For my signature assignment I will be assessing a 63-year-old patient name Sarah. We have a brief overview that she has a medical history of diabetes mellitus, cirrhosis, gout. She has a past habit of smoking a 30-pack a year, which resulted in a trip to the emergency room they found pericarditis in the echocardiogram, which is the end-stage of renal disease. She appears to have yellowish discoloration of the skin and sclera, multiple bruises. She is currently on Glisten. We will examine some of her charts that will help us see her calcium and sodium levels to determine here electrolyte balances. He results will help us to determine if she anemic and explain the cause of her hypotension. We will get a pee test and stool test to determine alkaline levels and if she has high or low glucose. We will also be looking to see what vitamins she is deficient in. we will also talk about her medication might react in the body. This will all be explained in the paper and what disease we can revile through these tests and how her past medical history can help us to know what is wrong with Sarah.
The reason for her low calcium and sodium levels. Sarah is suffering from low calcium. She also has low levels of vitamin D, which is what we get from sunlight exposure, which helps maintain calcium levels. In the article “Vitamin D helps regulate the immune system and the neuromuscular system. Vitamin D also plays major roles in the life cycle of human cells.” (DeNoon, 2010). Without vitamin D our calcium levels will be low as well. We first need to maintain a balance of vitamin D before calcium can be absorbed into our bones.
Sarah is also suffering from low levels of sodium. Sodium help balance electrolytes, which helps maintain blood pressure, nerves and muscle regulation, fluid balance. When we have low levels, we cannot regulate water. The normal “blood sodium level is 135 – 145 milliEquivalents/liter (mEq/L), or in international units, 135 – 145 millimoles/liter (mmol/L)” (DeNoon, 2010). She has a low level of 126 (mEq/L), so she could be suffering from hyponatremia, which causes by elevated levels of ADH, which is the cause of water retention making her body low in sodium. This low sodium level will cause our cells to swell, because the water is getting reabsorbed and diluting the sodium in our body.
The reason for her anemia is her red blood cell count would be done to find out if Sarah is suffering from Anemia. Her result show that she is low so this signifies that the is suffering from Anemia, which develops when the blood lacks “healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen.” If our red blood cells are low, and hemoglobin, cell will not get enough oxygen for them to survive, which causes them to die.
Sarah hypotension cause and how here body might establish homoeostasis again? Normal blood pressure is a “reading of less than 120/80 mmHg (mmHg = millimeters of mercury, a unit for measuring pressure)” (tagnal). Sarah has an abnormally low blood pressure of 92/64 mmHg, is causing hypotension. What will help bring her blood pressure back to homeostasis is a sensory nerve that is in our carotid sinuses, aortic arch and other that are found int walls of larg arteries and veins and some in the walls of the heart these are called baroreceptors. These baroreceptors aid in monitoring any changes that we might have in blood pressure. The Impulses they send are from receptors in the medulla oblongata, which is a part of the brain; where are “autonomic activity is directed so that the heart rate and resistance of the peripheral blood vessels can be adjusted appropriately so that the necessary blood pressure is maintained”(Tagnal)
Looking at Sarah’s acid base result it appears to be a more acidic balance based off her results of being less than 7.35 along with her HCO3 levels. She has developed metabolic acidosis, which is an acid base disorder. This disorder will disable her kidneys to secrete enough ammonia in the proximal tubes, which is in the duct system of the kidneys nephron. Ammonia is important, because it excretes endogenous acid into our urine in the form of ammonia. Our kidneys cannot carry enough acid from the body and will get help from a process called physiochemical mineral dissolution, which will help aid in turning excess hydrogen ions into bone carbonates. We will also see an increased of HCO3 absorption into the kidneys.
What is the cause of her elevated ADH and glucose levels. Sarah does show a history of diabetes mellitus, so she did show elevated glucose levels, which is increased from an insulin deficiency. diabetes can cause kidney dieses, because the kidneys are filtering this glucose through their tiny blood vessels. When blood glucose levels are to high it makes these small vessels work hard to filter blood. After many years of abuse to the kidneys, they will start to leak, and protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. With glucose destroying the filter vessels it has and effect the antidiuretic hormone which is, “a vasopressin, targets the kidneys. it promotes the reabsorption of water and elevation of both blood volume and blood pressure” (Noone) with Sarah’s elevated levels this will cause her kidneys to shut down, because it causes water retention, low blood sodium, and decreased blood osmolality which will cause swelling to the body. This process causes the kidneys to fail know as renal disease. Having renal problems can lead to heart diseases so this is why she has pericarditis in her EKG. Show could also have lung carcinoma, because of her past years of smoking as well
What is the correlation between her illnesses and the low vitamins (D, K, E, and A), renin, and aldosterone levels?
Having low vitamin K blood coagulation and is in control of binding calcium to bones and tissue. Without this vitamin we have uncontrolled bleeding resulting to hypocalcemia.
Vitamin D effects our blood pressure and the vasculature, can cause to renal damage, with those types of damages would cause hypocalcemia. Low vitamin A is sufficient in retinol production and keeping our skin healthy. This vitamin helps the skin from getting bruised easily, so Sarah is deficient. Having a low vitamin E production in the body causes fatigue and weak bones. Being vitamin e deficiency can cause anemia
Which hormone would the body elevate in response to her low calcium levels? Why?
Sarah’s Parathyroid hormone (PTH), because they “motion the concentration of calcium ions into the bloodstream”. (Nath) When Ca+ are low, the parathyroid cells will secret PTH, which increases calcium and stimulate osteoblasts that binds osteoclast. Blood calcium concentration happen.
Explain the physiological reason behind her physical findings (yellowish hint of the skin, sclera, multiple bruises, weakness, and edema).
Sarah is suffering with Cirrhosis, which is scaring of the liver due to liver intoxication, which can be causes from harmful substances such as, alcohol and iron overdose and many other harmful substances, but alcohol seems to be the most detrimental to the liver. The liver is what filters out all harmful toxins, cleaning the blood and making nutrients for the body. If the liver gets severely damaged we can get “Jaundice, which occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from your blood. Jaundice that is caused from pancreatic damage from her years of smoking that can cause yellowing of the skin. Her low levels of vitamin K (what we get from leafy greens) can also play into a factor as to why she is bruising easily, because it is “Known primarily for helping blood to clot and the promotion of strong bones”(Nonooe) vitamin A would cause busing as well since it helps with skin integrity.
Explain the cause of her abnormal stool and urine sample.
The cause of here abnormal stools is due to vas amount of bilirubin getting excreted from the liver caused from hepatitis which is inflammation to the liver and she has jaundice from the looks of her skin so we can tell this by looking at her stools and skin.
What cell does Glisten work on? Explain how this medication is able to stimulate insulin secretion.Glisten works in the beta cell membrane, because this is where secretion of insulin happens along its electrical ionic events. With glucose being absent this potential will remain at it potential of (-65mV). The potassium channels in the membrane get blocked from ATP glucose metabolism. This decreased potassium ions within the cell cause depolarization, which opens Ca2+ voltage gated channels. Causing calcium to influx in the cells. This raised “intracytoplasmic Ca2+ level will in turn cause exocytosis of insulin secretory granules”(Nath) It also closes ATP dependent potassium channels provoking insulin from beta cells.