Category: Nursing

BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

Lab One

Microscopy

Ubiquity of Microorganisms

 

Microscope
– coordinated system of lenses arranged to produce an enlarged (magnified), focusable image of a specimen.

The microscopes used in lab are expensive instruments and should be treated as such.  Please take care when transporting, using, and storing them! BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

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Components of the compound microscope

You should review each of the components of the compound microscope and be familiar with where they are located and their function as well:

Arm

Base

Mechanical Stage

Light Source/Illuminator

Voltage control/regulator

Lens Systems

Ocular(s)

Diopter adjustment ring

Rotating head

Objective(s) (4x, 10x, 40x, 100x)

k.a – low/scanning, high-dry, and oil immersion objectives

Nosepiece

Condenser

Iris diaphragm

Mechanical stage control

Adjustment Knobs

Coarse adjustment

Fine adjustment

 

Resoultion

The resolution (resolving power) of a lens, or microscope, refers to its ability to distinguish between two separate points.  The limit of resolution for most light (compound) microscopes is 1000x.

Magnification increases
resolution
, ability to distinguish two points as separate points. The better the resolution, the sharper or crisper the image! BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

Resolving power of the human eye = 0.1mm (meaning our eyes can distinguish two points that are at least 0.1mm apart)

Resolving power of the light microscope = 0.2µm (anything closer than this to the objective would not be distinguishable)

Magnification

The apparent increase in size of the specimen that occurs due to the microscope

Determining total magnification: Mag
Tot
= Mag
Obj
X Mag
Ocu

Ocular magnification = 10X

Objectives = 4X, 10X, 40X and 100X(oil immersion)

Parfocal – image remains relatively focused when changing objectives

Parcentered – the center of the image is still the center when changing objectives

Other terms related to microscopy to know

Field of view – the circle of light you see when looking into the microscope

Depth of field – the distance through which you can move the specimen and still have it remain in focus

Working distance – the space between the objective lens and the surface of the slide

Contrast – how well the details of the specimen stand out against the background of the image.  In many cases, staining improves contrast. BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

Qualitative observation – a subjective observation (in other words, one that is not defined by a numerical value).  For example “he is tall” or “the surface is hot”.

Quantitative observation – observation that involves measurement or a numerical value.  For example, “he is 6 feet tall” or “the surface is 96 degrees”.

 

Instructions for Using the Light Microscope

Please see your lab manual for correct usage of the light microscope. You are responsible for understanding the correct manner in which the microscope should be used. BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

 

Slides available for viewing

 

Letter “e”

Silk Threads

Various slides of microbes for further practice using the microscope.

 

***Each student should view the letter ‘e’ and silk threads to get accustomed to the microscope.  The other prepared slides of the organism are for you to get acquainted with focusing on specific organisms.  You DO NOT need to view them all at this time.  Any of the slides will be sufficient to provide you with practice on focusing the microscope.*****

 

Steps for properly storing the microscopes.

Click the 4X objective into place.

Bring the stage to its
lowest
level.

Remove the slide and dispose of it appropriately.  Wipe
prepared
slides until ALL oil/dirt is removed (top and bottom).

Clean objective lenses with lens paper, and, if using oil, liquid lens cleaner. BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

Clean eyepieces with dry lens paper.

Clean condenser lens with lens paper

If necessary, clean the stage with a damp lens paper.

Turn the light switch OFF.

Rotate the head so that the eyepieces are facing
away
from the stage (or toward the arm).

Replace the dust cover.

Return the microscope to the appropriate location in the cabinet

 

Other Types of Microscopes used in Microbiology (see lab manual)

 

The Darkfield Microscope

Purpose of Darkfield Microscopy

Used to view delicate, transparent, living organisms

Principally used to view spirochetes from
syphilitic lesions (
pallidum
)

Mechanism

Dark-filed filter is placed within condenser

Filter alters the wavelength of light passing through the condenser

Light rays are taken out phase, so that the background will look completely dark/black BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

As rays pass through specimen, the rays are refracted and brought into phase so that the specimen appears brighter

Causes background to appear dark, while specimen typically are white or may fluoresce due to staining

 

Phase-Contrast Microscope

Purpose of phase-contrast microscopy

To observe living cells without using staining techniques

Vital to observing
internal structures
within microorganisms

Allows cells to remain alive and achieves contrast of structures within the cell as well

Mechanism

Light waves passing through specimen are brought into phase with one another to produce a brighter image (coincidence)

Light waves passing through specimen that are out of phase with one another lead to darker image (interference)

 

 

The Ubiquity of Microorganisms

Microorganisms are the most widely distributed life forms in the world.  They can be found in varying locations such as the digestive tract of human beings, hot springs, the air around us, rivers, deep within the earth, oceans, and soil.  Some are potentially pathogenic (disease causing) while other perform functions vital to the maintenance of our environment such as producing oxygen and eliminating carbon dioxide.  Although small in size, microorganisms are diverse in structure and in function.  In today’s exercises we will observe several microorganisms and you will see the diversity amongst sizes, shapes, functions, and characteristics.

 

Cells are divided into two major groupings based on their characteristics.  There are Prokaryotes and Eukaryotes respectively.  Prokaryotes are those cells that lack a membrane-delimited nucleus.  In contrast, Eukaryotes have a membrane-delimited nucleus.  Microorganisms (and all living organisms) are divided based upon these characteristics, in part, into the three domains of life.  These three domains are based upon the genetic similarity that exists between organisms.  The three domains are Bacteria, Archaea, and Eukarya.  Bacteria (Eubacteria) are those organisms that have a cell wall composed of peptidoglycan (a polysaccharide).  Many of these organisms are present in our everyday environment.  In contrast there are also Archaea (Archaeabacteria) that lack peptidoglycan in their cells walls.  They are usually found in more extreme environments such as thermal vents on the ocean floor, hot springs, and Antarctica.

 

We will look at the shape and morphology of a variety of eubacteria in this lab.

