NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders

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NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders

Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders

Nutritional disorders in older adults may present in many different ways and be caused or affected by a number of patient factors and comorbidities. Consider a patient with decreased cognitive function and mobility who may experience undernutrition because of low variety and quantity of food consumed. Another patient suffering from obesity may experience fatty liver, diabetes, or colon cancer due to dietary fat intake. Issues such as food scarcity and cost also play a role in nutritional disorders for this population. NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders

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This week, you explore geriatric patient presentations nutritional disorders, as well as endocrine and metabolic disorders. You also examine assessment, diagnosis, and treatment for these disorders and complete a SOAP note.

Learning Objectives

Students will:

  • Evaluate patients presenting with endocrine, metabolic, or nutritional disorders
  • Develop differential diagnoses for patients with endocrine, metabolic, or nutritional disorders
  • Develop appropriate treatment plans, including diagnostics and laboratory orders, for patients with endocrine, metabolic, or nutritional disorders
  • Analyze the diagnosis and treatment of endocrine, metabolic, or nutritional disorders

Learning Resources

Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Recommended Media (click to expand/reduce)

Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

Like many disorders affecting other systems, those related to endocrine, metabolic, and nutritional concerns have specific considerations for geriatric populations. Accurate history taking of symptoms associated with these disorders is essential for completing an assessment of the older adult, since onset of symptoms (for example, with some endocrine disorders) may appear more subtly than those in younger patients. It can also be difficult to determine onset and severity of illness in older adults.

Keep in mind special considerations for older adults as you complete your case analysis and SOAP note on endocrine, metabolic, and nutritional disorders.

Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images

To prepare:

  • Review the case study provided by your Instructor.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources. NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders

The Assignment:

Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:

  • Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
  • Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
  • Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned. NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders
  • Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.

By Day 7

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Submission and Grading Information

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Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Content

Name: NRNP_6540_Week9_Assignment_Rubric

Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

Excellent Good Fair Poor
Create documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned. 

In the Subjective section, provide:

• Chief complaint

• History of present illness (HPI)

• Current medications, checked against Beers Criteria

• Allergies

• Patient medical history (PMHx)

• Review of systems
Points Range: 9 (9%) – 10 (10%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.
Points Range: 8 (8%) – 8 (8%)
The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 7 (7%) – 7 (7%)
The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.
Points Range: 0 (0%) – 6 (6%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.
In the Objective section, provide: 

• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses
Points Range: 9 (9%) – 10 (10%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
Points Range: 8 (8%) – 8 (8%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
Points Range: 7 (7%) – 7 (7%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
Points Range: 0 (0%) – 6 (6%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide: 

• At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
Points Range: 23 (23%) – 25 (25%)
The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 20 (20%) – 22 (22%)
The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.
Points Range: 18 (18%) – 19 (19%)
The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.
Points Range: 0 (0%) – 17 (17%)
The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
In the Plan section, provide: 

• A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits.

• A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors.
• Reflections on the case describing insights or lessons learned.
Points Range: 27 (27%) – 30 (30%)
The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 24 (24%) – 26 (26%)
The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking.
Points Range: 21 (21%) – 23 (23%)
The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics.
Points Range: 0 (0%) – 20 (20%)
The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care.
Points Range: 9 (9%) – 10 (10%)
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.
Points Range: 8 (8%) – 8 (8%)
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.
Points Range: 7 (7%) – 7 (7%)
Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.
Points Range: 0 (0%) – 6 (6%)
Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Written Expression and Formatting—Paragraph Development and Organization: 

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.
Points Range: 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards: 

Correct grammar, mechanics, and proper punctuation
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors.
Points Range: 3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors.Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Points Range: 4 (4%) – 4 (4%)
Contains a few (one or two) APA format errors.
Points Range: 3 (3%) – 3 (3%)
Contains several (three or four) APA format errors.
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ five) APA format errors.
Total Points: 100

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Name: NRNP_6540_Week9_Assignment_Rubric

Focused SOAP Note Template

Assignment: Week 9 case study

Case number 1: Low Blood Sugar

Patient Information:

Initials: S.L, Age: 63, Sex: Female, Race: African American

S (subjective)

CC (chief complaint):Continued fasting blood sugar of 50mg/dl.

