A
25-year-old male was admitted to the medical/surgical unit with a blood
glucose of 600 mg/dl. On assessment, the nurse observed his breathing was
deep and rapid and his breath smelled of acetone. His face was flushed and
his skin was dry. His pH was low. Describe the physiological response that
is occurring.
High blood glucose levels are characteristic of diabetes
mellitus. Insulin is a hypoglycemic hormone meaning it lowers the amount of
glucose in the blood. Insulin deficiency
results in high levels of glucose in the blood. The pancreas possesses a
cluster of cells called islet cells. Beta cells are the specific type of islets
that produce insulin. Beta cells act as sensors which detect when glucose
levels are high, such as after eating. An individual with type 1 diabetes lacks
normal insulin producing beta cells of the pancreas. An individual with type 2
diabetes possesses beta cells, but is lacks receptors for glucose. The pancreas
releases insulin into the blood which stimulates absorption of glucose into
liver and other tissue cells. The liver then converts glucose into glycogen
which is essentially long chains stored glucose. The absorption and conversion of
glucose return blood glucose levels to a “resting” homeostatic balance. Without
sufficient insulin none of this can take place. Glucose continues to build up
in the blood stream. Normally, glucose is the primary source of energy fuel for
the body. Without glucose being absorbed into tissues cells, proteins and fatty
acids are accessed as an alternative energy source. The rise of fatty acids in
the blood causes a series of negative conditions. Ketone is a shared term for
fatty acid metabolites. Elevated ketones in the blood occur in extreme cases of
untreated diabetes mellitus. This can cause the breath to smell of acetone. The
rise of ketones also causes blood pH to decline. Urine output increases and
excess ketones are expelled in urine. In an attempt to raise pH levels an
effort is made to remove carbon dioxide from the blood via rapid breathing.
Application:
As a registered nurse I encounter a
patient who is experiencing increased urination and unexplained weight loss. I
order a blood glucose test and a urine analysis to check her ketones levels. My
patient’s blood glucose level is at 300mg/dl which indicates diabetes mellitus.
I advise my patient to follow a diabetic diet and to exercise regularly. I also
prescribe regular insulin injections and instruct her check her glucose levels
twice daily. I inform my patient that with these proper adjustments her
condition is completely manageable.
Resources:
1.)
" Diabetes Animation - YouTube ." YouTube
- Broadcast Yourself. . Pearson, 19 May 2010. Web. 28 Jan. 2012.
.
2.)
"Diabetes Mellitus." Medicine Net.
N.p., n.d. Web. 27 Jan. 2012.
3.)
Marieb, Elaine N. , and Katja Hoehn. "The
Endocrine System." Human Anatomy & Physiology. 7th ed. San
Francisco: Pearson, 2007. 632-634. Print.
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