Category: Biology

Type 2 diabetes

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5-7 years (not part of the classroom coursework).
3.1 In 2018, there were 105 new cases of type 2 diabetes reported in Smithville, a city of 500,000. This brought the total number of active cases of type 2 diabetes in Smithville to 3,075. During this time, there were 105 deaths attributable to the disease.
1.  What was the incidence rate per 100, 000 for type 2 diabetes in 2018?
2.  What was the prevalence rate of type 2 diabetes per 100,000 in 2018?
3.  What was the cause-specific death rate of type 2 diabetes in 2018?
3.2 A city contains 100,000 people (45,000 male and 55,000 females), and 1,000 people die per year (600 males and 400 females). There were 50 cases (40 males and 10 females) of lung cancer per year of whom 45 died (36 males and 9 females).
Using this information compute:
1.  The crude mortality rate per 1,000
2.  The sex-specific mortality rate per 1,000
3.  The cause-specific mortality rate per 1,000 for lung cancer
4.  The case fatality rate for lung cancer
5.  The proportionate mortality ratio for lung cancer
 3.3 A new rapid blood test was created to test for human papillomavirus (HPV) in a rural clinic. The following is a 2 × 2 chart that describes the results of the test. Answer questions 1–7 using the 2 × 2 chart.
HPVNo HPVTotals
Positive Test 95 37 132
Negative Test 39 278 317
Totals 134 315 449
1.What is the sensitivity of this test?
2.  What is the specificity of this test?
3.  What is the positive predictive value?
4.  What is the negative predictive value?
5.  Describe in words the sensitivity of this test.
6.  Describe in words the negative predictive value.
7.  What is the disease prevalence in this population?
3.4 An epidemiological study is conducted to learn about the relationship between celiac disease and colon cancer. Suppose there are 77 cases of colon cancer in 68,000 person-years in persons with celiac disease and 54 cases of colon cancer in 215,000 person-years in those without celiac disease. (The overall rate in both groups combined = 131 cases in 283,000 person-years overall.) Use this information to answer questions 1–3.
1.  Calculate the rate of colon cancer in the celiac group (R1), in the no celiac group (R0), and overall (R). Express all rates in “per 100,000 person-years.”
2.  Calculate and interpret the relative risk of colon cancer associated with celiac disease.
3.  Calculate and interpret the attributable risk of colon cancer associated with celiac disease.
3.5 This week you have been learning about from your readings about the critical components of data analysis, including bias, causality, confounding, and interaction. It also covers more in-depth discussion of study designs, as well as a comprehensive review of ways to report on randomized and nonrandomized studies. So what do these mean to you as an advanced practice nurse? How are you able to see the connection between the numbers on the page and ways you might apply this in a practice situation? How is this data important to your role as an advanced practice nurse. Why is it important to know how to calculate and interpret prevalence and incidence rates of diseases? Why are mortality and morbidity rates important? Why is the sensitivity of a specific test important? What about relative risks.
Most nurses don’t like what we call numbers or statistics it is as if our brains just want to shut off but understanding how to interpret these results and numbers is important to population health interventions in what way?

Cardiovascular/pulmonary disorder/disease

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Develop a PowerPoint presentation on a cardiovascular/pulmonary disorder/disease discussed in the McCance text.
The presentation must provide information about the incidence, prevalence, and pathophysiology of the disease/disorder to the cellular level. The presentation must educate advanced practice nurses on assessment and care/treatment, including genetics/genomics—specific for this disorder. Patient education for management, cultural, and spiritual considerations for care must also be addressed. The presentation must specifically address how the disease/disorder affects 1 of the following age groups: infant/child, adult, or elderly.

• Select a cardiovascular or pulmonary disorder.
• Provide information about the incidence, prevalence, and pathophysiology of the disease/disorder to the cellular level.
• Educate advanced practice nurses on assessment and care/treatment, including genetics/genomics—specific for this disorder.
• Provide patient education for management, cultural, and spiritual considerations for care must also be addressed.
• Must specifically address how the disease/disorder affects 1 of the following age groups: infant/child, adult, or elderly.

 

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests

Posted on | by Brian Leakey

Adolescent With Diabetes Mellitus (DM)
Case Studies
The patient, a 16-year-old high-school football player, was brought to the emergency room in a
coma. His mother said that during the past month he had lost 12 pounds and experienced
excessive thirst associated with voluminous urination that often required voiding several times
during the night. There was a strong family history of diabetes mellitus (DM). The results of
physical examination were essentially negative except for sinus tachycardia and Kussmaul
respirations.
Studies Results
Serum glucose test (on admission), p. 227 1100 mg/dL (normal: 60–120 mg/dL)
Arterial blood gases (ABGs) test (on admission),
p. 98
pH 7.23 (normal: 7.35–7.45)
PCO2 30 mm Hg (normal: 35–45 mm Hg)
HCO2 12 mEq/L (normal: 22–26 mEq/L)
Serum osmolality test, p. 339 440 mOsm/kg (normal: 275–300
mOsm/kg)
Serum glucose test, p. 227 250 mg/dL (normal: 70–115 mg/dL)
2-hour postprandial glucose test (2-hour PPG), p.
230
500 mg/dL (normal: <140 mg/dL) Glucose tolerance test (GTT), p. 234 Fasting blood glucose 150 mg/dL (normal: 70–115 mg/dL) 30 minutes 300 mg/dL (normal: <200 mg/dL) 1 hour 325 mg/dL (normal: <200 mg/dL) 2 hours 390 mg/dL (normal: <140 mg/dL) 3 hours 300 mg/dL (normal: 70–115 mg/dL) 4 hours 260 mg/dL (normal: 70–115 mg/dL) Glycosylated hemoglobin, p. 238 9% (normal: <7%) Diabetes mellitus autoantibody panel, p. 186 insulin autoantibody Positive titer >1/80
islet cell antibody Positive titer >1/120
glutamic acid decarboxylase antibody Positive titer >1/60
Microalbumin, p. 872 <20 mg/L
Diagnostic Analysis
The patient’s symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis
associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over
the last several months. The results of his arterial blood gases (ABGs) test on admission
indicated metabolic acidosis with some respiratory compensation. He was treated in the
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
emergency room with IV regular insulin and IV fluids; however, before he received any insulin
levels, insulin antibodies were obtained and were positive, indicating a degree of insulin
resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often
a late complication of diabetes.
During the first 72 hours of hospitalization, the patient was monitored with frequent serum
glucose determinations. Insulin was administered according to the results of these studies. His
condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to
an insulin pump and did very well with that. Comprehensive patient instruction regarding selfblood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the
signs and symptoms of hyperglycemia and hypoglycemia was given.
Critical Thinking Questions

