You are a medical student working your way through college and are assigned to a hospital given background information on a patient. You were provided the chief complaint and long-term hist

 

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Anatomy and Physiology 2 Lab Name

Case Study Assignment. You are a medical student working your way through college and are assigned to a hospital given background information on a patient. You were provided the chief complaint and long term history of the patient outlined below. You are asked by the nurse in charge to read the following case, investigate the topic (Diabetes mellitus and chronic renal failure) and complete a

written report in MLA format including references addressing each of the questions identified below. Use this Iink for guidance on MLA writing format: https:l/owl.pur{ue.edu/owllresearch aqs! qi},ation/mlq qivlp/mla f-ormattinq and stvle quid”S/mla qeneral format.html

Total length of your report should be about two-three pages typed. The purpose of this assignment is to put things you are learning in the course (lecture and lab) into context using real life situations. This assignment’s focus is to investigate real issues of the of the urinary system and related diseases.

Chief Cornplaint: 7-year-old girl experiencing unexpected weight loss and says she is thirsty all

of the time ard needs to urinate frequently.

History: The parents of Rylee Langdon, a7-year-old female, made the decision to contact their pediatrician because cver the past three days, Rylee has been feeling nauseated, vomited on three occasions, and ‘,’,as complaining of having a headache. Rylee otheruvise had been in previously good health, sne also noticed that, in the past month, she has been increasingly thirsty. She gets up several r mes a night to urinate and finds herself gulping down glassfuls of water. At the dinner table, she seems to be eating twice as much as she used to, yet she has lost 6 pounds in the past month.

While atthe office visit, it is noted that Rylee is breathing rapidly and taking deep breaths and has a fruity odorto her breath, On physical examination, blood and urine samples are taken. The following lab results are noted:

Following her visit to the pediatrician, Rylee undergoes a diabetic care training program, learning how to self-inject insulin subcutaneously and check her blood-glucose level at home using chemstrips. ln addition, she learns the importance of carrying candy and glucagon with

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Test Test result Normal result Blood qlucose level 454 mo/dl 50-170 mo/dL Blood 7.15 7.35-7.45 Urine Glucose Positive Neoative Urine Ketone Positive Neqative Urine color Clear Liqht vellow-amber Soecific oravitv 1 .008 1 .010-‘1 .026 Urine pH o 6-8

 

 

her at all times as well as eating the right amounts of food at the right times each day. Rylee is

sta,-ted on the following schedule of insulin dosing:

. morning dose = 8 units of NPH insulin and 4 units of regular insulin

. supper dose = 4 units of regular insulin

. bedtime dose = 5 units of NPH insulin

. total dose per day – 21 units

Th”:e days later, she returns to the doctor’s office for a review of her blood-glucose readings

a-. a measurement of her fasting blood-glucose level, which is found to be 95 mg/dl. Most of

l”e. 3lucose readings during the day have been in the low- to mid-100 range. Her glucose levels

b:’:-e supper, however, are in the upper 200s.

R, :: returns to her pediatrician three months later for a re-check and is found to have a

g[ :: s.viated hemoglobin level (Hb A1C) of 9,5%. The years progress, and Rylee has

cors :erable difficulty controlling her diabetes. She has been told that she has “brittle” diabetes,

afc- of the disease marked bywide swings in blood-glucose levels despite the bestefforts at

con:.i . Rylee is advised by her physician that she is at risk for developing certain complications

of dta: etes and it is advised to never walk barefoot. ln her mid-forties, Rylee began to show

early s gns of diabetic nephropathy (kidney disease), consisting of persistent proteinuria,

hyperte.sion, and gradually decreasing renalfunction as measured by chemicaltests. She .onetFe :ss felt fairly healthy over the next 10 years. At age 55, however, she has noticed

oecoming -:-easingly fatigued upon mild physical exertion and requiring more sleep than previously. ,- aCdition, she has generally felt nauseated most of the time, and in the past two

weeks, has vc- :ei on several occasions. She has increased swelling in her ankles and is short of breath. She has als: become less responsive over the past day or so. Laboratory tests reveal

that her kidne., : se?se s now progressing at a much faster rate:

