W7.

5 SUMMATIVE ASSIGNMENT 4
Human Diseases and Drug Pharmacology
Tracy Sullivan
6/15/18
Questions
1. Based on the medical record above, differentiate the presenting signs and symptoms
with following diseases/conditions: Diabetes mellitus, COPD, and anxiety.
Ms. T presents with classic COPD symptoms upon physical exam which include shortness of

breath, wheezing, and chest tightness. Other symptoms can also include cyanosis in the

phalanges, which was remarked upon examination. Diabetes mellitus (DM) signs or

symptoms for this visit include neuropathy which is reported as lower extremity paresthesia,

cutaneous manifestations of facial erythema, polydipsia, nocturia, and a leg ulcer most likely

due to neuropathy. Anxiety is expressed in the physician’s comments in that the patient has

been diagnosed within the year with a mood disorder, and the patient is under the care of a

psychiatrist. In addition to this mention, it states that the patient is agitated with an overall

feeling of stress.

2. For each disease/condition stated below, discuss how the process and development of
each resulted in this patient’s laboratory/diagnostic test results and medication list.
a. Diabetes Mellitus
Ms. T is prescribed a medication called Metformin. Metformin works by reducing the

absorption of glucose. By reducing the absorption of glucose, it reduces the demand for the

release of glycogen. Within the laboratory/diagnostic test results what indicates diabetes mellitus

are located within the urinalysis. Ketones are positive in Ms. T’s urine sample. Ketones are a by-

product when the body burns fat for energy, and if there is not enough insulin to help your body

use sugar for energy this is shown within a urinalysis. Glucose is not usually found in urine but is

present in this urinalysis. Glycosuria is regularly caused by elevated blood glucose levels, most

commonly due to uncontrolled, unregulated, or untreated diabetes mellitus. Positive creatinine

suggests diabetic nephropathy. Creatinine is a waste product that should not register within a
 W7.5 SUMMATIVE ASSIGNMENT 4
Human Diseases and Drug Pharmacology
Tracy Sullivan
6/15/18
urinalysis. If it does, measuring the levels of creatinine in the urine can be helpful for tracking

the progression of diabetic kidney disease. It also appears that Ms. T has proteinuria. Diabetes

can cause damage to the kidneys, which leads to proteinuria. According to the Mayo Clinic, the

normal reference range for a woman and their hemoglobin test (Hgb) should be 12.0 to 15.5

grams per deciliter. Ms. T’s Hgb is elevated at 17 g/dL.

b. COPD
In the past, primary care doctors would assess COPD patient’s subjectively asking about

symptom frequency and the frequency in use of inhalers. Spirometry measures how much air an

individual can blow out and how fast. Pulmonary function tests are designed to measure the

amount of air the patient can inhale and exhale, and measure if the lungs are delivering enough

oxygen to the blood. The Forced Vital Capacity (FVC) is the total amount of air that can be

exhaled following as deep of an inhalation as possible. A patient must try to exhale for at least 6

seconds to obtain a useful FVC measurement. I could not find a reference range for FVC

measurement that coincides with L/min, but feel it is important to state within this assessment

that Ms. T’s was FVC 2.3 L/min. In addition, Ms. T had a pulse oximeter performed. Pulse

oximetry is a method used for monitoring a person's oxygen saturation. According to the Mayo

Clinic, normal pulse oximeter readings usually range from 95 to 100 percent. Ms. T’s value was

95%.

c. Anxiety
To my knowledge, there are no laboratory indicators in which anxiety can be measured.

However, the doctor has Ms. T on the medication, Alprazolam. Alprazolam is an anxiolytic drug
 W7.5 SUMMATIVE ASSIGNMENT 4
Human Diseases and Drug Pharmacology
Tracy Sullivan
6/15/18
that falls within the drug class of benzodiazepines. Benzodiazepines are a type of anxiolytic

commonly used to treat patients with anxiety. Benzodiazepines produce an overall sedative

effect on the body. There are some serious side effects aside from dependency issues that should

be monitored. These include depressed mood, thoughts of suicide or hurting yourself, unusual

risk-taking behavior, decreased inhibitions, no fear of danger, confusion, hyperactivity, agitation,

hostility, hallucinations, feeling like you might pass out, urinating less than usual or not at all,

chest pain, pounding heartbeats or fluttering in your chest, uncontrolled muscle movements,

tremor, or seizures.

3. For each disease/condition stated below, discuss the complications that might develop if
they are left untreated or not properly managed.
a. Diabetes Mellitus
Some likely complications that can occur with diabetes mellitus is diabetic neuropathy.

Neuropathy is nerve damage that can cause tingling, burning, pain, stinging, or weakness in the

foot. Neuropathy also can cause loss of feeling in the feet which can lead to patients injuring

themselves and not knowing it. Another complication that can arise is diabetic ketoacidosis.

