CNA153 Foundations For Professional Practice 2 : Essay Fountain


Case study

You are the District nurse who is visiting Violet, who has type 2 diabetes, osteoarthritis and a lower left leg ulcer. She is ambulant over short distances with a walking frame. Violet has been approved for residential aged care and has been waiting for a nursing home bed. During the last 3 months you have been visiting to attend to Violet’s BSL’s and daily dressings, until a suitable placement becomes available
Violet currently lives with her daughter Gemma, Matthew (Gemma’s husband), and their two young children, Scott aged 5 and Lucy aged 7, who both attend the local primary school. The family lives in a two-bedroom town house. Gemma works night shift as an enrolled nurse, and earlier in the year Matthew was made redundant from his job and is currently unemployed.
The house is becoming quite stressful. The children have given up their bedroom for their grandmother and are sleeping in the lounge room. Violet requires a lot  of care and is demanding of her daughter’s time. Violet argues frequently with Matthew about him not working and his drinking of alcohol. You are very fond of the family and feel for the pressures that they are under. One day after you shower and attended Violets wound care you pass Matthew sitting on the front step of the house. He is drinking alcohol and it is 10am. You ask him how he is coping with having Violet staying with the family. He says he’s not doing so well and “lately I’ve had trouble controlling my temper with the kids”

Task description

Identify a clinical issue from the case study provided.  Formulate both a qualitative and a quantitative clinical question to explore  this issue. Search for evidence to answer or address your questions.

Assessment criteria

1. Formulates searchable clinical questions for both quantitative and qualitative aspects of a scenario.

2. Demonstrates the ability to search for research evidence to answer the questions.

3. Identifies appropriate evidence to address/answer these questions.

4. Demonstrates ability to use research findings to answer a clinical question.




Form the case study, Violet has been suffering from various clinical problems. For the three month period that she has been under my care, there are identifiable clinical conditions. They include type 2 diabetes, osteoarthritis, and she also suffers from a left leg ulcer. Violet can walk over a short distance using her walking frame but is awaiting to join residential care for the aged. In the course of these three months, I’ve been attending Violet to check her blood sugar levels as well as her dressings. Having a look at the clinical conditions violet is suffering from;

Type 2 diabetes; its chronic diseases that affect how the human being metabolize sugar. With this condition, the human body doesn’t accept the effects of insulin, a hormone that controls the movement of sugar in the body cells. With the state, the pancreas may also not be failing to produce sufficient insulin to sustain the required glucose levels (Nolan, Damm, and Prentki, 2011,p.169) the exact cause of this condition is not well known, but both genetic and environmental factors are contributing factors. These factors include being overweight and inactive.

Osteoarthritis is one of the most common forms of arthritis, which not only Violet but most people in the world have. This disorder mostly affects the joints in the hands, hips, spine, and knees. The symptoms shown by this condition can be managed, but the damage caused on the person’s joints can’t be reversed. Regular exercise, keeping a healthy body weight, and taking medication may relieve pain and prevent the progression of this condition. Some of the symptoms that accompany this condition are; pain in the joints, stiff joints, and swelling on the joints, among others (Rother 2007 .p 57)

A chronic leg ulcer is a skin defect that occurs below the knee, and it persists for more than a week and shows no signs of healing after a period of three or more months. Violet suffered from a left leg ulcer, which is more prevalent amongst adults. This condition causes pain and reduces the patient’s quality of livelihood (Chaudhur et al,2017,p.67 Various conditions cause this condition; they include venous diseases and neuropathy diseases. However, metabolic disorders, infectious diseases, and hematological disorders are considered to be of less impact to its occurrence.

These clinical conditions discussed above are all involved in the case study of Violet. In my research, I will focus on type 2 diabetes to develop both qualitative and quantities research questions. The clinical issue identified from the case study is the patient suffering from type 2 diabetes. Therefore, this particular clinical issue needs to be addressed, well understood so as to offer the correct intervention for control and treatment.


Research question: 

What are the causes and intervention procedures for type 2 diabetes? 

