Scene-Based-Reflection (SBR2)

 SBR 2

Seorang ibu mengandung berumur 37 tahun, dengan umur kandungan 32 minggu telah pergi ke klinik kesihatan ibu dan anak untuk pemeriksaan kesihatan. Beliau ke klinik ditemani oleh suaminya. Pemeriksaan kesihatan mendapati Ibu ini telah didiagnos dengan kencing manis. Suami beliau yang juga seorang pesakit diabetes mellitus jenis 2 merasa risau dengan diagnosis tersebut. Pada pendapat si suami; kerisauan ini kerana tidak mahu anak dalam kandungan “dijangkiti” penyakit tersebut dan seterusnya perlu mengambil ubat seumur hidup.

Diabetes mellitus Type 2	The body's capacity to manage and utilise sugar (glucose) is impaired. A high blood sugar level is caused by this long-term (chronic) sickness. Hyperglycaemia can cause difficulties with the circulatory, neurological, and immune systems in the long term. Because the pancreas does not produce sufficient insulin (a hormone that regulates the amount of sugar entering cells) and cells do not behave properly to insulin, sugar uptake is lowered.
Factors increase risk of Type 2 diabetes mellitus	Weight Obesity or being overweight is a major risk factor. The diffusion of fat Fat storage mostly in the belly, instead of the hips and thighs, implies a higher risk.  If you're a guy with a waist circumference of more than 40 inches or a woman with a waist of more than 35 inches, more likely to develop type 2 diabetes. Inactivity The lower your level of activity, the higher your chance. Physical activity promotes weight loss by burning glucose for energy and creating the cells highly insulin sensitive. History of the family  If your close family member has type 2 diabetes, you're more likely to develop the disease. Lipids levels in the blood Decreased amounts of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) and elevated levels of triglycerides are associated with a greater risk. Age And when you get older, your chance of developing Type 2 diabetes rises, particularly after the age of 45. Risks associated with pregnancy.  If you had gestational diabetes while pregnant or went into labour with a kid weighing more than 9 pounds, you're more prone to diabetes (4 kg). Polycystic ovarian syndrome (PCOS) is a kind of polycystic ovary syndrome Polycystic ovarian syndrome, a common disorder marked by irregular menstrual cycles, excessive hair growth, and obesity, raises the chance of developing diabetes.
Complications of diabetes mellitus	Mother Preeclampsia (high blood pressure, extra proteins in the urine, leg/feet edoema) in the mother, increased risk of gestational diabetes in subsequent pregnancies, and increased risk of diabetes later age. New born  Increased birth mass, low blood sugar (hypoglycemia) in the baby, increased chance of getting Type 2 diabetes over time, and mortality shortly after delivery.
Diagnosis of diabetes mellitus	Fasting plasma glucose test This test is most effective when performed in the morning following an eight-hour fast (nothing to eat or drink except sips of water). Random plasma glucose test This test can be performed at any time and does not need fasting. A1c test This test measures your overall blood glucose level over the past two to three months and is also recognized as HbA1C or glycated haemoglobin testing. The amount of glucose attached to haemoglobin, the oxygen-carrying protein in your red blood cells, is evaluated by this test. There is no need to fast before this exam. Oral glucose tolerance test  Following a 8-hour period, this test analyses blood glucose levels. After that, you drink a sweet beverage. Then, at hours one, two, and three, your blood glucose level is examined.
Gestational diabetes mellitus	When the body doesn't produce enough insulin during pregnancy, gestational diabetes emerges. Insulin, a hormone generated by the pancreas, allows your body use sugar for energy and regulate blood glucose levels in balance. The body creates unique hormones and goes experience several changes during pregnancy, such as weight gain. The body's cells become resistant to insulin as a result of these alterations. Insulin resistance affects all pregnant mothers at some point throughout their pregnancy. Whereas the majority of pregnant women may produce enough insulin to combat insulin resistance, others cannot. This group of pregnant women suffers gestational diabetes.
Effect of Gestational Diabetes mellitus	Diabetes mellitus during pregnancy has a variety of negative consequences for the mother, including an elevated risk of cardiovascular disease and type 2 diabetes, as well as macrosomia and childbirth problems in the newborn. Obesity, type 2 diabetes, and cardiovascular disease are all long-term risks for the newborn. Although insulin does not penetrate the placenta, other substances such as glucose do. As a result, more blood glucose passes through the placenta, resulting in elevated blood glucose levels in the newborn. To get removal of the blood glucose, the baby's pancreas produces more insulin. The excess energy is stored as fat because the infant is receiving more energy than it requires to grow and develop. This can result in macrosomia, or an "overweight" infant. Macrosomia babies have their own set of health issues, including shoulder injury at birth.
Treatment For  Gestational Diabetes mellitus	Monitoring your blood glucose levels to ensure they remain within a safe range. Insulin injection Insulin lispro, aspart, and detemir are approved to be used in pregnancy in which functions to regulate blood sugar levels and store excess glucose as energy. Eating the correct kinds of healthful foods at the appropriate times.  Follow your doctor's or dietitian's appropriate dietary advice. Being active is important.  Regular moderate-intensity physical exercise (such as light exercise) drops blood sugar and enhances insulin sensitivity, allowing your body to need little insulin. Check with your doctor to see what kind of physical exercise you can participate in and which ones you might prevent. Keep an eye on your child.  Your baby's growth and development will be monitored by your doctor.
Inheritance	Type 2 diabetes is more strongly linked to genetic history and ancestry than type 1, and several studies have found a significant genetic component in type 2 diabetes generation. The risk of type 2 diabetes raises as the quantity of diabetic family members raises. The increased risk is most likely due to shared genetic factors, but it is also linked to shared lifestyle influences (such as eating and exercising behaviours) among members of the family.

