Posted: December 30th, 2021

Primary Healthcare of Chronic Client/Families Across the Lifespan

Week 7 Signature Assignment

Name xxx
United State University
Primary Healthcare of Chronic Client/Families Across the Lifespan
Course Name xxx
Professor xxxx
Date xxxx
Signature Assignment Current-Type 2 Diabetes Mellitus
This paper provides an in-depth examination of the chronic health problem known as type 2 diabetes mellitus. The foundation for this research is two peer-reviewed original research contributions. The paper examines major concepts and viewpoints on chronic health concerns using these resources. The objective is to provide the reader with a deep insight into type 2 diabetes mellitus with regard to clinikc evaluation, symptomatic presentation, evaluation, and management of clinical guidelines
SOAP Note
Patient ID: Mr. G.H DOB, 1/1/1957, age 65, is an American white man who has presented himself to the clinic and seems to be a reliable historian.
Subjective Data
Chief Complaint: “I am here for an annual checkup.”
History of Present Illness: The patient is a 65-year-old retired firefighter officer. Mr. G.H has a past medical illness of type 2 diabetes mellitus and Hyperlipidemia, and he is currently on medications. The patient’s prescriptions are a daily oral dose of Metformin 500mg and a daily oral dose of Simvastatin 10 mg. He claims he has no complaints and is only here for a checkup because he had blood work done two weeks ago. The laboratory test results reveal that his health has significantly improved regarding glucose and cholesterol levels. At this moment, he denies experiencing an increase in urination. He denies fever, vomiting, diarrhea, constipation, muscle numbness, or pain. He denies loss of appetite or weight loss. He also denies experiencing cardiovascular and respiratory disorders.
Past Medical History
Major illness:
Type 2 diabetes mellitus
Hyperlipidemia
Current Medication:
Takes Metformin 500mg PO daily for type 2 diabetes control
Takes Simvastatin 10 mg PO daily film-coated tablet for Hyperlipidemia
Allergies: No known allergies
Immunizations: Up to date
Surgery: None
Social History
Living situation: He lives with his wife and two grandchildren. Denies financial strains.
Occupation: Retired firefighter
Marital Status: Married
Tobacco/Street drugs: Denies
Alcohol: Stopped drinking 10 years ago
Diet: Vegan
Exercise: Occasionally, only once in two weeks
Ability to perform ADLs: Yes
Family History:
Father: Died, had diabetes
Mother: Alive, has diabetes and Osteoarthritis
Grandfather: Diseased, no known illness
Grandmother: Diseased, no known illness
Review of Systems
General: He denies experiencing fatigue, fever, breathing difficulties, chest pain, muscle pain, nausea, vomiting, or diarrhea, and he states to have a normal appetite. He states he is in good health.
Head: Denies loss of consciousness or head injuries.
Eyes: Denies color blindness, eye pain, dryness, or excessive tears. Uses corrective lenses.
Ears: Denies hearing loss, ringing in ears, discharge, or ear pain.
Nose: Denies nosebleed, loss of smell, nasal congestion, or pain.
Mouth: Denies mouth wounds, bleeding gums, or lesions. No tooth decay. He states Last dental checkup was approximately 6 years ago.
Throat: Denies sore throat, swallowing discomforts, altered taste, or hoarseness.
Skin: Denies skin color change, bruises, rashes, or lesions.
Respiratory: Denies coughing, wheezing, breathing difficulties, or dyspnea at the moment.
Cardiovascular: Denies chest pain, tachycardia or palpitations.
Gastrointestinal: Denies vomiting, odynophagia, constipation, dysphagia, nausea, abdominal discomforts, or diarrhea
Genitourinary: Denies penile abnormal discharge. Denies increase in urine frequency. No burning sensation.
Musculoskeletal: Denies muscle and joint pain, tenderness, swelling, or a reduction in range of motion in the joints.
Heme/Lymph/Endo: Denies swollen gland, history of blood transfusion. Denies excessive sweating.
Neurologic: Denies dizziness, headaches, seizures, transient paralysis, tremors, or syncope.
Psychological: Denies suicidal thoughts, depression, hallucinations, anxiety, or memory loss.
Objective Data
Vital Signs: Temperature: 98.4F, Blood Pressure: 118/77mmHg, Pulse rate: 62 beats per minute. Weight: 176.3 lbs. Height: 6ft, BMI: 23.9
Physical Examination
Head: normocephalic, atraumatic, symmetric
Ears: Hearing grossly intact, external auditory canals and tympanic membranes clear.
Eyes: Positive PERRLA. EOMI. Anicteric.
