D.T. is a 42-year-old woman who presents with numbness and weakness in her left foot for 3 weeks. She has a history of gestational diabetes, hypertension, and weight gain of 50 pounds in the last 10 years including 20 pounds in the last 6 months. She reports increased thirst and urination.

1. Chief Complaint
“My left foot feels weak and numb. I have a hard time pointing
my toes up.”
History of Present Illness
D.T. is 42-year-old Caucasian woman who has had an elevated
blood sugar and cholesterol 2 years ago but did not follow up
with a clinical diagnostic work-up. She had participated in the
state’s annual health screening program and noticed her fasting
blood sugar was 160 and her cholesterol was 250. However, she
felt “perfectly fine at the time” and did not want to take any
more medications. Except for a number of “female infections,”
she has felt fine recently.Today, she presents to the clinic
complaining that her left foot has been weak and numb for
nearly 3 weeks and that the foot is difficult to flex. She denies
any other weakness or numbness at this time. She does report
that she has been very thirsty lately and gets up more often at
night to urinate. She has attributed these symptoms to the
extremely warm weather and drinking more water to keep
hydrated. She has gained a total of 50 pounds since her last
pregnancy 10 years ago, 20 pounds in the last 6 months alone.
Past Medical History
Seasonal allergic rhinitis (since her early 20s)Breast biopsy
positive for fibroadenoma at age 30Gestational diabetes with
second child 10 years agoMultiple yeast infections during the
past 3 years that she has self-treated with OTC antifungal
creams and salt bathHypertension for 10 years
Past Surgical History
C-section 14 years ago
OB-GYN History
Menarche at age 11Last pap smear 3 years ago
Family History
Type 2 DM present in older brother and maternal grandfather.
Both were diagnosed in their late 40s. Brother takes both pills
and shots.Mother alive and wellFather has COPDTwo other
siblings alive and wellAll three children are alive and well

2. Social History
Married 29 years with 3 children; husband is a school
teacherFamily lives in a four bedroom single family
homePatient works as a seamstressSmokes 1 pack per day (since
age 16) and drinks two alcoholic drinks 4 days per weekDenies
illegal drug usesNever exercises and has tried multiple fad diets
for weight loss with little success. She now eats a diet rich in
fats and refined sugars.
Allergies
NKDA
Medications
Lisinopril 10 mg dailyLoratadine 10 mg daily
Review of SystemsGeneral
Admits to recent onset of fatigue
HEENT
Has awakened on several occasions with blurred vision and
dizziness or lightheadedness upon standing: Denies vertigo,
head trauma, ear pain, difficulty swallowing or speaking
Cardiac
Denies chest pain, palpitations, and difficulty breathi ng while
lying down
Lungs
Denies cough, shortness of breath, and wheezing
GI
Denies nausea, vomiting, abdominal bloating or pain, diarrhea,
or food intolerance, but admits occasional episodes of
constipation
GU
Has experienced increased frequency and volumes of urination,
but denies pain during urination, blood in the urine, or urinary
incontinence
EXT
Denies leg cramps or swelling in the ankles and feet; has never
experienced weakness, tingling or numbness in arms or legs
prior to this episode
Neuro

3. Has never had a seizure and denies recent headaches
Derm
Has a rash under her bilateral breast and in groin area
Endocrine
Denies a history of goiter and has not experienced heat or cold
intolerance
Vital Signs
BP 165/100, T 98 F, P 88 regular, HT 5 feet 4 inches, RR 20
non labored, WT 210 lbs
What you need to do:
Develop an evidence-based management plan.Include any
pertinent diagnostics.Describe the patient education
plan.Include cultural and lifespan considerations.Provide
information on health promotion or health care maintenance
needs.Describe the follow-up and referral for this
patient.Prepare a 3–5-page paper (not including the title page or
reference page).
Format
The paper should be no more than 3–5 pages (not including the
title page and reference pages.
Assignment Requirements:
Before finalizing your work, you should:be sure to
read the Assignment description carefully
(as displayed above);
consult the Grading Rubric
(under the Course Resources) to make sure you have included
everything necessary; andutilize
spelling
and
grammar check
to minimize errors.Your writing Assignment should:follow the
conventions of
Standard American English
(correct grammar, punctuation, etc.);be
well ordered
,

4. logical
, and
unified
, as well as
original and insightful
;display
superior content, organization, style,
and
mechanics
; anduse
APA 6th Edition
format as outlined in the
APA Progression Ladder
.