Ways to Handle High Blood Pressure (SBR1)

 

Exercising	Weight reduction is one of the most helpful lifestyle changes for controlling blood pressure. Reducing even a few pounds when you're overweight or obese can dramatically reduce your blood pressure. In general, losing one kilogramme (2.2 pounds) drops your blood pressure by around one millimetre of mercury (mm Hg).
Eat a healthy diet	Maintaining a high intake in whole grains, fruits, vegetables, and low-fat dairy products while eliminating fat and cholesterol can lower blood pressure by up to 11 mm Hg. Consider boosting your potassium intake as well. By counterbalancing the effects of salt, potassium can help reduce blood pressure. Potassium is best obtained through foods such as fruits and vegetables rather than supplements. However, you should first visit your doctor to verify the suitable potassium prescription.
Cut off sodium (salt)	If we have hypertension, even a minor drop in salt in our daily routine diet can enhance our cardiovascular health and lower our blood pressure by 5 to 6 mm Hg. Read the labels on the foods we buy. If at all necessary, switch low-sodium meals and beverages for your regular purchases. Reduce intake of processed foods.  Natural foods have just a little quantity of salt. The majority of sodium is added during the manufacturing process.
Quit smoking	Your heart is racing for many minutes after you stop smoking a cigarette. Quitting smoking can enable you get back to a healthy blood pressure level. By diminishing your risk of heart disease and increasing your overall health, smoking cessation can aid you live a better life. People who quit smoking have a better chance of living longer than those who do not.
Cut caffeine intake	Within 30 minutes of drinking a caffeinated drink, caffeine can elevate blood pressure by up to 10 mm Hg. You could be vulnerable to the blood pressure-raising effects of coffee if your blood pressure rises by 5 to 10 mm Hg.
Avoid stress	Psychological stress can aggravate hypertension. More research is necessary to confirm the influence of chronic stress on hypertension. High blood pressure can develop if you respond to stress by snacking, excessive alcohol consumption, or cigarettes.     Stay away from stressors.  When you can, try to stay away from triggers. If rush-hour traffic on your commute to work, for example, is causing you stress, consider leaving earlier in the morning or taking public transit. If at all possible, avoid people that make you feel stressed.

