1. Mr. Sanchez makes an appointment to see his doctor for pain in his abdominal area.

Tests and x-rays reveal kidney stones as well as bones with a moth-eaten appearance. Further questioning reveals a medical history of ABNORMAL reflexes and weakness. What is the problem and what treatment would be recommended?

Calcium is an essential element for human life. Many of our body systems work through a manner of de/re/polarization and Ca2+ is a major player. As chemical impulses travel along within the nervous system, moving from axon to cell body, they cross a junction called the synaptic cleft. As the wave approaches the axon terminal, depolarization causes an influx of calcium ions. The calcium acts as a messenger, directing synaptic vesicles to fuse with the axon membrane and empty their contents into the synaptic cleft, thus relaying the message. (Marieb & Hoehn 410) Within our muscles the release of calcium ions leads to temporary bonds which change the shape of troponin, which opens them up to the myosin heads and leads to muscle contraction. We simply could not function without calcium, in fact its so important that it has its very own endocrine gland, the parathyroid gland, to continually monitor and adjust its serum level to between 8.6 to 10.0 mL/dL. Mr. Sanchez is suffering from hyperparathyroidism; his symptoms are directly related to the continually high levels of calcium in his blood. Normally the parathyroid maintains a calcium level between 8.6 and 10.0 ml/dL. The parathyroid releases PTH when calcium levels are low, this stimulates osteoclast to withdrawal calcium from the bone storage and increases calcium absorption in the intestine. When calcium levels increase to a normal level the parathyroid stops the release of PTH via negative feedback. During hyperparathyroidism excessive amounts of PTH are released, the gland is no longer getting the shut off signal. High calcium levels or hypercalcemia can lead to weakness and delayed reflexes, mental confusion and depression. The best way to treat hyperparathyroidism is to remove the gland itself. The gland is actually four or more separate glands located on the posterior of the thyroid gland. Hyperparathyroidism is almost always caused by a benign tumor of one or more parathyroid glands. The removal of the gland will fix the hormonal imbalance and the remaining parathyroid glands will resume their position of regulating calcium. As a nurse I could apply my knowledge of calciums role within the body during patient evaluation and education. During my assessment I will be able to make the connection between nervous system depression and kidney stones with high calcium levels. I will be able to explain the physiology of their condition and steps to combat symptoms such as increasing their water intake to help flush out excess calcium and fall precautions related to the osteoporosis while they prepare for surgery. I will also be able to interpret muscle excitability, Trousseau and Chvostik sign with hypocalcaemia. I can help educate my patients on foods high in calcium and the importance of supporting vitamins such as vitamin D.

Works Cited Marieb, Elaine and Hoehn, Katja. Human Anatomy & Physiology. San Francisco: Pearson, 2007. Print

2. 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.

Excessively high levels of glucose are a sign of uncontrolled diabetes mellitus. Normally our pancreas releases insulin in response to rising glucose levels. Insulin acts as the key, unlocking the glucose so our cells can use it for energy. Glucose also goes to the liver for conversion and storage. This combination brings blood glucose levels drops back down to between 90 and 110 mg/dl. In an individual with type 1 diabetes mellitus the pancreases doesnt produce enough insulin. It is an autoimmune disorder where the body gradually destroys the beta cells of the pancreases that produce insulin. Type 2 diabetes mellitus is a combination of insulin resistance, beta cell exhaustion an abnormal hepatic glucose regulation. Without insulin to unlock the glucose for cell use the body turns to proteins and fatty acids for energy. The by-products of their metabolism are ketones an acidic substrate. Accumulation of ketones in the blood can cause ones breathe to smell of acetone and the blood pH to decline. The patient is now experiencing metabolic acidosis. The body attempts to correct this imbalance by blowing off excess CO2 though rapid breathing. The body also tries to flush out the excess ketones in the urine, resulting in polyuria, which can lead to dehydration and hot dry skin. When working in the nursing field I will undoubtedly have a diabetic patient or two under my care, given the increasing incidence of this disease. I will be able to apply my understanding of the physiological response through symptom identification. If a patient is exhibiting signs such as fruity breath, flushing and increased urination I would then check their blood glucose level and administer insulin per their sliding scale. On the other hand lethargy, cold clammy skin and shakiness would make me think low blood sugar. I would check their blood glucose level and then have them consume probably some orange juice and nut butter to bring their glucose level back up and help stabilize it. I will also be able to utilize this knowledge through patient and family education to help them manage this condition at home.