Patient Encounter, Part 1 A 62-year-old obese female with a history of diabetes and hypertension presents to clinic for

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Patient Encounter Part 1 A 62 Year Old Obese Female With A History Of Diabetes And Hypertension Presents To Clinic For 1 (106.54 KiB) Viewed 18 times

Patient Encounter, Part 1 A 62-year-old obese female with a history of diabetes and hypertension presents to clinic for routine follow-up. Her fasting blood sugars have been elevated recently, averaging 180 to 250 mg/dL (10 to 13.8 mmol/L). PMH CV: Regular rate and rhythm, normal S, Szi no murmurs, rubs or gallops; lungs clear Abd: Obese; no organomegaly, bruits or tenderness, (+) bowel sounds; heme (-) stool Exts: Trace pedal edema bilaterally; decreased sensation in feet to light touch; no lesions Labs (fasting Sodium 145 mEq/L (145 mmol/L); potassium 3.2 mEq/L (3.2 mmol/L); chloride 112 mEq/L (112 mmol/L); carbon dioxide 26 mEq/L (26 mmol/L); blood urea nitrogen 20 mg/dL (7.14 mmol/L urea); serum creatinine 1.4 mg/dL (123.76 umol/L); glucose 240 mg/dL (13.32 mmol/L); total cholesterol 196 mg/dL (5.07 mmol/L); low-density lipoprotein cholesterol 112 mg/dL (2.90 mmol/L); high- density lipoprotein cholesterol 28 mg/dL (0.72 mmol/L); triglycerides 280 mg/dL (3.16 mmol/L); hemoglobinaic (Hbald 10% (0.1); urine microalbumin 270 mg/dL (2.7 g/L) • Diabetes mellitus for 8 years, not currently controlled • Hypertension for 5 years, not currently controlled • Hyperlipidemia, currently managed by diet therapy FH Mother is alive at age 87 with coronary artery disease; father is deceased from diabetes; she has no siblings. SH She does not work; she smokes 1 pack of cigarettes per day, but denies alcohol or illicit drug use; she is sedentary Meds Furosemide 20 mg orally daily Nifedipine XL 30 mg orally daily Glyburide 10 mg orally daily ROS Unremarkable PE VS: Blood pressure 145/92 mm Hg, pulse 82 beats per minute, temperature 36.9°C (98.4°F), Ht 5'4" (162.5 cm), Wt 190 lb (86.4 kg) • What risk factors does the patient have for the development of CKD? • What signs and symptoms are consistent with CKD? • How would you classify her CKD? • Identify your treatment goals for the patient. • What lifestyle modifications would you recommend for the patient with CKD? • What pharmacologic alternatives are available for the patient for treatment of CKD? • What other interventions are appropriate to minimize the progression of CKD?