Clinical issue: Type 2 diabetes

In general, diabetes occurs when sugar levels accumulate in the bloodstream. When it comes to type two diabetes, the body cells aren’t able to respond as required to insulin. At advanced stages, the body may then fail to produce enough insulin. In the body, insulin is used to assist the body remove excess glucose from the blood into the body cells where it is used as energy. Failure of its control, this condition can lead to high blood levels as well as cause serious complications. In the United States, over 30 million people have diabetes, which is about 10% of the entire population (Tomlinson, Millward, Stenhouse & Pinkney, 2010 p. 102)


What are the symptoms present in type 2 diabetes?

In type 2 diabetes, the fails to use insulin, which helps bring sugar broken down to glucose into the body tissues. The body, therefore, depends on other various energy sources in the body tissues, this process hence causes several symptoms which include (Ismail-Beigi, 2012.p 17)

Regular urination when the kidneys try to keep out the excess sugar present in the blood by filtering it out of the bloodstream. A person suffering from this condition frequently urinates, especially at night.

Increased thirst or a dry mouth is also another symptom that occurs as a result of frequent urination. As the person keeps on urinating, the blood loses water, causing dehydration. This condition makes the patient experience more thirst than usual (Kumar, Saravanan & Ramachandran, 2011 p.98)

Increased hunger as a symptom is caused by the failure of glucose broken down from food failure to move from the bloodstream into the body cells. Glucose broken down food needs to be stored in the body cells as fuel. People suffering from this condition get hungry from time to time, regardless of how often they eat.

Weight loss may occur in the eventuality where we have uncontrolled type 2 diabetes. It occurs due to excessive loss of water and also the failure of cells to get enough supply of glucose.

Fatigue is also another sign to show that a person might have diabetes. This condition shows up as a result of less sugar moving into the bloodstream from the body cells. Blurry vision is also another symptom of type two diabetes as excess sugar damage the small blood vessels in the human eye. It can occur on both or one eye, failure to seek medical attention this condition can result in blindness (Szabo, 2011p.32)

According to the article Szabo (2011),slow-healing cuts and wounds may also show up as one of the symptoms of type 2 diabetes. It happens when then high blood sugar damage the blood vessels and the body nerves. Small woods that may be inflicted on the patient may take a long period to heal. These wounds expose the patient to infections as they treat over a long period.

Other signs that a person maybe has type 2 diabetes include numbness or pain in the hands. Dark patches on the skin, particularly on the neck or groin, are signs that one is suffering from this condition.

Itching and yeast infections are also other symptoms of this condition. Excess glucose in the bloodstream and yeast provides food to the fungus that causes these infections. These infections mainly occur in the genital areas and the mouth. Affected areas experience is usually itchy and have burning effects (Sinclair et al,p.206)


What are the Causes of type 2 diabetes?

Overweight, obesity and physical inactivity are some of the conditions that cause this type of diabetes. The extra weight on an obese person causes insulin resistance and is more prevalent in people with type 2 diabetes.Insulin resistance is linked to excess berry fat, which also causes blood vessels and heart disease. Obesity and inactive lifestyles have been found to contribute to about 90% to 95%es of type 2 diabetes.

Insulin resistance is a condition whereby type 2 diabetes begins. In this condition, the liver and fat cells fail to use insulin. This condition causes the body to demand more insulin to keep glucose in the cells (Tahrani,Bailey,Del Prato,and Barnett, 2011,p.182). The pancreas being the organ to produce this insulin, fails to make enough over time, causing the blood glucose to rise.

Genes and family history may be another cause of type 2 diabetes. This condition tends to be in a particular family can occur s mainly in some of the ethnic groups. In 2016 diabetes, in general, was responsible for approximately 1.6 million deaths. The ethnic groups affected include African Americans, American Indians, and Hispania’s, among others (Perry,et al, 2011 .p 176)

Which are the medical interventions for type 2 diabetes

In some selected cases, change of lifestyle help in keeping type 2 diabetes under control. Besides several medicines may also be used, some of these include;

Metformin can help lower the body glucose levels and help it respond to insulin. It is the most used method of treatment for people with type 2 diabetes. In the same account, Sulfonylureas, which boost the body to make more insulin, may also be used. Meglitinides are drugs that stimulate our pancreas to produce more insulin and act under a short duration of time. Thiazolidinedione makes the body more sensitive to insulin. Glucagon-like peptide and sodium-glucose cotransporter, among other drugs, help in the treatment of type 2 diabetes as stated (Yang, Ma, Fan, & Zhao, 2011 .p 97)

Patients suffering from this condition need to maintain a healthy diet to maintain the blood glucose level at the allowed range (Ritz, Raine& Cordonnier, 1994 p. 45) some foods which one should avoid include processed meat. Besides, foods saturated with fats, processed snacks, high- fat dairy products, and sugary drinks, among other products, should be avoided. Healthy eating is to be observed not only by patients but also by healthy people to prevent this condition.

