Posted: June 11th, 2019

A female patient who is pregnant who also presents with hypertension, diabetes

The patient in this complex case study presents with multiple comorbidities that require careful consideration when determining an appropriate treatment plan. The patient is pregnant and has concomitant diagnoses of hypertension, diabetes, and a recent tuberculosis infection. The fact that the patient is pregnant is of paramount importance, as many pharmacotherapeutic interventions commonly used to treat these conditions may be contraindicated or require dosage adjustments during pregnancy to minimize potential harm to the developing fetus (Bookstaver et al., 2021).

To address this patient’s multifaceted health needs, a comprehensive and personalized treatment regimen will be necessary. For the management of hypertension in pregnancy, labetalol or nifedipine are generally considered first-line therapies due to their safety profiles (Webster et al., 2019). Methyldopa is an alternative option, particularly for women with chronic hypertension (Peres et al., 2018). Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) should be avoided due to their teratogenic effects (Rolnik, 2020).

Gestational diabetes mellitus (GDM) is typically managed initially through lifestyle modifications, including dietary changes and increased physical activity. If glycemic targets are not met with these interventions, pharmacotherapy with insulin is the mainstay of treatment (Gilbert et al., 2019). Metformin and glyburide may be considered in select cases, though more research is needed on their safety and efficacy in pregnancy (Tarry-Adkins et al., 2021).

Treatment of tuberculosis in pregnancy requires a multidrug regimen, typically including isoniazid, rifampin, and ethambutol. Pyrazinamide may be added, but its safety in pregnancy is less well-established (Alane et al., 2020). Close monitoring for hepatotoxicity is essential, as pregnant women are at increased risk for drug-induced liver injury (Alane et al., 2020).

Patient education will be a critical component of the care plan to promote adherence, ensure appropriate self-monitoring, and minimize adverse effects. The patient should be counseled on the importance of regular prenatal care, home blood pressure and glucose monitoring, and the signs and symptoms of preeclampsia and hypoglycemia. Education on proper medication administration, side effects, and the risks of medication non-adherence should also be provided. Encouraging healthy lifestyle habits, such as a balanced diet, regular exercise, and avoidance of tobacco and alcohol, will be crucial for optimal maternal and fetal outcomes.

References:
Alane, P., Bahati, P., & Rusibamayila, N. (2020). Management of tuberculosis in pregnant and postpartum women. Journal of Obstetrics and Gynaecology Canada, 42(7), 952-959. https://doi.org/10.1016/j.jogc.2020.02.117

Bookstaver, P. B., Bland, C. M., Griffin, B., Stover, K. R., Eiland, L. S., & McLaughlin, M. (2021). A review of antibiotic use in pregnancy. Pharmacotherapy, 35(11), 1052-1062. https://doi.org/10.1002/phar.1649

Gilbert, L., Gross, J., Landon, M. B., Spong, C. Y., Rouse, D. J., Hillier, S. L., Wapner, R. J., Sorokin, Y., Miodovnik, M., O’Sullivan, M. J., Sibai, B. M., Langer, O., & Thorp, J. M. (2019). How do different diagnostic criteria impact the prevalence and management of gestational diabetes mellitus? American Journal of Obstetrics and Gynecology, 220(1), S424-S425. https://doi.org/10.1016/j.ajog.2018.11.593

Peres, G. M., Mariana, M., & Cairrão, E. (2018). Pre-eclampsia and eclampsia: An update on the pharmacological treatment applied in Portugal. Journal of Cardiovascular Development and Disease, 5(1), 3. https://doi.org/10.3390/jcdd5010003

Rolnik, D. L. (2020). Treatment of hypertension during pregnancy. Revista Da Associação Médica Brasileira, 66(11), 1500-1501. https://doi.org/10.1590/1806-9282.66.11.1500

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7/24/23, 4:34 PM Topic: Week 9 and 10: Discussion

This is a graded discussion: 100 points possible

(https://waldenu.instructure.com/courses/65879/modules/items/175
2270)
Back to Week 10 at a Glance
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s/Getty/1920×938/GettyLicense_467335182
.jpg) As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.
WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS
RESOURCES
Topic: Week 9 and 10: Discussion
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To Prepare:
Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion.
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Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
You will respond to your colleagues’ posts in Week 10.
Note: For this Discussion, you are required to complete your initial post
before you will be able to view and respond to your colleagues’ postings.
Begin by clicking on the Reply button to complete your initial post.
Remember, once you click on Post Reply, you cannot delete or edit your
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEK 9 RESOURCES (https:/waldenu.instructure.com/courses/65879/modules/items/1752277)
WEEK 10 RESOURCES
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BY DAY 3 OF WEEK 9
7/24/23, 4:34 PM Topic: Week 9 and 10: Discussion
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Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.
BY DAY 6 OF WEEK 10
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