NURS 676 Miami Dade College Beta Blocker Discussion Replies – Description
Two Replies
Elizabeth Guilliams YesterdayJun 19 at 6:53pmManage Discussion EntryGood evening, Professor and Fellow Classmates,My assigned discussion is:Susan is a 47-year-old female patient in for a follow-up visit to monitor her treatment for type 2 diabetes. Regular insulin was added to her treatment regimen last month. She denies symptoms of hypoglycemia and her glucose levels have been between 60 and 80. She tells you that her visit to her cardiologist went well and she was prescribed a new medication, atenolol. Discuss the possible complications when patients with diabetes are treated with a beta blocker. Are certain beta blockers more likely to create problems more than others are?I would discuss with Susan the way in which her newly prescribed medication works within her body. I would assess Susan’s best learnings style and level of education. Explaining in medical terms usually creates confusion for the patient. Leaving the patient with little to no understanding of our education. I would explain that atenolol is in a class of medications called beta blockers and can decrease or compromise her body’s ability to compensate for insulin-induced hypoglycemia. I would further explain, meaning that if her blood sugar became low it would be difficult for her body to react in the manner it should. Explaining the medication blocks the effects of norepinephrine. Confusion, irritability and the feeling of hunger may go unseen. Yes, some beta blockers are more likely to cause the effects of masking of hypoglycemia, such as atenolol and metoprolol. Not all beta blockers cause this effect, for example carvedilol does not affect blood glucose levels.Lifestyle measures (diet and physical activity) and drug therapy are the foundation of glycemic control. Physical activity provides the additional benefit of promoting glucose uptake by muscle, even when insulin levels are low. In addition to glycemic control, the plan should address other factors that can increase morbidity and mortality. Accordingly, all patients should be screened and treated for hypertension, nephropathy, retinopathy, and neuropathy. In addition, dyslipidemias (high LDL cholesterol, low high-density lipoprotein [HDL] cholesterol, and high triglycerides) should be corrected (Burchum & Rosenthal, 2021).I would discuss the target goal of glucose readings.Premeal plasma glucose 70–130?mg/dLa (Burchum & Rosenthal, 2021). Her reported blood glucose readings are within our target.By blocking ?1 receptors in the heart, all of the ? blockers can cause bradycardia, AV heart block, and, rarely, heart failure. By blocking ?2 receptors in the lung, the nonselective agents can cause significant bronchoconstriction in patients with asthma or chronic obstructive pulmonary disease. In addition, by blocking ?2 receptors in the liver and skeletal muscle, the nonselective agents can inhibit glycogenolysis, compromising the ability of patients with diabetes to compensate for insulin-induced hypoglycemia. Because of their ability to block ?-adrenergic receptors, carvedilol and labetalol can cause postural hypotension (Burchum & Rosenthal, 2021).For Susan, it is vital that all her major medical diagnoses are treated, and for her to understand how treatment for one diagnosis could have an effect on another. Explaining that she must be mindful or suggested medical advice. Medical advice such as glucose checks daily, blood pressure/pulse checks, routinely taking medication, managing her diet, regular exercise, and routine medical visits for monitoring. I would further recommend a medical alert bracelet for Susan, as this would be important information for medical professionals in an emergency hypoglycemic episode.The preferred method is to slow ventricular rate by long-term therapy with a ? blocker (atenolol or metoprolol) or a cardio selective CCB (diltiazem or verapamil), both of which impede conduction through the AV node. For patients who elect to restore normal rhythm, options are DC cardioversion, short-term treatment with drugs (e.g., amiodarone, sotalol), or RF ablation of the dysrhythmia source (Burchum & Rosenthal, 2021).I would highly encourage Susan to read information from The American Diabetes Association for more knowledge. I would encourage her making sure she understands the medications she is currently taking, and how her diabetes management will be best managed with her knowledge alongside the physician/care