Why the patient be instructed to avoid tobacco and caffeine

Assignment Help History
Reference no: EM133552848

Assignment

Textbook: Pagana: Mosby's Manual of Diagnostic and Laboratory Tests, 6th Edition.

Part I: Adolescent With Diabetes Mellitus (DM)

Case Study

The patient, a 16-year-old high-school football player, was brought to the emergency room in a coma. His mother said that during the past month he had lost 12 pounds and experienced excessive thirst associated with voluminous urination that often required voiding several times during the night. There was a strong family history of diabetes mellitus (DM). The results of physical examination were essentially negative except for sinus tachycardia and Kussmaul respirations.

Studies

Results

Serum glucose test (on admission), p. 227

1100 mg/dL (normal: 60-120 mg/dL)

Arterial blood gases (ABGs) test (on admission), p. 98

 

pH

7.23 (normal: 7.35-7.45)

PCO2

30 mm Hg (normal: 35-45 mm Hg)

HCO2

12 mEq/L (normal: 22-26 mEq/L)

Serum osmolality test, p. 339

440 mOsm/kg (normal: 275-300 mOsm/kg)

Serum glucose test, p. 227

250 mg/dL (normal: 70-115 mg/dL)

2-hour postprandial glucose test (2-hour PPG), p. 230

500 mg/dL (normal: <140 mg/dL)

Glucose tolerance test (GTT), p. 234

 

Fasting blood glucose

150 mg/dL (normal: 70-115 mg/dL)

30 minutes

300 mg/dL (normal: <200 mg/dL)

1 hour

325 mg/dL (normal: <200 mg/dL)

2 hours

390 mg/dL (normal: <140 mg/dL)

3 hours

300 mg/dL (normal: 70-115 mg/dL)

4 hours

260 mg/dL (normal: 70-115 mg/dL)

Glycosylated hemoglobin, p. 238

9% (normal: <7%)

Diabetes mellitus autoantibody panel, p. 186

 

insulin autoantibody

Positive titer >1/80

islet cell antibody

Positive titer >1/120

glutamic acid decarboxylase antibody

Positive titer >1/60

Microalbumin, p. 872

<20 mg/L

Diagnostic Analysis

The patient's symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over the last several months. The results of his arterial blood gases (ABGs) test on admission indicated metabolic acidosis with some respiratory compensation. He was treated in the emergency room with IV regular insulin and IV fluids; however, before he received any insulin levels, insulin antibodies were obtained and were positive, indicating a degree of insulin resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often a late complication of diabetes.

During the first 72 hours of hospitalization, the patient was monitored with frequent serum glucose determinations. Insulin was administered according to the results of these studies. His condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to an insulin pump and did very well with that. Comprehensive patient instruction regarding self-blood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the signs and symptoms of hyperglycemia and hypoglycemia was given.

Task

A. Why was this patient in metabolic acidosis?

B. Do you think the patient will eventually be switched to an oral hypoglycemic agent?

C. How would you anticipate this life changing diagnosis is going to affect your patient according to his age and sex?

D. The parents of your patient seem to be confused and not knowing what to do with this diagnoses. What would you recommend to them?

Part II Esophageal Reflux

Case Study

A 45-year-old woman complained of heartburn and frequent regurgitation of "sour" material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative.

Studies

Results

Routine laboratory studies

Negative

Barium swallow (BS), p. 941

Hiatal hernia

Esophageal function studies (EFS), p. 624

 

Lower esophageal sphincter (LES) pressure

4 mm Hg (normal: 10-20 mm Hg)

Acid reflux

Positive in all positions (normal: negative)

Acid clearing

Cleared to pH 5 after 20 swallows (normal: <10 swallows)

Swallowing waves

Normal amplitude and normal progression

Bernstein test

Positive for pain (normal: negative)

Esophagogastroduodenoscopy (EGD), p. 547

Reddened, hyperemic, esophageal mucosa

Gastric scan, p. 743

Reflux of gastric contents to the lungs

Swallowing function, p. 1014

No aspiration during swallowing

Diagnostic Analysis

The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient's symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms.

