Assessment 2: DKA, HHA, and Diabetes Education in Primary Care

This assignment, completed by a nursing student, addresses key aspects of diabetes management, focusing on Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic Acidosis (HHA), and patient education within a primary health care setting. The student's answers cover the roles of pancreatic islet cells in glucose regulation, differentiating between gluconeogenesis and glycogenolysis, and outlining steps for educating newly diagnosed diabetic clients about managing blood sugar levels. The assignment delves into the pathophysiology of DKA, including clinical presentations, blood glucose, and ketone levels, confirming diagnosis. It also examines the pathophysiology, diagnosis, and management priorities of HHA, including clinical presentations and the identification of genetic and diagnostic markers for Type 1 Diabetes Mellitus (T1DM). Furthermore, the assignment includes instructions for providing patient education on foot care in diabetes and explaining HbA1c testing and its significance in monitoring average blood glucose levels. The answers demonstrate a comprehensive understanding of diabetes-related conditions and patient care strategies.

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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:
Alpha cells (A cells) produce the glucagon hormone, this hormone prevents the
blood glucose level to droop down. After eating, the blood glucose level
decreases, and thus pancreas are stimulated to release glucagon which will
provide signals to the muscle cells and liver that will be eventually responsible
for converting the glycogen into glucose (glycogenolysis) and maintaining the
Answer:
Click here to enter text.
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blood glucose level (Hughes et al., 2018).
Beta cells (B cells) secret the hormone insulin, and has an opposite action of
maintaining glucose level as compared to the glucagon. These hormone
absorb the glucose, when the blood glucose level is extremely high and
therefore maintain the glucose level in the body (Boland, Rhodes & Grimsby,
2017).
Delta cells (D cells) produce the somatostatin hormone, which affects different
parts of a human body. The excess secretion of somatostatin hormone will
result in reduction of different endocrine hormone and might also suppress the
secretion of insulin releases by the pancreas that will ultimately increase the
blood glucose level and also result in the condition of diabetes mellitus (Riggs,
Itakura & Boyer, 2018).
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 defined as the process of producing glucose from the non-
carbohydrate sources, such as lactic acids and amino acids convert
themselves to produce glucose. It is the anabolic process which produces six
ATP’s that is further used for producing glucose and occurs in the tissues and
liver with high claim for glucose (Chung et al., 2015).
Whereas, Glyconeolysis is defined as the procedure of glycogen breakdown
and during this procedure the glycogen is separated or broken down into the
form of glucose-6-phosphate. It is the catabolic process which produces limited
quantity of ATP and occurs in the muscle and liver (Chung et al., 2015).
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:
The patient had 2.8 mmol/L BGL that exhibit the condition hypoglycaemia and
thus require the patient to increase their awareness of managing their blood
glucose level. The steps used for educating the newly diagnosed patents are
Comment:
Click here to enter text.
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as follows (American Diabetes Association, 2017):
 Providing an introductory information to the patient that will help them to
enhance their knowledge reading diabetes and its management.
 Educating the patient to monitor their blood glucose level regularly
using glucometer or BGL evaluation.
 Educating the patients to improve their lifestyle habits and adopt
strategies such as exercising, physical mobility and yoga that will help
them to manage their blood glucose level.
 Educating the patient to plan their meal that has low sugar and
saturated fat intake to improve their insulin production and also manage
their weight.
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:
Diabetic Ketoacidosis (DKA) is considered as the acute metabolic impediment
of diabetes that is characterised by metabolic acidosis, hyperglycaemia and
hyperketonemia. DKA is associated with type 1 diabetes mellitus and
progresses when inadequate amount of insulin is present in the patient body
and they cannot meet the simple metabolic demands of the body. The insulin
deficiency trigger the human body to metabolize amino acids and triglycerides
instead of the glucose to predict energy that result in insulin deficiency and
further osmotic diuresis triggering the effect of Diabetic ketoacidosis. There are
other physiological stressor that is also accountable for triggering the condition
of DKA associated with low level of insulin, which includes trauma, myocardial
infraction, pneumonia, UTI, stroke and pancreatitis (Umpierrez & Korytkowski,
2016). Hence, the above mentioned stressor and the inadequate amount of
insulin result in the progression of DKA condition in the patient. The clinical
presentation of DKA are vomiting, nausea, anorexia, diffused abdominal pain
and reduced appetite.DKA is confirmed if the serum concentration is high in
ketone, therefore exhibiting the condition of DKA when the blood ketone level is
more than 5 mEq/L and the blood glucose level is more than 250 mg/dL (which
is considered extremely high). If the blood PH value is less than 7.3, it also
exhibit the presence of Diabetic Ketoacidosis (DKA) (Gomez et al., 2016).
Comment:
Click here to enter text.
Question 5 Explain the following, in detail;
 pathophysiology (1 mark per detail = 5 marks)
Satisfactory response
Yes ☐ No ☐
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 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)
Answer:
Hyperosmolar Hyperglycaemic Acidosis (HHA) is a life-threating health
condition that is majorly caused due to lactic acidosis among the patient
suffering from type 2 diabetes mellitus. This condition is triggered during
inadequate availability of insulin that result in dehydration therefore making the
blood additionally more concentrated as compared to the normal and hence
lead to the condition of hyperosmolarity. The condition of hyperosmolarity result
in the effect of osmotic diuretic, which further leads effects the organs and lead
to cardiovascular dehydration without substantial ketoacidosis. The
pathophysiology of HHS is similar to that of DKA, except they differ in the level
of rigorousness of dehydration, metabolic acidosis and ketosis (Umpierrez,
2018). The initial symptoms of HHS includes polydipsia, polyuria and weight
loss and develop and become severe in some days. The condition of
hyperglycemia progresses that leads to neurological symptoms and decrease
the conscious state of the patient. Therefore, it leads to enhanced level of
serum glucose which causes osmotic diuresis and dehydration.
