Case
Rene has come in today for follow-up of his hyperglycemia. He has been using an OTC “magic pill” – taken po, qd that his co-worker gave him to use since about a week after his last visit (3 months ago). He has noticed a change in his symptoms – the polyuria and polydipsia have resolved. In the past two months, he has also noticed changes in his previously increased difficulties performing his ADLs – previously he had numbness and bilateral tingling of his lower extremities that he wasn’t sure the cause of.
He has a history of hypercholesterolemia and DM that were diagnosed earlier this year. His DOB is 11/19/1980 and his BMI is 36.9. He is concerned about his abdomen due to recent weight gain and he is worried about a “rash on his neck.” He thinks maybe he needs a biopsy since it might be “malignant melanoma,” which he has been reading about. His wife thinks he might be a hypochondriac but she is also worried that he has decided to take the “magic pill” instead of the antidiabetic he was prescribed. He has a glucometer and checks his sugar BID, post-prandial. He also describes occasional photophobia, was seen by an opthalmologist. His mother has diabetes, but she lives in the Philippines – he is unsure what her medications are but he thinks she might take insulin and everyone he knows that has taken insulin has problems with their kidneys and some have even had amputations
His physical exam was essentially normal, but significant for acanthosis nigricans, elevated blood pressure (this is the third visit with elevated blood pressure, indicating the presence of hypertension). He will have his labs ordered with the new diagnosis but also will have his A1C checked.
Discuss each of the bolded, italicized words as you discuss any aspect of this case you’d like to address as Rene’s PCP. And, always – have fun!
Questions
Advanced Pharmacology
1. What medications might you change or add today?
2. What are the main classes of medication for Rene’s conditions?
3. How might you start medications for Rene and over what period of time would you increase and why?
Advanced Pathophysiology
1. Be sure you understand each of the bolded, italicized words of this case.
2. As Rene’s PCP, select 5 bolded, italicized words (except antidiabetics, prescribed and acanthosis) and describe them in detail and their significance pathophysiologically.
 
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Develop a scholarly paper addressing a problem, issue, or situation needing change within the practice setting. The paper will address how the advanced practice nurse can facilitate and develop a road map for change.
Assignment Criteria:
1. Identify a problem, issue, or situation needing change within the practice or organizational setting. Include background information.
2. Select and discuss a change model that can be applied to the selected problem, issue, or situation.
a. Discuss how to facilitate the change and create buy-in from the health care professionals
b. Discuss possible resistance to the change that would need to be overcome
3. Articulate a plan for making the change using a change road map for the team (the starting point, steps to take for making the change, and successful completion). This is a narrative format, not a diagram.
4. Explain the importance of effective communication and the role it plays in influencing decisions during the change.
5. The scholarly paper should be in narrative format and 4 to 5 pages excluding the title and reference page.
6. Include an introductory paragraph, purpose statement, and a conclusion.
7. Include level 1 and 2 headings to organize the paper.
8. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used.
9. Include three professional peer-reviewed scholarly journal references to support the paper (review in Ulrich Periodical Directory) and be less than five (5) years old.
10. APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).
11. Submit the assignment to Turnitin prior to the final submission, review the originality report, and make any needed changes.
12. Submit by the posted due date.
 
 
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