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Epidemiological information - Identify diabetes in New Zealand population

Case Study One

Marty Stokes, a 66 year old Maori male with type 2 diabetes is admitted to hospital with pneumonia. He is unusually lethargic and when questioned complains that he has a headache and is nauseated. His Heart rate is 120 b/m and regular, Blood pressure 105/65 and respiration 32. He is flushed, and feels warm and dry. His urine output for the morning has been unusually high at > 200mL per hour and very dilute. Marty has a blood glucose of 55 mmol/L, an HbA1c of 100 mmol/mol, a normal pH, an absence of serum and urine ketones and a serum osmolality >350mmol/L

Question 1

Use current epidemiological information to identify trends affecting the possible causes and risk factors of Type 2 diabetes in the New Zealand population with special reference to Marty.

Question 2

Clinical manifestations of all types of diabetes include the 3Psí Explain what each represents.

Question 3 (2 marks)

Marty has been diagnosed with an acute complication of his diabetes known as HHS (Hyperosmolar Hyperglycaemic Syndrome) which is a life-threatening condition. Explain what is meant by this syndrome.

Question 4

Marty has an increased HbA1c and serum osmolality with an absence of ketones. What is meant by each of these laboratory tests and explain the significance of these results for Marty?

Question 5

Insulin is secreted by the beta cells in the islets of Langerhans in the pancreas and is considered the main anabolic hormone in the body. Give six (6) functions of Insulin in the body.

Question 6

Describe the 4 major metabolic abnormalities that play a role in the development of Type 2 diabetes.

Question 7

Marty has been diagnosed with diabetic retinopathy and early diabetic nephropathy. Describe what is meant (pathophysiology) by these chronic microvascular complications of his diabetes.

Question 8

, Marty will be at risk of developing foot ulcers. Explain how this multifactorial complication does occur in patients with diabetes.

Case Study Two

Mr Thomas Puru is a 79 year old Maori gentleman with a 5 year history of Parkinsonís disease (PD).  He is a retired teacher, married, and lives with his wife in a retirement village.  He has two adult children who live close by. He is on carbidopa/levodopa (Sinemet), pergolide and amantadine.  During his current clinical visit, Thomas reports that he has noticed some physical changes since his last appointment 9 months ago. He reports that his tremor has increased, his gait is perhaps a little more unsteady, and his fatigue is more noticeable.  Thomas is also concerned about increased drooling.  Thomas and his wife report that he is taking Sinemet 100mg, two tablets, qid and Sinemet SA (short acting) 200mg, one tablet at bedtime. This seemed to be working until he became aware of his changing physical abilities. Thomas asked his Dr if his medication dose was increased would he notice any physical improvement.

Question 1

Use current epidemiological information to identify trends affecting the possible causes and risk factors of Parkinsonís disease in the New Zealand population with special reference to Thomas.

Question 2

Discuss five (5) stages involved in the pathophysiology of Parkinsonís disease.

Question 3

Identify two (2) primary clinical manifestations and two (2) secondary clinical manifestations of Parkinsonís disease that Thomas is exhibiting.

  Question 4

Thomasís wife asks you ďWhat tests are likely to be involved during the investigations?Ē  Explain how the diagnosis of PD is made.

Question 5

You are giving Thomas his medication when he asks you for his dopamine tablet.  Explain why oral dopamine cannot be given as replacement therapy.

Question 6

Thomas understands that his medication, Sinemet contains two (2) drugs which must be given together. Explain to him how each of these drugs work.

Question 7

Thomasís wife is curious, she asks you ďIs medication the only method to assist with the clinical manifestations of Parkinsonís?Ē Identify and explain two (2) alternative types of treatments available for patients with PD.

Question 9

Identify and discuss three (3) nursing interventions that you will implement when caring for Thomas.

Question 10

You are discussing with the Multidisciplinary team (MDT) that Thomas will likely be discharged home within the next 2-3 days.  Identify four (4) things that you would assess to determine if Thomas could be cared for in his home

Epidemiological information - Identify diabetes in New Zealand population

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