Case Study #1

25-year old Caucasian female 5’6” 110 pounds

Allergic to wheat

No medications currently taken

CC:  Glossitis and diarrhea

Patient noticed over the past week her tongue has become sore and inflamed.   She feels the pain is constant, aggravated by eating and alleviated by “not letting anything touch it.”  Patient states tongue feels “tender.”  She has no idea what is causing it.  No other treatments have been attempted.  Severity/significance is a 9 out of 10.  She also states she has had diarrhea “worse than usual for the past 6 months.”  When asked if she has an chronic conditions, she states she has Celiac Disease but has a “tendency not to avoid pastries – her favorite!” Currently, her diarrhea is worse after she eats going up to 6 times per day.  She does notice the frequency increases when she eats any bread product and it is stops when she stops eating bread products.  On occasion, she takes over the counter diarrhea medication.  The severity is 5 out of 10.  Blood work shows red blood cells are larger than normal (macrocytic).

Case Study #2

70-year old Black male 5’10” 200 pounds.

No Known Drug Allergies

Currently taking Lisinopril and Crestor

CC:  Dysphagia

Patient has noticed he has had difficulty swallowing food over the past 8 months.  He has noticed that in the beginning it only occurred with solid food but now it has progressed to include really any type of food.  Nothing appears to alleviate the condition.  He is only reminded of it “when he starts to eat.”  He has tried no other treatments.  Severity is 8 out of 10.  When asked if he has noticed anything else, he mentioned he has lost 10 pounds without trying in the last month and feels he has lost his strength.  Also, he notices when he actually “decides to eat” he does not eat much and feels full quickly.  CT scan shows epigastric mass.

Case Study #3

57-year old female

5’5” 300 pounds

No Known Drug Allergies

Current medications – none

CC:  Sudden one-sided facial paralysis

Patient states that her family noticed during Thanksgiving dinner that one side of her face became “frozen.”  Patient became extremely upset and wanted to be taken to the emergency room.  Family took her to the emergency room and the following exams were done:

CT – negative for infarct but to be sure MRI was done and was also negative for infarct, mass lesion or hemorrhage.  Facial paralysis went away within the hour.  However, patient was kept in the hospital for observation.

1. Formulate the Conclusion section of your selected topic.  

This section should contain conclusive statements and recommendations for future research.

Topic:  

Benefits of Legalizing Marijuana in the U.S.

Attached is the Word Document with all the rearch paper until now. Please write the conclusion.

Purpose

The purpose of this assignment is to provide an analysis and synthesis-level evaluation of the factors that influence both contemporary advanced practice nursing and the time-period of transition that occurs within the first year of clinical practice.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Reflect on the elements of a successful transition from Registered Nurse to Advanced Practice Registered Nurse. (CO 5)
2. Evaluate the patient-centered medical home, value-based payment, and interdisciplinary care models espoused by the Medicare Access and CHIP  Reauthorization Act of 2015 (MACRA) and its’ impact on the quality of  healthcare. (CO 2, 5) 

Requirements:

Part 1: Using Brown and Olshansky’s (1997) model,  describe what interventions you plan to do during your first year of practice to help you navigate the changes described during each phase.

Part 2: We are seeing a rapid change in primary care as stakeholders are demanding higher quality healthcare at reduced costs. After reading the Cuenca (2017) and Shi, et al. (2017) articles,  provide a synthesis-level evaluation of how you believe the patient-centered medical home and value-based payment models will: (1)  impact your personal practice as a nurse practitioner, and (2) transform the way primary care is delivered in the United States.

Part 3: After reading the AANP (2015) and White, et al. (2017) articles, what are your thoughts on the economic benefits of using nurse practitioners in healthcare practices? How would you respond to this question if asked in a job interview? Support your response in  Part 3 with evidence from the literature.

 Type 2 Diabetes Mellitus

      Diabetes mellitus (DM) is a common chronic disease that brings burden on health care systems worldwide and the ninth major cause of death (Marie et al., 2018, Zheng et al., 2018). DM

is a clinically and genetically heterogeneous group of disorders characterized by abnormally high blood glucose levels as a result of either insulin deficiency or cellular resistance to the action

of insulin (Arcangelo et al., 2016). Type 2 diabetes mellitus (T2DM) is the most prevalent form of DM accounting to 90% to 95% of the DM cases. In T2DM, there is insulin resistance and

inappropriate insulin secretion.  Family history of DM, obesity (205 over desired body weight), Race/ethnicity (African Americans, Hispanic Americans, Native Americans, Asian Americans,

Pacific Islanders have increased risk), age older than 45 years-old, previously identified as having impaired fasting glucose, hypertension, high-density lipoprotein (HDL) cholesterol level

greater than 35 mg/dl or triglyceride level greater than 250 mg/dl, history of gestational DM, and sedentary lifestyle are the major risk factors for T2DM (Rosenthal & Burchum, 2018).

                                                                                      Drug for T2DM

                 The Association for the Study of Diabetes (ADA) and the European Association for the study of Diabetes recommended a four-step approach in managing hyperglycemia for

T2DM. Metformin is the first drug of choice for T2DM after diagnosis (Rosenthal & Burchum, 2018). Biguanides (metformin) are oral antidiabetic drugs. However, are not considered

hypoglycemic agents because their primary pharmacologic action does not increase insulin secretion (Arcangelo et al., 2016). Metformin is started immediately along with lifestyle and diet

changes. Metformin when used as monotherapy does not caused hypoglycemia and do not promote hyperinsulinemia or weight gain. Metformin reduces low-density lipoprotein (LDL) and

raised HDL. Common side effects are lactic acidosis, gastrointestinal reactions (nausea, upset stomach and diarrhea). Patients’ needs to take metformin before meals in the morning and

evening. The dosage is started low (500 or 850 mg daily or twice daily for the IR tablets) and can be increased weekly as needed to the maximum (2,550 mg per day). Metformin should be

carefully titrated in elderly and contraindicated in children, alcoholics, presence of kidney and hepatic dysfunction (Rosenthal & Burchum, 2018). 

       Short-term impact of uncontrolled DM

        Maintaining a healthy body weight by engaging in regular physical activity, consuming a healthy diet and medication adherence is important for reducing the risks of chronic

uncontrolled DM (hospitalizations due to diabetic ketoacidosis and coma) ( Zheng et al., 2018).

           Long-term impact of uncontrolled DM

     Insulin dysfunction affects many body systems causing hypertension, coronary heart disease, and other complications like neuropathies, retinmopathies, amputation that may affect social

life and quality of life ( Zheng et al., 2018). Advanced practice registered nurses have a vital role in focusing on preventative healthcare maintenance to promote quality of life and prevent

uncontrolled DM impacts.

                                                                                              References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2016). Pharmacotherapeutics for advanced practice (4th ed.). Lippincott Williams And Wilkins.

Marie, M. H., Andersen, H. U., Thorsteinsson, B., & Pedersen- Bjergaard, U. (2018). Hypoglycemic exposure and risk of asymptomatic hypoglycemia in type 1 diabetes assessed by

    continuous glucose monitoring. The Journal of Clinical  Endocrinology and Metabolism, 103(6), 2329-2335. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.  1210/jc.2018-00142

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Speed Pharmacology. (2017). Drugs for Diabetes (Made Easy) [Video]. https://www.youtube.com/watch?v=LWDQyaKVols&t=79s

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews.Endocrinology, 14(2), 88-98.

     doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1038/nrendo.2017.151

Instructions Reply 

Respond to a colleague and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region (Florida). Be specific and provide examples. At least 2 references