• Internal Code :
  • Subject Code : NUR2100
  • University : RMIT University
  • Subject Name : Nursing

Medical and Nursing for Hypertensive Diabetic Patient

Table of Contents

Pathophysiology of type 2 diabetes as it relates to the chronic symptoms

Management approaches which include medical and nursing for hypertensive diabetic patient

References

Pathophysiology of type 2 diabetes as it relates to the chronic symptoms

Bill McDonald is a 72 years old person who has been diagnosed with diabetes mellitus type 2 and hypertension. This is due to the not controlling blood sugar and routine alcohol intake since many years. However, he quit the cigarettes when he got diagnosed with diabetic. He was not able to control these two diseases which caused to damage the other body organ. He was getting symptoms of Chronic Kidney Damage of not adhering the diet and control blood sugar and blood pressure (DeFronzo, et. al., 2015).

When the blood glucose increases in the blood cells, it starts to create problems for the body. In the case of Mr. Bill McDonald, he suffers from type 2 diabetes and hypertension which is due to the diabetes. Although, he does not do the routine check-up of his disease. That is why, these diseases become more terrible and started to damage the other body organ. On the recent investigation, it is found that the patient Serum albumin 6.1mg/dl, serum protein 4+, serum urea 25mg/dl which is the starting alarm for Acute Kidney Damage. Here are following points shows a brief description of the pathophysiology of the primary medical diagnosis:

The pathophysiology of type 2 diabetes mellitus is complex which is characterized by decreasing function of β- cell, impaired regulation of hepatic glucose production, peripheral insulin resistance (Zheng, Ley and Hu, 2018).

Pathophysiology of type 2 diabetes mellitus

Figure 1: Pathophysiology of type 2 diabetes mellitus

The type 2 diabetes mellitus occurs when the body does not produce enough insulin or less insulin which ultimately helps to increase the glucose in the blood cells of the body. The pathophysiology of type 2 diabetes was increased in the hepatic glucose production, declining of peripheral glucose uptake, decreased insulin secretion, and enhances carbohydrates for the body. These starts to create problems for the human body and starts to damage the other body organ. In the referred case, Mr. Hank Jackson was facing the issue of not controlling the diabetes which may lead to loss of his left eye vision (Zimmet, et. al., 2016).

Diabetic nephropathy simply indicates the decreasing of kidney function which seen in type 2 diabetes mellitus patients. The development of such disease refers to have in a series of stages and totally linked to the body’s glycaemic and control of blood pressure (Majumder and Wu, 2015). However, it is not seen in any of the diabetic patient with prevalence of chronic kidney disease who are keen in controlling aggressive blood sugar control. This is due to the poor nutritional awareness and irregular check-ups of their body. However, it is much challenging for the diabetic patients for their dietary management (Daskalopoulou, et. al., 2015). Patient’s nutritional education is must in order to avoid any kind of adverse impact on the other body organs.

Patients with type 2 diabetes, progression and regression is much variable as this diagnosed with secondary disorder. There is a report on microalbuminuria and decreased Global Filtration Rate (GFR) in 38% and 29% patients correspondingly. This is the detailed follow-up for 15 years. As far as the progression is concerned, the similar research indicates a transformation from microalbuminuria- macroalbuminuria-ESKD at 2.8% and 2.3% per year correspondingly. Unlikely, Pima Indians research indicate that macroalbuminuria was 50% amid a median follow-up of 20 years. Moreover, consistent deteriorating the kidney function was observed as 7.3% patients were found with microalbuminuria, 17.3% during 5 years, 24,9% during 10 years and which were reached to 28% in 15 years. Epidemiological research in Western and Pima Indian populations likewise guided that the prevalence of Kidney disease is around 21% in those patients who are having type 1 diabetic while in type 2 diabetic patients is reached to 20-25% amid the onset of disease (Sulaiman, 2019).

