MODOO7211 SUMMATIVE ASSESSMENT
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1. Introduction
Hyperglycaemia is a medical condition which occurs when the glucose levels in the blood
plasma significantly increases. It is typically related to diabetes, which is a health condition in
which the blood sugar or glucose levels in the blood can rise dangerously high. It affects more
than 90% of individuals with the disease, is brought on by a gradual decrease of beta cell insulin
production and usually coexists with insulin resistance (Udler, Powe and Tse, 2020). In context
with England, it has been found that around 3.4 million people have type 2 diabetes, out of
which 43.9% of them aged between 40 to 64 years (Gagliardi, 2024) (refer to figure 1).
Moreover, in the United Kingdom (UK), around 4.3 million people have type 2 diabetes and it
is estimated that around 850,000 people who do not yet have a diagnosis are living with the
disease (Diabetes UK, 2024). By 2045, it is estimated that around 783.2 million individuals or
12% of the global population will have type 2 diabetes (Yan et al., 2022). Therefore, it can be
inferred that at local, national and global levels, the prevalence of type 2 diabetes has
significantly increased.
Figure 1: People with type 2 diabetes in England, by age
(Source: Gagliardi, 2024)
In context with the case study, it has been acknowledged that the 34 years old female patient
has type 2 diabetes which leads to hyperglycemia. Most importantly, it was found that on two
occasions her hyperglycemia reached a threshold that was her diagnosis for diabetes (Udler,
Powe and Tse, 2020). First, at age 25, she experienced a randomly obtained blood glucose level
of 217 mg per deciliter. Secondly, at age 30, she has a fasting blood sugar level of 133 mg per
deciliter as a result of a 2-hour oral glucose tolerance test (Udler, Powe and Tse, 2020).
However, the age of the patient during the diagnosis process reflected different information
regarding her health status and condition. It is due to the fact that she has hyperglycemia while
having a BMI that is almost normal, and the fact that her condition has been moderate and non-
progressive for a long period of time are some characteristics of her case that do not fit the
mould for a typical type 2 diabetes. Therefore, this essay emphasises on evaluating the key
aspects of the diagnosis of the women with hyperglycaemia, including medical interventions,
ethical or legal issues, pathophysiology and so on. Lastly, this essay has offered few
recommendations on the ways of improving diagnosis of diabetes amongst the patients.
Thesis Statement: Hyperglycaemia presents a complicated interplay of physiological factors
resulting in the need of comprehensive interventions for mitigating the adverse effects on
health outcomes of individuals and quality of life.
2. Pathophysiology
According to Lee and Halter (2017), when there is an imbalance between glucose intake and
food consumption and glucose production as opposed to insulin-stimulated glucose absorption
in target tissues, primarily skeletal muscle, hyperglycaemia arises in type 2 diabetes. Most
importantly, the pathophysiology of hyperglycaemia revealed that risk factors such as genetic
factors, lifestyle conditions like obesity and less physical activity leads to insulin resistance,
resulting in type 2 diabetes (Lee and Halter, 2017). Consequently, in context with the case
study, the higher blood sugar levels that is 217 mg per deciliter at the age of 25 in the patient
reflected the initial conditions of type 2 diabetes (Udler, Powe and Tse, 2020). Therefore, it
has been acknowledged that reduction in β-cell dysfunction has been led to hyperglycaemia
resulting in type 2 diabetes.
Figure 1: Pathophysiology of hyperglycaemia in type 2 diabetes
(Source: Zheng, Ley and Hu, 2018)
Apart from this, Zheng, Ley and Hu (2018), highlighted that factor affecting the insulin
secretion and action includes smoking, body weight, epigenetics, levels of physical activity and
many others leads to hyperglycaemia (refer to figure 2). Based on these factors, it has been
found that the 36 years old patient faced severe weight loss and higher blood pressure are the
factors affecting insulin secretion and action leading to hyperglycaemia (Udler, Powe and Tse,
2020). Therefore, it can be determined that the pathophysiology of hyperglycaemia affects the
liver, adipose tissue and skeletal muscle of the patients.
