Case Histories 1 ( Case 8 from McKinley Materials)
A 21-year-old noncompliant female with a history of type I (insulin-dependent) diabetes mellitus was found in a coma. Her blood glucose was high, as well as her urine glucose, urine ketones, and serum ketones. Her serum bicarbonate was < 12 mEq/L. Her respiration was exaggerated and his breath had an acetone odour. Her blood pressure was 90/60 and his pulse weak and rapid (120).
1. Define noncompliant.
2. Is this person experiencing ketoacidosis or insulin shock? Explain your answer.
3. Why is the serum bicarbonate low?
4. What is the acid-base status of this individual?
5. What is the cause of the dyspnea, hypotension, and tachycardia?
6. What type of treatment does this person need?
Gastrointestinal Case Histories – Case 21Audio Assignment
Steve was a 21-year-old male college student who complained of pain, nausea with vomiting, and tenderness in the right lower quadrant. The pain was first vague and diffuse, then became more severe in the mid-epigastric region before localising in the right lower quadrant. The pain was accentuated by movement, deep respiration, coughing, or sneezing. A mild fever of 102.2° F and a moderate leucocytosis (11,500/cu mm) were present. A marked tenderness was noted over the right lower quadrant at McBurney’s point (one-third the distance between the anterior superior iliac spine and the umbilicus). The psoas sign (pain on passive hyperextension of the thigh) was also present. His vitals were:
|Respiration||18 b/min and shallow|
His abdomen was protuberant with decreased bowel sounds. The abdominal x-ray indicated distended bowel loops.
1.What is the diagnosis of this individual?
2.Describe in anatomical terms the location of the organ involved.
3.Locate the mid-epigastric region and McBurney’s point on yourself. Describe these locations below.
4.What is the cause of the fever, pain, and leukocytosis in this person?
5.What is the usual treatment of this disorder?