Case Study 1 – Endocrine system
Y.L., a 34- year- old Southern Asian woman, comes to the clinic with complaints of chronic
fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning,
or low back pain on urination. She tells you she has a vaginal yeast infection that she has
treated numerous times with over-the-counter medication. She works full time as a clerk in a
loan company and states she has difficulty reading numbers and reports, resulting in her
making frequent mistakes. She says, “By the time I get home and make supper for my family,
then put my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn
or feel like there are pins in them.” She has a history of gestational diabetes and reports that
after her delivery she went back to her traditional eating pattern, which is high in
carbohydrates.
In reviewing Y.L.’s chart, you note she last saw the provider 6 years ago after the delivery of her
last child. She has gained considerable weight; her current weight is 173lbs. Today her BP is
152/97 mm Hg, and random plasma glucose level is 291 mg/ dL. The provider suspects that Y.L.
has developed type 2 DM and orders the laboratory studies shown in the chart.
Chart view Laboratory Test Results
Fasting glucose
184 mg/ dL
Hemoglobin A1C
8.8%
Total Cholesterol
256 mg/dL
Triglycerides
346 mg/dL
Low- density lipoprotein (LDL) 155 mg/ dL
High- density lipoprotein (HDL) 32 mg/ dL
Urinalysis +glucose, -ketones
1. Interpret Y.L.’s laboratory results.
Her fasting glucose, hemoglobin A1C, total cholesterol, LDL, and triglycerides are all high
indicating she has most likely developed type 2 diabetes and hypercholesterolemia. Her HDL is
low and is positive for glucose in her urine, further suggesting she has diabetes and
hypercholesterolemia.
2. Identify the three methods used to diagnose DM
Hemoglobin A1C, symptoms (polyuria, polydipsia, polyphagia), fasting glucose test
3. Describe the functions of insulin (long acting & fast acting)
Long-acting insulin is used to sustain a basal level of insulin in a 24 hour period to manage blood
glucose between meals and overnight. Short acting insulin works quickly and is to be
administered 30 mins before meals to manage blood sugar spikes.
4. List the steps on how to take Y.L’s blood glucose reading:
Perform hand hygiene, have the patient perform hand hygiene, wipe the fingertip of the finger
to be used with alcohol, put stirp into glucometer and turn on, then use the lancet to prick the
edge of the fingertip, wipe the first drop of blood, then put the test strip to the drop of blood
and wait for glucometer to read.
5. List the steps on how to give insulin to Y.L.:
Read provider’s orders first, and take patient’s blood glucose if needed, ensure the patient is
not hypoglycemic before administering, draw up insulin to the provider’s orders, then pick a
site that hasn’t been used on the patient to inject, cleanse site with alcohol pinch subcutaneous
fat, insert needle, inject insulin, take needle out while still pinching skin, then release skin.
6. Name six risk factors for type 2 DM. Place a star or asterisk next to those that Y.L.
exhibits.
History of gestational diabetes *, Asian descent *, sedentary lifestyle *, carb heavy diet*, diet
lacking fruits and veggies, being overweight*, family history
Y.L. is diagnosed with type 2 DM. The provider starts her Metformin (Glucophage) 500mg and
glipizide (Glucotrol) 5mg orally each day at breakfast and atorvastatin (Lipitor) 20mg orally at
bedtime. She is referred to the dietitian for instructions in starting a 1200-calorie diet using an
exchange system to facilitate weight loss and lower blood glucose, cholesterol and triglyceride
levels. You are to provide education regarding pharmacotherapy and exercise.
7. What is the rationale for starting Y.L. on Metformin (Glucotrol)?
She is started on metformin to control her blood glucose levels, and type 2 diabetes
8. Outline the teaching you need to provide to Y.L. regarding oral hypoglycemic therapy.
Medication adherence, take it at the prescribed time, if dose is missed do not double up, avoid
excess alcohol, take with food
9. What benefits should Y.L. receive from encouragement to exercise?
Exercise can help her lose weight and manage her type 2 diabetes and possibly put it into
remission if her blood glucose is within normal range with a proper diet and exercise, can also
help with circulation
Y.L. comments. “I’ve heard many people with diabetes lose their toes or even their feet.” You
take this opportunity to teach her about neuropathy and foot care.
10. Which of the symptoms that Y.L. reported today led you to believe she has some form
of neuropathy?
Foot pain, with pins and needles feeling
11. What other findings in Y.L.’s history place her at risk for developing neuropathy?
Sedentary lifestyle
12. What would you teach Y.L. about neuropathy?
Check feet daily, ensure proper foot care, wear proper shoes
13. Because Y.L. has symptoms of neuropathy, placing her at risk for foot complications, you
realize you need to instructs her on proper foot care. Outline what you will include
when teaching her about proper diabetic foot care.
Wearing proper shoes, and always wear shoes, check feet daily, keep feet dry (bacteria lie
moist environment), report skin breakdown or lesions that are getting worse
Harding, M., Snyder, J. S., Preusser, B. A., & Winningham, M. L. (2016). Winningham's critical thinking
cases in nursing: medical-surgical, pediatric, maternity, and psychiatric. 6th edition. St. Louis, Missouri,
Elsevier.
Harding, M. M., Kwong, J., Hagler, D., Reinisch, C., & Lewis, S. M. (2023). Lewis’s medicalsurgical nursing: Assessment and management of clinical problems. Elsevier.