Jessica Sagat, 21 years old, is a type 1 diabetic client. She has been ill for the past several days and is unable to control her blood sugar. She has developed elevated blood sugar, nausea, vomiting, rapid and deep respirations, and a fruity odor to her breath. An arterial blood gas (ABG) is taken and the results are pH 7.30, PaCO2 43 mm Hg, Bicarb (HCO3) 19 mEq/L, and PaO2 93 mmHg.(Learning Objective10) 1. What type of acid-base imbalance is this client experiencing? What components of the acid-base balance system are involved in this imbalance? 2. What are the normal ABG values

A client is on complete bed rest after a total hip replacement surgery while he is being treated for a mild postoperative surgical wound infection. Identify the underlying physiologic factors that could increase the nutritional needs of this client. Give specific rational A.Anabolism, polydipsia, hypertriglyceridemia B.Elevated protein plasma levels, hypotension, glycolysis C.Large abdominal girth,insulin resistance, acidosis D.Fever, increased white blood cell count, negative nitrogen plasma level

A 68-year-old patient was delivered to the intensive care unit with the suspicion of hyperlactacidemic coma and complaints of severe muscle ache, vomiting drowsiness alternating with stupor, pain in the heart region. Objectively: eye ball tone is lowered, arterial pressure –100/55, pulse - 136beats/minute, glycemia - 14mmol/l, acidosis, blood PH – 7.0, level of lactic acid – 1.9mmol/l. What are you going to do in this case?A. Injecting 1% solution of methylene blueB. Injecting 500ml 5% glucose solutionC. Injecting 0.1% adrenaline solutionD. Introducing 100 mg prednisoloneE. Introducing 500 ml 0.9% sodium chloride

An unresponsive client who has diabetes is brought to the emergency department with rapid, deep respirations. Additional findings include: blood glucose 24.9 mmol/L, arterial pH 7.2 and urinalysis showing presence of ketones and glucose. Which of the following statements best describes the underlying cause of this patient’s presentation? Question 64 options: a)  Relative insulin deficiency, causing hyperglycemia, oxidative stress, renal dysfunction and acidosis b)  Nocturnal elevation of growth hormone resulting in hyperglycemia in the morning c)  Absolute insulin deficiency, increased counter-regulatory hormone, lipolysis and free fatty acid release d)  Hypoglycemia causes release of glucagon, resulting in glycogenolysis and hyperglycemia

James Dunn is a 40-year-old African American man. He presents to the physician’s office today complaining of headache. His vital signs during triage are as follows: blood pressure 165/90 mm Hg, heart rate 80 beats/minute, temperature 98.5F, weight 125 kg (275 lb), and height 5 ft 11 in. He currently has no other diagnosed medical conditions. The physician gives Mr. Dunn a prescription for lisinopril/hydrochlorothiazide (Prinzide) 10/12.5 mg with directions to take one tablet by mouth daily in the morning. (Learning Objectives 1, 3, 4, 8) 1. In which stage of hypertension would you place Mr. Dunn? 2. What lifestyle modifications should Mr. Dunn be encouraged to follow? 3. What class of antihypertensive is lisinopril/hydrochlorothiazide? 4. What would you tell Mr. Dunn about his new medication?

You are a nurse in an acute care hospital. Your new patient JD is in the hospital for fractures. His chart showed he has type 2 diabetes with HbA1c of 8.0%. JD’s sister came in to visit at lunch and brought him a Big Mac (3 slices of bread) with large fries on the side in addition to a bag of potato chips and a bottle of orange juice. You are concerned about the high carbohydrate content of the meal and discussed this with JD and JD’s sister. JD’s sister said, “I know my brother has diabetes, so I didn’t bring him soda or dessert.”  JD said “I really love my carbs, but I know I should avoid all carbs to make my sugar low. Doctor said something about my ‘A1c’. Do you know what that is about?” Both JD and his sister said they would like to learn more about diabetes and diet. Please explain to JD and his sister what the HbA1c test is and how to use A1c level to categorize normal blood sugar, pre-diabetes, and diabetes according to the ADA. Please also describe the target HbA1c level for…

Jeff is a 57-year-old male with a long history of type 1 diabetes. He takes insulin to manage his diabetes, but he has been having trouble maintaining steady blood glucose levels over the last two weeks. Jeff suffered a week-long case of influenza last month but is otherwise healthy. This morning, he began vomiting upon waking. This was followed by extreme abdominal pain and extreme thirst. He called his endocrinologist, who told him that he needs to seek emergency care. Briefly explain why Jeff has a feeling of extreme thirst.

JH, a 53 year-old female, had not been feeling well lately and suddenly started to feel acutely worse. She started to have shortness of breath, and was experiencing an irregular heartbeat, chest pain, muscle weakness, and feelings of severe nausea. She called 911 and was taken to the hospital where blood samples were drawn. The following table summarizes the results of her bloodwork (Table 1) Table 1: JH ion concentrations at intake (blood). lon Plasma concentration - measured (mM) Plasma concentration - normal (mM) K+ 8 5 Na+ 142 142 Cl- 105 105 Ca2+ 2.5 2.5 JH was diagnosed with hyperkalemia and ordered IV fluids. The IV fluids she was given contained calcium gluconate and insulin. Her potassium levels were monitored over a 24-hour period and were as summarized in Table 2. Table 2. JH potassium concentrations post-IV fluids (blood). Time (hours) Measured plasma K+ (in mM) 0 8.0 3 7.1 6 6.4 9 5.9 12 5.6 15 5.3 18 5.1 21 5.0 24 5.0   Calculalated…

A 31-year-old white male patient with known type 1 diabetes mellitus, end-stage renal disease secondary to diabetic nephropathy, and a history of alcoholism was admitted with acute abdominal pain in the mid-epigastrium, with a blood gas values of pH of 7.48, poz of 121 mm Hg, 02 saturation of 99%, pCO2 of 30 mm Hg, and bicarbonate of 20 mE q/L. What is a possible compensatory mechanism? A. Decreasing H* ion retention B. Increasing bicarbonate retention C. Increasing the respiratory rate D. Decreasing the respiratory rate

Jessica Sagat, 21 years old, is a type 1 diabetic client. She has been ill for the past several days and unable to control her blood sugar. She has developed elevated blood sugar, nausea, vomiting, rapid and deep respirations, and a fruity odor to her breath. An arterial blood gas (ABG) is taken and the results are: pH 7.30, PaCO2 43 mm Hg, Bicarb (HCO3) 19 mEq/L, and PaO2 93 mmHg. What type of acid–base imbalance is this client experiencing? What components of the acid–base balance system are involved in this imbalance? What are the normal ABG values?