interdisciplinary team

Interdisciplinary Team (Workgroup) Assignments

Please use your discussion posts to answer the following question using both your professional knowledge and the best available research evidence:

What do you think your professional role is in this case study?

Original posts should be a minimum of 250 words and incorporate the use of additional resources. Please remember to cite your references using APA format.

In addition to your original post, you will be required to provide 2 follow-up posts to team members outside of your professional discipline that are Physical Therapy and Athletic Training.  (suggest to them things that they can do to help the patient) Response posts should be a minimum of 130 words. Your response posts should be relevant and add supplementary content to the overall thread.

 

Case Presentation

You first met Mary Smith, a 14-year-old African American female, when she comes to your urban community health center for “follow up’. Three weeks ago, while visiting her aunt in another city during summer vacation, she became ill and was hospitalized for 3 days. Hospital records document that Mary presented to the hospital ER with persistent vomiting, polyuria, and excessive thirst. She had been ill for the past 2 days. Her past medical history was uneventful and her prior health described as excellent. Although sluggish, she was oriented to time, person and place. On physical exam, her pulse was 108, respirations 30, temp 98.6, BP 130/90, and weight 142 lbs. Lungs clear to auscultation, heart sounds normal, and abdomen was soft without hepatosplenomegaly. Notable among Mary’s laboratory results, blood glucose was reported as 500 mg/dL, serum sodium 128 mEq/L, and blood urea nitrogen (BUN) 40mg/dL. Venous blood gas results were with pH 7.12 and pCO2 10. Urinalysis result demonstrated specific gravity > 1.030, large glucose, and large ketones. Hemoglobin A1C was 12% and ICA and GAD antibodies were reported as negative.

She was discharged from the hospital on a two injection per day regimen of combined short- and intermediate- acting insulin. Mary is currently monitoring her blood glucose levels four time per day. She complains of feeling very hungry before lunch and at bedtime. Mary does not bring her blood glucose records but does bring her blood glucose meter to the visit. Review of blood glucose values stored in the glucometer memory demonstrate readings in the range of 80-100 mg/dl before breakfast and dinner and readings in the range of 60-80 before lunch and at bedtime.

You discover that Mary’s maternal grandmother and uncle have type 2 diabetes. Mary’s uncle receives dialysis for diabetes-associated end stage renal disease. Mary has two younger siblings, an 11-year brother and a 5-year old sister. You ask Mary’s mother to wait in the waiting room while you talk to Mary and complete her physical examination.

History:

Your conversation with Mary reveals the following: Menarche occurred 2 years ago; her menstrual periods are irregular and occur every 2 to 3 months. She denies any sexual activity, smoking, or drug use. Mary administers all insulin injections and talks about how hard it is to resist eating “junk food”. She plays softball on a school team 2 days per week but is inactive on other days. She is in the 9th grade and is a “B” student. She has several friends but has not told anyone about her diabetes. She asks you, “Will I always need to take insulin?” You respond by saying that for now she needs to continue with injectable insulin to control her hyperglycemia, and that you need additional information before you can answer her question.

Physical Examination Findings:

You go on to complete her physical examination before deciding on your plan of care for this long-term diagnosis.

Height: 63 inches (50th percentile); weight 150 lbs (90-95th percentile); BMI 26.6 kg/m2 (90-95th percentile); blood pressure 132/86 (>95th percentile for age and height); heart rate 78 bpm; respirations 14 bpm; office urinalysis pH 7.0, specific gravity 1.010; glucose, protein, and ketones negative. Mary’s physical exam is positive for the presence of moderate acanthosis nigricans on the back of her neck and axillae.

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