Case Study Two: Diabetes Type 2 and Percy's Leg Ulcer

CRS176
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Assessment Task : Case Study Two
Student Version: Report, Project, Portfolio
Student information
Student name: Click here to enter text.
Please use the student’s full name
(no abbreviations or nicknames).
Student ID: Click here to enter text.
Section A – Program/Course details
Qualification code: HLT54115 Qualification title: Diploma of Nursing
Unit code: HLTAAP002
HLTAAP003
Unit title: Confirm physical health
status
Analyse and respond to client
health information
Section B – Assessment task details
Assessment number: Five – case study 2 Semester/Year: Two
Due date: 31/08/2018 Duration of assessment: Copy and paste here from Assessor
version.
Assessment task
results:
This assessment task will be marked as:
☐ Ungraded result: Satisfactory or Not Satisfactory
☒ Other (eg points): Graded
Section C – Instructions to students
Task instructions:
● Students will be assessed according to the marking guide provided
● This assessment is to be completed in the students own time
● There are three (3) case studies in this assessments
● Students are to answer all questions
Answer the questions listed in relation to the following case studies
Case Study 1 – Endocrine, integumentary and neurovascular disorders
Percy Jones is seventy two (72) year old male who was admitted with unstable blood glucose levels two (2) days ago.
He has a past medical history of:
● Diabetes Type 2
● Peripheral neuropathy
● Chronic left leg ulcer
Percy’s chronic ulcer is red with exudate and odour. He visits his General Practioner (GP) once a week to have the
dressing changed. The dressing impacts upon him walking as he is afraid of dislodging it. Percy currently lives at
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home alone with no assistance.
At 0730 these are you findings:
● BGL – 2.7mmol/l
● HR – 105bpm
● RR – 16
● BP – 140/80
● Temperature – 37.6C
● SaO2 – 95% R/A
● Slightly confused
Question1 – Describe Diabetes Type 2
Ans. The major pathophysiology associated with Type 2 diabetes is the defect in the secretion of insulin. In the
disease for maintaining the level of glucose the secretion of insulin in the blood varied against the sensitivity of
insulin in the blood. The patients suffering from Type 2 diabetes doesn’t have the power of increasing the
secretion of insulin in a proper way for overcoming the resistance towards insulin and for having a lower
disposition index. The other characteristic pathophysiology associated with the type 2 diabetes is the resistance
towards insulin in the peripheral region, variation in the regulatory mechanism of the production of hepatic
glucose, as well as decline in the function of β-cell, which leads to the failure of the β -cell.
Question 2 – What is the relationship between Diabetes Type 2 and Percy’s leg ulcer?
Ans. In Percy’s case diabetes type 2 as well as chronic leg ulcer is reported, the diseases are related as their is
sensation loss due to diabetes leading to regular small injuries caused due to internal as well as external issues
which remains undetected and consequently leading towards ulcer in foot. In the case of diabetes and nerve
damage have its impact on the fibres such as motor, sensory, as well as autonomic leading to weakness of
muscles pain sensation, as well as decreased sweating, which results in the skin integrity loss increasing the
vulnerability of the skin for infection caused due to microbes.
Question 3 – Percy’s BGL is 2.7mmol/L, what condition is he currently experiencing? What is your immediate
action going to be?
Ans. The decreased level of BGL i.e., blood glucose level i.e., 2.7 mmol/L states the condition of hypoglycaemia,
also known as low glucose (i.e., below 4 mmol/L). The immediate action associated with hypoglycemia includes
the bedside assessment such as the level of consciousness, overall status of respiration as well as circulation,
the results if blood test, the presence of IV access, total amount of time as well as the quantity of the dose of
insulin, and NPO. Percy should be provided with some oral carbohydrate either in the form of a liquid or a
dissolving tablet. The treatment should also include IV access for a rapid dextrose administration or an
intramuscular glucagon injection.
Question 4 – Why is Percy’s wound red with exudate? How does diabetes contribute to this wound
condition?
Ans. The chronic leg ulcer leads to muscle atrophy in the foot along with toes clawing which results in the
trauma repetition inside the feet and hence alterations in the skin turgor, hence promote the increased formation
of ulcers in the foot Such type of features, along with diabetes leads to poor healing of the wound which is as a
result of collagen synthesis, as well as ECM proteins, and hence decreasing the proliferation of fibroblast which
tends to develop a reddish color with exudate of the wound. Moreover, Percy is more susceptible towards
wound infections, along with elevation in the level of glucose levels along with elevated granulocytic function.
Question 5 – Describe three (3) health professionals who will be involved in Percy’s care. At least one (1) of
these health professional should be medical and one (1) should be an allied health professional
Ans. A diabetologist, podiatrist and a diabetic and wound care nurse.
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Case Study two – Neurological and urinary disorders
Lee Ming, forty five (45) was admitted to hospital three (3) weeks ago. She presented to the emergency department
displaying intermittent left sided facial dropping, tingling of her lips, and left sided arm weakness. She was diagnosed
with TIA and transferred to the ward for observation. Overnight her condition deteriorated. CT scan of her brain
showed an occlusive CVA, with significant brain injury.
Lee is displaying the following symptoms:
● Left hemiplegia
● Aphasia
● Emotional lability
● Defects in right visual field
Lee’s management has included:
● Urinary catheter
● Thickened fluids
● Full nursing care (assistance with all Activities of Daily Living (ADLs)
● Emotional support
You are caring for Lee this morning. You note that the urine in the catheter bag is cloudy and has an offensive odour.
You take her temperature tympanically and it is 38.2 C. You perform a urinalysis and obtain the following results:
● Glucose – negative
● Protein - ++
● Nitrates - ++
● Ketones – negative
● Blood - +++
● pH – 5
Question 6 – What would you conclude from the urinalysis?
Ans. The urinalysis suggests that Lee has a urinary tract infection as the number of RBCs increases in the urine
due to the presence of infection depicting positive results. The results of urinalysis also depicts positive results
for nitrates as well as protein which also suggests the presence of urinary tract infection. However, the presence
of protein in urine is usually undetectable and if there is presence of protein it suggests the condition of
proteinuria which could be the initial sign of the disease of kidney.
Question 7 – Describe two (2) risk factors does Lee have for a urinary tract infection?
Ans. The 2 major risk factors which Lee have for a urinary tract infection is the abnormality in the urinary tract,
which could act as major focus towards infection and the other risk factor is age i.e., 45 years as the overall rate
of urinary tract infection increases in women with increasing age.
Question 8 – Explain the relationship between the presence of an elevated temperature and an infection?
Ans. The infection is considered as a bacteriuria which is caused by the bacteria and when the significant
symptoms are present. The organisms causing infection such as UTI belongs to an organism subset which are
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