team.The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted (American Diabetes Association, 2021).The below information is not in direct relation to Susan, but rather to place some research facts in our discussion of this matter.We retrospectively identified non-critically ill hospitalized insulin requiring patients who were undergoing bedside glucose monitoring and received either carvedilol or a selective beta blocker (metoprolol or atenolol). Patients receiving other beta blockers were excluded. Hypoglycemia was defined as any glucose?3.9 mmol/L within 24 h of admission (Hypo1day) or throughout hospitalization (HypoT) and any glucose?2.2 mmol/L throughout hospitalization (Hyposevere).There were 1020 patients on carvedilol, 886 on selective beta blockers, and 10,216 on no beta blocker at admission. After controlling for other variables, the odds of Hypo1day, HypoT and Hyposevere were higher for carvedilol and selective beta blocker recipients than non-recipients, but only in basal insulin nonusers. The odds of Hypo1day (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.28, 3.09, p?=?0.0002) and HypoT (OR 1.38, 95% CI 1.02, 1.86, p?=?0.03) but not Hyposevere (OR 1.90, 95% CI 0.90, 4.02, p?=?0.09) were greater for selective beta blocker vs. carvedilol recipients in basal insulin nonusers. Hypo1day, HypoT, and Hyposevere were all associated with increased mortality in adjusted models among non-beta blocker and selective beta blocker recipients, but not among carvedilol recipients. Beta blocker use is associated with increased odds of hypoglycemia among hospitalized patients not requiring basal insulin, and odds are greater for selective beta blockers than for carvedilol. The odds of hypoglycemia-associated mortality are increased with selective beta blocker use or nonusers but not in carvedilol users, warranting further study (Dugan, Merrill, Long & Binkley, 2019).References:American Diabetes Association. (2021). 3. prevention or delay of type 2 diabetes: standards of medical care in diabetes-2021. Diabetes Care, 44(Suppl 1), 39. https://doi.org/10.2337/dc21-S003Links to an external site.Burchum, J., & Rosenthal, L. D. (2021]). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier Health Sciences (US). https://online.vitalsource.com/books/9780323554954Links to an external site.Dungan, K., Merrill, J., Long, C., & Binkley, P. (2019). Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients. Cardiovascular Diabetology, 18(1), 163–163. https://doi.org/10.1186/s12933-019-0967-1Links to an external site.
Gibson Perez YesterdayJun 19 at 5:56pmManage Discussion EntryNolan is a 55-year-old male with a 5-day history of nasal congestion, rhinorrhea, malaise, and irritated sore throat. His nasal discharge has gone from clear to yellow in color. He took OTC acetaminophen at onset of symptoms with minimal relief. He has no health history and his examination in your office today is unremarkable. He has already missed 2 days of work and insists he needs an antibiotic. He adds that he “always gets an antibiotic” when he sees the other clinician in your clinic. When looking at his chart, you confirm this to be true. You have diagnosed Nolan with a viral URI. What medication treatment plan do you recommend, if any? Discuss your patient education and outcome evaluation for this patient. What does the literature say about the over prescribing of antibiotics?Mr. Nolan’s 5-day history of nasal congestion, rhinorrhea, malaise, and irritated sore throat is consistent with Viral Upper Respiratory Tract Infection (URI), known as the common cold. This disease process is caused by viral pathogens such as rhinovirus, influenza, adenovirus, enterovirus, and respiratory syncytial virus. The treatment plan for Mr. Nolan’s Viral infection is based on symptomatic relief. Antibiotics solely work on bacterial infections and not viral infections.For symptomatic relief, I recommend continuing taking over the counter (OTC) antipyretics such as Tylenol (acetaminophen). Tylenol can be used as both an antipyretic and a non-opioid analgesic. I would educate Mr. Nolan to take 500 mg every 4 to 6 hours and stay within 4000 mg in 24 hours. “Acetaminophen controls pain and fever but does not reduce inflammation, as does aspirin and other widely consumed non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin, generics) and naproxen (Aleve, generics)” (Harvard Medical School, 2020, para. 3. The patient can take decongestants or an antihistamine/decongestant medication regarding rhinorrhea. H-1 Receptor antagonists will help reduce