Everyone is vulnerable to diseases, and thus, it is necessary to prevent or control diseases as well as treat the infected. The process of preventing, controlling, and treating diseases varies from one disease to another. The survival rate of the patients affected by the different diseases depends on the measures taken towards containing the diseases and ailments. Confirming whether one has a disease or not through specific tests creates the best platform for them to seek relevant medical attention. Diagnostic tests accurately establish the conditions that a patient is suffering from, thus enabling the physician to prescribe the relevant medical procedures that will see the patient’s condition ironed out. Afterward, the specific prescribed actions and steps are followed to ensure that the patient receives the best possible medical services. Furthermore, healthcare providers will ensure that there are follow up activities that the patients have to undergo as per the guidelines for treating their conditions. The follow-up procedures ensure complete recovery and safety from infection, thus enabling patients to resume their normal lives.
This management plan will guide and ensure that Mrs. Wong undergoes the required diagnostic procedures. Afterward, Mrs. Wong will be given the best instructions on how to cope with the health challenges in her life. The plan explores the medical procedures that Mrs. Wong is supposed to undergo depending on her diagnosis to ensure that her health status is restored to normal. The guidelines suggested in the management plan will enable Mrs. Wong to manage her weight condition and go over the various diagnosed conditions like knee arthritis. Furthermore, the management plan will give Mrs. Wong and her caretakers the appropriate follow up procedure to manage her medical and health conditions after being discharged from the hospital.
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Assessment
Primary diagnosis- Diabetes (E11.65)
Pathophysiology - Diabetes mellitus or type two diabetes is a complex metabolic and endocrine disorder. Various factors, genetic and environmental result in varying degrees of insulin resistance and dysfunction of pancreatic β-cell dysfunction. Too much weight and obesity are the leading causes the insulin resistance and impaired glucose tolerance. The patient cannot produce adequate insulin to overcome insulin resistance. The resulting symptoms include fatigue, frequent urination, unexplained weight loss, frequently feeling thirsty, slow healing sores, and presence of ketones in the urine (American Diabetes Association, 2019a).
Pertinent positive findings - Mrs. Wong displayed several symptoms relating to diabetes as per the data from the laboratory tests she took. Some of the symptoms and signs of diabetes include; wounds take time to heal, gaining of weight in a short period, fatigue in person, poor vision, frequent urination, and some hunger and thirsty (Ramachandran, 2014). These signs and symptoms were present in Mrs. Wong’s diagnosis, indicating the likelihood that she may have developed diabetes. Her hemoglobin AIC test score was 6.6%, which is above the American Diabetes Association (2019a) recommended a threshold of ≥ 6.5%. The high level of glucose at 1+ also confirms the development of a new cure for the disease. The high level of glucose in the body at 1+ and a high number of alkaline phosphate confirmed that Mrs. Wong had diabetes.
Pertinent negative findings -Mrs. Wong presented several symptoms and had test results that were not indicators of diabetes. For instance, she had rapid weight gain instead of weight loss. She did not report extreme hunger and fatigue, irritability or blaring visions. Also, she did not have ketones in her urine, which critical area indicator of diabetes (American Diabetes Association, 2019a).
Rationale for diagnosis - Mrs. Wong’s symptoms and laboratory test confirmed that she has diabetes. Her symptoms and testy result meet the diagnostic criteria for diabetes since the above signs and symptoms confirm that Mrs. Wong is diabetic. Her AIC test score was 6.6%, which is ≥ 6.5%. Her wounds take time to heal, gaining of weight in a short period, fatigue in person, poor vision, frequent urination, and some hunger and thirsty. They symptoms are consistent for diabetes and per the American Diabetes Association (2019a) diagnostic criteria.
Secondary diagnosis: Hyperlipidemia (E78.5)
Pathophysiology - Hyperlipidemia is a medical condition characterized by excessive levels of fats (lipids) in a patient’s blood. The primary lipids present in the blood are cholesterol and triglycerides. Hyperlipidemia is mostly associated with cholesterol levels and thus is also referred to as high cholesterol (American Diabetes Association, 2019b). Although the condition is commonly inherited, it also develops as a product of poor lifestyles. It is also common in patients with diabetes, kidney conditions, an underactive thyroid, and pregnancy. Lifestyle factors for high cholesterol include obesity, alcoholism, smoking, large waist circumference, lack of exercises, and poor diet. Symptoms may include yellowish fatty growth, especially around joints and eyes (Nelson, 2013).