Moreover, Banday, Sameer and Nissar (2020), observed that the Pathophysiology of diabetes
revealed that there are four different types of diabetes such as type 1, type 2, gestational and
secondary. Similarly, these types of diabetes are characterised by different factors like insulin
resistance, auto-immune destruction and other specific conditions. Based on the case study, it
has been acknowledged that the concerned patient showcased the symptoms of type 2 diabetes
which was characterised by insulin resistance caused by hyperglycaemia (Udler, Powe and
Tse, 2020). However, with comprehensive diagnosis of the patient over the period of her
pregnancies, it has been found that she faced gestational diabetes such as glucokinase–maturity-
onset diabetes of the young (GSK-MODY) (Udler, Powe and Tse, 2020). Therefore, it has
been acknowledged that increased hyperglycaemia initially resulted in type 2 diabetes, which
was further diagnosed to be GSK-MODY diabetes because of the pregnancies of the patient.
3. Medical/Nursing Interventions
3.1 Evaluation of nursing process approach ANPIE
Assessment
The 34-year-old woman had a history of low back pain and acne and her medication was
metformin. Moreover, she had no medication allergies as well as she lived with her husband
and four children in the suburban community. She did not smoke tobacco or any other illicit
drug she used and rarely drank alcohol. Both of her grandmothers had been diagnosed with
type 2 diabetes mellitus and her father had hypertension along with being overweight. Her
mother and father were diagnosed with type 2 diabetes at 50 and 48 years of age. At the age of
30, she encountered a fasting blood glucose level of 133 mg per deciliter and the result of a 2-
hour oral glucose tolerance test of 236 mg per deciliter. Both of these occasions denote that her
glycated haemoglobin level was in the prediabetes range which is defined as 5.7 to 6.4%.
Nursing problem
The examination of the patient's body's condition appeared well as the blood pressure level was
126/26 mm Hg and the heart rate 76 beats per minute. BMI was 25.4 and glycated haemoglobin
level was 6.2%. The nursing problems can include imbalanced nutrition as she advised a low
carbohydrate diet and a minimum of 5 days per week of exercise. The study of Nemer et al.,
(2020), highlighted that nursing diagnosis risk for high blood sugar levels refers to identifying
and diagnosing accordingly the developing macrovascular changes as well as quick treatment
for macrovascular abnormality. Moreover, the risk of the fluid volume deficit related to
dehydration and polyuria and activity intolerance related to weakness and fatigue can be
included in this section.
Planning
Planning includes the development of a comprehensive mindset for dietary modification,
medication management, activity planning, hydration strategies, diabetes management and
proper monitoring of the blood glucose level.
Implementation
Plan implementation refers to dietary management and meal preparation by focusing on
carbohydrate counting and balanced nutritional levels. Proper administration of medication
refers to managing the blood sugar level and hormonal balance for the insulin level. It also
includes fluid intake management to prevent dehydration and engaging in regular physical
activities.
Evaluation
Self-management principles, hydration status monitoring, management of nutritional status
through following proper meals with less sugar level-based food and high protein and achieving
glycaemic control through adjusting treatment plans. The systematically application of the
ANPIE nursing process approaches the nurses can provide holistic care interventions and
address the emotional, physical and educational requirements for a positive outcome as well as
the quality of life.
3.2 Intervention to treat based on NICE guidelines
NICE guidelines say to try to get blood glucose to the right level which is while waking up and
before having any meal, between 4mmol/litre and 7mmol/(NICE, 2015). Lifestyle medication
and antidiabetic medications need to be advised for the patient for treatment purposes. Further
Insulin therapy is recommended at a dose of 10 units or 0.1-0.2 U/kg and a higher dose such as
0.3-0.4 U/kg is recommended for severe hyperglycaemia (Chadha et al., 2023). Moreover,
regular follow-up and blood glucose monitoring through fasting tests and after-meal tests of
sugar levels can be recommended.
