[Solved] BW is a 23-year-old woman who presents for a well-woman examination and resumption of contraception – Fast, Quality and Affordable Assignment Expert

BW is a 23-year-old woman who presents for a well-woman examination and resumption of contraception

Module 8 Discussion

Case Study: Diabetes Case

LL is a 47-year-old African-American woman with three children and one unsuccessful pregnancy. She has a full-time clerical job for a transportation company. During her last pregnancy five years ago, she had gestational diabetes. No other significant history.

She returns for her annual check-up. Her lab tests were drawn pre-visit.

The American Diabetes Association recommends repeating the fasting blood glucose to confirm the diagnosis of diabetes. A repeat fasting blood glucose is 215 mg/dl confirming the Type 2 diabetes. You take a point of care A1C and it results at 8.7%.

How would you initially treat this patient? What counseling would you give this patient, including lifestyle modifications? What would your treatment goals be?

Instructions: Respond to case discussion questions above in a  3-5 minute video [via VoiceThread, Canvas Studio, Zoom, etc].  Your video should be recorded as if you were discussing the treatment with the patient.  Be sure to include how you would instruct the patient on their diagnosis, medication prescribed, therapeutic goals, and key counseling points.  Please post a link to your video no later than Thursday at 11:59 pm EST. Please make sure to be specific in the medication(s) you select including the name of the medication, dose, and frequency. 

Expert Answer and Explanation

Hello, LL. Today, we’re going to talk about your Type 2 diabetes and what we can do to manage it. I will explain the steps we’ll take to help you. You are not alone in this, and we will get through it together.

Medication

To start, I will give you a medication called Metformin a commonly prescribed medication for Type 2 diabetes. It is a pill you take every day and helps keep your blood sugar in check. In your case, you will take 850 mg of Metformin once daily with a meal for the duration of the disease as it is a long-term medication. It is a crucial part of your treatment and the overall crucial component of diabetes management (Al‐Taie et al., 2020). However, medication is just one aspect of your health management since lifestyle modifications are equally vital.

Lifestyle Changes

Alongside the medication, I would like you to make some changes to your daily life. Ensure that you work on your diet and exercise as a form of complementary medication. You should aim for a balanced diet with more fruits, vegetables, and whole grains while limiting the intake of sugary and processed foods. Exercise is another key element that needs to be part of your daily life going forward. I would recommend at least 30 minutes of moderate physical activity most days of the week, like brisk walking, as it significantly aids in blood sugar management.

Monitoring

Regular monitoring of blood sugar levels at home is essential. As a precaution and to aid with monitoring, you would be encouraged to keep track of your levels to help us gauge the effectiveness of the treatment and make necessary adjustments as needed. Monitoring can increase the nature in which care delivery is administered and the different ways to adjust your medication based on the reaction of your body (Świątoniowska-Lonc et al., 2021).

Counseling Points

In our practice, we have a dedicated team that includes a diabetes educator. This professional would work closely with you to guide you through these lifestyle changes and address any questions or concerns that you may have. It’s important for you to know that you are not alone in this journey, and I and the entire hospital personnel or resources are here to support your every step of the way.

Therapeutic Goals

Our primary treatment goal is to achieve an A1C level of less than 7%. This target is crucial as it significantly lowers the risk of diabetes-related complications. We would schedule regular follow-up visits to monitor your progress and ensure that you are on the right track to achieving these goals. In conclusion, the initial treatment and counseling for Type 2 diabetes involve a multi-faceted approach. Medication, lifestyle modifications, regular monitoring, and a dedicated support team all play a role in helping our patients (Shah et al., 2019).

Conclusion

These medication regimens are aimed to help patients like you manage your condition effectively. With the medication, lifestyle changes, monitoring, and our support team, you’re in good hands. We’re here to help you live a healthier life. Thank you, LL.

References

Al‐Taie, A., Izzettin, F. V., Sancar, M., & Köseoğlu, A. (2020). Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting. European journal of cancer care, 29(5), e13261.

Shah, M. K., Moore, M. A., Narayan, K. V., & Ali, M. K. (2019). Trends in lifestyle counseling for adults with and without diabetes in the US, 2005–2015. American journal of preventive medicine, 57(5), e153-e161.

Świątoniowska-Lonc, N., Tański, W., Polański, J., Jankowska-Polańska, B., & Mazur, G. (2021). Psychosocial determinants of treatment adherence in patients with type 2 diabetes–a review. Diabetes, Metabolic Syndrome and Obesity, 2701-2715.

Module 9 Discussion

Case Study: Contraception Case

BW is a 23-year-old woman who presents for a well-woman examination and resumption of contraception.

Her last menstrual period began 8 days ago, occurred at the expected time, lasted a normal number of days for her, and flow was her normal amount. In the past she has used combined oral contraceptives but reports that she has “so much extra bleeding no matter what pill she tried.”

Upon further questioning, she tried two different brands of “very low-dose newer” pills, using each for two cycles before abandoning pills altogether. With each brand, she had spotting for several days during active pills as well as during the inactive pills.

Currently, she is using condoms for contraception with most acts of intercourse but has used emergency contraception twice during the past 5 months due to condom breakage.

She recalls that she had trouble remembering to take the pill daily due to her erratic schedule while in college, but she states that she is willing to try pills again because she knows of their efficacy in preventing pregnancy.  She is open to other methods but know little about them. She has been in her current intimate relationship for 9 months, which is consensual and mutually monogamous.

Menarche occurred at 12 years and she has regular menses every 28 to 32 days, lasting 4 to 6 days, with minimal dysmenorrhea on the first day ameliorated by use of OTC doses of ibuprofen. She denies sexually transmitted infections or abnormal Pap smears.

Her physical examination reveals height 5’4,” weight 175 lb, and BP 126/74.

Does BW have any contraindications noted to contraception? What would be your initial management plan including counseling and follow up?

Expert Answer and Explanation

Clinical Approach to Managing a Contraception Issue

The contradictions to conception are associated with certain risk factors including obesity, age and lifestyle habits. If one is obese, the contraceptives they use may be less effective, raising the risk of contradictions. Analysis of the case reveals that BW is obese considering that she weighs 175lbs with 5’4” height. This is a potential risk factor for contradictions, which are equally associated with age. However, this risk is also tied to other factors such as one’s sexual behavior, their blood pressure (BP) levels, and age (Assiri et al., 2022).

Given the details of the case study, it is important to rule out the effect of age and the B.P because contradictions are prevalent in hypertensive persons, and in people above aged 35-years. BW’s 126/74 is within the normal B.P. range, and given that she is 23-years old, there is limited possibility that age and B.P. could cause the contradictions. However, the patient inconsistently uses condom which may increase her chances of contracting pregnancy.

Given the presented information about BW, the initial management plan would focus on helping her reduce the exposure to factors that may increase her risk of contracting pregnancy, by increasing her adherence to the recommended conceptive, and helping her manage her weight. The initial step would involve assessing whether BW understands how noncompliance to the contraceptives and obesity can increase her risk of becoming pregnant (Römer, 2019).  When explaining how this risk may increase, a provider should focus on the physiological aspects of obesity, and the inconsistent use of the condoms can increase BW’s chances of becoming pregnant.

After determining that BW is aware of the link between the risk of pregnancy, and obesity including the inconsistent use of contraceptives, the next step is to work with her to set goals that can help guide her as she focuses on managing her weight while ensuring that she complies with the prescription information. Some of the aspects of weight management strategies to prioritize include regular exercise and use of appropriate diet. This would require involving a nutritionist and a physiotherapist to contribute to the preparation of the plan (Britton et al., 2020).

When counseling the patient, a provider should address the concerns she has about the oral contraceptives, highlighting the need to have her preferred contraceptive incorporated into treatment. Explaining the different options of contraceptives that she can use, can equally increase her options in terms of the type of contraceptive she can choose. The injection with Depo-Provera is one of the options she may consider.

References

Assiri, G. A., Bannan, D. F., Alshehri, G. H., Alshyhani, M., Almatri, W., & Mahmoud, M. A. (2022). The Contraindications to Combined Oral Contraceptives among Reproductive-Aged Women in an Obstetrics and Gynaecology Clinic: A Single-Centre Cross-Sectional Study. International journal of environmental research and public health, 19(3), 1567. https://doi.org/10.3390/ijerph19031567.

Britton, L. E., Alspaugh, A., Greene, M. Z., & McLemore, M. R. (2020). CE: An Evidence-Based Update on Contraception. The American journal of nursing, 120(2), 22–33. https://doi.org/10.1097/01.NAJ.0000654304.29632.a7.

Römer, T. (2019). Medical Eligibility for Contraception in Women at Increased Risk. Deutsches Arzteblatt international, 116(45), 764–774. https://doi.org/10.3238/arztebl.2019.0764.

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