CNA255 Case Study: Diabetes Mellitus, Acute Kidney Injury, and Fertility Issues

This case study covers three different scenarios, discussing cues, interpretation, and explanation for each of the cues. It covers topics such as Diabetes Mellitus, Acute Kidney Injury, and Fertility Issues. The output is in JSON format.

CNA255
Scenario 1
Ms Connie Chen is 52 years old. She is currently single and has two adult children. Ms
Chen reports that she has been feeling rather fidgety lately, as if she can’t sit still. She
has also been feeling unusually hot. Her sleep is interrupted at night by the urgent need
to pass urine and have a drink. She is always thirsty and is wondering if it is due to
feeling so warm. Recently, she noticed that there is a large lump in her neck, just below
her ‘voice box’ and her eyes seem to be ‘popping out’ more than normal.
She has come to the clinic in which you work because she is concerned about her
symptoms.
As part of Mrs Chen’s assessment, you perform a random blood glucose measurement,
which provides a reading of 13.8 mmol/L.
1. Make a list of the cues from Connie’s case study and provide an interpretation of,
or explanation for, each of these. The cues from Connie’s case study include,
feeling hot, frequent urination, thirst, large lump in the neck, blood glucose
level of 13.8 mmol/L.The first cue is a blood glucose of 13.8 mmol/L.A normal
blood glucose level should be between 3.9 mmol/L and 5.5 mmol/L.A blood
glucose of 13.8 mmol/L is by far the maximum threshold and this therefore
indicates that Connie is diabetic. A large lump on the neck is the thyroid which
has become inflamed due to its overstimulation to produce insulin by the beta
cells of the pancreas. Unusual hot feeling is as a result of the breakdown of
excess glucose in the body to release energy. Frequent urination on the other
hand is as a result of the kidney striving to release excess sugar in the body.
Finally, the thirst is as a result of the body striving to maintain a homeostatic
state in the body since excess glucose leads to a hypertonic state of the cells.
There should be intake of more water to correct the hypertonic state.
2. Explain the difference between Diabetes Mellitus types 1 and 2. Describe the
treatment options for each condition. Diabetes Mellitus are both conditions in
which there is excess glucose or sugar levels in the body. However, the
difference between the two conditions is that in Diabetes Mellitus type 1, the
immune system attacks beta cells of the pancreases therefore rendering or
impairing its ability to produce a hormone called insulin that breaks down
excess sugar in the body. Diabetes Mellitus type on the other hand is a
condition in which the insulin hormone is produced either in very small
quantities that are not significant in the breakdown of excess sugar in the body
or but the body does not respond to it. The treatment option of Diabetes
Mellitus type 1 is through injection of the insulin under the fatty tissue while
the Diabetes Mellitus type 2 is not treatable but only manageable through
actions like weight management, dietary practices as well as exercise.

3. State the hormones that can affect blood glucose levels. Describe where each is
produced, what its target is, and how it alters blood glucose. Basically, there
are two major hormones in the human body that alter the level of glucose in
the body. They include insulin and glucagon hormones. Insulin is produced by
the beta cells of the pancreas while glucagon hormone is produced by the
alpha cells of the pancreas. Insulin is produced when the level of glucose is high
and its target is blood where it breaks it down into less harmful substance like
glycogen. Glucagon on the other hand is produced when the level of glucose is
low. The target organ of the glucagon on the other hand is the liver where it
stimulates it to release the stored glucose so that the body has enough glucose.
Scenario 2
Mrs Amy Adams is 74 and has been brought to the hospital for a suspected broken
Neck of Femur (NoF). According to her daughter, who arrived with her in the
ambulance, Mrs Adams has a five-day history of vomiting due to a ‘stomach bug’. This
morning her mother rose from her bed to let her cat out, experienced about of dizziness
and lost her balance. She fell over and now has severe pain in her right hip and leg. You
notice that she looks pale and her lips are dry. Her daughter reported that her mother
had told her that she has hardly urinated in over 24 hours.
4. Make a list of the cues from Amy’s case study and provide an interpretation of, or
explanation for, each of these. No urination in over 24 hours might indicate
impairment of the kidneys or fluid imbalance in the body. Pale and dry lips
indicate dehydration in the body. Dizziness is as a result of ear disorders that
arise due to impaired fluid balance regulating systems in the ear.
5. What changes are happening in Amy’s kidneys as a result of her current fluid
balance status? Explain what you would expect in terms of her eGFR, blood
results, urinalysis and hormonal responses. Since Amy is dehydrated, the
kidney will retain a lot of water and there will be very little urination. The rate
of glomerular infiltration will increase and the ADH will increase permeability of
the renal tubules to absorb more water.
6. For Amy’s IV therapy, state the equipment required, the procedure for establishing
her IV line, any precautions that you will take and suggest any indications for
concern after the line has been established. There are different equipment but
the basic equipment include gloves and protective equipment, IV bag that has

