In the Shadow Health assessment, I was able to achieve rapport with the patient. This was manifested through the conversational ease I experienced during the assessment. Similarly, the patient responded to the questions asked in a precise and comprehensive manner which enabled an easier collection of the data I needed.
The question that the patient answered to intensively was when I inquired about her medical history. Through the assessment, I found that the patient, Miss Jones, was an obese 28-year-old lady with a 90 kg weight and a BMI of 31. After answering that she had a diabetic condition, a series of questions ensued. I found out that she is also a type 2 diabetes patient with her blood sugar level at 238. She had been taking Metformin for diabetes although she discontinued its use without a pharmacist’s approval. She had pain in the right foot from a wound, approximately 2cm and 1.5mm in-depth, that would not heal and for which she was taking Tramadol to help with the pain. Additionally, she had a fever of 101.1 and she was allergic to Penicillin although she could take Tetracycline.
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This comprehensive discourse was due to the nature of the initial question regarding her medical history, which was open-ended and required a graded response. However, during the interview, I felt like I was paraphrasing my questions so that they seemed more avoidant. I was also uncomfortable by the seeming lack of order in the sequence with which the questions were issued. Moving forward, I hope to be more direct when asking questions and also arrange the questions so they seem more progressive.
After analyzing the findings, I sent the wound culture to a lab for C & S, since its condition is not improving. Diabetic patients with chronic wounds may have infections or obligate anaerobic pathogens that require a culture before antibiotic therapy may be commenced, if they have been treated before ( Lipsky et al., 2019 ). I am considering a differential diagnosis between wound healing and diabetes, to get alternatives for suitable therapy. With the current information, I would prescribe medication for Miss Jones. This is because her wound, which would not heal, is painful every time the foot bears weight. Additionally, she also has a fever. Since she is allergic to Penicillin, I would prescribe Tetracycline which are unrelated to penicillins and they are thus suitable for treating Miss Jones who is allergic to penicillin ( Jethwa, 2019 ).
After the analysis, I also recommended a better diet and exercise regime for Miss Jones. Exercise and weight loss training are associated with reduced blood glucose, blood pressure, and thus reduced the need for medication to manage the mentioned conditions ( Look AHEAD Research Group, 2019 ). Additionally, changes in diet and exercise regime also improve LDL and HDL cholesterol and reduced medications to control lipids. I also think additional teaching is needed to inform the patient on the importance of taking prescription medicine for her diabetes therapy. She needs to understand the importance of continuous treatment even if she does not want or see the need to, and as such, she has to report to her doctor that she ceased medication.
References
Bickley, Lynn S., Peter G. Szilagyi, and Barbara Bates. Bates' guide to physical examination and history taking. Lippincott Williams & Wilkins, 2009.
Jethwa, S. (2019). Penicillin allergy: identification and management. Retrieved 22 August 2019, from https://www.pharmaceutical-journal.com/learning/learning-article/penicillin-allergy-identification-and-management/20069170.article
Lipsky, et al,. (2019). Diagnosis and treatment of diabetic foot infections. - PubMed - NCBI. Retrieved 22 August 2019, from https://www.ncbi.nlm.nih.gov/pubmed/16799390
Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England journal of medicine , 369 (2), 145-154.