HPI(history of present illness): Ms. Lewis is a 63yr old African American female came in with concern of low blood sugar in the low 50’s, especially in the morning fasting. This has continued for the past few weeks.

Current Medications:

  • Amlodipine 5mg 1 tablet orally daily
  • Aspirin 81mg 1 tablet orally daily
  • Women’s one A Day Multivitamin 1 tablet daily
  • Chlorthalidone 25mg 1 tablet orally daily
  • Fish oil 1 tablet orally daily
  • Atorvastatin 40mg 1 tablet orally at bedtime daily
  • Novolog 10units subcutaneously with meals three times a day
  • Lantus insulin 25units subcutaneous every night
  • Ergocalciferol 50,000 units orally once a month.

Allergies: Penicillin, Lisinopril

PMHx:Type 2 Diabetes mellitus, Hypertension, Hyperlipidemia, and chronic Osteoarthritis. Ms. Lewis is up to date with herannual Influenza vaccine, and last pneumonia vaccine was 3 years ago. Date of last Tetanus vaccine was 12/03/2018. COVID vaccination was 4/02/21 & 4/26/21.
Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
SocandSubstance Hx:Ms. Lewisis retired postal worker. She is divorced with 3 children, alive and healthy. Shenever smoked cigarette, non-drinker and never engages in illicit drugs. She lives inher own home, a one-story building with working smoke detectors. She uses seat belts while been driven by family members and has a strong support system—2 sons and 1daughter, family, and friends.

Fam Hx:No history of family illnesses or genetic predispositions.  Both parents are late, mother was hypertensive and Diabetic, while father had heart disease, and died of a stroke. No known medical history of late grandparents. She has 2 siblings, an elder brother—66yr and a younger sister- 60, both alive and well.

Surgical Hx:None of note

Mental Hx:No history of mental illness, depression non anxiety.

Violence Hx:No safety issues or concern. No history of sexual or elderly abuse.

Reproductive Hx:None of note

ROS (review of symptoms):

GENERAL: No history of recent weight loss and fever, chills, weakness, and fatigue.

HEENT:

  • Eyes:No visual loss, blurred vision, double vision or yellow sclerae.
  • Ears, Nose, Throat:No hearing loss, sneezing, congestion, runny nose, or sore throat. Denies visual or auditory hallucinations.

SKIN:Intact skin, no rashes non lesions.

CARDIOVASCULAR:No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:No complaint of shortness of breath. Nocough, or sputum production.

GASTROINTESTINAL No report of abdominal pain. No nausea non vomiting. No report of blood in stool.

ENDOCRINE: No history of diabetes, denied Polyphagia, polyuria.

GENITOURINARY:No report of dysuria, frequency, or hesitancy

NEUROLOGICAL:No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:Deniesmuscle pain, bone, and jointpains.No falls.

HEMATOLOGIC:Denies history of anemia, bleeding gumsand easy bruising.

LYMPHATICS:No report of enlarged lymph nodes. No history of splenectomy.

PSYCHIATRIC:No history of dementia, anxiety, depression non suicidal ideation.

ENDOCRINOLOGIC:Denies night sweating. No polyuria or polydipsia.

REPRODUCTIVE:Not Sexually active

ALLERGIES:No known drug allergy.No history of asthma, hives, eczema, or rhinitis.

O (objective)

Physical exam:Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

Vital signs: Temperature: 98.1, Pulse: 89, Respiration:20, B/P: 165/90, O2 Sat: 98%. HT:5’7, Weight: 176ibs, BMI: 27.6

General: 63yr old female patient is alert and oriented to time, space, and situation. Speech is clear and coherent. Patient well nourished, and appropriately dressed, and appeared stated age.

HEAD:Normocephalic, no masses or lesions.