solution set or the saline lock, non-sterile 2 by 2 gauze,6 by 7cm of Tegaderm
Transparent dressing, alcohol swabs, non-latex tourniquet and appropriate size
catheter 14-25G IV catheter. The procedure for establishing the IV line is as
follows: The equipment are assembled and then donning of good size non-latex
examination gloves. The tourniquet is then applied to the IV arm just above the
site. The vein is then visualized and palpate. The site is then cleansed using the
chlorhexidine swab in an expanding circular motion. The catheter is then
inspected and the vein stabilized. Counter tension of the skin is then applied
and then the stylet is inserted through the skin while reducing the angle as one
advances to the vein. The flashback is observed as the blood slowly fills the
flash back chamber. The needle is then advanced 1cm up the vein. The needle
is then pulled back 1 cm with the middle finger while holding the end of the
catheter with the thumb and the index finger. The catheter is then advanced
into the vein slowly while keeping tension on the vein and the skin. The
tourniquet is then removed. The catheter is then secured by placing the
tegaderm on the lower half of the catheter hub while taking care not to cover
the IV tubing connection. The distal end of the catheter is then occluded with
the 3rd, 4th, and 5th fingers of the dominant hand. The catheter hub is then
secured and the index finger and the needle is carefully removed. The needle is
then placed in the sharps container. The cover from the end of the IV tubing is
removed and inserted into the hub of the catheter. The tubing is then secured
through screwing the Luer Lock tight and the IV roller clamp is opened up and
the drips forming in the drip chamber are observed. The IV is checked if it is
infusing into the vein through occluding the vein distal to the catheter and
observed. The IV drop is then adjusted so as to keep the vein open rate of
approximately 30-60 ml/hr. The piece of tape is then placed over the catheter
hub. A small loop is then made in the IV tubing and place the second piece of
tape over the first so as to secure the loop. The 3rd piece is then placed over the
IV tubing above the site. The IV is then properly securely by infusion. All the
sharps are then placed in the sharps container. The indications in this case is
that IV access is crucial when it comes to managing problems in all patients
with critical conditions.
7. Amy is at risk of acute kidney injury (AKI). Explain why. Explain how AKI differs
from chronic kidney disease (CKD). Amy is at risk of acute kidney injury due to
the trauma after falling off. Acute kidney Injury is different from chronic kidney
injury in the sense that acute kidney injury is sudden impairment in the
glomerular filtration rate due to different reasons while chronic kidney injury is
the loss of glomerular filtration due to underlying diseases like diabetes. Acute
Kidney injury is also reversible while the chronic kidney injury is irreversible.
8. Amy also has benign prostatic hyperplasia (BPH). Explain how BPH poses a risk to
her kidneys. After problems with urethral obstruction, an indwelling catheter