 

 

The Prokaryotes

Cyanobacteria (“Blue-Green Algae”)

Characteristics

Do not contain an organized nucleus

Do NOT contain chloroplasts

Not necessarily blue or green in color; others do exist

Example:  Oscillatoria

 

Ubiquity of Bacteria

Bacterial characteristics

Bacteria usually contain a cell wall that separates them from their external environment

Depending on the characteristics of the cell wall, bacteria can usually be separated into two groups based on their staining properties: Gram-negative vs. Gram-positive

The cell wall typically contains peptidoglycan

They are prokaryotic organisms

BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

They lack a membrane bound nucleus and organelles

Do contain ribosomes for protein synthesis, however, these ribosomes are different from eukaryotic ribosomes

Contain 70S ribosomes vs. the 80S ribosomes of eukaryotic organisms

Common Bacteria shapes

Cocci – spherical

Streptococci – chains, of spherical organisms

Staphylococci – grape-like clusters

Diplococci – groups of two spherical organisms. BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

Tetrads – groups of four organisms in square-like arrangement

Sarcina – 8 cocci arranged into a cube

Bacilli – rod-shaped

Coccobacillus – short rods with curved ends resembling a cocci

Palisade – bacilli that are “stacked” together

Streptobacilli – bacilli arranged in a chain-link manner

Spirals

Spirilla – Rigid helices

Spirochetes – Flexible helices

Vibrio

Curved rods

Pleomorphic

Variable shape

BIOL-2010-01 Lab One Microscopy Ubiquity of Microorganisms

Tina Jones Health History shadow health Information Processing

Information Processing 
: 39 of 40 (97.5%)

Each relevant diagnosis is scored on a four-point scale:

Priority (1 point):
 the correct priority of the diagnosis was chosen

Evidence (up to 2 points):
 the strength of the patient cue(s) selected as evidence for the identified diagnosis

Required Evidence:
 selecting at least one cue that 
directly indicates
 the presence of a problem or risk is worth 2 points

Tina Jones Health History shadow health Information Processing

Supporting Evidence:
 selecting at least one cue that is a 
contributing factor
 or 
cause
 of a problem or risk, without the presence of Required Evidence, is worth 1 point

Planning (1 point):
 the plan proposed to address the diagnosis includes at least one correct component

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Relevant Diagnoses

 1. Acute pain of the foot

4 of 4 points

Priority 
1 / 1

Student Response:
 
 High

Correct Priority:
 High

 Priority Pro Tip: 
Managing acute pain is an immediate high priority, because other health concerns cannot be effectively addressed while a patient experiences severe pain. Tina Jones Health History shadow health Information Processing

Evidence 
2 / 2

Relevant

“I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet.” 
Required Evidence

Irrelevant

(None provided)

 Evidence Pro Tip: 
Tina reports intense pain and rates her pain on a numerical scale. She also reports characteristics of the pain, including its duration of one week; this timespan defines her pain as acute. Tina Jones Health History shadow health Information Processing

Planning 
1 / 1

Relevant

Intervene – Prescribe:
 Prescribe medications to treat pain.

Educate – Medication:
 Educate the patient on medications used for pain relief.

Educate – Medication:
 Educate the patient on non-pharmaceutical methods to reduce pain intensity.

Irrelevant

Intervene – Labs:
 Order a fasting lipid panel to evaluate for dyslipidemia.

Intervene – Labs:
 Order a test of thyroid stimulating hormone.

 Planning Pro Tip: 
Intervene to reduce the pain by prescribing an appropriate analgesic and educating the patient on its effective use and potential side effects. Provide the patient with options for non-pharmacological pain relief, such as RICE (rest, ice, compression, elevation). Tina Jones Health History shadow health Information Processing

 2. Local infection of skin and subcutaneous tissue of the foot

4 of 4 points

Priority 
1 / 1

Student Response:
 
 High

Correct Priority:
 High

 Priority Pro Tip: 
Treating this infection is a high priority, as failure to treat the infection may lead to it spreading to surrounding tissues or systemically. Treating the infection can prevent adverse events such as osteomyelitis and bacteremia.

Evidence 
2 / 2

Relevant

“Yeah, it looks swollen around the scrape.” 
Required Evidence

“I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!” 
Supporting Evidence

Irrelevant

Tina Jones Health History shadow health Information Processing

“Yeah, there’s definitely pus.”

 Evidence Pro Tip: 
Tina presents with an open wound on the plantar surface of the foot. The wound is red, swollen, warm, and produces purulent discharge. Tina reports that the appearance and level of discomfort have worsened with time- all of these factors support a diagnosis of acute infection. Tina Jones Health History shadow health Information Processing

Planning 
1 / 1

Relevant

Assess – Integumentary:
 Assess wound parameters (size, depth).

Assess – Lymphatic:
 Assess lymph nodes regional to legs and feet.

Intervene – Labs:
 Obtain a wound culture.

Intervene – Other:
 Clean wound and cover with sterile dressing.

Educate – Medication:
 Educate the patient on the course of antibiotics, importance of taking all prescribed antibiotics, and side-effects.

Educate – Health Maintenance:
 Educate the patient on the importance of screening tests and foot care, as relates to diabetes.

Educate – Disease Process:
 Educate the patient on the signs and symptoms of worsening infection.

Irrelevant

(None provided)

 Planning Pro Tip: 
Assess the wound directly and obtain a culture so that the infectious organism may be identified, then clean and re-dress the wound. Regional lymph nodes may be swollen. Because the infection is the root cause of Tina’s other acute issues, prescribing an anti-infective will begin to resolve the issues; after receiving culture results, the specific anti-infective given may be changed. Ensure that Tina understands how to treat the wound, use the anti-infective effectively, and to report symptoms of a worsening infection. Foot care is especially important for diabetics, so you should help Tina better understand diabetes’ impact on wound healing and the need to proactively monitor her foot health. Tina Jones Health History shadow health Information Processing

 3. Uncontrolled type 2 diabetes mellitus

3 of 4 points

 4. Asthma

4 of 4 points

Priority 
1 / 1

Student Response:
 
 Low

Correct Priority:
 Low

Tina Jones Health History shadow health Information Processing

 Priority Pro Tip: 
Although Tina requires education to better manage her asthma, she does not report active respiratory complaints, making this a lower priority diagnosis. Tina Jones Health History shadow health Information Processing

Evidence 
2 / 2

Relevant

“Um, the only things I know I’m diagnosed with are diabetes. And asthma.” 
Required Evidence

“It’s really rare for me to have an attack now. Three days ago I had some breathing problems, but I guess probably my last full attack was in high school.” 
Required Evidence

Irrelevant

(None provided)

 Evidence Pro Tip: 
Tina reports a personal history of asthma, including past hospitalizations for asthma attacks, as well as her use of an albuterol inhaler. Her sibling’s asthma is of interest, given the strong genetic and environmental factors in the development of asthma.

Planning 
1 / 1

Relevant

Assess – Respiratory:
 Assess lung sounds with auscultation.

Tina Jones Health History shadow health Information Processing

Assess – Respiratory:
 Assess pulmonary function using spirometry.

Assess – Respiratory:
 Assess respirations (rate, rhythm, depth, quality).

Educate – Health Maintenance:
 Educate the patient on avoiding triggers of asthma.

Educate – Health Maintenance:
Educate the patient on enacting her asthma action plan including proper use of rescue inhaler. Tina Jones Health History shadow health Information Processing

Irrelevant

(None provided)

 Planning Pro Tip: 
Because Tina does not report treatment for maintenance of her asthma, instead relying on a rescue inhaler for sporadic attacks, educate her on developing and enacting a proactive plan to manage the disease. Though Tina does not report an active respiratory complaint, it is valuable to assess for abnormal findings that she may not report. Tina Jones Health History shadow health Information Processing

 5. Dysmenorrhea

4 of 4 points

 6. Hypertension

4 of 4 points

 7. Menorrhagia

4 of 4 points

Priority 
1 / 1

Student Response:
 
 Low

Correct Priority:
 Low

 Priority Pro Tip: 
Menorrhagia is a secondary issue caused by Tina’s endocrine and metabolic disorders and thus is a lower priority diagnosis.

Evidence 
2 / 2

Relevant

“I’d say it’s heavy. I use the like, extra absorbent tampons, and I still have to change it every two or three hours.” 
Required Evidence

Irrelevant

“It’s not regular. Sometimes it’s every month, but sometimes it’s more like every two months. I don’t write it down or anything. I probably get…six periods a year.”

 Evidence Pro Tip: 
Tina reports menstruation lasting longer than 7 days, with heavy bleeding. Tina reports no recent sexual activity or potential for pregnancy, ruling out a common cause of irregular bleeding. Other potential causes ruled out by Tina’s history are hormone use, oral contraceptives, and intrauterine devices. Tina Jones Health History shadow health Information Processing

Planning 
1 / 1

Relevant

Intervene – Labs:
 Order a test of free androgen index.

Educate – Medication:
 Educate the patient on the use of NSAIDs to reduce menstrual blood flow.

Educate – Medication:
 Educate the patient on the use of oral contraceptives to reduce menstrual flow and regulate the menstrual cycle.

Educate – Health Maintenance:
Educate the patient to keep a menstrual calendar to assist assessing her pattern. Tina Jones Health History shadow health Information Processing

Irrelevant

(None provided)

 Planning Pro Tip: 
Endocrine disorders are the cause of Tina’s heavy and irregular menstruation, so order labs to evaluate for poly-cystic ovarian syndrome and thyroid disease. Tina Jones Health History shadow health Information Processing. Inspect for both hair growth indicative of excessive androgen production and that indicative of deficient production, and inspect for acanthosis nigricans. Educate your patient on keeping a menstrual calendar to more precisely identify irregularities in her cycle, and using oral medications to reduce symptoms.

 8. Obesity

4 of 4 points

 9. Oligomenorrhea

4 of 4 points

Priority 
1 / 1

Student Response:
 
 Low

Correct Priority:
 Low

 Priority Pro Tip: 
Oligomenorrhea is a secondary issue caused by Tina’s endocrine and metabolic disorders and thus is a lower priority diagnosis.

Evidence 
2 / 2

Relevant

“It’s not regular. Sometimes it’s every month, but sometimes it’s more like every two months. I don’t write it down or anything. I probably get…six periods a year.” 
Required Evidence

Irrelevant

Tina Jones Health History shadow health Information Processing

(None provided)

 Evidence Pro Tip: 
Tina reports having about 6 periods per year, meeting the criteria for oligomenorrhea, which are periods more than 35 days apart or 9 per year. Her periods occur fewer than 90 days apart, making oligomenorrhea the correct diagnosis rather than amenorrhea.

Planning 
1 / 1

Relevant

Assess – Integumentary:
 Assess for presence of axillary and pubic hair by inspection.

Assess – Integumentary:
 Assess severity of hair growth at areas including upper lip, chin, chest, thighs, upper arm, forearm, back, abdomen.

Intervene – Labs:
 Order a follicle-stimulating hormone test.

Intervene – Labs:
 Order a test of free androgen index.

Intervene – Labs:
 Order a test of free testosterone.

Intervene – Labs:
 Order a test of thyroid stimulating hormone.

Educate – Health Maintenance:
 Educate the patient to keep a menstrual calendar to assist assessing her pattern.

Irrelevant

(None provided)

 Planning Pro Tip: 
Endocrine disorders are the cause of Tina’s irregular menstruation, so order labs to evaluate for poly-cystic ovarian syndrome and thyroid disease. Inspect for both hair growth indicative of excessive androgen production and that indicative of deficient production, and inspect for acanthosis nigricans. Tina Jones Health History shadow health Information Processing. Educate your patient on keeping a menstrual calendar to more precisely identify irregularities in her cycle. Tina Jones Health History shadow health Information Processing

 10. Polycystic ovarian syndrome

4 of 4 points

Priority 
1 / 1

Student Response:
 
 Low

Correct Priority:
 Low

 Priority Pro Tip: 
PCOS is the root cause of several of Tina’s symptoms and should be addressed. However it is lower priority than Tina’s acute problems; addressing her pain and hyperglycemia are more immediate needs to improve her status.

Evidence 
2 / 2

Relevant

“BMI: 31” 
Supporting Evidence

“It’s not regular. Sometimes it’s every month, but sometimes it’s more like every two months. I don’t write it down or anything. I probably get…six periods a year.” 
Required Evidence

Irrelevant

“Weight: 90 kg”

 Evidence Pro Tip: 
The Rotterdam criteria should be used to establish a diagnosis of PCOS. At least two of the following must be present: ovulatory dysfunction (Tina reports infrequent menstruation), androgen excess (Tina reports excess hair in a male pattern), or poly-cystic ovaries. Diabetes, obesity, and acanthosis nigricans – all reported by Tina – are common signs and symptoms of PCOS. Tina Jones Health History shadow health Information Processing

Planning 
1 / 1

Relevant

Assess – Genitourinary:
 Assess for enlarged ovaries by palpation.

Assess – Integumentary:
 Assess severity of hair growth at areas including upper lip, chin, chest, thighs, upper arm, forearm, back, abdomen.

Educate – Disease Process:
 Educate the patient on the pathophysiology of polycystic ovarian syndrome.

Irrelevant

(None provided)

 Planning Pro Tip: 
A pelvic exam should be performed in order to assess for palpable enlargement of the ovaries. An ultrasound may be needed to evaluate for cysts of the ovaries. Educate Tina regarding PCOS and its relationship to diabetes. Work with Tina to assist her in establishing GYN care. Further assessment and lab work may be performed to evaluate for androgen excess. Tina Jones Health History shadow health Information Processing

Other Diagnoses Identified

Type 2 diabetes free sample essay

According to the World Health Organization (WHO) (2021), there are about 422 million people worldwide have diabetes. Diabetes is a chronic disease that is characterized by elevated levels of blood glucose and can lead to serious damage to the heart, blood vessels, kidneys, nerves, and eyes over time (WHO, 2021). Type 2 diabetes free sample essay. There are four different types of diabetes including type 1, type 2, gestational diabetes, and juvenile diabetes. Type 1 diabetes can occur at any age and in people of every race, shape, and size, and is known as insulin-dependent diabetes. Type 1 diabetes is when the body is not able to produce insulin, which is the hormone needed to get glucose from the bloodstream into the cells of the body (American Diabetes Association (ADA), 2021). Type 2 diabetes, is the most common form of diabetes, and is when the body does not use insulin properly, becomes resistant to insulin, or does not make enough insulin (WHO, 2021). Type 2 diabetes usually is diagnosed in adults. Gestational diabetes is a form of diabetes that appears in in patients during pregnancy and then subsides rapidly after delivery (Rosenthal & Burchum, 2019). Gestational diabetes occurs when hormones block the action of the mother’s insulin to her body and causes insulin resistance (ADA, 2021). Lastly, juvenile diabetes, is the term used for type 1 diabetes in children and adolescents. Type 2 diabetes free sample essay.

