Capella FPX 4015 Assessment 5
Student Name
Capella University
NURS-FPX4015 Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care
Prof. Name
Date
Comprehensive Head-To-Toe Assessment
Hi to all! My name is __________. Today, I will conduct a thorough head-to-toe assessment on my Sentinel U case study subject, Aiyana Tehanata. Her primary sign has been tingling in her feet for two months. The pain can be severe, searing, or stinging, with a pain level of 5/10 along with elevated glycaemia level. She has a history of hypertension. This evaluation will focus on all main body systems and highlight results relevant to the patient’s health. I will detail my actions and discuss my findings for better understanding.
Thorough and Accurate Assessment
Before starting the assessment, I would like to assure you and explain how the evaluation process will happen. I want you to feel relaxed and prepared for a head-to-toe evaluation. Your primary signs include foot tingling, moderate discomfort (5/10 level), and hyperglycaemia. I will conduct a physical check-up to assess your condition and inspect all vital organs. Initially, for your dermatological examination, I will check your skin texture, temperature, and colour of your skin and nails. Change in texture and colour can show low blood circulation due to hyperglycaemia. Your feet have redness and dryness, however, there is no wound.
Dry and peeling skin could indicate autonomic neuropathy (Bodman et al., 2024). Now, in the neurological exam, I will examine your feet where you feel pain and tingling for sensation assessment. I will touch the affected area with monofilament if there is any indication of nerve damage, swelling, or another pathological sign. I am gently stroking different areas of your foot. Please let me know if the pain worsens or if you experience feeling numb or tingling. This will help us identify the extent of nerve harm due to hyperglycemia.
Next, I will conduct a vascular assessment. I will check your circulation by feeling the pulses in your feet. I will palpate the pulse at the top and the ankle. Your pulses at these points are reduced due to lower blood flow to the extremities. Now I will do a cardiovascular evaluation to examine your blood pressure and the functioning of your heart, as you told me that you have a history of high blood pressure. Diabetes or Hyperglycemia and high blood pressure are risk factors for cardiovascular disease (Liu et al., 2021), so examining your blood pressure and cardiac condition is necessary.
I am fitting a blood pressure cuff on your arm to check your blood pressure, and a stethoscope to listen to the sound of your heart. In analysis, I find an abnormal heartbeat (S4 cardiac beat), which is an indication of Coronary Heart Disease (CHD). Your breathing rate is rapid, and you experience shortness of breath. Now I will perform your musculoskeletal exam. Your hand squeeze demonstrates diminished strength, which appears to be due to weariness. Your capacity to push with your feet demonstrates slight weakening in lower limb muscles, indicating inadequate blood circulation. A lack of oxygen may cause the feeling of tingling in your feet. I do not observe any joint abnormalities and edema.
Analysis of Diagnosis and Findings
Through your extensive assessment, I have found the reason for feeling pain and tingling in your feet with a higher glucose level. Based on your physical exam findings, the primary signs of numbness and moderate pain (5/10), can be due to nerve injury leading to diabetic peripheral neuropathy (DPN) among diabetic patients. Patients with peripheral neuropathy can experience varying degrees of weakness, tingling, discomfort, blistering, and weakened limbs (Bodman et al., 2024). It is due to high blood sugar levels, which cause significant damage to nerves, particularly those in the lower limbs. During the sensation and neurological exam, when I stroked your feet, feelings of tingling and pain worsened in certain parts, indicating nerve engagement.
Additionally, in vascular assessment, I checked your circulation by feeling the pulses in your feet at the top and ankle. Your pulses were reduced due to lower blood flow to the extremities, indicating an issue in blood circulation. Further, during a cardiovascular evaluation, an erratic heartbeat indicates that your heart is receiving an insufficient blood supply due to CHD. Your history of hyperlipidemia, hypertension, and high cholesterol increases your risk of developing CHD. When there is inadequate flow of oxygen to the heart, the heart operates at a higher rate with erratic cardiac patterns, as established during the check-up. As you mentioned, dizziness, light headedness, and foot numbness could result from circulation issues, which are common in CHD. High blood pressure and heart rate signal an exhausted heart, and portions of your blood arteries get constricted, reducing heart pumping efficiency. It is critical to address this potential disease promptly with proper cardiac tests and changes in habits that promote heart wellness.
