type 2 diabetes

Mike was recently diagnosed with type 2 diabetes.  He is feeling good and has not noticed any changes in his health.  Sam, his twin, has not been diagnosed with type 2 diabetes.  They both like the same activities and foods. Mike does not understand why he has diabetes, but his brother does not and why he has not had any noticeable symptoms. How would you explain this to him? Carbohydrate is broken down in our digestive tract to monosaccharides and glucose, a monosaccharide, stimulates the release of insulin.  The release of insulin does not cause insulin resistance and eating more carbohydrate does not cause insulin resistance either.  Insulin acts at the muscle to unlock the cell and let glucose in.  Sometimes that key does is not as efficient at letting glucose in causing insulin resistance.  One thing we know promotes resistance is excess fat which somehow blocks insulin’s efforts to get glucose into the cell.  In our example, Mike has type II diabetes.  He has plenty of insulin, but it is not working right.  What health changes should Mike make to reduce his body fat?

 

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practicum experience

Please share practicum experiences with classmates by addressing the following information:

  • Type of practicum setting
  • Average number of patients seen by you and the preceptor on a daily basis
  • Most common diagnosis treated
  • Available resources (low cost meds, social services, community resources, etc.)
  • Most interesting patient presentation
  • Comfort level with history-taking, physical exam, medical diagnosing, Management plans including prescribing medications and health education.
 

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professional practice.

Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally.

You are required to post one scholarly activity while you are in the BSN program, which should be documented by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis.

In Topic 10, you will submit a summary report of your scholarly activity. You may use the “Scholarly Activity Summary” resource to help guide this assignment.

 

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clinical presentations.

Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.

            Through the case study I learnt how the symptoms of multiple conditions overlap and create difficulty for patient’s to cope up with the symptoms. This case also though to how to use polypharmacy for patients suffering from a number of sleep problems. In the current case, patient has suffering from restless leg syndrome and obsessive sleep apnea. For OSB, CPAP treatment was recommended for the patient which she denied. If I would be in a similar situation in my clinical practice, I would try to convince my patient for CPAP treatment. If however, patient would not agree then I would consider other treatment options. 

                                                                                                            References

Choi, H., Irwin, M. R., & Cho, H. J. (2015). Impact of social isolation on behavioral health in elderly: Systematic review. World Journal of Psychiatry, 5(4), 432-436. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694557/

Cochrane. (2016). Iron for restless legs syndrome. Retrieved from https://www.cochrane.org/CD007834/MOVEMENT_iron-for-restless-legs-syndrome

Dayan, C. M., & Panicker, V. (2013). Hypothyroidism and depression. European Thyroid Journal, 2(3), 168-179. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017747/

Foroughi, M., Razavi, H., Malekmohammad, M., Naghan, P. A., & Jamaati, H. (2016). Diagnosis of Obstructive sleep apnea syndrome in adults: A brief review of existing data for practice in Iran. Tanaffos, 15(2), 70-80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127617/

Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., & Wang, T. (2017). Restless Legs Syndrome: From pathophysiology to clinical diagnosis and management. Frontiers in Aging Neuroscience, 9(1), 171-182. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454050/

Luca, A., Luca, M., & Calandra, C. (2013). Sleep disorders and depression: Brief review of the literature, case report, and nonpharmacologic interventions for depression. Clinical Interventions in Aging, 8(1), 1033-1042. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760296/

Schlarb, A. A., Claßen, M., Grünwald, J., & Vögele, C. (2017). Sleep disturbances and mental strain in university students: Results from an online survey in Luxembourg and Germany. International journal of mental health systems, 11(1), 24-29. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372247/

Singh, P. (2016). Insomnia: A sleep disorder: Its causes, symptoms and treatments. International Journal of Medical and Health Research, 2(10), 37-41.

Stahl, S. M. (2014). The prescriber’s guide. New York, NY: Cambridge University Press. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c114.html.therapeutics&name=SERTRALINE&title=Therapeutics

 

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therapeutic changes

If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

            A potential mistake or medical prescription error I noted in the case was that at second interim follow up Celexa was increased to 30 mg/day. However, maximum dose of Celexa for elderly is 20 mg/day (Stahl, 2014). Considering the age of patient, I would have not increased the dose to 30 mg/day. Another issue that I noted in the case was that patient did not agree for CPAP in repeated visits. I would have researched for new generation CPAP equipment and would have motivated the patient for CPAP treatment.

