USC NUR231 Assignment: Nursing Care Plan for Sharon's Health Issues

This report details a nursing care plan for Sharon, a 58-year-old female diagnosed with type 2 diabetes and chronic kidney disease. The assignment analyzes Sharon's case, interpreting the relationship between her diabetes and kidney disease, comparing her blood glucose levels to normal ranges, and suggesting the addition of Glucovance to her medication regimen. Furthermore, the report suggests two new medications to improve Sharon's condition and outlines a comprehensive nursing care plan, emphasizing the importance of assessment, collaborative care, documentation, and resource coordination. The analysis integrates pathophysiological and pharmacological concepts, creative and critical thinking regarding new medication design, and ethical considerations relevant to nursing practice, supported by evidence-based arguments and Harvard referencing.

Running head: BACHELOR OF NURSING
BACHELOR OF NURSING
Name of the Student
Name of the University
Author note

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Table of Contents
Question 1- Interpretation of the relation between Sharon’s diabetes and chronic kidney disease.2
Question 2 – Comparison of Sharon’s blood glucose level to normal glucose level......................2
Question 3 – Addition of Glucovance 500mg/2.5mg to the current medication list of Sharon......3
Question 4 – Suggestion of two new medications to Sharon..........................................................4
Question 5 – Preparation of a nursing care plan..............................................................................4
Reference........................................................................................................................................6s

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Question 1- Interpretation of the relation between Sharon’s diabetes and
chronic kidney disease
In the given case study, Sharon is an old female of 58 years of age. Her height is 170cm
and her weight is 120kgs. Her blood glucose level value is 8 to 11 mmol/L in the day and 7 to 8
mmol/L in the morning. Diabetes is the type of disease where the body cannot prepare enough
insulin. Because of diabetes, the small blood vessels of the body are injured so when the small
blood vessels of the kidney are injured, it becomes difficult for the kidney to clean the blood. So
the body of the diabetic patient will retain more water and salt than it is supposed to be. This well
lea to gain in weight and swelling of the ankle. Also the urine may contain proteins.
She is taking the medicine metformin Sandoz of 1000mg twice per day. Metformin an
anti-hyperglycemic medicine used to control type II diabetes mellitus. It is considered to be the
anti hyperglycemic drug because it lowers the glucose concentration in the blood of a diabetic
patient without causing hypoglycaemia. Metformin is the first line therapy for diabetes
throughout the world. The molecular mechanism is still not clearly understood (Markowicz-
Piasecka et al. 2017). Till now multiple potential therapy has been proposed. The mechanisms
include inhibition of the complex I of mitochondrial respiratory chain, activation of AMP-
activated protein kinase, inhibition of glucagon induced elevation of cyclic adenosine
monophosphate with reduction in the activation of protein kinase A (Morrissey et al. 2016).
Other mechanisms include inhibition of glycerophosphate dehydrogenase of mitochondria and
also an effect on the microbial flora of the gut. The net result of the mechanism is that it reduces
the procedure of gluconeogenesis which means the glucose production in the liver decreases. It
also has an effect of insulin-sensitization in the along with multiple actions in the tissues of liver,
skeletal muscle, adipose tissue, endothelium and the ovary (Hibma et al. 2016)
Question 2 – Comparison of Sharon’s blood glucose level to normal glucose
level.
BGL stands for blood glucose level and it represents the amount of glucose present in the
blood. Glucose is the simplest of all sugars and normally only 4gms of glucose should present in
a human of weight 70kgs. An increase in the amount of glucose lead to the condition of glucose
toxicity. This toxicity is so crucial that it leads to the malfunctioning of the cells of the body and

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also the pathology. This abnormality is also known as complications of glucose. Increase in the
glucose blood levels is called hyperglycemia and decrease in the blood level of glucose is called
hypoglycaemia (Portillo-Sanchez et al. 2015).
The patient’s blood glucose level after meal and throughout the day is 8 to 11 mmol/L and 7 to 8
mmol/L in fasting condition, after waking up in the morning. The normal blood glucose level of
a non-diabetic person before meal is 4 to 5.9 mmol/L in the fasting condition and under
7.5mmol/L after meals (Portillo-Sanchez et al. 2015). For a person suffering from type II
diabetes the blood glucose level value should be in the range of 4 to 7 mmol/L in fasting
condition and under 8.5mmol/L after meal (Ferrannini and DeFronzo 2015) This should be the
current blood glucose level values of Sharon as she is taking metformin Sandoz since the last
three years. So if compared with the normal blood glucose levels of a diabetic patient, Sharon’s
blood glucose is higher. Her BGL value should have lowered than it is in the present as she is
taking high dosage of metformin daily. Her blood glucose should have dropped down to normal
BGL value.
Question 3 – Addition of Glucovance 500mg/2.5mg to the current medication
list of Sharon.
In the given case study Sharon has been found take metformin twice a day. Still after
taking the medicine, her blood glucose level is high both in the fasting condition and in after
taking the meal. Normally the blood glucose level is high after having meal for both the diabetic
patient and the non-diabetic patient. Sharon’s blood glucose level is really high and so she need
other medicines. She needs to take Glucovance 500mg/2.5mg along with the present medicines
that she is taking. Glucovance is used mainly when the medicine metformin along with exercises
and proper diet fails to treat diabetes (Balijepalli et al. 2017). This medicine is given to patients
whose blood glucose level has not been controlled, by the usage of metformin and sulfonylurea.
Glucovance is comprised of glibenclamide and metformin hydrochloride. If the blood glucose
level is not controlled properly then hyperglycemia and hypoglycemia occurs (Tabatabaei-
Malazy et al. 2016).

