Diabetes Case Study Peer Review assignment

Diabetes Case Study Peer Review assignment

Are The Clinical Guidelines In This Case Study Appropriate?

According to the American diabetes association ADA, the diagnosis includes random blood sugar above 200mg/dl, fasting blood sugar above 126mg/dl, OGTT above 200mg/dl, and HbAIC above 6.5% (Chung, et al, 2020). The patient presents with symptoms of hyperglycemia (blurring of vision, fatigue, and generalized body weakness) and random blood glucose of 260mg/dl. Therefore, the diagnosis for the patient is hyperglycemia because there are no fasting blood sugar and A1C results. I agree with the ADA guidelines criteria for diagnosis. The guidelines recommend ongoing diabetes self-management and support programs, individualized programs for nutritional therapy, and increased physical activities to improve glycemic control. Diabetes Case Study Peer Review assignment

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Sodium-glucose cotransporter-2 inhibitor (SGLT2) like Empagliflozin is recommendable in diabetic patients with a risk of cardiovascular diseases (Davies, et al, 2018). Calcium channel blockers, ACE inhibitors, and angiotensin-receptor blockers are appropriate in treating hypertension in diabetes patients to reduce the risk of cardiovascular and kidney diseases (Woods, et al, 2019). The patient is at risk of cardiovascular diseases due to his inability to complete activities of daily living and history of hypertension, hyperlipidemia, and hyperglycemia. The guidelines recommend metformin as the initial lowering agent. However, it is not the best for the patient because it increases the risk of kidney injury. There is utilization of the ADA guidelines in treating diabetes by prescribing acarbose, which is cardio-protective for this patient. Moreover, the care provider recommends self-glucose monitoring for the patient and lifestyle modification to control the blood sugar.

Do You Agree With The Initial Treatment Plan?

The therapeutic goal for the patient is to control the blood glucose, hypertension, hyperlipidemia, and the complications of metabolic syndrome (coronary heart disease and kidney injury). Propranolol is a beta-blocker that inhibits glucose-induced insulin secretion thus increasing blood glucose levels, increasing blood cholesterol, and decreasing high-density lipoproteins (Lin, et al, 2020). It also masks the symptoms of hypoglycemia and hyperglycemia. Moreover, propranolol reduces cardiac output and renal perfusion pressure thus increasing the risk of kidney injury and cardiovascular disease. Therefore, it is not recommendable in elderly patients with hyperlipidemia and hypertension.  Diabetes Case Study Peer Review assignment

A fad diet causes nutritional deficiencies that may negatively affect the patient’s metabolism. Hence, the onset of metabolic diseases, and multivitamins help in filling the nutritional gap. I do not agree with the initial treatment of the patient because the American heart association recommends ARBs or ACEs as the first-line treatment for hypertension in elderly. Additionally, ADA recommends physical exercise and high fiber diet for weight loss. Arcabose is appropriate for the patient to control the blood glucose level by inhibiting the metabolism of sucrose to glucose and fructose. Atorvastatin is a lipid-lowering agent that inhibits rate-limiting in cholesterol synthesis hence lowering the total cholesterol in the blood. Arcabose and atorvastatin meet the therapeutic goal of blood glucose control and hyperlipidemia. Diabetes Case Study Peer Review assignment

Provide Evidenced-Based Addition Or Provide Constructive Feedback To The Case Study

Metabolic syndrome is the presence of hypertension, diabetes mellitus, obesity, and hyperlipidemia. It increases the risk for cardiovascular diseases, kidney injury, and osteoarthritis. The patient has symptoms of cardiovascular disease because he is unable to perform activities of daily living. He has kidney injury due to the high creatinine and urea. Therefore, consideration of the comorbidities prevents complications and drug interactions during drug prescription. This patient should have renal and cardioprotective drugs for diabetes and hypertension (Woods, et al, 2018). Lower doses of statins for example atorvastatin 40mg is recommendable in patients with diabetes mellitus to reduce the risk for hyperglycemia. Patient education on the signs and symptoms of hypoglycemia and hyperglycemia is important to help in self-monitoring and treatment at home. Patient education helps the patient comply with treatment hence, improving the outcome. Referring the patient to a physician helps control hypertension and diabetes. The nephrologist and cardiologist monitor and treats kidney and heart disease.  Lifestyle modification is the mainstay treatment for metabolic syndrome Diabetes Case Study Peer Review assignment

References

Chung, W. K., Erion, K., Florez, J. C., Hattersley, A. T., Hivert, M. F., Lee, C. G., … & Franks, P. W. (2020). Precision medicine in diabetes: a consensus report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes care, 43(7), 1617-1635. Diabetes Case Study Peer Review assignment https://doi.org/10.2337/dci20-0022

Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., … & Buse, J. B. (2018). Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of diab(EASD). Diabetologia, 61(12), 2461-2498. https://doi.org/10.17632/h5rcnxpk8w.1 

Lin, S. Y., Wang, Y. Y., Chang, C. Y., Wu, C. C., Chen, W. Y., Kuan, Y. H., … & Chen, C. J. (2020). Effects of β-adrenergic blockade on metabolic and inflammatory responses in a rat model of ischemic stroke. Cells, 9(6), 1373. https://doi.org/10.3390/cells9061373

Woods, T. C., Satou, R., Miyata, K., Katsurada, A., Dugas, C. M., Klingenberg, N. C., … & Navar, L. G. (2019). Canagliflozin prevents intrarenal angiotensinogen augmentation and mitigates kidney injury and hypertension in mouse model of type 2 diabetes mellitus. American journal of nephrology, 49(4), 331-342 https://doi.org/10.1159/000499597

Nursing Pharmacology

Are the clinical practice guidelines used in this case study appropriate? Why or why not?

