NR 508 Week 2 Discussions 1 (Part Three) Recent

discussion part three

given cynthia’s increased creatinine and renal deterioration, metformin is probably not optimal in this case. therefore, upon subsequent visits, you decide to start her on a sulfonylurea. she reappears in your clinic fairly soon thereafter with complaints of shakiness, sweating, chills, clamminess, lightheadedness, and a moderately severe headache.

• what is the diagnosis given these symptoms and the medications she is currently taking from parts one and two, and how would you proceed? NR 508 Week 2 Discussions 1 (Part Three) Recent

• at this point, please also be sure to also provide an accurate summary of cynthia’s medication plan.

discussion part one

elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. the patient is also complaining of a runny nose, cough, and head/chest congestion. he has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing. below is a list of the patient’s medications, his physical examination, and his laboratory findings:

medications NR 508 Week 2 Discussions 1 (Part Three) Recent

digoxin 0.25 mg qd cimetidine otc bid

pseudoephedrine sr 120 bid warfarin 7 mg qd

allergies: nkda

physical examination

vs: bp: 180/95, hr 75, irregularly irregular, rr 17

weight: 95 kg NR 508 Week 2 Discussions 1 (Part Three) Recent

heent: wnl

abd: + bowel sounds ext: bruising on arms and legs

neuro: alert & oriented x 3 gen: well developed, well-nourished male

ecg: atrial fibrillation

laboratory

na 143 meq/l k 4.5 meq/l

cl 99 mmol/l co2 25 meq/l

bun 18 mg/dl scr 0.9 mg/dl

inr 4.8 hct 42%

hbg 15 mg/dl digoxin 3.8 ng/ml

what problems should be identified in this patient? NR 508 Week 2 Discussions 1 (Part Three) Recent

what are the precise mechanisms of action of each drug?

what do you think is contributing to the patient’s hypertension?

are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?

what is the clinical significance of these interactions? NR 508 Week 2 Discussions 1 (Part Three) Recent

Description

Below is a response to the attached essay. Answer the bold questions. answer does not need to exceed a couple of paragraphs but any length you prefer.

I especially like the way you emphasize that “Nick Caraway, who seems unaware of his gay orientation, shows the expression of a heterosexual plot through closeted gay susceptibility.” NR 508 Week 2 Discussions 1 (Part Three) Recent

The “heterosexual plot,” of course, is the classic love triangle of Gatsby, Daisy, and Tom. When you boil it down, the plot is almost a cliche: Poor Boy loves Rich Girl; Poor Boy goes off to make his fortune so he can marry Rich Girl; while Poor Boy is gone, Rich Girl gets tired of waiting and marries some Other Man, Poor Boy dies trying to win her back. NR 508 Week 2 Discussions 1 (Part Two) Recent

Ho hum.

One way Fitzgerald makes this cliche a little more interesting is by making the Poor Boy a mobbed-up criminal. Another is to make the Other Man a mean, racist, cheating bastard. NR 508 Week 2 Discussions 1 (Part Two) Recent

Yet another way of spicing up this formula would be to have the story told through the eyes of a gay man (either closeted or clueless, take your pick), and maybe this is exactly what Fitzgerald did by including the McKee scene, and thereby suggesting Nick is gay.

So, if we read The Great Gatsby with the assumption that its narrator is gay, what new insights do you think we get from it? What do we notice that we might have missed otherwise? NR 508 Week 2 Discussions 1 (Part Two) Recent