Pathophysiology Assignment: Identification of Endocrine Condition through Blood Testn

Question

Task

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: 37.7ºC 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 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

Consider the above case scenario and write a pathophysiology assignment report addressing the following parts:

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 HbA1c.

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.

Answer

Executive Summary
The report on pathophysiology assignment is all about identifying underlying endocrine condition of Sandra on the basis of her blood test. Along with that this report has also analysed the clinical features and condition that she is experiencing presently. For example, it has interpreted blood test results of Sandra along with identifying risk factors along with pathophysiological condition of Sandra. It has also been identified causes of HbA1c and BGL of Sandra.

Introduction
Sandra Bullock is a middle aged lady with five children and a modern lifestyle and no time for her proper diet and exercise. In this case, Sandra Bullock has come to a GP with sudden changes regarding tremor, palpitations, and tiredness. This report focuses on identifying the underlying endocrine condition of Sandra on the basis of her blood test along with clinical features and condition that she is experiencing presently along with the medicines she is prescribed by the endocrinologist.

Part 1 Questions

1.1 Identifying underlying condition
Endocrine conditions occur in human bodies due to malfunction of the endocrine system at the time of secretion of hormones from the perspective of medical conditions. Three basic reasons for endocrine conditions include inability of proper functional activities, overproduction of certain hormones, and underproduction of hormones such as thyroid (Taylor et al. 2018). In this case, Sandra has already been suffering from rheumatoid arthritis and type 2 Diabetes for the last couple of years. Unexplained weight loss and endless energy are initial symptoms of hyperthyroidism that often seems good in the beginning (Ali et al., 2019). However, hyperthyroidism becomes under diagnosed endocrine conditions that remain unchecked in many cases. However, in the case such as Sandra it can occur with major complex conditions that can create serious complications in later life in the form of hypertension and eyesight problems. Blood test reports of Sandra are showing the underlined critical condition of Triiodothyronine (T3) and Thyroxine (T4) as they are above normal.

Primarily, thyroid hormones control body temperature, weight, nervous system, heart rate, breathing, and metabolism (Zader et al. 2019). In this case, breathing rate, heart rate, and body temperature are not normal for Sandra that shows underlying complexities regarding hyperthyroidism with excessive sweating, anxiety, nervousness, and hand tremors.

1.2 Interpreting Sandra’s blood test and clinical features
Normal range for haemoglobin for a woman is 120-150 g/L, and in this case, the level of haemoglobin in the body of Sandra is 125 g/L that ensures the normal condition of her. Along with that, platelet count, neutrophil, and white cell count are absolutely normal in the case of Sandra. On the contrary, she is facing a problem regarding hyperthyroidism with palpitation and irregular heartbeat where she has low TSH and high T4 and T3. At the same time, her body has developed a TSH-Receptor antibody that indicates her critical condition regarding endocrine that requires proper treatment along with identification of reason for such a fact. For example, her hyperthyroidism may occur due to the presence of Grave’s disease such as type 2 diabetes (Iotova et al. 2021).This disease is one of the most common reasons for the occurrence of hyperthyroidism as patients go through secretion of excessive thyroid hormone due to autoimmune disorder.

Thyroiditis is another reason for the occurrence of hyperthyroidism when an inflammation of thyroid happens in three patterns, including silent, postpartum, and subacute. For example, silent thyroiditis happens due to a possible enlarged thyroid that is a variant form of autoimmune condition, and this condition is painless for the patients (de Graaf et al.,2021). On the other hand, postpartum cases occur when women go through thyroiditis after giving birth to children. Subacute is another form of thyroiditis that can arrive due to bacteria and virus with enlarged thyroid that is also painful for the patient. However, in the case of Sandra an Overactive thyroid nodule is the reason for the ramp up production of thyroid hormone due to lumps on thyroid gland.

