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Katia Gedeon
Clinical Experience
I worked in a clinic where I majorly dealt with outpatient adults from different backgrounds and cultures. The experience was both exciting and challenging. One main challenge that I experience was creating a personal connection with some of the patients. This challenge was most predominant in situations where I met patients who had strong religious beliefs against medical norms. Convincing these people to embrace medication while also respecting their ideas was a challenge.
I attended to a 60-year-old white female who had come up for a follow-up concerning her diabetes management and further assessment. She had multiple medical conditions such as type 2 diabetes diagnosed in 1998, asthma, hypertension, coronary artery disease, hyperlipidemia, and persistent peripheral edema. The patient’s medical history included knee replacement, emergency room admissions for asthma, anemia, and atrial fibrillation with cardioversion.
The patient’s diabetes was being managed with premixed preparation of seventy-five percent insulin lispro protamine suspensions with twenty-five percent insulin lispro preparations, 23 units before supper, and 33 units before breakfast. The patient stated that at times she takes little extra insulin when she experiences high blood glucose readings. However, the patient had not been educated on how to make use of the insulin adjustment algorithm. The patient’s other medications routine included two puffs twice a day for salmeterol MDI (Seventh MDI), a fluticasone metered-dose inhaler (Flovent MDI), and 375 mg twice per day; enteric-coated aspirin.
Her chief complaint during the visit was increasing exacerbations of asthma and the need for prednisone tapers. She states that her blood glucose readings rose to 300-400 mg/dl during the last round of the prednisone therapy even though she vastly reduced carbohydrate intake. The main lesson I learned during the clinical experience was the importance of collaboration. I realized that health professionals need a lot of teamwork for them to realize success within the organization. This was most essential during emergency cases like the one described here. The practitioners worked as a team, and there was a lot of collaboration that eventually saved situations.
Physical Examination
The patient was obese but well-appearing and was not in acute distress. Physical exam revealed:
- BP: 130/78
- Weight: 302 lb
- Pulse 88 bpm, respirations 22 per min
- Lungs: Without rhonchi, rales, or wheezing
Lab Results
- Creatinine: 0.7 mg/dl
- Potassium: 3.4 mg/dl
- Calcium: 8.2 mg/dl
- Sodium: 140mEq/l
Assessment
- Persistent, severe, poorly controlled asthma
- Obesity, stable
- Diabetes: Controlled but recently worsened by asthma treatment and exacerbations
- Inadequate patient’s education concerning the role and purposes of specific medications
After a broader collaboration, it was decided that the patient’s high blood glucose levels and asthma exacerbations to be tackled first. Therefore, she was counseled on the importance of the maintenance of asthma medications instead of rescue drugs (Foer et al., 2021). She was eventually willing to change to a product that combined fluticasone and salmeterol (Advair Diskus). Furthermore, her insulin was changed to a particular basal-based regimen that utilizes glargine and premeal lispro insulin. The education was offered on the dosing concept (Wu, 2021).
The main lesson I learned during the clinical experience was the importance of collaboration. I realized that health professionals need a lot of collaborations for them to realize success within the organization. This was most essential during emergency cases like the one described here. The practitioners worked as a team, and there was a lot of collaboration that eventually saved situations.
References
Foer, D., Beeler, P. E., Cui, J., Karlson, E. W., Bates, D. W., & Cahill, K. N. (2021). Asthma exacerbations in patients with type 2 diabetes and asthma on glucagon-like peptide-1 receptor agonists. American Journal of Respiratory and Critical Care Medicine, 203(7), 831-840. https://www.atsjournals.org/doi/abs/10.1164/rccm.202004-0993OC (Links to an external site.)
Wu, T. D. (2021). Diabetes, insulin resistance, and asthma: a review of potential links. Current Opinion in Pulmonary Medicine, 27(1), 29-36. https://journals.lww.com/co-pulmonarymedicine/Abstract/2021/01000/Diabetes,_insulin_resistance,_and_asthma__a_review.7.aspx
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