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W5 Case Study Discussion

1.    To address Mrs. Anderson’s newly diagnosed Diabetes Mellitus Type 2 (DM 2), I would recommend the initiation of oral treatment with Metformin. Metformin falls under the drug class of Biguanides and is also known by its trade names of Fortamet, Glucophage, and Glumetza. I would suggest a starting dose of 500mg twice daily and increase to 850mg twice daily only as needed and dependent upon her response to treatment. I would recommend Metformin only after assessing Mrs. Anderson’s allergies as well as any pre-existing renal issues, as this medication can easily accumulate to toxic levels in individuals with renal impairment (Burcham & Rosenthal, 2019). Metformin is commonly implemented as initial treatment for individuals newly diagnosed with DM 2 as it works primarily by decreasing the liver’s production of glucose and increasing insulin response in the skeletal muscle and adipose tissues (Burcham & Rosenthal, 2019).
To address Mrs. Anderson’s newly diagnosed hypothyroidism, I would recommend starting her on Levothyroxine, which is a synthetic version of the natural thyroid hormone thyroxine (Burchum & Rosenthal, 2019). Levothyroxine is its generic name and its trade names include Synthroid and Levothroid. I would recommend initiating her on a low dose of Levothyroxine of 25mcg daily with a reevaluation every 6-8 weeks of her physical response as well as her TSH levels prior to increasing her daily dose. Levothyroxine is the preferred initial drug of choice for patients newly diagnosed with hypothyroidism as it most closely resembles that of the natural thyroid hormones (Burchum & Rosenthal, 2019).
To address Mrs. Anderson’s newly diagnosed GERD (gastroesophageal reflux disease), I would recommend starting her on Omeprazole, a proton pump inhibitor. Omeprazole, the generic name, is also commonly known by its trade name of Prilosec. I would recommend starting her on a low dose of 20mg once daily, taken prior to a meal, for a total duration of 4-8 weeks as short-term therapy in an effort to adequately treat her symptoms while also preventing adverse effects of prolonged therapy. I would recommend this medication as it has been proven to adequately suppress gastric secretion and consequently reduce symptoms of GERD, such as heartburn (Burchum & Rosenthal, 2019).
To address Mrs. Anderson’s staph aureus wound infection, I would recommend initiating a prescription of Cephalexin, a first-generation cephalosporin medication also known by its trade name Keflex. I would recommend a dose of 500mg PO every 12 hours for a total of 10 days. First-generation cephalosporins such as Cephalexin have been proven to be highly effective in the treatment of these kinds of infections. However, if these infections are resistant to methicillin-like drugs, they will require treatment with another medication (Burchum & Rosenthal, 2019).
2.    Side effects of Metformin are commonly those of the gastrointestinal system. The most common side effects include nausea, diarrhea, and decreased appetite which can cumulatively lead to weight loss (Burcham & Rosenthal, 2019). Thus, dosages can be titrated based upon patient response and side effects experienced.
Side effects of Levothyroxine are commonly the result of taking too much of the medication than is clinically necessary. This can result in over-stimulating effects such as tachycardia, angina, tremor and diaphoresis, which are commonly grouped into the condition called thyrotoxicosis. Many medications interact with Levothyroxine, which is why it is prescribed to be taken in the morning on an empty stomach at least 30-60 minutes prior to eating. Additionally, H2 blockers, proton pump inhibitors, and certain supplements can reduce the effects of Levothyroxine and should be taken at least 4 hours apart to prevent this interaction (Burchum & Rosenthal, 2019).
Side effects of Omeprazole tend to arise from prolonged use, which is why short-term therapy is always recommended. Short-term effects, however, can also occur and cause side effects such as nausea, vomiting, and diarrhea. Additionally, long-term use can precipitate adverse effects such as the development of pneumonia or fractures, which typically results from decreased absorption of calcium due to reduced gastric secretion (Burchum & Rosenthal, 2019).
Side effects of Cephalexin include allergic reactions, including cross-reactivity with penicillin medication allergies. Consequently, patients should be monitored and educated regarding potential signs of allergic reactions.
3.    In order to recommend non-pharmacological interventions, I would first assess Mrs. Anderson’s current modifiable lifestyle factors that may be negatively contributing to her newly diagnosed conditions. Subsequently, I would recommend Mrs. Anderson adhere to a healthy diet low in saturated fats, processed meats and refined sugars and higher in healthy proteins, whole grains, vegetables, and healthy fat sources (Ley et al., 2016). Furthermore, I would recommend she engage in daily physical exercise in order to prevent long-term complications from her diabetes.
4.    To promote optimal health outcomes, I would educate Mrs. Anderson on her newly diagnosed conditions so that she fully understands the potential detriments of not controlling these conditions. Additionally, I would educate her on the various new medications I would prescribe her as well as the potential side effects and drug interactions to be aware of, as previously described. Due to her unresolved wound infection, I would educate her on the dangers of allowing diabetic wounds to go untreated and the importance of daily feet and leg assessments to prevent infections and amputations down the road. Furthermore, I would educate Mrs. Anderson on the importance of taking her new medications daily and at specific times - such as ensuring her levothyroxine is taken first thing in the morning prior to eating and at least 4 hours before taking her omeprazole. Lastly, I would educate her on the importance of following up with me - her primary care provider - routinely in order to assess response to treatment as well as make any necessary modifications to her plan of care.

References:
Burcham, J.R. & Rosenthal, L.D. (2019). Lehne’s pharmacology for nursing care (10th ed.). Elsevier.

Ley, S. H., Ardisson Korat, A.V., Qi, S., Tobias, D.K., Cuilin, Z., Lu, Q., Willett, W.C., Manson, J.E. & Hu, F.B. (2016). Contribution of the nurses’ health studies to uncovering risk factors for type 2 diabetes: Diet, lifestyle, biomarkers, and genetics. American Journal of Public Health, 106(9), 1624-1630.