Nursing Case Study on Type 2 Diabetes Mellitus

This nursing case study focuses on Type 2 Diabetes Mellitus and explores various treatment options, pathophysiology, complications, and medication. It provides expert guidance on nursing considerations and patient indicators.

Nursing case study

Contents
INTRODUCTION...........................................................................................................................1
Part 1................................................................................................................................................1
1.1................................................................................................................................................1
1.2................................................................................................................................................2
1.3................................................................................................................................................2
Part 2................................................................................................................................................3
2.1................................................................................................................................................3
2.2................................................................................................................................................5
Part 3................................................................................................................................................6
3.1................................................................................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
A case study based on Emily Smith will be analysed in this report who is suffering from
Type 2 Diabetes Mellitus. In this report various treatment options of T2DM will be analysed
along with surgical options to the patients. The main aim of developing this report is to enhance
the nursing decision making.
Part 1
1.1
The case study of Emily Smith is focused towards the Type 2 Diabetes Mellitus which has
been diagnosed 6 months ago. At this stage, it is possible to control this Diabetes condition. The
concept of pathophysiology is a study in which it can be identified that how a disease can affect
the systems of a body. Pathophysiology for Type 2 Diabetes Mellitus in this case Insulin
resistance and decreased insulin secretion.
Insulin resistance is a pathophysiology which is a result of T2DM in this case of Emily
Smith. Insulin resistance is a condition where when insulin is injected in the body, it fails to exert
sufficient action in respect to the blood concentration (Zheng, Ley and Hu, 2018). In simpler
words, insulin resistance is what limits insulin to act in a human body. This condition further
targets main organs of a human body that can include liver. For this pathophysiology, it is
important to analyse how insulin actually works. The insulin has the ability to limits the
production of glucose in a human body which ensures the efficient functioning of liver and other
muscles but the T2DM builds a resistance in human body for insulin due to liver organ is at risk.
Another pathophysiology for T2DM is impaired insulin secretion; in this pathophysiology
responsiveness of glucose decreases due to which human body develops glucose toxicity.
Type 2 Diabetes Mellitus is a common condition which has various risk factors including
overweight, inactivity of patient, medical history of patient, medical history of patient’s family,
distribution of fat and age (Zeitler and et.al., 2018). All these factors can increase the risk of
T2DM. All these risk factors will levy 90% chances for a human to adopt this disease. The most
influential risk factor is over weight as being overweight can old can elevate the chances of
suffering from this medical condition.
It is important to understand the pathogenesis of Type 2 Diabetes Mellitus and this can be
understood by analysing the source of this disease that can be genetic and acquired. The
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pathogenesis of Type 2 Diabetes Mellitus includes beta cell dysfunction and insulin resistance. A
beta cell dysfunction includes both acquired and inherited factors and it has been also observed
that ethnic groups can even have a marked difference.
It is important to identify possible complications under Type 2 Diabetes Mellitus so that
case of Emily Smith can be analysed with appropriate medical treated. The complications under
T2DM includes kidney damage, slow healing, nerve damage, heart and blood vessel disease.
These complications will result due to insulin resistance will has lead towards the elevated
glucose in the body.
There are three levels of a treatment which are referred as primary, secondary and tertiary.
Three levels of treatment options for T2DM includes physical exercise, weight loss and healthy
eating; this treatment is the primary treatment for this disease (Kato and et.al., 2019). Secondary
treatment of this disease is insulin therapy along with regular blood sugar tests and tertiary
treatment of this disease includes inhibitors, receptors, metformin, sulfonylureas and
meglitinides.
The above treatment can Emily Smith to control her Type 2 Diabetes Mellitus. It is also
required in her case that all risk factors are identified as according to her this disease is common
in her family medical history.
1.2
Differences in T2DM and T1DM includes the following:
T1DM or type 1 Diabetes Mellitus is a condition where cells in a human body’s pancreas
are attacked due to which body unable to make any insulin. On the other hand, Type 2 Diabetes
Mellitus or T2DM, body becomes unable to make enough insulin to fight blood sugar. Another
difference between these diseases is T1DM’s symptoms appear quickly and symptoms of T2DM
takes time to appear. T1DM can be controlled by treating with insulin and T2DM demands
combination of medication and physical diet and exercise. T1DM is usually diagnosed in
childhood but T2DM is diagnosed in older adults. T1DM is a condition which is associated with
higher ketone levels and T2DM is associated with hypertension and high cholesterol levels (Jalal
and et.al., 2017).
