HLT54115 Diabetes is a Disorder

Type 2 diabetes is a disorder that develops in the absence of a proper response to the insulin by the human body (National Health Service, 2017). However the pancreas still produces insulin but insulin does not work effectively (Diabetes Australia, 2018). Abnormal secretion of insulin occurs due to the glucose responsiveness that can be examined before the diagnosis of the disease. The impaired secretion rises with the time and the progression of this condition includes lipo-toxicity and glucose toxicity.

The untreated condition leads to cause a reduced level of pancreatic beta cells mass. This progression of impaired beta cells may affect the long-term blood-glucose level control.  Farther it causes a permanent elevation of blood glucose. The insulin abnormality majorly targets the organs such as like liver. It commonly occurs in people who are more than 30 years old. This disorder can be caused by the genetic factors and may become worse in case of overweight and lack of exercises (Kahn, Cooper, & Del Prato 2014, pp. 1068-1083).

Answer 2. Diabetes type 2 and foot ulcer

Foot ulcers can occur in any person and appear on the lower leg or foot as the patches of broken down skin. When the blood sugar level is increased or fluctuate at regular intervals, the skin that heals normally may not repair properly itself due to nerve damage. As mentioned in Percy’s case his blood glucose level was disturbed and fluctuates below the normal range. The people with diabetes have the reduced nerve functioning because of peripheral diabetic neuropathy. This means the sensation carrying nerves do not function properly and the patient cannot feel the foot damage (Tesfaye, & Selvarajah 2012, 18-14).

The ulcers generally neglected due to it does not cause pain. The issues may occur in diabetes by the diseased blood vessels and the increased susceptibility to infection. Various factors associated with the neurotropic foot ulcers are neuropathy, vascular supply, and biomechanical pressure. People with the diabetic disorders have the high risk of developing arterial ulcers. The arterial leg ulcers are caused by the poor blood pressure circulation because of the narrowed arteries. In Percy's case, the systolic pressure was abnormal (140/80) which indicated the abnormal blood circulation and risk of having hypertension. People with diabetes have the higher risk of developing atherosclerosis.

Answer 3. Low BGL and related interventions

The blood glucose level of Percy (2.7 mmol/L) is below the normal range that is 4mmol/L which indicated that the patient has hypoglycemia. This health condition can occur in people with diabetes type 2 where the person does not use insulin. The symptoms of hypoglycemia include sweating, headache, dizziness, pins and mood change (Ktsilambros, Kanaka- Gantenbein, Liatis, Makrilakis, & Tenrolouris 2011, pp. 28-32).

In the given case the patient suffers from severe low BGL and the immediate nursing care that can be provided is administration basal and the prandial insulin. The patient can also be provided with glucose and jelly beans to recover the low levels of glucose. The hypoglycaemic medication such as glipizide and glimepiride should be given orally (Briscoe, Griffith, & Davis 2010, pp. 225-235). After the analysing the decreased blood glucose level in the patient, the assigned physician should be reported immediately and the levels related to the BGL should be recorded in the patient’s datasheet

Answer 4. Wound red with exudate

In Percy's case, the red appearance is may be due to the chemical reaction caused by long time dressing on foot. As discussed in the case study he visits the general practitioners to have the dressing changed once in a week which is a long time. During this time the bacterial infection may be occurring. The exudate plays a critical role to heal the wound and providing the most environment, nutrients and oxygen to the newly developing tissues and removing the toxic material and waste products. The highly educating and non-healing wound exudate may create problems.

 The red color is the sign of normal healing of the wound. Diabetes occurs when the body is unable to produce or use insulin which is the hormone that allows the body to turn glucose into energy.  The peripheral neuropathy is caused by the altered BGL levels, this leads to damaged nerves and vessels and cause poor or no sensation at the affected areas. When the body has difficulty to metabolize the glucose it ultimately leads to slow healing of wounds.

There are various factors that may contribute to this situation such as high blood sugar level, peripheral neuropathy which occurs due to the abnormal BGL levels, poor blood circulation level in the diabetic patient, immune deficiency and microbial infection. When the blood sugar level is imbalanced it prevents the nutrients and oxygen distribution in cells and increases the inflammation in cells, these results in affected wound healing (Brem & Tomic-Canic 2007, pp. 1219-1222).