  1. Why was this patient in metabolic acidosis?
  2. Do you think the patient will eventually be switched to an oral hypoglycemic agent?
  3. How would you anticipate this life changing diagnosis is going to affect your patient
    according to his age and sex?
  4. The parents of your patient seem to be confused and not knowing what to do with this
    diagnoses. What would you recommend to them?

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests

Posted on | by Brian Leakey

Adolescent With Diabetes Mellitus (DM)
Case Studies
The patient, a 16-year-old high-school football player, was brought to the emergency room in a
coma. His mother said that during the past month he had lost 12 pounds and experienced
excessive thirst associated with voluminous urination that often required voiding several times
during the night. There was a strong family history of diabetes mellitus (DM). The results of
physical examination were essentially negative except for sinus tachycardia and Kussmaul
respirations.
Studies Results
Serum glucose test (on admission), p. 227 1100 mg/dL (normal: 60–120 mg/dL)
Arterial blood gases (ABGs) test (on admission),
p. 98
pH 7.23 (normal: 7.35–7.45)
PCO2 30 mm Hg (normal: 35–45 mm Hg)
HCO2 12 mEq/L (normal: 22–26 mEq/L)
Serum osmolality test, p. 339 440 mOsm/kg (normal: 275–300
mOsm/kg)
Serum glucose test, p. 227 250 mg/dL (normal: 70–115 mg/dL)
2-hour postprandial glucose test (2-hour PPG), p.
230
500 mg/dL (normal: <140 mg/dL) Glucose tolerance test (GTT), p. 234 Fasting blood glucose 150 mg/dL (normal: 70–115 mg/dL) 30 minutes 300 mg/dL (normal: <200 mg/dL) 1 hour 325 mg/dL (normal: <200 mg/dL) 2 hours 390 mg/dL (normal: <140 mg/dL) 3 hours 300 mg/dL (normal: 70–115 mg/dL) 4 hours 260 mg/dL (normal: 70–115 mg/dL) Glycosylated hemoglobin, p. 238 9% (normal: <7%) Diabetes mellitus autoantibody panel, p. 186 insulin autoantibody Positive titer >1/80
islet cell antibody Positive titer >1/120
glutamic acid decarboxylase antibody Positive titer >1/60
Microalbumin, p. 872 <20 mg/L
Diagnostic Analysis
The patient’s symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis
associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over
the last several months. The results of his arterial blood gases (ABGs) test on admission
indicated metabolic acidosis with some respiratory compensation. He was treated in the
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
emergency room with IV regular insulin and IV fluids; however, before he received any insulin
levels, insulin antibodies were obtained and were positive, indicating a degree of insulin
resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often
a late complication of diabetes.
During the first 72 hours of hospitalization, the patient was monitored with frequent serum
glucose determinations. Insulin was administered according to the results of these studies. His
condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to
an insulin pump and did very well with that. Comprehensive patient instruction regarding selfblood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the
signs and symptoms of hyperglycemia and hypoglycemia was given.
Critical Thinking Questions

  1. Why was this patient in metabolic acidosis?
  2. Do you think the patient will eventually be switched to an oral hypoglycemic agent?
  3. How would you anticipate this life changing diagnosis is going to affect your patient
    according to his age and sex?
  4. The parents of your patient seem to be confused and not knowing what to do with this
    diagnoses. What would you recommend to them?

The cardiovascular and cardiopulmonary pathophysiologic processes

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A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF)

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.

 

Disorder from the Disruptive, Impulse-Control, and Conduct Disorder

Posted on | by Brian Leakey

Select one disorder from the Disruptive, Impulse-Control, and Conduct Disorders section of the DSM-5.
Search the Walden library and/or the internet for a minimum of 5 peer-reviewed articles related to the disorder that you selected.

Synthesize the empirical literature that you identified about the disorder that you selected and address the following questions:

Describe the disorder that you selected.
What are the DSM-5 criteria for the disorder that you selected?
What are the forensic psychological aspects of this disorder? (e.g., how does it relate to criminal behavior, forensic assessment, criminal sentencing, and probation, etc.)
What are the potential consequences of this disorder when left untreated?
What are the best practices for screening and intervention for this disorder?
How has the diagnostic criterion for the disorder evolved over time (i.e., historical perspectives)?