Borderline diabetes

Case Study Diabetes

02/07/2021

Patient A.B. a 69-year-old White mail visited his local clinic for a checkup as lately he was feeling lethargic and has gained 22 lbs in the past year. He also has episodes of nocturia. He has being diagnosed with Type 2 diabetes for 5 years. However, he was diagnosed with Borderline diabetes since 1997, but never took it seriously and made no lifestyle changes. He has symptoms of hyperglycemia for the past 2 years. He does not check his glucose daily. He has never had a foot examination.

AB carbohydrate intake daily most times consists of eating at least three slices of bread with each meal and eating pasta meals at least 3 times a week. He likes his wife to cook Italian meals no less than 3-4 times a week. He drinks a glass of red wine with dinner every day. He stopped smoking 10 years ago. He exercises on occasion, maybe once or twice a month.

A.B. takes Atorvastatin 10mg daily. Glyburide 2.5mg daily. However, he reports he stopped taking the Glyburide about 6 months ago as it was making him feel dizzy whenever he took it. He has not notified his PCP about not taking the Glyburide.

Physical Examination

Constitutional: Alert and oriented to person, place, time and situation. He is well groomed.  He is 5 feet 2 inches and weighs 178 pounds.

Eyes: Pupils round, reactive to light. EOM intact. Fundi clear.

Hearing: No deficit noted

Mouth: Mucosa moist. Upper and lower dentures.

Heart: Rate and rhythm regular. No murmur.

Lungs: Clear to auscultation

Neurological assessment: Diminished vibrating sense to the forefoot, absent ankle reflexes. Monofilament felt only above the ankle.

Vascular: No carotid bruits. Femoral, popliteal and dorsalis pedalis pulses 2+ bilaterally.

His Immunization is updated. He has erectile dysfunction and takes Sildenafil.

Vital signs: BP= 150/87, P= 88, RR= 20, T= 97.8, Oxygen Sat= 98%

Laboratory Results:

Glucose (fasting) = 178mg/dl

Creatinine = 1.0mg/dl

Blood Urea Nitrogen = 18mg/dl

Sodium = 141 mg/dl

Potassium = 4.3 mg/dl

Total Cholesterol = 162 mg/dl

HDL Chol = 43mg/dl

LDL Chol = 84 mg/dl

Triglycerides = 177 mg/dl

AST = 14 IU/L

ALT = 19 IU/L

Alkaline Phosphatase = 56 IU/L

A1C = 8.1%

a) Nursing Plan for A.B.

b) No less than three nursing diagnoses

c) Fully developed care plan

d) What is the priority nursing education this patient needs with rationale?

e) Nursing interventions

Remember no less than 2 references.

Laboratory for Diagnosis, Symptom and Illness Management Case Study 3 & 4 (see attached pdf) Due by 02/17/2020 Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle. Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program) Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Laboratory for Diagnosis, Symptom and Illness Management

Case Study 3 & 4 (see attached pdf)  Due by 02/17/2020

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

HEART MURMURS

What can you as nursing teaching your patients about “heart murmur”? 

I need patient teaching PowerPoint on the “Heart Murmur.” I only two slides, what I can teaching my patient about heart murmur and what they can do for the condition not to get worse

Use the scholarly articles that are less than 5 years published and one from the book we are using in the class.

teaching modalities

 teaching modalities

Teaching Goals What are the priorities? (“By the end of the teaching session, the patient will…”)

Content Outline What will you teach? Use bullet points to organize topical information

Methodology How will you teach the content? What modalities will you use?

Rationale Why have you chosen the teaching modalities?

Evaluate Purpose: To demonstrate effective teaching/learning skills for the childbearing family. Topics:

Choose a topic to teach: Newborn Feeding (breastmilk or formula), Infant Safety, Newborn Care (bathing, circumcision care) Car Seat Safety, or another newborn care topic of your choosing (do not select Safe Sleep Practices/SIDs as this topic is included in another clinical activity…additional topics may be chosen with instructor approval). Instructions: ~Research your chosen topic, using websites, textbooks, patient teaching materials from clinical setting, observation in clinical setting etc. ~Create a teaching plan on your chosen topic using patient information handouts from the facility or create a brochure with information on your topic. ~ Find two articles from a nursing or allied health journal that relates to patient education or the topic you have chosen for your teaching plan. Include the citation with any other resources you used.

Policy/Regulation Fact

Policy/Regulation Fact

As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.

With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.

In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.

To Prepare:

  • Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics.
  • Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA).
  • Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study.

