question archive 1)Is there any additional subjective or objective information you need for this client? Explain
1)Is there any additional subjective or objective information you need for this client? Explain
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1)Is there any additional subjective or objective information you need for this client? Explain.
For subjective information I would ask how long she has been diagnosed and taking the prescribed medications as well as how long she has been taking the herbal supplements. I would ask about any other medications she is taking for diabetes type II. How does she control blood sugar whether it’s change in diet or exercise etc.? Also ask about any new and existing issues or problems that she has noticed. Ask about medical and family history, why she was prescribed coumadin? When was the last PT/INR lab result? For Objective data vital signs, BMI should be obtained, full head to toe exam, blood work including hemoglobin A1c, and memory exam.
2)What would be your position on the Ms. GMs use of alternative supplements for her diabetes and memory? Explain and include contraindications, if any.
As an APN, I am to provide information and knowledge on the use of alternative supplements and prescribed medications. I am to educate my patient about the use of alternative therapies or supplements including side effects and interactions in relations to other medications. I would inform Ms. GM of how important it is not to take Ginseng while also taking Coumadin. Taking Ginseng while on Coumadin has been reported that Ginseng, a popular herbal supplement that proponents tout as a tonic for improvined energy and vitality, reduces the effects and blood level of warfarin coumadin ( Mitka, 2004). Decreasing the effectiveness would lead to high risk for clotting. Ginseng, as a dietary supplement, plays a key role in disease prevention by modulating the immune function of human body ( Riaz M., et al 2019). This herbal supplement has been shown to improve brain function such as memory and mood. In a study it mentioned that Ginseng is effective and safe as an additional treatment in management of type 2 diabetes ( Chen W., 2019) Cassia cinnamon can be used for diabetes and prediabetes. Cassia cinnamon contains chemicals that seem to improve insulin sensitivity (WebMD, 2021).
3. Are there any additional test/assessments you would complete for this patient given this list of medications? Explain.
According to the patient history of type 2 diabetes. I would assess lab results like hemoglobin A1c, fasting glucose, CMP, CBC, liver, and kidney function. INR/Platelet counts. Because the patient is taking Coumadin INR/ platelet counts need to be monitored. Liver and kidney function test because Cassia cinnamon can affect the liver.
4. How might your treatment plan, in terms of medications, differ for this patient? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; contraindications and black box warnings.
Depending on the results of her labs and glucose control, I would consider starting her on a medication for her diabetes such as Jardiance. Jardiance is Empagliflozin is indicated as an adjunct to diet and exercise to improve glycemic control in adult patients with type 2 diabetes. It is also indicated to reduce the risk of cardiovascular death in adult patients with both type 2 diabetes mellitus and established cardiovascular disease. Mechanism of action: The vast majority of glucose filtered through the glomerulus is reabsorbed within the proximal tubule, primarily via SGLT2 (sodium-glucose linked co-transporter-2) which is responsible for ~90% of the total glucose reabsorption within the kidneys. Na+/K+-ATPase on the basolateral membrane of proximal tubular cells utilize ATP to actively pump Na+ ions into the interstitium surrounding the tubule, establishing a Na+ gradient within the tubular cell (DrugBankonline, 2021). Route: Pill or injection once daily in the morning Half-Life: The apparent terminal elimination half-life was found to be 12.4 h based on population pharmacokinetic analysis. Metabolized In: Empagliflozin undergoes minimal metabolism. It is primarily metabolized via glucuronidation by 5'-diphospho-glucuronosyltransferases 2B7, 1A3, 1A8, and 1A9 to yield three glucuronide metabolites: 2-O-, 3-O-, and 6-O-glucuronide. Elimination from the body: After oral administration of radiolabeled empagliflozin approximately 41.2% of the administered dose was found eliminated in feces and 54.4% eliminated in urine. The majority of radioactivity in the feces was due to unchanged parent drug while approximately half of the radioactivity in urine was due to unchanged parent drug (DrugBankonline, 2021). Contraindications: Serious hypersensitivity to empagliflozin(angioedema). Patients on dialysis. Cautions increase serum creatinine (DrugBankonline, 2021) Black Box Warnings: Increased risk for amputations of toes, feet, and legs(DrugBankonline, 2021)
5. What health maintenance or preventive education is important for this client based on your choice medication/treatment?
Ms. GM needs to be educated about herbal supplements and prescribe medications if she does not wish to stop taking the supplements. Ms. GM needs to know that Cassia cinnamon supplement is only safe for a short term if not consuming large doses. Cassia cinnamon especially sensitive persons, even comparatively small quantities of coumarin cause liver damage (Bundesingtitut F. R., 2012). That’s why it would be important to educate on monitoring liver function while taking this supplement. I would recommend follow-up appointments to track progress of medication and lab values such as PT&INR. I would instruct to perform daily blood sugar checks. Order and educate patient to take medications as prescribed and to monitor/are notify provider if adverse reaction occurs.
