CC: Observe up post-sanatorium discharge.
SUBJECTIVE: That is a 66-twelve months-feeble sad male with a PMH of HTN, IDDM2, and prostate most cancers s/p prostate radiation treatment. Surgical Hx: Prostate surgical treatment and supreme radiation Might perhaps also fair 2022, FMHx: is major for DM, HTN in his grandmother, Social Hx: denies alcohol and tobacco employ, allergic reactions: NKDA. The patient items for a observe-up skedaddle to after being hospitalized for hyperglycemia. Clinic admission changed into from 9/5-10/2024 at SJH with a blood glucose diploma of 800 mg/dl upon admission. He changed into no longer in diabetic ketoacidosis (DKA) and tested detrimental for ketones. HBA1C changed into >14% per the sanatorium discharge summary. The patient admits to being non-compliant with insulin and oral glycemic medicine. He endorses no longer the employ of insulin Novolin R and Lantus for the previous eight months before sanatorium admission. At some stage within the overview, the patient advised symptoms of polyphagia, polyuria, and polydipsia. He denies tingling and numbness within the decrease extremities, unintended weight loss, cough, chest anxiety, SOB, dizziness, blurry vision, palpitation, or headaches. Fingerstick blood glucose changed into 220 mg/dl within the place of business, and he reported drinking feeble-long-established oatmeal without added sugar three hours prior.
OBJECTIVE:
Major Indicators: Ht(without shoes) 178 cm (5’10”). Wt. (dressed) 89.34 kg (197 lbs.) (BMI: 28.3 kg/m2) BP 132/96 mmHg (appropriate arm seated); 135/90 mmHg (left arm, seated); with broad cuff. Heart rate (HR) 96 bpm and conventional. Respiratory rate (RR) 18 bpm. Temperature (oral) 97. 6°F, Spo2: 98% Room air.
Eyes; Vision 20/20 in both eyes. Visual fields plump by incompatibility. Conjunctive pink; sclera white. Pupils 4 mm constricting to 2 mm. PERRLA. EOMI. Disc margins though-provoking, without hemorrhage, exudate. No arteriolar narrowing or A-V nicking.
Ears: Ear canal certain bilaterally. TM certain bilaterally; bilaterally Ear handsome cone of sunshine. The cone of sunshine is at 5 o’clock within the correct ear and 7 o’clock within the left ear. Rinne take a look at: Optimistic bilaterally (AC > BC). Weber midline: No lateralization. Mastoid course of: No tenderness infamous bilaterally.
Nostril Mucosa pink, septum midline. No sinus tenderness. No polyps, turbinates intact, no proof of bleeding.
Mouth: Oral mucosa pink. The dentition is handsome. Tongue midline. Tonsils 1+. Pharynx without exudates.
Neck: Neck Supple. Trachea midline. Thyroid isthmus palpable, lobes no longer felt.
Lymph Nodes: No cervical, axillary, or epitrochlear nodes.
Thorax and Lungs: Thorax Symmetric with handsome growth. Lungs resonant on percussion. Breath sounds vesicular with no added sounds. Diaphragms descend 4 cm bilaterally.
Cardiovascular: Stylish rate and rhythm, coronary heart rate 96 bpm. Crisp S1 and S2. At the atrocious, S2 is louder than S1. At the apex, S1 is louder than S2. There are no murmurs or extra sounds.
Stomach: soft, non-comfy + BS no guarding
Diagnostics:
Blood Glucose Monitoring:
· In-place of business fingerstick blood glucose: 220 mg/dl.
Laboratory Exams:
· HBA1C: >14% (from sanatorium discharge summary), indicating poorly controlled diabetes.
· Overall Metabolic Panel (BMP): To assess kidney neutral, electrolyte ranges, and glucose.
· Fasting Lipid Panel: To assess cholesterol ranges and cardiovascular chance.
· Urine Microalbumin: To examine for early signs of diabetic nephropathy.
Blood Stress Monitoring:
· Blood Stress readings in-place of business 132/96 mmHg (appropriate arm) and 135/90 mmHg (left arm).
Evaluate: 66-twelve months-feeble male with poorly controlled IDDM2, non-compliance with insulin treatment, fresh sanatorium admission for hyperglycemia, hypertension, and prostate most cancers (s/p radiation treatment). Hyperglycemia is doubtless secondary to medicine non-compliance.
Elevated HBA1C >14%, indicating severely uncontrolled diabetes.
Blood stress is moderately elevated diastolic blood stress (DBP) >90.
Concept:
· Medications:
· Metformin HCL 500 mg tablet, take one tablet by mouth thrice every day
· Novolin 70-30, 100-unit insulin pen, inject six items subcutaneously thrice every day before each and each meal
· Lantus 100 items insulin pen, inject 24 items subcutaneously at bedtime
· Norvasc 10 mg tablet, take one tablet (10 mg) by oral route once every day
· lisinopril 2.5 mg tablet, take one tablet (2.5 mg) by oral route once every day
· Continues Glucose monitoring (CGM) Dexcom-G7 sensor/reader commerce every ten days.
Education:
· Procedures: None at the present
· Education:
The risks of uncontrolled diabetes, including doable complications, had been discussed. Educate on recognizing symptoms of hyperglycemia and hypoglycemia.
The importance of a balanced weight loss arrangement and constant carbohydrate intake the employ of my plate meal planner to devise my weight loss arrangement.
Help increased physical job, equivalent to 150 minutes of brisk strolling thrice weekly.
Emphasize the importance of medicine adherence, including traditional insulin employ (Novolin R and Lantus).
Schedule training classes with a diabetes educator to toughen working out of insulin employ, weight loss arrangement, and monitoring.
Help frequent dwelling blood glucose monitoring (as a minimal thrice per day). Prior to breakfast, lunch, and two hours after dinner. The aim purpose of FS is between 120-130 mg/dl before breakfast and 160-180 mg/dl two hours after dinner.
Help dwelling blood stress monitoring with the purpose of
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