$20 Bonus + 25% OFF
Securing Higher Grades Costing Your Pocket? Book Your Assignment at The Lowest Price Now!

HSNS367 Nursing Practice: Complex Integrated Care

tag 0 Download10 Pages 2,366 Words tag Add in library Click this icon and make it bookmark in your library to refer it later. GOT IT
  • Course Code: HSNS367
  • University: University Of New England
  • Country: Australia


Describe the pathophysiology of the chosen complication.

Discuss the assessment and diagnostics of this complication.

Discuss the treatment and management of this complication.

Demonstrated ability to review the literature and select appropriate sources.

Demonstrated ability to appraise and analyse the literature .




Diabetes Mellitus (DM) is a metabolic disorder. It is characterized by hyperglycemia that generates due to disequilibrium in insulin secretion and/or insulin action. The pathological hallmark of DM encompasses vasculature leading to microvascular and macrovascular complications. The microvascular complications like nephropathy and retinopathy accelerates the chance of developing macrovascular complications, which promotes atherosclerosis and eventually leads to the development of cardiovascular disease, peripheral vascular disease and stroke (Marieb & Hoehn, 2015). The following essay aims to highlight the pathophysiology associated with macrovascular complications of diabetes followed by assessment and diagnostic criteria. At the end, the essay will explore common treatment and management principles underlying macrovascular complications of diabetes.


Macrovascular complications: pathophysiology

According to Chilelli, Burlina and Lapolla (2013), the main pathological mechanism in macrovascular complications in DM mainly involves atherosclerosis. Atherosclerosis results from chronic injury or inflammation of the wall of arteries present in the coronary or peripheral vascular system. Inflammation the walls of the arteries cause oxidation of the lipids from low-density-lipoprotein particles under the action of angiotensin II. The oxidized lipid particles accumulate in the endothelial walls leading to narrowing (Bullock & Hales, 2016). The activation of the inflammatory pathway causes stimulation and proliferation of macrophage and attraction of T-lymphocyte at the site of inflammation. The activated T-lymphocyte induces proliferation of smooth muscle in the arterial walls and simultaneous collagen accumulation leading to thickening of arteries. The arterial inflammation leads to narrowing of the arterial walls throughout the body and thereby increasing the chance of cardiovascular accident (Chilelli, Burlina & Lapolla, 2013).

Chawla, Chawla and Jaggi (2016) highlighted the pathophysiology underlying the inflammation in diabetes and subsequent development of macrovascular complications in details. According to Chawla, Chawla and Jaggi (2016), hyperglycemia provokes monocyte adhesion to the arterial cells. These monocyte adhserion triggers type 1 hypersensitivity reaction, promoting the accumulation of the primary mediators of hypersentivity and thereby causing thickening of the arteries. Increase blood glucose level activates matrix-degrading enzyme metalloproteinase, which cause plaque rupture and arterial remodelling leading toe thickening of the arteries. Diabetes also increases the secretion of the primary inflammatory mediators like C-reactive protein, plasminogen activator inhibitor and interleukine-6 that cause activation of macrophage and thereby leading to the development of inflammatory reaction under the influence of protein kinase C (PKC) pathway.

Another underlying pathophysiology behind the development of the macrovascular complications include increased rate of platelet adhesion and hypercoagulability (Zhang et al., 2014). Impaired nitric oxide generation, free radical formation in the platelets and altered calcium regulation promote platelet aggregation cause hypercoagulability. Increased levels of plasminogen activator inhibitor type 1 impair fibrinolysis in patients with diabetes. The combination of these cause increased level of platelet coagulability which in turn cause vascular occlusion and cardiovascular events in type 2 diabetes (Zhang et al., 2014).

Chawla, Chawla and Jaggi (2016) stated that hyperglycemia and insulin resistance are main reasons behind the development of macrovascular complications of diabetes. Development of diabetes is inherently associated with hyperglycemia. However, insulin resistance develops years before hyperglycemia and during the course of time becomes clinically significant. Obesity plays an important role in the development of insulin resistance (common among the people with type 2 diabetes). The release of free-fatty acids, inflammatory mediators and reactive oxygen species increases the chance of systemic inflammation and thereby leading to the development of atherosclerosis.  


