2808NRS Human Pathophysiology And Pharmacology 2
Question:
Purpose:
The aim of this case-based assignment is to allow you to demonstrate your clinical reasoning skills, your capacity to differentiate normal from abnormal presentation and to identify appropriate (evidence-based) investigations and treatment modalities associated with the assigned case-study, which are skills that are crucial to safe and effective nursing practice.
Task:
Provide a explanation, demonstrating analysis of the case study scenario.
- In your concept map you must include:
- Your Interpretation ofthe patient’s risk factors (from the case-study scenario) and determine how these risk factors relate to the diagnosed disease/disorder using evidence based literature;
- An outlineof the links between the aetiology, cellular pathology and the pathophysiology of the diagnosed disease;
- A description ofhow the pathophysiology of the disease/disorder accounts for the patient’s clinical manifestations (described in the case-study scenario); and
- An analysis and interpretationincluding evidence-based research to suggest appropriate diagnostic assessments and treatment modalities for the patient’s diagnosis.
Case Study:
Answer:
Key
In this scenario, Emilia is 11 year girl who admitted to the hospital due to 20hours of worse vomiting. She was diagnosed with celiac disease and tonsillitis. This scenario, Emily might expose to gluten containing food such as wheat, barley and rye. Subsequently, over the time, the consumption of gluten leads to the inflammation and damage the lining of small intestine. Eventually, diarrhoea, severe vomiting and behavioural issues observed. Gluten diet also leads to enlargement of tonsil (Haynes et al., 2014). Therefore, her tonsillitis was removed. When she was admitted to the hospital, she was diagnosed with type 1 diabetes. The major linked between two disease is both celiac and type 1diabetes are both autoimmune disease affected by gluten.
1) Risk factor and aetiology of disease:
In above scenario, Emilia had history of celiac disease along with diabetes. According to evidences, if family members have the history of celiac disease then high chances are offspring will also develop celiac disease in future.Moreover, in majority of the cases; those people have celiac disease also develop Type 1 diabetes due to the fact that they share same over lapping genes .Approximately 40 loci associated with Type 1 diabetes out of which 39 associated Celiac disease. These genes RGS1, IL18RAP, CD26, CTLA4, ICOS, CCR5, IL2, IL21.In future these genes give rise to other autoimmune diseases. Therefore, Emily developed diabetes type 1. Another risk factor is Gluten containing diet. Gluten containing diet such as wheat, barley and rye, both induce inflammation and subsequent autoimmune diseases such as celiac disease and type1diabetes.However, gluten free diet can lead to the deficiency of vitamin b12 and D and other fat soluble vitamin (Zhang et al. 2015)
Emilia diagnosed with Diabetes type 1 when admitted to hospital .Aetiology of diabetes mellitus as follows:
Researchers identified specific genetic region called IDDM1 strongly responsible for type 1 diabetes. Some of the region also overlapped with celiac disease (Adlercreutz, et al.2015).Different types of enterovius attachment can lead to the diabetes mellitus in few cases. Moreover, vaccinations of small pox. Tuberculosis also give rise to type 1 diabetes since tuberculosis causes poor glycaemic control. Drinking cow milk has a link with occurrence of the diabetes Type 1(Willi et al., 2015).
2) Pathophysiology of the disease:
After admitted to the hospital Emily diagnosed with type 1 diabetes mellitus where she has history of celiac disease. Therefore, the pathophysiology of Type 1 daibetes as follows:
In diabetes mellitus, blood glucose level fluctuates rapidly and insulin level also become low or absent.In absence of insulin, plasma glucagon level elevated and pancreatic beta cell unable to respond to all insulin secretary stimulation (Gong et al., 2015). Lymphatic infiltration observed by pancreas, as a result all insulin secretary cells destroyed. Subsequently, insulin deficiency leads to the interruption of glucose uptake of muscles, lipolysis and ketogenesis. Extreme insulin deficiency leads to osmotic diuresis, dehydration .Eventually patient excessively urinate and become extremely thirsty. Besides, elevated level of free fatty acid along with that diabetic ketoacidosis observed (Chiang et al., 2014).
