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BSNC 2000 METABOLISM, Summaries of Nursing

British Columbia Institute of TechnologyNursing

BSNC 2000 METABOLISM LECTURE NOTES

Typology: Summaries

2024/2025

Uploaded on 03/28/2025

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Metabolic Regulation
Unfolding Case Study: Rosa Li
Revised Feb 2022
The following scenarios focus on the concept of Metabolic (Glucose) Regulation. To support
your answers and thinking, include specific information from the scenario, knowledge gained
from your readings and learning activities, and current, relevant evidence.
1. How would Rosa describe her health?
2. Which type of diabetes does Rosa likely have? Explain your thinking.
3. Identify 3 factors contributing to Rosa’s risk for diabetes. Explain your thinking.
4. If time permits, complete the CANRISK calculator from Public Health Agency of Canada using
the information provided in the Rosa Li case scenario.
https://www.healthycanadians.gc.ca/en/canrisk
5. How does waist circumference affect Rosa’s diabetes risk?
Follow up Questions (to be discussed in class)
Based on what you know about the pathogenesis of type 1 diabetes,
6. How would blood tests be used to rule out a diagnosis of type 1 diabetes?
7. What factors contribute towards adult-onset type 1 diabetes?
Scenario 1: Diabetes Risk Factors and Pathogenesis
Rosa Li, a 61-year-old female, had a fall at home. She is admitted to the medical/surgical
floor for several days for conservative treatment focusing on alleviating her pain and
preventing further injury. She has a history of dyslipidemia, hypertension, depression,
diabetes diagnosed 3 years ago, and osteoarthritis diagnosed 1 year ago. She was referred to
a chronic disease outpatient clinic 3 years ago after her diabetes diagnosis.
Her current medications include: 5mg ramipril BID, 20mg furosemide OD, 60mg atorvastatin
OD, and 500mg metformin BID, Vit D and Calcium.
Rosa’s father had hypertension and type 2 diabetes and her mother has osteoarthritis and
Alzheimer disease. Rosa was born and raised in South Africa, and moved to Canada with her
family when she was 16 years old. She is married to Zander Li and has two children. Rosa’s
highest education level is a high school diploma and she has worked as a grocery store
cashier for the past 30 years.
Recent Physical Examination:
• height 162.5 cm
• weight 81 kg
• waist circumference 90 cm
• BP 148/84
• HR 82/min, regular
• RR 18/min, effortless
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Unfolding Case Study: Rosa Li

The following scenarios focus on the concept of Metabolic (Glucose) Regulation. To support your answers and thinking, include specific information from the scenario, knowledge gained from your readings and learning activities, and current, relevant evidence.

  1. How would Rosa describe her health?
  2. Which type of diabetes does Rosa likely have? Explain your thinking.
  3. Identify 3 factors contributing to Rosa’s risk for diabetes. Explain your thinking.
  4. If time permits, complete the CANRISK calculator from Public Health Agency of Canada using the information provided in the Rosa Li case scenario. https://www.healthycanadians.gc.ca/en/canrisk
  5. How does waist circumference affect Rosa’s diabetes risk?

Follow up Questions (to be discussed in class) Based on what you know about the pathogenesis of type 1 diabetes,

  1. How would blood tests be used to rule out a diagnosis of type 1 diabetes?
  2. What factors contribute towards adult-onset type 1 diabetes?

Scenario 1: Diabetes Risk Factors and Pathogenesis Rosa Li, a 61-year-old female, had a fall at home. She is admitted to the medical/surgical floor for several days for conservative treatment focusing on alleviating her pain and preventing further injury. She has a history of dyslipidemia, hypertension, depression, diabetes diagnosed 3 years ago, and osteoarthritis diagnosed 1 year ago. She was referred to a chronic disease outpatient clinic 3 years ago after her diabetes diagnosis. Her current medications include: 5mg ramipril BID, 20mg furosemide OD, 60mg atorvastatin OD, and 500mg metformin BID, Vit D and Calcium.