Assessment and diagnostics

The study conducted by Donaghue et al. (2014) highlighted that assessment of macrovascular complication of diabetes should start after the age of 10. The main screening methods that are used to highlight the marcrovascular complications include testing the lipid profile of the individual after every 5 years along with the annual tabulation of blood pressure. Truong, Maahs and Daniels (2012) highlighted that for type 1 diabetes (T1D) individuals, with no significant family history of early cardiovascular disease or individuals who are over 12 years of age, should undergo proper screening of glycemic level after every 5 years. If T1D have family history of cardio-vascular disease then fasting lipid profile must be used as screening tool for the detection of macrovascular complications. If lipid screening is found to be abnormal, annual screening is recommended. For type 2 diabetes (T2D), lipid profile must be done after every 2 years if lipid content of the blood is found within the permissible range (Truong, Maahs & Daniels, 2012). Other hallmarks apart from blood lipid concentration, which can be used to detect the tendency of developing macrovascular complication, include microalbuminuria. Donaghue et al. (2014) stated that microalbuminuria is confirmed via analysis of two or three samples for a period of three to six months. Persistent microalbuminuria is found to predict the end stage of the renal failure, which in turn increases the chance of developing macrovascular disease. Donaghue et al. (2014) highlighted that loss of nocturnal dipping on round the clock blood pressure monitoring is regarded as the early marker for the assessment diabetic renal disease which simultaneously precedes towards microalbuminuria leading the renal hypertrophy and subsequent development of macrovascular complications.

In the domain of selection of the proper assessment and diagnostic tool for the detection of macrovascular diseases (MVD) in diabetes, Papa et al. (2013) conducted a population based study. 1199 diabetic cohort from outpatient department were selected on the basis of their cardiovascular history and other medical and hospital records (cardiac index, brachial index, duplex ultrasonography of the carotid and lower limbs, computed tomography angiography and peripheral arteriography). Over the selected group of individuals, Papa et al. (2013) conducted standardized procedure for the assessment of macrovascular complications. The analysis of the results indicated that the phenotypic heterogeneity is associated with different types of macrovascular complications among type 2 diabetes patients. They are also found to have different metabolic syndrome. Depending on this phenotypic heterogeneity, the development of the diagnostic tools and therapeutic strategies for MVD must be selected (Papa et al., 2013).

Park et al. (2015) highlighted that the diagnostic method that can be used for the detection of MVD include bronchial artery ultrasound for the detection of flow-mediated dilation. Other diagnostic test for the detection of arthrosclerosis, include cardiac catheterization, angiogram and echocardiogram. These tests help to analyze the position where exact thickening of the arteries have occurred (Park et al., 2015). Truong, Maahs and Daniels (2012) highlighted the importance of cardiovascular imaging in the diagnosis of MVD, a non-invasive imaging helps to analyze the involvement of heart and vasculature in diabetes.


Treatment and management

The main foundation of care for the treatment and effective management of MVD complications among diabetic patient include proper patient education, nutritional planning, physical activity, smoking cessation and psychological care. Medical nutrition therapy is regarded as an effective means for the management and treatment of MVD. The medical nutrition therapy mainly promotes and support healthy eating patterns, which emphasize on a variety of nutrient-dense foods in proper size (Brown, Edwards, Seaton & Buckley, 2015). Consumption of nutritional rich food promotes reduction of the lipid content of the blood, reduction of glycemic level and blood pressure. Nutritional diet based on height and weight of the body helps to achieve proper body weight and thereby delaying the MVD complications in diabetes (Evert et al., 2014). In order to access the nutritional needs, personal and cultural preferences must be taken in to consideration along with proper health literacy. Proper health literacy will promote willingness to consume healthy food along with behavioural change in the diet plan (Gosmanov & Umpierrez, 2013). Khan, Stephens, Franks, Rook and Salem (2013) highlighted that physical activity is another important aspect for controlling MVD complications among diabetic patient. This promotion of physical activity also highlights the importance of reduction in sedentary time. Adults with T2DM should be encouraged to perform resistance training at least twice a week. Connelly, Kirk, Masthoff and MacRury (2013) however, highlighted that the older adults with sever MVD complication, might not be capable for entering into resistance training. In that case, of older adults, mild to moderate physical exercise like 15 minutes of walk can be proved to be effective. Apart from proper nutritional diet and physical activity, American Diabetes Association (2015) highlighted the importance of smoking cessation as important interventions for MVD. Smoking cessation counselling is regarded to be effective in controlling smoking habits (Tollefson & Hallman, 2016). In relation to treatment and management of MVD in diabetes, American Diabetes Association (2015) highlighted that the people with MVD in diabetes should receive medical care from an integrated and collaborative team who have supreme expertise in diabetes. The management plan should be written via taking inputs from both the healthcare professional, patients and their family members (American Diabetes Association, 2015). In domain of medication management, Bullock & Manias (2016) highlighted the use of subcutaneous insulin injection in order to manage hyperglycemic shocks and thereby preventing the chance of developing MVD. The dosage however, needs to be adjusted by the physicians as per the blood glucose level; age and body mass (Brotto & Rafferty, 2016).


