Comprehensive Case Study: Integrated Care for UTI, Diabetes, & Graves'

This case study focuses on the management of a patient presenting with a urinary tract infection (UTI), type 2 diabetes mellitus, and Graves' disease. It details the nursing actions required to confirm a UTI diagnosis, interpret dipstick test results, and implement measures to reduce future UTI incidence. The study also addresses the pathophysiology and management of type 2 diabetes, including the impact on wound healing and the significance of HBA1c levels. Furthermore, it explores the implications of Graves' disease, including potential complications, and outlines comprehensive nursing care plans addressing UTI symptoms, Graves' disease management, and wound care. The case concludes with recommendations for referrals to allied healthcare professionals, such as an endocrinologist, optician, microbiologist, and psychiatrist, to ensure comprehensive and integrated patient care.

Running head: CLINICAL SCENARIO 2 1
Clinical Scenario 2
Name
Institution

CLINICAL SCENARIO 2 2
Clinical Scenario 2
1. Nursing actions to confirm if it is a UTI
The first action would be to monitor Betty’s urinary pattern such as hesitancy, frequency,
and urgency. The nurse also needs to assess the patient’s urine for characteristics such as the
concentration, color, cloudiness, and volume (Rowe & Juthani-Mehta, 2014). The nurse needs to
also assess her history of sexual transmitted illnesses.
2. Things that could show up in a dipstick for UTI diagnosis
The dipstick test is invaluable in the diagnosis of the UTI through assessment of pyuria
and bacteriuria (Mambatta et al., 2015). Therefore, the levels of nitrites and leucocyte esterase
would be expected to be highly elevated in Betty’s urine if she has a urinary tract infection.
3. Findings that would support a diagnosis of UTI
From Betty’s symptoms, the findings such as incontinency of urine, fever, and the
offensive odour support the diagnosis of a UTI.
4. Reducing incidence of UTI in the future
Management of the diabetic condition and proper urinary tract hygiene could be some of
the measures Betty should take to reduce incidence of UTI in the future (Al-Badr & Al-Shaikh,
2013).
5. Cause of lymphedema
Cancer and infection are some common causes of lymphedema. Betty has a history of
breast cancer and masectomy, which are risk factors for lympedema.
6. Using her right arm for BP
Betty had a right mastectomy, which might have led to lymphedema. Using her right arm
to take BP might cause swelling and discomfort.

CLINICAL SCENARIO 2 3
7. Normal blood glucose level
The normal blood sugar levels range from 3.9 to 6.0 mmol/L when fasting (and up to
7.8mmol/L after a meal (Melmed, 2016). Infections (including UTIs) are often associated with a
rise in stress hormones such as cortisol, which often cause an increase in the circulating blood
sugars.
8. Signs and symptoms if Betty had a hypoglycemic episode
Betty would experience shakiness, heart arrhythmias, anxiety, sweating, hunger, and
irritability if she experiences a hypoglycemic episode (Melmed, 2016).
9. Pathophysiology of type 2 diabetes mellitus
Type 2 DM arises through two different mechanisms. The first mechanism is the low or
inadequate production of insulin by the beta cells of Langerhan of the pancrease. As a result, the
insulin action is reduced, resulting in high levels of circulating glucose. The second mechanism
is through insulin resistance. The body cells might fail to respond to insulin actions, even when
the insulin levels are high (Melmed, 2016). Consequently, there is a sudden increase in the levels
of glucose in the blood. Insulin resistance is linked to lack of physical activity and obesity.
10. Differences with type 1 diabetes mellitus
Type 1 DM, also known as insulin-dependent, is an autoimmune disease that is detected
during childhood. The body’s immune cells mistakenly attack the beta cells of the pancreas that
produce insulin (Melmed, 2016). Consequently, the pancreas is incapable of producing increase.
The patient requires constant injection of insulin to survive.
11. Effect of type 2 diabetes on wound healing
Diabetes has a negative influence on the wound healing properties of the patient. The
slow wound healing is linked to the high levels of circulating blood glucose. Higher than optimal

CLINICAL SCENARIO 2 4
glucose levels have been linked to stiff arteries, which causes poor circulation and the
concomitant diabetic neuropathy. Delayed wound healing might expose Betty to an increased
risk of bacterial and fungal infections, and even gangrene.
12. HBA1c
Glycated haemoglobin (HBA1c) results when the circulating haemoglobin attaches to the
sugars in circulation. The glucose attaches to the haemoglobin in the red blood cells, and makes
it “glycated” (Melmed, 2016). Since the average lifespan of red blood cells is 120 days, the
levels of HBA1c can help assess the circulating glucose levels in the patient for the two to three
months. High levels of HBA1c could imply that Betty’s sugar levels have been elevated in the
past three months.
13. Graves’ disease
The disease (also toxic diffuse goiter) is a thyroid autoimmune disease. It is caused when
the body’s antibodies attack the thyroid, causing hyperthyroidism. The patient might present with
an enlarged thyroid, but the symptoms might extend to severe signs such as Graves’
ophthalmopathy, dermopathy, and even psychosis (Burch & Cooper, 2015). Therefore, Betty
might present with excessive lacrimation, depression, or even psychosis if the disease becomes
unstable.
14. Nursing care plans for Betty
The first plan is on her UTI symptoms. The major goal for the patient is relief of the
discomfort and pain caused by the urinary tract infection. The actions would include
commencement of antimicrobial and antispasmodic agent treatment after diagnosis. The nurse
can also evaluate of the patient’s knowledge of antimicrobial use. The expected outcome is Betty
experiencing relief of the pain and discharging normal urine.

CLINICAL SCENARIO 2 5
The second plan is on the management of Graves’ disease to avoid complications. The
goal for this plan is to prevent the development of complications associated with unstable
Graves’ disease. The course of action include using stabilizing medications for her symptoms
and referring her to a specialist to manage her condition. The expected outcome is reduced
complications from Grave’s disease such as confusion or ophthalmopathy.
The third plan is the treatment of her wounds caused by the fall she had. The goal for this
plan is to ensure that her wounds heal quickly to prevent any associated complications. The
course of action if to provide guidelines and information about appropriate diet for diabetic
patients, and encourage the patient to adhere to antidiabetic medications. The expected outcome
is quick wound healing of the patient.
15. Allied healthcare professionals to refer Betty
The patient can be referred to an endocrinologist for her diabetes mellitus treatment, an
optician to assess her probability of developing Graves’ ophthalmopathy, a microbiologist to
assess her urinary tract infection and a psychiatrist to assess her symptoms of confusion.

CLINICAL SCENARIO 2 6
References
Al-Badr, A., & Al-Shaikh, G. (2013). Recurrent urinary tract infections management in women:
a review. Sultan Qaboos University Medical Journal, 13(3), 359.
Burch, H. B., & Cooper, D. S. (2015). Management of Graves disease: a review. Jama, 314(23),
2544-2554.
Mambatta, A. K., Jayalakshmi Jayarajan, V. L. R., Harini, S., Menon, S., & Kuppusamy, J.
(2015). Reliability of dipstick assay in predicting urinary tract infection. Journal of
family medicine and primary care, 4(2), 265.
Melmed, S. (2016). Williams textbook of endocrinology. Elsevier Health Sciences.
Rowe, T. A., & Juthani-Mehta, M. (2014). Diagnosis and management of urinary tract infection
in older adults. Infectious disease clinics of North America, 28(1), 75.