Chapter 43, Patient Assessment: Endocrine System
Case Study/Short-Answer Questions and Discussion Points
Mrs. R., a 61-year-old African American female, arrives in the emergency
department after experiencing severe chest pressure, nausea, and diaphoresis at
5:30 AM. She takes a fluid pill for high blood pressure and reports nocturia at
least three times. She smokes about a half pack of cigarettes a day (positive
history of smoking 1 pack/d for over 40 years) and drinks one to two glasses of
wine per week. She is allergic to penicillin (rash). Currently, she works as a
secretary part-time and does not exercise much. She has been overweight all of
her adult life and has gained about 12 pounds this past year.
The nurse notes that Mrs. R. is fully oriented, obese, with slightly
diaphoretic skin and dry buccal membranes. Her vital signs are blood pressure,
165/110 mm Hg; heart rate, 102 beats/min; and respiratory rate, 24 breaths/min.
She is afebrile.
Mrs. R.’s laboratory results show a glucose level of 220 mg/dL, serum
ketones are mildly positive, and white blood cells are normal. Mrs. R.’s
electrocardiogram shows sinus rhythm (rate, 86 to 94 beats/min) with ST
elevation in inferior leads. She denies acute chest pain upon arrival as the staff
prepares to start an intravenous line.
1. Mrs R. has not been diagnosed with diabetes. Explain how she will be
diagnosed using the American Diabetes Association’s criteria.
Mrs. R. arrived in the emergency room after awakening at 5:30
AM
and her
glucose level is 220 mg/dL. According to the American Diabetes Association, a
diagnosis of diabetes can be established when the patient has a glucose level
greater than 200 mg/dL and classic signs of hyperglycemia are evident. In this
case, Mrs. R. reports nocturia and polydipsia, has dry buccal membranes, is
slightly tachycardic, and tests positive for small ketones. She was unaware of
her glucose level and had never been diagnosed with diabetes prior to this
admission.
2. Since Mrs. R. was not diagnosed with diabetes previously, discuss
several reasons why she may be displaying signs and symptoms of
diabetes currently.
Mrs. R. is experiencing a life-threatening myocardial infarction. Her adrenal
hormones are being secreted in response to assist her with the “fight or flight”
reaction to extreme stress. In particular, the counterregulatory hormones of
cortisol and catecholamines are secreted, and they will exacerbate blood
glucose levels. Being diagnosed during an acute episode of illness is a
common presentation of diabetes for people who were previously unaware of
their status.
3. What specific risk factors for type 2 diabetes mellitus are illustrated in
this case study?
Mrs. R. has the following risk factors for developing type 2 diabetes: being
African American, advancing age, being obese and inactive, recent weight
gain, smoking history, and having hypertension.