Pertinent positive finding - The rapid weight gains could indicate that Mrs. Wong has Hyperlipidemia. Other positive symptoms include past pregnancy, presence of diabetes, and cases of fatigue depict the presence of Hyperlipidemia (American Diabetes Association, 2019b). Test results indicate TC 215 mg/dl, LDL 144 mg/dl, triglycerides 229, HDL 32 mg/dl. All these test scores were above the threshold for diagnosing Hyperlipidemia, which are TC 200 mg/dl, LDL130 mg/dl, triglycerides 150 mg/dl, HDL 50 mg/dl ( for HDL higher levels are better).
Pertinent negative finding. - Mrs. Wong regularly therefore she has adequate exercises for a person of her age. She does not have a poor lifestyle, and the only substance she consumess is medication Tylenol for her arthritis, multivitamin, turmeric, and CBD oil.
The rationale for diagnosis - Mrs. Wong’s symptoms and laboratory results meet the criterion for the diagnosis of Hyperlipidemia (American Diabetes Association, 2019b). Her tests revel high levels of cholesterol and triglycerides in her blood, which are satisfactory confirmatory outcomes of the lipids tests. (Nelson, 2013).
Differential diagnosis: Obesity ( E66.01).
Pathophysiology - Obesity is an excessive body weight condition that currently affects many people across the world. Body weight is controlled through eating a balanced diet with low fats and cholesterol-rich products like cheese (Xu & Xue, 2016). Obesity as a condition is attributed to excess fats in the body that results in the affected persons packing a lot of weight resulting in a high BMI. According to American Diabetes Association (2019c), symptoms include snoring, increased sweating, tiredness, reduced confidence, and self esteem, back and joint pains, snoring, breathlessness, inability to handle sudden physical activity and isolation.
Pertinent positive findings - Mrs. Wong displayed the following symptoms during her tests, which are aligned to obesity. She exhibited shortness in her breath; she had an excess weight of about 165 pounds (Xu & Xue, 2016). There are high levels of cholesterol in her body, that is, TC at 215mg/dl and LDL at 144mg/dl (Xu & Xue, 2016). Furthermore, Mrs. Wong’s pulse rate is slightly above the standard rate since. At 80 pulses per minute, the high rate proves that her heart is straining to ensure that blood circulates in her body. The high rate is a result of fat accumulation in arteries and muscles.
Pertinent negative findings -.Mrs. Wong does not report any joint pain associated with obesity. She also has no back pains; she did not report snoring, sweating, inability to handle sudden physical activities, self-esteem issues, or isolation.
The rationale for diagnosis - The findings indicate a possibility of obesity in the patient. However, these symptoms are also shared with the primary diagnosis and the secondary diagnosis of diabetes and hyperlipidemia, respectively, which make it hard to declare Mrs. Wong obese conclusively. She is certainly overweight, and thus, obesity treatment should be considered under the treatment regime (Xu & Xue, 2016).
Plan
Lab test: Basic metabolic panel test
Mrs. Wong should undergo a basic metabolic panel test as it will provide the relevant information on the balance of fluids in her body, how well her kidney is working and levels of potassium, sodium in her body. The process of testing for the basic metabolic panel starts with ensuring that Mrs. Wong skin is clean, so a sample of blood is sourced from one of her veins (Healthwise Staff, 2018).
Rationale of Basic metabolic panel test
The basic metabolic panel is important to Mrs. Wong since it will help in determining what is needed to control levels of sugar in her blood. As a result, it will facilitate the treatment and control of her diabetes and obesity. Furthermore, information from the tests will be useful in establishing how to maintain the balance of potassium and sodium in the body fluids to support proper kidney function.
