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

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