Describe the molecular mechanism of the development of ketoacidosisPART No. 1: Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show: Sodium (Na+) 156 mEq/L H Potassium (K+) 4.0 mEq/L N Chloride (Cl–) 115 mEq/L H Arterial blood gases (ABGs) pH- 7.30; Pco2-40; Po2-70; HCO3-20 METABOLIC ACIDOSIS with respiratory compensation, High anion gap Normal values Sodium (Na+) 136-146 mEq/L Potassium (K+) 3.5-5.1 mEq/L Chloride (Cl–) 98-106 mEq/L Arterial blood gases (ABGs) pH- 7.35-7.45 Pco2- 35-45 mmHg Po2-80-100 mmHg HCO3–22-28 mEq/L List three (3) reasons on why she may have become bed ridden? Flu? Pneumonia? Based on these reasons what tests would you order? Accu check? CXR? Lactic Acid level, serum and urine ketone levels Describe the molecular mechanism of the development of ketoacidosis. (p. 744) *Pt’s who develop DKA do so bc bicarbonate buffering does not occur, which begins the development of metabolic acidosis pH 7.30 = acid CO2 40 = Normal O2 70 = Low HCO3 20 = acid PART No. 2: A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. The vomiting has become more frequent this past week and he is beginning to lose weight. Write three (3) differential diagnoses at this time? Is there any genetic component to the top of your differentials? What tests would you order? PART No. 3: Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis? PEER: NR 507 Week No. 5 Quiz: 1. Aldosterone synthesis and secretion are primarily regulated by the (Points : 2) 2. A surgical individual just arrived on the unit from the postanesthesia care unit. This person’s respirations are 4 per minute and shallow. As the nurse calls for assistance, the person suddenly feels jittery and breathing quickens. Which of the following feedback loops is operating for the nurse in this situation? (Points : 2) 3. What effect does aldosterone have on fluid and electrolyte imbalances? (Points : 2) 4. What effect does hyperphosphatemia have on other electrolytes? (Points : 2) 5. Where is oxytocin synthesized? (Points : 2) 6. Which mineral is needed for the synthesis of thyroid hormones? (Points : 2) 7. The portion of the pituitary that secretes oxytocin is the _____ pituitary. (Points : 2) 8. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of a _____ effect by a hormone. (Points : 2) 9. Which of the following hormones acts on its target cell via a second messenger? (Points : 2) 10. Target cells for parathyroid hormone (PTH) are located in the (Points : 2) 11. Which hormone is involved in the regulation of serum calcium levels? (Points : 2) 12. A person who has experienced physiologic stresses will have increased levels of which hormone? (Points : 2) 13. The first lab test that indicates type 1 diabetes is causing the development of diabetic nephropathy is (Points : 2) 14. A deficiency of which of the following may result in hypothyroidism? (Points : 2) 15. Diagnosing a thyroid carcinoma is best done with (Points : 2) 16. The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute (Points : 2) 17. Which of the following clinical manifestations is not common to both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS)? (Points : 2) 18. The signs of thyroid crisis resulting from Graves disease include (Points : 2) 19. What causes the microvascular complications of clients with diabetes mellitus? (Points : 2) 20. A man with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, there is no change in his polyuria. These are indications of (Points : 2) 21. Amenorrhea, galactorrhea, hirsutism, and osteopenia are each caused by a (Points : 2) 22. The most common cause of hypoparathyroidism is (Points : 2) 23. The level of thyroid-stimulating hormone (TSH) in Graves disease is usually (Points : 2) 24. The most probable cause of low serum calcium following a thyroidectomy is (Points : 2) 25. Hyperpituitarism is generally caused by (Points : 2)
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