Diabetes and Related Health Issues
Added on 2020-05-11
20 Pages6046 Words180 Views
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Running head: NURSING PLACEMENTNURSING PLACEMENTName of the StudentName of the UniversityAuthor note
1NURSING PLACEMENTIntroductionThe purpose of the paper is to gain a deep insight regarding the importance ofpathophysiology, pharmacology, assessment of the diseases that are manifested by the patient inthe given case study. In the given case study, the patient named Jackson Roland was admitted toHampstead hospital as he fell in the aged care and got injured sustaining cervical spine. Theactual patient name has been used in here. As he has no one to look after him, he haspermanently stayed in aged care. Jack had a past medical history of Diabetes Mellitus (DM) type1, hypertension, Ischemic Heart Disease (IHD), atonic bladder (SPC), Peripheral vasculardisease(PVD). A catheter that is inserted surgically through the lower part of theabdomen directly into the bladder is known as suprapubic catheter or SPC.He also underwent bilateral transmetatarsal amputation, carpal tunnel surgery and CABG* 2 8stunt 2008. As he is suffering from severe sensorimotor polyneuropathy due to diabeticneuropathy, there is risk for fall due to decreased sensation and lack of muscle coordination andcontrol. Due to high blood sugar level, the nerves are damaged and can lead to neuropathyenhancing the risk for fall (Vinik et al. 2015). This condition is a diabetic complication andmostly occurs when diabetes remain undiagnosed or not well controlled. This could be thereason for Jack’s fall and his need for admission at the hospital. For the access to Jack’s information, informed consent is required from him or hiscaregiver at the aged care. The confidentiality is important while getting access to his personalinformation like past medical history, current medications, past surgeries and in getting previousmedical records (Keast 2016, pp.20). Patient confidentiality has been maintained in here. Themain risk for Jack after admission is the moderate or severe brain injury that could be associatedwith the sustained cervical spine injury (Theologis et al. 2014, pp.356-361). Therefore, there is a
2NURSING PLACEMENTrequirement of diagnosis and management of cervical spine trauma and assessment of diabetesand hypertension being the major concern and SPC supra pubic catheterisation due to atonicbladder. Pathophysiology As mentioned above, the medical history of Jack revealed that he is suffering from DMtype 1, IHD, PVD, hypertension, atonic bladder (SPC) and severe sensorimotor polyneuropathy.Diabetes and hypertension are the major concern that could have manifested the signs andsymptoms in Jack and made him prone to fall. Type 1 DM or juvenile diabetes is a condition when the body does not produce insulinthat is important to break down the starches and sugars for energy generation (AmericanDiabetes Association 2015). The pathophysiology of DM type 1 is the destruction of beta cellsthat secrete insulin from the islets of Langerhans in the pancreas (Jennings 2015). There isdecline in beta cell mass that in turn decreases the insulin secretion until there is no adequateinsulin to maintain the normal blood sugar levels where autoimmunity is the major DM type 1pathophysiology (American Diabetes Association 2015). There is sensory neuropathy caused bysegmental demyelination and axonal degeneration that is manifested in Jack making him proneto fall due to sustained hyperglycaemic condition. A patient having chronically elevated glucoselevel is exposed to damage to the longest nerves in their bodies that convey sensory informationfrom the feet and toes to the spinal cord. The loss of muscle tone and sensation are worst felt atthe ankles and feet. This makes it difficult for the patient to walk or stand up. This is moreprominent at old age. The condition brought about by neuropathy is one of the major reasons that
3NURSING PLACEMENTpeople with diabetes have such a high risk for falls (Atkinson, Eisenbarth and Michels 2014,pp.69-82). Pathophysiology of hypertension is multi-factorial and complex where kidney acts as themajor target organ and contributing factor. Arterial hypertension is the persistent systemic bloodelevation where the cardiac output is elevated or systemic vascular resistance increase. There is astrong link between hypertension and diabetic neuropathy where hypertension acts as theindependent risk factor as RBCs and Na/K ATPase decrease. An alteration in themicrocirculation plays an important role in this regard. Hypertension leads to up-regulation ofmatrix metalloproteinase (MMP) expression at the sites of myelin thinning at sensory nervefibers. This potentially worsens comorbid diabetes (Visser et al. 2014). This could be thepathophysiology of hypertension in Jack with diabetes, both being intertwined conditions sharingsignificant overlap in the manifestation of the underlying risks (Burnier and Wuerzner 2015,pp.655-683). There are macrovascular complications associated with longstanding hypertension ordiabetes which includesIHD (Ischemic Heart Disease) and PHD (American DiabetesAssociation 2015). Microvascular complications include sensorimotor polyneuropathy that iswitnessed in Jack on admission. IHD is a condition in which there is narrowing or blockage of the blood vessels thataffects the blood supply to the heart. This occurs due to cholesterol deposition on the walls of thevessels reducing the nutrient and oxygen supply to the heart muscles that is essential for theproper functioning of the heart. Therefore, this condition occurs when some part of the heart isdeprived of the oxygen and blood supply that can lead to heart attack (Shepard et al. 2015,
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