Answer 5. Three health professionals

Wound Nurse

A wound Nurse is the one who is expert in managing and providing nursing care to the patient with wound. The role and responsibilities the wound care nurse has been developed to meet the requirements of expert wound care advice. The wound care nurse improves the healing times and reduced the pressure injury prevalence (Dutton, Chiarella, & Curtis 2014, pp. 39-47). Percy has been suffering with the exudate wound and a wound nurse might help him to improve his wound.  

Dietician

The dietician or nutritionist is the allied health professional who is an expert in maintaining the nutrition intake for the patient. The registered nutritionist or dietician nutritionist change the diet and nutrition consumption according to the requirements and the type of disease they have (Brown & Phillips 2010, pp.432-439). In the case of Percy, the nutrition balance is very essential as his BGL level and systolic blood pressure are unbalanced. Therefore the dietician can help to maintain the essential nutrients intake to successfully achieve the health goals.

Endocrinologist

An endocrinologist is the one who specializes or expert in treating diabetes and diseases related to the endocrine system. They also deal with diseases associated with bones, thyroid gland, and pituitary gland. The pancreas is the part endocrine system where the insulin produced (Diabetes Australai, 2017). Many people with diabetes may prefer dialectologist as they have taken a special interest in diabetes management but diabetology is not abroad field of medicine as endocrinology. As mentioned in the case study the patient is suffering from diabetes type 2 and has a low BGL level. As menrioned in the case study Percy has disturbed BGL levels and an endocrinologist can help to maintain the insulin levels in the patient’s body.

Answer 6. Urinalysis

Urinalysis is the test that examines Urine for the diagnosis of diseases or infections, kidney problems, and diabetes. It involves examining the urine for its color, appearance, and odor. It also checks the urine for any substances that are not present in the urine normally such as blood, high protein, glucose, bilirubin, and ketones (Medline Plus, 2016). Urinalysis can diagnose the disease that is not noticed because they do not possess any symptoms for example diabetes mellitus (Klatt, 2018)

Post urinalysis results of Percy

Glucose – negative (Low levels of glucose

Protein ++ (patient have protein in urine, this can be a sign of kidney disorder)

Nitrates ++ (means presence of nitrate in urine)

Ketones –negative (means ketone level is less than 0.6 mmol/L)

Blood ++ (means presence of blood in urine)

Ph -5 (Acidic nature or urine)

Answer 7. Risk factors of UTI

Urinary tract infection is the infection occurs in any part of the urinary system such as kidneys, bladder, and urethra. The risk factors of UTI are Age, gender, and genetic factor, the medical condition like diabetes and paralysis, and sexual activity. In the case of Lee, there are two major risk factors associated with urinary tract infection include age and paralysis. He was suffering from hemiplegia and aphasia which increases the risk of UTI. The people with paralysis have the high risk of developing urinary tract infections which can be caused by the microbial activity.

In paralysis case the patient is not able to empty their bladder completely; the microbes are likely to be developing in the urine that left in the bladder. The symptoms associated with this infection are smelly and cloudy urine, fever, chills, headache, and autonomic dysreflexia (Christopher & Dana Reeve Foundation, 2018). People of this age group and sex have a higher rate of UTI because the openings of the rectum and urethra are in close proximity. Menopause is also the contributing factor of UTI that occurs after 40 or 45 years, as mentioned in given information the patient is of 45 years old women, therefore, she has the risk of developing the problem (Mayo clinic, 2018)

Answer 8. The relation between temperature and infection

The presence of elevated temperature is usually related to the body's immune system response against the microbial attack in the body. The raising temperature supports the immune system to kill the pathogenic agents that may cause infection. When the bacteria enter the body, the immune system identifies the pathogen as the foreign invader and triggers the chemical process to destroy that agent. Some of these events result in pyrogens. These chemical agents travel to the brain.

When the hypothalamus interacts with these pyrogens, it reset the thermostat and indicates the body to generate more heat which results in elevated temperature (Haugen & Galura 2010, pp. 150-170). In this given case scenario the patient is suffering from the Urinary tract infection and elevated temperature (which is more than 38-degree centigrade) is associated with it.

Answer 9. TIA and CVA

TIA (Transient ischemic attack)

The transient ischemic attack is the neurological event in which the blood supply to the brain is blocked for some time. The signs of this blockage are similar to the stroke, therefore, it is called mini-stroke. It typically lasts for two to thirty minutes. It occurs due to the temporary lack of blood and oxygen supply to the brain. This is caused by the narrowing of carotid arteries that supply blood to the brain. The people with diabetes have the high risk of TIA. The symptoms associated with TIA include loss of vision, numbness, dizziness, headache, and paralysis of the face, arm or legs (Pendlebury, Lau, & Rothwell 2018, pp. 243-250).

