Essay about the Nursing 2022

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
Introduction:
The purpose of this essay is to review the case study of Bill McDonald, a 75 year old man
who has been diagnosed with type 2 diabetes (T2D) and suffering from high BP. During
presentation to the GP for a normal visit, he was found to have high blood pressure. Many
additional test and vital sign examination was done for Bill. The essay will examine the
symptoms and discuss its relation to the pathophysiology of T2D. In addition, based on the
analysis of immediate and long-term health care needs of patient, the essay will give insight into
potential management and nursing approaches that is necessary for managing a hypertensive
diabetes patient.
Pathophysiology of diabetes:
Mr. Bill is a patient with a previous diagnosis of T2D. Diabetes is a complex chronic
disease that is associated with impaired insulin secretion or impaired insulin function and poor
glucose control. In case of type 1 diabetes, the immune cells attack the insulin producing cells
leading to poor production of insulin, whereas in T2D, the cells fail to respond to insulin (known
as insulin resistance) and beta cells of the pancreas fail to produce enough insulin to meet the
needs of the human body. This results in poor opening of glucose channels and building up of
glucose into the blood instead of getting absorbed in the cells for the generation of energy (Better
Health Channel, 2020). Hence, high blood glucose level is the main indicator of T2D and this is
mainly diagnosed or regularly monitored by fasting blood glucose (FPG) test and HbA1c level.
The HbA1c level and FPG test was done for Mr. Bill too and the impact of insulin resistance on
blood glucose level was evident from the results obtained from this test. HbA1c level is useful
for assessment of average glycemic status over the course of 2 to 3 months. Mr. Bill’s HbA1c

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level was 7.2%. The value of 6.5% or higher suggest that the person have diabetes. Moreover,
his FPG value ranged from 4.5 to 7 mmol, which is an indication that condition is fluctuating
between pre-diabetes and diabetes stage (Wang,, 2017).
According to Zaccardi et al. (2016), peripheral insulin resistance, poor hepatic glucose
production and decline in beta cell function is involved in the pathophysiology of T2D. Beta cell
dysfunction means impairment in the insulin secretion during glucose stimulation process. Two
factors namely reduced insulin production from pancreatic beta cells and peripheral insulin
resistance contributed to T2D. Hepatic glucose production increases due to the elevation of the
fatty acids in the plasma and decrease in the glucose transport into the muscle cells. Hence,
insulin resistance and beta cell dysfunction together plays a role in the pathophysiology of
diabetes (Al-Goblan, Al-Alfi & Khan, 2014). There are various factors that predispose people to
risk of T2D. This includes combination of genetic factors as well as environmental factors such
as obesity, poor nutrition, aging, physical inactivity and stress. The genetic factor contributes to
insulin secretion and insulin resistance due to the genetic abnormality in the molecules involved
in the regulation of glucose metabolism (Kohei, 2010). The genetic risk of diabetes is seen in Mr.
Bill as her mother also had diabetes and she died of heart failure at the age of 65 years. In
addition, risk of poor nutrition was evidenced by his Mr. Bill’s love for fresh fruit specially
banana. Increase in the consumption of sugar can deteriorate blood glucose level of client.
The effect of environmental factor on risk of T2D is seen for Mr. Bill too as he was
leading a sedentary lifestyle and was suffering from obesity too. His weight was 123 kg which
can be one of the causes behind diabetes. The role of obesity in the pathophysiology of T2D is
that obesity is associated with decrease in muscle mass and promotion of insulin resistance. Even
mild obesity increases the risk of T2D by 4-5 times (Kohei, 2010). Moreover, Al-Goblan, Al-