Management approaches which include medical and nursing for hypertensive diabetic patient

Diabetes and hypertension are common conditions which are found in the patient, the combination of both increased the risk for cardiovascular and renal disease. Hypertension is mostly recognised in people who are suffering from diabetes and this association is particularly strong in type- 2 diabetes. In diabetes, medical care indicates that a majority of patients with diabetes mellitus have hypertension. In patients with type 1 diabetes, nephropathy is often the cause of hypertension, whereas, in type 2 diabetes, hypertension is one of a group of related cardiometabolic factors (Ríos, Francini, & Schinella, 2015). Mr. Bill suffering from type- 2 diabetes and so much overweight creates high BP or hypertension problems for Mr. Bill. The main cause of hypertension is improper diet management and the intake of unhealthy food.

Potential management approach for medical

Management of diabetic hypertensives starts with lifestyle changes like reduction in weight, do exercise on regular basis, control of protein diet, sodium, and alcohol consumption. With the routine change, the patient should control hyperglycemia, dyslipidemia, and proteinuria which is necessary to control and recommended by the doctor to the patient. Effective management and treatment of hypertension need doctors and patient’s coordination to work together and balance the pharmacologic and nonpharmacologic & prevent the organ from any damage (Daskalopoulou, et. al., 2015). Below figure shows the comprehensive algorithm encompassing all the armamentarium of management:

Algorithm for the management of hypertension in diabetes

Figure 2: Algorithm for the management of hypertension in diabetes

A change in lifestyle is very important to control hypertension in diabetes and the patient should manage the whole thing according to the doctor's suggestion. Lifestyle modification includes exercise, a diet low in sodium, manage cholesterol, avoid saturated fat, and high in potassium, fibre, calcium which reduces and accurately manages the BP. The doctor recommends that salt intake should be less than 2300 mg and excessive sodium intake is harmful to the patients who are suffering from type- 2 diabetes & it may also decrease the antihypertensive effects of medications. An effective dietary plan controls diabetes and effectively prevents the complications.

Hypertension can be control when the weight is managed and the diet is healthy. For diabetes patient, the blood pressure is more difficult to control because most of the patient does not follow the diet plan and not do any physical work (Morris & Dunham, 2018). Type- 2 diabetes care is the best offer by a medical professional team who know regarding cure this disease in an appropriate manner.

Potential management approach for nursing

There is a complicated task for the adult to take his medication regimen. Sometime, nurses do not take care of the patients due to the hectic work schedule hence which may lead to create problems in the patients’ health condition. In the cited case, Mr. McDonald is taking Metformin 1000 mg twice in a day. If the nurse will not do routine check-up of patient’s blood sugar and blood pressure and give medicines as prescribed by doctor, then this may create a severe health problem for the patient. The case of hyperglycaemia and hypertension could arise that may lead to stop of heart rate of the patient or may lead to have in comma and cause to damage the other body part of patient (Rena, Hardie, & Pearson, 2017). This is occurred in case of Mr. Bill and his blood sugar was not controlled as per the test done of HbA1c which shows 7.2% of fasting which is too high that indicates of non- controlling of blood sugar. The nurse responsibility is to improve the quality of life of elderly patients such as Mr. Bill. This is happened by making the inter- professional plan of care for him. With the help of inter-profession care plan, Mr. Bill can survive with the healthy environment for a longer time.

Mr. Bill McDonald is a 75 years old man who has a type 2 diabetes and diagnosed one year ago. He is on the tablet and taking Metformin 1000 mg twice in a day. He does not follow diet and also not follow routine check-up so that he could take medicines properly. She also has blood pressure due to obesity and for maintaining this doctor has not mentioned anything for controlling his blood pressure. Now he has diagnosed Hypertension and his BP was diagnosed with 170/100 mmHg which is the indication of High blood pressure (Zaccardi, et. al., 2016).

Health promotion and education is the crucial part for Mr. Bill perspective, which is linked to the current fact that of mismanagement of his condition himself. There is a need to aware of not controlling the diabetes and hypertension and that can lead to create serious health issues for the patient. Now he needs get a nurse in order to facilitate interdisciplinary plan of care for Mr. Bill.

