The S.T may elevation be due to the side effect of the drug digoxin. However, other causes can cause such an elevation such as preexisting heart condition. The serum potassium levels of the patient are below the normal reference range and are on diuretic therapy. Her kidney might be diseased because her blood urea nitrogen levels are elevated
She is experiencing metabolic alkalosis; hence, the retention of excess CO2 is to offset the situation. This is evidenced by bicarbonate levels, which are above the normal ranges. The compensatory mechanism is evident due to the reduced breathing and an elevated carbon dioxide.
At her age, she is less likely to consume fewer fluids hence the risk of dehydration. Also, her turgidity of the skin is lost; more water can be lost through sweating. Furthermore, in older patients the rena functions are greatly reduced
The patient should continue on her medication to alleviate the excess fluid in the body, which may be dangerous for her heart condition. The care plan should also include reduced fluid intake as it may be a risk to her health. The plan would also include treating the metabolic alkalosis and ensuring that the vital signs are stable.
Aldosterone stimulates the reabsorption of sodium in the tubules of the kidney. Reabsorption of sodium is achieved through ENACs, and thus sodium is followed by water. In fluid deficiency, excess aldosterone is produced, and in fluid overload, the production is reduced.
Case study #2
R.R has Type 1 diabetes hitherto named as insulin reliant diabetes Mellitus. In this condition, the physique fails to produce sufficient insulin since the islets are destroyed in an autoimmune fashion. There are various risk factors for type 1 diabetes includes a genetic predisposition if one of the family members in the family, coexisting autoimmune diseases in the body like Hashimoto’s. Another risk is the geographical location as being in Eastern Europe has a higher risk than those living in America. Environmental factors such as viral infections like the Coxsackie virus have also been posed to be a risk factor. Exposure to chemicals like pentamidine also posits a risk.
R.R is currently experiencing ketoacidosis. In Diabetes, concentration of triglycerides and free fatty acids is elevated due to decreased removal. In the liver, the free fatty acids are converted to acetyl-CoA but the ability to catalyze acetyl-CoA is overwhelmed in the liver. This acetyl-CoA is then converted to acetoacetyl-CoA then to acetoacetate. Acetoacetate and the products derived from it like beta-hydroxybutyrate go into the circulation and upon ionization, they produce hydrogen ions. Some of the hydrogen ions are buffered but the body’s ability to buffer these ions is exceeded, and there is an increase in the number of hydrogen ions hence acidosis, which produces Kussmal breathing. This is supported by her blood ketone levels, which are 3+.
To prepare her mentally, it would be an essence to tell that she will be on medication that the doctors will prescribe and not necessarily, what her friend is taking. This would make sure that she is prepared to take the medication once the treatment protocols begin
Nursing diagnosis must be instituted in order to take care of her acute phase. Fluid volume deficit, which is due to polyuria and osmotic diuresis as evidenced by excessive thirst, can be achieved by encouraging her to take fluids to replace what is lost. In addition, the issue of imbalanced nutrition, which is evidenced by weight loss, fatigue, and ketosis, should be addressed by providing fluids rich in nutrients and electrolytes if the patient cannot tolerate solid. The patient can also be given insulin to push excess glucose into the cells. Fatigue, which is evidenced by the lack of energy, can be mitigated by increasing the activity of the patient and in between, she should have rests.
The five units of insulin will not help her reduce blood glucose by stimulating a wide range of activities in her body. Insulin should rapidly cause transport of glucose and amino acids into insulin-sensitive cells, stimulates the synthesis of proteins, activates glycolytic enzymes and glycogen synthase, as well as, inhibits gluconeogenic enzymes. However, Lantus is long acting, and a shorter acting version of insulin is needed.
Case Study #3
Mary has type 2 diabetes formerly talk about as non-insulin reliant on diabetes Mellitus. As a nurse, the nurse should be ready to tell her of the mother’s gestational diabetes condition, which may be the precursor of her condition. The nurse should also explain that type 2 diabetes is a progressive condition, and aggressive treatment slows its treatment and tries to explain its pathophysiology using simplified terms.
HbA1c is hemoglobin, which has been glycated as a result of hemoglobin being bound to glucose. It is used to assess the efficacy of the treatment used to control diabetes.
The nurse ought to advise Mary on her diet and fluid intake. She should specify the type of foods that she should avoid. In addition, the teachings should also emphasize on the need of regular exercise. Furthermore, she should be alerted to the need to visit the clinic and have her medication on time. Moreover, any comorbidities that she develop should be addressed immediately to prevent complications
The hazard aspects for this type of diabetes comprise stoutness, gestational diabetes, genetic predisposition, and pre-diabetes. Mary treatment plan includes healthy diet, regular exercise, diabetes medication, insulin therapy, and blood glucose monitoring. Metabolic syndrome is a constellation of symptoms that include elevated blood pressure and sugar, abnormal fat distribution and high cholesterol levels that predispose an individual to heart disease.
Harsh, M. (2010). Textbook of pathology. Jaypee Brothers Medical Publishers (P) Ltd.