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Type 2 diabetes is the most prevalent form of diabetes and accounts for 90% to 95% of all diagnosed cases (Rosenthal & Burchum, 2019). This form of diabetes can be controlled with lifestyle changes; with the first treatment for blood glucose control being meal planning, weight loss, and exercising; and the next step being medications that lower blood glucose levels when lifestyle changes are not enough (ADA, 2021). Among the medications used for type 2 diabetes, the oral medication metformin is most widely used and among the injectable drugs, insulin is most widely used (Rosenthal & Burchum, 2019). Metformin monotherapy is the preferred initial pharmacologic agent in treating type 2 diabetes and should be started at diagnosis. It can safely be used with patients with an estimated GFR as low as 30mL/min/1.73m2 (ADA, 2017) Type 2 diabetes free sample essay. Metformin has been approved to be safe, effective, inexpensive, and has beneficial effects on A1C, weight, and cardiovascular mortality (ADA, 2017). Patients should be advised to stop taking the medications if there are cases of nausea, vomiting, or dehydration. Also, long-term use of metformin has been associated with vitamin B12 deficiency and vitamin B12 levels should be monitored (ADA, 2017).

Metformin should be taken with meals to help reduce bowel side effects or upset stomach, which is common especially during the first few weeks of treatment (Mayo Clinic, 2021). The tablet or extended release tablet should always be taken with a full glass of water, and the tablet should never be broken, crushed, or chewed. Type 2 diabetes free sample essay. If a dose is missed, it should be taken right away, unless it is too close to the time of the next dose; doses should not be doubled (Mayo Clinic, 2021). There are regular metformin tablets and a few types of extended-release metformin medications including Fortamet, Glucophage XR, and Glumetza (Mayo Clinic, 2021). Type 2 diabetes free sample essay Each of the types of metformin are started as smaller doses, usually at 500mg one to two times per day, and then increased until blood sugar is controlled, not usually exceeding 2000mg daily (Mayo Clinic, 2021). Although there are no specific diets with taking metformin, a meal plan should be made with a physician in order to help control type 2 diabetes. Diets should include consuming protein from lean meats, beans, soy, and nuts; while the amount of red meat should be limited. It is also important to stay away from sugar-sweetened beverages. Individuals should eat foods that are high in fiber and include carbohydrates from fruits, vegetables, low-fat milk, and whole-grains (Mayo Clinic, 2021) Type 2 diabetes free sample essay.

Overall, diabetes of all types can lead to complications and increase an individual’s risk of morbidity and mortality. Of the complications includes kidney failure, vision loss, nerve damage, leg amputations, heart attacks, and stroke (WHO, 2021).

 

References

American Diabetes Association. (2017). 8. pharmacologic approaches to glycemic treatment:Standards of medical care in diabetes—2018. 
Diabetes Care, 41
(Supplement 1), S73-S85. https://doi.org/10.2337/dc18-S008 Type 2 diabetes free sample essay

American Diabetes Association. (2021). 
Diabetes symptoms, causes, and treatments
. American Diabetes Association. https://www.diabetes.org/diabetes

Mayo Clinic. (2021). 
Metformin (oral route).
 Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/metformin-oral-route/proper-use/drg-20067074

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

World Health Organization. (2021). 
Diabetes.
 World Health Organization. https://www.who.int/health-topics/diabetes#tab=tab_2

 

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.

By Day 6 of Week 5 Type 2 diabetes free sample essay

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. Type 2 diabetes free sample essay

 

Type 2 diabetes free sample essay response

I enjoyed reading your posting. Learning that global diabetes incidences are approaching half a billion people was mind blowing to me. When you look at US alone, there is approximately 34.1 million adults aged 18 years or older who are diabetic; this translates to about 13.0% of all US adult population (National Diabetes Statistics Report 2020, 2020). That a significant number, but what is even more concerning is the number of individuals being diagnosed with prediabetes; it is estimated 88 million adults in the US aged 18 years or older had prediabetes in 2018 (National Diabetes Statistics Report 2020, 2020). Diabetes is a condition with complex driven largely by non-modifiable genetic influences (Rosenthal and Burchum, 2021). Rising trend in obesity have led to a significant increase in type -2 diabetes (McCance and Huether, 2019). According to the National Diabetes Statistics Report 2020, (2020), approximately 42.4% of US adults were obese in 2017–2018.  Obesity modifiable risk factor that we can target as care providers by education our patients about healthy lifestyles; eating healthy and increasing physical activity with the hope of reducing the risk developing diabetes for the 88 million individuals with prediabetes.

References:

McCance & Huether, (2019). 
Pathophysiology: The biologic basis for disease in adults and children
 (8th ed.). St. Louis, MO: Mosby/Elsevier.

National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. (2020). 
Medical Benefits
, 
37
(4), 3–4.

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

 

 

response sample 2

great post! I agree with the definitions and comparisons of the four types of diabetes covered in the post: type 1, type 2, gestational and juvenile diabetes. Type 1 diabetes occurs when the body cannot produce insulin and hinders glucose from the bloodstream to the body cells. Type 2 diabetes occurs when the body does not produce insulin properly, produces inadequate insulin, or is resistant to insulin (Rosenthal & Burchum, 2021). Type 2 diabetes free sample essay. Gestational diabetes occurs among pregnant women when hormones block the action of insulin leading to resistance. On the other hand, juvenile diabetes refers to type 1 diabetes among children and adolescents. The post covers an accurate definition of all these types. The post selects and focuses on type 2 diabetes in contrast to my selection of type 1 diabetes. Type 2 diabetes free sample essay. The selection was precis since type 1 and type 2 diabetes is the most common type of diabetes. The post explains the prevalence of diabetes and its interventions such as lifestyle changes in dieting, weight loss, exercise, or medications to support lifestyle changes (Mayo Clinic, 2021). The most common and widely used medication is metformin, preferred as an initial pharmacologic agent in treating type 2 diabetes that ought to be started at diagnosis. Metformin is a safe, effective, and affordable treatment option for type 2 diabetes. However, it has some side effects such as nausea, vomiting, or dehydration. The post provides guidelines on the usage of the drug based on its different types (Mayo Clinic, 2021). Physicians recommend a meal plan consisting of protein but little red meat. I agree with the insights provided in the post about type 2 diabetes. It is informative and uses factual and specific information to increase knowledge in type 2 diabetes.

