Health Care Assignment: Case Analysis of Emily Smith

Question

Task: Case scenario:
Emily Smith is a 53 year old woman who has been admitted to your surgical ward for the drainage of a Bakers Cyst. She is mother of five children and lives in a rural Victorian town. She has been married to Frank who is an electrician, for 28 years. They live on a farm, tending to be self-sufficient growing their veggies, some fruit and have chicken and cows. She was diagnosed with Type 2 Diabetes Mellitus (T2DM) 6 months ago, during a routine workup for surgery. She takes no specific medication for her diabetes, and has been told by her GP to ‘watch what she eats’. She was devastated to discover her diagnosis of T2DM, as she was aware of the risks due to her family history. She has not returned to her GP since her initial diagnosis. She has no other past medical history of note. Emily says tearfully “I have been trying to eat right and exercise, but I can’t walk because of the pain in my knee and I was feeling down and eating ice cream. I have hardly eaten anything in the last week because I am trying to lose weight and get my blood sugar down.” Her mother and older sister were both diagnosed with T2DM in their early 50’s. Emily tells you she has had the Bakers Cyst for about 2 years. It has been increasing in size over the last 8 months, restricting her movements. The planned surgery is drainage followed by two follow up cortisone injections.

On Admission at 0800 - her blood glucose level (BGL) was 22.9 mmol/L [3.9-6.1 mmol/L]; HbA1c: 11% [normal< 6.5%] She has been fasting since midnight. She notes that she is feeling quite “stressed” about the surgery. On admission the following were recorded:

• Height: 167cm
• Weight: 105kg
• Blood Pressure: 140/80 mmHg
• Pulse rate: 95 beats/min
• Respiratory Rate: 22 breaths/minute
• Temperature: 36.7 ºC
• SpO2: 97%

Refer to the above case scenario and answer the following questions through this health care assignment:

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

1.1. 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.

1.2. Differentiate between T2DM and T1DM (at least 5 differences).
1.3. 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 was BGL 8.8 mmol/L [3.9-6.1 mmol/L]; HbA1c: 8% [normal<6.5%]

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

2.2. 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 ?mol/L [50-110 ?mol/L]
• 3.1 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

Answer

Part 1: Questions
Introductionto the case scenario of health care assignment
Emily Smith is a woman who is 53 years old and was admitted to the surgical ward for the draining of Bakers Cyst. Moreover, she developed a Bakers Cyst which restricted her movements for 8 months. Her blood glucose level rose and the research report focuses on the recordings of her health facts in detailed analysis.

1.1 Question 1
Linked with the case of Emily, the pathophysiology of T2DM is featured through peripheral resistance of insulin, impaired production of hepatic glucose, and decreasing function of beta cells. She was diagnosed with T2DM or the Type 2 diabetes mellitus six months ago and it leads to the failure of beta cells. Emily’s blood glucose level rose, which is a vital factor to be considered in this context of health care assignment. Emily took no particular medicine for her diabetes and was very much aware of her history in the family as her sister and mother were both captured by T2DM.

The pathophysiology of T2DM is connected with the levels of insulin inside the human body and the ability of the body in using them. There is a whole lacking insulin range in type 1 diabetes whereas in type 2 diabetes the tissues of the peripheral sphere resist the impacts of insulin. It captures people who are not active by physical terms or possesses a historical background of stroke or heart diseases.The risk factors associated with the T2DM are inter-related with the combination of lifestyle patterns and genes. The risk factors cannot be curtailed because of the family histories but by changing lifestyle, probable solutions can be achieved in dealing with T2DM(Jehan et al., 2018). The various risk factors associated with the T2DM in accordance with the case of Emily involves overweight issues. It also is concerned with higher age like 45 or more and family histories and gene stories. The risks are very much prone to the patients having higher range of blood pressure and lower range of HDL, triglycerides, and cholesterol.

