Clinical Experiences
This past week, I encountered an interesting case of a 67-year-old African American female who presented with complaints of vision loss. She appeared exhausted. During history taking, it was established that she is a first-generation immigrant without any medical checks for the past 20 years. Preliminary findings on the patient’s vitals revealed a repeat BP of 156/86mmHg, a PR of 91bpm, and an oral temperature of 37 degrees. The patient was also obese, indicated by a BMI of 31. Physical examination revealed dryness of the lips, mouths, and eyes. Examination of the eyes using the Snellen chart showed a marked reduction in visual acuity. A cataract was also seen in her left eye. The differentials listed for the patient were diabetic cataract, glaucoma, hypertensive retinopathy, ruptured micro-aneurysm, and macular edema secondary to the epiretinal membrane. Lab diagnostics on blood sugar were ordered to exclude other causal factors for blindness. Laboratory examination revealed an RBS of 21omg/dL, an FBS of 130mg/dL, and an HBA1c of 10%. The patient was diagnosed with diabetes and hypertension.
As evident from the literature and based on what I learned from class, fundus examination is warranted for clinical presentations that resemble diabetic retinopathy. Fundus examination revealed that the patient had nonproliferative diabetic retinopathy as a complication of diabetes. The history of the patient, coupled with physical and laboratory examination of the patient, indicated that the patient had diabetic nephropathy, which is a microvascular complication of uncontrolled diabetes. Diabetic retinopathy is a leading cause of blindness among older people (Faselis et al., 2020). The patient was started on insulin, and further funduscopic examination was scheduled to reveal the extent of the pathological changes in the eye.
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References
Faselis, C., Katsimardou, A., Imprialos, K., Deligkaris, P., Kallistratos, M., & Dimitriadis, K. (2020). Microvascular Complications of Type 2 Diabetes Mellitus. Current Vascular Pharmacology, 18(2), 117-124. https://doi.org/10.2174/1570161117666190502103733
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Question 
Clinical Experiences
Discuss an interesting or challenging case you encountered this past week. How did you use evidence to support your actions?
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last five years