Nursing NR 565Wk 5 Endocrine Case study Answers Nursing NR 565Wk 5 Endocrine Case study Answers

Nursing NR 565Wk 5 Endocrine Case study Answers Nursing NR 565Wk 5 Endocrine Case study Answers Question 1 Please explain the value and reason for doing your own work and not copying or taking answers from another source and claiming them as your own. Doing your own work and learning this skill supports your future independent practice as a nurse practitioner. While there may be opportunities beyond faculty’s control to collaborate or share answers with peers, it would not benefit your own personal and professional growth to do so. By doing your own work, you take personal responsibility for your own learning. Question 2 Use the John Jones case study to answer the following question. Using diagnostic criteria for diabetes, what is John’s diabetic status? What treatment plan should be introduced at this time? He has diabetes and requires pharmacological intervention. Values that supports his diabtes DM Diagnostic Criteria on pg 398 reviews the four criteria to diagnose DM which is the precursor to pharmacological intervention. These criteria include: • Fasting plasma glucose ≥126 mg/dLa Or • Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes Or • Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLc Or • Hemoglobin A1c 6.5% or higher; References Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. Question 3 Use the John Jones case study to answer the following question. Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? BP 130/90 His diet largely consists of fast-food meals. He drinks sweet tea with every meal. Weight 235lbs (Rosenthal & Burchum, 2021). Sits at a desk several hours a day. The combination of moderate exercise and weight loss reduces the risk for the development of type 2 diabetes and improves outcomes for patients with type 2 diabetes (Rosenthal & Burchum, 2021). This study source was downloaded by from CourseH on :50:17 GMT -05:00 Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. Question 4 Use the John Jones case study to answer the following question. Which behavior in John’s social history poses a potential concern with first line pharmacological treatment for diabetes and why? He reports drinking “a few beers on the weekend during football season”. Metformin is contraindicated in alcoholics. Although it does not sound as if John is an alcoholic, further questioning is needed, and the discussion should be documented. Metformin taken by alcoholics increases the risk of lactic acidosis so John should be educated on this risk along with signs and symptoms of lactic acidosis (Rosenthal & Burchum, 2021). References Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. Question 5 Use the John Jones case study to answer the following question. Name the specific names of labs you would order and the intervals at which you would order them to monitor the safety and efficacy of metformin. Lab work related to both hepatic function, renal function, and blood sugar all need to be monitored both before and during treatment. Question 6 Use the Alfonso Giuliani case study to answer the following question. Atherosclerotic cardiovascular disease (ASCVD) risk factors include age, gender, race, blood pressure, cholesterol values, history of diabetes, tobacco use, treatment of hypertension, statin therapy, and aspirin therapy. Look at Alfonson’s ASCVD risk factors. Should Alfonso be taking something for hyperlipidemia? If so, what would you recommend? Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., ... & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74(10), 1376- 1414. external site.) This study source was downloaded by from CourseH on :50:17 GMT -05:00 References American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Question 7 Use the Alfonso Giuliani case study to answer the following question. Which diabetic drug classes should be considered in addition to metformin to prescribe for Alfonso and why? GLP-1 and SGLT2i According to the ADA Standards of Medical Care in Diabetes-2020, GLP-1 and SGLT2i drugs are recommended in conjunction with metformin . secondly, in Alfonso, ASCVD risk predominates and has a ASCVD risk score more than 40%. References American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. Question 8 Use the Alfonso Giuliani case study to answer the following question. There are two drug classes to consider for prescribing for Alfonso in addition to metformin. What baseline data will you need to obtain for each of those drug classes? Provide the name of the drug class and the baseline data needed for that drug class.  Baseline for both GLP-1 and SGLT2i  Random plasma glucose  HbgA1C  Serum electrolytes  Urinary glucose and ketones  Fasting plasma glucose  (Rosenthal & Burchum, 2021).  References  Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. Question 9 Use the Alfonso Giuliani case study to answer the following question. This study source was downloaded by from CourseH on :50:17 GMT -05:00 teaching do you need to provide when prescribing medication from this drug class? Patient should be educated on the signs and symptoms of hypoglycemia. Patient should also be educated that These drugs also delay gastric emptying, so may delay the absorption of other drugs if taken simultaneously (Rosenthal & Burchum, 2021). References Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. Question 10 Use the Helen Smith case study to answer the following question. Why is caution indicated if metformin was prescribed for Helen? Because heart failure (HF) can predispose to lactic acidosis, metformin is contraindicated for people with failing hearts (Rosenthal & Burchum, 2021). However, in one study, patients with HF who took the drug were less likely to die than those who took a sulfonylurea. These data suggest that use of metformin in HF is much safer than previously believed. References Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. Question 11 Use the Helen Smith case study to answer the following question. If the standard starting dose of levothyroxine 1.6 mcg/kg/dose is prescribed for Helen, what is the correct dose? Would this be the correct starting dose for Helen? Why or why not? The correct dose is 175mcg/dose. Calculations are 1.6 mcg/kg/dose. Helen weighs 242 pounds; therefore the dose calculation is 1.6mcg/110kg (242 pounds) or =175.63. Therefore, the closest available dose to order would be a 175mcg tablet. This is a high dose to start for an older patient with cardiac disease so it would be appropriate to choose a lower starting dose for Helen and titrate up. Question 12 Use the Helen Smith case study to answer the following question. Which of the Helen’s lab values require consideration for possible treatment? Provide the lab name and Helen’s result. Use these sources for lab reference values: This study source was downloaded by from CourseH on :50:17 GMT -05:00 normal limits: Total Cholesterol 240 mg/dl HDL 35 mg/dl LDL 120mg/dl Triglycerides 260 mg/dl TSH 24 mU/L Free T4 0.2 ng/dl Question 13 Use the Helen Smith case study to answer the following question. Which DM drug class is contraindicated in patients with heart failure and why? The why portion of this question will require some independent web or article searching to understand why this contraindication exists. Be sure to cite your sources. Thiazolidinediones (TZD) (Rosenthal & Burchum, 2021) Makes the heart failure worsen due to fluid retention References Rosenthal, L., & Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences. . This study source was downloaded by from CourseH on :50:17 GMT -05:00 Powered by TCPDF ()