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QUESTION
W2. Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
Case:
Carl is a 67-year-old Hispanic male with type 2 diabetes who takes metformin 1000mg twice daily. He stopped smoking more than 20 years ago and does not drink. He is 5’8’ and weighs 188 lbs. His last cholesterol level reading last month was 188 triglycerides 108, A1C 6.9. His blood pressure has been maintained at a normal range. What health promotion priorities do you have for Carl on this visit?
Textbook: Primary Care. The art and science of Advanced Practice Nursing -an interprofessional approach---- 5th edition Lynne E. Dumphy
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas
| Subject | Nursing | Pages | 3 | Style | APA |
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Answer
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Experts have described type 2 diabetes as a chronic situation characterized by a reduced body response to metabolize glucose. From the case presented, Carl, 67 years old, the patient requires a management plan to promote better health conditions. This paper seeks to discuss questions that the patient will be asked upon arrival at the health facility, physical extermination, and testing to manage the patient's condition. Additional discussion will be provided in this paper on a treatment plan, complementary and OTC therapy, and effective referral to team members for complete care.
During the initial stage of the initial meeting with the patient, I will ask about the type of diet Carl takes, the frequency of exercise taken, and the type of medications taken to manage the condition. On the other hand, I will ask the patient-specific time for taking medication, and problems faced when taking the medication, and frequency of blood glucose tests conducted to determine its stability (Danphy, 2001). In the patient's physical extermination, I will consider the patient's general appearance, vital signs of blood pressure, and pulse pressure. The skin condition will also be analyzed for acanthosis nigricans papules and skin thickening. I will conduct additional extermination on the heels, neck, lungs, heart, abdomen, and back conditions of the patient.
The blood test will be my critical considerations for establishing treatment modules for the patient. In this test, I will begin with an oral glucose tolerance test, followed by fasting blood sugar collected early in the morning before taking any meal. Other tests will be a two-hour postprandial test, random blood sugar, and hemoglobin A1C test. The results obtained will then be analyzed for conclusions to a different working diagnosis. The differential diagnoses for diabetes type 2 are considered in three stages: differential diagnosis 1, 2, and 3. In differential diagnosis 1, I will consider symptoms such as hemoglobin equal to or above 6.5%, fasting plasma glucose above 126mg/Dl. In differential diagnosis 2, I will consider testing abdominal obesity, high triglyceride level, and reduced presence of high-density proteins (Staggs, 2020). Others will include considerations for high blood pressure and the value of fasting glucose above 100mg then conclude the presence of type 2 diabetes.
In differential diagnosis 3, I will test the thyroid function, availability of autoantibodies, and thyroid image rules. The next step that I will consider is the development of a treatment plan for the patient. Consequently, the treatment plan for type 2 diabetes is majorly focused on the lifestyle of an individual. Dietary considerations for the patient include meals rich in fiber, eating at regular intervals, and weight management. In adverse conditions, medications are considered to bring the situation under control. Among drugs to be taken includes metformin for lowering blood glucose, sulfonylureas for insulin control, and meglitinides.
Complementary treatment for type 2 diabetes includes advising the patient to use herbal supplements such as aloe Vera, alpha-lipoic acid food to act as anti-oxidants. Finally, it is essential to consider primary care providers to facilitate a healthy lifestyle. The inclusion of other nurses with vast experience in managing type two diabetes is essential for benchmarking the patient's results and designing the right treatment and management plan.
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References
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Dunphy, L., & WINLAND-BROWN, J. E. (2001). The Art and Science of Advanced Practice Nursing.
Staggs, M. (2020). Always a Nurse: The Advanced Practice Nurse. Nursing Administration Quarterly, 44(1), 23-24.
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Week 4 Discusssion
Choose ONE of the following discussion question options to respond to: Using Adverse Conditions to a Company's AdvantageThis is a discussion question that I need answered. I need the second portion of the questioned answered thoroughly, both bullet points. I have highlighted it in yellow to show that it is what I need answered. I need this r returned to me completed without any grammatical or punctual errors. The company that I want this question written about is Nissan Motor Corporation. - Chakravorti (2010) discusses four methods that corporate innovators use to turn adverse conditions to their advantage. Examine an organization of your choice and briefly discuss how the organization might use one of these methods.
- Using the company of your choice, identify an important and difficult decision that they faced. What were the most important risks and the most important rewards of the decision?
