Scenario
Madam Kwok is a 60 year old female who lives with her husband in Singapore. They have both retired and have two grown up children who live nearby. As part of the national screening programme in Singapore, Madam Kwok is attending an appointment tomorrow. She has recently been feeling lethargic and passing urine more frequently overnight and has also been complaining to her husband that she is always thirsty.
On consultation within the community practice, the doctor takes a patient history. Her previous past medical history is hypertension which was diagnosed approximately 15 years ago and she takes Ramipril for this. More recently she has been diagnosed with stable angina, which is usually due to increased exercise. She rarely has an angina attack but takes GTN spray which has a good effect. She has never been admitted to hospital. She sees the doctor and is diagnosed with type 2 diabetes. This is because she has a high fasting, and had a high random blood glucose level, and she also has hyperglycaemic symptoms of lethargy, polyuria and thirst.
She has no known drug allergies. At the clinic Mrs Kwok’s observations are respirations 18/min, Heart rate 80/min, strong and regular, Blood pressure 180/70mmhg and Temperature 36.0. Blood glucose 15.2mmol/l. She is alert and orientated.
Madam Kwok does not smoke or drink any alcohol.
Her weight is 75kg and height 1.5m (150cm) which equates to a Body Mass Index (BMI) of 33.3. She eats three meals a day at breakfast, lunch and evening. She does try to have a healthy diet but she has a sweet tooth and often has snacks in between meals. Her daughter has also been telling her that she should try and reduce her carbohydrate portion sizes and fat content, but she thinks this is not necessary.
Her mobility is limited and she hasn’t been walking as much over the last couple of months as she has been experiencing some pain in her right foot, but has not taking any painkillers for it. She is also worried about walking and causing an angina attack. The foot pain is a sharp, burning pain and often happens at night. She finds if she gets out of bed and stands on a cold floor this helps take the pain away. She has never attended a podiatrist as she feels she can look after her own feet and she has always managed to cut her own nails.
Despite her limited mobility she still manages to do the housework, and she also does the shopping although she relies on her husband to take her in the car. She enjoyed gardening and this was her hobby, however in the spring this year she struggled to tidy the garden after the winter as she felt so tired. Due to all of these factors she does feel low in mood a lot of the time, and her family have also noticed this.
The doctor and practice nurse explain that she will be cared for in the community practice, and that her lifestyle will be assessed first to identify any important areas for behaviour change. She has been taught how to monitor her own blood glucose. She will be reviewed in one month to consider whether she needs medications to control her blood glucose.
They mentioned the importance of regular exercise however Madame Kwok had never undertaken regular exercise before and is concerned how this will affect her blood glucose.
The formative assignment should include 500 word outline including the following:
1. A brief introduction of the epidemiology and aetiology of the chronic condition.
2. A presentation of one common symptom relevant to the chronic condition and scenario
3. Evaluate one advantage and one disadvantage of a relevant assessment tool related to the condition and/or symptom.
4. A brief conclusion summarising the key points
5. References (maximum of 3) (not included in word count).