The foods that these people should choose include carbohydrates such as whole fruits, legumes, non-starchy vegetables, and sweet potatoes, among others.



From the research questions formulated, we can study type 2 diabetes with its causes, treatment, and symptoms. This condition has been clearly understood to be caused as the sugar level builds up in the bloodstream beyond the required standard. We can understand that bad eating habits and lack of regular exercise may cause this condition. It is as a result of the accumulated fats in the body and obesity that causes insulin resistance.  This condition has also been found to pose various symptoms that are specific for this type of diabetes. Some of these symptoms include tiredness, blurry vision, frequent urination, and pain in the hands, among others. However, there are specific ways that have been found to manage and prevent this type of diabetes. Some of these ways include regular exercise, eating a healthy diet, and weight management. From the article, Hsieh et al (2012,p.245) it is evident that type 2 diabetes is one of the common diseases. It affects a large population all over the world, clearly shows the need for is control.



Sinclair, A.J., Paolisso, G., Castro, M., Bourdel-Marchasson, I., Gadsby, R. and Mañas, L.R., 2011. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes & metabolism, 37, pp.S27-S38.

Ismail-Beigi, F., 2012. Glycemic management of type 2 diabetes mellitus. New England Journal of Medicine, 366(14), pp.1319-1327.

KUMAR, G.T., Saravanan, A. and Ramachandran, C., 2011. Mean Blood Glucose Level and Glycated Hemoglobin Level in Patients of Non-Insulin Dependent Diabeties Mellitus and its Correlation With Serum Ferritin Level. Int J Med Sci, 4(13), p.e7.

Perry, J.R., Weedon, M.N., Langenberg, C., Jackson, A.U., Lyssenko, V., Sparsø, T., Thorleifsson, G., Grallert, H., Ferrucci, L., Maggio, M. and Paolisso, G., 2011. Genetic evidence that raised sex hormone binding globulin (SHBG) levels reduce the risk of type 2 diabetes. Human molecular genetics, 19(3), pp.535-544.

Nolan, C.J., Damm, P. and Prentki, M., 2011. Type 2 diabetes across generations: from pathophysiology to prevention and management. The Lancet, 378(9786), pp.169-181..

Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., Ravilla, R., Marco, A., Shekhawat, N.S., Montales, M.T. and Kuriakose, K., 2017. Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Frontiers in endocrinology, 8, p.6.

Hsieh, Y. T., Tu, S. T., Cho, T. J., Chang, S. J., Chen, J. F., & Hsieh, M. C. (2012). Visit?to?visit variability in blood pressure strongly predicts all?cause mortality in patients with type 2 diabetes: a 5· 5?year prospective analysis. European journal of clinical investigation, 42(3), 245-253.

Tahrani, A.A., Bailey, C.J., Del Prato, S. and Barnett, A.H., 2011. Management of type 2 diabetes: new and future developments in treatment. The Lancet, 378(9786), pp.182-197.

Szabo, C.P., 2011. Eating disorders and diabetes. South African Journal of Diabetes, 2(4), pp.7-12.

Tomlinson, J., Millward, A., Stenhouse, E. and Pinkney, J., 2010. Type 2 diabetes and cardiovascular disease in polycystic ovary syndrome: what are the risks and can they be reduced? Diabetic Medicine, 27(5), pp.498-515.

Vaibhav, Atul, Mathew Mathai, and Shaun Gorman. “Atypical diabetes in children: ketosis-prone type 2 diabetes.” Case Reports 2013 (2013): bcr2012007704.

YANG, X.L., MA, J., FAN, X.P. and ZHAO, J.J., 2011. Effect Analysis of Dietary Intervention for Army Elderly Inpatients with Type 2 Diabeties [J]. Nursing Journal of Chinese People’s Liberation Army, 11.

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