Hltenn025: Sarah Green Case Assessment Answer

TASK:

1. Describe the mechanism for glucose regulation in a healthy body.

2. Outline the pathophysiology of type 1 diabetes

3. Outline the pathophysiology of type 2 diabetes

4. Outline the pathophysiology of Gestational Diabetes

Scenario 1 Type 2 Diabetes Mellitus Case study
Sarah Green is a 64 year old Aboriginal woman who has been transferred to Perth form a Kimberly town for management of complications of t2DM. On arrival her observations are as follows, T 37.8, P 102, R 22, BP 180/95, spo2 95%, BGL 24, height 155 cms, weight 89kgs. Other relevant medical history includes angina, cardiac stents x 5 and chronic renal failure.

Assessment 1 - Knowledge Assessment

She does not yet require renal dialysis. She has an ulcer on her left ankle which has been present for four months, she attends the health centre near her home for regular dressings. She wears her thongs when walking around her community however the skin on her heals is cracked and dry. She says she has very little feeling in her feet. Her regular medication includes metformin 1000 BD, sitagliptin 25mg daily

5. Review the patients presenting symptoms and observations on the case study and explain how these relate to her diagnosis of type 2 diabetes

6. Consider the patients’ medical history and from this identify 2 macrovascular complications and 2 microvascular complications that the patient has developed.
Macrovascular

7. Explain the relationship between high BGL and the slow healing ulcer on the patient’s ankle?

8. The diabetes educator has advised Mrs Green that she should try to lose weight and take more exercise
a) What are the benefits of increased exercise for glycaemic control

b) Describe 3 benefits of weight loss for this patient.

c) What is a healthy hip to waist ratio

9. Describe 5 strategies or suggestions you could offer to help her to comply with these health promotion goals.
10. Identify nursing concerns regarding the patient’s foot care? and what advice would you give her regarding foot care?

11. Upon discharge Mrs Green wishes to return to her remote community in the Kimberley. What issues could she face? How could the discharge process assist in overcoming these challenges?

12. She states that her sister did not manage her t2DM and was taken to hospital in Port Hedland in

13. A. There is an increase in t2DM in the community. Describe 2 social factors and 2 environmental factors contributing to these increases in diabetes
13. B. There is an increase in t2DM in ATSI peoples. Describe 2 social factors and 2 environmental factors contributing to these increases
Scenario 2 Type 1 Diabetes Case Study
Sam is 18 years old and has been admitted to the ward with a new diagnosis of type 1 diabetes and a skin infection. On admission to the ward Sam’s skin is dry and hot to touch, he is flushed. He is 180cm and weighs 62Kilos. He is complaining of thirst and tiredness His observations on admission are as follows: T 38.8, P 120bpm Regular, R26 rpmBP 100/60 BGL
22mmol/L Ketones 2.6 mmol/L, blood ph 7.36 mmol/L
Sam enjoys sports and plays football every weekend for his local team, he socialises with a group of friends he has known since school usually going out at weekends to the city night clubs. Sam smokes 10 cigarettes every day and frequently buys lunch from fast food outlets Sam has been commenced on an insulin infusion, IV normal saline 250mls/hr for 4 hours and IV antibiotics
14. Analyse the above observations and select whether Sam is presenting with Hyperglycaemia, Hypoglycaemia, Ketoacidosis or Hyperosmolar Non Ketotic Coma. Give a brief explanation for your response

15. Diabetic Ketoacidosis is a severe complication of type 1 diabetes. Describe how you could explain ketoacidosis to Sam and what steps he can take to avoid this complication.

16. Why would you advise cessation of smoking for a patient with diabetes?

17. Why should this young patient have eye screening and how often should this check occur.

18. Sam states he is frightened that he will have a hypoglycaemic episode, what advice could you offer the patient to reduce the risk of Hypoglycaemia.

19. Discuss the potential impact of managing diabetes may have on Sam’s self- esteem.
20. Discuss the possible psychosocial issues that Sam may experience due to his t1 diabetes.

21. Sam states that he wants to use continuous glucose monitoring and an insulin pump post discharge. What advice would you give him in regards to access to resources and support in the community post discharge from hospital?

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