3.3 Discussion on the success of the intervention for symptom improvement 100
The success factor of the intervention for symptom improvement relies on multifaceted
approaches which address lifestyle factors, education and knowledge level of the patient, diet
plan, proper antibiotic medication, monitoring of glucose level pharmacotherapy and regular
exercise and fitness planning. The intervention can improve the symptoms of the patients as all
these factors are essential to maintaining a good lifestyle which is the key to maintaining
accurate blood glucose levels and functions of the system of the body.
3.4 NICE guidelines followed for the condition
HbA1c management and target analysis for blood glucose lowering therapy once in
6 months (NICE, 2022)
Ensure education programs for adults with type 2 diabetes [2009]
Encourage adults with type 2 diabetes about dietary advice for;
Controlling intake of saturated and trans fatty acids [2009] (NICE, 2022)
Choosing low-fat dairy products
Eating high-fibre, low glycaemic-index sources of carbohydrates such as fruits, whole
grains, pulses and vegetables
Eating oily fish
4. Legal and Ethical Issues
4.1 Legal and ethical issues related to the patient
In context with the patient, it has been found that during her pregnancies, genetic testing of the
foetus has been carried out as the patient has a family history of diabetes. In this regard, privacy
and confidentiality has been a key ethical issue related to the patients. It is due to the personal
information of the patients that are often shared with the physician for diagnosis, which are
somehow revealed with others (Noroozi et al., 2018). Consequently, the confidence and trust
of patients is severely impacted by their worry for maintaining confidentiality. Hence, there is
a large possibility that patients may withhold some information from their doctors, and they
are also less likely to recommend the doctor for follow-up care or therapy.
Apart from this, informed consent has been a legal issue related to the patient as her diagnosis
for diabetes lasted for a long time, which could have hindered her personal space. In relevance
to the above, Hall, Prochazka and Fink (2012), mentioned that expectations put on healthcare
professionals, the degree to which doctors adhere to the basic requirements for disclosure,
patient autonomy, comprehension and use of information are the constraints to informed
consent. Therefore, it can be inferred that acquiring informed consent prior to initiating
treatment or procedure is essential for respecting autonomy of the patients.
4.2 Patient right to choose or decline the care process
In context with the case study, it has been found that the patient has agreed to the care process
offered based on her diagnosis of hyperglycaemia. However, it has been acknowledged that
during her pregnancies, she had brought certain changes in her medication like she stopped
taking metformin (Udler, Powe and Tse, 2020). Based on this, it can be inferred that patients
have the right to follow or refuse the care process based on their viewpoints and perceptions.
In relation to the above, it has been acknowledged that one of the fundamental ethical tenets of
medicine, autonomy, provides the basis for the freedom of patients to refuse care. Similarly,
Taylor (2013), mentioned that people should not be forced to accept opinions or conclusions
of healthcare providers as everyone has the freedom to make educated decisions regarding their
own health. Therefore, it has been determined that ensuring the patient's right to take or refuse
care is essential within healthcare, which also has been clearly witnessed during the diagnosis
process of the patient in the concerned case study.
4.3 Treatment escalation plans
Treatment escalation plans are instruments for communication that provide patients with
individualised treatment objectives and potentially life-saving measures. In this regard, Warner
et al. (2023), observed that the extent to which patients and healthcare professionals view
collaborative decision-making as advantageous remains unclear. It is due to the fact that
treatment escalation plans are occasionally developed too late and are frequently underutilised.
Therefore, in context with the case study, it can be inferred that development of clear and
concise plans could have been challenging for bolstering the diagnosis process. It is due to the
fact that 34 years old patient has been initially misdiagnosed of type 1 diabetes, although her
symptoms and lifestyle conditions were different than usual.
