Case study 2 (Part 1) (Total 17 marks)
Case study 2 – Mary
Mary is a 56 year old woman who has recently been diagnosed with type 2 diabetes. She is morbidly obese and has a body mass index (BMI) of 35. She is visiting a community health clinic for assessment and education for her newly diagnosed condition.
1. (a) Explain six (6) potential health issues Mary faces as a result of her obesity. (3 marks)
(b) In planning services for your client, you follow organizational requirements and obtain a urine test from Mary. You note that Mary’s urinalysis shows that there is a moderate amount of protein present. Is this finding normal or abnormal? Justify your answer. (1 mark)
2. Name two (2) external and (2) internal factors that could be affecting Mary’s health status. (2marks)
3. What type of health education should nurses give this client to assist her with controlling her condition? (2 marks)
4. In your planning of services for Mary you identify that she needs to see a Dietician. What is the most likely impact of this intervention for Mary? (2 marks)

Case study 2 (Part 2)
5. Identify the body systems that are affected by Mary’s Type 2 diabetes. (2 marks)
Cardiovascular system Nervous system Integumentary system
Endocrine system Sensory system Urinary system
Body System Structure and function
Consists of heart and blood vessels. Heart pumping action ensure constant circulation of the blood. Blood vessels through which the blood flows. The system is dividing into pulmonary and systemic systems.
The main excretory system and consists of the following structures:
• 2 kidneys, which secrete urine
• 2 ureters, which convey the urine from the kidneys to the bladder
• The bladder where urine collects and is temporarily stored
• The urethra through which the urine is discharged from the urinary bladder to the exterior.
Plays a vital part in maintaining homeostasis of water and electrolyte concentrations within the body. Produces urine that contains metabolic waste products, including the nitrogenous compounds urea and uric acid, excess ions and some drugs.
Detects and responds to changes inside and outside the body. Response to changes in the internal environment regulates essential involuntary functions, such as respiration and blood pressure. Response to changes in the external environment maintains posture and other voluntary activities. Together with the endocrine system, this system controls many vital aspects of body function and maintains homeostasis. Therefore it is important to study and understand the structure and organisation of different aspects of the nervous system.
Completely covers the body and is continuous with the membranes lining the body orifices.
Protects the underlying structures from injury and from invasion by microbes contains sensory (somatic) nerve endings of pain, temperature and touch is involved in the regulation of body temperature.
Consists of glands widely separated from each other not physically connected, endocrine glands are groups of secretory cells surrounded by extensive networks of capillaries that facilitate diffusion of hormones directly into the blood stream.
Hearing, sight, smell and taste all have specialised sensory receptors outside the brain. These are found in the ears, eyes, nose and mouth. In the brain the incoming nerve impulses undergo complex processes of integration and coordination that result in perception of sensory information and a variety of responses inside and outside the body.
6. Complete the table below with the health impact that diabetes can have on the body systems provided. (2 marks)
Sensory systems, the eye Cardiovascular system
Nervous system
Cardio vascular system – Hypertension Urinary system
Body System Potential effects of Diabetes
Prolonged raised blood glucose can lead to atherosclerosis – hardening and narrowing of the arteries, and if affects the coronary arteries, it can cause coronary heart disease leading to heart attacks and angina
Diabetes, obesity and a sedentary lifestyle are all risk factors contributing towards development of hypertension. Untreated hypertension can lead to heart failure, stroke and kidney damage.
Atherosclerosis in the brain can cause an ischaemic stroke.
High blood glucose damages small and large blood vessels throughout the body. In the kidneys the damage is referred to as diabetic nephropathy (Waugh and Grant, 2010, p 345). Glomeruli are progressively damaged allowing protein into the urine. Atheroma of renal arteries can lead to renal ischaemia, hypertension and eventually chronic renal failure.
Microvascular complications of diabetes can impair eyesight or cause vision loss.
7. Fill in the blanks regarding the impacts of health services in relation to the health issues experienced by Mary, refer to the example provided as your guide. (3 marks)
Health Issue Health Service Impact of service on clients condition
Example:
Peripheral neuropathy Podiatrist Minimise risk of potential ulcers/sores developing and becoming infected (Peripheral neuropathy causes decreased sensation to feet)
Dietician
Treat underlying depression/eating disorders
General practitioner Manage blood glucose monitoring, and overall health and well-being of a client with a chronic condition
Diabetic retinopathy
Endocrinologist Monitors diabetes and insulin/medication regime and specialised treatments