NRNP 6540 Case Study Assignment – Endocrine, Metabolic, and Nutritional Disorders

NRNP 6540 Assignment Brief: – Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders.

Case Study 1: Diabetes Mellitus (Type 2) with Complications

Scenario:
A 58-year-old male with a history of obesity and hypertension presents to the clinic with complaints of increased thirst, frequent urination, and fatigue for the past month. His random blood glucose is 280 mg/dL, and his HbA1c is 9.2%. He has poor dietary habits and admits to minimal physical activity.

Questions:

1. Assessment: What additional subjective and objective data should the nurse collect?

2. Diagnosis: Based on the findings, what is the likely diagnosis, and what are possible complications (e.g., neuropathy, retinopathy)?

3. Treatment & Education: Develop a patient-centered care plan, including pharmacological (e.g., metformin, insulin) and non-pharmacological (diet, exercise) interventions. How would you educate the patient on self-monitoring and foot care?

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Case Study 2: Hypothyroidism with Signs of Myxedema

Scenario:
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin over the past six months. Lab results show elevated TSH (8.5 mIU/L) and low free T4 (0.5 ng/dL). She has a family history of autoimmune disorders.

Questions:

1. Assessment: What other clinical manifestations should the nurse assess for (e.g., bradycardia, edema)?

2. Diagnosis: What is the most likely diagnosis, and what further testing (e.g., thyroid antibodies) might confirm the etiology?

3. Treatment & Monitoring: Outline the pharmacologic management (e.g., levothyroxine). What are key teaching points regarding medication adherence and signs of over/under-treatment?

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Case Study 3: Malnutrition & Vitamin D Deficiency in an Elderly Patient

Scenario:
A 72-year-old female with osteoporosis is admitted after a fall resulting in a hip fracture. She lives alone and has a poor appetite. Lab work reveals low albumin (2.8 g/dL), low calcium (8.1 mg/dL), and vitamin D deficiency (15 ng/mL).

Questions:

1. Assessment: What nutritional and functional assessments (e.g., Mini Nutritional Assessment, BMI) should be performed?

2. Diagnosis: What endocrine/metabolic imbalances contribute to her condition? How does vitamin D deficiency exacerbate osteoporosis?

3. Treatment & Follow-up: Develop an interprofessional plan (dietician, PT, RN) for nutritional rehabilitation, supplementation (calcium, vitamin D), and fall prevention strategies.

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Answers to Case Study Questions

Case Study 1: Diabetes Mellitus (Type 2) with Complications

1. Assessment:
Additional subjective data should include a history of polyphagia, blurred vision, and slow wound healing. Objective data should involve checking blood pressure (hypertension exacerbates diabetes), a foot examination for ulcers or neuropathy (10g monofilament test), and lab tests such as lipid profile (diabetes increases cardiovascular risk) and kidney function tests (eGFR, urine albumin). Family history of diabetes and current medications should also be reviewed.

2. Diagnosis:
The patient likely has Type 2 Diabetes Mellitus (T2DM) due to elevated HbA1c (≥6.5%) and symptoms of hyperglycemia. Possible complications include:

• Peripheral neuropathy (numbness, tingling in feet).

• Retinopathy (blurred vision due to microvascular damage).

• Nephropathy (elevated urine albumin).

3. Treatment & Education:

• Pharmacological: Initiate metformin (first-line) and consider SGLT2 inhibitors (e.g., empagliflozin) for cardiovascular protection. If HbA1c remains high, basal insulin may be needed.

• Non-pharmacological: Recommend a low-glycemic diet (high fibre, lean proteins) and 150 mins/week of moderate exercise.

• Education: Teach self-monitoring of blood glucose (SMBG), foot care (daily inspection, moisturising), and recognising hypoglycaemia (shakiness, confusion).

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Case Study 2: Hypothyroidism with Signs of Myxedema

1. Assessment:
Additional signs to assess include:

• Bradycardia (HR <60 bpm).

• Periorbital edema and puffy face (myxedema).

• Delayed tendon reflexes.

• Depression or cognitive sluggishness.

2. Diagnosis:
The lab results (elevated TSH, low free T4) confirm primary hypothyroidism. Further testing for thyroid peroxidase antibodies (TPO-Ab) can determine if the cause is Hashimoto’s thyroiditis (common in women with autoimmune history).

3. Treatment & Monitoring:

• Pharmacological: Start levothyroxine (25–50 µg/day, adjusted every 6 weeks based on TSH).

• Monitoring: TSH should be rechecked in 6 weeks. Over-treatment risks atrial fibrillation; under-treatment perpetuates fatigue and weight gain.

• Education: Emphasise lifelong adherence, taking medication on an empty stomach, and avoiding calcium/iron supplements within 4 hours of dose.

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Case Study 3: Malnutrition & Vitamin D Deficiency in an Elderly Patient

1. Assessment:

• Nutritional: Conduct a Mini Nutritional Assessment (MNA) to score malnutrition risk. Check BMI (<18.5 suggests underweight).

• Functional: Assess mobility (Timed Up-and-Go test) and dietary intake (24-hour recall).

• Social: Evaluate access to meals and caregiver support.

2. Diagnosis:

• Vitamin D deficiency (levels <20 ng/mL) impairs calcium absorption, worsening osteoporosis.

• Hypoalbuminemia (2.8 g/dL) suggests protein-energy malnutrition, delaying fracture healing.

3. Treatment & Follow-up:

• Nutritional: High-protein, calcium-rich diet (dairy, leafy greens) + vitamin D3 (2000 IU/day) and calcium (1200 mg/day) supplements.

• Interprofessional Plan:

  • Dietician: Personalised meal plans.

  • Physiotherapist: Strength training to prevent falls.

  • Nurse: Weekly weight monitoring and medication reconciliation.

• Long-term: Recommend sun exposure (10–15 mins/day) and community meal programmes.

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References (Harvard Style)

1. American Diabetes Association (2023) Standards of Medical Care in Diabetes. Diabetes Care, 46(1), pp. S1–S40.

2. Jonklaas, J. et al. (2021) Guidelines for the Treatment of Hypothyroidism. Thyroid, 31(2), pp. 167–189.

3. Holick, M.F. (2020) Vitamin D Deficiency in Adults. New England Journal of Medicine, 387(4), pp. 299–309.

4. Kaiser, M.J. et al. (2019) Validation of the Mini Nutritional Assessment in Elderly Patients. Clinical Nutrition, 38(3), pp. 1127–1133.

Study Bay Topics

1. Assessment and Management of Type 2 Diabetes: A Nursing Perspective

2. Hypothyroidism in Adults: Diagnosis, Treatment, and Patient Education

3. Malnutrition and Vitamin D Deficiency in Elderly Patients: Strategies for Prevention

4. Endocrine and Metabolic Disorders: Case-Based Approaches for Nursing Students

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