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 cant 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 50s.
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 C
SpO2: 97%
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 Emilys 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 Emilys 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%].
2.1. Discuss the three medications Emily is on. Include in your answer the action, complications/side effects and nursing considerations linked to Emilys situation.
2.2. Discuss the two blood results, one from prior to surgery and one from the clinic visit of Emilys 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:
a.GFR (glomerular filtration rate) was found to be 10ml/min/1.73m2 [90 to 120 mL/min/1.73 m2 ]
b.Hb (Haemoglobin) was 95g/L [120 to 155 grams/L for female]
c.Serum Potassium was 5.7 mmol/L [3.6 to 5.2 mmol/L]
d.Serum Urea 17 mmol/L [2.9-8.2 mmol/L]
e.Serum Creatinine 150 mol/L [50-110 mol/L]
3.1 What does Emilys renal function test indicate? Explain her renal function test. What appropriate treatment should be available to Emily? Explain her treatment options with rationale
Add a conclusion in your own words (no new reference should be added in the conclusion)
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