Your hyperglycemia condition had a substantial impact on this assessment. It induces nerve issues. Hyperglycemia can cause excess harmful products and oxidative damage, harming nerve fibres and disrupting nerve transmission. Microvascular alterations cause lower blood supply to nerves, which contributes to the onset of neuropathy (Yachmaneni et al., 2023). Combining the evaluation findings, such as sensations you have had in your feet and irregular heartbeat due to improper blood flow, suggests that DPN is the secondary diagnosis linked to your primary assessment of CHD. I would like to stress that you can regulate your disease by implementing a variety of measures, including drug compliance and lifestyle changes. Healthy lifestyle management is an essential informal therapeutic option for CHD patients (Marselin et al., 2023). Effective care can significantly lessen the impact of CHD and DPN, avoiding complications and improving health outcomes.
Comprehension of Pharmacological Requirements
Pharmacological therapy will be directed toward both DPN and CHD to manage your condition successfully. CHD treatment requires medication to improve the heart’s pumping efficiency and prevent fluid build-up. Your physician will select a drug based on your health issue from diuretics and beta-blockers. Thiazide-like diuretics are among the efficient therapy for hypertension and CHD (Barracano et al., 2023). This class includes Furosemide and Chlorthalidone. Chlorthalidone, with a longer span of action and extended half-life at smaller doses, is effective in lowering the threats of cardiovascular events.
However, it can cause gastrointestinal issues like dizziness, vomiting, and cramps (Arumugham & Shahin, 2023). Furosemide helps treat CHD by controlling retained fluids, which can be a consequence of cardiac failure. It functions by boosting the release of urine, which reduces fluid volume in the body and minimizes symptoms while also lessening the burden on the heart. However, it can trigger allergic reactions such as skin rashes and serious interstitial nephritis (Arumugham & Shahin, 2023). Beta-blockers are especially beneficial for treating hypertension in some instances, such as controlling cardiac rate and arrhythmias (Barracano et al., 2023). Metoprolol, a popular beta blocker used to treat CHD, lowers arterial pressure, relieves chest discomfort, and optimizes cardiac output. Tiredness, dizziness, and shortness of breath are adverse effects.
Further, you are experiencing elevated glycaemic levels and symptoms of damaged nerves or DPN, it is critical to successfully control your diabetes while also potentially treating the DPN to alleviate the agony in the feet. Metformin is a frequent primary medication for managing blood sugar. Metformin assists in controlling diabetes by boosting the body’s sensitivity to insulin and lowering glucose synthesis in the liver. It is regarded as a core treatment because of its efficacy. It can alleviate the neuropathic discomfort resulting from diabetes.
However, it has a few uncommon and moderate side effects, including hypoglycemia, nausea, gastroenteritis, and reduced functioning of the kidneys and liver (Wei et al., 2022). However, some people need other drugs to manage their glycemic levels. Other drugs, such as SGLT-2 inhibitors (empagliflozin, dapagliflozin), or insulin, can be used to help regulate glucose levels. SGLT-2 inhibitors are critical for lowering serum sugar levels. Kandeel et al. (2022) found that SGLT2I moderately reduced diabetic neuropathy in the legs, events, and nerve conduction. Frequent blood glucose testing is crucial, as drug modifications can be needed periodically. These medications are efficient when combined with lifestyle shifts, such as a nutritious diet and exercise.
Your clinical history and other illnesses are important when deciding on pharmacological therapies. If you are taking drugs for hypertension or CHD, you should assess possible interactions between drugs to avoid problems. Observe all treatment side effects, such as dizziness, stomach infection, skin rash, and any unexpected symptoms, and notify me promptly for further evaluation. By diligently choosing the proper drugs and continually tracking your condition, we can assist in reducing signs and complications from DPN and CHD. But regular follow-up and communication with the caregiver are vital to manage health.
