Assignment-Case Study-End Stage Kidney Disease.

My patient is a 63-year-old woman named Rebecca who was admitted to the hospital after experiencing chest pain. After admission, an echocardiogram was conducted and then pericarditis was diagnosed. The patient was also identified with the end-stage kidney disorder. After going through her medical history, it was identified that she also suffers from diabetis mellitus, gout, and liver cirrhosis. According to her medical records, she is also recorded as a heavy smoker who takes about 30 cigarettes packets yearly. When conducting physical examination, the patient shows signs of multiple bruising, jaundices, bilateral edema +2, and also has been weak for a period of 3 weeks. The presents the type of medication she has been using to control diabetes that is Glisten. After completing her lab tests, I will go through her tests and examine them. Some of the lab results that I will require to examine include: Blood Gases, her CBC, Vitamin Count, Hormone Panel, Stool and Urine Samples, and also conduct her vitals. Her vitals read 92/64 that is very low. Also, after evaluating the lab results, it was evident that her calcium and sodium, and CBC were low; her level of red blood cells was below the standard, and level of her glucose high. Her blood sample test indicated that the blood pH was slightly acidic, high levels of CO2 and levels of bicarbonate low. Her hormone panel indicates that aldosterone and renin were below normal levels, while her level of ADH was high. She indicates signs of deficiency in Vit-E, K, D, and A. her color of urine was observed to be white, her stool had a gray color, and also had a lot of content contents.

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1. Explain the cause for her low calcium and sodium levels.

The level of low blood sodium in her case can be attributed to elevated levels of ADH that helps in water retention in the body, thus leading to reduced sodium concentration in her blood.

Also the condition can occur when a lot of calcium is lost from the body through urine or incase the body fails to absorb enough calcium into the blood. Her final stage of kidney disease made more calcium to be excreted from the body through urine making it difficult for the kidney to absorb or activate vitamin-D. When the body has a lot of water or fluid, it leads to hyponatremia or low sodium levels in the body. Because of her condition of kidney failure, her body is not capable of excreting the excess water or fluid.

2. Explain the cause of her anemia. What laboratory test should indicate she is suffering from anemia?

The main cause of anemia to the patient can be attributed to her kidney disease that in her condition is the final stage of the renal disease. Anemia is mostly associated with the end-stage kidney disorder as it is mostly present to those individuals having this disorder. Kidney allows the secretion of erythroprotein, a hormone that strengthens the bone marrow and helps it release RBC. When a patient is suffering from kidney failure, then the amount erythroprotein secreted is reduced causing anemia. It is also observed that a patient who shows signs of jaundice such as in the case of our patient, it can be determine that she is having hemolytic anemia.

3. Explain the cause of her hypotension. How will her body attempt to establish homeostasis?

Because the patience in the case study is anemic, then her body fails to secrete adequate red blood cells, which basically lead to low blood pressure. The body often tries to maintain homeostasis by raising the levels of ADH secreted. The hormone then sends signals to specific cells to absorb more and more water, reducing or controlling excretion of or loss of body fluid through urine. This will in return raise the level of body fluid and assist to maintain blood pressure and volume.

4. What type of acid-base disorder has she developed, and how will her body compensate?

Metabolic acidosis is a condition resulting from accumulation of acid in the body as a result of kidney failure, and at a time the fluid in the body has a redundant acid quantity. Kidney helps to maintain the levels of acid in our bodies. Thus in case it fails to get enough acid from blood, the condition occurs.

5. Explain the cause of her elevated ADH and glucose levels.

Her main cause of high levels of ADH results as the body attempts to balance the blood pressure of her body. Because she is suffering from hypotension, then her body releases a lot of ADH in order to retain a lot of water. People suffering from diabetes are observed to have high levels of blood glucose, which can also lead to long-term problems and even kidney failure.

6. What is the correlation between her illnesses and the low vitamins (D, K, E, and A), renin, and aldosterone levels?

Aldosterone disturbs the ability of a body to control the blood pressure. It sends impulses to some organs such as kidney, which can produce more sodium into blood. The hormone is also closely associated with angiotensin and renin that produces a system called renin-angiotensin aldosterone. This system gets activated once the body has reduced the amount of blood flowing into the kidney.

7. Which hormone would the body elevate in response to her low calcium levels? Why?

When the blood level of calcium gets very low, the parathyroid glands senses it and then continues to secrete a lot of parathyroid hormone. After the hormone is absorbed into her blood stream, it helps different organs to produce and raise the quantity of calcium; such as absorbing it from bones.

8. Explain the physiological reason behind her physical findings (yellowish hint of the skin, sclera, multiple bruises, weakness, and edema).

As a result of low vitamin levels in her blood, then she develops the physical abnormalities. This occurs when the system has more bilirubin, a yellow pigment found when the dead red blood cells is broken down in the liver. Bruises will develop when a person’s level of vitamin K are below normal. Insufficient vitamin D causes weakness of muscles. While a deficiency in vitamin E leads to edema or swelling.

9. Explain the cause of her abnormal stool and urine sample.

The reason for her abnormal stool can be linked to less or no bile juice. This is observed in case the liver fails to produce adequate bile juice or its flow is limited. In case of a urinary tract infection, then a person will produce white urine.

10. What cell does Glisten work on? Explain how this medication is able to stimulate insulin secretion

Production, release and storage of insulin is done in the pancreas by Beta cells. When a patient is given Glisten, it makes the channels that are sensitive to ATP to block, secreting insulin. What she requires to do is change her life style, start exercising a lot and also change her eating style.

References

Berkowitz, Aaron. “MRS – Clinical Pathophysiology, 1st – PDF Free Download.” Edoc.site, EDOC.SITE, 2007, edoc.site/mrs-clinical-pathophysiology-1st-3-pdf-free.html.

Crosta, Peter. “Pancreas: Functions and Disorders.” Medical News Today, MediLexicon International, 26 May 2017, www.medicalnewstoday.com/articles/10011.php.

Gilles, Gary. “This Is What the Pancreas Actually Does.” Verywell Health, Verywellhealth, www.verywellhealth.com/what-is-the-pancreas-3289656.

Hare, Homart Amory. “Practical Diagnosis: The Use of Symptoms in the Diagnosis of Disease.” Full Text of “Passing”, London: F. Warne; New York : Scribner, Welford, and Armstrong, Aug. 1896, archive.org/stream/b21962728/b21962728_djvu.txt. Assignment-Case Study-End Stage Kidney Disease.

Jewell, Tim. “Kidney: Function and Anatomy, Diagram, Conditions, and Health Tips.” Healthline, Healthline Media, 1 Mar. 2018, www.healthline.com/human-body-maps/kidney. Assignment-Case Study-End Stage Kidney Disease.