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Mary is a 65-year-old woman with a 3-year history of diabetes is seen...

Mary is a 65-year-old woman with a 3-year history of diabetes is seen...

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Author: brecht 2017
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Mary is a 65-year-old woman with a 3-year history of diabetes is seen in the hospital for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease

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 Mary is a 65-year-old woman with a 3-year history of diabetes is seen in the hospital for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. 
She was treated via a three-day stay in the hospital and sent home with a drug regime and since then has been seen in the ER two times and now re-hospitalized with shortness of breath and blood sugar of 245. She does not understand why the medications are not working. She needs to be healthy because she is the only caregiver for her ailing bed-ridden husband with ALS. 
Mary is the only caregiver and takes all of her medication but eats on the run when not caring for her husband. She now does not exercise and only goes out of the home for doctor visits and grocery shopping. She is always tired and is extremely worried about her husband’s health issue. 
They are on a fixed income since retirement. 
During the hospital stay she was put on new medications and one of them was Prednisone. The doctor has told her to change her lifestyle, continue with meds and to monitor her vital signs at home. He has also suggested a move to an assisted living center. She has many questions about assisted living. She is willing to do anything but has no one to help her make this decision. They have no family or close friends near them. 
The nurse just came in and told her she is discharged, handed her a bunch of papers about diet, exercise, and diabetes and said a home health nurse would come to the house in a few days. 
Directions: 
Formulate searchable, clinical questions in the PICO(T) format using the material is this case study. 
There are several potential questions that could be asked, but you only need to identify two. Determine if the focus of each question is assessment, etiology, treatment, or prognosis. 


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