1.3 Four risk factors

1. Risk factors in the case of Sandra for the development of hyperthyroidism with these test results of blood include having a family history of thyroid disease as her mother has Hashimoto thyroiditis. Therefore, genetic factor is a critical risk factor in the case of Sandra.
2. Blood Glucose level is not normal as per the blood report presented in her case study. In the case of Sandra this factor has made her exposed to the condition of hyperthyroidism (Mulukutla&Fegan-Bohm, 2019).
3. Hectic lifestyle with smoking behaviour and not having proper dietary control and medicines on time are critical risk factors
4. Gender is another factor as female patients develop such issues regarding thyroid compared to men (Reddy et al. 2017).

1.4 Pathophysiology of specific condition Sandra is suffering from
Sandra is suffering from hyperthyroidism that has affected her daily life along with her ill health conditions. Primarily, in the case of hyperthyroidism, secretion of T3 increases compared to T4 in the human body while T4 converts into T3 in peripheral tissues (Taylor et al. 2018). In this case, blood report of Sandra has identified higher level of T3. Moreover, hyperthyroidism is all about too much production of thyroxin hormone. Primarily, this disease comes with symptoms such as irregular heartbeat along with unintentional weight loss. All these symptoms are present in Sandra, and significant tiredness is another symptom that was felt and witnessed in the case of Sandra. Reason for such a fact is that endocrine glands produce an accurate amount of every hormone to complete different processes of the human body. Hormones are critical chemical messengers of the human body that affect mood, weight, and appetite with other aspects of body and mind. However, the fast-paced lifestyle in these modern days has come with hormonal imbalances. Additionally, while some hormones decline with age some people experience critical endocrine conditions dramatically compared to others. It is an undeniable fact that balancing hormones is an essential part of controlling endocrine conditions in patients.

1.5 Five complications of the condition
Sandra is facing complications regarding hyperthyroidism, including Irregular Heartbeat and Heart Palpitations, shakiness and hand tremors, excessive sweating, and heat intolerance, and increased blood sugar, and eye problem. In this case, Sandra has issues regarding Type 2 Diabetes (Bragg et al. 2018).

• Irregular heartbeat and heart palpitations

Thyroid hormones of Sandra have directly affected the function of the heart that has increased the irregularity of heartbeat along with the palpitations. This abnormal rhythm needs to be taken seriously to make her free from the situation (Li et al. 2017). Heart problem is evident in the case of Sandra as her reports are showing the irregular heartbeat and palpitations.

• Excessive Sweating and tiredness

Tiredness is a common complexity regarding health when it comes to hyperthyroidism, and Sandra has been witnessing this problem for a few days.

• Eye problem

Eye problem is evident in the case of Sandra as she noticed “a bit puffy” eyelids and her friends addressed that her eyes look as if she is staring at them.

• Shakiness and tremor

It is another complication that has been identified in the case of Sandra as she has witnessed the sudden changes in her health that has affected her normal behaviour. For example, she has always faced shakiness and tremor in her hands (Pugliese et al. 2019). Most importantly, it is one of the critical aspects and complications of hyperthyroidism that affect the human body.

• Heat intolerance

This complication has also been witnessed in the case of Sandra as she felt excessively hot even when others did not feel too hot. This aspect was noticed in her statement when she went to a GP for her treatment.

Part 2 Questions

2.1 Four risk factors
Followings are four risk factors that have created high BGL and HbA1c in Sandra:

• Overweight

It is evident from the reports of Sandra that she is near the obesity level as she is an overweight person.

• High Blood Pressure

Blood pressure over 140/90 has increased the risk of type 2 diabetes in the case of Sandra that is a complex risk factor for the occurrence of HbA1c and BGL in this case (Taylor et al. 2018).

• Age

Although nowadays, type 2 diabetes is also noticed among younger adults, adolescents, and children the risk of BGL and HbA1c increase with aging. In this case, Sandra has gained weight with her growing age along with losing muscle mass as she does not exercise. At the same time, she does not eat healthy food and does not take her medicines in time.

