Posted: September 13th, 2017

Case Study

Paper, Order, or Assignment Requirements

I’ve attached two files. the first file contains all my instructions and the second file contains my case study.

Case study:

MR RS a 46yr old retired hobby farmer who developed an infected wound following a mid-foot amputation. It presented as a fungating ulcer with clear signs of infection and inflammation to the mid-foot area. He was sent to theatre for further debridement of wound.

Medications on admission Amlodipine 10mg in the morning

Atenolol 50mg daily

Metformin 500mg twice a day

NovoRapid 25 units mane, 20 units noon, 25 units nocte

Prazosin 1mg twice a day

Ramipril 10mg daily

Simvastatin 40mg at night

BP 156/74 Creatinine 144 μmol/L (60 – 110 μmol/L)

eGFR 40 mL/min/1.73 m2

Nil tobacco, Alcohol occasionally

Mr RS developed hyperglycaemia post-surgical procedure.

He was commenced one insulin glargine (Lantus) 34 units mane and 20 units nocte whilst in hospital. Other medications and adjustments made during admission were as follows.

Cephalexin 500mg orally QID

Sitagliptin and Metformin (Janumet) 50/500mg BD

Metformin 500mg BD

NovoRapid 14 units TDS (before meals)

Ibuprofen 400mg three times a day and Oxycodone 5mg to 10mg every 3 hours when needed for severe pain.

Questions:

1. Describe the microvascular and  macrovascular issues in diabetes and how these may have impacted Mr RS.( 200 words )

2. Discuss diabetes management in relation to his surgical procedure..( 200 words )

3. Discuss insulin glargine, listing any potential benefits this therapy may offer and the specific aspects of the formulation in relation to its action. Include appropriate counselling points regarding the administration of this agent..( 250 words )

4. Discuss the new oral medication for this patient and any concerns that you would have with its use specifically in this patient taking into account the information presented?( 200 words )
5. What considerations need to be made regarding this patient’s pain relief?( 200 words )