Acute Care Nursing: Pathophysiology and Management of Hypertensive Diabetic Patient

Running head: ACUTE CARE NURSING
Acute care nursing
Name of the student:
Name of the University:
Author’ s note

1ACUTE NURSE NURSING
Introduction:
Diabetes is a chronic disease condition that leads to poor blood sugar control and increase
in risk of other disease like heart disease (Goldstein & Müller-Wieland, 2016). Although
controlling diet and blood sugar level of patient is a challenge, several people with history of
diabetes also suffer from hypertension. The issue associated with co-existence of hypertension
and diabetes is that it worsens clinical outcome of patient (Horr & Nissen, 2016). Hence,
multifaceted approach is needed to achieve gylcemic as well as blood pressure control. This
essays looks at the problems experienced by a client with hypertension and diabetes. The main
purpose of this essay is to review the case study of Bill McDonald, a 58 year old male patient
who has been diagnosed with type 2 diabetes and discuss the pathophysiology behind the disease
in relation to the chronic symptoms presented by Mr. Bill. The essay also reviews physical
examination data of Bill to identify potential management approach needs to treat a hypertensive
diabetic patient. The essay also presents an education plan for Bill based on assessment of his
care and treatment needs.
Pathophysiology of type 2 diabetes in relation to the chronic symptoms presented by Bill:
Mr. Bill McDonald is a patient with history of type 2 diabetes and heavy alcohol use. He
also smoked cigarette for 35 years. On regular visit to the GP, he was found to have high blood
pressure. Although no other symptoms like headache, dizziness or blurred vision was found,
however reported his eyes to get tired easily. Elevated blood pressure is closely linked to the
pathophysiology of diabetes mellitus because patients with diabetes experience peripheral artery
resistance and increased body fluid volume due to insulin resistance. Circulatory fluid volume
and peripheral vascular resistance also has an impact on blood pressure level. In case of diabetic

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patients, initiation of vascular remodelling and hyperglycemia are two mechanisms that elevate
systemic blood pressure in patients (Lastra et al., 2013). However, risk of hypertension is not
seen in all diabetic patients, it is a phenomenon that gradually develops due to long history of
diabetes and poor control of glucose for long period. Ohishi (2018) argues that elevated blood
glucose level and cluster of metabolic and vascular abnormalities like hypertension and
hyperglycemia is linked to each other due to natural history of type 2 diabetes.
There are many reasons behind why diabetes mellitus and hypertension coexist in many
people. The main reason is that both of the disease share several pathophysiologic mechanisms.
This includes inflammation, inappropriate activation of rennin angiotensin aldosterone system
(RAAS), impaired vasodilatation, oxidative stress, sympathetic nervous system activation,
abnormal renal handling of sodium and dysfunctional immune response. Obesity is also regarded
as pathogenic factor that explains why hypertension and diabetes co-exists (Lastra et al., 2013).
In case of Mr. Bill, it has been found that obesity is also an issue for him as his weight is 123 kg.
Obesity has been an issue for him in the past too as his weight was 156 kg two years ago. The
above mentioned pathophysiologic mechanisms are initiated because of obesity and increased
visceral adiposity. Oxidative stress and inflammation in the adipose tissue lead to high
production of angiotensin and activation of RAAS consequently. Patel et al. (2016) supports that
waist circumference and BMI are both predictors of diabetes and hypertension. This conclusion
has been made after examining association between obesity and cardiovascular health in four
countries. It indicates that waist circumference and BMI can be useful source to identify
presence of hypertension and diabetes in patients. Hence, target reduction weight control is also
necessary to reduce blood pressure of Bill McDonald.

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The review of the case study of Bill McDonald also reveals several factors that have led
to diabetes and hypertension. For example, Mr. Bill was an active smoker since the past 35 years.
He had a history of heavy alcohol use too. Gao, Shi & Wang (2017) explains that smoking is one
of the preventable cause of hypertension. Alcohol consumption is also a behaviour that worsens
blood sugar level in diabetic patients and increases the likelihood of severe health consequences
for patient. Alcohol consumption increases blood pressure. Alcohol consumption damage the
arteries by increasing amount of lips and fats in blood and this in turn lead to hardening of the
arteries and hypertension (Husain, Ansari & Ferder, 2014). Hence, vascular injury caused due to
alcohol consumption is the main pathophysiology behind hypertension in Mr. Bill. Current issue
faced by Mr. Bill includes unstable and fluctuating blood glucose control since the past 3
months. This is also linked to presence of risk factors like smoking and alcohol consumption for
the client.
The review of physical examination for Mr. Bill indicates that his pulse rate and
respiratory rate is normal. However, he has been found with pitting oedema in both his lower
legs. The symptom of peripheral edema should be considered as a serious symptom for the client
because it is indicative of diabetes related complications for patients. It may lead to delayed
wound healing for Mr. Bill and this symptoms suggest that extra precaution needs to be taken so
that no injuries or cuts takes place. Controlling edema needs to prioritized while developing care
plan for Mr. Bill.
Potential management approach for hypertensive diabetic patient:
Mr. Bill had a blood pressure of 170/100 mm Hg. This is indicative of high blood
pressure as normal blood pressure is 120/80 mm Hg. The review of his blood glucose level