• Inactivity

Inactivity is the most critical reason for developing “type 2 diabetes” that has increased the risks for Sandra. Primary reason for such a fact is that it is only physical activity that can help a person to control the procedure of gaining weight (Kitahara et al. 2019). However, it helps the person to utilise the glucose to create energy that makes the cells of the human body more sensitive towards insulin.

2.2 Discussion of medications

Sitagliptin (Januvia) 50 mg
This medicine of Sandra will help her to fight type 2 diabetes mellitus. However, it is crucial for Sandra to use this medicine with regular exercise and a healthy diet. Primarily, it has been found in her case study that she is not habituated to any exercise and she does not get proper time to have any healthy diet as per her job role. Along with that, she is the mother of five children and she smokes daily. From that concern, she is required to manage her daily lifestyle that can affect her heartbeat rate along with managing the overall process regarding fighting this serious condition.

Most important reason for prescribing this medicine to Sandra is that other medicines that she takes daily along with only exercise cannot control her BGL sufficiently. This medicine is for having a meal or on an empty stomach (Ahmed, 2017). However, Sandra requires taking this medicine every day at the same time to get effective results. This tablet is from a group of medicines named gliptins or DPP-4 inhibitors that helps in increasing insulin production after having a meal.

However, this tablet also comes with some side effects, including nasopharyngitis, upper respiratory tract infection, hypoglycaemia, and headache.

Glipizide 5 mg (Minidiab)
It is an oral diabetes medication that helps to treat type-2 diabetes mellitus when it is moderate or mild. This medicine is effective for maturity onset diabetes and non-insulin-dependent diabetes with antihyperglycemic compositions (Osuna et al. 2017). However, this medicine is not safe for pregnant women or people with an allergy to glipizide.

Carbimazole 5 mg
It is an effective anti-thyroid medicine that helps patients to get relief from an over-active thyroid gland. However, it should not be taken for the patients with serious blood disorders or severe liver disorders (Lillevang et al. 2019). Therefore, Sandra can get relief from these medicines to manage thyroid as she does not have any serious blood disorder.

2.3 Five complications
Following are complications that might Sandra face if she fails to control her lifestyle, exercise, and healthy eating along with taking medicines prescribed by doctor on time:

• Cardiovascular disease
• Clouding of the cataract of eye
• Kidney failure or damage due to diabetic nephropathy
• Nerve damage
• Damages of blood vessels of retina that leads to blindness in the case of diabetic retinopathy (Zader et al. 2019)

Most important reason for the concern related to Sandra is her poor lifestyle that does not give her time to take sufficient healthy food.

2.4 Preventive measures

• Selection of carbs carefully

Healthy diet is the only concern that can help Sandra to go beyond her issues regarding managing diabetes efficiently. On the other hand, she is required to consider her ill health before anything else (Moleti et al. 2019). Healthy eating and taking medicines on time can help Sandra to resolve her issue. Primary reason for prioritising this measure is that Sandra does not take healthy food for lunch along with forgetting to take medicines on a daily basis.

• Losing weight

Heavy weight is one of the most important causes of concern for Sandra when it comes to increasing the risk factor related to fighting this issue (LiVolsi & Baloch, 2018). In this concern, sufficient exercise and an active day is a must for Sandra.

• Managing stress

Sandra follows a hectic lifestyle as she works and she is the mother of five children, and she needs personal time to stay free and happy (Pearce et al. 2019). In such a condition, stress management procedure and meditation can help her to resolve her issues.

• Get enough sleep

Sleep and rest are essential aspects of a healthy living that will help Sandra to manage her diabetes along with releasing and managing her mental stress and irregular heartbeat and breathing issues.

Conclusion
In conclusion, Sandra has the opportunity to resolve her issues regarding type 2 diabetes mellitus only by taking care of exercise and daily routine along with having all the medicines on time. However, before that, it is essential to consider that she suffers from hyperglycemia and hyperthyroidism. Primary reason for such a health related issue for Sandra is her unhealthy lifestyle, diet, and poor exercise. Along with that, it is also essential for Sandra to take care of her activities.

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