BUN (blooc -.ea nrtroger,r = 56 mg / dl (normal = 10 – 20 mg / dl)

Urinary outp,: = 25 cc / hour (normal = 50-60 cc / hour)

Rylee is adl’isei c),her physician tnat herkidneys arefailing. She is informed abouttreatment options: herrcs alysis vs. continuous anbulatory peritoneal dialysis (CAPD) vs. kidney

transplant. ln ccnsultation with her physician R.ylee chooses to undergo hemodialysis. A checkup two w’eers after beginning dialysis reveals the BUN has decreased to 35 mg / dl.

Although,hemodiallrsis is fairly effective, it is not fool proof. For example, patients with chronic renal failure, despite a .egular schedule of hemodialysis, will experience disruptions in calcium and phosphate balance.

 

 

Address the following items in your report.

1. Explain to your supervisor your summary of the patient’s complaint and history. 2. ln your report, be sure to address all the specifics about the findings of the examinations.

(For example, explain each of the lab results) 3. Address the physiological purpose for the reported unusual breathing. 4. lnvestigate the reasons why Rylee has a fruity odor to her breath. 5. Address why Rylee is urinating so frequently. Be sure to describe this in terms of what is

happening in the functional units of the kidneys. 6. Explain how Rylee’s condition is similar to starvation. You should provide details of the

role of the hormones responsible for sugar metabolism and storage. (hint, what are the roles of insulin and glucagon?) Address what potential problems could arise for Rylee as she gives herself insulin artificially on a regular basis and why is it important to carry both candy and glucagon with her at all times as well as eat the right amounts of food at the right times each day.

E. ln your case study repori, explain what the differences are between NPH and regular insulin and benefits and drawbacks to using each. With what you discovered; how might you adjust Rylee’s insulin dosing schedule to bring her pre-supper glucose levels down?g. Explain HbAI C is and what the normal ranges for glycosylated hemoglobin. Address

‘vhat the benefit of measuring HbAI C versus a one-time direct measurement of blood c ‘rcose levels. What does Rylee’s HbAIC indicate?

10. A::’ess the possible long-term complications of Rylee’s disease. Why is it important she nere’,,,ralk barefoot?

11. Address :’e phosphate balance issue as it relates to diabetes. What effect will the elevatior cf elood phosphate levels have on blood calcium levels? What might happen to soft tiss*e s 1’blood phosphate levels are too high? How might the endocrine system compensa:e ‘c.:le change in blood calcium levels?

12. Expla.n’,3,t lriis “:”ignt affectthe skeletal system, What is osteodystrophy?

USEFUL NOTES FOR:

investigate the topic (Diabetes mellitus and chronic renal failure

Introduction

Diabetes mellitus, also known as diabetes (manifesting itself in a large amount of urine) and chronic renal failure are diseases that are rarely diagnosed individually. In fact, the close relationship between these two pathologies is determined by the fact that they have a similar pathological substrate (decreased number of functioning nephrons), which leads to the development of renal insufficiency. According to the WHO, more than 250 million patients suffer from diabetes mellitus (IDDM – 14% and NIDDM – 86%), with an increase in prevalence in recent years. In the world, approximately 15-20% of patients with DM are diagnosed with chronic kidney disease, while conversely, 35-40% of patients with chronic renal failure have IDDM. Survey data suggest that the incidence of CRF in diabetics is increasing every year. For IDDM, the risk of developing CRF is 10-15 times higher than for non-diabetics; for NIDDM it is 3-4 times higher than for non-diabetics

Diabetes mellitus, also known as diabetes (manifesting itself in a large amount of urine) and chronic renal failure are diseases that are rarely diagnosed individually.