Lab test: The complete blood count test
The complete blood count test will help in evaluating the overall health of Mrs. Wong, thus facilitating detection of the several disorders and infections like diabetes and high blood pressure. The test will measure specific components and features of Mrs. Wong’s blood, including; red blood cells, hemoglobin, hematocrit, and platelets (American society of clinical oncology, 2017). The procedure for testing Mrs. Wong will take the following steps; cleaning of the skin, putting an elastic band above the vein to ensure it swells, inserting the needle in the vein and pulling a sample of blood into a syringe. Finally, the lab technician will take off the elastic band and pull out the needle from the vein gently.
The rationale of complete blood count test
The test is vital for containing Mrs. Wong’s health conditions and ensuring a sustainable future. The test helps in reviewing of the overall health of Mrs. Wong, hence facilitate the examination and monitor the conditions like high blood pressure and diabetes in her body (American Society of Clinical Oncology, 2017). Furthermore, the test will help in ensuring that her medical conditions and treatment plan are well adhered to thereby avoiding complications in her treatment process. The causes of the signs and symptoms that Mrs. Wong’s presence will be known and easily treated. A prevention plan may also be developed to prevent recurrence of the condition in the future.
Medication for obesity and weight loss in Mrs. Wong
Medication
Phentermine-topiramate ( Diabetes and Hyperlipidemia)
Rationale
The dosage for this medication is prescribed and recommended for both children and adults. Mrs. Wong should take 3.75 mg/23 mg per day for the first 14 days. O the fifteenth day, she should take a different form of 7.5 mg/46 mg per day for 12 weeks after which she will be able to evaluate her weight (American Diabetes Association, 2019c). In case there is no significant change she should continue as follows; she will have to increase the dosage to 11.25 mg/69 mg per day for 14 days; then followed by dosing 15 mg/92 mg per day (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016). Phentermine-topiramate is one of the best medications for obesity for Mrs. Wong since it has fewer side effects, and the procedures involved are simple and easy to achieve as per her immunity.
Medication
Orlistat (Diabetes and Obesity)
Rationale
Works for both children and adults. The recommended dosage for both children and adults is one-120-mg capsule three times a day after each meal, that is, breakfast, lunch, and dinner. It is recommended that the capsule is taken an hour after taking the meals (American Diabetes Association, 2019d). The medication is less expensive and will work in favor of Mrs. Wong since she is still genetically strong and immune thus the minimal side effects that might accompany the medication will be easily managed through physical exercises like jogging (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016).
Education
Diagnosis
Mrs. Wong proved positive for diabetes and Hyperlipidemia from the tests that she took. The two diagnoses are important; hence, Mrs. Wong should ensure that both are well guided and engaged in by a special practitioner. Hyperlipidemia is more dangerous as compared to diabetes since it is its advanced stage that led to death within a short period (Nelson, 2013). Therefore Mrs. Wong should keenly fight Hyperlipidemia in her life, and it will eventually help her overcome diabetes and obesity menace.
Medication purpose and side effects
Orlistat is always available in some lower doses though without prescription to all genders and age groups. They help in reducing the volume of fats in Mrs. Wong’s body for the period she will be using them. It mainly works in her gut for the process of reducing the fats to be effective since the process of fat absorption is faster in the abdominal region.
The following side effects might be witnessed during the period she will be using Phentermine-topiramate and Orlistat (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016). Diarrhea and accumulation of gas in the stomach are among the common side effects witnessed. Furthermore, stomach pains will be felt during defecation, and the stool produced will be oily.
Diet
Mrs. Wong should eat healthy carbohydrates, fiber-rich, and good fat foods. Other healthy foods that she should eat include grains, vegetables, legumes like peas, nuts, canola, and avocados. Eating foods with polyunsaturated fats will help in the reduction of cholesterol levels in Mrs. Wong’s body (Spritzler, 2017). Eating a fish like salmon and tuna once every week will reduce the chances of high blood pressure. These foods should not be eaten frequently in every week, but at alternating intervals to enhance their distribution and impact on her health safety.
Personalized appropriate exercise recommendations
Mrs. Wong should ensure that physical exercises are part and parcel of her daily life. There should be a tight schedule regarding how she will engage in her exercises in the morning and evening hours (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016). Jogging and running around her compound is among the basic exercises she should embrace. This will guarantee her fat loss and reduced her blood sugar levels.
