Genetic factors involved in Kathleen’s Disease

Kathleen’s disease mostly falls into two main aetiopathogenetic categories. The first type (type 1), it causes damage to the islet cells which are located in the pancreas because the cells developed autoimmunity (Abdul-Ghani et.al, 2017). Genetic markers and serological tests are often identifying people who are at higher risk of getting(type 1). The second type (type 2) which is the primary causative agent of Kathleen’s condition is triggered by a grouping of genetic factors associated with insulin resistance and weakened insulin secretion and environmental factors, for example, overeating, obesity, stress, lack of sufficient exercise and aging. The disease is multifactorial, and it is accompanied by environmental factors and multiple genes (Jayanthi, Srinivasan,  Hanifah, & Maran, 2017).

Genetic factors involved -The development of Kathleen’s disease is mostly related to her family history of Diabetes.

The lower concordance rate between dizygotic twins than monozygotic twins indicates the participation of genetic factors. The pathogenesis is presumed to include the abnormality in the molecules associated with the regulatory system of the glucose absorption

Roles of environmental Factors- Obesity, aging, inadequate energy consumption, smoking, alcohol drinking, etc. are independent factors that affect pathogenesis. The reduction in muscle mass characterizes obesity (specifically visceral fat obesity) caused by lack of adequate exercise, increase in high- and middle-aged patients, and stimulates insulin resistance. The changes with the energy associated with dietary, specifically increase in the consumption of pure sugar, higher intake of fats, high-aged patients and decrease in the absorption of fats, lead to obesity and stimulate the decline of glucose tolerance.

Insulin resistance and impaired insulin secretion contribute to the occurrence of Pathophysiological conditions.

Impaired insulin secretion- it begins with the reduction in the glucose content. The impaired insulin secretion is mostly progressive, and its progression includes glucose lipo-toxicity and toxicity. When untreated, it causes a decrease in B cell mass.

Insulin resistance- the function of insulin is to enable the body’s cells to convert glucose into fuel or to be reserved as fats. It means that the concentration of glucose will be high in blood and this may contribute to the higher sugar level in the blood (Marso et.al, 2016).

If the body becomes resistant to insulin, it will respond by producing more insulin. Therefore Kathleen will produce more insulin, a process known as Hyperinsulinemia.

Symptoms of insulin resistance include:

High blood pressure, high cholesterol levels, belly Fat, hunger, and brain fog

Insulin resistance occurs mostly when one of the following factors takes place:

Roles of environmental Factors in Kathleen’s Disease

Weight gain, high blood pressure, and high cholesterol level

Nursing diagnosis- ineffective protection associated with the inability to generate adrenal gland.

Risk for infection linked to suppressed responses of the inflammatory initiated by high levels of adrenocorticoid preoperatively and usage of adrenocorticoid replacement postoperatively. 

A risk for damage associated with dramatic blood pressure fluctuations initiated by abrupt changes in catecholamine or adrenocorticoid levels.

Nursing interventions

The tube of orogastric should be detached at the finishing point of the procedure. The complete count of blood cell and a chemistry screen are acquired in the PACU. Since the adrenal glands perform an essential role in the regulation of BP and stress responses, the monitoring of BP is critical thru BP cuff or arterial line. The Patients need close checking of electrolytes, such as Potassium. The PACU RN should also check the patient thoroughly for signs of bleeding

The nurse of the PACU provides medication for the patients and assesses the level of pain for the patients. Usually, the patient will not need the PCA as would be required in the open adrenalectomy. Because of the minor laparoscopic incisions, patients are given medications. Patients are advised to ambulate immediately after the surgery (Chatterjee, Khunti & Davies, 2017).

The removal of urinary drainage catheter on the initial postoperative day and on that first postoperative day, a clear liquid diet should be offered. Then the levels of Serum cortisol should be evaluated to ensure that no insufficiency of adrenal elements needs supplementation.

 A patient undergoing adrenalectomy unilateral may need short-term replacement of glucocorticoids and there should be the administration of intravenous fluids. The patient should be encouraged to deep breathing and coughing in order to avoid respiratory infection.

Impaired would healing raise the infection risk in clients with the disorders of the adrenal. Apply aseptic technique to reduce this offer routine post-op care. Then evaluate the body temperature, wound drainage, and WBC levels. The dressing should also be changed by use of the sterile technique. The final intervention is the recording of critical vital signs, measure output and intake, and monitor electrolytes on a regular schedule, mainly during the initial 48 hours after surgery.