The Assignment: (1 page not including the title and reference page)

Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:

  • Briefly and generally explain the policy or regulation you selected.
  • Address the impact of the policy or regulation you selected on system implementation.
  • Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
  • Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.
  • Use APA format and include a title page, in-text citations, and reference page.
  • Use the Safe Assign Drafts to check your match percentage before submitting your work.

Quantitative Reasoning

Quantitative Reasoning

Have you ever wondered about the likelihood of an event occurring? Whether it’s the odds of your favorite football team winning on Sunday or how much you pay for car insurance, probability concepts can play a role in making those determinations.

  • Consider a situation that you might need to use your understanding of probability to make an informed decision.
  • What sorts of information would you collect?
  • How might you use what you have learned about probability to determine a course of action?
  • What are the possible benefits and limitations of this approach?

the different advanced practice roles and scope of practice found in the master of nursing curriculum

the different advanced practice roles and scope of practice found in the master of nursing curriculum

Overview/Description: The final written assignment will synthesize what you have discovered about the different advanced practice roles and scope of practice found in the master of nursing curriculum: APRNs, nurse educator, nurse informaticist, and nurse administrator/executive. (the area I choose and want to focus on is ARNP or family nurse practitioner).You will review all roles and then examine the specialty for which you were admitted, focusing on the scope of practice, core competencies, certification requirements, and legal aspects of practice for that specific role. You will also identify the practice environment and population you will be working with, as well as peers and colleagues. In addition, you will discuss your future leadership role and participation in professional organizations.Your paper is to be based on current literature, standards of practice, core competencies, and certification bodies for your chosen role. The paper should be 8-10 pages excluding the title and reference pages, and APA format is required.Category of Roles:

  • Advanced Practice Roles in Nursing:
    • Briefly define advance nursing practice and the roles in advanced practice nursing pertaining to clinical practice, primary care, education, administration, and health information. Distinguish between ANP and the APN.
    • Describe the advance nursing practice role you aspire and briefly share the experiences and/or qualities you have that have influenced your decision. Include your personal philosophy.
  • Selected Advanced Practice Role:
    • Identify the AP you interviewed and summarize the interview, which should/may include (if not in the interview, please address):
    • Examine regulatory and legal requirements for the state in which you plan to practice/work.
    • Describe the professional organizations available for membership based on your selected role.
    • Identify required competencies (domains), including certification requirements for your selected role.
    • Describe the organization and setting, population, and colleagues with whom you plan to work.
  • Leadership Attributes of the Advanced Practice Role:
    • Determine your leadership style
    • Define Transformational Leadership and as it relates to your identified leadership attributes that you possess or need to develop
    • Apply the leadership style you will embrace in AP to one of the domains
  • Health Policy and the Advanced Practice Role:
    • Based on your program of study, review the literature and address the following:
      • FNP/AGNP: Medicare reimbursement for NPs is 85%for the same health care that MDs receive at 100% reimbursement? Please address questions below and state your position on this mandate.
      • FNP/AGNP: What states have NP Full Practice Authority and which states have limitations or restrictions? How does this apply to your state? Please address questions below and state your position on this regulation.
      • Nurse Executive: What is value based care and how will it impact decisions made at the executive level relative to nursing and AP nursing? Please address and state your position on the regulation.
      • Nurse Informaticists: What law(s) was enacted to regulate health information? Please address questions below and state your position on this regulation.
      • Nurse Educator: What agency regulates nursing education?  Explain in detail.
  • For the above category chosen, address the following:
  • Describe the current policy or trends and determine if it needs to change; if opposed to change state why
  • Provide the process required to make the change with key players and parties of interest; support opposition
  • Explain how you could lead the effort to make or influence the change in policy or keep the policy the same and the impact in healthcare quality.
  • Conclusion-Summarize your role paper by highlighting key points made in your paper.

Submission Details:

  • Support your responses with examples.
  • Cite any sources in APA format.

family nurse practitioner

family nurse practitioner

Discussion Question

Considering your role specialization (family nurse practitioner), rank the top three current trends or issues that you believe to be most important with regard to advance practice.  Credentialing, reimbursement, value based outcomes, and health information (HIT), are just a few of the broad topics.  Then identify two strategies that address how these issues will strengthen advanced nursing practice. Synthesize knowledge from theory, ethics and legal/regulatory statutes; and develop your personal philosophy for a career as an advanced practice nurse.

please use apa style references to justify your work/ research. 

