Imaging studies are not indicated based on the current presentation.

Assessment:
Based on the patient’s symptoms and clinical findings, the following differential diagnoses are considered:

Type 2 diabetes mellitus exacerbation: This is the primary differential diagnosis given the patient’s history of diabetes, fatigue, polyuria, and elevated blood glucose levels. The diagnostic criteria include symptoms of hyperglycemia, elevated blood glucose levels, and HbA1c levels above the target range. The presence of obesity and uncontrolled hypertension further supports this diagnosis.

Hypothyroidism: Fatigue, weight gain, and joint pain can be associated with hypothyroidism. However, the absence of specific symptoms related to thyroid dysfunction and normal thyroid function tests make this diagnosis less likely.

Obesity-related metabolic syndrome: The patient’s obesity, hypertension, and dyslipidemia suggest the possibility of metabolic syndrome. However, further evaluation is needed to confirm this diagnosis.

The primary diagnosis is exacerbation of type 2 diabetes mellitus based on the patient’s history, symptoms, and elevated blood glucose levels.

Plan:

Diagnostic studies:

Obtain a comprehensive metabolic panel to assess renal function, liver function, and electrolyte levels.
Perform a lipid profile to further evaluate dyslipidemia.
Repeat HbA1c test to monitor glycemic control.
Conduct a thyroid-stimulating hormone (TSH) test to rule out hypothyroidism.
Referrals:

Refer the patient to a registered dietitian for nutritional counseling and weight management.
Consult with an endocrinologist to optimize diabetes management and evaluate the need for insulin adjustments.
Therapeutic interventions:

Adjust the dose of NovoLOG FlexPen and provide additional education on self-monitoring of blood glucose levels and insulin administration.
Initiate lifestyle modifications, including a balanced diet, regular physical activity, and weight loss strategies.
Review and optimize the patient’s current antihypertensive and lipid-lowering medications.
Education:

Educate the patient about the importance of medication adherence and regular follow-up appointments.
Provide information on self-care measures to manage diabetes, including blood glucose monitoring, symptom recognition, and proper foot care.
Disposition:

Advise the patient to continue taking the prescribed medications and return for a

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Study Notes & Homework Samples: Within the Discussion Board area, write 400–600 words »Using the theory of unpleasant symptoms as a guide