Answer ONE questiоn ONLY in this sectiоn( 50 mаrks eаch). Pleаse indicate оn your answer which questions you have attempted. Scenario 1 Mrs Jones is a 67-year-old lady who has been admitted to the medical ward with a wound infection at the surgical site following a recent cholecystectomy. The surgical wound appears red, swollen, and has purulent drainage. Mrs Jones reports increased pain at the site and malaise. She has been started on IV antibiotics. She is diabetic and is on insulin therapy, also has history of hypertension. She is also a chronic smoker. Due to this surgery and the current infection, she struggles to get washed and dressed. Mrs Jones lives with her husband in a terraced house. He helps her with the administration of Insulin at home, but states that she is non-compliant at times. They have one daughter who lives nearby and comes in occasionally to check her parents. Scenario one questions. What do you understand by Diabetes Mellitus? In the pathophysiology of Type 2 DM, describe the role of insulin resistance and beta-cell dysfunction. How do these factors contribute to the hyperglycaemia observed in individuals with Type 2 Diabetes (10 marks). 2. Considering the above scenario, identify five care needs that Mrs Jones would have to recover from the wound infection. List two risk factors that would interfere with the healing. Why are they considered as risk factors? Explain (10 marks). 3. What would you consider when Mrs Jones get discharged from hospital? What are the support systems that Mrs Jones might need at home to carry out her ADL? (10 marks) 4. What health promotion would you provide Mrs Jones when she gets discharged? Include a care plan with smart goals for one of the problems that you have identified. (10 Marks) 5. What public health issues are raised within this case? Identify one public health programme (real or proposed) and discuss how this could improve your identified issue for an individual’s health as well as the capacity of the NHS? (10 marks) Scenario 2 Emily is a 42-year-old patient residing in a supported accommodation facility due to her diagnosis of Down’s Syndrome. Recently, she visited the haematology department following a referral from her GP due to abnormal blood work. Emily has received a provisional likely diagnosis of non-Hodgkin’s lymphoma and has been advised to undergo a chemotherapy regime in the next month. Prior to the treatment, she needs preparatory tests, and you, as her case worker, meet with her to discuss the purpose of these tests and ensure her understanding of the consultation information. Emily was accompanied to the appointment by her paternal uncle, as both her parents are deceased. She has the capacity to make decisions and has provided consent for the chemotherapy. Emily is self-sufficient in her activities of daily living (ADLs) and holds a part-time position in a supermarket bakery. Her primary reason for residing in supported accommodation is to receive assistance in managing her financial affairs and to enjoy companionship. Emily shares a strong bond with her uncle, but he lives an hour away, still works, and has a family of his own. After the passing of her parents, it was decided that Emily would move into her current residence to maintain her independence while accessing the necessary support. She is well-settled in the community and her work. During your meeting with Emily, she expresses her understanding of her cancer diagnosis and the need for treatment. She is particularly distressed about not being able to work during the treatment. Emily also inquires about the possibility of continuing her Saturday morning football training, which she enjoys and often follows with lunch at a pub or café. She mentions the lump under her arm that led her to the GP, expressing concern about its increasing size. The haematologist has prescribed steroid medication, dexamethasone, to reduce the swelling before the treatment, but Emily admits she hasn’t taken it as she found frightening information about it online. Additionally, she is scheduled for a heart scan related to determining the appropriate medication dosage. Emily becomes visibly distressed and admits to feeling scared during this part of the conversation. Scenario two questions Examine the pathophysiological changes in individuals with cancer. Address the risk factors influencing cancer development and explore the cellular alterations accompanying tumour formation. (10 marks) Identify three potential care requirements for Emily, evaluating their potential impact and proposing viable solutions for each. (20points) Identify a potential supplementary care requirement that might arise for Emily post-diagnosis or treatment. Elaborate on the measures you, as his case worker, would implement to mitigate its impact. (10 marks) Pinpoint a contemporary health promotion initiative focused on enhancing cancer survival. Illuminate how this initiative seeks to ameliorate conditions for patients and positively impact the health service. (10 marks).