Understanding of Pathophysiology
Discussing pathophysiology will help you grasp CHD and diabetes-related DPN. The heart controls the movement of blood throughout the body. CHD occurs when atherosclerosis leads to plaque store and restricts the cardiac supplying arteries, resulting in reduced tissue oxygenation (Johns Hopkins Medicine, 2024). CHD primarily impacts cardiac muscles and blood arteries. Angina, chest pain, and shortness of breath are caused by decreased oxygen delivery to the cardiac muscle, leading to cardiac failure. The consequences of this condition include dizziness, exhaustion, and erratic heartbeats. A build-up of fluids in the lungs complicates normal breathing, especially when exercising. CHD can worsen, resulting in medical issues such as cardiac arrest or arrhythmias. Other vital signs must be monitored to manage CHD, blood pressure, and cholesterol levels effectively. Awareness of warning signs enables rapid action, which enhances disease management.
The secondary diagnosis of diabetes type 2 with DPN problems is a severe concern that affect the body’s capacity for controlling glucose levels. The insulin hormone aids in transporting sugar from the bloodstream to the cells. Diabetes type 2 causes cells to become less or non-responsive to insulin, resulting in higher levels of sugar in the blood (Goyal et al., 2023). Unmanaged hyperglycaemia causes severe medical issues, including cardiovascular illnesses (Liu et al., 2021). Higher glucose levels can affect arteries by causing fat accumulation, leading to vasoconstriction of arteries and raising the threat of heart issues. It also causes poor circulation in the lower extremities, contributing to foot soreness or tingling feelings, a common indication of damaged nerves or DPN. Hyperglycemia can also cause excess harmful products and oxidative damage, harming nerve fibres and disrupting nerve transmission. Microvascular alterations cause lower blood supply to nerves, which contributes to the onset of neuropathy (Yachmaneni et al., 2023).
Capella FPX 4015 Assessment 5
Unmanaged type 2 diabetes causes severe signs. These include restricted circulation, which may cause nerve-linked pain like foot ulcers and DPN. Renal and cardiac strain may manifest as swelling in the lower limbs. Further, Excessive thirst, more urination, diminished energy and exhaustion, infections, and prolonged wound healing are all symptoms of poor blood sugar regulation. Some individuals may also report warmth or tingling in their feet and hands and distorted eyesight (Goyal et al., 2023). You are already encountering pain and tingling in your feet, which is a sign of nerve damage due to high glucose levels. Acknowledging the close relationship between diabetes and heart conditions is critical. Ensuring drug compliance and a healthy lifestyle can overcome your risks related to CHD and DPN, improving health outcomes.
Analytical Thinking and Clinical Decision-Making
The primary solutions are controlling your glucose level, treating DPN affecting your feet, and avoiding primary complications like CHD. The first intervention is to manage glycaemic levels to reduce complications related to DPN. Frequently elevated levels of glucose can affect the cardiovascular, neurological, and other vital organs. For managing hyperglycaemia and pain related to nerve damage, drugs such as Metformin are frequently used to assist in lowering blood sugar levels. Other therapies, such as insulin injections, can be recommended to decrease the glucose level. Metformin helps in controlling diabetes by boosting the body’s sensitivity to insulin and lowering glucose synthesis in the liver. It can alleviate the neuropathic discomfort from diabetes (Wei et al., 2022). Regular examination for foot injuries or ulcers and using comfortable and appropriate footwear lowers the likelihood of infections and DPN-related complications.
According to the Centres for Disease Prevention and Control (CDC), the set targets are 80 to 130 mg/dL before eating a meal, while after 2 hours of the meal, they should be 180 mg/dL (CDC, 2024). Remaining in the set targets helps to avoid complications like DPN and CHD. Combining pharmacological care with lifestyle modification, improving diet and workout is vital to manage hyperglycaemia. CDC recommends that portion control, avoiding sweets instead of it consume fruits, and limiting alcohol use are lifestyle changes that help people manage their sugar levels (CDC, 2024).
The deadly consequences of diabetes are CHD (Lui et al., 2021). Whenever high sugar levels remain persistently, they can damage the vessels in the body. This injury can cause the slow accumulation of fatty substances within the arteries that supply blood to the heart. It raises the risk of major complexities including cardiac attacks and cardiovascular disease. To optimize cardiac functioning, beta-blockers are especially beneficial for treating hypertension in some instances, such as controlling cardiac rate and arrhythmias (Barracano et al., 2023). Metoprolol, a popular beta blocker used to treat CHD, lowers arterial pressure, relieves chest discomfort, and optimizes cardiac output. Tiredness, dizziness, and shortness of breath are adverse effects. Further to manage CHD-related issues and hypertension, Thiazide-like diuretics are efficient therapy for hypertension and CHD (Barracano et al., 2023). This class includes Chlorthalidone, with a longer span of action and extended half-life at smaller doses, which is effective in lowering the threats of cardiovascular events. Checking vital signs like blood pressure and heartbeat ensures the efficacy of these medications and protects from difficulties.