Nose: Moist mucous membranes. Nasal mucosa pink. No bleeding, lesions, or maxillary sinuses.
Throat: No exudate, lesions, inflammation. Pharynx normal. Teeth and gingiva in excellent general condition.
Skin: Smooth, warm, smooth, and dry. No rashes, bruises, or change in skin color.
Cardiovascular: Regular heart rhythm. Normal S1 and S2 sounds.
Gastrointestinal: Soft, non-tender, and non-distended abdomen. No palpable masses.
Respiratory: Auscultation of the lungs reveals no abnormalities.
Genitourinary: Prostate assessed with the digital examination, which reveals no abnormalities.
Musculoskeletal: No swollen, stiff, or tender joints or muscles.
Extremities: No edema.
Neurological: Normal gait and Stable balance. Clear speech and clear voice tone.
Psychiatric: Perfect memory. Cooperative, alert, good mood and behavior. Clear response.
Lab tests:
HbA1c test – 8.0%
LDL cholesterol – 186 mg/dL
Assessment
Type 2 Diabetes mellitus (E11. 9) – this is a disorder in which the body’s ability to control and utilize glucose as energy is impaired (Madhu et al., 2020). This long-lasting illness results in an abnormally high blood sugar level. Without control, it is possible to develop immune system diseases as a result of excessive blood sugar levels (Madhu et al., 2020). According to the lab test results, the diagnosis is ruled in
Hyperlipidemia (E78.5) – this is a condition whereby the blood contains an excessive amount of lipid particles (Saraogi et al., 2022). Hyperlipidemia is an asymptomatic disorder that can be detected with a blood test (Saraogi et al., 2022). In this case, the patient patients LDL cholesterol level is at 186 mg/dL; as a result, we rule in the diagnosis.
Dental complications (K08. 9) – Without proper care for diabetes, a person is more likely to have oral complications (Poudel et al., 2018). The blood sugar could become more difficult to control as a result of gum disease. Occasionally, individuals may start noticing that their gums seem inflamed and bleed during brushing and flossing (Poudel et al., 2018). Others report oral dryness, discomfort, white spots, or having a bad taste (Poudel et al., 2018). Even though the patient did not mention any symptoms in regard to oral complications, visiting a dentist is a good idea for any of these reasons.
DX: Type 2 Diabetes mellitus
Plan
Diagnostic Plan
Hemoglobin A1C test – The hemoglobin A1C test assesses whether the blood sugar level is too high or too low. HbA1c is also referred to as glycosylated hemoglobin (Madhu et al., 2020). The findings of one-day testing will not give a realistic assessment of how effective the treatment is working; therefore, individuals with diabetes must undergo this test on a frequent basis in order to check their blood sugar levels (Madhu et al., 2020). This also will help to evaluate if the diabetic medications should be modified. In this case, the HbA1c test result is 8.0%. These findings indicate that the medication is effective.
Lipid test – Due to the absence of symptoms, detecting Hyperlipidemia is challenging (Saraogi et al., 2022). But diagnosing Hyperlipidemia can be identified with a lipid profile blood test (Saraogi et al., 2022). As a result of this test, it is found that the patient has a high level of fats in the blood, but there has been a positive improvement.
Treatment Plan: In this case, we will not modify the medications. Therefore the patient will continue taking a daily oral dose of Metformin 500mg for type 2 diabetes and a daily oral dose of Simvastatin 10 mg film-coated tablet for Hyperlipidemia
Patient Education:
• To strictly take medication as prescribed
• To schedule daily exercises in order to keep fit
• To schedule a dental checkup at least twice a year
• To do a routine self-glucose assessment
Referral: Even though the patient did not show any symptoms related to dental disorders, he is recommended to check a dentist for a further dental examination.
Follow-up: The next visit will be in three months, but he is also recommended to visit the clinic as soon as possible if any symptoms arise.

EBP Resources
Type 2 diabetes mellitus (T2DM) is a disorder in which the body’s ability to control and utilize glucose as energy is impaired. This long-lasting illness results in an abnormally high blood sugar level. Without control, it is possible to develop immune system diseases as a result of excessive blood sugar levels. According to the lab test results, the diagnosis was ruled in. Therefore, the following are the two research-based resources I have chosen for this case study:
Article 1: Madhu, S. V., Chawla, R., Makkar, B. M., Ghosh, S., Saboo, B., & Kalra, S. (2020). RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian Journal of Endocrinology and Metabolism, 24(1), 1. https://doi.org/10.4103/ijem.ijem_225_20
Article 2: Gnesin, F., Thuesen, A. C. B., Kähler, L. K. A., Madsbad, S., & Hemmingsen, B. (2020). Metformin monotherapy for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD012906.pub2
Similarities of these Articles
These articles discuss how type 2 diabetes is diagnosed and managed. By contrast, these articles highlight the necessity of adhering to established clinical recommendations for disease treatment and educating patients about the critical role they can play in treatment decisions and lifestyle modifications. The primary focus of Madhu et al. (2020) article is on screening for type 2 diabetes before it becomes uncontrollable. The Gnesin et al. (2020) article has also shown that metformin can be used to treat people with type 2 diabetes in other research.
