Outline the pathophysiology of type I (Insulin –dependent) diabetes

Section 1 – Pathophysiologic and pharmacologic concepts
Collect information: Pathophysiology
Q1. Outline the pathophysiology of type I (Insulin –dependent) diabetes.

Process information: Pharmacologic concepts in glycaemic management
Q2. What specific information do Tony and his family need to know about insulin absorption in order to manage the insulin regime at home?
Discuss your answer in relation to:
a) The ‘Time-course of formulations’ of insulin and the effect on absorption of insulin
b) The appearance of different types of insulins
c) The principles underpinning a ‘basal-bolus’ regime of insulin
d) The practical skills and knowledge Tony needs to self-administer insulin
Q3. From your knowledge of pharmacodynamics, explain how insulin works to reduce blood glucose level.
Q4. Identify 3 objective tests that may be used to assess Tony’s current glycaemic status ie. how would you know if Tony was stable or unstable?

Section 2 – Decision-making
Synthesise the information
Q5. Examine the information that you have about Tony’s presentation to hospital and identify two possible nursing diagnoses from the following options.
Tony has:
a) hypoglycaemia possibly related to excessive carbohydrate intake
b) hyperglycaemia possibly related to inadequate carbohydrate intake
c) hyperglycaemia possibly related to excessive carbohydrate intake
d) hypoglycaemia possibly related to inadequate carbohydrate intake
e) hypoglycaemia possibly related to inadequate insulin administration
f) hypoglycaemia possibly related to inappropriate insulin administration

Establish goals
Q6. Before initiating any actions, it is important to be clear about your goals for Tony.
(i) What goal would you set regarding Tony’s Blood Glucose Levels (BGLs)?
(ii) What goals would you set regarding Tony’s knowledge deficit?

Take action
Q7. What are your nursing actions in the event that Tony is found to be:
(a) hypoglycaemic (BGL <3.5mmol/L) and conscious?
(b) hypoglycaemic (BGL <3.5mmol/L) and unconscious/altered consciousness?
Give a rationale for your clinical decisions and actions in Q7a and Q7b.

Section 3 – Professional standards
Q8. Choose 2 ethical value statements and 2 standards for practice that will guide your nursing care of Tony and his family whilst in hospital and/or in discharge planning activities.
Give examples of how the 2 value statements and the 2 standards apply to this case.
Q9. The central principles of social justice in the health care context are self-determination, equity, access and rights and, participation. Health professionals have an ethical obligation to ensure that patients are treated fairly.
Discuss how psycho-social factors in Tony’s life might impact on how he participates in his own health care (including medication adherence), and interacts with health professionals?
Q10. Write down what actions will you take in your future practice because of what have learned from this scenario?

Section 4 – Conveys scientific information
Check your answers and ensure that you have used professional language throughout your assignment. Proof read for logical structure, accuracy and clarity.

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