CVA (Cerebrovascular accident)

The cerebrovascular accident is a medical condition of stroke in which the blood flow is stopped in a part of the brain either by a blockage or the rupture of a blood vessel. The occurrence of symptoms depends on the area of the brain that affected by this stroke. The types of CVA attack are ischemic stroke and hemorrhage stroke. The symptoms associated with CVA are difficulty walking, dizziness, and loss of balance, difficulty in speaking, numbness or paralysis on one side of the body, blurred or dark vision, and sudden headache (Carpenito-Moyet, 2009).

Ischemic strokes also CVA embolic strokes that are caused by the formation of a blood clot that developed elsewhere in the body (embolus) and passes through the blood circulation to the brain. In some cases, the clots are formed in the largest artery of the heart called the aorta and travels to the brain. These strokes can cause the symptoms of ischemic attacks (Mena, 2016).

Answer 10. Three health professionals

Neurologist

The neurologists are the one who treat the problems related to the brain spinal cord, and nervous systems such as transient ischemic attack, acute ischemic strokes, and cerebrovascular disease.  As mentioned in the case study the patient is diagnosed with a transient ischemic attack in which a neurologist can play a vital role to achieve recovery.

Urologist

A urologist is a specialist doctor who deals with the problems associated with the urinary tract. They trained in the medical and surgical treatment of the disease caused in organs such as kidneys, urinary bladder, adrenal glands, and urethra. The urologist can help to manage and treat the urinary tract infection and other related problems in Lee’s case.

Nutritionist or dietician

A nutritionist or dietician is expertise in the field of nutrition and food they trained to maintain the nutrition in the patient according to the disease. As nutrition and diet are the key elements to recover in most of the health issues. The patient in the given case study having low pH and glucose level and instructed to take thickens fluids. In this case, the nutritionist might help to maintain the diet and to provide essential nutrition so that the problem can be controlled. The dietician can also help the patient to maintain the water loss occurs due to the frequent urination.

Answer 11.  Genetics of cystic fibrosis

Cystic fibrosis is the inherited disorder in which, thick and sticky mucus is build up that can damage many organs of the body. The most common symptoms of this disease include problems in the digestive system, and progressive damage occurs in the respiratory system. To have cystic fibrosis a person must inherit two copies of the CFTR gene that contains the mutation.  There is a 25 % of probability for them having a child with CF (Lommatzsch, & Aris 2009, pp. 531-538)

Answer 12. Impacts of CF on the respiratory system

Cystic fibrosis builds up a thick and clogs in certain parts of the body like lungs caused by a mutation occurs in the gene called CFTR. The changes occurred, may cause the mucus to become more thickened and sticky over the time (University of Rochester medical center, 2018). Initially, it affects the small airways of lungs and then can affect all the airways. In children's, the thickened mucus can also prevent the cilia to sweep the microbes or germs and the other particles to pass out of the lungs.

Because of this the bacteria is trapped inside and may cause infections. To remove the bacteria immune system sends WBCs t the lungs that kill bacteria as well as other surrounding healthy cells. other impacts of respiratory system includes chronic cough, collapsed lungs, heart enlargement, nasal polyps, shortness of breath, and coughing up blood. (Healthwise, 2018)

Answer 13. Impact of CF on male fertility

In males vas deference is caused to atrophy in embryonic development by CF because of the males with CF born without VD, this is called the congenital bilateral absence of the vas deference (CBAVD). The vas deferens is the tube-like structure that carries the sperm from testicles to the other parts of the male reproductive system. People with this disorder the vas deferens is may be blocked or defective. Therefore the person might can experience a normal erection or ejaculation but there is no sperm in the semen. Due to this it is not possible to fertilize the egg.

Answer 14. Impacts of pregnancy on the respiratory system

There are marked changes occurs in respiratory physiology during the pregnancy. The pulmonary blood flow is increased due to an increase in cardiac output. Hypermedia and edema of upper respiratory mucosa occur due to the blood volume expansion and the vasodilation in pregnancy. During pregnancy capillary engorgement and swelling in mucosa lining occurs due to the hormonal changes.

The oxygen consumption increases up to 60%. In some cases the manipulation of airways leads to profuse bleeding form oropharynx or nose, airway resistance is reduced because of bronchial musculature relaxation mediated by progesterone hormone. Other possible changes that occur during pregnancy are running nose, barrel-shaped chest, movement of the diaphragm upward, and reduced lung capacity. These changes may cause shortness of breath in some women's (LoMauro & Ai]liverti 2015, pp. 297-302).

