Consider the patient's situation. Criterion1: Application of pathophysiological concepts to justify clinical decision- making Collect cues/information 1.As a nursing student, your clinical facilitator has allocated you to care for Jarrah. After the morning handover, you are asked to explain the Pathophysiology of type 1 diabetes to the clinical facilitator. What is your response? 2.Your clinical facilitator tells you that Jarrah would rather not have multiple daily injections. He wants to know why he cannot just have tablets to manage his type 1 diabetes-like his friend who has type 2 diabetes. What is your response?

Labetalol infusion is used for the management of severe hypertension. Labetalol acts as an

antagonist. Labetalol blocks alpha-adrenoreceptors in peripheral arterioles, which results in

decreasing peripheral resistance. It concurrently blocks beta-adrenoreceptors in the heart

due to peripheral vasodilation that occurred during the blockage of alpha-adrenoreceptors.

Due to a decrease in peripheral resistance, peripheral vasodilation reduces blood pressure

without achieving cardiac stimulation. Labetalol establishes a precise relationship between

alpha and beta-blocking effects. In a therapeutic range of doses, labetalol is less active in

blocking alpha-adrenoreceptors than beta-adrenoreceptors; therefore, adequate vasodilation

occurs without excessive lowering in blood pressure (“Presolol”, 2021). Labetalol has a

plasma half-life of around five hours, and the peak effect is 5 to 15 minutes. The protein

binds about half of the labetalol in the blood. Labetalol is predominantly metabolised by

conjugation to inactive glucuronide metabolites. These are excreted in the urine (55-60%)

and the faeces by the bile. Only trace quantities of labetalol pass through the blood-brain

barrier. Labetalol passes through the placental membrane during pregnancy (“Labetalol”,

2021).

Paracetamol is prescribed for the relief of headache associated with migraine. It is a para-

aminophenol derivative that exhibits analgesic and antipyretic activity. It inhibits the

prostaglandin synthesis in the central nervous system and does not possess anti-

inflammatory activity which relieve pain. Paracetamol is rapidly and completely absorbed

from the GI tract after administration. The release of paracetamol ensures that the plasma

paracetamol concentrations are rapidly attained and maintained until up to eight hours after

administration. It distributes into most of the body tissues. The binding of paracetamol is

minimal with plasma proteins at therapeutic concentrations, but it increases with an

increase in dose. It is metabolised in the liver and excreted in the urine as inactive

conjugates of glucuronide and sulphate. Approximately 85% of paracetamol is excreted in

urine as free and conjugated paracetamol 24 hours after administration (“Amcal Osteo

Relief Paracetamol”, 2021).

Nifedipine is indicated for the treatment of hypertension. It acts as a calcium antagonist.

Nifedipine reduces the arterioles' vasoconstriction, which helps to decrease peripheral

resistance and consequently lowers blood pressure. At the beginning of the nifedipine

treatment, there may be an increase in the heart rate, which increase the cardiac output.

However, this increase in the cardiac output is not enough to compensate for the

vasodilation, which reduces blood pressure and maintains normal blood pressure. After oral

administration of Nifedipine, the bioavailability of the drug is 45 to 56%. 95% of the drug

is bound to albumin. It is completely metabolised in the body and only traces detected in

the urine in an unchanged form. 70-80% of the Nifedipine is excreted via the kidneys in the

form of highly water-soluble pharmacologically inactive metabolites, and the remainder is

excreted in the faeces (“Adalat”, 2021).

Diazepam is used for the management of anxiety. It provides short-term relief from the

symptoms of anxiety. Diazepam is a member of the group of benzodiazepines that exhibits

an anxiolytic and sedative effect. The generation of active metabolites helps to enhance its

action. It enhances the GABA receptor's affinity for the neurotransmitter through positive

allosteric modulation, which increases the action of released GABA on the postsynaptic

transmembrane chloride ion flux. After oral administration of Diazepam, it is rapidly and

completely absorbed by the GI tract, and peak plasma concentration reaches after 30 to 90

minutes. Diazepam widely distributes into tissues despite high binding to the plasma

proteins. It is metabolised to pharmacologically active metabolites (desmethyldiazepam)

and small amounts of oxazepam and temazepam. The elimination half-life value for

Diazepam and desmethyldiazepam is in the range of 24-48 hours and 40-100 hours

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