References

Mayo Clinic. (2021). Metformin (oral route). Mayo Clinic. 
https://www.mayoclinic.org/drugs- supplements/metformin-oral-route/proper-use/drg-20067074

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

 

sample response 3

Great post. Type 2 diabetes mellitus is a disease that affects more than 400 million people worldwide. In 2040, there will be more than 640 million people with diabetes worldwide  (Marín-Peñalver et al., 2016).  Type 2 diabetes free sample essay. The prevalence of expects to double within the next 20 years due to the increase of age, obesity, and the number of ethnic groups of high risk in the population, with significant increases in cardiovascular disease, end-stage renal disease, retinopathy, and neuropathy (Marín-Peñalver et al., 2016). Dietary intake and physical exercise are the two main determinants of energy balance, and they are considered a primary base in the treatment of patients with diabetes. Adequate rest is also essential for maintaining energy levels and well-being, and all patients should advise sleeping approximately seven hours per night (Mayo Clinic, 2021). Although there is no consensus on the percentage of carbohydrates that people with diabetes should eat, it shows that the amount and carbohydrates are the main determinants for glycemic control. Counting carbohydrates has proven to be very important in all patients. It allows a better adjustment of the postprandial blood glucose for those who take insulin (Mayo Clinic, 2021.

You provide tremendous details about the use of Metformin for patients with type 2 diabetes. There is a four-step approach I learn through the study that works to treat type 2 diabetes. Type 2 diabetes free sample essay At the beginning of diagnosis, there must be an initiation of lifestyle change, including the drug metformin. The second phase is to continue lifestyle change, plus Metformin, and add a second drug. A drug such as a sulfonylurea or basal insulin needs to add if the patient does not achieve their expected goal. The third step is to continue with the second step with a three-drug regimen, including Metformin. The fourth step states that if the three-drug combinations that include basal insulin fail to achieve treatment goals after 3 to 6 months, the recommendation is to proceed to a combination injectable regimen inclusive of insulin and possibly a GLP-1 receptor agonist (Rosenthal & Burchum 2021). Type 2 diabetes free sample essay

Patients need to know there are a long-term treatment and evaluation plan. Health care providers will repeat the test A1C levels at least two times a year and any treatment changes (Marín-Peñalver et al., 2016).  To achieve reasonable metabolic control in diabetes and keep long-term, a combination of lifestyle and pharmacological treatment changes is necessary (Marín-Peñalver et al., 2016).

References

Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & Del Cañizo-Gómez, F. J. (2016, September 15). 
Update on the treatment of type 2 diabetes mellitus
. World journal of diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027002/. Type 2 diabetes free sample essay

Mayo Clinic. (2021, January 20). 
Type 2 diabetes
. Mayo Clinic. 
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
.

Rosenthal, L. D., & Burchum, J. R. (2021). 
Lehne’s pharmacotherapeutics for advanced practice

            nurses and physician assistants 
(2
nd
ed.) Type 2 diabetes free sample essay

Diabetes and Drug Treatments sample discussion essay

Types of Diabetes and Differences

Type 1 Diabetes Mellitus (DM) is considered an autoimmune chronic illness that results from the inability to produce insulin due to the destruction of beta cells in the pancreas. Diabetes and Drug Treatments sample discussion essay.  The onset of the disease is generally in childhood although it can occur in adults (Khardori, 2021). What was previously referred to as Juvenile Diabetes is now referred to as type 1 DM (Babu & Eisenbarth, 2012). The classical presentation is polyuria, polyphagia, polydipsia in hyperglycemic patients, and unexplained weight loss. Symptoms can be severe when the patient develops Diabetic ketoacidosis (Khardori, 2021). In contrast, type 2 DM develops because of resistance to insulin action, inadequate insulin secretion, and excessive glucagon secretion that also leads to hyperglycemia (Khardori, 2021) Diabetes and Drug Treatments sample discussion essay. Unlike patients with type 1 DM, type 2 DM patients are not completely dependent on insulin as endogenous secretion occurs although many patients end-up needing insulin injections. Patients may be asymptomatic or present with the same symptoms as those with type 1 DM (Khardori, 2021). Diabetes and Drug Treatments sample discussion essay. Pregnant patients can also develop DM. To be classified as Gestational Diabetes Mellitus (GDM), the onset must occur during pregnancy and is defined by any degree of glucose as well as carbohydrates intolerance and accounts for 90% of DM in pregnant patients (Al-Azemi et al., 2021).

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Treatment of Diabetes Type 1 and Dietary Considerations

For patients with type 1 DM, insulin is the mainstay of therapy. As per the literature review, there are minimal differences between administering insulin multiple times a day versus continuous subcutaneous insulin infusion CSII. Although, an infusion pump showed reduced nocturnal hypoglycemia without affecting the AIC (American Diabetes Association, 2018) Diabetes and Drug Treatments sample discussion essay. As for the type of insulin, analogs, whether it is long-acting or rapid-acting, are associated with better glycemic control. Analogs compared to human insulin result in less weight gain and hypoglycemia as well as a lower A1C (American Diabetes Association, 2018). The patient should be educated on special dietary considerations with the use of prandial insulins. The patient should become proficient in carbohydrate counting to adjust and administer the correct amount of insulin (American Diabetes Association, 2018). An agent that can be added to the insulin regimen is Pramlintide which is an amylin analog. The effects of this pancreatic enzyme analog are delay gastric emptying, a decrease in glucagon, and enhanced satiety. Special consideration is to decrease prandial insulin dosing (American Diabetes Association, 2018) Diabetes and Drug Treatments sample discussion essay. Lastly, if the treatment goals are to reduce body weight and LDL cholesterol, Metformin has shown to accomplish that. Moreover, insulin requirement was also reduced in these patients although glycemic control was not improved (American Diabetes Association, 2018).