Warning sign for diagnosis and medications if applicable
There are several warnings associated with diagnosis and medication of the conditions in Mrs. Wong. There are some cases of liver injury and irritation when taking Orlistat, especially when mixing it with cyclosporine (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016). Mrs. Wong should take the dosage carefully without skipping since skipping might lead to congenital disabilities.
Referrals
Specialty organization and services
The conditions around the health of Mrs. Wong will be managed if she can strictly follow the guidelines made, but if this fails, she can seek more intervention and medical care services from the following health organizations (Dendrite Clinical Systems, 2019). American Diabetes Association, NIH Obesity Research Task Force, Diabetes Advocacy Alliance, and the International Federation for the Surgery of Obesity and Metabolic Disorders.
Rationale
The organizations will significantly provide the relevant information and proper guidance regarding her diagnoses. These organizations have the best staff which is qualified to offer skillful and standard advice with medical services to those with obesity and diabetes like Mrs. Wong. Taking an example of The International Federation for the Surgery of Obesity and Metabolic Disorders, it has qualified staff members around the world that are specialized in providing surgical services to patients trapped in a dangerous Hyperlipidemia and an obese situation like Mrs. Wong (Dendrite Clinical Systems, 2019).
Follow up
It will be of great importance for Mrs. Wong to return to her practitioners on the 22 nd of September to assess her medical progress. Follow up will ensure that Mrs. Wong treatment process is kept and that her life will remain safe even when she is out of the hospital.
Rationale on follow up
Complications that might arise out of her operations at home may be examined and solved during the process of follow up. Furthermore, there might be medication changes that might be incorporated to speed up the treatment process that may have been ignored or not noticed in the first medication process hence coming as a secondary diagnosis (Leonard, 2008). For Mrs. Wong, conditions like obesity might be discovered during the follow-up process since there were earlier concerns of the disease in her body, but this was not well examined as it was a secondary diagnosis that needed confirmatory tests.
Medication Cost for Mrs. Wong
| Medication | Cost |
| Tylenol 500 mg 2 tabs in AM for knee pain | $ 12 |
| Daily multivitamin for the adult | $15 (Langreth, 2019) |
| CBD oil for her knee | $10 |
| Phentermine-topiramate (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016) | $ 160 |
| Orlistat (The National Institute of Diabetes and Digestive and Kidney Diseases, 2016) | $ 12 |
| Turmeric | $ 2 (Langreth, 2019) |
| Total | $ 211 |
This cost reflects a minimum monthly cost that Mrs. Wong should spend on the medication to go through the healing process as per the physician’s directive. The price is standard; thus, she should be able to afford and pay for the services to guarantee her survival through the medical procedures intended (Langreth, 2019). The presence of Phentermine-topiramate and Orlistat in the list of medication specifications ensures better levels of both sugar and fats, respectively in her body. It will be more successful when incorporated hand in hand with physical exercises on a routine basis. In case Mrs. Wong is unable to pay for the medication specifications providing a need for adjustments, she should opt for changes in specific medication such as Turmeric and Tylenol since she has been using them over a long period and Phentermine-topiramate and Orlistat overpower their impact
In conclusion, diabetes and obesity are among the killer diseases and conditions in the United States of America and the world at large. These two conditions continue to wipe out a significant number of persons reducing the earth population in the recent past, and this has been attributed to the lifestyle of persons. Mrs. Wong should be able to seek the required medical care at standard services to go through her current situation. Following the guidelines made through this management plan will enable her to successfully manage her weight and reduce the number of sugar levels in her body.
SOAP note
Patient information
Name : Mrs. Wong
Age : 59
Sex : Female
Race : Asian
S:
Chief complaint : Arthritis
HPI:
Mrs. Wong, a 59-year-old Asian female, presents in office for three months follow up of diagnosed knee arthritis. She is experiencing knee pain, but her mobility has increased since the treatment began. Her report shows that she been experiencing fatigue over the last two months and has been gaining weight despite the physical exercises she undergoes every day. Furthermore, the exercise makes her more hungry and thirsty instead of relieving her.
