Assignment task:
G.A. is a 50-year-old female who presents to your primary care office for her complete physical. You last saw her approximately one and a half years ago for a physical and then during a follow-up on the labs to her physical. At that time, you diagnosed her with type 2 diabetes and proteinuria. You started her on Metformin 500mg BID and instructed her on the use of a glucometer and asked her to follow up with you in approximately four weeks. Her A1C at that time was 8.2%. Her past medical history includes HTN, gout, obesity, and hyperlipidemia. She is a smoker, does not drink ETOH, and does not use illicit drugs. Her past surgical history includes a hysterectomy for DUB related to benign fibroids at age 48 and a tonsillectomy at age eight.
G.A. cancelled that four-week follow up with you last year because she lost her job and thus lost her insurance. She is still unemployed but finally has been able to secure insurance through a state insurance program and is ready to have her physical exam with you today. She has not been taking any medications.
Her vital signs are at present: Height: 66.25″, weight: 242 lbs., BP: 148/96, P: 88, RR: 18, temp: 98.9, O2: 98% RA
Her hemoglobin A1C is 9.2 today.
Initial Post
After reading the case study, respond to the following prompts:
Q1. What subjective questions, relevant to her listed diagnoses, would you ask at this visit?
Q2. Which systems would you examine during the objective part of the visit related to her diabetes?
Q3. What primary prevention is important for this patient? What secondary prevention for this patient is important?
Q4. What medication would you begin as first line treatment? Be sure to include your rationale for choosing this medication (based on guidelines) and dosage.
Q5. What education would you include for this medication?
Q6. What other education would you recommend to this patient today?
Q7. When would you like to see her for follow up?