EYES: Fair eye contact, intact visual fields. PERRLA, conjunctiva clear, sclera white, anicteric. EOMI, no ptosis, fundi: red reflux present.

EARS: TM’s non-injected. Non-bulging. Good light reflex, no protrusion or retraction. Weber midline. Whisper test 3:3

NOSE: Patent nares, no deformity, no septal deviation, or perforation.

THROAT: Pharynx non-injected, palate symmetrically, gag present.

MOUTH:Moist and intact buccal mucosa, tonsils present, intact dentition, void of caries. Tongue midline without inflammation.

NECK, AXILLA & BREAST: No lymphadenopathy, no masses or thyromegaly/focal lump. Carotid pulse 2+, no bruits. ROM: Full and Supple, trachea midline, breast symmetric. No lesions, lumps, masses, or tenderness.

LUNGS:Clear lung sounds all fields upon auscultation, no adventitious sounds (rales, crackles, wheezes, or rhonchi). Symmetric chest expansion. NRNP_6540 Week 9: Endocrine, Metabolic, and Nutritional Disorders

CARDIOVASCULAR:RRR, no murmur, rubs or gallops. Pacemaker to left chest wall.

ABDOMEN:Abdominal pain on palpation. No masses.

GENITOURINARY:No vaginal pain non discharge.

MUSCULOSKELETAL:No unusual motor movements or tics. Joint and bone pains/stiffness. Weak and lethargic.

NEUROLOGICAL: Alertand oriented to time, place, and situation. Affect is fair. Clear speech.

SKIN/NAILS: Good skin turgor. No lesions/rashes.

EXTREMITIES: Extremities are symmetric with no deformity, no swelling/atrophy. All pulses are present 2+.

PSYCHIATRIC: Alert and oriented to time, place and oriented. No suicidal thoughts or ideations.

Diagnostic Laboratory tests:

Chest X-ray: No cardiomegaly found, no mass or lesions noted.

Basal Metabolic Panel: Glucose: 85, Sodium: 134, Potassium: 4.2, Chloride: 104, Carbon dioxide: 29, Calcium: 9.0, BUN: 20, Creatinine: 1.01, e GFR: 76.

Complete blood count: WBC:7.3,RBC: 4.31, H&H: 14, 42, MCV: 90, MCHC:34, PLATELET: 272.

Vitamin D:  1.25.

A (assessment)

The prevalence of Type 2 diabetes mellitus has continued to increase in our society, as people live longer and heavier. Older adults over 65yrs, that are overweight with one or more risk factors are likely to be diagnosed with type 2 diabetes. These risk factors include—Obesity, sedentary lifestyle, hyperlipidemia, hypertension, history of gestational diabetes, close family history of type 2 diabetes and smoking (Kennedy-Malone, Martin-Plank, & Duffy, 2018). Older patients with Type 2 diabetes like Ms. Lewis are at increased risk for polypharmacy, functional disabilities like gait unbalance, depression, cognitive impairment, and incontinence (Munshi, Nathan, Schmader, Mulder & Givens, 2021), hence the management of other health conditions is important as it might influence the ability for self-management.

The diagnosis

The diagnosis of type 2 diabetes is either through double fasting blood glucose check with readings greater than or equal to126mg/dl or a random level greater or equal to 200mg/dl (Kennedy-Malone, Martin-Plank, & Duffy, 2018). The use of oral glucose tolerance test (OCTT), this test can be confusing in the elderly as it rises more rapidly after 2 hours, than in younger adults (Kennedy-Malone, Martin-Plank, & Duffy, 2018). Another method of diagnosis if the A1c testing, where a level greater than 6.5 is indicative of type 2 diabetes. It has been argued that a second confirmatory test should be done in the absence of other chronic health conditions.