Follow diet chart: Mr. Bill needs to adopt high fibre, healthy nutrients fortified with vitamin D and low carbohydrate diet. Lean protein must be added for building immunity strengths. Unsaturated fats may include in the diet which helps to add high proportion molecules which considered to be the healthier than the saturated fats. High fibre foods must be added in the diet for controlling the blood pressure and sugar level. Fruits and vegetables give energy as these are having natural sweetness in the body (Type 2 diabetes Guide and the diet cure, 2020).

Type 2 diabetes guide

Figure 3: Type 2 diabetes guide

Management includes the following:

Appropriate goal setting: This goal is set by the doctor for the patient and the patient must appropriately achieve this. Nurse allows the patient to take his medicines on time with appropriate quantity. The dosage should not overdosage or less. If the patient is having some issues in the health conditions then in that case, nurse needs to check the patient health and then give dosage of his medicines. Additionally, doctor consultation is much needed on time so that the patient condition could be assessed.

Exercise and dietary modifications: To do regular exercise which includes morning walk and easy work out which can be easily done by the patient. Jogging is required for Mr. Bill so that the blood sugar and blood pressure level can be controlled naturally. These are the best part for the patients like Mr. Bill to maintain their blood sugar and hypertension level naturally (Sulaiman, 2019). Proper diet modifications are very essential for the hypertensive diabetic patient which manages the blood glucose and level of sodium in the body of Mr. Bill.

Regular monitoring for complications: While doing regular monitoring to the patient, the complication can be removed promptly. Delay in treatment can cause a worse situation to the patient and increases the chance of other diseases.

Appropriate self- monitoring of blood glucose (SMBG): When the blood glucose is managing the patient can be healthy and they can control hypertension. The blood glucose can be managed with an appropriate diet plan and self- caring.

Assessment or test in the laboratory: In each month, the patient goes to diagnose centre to check the level of blood glucose and blood pressure which is important for every diabetes patient. With the help of this, the patient can appropriately maintain themselves. Nurse should require to do routine check-ups of Mr. Bill as his blood glucose level seems higher than the normal. The Hba1c is 7.2% which reflects the indication of hyperglycaemia which simply means that the patient is having imbalance in blood sugar for 2-3 months (Zheng, Ley, & Hu, 2018). With the help of routine check-ups, patient’s medicines dosage could be changed in order to keep balance of blood sugar and hypertension.

These all are required by the nurse for Mr. Bill as an inter-professional plan of care.

References

Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., Gelfer, M., Lamarre-Cliche, M., Milot, A., Bolli, P. & McKay, D. W. (2015). The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 31(5), 549-568.

DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., ... & Simonson, D. C. (2015). Type 2 diabetes mellitus. Nature reviews Disease primers, 1(1), 1-22.

Majumder, K., & Wu, J. (2015). Molecular targets of antihypertensive peptides: Understanding the mechanisms of action based on the pathophysiology of hypertension. International Journal of Molecular Sciences, 16(1), 256-283.

Morris, J., & Dunham, A. (2018). Metoprolol. In StatPearls [Internet]. StatPearls Publishing.

Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60(9), 1577-1585.

Ríos, J. L., Francini, F., & Schinella, G. R. (2015). Natural products for the treatment of type 2 diabetes mellitus. Planta Medica, 81(12/13), 975-994.

Sulaiman, M. K. (2019). Diabetic nephropathy: recent advances in pathophysiology and challenges in dietary management. Diabetology & metabolic syndrome, 11(1), 7.
Type 2 diabetes Guide and the diet cure, (2020) [Online]. Available through:<https://www.trifectanutrition.com/health/type-2-diabetes-guide-the-diet-cure>.

Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal, 92(1084), 63-69.

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88.

Zimmet, P., Alberti, K. G., Magliano, D. J., & Bennett, P. H. (2016). Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nature Reviews Endocrinology, 12(10), 616.

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