Sandra Bullock, 39 years of age is seeing a GP, where you work as practice nurse. Over the past 3
weeks, Sandra has noticed significant tiredness, palpitations, and tremor. She has also noted that
she is always feeling hot, ‘even when others are feeling cold’. She has lost 5 kg in weight over the
past 2 weeks without any effort or exercise. She has also noticed a swelling over the front of her
neck. On direct questioning, Sandra has noticed her eyelids are ‘a bit puffy’ and friends have
commented that she often looks like she is ‘staring’.
Sandra is a mother of 5 children and lives in suburban Melbourne. Sandra works as a Real-Estate
Manager. She has been married to Frank, who is an electrician, for 18 years.
Sandra has been suffering from type 2 Diabetes and rheumatoid arthritis for the past two years. She
takes metformin (APO-Metformin XR 500 mg tablet daily) and glipizide (Minidiab 5 mg half a tablet
daily) to control her diabetes and Ibuprofen (APO-Ibuprofen 400 mg one table daily) for joint pain.
She does not get enough opportunity to exercise and depends on “takeaway” for her lunch and
eating snacks and ice cream. She states that she often forgets and does not take her medication
regularly. Sandra also smokes 5-6 cigarettes daily.
Her mother and older sister were both diagnosed with T2DM in their early 50’s. Her mother also has
Sandra is quite “stressed” about her ongoing conditions and the recent development of other
The examination findings of Sandra are as following -
• BMI: 29 m2
• Blood Pressure: 140/90 mmHg
• Pulse rate: 105 beats/min, irregular
• Respiratory Rate: 22 breaths/minute
• Temperature: 37.7ºC tympanic
• SpO2: 97% on RA (Room Air)
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