Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 Case Study 6 week 6
- Institution
- William Paterson University
NUR 6111 Adv Nursing Practice 1
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Case Study#6A 7-year-old boy is brought to the emergency department by his grandmother. She informs the staff that
she is her grandson’s guardian and that he is breathing heavily and smells funny. Laboratory tests
confirm that the child is in DKA. During DKA, insulin counter-regulatory hormones, such as
catecholamines and cortisol, increase. Profound insulin deficiency results in:
1. Decreased fat mobilization
2. Activation of glucose forming pathways in the liver
3. Increased glucose uptake
4. Activation of bicarbonate buffering
Explanation you answer: Profound insulin production deficiency results in Activation of glucose forming
pathways in the liver. DKA is most common in children with type 1 diabetes because they already have a
deficiency of insulin. The counter-regulatory hormones antagonize insulin by increasing insulin
production and decreasing tissue use of glucose. When there is a profound insulin deficiency there will
be a decreased glucose uptake, increased fat mobilization with release of fatty acids, and accelerated
gluconeogenesis, glycogenesis, and ketogenesis. When there is little insulin, fatty acid is released from
the adipocytes increasing production of ketone bodies. A lot of ketones will cause metabolic acidosis,
and this is why the boy smells funny. To compensate for acidosis the boy was breathing heavily. This is
known as Kussmaul respirations.
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