N512-19A Module 7: Disorders of the Endocrine System Across the Life Span

N512-19A Module 7: Disorders of the Endocrine System Across the Life Span N512-19A Module 7: Disorders of the Endocrine System Across the Life Span Discussion 7 Question 1 Leonard Mays, a 58 y.o., Caucasian, homeless man with long-standing insulin-treated type 2 diabetes has been diagnosed with right lower extremity cellulitis. He has taken a prescribed oral antibiotic for the past week but has not noticed much improvement. For the last 2 days, he has complained of intermittent fevers and chills, nausea with poor oral intake, and proximally spreading erythema over his right leg. N512-19A Module 7: Disorders of the Endocrine System Across the Life Span. On the evening of admission, a worker at the homeless shelter notices that he is markedly confused and calls 911. In the emergency room, he is oriented only to his name. The patient is tachypneic, breathing deeply at a rate of 24/min. He is febrile at 38.8°C. He is normotensive, but his heart rate is elevated at 112 bpm. On examination, this patient is a delirious, unkempt man with a fruity breath odor. His right lower extremity is markedly erythematous and exquisitely tender to palpation. Serum chemistries reveal glucose of 488 mg/dL, potassium of 3.7 mg/dL, and sodium of 132 m/dL. Urine dip-stick is grossly positive for ketones. Permalink: https://nursingpaperessays.com/ n512-19a-module-…ss-the-life-span / In this discussion: Describe and discuss with your colleagues the pathophysiology of ketoacidosis in this diabetic patient. What is causing his altered mental status? Describe the pathogenetic mechanism of his respiratory pattern. Describe and discuss a plan of care for this patient during his first few days in the hospital. Describe a plan of care for him at discharge (he will likely be admitted to the “medical floor” of the homeless shelter, which has the services of an Nurse Practitioner three times per week and a registered nurse four times per week). Include plans for at least one population-focused intervention. Include citations from the text or the external literature in your discussions. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Example Solution for Discussion 7 In the case of L.M., he is a type 2 diabetic who is being treated with insulin. In type 2 diabetics, the disease is usually acquired after many years of insulin resistance (Hammer & McPhee, 2019). Since there is a lack of insulin in the body, there are not enough signals to tell glucose to go into the cells to act as fuel (NIH, 2020). In order to produce fuel, the liver starts to process fat into fuel (NIH, 2020). Because this process is happening so quickly, there is no room to store the fuel and it spills into the blood in the form of ketones (NIH, 2020). This is a normal process, however, since it is happening very quickly, the blood is becoming overwhelmed and acidic (NIH. 2020). When the acids in the blood are metabolized, they produce acetone. The acetone is now building up in the blood (Mistovich, 2020). When small amounts of acetone are released during respiration, it produces a fruity smell to the breath (Mistovich, 2020). Now that ketones are building up in the body, the excess will be excreted in the urine (Mistovich, 2020). Ketones are buffered for excretion by sodium and sodium is followed by water (Mistovich, 2020). The patient is now losing increased amounts of fluid so they are experiencing polyuria (Mistovich, 2020). While this is happening, the blood glucose is rising and the excess will also spill over into the urine (Mistovich, 2020). The glucose molecules, however, are also followed by water, so more water is being pulled from cells (Mistovich, 2020). With all of this water being excreted, dehydration is occurring as well as volume depletion (Mistovich, 2020). The deep, rapid rate of respirations that L.M. is experiencing is due to the ketoacidosis. This type of respiratory pattern is the body’s way of compensating by trying to remove excess carbon dioxide from the alveoli (Whited & Graham, 2020). The respiratory center is stimulated by the fall of the body’s pH (Whited & Graham, 2020). L.M.’s episode of diabetic ketoacidosis was probably caused by the infection to his leg. As he is homeless, other factors could be noncompliance with insulin therapy related to his inability to access his medications or knowledge deficit (Mendez, Surani, & Varon, 2017). Other factors that may have contributed include his diet and hygiene. According to Mendez, Surani, & Varon (2017), diabetic ketoacidosis is usually treated in the