Example Of Case Study On Differential Diagnosis Assignment

NURS 5305 Adult Management

[Date appears here]

Differential Diagnoses Assignment Answer Sheet

Medical Diagnosis and ICD-9 Code(s):
Differential diagnosis 1:
Diabetes Mellitus ICD-9 250.0 (CDC Classification of Diseases-9)
Differential diagnosis 2:
Hypothyroidism ICD-9 244 (CDC Classification of Diseases-9)
Differential diagnosis 3:
Urinary tract infection (UTI) ICD-9 599.0 (CDC Classification of Diseases-9)
Differential diagnosis 4:
Cushing Syndrome ICD-9 255.0 (CDC Classification of Diseases-9)
Nursing diagnosis:
Uncontrolled hyperglycemia
Initial Treatment Plan:
Diagnostics/Laboratories:
Hemoglobin A1c.
Urea, Creatinine & Electrolytes.
Thyroid stimulating hormone (TSH), Free T3 and Free T4.
Urine detailed report (D/R)
Urine culture and sensitivity (C/S)
Lipid profile
Liver function test.
Treatment:
Initiation of anti-hypertensive according to JNC-8 guidelines (2014):

Thiazide type diuretics, Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)

Addition of a calcium channel blocker (CCB) if still uncontrolled.
They can be used alone or in combination
Initiation of hypoglycemic drugs (NICE Diabetes guidelines, 2014)
Start oral hypoglycemic like metformin 500mg B.D.

A sulfonylurea can be added with metformin

Addition of dipeptidyl peptidase-4 (DPP-4) inhibitors, Rapaglinide, insulin sensitizers or alpha-1 glucosidase inhibitors can be used.
If blood glucose is still uncontrolled, injectable insulin should be preferred.
A statin should be started in a patient with hypertension coexistent with diabetes regardless of the serum lipid levels.
Nursing Interventions / Education:
According to Royal college of nursing, United Kingdom guidelines (2015):

Alcohol moderation

Strict blood glucose monitoring
Special emphasis on nutrition and diet
Emotional nourishment and well-being
Encouragement of physical activity
Smoking cessation
Special focus should be given on patient education regarding the complications of diabetes and its adverse effects on quality of life. Strict adherence to the treatment plan should also be emphasized and compliance should be checked. Patient should be briefed regarding the consequences of hyperglycemia, risk of microvascular and macrovascular complications, kidney involvement, atherosclerosis, and cataract formation. Benefit of balanced diet and regular exercise and physical activity should be discussed and patient should be facilitated in whatever way possible.

REFERENCES

Diabetes - Management and Treatment. (2015, January 20). Retrieved March 10, 2015, from http://www.rcn.org.uk/development/practice/diabetes/management_and_treatment
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). (2013, June 18). Retrieved March 10, 2015, from http://www.cdc.gov/nchs/icd/icd9cm.htm
James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.
Type 2 diabetes: The management of type 2 diabetes. (2014, December). Retrieved March 10, 2015, from https://www.nice.org.uk/guidance/cg87