Patient Diagnosis Case Study – Metabolic Syndrome

Scenario

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You have a patient who presents to your office with the following for the initial visit:

42-year-old Caucasian female, BMI 45, BP: 152/86, Pulse: 91, O2: 97%
Past Medical Hx: Hypertension, Pre-Diabetes, Osteoarthritis, Chronic Migraine
Past Surgical Hx: none
Social: Occasional Smoker, Occasional alcohol use (1-2 per week), no drug use
Most recent labs (that you had access to):
- Total Cholesterol: 172, Triglycerides- 253, HDL- 19, LDL- 130
- Thyroid function tests: WNL
- Fasting glucose: 119
- A1C:4

The patient reports that she has been prescribed Metformin in the past but does not take it every day. She reports failing several diets that were recommended by her previous provider. She states, ‘I don’t have time for exercise’ and ‘I can’t afford a gym membership.’ She thinks there may have been a blood pressure pill prescribed in the past but she’s not sure.

Based on the scenario provided, fully inform your patient and explain their diagnosis.

Ensuring that a patient understands their diagnosis is critical during diagnosis. As a nurse, I understand that making the patient comprehend their health care issue is the first step towards the delivery of effective nursing care. Explaining the diagnosis to a patient promotes informed participation in the diagnosis and treatment process and avoids any possible misunderstandings that may delay care delivery (Kreps, 2018). Explaining a diagnosis to a patient also allows the nurse to know what the patient already knows and provide new information that improves their health literacy by simplifying the diagnosis and helps them have a positive reception to the diagnosis and other related health reports. Additionally, explaining a diagnosis to a patient serves as an opportunity for patient education in which various options for treating their condition, possible risks, and how to improve their health outcomes can be discussed (Fereidouni et al., 2019).

To inform the above-diagnosis patient in the provided scenario, the first thing would be to first congratulate the patient for choosing to visit the clinic and having herself checked to address her health concerns. However, before informing her of the diagnosis, I would focus on understanding what she knows about her condition and what concerns she has so far regarding her current symptoms and medications. This would be important to prepare her for the information that I will provide regarding the diagnosis. It would help ease her of any worries that she may have and ensure that she understands the diagnosis and underlying factors and reasons for her test results and diagnosis.

The first part of the diagnosis is to inform her about the basics of the diagnosis, including the review of systems (ROS). The most notable part of the diagnosis is the BMI of 45. A BMI of 45 means that a person is severely obese. At this point, I will inform the patient of the health risk of being excessively obese and how her weight is contributing to her current health issues and other parts of the diagnosis, including the patient’s history with hypertension, pre-diabetes, osteoarthritis, and migraines. The next is the blood pressure reading. The blood pressure reading of 152/86, in which 152 is the systolic reading and 86 is the diastolic reading, means the patient has high blood pressure, also known as hypertension. A normal blood pressure reading would range between 90 to 120 mmHg for systolic reading and 60 to 80 for diastolic reading. A range between 120-139 diastolic pressure and less than 80 mmHg for the systolic pressure indicates elevated blood pressure or prehypertension. A reading of 152/86 is beyond elevated and indicates stage 1 blood pressure. Evidence shows that untreated or poorly managed high blood pressure increases other complications such as cardiovascular disease and stroke (Fuchs & Whelton, 2020). The pulse rate of 91 is in the high normal range, while the O2 reading shows the blood oxygen saturation which is currently at 97% and within the normal range.

The next step is to inform the patient of her most recent lab tests. In this case, the first lab result is the total cholesterol test, which is 172. This is within the normal range for her age. Any reading below 200 is within the normal range, while above 200 to 239 mg/dL is considered borderline high. The triglyceride levels of 253 mg/dL are way above the normal range which is less than 150. Considerably, high triglyceride can increase the risks of high blood pressure and other complications such as heart disease and stroke. Moving forward to HDL, cholesterol at 19 is way too low and is a risk for related complications such as heart disease and an underlying metabolic issue. The desirable level for a 42-year-old woman is above 60mg/dL. The LDL cholesterol is at 130, slightly above optimal recommended levels, and lies on the lower side of borderline high. The other important part of the diagnosis is the test for thyroid function, which is within normal limits. This means there is no issue of concern related to the patient’s thyroid function. Finally, the fasting glucose is at 119, and the A1C is 6.4. According to the guidelines provided by the Centers for Disease Control and Prevention (2023) for diabetes testing, a fasting glucose of 119 mg/dL and an A1C of 6.4% indicate pre-diabetes. A pre-diabetes diagnosis means the blood sugar levels are slightly elevated above normal but not high enough to be diagnosed as diabetes. This is a warning sign that the patient is at risk of developing full-blown diabetes, and immediate care is needed to prevent the development of diabetes.

Use UpToDate, Medscape, AACE, ADA, or AHA located in the University Library to search for and locate the most current evidence-based guidelines to answer the following questions.

