Assessment 2: DKA, HHA, Education in Primary Health Care (HLTENN025)

This document presents a student's responses to an assessment task (Assessment 2) for the HLTENN025 unit, focusing on implementing and monitoring care for individuals with diabetes. The assignment covers key aspects of diabetes management, including the roles of glucagon, insulin, and somatostatin in regulating blood glucose; the differences between gluconeogenesis and glycogenolysis; and step-by-step instructions for educating newly diagnosed diabetic clients about managing low blood sugar. The assessment delves into the pathophysiology of Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic Acidosis (HHA), requiring detailed explanations of clinical presentations, diagnostic markers (blood glucose, ketone levels, serum osmolarity, and bicarbonate levels), and management priorities. The student also identifies genetic and diagnostic markers for Type 1 Diabetes Mellitus (T1 DM) and provides instructions for foot care education in a primary health care setting. Additionally, the assignment requires an explanation of the HbA1c test and its implications for diabetes diagnosis and management. The student's answers demonstrate their understanding of diabetes care in a primary health care setting.

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Assessment Task 2: DKA, HHA & Education in the Primary Health Care Setting
Student Version: Knowledge
Student information
Student name: Student
ID:
Section A – Program/Course details
Qualification code: HLT54115 Qualification title: Diploma of Nursing
Unit code: HLTENN025 Unit title: Implement and monitor
care for a person with
diabetes
Section B – Assessment task details
Assessment
number:
2 Semester/Year: Enter Semester/Year
Due date: Week 8 Date of submission:
Assessment task
results:
This assessment task will be marked as:
☒ Graded result: 40 marks. To be deemed satisfactory, a minimum score of 20/40
must be achieved.
☐ Other
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Section B – Assessment task details
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Section C – Conditions for Assessment
Conditions:
 Students to enter their details on coversheet and answer questions on template provided.
 Cover sheet and answers to be submitted together in word doc format. No jpegs, images,
screenshots or pdf formatted work will be accepted.
 All pages must have the student’s name, ID number and signature on it, where stipulated
 Due date for this assessment task is Week 8.
 Any questions are to be addressed to the teacher.
 This is an individual assessment task (No group answers will be allowed).
 Answers to be typed using Arial font size 12 and double-spaced
 Referencing in APA 6th Style (include Reference List and in-text referencing)
 Plagiarism will not be accepted.
 A minimum score of 20/40 to be deemed satisfactory for this assessment.
 Students will be allowed two attempts to achieve a satisfactory result.
 If a second attempt is required, this is to be completed one week after the first attempt to allow for
revision.
 Students requiring a second attempt will be awarded a maximum score of 20/40 if they achieve a
satisfactory result.
 Please let the teaching staff know if special consideration or adjustment will be required before the
assessment task begins. Approval must be confirmed prior to commencement.
Equipment/resources students must supply: Equipment/resources to be provided by the
RTO:
Pen/laptop, copy of Assessment Task Coversheet
and
Worksheet
Assessment Task Cover sheet/worksheet to be
downloaded by the student, from Brightspace

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Section D – Instructions to Students:
Task Instructions:
 Students are to answer all questions using their own words.
 Plagiarism will not be accepted.
 Answers must be typed directly onto template provided.
 Answers must be typed in Arial font size 12 and double spaced
 Due date for this assessment tsk is week 8.
 Students are allowed two attempts at this assessment task.
 Any late submissions will be deemed as a second attempt.
Section E – Marking Guide Student Answer Sheet
Assessment
number:
2 Assessment
title:
DKA, HHA and Education in the Primary
Health Care Setting
Student ID: Student name:
Unit code: HLTENN025 Unit title: Implement and monitor care for a person with
diabetes
Date submitted:
Questions: Provide your responses in the boxes below each question.
Question 1 Pancreatic islet cells produce glucagon, insulin and
somatostatin.
Which islet cells produce each hormone and how does each
hormone work to regulate blood glucose levels?
(0.5 marks per correct islet cell identification)
(0.5 marks per description of hormone action)
(3 marks in total)
Satisfactory response
Yes ☐ No ☐
Answer:
1. Alpha cells secrete hormone glucagon, Beta cells release insulin, Delta
cells release somatostatin (Gruccio et al., 2016).
