Respond to your peers post
APA format
POST 1
Diabetic Ketoacidosis (DKA) is a very serious and common complication of type 1 diabetes, but can also occur in individuals with type 2 diabetes. According to Misra and Oliver (2015) DKA has a mortality rate of 3-5%, and 6% of DKA cases are the initial presentation of diabetes in an individual.
DKA most often occurs due to an illness, such as an infection, “when there is an absolute or relative deficiency of insulin and an increase in the levels of insulin counterregulatory hormones” (McCance et al., 2013, p. 744). The increase of these hormones, along with the deficiency of insulin, cause the body to go into a state in which there is “decreased glucose uptake, increased fat mobilization with release of fatty acids, and accelerated gluconeogenesis and ketogenesis” (McCance et al., p. 744). Additionally, increased ketone concentrations are caused, which then causes a loss of bicarbonate, and leads to the development of a metabolic acidosis.
Hallmark signs of DKA include polyuria, polydipsia, lethargy, nausea, vomiting, altered mental status, Kussmaul respirations, and sweet-smelling (acetone) breath.
In the case of Ms. Blake, the following are all abnormal lab results: Sodium 156; Chloride 115; ABG pH 7.30, PO2 70 and HCO3 20. The ABG values show a metabolic acidosis as well as a low blood oxygen saturation. The sodium may be elevated in this case due to severe dehydration, which can also cause other dangerous electrolyte abnormalities.
For patients with all types of diabetes, it is important to ensure that they understand the many complications that are associated with their diagnosis. For Ms. Blake, it is important to ensure that she understands the severity of her DKA diagnosis, and how it may have been prevented. Education should also be reinforced in regard to the home monitoring of glucose and ketone levels. Additionally, it is important to find out if she has family or friends that are available to check in with her frequently, especially when she if feeling unwell, so that she can be seen by a physician sooner rather than later.
POST 2
Week five case study involves a three-month-old infant diagnosed with pyloric stenosis. The etiology behind pyloric stenosis is unknown at this time but it is thought to have a connection to genetics and environmental factors. The pathophysiology behind pyloric stenosis involved a thickening of antropyloric portion of the stomach which the lumen has edematous mucosa which cause an obstruction (Hernanz-Schulman, 2018). The hyperplasia and hypertrophy of the muscle literally blocks of the pylorus which inhibits the passage of food to be digested. The gastric outlet obstruction then causes food to not be able to pass and thus leads to forcefully vomiting. This typically occurs in infants three to five weeks old (Hernanz-Schulman, 2018). The classic signs that are hallmark include vomiting, persistent hunger, changes in bowel movements, dehydration, and decreased weight (Hernanz-Schulman, 2018). This case study described that the infant was having frequent episodes of vomiting after eating, swollen belly, fussiness due to being hungry, and decreased weight because the body was not being able absorb any food because it was being blocked from small intestine.
Complications from pyloric stenosis include failure to grow, jaundice due to bilirubin buildup, stomach irritation and dehydration (Hernanz-Schulman, 2018). On assessment a provider may be able to palpate and fill an olive like lump that indicates an enlarge pylorus. They may order follow up ultrasound testing as well. The only treatment for pyloric stenosis is surgical intervention. The surgical intervention known as pyloromyotomy will help open up the pylorus enable food to be able to pass through. Post pyloromyotomy the patient will be able to have gastric emptying which will allow for proper digestion. It would be important to teach the parents on what exactly is happening with the anatomy of the child and why they are presenting with these signs and symptoms. The provider will need to educate them that they will need to immediately see a gastroenterologist or pediatrician for immediate surgery to fix this problem. It is important to let them know these procedures can be done laparoscopic ally and is minimally invasive through the naval. Once the procedure is completed the provider should let the family know they may still have some vomiting post opt and will be able to eat normally within twenty-four hours. Additionally, it is important to educate them on fluids post opt. The main thing to stress to these parents is how essential surgical intervention is so the child can eat, grow, and absorb nutrient adequately.