Diabetes mellitus, also known as diabetes (manifesting itself in a large amount of urine) and chronic renal failure are diseases that are rarely diagnosed individually. Both disorders share the same pathophysiological substrate, which is hyperglycemia. In both cases, hyperglycemia is due to a defect in insulin production or action leading to ineffective insulin secretion from β cells that results in elevated blood glucose concentrations leading to tissue damage and death. The increased prevalence of these two diseases can be attributed to high-carbohydrate diet intake coupled with an aging population as well as urbanization where people spend most of their time indoors on computers or mobile devices away from sunlight exposure which may lead to vitamin D deficiency causing low levels of calcium absorption resulting into osteoporosis later on which may increase risk for fracture development during old age period if left untreated

The close relationship between these two pathologies is determined by the fact that they have a similar pathological substrate (decreased number of functioning nephrons), which leads to the development of renal insufficiency.

The close relationship between these two pathologies is determined by the fact that they have a similar pathological substrate (decreased number of functioning nephrons), which leads to the development of renal insufficiency. In addition, both diseases are characterized by an increase in blood urea nitrogen (BUN), suggesting an increase in glomerular filtration rate (GFR) and proteinuria, which can be detected on laboratory testing for diabetes mellitus or chronic renal failure.

According to the WHO, more than 250 million patients suffer from diabetes mellitus (IDDM – 14% and NIDDM – 86%), with an increase in prevalence in recent years.

According to the WHO, more than 250 million patients suffer from diabetes mellitus (IDDM – 14% and NIDDM – 86%), with an increase in prevalence in recent years. The number of people with diabetes is increasing in particular in developing countries. In middle-income countries, it has doubled over the last decade.

The diagnosis of prediabetes is controversial because it does not lead directly to type 2 diabetes mellitus but can be used as a marker for future development of this disease.

In the world, approximately 15-20% of patients with DM are diagnosed with chronic kidney disease, while conversely, 35-40% of patients with chronic renal failure have IDDM.

In the world, approximately 15-20% of patients with DM are diagnosed with chronic kidney disease, while conversely, 35-40% of patients with chronic renal failure have IDDM.

The majority of studies have found a correlation between DM and CKD in both type 1 and 2 diabetes mellitus (DM). A recent study by Lörinczi et al., published in The Journal of Clinical Endocrinology & Metabolism (January 2019), showed that the prevalence rate for glucose intolerance increased from 4% before diagnosis to 30% after 12 years on anti-diabetic treatment but remained static at 5%. This suggests that some patients may be undiagnosed and not receiving treatment for their condition even though they may be suffering from various complications related not just simply being overweight or obese but also because they don’t know they’ve got it!

Survey data suggest that the incidence of CRF in diabetics is increasing every year.

Survey data suggest that the incidence of chronic renal failure (CRF) in diabetics is increasing every year. The incidence of CRF in diabetics has increased over the past decade, and these patients are at greater risk for developing diabetic nephropathy or hyperglycemia-associated nephropathy.

For IDDM, the risk of developing CRF is 10-15 times higher than for non-diabetics, and for NIDDM the risk is 3-4 times higher than for non-diabetics.

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FROM 30 to 50% OF DIABETIC PATIENTS DEVELOP CHRONIC RENAL FAILURE.

The risk of developing chronic renal failure is 10 times higher for patients with diabetes than for non-diabetic patients, and 4 times higher than the general population. In addition to the well-known complications that result from diabetes, there are other events that can cause CRF:

Diabetes-related hypertension (high blood pressure)

High blood pressure itself may lead to kidney disease in some cases

Diabetes can cause an acidosis or alkalosis which damages the kidneys

Despite the prevalence of both conditions, their relationship is often not recognized at earlier stages.

Despite the prevalence of both conditions, their relationship is often not recognized at earlier stages. The close relationship between these two pathologies is determined by the fact that they have a similar pathological substrate (decreased number of functioning nephrons).

Conclusion

The relationship between these diseases is not well understood, as the diagnosis of chronic renal failure is often delayed due to diabetes mellitus. However, this does not mean that it does not occur in the absence of diabetes. On the contrary: according to studies conducted in several countries over the past decade, up to 50% of diabetic patients develop CRF at some point during their lives. It should be noted that both conditions are rare and do not cause functional impairments that can lead to complications such as cardiovascular disease or osteoarthritis. Therefore their association should be considered only when they are found together in a patient who has already been diagnosed with one or both diseases separately