Question

Carolyn Mason is a nurse working in a community health setting. One of her roles is to organize screenings and clinics in local retirement communities. She is conducting a diabetes screening clinic in a lower income retirement complex. The center has access to transportation for the residents to visit primary care providers. The residents live independently and prepare their own meals.

Carolyn is approached by a 72-year-old woman who has non–insulin-dependent diabetes and hypertension. She shares with Carolyn that she has been experiencing episodes of fatigue, weakness, and thirst. She is able to perform her grocery shopping through public transportation, but because of her limited income, she relies on convenience foods most of the time.

1. In a lower income retirement community, what is the community health nurse most concerned with regarding diabetes care and control of symptoms?

1. Medication and diet compliance
2. The use of complementary therapies
3. Access to transportation
4. Availability of general practitioners in the community

2. Carolyn Mason uses technology to upload glucose readings to primary care providers to ensure that they are aware of trends. What are the most significant negative aspects of the use of new technology? (Select all that apply.)

1. High cost of equipment
2. Potential for privacy breach
3. More convenient for providers
4. Increased legal liability
5. Increased efficiency

3. A few residents of the retirement community in which Ms. Mason is working belong to the Medicare Advantage program. This is an example of which of the following systems?

1. Health maintenance
2. Primary care
3. Public health
4. Managed care

4. In the event that a resident of the senior retirement community required follow-up for a tuberculosis exposure, which entity would have primary accountability for service?

1. State health department
2. Centers for Disease Control and Prevention
3. Local public health department
4. Home health providers

Answer 1

Here our patient is having non-insulin-dependent (type II) diabetes mellitus and hypertension, it should be treated with oral hypoglycemic drugs and anti-hypertensive medications.

The non-insulin-dependent diabetes mellitus is a metabolic disorder which is characterized by hyperglycemia with ketosis resistance. The onset of non-insulin-dependent diabetes mellitus is usually after the age of 40 years. In some cases insulin therapy may be needed during some illness/ surgery or pregnancy times. Hence it is a chronic condition which affects the way by the body manage the blood sugar. In type 2 diabetes, our body either doesn't produce enough insulin, or it may be resists insulin receptors. The major symptoms include hunger , increased thirst, fatigue ,frequent urination and blurred vision. Usually the treatments for the type 2 include diet, and exercise, medication and the insulin therapy.

The common medications that we are using is,

1) The Sulfonylureas (glipizide, glyburide, gliclazide, glimepiride..etc)

2) Meglitinides ,incretins (Repaglinide and nateglinide…)

3) Biguanides molecule (Metformin)

4) Thiazolidinediones PPAR gama activator (rosiglitazone, pioglitazone)

5) The α-Glucosidase inhibitors (acarbose, miglitol, voglibose)

6) Dipeptidyl peptidase IV inhibitors (e.g., sitagliptin)

The patient should treat the hypertension also with the diagnostic condition with the anty hypertensive drugs like,

he classes of blood pressure medications include:

1) Diuretics.

2) Beta-blockers.

3) ACE inhibitors.

4) Angiotensin II receptor blockers.

5) Calcium channel blockers.

6) Alpha blockers.

7) Alpha-2 Receptor Agonists.

8) Combined alpha and beta-blockers.

Also the nurse should be concern about the use of “complementary therapies”, since the patient is a limited income person, she should advice the complementary therapies too. There is no enough valid proof to suggest complementary drugs will help patients having diabetes.

Still the nutritional supplements, plants, and herbs have been using. The supplements that may be good to patients are Aloe Vera , cinnamon. Cinnamon is a spice that takes from the bark of a Cinnamomum verum, Bitter melon, Milk thistle, Fenugreek, Gymnema and ginger.

In the community the availability of general practitioners is very less, it is an important area where which nurse have to concentrate more and give his/her 100 percentage work. Then only the community health will become better, and do something to the transportation access also.

Second part

The most important negative impacts by the use of modern technologies in our society and its after effects on an individual character could be the formation of personal beliefs, The high cost of equipment, social isolation, it may be potential for privacy breach, reduction in the family ties like between the family and society members, it may increase legal liability, inactivity of workers, obesity of workers, it will lead to lack of desire to work at different activities… Also the most critical problems facing the new industry by the use of modern technologies are

1) It will lead to cyber security problems.

2) It will lead the invention of robots and artificial intelligence.

3) It will steep pressure to innovate.

4) It will lead to the workforce shortage.

5) The lacking in diversity is also one of the major problem.

Third part

The Medicare advantage plans are the type of “Medicare health plan” which is offering by a independent company that will contracts with Medicare to give all the patient’s benefits. The most of the Medicare Advantage Plans are offering the coverage to prescription drugs. It is a type of managed care.

Fourth part

It is the duty of the Public health service to address the tuberculosis. Report the TB to the health department. And take the treatment by the drugs HERSL (isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin).