CXA243 Pathophysiology for Health Care

Explain the rationale of the therapeutic approaches for this patient as identified in the supporting document.

Exercises, especially aerobic ones, increase insulin sensitivity and increase muscular strength. They lower cardiovascular and overall mortality rates. They also help in the management of blood pressure and improves lipid levels. Exercises can also help in the management of weight. They help in weight loss. Metformin 500mg and empagliflozin 5mg are used to reduce the blood sugar levels of the patient. Metformin acts directly and indirectly on the liver to lower the production of glucose as it suppresses the process of gluconeogenesis. It inhibits the function of mitochondrial respiratory complex 1, which leads to an increase in the cellular ratio of adenosine monophosphate to adenosine triphosphate, therefore, reducing the efficiency of adenosine triphosphate production. Empagliflozin works by inhibiting the sodium-glucose co-transporter found in the renal tubules of the kidney, hence reducing the renal reabsorption of glucose and enhancing the excretion of glucose in urine. Ramipril 5mg daily is given to treat kidney disease that is associated with diabetes mellitus. The performance of checking the HbA1c levels every three months is to monitor the progress of blood glucose levels and check for any impending complications of diabetes. Renal functions and lipid profiles are to check for the extent of damage to the kidneys and albumin levels which can be an early sign of vascular damage—a lipid profile every three months to monitor the cholesterol levels in the body. The medication of rosuzet that is given daily helps reduce cholesterol in the body, thus reducing the levels of albumin. Weight management is key to managing type 2 diabetes management and improving insulin resistance and glycemic outcomes. With weight loss, there has been an improvement of the blood lipids, cholesterol levels and even the theHbA1c levels for the patient.

Relate the therapeutic approaches to the pathophysiology presentation of this patient.

The patient has an HbA1c of 9%, which is an indication of high blood glucose levels. This also shows impending damage to the kidneys. With this, the patient will be given metformin 500mg and empagliflozin 5mg to help in the reduction of the blood sugars. Following instructions about diet management as per the dietitian to reduce oral glucose taken and having the test of HbA1c every three months to monitor blood glucose. The patient also presents with an eGFR of 90ml/min, a sign of kidney damage. Medication of ramipril 5mg will be administered, and an annual renal function test to check for the progress in the damage. Ramipril inhibits Angiotensin-Converting Enzyme reducing the Angiotensin 2 formation, and this results in the slow down of the sympathetic activities. There is a reduction in water reabsorption from the kidneys, and as a result, there is a reduction in blood pressure. With this, there is a reduction or slow down in kidney damage and other complications of diabetes arising.

The patient will be required to reduce beer consumption because alcohol is a factor that causes kidney damage. The patient also presents with a decreased dorsalis pedis and the posterior tibialis pulses in both legs. A decrease in pulses will indicate a complication of diabetes to the vasculature of the legs. Regular and planned exercises will help in the strength of muscles, increased blood flow to the legs and therefore achievement in the pulses. Visits to the podiatrist should be recommended as they are specialists that deal with disorders of the feet or any structures of the legs. There should be yearly visits to the optometrist to check for any visual complications that involve compromise to the blood flow to the eye. Yearly assessment of the eyes is advocated because diabetic retinopathy may settle in as a complication of diabetes due to the damage to the blood vessels at the back of the retina. The symptoms may include blurry vision and loss of vision. This happens if the blood sugars are not controlled.

There is a marked level of microalbuminuria of 3.5%, which is a sign that there is albumin in the urine. This indicates an early stage in kidney disease. This may pose a cardiovascular issue that comes as a result of diabetes mellitus. For this, a lipid profile is performed every three months to assess the severity and progress of the kidney damage. Administration of rosuzet (rosuvastatin 20mg and ezetimibe 10mg) daily will help in the reduction of cholesterol. This combination of drugs works in the essence that it decreases the absorption of cholesterol in the small intestines and reduces the amount of cholesterol produced by the liver. There is a cardiovascular risk of more than 15%. The cessation of smoking cigarettes for this patient will help improve the cardiovascular system because the smoke causes the blood vessels that line the airways to be swollen and get inflamed. This leads to the narrowing of the vessels leading to many cardiovascular conditions.

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