Assignment Prompt & Instructions
You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words each reply with references under each reply.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Reply 1
**Weekly Clinical Experience 1**
In my clinical practice this week, I focused on providing broad-ranging assessments of patients primarily seen in a primary care context and attending to the development of specific care plans. The first patient that I observed was a 50-year-old man asymptomatic, reason of the visit 3 Month follow up lab review.
**Primary diagnosis New Onset DM II (ICD-10: E11)** HbA1c 7.4 today —->6.3—>5.9—>5.4.
Obesity (ICD-10: E66.9) – BMI of 28.6 consistent with obesity classification.
Hypothyroidism (ICD-10: E03.9) Can cause weight gain, TSH and free T4 testing need to be ruled out.
First-line of interventions for Type 2 Diabetes Mellitus (T2DM) as set out by the American Diabetes Association (ADA), as the patient was placed on Metformin 500 mg BD (twice a day) by mouth. The patient was provided with information about; Metformin reduces the production of glucose in the liver and increases the sensitivity of the bodies towards insulin. It can be used with meals to lessen gastrointestinal disturbance (ADA, 2022). I will remind compliance and alcohol avoidance in fear of lactic acidosis. It is also important to inform the patient that the dosing will depend on her tolerance and blood glucose response during follow-ups.
Minimal side effects characterize Metformin and are likely to induce gastrointestinal pathologies such as nausea, diarrhea, or abdominal pain during the initial period of the use of medication. The most hazardous, not rampant side effect is known as lactic acidosis, and such happens mainly to renal dysfunction patients. As a result, pre-and post-treatment measures should assess renal function. Additionally, anemia and vitamin B12-deficient neuropathy have been linked to the continuous use of Metformin (Bosni Pac et al., 2023). Additionally, they should avoid experiencing pins and needles, numbness, or fatigue. The fact that these side effects are harmful supports the idea of implementing a holistic approach to treating patients, which considers educating patients and monitoring their use to ensure they are safe in this situation and taking medications properly.
We will follow up with additional lab tests to ensure that all the parts of the body are checked and there is no development of problems. Among these, there is HbA1c, which determines sustained control of blood sugars; the Comprehensive Metabolic Panel (CMP), which evaluates liver and kidney function; and the fasting lipid profile, which computes a cardiovascular risk. Diabetic nephropathy should be diagnosed using a urine albumin-to-creatinine ratio (UACR). As the risk of excess weight gain due to hyperthyroidism is high, a thyroid-stimulating hormone (TSH) examination can be beneficial in addressing the issue by helping the patient lose weight (ADA, 2022). I also recommend vitamin B12 testing for baseline levels, particularly in individuals taking Metformin, due to its long-term effects. Their tests offer the ground on which effective management and individualized care can be based.
This newly diagnosed diabetic patient requires comprehensive education. She is to be trained to check her blood sugar, learn the symptoms of hyper and hypoglycemia, and record the levels to review them later. Eating education must be centered on carbohydrate counting, low-glycemic foods, and balanced meal planning (Bosnić et al., 2023). I would advise her to engage in at least 150 minutes of moderate exercise per week and learn stress-reduction methods. The significance of taking medication, sick-day regulations, and alcohol moderation will be covered.
This visit is required to customize treatment when needed and evaluate the presence of endocrine-related issues. I also consulted with a registered dietician to prepare an individual meal plan that contributes to glycemic control (Bosnić et al., 2023). I will make referrals to nephrology, podiatry, or ophthalmology in the event of future complications, such as nephropathy, neuropathy, or retinopathy. The collaboration of health professionals leads to more successful outcomes, curbs the emergence of diseases, and allows chronic diseases to be treated without gaps.
Reply 2
**Clinical Experience 1**
This week in the adult primary care clinic was a rich experience in dealing with hypertension. An outstanding patient encounter was that of hypertension, where a patient had high blood pressure and the case symptom was characterized by the following: the patient had infrequent headaches, occasional dizziness, and fatigue. This experience proved that a complicated situation assessment and interventions that affect the guidelines are necessary to normalize the blood pressure level long-term.
**Clinical Experience: Challenges and Successes**
One of the most significant challenges faced was the history of the patient concerning poor compliance with antihypertensive drugs because of side effects. This resulted in persistence in elevated blood pressure and the persistence of symptoms. Nevertheless, the scenario represented the possibility of enhancing care by engaging patients and involving them in the decisions. Having learned about the history of medications and concerns of the patient, a different treatment option was offered to the patient, which was more likely to be tolerated by the patient. The result of this change was the improvement of the attitude toward taking medication, which became one of the biggest successes of the week.
**Patient Assessment and Differential Diagnoses**
The evaluation showed high blood pressure, some swelling on the lower extremities, and a complaint of fatigue. The patient denied chest pains, palpitations, or yellow vision. These results were following inadequately managed hypertension. Therefore, the care plan embraced the introduction of a calcium channel blocker, teaching the patient how to monitor blood pressure at home, reinforcing dietary and lifestyle changes, including dietary salt reduction and increased exercise. Progress would be monitored later through follow-up visits to check progress and compliance.
Three differential diagnoses were addressed. Primary hypertension was the most probable one, as the readings were consistently high, and it was determined that there was no secondary cause of its development. Secondly, possible causes of renal artery stenosis were also assessed, including medication resistance, but the absence of renal bruit and declining kidney functioning eliminated this hypothesis. Lastly, it was also possible that secondary hypertension could be endocrine related, and this could be hyperaldosteronism, but this was unlikely as there was no hypokalemia or endocrine symptoms.
**Health Promotion Intervention**
The primary intervention, health promotion, consisted of explaining to the patient how to change his lifestyle to assist in controlling blood pressure. This involved using the Dietary Approaches to Stop Hypertension (DASH) diet, reducing less than 2 grams of sodium daily, exercising regularly, and quitting smoking. According to Campbell et al. (2022), these suggestions follow the international guidelines on treatment and underline the importance of non-pharmacologic measures as part and parcel of hypertension management.
**What I Learned**
This week's experience further highlighted the consideration of patient-centered care and the necessity of personalizing treatment plans. It also highlighted the purpose of advanced practice nurses in identifying barriers to adherence and modification of interventions. Patients with chronic illnesses, such as hypertension, prompt the need for effective communication, cultural sensitivity of healthcare workers, and evidence-based decision-making to support patient outcomes.
**Support for Plan of Care**
The new plan of care corresponded with the World Health Organization guidelines of 2021, which state that adults with stage 2 high blood pressure should start taking medicine and apply lifestyle changes to gain thorough control of the disease (Campbell et al., 2022). This aligns with Silva et al. (2022), where the authors emphasize combining clinical standards and custom treatment in managing challenges perceived in hypertension management.