Task

A. Why would the patient be instructed to avoid tobacco and caffeine?

B. Why did the physician recommend 6 weeks of medical management?

C. How do antacid medication work in patients with gastroesophageal reflux?

D. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach?

Reference no: EM133552848

Questions Cloud

How many tickets do the bruins sell to each unenthusiastic : How many tickets do the Bruins sell to each Unenthusiastic fan? What is the price of this package? b) What is Enthusiastic fan surplus when they buy
Which electronic medical record is the best one : Which electronic medical record (EMR) is the best one? Why? Which attributes of an EMR are most important?
Relationship between a childs looks and academic achievement : With ratings in hand, the researchers then analyzed the relationship between a child's looks and academic achievement.
Why is it important to perform a head-to-toe assessment : Why is it important to perform a head-to-toe assessment on your assigned patients? What are the concepts and principles involved in the assessment
Why the patient be instructed to avoid tobacco and caffeine : Why would the patient be instructed to avoid tobacco and caffeine? Why did the physician recommend 6 weeks of medical management?
Are there any concerns about the feds policy : If you post your primary response before the Fed's announcement becomes public, what do you expect to hear? Do you believe the Fed will raise/lower the target
Compare and contrast united states and the united kingdom : Compare and contrast the United States and the United Kingdom (England) with regard to the organization, structure, and function of health care, public health
Hypothesize why we might not see the wage gaps : Hypothesize why we might not see the wage gaps between self-identified gay vs heterosexual men and between self-identified lesbian vs heterosexual women
Describe the main stages of the vr design framework for : Distinguish between virtual reality (VR), Industry 4.0 and the maintainability approach. Describe the main stages of the VR design framework for training.

Reviews

Write a Review

History Questions & Answers

  How is american society different today from its beginnings

What were the major changes in immigration patterns after 1945? Be sure to include summation of the significant immigration acts and legislation of the period.

  Discuss the impact of black feminists-black gay

What issues did these groups bring to the fore in the black political arena and what were some of the obstacles they confronted in black communities?

  What impact did the black power movement have

Who and what promoted change? What resistance was met and why? What impact did the Black Power movement have?

  What caused the rise of national monarchies in england

What caused the rise of national monarchies in England and France in terms of the Hundred Years War? or discuss the emergence of Russia?

  Choose the harlem renaissance and the black power movement

Create a PowerPoint project, it must be 14 slides, plus a title slide and a reference slide, formatted according to APA style. You must properly cite your sources according to APA style - choose the Harlem Renaissance and the Black Power Movement a..

  Which case established the principle of judicial review

Which case established the principle of judicial review? roe v.wade (1973), mcculloch v.maryland (1819), marbury v.madison (1803), brown v.board of education (1954).

  One of the characteristics of modernism

One of the characteristics of modernism is that it

  Why do you think alexander had so many achievements

Why do you think Alexander had so many achievements? Why do you think Alexander the Great continues to fascinate so many centuries after his death?

  What resources you used to assist you with being successful

what resources you used to assist you with being successful? As you begin to read the course materials, how would you define the term history?

  Searching for a cause for suffering

In searching for a cause for their suffering, who did Europeans blame for the Black Death and how did they seek revenge?

  The citizens of denmark participated in anbsp resistance

the citizens of denmark participated in anbsp resistance movement against the nazi regime.nbsp what were the factors

  What additional primary sources about the aztec

What additional primary sources about the Aztec and Inca empires of the 15th century would you like to have?

Free Assignment Quote

Assured A++ Grade

Get guaranteed satisfaction & time on delivery in every assignment order you paid with us! We ensure premium quality solution document along with free turntin report!

All rights reserved! Copyrights ©2019-2020 ExpertsMind IT Educational Pvt Ltd