Pathophysiologic and Pharmacological Evidence Based Nursing Care

Diabetes Case Study:  Module 4

The purpose of this assignment is to use concepts from both pathophysiology and pharmacology to discuss the management of those diagnosed with diabetes, hypertension and hyperlipidemia. This assignment is worth 10% of your course grade.

 

This assignment will address the following course objectives:

 

1. Explain the pathophysiological rationale supporting the use of drug therapy in relation to the drug purpose, metabolism, dosage, and effect on patient outcomes for commonly occurring health problems across the
2. Use evidence-based practices to promote risk reduction related to medication
3. Examine potential drug-drug interactions and drug-food interactions based on physiologic responses to pharmacological

After completing this assignment, you will be able to:

 

1. Use concepts from pathophysiology and pharmacology to explain the clinical manifestations and pharmacotherapy associated with type 2 diabetes mellitus, hypertension, and hyperlipidemia.
2. Determine congruence between a prescribed plan of care and current, evidence-based clinical practice guideline
3. Identify precautions to be taken during treatment of patients with multiple co-morbidities receiving multiple pharmacological

Instructions

 

Review the assessment data provided for Judy and address the discussion points located at the end of this document. It is expected that clinical practice guidelines and evidence reports (provided in Modules 2 – 4) along with information from your course textbook, videos, journal articles and web resources be used to support your answers. Additional outside research is encouraged. The grading rubric for this assignment is included with this case study. At least three professional references (peer-reviewed articles, professional websites….) published within the past five years are required, and your paper should follow APA 7^th ed. formatting guidelines. The body of the paper is limited to 3-5 pages, not including the title and reference pages.

 

Module 4 Analysis Data

 

Judy is a 57-year-old African American female who is reporting to her primary care provider for a routine follow-up visit for evaluation of her type 2 diabetes, hypertension and hyperlipidemia.

 

Medical Diagnoses: Stage 2 hypertension, hyperlipidemia, type 2 diabetes mellitus, obesity, hypothyroidism, osteoarthritis

 

Current Medications:

 

• Lisinopril 20mg by mouth daily
• Metformin 500 mg by mouth twice daily
• Atorvastatin 20 mg by mouth daily at bedtime
• Levothyroxine 75mcg by mouth daily
• Aspirin 81mg by mouth daily
• Meloxicam 15mg by mouth daily

 

Notable Health History

 

Superficial retinal hemorrhage noted to right eye noted 3 months ago

Reports not always taking medications as prescribed because she forgets or doesn’t have the money Mother with a history of breast cancer and father had a CVA

 

Review of Systems Subjective Data

 

General: Well-groomed, alert, steady gait; reports increased fatigue

 

Skin: Denies rashes, lesion, pruritus or dry skin

 

HEENT: Reports intermittent blurred vision and occasional dizziness; wears glasses all the time

 

Cardiac: Denies chest pain or tightness

 

Respiratory: Denies shortness of breath, cough or breathing difficulty

 

GI: Reports occasional GI upset

 

GU: Denies pain, burning, hesitancy, blood or urgency with urination but does report going to the bathroom to void a lot more often than she used to

MS: Denies muscle pains, cramps or issues with range of motion

 

Neuro: Reports tingling sensation in feet; denies weakness or changes in speech or memory

 

Psych: Denies feeling depressed or down

 

Physical Examination

 

Ht: 5’ 7” Wt: 236 pounds BP 142/86, T 98.1°F, P 102, R 22

 

General: Appears to be older than reported age, alert and oriented; no signs of distress; smooth but slow gait; appears clean and well-groomed

 

HEENT: Oral mucosa pale and dry; xanthelasma noted to right eyelid

 

Skin: Cool to touch, dry; nail beds pale

 

Cardiac: S1, S2, S3

 

Respiratory: Clear to auscultation bilaterally

 

GI: Soft, non-tender, no bruits; Normoactive bowel sounds x 4

 

Neuro: Decreased sensation with monofilament, 1+ reflexes bilaterally

 

Lower Extremities: Pedal pulses 1+ bilaterally; skin cool and dry; capillary refill 3 seconds

 

Notable Laboratory Results:

 