Patient education is vital to improve patients’ dietary habits and lifestyles. To manage CHD-related risks, educating patients on the DASH diet, which includes more use of fruits and vegetables and restricted salt use, helps to manage blood pressure and improve heart health. The American Heart Association (AHA) suggests that adopting a cardiac health diet based on whole grains, fruits, low-fat milk products, and vegetables is essential. Individuals must avoid oils, fats, sodium use, canned meats and foods, and alcoholic drinks to improve heart health by managing blood pressure (AHA, 2024). Adopting these evidence-based interventions and care solutions will help you manage your condition effectively.
Conclusion
Managing overall health and controlling complications like DPN and CHD is a vital part of Aiyana’s treatment regimen. Thorough analysis and evaluation diagnose CHD as the primary issue, along with the secondary issue of diabetes linked DPN complications. Adopting effective medications like beta-blockers and diuretics helps to manage her blood pressure and cardiac output, improving circulation. Further hyperglycaemia management drugs like metformin play a crucial role in lowering glucose levels, while addressing nerve damage-related pain. Besides medication, a healthy lifestyle and regular monitoring of vital signs help to manage the condition efficiently, improving medical results.
References
AHA. (2024). Managing blood pressure with a heart-healthy diet. American Heart Association.org. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-blood-pressure-with-a-heart-healthy-diet
Arumugham, V. B., & Shahin, M. H. (2023, May 29). Therapeutic uses of diuretic agents. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557838/
Barracano, R., Ciriello, G. D., & Sarubbi, B. (2023). Pharmacological therapy in adult congenital heart disease with coronary artery disease and atrial fibrillation. International Journal of Cardiology Congenital Heart Disease, 12, 100446–100446. https://doi.org/10.1016/j.ijcchd.2023.100446
Bodman, M. A., Dreyer, M. A., & Varacallo, M. A. (2024, February 25). Diabetic peripheral neuropathy. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK442009/
CDC. (2024). Manage blood sugar. Centers for Disease Prevention and Control.gov. https://www.cdc.gov/diabetes/treatment/index.html#:~:text=A%20blood%20sugar%20target%20is,Less%20than%20180%20mg%2FdL.
Capella FPX 4015 Assessment 5
Goyal, R., Singhal, M., & Ishwarlal Jialal. (2023, June 23). Type 2 diabetes. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/
Johns Hopkins Medicine. (2024). Coronary heart disease. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronary-heart-disease
Kandeel, M. (2022). The outcomes of Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2I) on diabetes-associated neuropathy: A systematic review and meta-analysis. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.926717
Liu, Y., Li, J., Dou, Y., & Ma, H. (2021). Impacts of type 2 diabetes mellitus and hypertension on the incidence of cardiovascular diseases and stroke in China real-world setting: A retrospective cohort study. British Medical Journal Open, 11(11), e053698–e053698. https://doi.org/10.1136/bmjopen-2021-053698
Marselin, A., Amalia, L., & Dinarti, L. K. (2023). The interventions to improve medication adherence in coronary heart disease patient: A systematic review. Journal of the Saudi Heart Association, 35(4), 259–278. https://doi.org/10.37616/2212-5043.1356
Wei, J., Wei, Y., Huang, M., Wang, P., & Jia, S. (2022). Is metformin a possible treatment for diabetic neuropathy? Journal of Diabetes, 14(10), 658–669. https://doi.org/10.1111/1753-0407.13310
Yachmaneni Jr, A., Jajoo, S., Mahakalkar, C., Kshirsagar, S., & Dhole, S. (2023). A comprehensive review of the vascular consequences of diabetes in the lower extremities: Current approaches to management and evaluation of clinical outcomes. Cureus, 15(10), e47525. https://doi.org/10.7759/cureus.47525