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There is one thing which needs to be considered in this case is the patient is consistently
suffering from kidney diseases and some proteinuria also. This drug cannot be prescribed to
patients suffering from severe or chronic kidney problems. This thing needs to be considered
seriously along with the previous medicines so that the kidney problems does not get increased.
So along with these medicines, medicines regarding the kidney problems must also be given so
that the conditions of the kidney do not get decreased (Fleming, Fleming and Davis 2015).
Question 4 – Suggestion of two new medications to Sharon
The medicines that Sharon is taking at present is not enough to cure her completely, she
needs some new medicines. If some better medicines are invented for curing diabetes mellitus
and the chronic kidney diseases from which she is suffering, then Sharon may get cured
completely. This type of diabetes or diabetes mellitus causes increase in the level of blood sugar.
Different long term and short term issues are created because of the increase of sugar in the
blood like damage in the nerve, kidney damages, blindness and also it causes extreme heart
diseases. Sodium-glucose co-transporter inhibitor as a drug if used or if invented cab help in
preventing the kidneys from the reabsorption of glucose (Sinclair, Dunning and Rodriguez-
Mañas 2015). So if such a medicine is invented then more glucose will be excreted and this will
obviously lead to the decrease in the level of glucose in the blood. So if this medicine is
invented will surely become an extra or become an additional medicine along with the medicines
which are still use today for the purpose of the treatment of diabetes mellitus.
The patients suffering from diabetes mellitus also suffer major issues regarding the
kidneys. The patients suffering from diabetes normally face the problems of proteins growing in
the tissues and this ultimately lead to scar formation and this cause kidney failures. These kidney
failures are so critical that the patient may need to dialysis regularly and sometimes this
conditions lead to the requirement to do transplantation of kidneys. A medicine is needed to be
invented which can have potential effect of healing wounds and which can cause reduction in the
lesions of the nephrons of the kidneys and in this way the kidney diseases can be cured (Looker
et al. 2015). If such medicines are invented then no doubt Sharon will get cured.

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Question 5 – Preparation of a nursing care plan
An appropriate way of how to take care of all patients is provided by the registered nurse
standard. In the given case study, the patient needs proper care. So if Sharon is provided with a
proper care by following the by following the different rules and regulations of the registered
nurses, then she will surely start improving and will get cured. The nurse need to do the
following things for curing Sharon:
 The nurse need to assess all the things or data that are available and also she need to
assess all the evidences that are available so as to prepare the care plan up to her best
(Scanlon et al. 2016).
 A collaborative care plan need to be prepared by her , which must include the goals of
the care plan, the options, the goals of the care plan and also the options which must be
from type II diabetes mellitus and also from chronic problems of kidneys. So the nurse
must start her treatment accordingly and should provide her with medicines of diabetes
mellitus (Scanlon et al. 2016).
 For the purpose to get a proper outcome, the nurse must prepare all the documentation
and at the same time she need to record all the improvements that the patient is doing
daily. She also need to do the evaluation of the records also must change the nursing
care plan according to the improvements of the patient. A patient after getting cured a
little bit need different care plan (Birks et al. 2016).
 The nurse is responsible for doing the planning and negotiation of the evaluation of the
plan and she will also do the frame for doing the treatment. A proper time period should
be prepared for Sharon and must be followed that (Birks et al. 2016).
 The nurse is responsible for coordinating about all the available resources effectively
and also very effectively use resources for the preparation of the action plan. The nurse
at first make sure that the things required for her to treat the patient are available or not.
The nurse needs the medicines from time to time and also she requires proper economic
facilities for arranging an efficient diet plan for Sharon, the patient (Birks et al. 2016).

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Reference
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Hypoglycemia: a review of definitions used in clinical trials evaluating antihyperglycemic drugs
for diabetes. Clinical epidemiology, 9, p.291.
Birks, M., Davis, J., Smithson, J. and Cant, R., 2016. Registered nurse scope of practice in
Australia: an integrative review of the literature. Contemporary Nurse, 52(5), pp.522-543.
Ferrannini, E. and DeFronzo, R.A., 2015. Impact of glucose-lowering drugs on cardiovascular
disease in type 2 diabetes. European heart journal, 36(34), pp.2288-2296.
Fleming, J.W., Fleming, L.W. and Davis, C.S., 2015. Fixed-dose combinations in type 2
diabetes–role of the canagliflozin metformin combination. Diabetes, metabolic syndrome and
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pharmacokinetics, 55(6), pp.711-721.
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Turner, C., Palmer, C.N., Nogoceke, E. and Groop, L., 2015. Biomarkers of rapid chronic kidney
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Markowicz-Piasecka, M., M Huttunen, K., Mateusiak, L., Mikiciuk-Olasik, E. and Sikora, J.,
2017. Is metformin a perfect drug? Updates in pharmacokinetics and
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Subbarayan, S., Webb, A., Hecht, J. and Cusi, K., 2015. High prevalence of nonalcoholic fatty

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liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase
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