Case Study: A 60-Year-Old Woman With Type 2 Diabetes and COPD

Posted on: 30th June 2023

Question

Case Study: A 60-Year-Old Woman With Type 2 Diabetes and COPD

Presentation

A Sara Thompson a 60-year-old woman with a 3-year history of diabetes was seen last week by her doctor for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated (glycosated) hemoglobin measured 1 month ago was 6.8% (normal 4–6%).

Today Sara seems anxious with a blood pressure 130/70 mmHg, pulse 120, respiratory rate 24, and weight 90 kg. You hear wheezing when she breathes, while she is resting in a chair.  No cyanosis is present. O2 Sat: 88%

When she visited the doctor last week she started on albuterol inhaler 2 puffs qid. And she was also started on a course of prednisone at 40 mg/day for 3 days, tapering over 2 weeks. Today when she checked her blood glucose level is 12mml/L at 8:00 a.m. 

Questions

  1. List all the information in the case study that should be reported to the supervisor.
  2. What does “No cyanosis is present” mean?
  3. When type 2 diabetes is ‘managed with diet and exercise’ what does that mean?
  4. What is albuterol inhaler for?
  5. Besides diet and exercise what other care activities are important for diabetics to follow?
  6. Sara says that it is time for her inhaler and asks you to bring it to her.  She tells you she left it in her bedroom. When you go to get it for her, you can’t find it. What do you do?
  7. What is dyspnea and what can you do to help her feel more comfortable?
  8. What is glycosylated (glycosated) hemoglobin?

Based on the case study, answer the 8 questions.

You need to use Chapter 17 of the Mosby book and Chapter 14 of the attached book.

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Solution

Case Study: A 60-Year-Old Woman with Type 2 Diabetes and COPD

Presentation

Sara Thompson, a 60-year-old woman with a 3-year history of diabetes, was seen last week by her doctor for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated (glycosylated) hemoglobin measured one month ago was 6.8% (normal 4–6%).

Today Sara seems anxious with a blood pressure of 130/70 mmHg, pulse of 120, respiratory rate of 24, and weight of 90 kg. You hear wheezing when she breathes while she is resting in a chair.  No cyanosis is present. O2 Sat: 88%

When she visited the doctor last week, she started on an albuterol inhaler, two puffs qid. And she was also started on a course of prednisone at 40 mg/day for 3 days, tapering over 2 weeks. Today when she checked, her blood glucose level was 12mml/L at 8:00 am.

Questions

1. List all the information in the case study that should be reported to the supervisor.

The patient is 60 years old with a three-year history of diabetes and chronic obstructive pulmonary disease since she was 55 years old. She has a persistent cough and dyspnea with minimal physical activity that has worsened. Glycosylated hemoglobin measured one month ago was 6.8%. The vital signs were taken today, and her blood pressure is 130/70mmhg indicating elevated systolic BP. She has tachycardia with a 120b/min pulse rate and tachypnea with a 24b/min respiratory rate. The oxygen saturation rate is 88%, and she is experiencing wheezing at rest. No cyanosis is present. She weighs 90kg. The patient visited a doctor the previous week and was started on an albuterol inhaler with two puffs QID and prednisolone 40mg/day to be tapered over two weeks. Blood glucose levels at 8.00 am are 12mmol/l.

2. What does “No cyanosis is present” mean?

Cyanosis refers to the bluish discoloration of the skin and mucous membranes. It’s classified under disorders of deoxygenated haemoglobin and abnormal haemoglobin. The oxygen in the haemoglobin is not adequate. There is central and peripheral cyanosis. No cyanosis indicates that the haemoglobin has adequate oxygen hence sufficient oxygenation of the body tissues.

3. When type 2 diabetes is ‘managed with diet and exercise,’ what does that mean?

Type-2 diabetics are at a high risk of developing a variety of life-threatening consequences, such as cardiovascular disease, peripheral vascular disease, nephropathy, retinal abnormalities, and blindness, which can all lead to disability and death. It also imposes significant medical and financial costs. Lifestyle modifications, healthy eating as a strategy, walking, exercise, and other physical activities are all part of managing diabetes type 2 with diet and exercise (Sorrentino & Remmert, 2013). Maintaining a healthy diet and getting enough exercise are key components of diabetes treatment in later life, just as they are in earlier life stages. Portion control, carbohydrate and lipid consumption, meal spacing, and nutritional awareness are all factors that can assist in improving metabolic outcomes (Sorrentino & Remmert, 2013). Exercise therapies help with glycemic control, muscle insulin sensitivity, intra-abdominal adipose tissue, muscle fat infiltration, and lowering diabetes-related cardiovascular risk factors.

4. What is albuterol inhaler for?

Albuterol belongs to the drug class bronchodilators. It’s used to treat and prevent symptoms, including wheezing, shortness of breath, coughing, and chest tightness caused by COPD or asthma. It’s a quick-relief medication that dilates the airway bronchial smooth muscles to facilitate breathing.

5. Besides diet and exercise, what other care activities are important for diabetics to follow?

Compliance with medications such as insulin or oral hypoglycaemic agents lowers blood sugar levels and maintains them within normal ranges. The patient should also be educated on how to administer the self-injections. The abdomen, hips, posterior area of the arms, and anterior surface of the thighs are all common injection locations (Sorrentino & Remmert, 2013). They should know the techniques and sites to inject. Encourage the patient to adhere to foot care by avoiding going barefoot and wearing garters and tight socks. They should also not cross their legs and have their feet checked at least once a year for loss of sensation. The patient should see a podiatrist for calluses or toenails problems.

6. Sara says that it is time for her inhaler and asks you to bring it to her. She tells you she left it in her bedroom. When you go to get it for her, you can’t find it. What do you do?

The patient might have forgotten where she placed her inhaler, so inform her that you could not find it. At the same time, you look for an alternative inhaler to enable the patient to take the medications at the right time and avoid missing doses.

7. What is dyspnea and what can you help her feel more comfortable?

Dyspnea is also known as shortness of breath. It refers to difficulties or labored breathing caused by pulmonary disorders such as COPD and asthma (Herlihy, 2017). Dyspnea is managed by administering short or long-acting bronchodilators such as albuterol and corticosteroids such as albuterol. Non-pharmacological techniques such as breathing and relaxation exercises are effective in managing dyspnea.

8. What is glycosylated (glycosylated) hemoglobin?

This is a test that determines the body’s blood glucose levels. The test measures the average plasma levels of glucose from the past 12-15 weeks, which can be done at any time since no special preparation, such as fasting, is required. It’s the principal test for determining glycemic control in persons with diabetes because of these qualities (Sinclair et al., 2019). The test is graded on a percentage scale. Levels of glycosylated (glycosylated) hemoglobin indicate you don’t have diabetes if you have less than 5.7 percent, pre-diabetes if you have 5.7 percent to 6.4 percent, and diabetes if you have 6.5 percent or more.

References

Herlihy, B. (2017). The Human Body in Health and Illness-E-Book. Elsevier Health Sciences.

Sorrentino, S. A., & Remmert, L. (2013). Mosby’s Textbook for Nursing Assistants-Soft Cover Version-E-Book. Elsevier Health Sciences.

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