The clinical practice guidelines are appropriate for the case study. This is because statins are the mainstay of therapy, alongside healthy living interventions, among the lipid-lowering drugs. Statins reduce the triglyceride levels, total cholesterol, and low-density lipoprotein while increasing the high-density lipoprotein amount. The goal is to reduce the risk of stroke, myocardial infarction, and atherosclerosis. However, according to Hoover (2019), liver function should be assessed before initiating therapy since statins are contraindicated in patients with an underlying hepatic disease.

Acarbose is an alpha-glucosidase inhibitor used to treat type 2 DM together with diet only or diet and exercise. Although the first line is metformin, it is not used because of the impaired renal function of the patient. According to Aschner et al., (2016), administering metformin in patients with impaired renal function may cause build-up leading to lactic acidosis. Therefore, according to the clinical guidelines, acarbose can be used as monotherapy to manage diabetes mellitus.

Do you agree with the initial treatment plan? Why or why not. Use clinical practice guidelines to support your answer. Diabetes Case Study Peer Review assignment

I agree with the initial treatment plan. Propranolol LA is a beta-blocker that is indicated in the management of Hypertension. The long-acting propranolol allows for controlled release of the drug in that the plasma concentration at 24 hours is greater with LA propranolol than with the conventional tablets. On the other hand, I cannot entirely agree with diagnosing the patient with hyperlipidemia and not giving the necessary lipid-lowering drugs. Although patients with hyperlipidemia are often asymptomatic, it is associated with increased morbidity and mortality rates. It is one of the prevalent risk factors causing atherosclerosis and consequent vascular diseases: peripheral artery disease, cerebral vascular accident, coronary artery disease, and aneurysms.

Provide evidenced-based addition or provide constructive feedback to the case study.

Since the patient is experiencing difficulty completing daily living activities, it is essential to rule out congestive heart failure. According to Inamdar & Inamdar (2016), hypertension is one of the most common modifiable risk factors that lead to cardiovascular diseases. Hypertension predisposes to left ventricular hypertrophy, which eventually leads to heart failure. In addition to that, there is also an increased risk of cardiovascular disease in the patient due to a history of hyperlipidemia, which causes atherosclerosis leading to narrowing of the blood vessels. A chest x-ray will help assess for cardiomegaly, and an echocardiogram will help detect the functional and structural abnormalities caused by Hypertension.

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The patient has an acute kidney injury from the kidney function tests and a sudden rise in serum creatinine. According to the kidney disease improving global outcomes criteria, diagnosing AKI requires the presence of either of the following; 1) reduced urine output <0.5ml/kg/hr, 2) increment in serum creatinine by 0.3mg/dl or more within 48hours or 3)increase in serum creatinine to 1.5 times or more baseline within seven days. Given the urea and creatinine derangement, it is crucial to calculate the GFR that predicts an impending end-stage renal disease or cardiovascular disease and prompts early intervention (Levey & James, 2017). People with diabetes and Hypertension are primarily at risk of kidney diseases, and therefore screening them is one the effective strategies. Diabetes Case Study Peer Review assignment

References

‌ Inamdar, A. A., & Inamdar, A. C. (2016). Heart failure: diagnosis, management and utilization. Journal of clinical medicine, 5(7), 62. https://dx.doi.org/10.3390%2Fjcm5070062

Aschner M, P., Muñoz V, O. M., Girón, D., García, O. M., Fernández-Ávila, D., Casas, L. Á., & Bustamante S, Á. A. (2016). Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults. Colombia Médica, 47(2), 109-130.‌

Hoover, L. E. (2019). Cholesterol Management: ACC/AHA Updates Guideline. American Family Physician, 99(9), 589-591. https://www.aafp.org/afp/2019/0501/p589.html

Levey, A. S., & James, M. T. (2017). Acute kidney injury. Annals of internal medicine, 167(9), ITC66-ITC80

Diabetes case study peer review 11 unread reply.44 replies. Post your response to the case study here by answering the following questions: Are the clinical practice guidelines used in this case study appropriate? Why or why not? Do you agree with the initial treatment plan? Why or why not. Use clinical practice guidelines to support your answer. Provide evidenced-based addition or provide constructive feedback to the case study. please use the questions as headers pls use professional references APA 7

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Assignment instructions Topic- Therapy for Patients With Anxiety Disorders and PTSD Treatment The Assignment: 5 pages Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. Link to case study- https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Diabetes Case Study Peer Review assignment