 

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pharmacologic agents

List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

            The two pharmacologic agents that would be appropriate for the patient include:

  1. modafinil 
  2. Mirapex

Modafinil is a wake-promoting agent approved for the treatment of excessive sleepiness associated with shift work disorder, obstructive sleep apnea (OSA) and narcolepsy (Stahl, 2014). This drug would be helpful for patient in controlling her problem of obstructive sleep apnea (OSA) that is causing her issues of snoring. The current dose of modafinil prescribed to the patient is 400 mg/day. This dose is the full dose. However, I would not prescribe full dose to the patient considering her age and possible side effects of the medicine at full dose. 

            Mirapex is prescribed for treatment of restless legs syndrome and Parkinson’s disease. The medicine can improve symptoms of restless legs syndrome and Parkinson’s disease and can improve sleep (Stahl, 2014). The medicine should be started at lowest dose (0.125 mg) and increased necessary every 5 to 7 days until symptoms are controlled (Stahl, 2014). Therefore, for the treatment of RLS, Mirapex would be prescribed to the patient. 

 

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physical exams

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

            A complete physical exam would be performed for the patient. Patient has depression, sleeping problems and leg ache. Physical exam would help determine if physical problems or weakness are the underlying cause of these problems. An eye exam would also be performed during physical exam to access why the patient is having the issue of tears in her eyes. Her eye problem would be accessed and appropriate eye drops would be prescribed. Thyroid test would be important to access the level of thyroid hormone in the body. This is because thyroid hormonal level is found to have a relationship with depression (Dayan & Panicker, 2013). Iron level test would also be needed to identify if inadequate levels of iron in the body are causing of restless leg syndrome (Cochrane, 2016). DSM-5 criteria would be used to determine the patient’s mental health problem and diagnosis.  

 

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hearing issues

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

            I would ask specific questions and would take specific feedback from patient’s son. The case reveal that patient has a son who visits him often but does not live with her. Patient is 70-year-old, is elderly and has hearing issues. Asking the following questions from her son would be helpful to understand her problem in detail

  1. Other than your father’s death, has anything tragic happened in your mother’s life?
  2. Have you notices anything notable in your mother’s behavior over the past six months?
  3. Do you think your mother hearing and sadness problems are interrelated?
  4. Why you do not keep your mother with yourself?
  5. Does your mother ever insist to take her with you?

The above mentioned questions would provide useful insight to evaluate the health condition, past life condition and social life of the patient. I would indicate when the patient’s problem started.          

Patient is an elderly and wants support from her love one still her son does not live with him. The other person caring for patient is her aide and I would also ask from questions from her to access patient’s condition and underlying problems more accurately.

  1. Since when you have been caring for the patient?
  2. How does the patient behaves with you?
  3. Have you noticed any changes in patient’s behavior over the past few months?
  4. What do you think might be the cause of her sleeping and sadness issues?

            These questions would help analyze the relationship between patient and her aide. Patient is taken care by her aide. At this point we do not know the behavior of her aide. These questions are important to access if aide is caring for her in the right manner or she is not taking care of the patient. 

 

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List three questions you might ask the patient if he or she were in your office

Provide a rationale for why you might ask these questions.

            I would ask the following questions from the patient 

  1. How has your life changed after the death of your husband?

The case reveals that patient’s husband died many years ago. This is an open ended question to ask about changes in patient’s life after the death of her husband. May be she feels lonely, maybe she does not have someone to listen to her views. Spending such a life for years might have resulted in symptoms of depression. Social isolation affects behavioral health in elderly people. It contributes to depression and sleep disturbance (Choi, et al., 2015).   

  1. Do you feel stressful in your life?

Depression and sleep problems are often associated with stress. Sleep disturbances often occur during high-stress periods (Schlarb, et al., 2017). This question access if patient’s sadness and sleep issues are due to stress in her life. May be feels stressful about something in her life. May be to deal with stress she prefer to watch TC until late at night. 

  1. What do you feel about your cochlear implant?

The case reveal that patient has a chief complaint of being sad. She is also expected to have a cochlear implant in future. This question access if her sadness issue is related to her hearing issue. The answer to this question would reveal if patient’s hearing problem is the reason behind her sadness or there is something else. 

 

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critical care unit

in our critical care unit, we have units champions; we have cardiovascular champions, foley catheter champions, infectious disease champions, and they too are encouraged to review evidenced-based practice, present their ideas to the unit educator and unit manager for review and if it turns out to be something that is feasible, they are encouraged to present it to staff. Not too long ago, we had our cardiovascular champions give a brief presentation on transvenous cardiac pacing, and what is needed at the bedside to assist the physician during insertion. 

 

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