Experiencing unexpected weight loss

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

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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


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?

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