Pathophysiology

Topic 3 DQ 1

Choose a medical condition from the fluid, electrolyte, or acid-base system and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Make sure that you select a different medical condition than your peers. Include the name of the medical condition in the subject line so that the medical conditions can be followed. Include your references in APA style.

Sample student response 1

Hyponatremia

Sodium is an electrolyte that helps in the regulation of water around the cells. Hyponatremia is a medical condition associated with abnormally low sodium levels (less than 136 mmol/L). (Hoorn & Zietse, 2017). The pathophysiology behind the condition involves. Hyponatremia usually occurs when there is a condition that impairs the normal excretion of water. Serum osmolality of less than 280 mOsm/kg indicates excess water in the extracellular fluid relative to solutes (Sahay & Sahay 2014).

Water usually moves freely in and out of the cellular membrane, which is not the case for electrolytes. Therefore, when the level of water in the extracellular fluid is higher relative to the solutes, it means that some of the water will be displaced inside the cell membrane causing a build-up and swelling of the cells (edema). The imbalance can occur through solute dilution (in this case sodium) or depletion of the solute or both.

Just like hypernatremia, the symptoms of hyponatremia can range from mild to life-threatening, some of which include nausea and vomiting, lethargy, confusion, seizures, and in severe cases the patient can go into a coma. Severe symptoms may start to display when the serum sodium levels drop below 120 mEq/L, which can lead to brain edema (Chawla et al., 2011). Some of the common causes of hyponatremia include the use of diuretics, diarrhea, liver disease, and renal disease,  

It is crucial to follow the recommendations provided by the physician when managing hyponatremia. Some of the pointers to include in patient education related to hyponatremia include taking the prescribed medication as recommended. The physician may recommend a change in medication for patients with hypertension who are under diuretics. Similarly, the patient needs to limit fluid intake as instructed by the physicain, and if recommended, the patient should take fluids that contain some sodium. Lastly, the patient should have their sodium levels checked often on clinical visitations.

References

Chawla, A., Sterns, R. H., Nigwekar, S. U., & Cappuccio, J. D. (2011). Mortality and serum sodium: do patients die from or with hyponatremia?. Clinical journal of the American Society of Nephrology : CJASN, 6(5), 960–965. https://doi.org/10.2215/CJN.10101110

Hoorn, E. J., & Zietse, R. (2017). Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. Journal of the American Society of Nephrology : JASN, 28(5), 1340–1349. https://doi.org/10.1681/ASN.2016101139

Sahay, M., & Sahay, R. (2014). Hyponatremia: A practical approach. Indian journal of endocrinology and metabolism, 18(6), 760–771. https://doi.org/10.4103/2230-8210.141320

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Sample student response 2

DKA

For this weeks discussion, I will discuss diabetic ketoacidosis, or DKA. “Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, ketonemia, and metabolic acidosis, with rapid symptom onset” (BMJ Best Practice, 2022). The pathophysiology can be described as when “absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source.

The overproduction of ketones ensues, causing them to accumulate in the blood and urine and turn the blood acidic. DKA occurs mainly in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes “(Hamdy, 2021). Furthermore, “Profound insulin deficiency results in decreased glucose uptake, increased fat mobilization with release of fatty acids, and accelerated gluconeogenesis, glycogenesis, and ketogenesis” (McCance & Huether, 2018, p. 694).  

Patient education includes strict adherence and compliance with monitoring and administering insulin. It is also important to note that if the patient is sick, more frequent monitoring of glucose and urine ketones is key to preventing DKA. Maintaining food and liquid intake is important for regulating sugars, as well as understanding that vomiting and diarrhea can significantly impact your sugars as well as general electrolyte balance.  

DKA is an extremely dangerous and life threating condition if not treated. Clinical treatment includes includes volume replacement, monitoring of ketogenesis and correction of hyperglycemia and electrolyte imbalances. Electrolyte and acid base imbalances can include metabolic alkalosis as well as hyperglycemia  causing an osmotic diuresis further causing hypokalemia, hypocalcemia, and hypochloremia.