Answer 15. Three health professionals

Pulmonologist

The pulmonologist is ta Cystic fibrosis doctor who is an expert in providing care to the people with CF. he or she is trained to diagnose and treat the diseases related to lungs. CF is a complex disorder, and the treatment requires a whole team of nurse, physiotherapist, social-worker, general physician to provide goal-oriented interventions. A CF doctor collaborates with other team members in order to achieve quality improvement. In the given case study the patient diagnosed with respiratory issues and a pulmonologist can help in this case.

Respiratory therapist

The respiratory therapist is the allied health professional who performs the pulmonary function test or measures the flow and volume of air in the lungs. (The respiratory therapist also helps in pulmonary therapies that are used to clear the mucus from the lungs and controlling the bacterial infection of airways. The RF is responsible to teach the patients and their family about how to take the inhaled medication.  As mentioned in the case of Madeleine Brown has respiratory problems, an RF can play an important role to treat the respiratory system related issues such as breathless, increased RR, and reduced air entry.  

CF dietician

The higher weight promotes a better lung function and this can be achieved by consuming a good nutrition and a better diet. The registered dieticians are expert and trained to maintain a daily food intake, growth, and the overall nutritional status. He or she can teach the patient or the family members about how to improve the eating habits, vitamin, and dietary supplement intake (European Cystic Fibrosis Society, 2018)

References

American Diabetes Association (2017). Your healthcare team. 

Diabetes Australia (2015). Type 2 diabetes. Type 2. 

Brem, H., & Tomic-Canic, M. (2007). Cellular and Molecular Basis of wound healing in diabetes. The Journal of clinical investigations, 117(5), 1219-22.

Briscoe, V. J., Griffith, M. L., & Davis, S. N. (2010). The role of glimepiride in the treatment of type 2 diabetes mellitus. Expert opinion on drug metabolism & toxicology, 6(2), 225-235.

Brown, K. L., & Phillips, T. J. (2010). Nutrition and wound healing. Clinics in dermatology, 28(4), 432-439.

Carpenito-Moyet, L. J. (2009). Nursing care plans & documentation: nursing diagnoses and collaborative problems. (5^th ed.).China: Lippincott Williams & Wilkins.

Christopher & Dana Reeve Foundation (2018). Bladder management. 

Cystic fibrosis Western Australia (2014). A guide to Cystic fibrosis for health professionals.

Dutton, M., Chiarella, M., & Curtis, K. (2014). The role of the wound care nurse: an integrative review. British journal of community nursing, 19(Sup3), S39-S47.

European Cystic Fibrosis Society (2018). Allied health professionals. 

Haugen, N., & Galura, S. J. (2010). Ulrich & Canale's Nursing Care Planning Guides-E-Book. (7^th ed.). Missouri: Elsevier Health Sciences. 

Healthwise (2018). How cystic fibrosis affects breathing and the lungs

Klatt, E. C. (2018). Urinalysis. 

Ktsilambros, N., Kanaka- Gantenbein, C., Liatis, S., Makrilakis, K., & Tenrolouris, N. (2011). Diabetic emergencies: diagnosis and clinical management. (2^nd ed.). West Sussex, UK: John Wiley & Sons.

Lommatzsch, S. T., & Aris, R. (2009). Genetics of cystic fibrosis. In Seminars in respiratory and critical care medicine, 30(5), 531-538.

Mayo Clinic (2018). Urinary tract infection. 

Medline Plus (2016). Urinalysis. 

Medline Plus (2018). Diabetes- low blood sugar- self-care. 

Mena, K. (2016). Embolic stroke.

National Health Service (2017). What is type 2 diabetes

Pendlebury. S. T., Lau, G. K. K., & Rothwell, P. M. (2018). Transient ischemic attack and stroke: diagnosis, investigation, and treatment. (2^nd ed.). Port Melbourne, Australia: Cambridge University Press.

Tesfaye, S., & Selvarajah, D. (2012). Advances in the epidemiology, pathogenesis, and management of diabetic peripheral neuropathy. Diabetes/metabolism research and reviews, 28, 8-14.

University of Rochester medical center, (2018). Cystic fibrosis and respiratory system. 

Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083.

LoMauro, A., & Aliverti, A. (2015). Respiratory physiology of pregnancy. Breathe, 11(4), 297-301.