2. As blood glucose level decreases, then the alpha cells releases glucagon
to regulate blood sugar level; when there is a rise in the sugar level then
beta cells release insulin to manage blood sugar level; when there is a
raised level of insulin and glucagon the delta cells secrete somatostatin to
Answer:
Click here to enter text.
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regulate blood glucose level.
Question 2 What is the difference between Gluconeogenesis and
Glyconeolysis?
(1 mark per definition)
(2 marks in total)
Satisfactory response
Yes ☐ No ☐
Answer: Gluconeogenesis is a method of production of glucose from non-
carbohydrate sources, whereas the Glyconeolysis is the process of breakdown
of glycogen. During the Gluconeogenesis process molecules like amino acids
and lactic acids convert into glucose. However, during the Glyconeolysis
process, the glycogen is broken and converted to form glucose-6-phosphate.
Comment:
Click here to enter text.
Question 3 Describe, step by step, what you would need to educate a
newly diagnosed diabetic client, regarding the management
of a blood sugar level of 2.8 mmol/L.
(1 mark per step)
(4 marks in total)
Satisfactory response
Yes ☐ No ☐
Answer: If the patient is detected with blood glucose level of 2.8 mmol/L, then
that means the patient is having low blood glucose level. To manage the blood
glucose level they should:
 Eat 10-30 grams of fast-acting carbohydrate (such as fruit juice, candies,
glucose tablets).
 Foods which consist of fats and protein should be neglected as they slow
down the body’s ability to absorb glucose.
 They should avail emergency kits comprising of Glycagon as it helps in
raising the blood glucose levels.
 The patient should have someone close who is well-trained to identify low
glucose level and should be able to treat it quickly.
Comment:
Click here to enter text.
Question 4 Explain, in detail, the pathophysiology of Diabetic
Ketoacidosis. Include clinical presentation, blood glucose
and blood ketone levels confirming diagnosis.
(1 mark per detail – 10 details required)
(10 marks in total)
Satisfactory response
Yes ☐ No ☐
Answer: When there is excess amount of glucagon, there is a deficiency in
the level of Insulin which allows the body to break triglycerides and amino
acids to produce energy as an alternative of glucose. Glucagon is responsible
for the mitochondrial transformation of free fatty acids into ketones. Generally
insulin is responsible for the restriction of ketogenesis, however due to the
deficiency of insulin, ketogenesis occurs. Due to insulin deficiency there is
Hyperglycemia which causes an osmotic diuresis that cause urinary loss of
water and electrolytes. Urinary excretion of ketones compels extra loss of
sodium and potassium. The level of sodium in serum may decrease due to
Comment:
Click here to enter text.
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natriuresis or increase in the elimination of large quantity of free water.
Sometimes there is loss of potassium in large volume. In spite of the fact that
due to a crucial loss of potassium, the initial level of potassium in the serum is
either normal or increased due to the extracellular movement of potassium in
reaction to acidosis. During the insulin therapy, the potassium level generally
decreases as all the potassium is sent into the cells. If potassium level in
serum is not diagnosed and replaced as required, serious hypokalaemia may
develop and harm the body (Brutsaert, 2019).
Clinical presentation – excessive thirst, repeated urination, nausea, vomiting,
fatigue, confusion, and many more.
High ketone levels in blood means high level of fatty acids which leads to
insulin resistance. The patient with critical Ketonaemia will require excess
amount of insulin to regulate the BGL (NICE, 2015).
Question 5 Explain the following, in detail;
 pathophysiology (1 mark per detail = 5 marks)
 confirmation of diagnosis i.e blood glucose, blood
ketone, Se osmolarity and Se bicarbonate levels, and
clinical presentation (1 mark per diagnostic marker = 6
marks)
 list three management priorities of Hyperosmolar
Hyperglycaemic Acidosis (1 mark)
(12 marks in total)
Satisfactory response
Yes ☐ No ☐
Answer:
1. Pathophysiology – It is a field in medical science which focuses on the
function and indications of affected organs due to a certain disease,
generally for the purpose of diagnosis and patient treatment.
Pathophysiology is a series of steps that help the specialists determine the
test, diagnosis and treatment of the disease. Pathophysiology aims in
identify the disease, its aetiology, symptoms, diagnosis, treatment,
prognosis.