(IDC) is inserted. Explain the procedure, and your precautions and nursing
considerations. Benign prostatic hyperplasia is an enlarged prostrate that
pressurize the urethra. The pressure on the urethra in return cause obstruction
to the outflow of urine. Since anything that obstructs urine from the kidney
leads to acute renal failure, the pressure on the urethra by the enlarged
prostrate due to BPH cause renal failure and subsequent kidney damage. The
procedure for inserting an indwelling catheter is as follows, first the nurse has
to gather the necessary equipment and explain to the patient in details how
the procedure will be carried out. After that, the patients is assisted into a
supine position with the legs spread apart while the feets are together. The
catheterization kit is then opened and a sterile field is prepared. Gloves are the
applied and the balloon is checked for patency. After that, the distal portion of
the catheter is generously coated with a lubricant and a sterile drape is then
applied. If the patient is female, the labia is separated using a non-dominant
hand but if it is a male, the penis is held with the dominant hand and the hand
position is maintained until when preparing to inflate the balloon. Using the
gloved dominant hand, the catheter is then picked. The catheter is then held
while it is loosely coiled in the palm of the dominant hand. If the patient is
male, the penis is lifted higher in a perpendicular position relative to the
patient’s body and light upward traction is then applied. The urinary meatus is
identified and the catheter is inserted gently up to 1 to 2 inches beyond which
urine can be posted. The balloon is then inflated using the right amount of the
sterile liquid. The catheter is then pulled gently until the inflated balloon is snug
against the bladder neck. The catheter is then connected to the drainage
system and secured to either the abdomen or thigh with no tension on the
tubing. The drainage bag is then placed below level of the bladder. After that,
evaluation of the catheter function as well as amount color, odor and quality of
urine is carried out. The nurse then removes the gloves and dispose the
equipment correctly and washing hands. The size of the catheter is
documented, the amount of water in the balloon as well as the patients
response to procedure and assessment of the urine. The precautionary
measures and nursing consideration include protecting potential contact with
the blood as well as body fluids of the patients and therefore the nurse has to
ensure that gloves are worn appropriately when starting the Foley.
Scenario 3
Robert and Julie have been together for four years. They have been trying to conceive
for the past two years. Robert is 52 and Julie has just turned 40. They attend your clinic
to discuss their fertility issues.

You conduct sexual and reproductive health interviews with both Robert and Julie.
Robert informs you that he had a vasectomy at the age of 42, followed by reversal
surgery at the age of 50 when he and Julie decided that they wanted a baby together.
During the sexual and reproductive health interview, Julie informs you that she had
been taking the oral contraceptive pill for 20 years prior to their decision to conceive.
Julie also reveals that she was diagnosed with Chlamydia in her early 20’s despite
having no initial symptoms. It then developed into pelvic inflammatory disease (PID).
9. Make a list of the cues from given case study and provide an interpretation of, or
explanation for, each of these. History of vasectomy. This is a birth control
mechanism that means Robert could not be able to fertilize the ovum from
Julie. Chlamydia that developed into PID means that Julie has an STD in the
name of chlamydia.
10. Julie has two STIs. From the cues provided, what are they likely to be? What
nursing considerations do you have for managing each condition? What is the
likely long-term prognosis for each condition? From the cues, Julie is likely to
be suffering from chlamydia and Lymphogranuloma venereum STIs. The long
term prognosis include permanent damage to the reproductive system and
lead to infertility as well as ectopic pregnancies in female. The considerations in
this case include encouraging them to use male condoms as well being
monogamous.
11. Julie has acquired an STI due to infected semen from early age. Describe the
pathway of sperm from its site of production to the site of deposition in the
vagina. Name five circumstances under which successful transfer of sperm
from the male into the female may be impaired/impeded. Production of the
sperms occur in the testes. The epididymis receives the sperm from the testes
and it stores it for quite some days. During ejaculation, it is released from the
tail of the epididymis into the ductus deferens. It then moves through the
ductus deferens up to the spermatic cord into the pelvic cavity that is situated
over the ureter to the prostrate just behind the gall bladder. It is at this
juncture that the vas deferens joins the seminal vesicle to result into what is
called the ejaculatory duct. It is the ejaculatory duct through which the sperm
move through the prostrate and finally empties into the urethra. It is the
urethra that opens up in the vagina then the sperms are deposited.
12. When taking a blood sample from Julie, what equipment will you use and
what will the procedure be? If you accidentally stick yourself with the needle,

