Often  we see a great deal of misinformation in the care of patients with  diabetes, and often this misinformation is centered around the role and  choice of medications.  Many patients, especially newly diagnosed  patients, are prescribed medications that do not fit into the scheme of  the ADA / AACE guidelines / best evidence based practices – for  instance, starting on Januvia (sitagliptin) or Jardiance (empagliflozin)  or Byetta (exenatide) as initial monotherapy without a compelling  indication or reason.

In this discussion, please talk about  how patients get put on these medications and why/how they should be  transitioned to more evidence based treatments.  

• Is it okay to start a patient on a  drug (particularly an oral drug) other than metformin as an initial  drug?  Please cite possible circumstances where this could be  reasonable.
• What anti-diabetic medications have  compelling evidence for use in select populations, possibly as initial  therapy, and is this benefit a “class” effect? 
  • (eg. SGLT2Is – Patients with type 2  diabetes and a high risk of cardiovascular disease had reduced risk of a  cardiovascular death, nonfatal myocardial infarction, or nonfatal  stroke relative to those randomized to receive placebo)
• How can patients and practitioners be convinced to change their behavior and opt for more evidence based approach to therapy?

Now let’s consider the following case about thyroid disorders. A  69-year-old man goes to his family doctor because he has been feeling  fatigued and lethargic. His doctor does a complete evaluation. This  patient had a myocardial infarction and has a recurrent ventricular  arrhythmia (treated with amiodarone). The patient’s TSH is elevated and  his T4 is slightly decreased. 

• Please provide an evaluation of this patient’s condition, approach to therapy and factors you have taken into consideration 

Post your initial response by  Wednesday at midnight. Respond to one student by Sunday at midnight.   Both responses should be a minimum of 150 words, scholarly written, APA  formatted, and referenced.  A minimum of 2 references are required  (other than your text). Refer to the Grading Rubric for Online  Discussion in the Course Resource section.

Describe how epidemiological data influences changes in health practices. Provide an example and explain what data would be necessary to make a change in practice.

Directions:

Heart disease remains one of the top causes of mortality in the United States. Consider the various types of heart disease covered in class this week. For your discussion, complete these items:

• The etiology of the selected heart disease
• Modifiable factors
• Non-modifiable factors

Use at least one scholarly source to support your findings. Examples of scholarly sources include academic journals, textbooks, reference texts, and CINAHL nursing guides. Be sure to cite your sources in-text and on a References page using APA format.

You can find useful reference materials for this assignment in the School of Nursing guide: 

Have questions about APA? Visit the online APA guide:

 4 DQ 1

Even though nurses form the majority of the healthcare team, my opinion is that they are not considered or have been inadequately involved in the policy development process. Nurses have a right to develop or influence policies at any level (Brokaw, 2016). However, there exist barriers that limit them from succeeding in their efforts towards policy development and implementation. When these barriers are eliminated and nurses adequately supported, they can lead the industry in making the best reforms and changes (Gerber, 2018). For instance, when Audrey Gibson advocated for policies targeting to prevent maternal mortality, he aimed at achieving the health goals of reducing the maternal mortality rate. Unfortunately, success in most initiatives and strategies is not achieved since developers do not recognize and involve nurses.

 Choose a legislator on the state or federal level who is also a nurse and discuss the importance of the legislator/nurse’s role as advocate for improving health care delivery. What specific bills has the legislator/nurse sponsored or supported that have influenced health care.  

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.

 4 DQ 1

Early on in my nursing career while working in long term care, I often witnessed death. I recall the first time I had to check vitals to determine if my patient was or was not absent of vitals. This was a very difficult determination; at the time I recall thinking that I could still feel a pulse, even though my instruments were telling me otherwise. Working as a DON at that time we had the authority to pronounce patients dead, this did not seem like it would be difficult when asked of me, but it was when the situation actually took place. For family members that were involved, watching them and engaging in the care of their loved ones during this last phase of life was hard to experience, the more often being involved in these situations, the easier it became to engage with the family members and console them. According to Grand Canyon University (2020), the best way to help comfort family members and loved ones it to be honest and sympathetic, truthful, and compassionate. For example, suggesting to a patient that there is still hope that their loved one currently on hospice care might make a full recovery and not die, may be suggesting false hope and should be avoided, instead honesty and compassion as well as supportive listening would be most appropriate during these times.

Currently, working as a depression case manager in mental health, due to my experience in the past, it has become easier to accept the death of my patients. This acceptance is due to knowing that death is a part of life, life’s natural process. The challenge at times I notice is when there are patients that do not have close family members or loved ones and they die alone, this is really hard to see, and this does not get easier; there is not much that is more sad to see, than someone dying alone with the absence of loved ones and/or family members.

 How often do you engage with or witness death in your work? How has this experience or the lack of it shaped your view of death? Has it gotten easier or harder for you to accept the fact of death? As you explain, include your clinical specialty.

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.