Assessment Task 2: Case Scenario

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 28 years.
Sandra has been suffering from type 2 Diabetes and rheumatoid arthritis for the past two years. She
takes metformin (APO-Metformin XR 1000 mg half a 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

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.
Add a conclusion in your own words (no new reference should be added in the conclusion)