what steps will you take? When taking blood from Julie, the equipment to be
used is needle and syringes as well as alcohol swabs and the vacutainer and
finally the tourniquet. The procedure is first tying the upper arm with the
tourniquet so as to locate the vein. Once the vein is located, I will sterilize the
point with the alcohol swabs and then puncture the vein using the needle. The
blood is then drawn into the syringe and transferred to the vacutainer. If I
accidentally stick myself with a needle when drawing blood from Julie, I will
straight away subscribe to post exposure prophylaxis to protect myself against
HIV/AIDS.
Scenario 4
Mr David Dixon is 63 years of age and a retired bank manager. He is married and has 6
grandchildren. Mr Dixon’s father died of colorectal cancer and Mr Dixon has had
several colonoscopies in the past to remove polyps from his colon, all of which have
turned out to be benign. Unfortunately, his most recently removed polyps have come
back as cancerous and he has been diagnosed with adenocarcinoma of the colon.
Mr Dixon has been recommended surgical resection followed by adjuvant therapy. He
has also been told that the staging and grading of his cancer can only be performed post-
operatively.
His blood tests demonstrate that he is severely anaemic as a result of blood loss caused
by the cancer.
13. Explain the meaning of Dixon’s blood test results. What are the risks to Dixon
for each finding? From Dixons blood test results, it indicates that he is severely
anemic. By this it means that he has low levels of red blood cells in his body.
Due to anemia, Dixon has risks which include hypoxia. Hypoxia is a condition
where tissues and organs in the body are devoid of oxygen. This is because
hemoglobin is a pigment found in the red blood cells and it is responsible for
transporting oxygen to various parts of the body. The fact that Dixon has few
red blood cells means there will be limited transportation of oxygen to the
tissues and that is why hypoxia is likely to occur. Suffocation therefore is the
end result of anemia.
14. Explain what chemotherapy is, how it works to treat cancer, and what
precautions should be taken around administration. Chemotherapy has two
words, chemo and therapy. Therapy generally refers to treatment of a

condition while chemo is chemicals. Chemotherapy therefore means the
treatment of cancer using medications. Chemotherapy treats cancer by the
chemical composition of the medicines that interfere with process of cancerous
cells division ultimately causing their death. The kind of medicines used during
chemotherapy are very strong and therefore the need for safety during
administration. Some of the precautions during administration include the use
of protective clothing like gloves and glass as well as masks to prevent contact
with the body. After, their use, they are disposed in special bags or tins that are
labelled red for easy identification. Some medicine like the 5-fluorouracil can
cause sensitivity to the sun or heat and therefore the patients should be warned to
minimize exposure to the sun.
15. Name 4 potential side effects of adjuvant therapies including chemo- and
radio-therapy. Choose one side effect and discuss the goals of care and
management options for that side effect. Just like all other therapies for
neoplasms, adjuvant therapy is associated with different side effects like
vomiting, nausea, alopecia and finally the myelosuppression especially
neutropenia. One particular side effect is vomiting and it is due to a
combination of different muscles within the body. The goals of care for this side
effect is to prevent vomiting. There are several management options for
vomiting and they include drinking a lot of fluids, avoiding unpleasant smells,
use of relaxation techniques, eating what appeals to the patient, eating small
meals and finally the use of complimentary therapies like acupuncture and
aromatherapy are the best management options of vomiting as a side effect of
adjuvant therapies.
16. Dixon requires a blood transfusion. Explain the process and checks that need
to occur for this type of therapy. If Dixon is of blood type B+, what blood
types can she be transfused with? Blood transfusion therapy involves the
introduction of blood through the intravenous lines. Conditions that need
blood therapy include cancer and hemophilia .However, before the blood
transfusion therapy, there should be different processes and checks that need
to take place. The first process is laboratory tests to ensure that the blood from
the donor is compatible with that of the recipient. There are different types of
blood groups depending on the Antigen present. The blood groups are O, A, B
and AB. Other people have Rhesus factor in their blood and are therefore
referred to as rhesus positive. After compatibility tests have taken place.
Screening of the blood is then done to ensure that it is free from different
infections like viruses. After screening, there is transfusion through the
intravenous route. Since Dixon has blood group B+,it means he has the rhesus
factor and is only eligible to receive blood types O both positive and negative
and blood type B+ as well.

17. Name three nursing considerations for Mr. Dixon relating to her a) Anemic, b)
blood transfusion. The three basic considerations for anemia and blood
transfusion include managing fatigue through exercise as well as physical
activities. Maintain adequate nutrition by prescribing a good diet and teach on
how to avoid alcoholism. Finally, it is maintaining of adequate perfusion by
monitoring the blood transfusion.