P (plan

The management of diabetes requires self-management decision making and support for the patient. This support addresses the daily self-monitoring of glycemic target individualized to the patient (Powers, Bardsley, Cypress, Funnell, Harms, Hess-Fischi, Hooks, Isaac, Mandel, Maryniuk, Norton, Rinker, Siminerio, &Uelmen, 2021). The goal of treatment is to glycemic control, good nutritional health, weight management and exercise program. For Ms. Lewis, the goal is to control manage and prevent further hypoglycemia. Hypoglycemia is common in the older adults with diabetes.

Recommended medications

For Ms. Lewis, who has a personal history of hypertension and hyperlipidemia, and recent complaint of hypoglycemia for a couple of weeks. The first step is to control the hypoglycemia, by reviewing her blood glucose log for the past one month and immediate adjustments made. Addition of glucagon is recommended for all patients with level 2 hypoglycemia like Ms. Lewis. Type 2 hypoglycemia is blood glucose level less than 54 (American Diabetic Association, 2020).Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

 

 

I would reduce her Novolog from 10units three times a day, to twice a day. And reduce the Lantus dose from 25 units at bedtime to 15units. These changes will be re-evaluated in 1 week, while comparing her blood glucose log.

Another step will be to control her blood pressure reading, as current reading is 165/90mmHg. An addition of Angiotensin 11 receptor blocker — Losartan 25mg 1 tablet daily may be beneficial in hypertension management since she is allergic to an ACE inhibitor—Lisinopril. Another change may be to replace Atorvastatin with pravastatin, as it is the least diabetogenic of all the statins that has the potential of causing insulin insensitivity and lower insulin secretion (Kennedy-Malone, Martin-Plank, & Duffy, 2018). Addition of Metformin 500mg daily with breakfast, and Novolog removed from medication list, to prevent continued hypoglycemic incidents.

Health education:

Patient education for a diabetic patient should be individualized meeting the patient’s existing needs and health conditions. Education is aimed to improve clinical outcomes through maintenance of healthy behaviors like healthy diet, physical exercise to reduce patient morbidity and mortality (Liu, Shi, Willis, Wu, & Johnson, 2017). Education should be given at the patient’s level of health literacy, treatment goals, and response to treatment (Kennedy-Malone, Martin-Plank, & Duffy, 2018). Patient and family needs education on signs and symptoms of hypoglycemic incidents like extreme sweating, feeling faint, headaches, dizziness, nausea/vomiting, confusion, and stupor in extreme cases. Patient to carry hard candies, and diabetes card in her purse for easy identification in time of health emergency. Patient/family educated on self-monitoring of blood glucose (SMBG), as it is helpful in management of patients with type 2 diabetes and other chronic health conditions (incontinence (Munshi, Nathan, Schmader, Mulder & Givens, 2021). Patient and caregivers should know where the glucagon is, how and when to administer it (American Diabetic Association, 2020).

References

American Diabetes Association (2020). Glycemic targets: Standards of Medical care in Diabetes-2020. Care.diabetsjournals.org/content/43/supplement_1/s601/

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2018). Advanced practice nursing in the care of older adults. FA Davis.

Munshi, M., Nathan, D.M., Schmader, K.E., Mulder, J.E. & Givens, J. (2021). Treatment of type 2 diabetes in the older patient. Https://www.uptodate.com/contents/treatment-of-type-2-diabetes-mellitus-in-the-older-patient.

Liu, Xian-Liang, Shi, Y., Willis, K., Wu, C, J., & Johnson, M. (2017). Health education for patients with acute coronary syndrome and type 2 diabetes mellitus: an umbrella review of systemic reviews and meta-analyses. Bmjopen.bmj.com/content/bmjopen/7/10/e016857/full. Text/

Powers, M.A., Bardsley, J.K., Cypress, M., Funnell, M.M., Harms, D., Hess-Fischi, A., Hooks, B., Isaac, D., Mandel, E.D., Maryniuk, M.D., Norton, A., Rinker, J., Siminerio, L.M., &Uelmen, S. (2021). Diabetes self-management education and support in Adults with Type 2 diabetes. Https://www.pubmed.ncbi.nlm.nih.gov/34078207/ Assignment: Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders

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