Nursing Assignment: Diabetes, Renal Health, Medication, and ICN Ethics

This report analyzes a nursing assignment focused on a 58-year-old female patient, Sharon, diagnosed with type 2 diabetes and potential renal complications. The assignment delves into the pathophysiology of diabetes-related kidney disease, examining how high blood glucose levels damage kidney blood vessels and discussing the role of endothelial dysfunction. It reviews Sharon's current medication, Metformin, and evaluates its effectiveness in her condition. The report also addresses Sharon's elevated BGL levels, explores the potential use of Glucovance and new drug design strategies, such as DPP-4 inhibitors and vitamin D supplements, to improve patient outcomes. Furthermore, it emphasizes the importance of nurses adhering to the ICN codes of ethics, including patient education, medication adherence strategies, and continuous monitoring of BGL levels. The report also highlights the need for nurses to address additional factors like obesity and collaborate with dieticians to formulate a comprehensive care plan.

Running head NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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1. Diabetes has been found to be one of the leading cause of kidney failure. Poor
hyperglycemia. Landmark trials conducted with patients suffering from diabetes have found
that intensive control of blood sugar level in the early onset of the disease exhibits a long
lasting effect of the risk of chronic kidney disease. The high blood glucose level damages the
blood vessel of the kidneys. When the blood vessels are damaged, they don’t work well, that
can also damage the kidneys.
According to Nasri and Rafieian-Kopaei (2015) the endothelial changes plays an
important role in the pathophysiology of renal disease. Endothelial dysfunction precedes the
changed vascular permeability and causes albuminuria. There are several markers of endothelial
dysfunction. Markers of the endothelial dysfunction like soluble intercellular and the vascular
adhesion of the molecules and the microvascular reactivity can be observed in patients with
diabetes the before any clinical manifestation of diabetes mellitus (Toth-Manikowski and Atta
2015). An accumulation of the uremic toxins and an increased parathyroid levels, increase in
patients with chronic kidney condition (Nasri and Rafieian-Kopaei 2015). Chronic kidney
disease cause insulin resistance in the tissues particularly the skeletal muscle tissues. Insulin
resistance has been found to have been reduced in patients with chronic renal disease (Nasri and
Rafieian-Kopaei 2015).
With the onset of diabetes, there is an increase in the glomerular expression of the
endothelial growth factor A (VEGF-A), parallel to the dysregulation of the other vascular growth
factors like angiopoetins-1/2, which is again accompanied by an increase in the glomerular
capillary length and diameter, increase in the glomerular volume and increased vascular
permeability (Nasri and Rafieian-Kopaei 2015). However, the mechanism under the glomerular
hyper filtration in diabetes in not understood properly. It is evident from the case study, that

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Sharon had been receiving Metformin. It is an antihyperglycemic agent that improves glucose
tolerance in patients suffering from type 2 diabetes and helps in lowering both the postprandial
as well as the basal level. Metformin reduces the production of the hepatic glucose, decreasing
the intestinal glucose absorption and improves the insulin sensitivity by enhancing the peripheral
glucose utilization and uptake (FDA 2017). Unlike sulfonylureas, metformin does not produce
hypoglycemia in individuals suffering from type 2 diabetes (Lalau et al. 2018). Metformin
treatment has been proven to be pharmacologically efficacious for mild to moderate diabetes
related renal disease (Reidy et al. 2016). Hence, as per Sharon’s physical condition, it can be said
that Metformin is an efficient drug to treat her condition.
2. The case study reveals that the BGL value of Sharon is 8-11 mmol/L throughout the day and
7-8mmol/L when she wakes up at the morning, which is quite high in comparison to the
standard blood glucose level,that remains within the range 4-5 mmol/L during fasting and up
to 7.8 mmol/L after the consumption of meals. Greater than these value signifies that the
person was having diabetes. The BGL level of Sharon signifies that she had been suffering
from diabetes, in spite of taking Metformin, since she had been diagnosed with diabetes
(FDA 2017). Metformin is an antidiebetic medicine that is normally used to control the blood
sugar level. This indicates towards the fact that the patient might be missing doses of
medicines.
3. The case study has revealed that glucovance is another oral antihyperglycemic drug. Each of
the drug is available for the oral administration of the tablets. Some of the warning size of the
disease is stomach upset, nausea and weight gain. The stomach symptoms that might occur
during the first day of the treatment can be a sign of lactic acidosis (Rahmah 2013). Serious
effect like bleeding, bruising, signs of infection. Some of the serious effect of the medication

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is low blood sugar level. Some of the symptoms that might lower the blood sugar level is
sweating, shaking, fast heartbeat.
A serious allergic reaction related to this drug is usually not seen. However, it is necessary to
remain careful about the dosage and the contraindications. As per the case study, the patients
is already under Metformin, and further administration of 500mg might lead to excessive
blood glucose level control or hypoglycemia.
4. Due to the rampant prevalence of type 2 diabetes, new drugs are still under the development.
However, this section of the assignment would discuss about the entirely new drug that can
be made. For example a drug “x” can be used in addition to the diet. It might work by the
maximum inhibition of the dipeptidyl peptidase 4. Thus inhibition of the DPP-4 might
increase the glucagon like peptide molecules, that might ultimately lead to the reduction in
the glycosylated hemoglobin and the fasting plasma glucose level. The breakdown of the
GLP drug and the glucose dependent insulinotropic polypepetide s slowed down is slowed
down. The reduction in the GLP and the GIP can stimulate the release of the beta cells in the
pancreas, while the inhibition of the release of the glucagon from the beta cells of the
pancreas. These tow collaborative effects might be used to reduce the breakdown of glycogen
in the liver and increase the release of insulin in response to glucose.
Another new drug that can be used against type- 2 diabetes is a vitamin supplement, with
the rationale that vitamin D deficiency is often thought to be a risk factor for the development of
type 2 diabetes. This can be supported by the fact that Vitamin d plays an important role in the
metabolism of calcium. Vitamin D has been found to be having some relation with glucose

