Comprehensive Treatment Plan for Type II Diabetes Mellitus in a Patient with Hypertension and Renal Impairment

by | Jul 10, 2024 | Nursing

SCENARIO 2
Joe is a 48-year-old male diagnosed with Type II Diabetes Mellitus for a year ago. He has controlled his blood glucose through dietary changes. He has hypertension and is currently on Lisinopril 20 mg po daily. He has no known allergies. His lab work includes these results: fasting BG is 225 mg/dL; HgA1C = 7.5%. Basic Metabolic Profile (BMP) is normal except for a Cr of 2.0 and eGRF of 28. What treatment plan would you implement for Joe? What medications would you prescribe and how would you monitor them? What education would you provide regarding his treatment plan?
To Prepare:
Review the case studies above and answer ALL questions.
When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patients current medications.
Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website to complete assignment.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

 

 

Sample Answer

Sample Answer

Essay

Comprehensive Treatment Plan for Type II Diabetes Mellitus in a Patient with Hypertension and Renal Impairment

Thesis Statement: Managing Type II Diabetes Mellitus in a patient with comorbidities such as hypertension and renal impairment requires a tailored treatment plan to achieve optimal glycemic control while considering the impact on renal function.

Treatment Plan:

For Joe’s Type II Diabetes Mellitus, the treatment plan should focus on glycemic control while considering his hypertension and renal impairment. Given his elevated HgA1C and fasting blood glucose levels, it is essential to initiate pharmacological therapy in addition to dietary modifications.

Medication Recommendations:

1. Metformin: A first-line agent for Type II Diabetes Mellitus, Metformin is preferred due to its efficacy, cardiovascular benefits, and minimal risk of hypoglycemia.

Prescription:

– Drug: Metformin
– Dose: 500 mg
– Route: Oral
– Frequency: Twice daily with meals
– Special Instructions: Titrate the dose gradually to minimize gastrointestinal side effects
– Dispensed: 60 tablets (30 days supply)

– Refills: 2

2. Blood Pressure Management: Given Joe’s hypertension, Lisinopril can be continued for blood pressure control. Regular monitoring of blood pressure is crucial to assess response to treatment.

Monitoring:

1. Glycemic Control: Follow up with Joe in 3 months to reassess his HgA1C and fasting blood glucose levels. Adjust the Metformin dose as needed to achieve target glycemic control.

2. Renal Function: Given Joe’s impaired renal function, monitor his creatinine levels and estimated glomerular filtration rate (eGFR) regularly to ensure that Metformin is safe and appropriate for him.

Education Regarding Treatment Plan:

1. Medication Adherence: Stress the importance of taking Metformin with meals to reduce gastrointestinal side effects and improve tolerability.

2. Blood Glucose Monitoring: Educate Joe on the importance of regular blood glucose monitoring to track his response to treatment and make necessary adjustments.

3. Dietary Management: Reinforce the significance of a healthy diet low in sugar, salt, and processed foods to manage both diabetes and hypertension effectively.

References:

1. American Diabetes Association. (2020). Standards of Medical Care in Diabetes – 2020. Diabetes Care, 43(Supplement 1), S14-S31.

2. Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140-149.

3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2013). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements, 3(1), 1-150.

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