What resources do you suggest for A.M. at this time?
Case Study Outcome During the next year, A.M. continued to miss appointments, and her weight increased to 272 lbs (123 kg). She was eventually diagnosed with type 2 diabetes mellitus, and at her last visit she asked her HCP about having weight loss surgery.
Case Study 4 Name _________________________________ Class/Group
______________________________ Date ___________
Scenario You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M., a man who has been coming to the clinic for several years for management of coronary artery disease (CAD) and hypertension (HTN). A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a chest x-ray (CXR) examination revealed cardiomegaly and a 12-lead electrocardiogram (ECG) showed sinus tachycardia with left bundle branch block. You review J.M.’s morning blood work and initial assessment.
Chart View
Laboratory Results Chemistry
Sodium 142 mEq/L (142 mmol/L)
Chloride 95 mEq/L (95 mmol/L)
Potassium 3.9 mEq/L (3.9 mmol/L)
Creatinine 0.8 mg/dL (70.7 mcmol/L)
Glucose 82 mg/dL (4.6 mmol/L)
BUN 19 mg/dL (6.8 mmol/L)
Complete Blood Count
WBC 5400/mm3 (5.4 x 109/L)
Hgb 11.5 g/dL (115 g/L)
Hct 37%
Platelets 229,000/mm3 (229 x 109/L)
Initial Assessment J.M. reports increased fatigue and shortness of breath, especially with activity, and “waking up gasping for breath” at night, for the past 2 days. Vital Signs
Temperature 97.9° F (36.6° C)