Question

1. A 56 year-old woman has had Type 2 diabetes mellitus for sixteen years. She now has gross proteinuria and her blood sugars average 256 mg/dl with glycosylated hemoglobin of 10.9%.

a. What recommendations do you have for her?

b. What are your treatment goals and why?

c. Discuss pathophysiology of the disease or physiology of the organism that the drug(s) are addressing.

d. Rationales for using the specified drug(s), emphasize the APRN role in the assessment, diagnosis, and pharmacological interventions of clients.

e. Indications, contraindications of the drug(s)

f. List the prices of three drugs to treat the selected problem from two different pharmacies.

g. Describe in detail the instructions the patient should receive for the selected drug(s). Write this at a fifth-grade level.

Answer 1

A. Recommendations for this patient-

Main focus for this patient to control the protein urea and control blood sugar level in normal range.

Long term dibetes cause damage to the kidney and causes diabetic nephropathy that may lead in protein urea.

So first control the blood sugar level of the patient by administrator medicine is most important and provide diabetic diet to patient.

Insulin infusion can be started to control the sugar in normal range untill the patient blood glucose becomes in normal range that is FASTIN blood sugar level 70-110 mg/dl. And PPBS- 110-140 mg/dl.

After that infusion cant be stop and insulin can be given just before the meal to regulate blood glucose levels.

B. Treatment goal-

to control the blood glucose levels in normal range is the main goal for this patient other wise patient can goes in diabetics ketoacidosis that can be fatal for the patient.

C. Pathophysiology of diabetes- Pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining β-cell function, eventually leading toβ -cell failure.

The primary events are believed to be an initial deficit in insulin secretion and, in many patients, relative insulin deficiency in association with peripheral insulin resistance.

D. Drug used in diabetediabetes-

1. Insulin infusion.

2. Subcutaneous injection of insulin.

3. Oral hypoglycemic agent like-

The major oral hypoglycemics drug types are:

A. Biguanides- metformin

B. Sulfonylureas- glimpiride
Ç. lpha-glucosidase inhibitors

D. Glitazones

E. DPP-4 inhibitors (gliptins)