Component	Value	Standard Range
COMPREHENSIVE METABOLIC PANEL
SODIUM	139 mmol/L	135 – 153 mmol/L
POTASSIUM	4.2 mmol/L	3.5 – 5.3 mmol/L
CO2	25 mmol/L	24 – 31 mmol/L
CHLORIDE	106 mmol/L	98 – 110 mmol/L
GLUCOSE	202 mg/dL	75 – 110 mg/dL
CALCIUM	9.3 mg/dL	8.5 – 10.4 mg/dL
CREATININE	1.2 mg/dL	0.5 – 1.4 mg/dL
BUN	29 mg/dL	8 – 21 mg/dL
BUN / CREAT RATIO	24	6 – 20
EGFR	58 mL/min	mL/min
GFR >= 60 mL/min/1.73m2 does not exclude kidney disease.
ALP	72 IU/L	33 – 120 IU/L
AST (SGOT)	12 IU/L	10 – 40 IU/L
ALT (SGPT)	9 IU/L	3 – 36 IU/L
ALBUMIN	3.7 g/dL	3.1 – 4.7 g/dL
LIPID PANEL
CHOLESTEROL	204 mg/dL	100 – 200 mg/dL
TRIGLYCERIDES	165 mg/dL	40 – 160 mg/dL
HDL CHOLESTEROL	42 mg/dL	30 – 70 mg/dL
CHOLESTEROL/HDL RATIO SCREEN	5	0 – 3
CHOL/HDL Ratio Risk Protective <3 Below Average Risk 3-5 Average Risk 6-7 High Risk 8-9 Dangerous Risk >9
LDL CHOLESTEROL DIRECT	132 mg/dL	0 – 129 mg/dL
COMPLETE BLOOD COUNT
WBC	6 K/mm3	4.8 – 10.8 K/mm3
RBC	3.8 M/mm3	4.70 – 6.10 M/mm3
HEMOGLOBIN	10.2 g/dL	14.0 – 18.0 g/dL
HEMATOCRIT	32 %	42.0 – 52.0 %
MEAN CORPUSCULAR VOLUME (MCV)	95 fL	80 – 104 Fl

 

MEAN CORPUSCULAR HEMOGLOBIN (MCH)	30 pg	26.0 – 34.0 pg
RDW	14.2 fL	37.0 – 54.0 fL
PLATELET COUNT (PLT)	248 K/mm3	130 – 400 K/mm3
HA1C	9.2%	< 5.7%

 

New Orders

 

Based upon the assessment findings, Judy’s Nurse Practitioner made the following adjustments to her plan of care:

 

• New diagnosis: Anemia of chronic disease
• Medication adjustments: Increase metformin to 1000mg by mouth twice daily
• New medication prescribed: Januvia 100mg by mouth daily

·         Lab orders: CBC, BMP, HA1C, serum iron and TIBC in 3 months

 

Module 4 Case Analysis Discussion Points

**Please write the following in paragraph form, using the subheadings:

 

1. Introduction
   • Introduction to the case analysis

 

2.       Pathophysiological bases of prescribed medication:

• Pathophysiology of Type 2 DM: Include specific details regarding the basic pathophysiology of the  disease processes
• MOA: of metformin and Januvia. Describe how each specific medication acts within the body (MOA) to counteract those pathophysiological processes. Do NOT simply report the therapeutic effect of these medications. Rather, specifically discuss the mechanism of action – where in the body (i.e. certain receptors…) and what the medications do to achieve their therapeutic The other medications are not required for this section. Be sure to include in-text citation.

 

3.           Congruence with CPG:

• Cite the most up to date Clinical Practice Guidelines
  • What is the 1^st line recommendations
  • What is second line recommendations
  • What is recommended as adjunct treatment with metformin
  • Provide rationale as to why these recommendations are considered the best options (what positive outcomes have they been shown to have that makes them preferred over other agents?). State the research and statistics to support this.
• Judy refused to take a GLP-1 injection daily for fear of needles so her provider prescribed Januvia daily to help manage blood glucose instead. How does the addition of this medication align with recommendations outlined in the American Diabetes Association Standards of Medical Care in Diabetes – 2021? Then state whether or not Judy’s care is in alignment with those You only need to focus

on recommendations for treatment of type 2 DM for this section – not the other disorders.

• Include references (3-5 years).

 

 

4.          Side Effects, Pharmacokinetics & Teaching

• Analyze Judy’s pharmacological treatment plan and her clinical presentation. Consider ALL medications prescribed for all disorders while completing this section including the newly-prescribed Address the following:
• 3 Side Effects:
  • Are there any assessment findings that indicate Judy may be experiencing side effects?
  • List at least 3 different medications associated with her symptoms.
• 2 Pharmacokinetics:
  • Be sure to consider all four components of pharmacokinetics (absorption, distribution, metabolism, and excretion) in your analysis. Include what the nurse should look for regarding the patient’s medications and labs.
  • 3 Drug-drug interactions: Plug in all Judy’s drugs and identify 3 major to moderate interactions Judy should know: https://www.drugs.com/drug_interactions.html

·         3 Patient Teaching:

• Discuss 3 key teaching points you would include if providing education to Judy about her metformin and newly-prescribed Januvia. Though non-pharmacological teaching is important, for the purpose of this assignment your teaching points should be specifically related to the Explain why you would include these specific points in your teaching plan.

• Include in-text citation.

 

7th ed. APA format

• Appropriate formatting & headings:
• 7th Reference APA (in-text and reference list):

Professional Language & Writing

• Professional vocabulary & writing style:
• 3 or more professional references:
• Published within 5 years:

Length

• Body: 3-5 pages:

 

 

 

Module 4 Case Analysis Grading Rubric

	Excellent	Good	Fair	Poor
Pathophysiological Basis of Diabetic Medications	Complete, accurate, clear explanations provided; both required medications addressed; pathophysiological basis for both medications thoroughly discussed; references provided (27-30 points)	Accurate and clear information provided most of the time; both required medications addressed; pathophysiological basis for both medications addressed somewhat thoroughly; references provided (24-26.9 points)	Pathophysiological basis of one medication addressed well but one is addressed vaguely; or both medications addressed but vaguely; or clear and accurate information provided some of the time; references may or may not be included (21-23.9 points)	Minimal to no information provided; or unclear/incorrect information provided; or the pathophysiological basis for 1 or more required medication not addressed at all; or references may or may not be included (0-20.9 points)
Congruence with Clinical Practice Guidelines	Complete, accurate and clear information provided; ADA Standards reference included (22.5 – 25 points)	Most information included; accurate and clear information provided most of the time; ADA Standards reference included (20-22.4 points)	Some information provided; or information clear and accurate some of the time; ADA Standards reference may or may not be included (17.5 – 19.9 points)	Minimal to no information provided; or unclear/incorrect information included or inappropriate guidelines used; or ADA Standards reference not included (0-17.4 points)
Side Effects, Pharmacokinetics, and Teaching	Complete, accurate and clear information provided; 3 side effects, 2 points related to pharmacokinetics, and 3 teaching points all thoroughly discussed; references provided (27-30 points)	Clear and accurate explanations provided most of the time; 3 side effects, 2 points related to pharmacokinetics, and 3 teaching points all discussed somewhat thoroughly; references provided (24-26.9 points)	Clear and accurate information provided some of the time; at least 2 (3 side effects, 2 points related to pharmacokinetics, and 3 teaching points) thoroughly discussed but one is not discussed at all – or all 3 discussed but vaguely; references may or may not be provided (21-23.9 points)	Minimal to no information provided; or less than 2 (3 side effects, 2 points related to pharmacokinetics, and 3 teaching points) discussed; or no references provided (0-20.9 points)
APA Format: Citations, Reference Page, Title Page, Margins, Font, Double- Spaced, Page Numbers, Headings, etc…	All references cited appropriately within the text; appropriate formatting and headings; 3 or less APA 7th ed. formatting errors (4.5-5 points)	Most references cited appropriately within the text; appropriate use of formatting and headings; or 4-6 APA 7th ed. formatting errors noted; (4-4.4 points)	Occasionally cites references appropriately within the text; or 7-9 APA 7th ed. formatting errors noted; or inconsistent use of appropriate formatting and headings (3.5-3.9 points)	Rarely or never cites references appropriately within the text; or 10 or more APA 7th edition; or appropriate formatting and headings are not used throughout the paper (0-3.4 points)
Professional Language and Writing	Professional vocabulary and writing style are used consistently throughout the paper; 3 or more professional references published within the past 5 years included (4.5 – 5 points)	Professional vocabulary and writing style are used frequently throughout the paper; 3 or more professional references published within the past 5 years included (4 – 4.4 points)	Professional vocabulary and writing style are used inconsistently throughout the paper; or only 2 professional references published within the past 5 years included (3.5 – 3.9 points)	Professional vocabulary and writing style are not used; or less than 2 professional references published within the past 5 years included (0 – 3.4 points)
Length	3-5 pages in length (5 points)			< 3 or > 5 pages in length (0 points)