NR 508 Week 5 Case Study Discussion: Case of Maria-Chamberlain College Of Nursing:SATISFACTION GUARANTEED

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Week 5: Discussion No unread replies. No replies. Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for mild depression and moderate obes... ity. 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 67" tall and weighs 225lbs today, no current medication. She does report taking a multivitamin daily but feel tired still, 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%, TSH 5.6. 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. Dr. Ruck and class, Goal of treatment for Maria 1. My goal of treatment is to maintain optimal glycemic index and prevent complications of diabetes. 2. Lifestyle changes through weight reduction, at present, Maria’s body mass index is 36.4 which I got by calculating her height and weight. My goal is to have a detailed discussion with Maria by looking at her work schedule and other This study source was downloaded by 100000831988016 from CourseHero.com on 04-24-2022 10:48:26 GMT -05:00 https://www.coursehero.com/file/36758090/NR-508-Week-5-PharmacologyDiabetesDiscussionsdocx/ activities and develop personal weight management strategies that will fit into her schedule it could be something as small as adding 30 minutes’ walk or exercise. 3. Another goal is to reduce hemoglobin AIC below or equal to 6.5% which is regarded optimal target by American Association of Endocrinologist (2016). 4. Diabetic group meeting: One of the recommendations made by American Diabetic Association (2018) is to encourage group settings and platforms that are technology based which will help Maria diabetic education and support. Also, because of Maria’s history of depression, group meetings will empower her and help her get support and encouragement with her diabetes management. 5. Dietary consideration: Another important factor is dietary approaches to stop hypertension (DASH diet). It is very important to help Maria, to change her dietary habit in order to prevent hypertension which can further complicate her diabetes. This can be achieved by referring Maria to a dietician in addition for meal planning and healthy diets. American Diabetic Association (2018), also recommend plant based meal and vegetables, and Mediterranean diet 6. Education: Understanding the disease, her family history and the risk associated with the new diagnosis will help Maria to adequately take care of herself. Maria needs to understand that diabetes is one of the highest causes of morbidity and mortality in the United States and all over the world if it is poorly managed. 7. Prevention of Microvascular diseases like stroke and MI plus prevention of Macrovascular diseases like retinopathy is very important in the goal of This study source was downloaded by 100000831988016 from CourseHero.com on 04-24-2022 10:48:26 GMT -05:00 https://www.coursehero.com/file/36758090/NR-508-Week-5-PharmacologyDiabetesDiscussionsdocx/ treatment. This can be achieved through diet and life style changes that have already been incorporated and an addition of monotherapy. 8. Another goal of therapy for Maria will be to do complete metabolic profile to assess renal competency including GFR and lipid profile which was done six months ago this will help me to choose effective patient centered treatment for Maria and also assess cardiovascular health. What is your plan for drug therapy? What is the mechanism of action for each drug? According to Association of Clinical Academy of Endocrinologist (AACE) (2018), monotherapy should be considered for those with hemoglobin AIC (HBAIC) of less than 7.5% although in some cases higher targets are required for some people. The medication I will give to Maria is Metformin 500mg twice daily. I chose to begin with the lowest dose at this time and will continue assess Maria’s blood glucose log which I will ask her to keep for the first 6 months. This will include her fasting blood glucose at home and after meal blood glucose. The medication can then be adjusted if needed. Mechanism of Action: Metformin helps with glycemic control. It does this by decreasing gluconeogenesis and decreasing the production of hepatic glucose (Woo & Robinson, 2016). Metformin helps with the uptake and utilization of peripheral glucose; therefore increasing target cell insulin sensitivity, it also enables good hepatic blood glucose control (Woo & Robinson, 2016). People who are taking metformin have the advantages of weight control because metformin causes weight loss (Woo & This study source was downloaded by 100000831988016 from CourseHero.com on 04-24-2022 10:48:26 GMT -05:00 https://www.coursehero.com/file/36758090/NR-508-Week-5-PharmacologyDiabetesDiscussionsdocx/ Robinson, 2016). Metformin also improve cardiovascular safety. However, according to AACE/ACE (2018), metformin should not be used for patients with a GFR less than 30ml/min 1.7m2 and not recommended to be initiated for patients with a GFR between 30-45ml/min 1.73m2. Five Teaching Point for Metformin  This medication will help to control your blood sugar by helping your body respond to insulin and control the amount of sugar your body absorbs after food.  Take this medication regularly as ordered in order to get the optimum benefit of the medication and prevention of complications associated with diabetes such as stroke, heart attack and retinopathy  Check your blood sugar before m [Show More]

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