Nursing Practise Assignment 2022

Running head: NURSING PRACTICE 1
Nursing Practice
Name of Author
Institution of Affiliation
Date of Submission
Nursing Practice

NURSING PRACTICE 2
History and Physical Exam
Mr Kelvin, a 50-year-old man with a five-month history of fatigue and anxiety. Besides
fatigue and stress, the patient also had a high level of urination, skin infection, and the dryness of
the eyes caused blurring vision which I suspected. His family had a history of diabetes type 2
from his paternal side. The patient had no history of cardiovascular disease, hypertension and
tobacco use. I assessed his blood pressure and confirmed it was normal. Besides, I did the
urinalysis test, which indicated negative. I also evaluated his BMI, which indicated 30kg/m2 and
applied daily blood tests which revealed he had HBA 1c of 71 mm/mol.
Based on his family history and BMI, I identified him with type 2 diabetes. I started him
on metformin but after three weeks the medication up-titrated. One month later, the patient came
for follow up and reported some weight loss and polyuria. He had become increasingly stressed
for his condition and noted that he had lost 4kg. I did a urine test for him and indicated that still,
the urinalysis remained negative.
Based on his condition, I administered a gliclazide and gave him lancets, strips and a
meter (Haas et al., 2012). I trained him about blood sugar monitoring DVLA rules and
hypoglycaemia. After six weeks, he attended for a review appointment and told me he had been
concordant with gliclazide drug. This time he reported a feeling of increased thirst, frequent
urination and blurred vision. The result from a laboratory test showed that the patient had a blood
sugar level of between 16mmol/l to 20mmol/l. Urinalysis at this time showed the presence of
glucose and ketones. The presence of glucose and ketone in urine assured me that the patient had
type 1- diabetes but not type 2, as I had earlier predicted.
Differential Diagnoses

NURSING PRACTICE 3
Diabetes type 1 is a health condition that is common to children and adults. It is a chronic
metabolic disorder that is characterized by the failure of the pancreas to release the required
insulin that can regulate blood glucose level in the body. The level of insulin may be little or no
insulin when some of the cells that produce insulin are destroyed in the pancreas (Funnell et al.,
2012). Lack of enough insulin makes glucose to pile up in the blood instead of penetrating in the
tissues. As a result, one is unable to utilize sugar for energy. Furthermore, the increased levels of
sugar that remains in the bloodstream leads to excessive dehydration, frequent urination and
destruction of cell tissues that are found in the body system. This is the reason why Kelvin was
experiencing a high level of urination and skin infection (Marcolino et al., 2013).
Type I diabetes is an autoimmune disorder. It starts by attacking the immune system of
the body, which results in the destruction of insulin-producing cells, also referred to as beta cells
in the pancreas being destroyed (Kerner & Brückel, 2014). It is not well known on why the
immune system attacks and destroys beta cells but several studies have demonstrated that the
condition is genetically predisposed. This is why Kelvin’s family had a history of type 2
diabetes. That does not mean it is a must they will get the disorder, but they will be at a high risk
to the conditions. As it is evidenced by (Delamater et al., 2014), environment, viral infections
and diet trigger the type 1 diabetes in individuals with a genetic predisposition. The symptoms of
the conditions may include weakness, blurry vision, irritability, frequent urination and dizziness.
Hypoglycemia can result in a coma if not corrected immediately with the required diet.
Type I diabetes is diagnosed by the combination of symptoms plus a person’s age and
blood tests. The blood tests constitute tests for sugar levels and soluble substances such as
glucose or ketone. Diabetes type 1 can be diagnosed through various blood tests, namely: