NSG 4055 Week 5 Discussion
What would you add to the current treatment plan? Why?
Since the patient is suffering from Diabetic Neuropathy, a Neurontin prescription would be a great pain reliever. The dosage can start at 100mg TID, and this can gradually be increased as pain increases. The use of Neurontin would help the patient cut down the need to use acetaminophen and should be limited to no more than 2 grams a day. This would help in preventing liver complications. To maintain and treat nerve pain, Elavil can be utilized by patients. However, caution is needed as a result of the patient’s CAD history. Elavil dosage is usually 50mg a day, and most of the time, it’s given during bedtime because of the drowsiness and sleepiness effect that it causes. According to Salehi et al. (2011), Gabapentin can also be used as an anticonvulsant can also be used in relieving nerve pain.
As a result of CAD history, there is a need to add a stronger anticoagulant like Plavix 75mg once daily or else increase aspirin to 325mg PO daily. I would also consider adding an oral nitrate like Imdur to the patient due to his angina. The Imdur mechanism of action is that it has the vasodilating effect, which allows blood to flow more freely, thereby allowing the body and the heart to receive more oxygenated blood. I would, therefore, prescribe 30mg of Imdur twice daily as I monitor the symptoms, and if need be, an increase is recommended. Effective management of angina should be an important goal since it seems to appear more often, affecting the patient’s quality of life.
NSG 4055 Week 5 Discussion
Would you discontinue any of the currently prescribed medications? Why or why not?
I would change the patient’s regimen by way of adding an oral nitrate that would be critical in reducing the need to utilize the sublingual nitrate, which is noted to cause a lot more side effects and adverse reactions such as headaches and hypertension while failing to prevent angina from occurring. It is important to note that Imdur can assist the body in getting a stable amount of blood flow to and from the heart as a result of the blood vessels’ widening effect. This can help in dealing with angina since there is a flow of oxygenated blood in the bloodstream.
How does the diagnosis of stage 3 chronic kidney disease affect your choices?
Since Mr. EBR has been diagnosed with chronic stage three kidney disease, it is crucial to consider prescribing medications that rely less on the metabolism or excretion by the kidneys. Also, it is important to monitor the symptoms of toxicity so that we can make any important intervention to prevent any damaging effects like death or further damage to his kidney, which may lead to organ failure. Since the patient is being treated with ARB’S and ACE inhibitors, it is crucial to monitor the kidney function and the GFR levels; there is the actual use of effectiveness within an end-stage or else an advanced kidney disease the patient has not been established, and since excretion is through the kidney, it is important to change medication (Postma & Boersma, 2012).
Why is the patient prescribed more than one antihypertensive?
As demonstrated by Postma and Boersma (2012), a combination of ARBs and ACE inhibitors helps with the progression of neuropathy and also in those who are stage 2 diabetics. It can also assist with decreasing and or preventing the progression of microalbuminuria in patients who are suffering from Type 2 Diabetes and have a history of hypertension and heart disease. ACE inhibitors are also beneficial as they reduce the risk and/ or reoccurrence of angina symptoms and/or MI, reducing risk by managing diabetes and hypertension to prevent further damage to the kidneys and the heart. The combination is a clear indication that I am effective in managing the patient’s diabetes and hypertension.
NSG 4055 Week 5 Discussion
What is the benefit of aspirin therapy in this patient?
For Mr. EBR, Aspirin is being utilized as an anticoagulant. According to Denali et al. (2007), an anticoagulant allows the patient to receive all the needed coagulation therapy without requiring adjustments, like in the use of coumadin. There is also the affordability aspect of receiving the ASA anticoagulant therapy, unlike the use of Xarelto or Eliquis, which are not cost-effective. Aspirin also helps in preventing the formation of clots, and it is also critical in thinning the blood, thereby reducing the possibility of blood clot formation. For Mr. EBR, having ASA a day reduces his chances of reoccurring heart attack as well as assists in preventing atherosclerosis build-up, which may lead to a heart attack.
Salehi, M., Kheirabadi, G. R., Maracy, M. R., & Ranjkesh, M. (2011). Importance of gabapentin dose in treatment of opioid withdrawal. Journal of Clinical Psychopharmacology, 31(5), 593-596.
Postma, M. J., & Boersma, C. (2012). Compliance, Persistence and switching Patterns of ace inhibitors and arbs. The Value of Personalized aPProaches To imProVe PharmacoTheraPy in renal disease, 17(9), 103.
Dentali, F., Douketis, J. D., Lim, W., & Crowther, M. (2007). Combined aspirin–oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Archives of Internal Medicine, 167(2), 117-124.
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Respond to one of the following questions:
Review the Healthy People 2020 objectives for Access to Care. Of all the objectives listed under this topic, which do you think would be most beneficial to the patients with chronic illness?
Please give rationales and support responses with references.
Discuss how you feel nurses can positively impact the Healthy People 2020 goals.
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