Respond to the post (Talk about the intolerance piece of metformin such as the GI side effects etc) 

Metformin for Treatment of Type 2 Diabetes

Metformin is part of the first treatment step in the four-step treatment approach. Metformin works in several different ways to manage blood glucose levels. One way is inhibiting glucose from being produced in the liver. Another way is that it slightly reduces glucose from being absorbed in the digestive tract. It also increases glucose uptake in tissues such as fat and skeletal muscle by increasing the sensitivity of insulin receptors. 

One of the positives of treatment with metformin is that there are few side effects, and because it does not actively reduce blood sugar, there is hardly any risk of hypoglycemia. The most common side effect is gastrointestinal issues. Although it is not common, the severe side effect is metabolic acidosis and is mainly a concern in patients with impaired renal function. 

Metformin is prepared as an oral medication; either an immediate-release or extended-release tablet or an oral solution is available. Metformin should be taken with food to avoid gastrointestinal upset side effects (Corcoran & Jacobs, 2022). 

Write a 1-page paper that addresses the following:

• Explain your diagnosis for the patient, including your rationale for the diagnosis.
• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. 

The patient has a history of drug abuse and possible Hepatitis C.

HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

This is a case study you do in a Grand Rounds (advanced clinician level brainstorming) style with the ‘Pharmacological Plan’ as the major part of your discussion.

Instructor/Facilitator help/suggestions:

1. Include three differential diagnoses. Do not just say “Symptoms are vague, no diagnoses possible, I will just do further assessment.” Subjective & Objective information are intentionally provided vague (as a clinical case) so that you can develop a couple of pharmacological cases & discuss.

2. Briefly address how you will pharmacologically treat the three diagnoses you listed (Pharmacological Plan).

3. Include why patient is on Synthroid, Nifedipine, a peripheral calcium channel blocker & prednisone an anti-inflammatory immunosuppressive agent (pharmacological information needed) and why patient was on these drugs, discussion based on your objective & assessment. Briefly state the mechanism of action of these agents.

4. Long discussions/stories of no relevance to advanced practice pharmacology will carry no value with this project.

5. Include NEWER AGENTS of cure for hepatitis C infection. Spell out the drug names. Discuss how these NEWER hepatitis C drugs of CURE work.

6. Include peer reviewed, scholarly articles of past 4 years as reference. 

7. Make it a Point you have Clinician Level Pharmacology in focus

Case 2: 1 year old overweight toddler who lives in a shelter with his underweight mother.

For this Assignment, you will consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

Assignment: Child Health Case: Include the following:

• An explanation of the health issues and risks that are relevant to the child you were assigned.
• Describe additional information you would need in order to further assess his or her weight-related health.
• Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
• Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

https://www.cdc.gov/obesity/childhood/

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

Respond to the following: 

A comprehensive understanding of a patient’s inherent characteristics is indispensable in improving the quality of care. A nurse should consider a specific set of questions that they should ask to facilitate comprehension of a patient’s history. The questions should be framed in such a way that they are not insensitive to the patient’s background, lifestyle, or culture. A review of the patient in the assigned case study affirms that she is 26 years old and Spanish speaking. Her chief complaint is abdominal pain, which has been getting worse. During her first visit to the clinic, Paloma relied on her younger bilingual daughter as a translator. Paloma was advised to take over-the-counter medication. She had been put on Omeprazole. However, her situation has not improved. In her present visit, she presents with the same problem. The limitations in the information presented about her case make it difficult to discern the exact cause of the patient’s worsening abdominal pain.

It is essential to consider a patient’s socioeconomic factors in the development of a treatment plan. Arpey et al. (2017) attest there is evidence that socioeconomic status affects an individual’s health outcome and health care received; people within the lower socioeconomic bracket are more likely to have worse self-reported health, lower life expectancy, and suffer from more chronic conditions compared with those of higher socioeconomic status. Some of the socioeconomic variables to consider when interacting with Paloma include her financial status, employment status, and availability of social support. A close examination of the above factors will facilitate the development of a patient-centered approach to managing her abdominal pain.

            The second set of factors to consider during the interactions with Paloma are spiritual factors. The existing evidence suggests that spirituality affects multiple facets associated with access to healthcare services. For instance, Rego et al. (2020) document that greater spiritual well-being is often associated with less decisional conflict, decreased uncertainty, a feeling of being more informed and supported, and greater satisfaction with one’s decisions. In Paloma’s case, assessing Paloma’s spiritual or religious beliefs would be critical to understanding the impact of these aspects on her coping mechanism and decision-making related to her health. Besides, the knowledge may help them comprehend some of her cultural or religious practices that might influence her preferences regarding treatment and the involvement of spiritual leaders in healthcare decisions. Overall, consideration of Paloma’s spirituality would improve the prospects of positive patient outcomes.

            Similarly, lifestyle factors have a considerable impact on the health and well-being of an individual. A keen review of the factors may facilitate the adjustment of a treatment plan to suit the needs of an individual patient. Contemporary evidence on the subject asserts that lifestyle factors have a momentous influence on the health and well-being of an individual. For instance, Li et al. (2018) postulate that factors such as diet, activity, alcohol consumption, and BMI have a considerable impact on the life expectancy of an individual. In Paloma’s case, it would be useful to consider her diet and nutrition. The outcome of such an assessment would offer insight into potential dietary causes or aggravating factors for her abdominal pain. Besides, it would be useful to explore her level of engagement in physical activity, exercise routines, and sedentary behaviors to assess her overall fitness and potential lifestyle-related risk factors. A close review of the above variables would facilitate the development of a tailor-made treatment plan for Paloma.

            It would be useful to explore Paloma’s culture as she seeks healthcare services. The prevailing evidence suggests a patient’s cultural background can have a profound impact on their treatment and diagnosis options. Shepherd (2019) suggests that healthcare professionals should strive to improve their intercultural awareness for them to progress the quality of healthcare services. In Paloma’s case, it would be useful to consider her cultural norms, values, and expectations to enhance the provision of culturally sensitive care and tailor the treatment plan to align with her cultural preferences and beliefs.

            An interaction with Paloma would require a consideration of a few sensitive factors. Such includes language and communication; it would be useful to avail a translator/interpreter to facilitate quality interactions. Suarez et al. (2021) assert that patients stand to benefit greatly from the presence of medical interpreters that double up as cultural brokers or literacy guardians. Besides, it would be useful to consider her level of health literacy. The move will make it feasible to discern whether she understands the information presented to her. Overall, a consideration of the above variables would improve the quality of her experience with the healthcare services.

            The following set of questions would help build Paloma’s health history and risks:

• Are there any factors that appear to trigger or worsen the pain?
• Have you experienced similar episodes of abdominal pain in the past?
• Does the pain radiate or spread to any other parts of your body?
• Do you have any other symptoms, such as fever, jaundice, or urinary problems?
• Are there any occupational or environmental exposures that might be relevant?