Thus from the above discussion, it can be concluded that pathological hallmark of DM are microvascular and macrovascular complications. Macorvascular complication of diabetes mainly arises from inflammation, which leads to the narrowing of the walls of the arteries. This narrowing of the arterial wall causes atherosclerosis, which increases the chance of developing several cardiac complications. The main assessment techniques used for the screening of MVD include detection of the lipid profile, blood glucose level and blood pressure. The main diagnostic approach that is used for the detection of MVD includes non-invasive screening techniques. The main treatment and management options for MVD as highlighted in the essay include observance of proper nutritional diet, daily physical activity, disease education, awareness, and cessation of smoking and medication management.



American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 33(2), 97. doi:  10.2337/diaclin.33.2.97

Brotto, V., & Rafferty, K. (2016). Clinical Dosage Calculations for Australia and New Zealand. Cengage Learning. Australia. 2nd ed. Retrieved from:

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2015). Lewis's Medical-surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences. Retrieved from:'s%20Medical-surgical%20Nursing%3A%20Assessment%20and%20Management%20of%20Clinical%20Problem&f=false

Bullock, S., & Hales, M. (2016). Principles of Pathophysiology. Pearson Higher Education;  Australia 1st ed. Retrieved from:,+S.,+%26+Hales,+M.+(2016).+Principles+of+Pathophysiology&ots=Sifud4CPBJ&sig=m9EoxqrYVoraaTWpd9J1mO0Gblo

Bullock, S., & Manias, E. (2016). Fundamentals of pharmacology. Pearson Higher Education; Austra;ia 8th ed. Retrieved from:,+S.,+%26+Manias,+E.+(2016).+Fundamentals+of+pharmacology&ots=WJccOhFh3X&sig=eC8QLAS81-xsSo2c3soUdbkzXKU#v=onepage&q&f=false

Chawla, A., Chawla, R., & Jaggi, S. (2016). Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum?. Indian journal of endocrinology and metabolism, 20(4), 546. doi:  10.4103/2230-8210.183480

Chilelli, N. C., Burlina, S., & Lapolla, A. (2013). AGEs, rather than hyperglycemia, are responsible for microvascular complications in diabetes: a “glycoxidation-centric” point of view. Nutrition, Metabolism and Cardiovascular Diseases, 23(10), 913-919.

Connelly, J., Kirk, A., Masthoff, J., & MacRury, S. (2013). The use of technology to promote physical activity in Type 2 diabetes management: a systematic review. Diabetic Medicine, 30(12), 1420-1432.

Donaghue, K. C., Wadwa, R. P., Dimeglio, L. A., Wong, T. Y., Chiarelli, F., Marcovecchio, M. L., ... & Craig, M. E. (2014). Microvascular and macrovascular complications in children and adolescents. Pediatric diabetes, 15(S20), 257-269. doi: 10.1111/pedi.12180

Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., ... & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 37(Supplement 1), S120-S143.

