Need help understanding the concept of a few questions regarding a scenario...

[mialong21]

]1. A large bookcase falls uponan elderly man in his home. His left legis pinned and he cannot move for 2 days until his neighbor finds him. He is hospitalized with massive trauma to hisleft leg, with resultant rhabdomyolysis (rhabdomyo means striated muscletissue; lysis means "break down"). His pulsesin that foot are unpalpable and the foot is pale and cool. Eventually his foot must be amputated.

]Which mini-concept map, showing one event leading tothe next, best fits with the scenario above?

]a. Massivemechanical trauma to legà] distal arterial flowblockedà] ischemia to footà] infarction of foot tissueà] amputation.

]b. Rhabdomyolysisà] damage to striated cells spreads to arteries proximalto the traumaà]

] ischemiaà] infectionà] amputation.

]c. Mechanicaltraumaà] interrupt cell membrane functions such as Na/K pumpà] solute imbalanceà] leg edemaà] amputation.

]d. Coolfootà] tissues become too cold to conduct metabolic pathwayfunctionsà] cells become dormantà] distal arterial flow increases pathologicallyà] amputation

** I am leaning on A...but B & C could possibly fit too....

2. Initial lab work is drawn that show a CK of 100,000(normal serum CK is 0 to 200). Why is itso high?

a. As acompensatory response, the production of the enzyme creatine kinase (CK) is increasedin the cells and then is excreted to "clean up" the cellular debris.

b. As aresult of injury, the striated cell membranes lose integrity and there isleakage of intracellular substances such as CK into the surrounding tissue bed.

c. Creatine kinase (CK) is only found instriated muscle cells, so it makes sense that

rhabdomyolysis would result in greater release of CK.

d. Localtissue response to injury includes release of toxic, lytic substances such as CK.

** I think it is B....

] 3. Becauseof massive cellular injury, myoglobin leaks from cells into blood. The patient eventually develops kidneyfailure from this myoglobinemia. All thefollowing are true about this situation EXCEPT

]a. thepatient may ultimately need injections of erythropoietin because of the ailing kidneys'failure to adequately create it.

]b. myoglobinuriawill likely be present acutely due to "spillage" of excess of myoglobin intothe urine.

]c. erythropoietinwill be dangerously high in the blood secondary to kidney over-secretion ofthis hormone.

]d. theetiology of the eventual kidney failure is most likely the high amounts ofmyoglobin that overwhelm the kidneys' ability to process it.

]

]

I think the answer is C....

[ArrowRN, BSN, RN]

Rhabdomyolysis - PubMed Health