Short-Term and Long-Term Impact of Type 1 DM and Treatment

The short-term complications of the disease that require special attention are hyperglycemia, hypoglycemia, and ketoacidosis. It is very difficult to achieve normal glycemic levels with exogenous insulin often leading to hyperglycemia (Kahanovitz et al., 2017). Symptoms of hyperglycemia as described above are the most frequent when the level of insulin decreases. When insulin levels decrease to a very low level, lipolysis occurs producing ketone bodies that accumulate to toxic levels and result in metabolic acidosis. Untreated ketoacidosis leads to cerebral edema, coma, and potential death (Kahanovitz et al., 2017) Diabetes and Drug Treatments sample discussion essay. On the other opposite end of the spectrum is hypoglycemia as a result of intensifying the insulin therapy to control hyperglycemia. Therefore, hypoglycemia results can be life-threatening (Kahanovitz et al., 2017). When a provider is devising a diabetic treatment plan for an older person, they must review the risks related to hypoglycemic complications and must compare them against the benefit of reducing microvascular and macrovascular complications.   Generally, a result of <7% on A1c goal is sufficient, but the provider may want to take a less aggressive goal.  When it comes to older people, you need to make sure than they do not get systematically hypoglycemic. The provider will want to avoid certain medications that are risk for hypoglycemia, such as Chlorpropamide, Glyburide, and Rosiglitazone. These should all be avoided with elderly patients (Fravel et al., 2011) Diabetes and Drug Treatments sample discussion essay. Long-term complications of inadequate management lead to medium and small vessel damages. Medium vessel damages lead to heart diseases, strokes, and peripheral vascular diseases. Small vessel damages lead to retinopathy with potential blindness, nephropathy, and kidney failure as well as neuropathy from loss of function (Kahanovitz et al., 2017). Diabetes and Drug Treatments sample discussion essay.   References Al-Azemi, N., Diejomaoh, M. F., Angelaki, E., & Mohammed, A. T. (2013). Clinical presentation and management of diabetes mellitus in pregnancy.  International journal of women’s health ,  6 , 1–10.  https://doi.org/10.2147/IJWH.S52391 American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes. Diabetes Care,  41 (Suplement 1), S73-S85. http:/care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf Babu, S. R., & Eisenbarth, G. S. (2012). Juvenile diabetes.  The Indian journal of medical research ,  136 (2), 179–181.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461727/ Fravel, M., McDanel, D., Ross, M., Moores, K., & Starry, M. (2011).  Special considerations for treatment of type 2 diabetes in the elderly . National Library of Medicine | PubMed.  https://pubmed.ncbi.nlm.nih.gov/21378298/    Diabetes and Drug Treatments sample discussion essay Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017). Type 1 Diabetes: A Clinical Perspective.  Point of care ,  16 (1), 37–40.  https://doi.org/10.1097/POC.0000000000000125 Khardori, R. (2021). Type 1 Diabetes Mellitus.  https://emedicine.medscape.com/article/117739-overview Khardori, R. (2021). Type 2 Diabetes Mellitus.  https://emedicine.medscape.com/article/117853-overview Rosenthal, L. D., & Burchum, J. R. (2021).  Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants  (2nd ed.). Elsevier. sample response Great job on your discussion. Although it can appear at any age, it is interesting to learn there are two times when it seems to peak. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old; however, only 5% of people with diabetes have type 1 diabetes (Mayo Clinic, 2021). It is also interesting to learn that diabetes type 1 tends to increase as one travels from the equator (Mayo Clinic, 2021). Diabetic ketoacidosis (DKA) is a severe complication of diabetes that can be life-threatening.  Very high blood sugar and low insulin levels lead to DKA. The two most common causes are illness and missing insulin shots. Diabetes and Drug Treatments sample discussion essay. It is essential to manage stress because it is harder to control blood glucose if it remains stressed. To proper treatment for type 1 diabetes is insulin, requiring lifelong insulin therapy (Rosenthal & Burchum 2021). The patients will receive their insulin treatment in two different ways. They will receive it through an injection or an insulin pump.  The pumps are programmed to dispense specific amounts of rapid-acting insulin automatically. Patients may also receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to help keep the kidneys healthy or a daily aspirin to keep them heart-healthy. It is vital to keep up with regular exercise such as walking and swimming to keep the blood sugars down (Mayo Clinic, 2021) Diabetes and Drug Treatments sample discussion essay. References Mayo Clinic. (2021, March 27).  Type 1 diabetes . Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011. Rosenthal, L. D., & Burchum, J. R. (2021).  Lehne’s pharmacotherapeutics for advanced practice             nurses and physician assistants  (2 nd ed.) St. Louis, MO: Elsevier. Diabetes and Drug Treatments sample discussion essay     sample response 2 Thank you for the reply with additional information.  I agree with you that control is the key to complications and the goal is to keep the A1C and daily blood sugar levels controlled.   Carbohydrate counting, premeal blood sugar, and anticipated activity level are all important in managing type one diabetes (Janež et al., 2020). Consistency is key with treatment. Patient education is very important in medication dosing during changes in illness, injury, and diet. Diabetes and Drug Treatments sample discussion essay.       A consistent dietary intake of carbs, fats, and proteins will lead to better drug efficacy over time (Chen et al., 2017). In other words, the more consistent the diet, the fewer fluctuations there will be in the patient’s blood sugar.     Long term, those with type one diabetes typically encounter problems at work and school due to managing their illness (Bronner et al., 2020) Diabetes and Drug Treatments sample discussion essay.   References   Bronner, M. B., Peeters, M. A. C., Sattoe, J. N. T., & van Staa, A. (2020). The impact of type 1   diabetes on young adults’ health-related quality of life.  Health and Quality of Life Outcomes ,  18 (1), 137. https://doi-org.ezp.waldenulibrary.org/10.1186/s12955-020-01370-8 Diabetes and Drug Treatments sample discussion essay   Chen, W., Qian, L., Watada, H., Li, P. F., Iwamoto, N., Imori, M., & Yang, W. Y. (2017).   Impact of diet on the efficacy of insulin lispro mix 25 and insulin lispro mix 50 as starter insulin in East Asian patients with type 2 diabetes: Subgroup analysis of the Comparison Between Low Mixed Insulin and Mid Mixed Insulin as Starter Insulin For Patients with Type 2 Diabetes Mellitus (CLASSIFY Study) randomized trial.  Journal of Diabetes Investigation ,  8 (1), 75–83. https://doi-org.ezp.waldenulibrary.org/10.1111/jdi.12547   Janež, A., Guja, C., Mitrakou, A., Lalic, N., Tankova, T., Czupryniak, L., Tabák, A. G., Prazny,   M., Martinka, E., & Smircic-Duvnjak, L. (2020). Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review.  Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders ,  11 (2), 387–409. https://doi-org.ezp.waldenulibrary.org/10.1007/s13300-019-00743-7   Discussion: Diabetes and Drug Treatments 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. Diabetes and Drug Treatments sample discussion essay 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.     