case study scenario

the sources given below should also be used for referencing:

Sandra Bullock, 39 years of age is seeing a GP, where you work as practice nurse. Over the past 3weeks, Sandra has noticed significant tiredness, palpitations, and tremor. She has also noted thatshe is always feeling hot, even when others are feeling cold. She has lost 5 kg in weight over thepast 2 weeks without any effort or exercise. She has also noticed a swelling over the front of herneck. On direct questioning, Sandra has noticed her eyelids are a bit puffy and friends havecommented 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-EstateManager. 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. Shetakes metformin (APO-Metformin XR 1000 mg half a tablet daily) and glipizide (Minidiab 5 mg half atablet daily) to control her diabetes and Ibuprofen (APO-Ibuprofen 400 mg one table daily) for jointpain. She does not get enough opportunity to exercise and depends on takeaway for her lunch andeating snacks and ice cream. She states that she often forgets and does not take her medicationregularly. Sandra also smokes 5-6 cigarettes daily.Her mother and older sister were both diagnosed with T2DM in their early 50s. Her mother also hasHashimoto thyroiditis.Sandra is quite stressed about her ongoing conditions and the recent development of othersymptoms.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: 37.7C tympanic SpO2: 97% on RA (Room Air) 

A smooth, mildly enlarged thyroid gland with a bruit (increased blood flow in the thyroidgland), mild proptosis eyelid retraction bilaterally brisk reflexes, and a fine tremor.Sandras blood tests reveal Full blood examination (FBE): haemoglobin: 125 g/L (reference range: 120150 g/L) White cell count: 11.5 X10^9/L (reference range: 4.010.0 X 10^9/L)

  neutrophil: 8.0 X 10^9/L (reference range: 2.07.0 X 10^9/L)

  lymphocytes: 0.8 X 10^9/L (reference range: 1.03.0 X 10^9/L)

  Platelet: 250 X 10^9/L (reference range: 150400 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 

Questions1.What underlying endocrine condition is indicated by Sandras blood test, as well as the signs andsymptoms (clinical features) she is experiencing? Describe the pathophysiology of the condition. Youneed to explain the following aspects in this section and link them to Sandra: 

1.1 Identify the underlying condition

 1.2 Interpret Sandras 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 toSandra throughout

 1.5   Explain at least 5 complications of this condition that are relevant to SandraPart 2 QuestionsFurther blood test results reveal that Sandras blood glucose level (BGL) is 12.9 mmol/L [3.9-6.1mmol/L]; HbA1c: 9% [normal <6.5%].Sandras GP referred her to an Endocrinologist. Her conditions, blood test results and medicationswere reviewed by the specialist. Sandra was advised to stop metformin and prescribed TabSitagliptin (Januvia) 50 mg daily in addition to glipizide 5 mg (Minidiab) half a tablet daily. TheEndocrinologist also added Tab Carbimazole 5 mg daily for managing her recently developed signsand symptoms, and the related Endocrinological condition. 

2.1. Identify 4 risk factors potentially causing Sandras high BGL and HbA1c. Discuss how each riskfactor affects BGLs and HbA1c.

 2.2 Discuss the three medications Sandra is prescribed by the Endocrinologist. Include in your answerthe action, complications, relevant side effects and relevant nursing considerations linked to Sandrassituation. 

2.3 Explain five complications that Sandra could experience if her blood glucose level (BGL) andHbA1c remain high. 

2.4 Identify and briefly discuss four preventive measures Sandra could use to reduce her risk ofdeveloping complications related to T2DM.Add a conclusion in your own words (no new reference should be added in the conclusion)