Respond to two peers using APA formate and site all referencesPEER #1 ClaudetteIs there any additional subjective or objective information you need for this client? Explain.Subjective Data: A comprehensive medical and surgical history should be obtained, including all the medications that the patient is currently taking, both prescribed, nonprescribed, and herbal medications. The patient social and family history should also be made available. Asking the patient questions such as, why is she taking Coumadin, and does she has her PT/INR drawn on a regular basis. The dates of her diagnosis, and by whom she was diagnosed need to be known. Other questions such as, is she compliant with her medication, does she perform glucose monitoring by checking daily fingerstick, and is there any nutritional issues that needs to be addressed.Objective Data: Perform a head-to-toe examination, obtain lab work, including HgA1C, and PT/INR. Vital signs, BMI, memory examination, medication dosage should all be done. It's essential to obtain as much relevant data as possible, during patient initial encounter with the provider. This is done to properly diagnose, treat and evaluate the current situation. By doing this, we can guarantee that the necessary plan of care can now be determine (Healthypeople.gov, 2018). 2. What would be your position on the Ms. GMs use of alternative supplements for her diabetes and memory? Explain and include contraindications, if any.Ms. Gami should be educated and advised on the risk and danger, for not properly managing her diabetes. Poor management can lead to a life-long of body systems complications. Adhering to alternative supplements as the only treatment for diabetes is crucial. Diabetes is considered a chronic disease, and should be treated aggressively. Patient taking Cassia cinnamon as the only treatment for there type 2 diabetes is insufficient to control the disease. Cassia cinnamon is contraindicated in people if they're allergic to cinnamon, or peru balsam. It should also be used with caution in patient who have hepatic disease. It can cause toxicity, and also affect blood glucose. As previously mentioned, INR and platelet counts when closely monitored will indicate signs and symptoms of a worsening state of Dementia. 3. Are there any additional test/assessments you would complete for this patient given this list of medications? Explain. Patient presenting with type 2 Diabetes should have their labs drawn, such as HgA1C, fasting blood glucose, CMP and CBC. Liver and kidney function tests need to be completed too. These results will provide a complete assessment, therefore, any existing issues will be address accordingly.4. How might your treatment plan, in terms of medications, differ for this patient? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; contraindications and black box warnings.Based on my current assessment and findings on Ms. Gami, Metformin 500 mg bid po, would be my drug of choice. It is classified as antidiabetic, and should be taken with meals. It binds insulin to the receptors and potentiates insulin action. Now tissues are more sensitive to insulin, and are ready to execute, thus lowering serum glucose. Metformin has a low half-life of 6.2-17.6 hours, 50-60% is absorbed in systemic circulation. It's also eliminated via urine. Contraindication includes: DKA, renal issues, and impairment with creatinine clearance of 1.5md/dl. Patients taking Metformin should be instructed to stop taking the medication 48 hours before surgery.Cassia cinnamon has proven to be ineffective by itself to treat Diabetes. Additional prescribed diabetic drug should be added to Ms. Gami list of medications, in order to proper control her disease. Cassia cinnamon is not approved by the FDA.Ginseng comes in various forms, and depending on the route use, the effects may differ. Detected adverse, new, or worsening reactions should be reported immediately.5. What health maintenance or preventive education is important for this client based on your choice medication/treatment?The patient need to be educated on nutritional choices for Diabetes. Proper diet and exercise regimen. The importance of taking the medication as prescribed, and contacting her provider if any adverse reactions, or missed doses. Bleeding precautions, signs and symptoms of hypo/hyperglycemia, lactic acidosis, and moderate use of alcohol, should all be emphasized in patient teaching. Return demonstration should be perform by the patient, to ensure patient understanding and safety measures. Patient should be told the importance of adhering to her follow-up appointment every three months.ReferenceWoo, T. M., & Robinson, M. V. (2019). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (5th ed.). F.A. Davis.PEER #2 HaleyIs there any additional subjective or objective information you need for this client? Explain.Ms. GM presents to the clinic today to establish care. While we are aware she has a diagnosis of type II diabetes there are some other we need to know if there is any other pertinent health information about Ms. GM. I would ask Ms. GM if she has any health complaints, or is she just looking to establish a relationship with a primary care provider. I would continue on to ask Ms. GM how long she has been diagnosed with type II diabetes, how she is managing her diabetes, does she have any past medical history, any past hospitalizations, surgeries, I would ask about her family as well as social history. This information is important when the provider is just getting to know the patient to create a baseline health history. Objective information would be to obtain baseline vital signs, draw a complete lab panel including CBC, CMP, A1C, liver enzymes, kidney function and a complete physical assessment. What would be your position on the Ms. GMs use of alternative supplements for her diabetes and memory? Explain and include contraindications, if any.Some patients prefer the use of herbal remedies over the traditional pharmacological medications. It is important for the health care provider to understand and respect the patient’s preference as well as guide them on what medicines are safe with herbal supplements. One of the health providers main role is to educate Ms. GM on the certain medications she is taking and if any other medications or supplements are contraindicated. Ms. GM is taking ginseng for memory, I would educate Ms. GM that ginseng, although one of the bestselling herbal supplements in the United States, interferes with coumadin. Coumadin has a narrow therapeutic index and daily doses of ginseng scientifically reduce the blood levels and the anti-clotting effects of coumadin, clearing the blood stream more rapidly (UChicago Medicine, 2004). Are there any additional test/assessments you would complete for this patient given this list of medications? Explain.I would draw an INR to be sure Ms. GM is within therapeutic range and if needed adjust the dose of coumadin. A CMP would be appropriate to check electrolytes, and AIC to evaluate her glucose levels as well as CBC to assess her complete blood count. Since Ms. GM is taking Aricept, I would check her cognitive function as well as any signs or symptoms of GI bleeding. How might your treatment plan, in terms of medications, differ for this patient? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; contraindications and black box warnings.Although highly popular, herbal drugs should not be used to replace treatment of chronic diseases such as diabetes. I would check Ms. GM’s INR, CBC and CMP and continue the use of coumadin and Aricept since there are no contraindications. I would discontinue the use of ginseng and cassia cinnamon. I would recommend to Ms. GM starting metformin 500mg twice a day to control her diabetes. Metformin decrease the hepatic glucose production and intestinal glucose absorption. It is excreted through the urine with a plasma half-life of 6.2 hours and blood half-life of 17.6 hours. Contraindications of Metformin are renal disease and dysfunction as well as metabolic acidosis. Metformin should be held and not be taken after a procedure where iodine or anesthesia will be used and can affect kidney function (Woo & Robinson, 2020). What health maintenance or preventive education is important for this client based on your choice medication/treatment?I would encourage Ms. GM to follow through with future doctor appointments especially when she is scheduled for a lab draw. It is important to check INR levels to ensure it is within normal safe levels. Coumadin can cause major bleeding which could become fatal. I would educate Ms. GM to watch for signs of bleeding such as dark stools or nosebleeds and to avoid activities that increase the risk for bleeding. Always inform any health care professionals what medicine you are taking, especially when there is an invasive procedure involved. Encourage Ms. GM to take the Aricept at night to reduce syncope risks. While taking metformin Ms. GM should check her finger stick blood sugar twice a day and watch for signs of GI problems like diarrhea, while these are temporary it may become troubling to the patient (Woo & Robinson, 2020). https://www.uchicagomedicine.org/forefront/news/gi...Medline. (2017). https://medlineplus.gov/druginfo/meds/a682277.htmlWoo, T., Robinson, M. (2020). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (5th ed.). Philadelphia, PA: F.A. Davis

Take the four most influential course objectives for you and review your learning and influence on your practice to date. The course objectives are:Use advanced communication skills and processes to lead change initiatives in healthcare systems.Employ effective collaboration and teambuilding skills in professional practice, including leading interprofessional teams in analysis of complex issues and practice improvement.Develop and sustain relationships with professionals and patients to improve patient outcomes.Guide, mentor and support other nurses to achieve excellence in nursing practice.Lead care initiatives with an understanding of current leadership models and applicable technology.Demonstrate sensitivity to diverse organizational cultures and populations, including patients and providers.