Types of Diabetes Type 1 diabetes, or insulin-dependent diabetes, is previously known as juvenile-onset diabetes (Mayo Clinic, 2021). It usually starts in childhood—the body’s system attack itself, where the pancreas cannot produce insulin (Mayo Clinic, 2021). Type 2 diabetes was previously known as non-insulin-dependent or adult-onset diabetes. The pancreas, at times,  creates some insulin; however, at times, it may not be enough, or the body is not using it (Mayo Clinic, 2021). Gestational diabetes is insulin resistance during pregnancy; However, glucose intolerance was not present or recognized before pregnancy(Gilmartin et al., 2018).  The woman’s pancreatic function is insufficient to overcome the diabetogenic pregnancy environment (Gilmartin et al., 2018). Gestational Diabetes Gestational diabetes is one of the most common health problems for pregnant women. It develops during pregnancy but subsidizes rapidly after delivery (Rosenthal & Burchum 2021). It is affecting about five percent of all pregnancies each year(Smyth, 2017). If not treated, it can cause health problems for the mother and fetus (Smyth, 2017) Diabetes and Drug Treatments sample discussion essay. Dietary Considerations Promoting a healthy pregnancy through a nutritious diet, the patient must work closely with the healthcare provider on a plan. For patients with gestational diabetes, a healthy diet also keeps blood sugar in the healthy range.  However, if the patient cannot control their glucose levels with diet alone, she will require insulin. Their blood glucose must monitor six to seven times a day while the insulin dosages and food intake monitor accordingly (Rosenthal & Burchum 2021). Diabetes and Drug Treatments sample discussion essay Treatment for Gestational Diabetes The treatment recommendation is to initiate insulin when the fasting blood glucose concentration is greater than 90 mg/dL on two or more occasions for two weeks or when the 1-hour postprandial blood glucose concentration is more significant than 120 mg/dL (Smyth, 2017). The insulin types most used are neutral protamine Hagedorn (NPH) and regular insulin. Diabetes and Drug Treatments sample discussion essay. NPH is an intermediate-acting insulin. It is typically used when the fasting glucose is high. The onset of action is 2 to 4 hours, the peak effect is at 6 to 12 hours, and the duration of action is 10 to 16 hours. Regular insulin has an onset of action within 30 to 60 minutes, a peak effect at 2 to 3 hours, and a duration of 3 to 6 hours. Among women with gestational diabetes, 15% will require insulin. Human insulin is the least immunogenic (Smyth, 2017). While there are controversial statistics regarding oral hypoglycemia medications, some healthcare providers use glyburide to treat when diet alone is insufficient. However, a significant number of these patients go on to require insulin to maintain optimal glycemic control. Another oral hypoglycemic agent that is using as a substitute for insulin is metformin. Compared to insulin, metformin has the same effect on the patients and does not affect the fetus, and it is becoming more of an alternative for women (Rosenthal & Burchum 2021).  Diabetes and Drug Treatments sample discussion essay. Exercise helps to improve glycemic control. The mechanism of this improvement is mainly secondary to increasing tissue sensitivity to insulin. Some patients find that exercising three or more times a week for at least 15 to 30 minutes is helpful to them (Smyth, 2017). Short-Term vs. Long-Term Effect Gestational pregnancy considers being short-term because 95% of women’s blood glucose normalizes after giving birth. The postpartum period recommends that the patient glucose tolerance screening be performed at 2 to 4 months after delivery to help detect the 3% to 5% of women who remain diabetic and require further treatment. The women need to follow up and get tested and monitor for type 2 diabetes. For long-term monitoring, if the patient blood glucose is normal, she needs to be checked for diabetes every three years. However, if she has an  Impaired Glucose Tolerance test, she must be tested for diabetes every year. Finally, if the patient develops type 2 diabetes, she must work with her physician to develop a treatment to manage the patient properly. Diabetes and Drug Treatments sample discussion essay   Reference Gilmartin, A. B. H., Ural, S. H., & Repke, J. T. (2018).  Gestational diabetes mellitus . Reviews in obstetrics & gynecology.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582643/ . Mayo Clinic. (2021, March 27).  Type 1 diabetes . Mayo Clinic.  https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011 . Rosenthal, L. D., & Burchum, J. R. (2021).  Lehne’s pharmacotherapeutics for advanced practice          nurses and physician assistants  (2 nd ed.) Diabetes and Drug Treatments sample discussion essay Smyth, T. (2017). Gestational Diabetes: Your Survival Guide to Diabetes in PregnancyGrant Paul Gestational Diabetes: Your Survival Guide to Diabetes in Pregnancy 128pp £9.99 Sheldon Press 9781847094414 1847094414.  Nursing Standard ,  31 (21), 32–32. https://doi.org/10.7748/ns.31.21.32.s36   sample response 1 you provided great information on gestational diabetes. It is interesting to read that once a woman has had gestational diabetes, they have a higher risk of developing type 2 diabetes (Mayo Clinic, 2021) Diabetes and Drug Treatments sample discussion essay. Therefore, they require frequent blood glucose testing after delivery. The three factors that predispose women to diabetes in pregnancy are the placenta’s higher hormone production that antagonizes insulin’s actions. Second, the production of cortisol promotes hyperglycemia. Third, glucose can pass freely in the circulation, in which an increase in the mother will stimulate excessive secretion of insulin in the fetus (Rosenthal & Burchum, 2021, p. 398). Diabetes and Drug Treatments sample discussion essay These patients should be provided information to manage gestational diabetes by eating healthy foods and exercising regularly (Centers for Disease Control and Prevention [CDC], 2020). If the patient cannot maintain normal blood glucose by nutrition and exercise, medications should be used. Two pharmacological options are insulin and oral medication, such as metformin or glyburide. Insulin is the treatment of choice; however, both approaches are effective (Durnwald, 2021). Diabetes and Drug Treatments sample discussion essay.   References: Centers for Disease Control and Prevention [CDC]. (2020). Gestational diabetes and pregnancy. Retrieved https://www.cdc.gov/pregnancy/diabetes-gestational.html Durnwald, C. (2021). Gestational diabetes mellitus: Glycemic control and maternal prognosis. Retrieved from https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis Mayo Clinic. (2021). Gestational diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 Diabetes and Drug Treatments sample discussion essay Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.     sample response 2 great post. You explained in detail the types of diabetes that exist and focused on gestational diabetes. For gestational diabetes, it is likely to be short term while the women is pregnant. However, it can turn into long term and does require follow-up (Smyth, 2017). There can be severe long-term effects to uncontrolled diabetes regardless of the type. This can include delayed wound healing, kidney disease, stroke and in severe cases limb amputations (Bagchi & Nair, 2018). Although it is uncommon to experience these complications if gestational diabetes is in control, it is something to be mindful of to follow up with after pregnancy. Diabetes and Drug Treatments sample discussion essay References Bagchi, D., & Nair, S. (Eds.). (2018). Nutritional and therapeutic interventions for diabetes and metabolic syndrome. ProQuest Ebook Central https://ebookcentral.proquest.com Smyth, T. (2017). Gestational Diabetes: Your Survival Guide to Diabetes in PregnancyGrant Paul Gestational Diabetes: Your Survival Guide to Diabetes in Pregnancy 128pp £9.99 Sheldon Press 9781847094414 1847094414. Nursing Standard, 31(21), 32–32. https://doi.org/10.7748/ns.31.21.32.s36 Diabetes and Drug Treatments sample discussion essay