Diabetic ketoacidosis occurs when the body produces high levels of ketones due to lack of

insulin. Diabetic ketoacidosis can cause a diabetic coma and can be life-threatening if left

untreated. Lastly, nephropathy can be a complication that arises in a diabetic patient. Diabetes

can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out

waste products, resulting in kidney disease.

b. COPD
Since our lungs are a visceral organ a complication that might develop is a respiratory infection.

One common lung infection is pneumonia. Since COPD damages the lungs, another potential
 W7.5 SUMMATIVE ASSIGNMENT 4
Human Diseases and Drug Pharmacology
Tracy Sullivan
6/15/18
complication is a pneumothorax. A pneumothorax occurs when the lung collapses. Since COPD

is the degeneration of a person’s lungs, air can leak into the space between the lung and the chest

wall. This leakage of air into the chest cavity pushes on the outside of the lungs causing it to

collapse. Lastly, COPD can lead to heart failure. It typically is brought on by ongoing high

blood pressure in the arteries of the lungs caused by low levels of oxygen in the blood.

c. Anxiety
There is no cure for an anxiety disorder. It is a chronic condition that can take on many forms.

The long-term outlook depends on the severity of the patient’s condition. A complication of

anxiety is the increased risk for depression. Dealing with a constant state of feeling worried can

make a person lose hope of ever feeling “normal”, for this very reason it exhausts a person

mentally and emotionally, leaving them at risk of depression or even suicide. Generalized

anxiety impairs a person’s ability to function, and to perform tasks quickly and efficiently

because they have trouble concentrating. These reasons can also take the person’s time and

focus away from daily activities.

4. For each disease/condition stated below, identify possible plan of care options that may
include patient education, treatment options, necessary referral(s), and/or further
diagnostic testing.
a. Diabetes Mellitus
The key to treatment of diabetes mellitus is keeping up with recommendations. Regular

checking of blood glucose should be done via a glucometer. Regulating diabetes also includes

medications. Some common medications for diabetic patients are Humulin, Metformin,

Avandia, and Invokana. The antidiabetic drug family is broad, and there are specific sub-classes

located within, that each performs in a different way. For example, thiazolidinediones such as
 W7.5 SUMMATIVE ASSIGNMENT 4
Human Diseases and Drug Pharmacology
Tracy Sullivan
6/15/18
Avandia works by increasing the body's sensitivity to insulin. The physician would educate the

client by recommending modifying eating habits and increasing physical activity. By modifying

these habits, they help in reducing blood sugar levels.

b. COPD

If the patient is a smoker the doctor would educate the patient by advising the patient to quit

smoking. Treatment of COPD includes a variety of medications to help treat the complications

and symptoms patient’s experience with COPD. One such medication is a bronchodilator. Since

COPD is the inflammation of the lungs, bronchodilators work by relaxing the muscles around the

airways making it easier for the patient to breath. The primary care doctor may refer the patient

to a pulmonologist for care. Some further therapies for COPD include oxygen therapy. This may

include an oxygen chamber or for the patient to carry around a portable supplemental oxygen

tank. A pulmonary rehabilitation program may be something the patient will be enrolled in.

These programs combine education, exercise training, nutrition advice and counseling.

c. Anxiety
If anxiety prevents the patient from living a normal life, the doctor may refer the patient to a

therapist or psychiatrist to help the person with strategies to cope with anxiety and identify

stressors or triggers that may heighten their feelings of angst. There are medications that can be

prescribed that can help to aid a person to lead a normal life. These medications are called

anxiolytics. One such anxiolytic is benzodiazepine such as Xanax. Before starting a

benzodiazepine, the doctor should educate the client with knowledge of the possibility for

dependency/addiction. Benzodiazepines can lead to psychologic and physiologic dependency on

 W7.5 SUMMATIVE ASSIGNMENT 4
Human Diseases and Drug Pharmacology
Tracy Sullivan
6/15/18
these kinds of medications. A patient on these medications should be closely monitored to ensure

that they are not abusing them.

Reflection Discussion

1. Describe your thoughts process and resources you used to reach the
conclusions for each of the questions. Explain how what you learned as it
relates to appropriate medication dosages will help you in your future
career.

With each part two summative assessments, I spend a great deal of time researching the disease.

Researching takes on many forms. I rely primarily on the textbook provided this semester, and

also, I check to see if there is any information in our Anatomy and Physiology class textbook. In

addition to textbooks, I used our weekly quizzes or summative assessment part one’s to help me

reach the conclusions for each answer this week. I also needed to do internet research. While

doing internet research, I go to reputable sources that have .org or .edu associated with the

corresponding disease, and I fact check to make sure information is accurate by corroborating

from a minimum of two different sources. Within each week going through the individual body

systems, I have learned about common medications that go along with specific ailments. With

my future career as a medical coder, I will be seeing the patient’s whole history, including

medications. I will know what they are, what they do, and how they help support the patient

through the treatment or management of their diseases.