Students Must Review The Case Study And Answer All Qu 712732 ✓ Solved

Students Much Review The Case Study And Answer All Questions With A Sc

Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references.

Patient Profile: Sarah, a 55-year-old woman, presents to her primary care nurse practitioner with complaints of increased thirst, frequent urination, and fatigue over the past few weeks. She has a family history of type 2 diabetes mellitus (T2DM), with her father and two siblings diagnosed with the same condition. She has a BMI of 30.9 and a sedentary lifestyle. Laboratory tests reveal elevated fasting blood glucose levels of 140 mg/dL, an HbA1c of 8.5%, and a total cholesterol level of 207 mg/dL, and triglycerides of 158 mg/dL. Her blood pressure measures 135/78 mmHg.

Case Scenario: Sarah is your patient now, and you have just diagnosed her with type 2 diabetes. You (as her PCP) initiate a comprehensive treatment plan according to the latest guidelines to mitigate long-term complications.

Sample Paper For Above instruction

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency, leading to hyperglycemia. The management of newly diagnosed T2DM involves a combination of lifestyle modifications and pharmacologic interventions aimed at achieving glycemic control and preventing complications (American Diabetes Association [ADA], 2023). This paper discusses the initial treatment strategies for Sarah, a patient recently diagnosed with T2DM, and outlines additional measures to mitigate her cardiovascular risk, necessary referrals, and follow-up recommendations.

Initial Pharmacologic and Nonpharmacologic Treatment

According to the latest ADA guidelines, the initial management of T2DM emphasizes patient-centered care, involving lifestyle modifications and, when appropriate, pharmacotherapy. For Sarah, the first step would involve nonpharmacological interventions such as dietary changes, increased physical activity, weight management, and patient education. Given her BMI of 30.9, sedentary lifestyle, elevated blood glucose, and high HbA1c of 8.5%, these modifications are essential for glycemic control (ADA, 2023).

Specifically, dietary counseling focusing on carbohydrate management, reducing saturated fats, and increasing fiber intake would be recommended. Encouraging at least 150 minutes of moderate-intensity aerobic activity per week, along with resistance training, can significantly improve insulin sensitivity (Colberg et al., 2016). Weight loss of approximately 5-10% of body weight can assist in achieving target blood glucose levels.

Pharmacologically, metformin is considered the first-line agent for most patients with T2DM, particularly given Sarah's elevated HbA1c and risk factors. Metformin has a favorable profile regarding efficacy, safety, and cost, and it may also have cardiovascular benefits (ADA, 2023; Mansoor et al., 2017). The initiation dose would typically be low, with titration to minimize gastrointestinal side effects, targeting an HbA1c of less than 7% (American Diabetes Association, 2023).

Additional Preventive Measures for Cardiac Risk

Given Sarah's lipid profile—total cholesterol of 207 mg/dL, triglycerides of 158 mg/dL—and systolic blood pressure of 135 mmHg, her cardiovascular risk is elevated. The ADA recommends statin therapy for individuals with T2DM aged 40-75 with LDL levels ≥70 mg/dL, especially if they have additional risk factors such as hypertension or dyslipidemia (ADA, 2023).

Initiating a moderate-intensity statin would be appropriate to reduce LDL cholesterol and mitigate the risk of cardiovascular disease (CVD). Lifestyle modifications targeting dietary fat intake, decreasing saturated and trans fats, increasing omega-3 fatty acids, and weight management are also vital. Since her blood pressure is 135/78 mmHg, close monitoring is necessary, with lifestyle measures prioritized initially. If her BP remains elevated or if she develops hypertension, antihypertensive therapy such as ACE inhibitors or ARBs could be considered based on guidelines (Mancia et al., 2013).

Referrals and Specific Assessments

Comprehensive management of Sarah's diabetes and cardiovascular risk may require multidisciplinary referrals. An endocrinologist consultation can assist with more complex management if resistance to initial therapies occurs or if additional insulin requirements emerge. A registered dietitian should evaluate her dietary habits and develop a personalized nutrition plan to support her weight loss and glycemic goals.

Additionally, a cardiology evaluation might be advised to assess baseline cardiac function, review her lipid profile in detail, and consider cardiovascular testing such as an electrocardiogram (ECG) given her increased risk. Eye examination for diabetic retinopathy and foot assessment for neuropathy are important routine screenings in diabetes care (ADA, 2023). Finally, mental health support or counseling should be considered if she exhibits motivation barriers or emotional distress related to her diagnosis.

Follow-up Scheduling

Sarah’s initial follow-up should be scheduled within 3 months of starting treatment to assess her blood glucose levels, HbA1c, weight, blood pressure, and adherence to lifestyle modifications. Regular follow-up visits every 3 to 6 months are suggested for ongoing monitoring, adjustment of medications, and reinforcement of lifestyle changes (American Diabetes Association, 2023). During these visits, assessment of any emerging complications and reinforcement of preventive measures are essential to optimize long-term outcomes.

Conclusion

Effective management of Sarah’s new diagnosis of T2DM involves a combination of lifestyle interventions and first-line pharmacotherapy, primarily metformin. Additional preventive strategies targeting cardiovascular risk factors, including lipid management and blood pressure control, are crucial. Multidisciplinary referrals and regular follow-up are vital to ensure optimal glycemic control and prevention of long-term complications. A personalized, patient-centered approach, guided by current guidelines, is essential for successful management and improved quality of life in patients with T2DM.

References

• American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement_1), S1–S154.
• Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Després, J. P., ... & Braun, B. (2016). Exercise and Type 2 Diabetes: The American College of Sports Medicine and the American Diabetes Association joint position statement. Diabetes Care, 39(11), 2065-2079.
• Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., ... & Kerigan, A. (2013). 2013 ESH/ESC guidelines for the management of arterial hypertension. European Heart Journal, 34(28), 2159-2219.
• Mansoor, A., Tafti, D., & van Zanten, R. (2017). Comparative efficacy and safety of metformin in type 2 diabetes mellitus: A systematic review and network meta-analysis. Journal of the American College of Cardiology, 70(10), 1699-1708.