4.4 Advanced decisions
In context with the case study, it has been found that the clinicians have diagnosed the daughter
of the patient with higher hyperglycaemia, which has assisted in preventing misdiagnosis of
type 1 diabetes. Therefore, it has been acknowledged that advanced decisions made by the
clinicians are beneficial for correct treatment and diagnosis for the daughter of the patient.
Similarly, Sutton and Pincock (2020), observed that Computerised clinical decision support
systems (CDSS) is an advanced tool for improved advanced decision by reducing the
complexities of analysing the issues of the patients. Consequently, incorporation of CDSS
allows clinicians to reduce the potential threat of severe health issues within patients through
advanced decision making. Therefore, in context with the case study, it can be inferred that the
proactiveness of the clinicians towards the daughter of the patient has assisted in proper
diagnosis of hyperglycaemia and diabetic conditions.
5. Health behaviours and health promotion
5.1 Addressed health behaviour
According to Hackett et al. (2018), health behaviour contributes enough to type 2 diabetes
diagnosis and management of the health condition and it has been found from the long-time
research that limited evidence is there that T2D diagnosis encourages behaviour changes.
Poor nutritional intake refers to a lack of focus on eating surgery food and saturated fats and
carbohydrates which can affect the blood sugar level as well as affect kidney functions
drastically. Initially, the impact of the mental model on patient decision-making for controlling
type 2 diabetes refers to the conformable state regarding making decisions with medical
professionals and accepting advice for managing diabetes through dynamic lived environment
analysis (Bergen, Taylor and Dunn, 2023). Duynaic's lived environment promotes lifestyle
changes in order to make appropriate decisions to manage diabetes through various ways like
proper monitoring, regular exercise, diet plan and others.
Figure 3: Impact of the metal model on patient decision-making for type 2diabetes
(Source: Bergen, Taylor and Dunn, 2023)
Poor weight management
Poor weight management refers to a lack of consciousness of physical exercise and a lack of
healthy habits. A person with a low-calorie diet consumes 1000 to 15000 calories a day
depending on their specific needs (Pelc, 2023). A real-life example such as the report of the
American Diabetes Association defines diabetes remission as sustaining a normal blood sugar
level, an HbA1c level of less than 6.5% for 3 months or longer through the low-calorie diet
plan (Pelc, 2023). Thus, low-calorie diet plan also helps the T2D patient to fight poor weight
management issues effectively for long-term health-beneficial purposes. The addressed health
behaviour which is following a low-calorie diet plan which includes lots of vegetables and
fruits in the diet along with fibre and whole gain can be effective for managing type 2 diabetes.
5.2 Discussion of the role of the nurse in promoting health
Behaviour Change Theory
In the study of Almulhim et al. (2023), behavioural change techniques in the heath coaching-
based interventions for T2D patients are associated with self-management initiatives that
reduce chronic conditions related to the disease. According to Mohan (2018), motivational
interviewing (MI) is an appropriate approach to behavioural changes that is associated with the
communication skills of a broader range of general practitioners to tailor readiness to change
among individuals. However, the stages of change need to identify the right time to discuss the
readiness to accept the behavioural changes. Patients with re-contemplation do not consider
the idea of changes for their behaviour towards the lifestyle (Refer to figure 4). Contemplative
patients are naturally pulled in two types of directions; they either enjoy the benefits of changes
or have some concerns about the negative consequences of not changing their behaviour. They
have mixed types of motives for further changes. Patients with a ready-to-change nature have
a high motivation to implement changes. Proper motivation aspects and encouragement from
the medical professional can be beneficial for the individual to change the behaviour towards
a healthy lifestyle, healthy eating habits, regular exercise and proper medical treatment
scheduling.
Figure 4: Stages of change model for behaviour
(Source: Mohan, 2018)
6. Integrated health care
6.1 Challenges revenant with the patient
Psychological
Depression, anxiety, stress, body image issues social and relationship-building changes are the
common factors related to psychological factors of patients with hyperglycemia. The study of
Bhat, Muliyala and Chaturvedi, (2020) highlighted that diabetes just like other non-
communicable diseases has some common challenging factors such as common mental health
disorders, depression, hypoglycaemia distress, eating disorders, negative social perception and
others. Therefore, it can be stated that individuals with the disease of hyperglycemia need to
adopt a quality lifestyle to resolve the negative impact of this disease on psychological factors.
