Week 5 Discussion (Initial Post)
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 fasti
...
Week 5 Discussion (Initial Post)
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.
What are your treatment goals for Maria?
Maria, a 46-year-old woman presents to the clinic for her yearly physical examination. At today’s
clinic visit, it is noted that she has positive glucose in her urine, has a fasting plasma glucose
(FPG) of 179 mg/dL (normal is <100 mg/dL and type 2 diabetes is = 126 mg/dL), hemoglobin
A1C (HbgA1C) of 7.4% (normal < 5.7% and type 2 diabetes is = 6.5%), and is considered obese
with a body mass index (BMI) of 35.3 (obese status is 30.0 and above) (Siu, 2015; CDC, 2017).
Maria’s vital signs are otherwise normal except for her blood pressure of 120/70, which could be
categorized as elevated (120 to 129 mm Hg systolic and less than 80 mm Hg diastolic)
(Armstrong, 2018). Based on Maria’s FPG, HbgA1C, BMI, and first-degree relative with
diabetes, she meets the criteria for the diagnosis of type 2 diabetes (DM). The treatment goals for
Maria at today’s clinic visit include: regulation of normal blood glucose, prevent organ damage
from disease advancement, and provide appropriate individualized diabetes self-management
education (Woo and Robinson, 2016). Patient education on lifestyle modifications need to be
reinforced by teaching Maria about the risk factors associated with her lifestyle choices including
increased morbidity and mortality from diabetes, hypercholesterolemia, hypertension, and
cardiovascular disease. Lastly, I would also want to assess Maria’s renal and hepatic function
prior to initiating drug therapy during this clinic visit.
What is your plan for drug therapy? What is the mechanism of action for each drug?
Type 2 DM, which occurs in up to 95% of persons with diabetes, is typically managed with
lifestyle modifications (diet and exercise) and oral antihyperglycemic medication (Hauk, 2017).
Maria appears to be ed
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