Use case Assignment for Lesson 3. Diabetes and Nutrition
Dear students!
Respond: Please, read the case of the patient in the case study below and submit your answers to the following task:
- Calculate the patient’s BMI, indicate normal values and pathology?
- What are the norms for waist size in women and men?
- What does an increased waist size indicate?
- What is your final diagnosis?
- What treatment does the patient require?
- Develop a rough meal plan
Grading: 0-49 points - unsatisfactory, 50-69 points - satisfactory, 70-89 - good, 90-100 - excellent.
Use case: Patient G., 54 years old, was admitted to the clinic with complaints of headache, dizziness, blurred vision, drowsiness, and mood swings.
From the anamnesis it is known that he has been suffering from arterial hypertension since the age of 48, after menopause, with maximum blood pressure values of 180/100 mm Hg. Art. Since that time, he has noted an increase in body weight of 25 kg. She does not receive constant antihypertensive therapy. Over the past year, he has been experiencing sleep disturbances with frequent and long periods of sleep apnea, compensated by daytime sleepiness. Notes a tendency towards depression. Leads a sedentary lifestyle. I could not tolerate AMI and stroke.
Family history: mother, 74 years old, suffers from coronary artery disease, arterial hypertension, and type 2 diabetes mellitus. My brother died at the age of 50 from stroke.
On examination: Condition is satisfactory. Increased nutrition. Height 156 cm, weight 94 kg. Waist circumference – 111 cm. Hip circumference – 108 cm. Skin and visible mucous membranes are of normal color and moisture. There is no peripheral edema. Lymph nodes accessible to palpation are not enlarged. The thyroid gland is unremarkable. In the lungs, breathing is vesicular, there are no wheezes, respiratory rate is 16 per minute. On percussion, the boundaries of the relative dullness of the heart are expanded to the left. Heart sounds are muffled, rhythmic, heart rate - 90 per minute, accent of the second tone in the second intercostal space to the right of the sternum, blood pressure - 170/100 mm Hg. The abdomen is soft, painless on palpation in all parts. The liver and spleen are not enlarged. The effleurage symptom is negative on both sides.
Clinical blood test: hemoglobin 157 g/l; red blood cells 5.0x1012/l; platelets 220x109/l; leukocytes 6.8x109/l; ESR 15 mm/hour.
Biochemical blood test: total protein 78 g/l; urea 7.0 mmol/l; creatinine 96 µmol/l; bilirubin total 16 µmol/l; total cholesterol 8.2 mmol/l (3.0-5.0 mmol/l); LDL 4.5 mmol/l (2.2-4.8 mmol/l); HDL 0.8 mmol/l (not less than 1.42 mmol/l); triglycerides 3.5 mmol/l (1.7 mmol/l); glucose 6.0 mmol/l (3.3-5.5 mmol/l); uric acid 620 µmol/l (150-350 µmol/l).
Blood glucose concentration 2 hours after a glucose load: 10.5 mmol/l. In daily urine: albumin 280 mg/day.