1.3
On admission, blood glucose level of Emily Smith was 22.9 mmol/L [3.9-6.1 mmol/L]
which quite high when fasting. There are two reasons which are identified that can justify being
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the cause of high glucose level. The first reason is stress; Emily was devastated when she came
to know that she is suffering with the condition of T2DM. Although Emily fo not have any
medical history indicating towards T2DM, but Emily family medical history is known to have
this condition as her mother and elder sister had this condition at their early 50s. Considering
this, it can be said that stress is the major cause of Emily’s elevated blood glucose level. The
cause “stress” impact blood glucose level; when a human body experiences stress, the adrenal
glands present in the body triggers the release of glucose which is already stored in certain
organs of the body and by this glucose level is increased in body (Orno, Arif and Idris, 2018).
Another cause due to blood glucose level of Emily was increased on admission was her
inability to perform regular physical exercise. Along with T2DM, Emily was also having an
issue of Bakers Cyst that needed to be drained. Such Bakers Cyst is a condition in which a cyst
containing fluid is grown behind the knee which results into pain and problems in walking. Due
to facing issues while walking, Emily was unable to walk properly and perform exercise and this
elevated her blood glucose level. The cause “Lack of regular exercise and overweight” impacts
blood glucose level; when bod mass index of a patient increases the insulin resistance also
increases which results in high glucose level in body.
Part 2
2.1
Medication Discussion Action Complications/side
effects
Nursing
considerations
Cortisone
injections
(Kenacort-
A 40)
Emily Smith was
given this
medication for
her post surgery
nursing. This
medication is for
systematic
corticosteroid
therapy which can
eliminate the risk
An action refers to
the action of
medication which it
performs in a
human body.
Kenacort-A 40
actions to suppress
inflammation in
skin and eliminates
swelling and helps
This medication is
used in form of an
injection and can
result in multiple
side effects which
includes joint
pains, infection
and in some cases
headache. This
medication can
While injecting
Kenacort-A 40, it is
important to
considered that this
medicine is injected
deep into the
muscle so that it
can be absorbed
into blood rather
than into skin as
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of post surgical
issues including
allergies and
tissue disorders.
in reducing pain.
This medication is
for Emily’s post
surgery which will
help in reducing the
joint problem at her
knee.
even react with
part of the skin
where injection
needle is injected.
skin acts as a carrier
to supply medicine
to all parts of the
body (Webster and
et.al., 2017).
Metformin
(APO-
Metformin
Tablets)
Metformin is a
medicine which is
given to Emily
Smith to control
her glucose level
and to make sure
that her type 2
diabetes is under
control. This
medicine can be
given to adults as
well as to
children who are
above 10 years.
This medicine is
part of a medicine
group which is
called biguanides.
When this medicine
is consumed by a
patient it triggers to
lower down blood
glucose level in
body by helping the
body to make better
use of insulin which
is produced by the
pancreas.
There are various
side effects of this
medicine but none
of them is at
chronic level. The
side effects of this
medicine includes
diarrhoea,
dizziness,
weakness,
vomiting, irregular
heartbeats, cold
and pain in
muscles which is
reported as
unusual.
This medicine is
observed to be
appropriate for
patients like Emily
who are
overweight. It is
important to
consider some
nursing
considerations
before consuming
this medicine. Such
considerations
include storage of
this medicine in an
air tight container
in a cold place and
ensuring patient do
not use this
medicine if have
renal problems even
such problems are
mild.
Glipizide This medicine is This medicine is Side effects of this This medicine has
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(Minidiab
Tablets)
given to Emily to
control her blood
sugar. This
medicine is used
in conditions
where patients
requires
mediation to act
non dependent on
insulin. This
medicine is
different from
above medicine
of T2DM as it
acts as an
addition to
regular exercise
and healthy diet.
dissolved blood of a
human body and
lower downs the
blood glucose by
elevating the
amount of insulin
which is produced
by pancreas.
medicine are
similar to
Metformin. Few
distinctive side
effects include
nausea, loss of
appetite, weight
gain and headache.
few nursing
considerations as
well which state
this medicine must
not be given to
patients which has
medical history of
being allergic to
sulfonylureas and
pregnancy
(Romagnani and
et.al., 2017).
