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Case Study 16-1: Acute Pancreatitis

Two weeks after his emergency cardiac bypass surgery, R.B. was admitted to the hospital with acute pancreatitis, probably triggered by the trauma of the heart surgery. As a nurse, R.B. knew that the mild form of the disease was self-limiting, whereas severe pancreatitis has a mortality rate near 50%. He was terrified, having survived heart surgery, to now have to worry about multisystem organ failure. He had once cared for a patient who died of necrotizing hemorrhagic pancreatitis.

On admission, R.B. had severe stabbing midepigastric pain that radiated to his back, nausea, vomiting, abdominal distention and rigidity, and jaundice. He also manifested a low-grade fever, hypotension, tachycardia, and decreased breath sounds over all lung fields. His cardiac enzymes were normal, but he showed an increase in serum leukocytes, amylase, and lipase. CT scan of the abdomen showed pancreatic inflammation with edema. His chest radiograph showed bilateral pleural effusion and atelectasis.

R.B.'s treatments included NPO, an NG tube, medications to decrease his pain and gastric secretions, and supplemental oxygen. He was monitored for all physiologic parameters, with close attention paid to his fluid and electrolyte balance and intravascular volume, and recovered and was discharged after 6 days.

Case Study 16-2: Hyperparathyroidism

B. E., a 58-year-old woman with a history of hypertension, had a partial nephrectomy 4 years ago for renal calculi. During a routine physical examination, her total serum calcium level was 10.8 mg/dL. Her parathyroid hormone level was WNL; she was in no apparent distress, and the remainder of her physical examination and laboratory data were noncontributory.

B.E. underwent exploratory surgery for an enlarged right superior parathyroid gland. The remaining three glands appeared normal. The enlarged gland was excised, and a biopsy was performed on the remaining glands. The pathology report showed an adenoma of the abnormal gland. On her first postoperative day, she complained of perioral numbness and tingling. She had no other symptoms, but her serum calcium was subnormal. She was given one ampule of calcium gluconate. Within 2 days, her calcium level had improved and she was discharged.

Case Studies, continued

Case Study 16-3: Diabetes Treatment With an Insulin Pump

M.G. a 32-year-old marketing executive, was diagnosed with juvenile-onset (type 1) diabetes at the age of 3 years. She vividly remembers her mother taking her to the doctor because she had an illness that caused her to feel extremely tired and very thirsty and hungry. She also had a cut on her knee that would not heal and had begun to wet her bed. Her mother had had gestational diabetes during her pregnancy with M.G.; M.G. was described as a "macrosomia" because she weighed 10 lb at birth.

M.G. has managed her disease with meticulous attention to her diet, exercise, preventative health care, regular blood glucose monitoring, and twice-daily injections of regular and NPH insulin, which she rotates among her upper arms, thighs, and abdomen. She continues in a smoking cessation program supported by weekly acupuncture treatments. She maintains good control of her disease in spite of the inconvenience and time it consumes each day. She will be married next summer and would like to start a family. M.G.'s doctor suggested she try an insulin pump to give her more freedom and enhance her quality of life. After intensive training, she has received her pump. It is about the size of a beeper with a thin catheter that she introduces through a needle into her abdominal subcutaneous tissue. She can administer her insulin in a continuous subcutaneous insulin infusion (CSII) and in calculated meal bolus doses. She still has to test her blood for hyperglycemia and hypo-glycemia and her urine for ketones when her blood sugar is too high. She hopes one day to have an islet transplantation.

CASE STUDY QUESTIONS

Multiple choice: Select the best answer and write the letter of your choice to the left of each number.

_ 1. Necrotizing hemorrhagic pancreatitis can be described as:

a. enlargement of the pancreas with anemia b. inflammation of the pancreas with tissue death and bleeding c. inflammation of the pancreas with overgrowth of tissue d. marsupialization of a pancreatic pseudocyst e. none of the above

_ 2. R.B.'s midepigastric pain was located:

a. inferior to the sternum b. periumbilical c. cephalad to the clavicle d. lateral to the anterior costal margins e. anterolateral

_ 3. Intravascular volume and hemodynamic stability refer to:

a. measured amount of urine in the drainage bag b. speed with which pancreatic fluid moves c. movement of cells through a flow cytometer d. body fluids and blood pressure e. blood count and clotting factors

Case Studies, continued

4.

Renal calculi are:

a. kidney stones

b. gallstones

c. stomach ulcers

d. bile obstructions

e. muscle spasms

5.

B.E.'s serum calcium was 10.8 mg/dL, which is:

a. 5.4 micrograms of calcium in her serous fluid

b. 10.8 grams of electrolytes in parathyroid hormone

c. 10.8 milligrams calcium in 100 cc of blood

d. 21.6 liters of calcium in 100 grams of serum

e. 10.8 micrograms of calcium in 100 cc of serous parathyroid fluid

6.

B.E. had perioral numbness and tingling. Perioral is:

a. peripheral to any orifice

b. lateral to the eye

c. within the buccal mucosa

d. around the mouth

e. circumferential to the perineum

7.

M.G.'s diabetes is also described as:

a. adult-onset diabetes

b. type 2 diabetes mellitus

c. diabetes insipidus

d. insulin-dependent diabetes mellitus

e. NIDDM

8.

Gestational diabetes occurs:

a. in a woman during pregnancy

b. to any large fetus

c. during menopause

d. at the time of puberty

e. at the time of delivery of a large baby with high blood sugar

9.

The term macrosomia describes:

a. excessive weight gain during pregnancy

b. a large body

c. an excessive amount of sleep

d. inability to sleep during pregnancy

e. too much sugar in the amniotic fluid

10.

M.G. injected the insulin into the subcutaneous tissue, which is:

a. only present in the abdomen, thighs, and upper arms

b. a topical application

c. below the skin

d. in a large artery

e. above the pubic bone

Case Studies, continued

_ 11. An islet transplantation refers to:

a. transfer of parathyroid cells to the liver b. excision of bovine pancreatic cells c. surgical insertion of an insulin pump into the abdomen d. a total pancreas and kidney transplantation e. transfer of insulin-secreting cells into a pancreas

Write a term from the case studies with each of the following meanings:

12. yellowish color of the skin _

13. enzyme that digests fats _

14. surgical excision of a kidney _

16. single-use glass injectable medication container _

17. high serum glucose _

Abbreviations. Define each of the following abbreviations:

18.

NPO

19.

NG

20.

BUN

21.

WNL

22.

23. CSII

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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Responses

  • Linda
    Is 10.8mg/dl of serum calcium?
    8 years ago

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