Directions

For this assessment task, you are required to write a 2000 word report answering the questions from the scenario. Heading, subheading, in-text references/citations and reference list will not be the part of the total word count. You will need to explore the pathophysiology, pharmacology and psychosocial aspects of the scenario and demonstrate your understanding in the answers you provide. Your answers should be informed by your reading of current research and literature.

A report format includes an introduction and conclusion, but headings and subheadings are used in the body of the text. Use the question you are answering as your heading. Do not use dot points (except medication table) for your answers. Do not write in the first person. Appropriately referenced and labelled tables, diagrams or images may be used in the body of the paper but will not be counted towards word count. You may produce a table (question 2.2 – medications) for your answers.

Use APA 7^th referencing throughout your assignment. References must be current, preferably from the past five years. You are required to cite no less than 15 references, and the majority of these should be current journal articles. We are looking at information informing current clinical practice, and your choice of references must reflect this.

Consider the quality of the references you use. Wikipedia, Web MD, the Better Health Channel and blogging websites are not acceptable references. Any non-reliable sources in your reference list will not count toward the number of required references, and this will result in a loss of marks. At this point in your BN you are expected to engage with best practice literature. References that are not written in English are not acceptable to be used as references for this task.

Criteria for grading

 Marking of this assessment task will be undertaken by academic and teaching staff. Pre and post moderation will be undertaken for this assessment task as per University guidelines.

The marking rubric for the assignment is provided on Moodle. Marks will be allocated for each section according to the rubric. Use the rubric as a guide when writing your assignment to identify the depth of the answer expected.

Case scenario: 

Sandra Bullock, 39 years of age is seeing a GP, where you work as practice nurse. Over the past 3 weeks, Sandra has noticed significant tiredness, palpitations, and tremor. She has also noted that she is always feeling hot, ‘even when others are feeling cold’. She has lost 5 kg in weight over the past 2 weeks without any effort or exercise. She has also noticed a swelling over the front of her neck. On direct questioning, Sandra has noticed her eyelids are ‘a bit puffy’ and friends have commented that she often looks like she is ‘staring’.

Sandra is a mother of 5 children and lives in suburban Melbourne. Sandra works as a Real-Estate Manager. She has been married to Frank, who is an electrician, for 18 years.

Sandra has been suffering from type 2 Diabetes and rheumatoid arthritis for the past two years. She takes metformin (APO-Metformin XR 500 mg tablet daily) and glipizide (Minidiab 5 mg half a tablet daily) to control her diabetes and Ibuprofen (APO-Ibuprofen 400 mg one table daily) for joint pain. She does not get enough opportunity to exercise and depends on “takeaway” for her lunch and eating snacks and ice cream. She states that she often forgets and does not take her medication regularly. Sandra also smokes 5-6 cigarettes daily.

Her mother and older sister were both diagnosed with T2DM in their early 50’s. Her mother also has Hashimoto thyroiditis.

Sandra is quite “stressed” about her ongoing conditions and the recent development of other symptoms.

The examination findings of Sandra are as following -

• BMI: 29 m²/kg
• Blood Pressure: 140/90 mmHg
• Pulse rate: 105 beats/min, irregular
• Respiratory Rate: 22 breaths/minute
• Temperature: 7ºC tympanic
• SpO2: 97% on RA (Room Air)
• A smooth, mildly enlarged thyroid gland with a bruit (increased blood flow in the thyroid gland), mild proptosis
• eyelid retraction bilaterally
• brisk reflexes, and a fine

Sandra’s blood tests reveal –

• Full blood examination (FBE): haemoglobin: 125 g/L (reference range: 120–150 g/L)
• White cell count: 5 X10^9/L (reference range: 4.0–10.0 X 10^9/L)
• neutrophil: 0 X 10^9/L (reference range: 2.0–7.0 X 10^9/L)
• lymphocytes: 8 X 10^9/L (reference range: 1.0–3.0 X 10^9/L)
• Platelet: 250 X 10^9/L (reference range: 150–400 X 10^9/L)
• Free T3 = 15 pmol/L (reference range 5 – 6.0 pmol/L)
• Free T4 = 75 pmol/L (reference range 10 – 20 pmol/L
• TSH = 0.02 (reference range 500 – 4.2 IU/L
• TSH-Receptor antibody (TSH-RAB AB) = positive and significantly
• Antithyroid peroxidase (anti-TPO) and antithyroglobulin = negative or low titre

Part 1 Questions

1. What underlying endocrine condition is indicated by Sandra’s blood test, as well as the signs and symptoms (clinical features) she is experiencing? Describe the pathophysiology of the You need to explain the following aspects in this section and link them to Sandra:
   • Identify the underlying condition
   • Interpret Sandra’s blood test results and clinical features, and link back to Sandra
   • Include at least 4 risk factors relevant to Sandra
   • Explain the pathophysiology of the specific condition Sandra is suffering from, making links to Sandra throughout
   • Explain at least 5 complications of this condition that are relevant to Sandra

Part 2 Questions

Further blood test results reveal that Sandra’s blood glucose level (BGL) is 12.9 mmol/L [3.9-6.1 mmol/L]; HbA1c: 9% [normal <6.5%].

Sandra’s GP referred her to an Endocrinologist. Her conditions, blood test results and medications were reviewed by the specialist. Sandra was advised to stop metformin and prescribed Tab Sitagliptin (Januvia) 50 mg daily in addition to glipizide 5 mg (Minidiab) half a tablet daily. The Endocrinologist also added Tab Carbimazole 5 mg daily for managing her recently developed signs and symptoms, and the related Endocrinological condition.

2.1. Identify 4 risk factors potentially causing Sandra’s high BGL and HbA1c. Discuss how each risk factor affects BGLs and HbA1c.

• Discuss the three medications Sandra is prescribed by the Include in your answer the action, complications, relevant side effects and relevant nursing considerations linked to Sandra’s situation.
• Explain five complications that Sandra could experience if her blood glucose level (BGL) and HbA1c remain high.
• Identify and briefly discuss four preventive measures Sandra could use to reduce her risk of developing complications related to T2DM.

Add a conclusion in your own words (no new reference should be added in the conclusion)