2. Biomarkers are essential components in the body that helps to diagnose a
specific health condition.
 In blood HbA1c acts as a biomarker for the presence of diabetes or pre-
diabetes. By measuring the HbA1c clinicians can diagnose the blood
glucose level.
 There are 3 types of ketone diagnostic biomarker - Acetone, Beta-
hydroxybutyric acid and acetoacetic acid which are found in the breath,
blood, and urine. Detecting these ketones bodies will help in the
Comment:
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detection and cure of diabetic ketosis.
 The serum osmolarity is the measure of different solutes present inside
the plasma. Serum osmolarity is calculated to evaluate the aetiology of
hypernatremia and can used to screen alcohol intoxication. Blood,
urine, saliva, and fluids can be used to calculate the serum osmolarity
(Muñoz, Kenzie & Armstrong, 2014).
 A serum bicarbonate test analyses the quantity of CO2 in a person’s
blood. The test uses the fluid present in the blood, and not the blood
cells or platelets. The test measures millimoles of CO2. Low CO2 level
can mean person is having kidney disease, Addison’s disease, and
many more conditions. High CO2 level can mean person is having
COPD, Dehydration, and many more conditions.
3. The main concern for the management of Hyperosmolar Hyperglycaemic
Acidosis are to gradually and safely (Umpierrez & Korytkowski, 2016) –
 Standardize the osmolarity level
 Replace shortages of fluids and electrolytes
 Standardize blood sugar level
Question 6 Identify the genetic and diagnostic markers including,
their relative results, which confirms a diagnosis of T1
DM. Do not include blood glucose level, blood ketone level
or signs and symptoms.
(0.5 marks per diagnostic marker)
(2 marks in total)
Satisfactory response
Yes ☐ No ☐
Answer: Gene analysis for the diagnosis of T1 DM by the discovery of protein
based polymorphisms (HLA - human leukocyte antigens) and DNA
polymorphisms in the insulin gene. The genetic markers are ITPR3 responsible
for insulin secretion and DRB1/DQA1/DQB1 responsible for antigen
presentation (Bonifacio, 2015). The other diagnostic biomarkers that help in
the prediction of T1 DM are serum autoantibodies against B-cell antigens which
include GAD, IA-2, and Zinc Transporter 8 (ZnT8) (Bonifacio, 2015).
Comment:
Click here to enter text.
Question 7 You are running an education session in a primary health
care setting, on foot care in people with diabetes. What
instruction you would need to provide?
(10 instructions required – 0.5 marks per instruction)
(5 marks in total)
Satisfactory response
Answer: Diabetes can become dangerous to the feet. Even a small injury can
result in the serious outcome. To avoid such serious problems certain steps
Yes ☐ No ☐
Comment:
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need to be taken:
 Inspect feet daily.
 Bath feet in lukewarm water.
 Cut nails carefully.
 Wear warm clean dry socks.
 Never walk barefoot.
 Take care of blood glucose level.
 Do not smoke as it restricts blood flow to the feet.
 Keep the feet warm and dry.
 Using moisturizer daily to keep the feet dry but not to apply between the
toes.
 Get periodic foot exams to get consultation and prevention from the foot
complications of diabetes (Lobmann et al., 2014).
Click here to enter text.
Question 8 Explain HbA1c – describe the test and explain how the
result gives a reading for the patient’s average BGL over the
last 3 months. State the HbA1c reading confirming a
diagnosis of diabetes.
(2 marks)
Satisfactory response
Answer: HbA1c test (haemoglobin A1c or glycated haemoglobin test), is a
crucial blood test that provides symptoms of blood glucose level of a person
(Renz et al., 2015) (Sherwani et al., 2016).
 HbA1c below 42 mmol/mol means the individual is not having diabetes.
 HbA1c of 42 – 47 mmol/mol is referred to as pre-diabetes which means that
the patient is having high BGL than normal range but cannot be identified
as diabetes.
 HbA1c above 48 mmol/mol means the patient is having Type 2 diabetes.
Yes ☐ No ☐
Comment:
Click here to enter text.
Section F – Feedback to Student
Score: / 40
Has the student successfully completed this assessment task?
Yes No
☐ ☐
Assessor comments:
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