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Sara Thompson a 60-year-old woman with a 3-year history of diabetes was seen last week by her doctor 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. Her last glycosylated (glycosatedhemoglobin measured 1 month ago was 6.8% (normal 4–6%). 

Today Sara seems anxious with a blood pressure 130/70 mmHg, pulse 120, respiratory rate 24, and weight 90 kgYou hear wheezing when she breathes, while she is resting in a chair. No cyanosis is present. O2 Sat: 88%

When she visited the doctor last week she started on albuterol inhaler 2 puffs qidAnd she was also started on a course of prednisone at 40 mg/day for 3 days, tapering over 2 weeks. Today when she checked her blood glucose level is 12mml/L at 8:00 a.m.


1. List all the information in the case study that should be reported to the supervisor.


2. What does “No cyanosis is present” mean?


3. When type diabetes is ‘managed with diet and exercise’ what does that mean?


4. What is albuterol inhaler for?


5. Besides diet and exercise what other care activities are important for diabetics to follow?


6. Sara says that it is time for her inhaler and asks you to bring it to her.  She tells you she left it in her bedroom. When you go to get it for her, you can’t find it. What do you do?


7. What is dyspnea and what can you do to help her feel more comfortable?


8. What is glycosylated (glycosated) hemoglobin?