Exam (elaborations) NR 507 PATHOPHYSIOLOGY WEEK 5 TD1 Alterations in Endocrine Function Discussion Part One.pdf

Week 5: Alterations in Endocrine Function - Discussion Part One Loading... This week's graded topics relate to the following Course Outcomes (COs). 1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1) 2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1) 3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7) 4 Distinguish risk factors associated with selected disease states. (PO 1) 5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1) 6 Distinguish risk factors associated with selected disease states. (PO 1) 7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4) Discussion Discussion Part One (graded) Responses Lorna Durfee 5/29/2016 8:58:33 AM Discussion Part One dMrisn. kB dlaukrein igs tahni so tlidmere .a Sduhlet hwaist ha dhiiasbtoerteys o afn Tdy hpaes Ib deieanb etoteos .i ll to get out of bed for two days. She has had a severe cough and has been unable to eat or On admission, her laboratory values show: PATIENT VALUES Sodium (Na+) 156 mEq/L Potassium (K+) 4.0 mEq/L Chloride (Cl–) 115 mEq/L Arterial blood gases (ABGs) pH- 7.30; Pco2-40; Po2-70; HCO3-20 NORMAL VALUES 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 five (5) reasons on why she may have become bed ridden? • Based on these reasons what tests would you order? • Describe the molecular mechanism of the development of ketoacidosis The patient is an older adult and has been ill for two days. She has a severe cough and not able to eat or drink. She has type I diabetes. Labs: Sodium is 156 mEq/L, normal is: 136-146, Chloride 115 mEq/L, normal is: 98-106, pH 7.30, normal is 7.35-7.45, little low, normal 80-100, HC03 low at 20, normal 22-28. Po2- 70, is low, The patient has: High sodium at 156, high chloride at 115. Low Ph 7.30, Low, Po2 (partial pressure of oxygen) is 70, HC03 (bicarbonate) is 20, low. Doctor Brown and Class: aKciisdhoosries .( 2H0e1 4a)l seox epxlapilnasi ntsh atht adti aDbKetAic okcectouarsc imdoossitsl yis i na tcyopme p1l idciaatbioente osf m deiallbietutess ( DchMar)a pctaetrieiznetds. b Wy hhyepne ar gplaytcieemnti ha,a sh ykpeetorkaectiodnoesims,i ath, eayn dc amne etxabhoibliict nausea, cvoonmfiirtimnged, awndit ha bddeotemctiinoanl poaf ihny. p Ietr ikse ato vneermy isae arinodu sa ncioonnd gitaiopn m theatat bcoalnic l eaacdid toos icse rweibtrha hl yedpeemrgaly acnedm ciao.m aB aesc awueslel tahsi sd epaatthie. n Tt hise idlli,a igt ncoasni sb oe fo DneK oAf tihs e stressors that can trigger DKA (Kishore, 2014). dMecvCelaonpcse a, sB ara rsehseurlst ,o Hf uae dtheefirc aienndc Ry oobf eirnts Eul iJno naensd (a2n0 1in4c)r teealsl eu isn t hthaet Dleivaeblest oicf kinestoualicni dcoosuins t(eDr-KreAgu) liast oa rsye rhioorums ocnoemsp (lMiccaCtioann coef edti.a able.,t e2s0 m14e lpl.i t7u4s.4 D). KItA is emsopsetc ciaolmlym a opnaltyie fnotu wndit hin d piaabtieetnetss twypiteh I t ydpiaeb Ie tdicia kbeettoeas cbiudto ssiosm ceatnim bee sa f soeurniodu isn ptryopbel eIIm d. i aTbheete asu. t hWohrse nal aso p raetileantet thhaast awnh iennte trhceurrer eisn ta inl linnetsesr rourp itniofenc otifo n, insulin administration can also result in DKA (McCance, Huether, Brashers, & Rote, 2014, p. 744). GWHhe. n T thheesree hiso irnmsounliens daenftiacgieonnciyze t hines cuoliunn bteyr -irnecgruelaastionrgy ghlourcmosoen ep rcoodnuccetniotrna ttihounss dienccrreeaassien. g T tihsosusee huoserm oof ngelus caorese c. a tWecihtho laa mdeifniecsie, nccoyrt iosfo iln, sgululicna tghoant ,i as nd gplruocfoounneodg, ethneersei si sa na dd ekcerteoagseende sgilsu. c oWseit hu pintackree.a s Aedls gol,u tchaegreo nis l eavne ilnsc trheearsee dis faa tc monettraibbuotliiosmn two itthhe t hacet irvealetiaosne ooff tfhaett yg