If the blood glucose level is more than 30 mmol/L, the osmolarity is more than
320 mOsm/kg, the bicarbonate level is more than 15 mEq/L and the blood
ketone level is 30 md/dL leads to the condition of HHS (Haak, Van & Van,
2015).
The clinical presentation of HHS are nausea, weakness, dehydration, vomiting,
tremors, low blood pressure, headache and altered level of consciousness.
The three management priorities of Hyperosmolar Hyperglycaemic Acidosis
are as follows (Wooldridge & Johnston, 2018):
 Quick rehydration and avoidance of hypovolaemia condition.
 Reverse the condition of severe hyperglycaemia into the form of
euglycaemia.
 Maintaining electrolytic balance
Comment:
Click here to enter text.
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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:
The primary cause of type 1 diabetes mellitus is unknown but there are various
associated risk factors that lead to the condition of diabetes. There are three
different types of genetic and diagnostic markers that lead to the condition of
type 1 diabetes namely HLA-DQA1, HLA-DRB1 and HLA-DQB1 genes. These
markers will deliver instruction to produce proteins which will affect the immune
system and increase the risk of type 1 diabetes mellitus (Pociot & Lernmark,
2016).
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:
The healthcare professionals are responsible for providing diabetes education
to the patient where foot care is the primary concern. The education session
will encompass the foot care activities that must be followed by the patient to
effectively manage their illness. In the education session, the patient will be
educated to adapt self-care strategies to manage their health and incorporate
activities such as washing their feet regularly, trimming their toenails, weaning
comfortable footwear, modifying their daily activities of life and their living
standards and following the educational instruction that is given to them to
manage their health and take care of their foot (Hernandez, 2016).
Yes ☐ No ☐
Comment:
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:
Haemoglobin A1c is termed or abbreviated as HbA1c, which is used by the
health practitioner to evaluate the average blood glucose level of the patient
Yes ☐ No ☐
Comment:
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suffering from either type1 or type 2 diabetes mellitus. HbA1c test exhibit the
blood sugar level of the patient from past 3 months that will help the patient to
gain relevant idea regarding their diabetic condition. If the HbA1c reading is
between the range 5.7% to 6.4%, it exhibit that the patient is under increased
risk of developing diabetes, where of the HbA1c level is more than 6.5% (14
test score), it exhibit that the patient already has the condition of diabetes
(Sohal, Wats & Vij, 2016).
Click here to enter text.
References
American Diabetes Association. (2017). 2. Classification and diagnosis of diabetes. Diabetes care,
40(Supplement 1), S11-S24.
Boland, B. B., Rhodes, C. J., & Grimsby, J. S. (2017). The dynamic plasticity of insulin production in β-cells.
Molecular metabolism, 6(9), 958-973.
Chung, S. T., Chacko, S. K., Sunehag, A. L., & Haymond, M. W. (2015). Measurements of gluconeogenesis
and glycogenolysis: a methodological review. Diabetes, 64(12), 3996-4010.
Gómez-Ríos, M., Gómez-Ríos, D., Paech, M., & Diéguez-Fernández, M. (2016). Managing diabetic
ketoacidosis in pregnancy. Saudi journal of anaesthesia, 10(2).
Haak, M. B., van Santen, S., & van der Hoeven, J. G. (2015). Severe metabolic acidosis in a patient with an
extreme hyperglycaemic hyperosmolar state: how to manage?. Magnesium (mmol/l), 1(1.11), 0-9.
Hernandez, M. (2016). Improving Foot Care and Kidney Disease Screening Through Implementation of
American Diabetes Association Standards–2016 in The Primary Care Setting.
Hughes, J. W., Ustione, A., Lavagnino, Z., & Piston, D. W. (2018). Regulation of islet glucagon secretion:
Beyond calcium. Diabetes, Obesity and Metabolism, 20, 127-136.
Pociot, F., & Lernmark, Å. (2016). Genetic risk factors for type 1 diabetes. The Lancet, 387(10035), 2331-
2339.
Riggs, A. D., Itakura, K., & Boyer, H. W. (2018). From somatostatin to human insulin. In Recombinant DNA
Products (pp. 37-45). CRC Press.
Sohal, S., Wats, A., & Vij, C. (2016). Evaluation of glycosylated hemoglobin (HbA1c) levels in hypothyroid
and hyperthyroid patients. Annals of Applied Bio-Sciences, 3(1), A101-107.
Umpierrez, G. E. (2018). Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar
State. Diabetes Complications, Comorbidities and Related Disorders, 1-21.
Umpierrez, G., & Korytkowski, M. (2016). Diabetic emergencies—ketoacidosis, hyperglycaemic
hyperosmolar state and hypoglycaemia. Nature Reviews Endocrinology, 12(4), 222.
Wooldridge, B., & Johnston, P. (2018). Management of hyperglycaemic emergencies. In The Beginner's
Guide to Intensive Care (pp. 269-278). CRC Press.
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