rhinorrhea and sneezing in patients with a URI. Some decongestants/antihistamine combos include Allegra-D, Zyrtec-D, and Claritin-D. “First-generation antihistamines are sedating, so advise the patient about caution during their use” (Thomas, 2022, para 11). Nasal irrigation with the use of saline solution can also help relieve nasal congestion and will also promote drainage of the mucus buildup. To address Mr. Nolan’s irritated sore throat, I would recommend the patient take throat lozenges or a Chloraseptic spray. Cepacol is an example of a throat-relief lozenge. An additional remedy that can be implemented in the care plan is to use a humidifier to cool and moisten the air, which helps prevent further irritating Mr. Nolan’s sore throat.Additional education I would provide Mr. Nolan is preventative measures. One prophylactic intervention that can be implemented is to take vitamin C daily. According to Thomas, “Vitamin C used as daily prophylaxis at doses of =0.2 grams or more had a ‘modest but consistent effect’ on the duration and severity of common cold symptoms (8% and 13% decreases in duration for adults and children, respectively)” (2022, para. 13). Another method to prevent future occurrences or to decrease the severity of URI’s is to get vaccinated. I will ensure that Mr. Nolan is up to date with his vaccines and, if not, schedule him for a follow-up once he is feeling well so he is updated with his vaccines.Finally, I would educate the patient to stay hydrated, get plenty of rest, and stay home until he feels better to prevent the spread of the virus. Implementing rest and hydrating will allow the body to recover and fight off the virus. I would also provide Mr. Nolan with how to explain his current viral URI diagnosis. I would educate the patient that Antibiotics are not effective with viral infections. I would also go over the potential period of the illness. It will typically resolve around 7 to 10 days.Furthermore, I would educate him to call emergency medical services if he is feeling short of breath, notice any blueness in his lips, difficulty breathing, or chest pain. I would also schedule Mr. Nolan for a follow-up if the symptoms worsen or he needs his vaccines updated. I would write him an excuse letter to address Mr. Nolan’s missed day at work. I would also emphasize that he needs to get plenty of rest and stay hydrated.Outcome evaluations for this patient include the prevention of complications such as pneumonia and effectively treating symptoms. Ensure that the patient follows medication compliance and gets ample rest and hydration. Ensure the patient understands to discontinue any irritants, such as smoking, that could further exacerbate the illness. Since this is a viral illness, ensure that in the future, avoid over prescribing antibiotics for viral infections. Finally, implement a teach-back method to ensure that the patient fully understands the education and treatment plan.Based on the literature, it is essential to avoid over prescribing antibiotics. Resistance to an antibiotic can occur due to an increase in antibiotic usage. “The more those antibiotics are used, the faster drug-resistant organisms will emerge” (Rosenthal et al., 2021, p. 654). In addition to this mechanism, the overuse of antibiotics promotes the development of overgrowth of normal flora, leading to antibiotic resistance. Multiple organizations, such as the Infections Diseases of America (ISDA) and the CDC, have worked together to develop focus areas to decrease antibiotic resistance. Focus Area I deals with the early detection and monitoring of drug-resistant infections. Focus Area II goals include helping with research on antimicrobial resistance and implementing this research into practice. Focus Area III aims to develop new products for antibacterial drugs, rapid diagnostics, and vaccines. Last is Focus Area IV, which includes applying an extensive assessment of present and future needs for antimicrobial-resistant medications for areas that needs them.ReferenceHarvard Medical School. (2020, April 15). Acetaminophen safety: Be cautious but not afraid. Harvard Health Publishing . https://www.health.harvard.eduLinks to an external site. /pain/acetaminophen-safety-be-cautious-but-not-afraidRosenthal, L. D., Burchum, J. R., & Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.Thomas M, Bomar PA. Upper Respiratory Tract Infection. (Updated 2022 Jun 27). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532961/
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