The following intervention should also be taken into consideration:  There should be self-administration of replacement hormones, there should provision of discharge planning and client teaching, unilateral adrenalectomy, deliver general treatment for the patient with abdominal surgery and observation for shock and hemorrhage. The patient should also use vasopressors and IV therapy as ordered. Hydrocortisone or Administer cortisone as ordered to sustain cortisol level. 

Physiotherapist

They assist people who are affected by disability or illness through exercise and movement, injury, manual therapy, advice, and education. Physiotherapist maintains the excellent health of the individuals of all ages, assisting patients to prevent disease and manage pain. The professional help in facilitating recovery and encouraging development, and this allow different individuals to remain in work while helping them to stay independent for a longer duration of time (Pfeffer et.al, 2015). Physiotherapy profession uses a whole person approach to wellbeing and health, which involves the patient’s overall lifestyle. The essential part is the patient’s involvement in their care, through awareness, empowerment, education, and participation in their treatment. Physiotherapy applies their skills and knowledge to improve the patient’s body conditions, such as multiple sclerosis, stokes chronic heart disease, etc.

Insulin resistance and impaired insulin secretion contribute to the occurrence of Pathophysiological conditions

Social workers

They offer spiritual care and counseling to assist the families of the patients to manage their psychosocial, economic, and emotional requirements. The social workers have the required skills in evaluating the patient’s and family’s requirements and the necessary care needed for the treatment of the patients (Holman et.al, 2017). They then assist in the establishment of a social work plan. Social workers help patients attain a sense of control by offering guidance and counseling. They also support in alleviating the difficulties which the patient’s families are experiencing by assessing the family’s and patient’s spiritual needs, economic, and psychosocial, and then assist in obtaining resources to satisfy those needs (Inzucchi et.al, 2015).

After the procedure in adrenalectomy, patients enquire hypertension because of primary aldosteronism which developed due to the elimination of the adrenal gland. Rennin angiotensin, mechanism of the aldosterone that helps in maintaining blood pressure back to normal get affected which result in high blood pressure (Goldberg, 2016). 

Specific renal actions associated with aldosterone decide the clinical features. Aldosterone raises the amount channels of sodium of the luminal membrane of the primary principal cells that are found in the collecting tubule hence, which increases the reabsorption of sodium. The successive cationic sodium loss creates the Lumen electronegative, creating an electrical gradient that enables the discharge of cellular potassium into the lumen. Adrenalectomy also contributes to the damage of renal structural leading to the decline in approximated glomerular filtration rate (Ehtisham, 2014).

Dietitian

They are the health professionals that diagnose, assess and treat nutritional problems and dietary at general public health and an individual level (Zinman et.al, 2015). They mostly perform their duties with both sick and healthy people. Dietitians apply the most recent scientific research and public health on food, disease, and health which they turn into practical guidance to allow people to come up with suitable food and lifestyle choices. Dietitians assist in designing food plans and counsel and educate patients to help them in managing the states of the disease such as high cholesterol, obesity, or heart disease. Dietitians perform in different areas for example geriatrics, pediatrics, diabetes education or renal disease (Wanner et.al, 2016). 

Conclusion

The healthcare team is made up of different Health professionals that work as a team with the aim of solving the needs and the requirements of the patients and their families. Different Nursing interventions should be put in place to help in solving the problems of the patients which are seeking treatment to the healthcare. 

References

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Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.

Ehtisham, S. (2014). Type 2 diabetes.

Goldberg, R. (2016). Type 2 diabetes. In Comprehensive Management of High Risk Cardiovascular Patients (pp. 213-280). CRC Press.

Holman, R. R., Bethel, M. A., Mentz, R. J., Thompson, V. P., Lokhnygina, Y., Buse, J. B., … & Maggioni, A. P. (2017). Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 377(13), 1228-1239.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), 140-149.

Jayanthi, R., Srinivasan, A. R., Hanifah, M., & Maran, A. L. (2017). Associations among Insulin Resistance, Triacylglycerol/High Density Lipoprotein (TAG/HDL ratio) and Thyroid hormone levels—A study on Type 2 diabetes mellitus in obese and overweight subjects. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11, S121-S126.

Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A., … & Steinberg, W. M. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 375(4), 311-322.

Pfeffer, M. A., Claggett, B., Diaz, R., Dickstein, K., Gerstein, H. C., Køber, L. V., … & Maggioni, A. P. (2015). Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. New England Journal of Medicine, 373(23), 2247-2257.

Wanner, C., Inzucchi, S. E., Lachin, J. M., Fitchett, D., von Eynatten, M., Mattheus, M., … & Zinman, B. (2016). Empagliflozin and progression of kidney disease in type 2 diabetes. New England Journal of Medicine, 375(4), 323-334.

Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., … & Broedl, U. C. (2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New England Journal of Medicine, 373(22), 2117-2128.