Review for Article 1
Type 2 diabetes mellitus (T2DM) is a disease that makes it hard for the body to control glucose and use it as energy. Because of this long-term illness, the blood sugar level is too high. Blood sugar levels that are too high can cause problems with the immune system if they are not kept in check. Based on the lab test results, it was clear what was wrong. So, here are the two research-based sources I chose for this case study:
Article 1: Madhu, S. V., Chawla, R., Makkar, B. M., Ghosh, S., Saboo, B., & Kalra, S. (2020). RSSDI-recommendations ESI’s for the care of people with type 2 diabetes mellitus in 2020. Indian Journal of Endocrinology and Metabolism, Volume 24, Number 1, Page 1. https://doi.org/10.4103/ijem.ijem 225 20
Article 2: Gnesin, F., Thuesen, A. C. B., Kahler, L. K. A., Madsbad, S., & Hemmingsen, B. (2020). Metformin alone is used to treat type 2 diabetes in adults. The Cochrane Database of Systematic Reviews (6). https://doi.org/10.1002/14651858.CD012906.pub2
What these articles have in common
These articles talk about how to diagnose and treat type 2 diabetes. On the other hand, these articles show how important it is to stick to established clinical recommendations for treating diseases and to teach patients how important their input is in treatment decisions and changes to their lifestyle. The article by Madhu et al. (2020) is mostly about finding type 2 diabetes before it gets out of hand. In other research, the Gnesin et al. (2020) article showed that metformin can also be used to treat people with type 2 diabetes.
Review for Article 1: The article by Madhu et al. (2020) is about how to find and keep track of diabetes mellitus. The article explains why people of all ages who might be at risk of developing acute diabetic symptoms should get checked. Even though the chance of organ damage stays the same, people who are screened for diabetes are more likely to be diagnosed and treated early. When lifestyle changes and medications are used, people with low fasting glucose or hyperglycemia are less likely to get diabetes. Because of this connection, I chose to use this piece of writing in this situation.
The tests show that the patient’s blood glucose levels are indeed higher than normal, which means the patient has type 2 diabetes (Madhu et al., 2020). His HgbA1c level was 8,0%, according to the tests. In this case, the patient said that he or she had been following the treatment instructions, so there has been a greater improvement. At this visit, the person says they don’t have any problems.
Review for Article 2 Gnesin et al. (2020) article has suggestions for how to use pharmaceutical formulations to treat type 2 diabetes. All parts of patient-centered programs must be taken into account when choosing or prescribing a treatment plan (Gnesin et al., 2020). For example, the type of medicine chosen must directly address concerns about controlling blood sugar levels and cardiovascular risks. Patients with diabetes also have to think about how much treatment costs, how much they can handle, and how well the treatment works. For example, US T2DM recommendations put a lot of emphasis on preventing hypoglycemia and reducing the weight effects of medications. However, they don’t put as much emphasis on the possibility that medications could increase the risk of heart disease. It is very important to know the best and safest ways to treat high blood sugar in people with type 2 diabetes, because specific medicines that lower blood sugar have not been shown to change the underlying heart prognosis. This article looks at the most widely accepted guidelines for treating hyperglycemia in these patients.
Rationale
Since this article 2 is focused on the patient, there are many things to think about when choosing the best diabetic medicine after looking at all the possible diagnoses. Some of the risk factors that should be looked for when making a treatment plan are hyperlipidemia and cardiovascular events (Madhu et al., 2020). So, using Article 2 makes it possible for doctors to give each patient the best treatment for them.
Important Ideas
Madhu et al. (2020) look at basic ideas like how often to screen, how to diagnose diabetes mellitus, and how to classify it. They also make important suggestions. One of the most important things we learn is that even though there are many diagnostic tests for diabetes mellitus, the hemoglobin A1C test is the one that Madhu et al. Other ways to find out if someone has diabetes are to test for competitive insulin autoantibodies, zinc transporter 8 (ZnT8) autoantibodies, and glutamic acid decarboxylase. These tests have different purposes. For example, c-peptide is important for figuring out how much insulin the body makes on its own, and ZnT8 is important for figuring out how common autoimmune-dysfunction diabetes is.