Interview Questions

What are possible questions you would ask to further explore the choices they’ve made to manage their disease processes? Use the POLDCARTS method to help formulate your questions.

Using the POLDCARTS method, possible questions for further the choices the patient has made to manage their disease processes would be:

How have you been managing the joint pain (related to the history of osteoarthritis)?
When did you start getting concerned with your blood pressure?

Do you have any specific parts of your body that feel pain or discomfort related to osteoarthritis or other symptoms of concern?

What is the duration? For how long have you experienced each of the symptoms you have mentioned?
Based on how you experience the symptoms you have mentioned, whether the headaches, heartbeats, or blood pressure, what have you noticed triggers such symptoms?
What do you usually do to relieve the symptoms you experience?

Is there a specific time you usually experience any of the mentioned symptoms?
On a scale of 1 to 10, which is low to very severe, how can you rate the joint pain and the migraines?

What questions would you ask to ascertain their knowledge of metabolic syndrome?

Have you ever heard of the term metabolic syndrome before?
Do you know what leads to heart disease and other complications such as stroke?

Do you think being obese has anything to do with high blood pressure, pre-diabetes, diabetes, or heart disease?

Do you think your current lifestyle increases the risks of metabolic syndrome?

Overall Health and Pathophysiology

What do you think is going on with the overall health of this patient? Describe in detail the pathophysiology as it relates to her current presentation and symptoms.

The current symptoms the patient presents are related to multiple underlying factors. The overall patient presentation and symptoms indicate deteriorating health and increased complications, including heart disease and stroke. The pathophysiology of her worsening health is contributed majorly by her high BMI of 45, which has majorly contributed to the development of other complications, including her current hypertensive status, pre-diabetic condition, osteoarthritis, and chronic migraines. Hypertension is a chronic medical condition majorly characterized by elevated blood pressure. It develops mostly due to being excessively overweight, leading to high cholesterol deposits in blood vessels that restrict blood flow. This causes the heart to strain in pumping higher diastolic and systolic pressure, which is a high risk of damaging the heart and other essential organs such as the kidney. This can also contribute to the occurrence of chronic migraines due to the inflammation related to obesity and high LDL cholesterol in the blood (Jukema et al., 2019).

Pre-diabetes is the first stage of the development of Type 2 diabetes mellitus (T2DM). It is related to increased insulin resistance, mostly in obese people whose body fails to efficiently use produced insulin. This level of diabetes development includes elevated levels of blood sugar. On the other hand, osteoarthritis develops due to continuous degeneration of joint disease and the cartilage in the joints. Obesity can increase the risk of osteoarthritis due to the extra weight placed on the joints, such as the knees, hips, and spine, causing wear and tear of the cartilage.

References

Centers for Disease Control and Prevention. (2023, February 28). Diabetes Tests. CDC. https://www.cdc.gov/diabetes/basics/getting-tested.html

Fereidouni, Z., Sabet Sarvestani, R., Hariri, G., Kuhpaye, S. A., Amirkhani, M., & Najafi Kalyani, M. (2019). Moving Into Action: The Master Key to Patient Education. The Journal of Nursing Research, 27(1), 1. https://doi.org/10.1097/JNR.0000000000000280

Fuchs, F. D., & Whelton, P. K. (2020). High Blood Pressure and Cardiovascular Disease. Hypertension, 75(2), 285–292. https://doi.org/10.1161/HYPERTENSIONAHA.119.14240

Jukema, R. A., Ahmed, T. A. N., & Tardif, J. C. (2019). Does low-density lipoprotein cholesterol induce inflammation? if so, does it matter? Current insights and future perspectives for novel therapies. BMC Medicine, 17(1), 1–9. https://doi.org/10.1186/S12916-019-1433-3/FIGURES/3

Kreps, G. L. (2018). Promoting patient comprehension of relevant health information. Israel Journal of Health Policy Research, 7(1), 1–3. https://doi.org/10.1186/S13584-018-0250-Z/METRICS

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Question

Patient Diagnosis Case Study – Metabolic Syndrome

This week, you focused on cardiovascular health. You will obtain patient information using POLDCARTS and apply the information you have gathered, leading to a diagnosis. You will apply your knowledge of the pathophysiology of the conditions to educate patients on their diagnosis. Now, it is time to apply your knowledge by completing a case study on metabolic syndrome.

For this assignment, you will use UpToDate from the Nursing Resources page to search for and locate evidence-based guidelines to answer the questions within the case study.

Watch the following videos on the POLDCARTS patient interview method to help you with this assessment on YouTube:
“How to Get a Patient History” from Real World NP
“Taking a headache history with OLD CAART” from Clinical Advisor

Complete the Patient Diagnosis Case Study: Metabolic Syndrome document.

Format your citations according to APA guidelines.