2.2
BGL or blood glucose level is the level of glucose in a human body. This level was 22.9
mmol/L [3.9-6.1 mmol/L] at the time of Emily’s admission to the hospital before surgery. This
level decreased to 8.8 mmol/L [3.9-6.1 mmol/L] when Emily came to the outpatient clinic. The
BGL measures the level of glucose and sugar content in the blood of a human body. A BGL of
less than 7.8 mm0l/L is considered as normal but at both the times BGL of Emily was higher
than this rate indicating Emily was suffering and is suffering from type 2 diabetes. The blood
glucose level of Emily changes for various reasons. These reasons include stress and medication;
when Emily was admitted for surgery, she was stressed due to which her BGL was higher and
then lowered down at the time of her check-up. Also, Emily was given medicines such as
Metformin and Glipizide which decreases her BGL.
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HbA1c or Glycated haemoglobin is a type of haemoglobin which is linked to sugar. The
time of admission of Emily at hospital, her HbA1c was 11% [normal <6.5%] and later it changed
to 8% [normal <6.5%]. A HbA1c measures the level of haemoglobin in a human body which is
linked with sugar and a normal HbA1c is 6.5%. This level has changed due to proper medication
intake by Emily.
Part 3
3.1
A renal function test is conducted to examine the blood urea nitrogen to determine
effectiveness of the kidney functioning. The renal function test of Emily indicates that her GFR
(glomerular filtration rate) is 10ml/min/1.73m2. When GFR is less than 15ml/min/1.73m2, it is
said that patient has G5 category. A G5 category refers to the end stage of renal failure and it
represents that Emily has lowest level of kidney function. As the Hb (Haemoglobin) of Emily
Smith was 95g/L, it indicates that Emily has kidney problems, gastrointestinal blood loss and
none marrow suppression (Kalantar-Zadeh and Fouque, 2017). Another indicator is serum
potassium; the Serum Potassium of Emily is 5.7 mmol/L which is higher than normal limit [3.6
to 5.2 mmol/L] and this indicates kidney failure and hypoaldosteronism and this is the reason due
to which Emily is experiencing palpitations.
Serun Urea 17 mmol/L is another indicator which indicates that Emily Smith has higher
Serum Urea as normal limit for this test of Emily must be [2.9-8.2 mmol/L]. This elevated limit
indicates congestive heart failure and heart attack. Last indicator from renal function test of
Emily is Serum Creatinine 150 μmol/L which is quite as normal limit is [50-110 μmol/L]. A
higher Serum Creatinine indicates that kidneys are not working well (Liu and et.al., 2018).
As per the indicators above, it is clear that Emily is suffering from chronic kidney disease.
There are two treatments available for Emily which are medicine for high blood sugar and
glucose and dialysis (Drawz, Hostetter and Rosenberg, 2020). The rationale for suggesting
medicine as treatment is that it will cure the cause of CKD which is high blood sugar. The
rationale of suggesting dialysis is that it will replicate some of the kidney’s function which are
necessary in stage 5 CKD.
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CONCLUSION
From the above report, it has been concluded that it is important to understand the
medical history as well as immediate family’s medical history to ascertain the cause of a disease.
It is also concluded that a case may represent disease causes as hereditary or adapted.
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REFERENCES
Books and Journals
Drawz, P., Hostetter, T. H., & Rosenberg, M. E. (2020). Slowing progression of chronic kidney
disease. In Chronic Renal Disease (pp. 937-959). Academic Press.
Jalal, M. & et.al. (2017). Association of Nonalcoholic Fatty Liver Disease with Insulin
Resistance in Type 2 Diabetes Mellitus–A Prospective Study. J Fam Med. 4(4). 1119.
Kalantar-Zadeh, K., & Fouque, D. (2017). Nutritional management of chronic kidney
disease. New England Journal of Medicine. 377(18). 1765-1776.
Kato, E. T. & et.al. (2019). Effect of dapagliflozin on heart failure and mortality in type 2
diabetes mellitus. Circulation. 139(22). 2528-2536.
Liu, B. C. & et.al. (2018). Renal tubule injury: a driving force toward chronic kidney
disease. Kidney international. 93(3). 568-579.
Orno, T. G., Arif, M., & Idris, I. (2018). Correlation Between Onset of Diabetes Mellitus and
Nitric Oxide Levels in Patient with Type 2 Diabetes Mellitus. Medical Laboratory
Technology Journal. 4(1). 8-11.
Romagnani, P. & et.al. (2017). Chronic kidney disease. Nature reviews Disease primers. 3(1). 1-
24.
Webster, A. C. & et.al. (2017). Chronic kidney disease. The lancet. 389(10075). 1238-1252.
Zeitler, P. & et.al. (2018). ISPAD clinical practice consensus guidelines 2018: type 2 diabetes
mellitus in youth. Pediatric diabetes. 19. 28-46.
Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes
mellitus and its complications. Nature Reviews Endocrinology. 14(2). 88.
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