Discussion: Diabetes and Drug Treatments NURS 6521

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Discussion: Diabetes and Drug Treatments NURS 6521

Discussion: Diabetes and Drug Treatments NURS 6521

WK 5 Main Discussion Post – Dana Sawyer

            Diabetes is a widespread disease in the United States, affecting over thirty million people while affecting more people over sixty-five (“What is diabetes?,” 2016). Diabetes often can be managed by lifestyle and diet modifications, but medications may necessary to assist in managing blood glucose levels. Diabetes is an endocrine disorder that affects carbohydrate metabolism (Rosenthal & Burchum, 2021, p. 397).

Type one diabetes or juvenile diabetes and type two diabetes are the primary two diabetes diseases. Other forms are gestational diabetes, monogenic diabetes, and cystic fibrosis related diabetes (“What is diabetes?,” 2016). Type one diabetes also termed juvenile diabetes because it is diagnosed in early childhood or adolescence. The body has an autoimmune response and destroys the pancreatic B cells responsible for insulin production. Type two diabetes is the most common form and progresses gradually, where type one diabetes is abrupt. Insulin is still produced and used by the body with Type two diabetes but falls over time. Genetics, diet, lifestyle, and obesity play a significant role in the cause of type two diabetes. Gestational diabetes occurs only in pregnancy and can causes problems for the mother and the fetus.

The first-line treatment for Gestational Diabetes is lifestyle modifications with diet and exercise (Venkatesh & Landon, 2021, p. 9). The American College of Obstetricians and Gynecologists (ACOG) recommends insulin therapy as the first-line treatment for gestational diabetes control; however, metformin or glyburide is an appropriate pharmacotherapy treatment when the patient declines to take insulin (“Updated ACOG guidance on gestational diabetes,” 2021). Long-acting insulin, as NPH, can be started in the morning, at bedtime, or both and adjusted as needed depending on glucose control. Sometimes short-acting insulin, as regular, may be needed with meals to achieve better control (Venkatesh & Landon, 2021, p. 13). Insulin does not cross the placenta barrier and can lead to better perinatal outcomes related to the child or mother developing diabetes later in life (Venkatesh & Landon, 2021, p. 14). Patient education is critical because the patient needs to learn to give themselves injections, correctly check and monitor glucose levels, and store insulin in the refrigerator. Using insulin versus metformin in pregnancy remains controversial because the long-term effects of developing diabetes are not thoroughly studied  (Venkatesh & Landon, 2021, p. 12). Insulin is given subcutaneously anywhere that fatty tissue can be located on the body, like the abdomen or upper outer arm. Forms of insulin cannot be used interchangeably because some are long-acting, short-acting, and intermediate (Rosenthal & Burchum, 2021, p. 402).

Gestational diabetes requires commitment on both sides of the patient and provider. Frequent provider visits are required with insulin to obtain optimum control and prevent the patient from becoming hypo or hyperglycemic. Gestational diabetes can cause fetal macrosomia, stillbirth, high blood pressure, preeclampsia, and a higher risk for a cesarean section (“Gestational diabetes and pregnancy,” 2020). Women with gestational diabetes should have testing for diabetes four to twelve weeks postpartum (“Gestational diabetes,” 2020). One in three women with gestational diabetes will develop type two diabetes postpartum (Venkatesh & Landon, 2021, p. 15). Prepregnancy risk factors include obesity, inactivity, previous diagnosis of gestational diabetes, heart disease, and high blood pressure (“Gestational diabetes,” 2020). There can never be enough patient education which is neverending.

References

Gestational diabetes and pregnancy. (2020, July 14). Centers for Disease Control and Prevention. Retrieved July 1, 2021, from 

Gestational diabetes. (2020, December). ACOG Gestational Diabetes FAQ’s. Retrieved July 1, 2021, from 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Nurse Practitioners and Physician Assistants (2nd ed.). Elsevier, Inc.

Updated ACOG guidance on gestational diabetes. (2021, January 4). The ObG Project. Retrieved July 1, 2021, from 

Venkatesh, K. K., & Landon, M. B. (2021). Diagnosis and Management of Gestational Diabetes: What every OB/GYN needs to know to manage this complication. Contemporary OB/GYN66(5), 9-15. 

What is diabetes? (2016, December 1). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved July 1, 2021, from 

Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images

Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/

To Prepare

Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes to focus on for this Discussion.
Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.
By Day 3 of Week 5

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

Week 5-Initial post

            Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia. Diabetes Mellitus is classified into different categories; Type 1 (Juvenile DM), Type 2, and gestational diabetes (Huether, McCance, Brashers, & Rote, 2017). Common clinical manifestations of DM are polydipsia, polyphagia, and polyuria

In Type 1 DM, the destruction of beta cells is related to genetic susceptibility and environmental factors. Autoimmune destruction of beta cells leads to decreased insulin secretion. The peak onset of Type 1 DM is from age 11-15 years and could be younger in girls (Huether et al., 2017). With Type 2 DM, genetic-environmental interactions lead to insulin resistance. The most common genetic-environmental contribution of Type 2 DM is obesity. Type 2 DM is commonly non-insulin-dependent. Gestational DM is glucose intolerance during pregnancy, common in women with previously undiagnosed Type 1 or Type 2 DM (Huether et al., 2017). Women with Gestational DM are at an increased risk of developing diabetes in the future.

