Week 9 Assignment: Management Plan

Management Plan
Primary Diagnosis
The client’s primary diagnosis is type 2 diabetes mellitus. Type 2 diabetes mellitus is a metabolic disorder characterized by the inadequate production of insulin by the pancreas (American Diabetes Association Professional Practice Committee, 2021). Patients exhibit symptoms that include elevated blood glucose levels, polyuria, polydipsia, and polyphagia. The additional symptoms include frequent urinary tract infections, lower limb paresthesia, vision changes, and nephropathy. The patient in the case study has these symptoms, hence, type 2 diabetes mellitus being the primary diagnosis. The ICD 10 code for type 2 diabetes mellitus is E11. The laboratory investigations needed for the patient include HBA1c test, renal function tests, random blood glucose, and fasting blood glucose tests. HBA1c is an accurate laboratory investigation that will provide an average of the patient’s blood glucose levels for the past three months (American Diabetes Association Professional Practice Committee, 2021). Renal function tests will provide insights into the potential of renal damage due to the disease.

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Guidelines Used for the Primary Diagnosis
The guideline by the American Diabetes Association (ADA) was used in developing the primary diagnosis. The ADA is an organization that provides current and evidence-based recommendations for diabetes care, treatment goals, and tools for evaluating the quality of diabetes care. According to ADA, type 2 diabetes develops from the progressive loss of beta cell secretion of insulin. The organization identifies that type 2 diabetes mellitus presents with symptoms such as hyperglycemia, polyuria, polydipsia, and polyphagia. The diagnostic criteria for type 2 diabetes include fasting plasma glucose of at least 126 mg/dl or HBA1c of at least 6.5%, or 2-hour plasma glucose of at least 200 mg/dl, or random plasma glucose of at least 200 mg/dl with classic symptoms of hyperglycemic crisis or hyperglycemia (American Diabetes Association Professional Practice Committee, 2021). Therefore, the recommendations by the ADA informed the diagnosis for the patient in the case study.
Differential Diagnoses
One of the primary diagnoses for the patient is Cushing’s disease. Cushing’s disease is a pituitary gland disorder that is characterized by the hypersecretion of the adrenocorticotrophic hormone. The disorder results in the increased body levels of cortisol. Patients affected by Cushing’s disease often experience symptoms that include buffalo hump, round face, purple stretch marks on the belly, armpits and chest, acne, hirsutism in females, rapid weight gain around the belly region, and easy bruising. Patients are also predisposed to complications such as vision problems, muscle weakness, headaches, infections, hypertension, hyperglycemia, and extreme fatigue(Fleseriu et al., 2021). Cushing’s disease is the least likely cause of the problem being experienced by the patient because of the absence of symptoms such as buffalo hump, truncal obesity, and rapid weight gain.
Benign prostatic hyperplasia is the other differential diagnosis that should be considered for the patient. Benign prostatic hyperplasia is a non-cancerous condition characterized by the enlargement of the prostate gland. Benign prostate hyperplasia is common in men aged 40 years and above, individuals born to families with a history of the disease, and history of medical conditions such as type 2 diabetes and obesity. The symptoms associated with the disease include urinary frequency and urgency, difficulties starting urine stream, weak urine stream, dribbling by the end of urination, urinary retention, and nocturia. Patients also experience urinary incontinence, frequent urinary tract infections, pain during urination or after ejaculation, and abnormal smell of the urine(Langan, 2019). The patient in the case study is least likely to be suffering from benign prostate hyperplasia since the symptoms do not align with those seen in the condition.
The last differential to be considered for the patient is obstructive sleep apnea. Obstructive sleep apnea obstructive sleep apnea is a condition characterized by partial or complete upper airway collapse, which lowers oxygen saturation. Patients often experience arousal from sleep. Patients complain of nonrestorative sleep, loud, disruptive snoring, and excessive daytime sleepiness, which are not evident in the case study(Slowik et al., 2023).
Medications
The recommended treatment for the patient is metformin. Metformin is the first-line drug of choice for patients diagnosed with type 2 diabetes mellitus. Metformin lowers the production of glucose by the liver, which enhances the sensitivity of the body to insulin. The recommended dosage for the drug is 500 mg once daily taken with the evening meal. Patient should be educated on the effective management of type 2 diabetes mellitus. Patient education should focus on a range of topics. One of them is on healthy, balanced diet. The patient should be educated on DASH diet and the importance of avoiding alcohol and smoking, as they worsen diabetes. The patient should also be educated about the importance of engaging in active physical activity for a healthy weight gain. Physical activity also helps minimize insulin resistance. The patient should be educated about the available resources for use to improve outcomes in type 2 diabetes (Lipari et al., 2019). The resources include community support groups for patients with diabetes and online databases and websites such as those of the Centers for Disease Control and Prevention, which provide valuable information for diabetes management. Patient education should also include self-management of diabetes, including glucose monitoring, warning signs of complications, and the importance of treatment adherence. The patient should also be educated about the side effects of metformin that include stomachache, loss of appetite, diarrhea, nausea, and metallic taste in the mouth.
Problem Statement
The patient in the case study presents with symptoms that align with those seen in type 2 diabetes mellitus. Type 2 diabetes mellitus is a source of considerable disease burden to the population. The prevalence of type 2 diabetes mellitus has been rising significantly globally. Lifestyle and behavioral factors such as sedentary behaviors and minimal engagement in active physical activity contribute to the problem. According to the CDC, 37.3 million people in the USA have diabetes. Diabetes is the eight leading disease contributing to mortalities in the USA. It costs the country about $327 billion in lost work, wages, and medical costs(CDC, 2023). Therefore, patient-centered interventions should be adopted to promote optimal outcomes in diabetes management in the case study.
Social Determinants of Health, Health Promotion and Patient Risk Factors
Social determinants of health influence diabetes statistics in the USA. Factors such as race and ethnicity have been shown to play a role, as evidenced by individuals from ethnic minatory backgrounds being highly at a risk and affected by type 2 diabetes mellitus. In addition, factors such as level of education, income, access to nutritious food, and lifestyle choices influence diabetes. Level of education affects awareness about the causes, risk factors, prevention, and management of type 2 diabetes. Lifestyle factors such as sedentary behaviors and minimal engagement in active physical activity increase the risk of type 2 diabetes. Therefore, health promotion interventions such as health education, screening, and initiation of preventive measures should be incorporated into the patient’s care plan(Hill-Briggs et al., 2021). In addition, patient risk factors such as sedentary behaviors, increased intake of unhealthy diets, smoking, and alcohol intake should be addressed.

References
American Diabetes Association Professional Practice Committee. (2021). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement_1), S17–S38. https://doi.org/10.2337/dc22-S002
CDC. (2023, April 4). The Facts, Stats, and Impacts of Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/spotlights/diabetes-facts-stats.html
Fleseriu, M., Auchus, R., Bancos, I., Ben-Shlomo, A., Bertherat, J., Biermasz, N. R., Boguszewski, C. L., Bronstein, M. D., Buchfelder, M., Carmichael, J. D., Casanueva, F. F., Castinetti, F., Chanson, P., Findling, J., Gadelha, M., Geer, E. B., Giustina, A., Grossman, A., Gurnell, M., … Biller, B. M. K. (2021). Consensus on diagnosis and management of Cushing’s disease: A guideline update. The Lancet Diabetes & Endocrinology, 9(12), 847–875. https://doi.org/10.1016/S2213-8587(21)00235-7
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2021). Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care, 44(1), 258–279. https://doi.org/10.2337/dci20-0053
Langan, R. C. (2019). Benign Prostatic Hyperplasia. Primary Care: Clinics in Office Practice, 46(2), 223–232. https://doi.org/10.1016/j.pop.2019.02.003
Lipari, M., Berlie, H., Saleh, Y., Hang, P., & Moser, L. (2019). Understandability, actionability, and readability of online patient education materials about diabetes mellitus. American Journal of Health-System Pharmacy, 76(3), 182–186. https://doi.org/10.1093/ajhp/zxy021
Slowik, J. M., Sankari, A., & Collen, J. F. (2023). Obstructive Sleep Apnea. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK459252/

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Please use the template uploaded as a guide to fill in the information. Be sure to include each heading.

Please ensure that the primary diagnosis is Diabetes Mellitus type 2. The differential diagnoses will be Cushing’s disease, benign prostatic hyperplasia, and obstructive sleep apnea. Please be sure to include the ICD codes and CPT codes.

Please ensure that the references are from 2018-current.

Please ensure that the paper is in APA format.

Health Promotion should include a list of recommended health screening exams based on age/sex/risk factors.

Social determinants of health please review the WHO website and search social determinants of health. Risk factors can be reviewed at the USPSTF website along with the recommended health screening exams.