Case scenario: Sandra Bullock, 39 years of age is seeing a GP, where you work as practice nurse. Over the past 3 weeks,

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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 mⓇ/kg Blood Pressure: 140/90 mmHg • Pulse rate: 105 beats/min, irregular Respiratory Rate: 22 breaths/minute Temperature: 37.7°C tympanic SpO2: 97% on RA (Room Air) ET

. 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 tremor. Sandra's blood tests reveal - . . . . Full blood examination (FBE): haemoglobin: 125 g/L (reference range: 120-150 g/L) White cell count: 11.5 X10^9/L (reference range: 4.0-10.0 X 10^9/L) neutrophil: 8.0 X 10^9/L (reference range: 2.0-7.0 X 10^9/L) • lymphocytes: 0.8 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 3.5-6.0 pmol/L) Free T4 = 75 pmol/L (reference range 10 - 20 pmol/L TSH = 0.02 (reference range 0.500 -4.2 IU/L TSH-Receptor antibody (TSH-RAB AB) = positive and significantly elevated. • Antithyroid peroxidase (anti-TPO) and antithyroglobulin = negative or low titre . e . .

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 condition. You need to explain the following aspects in this section and link them to Sandra: 1.1 Identify the underlying condition 1.2 Interpret Sandra's blood test results and clinical features, and link back to Sandra 1.3 Include at least 4 risk factors relevant to Sandra 1.4 Explain the pathophysiology of the specific condition Sandra is suffering from, making links to Sandra throughout 1.5 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 HbAlc. 2.2 Discuss the three medications Sandra is prescribed by the Endocrinologist. Include in your answer the action, complications, relevant side effects and relevant nursing considerations linked to Sandra's situation 2.3 Explain five complications that Sandra could experience if her blood glucose level (BGL) and HbA1c remain high 2.4 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)