FNP NR507 Week 6 Case Study – Synthesis Paper: Diabetes Mellitus
Solid academic research requires the utilization of literary sources to acquire information. Students and researchers can retrieve academic sources from government websites, educational sources, and other research sites. According to Lavidas et al. (2020), the best sources to incorporate in academic work include peer-reviewed articles, government websites, and other authoritative academic sites, depending on the field of study or research.
The sources are usually retrieved using search engines such as google scholar, pro-quest, and the Educational Resources Information Center (ERIC). In this discussion, information retrieved from google scholar, ERIC, and pro-quest on the search topic will be evaluated and discussed. I will also mention my preferred search engine among the three and share my experience when navigating the three search engines. The selected topic for this synthesis paper is diabetes mellitus.
I began with Pro-quest. The search results were about 214,351. These were general results since I had not filtered my search. The search engine has a feature that can sort the search results by relevance to the search topic. The other feature can filter the results based on the year of publication.
Also, a feature limits search results to peer-reviewed results only and whether the results should include full text. General search results included books, working papers, scholarly journals, theses and dissertations, reports, trade journals, newspapers, and other sources published in the last 12 months. Pro-quest also has a feature that allows one to customize the search results dates, language, and subject.
On navigating ERIC, the general search results were 185. They included peer-reviewed and full texts that include the phrase diabetes mellitus. However, going through the first page of the results, I realized most of the results were only related to diabetes mellitus. For example, one of the results read, “Treating Mental Illness among Diabetic Black Male Adolescents: A Review.” Such a result is only related to or has mentioned diabetes mellitus but is not entirely on diabetes mellitus.
Thus, it may not provide me with the required information. However, the search engine has advanced search features and filters that can assist me in narrowing down the search to ensure I get the required results. The features include customizing the publication date, location, audience, descriptor, educational level, and publication type.
Google Scholar had 3,150,000 results, provided in less than a second. These results were from a general search of the topic, sorted by relevance. The general search was not customized to select the year of publication and the source type. However, all the sources from google scholar are peer-reviewed and academically authoritative.
The first page of the search results included sources that would provide direct information on the search topic. The subsequent pages have sources related to diabetes mellitus. However, they are arranged in the order of relevance. The search features in google scholar include customizing the time of publication, the relevance, and whether the search should include citations.
Given the different features of the search engines, it is wise to incorporate sources from all three search engines, provided they provide the required information and are peer-reviewed (Usta et al., 2021). However, I prefer google scholar in doing my search.
The reasons for my preference include being fast, producing straight-to-the-point results, and its search-customizing features. More so, google scholar provides a link for other related sources, thus enabling me to get more information on the search topic. Finally, it is essential to utilize authoritative, peer-reviewed sources in academic research since the information is accurate and first-hand.
FNP NR507 Week 6 Case Study References
Lavidas, K., Achriani, A., Athanassopoulos, S., Messinis, I., & Kotsiantis, S. (2020). University students’ intention to use search engines for research purposes: A structural equation modeling approach. Education and Information Technologies, 25(4), 2463-2479. https://doi.org/10.1007/s10639-019-10071-9
Usta, A., Altingovde, I. S., Ozcan, R., & Ulusoy, O. (2021). Learning to Rank for Educational Search Engines. IEEE Transactions on Learning Technologies, 14(2), 211-225. http://doi.org/10.1109/tlt.2021.3075196
- Utilizing the Week 6 Case Study Template, provide your responses to the case study questions listed below.
Synthesis Paper: Diabetes Mellitus Assignment Description
Case Study Scenario
Chief Complaint
J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.
History of Present Illness
J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.
Past Medical History
- Hypertension
- Hyperlipidemia
- Obesity
Family History
- Both parents deceased
- Brother: Type 2 diabetes
Social History
- Denies smoking
- Denies alcohol or recreational drug use
- Landscaper
Allergies
- No Known Drug Allergies
Medications
- Lisinopril 20 mg once daily by mouth
- Atorvastatin 20 mg once daily by mouth
- Aspirin 81 mg once daily by mouth
- Multivitamin once daily by mouth
Review of Systems
- Constitutional: – fever, – chills, – weight loss.
- Neurological: denies dizziness or disorientation
- HEENT: Denies nasal congestion, rhinorrhea or sore throat
- Chest: (-)Tachypnea. Denies cough.
- Heart: Denies chest pain, chest pressure or palpitations.
- Lymph: Denies lymph node swelling.
General Physical Exam
- Constitutional: Alert and oriented male in no acute distress
- Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
- Wt. 240lbs., Ht. 5’8″, BMI 36.5
HEENT
- Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.
- Ears: Tympanic membranes intact.
- Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
- Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.
Neck/Lymph Nodes
- Neck supple without JVD.
- No lymphadenopathy, masses or carotid bruits.
Lungs
- Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart
- S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs.
Integumentary System
- Skin warm, dry; Nail beds pink without clubbing.
Labs
| Test | Patient’s Result | Reference |
|---|---|---|
| Glucose (fasting) | 132 | 60-120 mg/dL |
| BUN | 20 | 7-24 mg/dL |
| Creatinine | 0.8 | 0.7-1.4 mg/dL |
| Sodium | 141 | 135-145 mEq/L |
| Sodium | 141 | 135-145 mEq/L |
| Chloride | 97 | 95-105 mEq/L |
| HCO3 | 24 | 22-28 mEq/L |
| A1C | 7.2 | |
| Urinalysis Protein Glucose Ketones | Negative Positive Negative | |
| Oral glucose tolerance test (OGTT) | 220 mg/dL |
J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
- Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
- Explain the pathophysiology associated with your chosen diagnosis
- Identify at least three subjective findings from the case which support the chosen diagnosis.
- Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
- Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
- Describe the mechanism of action for each of the medication classes identified above.
- Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
- Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations
NR 507 Week 7 Case Study
Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
Alzheimer’s disease (AD) and frontotemporal dementia (FTD) are neurodegenerative diseases of the brain that result in dementia. According to Haque & Levey (2019), dementia is a clinical syndrome comprising impairment of individuals’ cognitive functioning, barring them from living complete, functional, and autonomous lives. AD is a chronic brain degenerative disorder in which there is an abnormal accumulation of amyloid proteins in the brain, particularly amyloid-Ꞗ (AꞖ) peptides in the extracellular senile plaques and the development of intracellular neurofibrillary tangles (NFTs) that comprises hyperphosphorylated and microtubule-associated protein tau (Haque & Levey, 2019).
On the other hand, Khan and De Jesus (2021) define FTD as a spectrum of clinical syndromes associated with neuronal degeneration and primarily affects the frontal and anterior brain lobes. In AD, the abnormal proteins accumulate in the hippocampus, amygdala, cerebral cortex, and associated cerebral vessels. Both AD and FTD affect elderly patients above 65 years; however, according to Kumar and Tsao (2019), AD is the most common cause of cognitive decline and, therefore, dementia, which is associated with impaired memory, attention, language, comprehension, judgment, and reasoning. The cognitive impairment in AD has been found to be severe enough to disrupt an individual’s performance of activities of daily living.
Khan & De Jesus (2021), on the other hand, reports that FTD is the third most common cause of dementia in elderly patients of 65 years and above but is again the second most common cause of early onset dementia in patients who are below 65 years of age with the patients’ age ranges being 45-65. FTD is characterized by heightened semantic and behavioral activities, impairment of language, motor speech, and motor functioning (Giebel et al., 2020). In a comparison of the impact on the activities of daily living (ADLs) among patients with AD and FTD, research conducted by Giebel et al. (2020), there was not much difference between the two disorders; however, it was established that initiative and planning were severely affected in patients with FTD as compared to those with AD. Risk factors associated with AD include advancing age, genetics, traumatic brain injury, and other systemic diseases. While the etiological cause of FTD is mainly sporadic, genetics have been documented, especially on mutations for genes encoding for tau protein, granulin, and hexanucleotide.
Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.
According to Breijyeh and Karaman (2020), AD is associated with decreased thinking and independence in ADLs. Other features include impairment in memory, language, comprehension, judgment, and reasoning, and upon mental state examination, there is impairment in executive functioning, concentration, memory, praxis, attention, and visuospatial skills (Kumar & Tsao, 2019). From the patient’s history, supportive evidence for AD includes reports of worsening memory by his wife, impaired judgment, and visuospatial skills evidenced by wandering away from home. He also has impaired reasoning since he brought a stranger to their house to buy them a home security system that they already have, and he has problems dressing himself or balancing his checkbook. He also has a family history of AD from his father, who died at 78 due to AD. On mental state examination, he scores 12/30, and magnetic resonance imaging shows hippocampal atrophy.
Explain one hypothesis that explains the development of Alzheimer’s disease.
The Amyloid Hypothesis
The theory suggests that amyloid beta peptide degradation decreases with advancing age, and several other pathological conditions result in the accumulation of the beta peptides (Breijyeh & Karaman, 2020). The increased ratio of Aβ42/Aβ40 triggers the formation of Aβ amyloid fibril, causing induction of tau pathology and neurotoxicity. The consequence of these events is neuronal cell death and neurodegeneration (Breijyeh & Karaman, 2020). The main pathology in AD is an accumulation of amyloid-beta peptides in the brain’s temporal lobes and other neocortical structures with associated neuronal degeneration; therefore, this hypothesis supports the development of AD.
Discuss the patient’s likely stage of Alzheimer’s disease.
The staging of AD is based on the patient’s symptomatic presentation, which is categorized as preclinical/presymptomatic, early, middle, late, and psychological and behavioral symptoms in dementia. The patient’s stage is moderate AD, as his features are consistent with impaired global intellectual functioning, executive dysfunction, aphasia, apraxia, and poor visual-spatial skills. The patient gets lost around his neighborhood, finds it difficult to dress, and has mood problems. Additionally, his mental state examination result is consistent with moderate Alzheimer’s dementia.
References
Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease: Causes and Treatment. Molecules, 25(24), 5789. https://doi.org/10.3390/molecules25245789
Giebel, C. M., Knopman, D., Mioshi, E., & Khondoker, M. (2020). Distinguishing Frontotemporal Dementia From Alzheimer Disease Through Everyday Function Profiles: Trajectories of Change. Journal of Geriatric Psychiatry and Neurology, 34(1), 66–75. https://doi.org/10.1177/0891988720901791
Haque, R. U., & Levey, A. I. (2019). Alzheimer’s disease: A clinical perspective and future nonhuman primate research opportunities. Proceedings of the National Academy of Sciences, 116(52), 26224–26229. https://doi.org/10.1073/pnas.1912954116
Khan, I., & De Jesus, O. (2021). Frontotemporal Lobe Dementia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559286/
Kumar, A., & Tsao, J. W. (2019, August 18). Alzheimer Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499922/