I am not a nurse but I knew this would be the perfect place to ask help with my anatomy homework. My teacher told our class it would be easier to ask someone in the health professional career field if we were having trouble with the questions. I hope you guys don't mind! We were given a scenario and have to answer two questions in great detail. I've been working on these for 11 hours but came up with nothing.
Scott, an overweight, unconscious 10-year-old boy is rushed to the ER by his father at 7:00 a.m. Upon first examination the boy appears comatose. He has a very low blood pressure (80 over 50) and a rapid heart rate (120 bpm), classic signs of hypovolumic shock. A quick oral history indicates that the boy has recently been diagnosed with type-2 diabetes, has been put on a low carb diet, and prescribed twice-daily insulin injections. Scott was non-responsive when the father tried to wake him for school.
Additional oral history is that Scott was at his Grandma Louise's house yesterday evening from supper time until 11:00 p.m Grandma Louise swears Scott only had a plate of spaghetti and garlic bread but no sweets and she gave him a syringe of insulin right before dinner. Since he doesn't like shots, she let him take the insulin orally. She also thinks he may have a bladder infection since he was in the bathroom a lot last night "Passing water". She gave him several glasses of cranberry juice cocktail to help.
*Emergency room diagnosis is nonketotic hyperglycemic-hyperosmolar coma
Q: Consider both the changes in blood pressure and osmolarity and discuss what is happening to organs such as the liver and brain.
Q: To stabilize Scott's condition, choose between fluid treatment( IV solutions) and insulin treatment and why?
From my 11 hours of research all I have come up with is the organs are lacking water and the brain shrinks?? The patient is dehydrated so he needs IV fluids. The blood volume had increased and the kidney's are working harder to eliminate the sugar? But my professor wants details and I don't know them.
It's worth 50 points so that's why I'm stressing out about it. I've looked at scholarly journals, I've asked on yahoo answers and I've asked a tutor with no luck!
HHNK after one bad night? That's some advanced diabetes that kid managed to get at the right bold age of 10. He must have been insulin resistant by age 1.
I'm really confused why they want you to choose fluids OR insulin. HHNK is a complicated condition that requires a multifaceted treatment.
Specializes in Complex pedi to LTC/SA & now a manager.
If this is week 2 A&P homework for a dental hygiene program there is something. This is not even week 2 of medical school homework nor week 2 of nursing school. It's oversimplify in a complex condition with an "oral history" inconsistent with the presented pathophysiology. Unlike severe hypoglycemia (insulin shock), this is not a rapid onset condition. I've never heard of the initial treatment of type 2(formerly known as non-insulin dependent) diabetes in an obese 10 year old as low carb plus multiple daily insulin. The scenario is off for a highly complex situation
So your case study got me thinking if the proposed scenario is even possible. HHNK is usually seen in long standing diabetes that's been untreated for ages, and often you need accompanying kidney failure to get your blood sugar up to the numbers needed to get your blood hyperosmolar.
So I did some Googling. And all evidence I've found says such a situation is undocumented.
So CHOP- a huge, well known children's hospital- followed all of their type 2 children for 5 years- 190 children. 7 of them developed HHNK during that time frame and ALL of them it was when they were first diagnosed and previously untreated. The mean age was 13.3, and the youngest was 10.1. The mean glucose was just over 1600. Way higher than you get with one missed insulin dose and some spaghetti and cranberry juice.
Me thinks your instructor doesn't know pathophysiology that great if she made up this scenario.
Hypo- (low) -vol- (volume) -emic (of blood) shock (medical emergency where tissues do not have adequate flow of blood).
Type 2 diabetes: a disorder that is characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin. When blood sugar is very high, the kidneys try to eliminate excess sugar resulting in frequent urination, which lowers blood volume, but causes the blood to become more concentrated (hyperosmolarity). Grandma gave cranberry juice, which has a great deal of sugar, which only compounded the problem, because Scott couldn't pee out enough sugar to correct his levels.
Hyper- (high) -osmolar (the concentration of dissolved substances in blood).
Insulin: a hormone that enables cells to use sugar for fuel. It is naturally produced by the pancreas. It cannot be taken by mouth because it is digested in the stomach before it can be absorbed. Therefore, it usually taken by injection, and is dosed by a patient's blood sugar.
Hyper- (high) -gly-(sugar) -emia (of the blood). High blood sugar
Non (not) ketotic (presence of ketones byproducts of fat and protein metabolism). These usually are present when there is absolute lack of insulin to move sugar into cells. In Scott's case, he must have at least a little circulation insulin, therefore has no ketones or is nonketotic.
You are on the right track, except that his blood volume has not expanded. You can tell that because he has hypovolemic shock.
Specializes in Complex pedi to LTC/SA & now a manager.
You need to show your professor our responses. This question is totally ridiculous for an anatomy class.
This made up inaccurate scenario that is impossible for the patient history should be responded that this is pure fiction with no basis in reality. This is NOT anatomy 1. Maybe advanced pathophysiology. Medical surgical nursing of the endocrine and neurological system. Graduate level endocrinology. But not freshman basic anatomy. Aside from this being an impossible scenario there is good reason you could not find basic info in your text---it's off topic to the level of the course. The reason you struggled with finding scholarly references is what blondy explained above regarding a pediatric endocrinology team following type 2 DM clients 10-14 years old
I am not even in the dental hygiene program yet! This is a prerequisite to apply for the program! I am at a community college. I am familiar with dental and oral pathology because I was a dental assistant in the military for 6 years. She obviously wanted us to think outside the box because she intentionally put flaws in the scenario to see if we could spot them. This was way out of my league. Although it will hurt my grade and my pride, I will probably take a zero for this. I will e-mail her why. I've never not turned in an assignment but I can't even BS these type of answers. Thank you all so very much for your input and letting me know that after 11 hours of trying to find the answers, I am not crazy! God Bless you all!
Funny thing is, she told us this was a real case that one of her friends had sent her :/
.thumb.jpg.32153ff3eaff9886e5b70223acf10ffa.jpg){kind=small}
ashleylea
9 Posts
From my 11 hours of research all I have come up with is the organs are lacking water and the brain shrinks?? The patient is dehydrated so he needs IV fluids. The blood volume had increased and the kidney's are working harder to eliminate the sugar? But my professor wants details and I don't know them.