Gosmanov, A. R., & Umpierrez, G. E. (2013). Management of hyperglycemia during enteral and parenteral nutrition therapy. Current diabetes reports, 13(1), 155-162.

Khan, C. M., Stephens, M. A. P., Franks, M. M., Rook, K. S., & Salem, J. K. (2013). Influences of spousal support and control on diabetes management through physical activity. Health Psychology, 32(7), 739.

Marieb, E. N., & Hoehn, K. (2015). Human anatomy & physiology. Pearson Education 10th Ed.

Papa, G., Degano, C., Iurato, M. P., Licciardello, C., Maiorana, R., & Finocchiaro, C. (2013). Macrovascular complication phenotypes in type 2 diabetic patients. Cardiovascular diabetology, 12(1), 20.

Park, H. B., Heo, R., ó Hartaigh, B., Cho, I., Gransar, H., Nakazato, R., ... & Budoff, M. J. (2015). Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve. JACC: Cardiovascular Imaging, 8(1), 1-10. Retrieved from:

Tollefson, J. & Hallman, E. (2016). Clinical Psychomotor Skills, Cengage Learning Revised 6th ed. 

Truong, U. T., Maahs, D. M., & Daniels, S. R. (2012). Cardiovascular disease in children and adolescents with diabetes: where are we, and where are we going?. Diabetes technology & therapeutics, 14(S1), S-11. doi:  10.1089/dia.2012.0018

Zhang, M., Chen, P., Chen, S., Sun, Q., Zeng, Q. C., Chen, J. Y., ... & Wang, J. K. (2014). The association of new inflammatory markers with type 2 diabetes mellitus and macrovascular complications: a preliminary study. Eur Rev Med Pharmacol Sci, 18(11), 1567-72. Retrieved from:


Cite This Work

To export a reference to this article please select a referencing stye below:

My Assignment Help. (2020). Nursing Practice: Complex Integrated Care. Retrieved from

"Nursing Practice: Complex Integrated Care." My Assignment Help, 2020,

My Assignment Help (2020) Nursing Practice: Complex Integrated Care [Online]. Available from:
[Accessed 01 April 2020].

My Assignment Help. 'Nursing Practice: Complex Integrated Care' (My Assignment Help, 2020) <> accessed 01 April 2020.

My Assignment Help. Nursing Practice: Complex Integrated Care [Internet]. My Assignment Help. 2020 [cited 01 April 2020]. Available from:

Getting academic assistance from is the wisest decision that one can take if you wish to secure high grades. If you are pursuing English and require assignment help in Australia, then we provide tailor-made assistance. Are you aware of the various types of essays? If not, then our writers can help you with any sort of essay, persuasive, narrative, scholarship, argumentative, college application essay, etc. Moreover, free essay editors at offer the students with revision and proofreading features. The pay for essay is also minimal.

Latest Medical Samples

BMI598 Biostatistics With Computational Applications

Download : 0 | Pages : 38

Answer: Raison D’être  Mission  The Mission statement of the company Soin des Yeux is to provide the patients suffering from eye problem the most innovative and best means of curing. It plans to provide the customers with the least invasive method of surgical correction equipments so that the fear for correctional surgery especially among patients suffering from eye problems is considerably reduced. Its goal is to conti...

Read More arrow

ADMN5005 Operations And Supply Chain Analytics

Download : 0 | Pages : 3
  • Course Code: ADMN5005
  • University: St. Lawrence College
  • Country: Canada

Answer: What is Art Therapy?It is a type of therapy that uses Art as an expressing format. There are various kinds of art therapies used till now which includes multidisciplinary platforms which includes subjects like art, sculpture, psychology, psychiatry and painting. The usage of art therapy leads to acknowledging the awareness of the self and the surrounding, it has potential to bring clarity and calmness into the doer’s mind.HistoryAr...

Read More arrow

ADMN5004 Team And Project Management

Download : 0 | Pages : 5
  • Course Code: ADMN 5004
  • University: St. Lawrence College
  • Country: Canada

Answer: Introduction Minute taking in a meeting is a vital process for any company to undertake. The taking of minutes is developed for various reasons as described below. Minutes serve as communication tools for the company by including all the information generated within a meeting. The recorded information may be vital for the development of organization activities since they outline the procedure to be undertaken as developed by the team ...