Scene-Based-Reflection (SBR1)

 Scenario 1 

Abdullah seorang guru, berumur 37 tahun mempunyai berat badan 80kg berketinggian 1.6meter. Beliau gemar meminum kopi dan seorang perokok tegar disebabkan oleh kesibukan tugas kerja. Walaubagaimanapun, beliau kerap bersukan dan juga pergi ke Gimnasium pada hujung minggu.

Pada suatu hari beliau mengadu sakit dibahagian dada. Kesakitan ini bertambah kuat apabila beliau mendaki tangga sekolah dan berhenti apabila beliau rehat. Beliau juga mengadu sakit kepala yang kuat.

Abdullah kemudiannya ke klinik dan pemeriksaannya mendapati nadi beliau 62 bpm dan bacaan tekanan darah beliau adalah 135 mmHg/90 mmHg. Ujian EKG mendapati pola normal. Sampel darah dan air kencing beliau telah diambil untuk ujian makmal. Manakala beliau diarahkan menjalani ujian pemantauan Holter. 

Facts	Explanation
80 kg & 1.6meter	BMI over the normal limit (Obesity) Excess fat in the body has the potential to cause heart disease
Coffee addict	High doses of caffeine increase the level of epinephrine in the blood. Epinephrine is also known as adrenaline. In its pure form, epinephrine can increase blood pressure, increase contraction or heart force, and indirectly increase heart rate.
Heavy smoker	Research has shown that smoking increases heart rate, narrows major arterial passages, and can cause irregular heartbeats.  Smoking also increases blood pressure, which increases the risk of stroke. Smoking increases the formation of plaque in the blood vessels. Coronary Heart Disease occurs when the arteries that carry blood to the heart muscle are narrowed by plaque or blocked by blood clots. The chemicals in cigarette smoke cause the blood to thicken and form clots in the veins and arteries.
Headache	One of the symptoms of hypertension.  The headache pulsates and is aggravated by physical exertion. Because high blood pressure impacts the blood-brain barrier, it can produce headaches. High pressure on the brains from hypertension can trigger blood to leak from the blood vessels in this region.
Blood pressure  135 mmHg/90 mmHg	Normal blood pressure readings for all ages are less than 120 for systolic pressure and less than 80 for diastolic pressure (<120/80 mmHg)  If the blood pressure is more than 130 for systolic pressure and more than 90 for diastolic pressure (> 130/90mmHg), this indicates that Abdullah has hypertension.  Abdullah's blood pressure is categorized as level 1 hypertension, which the blood pressure reading is from 130 to 139 (systolic) more than 80 to 89 (diastolic). Can be caused by poor diet or stress, considered moderate to maximum high blood pressure. If left untreated, stage 1 hypertension will increase the risk of heart attack, stroke, and other serious health problems.  It can also progress to stage 2 hypertension - more severe high blood pressure.
Blood & Urine Test	One of the diagnosis of hypertension or blood pressure  Blood test  To test the concentration of potassium, sodium, creatinine, blood glucose, total cholesterol, and triglycerides.  Urine test (urinalysis) To analyse urine for indicators that indicate another medical problem is causing your high blood pressure.
Holter Test	Type of portable electrocardiogram (ECG). While you are gone from the doctor's office, it constantly records the electrical activity of your heart for up to 24 hours.  A typical ECG, sometimes known as a "resting" ECG, is one of the most basic and quick diagnostics for evaluating the heart. Electrodes (small, skin-sticking plastic patches) are applied to specific areas of the chest and belly. Wires link the electrodes to the ECG equipment. An ECG measures the intensity and timing of these electrical impulses to determine how rapidly the heart is beating, the pattern of the heart beats (stable or abnormal), and the strength and timing of the electrical impulses. Changes in an ECG can indicate a variety of cardiac diseases.