The risk factors identified in this health care assignmentare merely concentrated around ethnicity, age, weight, and physical activities. The families having a history of gestational diabetes are much more prone to develop the disease of T2DM and they give birth to a baby weighing 9 pounds or more. It also captures people who are not active by physical terms or possesses a historical background of stroke or heart diseases. Also, it affects the patients dealing with depression and polycystic ovary syndrome. It constitutes acanthosis nigricans or thick and dark skins around the armpit or neck. The various risk factors associated with the T2DM in accordance with the case of Emily involves overweight issues. The diabetes risk test can be taken in formulating the type 2 diabetes or T2DM. The easiest way in finding out the weight risks for the T2DM, the height must be captured in the BMI or Body Mass Index charts of the patient. If a person’s weight isequal or greater than the listed weight, he or she possesses a big chance for developing the type 2 diabetes or T2DM.

The possible complications of T2DM involve damages to the eye, kidney, nerve and so on. Also, it effects the blood vessel and heart diseases as the diabetes rises the risk of heart attacks with higher levels of blood pressure by narrowing the blood vessels(Jehan et al., 2018). It also implants hearing impairments and sleep apnea along with worst skin conditions.

Three levels of treatment option for T2DM constitutethe first step asA1C test or Glycated hemoglobin indicating the average level of blood sugar for the past three months. The levels mainly concerned with random test of blood sugar, fasting test of blood sugar, and oral test of glucose tolerance. The American Diabetes Association recommend the screening routine for the type 2 diabetes starting at the age of 45 when a person is overweight or obese.

1.2 Question 2
The major difference between the T1DM and T2DM lies below within this health care assignment.

1.3 Question 3
Based on the readings of health care assignment, it can be stated that during admission, Emily’s BGL was high as she was very scared and tensed regarding her condition. It eventually led to an increase in the blood pressure and the glucose level rose. It is because it captures people who are not active by physical terms or possesses a historical background of stroke or heart diseases(Baig et al., 2020). Also, the risks are very much prone to the patients having higher range of blood pressure and lower range of HDL, triglycerides, and cholesterol. The T2DM do not respond in terms of insulin for they do not have the capability to produce sufficient insulin. It leads to the failure of beta cells in a person’s body. Emily’s blood glucose level rose, which is a vital factor to be considered in this context of health care assignment. The T2DM is a metabolic condition in which the body becomes resistant to the production of insulin. The T2DM is often milder than T1DM. It is because of the fact that it can be prevented through incorporating healthy and disciplined lifestyle via good diet, abolishing bad habits, and better mental health scenes. Another important factor behind the rise of Emily’s BGL is overweight. As she weighed 105 kgs, the T2DM stressed on her weighing issue and rose exponentially. The risk factors are family persons having the disease and the environmental as well as genetic factors. T2DM is featured through peripheral resistance of insulin, impaired production of hepatic glucose, and decreasing function of beta cells. The various risk factors associated with the T2DM in accordance with the case of Emily involves overweight issues(Malone & Hansen, 2019). The diabetes risk test can be taken in formulating the type 2 diabetes or T2DM. The easiest way in finding out the weight risks for the T2DM, the height must be captured in the BMI or Body Mass Index charts of the patient.

Part 2: Questions
2.1 Question 4
The three medications that Emily is on are injection of Kenacort-A 40, metformin (APO-Metformin tablets), and glipizide or Midinab tablets. It helped her to control her diabetes. The medications showed Emily the path of successful and healthy lifestyle in terms of keeping the blood sugar level to a normalized extent(Caballero & Quirce, 2020). She took the insulin or pills when she was supposed to, followed her meal planning, and got regular intervals of physical exercise.

She also checked her levels of blood sugar very often and made changes with the help of her nursing team. She visited her doctor and the team of diabetes healthcare at a regular basis. The easiest way in finding out the weight risks for the T2DM, the height must be captured in the BMI or Body Mass Index charts of the patient. If a person’s weight is equal or greater than the listed weight, he or she possesses a big chance for developing the type 2 diabetes or T2DM.The medications prevented further complications regarding the diabetes of Emily. With proper nursing and appropriate and effective healthy life, she was intended to get cured in terms of the provided medications(Malone & Hansen, 2019). The findings obtained in this segment of health care assignmentsignifies that the medicines reduced the amount of glucose that is released by the liver. It also increased the glucose uptake by fat cells and muscles. It also is intended to slow down the glucose absorption by the intestines. The T2DM is a metabolic condition in which the body becomes resistant to the production of insulin. The T2DM is often milder than T1DM. It is because of the fact that it can be prevented through incorporating healthy and disciplined lifestyle via good diet, abolishing bad habits, and better mental health.The most essential complication associated with Emily’s medication included lactic acidosis or building up of lactic acid within the body at a very fast rate than it can get metabolized in terms of fatal conditions. But it is very rare in such a case. The symptoms of lactic acidosis involve vomiting, nausea, pain in the stomach, breathing troubles, feeling of exhaustion, and so on. It also includes unusual pain in the muscles. The medications showed Emily the path of successful and healthy lifestyle in terms of keeping the blood sugar level to a normalized extent.