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

Pharmacotherapy for acute gastroenteritis

Acute gastroenteritis

Due to the presenting symptoms of nausea vomiting and diarrhea, the patient may be suffering from acute gastroenteritis. Acute gastroenteritis is an intestinal inflammation commonly characterized by diarrhea, nausea, vomiting, fever and abdominal cramps. It is commonly caused by viruses or bacteria. More diagnostic procedures such as blood and stool tests are required to determine the definitive cause of the condition (U. Desselberger, 2003). Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

Treatment of gastroenteritis is dependent on the cause. Risk factors of gastroenteritis include young children, elderly, and a weakened immune system. Based on the current medication taken by the patient, prednisolone, a corticosteroid is known of the effect of weakening the immune system which may in turn predispose the patient to other infections. Prednisolone may also have caused the presenting complaints since nausea, vomiting and diarrhea are its common side effects (Malangu, 2018) Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay.

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Appropriate drug therapy.

The appropriate drug therapy includes continuation of Synthroid 100mcg once daily to counter the hypothyroidism effect of hepatitis C. Tapering off prednisolone is also recommended to help elevate the body immune system as well as discontinue the possible associated side effects. The current nifedipine dosage should be investigated according to the underlying condition that could have led to the initiation and continuation of its dosage. Promethazine 25mg every 4 to 6 hours as desired is recommended to manage the nausea and vomiting. Oral rehydration by the use of Oral Rehydrating Salt is recommended to prevent dehydration due to excessive water loss through diarrhea and vomiting. Probiotics Saccharomyces boulardii is recommended for management of the acute diarrhea (Kenneth L. Koch, 2016). Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay.

 

 

References

Kenneth L. Koch, W. L. (2016).
Nausea and Vomiting: Diagnosis and Treatment.
Springer.

Malangu, N. (2018).
Pharmacokinetics and Adverse Effects of Drugs: Mechanisms and Risks Factors.
BoD – Books on Demand.

Desselberger, J. G. (2003).
Viral Gastroenteritis.
Gulf Professional Publishing. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

 

By Day 7 of Week 4

Write
 a 1-page paper that addresses the following:

Explain your diagnosis for the patient, including your rationale for the diagnosis.

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

Asthma and Stepwise Management PowerPoint presentation

Asthma management.

By Day 7 of Week 3

Create
a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following: Asthma and Stepwise Management PowerPoint presentation

Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.

Explain the stepwise approach to asthma treatment and management for your patient. Asthma and Stepwise Management PowerPoint presentation

Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

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Introduction

According to the Centers for Disease  Control and Prevention, Asthma is a condition characterized by narrowed airways that produce excess mucus making breathing difficult.

Common symptoms of asthma include wheezing, coughing, chest pains, shortness of breath and trouble sleeping.

Asthma is classified into the following categories according to the signs and symptoms. Asthma and Stepwise Management PowerPoint presentation

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent.

Mild intermittent symptoms occur to up to two days in a week and two nights in a month.

Mild persistent symptoms occur more than twice a week but do not exceed once a day.

Moderate persistent symptoms occur once daily and exceed more than one night a week.

Severe persistent symptoms occur throughout the day and frequently at night.

Asthma and Stepwise Management PowerPoint presentation

Management of asthma.

Long-term control involves use of medications that reduce the inflammation of the airways.

Long term control medications include inhaled corticosteroids, leukotriene modifiers, long acting beta agonists, combination inhalers and theophylline.

uQuick relief management involves use of medications that open up the airways.

uQuick relief medications include Short acting Beta agonists, ipratropium, and oral and intravenous corticosteroids.

Leukotriene modifiers relieve symptoms up to 24 hours. They are however linked to agitation, aggression, hallucinations and depression adverse effects.

LABA eg salmeterol and formoterol are often taken in combination to prevent the adverse effect of severe asthma attack.

Combination inhalers include a LABA and a corticosteroid such as fluticasone-salmeterol and mometasone-formeterol. Asthma and Stepwise Management PowerPoint presentation

SABA such as albuterol and levalbuterol are taken using devices such as portable hand inhalers and nebulizers to offer relief within minutes.

Ipratropium act immediately by causing bronchodilation.

Oral and intravenous corticosteroids such as methylprednisolone and prednisolone manage the inflammation of the airways during severe asthma and are used in short term to avoid side effects. Asthma and Stepwise Management PowerPoint presentation

Management of asthma.

stepwise approach of asthma is the increment or decrement of dose, number of medications and frequency of dosage to achieve symptomatic control.

stepwise approach occurs when dosage of the medication is increased until the patient can sleep well as night, stay active during the day and reduces emergency visits.

The goal of this approach is to establish the least amount of medication required to obtain good control.

Stepwise management is divided into intermittent asthma and persistent asthma.

The stepwise approach is aimed at assisting in the decision making process during prescription so as to attain individualized patient care.

The stepwise approach is imperative in addressing patient specific needs. Asthma and Stepwise Management PowerPoint presentation

Steps in asthma management.

Intermittent asthma-

ustep 1 SABA

uPersistent asthma-

uStep2  –  ICS

uStep 3 – low dose ICS + LABA or theophylline or LTRA

uStep 4 – medium dose ICS + LABA

uStep 5 – high dose ICS + LABA Asthma and Stepwise Management PowerPoint presentation

uStep 6 – High dose ICS + LABA + oral systemic Corticosteroid

Short acting beta-2 agonists such as salbutamol are used as needed for intermittent asthma. If symptoms recur more than two days in a week after treatment with SABA, the patient is treated for persistent asthma.

Inhaled corticosteroids (ICSs) are the preferred treatment for persistent asthma in step 2. Alternatives include theophylline, nedocromil, leukotriene receptor antagonist and cromolyn.

Long acting beta-2 agonists are used together with a low dose inhaled corticosteroid in step 3. Alternatives to LABA include Leukotriene receptor antagonists (e.g montelukast and zafirlukast) and theophylline.

A medium dose inhaled corticosteroid is used together with Long acting beta-2 agonist in step 4. A medium dose inhaled corticosteroid together with theophylline or LTRA.

A high dose inhaled corticosteroid is used together with long acting beta-2 agonist in step 5. alternative therapy includes a high dose inhaled corticosteroid together with theophylline or LTRA.

Step 6 include the use of oral systemic corticosteroid together with LABA and a high dose inhaled corticosteroid. Alternative therapy includes use of a high dose inhaled corticosteroid together with either LTRA or theophylline and oral systemic corticosteroid. Asthma and Stepwise Management PowerPoint presentation

uReference

uRosenthal, L. D., & Burchum, J. R. (2021). 
Lehne’s

pharmacotherapeutics
for advanced practice nurses and physician assistants 
(2nd ed.) St. Louis, MO: Elsevier.

u
https://www.cdc.gov/asthma/default.htm

u
http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

uKaplan, A., Mitchell, P. D., Cave, A. J., Gagnon, R., Foran, V., & Ellis, A. K. (2020). Effective Asthma Management: Is It Time to Let the AIR out of SABA?. 
Journal of clinical medicine
, 
9
(4), 921. Asthma and Stepwise Management PowerPoint presentation

NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

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When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.

Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post
 a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion.

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion

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For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.

Think about a personalized plan of care based on these influencing factors and patient history in your case study. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion

By Day 3 of Week 1

Post
 a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. Pharmacokinetics and Pharmacodynamics NURS 6521 Discussion