Cerebrovascular accident

Cerebrovascular accident

Cerebrovascular accident (CVA) better known as a stroke, occurs when blood flow is interrupted to any part of the brain. There are two main types of cerebrovascular accident: ischemic stroke and hemorrhagic stroke. Cerebrovascular accidents are major causes of morbidity and mortality (Vora et al., 2019). Risk factors for CVA are divided into modifiable and non-modifiable risk factors. Non modifiable risk factors include age, sex, ethnicity and geography, family history of stroke. Modifiable risk factors include smoking, alcohol consumption, drug abuse, arterial hypertension, diabetes mellitus, dyslipidemia, heart disease and hyperhomocysteinemia. Sudden signs of stroke consist of FAST: face drooping, arm weakness, slurred speech, time to call 9-1-1. . Cultures are at higher risk for Cerebrovascular accidents are American Indian/Alaska natives. Native Americans have 2.3 greater odds of being diagnosed with diabetes than non-Hispanic Caucasians, a condition that is a risk factor for heart attack and stroke (Van Hooser et al., 2020). Native American continue to experience healthcare disparities therefore causing lack of awareness to heart diseases, diabetes, and stroke.  Deep tendon reflex reveals involuntary muscle contraction, the intactness of the reflex arc at specific spinal levels, and the normal override on the reflex of the higher cortical levels. The DTR is sometimes called stretch reflex or myotatic reflex because of the stretch action and the muscle response involved (Rodriguez-Beato & De Jesus, 2020). The deep tendon reflex has 5 components: an intact sensory nerve (afferent), a functional synapse in the cord, an intact motor nerve fiber (efferent), the neuromuscular junction, and a competent muscle. The reflex response is graded on a 4-point scale: 0 No response, 1+ Diminished, low normal, or occurs only with reinforcement, 2+ Average, normal, 3+ Brisker than average, may indicate disease, probably normal, 4+ Very brisk, hyperactive with clonus, indicative of disease.Peripheral neuropathy is symmetric damage to peripheral nerves (feet or hands), resulting in pain without stimulation of the nerves. Diabetic peripheral neuropathy manifests as lack of sensation in the toes spreading to the foot, and the leg causing numbness and pain (Tahir et al., 2020). What I would expect to find in a person with diabetic peripheral neuropathy impaired light touch sensation to the feet, hands or legs, vibratory perception, absent or diminished ankle-deep tendon reflexes as well as muscle weakness. Due to neuropathy, patients have difficulty with mobility and daily activities.  We constantly have diabetic patients in the COVID unit. Most of my family members are diabetic as well, my mother has daily neuropathy pain. At work many of my diabetic patients go have dialysis. I recall a time when I cared for a diabetic patient with bilateral lower extremity amputation and an unstageable pressure ulcer to the sacrum. Wound healing is difficult in diabetic patients. Wound debridement was done.  Patient was frequently repositioned, pain medication administered, glucose levels maintained, and wound care provided. Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed and lead to complications if not treated on time.

ReferenceVora, C., Talsaniya, K., & Prajapati, B. (2019). Clinical profile of cerebrovascular accident patients with special reference to serum homocysteine level. International Archives of Integrated Medicine, 6(1), 76–82.Rodriguez-Beato, F. Y., & De Jesus, O. (2020). Physiology, Deep Tendon Reflexes. In StatPearls. StatPearls Publishing.Van Hooser, J. C., Rouse, K. L., Meyer, M. L., Siegler, A. M., Fruehauf, B. M., Ballance, E. H., Solberg, S. M., Dibble, M. J., & Lutfiyya, M. N. (2020). Knowledge of heart attack and stroke symptoms among US Native American Adults: a cross-sectional population-based study analyzing a multi-year BRFSS database. BMC Public Health, 20(1), 40. https://doi.org/10.1186/s12889-020-8150-xTahir, M., Adil, M., Khalid, S. R., Khan, S., & Tariq, S. B. (2020). Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Type 2 Diabetes Mellitus Patients. Professional Medical Journal, 27(9), 1885–1890. https://doi.org/10.29309/TPMJ/2020.27.09.4239

REPLY

Cerebrovascular accident also known as stroke affects the blood flow to the brain. Most risk factors are lifestyle based and others are unconditional. The first lifestyle-based risk factor is high blood pressure which is caused by the blood exerting more pressure than normal weakening the blood vessel walls causing cerebrovascular accident. Cigarette smoking also causes stroke. Smoke from cigarette constricts the arteries altering movement of blood through the vessels causing stroke. Among diabetic people, high blood sugar levels cause atherosclerosis hence stroke. Another common risk factor to stroke that attributes to hypertension and high cholesterol is obesity. Lack of regular exercise increases the chances of cerebrovascular accident as one is exposed to obesity and high blood pressure. There are however uncontrolled factors such as age where the elderly is more exposed, gender, where men are at a higher risk than women and family history in regards to the disease.

