S: CC : Diabetes, kidney recheck HPI: Jana Jenkins is an 89

S: CC : Diabetes, kidney recheck HPI: Jana Jenkins is an 89 yr old… S:CC: Diabetes, kidney recheckHPI:Jana Jenkins is an 89 yr old female returning to the clinic for recheck of her kidneys.  Three months ago, she was hospitalized due to acute kidney injury (AKI) that was felt to be related to use of trimethoprim/sulfamethoxazole for a urinary tract infection. The medication was stopped, she was given IV fluids, and her kidney function improved but not quite to her baseline. She states that she is still worried about her kidneys. She would like her kidney function checked today.  She also notes that she needs her diabetes check up.  She states she has followed her glucoses once per day and they have been 120-200 in the morning.  She states she stopped taking her metformin “awhile” ago. She felt like it might hurt her kidneys and her daughter-in-law told her she shouldn’t take it. She states she has been checking her feet daily and she doesn’t have any ulcers. Past Medical HistoryHTNGERDDMIIAKIPast Surgical HistoryHysterectomy at age 35 Current MedicationsLisinopril 20 mg dailyFamotidine 20 mg dailyMetformin 500 mg BIDAllergiesNKDATrimethoprim/Sulfamethoxazole – intolerance, caused acute kidney injuryROSConstitutional: – fevers, chillsHEENT: No changes in vision, no ear drainage, no sore throat.Cardiovascular: No chest pain, palpitations. No edema.Respiratory: No shortness of breath or cough.GI: No n/v/abd pain.GU: No dysuria, difficulty voiding. No hematuria.Integumentary: No rashes, wounds.Neuro: – HA, dizziness.  MS: No red or swollen joints.Endocrine: No polyuria, polydipsia, polyphagia.O:Physical ExamVS: T 97.6 P 72 R 18 BP 125/72 O2 sat 99% RAGeneral: Healthy appearing 89 yo woman, appears younger than her stated age. Reliable historian.HEENT: Nose without drainage. Mouth with moist mucous membranes. Normal dentition. Posterior oropharynx pink and moist.Cardiovascular: S1S2 normal.  No murmurs, rubs, or gallops.Respiratory: Lungs clear to auscultation. Respirations even and unlabored.Skin: No rashes on exposed skin.Neuro: No focal deficits. Protective sensation present in 7/10 right foot, 8/10 left foot – completed with monofilament.MS: No red or swollen joints. Enlarged DIP and PIP joints bilaterally.Extremities: No edema, DP 2+ bilaterally. Thickened bilateral great toenails. No fissures, calluses, skin cracks. Hair on bilateral feet, no Charcot deformities.Labs/Diagnostics (done just prior to this appointment)Creatinine 1.1Baseline 0.9 – 1.0eGFR 55K+ 4.2A1C 8.2 (average glucose 189)Unfortunately, Jana does continue to have a decreased eGFR so she may have Chronic Kidney Disease (CKD). After discussion with nephrology, you have ordered additional tests to confirm the diagnosis.What would be the best diabetes regimen for this patient given that her A1C is elevated and she has a possible new diagnosis of CKD?Restart metformin.Insulin glargine, insulin aspartAcarboseEmpagliflozin          Health Science Science Nursing NURSFXP4010

Let the Experts Do Your Homework Now



Do you have a similar question? Our professional writers have done a similar paper in past.
Give Us your instructions and wait for a professional assignment!

Get a plagiarism-free order today

we guarantee confidentiality and a professional paper and we will meet the deadline.

How it works

  • Paste your instructions in the instructions box. You can also attach an instructions file
  • Select the writer category, deadline, and education level and review the instructions
  • Make a payment for the order to be assigned to a writer
  • Download the paper after the writer uploads it

  • Will the writer plagiarize my essay?
    You will get a plagiarism-free paper and you can get an originality report upon request.

    Is this service safe?
    All personal information is confidential and we have 100% safe payment methods. We also guarantee good grades