intensive care unit due to the level of care initially required. L.M. will require hourly glucose monitoring, frequent laboratory testing, frequent vital sign monitoring, a titrated insulin drip, as well as IV antibiotics and IV hydration (Mendez, Surani, & Varon, 2017). Once his vital signs are stable and his blood sugar is under control, L.M. would be transferred to a med/surg floor for completion of his treatment (Mendez, Surani, & Varon, 2017). While in the hospital, he should have consults with a diabetic educator as well as a dietician for extra support and reinforcement. When L.M. has been discharged to the medical unit of the homeless shelter, he will require a lot of support and education regarding resources as well as medical care (Mcenroe-Petitte, 2020). He will continue to require daily glucose checks four times per day with insulin coverage. On the days that the RN or NP is present, he should have a urinalysis done. His wound should be checked daily and his dressings changed. Appropriate antibiotics should be administered as ordered. Other considerations during his stay should include his access to resources such as a social worker or case manager (Mcenroe-Petitte, 2020). He should be given information on the location of the food pantry and places where he can go for meals for free (Mcenroe-Petitte, 2020). Education must be given regarding the warning signs of diabetes and when he should seek immediate attention, and the importance of follow up appointments at the clinic (Mcenroe-Petitte 2019). He should be seen by the nurse practitioner as least every 2-4 weeks for the first 2 months after discharge and then every six months or as needed after that. He will also need to be given information about routine health screenings, which ones are of the utmost importance, and where and when he will be able to have them done (Mcenroe-Petitte, 2020). Lastly, the importance of keeping his wound clean as well as daily hygiene should be stressed to L.M. N512-19A Module 7: Disorders of the Endocrine System Across the Life Span References Hammer, G.D., and McPhee, S.J., (2019). Pathophysiology of disease; An introduction to clinical medicine, eighth edition. New York, NY;McGraw hill Education Mcenroe-Petitte, D., (2020). Caring for patients who are homeless. Nursing2020, 50(3), 24-30. Doi:10.1097/01.Nurse.0000654600.98061.61 Mendez, Y., Surani, S., and Varon, J., (2017). Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward? World Journal of Diabetes, 8(2), 40-44. doi:10.4239/wjd.v8.i2.40 Mistovich, J., (2020). Understanding the presentation of diabetic ketoacidosis. EMS1. Retrieved from https://www.ems1.com/ems-products/ambulance-disposable-supplies/articles/understanding-the-presentation-of-diabetic-ketoacidosis-NekpEYII8WCE32Jn/ National Institute of Health, U.S. National Library of Medicine, (2020). Diabetic ketoacidosis. Retrieved from https://medlineplus.gov/ency/article/000320.html Whited, L., and Graham, D.D., (2020). Abnormal respirations. Retrieved from https://europepmc.org/article/NBK/nbk470309 865 words Permalink In reply to Lisa-Kay McColgan Re: McColgan_Discussion7 by Lorri Rostetter – Sunday, September 6, 2020, 4:52 PM Hi Lisa, Thanks for the great information. I had no idea that the acid in the blood from ketones turns into acetone. That’s like finger nail polish remover. Gross! I really liked your plan of care. I didn’t think to include a consult to a social worker to address his homelessness. I used to volunteer at a homeless shelter where they did help people find employment and housing, but not every homeless shelter has that type of service. I agree that L. M. ‘s respiratory pattern is the body’s way of compensating by trying to remove excess carbon dioxide from the alveoli. In addition, there’s a lack of potassium, magnesium, and phosphate, which distresses the respiratory muscles; leading to respiratory failure. Reduced osmotic pressure increases water in the lungs, leading to pulmonary edema and diminished lung capacity (Gallo de Moraes & Surani, 2019). Your hospital care plan looks great, but according to Hirsch & Emmett, 2020, IV dextrose should be added to saline once glucose levels have fallen to 200 mg/dL. This is added to avoid the development of cerebral edema. Gallo de Moraes, A., & Surani, S. (2019). Effects of diabetic ketoacidosis in the respiratory system. World Journal of Diabetes, 10(1), 16–22. https://doi.org/10.4239/wjd.v10.i1.16 Hirsch, I. B., & Emmett, M. (2020). Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment. In D. M. Nathan (Ed.) 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