See Attached. Diabetes Mellitus ( Insulin dependent) with Renal Failure- please add medications to your plan of care. Mr. J is going for a colonoscopy. Medication: Digoxin, Amiodarone, Aspirin, Furosemide, Sodium Polystyrene, Calcium Gluconate, Fluticasone/Salmeterol, Gabapentin, Metformin, Glyburide, Acetaminophen, Magnesium Hydroxide, Silver Sulfadiazine, Cefepime, Vancomycin Purchase the answer to view it

Introduction:

Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels, either due to insufficient production of insulin or impaired insulin function. If left untreated, DM can lead to various complications, including renal failure. Renal failure, also known as kidney failure, occurs when the kidneys lose their ability to properly filter waste products and excess fluids from the blood.

In this case, Mr. J is a patient with insulin-dependent DM who also has renal failure. As part of his plan of care, it is important to consider the medications that he is currently taking and how they may impact his condition. In this assignment, we will assess the medications Mr. J is taking and provide recommendations for his plan of care.

Medication review:

1. Digoxin: Digoxin is a medication used to treat heart failure and certain heart rhythm disorders. It is important to monitor Mr. J’s kidney function while on this medication, as renal failure can affect the clearance of digoxin from the body. Close monitoring of digoxin levels and renal function is necessary.

2. Amiodarone: Amiodarone is an antiarrhythmic medication used to treat various types of irregular heart rhythms. Like digoxin, amiodarone is primarily metabolized and excreted by the liver and kidneys. Renal failure can impair the clearance of amiodarone, leading to higher drug levels in the body. Monitoring renal function and adjusting the dose of amiodarone accordingly is crucial.

3. Aspirin: Aspirin is an antiplatelet agent commonly used for cardiovascular prophylaxis. It is important to use aspirin with caution in patients with renal failure, as it can further impair kidney function and increase the risk of bleeding. The dose of aspirin may need to be adjusted or an alternative medication considered.

4. Furosemide: Furosemide is a loop diuretic used to treat fluid retention and edema commonly associated with kidney disease. Furosemide is primarily excreted by the kidneys, and its effectiveness may be reduced in patients with renal failure. Careful monitoring of fluid balance, electrolytes, and kidney function is necessary when prescribing furosemide.

5. Sodium Polystyrene: Sodium polystyrene is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines. In patients with renal failure, it is important to monitor serum potassium levels closely, as hyperkalemia can have serious cardiovascular effects. Sodium polystyrene should be used cautiously, and the dose may need adjustment based on renal function.

6. Calcium Gluconate: Calcium gluconate is a medication used to treat conditions associated with low calcium levels in the blood. It is important to monitor serum calcium levels in patients with renal failure, as imbalances can occur due to impaired kidney function. Dosing adjustments may be necessary based on renal function and serum calcium levels.

7. Fluticasone/Salmeterol: Fluticasone/salmeterol is a combination medication used to treat asthma and chronic obstructive pulmonary disease (COPD). In patients with renal failure, caution should be exercised when prescribing this medication, as its clearance and metabolism may be affected. Adjustments to the dose or frequency of administration may be required.

8. Gabapentin: Gabapentin is an anticonvulsant medication used to treat various types of seizures and neuropathic pain. In patients with renal failure, dosage adjustments are necessary due to decreased renal clearance of the drug. Monitoring renal function and adjusting the dose accordingly is crucial.

9. Metformin: Metformin is an oral antidiabetic medication commonly prescribed for type 2 DM. In patients with renal failure, metformin can accumulate in the body and increase the risk of lactic acidosis, a potentially life-threatening condition. The use of metformin is generally contraindicated in patients with severe renal impairment, and alternative medications should be considered.

10. Glyburide: Glyburide is an oral antidiabetic medication that stimulates the release of insulin from the pancreas. In patients with renal failure, glyburide should be used with caution, as its clearance may be impaired. Regular monitoring of renal function and adjusting the dose if necessary is essential.

11. Acetaminophen: Acetaminophen is a commonly used analgesic and antipyretic medication. Although acetaminophen is primarily metabolized in the liver, it is important to consider its use in patients with renal failure, as impaired kidney function may affect its metabolism and clearance. Dosage adjustments may be necessary based on renal function.

12. Magnesium Hydroxide: Magnesium hydroxide is an antacid and laxative commonly used to treat heartburn, indigestion, and constipation. In patients with renal failure, magnesium levels can become imbalanced, leading to symptoms such as muscle weakness, fatigue, and irregular heart rhythms. Monitoring magnesium levels and adjusting the dose is important.

13. Silver Sulfadiazine: Silver sulfadiazine is a topical antimicrobial agent used to prevent and treat infections in burn wounds. While there are no specific renal considerations for this medication, it is important to monitor for any potential adverse effects or interactions with other medications.

14. Cefepime: Cefepime is a broad-spectrum antibiotic used to treat various bacterial infections. In patients with renal failure, dosage adjustments are necessary due to decreased renal clearance of the drug. Monitoring renal function, drug levels, and adjusting the dose accordingly is crucial.

15. Vancomycin: Vancomycin is an antibiotic used to treat serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive bacteria. In patients with renal failure, dosage adjustments are necessary due to decreased renal clearance of the drug. Monitoring renal function, drug levels, and adjusting the dose is crucial.

Plan of care:

Based on the medications Mr. J is currently taking and his diagnosis of insulin-dependent DM with renal failure, the following recommendations can be made for his plan of care:

1. Monitor renal function: Regular assessment of Mr. J’s kidney function, including serum creatinine and glomerular filtration rate (GFR), is essential to guide medication dosing and prevent further deterioration of renal function.

2. Adjust medication doses: Depending on Mr. J’s renal function, some medications may need to be dose-adjusted to prevent accumulation and minimize the risk of adverse effects. This includes medications such as digoxin, amiodarone, furosemide, sodium polystyrene, calcium gluconate, fluticasone/salmeterol, gabapentin, metformin, glyburide, and vancomycin.

3. Consider alternative medications: In cases where medications are contraindicated or require extensive dose adjustments in renal failure, it may be necessary to consider alternative medications that are better tolerated or have fewer renal considerations.

4. Monitor electrolyte levels: Due to the risk of electrolyte imbalances in renal failure, regular monitoring of serum potassium, calcium, and magnesium levels is important. Medications such as sodium polystyrene, furosemide, and calcium gluconate may need to be adjusted to maintain optimal electrolyte balance.

5. Educate patient on medication adherence and self-care: It is crucial to provide Mr. J with appropriate education on the importance of medication adherence, regular monitoring of blood glucose levels, and self-care measures to prevent complications related to DM and renal failure.

Conclusion:

In conclusion, the management of a patient with insulin-dependent DM and renal failure requires careful consideration of the medications they are currently taking. Monitoring renal function, dose adjustment, and consideration of alternative medications are crucial components of the plan of care. By implementing these recommendations, healthcare providers can optimize medication therapy and improve patient outcomes in this complex population.