Clinical manifestation may vary person to person. According to above scenario, Clinical manifestation of diabetes are such as increased urination, Excessive thirst Skin problem, excessive hunger, fatigue, weight loss, numbness(Handelsman et al., 2015)
3) Diagnosis and treatment of disease:
In the above case study, Emily is diagnosed with diabetes type 1 after admitted to the hospital. She also had the history of the celiac disease. The diagnosis of the diabetes type 1 are including random plasma test, Fasting plasma glucose test, Oral glucose tolerance, Measurement of glycated protein, Glycated haemoglobin. Since it does not require fasting , random sampling is the most simple test to detect diabetes . Random plasma test 200mg/dl or more than this standard indicate diabetes. In case of fast plasma glucose test, Before take the test patient should fast for eight hours. Blood glucose more than 126mg /dl considered as type 1 diabetes. If random plasma glucose observed 200 mg/dl and fast plasma glucose level observed110mg/dl then this test should be taken (Insel det al., 2015). Then in this case, fasting require for 8 hours for confirmation. In case of Glycated haemoglobin, protein when reacted with glucose then produces glycated protein and frequency depends on the concentration of glucose observed in blood. Therefore, glycated protein should be measured for detecting type 1 diabetes. Another test is , Glycated haemoglobin (Inseld et al., 2015. In this case, hemoglobin fraction combined with blood give rise to glycated haemoglobin (Inseld et al., 2015). By monitoring the glycated haemoglobin HbA1c, medical staffs confirm the disease as it gives the indication of blood glucose (Patterson et al., 2014) . In few cases, fructosamine test also performed.Free amino acid of albumin combine with blood glucose, it produce glycated albumin. The measurement of this glucose observed with the period of 1 to 2weeks (Patterson et al., 2014) .
There are different kinds of test available for managing the symptoms of diabetes type 1 .In some cases, insuline sensitizer should be used orally such as Metformin, Rosiglitazone and Piogliatzone (See et al., 2015). In other cases, insulin secretagogues such as chlorpropamide, Tolazamide, Nateglinide should be used orally (Lind et al., 2014). Moreover, Gluten free diet should be maintained in order to avoid further probability of any secondary disease ( See et al., 2015) Avoiding food with saturated fat should be recommended. It should be advised to avoid food with sugar (Delahanty & Delahanty, 2015)
References:
Adlercreutz, E. H., Svensson, J., Hansen, D., Buschard, K., Lernmark, Å., Mortensen, H. B., & Agardh, D. (2015). Prevalence of celiac disease autoimmunity in children with type 1 diabetes:
regional variations across the Øresund strait between Denmark and southernmost Sweden. Pediatric diabetes, 16(7), 504-509. doi: 10.1111/pedi.12200
American Diabetes Association. (2015). 2. Classification and diagnosis of diabetes. Diabetes care, 38(Supplement 1), S8-S16.
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes care, 37(7), 2034-2054.
Delahanty, L. M., & McCulloch, D. K. (2015). Patient information: type 2 diabetes mellitus and diet (Beyond the Basics).
Gong, C., Meng, X., Jiang, Y., Wang, X., Cui, H., & Chen, X. (2015). Trends in childhood type 1 diabetes mellitus incidence in Beijing from 1995 to 2010: a retrospective multicenter study based on hospitalization data. Diabetes technology & therapeutics, 17(3), 159-165.
Handelsman, Y., Bloomgarden, Z. T., Grunberger, G., Umpierrez, G., Zimmerman, R. S., Bailey, T. S., … & Davidson, J. A. (2015). American Association of Clinical Endocrinologists and American College of Endocrinology–clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocrine Practice, 21(s1), 1-87.
Haynes, A., Cooper, M. N., Bower, C., Jones, T. W., & Davis, E. A. (2014). Maternal smoking during pregnancy and the risk of childhood type 1 diabetes in Western Australia. Diabetologia, 57(3),469-472.
Insel, R. A., Dunne, J. L., Atkinson, M. A., Chiang, J. L., Dabelea, D., Gottlieb, P. A., … & Ratner, R. E. (2015). Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes care, 38(10), 1964-1974.
Laitinen, A. U., Agardh, D., Kivelä, L., Huhtala, H., Lähdeaho, M. L., Kaukinen, K., & Kurppa, K. (2017). Coeliac patients detected during type 1 diabetes surveillance had similar issues to those diagnosed on a clinical basis. Acta Paediatrica, 106(4), 639-646.
Lind, M., Svensson, A. M., Kosiborod, M., Gudbjörnsdottir, S., Pivodic, A., Wedel, H., … & Rosengren, A. (2014). Glycemic control and excess mortality in type 1 diabetes. New England Journal of Medicine, 371(21), 1972-1982.
Patterson, C., Guariguata, L., Dahlquist, G., Soltész, G., Ogle, G., & Silink, M. (2014). Diabetes in the young–a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes research and clinical practice, 103(2), 161-175.
See, J. A., Kaukinen, K., Makharia, G. K., Gibson, P. R., & Murray, J. A. (2015). Practical insights into gluten-free diets. Nature Reviews Gastroenterology & Hepatology, 12(10), 580.
Zhang, M. X., Pan, G. T., Guo, J. F., Li, B. Y., Qin, L. Q., & Zhang, Z. L. (2015). Vitamin D deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients, 7(10), 8366-8375.
Willi, S. M., Miller, K. M., DiMeglio, L. A., Klingensmith, G. J., Simmons, J. H., Tamborlane, W. V., … & Lipman, T. H. (2015). Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics, peds-2014.
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