NSG2NCI Nursing Patients With Chronic Illness


Melanie is a 60 year old woman who has been admitted to your surgical ward for the drainage of a Baker’s Cyst. She was diagnosed with Type 2 Diabetes Mellitus (T2DM) 6 months ago, during a routine workup for surgery. She takes no specific medication for her diabetes,and has been told by her GP to ‘watch’ what she eats. She was devastated to discover her diagnosis of T2DM, as she was aware of the risks due to her family history.
She has not returned to her GP since her initial diagnosis. She has no other past medical history of note. Melanie says tearfully “I have been trying to eat right and exercise, but I can’t walk because of the pain in my knee and I was feeling down and eating ice cream. I have hardly eaten anything in the last week because I am trying to lose weight and get my blood sugar down’.
Her Mother and older sister were both diagnosed with T2DM in their early 50’s.
She tells you she has had the Baker’s Cyst for about 2 years. It has been increasing in size over the last 8 months, restricting her movements. The planned surgery is drainage followed by two follow up cortisone injections.
On admission at 0800 – her blood glucose level (BGL) was 22.9 mmol/L; HbA1c: 11%. She has been fasting since midnight. She notes that she is feeling quite ‘stressed’ about the surgery. On admission the following were recorded”
Height: 167cm Weight: 105kg
Blood Pressure: 140/80mmHg Pulse rate: 95 beats/min
Respiratory Rate: 22 breaths/minute Tempearature: 36.7 C

Part 1

Melanie is distressed that her blood glucose level is elevated and asks you for help in understanding her diabetes. She tells you that she has a friend who is very overweight, eats lots of cake and hardly every exercises, and he does not have diabetes.
1. Describe the pathophysiology of T2DM with linksto Melanie’s case. Include in your answer risk factors for T2DM, the pathogenesis of T2DM, possible complications of T2DM and outline the 3 levels of treatment options for T2DM. Excellent description of the pathophysiology of T2DM. Excellent discussion of pathogenesis,complications and/or treatment options clear links to Melanie’s.
2. Differentiate between T2Dm and T1DM (at least 6 differences)Excellent differentiation between T2DM and T1DM in students own words .
3. Identify at least 2 reasons Melanie’s BGL is high on admission.Discuss how each reason you identify effects BGL. At least 3 reasons for high BGL identified with excellent rationale and clear links to Melanie’s .

Part 2

The surgery is successful and Melanie comes to see you in the outpatient clinic for cortisone injections (Kenacort-A 40). She has been commenced on Metformin (APO-Metformin Tabs) and Glipizide (Minidiab Tabs) to help her control her diabetes. Her blood Test on this visit were BGL 8.8/L; HbA1c:8%.
1. Discuss the three medications Melanie is on.Include in your answer the action, complications/side effects and nursing considerations linked to Melanie’s situation. Excellent discussion re the use of medication linked to  All complications/side effects and/or nursing considerations discussed at length.
2. Discuss the two blood results, one from prior to surgery and one from the clinic visitof Melanie’s BGL and HbA1c. What are they? What do they measure and why they have changed?

While Melanie is waiting to see the doctor, she starts talking to you about her condition. She ask if she has insulin dependent diabetes or early onset diabetes. She is also unsure of how to use her BGL machine and BGL strips.
3. Discuss why the terms insulin dependent mellitus/non insulin dependent diabetesmellitus and early onset/mature onset are misleading. Excellent discussion of the terms and reasons why they are.
4. You need to teach Melanie how to use her BGL machine.Discuss the ‘teach back’ method for patient education (include evidence from peer reviewed sources). Discuss how you would use this method to teach Melanie how to use her BGL machine. Excellent discussion of the ‘teach back’ method clear application to the patient.
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