Endocrine Case Study

Assignment Objectives: 

• Describe the pathophysiologic manifestations of the disease(s).(Endocrine Case Study sample)
• Identify and select appropriate interventions including diagnostic tests and nursing interventions.
• Analyze physiological and psychological responses to illness and treatment modalities (Endocrine Case Study sample)

Purpose: Examine case studies related to endocrine system and answer the assigned questions. This assignment should help refine your clinical/critical thinking skills. Assignment Description: Answer the questions related to each of the patients provided. Your answer must follow APA 7th edition format. Submit the answer in the assignment area of your course.    Patient 1 – The parents of an 11 year old girl bring her for an office visit. She has been developing normally and has been healthy and active. Her parents report that for the past several weeks, she has been feeling tired and weak, drinking more fluids than normal, and has been urinating so much she has wet the bed at night. Two days ago, they noticed that her breath smelled “like fruit” and she lost 8 pounds these last weeks. Yesterday she began breathing fast and deep. (Endocrine Case Study sample)

a. Present your initial diagnosis.

b. Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented.

c. List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct. (Endocrine Case Study sample)

d. Describe your recommended treatment(s) and the rationale to support your recommendation(s). (Endocrine Case Study sample)

Patient 2– A  45 year old man is being seen because he has been experiencing vision changes, a burning sensation in his feet, and decreasing amounts of urine when he uses the bathroom. He has a long-standing history of hypertension and hyperlipidemia. Your physical exam reveals retinal hemorrhages in both eyes, and decreased sensation to moderate touch in the soles of his feet. A spot urinalysis shows microalbuminuria and a stat Basic Metabolic Profile (BMP) shows decreased Glomerular Filtration Rate (GFR). (Endocrine Case Study sample)

a. Present your initial diagnosis.

b. Describe the pathophysiologic processes related to your diagnosis that explain the signs/symptoms, and lab results obtained. (Endocrine Case Study sample)

c. State the effect of his symptoms on his life expectancy and the rationale for your answer. (Endocrine Case Study sample)

Endocrine Case Study sample-solution

(Endocrine Case Study sample) Nursing professionals and students alike require to use both teaching and learning resources that apply approaches meant to help learners’ link fundamental science and clinical applications in timely and meaningful ways. Healthcare organizations and their affiliated teaching facilities have invested their time and effort in juxtaposing fundamental and clinical science content.  However, some are not in sync with creating specific learning experiences that facilitate content teaching and ensure explicit material with discernable connections for the learners. The use of case studies approach in the endocrine physiology and pathophysiological is designed to assist learners in developing a learning g experience that is robust and one that incorporates different contexts of specific endocrine disorders. The representative cases are appropriate for any learner seeking to reinforce or revisit fundamental science nurses within clinical contexts irrespective of whether the learner is in the first year of their selected nursing course or their advanced level. This essay examines the selected case studies connected to the endocrine system and responds to the assigned questions. Each examines the pathophysiological manifestations of the disease in context, identifies and selects the appropriate diagnostic and nursing interventions before outlining an analysis of the physiological and psychological responses to the illness and treatment modalities. (Endocrine Case Study sample)

Case Scenarios Overview

Case 1 features an 11-year-old girl brought by her parents for an office visit with feeling tired, taking more than normal fluids, losing 8 pounds in the past several weeks, and two days before the visit, noticed that the child’s breath had a fruity smell. The diagnosis is diabetic ketoacidosis (DKA) which occurs in diabetes and is a potentially life-threatening condition. Case 2 features a 45- year old man who presents with experiences of vision changes, burning sensation in his feet, and a marked reduction of his urine. The middle-aged man also has a history of hypertension and hyperlipidemia. A physical exam reveals retinal hemorrhages and decreased sensation to moderate touches on the patient’s soles of his feet. Additionally, a spot urinalysis indicates microalbuminuria and while a stat basic metabolic profile (BMP) indicates decreased glomerular filtration rate (GFR). This case’s diagnosis is a kidney disease in the early stages due to complications of the existing condition hypertension or some other endocrine disorders like diabetes, either Type 1 or Type 2 (Endocrine Case Study sample)

Patient 1 Case Questions and Answers

1. Present your initial diagnosis

The initial diagnosis for Patient 1 is diabetic ketoacidosis, a condition whose incidence in the US was 8 per 100 person-years for children diagnosed with diabetes (Assefa et al., 2020). The cited authors also report that worldwide, recurrent DKA according to the international society of childhood and teenage diabetes, the risk for DKA in patients diagnosed with diabetes is 1-10% per patient per year in children. (Endocrine Case Study sample)

1. Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented.