Most common side effects of Emily’s medication involve diarrheaand nausea and the doctor must minimize the chances of her getting the side effects through ensuring eventual adjustments to the list of medicines. The dose prescribed must be changed or altered as per requirements. The benefits include observable loss in weight as overweight causes the burden of T2DM. If a person’s weight is equal or greater than the listed weight, he or she possesses a big chance for developing the type 2 diabetes or T2DM.The medications prevented further complications regarding the diabetes of Emily. It also indulges an improved level of lipids or cholesterol inside her body. Also, an advantage of prescribing such medication involvesrare causing of hypoglycemia or lowering of the levels of blood glucose at a large extent.

2.2 Question 5
It is also seen in the case scenario of health care assignmentthat the blood reports of Emily were received normal. They were BGL 8.8 mmol/L or 3.9-6.1 mmol/L andHbA1c is 8% which is normal and <6.5%. They measured that after taking the medications, Emily recovered from what she was going through. It also indulges an improved level of lipids or cholesterol inside her body.The betterment of her condition fully relied on proper nursing and appropriate and effective healthy life; she was intended to get cured in terms of the provided medications.

The medicines reduced the amount of glucose that is released by the liver. It also increased the glucose uptake by fat cells and muscles. It also is intended to slow down the glucose absorption by the intestines. It is because of the fact that it can be prevented through incorporating healthy and disciplined lifestyle via good diet, abolishing bad habits, and better mental health. The most essential complication associated with Emily’s medication included lactic acidosis or building up of lactic acid within the body at a very fast rate than it can get metabolized in terms of fatal conditions. But it is very rare.

Part 3: Questions
3.1 Question 6
Emily’s renal function test indicates that her GFR was 10ml/min/1.73m2 or 90-120ml/min/1.73 m2. It produced result of her Hb as 95g/L or 120-155 grams/L. it also introduced that her serum potassium was 5.7 mmol/L or 3.6-5.2 mmol/L and her serum urea was 17mmol/L or 2.9-8.2 mmol/L. it also stated that her serum creatinine was found to be 150 umol/L or 50-110 umol/L. It also increased the glucose uptake by fat cells and muscles. It also is intended to slow down the glucose absorption by the intestines. It is because of the fact that it can be prevented through incorporating healthy and disciplined lifestyle via good diet, abolishing bad habits, and better mental health. It also indulges an improved level of lipids or cholesterol inside her body.

Treatment for T2DM is change in lifestyle, exercise, diet, and insulin pills. The T2DM do not respond in terms of insulin for they do not have the capability to produce sufficient insulin. It leads to the failure of beta cells in a person’s body. Emily’s blood glucose level rose which is a vital factor to be considered in this context(Moravej Aleali et al., 2019). The T2DM is a metabolic condition in which the body becomes resistant to the production of insulin. The T2DM is often milder than T1DM. It is because of the fact that it can be prevented through incorporating healthy and disciplined lifestyle. She must take the insulin or pills when she was supposed to, followed her meal planning, and got regular intervals of physical exercise.

Conclusion
In T2DM, there is a little bit of insulin present in terms of production. For regaining the sensitiveness, the exercise and diet are advised. Treatment for T2DM is change in lifestyle, exercise, diet, and insulin pills. Thus, it is assessed in this research report on health care assignment that Emily can be cure by maintain proper lifestyle and a healthy diet along with prescribed medications.

Bibliography
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