Unit 3 Case Study endocrine system. Type 1 and type 2 diabetes. Due 1-26-23. 1200 words. 4 references.

Assignment Objectives: 

· Describe the pathophysiologic manifestations of the disease(s).

· Identify and select appropriate interventions including diagnostic tests and nursing interventions. 

· Analyze physiological and psychological responses to illness and treatment modalities 

Purpose:  Examine case studies related to endocrine system and answer the assigned questions. This assignment should help refine your clinical/critical thinking skills.  Assignment Description:  Answer the questions related to each of the patients provided. Your answer must follow APA 7th edition format. Submit the answer in the assignment area of your course.      Patient 1 – The parents of an 11 year old girl bring her for an office visit. She has been developing normally and has been healthy and active. Her parents report that for the past several weeks, she has been feeling tired and weak, drinking more fluids than normal, and has been urinating so much she has wet the bed at night. Two days ago, they noticed that her breath smelled "like fruit" and she lost 8 pounds these last weeks. Yesterday she began breathing fast and deep.

a. Present your initial diagnosis.

b. Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented.

c. List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct.

d. Describe your recommended treatment(s) and the rationale to support your recommendation(s).

answers to the questions

Patient 1 A. Initial diagnosis: Diabetic Ketoacidosis  associated with Type 1 diabetes   

B.Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented: In type 1 diabetes the body does not make enough insulin to control blood sugar levels, some or all of the insulin-producing cells in the pancreas are destroyed. This leaves the patient with little or no insulin. Without insulin, sugar accumulates in the bloodstream rather than entering the cells. As a result, the body cannot use this glucose for energy, thus the patient always feels tired and weak.In addition, the high levels of glucose that remain in the blood cause excessive urination and dehydration, and damage tissues of the body, thus the patient experience weight loss. Type 1 diabetes was previously called insulin-dependent diabetes or juvenile diabetes. Fruity-smelling  breath is a sign of high levels of ketones in someone who already has diabetes. The body is constantly doing work to maintain an average temperature and neutral blood acidity.  Breathing fast and deep means the patient is experiencing  Kussmaul breathing pattern that indicates that the body or organs have become too acidic. It is a sign of severe metabolic acidosis, which is a life-threatening condition, hospitalization is usually necessary. 

C.List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct.

· Fasting plasma glucose (FPG) test

· Oral glucose tolerance test (OGTT).

· Random blood glucose test

· Complete urinalysis 

· Arterial blood gas

D.Describe your recommended treatment(s) and the rationale to support your recommendation(s).   

· Pay attention to the emergency situation  (Diabetic ketoacidosis) first 

· Treatment of type 1 diabetes requires daily insulin injections. 

· Healthy diet and regular exercise are important for everyone—but particularly for people with diabetes. 

· Proper care of feet and regular eye examinations can help prevent or delay the onset of complications of diabetes.

Patient 2– A  45 year old man is being seen because he has been experiencing vision changes, a burning sensation in his feet, and decreasing amounts of urine when he uses the bathroom. He has a long-standing history of hypertension and hyperlipidemia. Your physical exam reveals retinal hemorrhages in both eyes, and decreased sensation to moderate touch in the soles of his feet. A spot urinalysis shows microalbuminuria and a stat Basic Metabolic Profile (BMP) shows decreased Glomerular Filtration Rate (GFR).

a. Present your initial diagnosis.

b. Describe the pathophysiologic processes related to your diagnosis that explain the signs/symptoms, and lab results obtained.

c. State the effect of his symptoms on his life expectancy and the rationale for your answer.

Complete this assignment and submit it to this assignment dropbox by Sunday at 11:59 pm CT.

answers to the questions

a. Present your initial diagnosis.

My initial diagnosis is acute renal failure, peripheral neuropathy and retinopathy secondary to hypertensive heart disease and hyperlipidemia.

b. Describethe pathophysiologic processes related to your diagnosis that explain the signs/symptoms, and lab results obtained. Hyperlipidemia results in formation of atheromatous plaques which result in endothelial injury. Endothelial injury result in further formation of clots through formation of thrombi because of stimulation of aggregation of platelets . The thrombi and atheromatous plaque occur in all blood vessels that is the arteries, and arterioles. This results in narrowing of the vessels. In the eye arterioles there is arteriosclerosis causing stiffening and destruction of these arterioles causing ischemia. The ischemia results in neovascularization due to hypoxia but these vessels have weak walls. Because of the hypertension it leads to retinal arterioles hemorrhages due to rupture of these vessels. The atheromatous plaques also causes renal artery narrowing and stenosis reducing renal perfusion. This results in renal ischemia and renal injury to the glomeruli and the tubular structures. This results in making the glomeruli porous to proteins resulting in loss of protein explaining the patient's microalbuminuria. This damage also results in severe decrease in glomerular filtration rate which also results in decreased urine production.

The hypertension and hyperlipidemia results in peripheral vascular disease. Narrowing and stenosis of these vessels in the lower extremities results in ischemia to both tissues and neuro vascular structures. The hypoxia and ischemia results in reduced sensation to touch and pain due to peripheral neuropathy causing the decreased sensation to moderate touch in the soles of his feet and burning sensation of the feet.

c. State the effect of his symptoms on his life expectancy and the rationale for your answer.

1. Retinal hemorrhages and vision changes can result in decreased and loss of vision which can affect the patient's ability to do activities of daily living. Loss of vision can also affect his quality of life and significantly reduce his life expectancy because he, will be, prone to injury and accidents.

2. a burning sensation in his feet can cause difficulty walking which can create issues like depression and him not taking care of personal hygiene. This predisposes him to suicide attempts and a, decreased life expectancy.

3. decreasing amounts of urine when he uses the bathroom can cause issues like bladder outlet obstruction and dysuria which can significantly reduce the patient's quality of life and life expectancy in general.

4. decreased sensation to moderate touch in the soles of his feet can predispose him to risk of injury because of his decreased ability to feel pain and touch sensation as the peripheral vascular diseases worsens. This also predisposes him to wounds and chronic leg ulcers which could result in significant decrease in the patient's life expectancy

Estimated time to complete: 6 hours

Rubric

NU621 Unit 3 Case Study