Type 2 Diabetes Mellitus and Metformin (Glucophage)

Metformin (Glucophage) is used in the treatment and prevention of Type 2 DM. Metformin (Glucophage) is a well understood oral hyperglycemic agent with minimal side effects and low-cost efficiency (Salber, Wang, Lynch, Pasquale, Rajan, Stevens, Grady, & Kenny, 2017). Metformin (Glucophage) increases insulin sensitivity and decreases intestinal glucose absorption. The kidney eliminates Metformin (Glucophage); thus, caution should be used when prescribing to patients with renal disease due to lactic acid build-up (Vallerand, Sanoski, Deglin, & Rodenberger, 2015). Metformin (Glucophage) is also contraindicated in dehydration, sepsis, hypoxemia, and hepatic impairment. Side effects of Metformin (Glucophage) are abdominal bloating, diarrhea, nausea, vomiting, and decreased Vitamin B12 levels in the long term. The starting daily dose of Metformin (Glucophage) is 500 mg and can be increased based on clinical needs and renal function (Chung, H., Oh, Yoon, Yu, Cho, & Chung, J., 2018).

In Type 2 DM, patient teaching should include diet control, exercise, and carbohydrate monitoring. Carbohydrates are broken down to glucose, which can cause hyperglycemia in patients with DM.

Short-term and Long-term Impact of Diabetes Mellitus

The Short-term impact of Type 2 DM and Metformin (Glucophage) is hypoglycemia and hyperglycemia. Thus, medication teaching, diet control, and exercise should be included in the treatment plan. Macrovascular complications due to damaged blood vessels in the eyes, kidneys, and nerves is a long-term effect of Type 2 DM. Insulin therapy should be considered in patients who do not respond to Metformin (Glucophage) and a combination of oral Sulfonylureas after three months (Vallerand et al., 2015).

Conclusion

Type 2 DM is an endocrine disorder characterized by insulin resistance. Obesity is the most common risk factor in the development of Type 2 DM. Diet, exercise, and oral hyperglycemic agents such as Metformin (Glucophage) are used to manage Type 2 DM. Renal function should be closely monitored when patients are on Metformin (Glucophage) because of lactic acidosis. Patient education should also include signs and symptoms of hypoglycemia and hyperglycemia. Metformin (Glucophage) can be used with other antidiabetic agents based on the patient’s clinical needs.

References

Chung, H., Oh, J., Yoon, S. H., Yu, K.-S., Cho, J.-Y., & Chung, J.-Y. (2018). A non-linear pharmacokinetic-pharmacodynamic relationship of metformin in healthy volunteers: An open-label, parallel group, randomized clinical study. PLoS ONE, 13(1), 1–11. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0191258

Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2017). Understanding pathophysiology. St. Louis, Missouri: Elsevier.

Salber, G. J., Wang, Y. B., Lynch, J. T., Pasquale, K. M., Rajan, T. V., Stevens, R. G., Grady, J. J., & Kenny, A. M. (2017). Metformin Use in Practice: Compliance with Guidelines for Patients with Diabetes and Preserved Renal Function. Clinical diabetes: a publication of the American Diabetes Association, 35(3), 154–161. 

Vallerand, A. H., Sanoski, C. A., Deglin, J. H., & Rodenberger, J. (2015). Davis’s drug guide for nurses (Fourteenth edition.). F. A. Davis Company.

By Day 6 of Week 5

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 of Week 5 and Respond by Day 6 of Week 5

To Participate in this Discussion:

Week 5 Discussion

What’s Coming Up in Module 5?

 

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.

Looking Ahead: Midterm Exam

Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.

 

Next Week

To go to the next week:

Module 5

 

Module 5: Neurologic and Musculoskeletal Systems
What’s Happening This Module?
Module 5: Neurologic and Musculoskeletal Systems is a 2-week module, Weeks 6 and 7 of the course. In this module, you will analyze drugs prescribed to treat neurological and musculoskeletal disorders and explore patient education strategies for treatment and management of these disorders. You will also evaluate the impact of patient factors on the effects of prescribed drugs and drug therapy plans for neurologic and musculoskeletal disorders. You will also complete your Midterm Exam.

What do I have to do?
When do I have to do it?
Review your Learning Resources
Days 1-7, Weeks 6 and 7
Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders
You are encouraged to begin your Assignment in Week 6 and continue working on it in Week 7. However, this Assignment is not due until Day 7 of Week 8 in Module 6.
Midterm Exam
Complete by Day 7 of Week 7.
Go to the Week’s Content

Week 6

Week 7

 

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
Chapter 15, “Adrenergic Agonists” (pp. 99–107)
Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

 

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Document: Mid-Term Summary & Study Guide (PDF)

 

Required Media (click to expand/reduce)

 

Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Laureate Education (Producer). (2019e). Complex regional pain disorder [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)

Week 5: Endocrine System Disorders and the Treatment of Diabetes

The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions. As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include

This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management.

Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from 

Learning Objectives

Students will:

  • Differentiate types of diabetes
  • Evaluate the impact of diabetes drugs on patients
  • Evaluate alternative drug treatments and patient education strategies for diabetes management

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397–415)
  • Chapter 49, “Drugs for Thyroid Disorders” (pp. 416–424)
Required Media (click to expand/reduce)

Speed Pharmacology. (2017). Drugs for Diabetes (Made Easy) [Video]. https://www.youtube.com/watch?v=LWDQyaKVols&t=79s
Note:
This media program is approximately 17 minutes.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6521_Week5_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100
Name: NURS_6521_Week5_Discussion_Rubric

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