n Interpret the meaning of each of the patient’s abnormal lab and diagnostic test results, as it relates to his medical problems. Include Scholarly References. See Case Study Data below: Mr. Tompkins is a 62 year old Native-American male. He comes in today because of the following symptoms: 1. Increasing dyspnea on minimal exertion (DOE) and 2. Swelling in his legs for the past week. 3. He has also noticed that his lower legs are red, warm to the touch, and mildly painful (4/10 on a pain scale). 4. His blood sugars on his fingersticks have been high – 190 fasting in the morning and 290 before evening meal.
5. He has gained 10 pounds since his last visit one month ago. His diet has not changed although he has been less active the past week due to the swelling in his legs. He denies chest pain, cough, fever, hemoptysis, taking any OTC meds, polyuria, polydipsia, and polyphagia. Medical History Diabetes Mellitus Type II for 5 years Family History Wife, children, and four living siblings have diabetes mellitus type II. His father and two brothers, now deceased, had hypertension as well as DM type II. Causes of deaths are not known. Medications Metformin increased to 1 Gm bid 30 days month ago to bring his sugars down about 20- to 30-points in the morning and evening. Allergies None reported. Social History Patient does not smoke or drink. Physical Examination Weight 225 lbs +10 pounds since his last visit 1 month ago, BMI 30 BP – 158/100, P – 100, T – 98, O2 sats – 94% room air at rest S3 & S4 gallop, + JVD, bibasilar crackles, 3+ pitting edema. The skin on his ankles to mid-calf is red, warm, slightly scaly, and tender to the touch. Labs Hemoglobin – 12 (13.8 – 17.2) Hematocrit – 38( 41 – 50) RBC Indices (MCV, MCH, MCHC) – In normal ranges WBC (white blood cells) – 12 (4.5 – 10.5) (differential is pending) BUN (blood urea nitrogen) – 22 (7 – 20) 6/8 Creatinine – 1.6 (0.8 – 1.4) Total cholesterol – 240 (<199) HDL (high-density lipoprotein) – 35 (>59) LDL (low-density lipoprotein) – 180 (<130) Triglycerides – 400 (30 – 149) Radiology Results of recent chest X-ray are pending.