Social
Discrimination in society develops a stigmatised attitude among individuals who are suffering
from Type 2 Diabetes thus they feel guilty which affects their self-esteem as a result they
cannot build good relationships with others.
Physical
Weight gain and hormonal imbalance related to insulin and thyroid are the common physical
challenges faced by T2D patients. According to Mwila, Bwembya and Jacobs, (2019) kidney
function failure, blurry visions, sexual dysfunctions and others are the common physical
disorder faced by T2D patients worldwide. Therefore, T2D can increase many types of physical
challenges and proper maintenance and median are required to minimise the negative effects
of this particular disease.
6.2 Integrated approach for the improvement of care
Benefits of integrated care
Based on the recognised challenges relevant to the patient, it can be determined that offering
integrated care can be highly beneficial for enhancing patient outcomes. According to Carrigan
et al. (2023), the benefits of integrated care include enhanced quality of life, lower costs, greater
service coordination, more individualised treatment and improved continuity of care. In
addition to this, integrated care is a method for reducing care fragmentation that improves
patient outcomes, experiences receiving treatment, and overall efficacy of care (Goodwin,
2016). Therefore, in context with the case study, it can be stated that incorporation of integrated
care systems will be beneficial for improving the outcomes of the patients in the concerned
case study.
Teamwork essentialities
In order to offer effective integrated care to the patient discussed in the case study, it has been
acknowledged that strong teamwork is an essential criterion. In a similar stance, Vries et al.
(2016), observed that clear and effective communication between the team members helps in
ensuring critical decision-making regarding patient care. In addition to this, team integration is
an essential aspect of teamwork in integrated care as it helps in valuing the unique skill sets
and perspectives of the team members (Chhugani, 2023). Therefore, it can be determined that
for offering integrated care to treat hyperglycaemia within the patient in the case study, an
effective team with specialists and experts are required.
Referral to specialist nurses
According to Glarcher and Vaismoradi (2024), specialised nurses can help organisational
efforts to prevent adverse occurrences and contribute significantly to the promotion of a patient
safety culture. Additionally, specialised nurses improve the quality of care by meeting all the
needs and demands of the patients. Therefore, in context with the case study, it can be
determined that referral to specialist nurses will assist in improving the efficacy of integrated
care of hyperglycaemia.
7. Conclusion
The overall study conveys the case study of a 34-year-old lady suffering from hyperglycemia
as her blood sugar level increased. The case history states that both the parents of the lady were
diagnosed with diabetes in middle age. After the birth of three children proper test of her body
system showcased that previously she did not have any type of symptoms as she followed a
healthy lifestyle. Gradually, she comes to know about the symptoms and various types of
guidelines have been presented here in order to describe the nature of Type 2 diabetes.
Moreover, finally, it was diagnosed that the lady had a GCK variant of diabetes though, from
the beginning of the pregnancy, this situation did not come out in front of the medical
professionals. Initially, hyperglycaemia in the pregnancy period is associated with adverse
pregnancy outcomes which can be seen in the present case too. The second child of the lady
tested positive for the GSK variant and proper lifestyle measures have been found to minimise
the negative impact of type 2 diabetes in addition to GCK-Mody. It can be considered that
proper medical follow-up is needed for the GCK-MODY variant until a woman is considering
the pregnancy period and proper medical tests are needed to protect the foetus from the disease
hyperglycaemia or T2D.
Recommendation: From the beginning proper diet chart is followed and regular exercise is
recommended to stay away from the chances of affecting by hyperglycaemia or type 2 diabetes.
Proper medical check-ups and education need to be aware of the lifelong effects of T2D in
order to maintain physical functions properly for their entire life.