In their article from 2020, Gnesin et al. talk about both ways to treat t2dm and the genetic problems that cause it. Changes to lifestyle and metformin monotherapy are also talked about in the article. To prove this, a study in the UK compared the drug’s effectiveness to that of other treatments and found that it stops the liver from making glucose and makes insulin less likely to be released. Also, Gnesin et al(2020) .’s article talks about the features of insulin glucose-lowering drugs, which will help people with type 2 diabetes decide what to do.
Different Points of View
Diabetes mellitus is a medical problem that can be caused by a number of well-known risk factors. It is not a very controversial topic. In terms of the quality of the studies, the two articles provide enough evidence to back up my clinical recommendations for solving client-related problems. They also answer the same question about the need to screen high-risk people regularly as a control measure. Based on the patient’s symptoms, the results of tests, and an analysis of their medical history, the most likely diagnosis is diabetes type 2. (Madhu et al., 2020). Using this clinical method, I was able to figure out what was wrong with this person and come up with a plan for treatment.
Evidence’s Worth
Both studies have enough evidence to back up their findings for the same condition. In their article from 2020, Madhu et al. cite reputable sources like the US Center for Disease Control, which supports screening for people over 40. The American Diabetes Association (ADA) also has case studies that show how important it is to expand risk assessment (Davies et al., 2018).
The American Diabetes Association (ADA) says that people should look at clinical effectiveness, patient compliance, glucose level, and patient preference when making decisions about treatment (Davies et al., 2018). These are just some of the things the American Diabetes Association (ADA) says should be taken into account when deciding how to treat diabetes. Based on the research that was looked at, screening is a very important health practice that should be done on people who are more likely to get diseases like type 2 diabetes.
Current EBM guidelines: There are already evidence-based guidelines for how to treat type 2 diabetes, and they are being updated to improve performance and standards. The guidelines make it clear that drugs should fix many problems with Type 2 diabetes and take a patient-centered approach that takes into account more than just controlling blood sugar and heart-healthy activities (Davies et al., 2018). Comorbidities, cost, tolerance, and glycemic effectiveness all affect the therapy options a patient has (American Diabetes Association, 2021). The US guidelines for Type 2 diabetes mellitus have put a lot of emphasis on the dangers of hypoglycemia and the bad effects of drug therapy, but they haven’t paid much attention to the possibility that certain drugs could affect the risk of heart attacks (American Diabetes Association, 2021). The new recommendations for how to treat people with T2dm say that people who take metformin should take it every day.
Controversial Viewpoints
This subject of diabetes mellitus is not particularly contentious as a medical issue caused by a range of well-known risk factors. In terms of study quality, the two articles give sufficient evidence to support my clinical recommendations for resolving client-related difficulties and answer the same issue regarding the requirement of screening high-risk individuals on a regular basis as a control strategy. Diabetes type 2 is the most likely diagnosis based on the patient’s symptoms and the results of tests and an evaluation of their medical history (Madhu et al., 2020). Using this clinical method, I managed to figure out what this person’s problem was and develop a treatment plan.
Merit of Evidence
Both studies contain sufficient evidence to support their results for the identical condition. Madhu et al. (2020) article refer to reputable authorities, such as the United States Centre for Disease Control, which advocates for screening individuals aged 40 and above. Additionally, the American Diabetes Association (ADA) has case examples demonstrating the importance of expanding risk assessment (Davies et al., 2018).
To make therapeutic decisions, the American Diabetes Association (ADA) says people should look at clinical effectiveness, patient compliance, glucose level as well as a patient preference (Davies et al., 2018). These are just a few of the things the ADA says should be taken into account when making decisions about how to treat diabetes. As per the reviewed literature, screening is an important health practice that should be undertaken on those who are at a higher risk of developing diseases such as type 2 diabetes.
Current EBM guidelines
Evidence-based guidelines for type 2 diabetes management are already available and updated in order to enhance the quality of performance and standards. The guidelines clarify that pharmaceuticals should address many Type 2 diabetes shortcomings and take a patient-centered strategy that takes into account aspects other than blood sugar control and cardiovascular rehabilitative activities (Davies et al., 2018). Comorbidities, cost, tolerance, as well as glycemic efficacy all have an effect on the therapy alternatives available to a patient (American Diabetes Association, 2021). The Type 2 diabetes mellitus recommendations developed in the United States have placed a heavy emphasis on the dangers of hypoglycemia and the detrimental effects of pharmaceutical therapy, but little attention has been made to the possibility of specific medicines to affect heart attack risks (American Diabetes Association, 2021). The new guidelines for treating people with T2dm say that individuals on metformin medication should take them every day.
