Comprehensive Patient Analysis: A Case Study in Diagnosis and Care

This case study delves into the diagnosis and care of a patient presenting with multiple health issues, including a suspected Urinary Tract Infection (UTI), lymphedema, and diabetes. The initial assessment involves collecting a urine sample for lab analysis and checking for a history of sexually transmitted illnesses. Elevated nitrites and leucocytes in the urine, along with symptoms such as urine inconsistency, offensive smell, fever, and a history of diabetes, support the UTI diagnosis. Recommendations for preventing future UTIs include maintaining proper genital hygiene and increasing fluid intake, particularly water and cranberry juice. The patient's lymphedema is attributed to a previous mastectomy, which likely damaged or removed lymph nodes, and the study advises against using the affected arm for blood pressure checks. The case also discusses the management of diabetes, differentiating between type 1 and type 2, and addresses the impact of diabetes on wound healing. The importance of HBA1c testing for assessing treatment adherence is highlighted, along with potential complications of uncontrolled Graves’ disease. The study concludes with recommendations for managing urinary incontinence, offensive urine odor, and fever, suggesting consultations with a physiotherapist, dietician, geriatrician, and urogynaecologist for comprehensive care. Desklib offers more solved assignments and resources for students.

Running head: CASE SCENARIO 2 1
Case Scenario 2
Name
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CASE SCENARIO 2 2
Case Scenario 2
Question 1
The nurse should collect a urine sample from a patient and send it to the laboratory for
analysis. The nurse might also check for history of sexually transmitted illnesses.
Question 2
Patients with Urinary Tract Infection (UTI) have elevated nitrites and leucocytes in urine
(Nitzan et al., 2015).
Question 3
In the case study, urine inconsistence, offensive smell, fever and diabetes support a
diagnosis of UTI.
Question 4
Betty should maintain proper genital hygiene and drink plenty of fluids especially water
and cranberry juice to prevent future occurrence.
Question 5
The lymphedema in her right arm time was caused by mastectomy. Some lymph nodes
might have been damaged or removed during the procedure.
Question 6
The use of the right arm to check BP might cause swelling and exacerbate the existing
lymphedema.
Question 7
A normal blood sugar level is 3.9–6.0 mmol/L while fasting or levels of up to 7.8mmol/L
after meals (Nussey & Whitehead, 2013). UTI increase these levels due to an upsurge of cortisol
and adrenaline which block insulin.

CASE SCENARIO 2 3
Question 8
Signs of hypoglycemia include sweating, rapid heartbeat, dizziness and blurred vision
(Nitzan et al., 2016).
Question 9
In type 2 diabetes, the body cells are resistant to insulin or the pancreas produces
inadequate amounts of the hormone (Nussey & Whitehead, 2013). As a result, the levels of
glucose in the blood remain high and damage vessels. It is insulin-independent and mostly
occurs in adults.
Question 10
Unlike type 2 diabetes, type 1 diabetes occurs in children due to an autoimmune reaction.
The body’s antibodies attack and destroy the beta cells of the pancreas, which eliminates the
source of insulin in the body (Nussey & Whitehead, 2013). Consequently, the patient requires
constant insulin injections.
Question 11
Diabetes affects wound healing by predisposing the individual to infections. Betty’s wounds will
take longer to heal due to her diabetic condition.
Question 12
HBA1C or glycated hemoglobin is a test to assess how patients adhere to treatment. It
indicates the amount of sugars that have bound to circulating hemoglobin. High circulating glucose
levels result in high HBA1c levels (Nitzan et al., 2016). Since the average lifespan of red blood cells
is three to four months, elevated HBA1c levels indicate high blood sugar levels for the past three
months.

CASE SCENARIO 2 4
Question 13
Graves’ disease is an autoimmune disorder that results in hyperthyroidism. It mostly
manifests as enlargement of the thyroid gland and bulging eyes (Nussey & Whitehead, 2013).
Uncontrolled Graves’ disease might lead to psychosis, dermopathy or ophthalmopathies.
Question 14
Betty has a problem with urinary inconsistency. To stop passing urine unconsciously will
undergo bladder control training and do exercises that to strengthen the pelvic muscles. She will,
therefore, gain the ability to control urine passage.
Betty’s urine has an offensive odor. To get clear non-smelling urine, she should increase fluid
intake and void urine after every 2 to 3 hours. These measures will prevent the accumulation and
multiplication of bacteria which cause the bad smell.
Betty has a fever. To lower her body temperature from 38.2 °C to 37°C, her caregivers will
treat infections that could be causing the fever. They will ensure she has appropriate clothing and
takes adequate food and fluids. These interventions will reduce the temperature.
Question 15
Betty should see a physiotherapist to help her with exercises to control urine incontinence. A
dietician could advise her on the best diets to control her blood sugar (Early & Stanley, 2018). Also,
a geriatrician would help her deal with social and rehabilitative issues that affect her health. A
urogynaecologist could help her manage the UTI and keep the genital-urinary tract.

CASE SCENARIO 2 5
References
Early, K. B., & Stanley, K. (2018). Position of the Academy of Nutrition and Dietetics: The Role
of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and
Treatment of Prediabetes and Type 2 Diabetes. Journal of the Academy of Nutrition and
Dietetics, 118(2), 343-353.
Nitzan, O., Elias, M., Chazan, B., & Saliba, W. (2015). Urinary tract infections in patients with
type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes,
metabolic syndrome and obesity: targets and therapy, 8, 129.
Nussey, S. S., & Whitehead, S. A. (2013). Endocrinology: an integrated approach. CRC Press.