Clinical discussion online assignment in class

L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.

Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.

Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.

One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.

Questions

1. What are the effects of controlling BP in people with diabetes?
2. What is the target BP for patients with diabetes and hypertension?
3. Which antihypertensive agents are recommended for patients with diabetes?

 

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Write a paper of 800-1,000 words that describes the national and international implications of Childhood obesity and diabetes. Include the following:

1. Scope and depth of the problem.
2. Countries that are faring better or worse than others.
3. How the United States ranks on this issue in relation to other countries.
4. Efforts of the World Health Organization and other agencies on this issue.
5. Existing disparities (include race, age, and gender, as appropriate) in relation to the issue: Describe the populations that have emerged as being disadvantaged and why.
6. Include 1 paragraph on health policy and ethics on childhood obesity and diabetes

 

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 Lyme Disease Case Study A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered: Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L) Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct), 36% (normal: 42%-52%) Rheumatoid factor (RF), Negative (normal: negative) Antinuclear antibodies (ANA), Negative (normal: negative) Diagnostic Analysis Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent. Critical Thinking Questions 1. What is the cardinal sign of Lyme disease? (always on the boards) 2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 3. Why was the ESR elevated? 4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatmen 

 

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Week One: Review of Current Healthcare Issues

Initial Post

Allyson Sheldt

Walden University

Review of Current Healthcare Issues

            I work in an adult intensive care unit in Florida, and there are many national healthcare issues and stressors that are faced on a daily basis. One healthcare issue that I feel is very prevalent and personal to me is the national opioid crisis. In my unit, we handle multiple patients who succumb to some form of substance abuse and understanding how to have a positive effect on this epidemic successfully is imperative for healthcare professionals to decrease the financial and personal effects of this crisis.

Opioid Crisis

Stevens et al. (2017) describes the quickly increasing rate of opioid-related overdose mortalities in the United States and depicts the significant impact that this crisis has on the financial burden of hospitals and society as a whole. Stevens et al. (2017) explain the importance of identifying the most effective way to utilize intensive care services and prevention strategies to avoid the necessity of critical care admissions. Hodge, Wetter, Chronister, Hess, and Piatt (2017) depict opioid abuse as the most lethal and avoidable risks to the health of those in the United States and the necessity for initiation of tougher public health interferences.

How the Opioid Crisis Impacts My Work Setting

I feel that the opioid crisis has had a significant impact on my job as a nurse, especially as an intensive care unit nurse. We have had to educate ourselves on the signs of substance abuse and techniques which can be implemented to have a positive effect on substance abuse. Gatchel (2018) discusses how the vital role that nurses have in the delivery of health care is many times unnoticed, especially when it comes to dealing with patients with opioid addictions, nurses are the main players who must handle the complex issues faced by these patients.

Personal Health System Work Setting

Marshall and Broome (2017) describe the triple aim as an effort created to offer a structure to connect various goals of health care, which includes population health, management of health care costs, and enhancement of the patient care experience. Overall, the corporation I am employed for has initiated certain educational programs to raise awareness of the opioid crisis, encouraging employees to be vigilant in observing patients and healthcare professionals for signs and symptoms of addiction. Also, they have implemented certain strategies to prevent and make it harder for people to misuse illegal or prescription medications,  such as creating stricter regulations on wasting narcotics and disposal of any tools that could be utilized to distribute these substances. For example, now the nurse who removes a controlled substance from the Omnicell must be the one to give this medication to the patient to avoid increases opportunities for misuse of these substances. Also, we now are making sure that no syringes or other tools that could be used by someone to inject a substance, even if there is no sharp utensil involved is disposed of in a Sharps container to avoid someone from being able to utilize them for misuse of drugs.

The corporation I am employed with have also instigated new techniques to improve patient experience, urging healthcare professionals to implement certain tactics into their practice to enhance patients’ experiences. Our team leaders make daily rounds to patients, discussing with them any concerns or issues that may have been experienced during their stay so the issues can be addressed prior to the patient leaving the facility, increasing patient satisfaction.

References

Gatchel, R. J. (2018). The importance of the profession of nursing in health care: Current and

future issues. Journal of Applied Biobehavioral Research, 23(1), 1. https://doi-

org.ezp.waldenulibrary.org/10.1111/jabr.12127

Hodge, J. . J., Wetter, S., Chronister, D., Hess, A., & Piatt, J. (2017). Redefining Public Health

Emergencies: The Opioid Epidemic. Jurimetrics: The Journal of Law, Science &

Technology, 58(1), 1–15. Retrieved from https://search-ebscohost-

com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=129653729&site=eds-

live&scope=site

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert

clinician to influential leader (2nd ed.). New York, NY: Springer.

Stevens, J. P., Wall, M. J., Novack, L., Marshall, J., Hsu, D. J., & Howell, M. D. (2017). The

Critical Care Crisis of Opioid Overdoses in the United States. ANNALS OF THE

AMERICAN THORACIC SOCIETY, 14(12), 1803–1809. https://doi-

org.ezp.waldenulibrary.org/10.1513/AnnalsATS.201701-022OC

2 hours ago

Donna Reinbeck-Grant WALDEN INSTRUCTOR MANAGER 

RE: Discussion – Week 1

 

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