Read More arrow Tags: Canada Ottawa Management University of Ottawa 

HLTDEN008 Prepare To Expose A Prescribed Dental Radiographic

Download : 0 | Pages : 6

Answer: The main consideration taken by the dental operator before the conduction of the radiographic examinations include the age and gender (Jansson et al. 2014). Other factors taken under consideration include evaluation of the dento-alveolar trauma in case of the intra-oral radiographic examination. If the main zone of interest extends beyond the dento-alveolar complex then extra-oral imaging is recommended. In case of bone-loss due to per...

Read More arrow

HLTDEN008 Prepare To Expose A Prescribed Dental Radiographic Image

Download : 0 | Pages : 6

Answer: Introduction: Over the decade, the importance of x-ray in the dentistry domain has increased exponentially.  Chang et al. (2017), highlighted that dental radiography is commonly used by dentists to evaluate the hidden structures, malignant or benign masses, bone loss. The case study represents the dental problem of Mathew who fell in the school play garden and his front teeth become a bit loose due to the incidents. He has been a...

Read More arrow

Save Time & improve Grades

Just share your requirements and get customized solutions on time.

We will use e-mail only for:

arrow Communication regarding your orders

arrow To send you invoices, and other billing info

arrow To provide you with information of offers and other benefits




Overall Rating



Our Amazing Features


On Time Delivery

Our writers make sure that all orders are submitted, prior to the deadline.


Plagiarism Free Work

Using reliable plagiarism detection software, only provide customized 100 percent original papers.


24 X 7 Live Help

Feel free to contact our assignment writing services any time via phone, email or live chat.


Services For All Subjects

Our writers can provide you professional writing assistance on any subject at any level.


Best Price Guarantee

Our best price guarantee ensures that the features we offer cannot be matched by any of the competitors.

Our Experts

Assignment writing guide
student rating student rating student rating student rating student rating 5/5

755 Order Completed

95% Response Time

Douglas Cowley

Masters in Finance with Specialization in Audit

Wellington, New Zealand

Hire Me
Assignment writing guide
student rating student rating student rating student rating student rating 5/5

1592 Order Completed

96% Response Time

Jane Sima

Ph.D in Psychology with Specialization in Industrial-Organizational Psychology

Singapore, Singapore

Hire Me
Assignment writing guide
student rating student rating student rating student rating student rating 5/5

1265 Order Completed

97% Response Time

James Cook

Masters in Management

Wellington, New Zealand

Hire Me
Assignment writing guide
student rating student rating student rating student rating student rating 5/5

647 Order Completed

98% Response Time

Adlina Han

Masters in Marketing with Specialization in Branding

Singapore, Singapore

Hire Me

FREE Tools


Plagiarism Checker

Get all your documents checked for plagiarism or duplicacy with us.


Essay Typer

Get different kinds of essays typed in minutes with clicks.


GPA Calculator

Calculate your semester grades and cumulative GPa with our GPA Calculator.


Chemical Equation Balancer

Balance any chemical equation in minutes just by entering the formula.


Word Counter & Page Calculator

Calculate the number of words and number of pages of all your academic documents.

Refer Just 5 Friends to Earn More than $2000

Check your estimated earning as per your ability




Your Approx Earning

Live Review

Our Mission Client Satisfaction

I got a 100 on my paper. Thank you for answer on such a short notice. It was a stiff price overall they responded and had me finish before my deadline!!!


User Id: 384118 - 01 Apr 2020


student rating student rating student rating student rating student rating

My assignment you did was really excellent and I really like it. I will use this one again. thanks


User Id: 388948 - 01 Apr 2020


student rating student rating student rating student rating student rating

this is the final assignment for this subject and did everything well and got a D grade for the subject.


User Id: 287765 - 01 Apr 2020


student rating student rating student rating student rating student rating

this is the final group assignment and needed to upload on Turnitin. I could do my part really well and got a hd for this subject. great work guys.


User Id: 287765 - 01 Apr 2020


student rating student rating student rating student rating student rating
callback request mobile
Have any Query?