Rosa’s father had hypertension and type 2 diabetes and her mother has osteoarthritis and Alzheimer disease. Rosa was born and raised in South Africa, and moved to Canada with her family when she was 16 years old. She is married to Zander Li and has two children. Rosa’s highest education level is a high school diploma and she has worked as a grocery store cashier for the past 30 years.

Recent Physical Examination:

  • height 162.5 cm
  • weight 81 kg
  • waist circumference 90 cm
  • BP 148/
  • HR 82/min, regular
  • RR 18/min, effortless

Unfolding Case Study: Rosa Li

  1. Given what you know about Rosa, what do you think might be going on with her? Provide a rationale for your hypothesis.
  2. Identify and describe three clinical manifestations of impaired glucose regulation that Rosa exhibited at the time of diagnosis.
  3. Create a Venn diagram comparing clinical manifestations of type 1 and type 2 diabetes.
  4. What other concepts may be important to consider for Rosa? Why?

Follow up Questions (to be discussed in class)

  1. Which assessments do you plan to make once you enter Rosa’s room? Identify specific assessment data you will collect. Which assessments will you do first and why? (Think - which assessments are most important?)
  2. What concerns you most about Rosa at this time? Explain your thinking.
  3. Considering what you know about Rosa, what factors would contribute to hyperglycemia during her hospitalization?
  4. How will you respond after checking Rosa’s capillary blood glucose level? (Think: scope of practice).

Scenario 2: Assessment of Impaired Metabolic Regulation (Manifestations of Diabetes) You are a term 2 BSN student assigned to care for Rosa Li. You read a note from the social worker on the unit that when Rosa was first diagnosed with diabetes, she presented to her family practitioner with complaints of fatigue, blurred vision, and weight gain. She blamed the fatigue on having to get up 2 or 3 times per night to urinate, and reported feeling thirsty all the time. She also complained of pain to her knees and weakness to her legs from her cashier job and that she was feeling “sad and worried about my mother”.

Scenario 3: Assessment of Impaired Metabolic/Glucose Regulation (Lab Tests) When Rosa wakes in the morning, she tells you she has a headache and “a sore knee”. She wants to eat her breakfast and requests water and some juice. She also asks for assistance to go to the bathroom. Her current vital signs are: BP 145/86, HR 81/min, regular, RR 16/min, effortless. You check Rosa’s capillary blood glucose level which is 8.6 mmol/L.

Unfolding Case Study: Rosa Li

Part 5: Management of Hypoglycemia You notice in Rosa’s chart that the nurse practitioner has written a new order:

Stop metformin Start 5mg glyburide once per day Nutritionist referral

  1. Why might Rosa now be taking glyburide instead of metformin?
  2. What nursing concerns due to this change in medication should the nurse be aware of? What patient education should be provided to Rosa regarding this change?
  3. Which interventions would you perform if Rosa was hypoglycemic? Identify specific assessment data you will collect. Which interventions will you do first and why? (Think - which interventions are most important?)
  4. How do Rosa’s medications influence metabolic regulation? Consider the therapeutic action of her medications.
  5. Bonus Question: A patient with type 1 diabetes takes their insulin before sleeping, yet wakes up with high blood glucose levels in the morning. What is happening?
  6. Identify long-term collaborative interventions for Rosa’s diabetes management and why each intervention is important.
  7. When considering lifespan development, how would you approach diabetes self-management education with Rosa in the hospital? At home?
  8. Which determinants of health may influence Rosa’s recovery and discharge? How will Rosa’s determinants of health influence your approach to her care?

Part 6: Diabetes Management You follow the nutritionist into the room. When talking to Rosa about her diet, Rosa indicates that her diet tends to be rich in carbohydrates and she admits that she has a sweet tooth. While she has been advised to lose weight, she complains that pain and instability in her knees makes it difficult for her to exercise. She claims to take her antidiabetic medications as prescribed; however, she hasn’t had an eye exam or seen her family practitioner in the last year.