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Question

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Task:

Part 1 Questions

Emily is distressed that her blood glucose level is elevated and asks you for help in understanding her diabetes. She tells you that she has a friend who is very overweight, eats lots of cake and hardly ever exercises, and he does not have diabetes.

Include an introduction or prelude 

1. Describe the pathophysiology of T2DM with links to Emily’s case. Include in your answer risk factors for T2DM, the pathogenesis of T2DM, possible complications of T2DM and outline the 3 levels of treatment options for T2DM.

2. Differentiate between T2DM and T1DM (at least 5 differences).

3. Identify at least 2 reasons Emily’s BGL is high on admission. Discuss how each reason you identify affects BGLs. 

Part 2 Questions

The surgery is successful and Emily comes to see you in the outpatient clinic for cortisone injections (Kenacort-A 40). She has been commenced on metformin (APO-Metformin Tablets) and glipizide (Minidiab Tablets) to help control her diabetes. Her blood test on this visit were BGL 8.8 mmol/L [3.9-6.1 mmol/L]; HbA1c: 8% [normal <6.5%].

1. Discuss the three medications Emily is on. Include in your answer the action, complications/side effects and nursing considerations linked to Emily’s situation. 

2. Discuss the two blood results, one from prior to surgery and one from the clinic visit of Emily’s BGL and HbA1c. What are they? What do they measure and why have they changed? 

Part 3 Questions

Ten years later, Emily is now 63 years old, she became concerned with her feeling of increasing tiredness, nausea and general pruritus. She visited her GP, who found her BP to be 190/110mm Hg. Although she is not diagnosed with hypertension, she admitted getting severe headaches and sometimes palpitations for over 5 years, when she was worried about the drought. She has been taking Ibuprofen and naproxen for the osteo-arthritis for nearly 5 years but did not seek medical help as she they would settle her discomfort. The GP referred Emily to a nephrologist who performed a renal function test. Her blood results were:

GFR (glomerular filtration rate) was found to be 10ml/min/1.73m2 [90 to 120 mL/min/1.73 m2 ]

Hb (Haemoglobin) was 95g/L [120 to 155 grams/L for female]

Serum Potassium was 5.7 mmol/L [3.6 to 5.2 mmol/L]

Serum Urea 17 mmol/L [2.9-8.2 mmol/L]

Serum Creatinine 150 μmol/L [50-110 μmol/L]

1 What does Emily’s renal function test indicate? Explain her renal function test. What appropriate treatment should be available to Emily? Explain her treatment options with rationale.

NURBN2016 Advanced Pathophysiology and Pharmacology

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This section will focus on the first 24 hours of post-surgical care and involves prioritising nursing care for Wendy.  Consider Wendy’s co-morbidities including obstructive sleep apnoea (OSA), previous MI, asthma, hypertension, and hypercholesterolemia in the context of having a gene ...

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