Nursing Practise Using Evidence Presented Chapter

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Evidence-Based Practice

The following is the assessment of AB case, a first time visitor to the writer. The assessment will include checking the pharmacologic treatment, reactions to the drugs in the medicines consumed, advisory healthcare practices and exercises, and non-pharmacologic treatment. More information to be provided if need be.

Patient Background

AB, an overweight, 52--?year -- ?old, Hispanic, male comes for the first visit to your office for assessment of complaints about tiredness, nocturia x 2 -- ?3, and finding it difficult to do the required paperwork in the office (Masters, 2014). He informs that he is reportedly having diabetes type 2 for about six years when he first experienced same feelings of fatigue and nocturia x 2 -- ?3. The patient informs he has attended infrequent classes on diabetes that emphasized on importance of physical activity and weight loss (Masters, 2014). His was accompanied by his wife to these classes and he informs that she helped a lot in initializing changes in diet. He is now divorced, having had disagreements with his wife and mostly eats out since then, lunching out of food truck and his dinners are at restaurant (Masters, 2014). Metformin was suggested three 3 years ago, but on increasing the dose he developed nausea. He has hence almost stopped taking it and informs that he takes it infrequently as and so "when I remember." The last time he has taken, it was about one week ago (Masters, 2014). AB has forgotten his last A1C level or even when it last was checked.

Evaluation of Pharmacologic Therapy

Major Conditions are as follows: Hypertension, Type 2 Diabetes, Dyslipidemia, Osteoarthritis and Sleep Apnea (Masters, 2014).

According to James Beckerman (2013) these are amongst the various drugs for treating high blood pressure, including: Angiotensin-converting enzyme (ACE) inhibitors; Angiotensin II receptor blockers (ARBs); Diuretics; Beta-blockers; Calcium channel blockers; Alpha-blockers; Alpha-agonists; Renin inhibitors and Combination medications.

AB can normalize or at least control his sugar levels by regular exercising and diet at least it was possible six years ago as he has type 2 diabetes, while some cases of type 2 diabetes need diabetes medications or insulin therapy in addition to the diet control and physical exercises (Mayo Clinic, 2014). The other factors including the sugar level and other symptoms are considered before suggesting medications to a Type 2 Diabetes patient. There may even be a need of combination of drugs to control the situation at times (Mayo Clinic, 2014).

Different types of drugs used for type 2 diabetes include: Metformin, Sulfonylureas, Meglitinides and Thiazolidinediones (Mayo Clinic, 2014).

Insulin injection may also be necessary in certain cases of type 2 diabetes. Insulin therapy was not the first line of treatment earlier, and was usually the last resort. It has more benefits and hence is being administered even earlier than ever before these days, normal digestion interferes with insulin taken orally hence insulin is injected (Mayo Clinic, 2014). Depending on the condition and symptoms, the physician may prescribe a mixture of insulin types to use. The common dose is that of a longer acting injection taken at night by people with type 2 diabetes.

There are several types of insulin, and have different functions. The different options are: Insulin glulisine (Apidra), Insulin lispro (Humalog), Insulin aspart (Novolog), Insulin glargine (Lantus), Insulin detemir (Levemir) and Insulin isophane (Humulin N, Novolin N) (Mayo Clinic, 2014).

When change in lifestyle is not enough to achieve normal lipid goals for Dyslipidemia, addition of lipid-modifying pharmacotherapy is advised (Joel C. Marrs, 2010). Each individual requires a different treatment, combination, and administration will depend on expected benefits, drug tolerance profile, comorbid diseases, effects on quality of life, and affordability.

AB also complains of osteoarthritis of knee and according to recommendations by The American College of Rheumatology (ACR) the pharmacological suggestion in addition to one of the following drugs is advised (Lozanda, 2014). Acetaminophen: Oral NSAIDs; Topical NSAIDs; Tramadol; Intra-articular corticosteroid injections.

The ACR suggests against advising chondroitin sulfate, glucosamine, or topical capsaicin for knee osteoarthritis in certain conditions (Lozanda, 2014). The ACR has not offered an opinion on of intra-articular hyaluronates, duloxetine, and opioid analgesics.

CPAP (Continuous positive airway pressure) is a therapy in the sleeping position when a mask is worn over the nose and/or mouth. A machine delivers a continuous flow of air into the nose through the mask. This air pressure opens up the nasal airway to help breathing clearly.

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CPAP is commonly used for sleep apnea. An alternative method bi-level positive airway pressure, or BPAP, which is similar to CPAP may also be used in which the flow changes while exhaling and inhaling.

Inspire, a new device is used for people who cannot sustain CPAP. This device, Upper Airway Stimulator, is a pulse generator put on upper chest under the skin (Beckerman, 2014). A sensor detects the breathing pattern through the movement of the lungs. The stimulator then causes the stimulation to the neck by keeping the airways muscles open. It is remotely programmable device (Beckerman, 2014). It is generally opened for activation during sleep hours at night and switched off at wake up.

Non-Pharmacologic Therapy

A most important way of preventing and treating high blood pressure is maintaining a proper lifestyle. The most appropriate changes in lifestyle are (Hypertension/High Blood Pressure:

Weight loss for those who are overweight or obese.

Avoid smoking.

Diet control, through the DASH diet (eating more vegetables, fruits, and low fat dairy products, less total and saturated fat).

Reducing the intake of salts particularly sodium to less than 1,500 milligrams per day if high blood pressure is detected. Healthy adults should not exceed their sodium intake over 2,300 milligrams per day (about 1 teaspoon of salt).

Getting regular aerobic exercise (such as walking at least half an hour per day at a brisk pace, several days a week).

Limiting alcohol intake to two drinks per day for males, one drink per day for females.

Control and maintenance of type 2 diabetes requires: Healthy diet, Exercising Regularly, Insulin injectibles or therapy or other drugs as required and regular monitoring of Blood sugar (Mayo Clinic, 2014). These steps are tantamount to maintaining status quo or delay worsening of condition by controlling sugar levels.

It is very important to pay closest attention to dietary habits and physical well-being through regular exercising in order to control cholesterol rise (Joel C. Marrs, 2010). The NCEP ATP III recommendations advice avoiding nutrients that raise LDL-C, like cholesterol (

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