Impact Practice and What Should be done
The two articles suggest that earlier screenings and pharmaceutical therapies in patients with diabetes are the optimal long-term solution for diabetic patients. Whereby regular screening and administering of the medicine minimizes organ harm. With the intervention provided in the two published studies, I intend to modify my approach to managing diabetic patients in order to guarantee that they receive a broad variety of treatment alternatives. These include lifestyle changes, medication therapy, as well as screenings for patients aged 40 and above. Everyone in the family of patients who have diabetes should be involved in the test results and education that will be given. This way, everyone knows how the disease is progressing in their family, and they can help each other get better at managing their health.
Cultural
The first step toward developing effective diagnosis and treatment is to recognize the importance of cultural awareness (Juanamasta et al., 2021). It transcends a limited interpretation of societal beliefs, attitudes, traditions, language groups, and other forms of thought and behavior. Clinicians must possess cultural humility in order to give effective medical training to their patients. This will aid in the development of a mutually beneficial and supportive relationship between patients and health care workers (Juanamasta et al., 2021). There are better results when both the patients with diabetes and the clinicians understand the culture. To successfully overcome cultural barriers in healthcare, clinicians must use proper communication skills with patients.
The spiritual convictions of patients with diabetes might profoundly affect their treatment. Many people with diabetes find it difficult to maintain a healthy diet, burn calories, or exercise just because of their spirituality (Choi & Hastings, 2018). There may be a link connecting religious beliefs, the capacity to cope with diabetes-related mental anguish, and healthy lifestyles that result in improved glycemic control for diabetes patients and their family members (Choi & Hastings, 2018).
Individuals’ social and economic status in society can be defined in a variety of ways, but it always boils down to how well they perform in comparison to their peers. Consequently, this can be based on their income or social status. These inequalities in socioeconomic status may deepen social class divisions. Diabetes and its effects disproportionately impact those from lower socioeconomic backgrounds (Choi & Hastings, 2018). Poor metabolic parameters, mental stress, and lack of access to prescribed preventative therapy are all factors that contribute to poor health outcomes for people with diabetes (Choi & Hastings, 2018). Many Americans at risk of chronic illness can now obtain better, more coordinated treatment at a reduced cost as a result of enhanced insurance coverage and new care plans (Choi & Hastings, 2018). People at risk for diseases like diabetes have not been able to get the help they need because health care reform has not been able to find socioeconomic concerns and put more emphasis on the risk factors of socioeconomic status.
Conclusion
We have described how to handle and regulate diabetes mellitus with the help of the two articles. Aside from raising awareness of the disease, the two articles have worked to educate the public on the need for self-care and following treatment standards. These publications have been beneficial in terms of diagnosis of diabetes and learning more about metformin therapy options and the distinctions between various techniques for controlling certain ailments.

References
American Diabetes Association. (2021). Standards of medical care in diabetes-2021 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 39(1), 14–43. https://doi.org/10.2337/cd21-as01
Choi, S. A., & Hastings, J. F. (2018). Religion, spirituality, coping, and resilience among African Americans with diabetes. Journal of Religion & Spirituality in Social Work: Social Thought, 38(1), 93–114. https://doi.org/10.1080/15426432.2018.1524735
Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing, P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018). Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 41(12), 2669–2701. https://doi.org/10.2337/dci18-0033
Gnesin, F., Thuesen, A. C. B., Kähler, L. K. A., Madsbad, S., & Hemmingsen, B. (2020). Metformin monotherapy for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 2020(6). https://doi.org/10.1002/14651858.CD012906.pub2
Juanamasta, I. G., Aungsuroch, Y., Gunawan, J., Suniyadewi, N. W., & Nopita Wati, N. M. (2021). Holistic care management of diabetes mellitus: An integrative review. International Journal of Preventive Medicine, 12, 69. https://doi.org/10.4103/ijpvm.IJPVM_402_20
Madhu, S., Chawla, R., Makkar, B., Ghosh, S., Saboo, B., & Kalra, S. (2020). RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian Journal of Endocrinology and Metabolism, 24(1), 1. https://doi.org/10.4103/ijem.ijem_225_20
Poudel, P., Griffiths, R., Wong, V. W., Arora, A., Flack, J. R., Khoo, C. L., & George, A. (2018). Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5485-7
Saraogi, G. K., Tholiya, S., Mishra, Y., Mishra, V., Albutti, A., Nayak, P., & Tambuwala, M. M. (2022). Formulation Development and Evaluation of Pravastatin-Loaded Nanogel for Hyperlipidemia Management. Gels, 8(2), 81. https://doi.org/10.3390/gels8020081

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