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1)Which clinical condition is associated with

Nursing

1)Which clinical condition is associated with...

 

1)Which clinical condition is associated with anabolism?

a)      Stress

b)     Starvation

c)      Healing

d)     Fever

Scientific rationale:

 

 

2)      Diagnostic measurement of protein metabolism is measured the plasma levels of ________________.

a)      ammonia

b.     urea

c.      creatinine

d.     nitrogen

Scientific rationale:

 

 

3.      Which information is correct regarding hormones and nutrient metabolism?

a.      Catecholamines increase glycogenolysis.

b.     Thyroid hormone lowers blood sugar levels.

c.      Growth hormone suppresses gluconeogenesis.

d.     Insulin increases blood glucose levels.

Scientific rationale:

 

 

4.      Which clinical manifestations are associated with metabolic syndrome?

a.      Polyuria, polydipsia, polyphagia

b.     High urea plasma levels and hypotension

c.      Large abdominal girth, hypertriglyceridemia, insulin resistance

d.     Fever and acidosis

Scientific rationale:

 

 

 

 

5.      What is the effect of aging on glucose regulation?

a.      Decreased response to insulin

b.     Increased secretion of glucagon

c.      Increased oxygen utilization

d.     Decreased platelet production

Scientific rationale:

 

6.      The nurse knows fever increases basal metabolic rate [BMR] by ___% for each degree Celsius.

a.      1%

b.     7%

c.      13%

d.     19%

Scientific rationale:

 

 

7.      A client is on complete bed rest after a total hip replacement surgery while he is being treated for a mild postoperative surgical wound infection. Identify the underlying physiologic factors that could increase the nutritional needs of this client.

a.      Anabolism, polydipsia, hypertriglyceridemia

b.     Elevated protein plasma levels, hypotension, glycolysis

c.      Large abdominal girth, insulin resistance, acidosis

d.     Fever, increased white blood cell count, negative nitrogen plasma level

Scientific rationale:

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  1. (C)Healing is associated with anabolism.
  2. (D) nitrogen
  3. (A) Catecholamines increase glycogenolysis.
  4.  (C)Large abdominal girth, hypertriglyceridemia, insulin resistance
  5. (A)  Decreased response to insulin
  6. (C) 13%
  7. (D) Fever, increased white blood cell count, negative nitrogen plasma level

Step-by-step explanation

  • During wound healing there is an increase in protein synthesis in order to mend the damage. Wound healing is a result of an increase in anabolic activity and reduction of catabolic response of the body.
  • The end product of protein digestion are amino acids, and when there is an excess the body do not have enough capacity to store them, thus they are converted(glucose,ketones) or decomposed. Decomposition of amino acids produce nitrogenous wastes and hydrocarbon. Thus Nitrogen plasma levels is used for the diagnostic measurement of protein.
  • During Fight of Flight situations, Catecholamines (Epinephrine and Norepinephrine) stimulates glycogenolysis in the liver to raise the level of blood glucose the muscles need.
  • Insulin resistance occurs when there is an overabundance of free fatty acids which are from the adipose-tissue triglyceride stores. The lipolysis of triglyceride rich lipoproteins in tissues by lipoprotein lipase also result to production of free fatty acids. Insulin mediates both the anti-lipolysis and the action of the enzyme lipoprotein lipase in the adipose tissue. So, when there's insulin resistance, the increase in lipolysis will result to production of more FFA which further decrease the antilipolytic action of insulin.
  • Increased waist circumference is caused by the increase of visceral adipose tissue. The free fatty acids derived from visceral adipose tissue reach the liver, this causes greater effects on the hepatic metabolism as compared to Subcutaneous adipose tissue.
  • Patients with metabolic syndrome have elevated levels of apoC-III carried on VLDLs and other lipoprotein. This ApoC III inhibits lipoprotein lipase and contributes further to hypertriglyceridemia.
  • Insulin effectiveness reduce with aging because of the following reasons: decreased physical activity, increased abdominal fat mass, hormonal changes, increased oxidative stress and inflammation, sarcopenia and mitochondrial dysfunction. Insulin secretion also decrease at a rate of 0.7% per year with aging.
  • When there is an infection/fever, the body requires more energy, the carbohydrates is not enough to compensate the need, so the body utilize the IL-1 produced by the mononuclear leukocytes stimulates the breakdown of the muscles into its precursor amino acids for gluconeogenesis. When there is an infection, the leukocytes release endogenous pyrogens (IL-1) to alter(increase) the normal body temperature, this increase in body temperature also increase the BMR. A 1C increase in temperature, the BMR increase by 13%.
  • The carbohydrates in the body is not enough to meet the increase in requirement by fever and catabolic response to infection. Thus patients with fever and infection need additional or other source of nutrition. Same goes with white blood cells, since they fight against pathogens in a state of infection, nutrition requirement increase in order to fulfill its optimal functionality. Negative nitrogen balance is a result of a greater urinary nitrogen loss than intake. It usually occurs in starvation and malnutrition.