References 

Hamdy, O. (2021, June 14). Diabetic ketoacidosis (DKA): Practice essentials, background, pathophysiology. Diseases & Conditions – Medscape Reference. https://emedicine.medscape.com/article/118361-overview 

McCance, K., & Huether, S. (2018). Pathophysiology: The biological basis for disease in adults and children (8th ed.). Mosby. ISBN-13: 9780323402811 

Overview of acid-base and electrolyte disorders. (2022, January 13). Clinical decision support for health professionals. https://bestpractice.bmj.com/topics/en-us/1072

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Topic 3 DQ 2

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action (pathophysiology) of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

Sample student response 1

Replies to Robertta Shelton

Tolvaptan 

I focused on Hyponatremia in my first post. It is a condition that can be treated with Tolvaptan. The drug belongs to a class known as vasopressin V2 receptor antagonists. The medication works by increasing water excretion. The excretion of water in the body increases the level of sodium in the blood. The major action of this medication occurs in the renal collecting ducts. The drug ensures that the ducts do not reabsorb water and process that leads to free water clearance.

A study conducted by Abdelwahed et al. (2022) found that Tolvaptan slowed the decline in kidney function, decreased kidney volume, and reduced-sodium excretion. Delbet et al. (2020) also noted in their study that Tolvaptan is effective in treating Hyponatremia. The authors recommended that the medication be considered in treating patients with therapy-resistant Hyponatremia.

Though the medication improves the symptoms of Hyponatremia, it should be monitored because it can rapidly increase the level of sodium in the body after intake. The rapid increase in sodium levels can cause nerve damage, known as osmotic demyelination syndrome. The physician should check for alcohol use and liver disease before prescribing the medication. A physician should treat a patient with Hyponatremia at the hospital for a few days to monitor the increase in sodium level to prevent the occurrence of osmotic demyelination syndrome.

The side effects of the medication include constipation, dry mouth, frequent, excessive urination, and thirst. It can also cause loss of appetite and nausea. The drug should not be taken with clarithromycin, nefazodone, itraconazole, and saquinavir. The physician should ensure that the patient is not under any mentioned drugs before prescribing Hyponatremia. 

References

Abdelwahed, M., Hilbert, P., Ahmed, A., Dey, M., Bouomrani, S., Kamoun, H., … & Belguith, N. (2022). Autosomal dominant polycystic kidney disease (ADPKD) in Tunisia: From molecular genetics to the development of prognostic tools. Gene, 817, 146174. https://doi.org/10.1016/j.gene.2021.146174

Delbet, J. D., Parmentier, C., & Ulinski, T. (2020). Tolvaptan therapy to treat severe hyponatremia in pediatric nephrotic syndrome. Pediatric Nephrology, 35(7), 1347-1350. https://link.springer.com/article/10.1007/s00467-020-04530-6

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Sample student response 2

One of the primary medications used in evidence-based treatment guidelines for my selected condition of metabolic acidosis DKA is intravenous (IV) potassium. For DKA, the care team gradually corrects dangerously high blood glucose levels with a continuous IV insulin drip. While insulin begins to enter cells, the body’s potassium stores also shift from outside the cell to inside the cell, resulting in hypokalemia (McCance and Huether, 2018).

Monitoring of patients receiving IV potassium must include cardiac monitoring and frequent lab rechecks to trend potassium levels. Nurses should be aware that if patients’ renal function is impaired they may not tolerate average doses of potassium replacement so the serum potassium levels need to be very closely monitored in renal failure patients. Most common side effects of IV potassium supplementation include pain or irritation at the peripheral venous administration site, and cardiac arrhythmias.

Drug interactions are common with potassium. The prudent nurse will utilize resources to confirm compatibility prior to infusing potassium with other IV medications or fluids (Whalen, 2018).

References:

McCance, K.L., & Huether, S.E. (2018). Pathophysiology (8th ed.). Elsevier Health Sciences.

Whalen, K. (2018). Lippincott illustrated reviews: Pharmacology (7th ed.). Wolters Kluwer Health.