Please Reply to the following 2 Discussion posts

Please Reply to the following 2 Discussion posts:

Requirement

APA format with intext citation

Word count minimum of 150 words per post

References at least one high-level scholarly reference per post within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

DISCUSSION POST #1 Reply to Minu

I was worried about the 42-year-old woman's general health when I first saw her blood results. When she came in for her yearly physical, I first wished I had known more about her overall evaluation and her vital signs. It is obvious that this person is not engaging in healthy daily practices given that she has smoked for more than 20 years and has been diagnosed with type 2 diabetes. It was interesting to hear that compared to her last physical, which was over 18 months earlier, majority of her lab readings during her current physical exam were outside of normal limits. I start to wonder what has changed in her life and what she does on a daily basis as a result. As a provider, I would want to learn more about the patient's health history during the previous 18 months and determine whether any changes in lifestyle may have led to the change in health.

Smoking and diabetes strongly interacted to raise the chances of recurrent cardiovascular disease events, and smoking in the past or present might offset the cardiovascular advantages of managing risk factors in diabetes (Yang et al., 2022). Examining her test results reveals that she is showing symptoms of dyslipidemia. Low HDL cholesterol and high triglycerides are risk factors for developing cardiovascular disease. It's crucial to emphasize that this patient has smoked every day for the previous 20 years in addition to her excessive cholesterol levels. Her type 2 diabetes will put her at a significant risk for cardiovascular disease in addition to smoking. This is due to the fact that having high blood sugar might gradually harm the cells and blood vessels that ultimately regulate your heart (Yu et al., 2022). 

I would want to talk about how smoking has harmed this patient's health and how it is already beginning to deteriorate. She will need to be informed about the significance of quitting smoking. I think setting objectives with her would be most helpful, bearing in mind that she has smoked every day for the past 20 years, in order for most people to maintain regular daily habits. I'll advise her to cut back on smoking as much as she can and set a short-term objective of smoking only a couple of days a week. I'd like to speak with her again soon and urge her to quit entirely. One study found that combining exercise, avoiding smoking or smoke exposure, weight loss, and dietary modifications reduced LDL-C levels. Most frequently, patients with type 2 diabetes may considerably reduce or even reverse their condition if they start eating the correct meals, monitoring their blood sugar levels, and exercising every day. The use of medicine to regulate her glucose levels is therefore something I'd like to talk about with her (Yu et al., 2022).

I would prefer to begin her on statin medication as a kind of pharmacologic intervention. I would start her on Atorvastatin 5-10 mg PO daily. (Rhee et al., 2019). Regulating cholesterol will be possible as a result. In order to assist her manage her type 2 diabetes, I would also want to recommend Metformin. I would start her on Metformin 500 mg PO twice daily. I want to examine the patient's blood levels and A1C three months after the initial visit (Yu et al., 2022). To make sure this patient is on the correct road and maintaining her health, follow-up visits will be scheduled every two weeks. To lessen the avoidable burden of CVD in adults with diabetes, it is important to avoid or stop smoking (Gallucci et al., 2020). 

 DISCUSSION POST # 2 Reply to Claire

Based on the lab results, the patient's cardiovascular risk is a stroke, transient ischemic attack TIA, coronary artery disease, COPD, heart failure, seizure, valvular heart disease, diabetic retinopathy, and renal disease, which is related to vascular changes. Lee et al. (2017) state:

High levels of triglyceride (TG) and low levels of HDL cholesterol (HDL-C) are considered to be risk factors for coronary heart disease (CHD) and ischemic stroke. Lowering the LDL cholesterol (LDL-C) level with statin therapy is the primary target in reducing atherosclerotic cardiovascular disease (ASCVD). Yet, high TG and low HDL-C levels remain prevalent in some statin-treated adults. Prospective studies have suggested that an elevated TG level in combination with a low HDL-C level, also called “atherogenic dyslipidemia,” may be a clinical marker to identify adults at risk for ASCVD. This may be particularly true of individuals with obesity and metabolic disease, as insulin resistance (IR) directly contributes to such dyslipidemia abnormalities.

Treatment for atherosclerotic dyslipidemia with diabetes is an ongoing battle. This can be managed in the primary care setting by the nurse practitioner (NP) with pharmacological and non-pharmacological management. Pharmacological management can include Ezetimibe and Pitavastatin. Banach et al. (2022) state:

I was shown that the addition of ezetimibe to Pitavastatin resulted in an additional reduction of LDL-C by 14%, enabling a 52% reduction in LDL-C, which was associated with a significant 23% reduction of event rate and other outcomes—with a 23% reduction of stroke risk and 55% reduction of all-cause mortality. Adding ezetimibe to statin therapy is associated with greater efficacy than statin monotherapy in reducing the incidence of CVD and stroke among diabetic patients.

Non-pharmacological management is through lifestyle modification. Diet changes that include low-fat, low-salt, carbohydrate reduction, exercise with walking at least 15 minutes a day for five days a week, and smoking cessation are beneficial in reducing cardiovascular risk.