Anatomy and Physiology of Diabetes Mellitus Type 2

NSB334
Integrated Nursing Practice 4
Assessment Task 2 Workbook

NSB334 Integrated Nursing Practice 4
Mrs. Ruby Pascal Simulation
Setting the scene
Refer to your simulation documents
Epidemiology/pathophysiology of disease processes
The National Health Priority Areas of Obesity, Diabetes Mellitus and Mental Health was established with
the aim of improving health outcomes in all these areas.
Excess weight, especially obesity, is a major risk factor for cardiovascular disease, type 2 diabetes, some
musculoskeletal conditions, and some cancers. As the level of excess weight increases, so does the risk
of developing these conditions. In addition, being overweight can hamper the ability to control or manage
chronic conditions.
The main factors influencing overweight and obesity are poor diet and inadequate physical activity.
Increased energy intake from the diet without an increase in energy expenditure through physical activity
will result in energy storage as fat and weight gain.
Diabetes is a chronic condition marked by high levels of glucose in the blood. The main types of diabetes
are type 1 diabetes, type 2 diabetes, and gestational diabetes. The prevalence of diabetes has been
escalating over the last 3 decades, with rates tripling over this period—diabetes affected around 1.2
million people in 2014–15. Rates of diabetes are generally higher among males, the elderly, Indigenous
Australians and people living in remote and socioeconomically disadvantaged areas. Type 2 diabetes is
the most common form and is largely preventable by maintaining a healthy lifestyle.
Mental illness comprises a wide range of disorders and varies in its severity. The effect of mental illness
can be severe on the individuals and families concerned and its influence is far-reaching for society as a
whole. Around 7.3 million Australians aged 16–85 (45% of that age group) will experience a common
mental disorder such as depression, anxiety or a substance use disorder in their lifetime, according to the
2007 National Survey of Mental Health and Wellbeing. Estimates from the second National Survey of
Psychotic Illness conducted in March 2010 suggest that almost 64,000 people have a psychotic illness
and are in contact with public specialized mental health services each year.
Bachelor of Nursing NSB334 Page 2 of 9

NSB334 Integrated Nursing Practice 4
WORKBOOK QUESTIONS
1. Review patients background and history. Ms. Ruby Pascal has multiple comorbidities
including obesity, diabetes mellitus type 2 and general anxiety disorder. Choose
Diabetes mellitus type 2 comorbidity and complete the following questions.
a. Discuss the anatomy and physiology of the chosen comorbidity (Diabetes
mellitus type 2).
Diabetes mellitus type 2 is a metabolic disorder marked by high insulin
resistance whereby body tissues or cells do not respond accordingly to insulin
action. Insulin resistance occurs primarily in the liver to cause excessive
release of glucose into the bloodstream, in the adipocytes to cause excessive
lipid breakdown and in the muscles to cause impaired glucose transport,
phosphorylation, and oxidation as well as impaired glycogen storage resulting
in hyperglycemia. Current studies have proven that this resistance is highly
attributed to genetics and inactivity or lack of exercise(Pedersen & Febbraio,
2012). There is also decreased, but not lack of, production of insulin by the
pancreatic beta cells of Langerhans leading to impaired blood glucose control
and marked hyperglycemia. ( Weir & Bonner‐Weir, 2013).
(2 marks)
b. Identify two (2) signs and/or symptoms of the chosen comorbidity (Diabetes
mellitus type 2). Discuss how each sign and/or symptoms support the
diagnosis of the chosen comorbidity.
 Increased random blood glucose levels above 11 mmol/ L- Ms. Ruby
Pascal has a blood glucose level of 16 mmol/ L.
 Excessive weight gain characterized by a basal metabolic index of
more than 25- Ms. Ruby has a basal metabolic index of more than 35.
c. Identify two (2) lifestyle factors that may have impacted/influenced the chosen
comorbidity. Justify your answer.
 Lack of exercise, as stated in Ms. Ruby' s history. Exercise is efficient
when it comes to improving blood sugar control as well as decreasing
body fat content leading to better insulin sensitivity. However, lack of it
leads to high accumulation of fats resulting in obesity that contributes
to high insulin resistance hence diminished or impaired insulin action
and consequently the development of diabetes mellitus type 2.( Hardy,
Czech & Corvera, 2012).
 Unhealthy diet, as evident in Ms. Ruby' s history, also predisposes
one to develop type 2 diabetes mellitus. A diet containing high
amounts of fats and carbohydrates does no good to the levels of
glucose in the blood. as the high amount of fats encourage insulin
resistance hence impaired blood glucose level regulation. Pandey,
Chawla & Guchhait, 2015). (4 marks)
2. Ms. Pascal acutely deteriorated in the first simulation scenario due to a pulmonary
embolism. Please read the first simulation scenario.
a. List four (4) signs and/or symptoms of a pulmonary embolism.
 Severe chest pain which becomes worse when the patient breathes
Bachelor of Nursing NSB334 Page 3 of 9