Reference no: EM132342022

Case Study Assignment

Details of task:
- Only choose ONE of the following three question sets for the essay (question set A OR B OR C).

Case

Bill McDonald is a 58-year-old male patient who was previously diagnosed with type 2 diabetes. He has smoked one pack per day of cigarettes for 35 years and has a history of heavy alcohol use but quit both after he was diagnosed with diabetes 1 year ago.

He was started on metformin 500 mg oral twice daily, was increased to 1000 mg twice daily 6 months ago. His latest HbA1c level is 7.2 %. Morning fasting glucose in the past week ranging from 4.5 to 7 mmol/L, however his glucose control has been unstable, fluctuating over the last 3 months.

Bill's mother had diabetes and died of heart failure at age 65 years. Bill is running a juice bar and loves fresh
fruits, especially banana. He has a sedentary lifestyle.

A week ago, he presented for a regular GP visit and was noted to have a blood pressure of 170/100 mmHg, he was asymptomatic, with no headache, dizziness or blurred vision, but reported his eyes get tired easily.

On examination, he is 175 cm tall, weight of 123 Kg (from 156 kg two years ago), had regular resting pulse rate at 82 /min, respiratory rate 18, temperature 37. The review of physical systems was unremarkable. No skin or nail lesions were noted but there was pitting oedema in both lower legs.

Urine analysis revealed an increased level of protein (4+). A blood test showed an increased level of urea (25 mg/dl) and serum albumin (6.1 mg/dl) and decreased Estimated Glomerular Filtration Rate. A 24 hour urine test revealed higher than normal rate of urinary albumin excretion.

Question set A

Analyse the case and respond to all below question set A in the essay
• Discuss the pathophysiology of type 2 diabetes as it relates to the chronic symptoms the patient is experiencing.

• Analyse the potential management approaches (medical and nursing) for a hypertensive diabetic patient.

• Develop an education plan for Bill based on support resources available in Australia, particularly his learning and treatment/care needs associated with his disease progress

After visiting the GP, Bill took a 4-day business trip to Sydney. He constantly felt fatigued, nauseated and had painful feet during the trip. Bill also lost his supply of metformin and glucose testing kit. He presented to the emergency department today after returning from Sydney.

On examination, Bill is 175 cm tall, weight of 120 Kg. His temperature is 39; irregular deep laboured breathing rate of 40 breaths/min, pulse 130/min. The review of systems shows clear lung and heart sounds. Left ankle open ulcers are noted. His blood glucose is 28mmol/L. Bill was conscious but drowsy. He has decreased skin turgor and dry mucosa.

Urinalysis test reveals 3+ of ketones and 4+ of glucose. Blood gas result shows pH of 7.20, bicarbonate 9.7 mmol/L. Blood test shows increased leucocyte and creatinine.

Question set B

Analyse the case and respond to all below question set B in the essay

• Discuss the pathophysiology of type 2 diabetes as it relates to the acute symptoms the patient is experiencing at the emergency department.

• Analyse the immediate management approaches (medical and nursing) for Bill.

• Develop an education plan for Bill based on support resources available in Australia, particularly his learning and treatment/care needs associated with his acute complications and recovery.

Bill returned home after a five day stay in the hospital. Although he has slowly recovered from the above ED visit, he has been feeling fatigued for the past few days and become increasingly depressed about his health status. He started drinking two large glasses of red wine on most evenings for two weeks since he was discharged.

One night, Bill was fast asleep when he experienced a sudden onset of epigastric pain at 2 am. He thought it was heartburn due to what he had eaten for dinner, but when he woke up at 5 am, the pain had not subsided and started to intensify and radiate into his jaw and left shoulder. Bill drove himself to the Emergency Department.

On arrival at the ED, Bill reported 9/10 crushing in his chest, nausea, and diaphoresis. A 12- lead ECG was taken (see below ECG strip). Blood work revealed increased level of Cardiac Troponin T (cTnT) and Creatine Kinase - MB (CK - MB).

Question set C

Analyse the case and respond to all below question set C in the essay

• Discuss the pathophysiology of the acute cardiac event Bill is experiencing.

• Analyse the immediate management approaches (medical and nursing) for Bill with an acute cardiac condition.

• Develop an education plan for Bill based on support resources available in Australia, particularly his learning and treatment/care needs associated with his recovery.