- What data, analysis or perspective would you have used to help Sr. Management decide if the rewards outweighed the risks?
| Subject | Business | Pages | 4 | Style | APA |
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Answer
Assessing Risk and Reward
The Nissan Motor Company is one of the leading automobile makers in the world. The Japanese carmaker has primarily enjoyed a successful run, allowing it to enter various regional and international markets such as the United States. However, the changing business environment was not favorable to the company in 2019. Notably, the cooperation recorded losses amounting to 7.8%. The experience pushed the management into making tough decisions, requiring almost all of its North American workforce to go for unpaid leaves.
In late 2019, the company announced that the decline in sales necessitated a two-day unpaid leave for the North American workers. The stated days for the vacation were January 2 and 3rd (Chicago Tribune, 2019). Notably, this move was a crucial decision for the company because of its conflicting impacts. Whereas on the positive side, it could help the firm minimize expenses, it threatened to affect the public perception of the company regarding employee welfare.
The rewards for the decision involved cutting expenses by not paying the workers on leave, which eventually would translate into reduced expenses. Another reward was that the decision could allow the company to optimize performance by evaluating employee performances then developing new milestones. However, on the low side, the company risked affecting its public image and brand name, especially in the North American market. As per Chakravorti (2010), the way an organization treats its employees influences the firm's public perception. Thus, Nissan risked eliciting a negative public perception. With a distorted public image, the company could fail to revive its declining sales.
I would have advised the management of Nissan to utilize the Predictive Analytic perspective in determining the right decision to take. Ideally, the approach tries to predict what might happen in the future if particular decisions or actions are undertaken at the moment (Traymbak & Aggarwal, 2019). Looking at the situation at Nissan, the company needed to develop a goal such as increasing sales. After that, they would have made decisions aimed at realizing the set goal. In this regard, the predicted outcome could give the management an overview of whether more risks existed or significant rewards could be realized.
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References
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Choudhry, Saad A, Muhammad Jahanzaib Anwar, Muhammad Afzal, and Abdul Shah. “Foodborne Botulism, I Only Had Nacho Cheese: A Case Report.” Cureus vol. 9, no. 9 e1666. 8 Sep. 2017, pp. 1-16. DOI:10.7759/cureus.1666
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Hellmich, Dorothea, Katja E. Wartenberg, Stephan Zierz, and Tobias J. Mueller. “Foodborne botulism due to ingestion of home-canned green beans: two case reports.” Journal of Medical Case Reports, vol. 12, Article number: 1, 2018. https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-017-1523-9
Jeffery, Lain. “Botulism.” StatPearls, 2020. https://www.ncbi.nlm.nih.gov/books/n/statpearls/article-18469
Kanaan, Manal Hadi Ghaffoori and Ahmad M. Tarek. “Clostridium botulinum, a foodborne pathogen and its impact on public health.” Annals of Tropical Medicine and Public Health, vol. 23, no. 5, 2020, pp. 49-62. DOI: 10.36295/ASRO.2020.2357.
Kryzowska-Firych, Joanna, Anna Miklaszewska, and Krzysztof Tomasiewicz. “Foodborne botulism in eastern Poland: a hospital-based retrospective study and epidemiological data review.” International Journal of Food Properties, vol. 23, no. 1, 2020, pp. 609-615. https://doi.org/10.1080/10942912.2020.1749065
Lonati, Davide, Azzurra Schicchi, Marta Crevani, Eleonora Buscaglia, Giulia Scaravaggi, Francesca Maida, Marco Cirronis, Valeria Margherita Petrolini, and Carlo Alessandro Locatelli. “Foodborne Botulism: Clinical Diagnosis and Medical Treatment.” Toxins vol. 12, no. 8. 7 Aug. 2020, pp. 1-81. DOI: 10.3390/toxins12080509
Rasetti-Escargueil, Christine, Emmanuel Lemichez, and Michel R. Popoff. “Public Health Risk Associated with Botulism as Foodborne Zoonoses.” Toxins vol. 12, 1. 30 Dec. 2019, pp. 1-119. DOI: 10.3390/toxins12010017.
Tamrin, Mohd IslahuddinMohd. “The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey.” International Journal of Infectious Diseases, vol. 95, 2020, pp. 157-159. https://www.sciencedirect.com/science/article/pii/S1201971220301764
Tiwari, Aman. “Clostridium Botulinum.” StatPearls, 2020. https://www.ncbi.nlm.nih.gov/books/n/statpearls/article-19635