22 Dec Discussion: Plan For Therapy Discussion: Plan For
Discussion: Plan For Therapy Discussion: Plan For Therapy Discussion: Plan For Therapy ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT:Discussion: Plan For Therapy NR 508 Week 5: Thyroid Disorders and Diabetes NR 508 Week 5: Discussion – Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for borderline hypertension and moderate obesity. Six months ago her fasting lipid profile was normal. Maria report that her mother and brother have diabetes and hypertension. She reports that she knows she should be on a low calorie, low fat diet and exercising but with her full time job and four children, she finds it difficult to exercise, and she eats out most of the time. She is 66″ tall and weighs 219lbs today, no current medication. She does report taking a multivitamin, biotin Vit-C when she remembers. She is a nonsmoker, only drinks sweet tea with each meal, 3-4 cups of coffee per day. Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 219 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%. Physical Exam reveals notable for acanthosis nigricans at the neck but otherwise is normal. What are your treatment goals for Maria? What is your plan for drug therapy? What is the mechanism of action for each drug? Please give five teaching points for each drug prescribed. How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale. ORDER NOW FOR A CUSTOMIZED PAPER What are your treatment goals for Maria? Treatment goals for Maria include oral medication implementation to treat the new onset diabetes type II and to educate Maria on the lifestyle changes that need to occur to manage this disease. It is essential that she understands the diet parameters as well as the need to incorporate exercise. Many support groups are available for newly diagnosed diabetes patients to help in the transition needed for the lifestyle changes as well as the ability to converse with professionals when questions arise. Maria will need to be educate on the use of operating a blood glucose machine and signs and symptoms to be aware of for both hypoglycemia and hyperglycemia. According to Melmer, Kempf, and Laimer (2018), studies showed that a diet program in combination with resistance training for 6 moths revealed a significant decrease in the HbA1c levels and after just 4 months many of the participants reduced the need for medications to control blood glucose levels. It is important to educate Maria that this disease can be controlled and possibly even eliminated with the proper lifestyle changes. According to the lab results both the fasting blood glucose level as well as the HbA1c were elevated but are manageable if changes and proper medication is applied. What is your plan for drug therapy? What is the mechanism of action for each drug? The drug that I have chosen to start Maria on as treatment for diabetes is metformin. According to Inzucchi, et al., (2015), Metformin is the chosen drug for monotherapy at this time. Metformin works by lowering hepatic glucose production as well as intestinal glucose absorption. When this occurs, it results in increased insulin sensitivity ultimately lowering the blood glucose level. For Maria I would choose to give the extended- release form of metformin and begin with a dose of 500 mg per day for 1 week and increase dose weekly as tolerated by 500mg until with the maximum dose being 2000mg per day (Epocrates). It is essential that Maria is monitoring her blood glucose levels and keeping a log in order to monitor effectiveness. I will follow up weekly until a 3-month scheduled visit when her HbA1c level will be reassessed and the need for further treatment options such as additional medications. I chose a one daily oral medication as the first treatment choice because this will hopefully increase the risk for compliance and management of the disease. In addition to medication treatment Maria will need to incorporate proper diet and exercise to avoid worsening symptoms and progression of diabetes. Metformin has also been shown to cause weight loss which is also beneficial in the management of diabetes. Please give five teaching points for each drug prescribed. Monitor and document blood glucose levels upon waking and before meals to monitor efficacy of medication. If blood glucose level less than 70 hold dose and contact our provider. Take Metformin at the same time each day, preferably in the morning to avoid hypoglycemic episodes throughout the day. Do not cut, crush, or chew metformin extended release. Performing these actions will change the efficacy of medication and possibly result in hypoglycemia. Common side effects of this medication include: diarrhea, nausea, vomiting, abdominal pain, headache, rash, metallic taste, indigestion, and ovulation induction. Signs of hypoglycemia symptoms include: excessive sweating, light headiness, fainting, blurred vision, fatigue, and confusion. If you experience severe fatigue, yellowing of the skin or eyes, persistent muscle cramps, loss of appetite, or altered mental status contact an MD immediately to be assessed for serious conditions. (Epocrates) How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale. If Maria had presented with the above lab results I would change her treatment plan to subcutaneous insulin rather than a oral medication. I would choose to place Maria Humulin N (NPH). This insulin in intermediate- acting insulin and would allow for one once daily administration subcutaneous injection. This particular medication works by “stimulating peripheral glucose uptake, inhibits hepatic glucose production, inhibits lipolysis and proteolysis, regulating glucose metabolism” (Epocrates). I would begin by prescribing 0.1 units/ kg/ day resulting in a dose of 10 units of NPH subcutaneous injection daily. According to Woo (2016), when a patient presents with blood glucose levels above 300 and a HbA1c over 10 insulin should be started rather than oral medications. According to Inzucchi, et al., (2015), it might also be reasonable to use combination therapy such as insulin and metformin as the beginning treatment for a HbA1c greater than 9. This is another option to discuss with the patient based on lifestyle, weight, and lab results. The patient will need follow up in three months to assess updated lab values and evaluate need for changes in the treatment plan. NR 508 Week 5: Discussion References Epocrates an athenahealth service. [Mobile Application Software]. Retrieved fromhttps://services.epocrates.comLinks to an external site. Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes.Diabetes Care,38(1), 140–149.https://doi-org.chamberlainuniversity.idm.oclc.org/10.2337/dc14-2441Links to an external site. Melmer, A., Kempf, P., & Laimer, M. (2018). The Role of Physical Exercise in Obesity and Diabetes.Praxis (16618157),107(17/18), 971. Retrieved fromhttps://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=131542645&site=eds-live&scope=siteLinks to an external site. Woo, T. M., & Robinson, M. V. (2016).Pharmacotherapeutics for Advance Practice Nurse prescribers(4th ed.). Philadelphia, PA: F. A. Davis Company. Chapter 33. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
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