Adult Case Study
Patient and family history
• 52 year-old black female
• Diagnosed with type 2 diabetes 6 yrs ago but did not follow up with recommendations for care
• Now complaining of weakness in her right foot and an itching rash in her groin area
• Pt. states that her foot has been weak for about a month and is difficult to dorsiflex; it also feels numb.
• Denies any other weakness, numbness, difficulty speaking or walking, syncope, or seizures. She finds watching tv particularly in the evening is becoming a problem because her eyes “are tired” more.
• Has had some increased thirst and gets up more often at night to urinate; sometimes excessively
• Says she has had the rash on and off for many years. It is worse when the weather is warm. It also occurs in her armpits. She gets some relief from salt baths. She occaisionally gets a boil in these areas.
• Denies any chest pain, SOB, edema, change in bowel habits, or skin ulcers.
• Patients remembers being told her blood surgar was ‘around 200’ when she was first diagnosed. She had gone for a work physical and felt fine at the time and saw no need for expensive drugs.
• Her mother and sister have diabetes. Both of them were diagnosed in their 40’s and are on pill and injections.
• Has been completely asymptomatic, except for the rash, until the foot weakness
• Has gained 18 pounds over the past year and eats a diet high in fats and refined sugars
• Employed as a banking executive and gets little exercise.
Physical Exam
• Obese female in no acute distress
• T – 37 C, P – 80 and reg, RR -15 and unlabored; BP 162/98 sitting. Wt. 84 kg
• Skin: erythematous moist rash in both inguinal areas, beneath both breasts, and in the axille. No petechiae or ecchymoses. Many dime sized hyperpigmented spots located on the anterior shins
• HEENT: PERRLA, fundi with mild arteriolar narrowing. Nares, tympanic membranes, pharynx clear. Neck without bruits or thyromegaly.
• Lungs, heart: lungs clear to auscultation and percussion. Cardiac exam shows distant heart tones, reg. rate and rhythm w/o murmurs or gallops
• Abd/extremities: Abd. moderately obese w bowel sounds heard in all 4 quadrants; no abd. bruits, tenderness, masses or organomegaly. Extremities w/o edema; arterial pulses are diminished in volume but palpable in both feet
• Neuro: Alert and oriented. CN 2-12 intact, limb strength 5/5 throughout except 2/5 on dorsiflexion of the right foot. Sensory perception to light touch diminished on the soles of both feet along the metatarsal bar. DTR reflexes 1+ and symmetric throughout. Gait normal except for accommodation to the right footdrop; negative Romberg test.
Lab Results
• Serum electrolytes including BUN, creatine, Ca, Mg WNL
• Random glucose: 253
• HgbA1c 9.1%
• Urine dipstick: + for glucose, neg for protein
• Wet prep of smear from skin rash consistent with fungal spores and mycelia
• ECG w evidence of early ventricular hypertrophy.
• Cholesterol: 246
• Electromyography consistent with peripheral neuropathy of the right foot.
Introduction and overview of the selected Grand Nursing Theory
Identification of ONE problem/issue to address using a grand nursing theory
Application of the theory to the nursing process:
Assessment
Nursing intervention
Evaluation.
Explanation of how applicable the model was to the clinical problem.
Analysis of how the theory applies to clinical practice, including critique of the ease of applying theory in practice
Conclusion and evaluation
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