Current medication:
Tylenol 500 mg 2 tabs in AM for knee pain, daily multivitamin, Turmeric and uses CBD oil for her knee
Allergies : allergic to Bactrim, cats, and pollen
PMHx : Knee arthritis diagnosed three months ago and was affected by Germany's muscles
Soc Hx : She divorced and worked from home as an administrative assistant
Fam Hx : Her parents are deceased, but her siblings are alive
CV: S1 and S2 RRR without murmurs or rubs.
Respiratory: Clear to auscultation bilaterally, respirations unlabored.
Musculoskeletal: Full ROM both knees. Nontender to palpation bilaterally. Gait normal.
General: Female in no acute distress. Alert, oriented, and cooperative.
O: BP 112/76; pulse 80, regular; respiration 16, regular Height 5’1.5”, weight 165 pounds
HEENT : Teeth in good repair, no cavities noted, Neck supple, Anterior and posterior cervical lymph nontender to palpation. Wears contacts, Tympanic membranes are gray and intact with light reflex noted, pinna and tragus nontender.
Skin : warm, dry and intact. No lesions noted.
Lung : Clear to auscultation bilaterally, respirations unlabored
Abdomen : soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Diagnostic:
A:
Primary diagnosis: Diabetes
Secondary diagnosis: Hyperlipidemia
P:
Differential diagnosis: Obesity
Medication:
Orlistat, Phentermine-topiramate, CBD oil for her knee, Daily multivitamin for the adult, Tylenol 500 mg 2 tabs in AM for knee pain and Turmeric
Education:
Reviewed medications
Discussed diabetes and obesity diagnoses and will test for high blood pressure.
Exercises should stress the range of motion and stretch like jogging
Therapy referral to assist examine the impact of diabetes on the liver
Referrals:
American Diabetes Association for blood sugar regulation procedures and The International Federation for the Surgery of Obesity for specialized obese surgeries.
Follow up:
Mrs. Wong should return to the office for evaluation of body weight and blood sugar levels in her body.
Reference
American Diabetes Association. (2019a). Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2019. Diabetes Care, 42 (Supplement 1): S13-S28. https://doi.org/10.2337/dc19-S002
American Diabetes Association. (2019b). Cardiov ascular Disease and Risk Management: Standards of Medical Care in Diabetes—2019. Diabetes Care, 42 (Supplement 1): S103-S123. https://doi.org/10.2337/dc19-S010
American Diabetes Association. (2019c). Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes—2019. 42 (Supplement 1): S81-S89. https://doi.org/10.2337/dc19-S008
American Diabetes Association. (2019d) Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers. https://doi.org/10.2337/cd18-0105
American Society of Clinical Oncology. (2017). Complete blood count tests . Retrieved from https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/reports-and-results/complete-blood-count-tests
Dendrite Clinical Systems. (2019). International Federation for the Surgery of Obesity and Metabolic Disorders. Retrieved from http://www.bariatricnews.net/?q=node/307
Healthwise staff. (2018). Basic metabolic panel . Retrieved from https://www.uofmhealth.org/health-library/tr6151
Langreth, R. (2019). Drug prices . Retrieved from https://www.bloomberg.com/quicktake/drug-prices
Leonard, M. P. (2008). The importance of follow-up . Canadian Urological Association Journal = Journal De L'association Des Urologues Du Canada, 2 (1), 32.
Nelson R. H. (2013). Hyperlipidemia as a risk factor for cardiovascular disease. Primary care, 40(1), 195–211. doi:10.1016/j.pop.2012.11.003
Ramachandran, A. (2014). Know the signs and symptoms of diabetes. The Indian journal of medical research, 140(5), 579–581.
Spritzler, F. (2017). The 16 best foods to control diabetes . Retrieved from https://www.healthline.com/nutrition/16-best-foods-for-diabetics
The National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Prescription medications to treat Overweight and Obesity . Retrieved from https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity.
Xu, S., & Xue, Y. (2016). Pediatric obesity: Causes, symptoms, prevention, and treatment. Experimental and Therapeutic Medicine, 11 (1), 15–20. doi:10.3892/etm.2015.2853
