Pharmacological management of comorbid cardiovascular risk and type 2 diabetes is undergoing a paradigm shift.General practitioner Kevin Fernando puts recommendations from the ADA/EASD into practice in this patient case study.
She has fractured her left shoulder in two places and has just had surgery.
She has a history of osteoarthritis, had a mild stroke some years ago, has mild congestive cardiac failure, a mild cognitive impairment and wears glasses for myopia and hearing aids.
I tell her that I’ll help her settle in and then we will run through a few tests to make sure we give her the right care while she’s here.
Elsie denies that she’s in any pain, but I notice she is wincing when I help her move around in bed.
She’s a bit drowsy so I’ll need to assess her ability to use the bell and repeat the instruction again.
I let her know that we that I’ll be checking in on her regularly to monitor her pain and provide medication if necessary, help her with getting comfortable, see if she needs to go to the toilet and help with anything else.
In the bathroom, the small amount of urine she passes is very dark in colour.
I show her how to sit on the commode safely and I explain that this is a sign of dehydration so we’ll need to keep her fluids up.
The doctor also notes that Elsie is at high risk of developing delirium from both unmanaged pain and dehydration.
She completes a frailty, pain and cognitive screen so that we can decide how to manage her symptoms and have a baseline on these areas to monitor throughout Elsie’s stay. With Elsie’s permission I call the GP to get more of a picture of her usual cognitive and physical function.