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Medicine

What are the contraindications of your selected diabetic therapy?

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations).
An obese patient, age 45, comes to your office. She recently moved from another state three weeks ago and told you that her FNP diagnosed her with type 2 diabetes mellitus. She is currently not on any medicine for her diabetes, and she wishes to avoid insulin, if possible. She is a non-smoker. Her blood pressure is 138/74 mmHg. Labs from 3-weeks ago was hemoglobin A1C = 8.4%; total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, HDL = 49 mg/dL, LDL = 170 mg/dL (calculated 10-year ASCVD risk = 6.2%). You discuss current treatment goal recommendations endorsed by the ADA regarding glycemic control, blood pressure control, and lipid management. She agrees to start any medications that you recommend with lifestyle modification and a DASH diet to treat hypertension.
Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class.
Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.
Q3. What are the contraindications of your selected diabetic therapy?
The patient returns to your office six months later complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism.
Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism?
Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.
Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?
Expectations
Initial Post:
Due: Thursday, 11:59 pm PT
Length: A minimum of 500 words, not including references
Citations: At least two high-level scholarly references in APA from within the last 5 years

Categories
Medicine

Discuss the concept of clinical pathway design and tap into the development process and highlight the importance of having the right approaches for successful rollout of clinical pathways.

attached a few files as a zipped folder. You can use graphs and tables from the files attached as needed. Read these files carefully and write the paper in the following manner:
1. Introduction (300 words):
– The introduction should be concise and include some information and reference to international and regional experiences (if available at regional level).
– Discuss the concept of clinical pathway design and tap into the development process and highlight the importance of having the right approaches for successful rollout of clinical pathways.
– Need to mention that the paper is mostly about describing the process of clinical pathways development and design as well as its impact with reporting on initial findings
2. Methodology (400 words):
– Study setting: for this study it is mostly about the facilities/ Clusters included ( data sources)
– Tools used to collect data
– Descriiption of the study variable that we are focusing on ( data points)
– Analysis methods used
– Ethical considerations
3. Results (1000 words)
– Restate key study findings
– State the main conclusion
– Compare the findings to other studies
– Emphasize the strengths and limitations
– Study implications and recommendations
4. Discussion (1000 words)
– Start off the discussion by summarizing key findings of the study.
– Add the study strengths and limitations
– Compare all findings to findings from the literature (regional – if available- and international)
5. Conclusion (300 words)
– Needs to be phrased in terms of implications and recommendations.

Categories
Medicine

What are the recommended medications to start this specific patient on?

Post your answers to the 5 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)
Eric Johnson is a 21-year-old Caucasian male who is in his senior year of college. The patient has a history of seasonal allergies. He does not remember what his allergist told him to take for his allergies in the past. He wants to know what he can take. He presents to the clinic today with complaints of a stuffy nose, shortness of breath, fever TMAX 102 at home, and a productive cough. He also notes that over the past few months he has also noticed a watery discharge and burning when he urinates. He does admit to having unprotected intercourse last month. He undergoes rapid testing and a chest x-ray while in the clinic. His diagnoses are pneumonia, chlamydia, and seasonal allergies.
Clinic Vital Signs: BP 125/75, HR 116, Temp 102.5, O2 94%. He has no known drug allergies.
Q1. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and the initial starting dose.
Q2. Please discuss the mechanism of action of each of the drugs you listed.
Q3. Please discuss the side effect profile of each medication you listed.
Q4. Are there any interactions between any of the medications you prescribed?
Q5. What other non-pharmacological interventions would be suggested?
Expectations
Initial Post:
Due:
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years

Categories
Medicine

What information should I need to give?

I am applying for gastroenterology and hepatology fellowship. I need a personal statement with 600 words. I will share some examples and qualities that need to be portrayed in the essay and will send some online articles with instructions of how my personal statement should look like. What information should I need to give? Do you any writers that have experience in it? I need the PS in 3 days.

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Medicine

How did you use word parts to determine what they mean?

Review the complete list of disorders and diseases posted by the National Institute of Health. Choose at least five diseases or disorders, and post their meanings. How did you use word parts to determine what they mean? Do you believe disease and disorder are the same? Explain your thoughts.
National Institute of Health Disorders Resource:
https://www.ninds.nih.gov/Disorders/All-Disorders?title=&title_beginswith=A
Disorders Link:
https://www.ninds.nih.gov/search?search_api_fulltext=disorders+disorder+index.htm
At least 250 words please. Please emphasize using word parts such as suffixes to understand the disease.

Categories
Medicine

What concerns do you have about her current regimen, and what alternatives will you discuss and offer?

You are a new FNP in a restricted state and you have your DEA license and state furnishing for schedule II-V controlled substances. You are working at a busy family practice group and you have a patient, ML, that is establishing care for the first time with your practice, and comes to you with the following scenario:
ML is a 54 y.o. Hispanic female with hx of chronic shoulder and back pain that began 10 years ago when she was in a boating accident
She lives in both US and Mexico, making regular visits across the border; lately, she has stayed in US due to Covid border crossing constraints, living with her daughter’s family
She had rotator cuff surgery in 2011 and reports to you that due to a long operation and poor positioning, she has suffered from not only pain, but also chronic numbness and tingling in her R shoulder
As “la abuela” (grandma) she is the primary caregiver of the children and homemaker for her family and her pain is exacerbated with housework, and especially with the prolonged carrying of her grandchildren; one of which is 10 m.o.
Currently, her med list is as follows
Losartan 50 mg BID for HTN
Gabapentin 300 mg po BID for pain
Atorvastatin 40 mg daily for cholesterol
Diazepam 5 mg po up to TID prn pain
Norco 5/325 mg – takes up to two, sometimes up to 4-5x a day, prn pain
She is a smoker, only smokes outside the house, and drinks 2-3 cans of beer on the weekends, but more on family celebrations
Denies recreational drugs and denies past overdoses
Recently moved to CA more permanently to stay to take care of children during Covid/school closures
She asks you to refill all her meds for 6 months like her doctor in Mexico did so she doesn’t have to make another co-pay and come back and see you so often; it’s hard for her to get an appointment, and with Covid her daughter has to take off of work to watch the kids just so she can come to you by bus since there is only one family car
Here VS are 135/75, 80, 97.5, 20 and PE unremarkable other than R shoulder exam with pain with ROM, but full ROM, no tenderness, otherwise normal, back exam including SLR are normal/neg

In 600 or fewer words, but a minimum of 250, please describe your approach with this patient. In your paragraphs, include the following:
What concerns do you have about her current regimen, and what alternatives will you discuss and offer? What other screenings might you apply? What are your own ethical standards on this case that you might consider in addition to legal standards?
Provide a sample of an appropriate pain contract that would suit this patient and address her specific safety concerns (cite it and attach the actual contract you found – you do not have to make your own – there are plenty online)
Include your steps to ensure safe prescribing. Include the registry you will search prior to any prescribing; name the CA registry and if you are in a different state, you should name that registry also.
If you were to keep her current list, what are the laws surrounding refills and the amounts you are allowed to dispense with the schedule II and III medications in the state of CA? In your own state?
Which medications on her list may you call into the pharmacy and which would you need a written scriipt or electronic order? What are some elements required to include on the prescriiption form (paper or electronic signature) for the scheduled medications?
After you prescribe, how, when, and where would you (or your staff) go about making a report of your scheduled prescriiption in the state registry so that other prescribers and pharmacies could be aware?
In restricted states, APRN prescribers must follow a standardized procedure or protocol for furnishing schedule II and III controlled substances with a patient-specific approach. Please outline the minimum required components of a protocol. You may outline this in bullet form. Alternatively, you may find an appropriate protocol, clinical guideline, or standardized procedure from a literature search and attach it in lieu of outlining your own protocol.