Insulin deficiency raises catecholamines, growth hormone, cortisol, and glucagon, all of which are insulin counter-regulatory hormones. This increase coupled with peripheral insulin resistance causes hyperglycemia, dehydration, ketosis, and the resulting imbalance. DKA-induced hyperglycemia develops through accelerated gluconeogenesis, decreased utilization of glucose, and glycogenolysis. The increased lipolysis and decreased lipogenesis impact abundant free fatty acids leading to their conversion to ketone bodies. Suffice it to say that the patient exhibits a fruity-scented breath, shortness of breath, and frequent urination indicators of DKA, hence the initial; diagnosis. (Endocrine Case Study sample)

1. List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct.

The confirmatory test for DKA is the Fasting Plasma Glucose (FPG) test and the Oral Glucose Tolerance Test (OGTT).  For a DKA confirmatory diagnosis, the patient’s plasma glucose concentration is more than 250 mg per dL, the accompanying pH is below 7.30, while the bicarbonate level should be 18mEq per L or less. Depending on the values obtained, one can classify the DKA as either mild, moderate or severe depending on the values of plasma glucose, arterial pH, serum bicarbonate, urine ketone, serum ketone, and effective serum osmolality. Other criteria and classification factors to be considered are the Anion gap and the patient’s mental status.(Endocrine Case Study sample)

1. Describe your recommended treatment(s) and the rationale to support your recommendation(s).

The treatment goals and management should feature the optimization of volume status, electrolyte abnormalities correction, hyperglycemia, and ketosis, besides addressing the potential precipitating factors. DKA management plan is to initiate IV fluids after blood sample in its early stages, ensure potassium level is more than 3.3 meq/L before initiating insulin therapy (Muneer & Akbar, 2021). To resolve the DKA, plasma glucose should be between 200-250 mg/dKL, serum bicarbonate concentration is less than 18meq/L and a venous pH of less than 7.3and an Anion gap of less than 10. Most importantly, fluid therapy replacing fluid deficit within 234-36 hours should target to replace about half of the volume within 12 hours. Transition to subcutaneous insulin by administering long-acting insulin t hours before the IV insulin is discontinued.(Endocrine Case Study sample)

Patient 2 Case Questions and Answers

1. Present your initial diagnosis.

In the second case, the initial diagnosis is a kidney disease in its early stages as a complication of hypertension or the presence of other endocrine disorders like either diabetes Type 1 or Type 2. (Endocrine Case Study sample)

1. Describe the pathophysiologic processes related to your diagnosis that explain the signs/symptoms and lab results obtained.

Since the patient already has a long history of hypertension and hyperlipidemia, it is instructive that, overtime, poorly controlled high blood pressure can cause the arteries around the kidneys to either harden, weaken or constrict. The damaged renal arteries are unable to filter blood well-meaning blood flow into the nephrons, implying that their ability to regulate acids, salts, hormones, and fluids as they filter blood is hampered. As the resulting kidney disease progresses, aldosterone production (whose function is to regulate blood pressure) goes into a negative spiral leading to eventual kidney failure, meaning the renal organ can no longer function after it gets blocked and stops functioning. Vaidya et al. (2020) observe that the progressive decline of all kidney functions happens in four phases, with the first being a reduction in excretory function, followed by a decrease in excretory kidney function, over-hydration together with electrolyte balance disruption. The fourth last phase in the pathophysiology of chronic kidney disease (CKD) is toxic organ damage leading to the uremic syndrome. The patient’s signs and symptoms that led to kidney disease diagnosis in its early stages include but were not limited to decreased urine output, microalbuminuria, and a decreased glomerular filtration rate.(Endocrine Case Study sample)

1. State the effect of his symptoms on his life expectancy and the rationale for your answer.

Neild (2017) posits that life expectancy is significantly reduced with end-stage renal failure in much the same way that renal failure stages’ degrees impact patients’ life expectancy.  In-Patient 2, the symptoms indicate the kidney disease is in its early stages, as evidenced by microalbuminuria. The Basic Metabolic Panel test accords the practitioner information about the patient’s status in glucose, calcium, potassium, bicarbonate, and chloride. Also included in the BMP are blood urea nitrogen (BUN) and creatinine. Simultaneously, there is a need for the patient’s eGFR to be closely monitored so that the progression from a normal eGFR of 60(60-89) is slowed down, and appropriate intervention is taken. The progression should be monitored from Stage 1 eGFR indicates kidney damage if more than 90. Stage 2 eGFR in the normal range of 60- 89 could indicate kidney damage if there is a protein in the urine. Stage 3 eGFR of 30-59 indicates moderate kidney damage, with Stage eG\FR of 15- 29 indicating severe damage. Stage 5 eGFR of 15 or less would mean the kidneys are either close to failing or have failed already, and therefore the patient would require renal replacement therapy. (Endocrine Case Study sample)

Conclusion

In conclusion, this study has determined that the endocrine case study approach is appropriate for nursing students of all levels as it reinforces the fundamental science with everyday clinical scenarios. Most importantly, using a case study approach in endocrine disorders accords the nurse practitioner and student alike with a firm grasp of endocrine physiology required in modern healthcare practice.(Endocrine Case Study sample)

References

Bulbul, M. C., Dagel, T., Afsar, B., Ulusu, N. N., Kuwabara, M., Covic, A., & Kanbay, M. (2018). Disorders of lipid metabolism in chronic kidney disease. Blood purification, 46(2), 144-152.

Assefa, B., Zeleke, H., Murugan, R., & Wondwossen, K. (2020). Incidence and predictors of diabetic ketoacidosis among children with diabetes in west and east Gojjam zone referral hospitals, northern Ethiopia, 2019. Italian Journal of Pediatrics, 46(1), 1-9.

Vaidya, Satyanarayana R., and Narothama R. Aeddula. “Chronic renal failure.” StatPearls [Internet] (2020).

Neild, G. H. (2017). Life expectancy with chronic kidney disease: an educational review. Pediatric Nephrology, 32(2), 243-248.

https://www.ncbi.nlm.nih.gov/