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homeostasis, which has a direct effect on the functioning of the beta cells of the pancreas and
thus on the insulin resistance. There had been several studies, that have shown that low vitamin
D is linked with the markers of disrupted glucose metabolism like glycosylated hemoglobin.
Again vitamin D tablets would also ensure good renal health as during a renal failure the ability
of the kidney to activate the Vitamin is lost.
Hence, these two types of medications can be given to Sharon to manage her diabetes and
renal health.
5. One of the elements of the ICN codes of ethics suggests that “The nurse carries personal
responsibility and accountability for nursing practice, and for maintaining competence by
continual learning. The nurse maintains a standard of personal health such that the ability to
provide care is not compromised.” This is related to evidence based research work, that all
the nurses are obligated to form. In the previous answer, where information has been given
about the development of a new drug, nurses require extensive researches, to have a clear
concept regarding the pathophysiology of a disease. As stated by (Munshi et al. (2017)
evidence based researches has been found to be effective in providing a patient centered care.
It is the legal and ethical obligations to use judgment regarding the development of the
individual competence, while accepting and delegating the responsibilities. A lifelong
learning, a continuous updating of the nursing standards and the protocols are required to
maintain competence (Munshi et al. 2017).
The nursing actions that will be taken for Sharon will not only improve the clinical
condition related to diabetes, but also address the other factors like obesity and the renal kidney

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disease, which would require a continuous follow up by the nurses or setting up exercises
regimen (Kangasniemi, Pakkanen and Korhonen 2015). It is clearly evident from the case study,
that Sharon was continuously under the medicine, Metformin, still her blood glucose level
showed an increased level, which might indicate towards the non –adherence of the patient to the
medicines. Hence, it the duty of the nurses to take up strategies for increasing the medication
adherence , which would include regular follow up via home visits or phone calls. Another duty
of the nurse is to ensure a continuous monitoring of the blood glucose level. One of the important
step towards the management of blood glucose level is a regular and a systematic screening of
the blood glucose level. The nurses can educate Sharon about the use of the devices that
facilitates a home based monitoring of the blood sugar level. Sharon can be educated about
various e- reminders or log books that can be used to keep a record of the BGL values, to avoid
the near misses, which can be assessed at the end of the month to assess the diabetic level.
Nurses are also accountable to take under considerations, other problems like obesity. In that
case, nurses might collaborate with the dietician to set up a diet chart for Sharon. According to
the ICN codes of ethics, nurses are obliged to safe administration of medications, that involved
correct dosage and routes. The dosages of Metformin, should be decided as per the age, weight
and the chronic condition of the kidney.

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References
FDA. 2017. Metformin extended release tablets. Access date: 26.4.2019. Retrieved
from:https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021748s002lbl.pdf
Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., Saran, R., Wang, A.Y.M.
and Yang, C.W., 2013. Chronic kidney disease: global dimension and perspectives. The
Lancet, 382(9888), pp.260-272.
Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.
Lalau, J.D., Kajbaf, F., Bennis, Y., Hurtel-Lemaire, A.S., Belpaire, F. and De Broe, M.E., 2018.
Metformin treatment in patients with type 2 diabetes and chronic kidney disease stages 3A, 3B,
or 4. Diabetes Care, 41(3), pp.547-553.
Munshi, M.N., Florez, H., Huang, E.S., Kalyani, R.R., Mupanomunda, M., Pandya, N., Swift,
C.S., Taveira, T.H. and Haas, L.B., 2016. Management of diabetes in long-term care and skilled
nursing facilities: a position statement of the American Diabetes Association. Diabetes
care, 39(2), pp.308-318.
Nasri, H., and Rafieian-Kopaei, M. 2015. Diabetes mellitus and renal failure: Prevention and
management. Journal of research in medical sciences : the official journal of Isfahan University
of Medical Sciences, 20(11), 1112–1120. doi:10.4103/1735-1995.172845

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Nasri, H., and Rafieian-Kopaei, M. 2015. Diabetes mellitus and renal failure: Prevention and
management. Journal of research in medical sciences : the official journal of Isfahan University
of Medical Sciences, 20(11), 1112–1120.
Rahmah, A.M., 2013. Effect of Switching from Free Co-administration of Sulfonylurea and
Metformin to Combined Combination of Glibenclamide and Metformin (Glucovance) on
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Journal: Incorporating the Middle East Journal of Family Medicine, 99(1144), pp.1-7.
Reidy, K., Kang, H.M., Hostetter, T. and Susztak, K., 2014. Molecular mechanisms of diabetic
kidney disease. The Journal of clinical investigation, 124(6), pp.2333-2340.
Toth-Manikowski, S. and Atta, M.G., 2015. Diabetic kidney disease: pathophysiology and
therapeutic targets. Journal of diabetes research, 2015.