Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis

Case Study 1: HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar in the morning, fasting. She reports seeing blood sugar as low as 50 fasting in the mornings for the last few weeks. She has a known history of Diabetes, Hypertension, Hyperlipidemia, and Chronic Osteoarthritis. She also reports elevated blood pressures. Her blood pressure at presentation is 165/90. RESOURCE FOR THIS WEEK: Review endocrine-related Evidence Based Practice Guidelines. Ms. Lewis is a 63 y/o female who is AAOX4. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls, denies any pain. (All other Review of System and Physical Exam findings are negative other than stated.) Vital Signs: BP 165/90, HR 89, RR 20, Temp 98.1 PMH: Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis Allergies: Penicillin, lisinopril Medications: Women’s One A Day-Multivitamin daily Chlorthalidone 25mg daily Fish Oil 1 tablet daily Amlodipine 5mg p.o. daily Atorvastatin 40mg p.o. at bedtime daily Novolog 10 units with meals TID Aspirin 81mg p.o. daily Lantus 25 units Subcutaneous nightly Ergocalciferol 50,000 units PO once a month Social History: as stated in Case Study ROS: as stated in Case study Diagnostics/Assessments done: • CXR- Last cxr showed no cardiopulmonary findings. Within normal limits. • Basic Metabolic Panel and CBC as shown below • Vitamin D Level- as noted below in lab results TEST RESULT REFERENCE RANGE GLUCOSE 85 65-99 SODIUM 134 135-146 POTASSIUM 4.2 3.5-5.3 CHLORIDE 104 98-110 CARBON DIOXIDE 29 19-30 CALCIUM 9.0 8.6- 10.3 BUN 20 7-25 CREATININE 1.01 0.70-1.25 GLOMERULAR FILTRATION RATE (eGFR) 76 >or=60 mL/min/1.73m2 TEST RESULT REFERENCE RANGE Vitamin D 1,25 OH 58 36-144 TEST RESULT REFERENCE RANGE WBC 7.3 3.4- 10.8 RBC 4.31 135-146 HEMOGLOBIN 14 13-17.2 HEMATOCRIT 42% 36-50 MCV 90 80-100 MCHC 34 32-36 PLATELET 272 150-400