Collaborative Practice Simulation Workbook - Nursing Assessment

School of Nursing
ASSESSMENT COVER SHEET
Student Name(s): Student No.(s):
Note: If this is a group assessment submission, please list the student name and
numbers of all group members in the above box.
Unit Name: Integrated Nursing Practice 4
Unit Code: NSB334 Due Date: Week 11, Friday 17th
May 2019 at 11:59pm
Lecturer’s/Tutor’s Name: Christina Parker/Karen Wynne
Tutorial Day/Time:
Assessment
No.
2 Assessment Title: Collaborative Practice Simulation
Workbook

Answer 1:
a. Anatomy and physiology of type 2 diabetes: Pancreas and hormones produced by
pancreas like insulin are the main anatomical structure involved in diabetes. The co-
morbidity of type 2 diabetes occurs because of pathophysiological alterations in these
structures and impaired production of insulin hormone (Eguchi & Nagai, 2017). In case
of type 2 diabetes, inadequate production of insulin hormone results in dysfunction of
the pancreatic beta cells and insulin resistance. Insulin resistance results in impaired
function of insulin thus leading to impaired glucose tolerance.. Relative deficiency in
insulin is a common physiological mechanism in patients with diabetes and this is
associated with insulin resistance too. Hence, diagnosis of diabetes is associated with
significant changes in the physiology of the endocrine pancreas and the alpha and beta
cells. The symptom of hyperglycemia is seen following combination of mechanisms like
resistance to insulin, inappropriate secretion of glucagon and inadequate insulin
secretion (Zaccardi et al., 2016).
b. Two sign and symptoms of the type 2 diabetes include frequent urination and fatigue
(Amiri, 2016). Frequent urination supports the diagnosis of diabetes mellitus because
urination is the first sign that denotes high blood sugar level is seen in the body of
patients with diabetes. This symptom emerges because of impaired insulin secretion
and insulin resistance. Impaired insulin secretion is the condition in which glucose
responsiveness decreases and insulin resistance is a condition in which insulin does
exert sufficient action according to blood concentration. As sugar builds up in the body
following pathophysiological changes in the pancreatic cell, the kidneys are forced to
work overtime to absorb the excess sugar. As kidneys fail to keep the load, excess

blood sugar is excreted into the urine along with other fluids. This form of changes gives
the perception to people to urinate frequently (Hadjadj et al., 2016). Hence, for this
reason, the symptom of frequent urination is linked to diagnosis of diabetes. For this
reason only, urine is a common test done in diabetic patient as it helps to detect excess
amount of glucose in the urine.
In addition, symptom of fatigue also supports diagnosis of diabetes because
increases urination leads to dehydration and decreases body’s ability to function
properly. As less number blood sugar is utilized for energy needs, it leads to symptom
of fatigue. Singh et al. (2016) gives the evidence that fatigue is a persistent symptom in
people with type 2 diabetes and it is linked to episodes of hyperglycemia in patient.
c. Two lifestyle factors that might have influenced development of type 2 diabetes
include sedentary lifestyle and smoking. This is said because low sedentary behaviour
is inversely associated with type 2 diabetes. Hamilton, Hamilton and Zderic (2014)
shows that increased sitting time is associated with greater risk of type 2 diabetes.
Smoking also influences diabetes because heavy smoking is associated with
higher risk of serious complications in diabetic patients such as heart disease and
kidney problem. Smoking increases inflammation and oxidative stress, thus leading to
direct damage of beta cell function and impairment of endothelial function (Chang,
2012).
Answer 2:
a. Four sign and symptoms of pulmonary embolism include cyanosis, leg pain or
swelling, excessive sweating and dizziness (Di Nisio, van Es & Büller, 2016).

b. Two risk factors of pulmonary embolism include obesity and cigarette smoking.
Being obese increased the risk of deterioration in patients experiencing
pulmonary embolism because obesity has impact on the respiratory system and
changes in respiratory mechanics due to obesity (Zammit et al., 2010).
In addition, cigarette smoking also deteriorate condition of patient. Several
studies have revealed about the association between cigarette smoking and
pulmonary embolism. Cigarette smoking is associated with increased risk for
VTE. Hence, reviewing of medical history of cigarette smoking in a patient can
explain the cause behind pulmonary embolism (Cheng et al., 2013).
Answer 3:
The standard 8 of the NSQHS focus on recognising and responding to acute
deteriorations. Two risk factors that increases Mrs. Pascal’s risk of clinical deterioration
includes chest pain and repeated admission to the hospital because of chest pain. This
clinical symptom might be a risk factor of future deterioration of symptoms as chest pain
might be an indicator of cardiovascular disease like myocardial infarction and angina.
Hence, delay in addressing chest pain symptom may deteriorate severity of pain and
even lead to death. Riley (2015) gives the evidence that acute onset of chest pain and
repeated hospitalization increases risk of heart failure and due to high risk of clinical
deterioration, the patient may require invasive cardiopulmonary support.
The second risk factor for acute deterioration in Mrs. Pascal includes history of
general anxiety disorder and worsening of anxiety. This may increase risk of acute
mental health deterioration as prolonged period of anxiety may predispose patient to
risk of depression. The patient may even engage in self-harm activities due to