Describe the pathophysiology of T2DM
Assessment Task 2: Case Scenario Due Date: Friday 18th Sept, 2020 at 5pm Word Count: 2000 words +/- 10% Format: Report style, with introduction and conclusion. A cover sheet is not required. You will be required
to submit this assignment through Turnitin.
Directions For this assessment task, you are required to write a 2000 word report answering the questions from the scenario. Heading, subheading, in-text references and reference list will not be the part of the total word count. You will need to explore the pathophysiology, pharmacology and psychosocial aspects of the scenario and demonstrate your understanding in the answers you provide. Your answers should be informed by your reading of current research and literature. A report format includes an introduction and conclusion, but headings and subheadings are used in the body of the text. Use the question you are answering as your heading. Do not use dot points for your answers. Do not write in the first person. Appropriately referenced and labelled tables, diagrams or images may be used in the body of the paper, but will not be counted towards word count. You may produce a table (question 2.1 – medications) for your answers. Use APA referencing (6th/7th) throughout your assignment. References must be current, preferably from the past five years. You are required to cite no less than 10 references, and the majority of these should be current peer-reviewed journal articles. We are looking at information informing current clinical practice, and your choice of references must reflect this. Consider the quality of the references you use. Wikipedia, Web MD, the Better Health Channel and blogging websites are not acceptable references. Any non-reliable sources in your reference list will not count toward the number of required references, and this will result in a loss of marks. At this point in your BN you are expected to engage with best practice literature. Criteria for grading Marking of this assessment task will be undertaken by academic and teaching staff. Pre and post moderation will be undertaken for this assessment task.
The marking rubric for the assignment is provided on Moodle. Marks will be allocated for each section
according to the rubric. Use the rubric as a guide when writing your assignment to identify the depth of
the answer expected.
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%
Part 1 Questions (1000 words) 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 (50 words) 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. (550 words)
1.2. Differentiate between T2DM and T1DM (at least 5 differences). (100 words) 1.3. Identify at least 2 reasons Emily’s BGL is high on admission. Discuss how each reason you
identify affects BGLs. (300 words)
Part 2 Questions (700 words) 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%].
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. (500 words)
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? (200 words)
Part 3 Questions (300 words) 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]
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 (250 words)
Add a conclusion in your own words (no new reference should be added in the conclusion) (50 words)