Question

CASE STUDY C Gestational Diabetes Mellitus Following delivery of the second child, C.s.'s blood pressure and blood glucose remained elevated, leading to a diagnosis of type 2 diabetes. In addition to regular exercise, metformin was prescribed and a nutritionist developed an appropriate diet. 1. Describe the pathophysiology of type 2 diabetes. 2. Briefly describe how diet, exercise, and this drug each contribute to reduction of blood glucose. 3. Explain how stressors might affect blood glucose levels and blood pressure. Hydrochlorothiazide (Hydro DIURIL) and irbesartan (Avapro) were prescribed to reduce blood pressure.

Answer 1

1. Describe the pathophysiology of type 2 diabetes.

Pathophysiology

Beta cells, situated in the Islets of Langerhans in the pancreas, deliver endogenous insulin

Insulin intercedes glucose take-up by means of receptors in liver and skeletal muscle cells; intrusion results in hyperglycemia

Pancreas discharge more insulin in light of expanded blood glucose bringing about transitory hyperinsulinemia which exists together with hyperglycemia

In pre-diabetes, the body reacts to high glucose by delivering unreasonable measures of insulin which makes the beta cells progress toward becoming exhaustion because of overcompensation, influencing the general capacity

Pancreas may likewise discharge glucagon from alpha cells, which invigorates the liver to improperly build blood glucose

Adjustment in the creation of hormones and cytokines by fat tissue is additionally a factor

Groups of variations from the norm that demonstration synergistically, for example, stomach corpulence, HTN, dyslipidemia, insulinresistance and dysglycemia enormously builds the danger of cardiovascular ailment and advancement of DM

(Michel, 2014 p 1433)

Clinical Manifestations

Weariness

Hyperglycemia

Hyperinsulinemia

Dyslipidemia

Repetitive contaminations

Hypertension (pg 48; diabetes book)

Hyperurecemia

Hypercoagulability

Visual sharpness changes

Drawn out injury mending

Excruciating fringe neuropathy in the feet

May encounter a portion of the exemplary Type 1 Diabetes Mellitus manifestations, for example, polyuria (visit pee), polydipsia (over the top thirst) and polyphagia (extreme appetite)

Symptomatic Tests

There are four techniques to analyze diabetes mellitus:

1. Hemoglobin A1C: >6.5%, utilizing an institutionalized, approved examine, without conditions that influence the exactness of the A1C

2. Fasting plasma glucose level: >7mmol/L. Fasting is characterized as no caloric admission for somewhere around 8 hours

3. Irregular or easygoing, plasma glucose estimation: >11.1 mmol/L, in addition to calssic indications of DM, for example, polyuria, polydipsia and unexplained weight reduction. Easygoing is characterized as whenever of day without respect to the interim since the last supper

4. Two-hour OGTT level: >11.1 mmol/L, utilizing glucose heap of 75 grams

Nursing Diagnosis and Interventions

DM Type II can be analyzed through intensive evaluation of clinical indications, blood glucose serum, lab esteems, crucial signs, screen liquid parity (consumption and yield) and nutritiontal and way of life information.

Intervention
-determine patient's level of knowledge pertaining to Type II DM

instruct on medication treatment/blend treatment (insulin type and oral antihyperglycemic operators)

- audit ventures of drug organization and request the patient to demostrate to guarantee precision

- guarantee patient's consciousness of medication adminsitration with timing of sustenance admission

- present self-checking of blood glucose

- nourishing treatment with respect to sustenance compostion, ETOH, good dieting educaion and exercise (dietary and way of life adjustments)

Hazard Factors

Stomach and instinctive adiposity (stoutness)

High hazard populace (Aboriginal, Hispanic, South Asian, Asian or African plunge)

Low or high birth weight

Destined to maternal with gestational diabetes (pg 46)

Ecological

Hereditary inclination

Stationary way of life

Poor wholesome decisions

Meds

Insulin

As insulin is either deficient or ineffectively used in Type II DM, exogenous insulin might be required to take care of the body's demand and additionally if oral enemy of hyperglycemic specialists can't keep up the blood glucose inside typical range.

Supper time Insulin (Bolus)

- Rapid acting insulins: Aspart (Novolog, NovoRapid, and so forth.)

- best impersonates characteristic insulin discharge in response to sustenance admission

- oversee 0-15 mins before suppers to accomplish most extreme postprandial glycemic control or up to 15 mins following dinners

- beginning activity of 10-15 mins

- diminishes post-feast hyperglycemia

As per HOMEWORKLIB POLICY, we can give the one answer at the time.

Please liked me......