Like most chronic illnesses, the prevalence of high blood pressure and heart diseases vary among individuals on the basis of ethnicity, and cultural backgrounds. Due to migration, the average blood pressures between traditional and modernized communities shows that the modernized community is exposed to obesity due to the different cultural lifestyles (Kyaw et al, 2018). Cultures such as drinking, smoking and drug use involve making decisions under uncertainties and may cause high blood pressure.

According to Rodriguez- Beato & De Jesus (2020) the deep tendon reflex is graded as, “0 = no response; normal, 1+= a slight response which may or may not be normal depending on the patient’s medical history, 2+ = a brisk response which is normal, 3+ = a very brisk response which may or may not be normal and 4+ = a tap elicits a repeating response which is abnormal”. Analysis of findings such as evidence of disease, muscle strength and tone determine other reflexes.

Diabetic neuropathy, also, nerve damage is a complication among diabetic patients. A patient diabetic peripheral neuropathy has numbness in their feet and are unable to feel their feet while walking. Sharp pains are also evident among them. They lose their balance as they walk and feet begin to look deformed. With sores and blisters. The patients have exaggerated sensations where warm feels very hot and hurts when touched by a person with cold hands according to Iqbal et. al (2018).

A patient with lower back pain and diabetes showed general body weakness. Muscle strength and tone, tendon reflexes and sensitivity to touch were examined. Nerve conduction testing was done to measure how quickly the nerves in the arms and feet conduct electrical signals. Since the condition has no specific treatment the treatment conducted was meant to relieve pain, manage complications and help the body regain function and cause slow progression of the disease. Maintaining the blood sugar levels within the patients was hence essential and giving prescription medications; antidepressants and anti-seizure dugs to relieve diabetes related nerve pain. Urinary tract infections, digestive complications, orthostatic hypotension were sexual dysfunction were managed in treatment.

References

Iqbal, Z., Azmi, S., Yadav, R., Ferdousi, M., Kumar, M., Cuthbertson, D. J., & Alam, U. (2018). Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clinical therapeutics, 40(6), 828-849.

Kyaw, H., Raju, F., Shaikh, A. Z., Lin, A. T., Abbound, J., & Reddy, S. (2018). Staphylococcus lugdunensis endocarditis and cerebrovascular accident: a systematic review of risk factors and clinical outcome. Cureus, 10(4).

Rodriguez-Beato, F. Y., & De Jesus, O. (2020). Physiology Deep Tendon Reflexes. StatPearls [internet]

200 WORDS FOR EACH REPLY

identify articles that relate to your PICOT

 identify articles that relate to your PICOT

The focus of this assignment is for you to write a PICOT using the PICOT template.  You will also identify articles that relate to your PICOT.  Further, you will have an opportunity to do a basic critique of one of the quantitative articles that is included in your identified articles.

  1. By now you should realize that research is ongoing and there is often new or more information available.  We realize you developed a PICOT question in MSN 600 and did part of this assignment.  Now it is time to take it to another step and look at your subject deeper.  If you liked your question, you may use it again here.  It is now time to improve your question, do so now.  If you do not like your question, start afresh.  Researchers typically modify their research question many times before they finalize it.  Choose a problem or issue that you anticipate within your future advanced nursing role.  Describe this problem in 5 sentences or less.  You will be able to use it in the next assignment and in future courses.
  2. Formulate your question using the PICOT format.  For those of you in clinical concentrations (NPs), your question needs to be a clinical question.  The NEL and NED students may develop a question within their concentration’s focus. This question will drive the literature search for your issue.
  3. To support and assist in choosing and writing your PICOT in question 1 of this discussion board, you should have reviewed a minimum of 6-10 articles with at least one being a quantitative design.  List the 6-10 articles here as a response to this #3 question.  The articles should be in alphabetical order and each article should be listed as a full citation using the APA format.
  4. Choose one of those articles cited in #3 above that is a quantitative article and use Polit and Beck (2020), Box 4.3 – Guidelines for Critically Appraising Research Problems, Research Questions, and Hypotheses on page 65.   Answer each of the 8 questions and discuss the relationship of this article to your PICOT.