laucciodns eaongde nacicc ealnedra kteedto genic liver pKaetthownaesy sa.r eB uesceadu sbey tthheer eti isss uinessu alsin s oduefricceise ntoc yr etgheen oevraetrep rtohde ubcitciaornb oonf ahteep. a Wtich Ben-h kyedtroonxeysb aurtey froatuen adn tdh eayc eatcota tcoe tbica laacnicdes tchaeu lsoinssg oinf cbriecaasrebdo nkaetteo.n es. nHoytp oecrckuerto, ntheem piaa tmienayt dbeev ae lroepssu lmt oetfa ibmopliaci ramciednots iins (thMec uCsaen ocfe keet taoln.,e 2s 0b1y4 t,i sps.u 7e4s5, ) this allows organic acids to circulate. If bicarbonate buffering does cDoiratbiseotilc, gKroetwotahc ihdoorsmiso rnees.u lTtsh ien e rfefdeuctcse do fi nhsourmlino nleavl eallst earnadti oenlesv aarteio; na cocfe cleoruantitoenr- roefg gulluactoornye ohgoermneosnise sa.n Tdh gel yhcoorgmeonnoelys sairse a cnadt eac hdoeclarmeaisnee isn, gglluuccaogsoen , uwthiliiczha taioren cboyn tvheer tpeedr itpoh keertaol nteis sbuoedsi etsh aint wthiell lrievseurl, ta innd h tyhpiso glelyadces mtoi ak,e atnodn eamn iian. c rTehaesree i nis laiplsool yasnis i nrecsruealtsien gin i np rion-cirnefalsaemdm parotodruyc ctiyotno koifn fer eaen dfa pttryo -acids, coagulation factor levels (Dynamed, 2016). iWnfeesctteirobne.r gT (h2e0 d1e3f)i c aielsnoc yin sftoimrmusl autes st hthaet DelKevAa trieosnu oltfs cino uinnsteurlrieng duelafitcoireyn chyo rfmroomne isn s (uWline snteornbceormg,p 2li0a1n3c,e p, .a 3n3d7 i)n.c rWeahseend tihnesruel iins nneoe adb bileictya utose u osfe glucose tohfe a bdoipdoys en eteisdssu ea naontdh ethr es ofurerec ef aotft ye naecridgsy .c oLnivpearste t hacet iavciettyy wl ciolle innzcyremaes eA a nfodr ceanuesregsy a p broredaukcdtioownn. oTfh aed riepmosaein tdisesru ies tbhraotk fernee dso fwatnty i natcoid kse. t oTnhees .b rTehake dboowdyn tuhseerse k ies tao nperso mfoor teionne rigny h. yHpoewrgelvyecre,m thiae ya nadcc luemadusl atote a rna poisdmlyo.t i Gc dlyiucoregseins tahnadt rpersouteltisn sin a dree hcyadtarbaotiloizne, dm aentadb foolrimc a gcliudcoossise .a nWd ihthy pthereo psrmoodluacrt isotant eo f glucose, (Westerberg, 2013, p. 338). aTnhde rteh ea rceo amt pleliacsatt (io5n) sf itvhea tr eaarsisoen ws fiothr tthhies pcaotniednitti obnei.n gA sb ewderi ddod enno. t Bkneocawu sthee t hmee pdaitciaetniot nhsa ss haen rienqfeucirteiosn w aen dd os hneo ti sk dnioawbe itfi cs,h iet hcaans mseet dthicea tsitoang e for DKA cboe mdephliyadnrcaet.e dM. Sedhiec aaltsioon hsa csa bne aclosmo ein wfleuaekn cbee cmaeutsaeb sohliec ips rnoocte sesaetisn. g T ohre d priantikeinntg a. pApgeaairns, two eh aavree na olta ccke rotafi anp wpehtaitt ei nasnudl iins snhoet mdrainyk bine gr eoqru eiaritningg, aanndd can lpeetrhhaarpgsy .s h Seh hea ms nayo th taavkee np rhoebrl ienmsus lwini tcho brrreecattlhyi.n gH, earn md esnhtea cl osutaltdu sh amvaey p bneecuommoen d due to dehydration. Because of her illness, she also may have oTrhdee rte wstosu tlhda tb ne eseedru tmo oebletacitnroedly aterse, oBuUtliNn,e dan bdy c Kreiasthionrine e(,2 g0l1u4c)o. s eT,h kee atountheos,r oinsmfoormlarsi tuys. oSfh teh ne eneedesd a t ou reivnael tueastte f hoer rk seetrounmes .g lIufc tohsee .k eAtodndeisti oarnea lp toessittsiv teo tghleunc oAseB aGn dm keeatsounreesm aernet .p oWsiittihv eD wKeA c a tnh eprree sisu mane ,a srtheer ihaal dp HD K A7..3 0 W wiitthh h aenri opnre gseanpt il l1n2e,s asn, dsh see raulsmo kneeteodnse asp ipnr tohper ipartees setnucdei eosf (hcyuplteurrgelsy, ciemmaigai.n gIf) urine (MKIi sahnodr ed,e 2te0r1m4i)n. e S ahben worimll anleiteieds a i nc hseesrtu xm- rKay. fWore h sehr ocuoludg mhienags utore r uplheo ospuht aptnee aunmdo mniaag onre soituhmer, pliavtehro elongzyy.m Sesh,e C sBhoCu lwdi thha vdeif faenr eEnCtiGal ,t oH sbcAre1ecn ( fDoyr naacmuteed , 2016). Further investigation is urgently needed.