Students much review the case study and answer all questions with a scholarly re

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Students much review the case study and answer all questionswith a scholarly response using APA and include 2 scholarly references. Answerboth case studies on the same document and upload 1 document to Moodle.The answers must be in your own words with reference to thejournal or book where you found the evidence to your answer. Do not copy-pasteor use past students’ work as all files submitted in this course are registeredand saved in turn it in the program.Answers must be scholarly and be 3-4 sentences in lengthwith rationale and explanation. “No Straight forward / Simple answer willbe accepted”.Turn it in Score must be less than 25 % or will not beaccepted for credit, must be your own work and in your own words. You canresubmit, Final submission will be accepted if less than 25 %. Copy-paste fromwebsites or textbooks will not be accepted or tolerated. Please see CollegeHandbook with reference to Academic Misconduct Statement.All answers to case studies must have the references cited“in the text” for each answer and a minimum of 2 Scholarly References(Journals, books) (No websites) per caseStudyAdolescent With Diabetes Mellitus (DM)Case Studies 3The patient, a 16-year-old high-school football player, wasbrought to the emergency room in acoma. His mother said that during the past month he had lost12 pounds and experiencedexcessive thirst associated with voluminous urination thatoften required voiding several timesduring the night. There was a strong family history ofdiabetes mellitus (DM). The results ofphysical examination were essentially negative except forsinus tachycardia and Kussmaulrespirations.Studies ResultsSerum glucose test (on admission), p. 227 1100 mg/dL(normal: 60–120 mg/dL)Arterial blood gases (ABGs) test (on admission),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)500 mg/dL (normal: <140 mg/dL)Glucose tolerance test (GTT), p. 234Fasting 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. 186insulin autoantibody Positive titer >1/80islet cell antibody Positive titer >1/120glutamic acid decarboxylase antibody Positive titer >1/60Microalbumin, p. 872 <20 mg/LDiagnostic AnalysisThe patient’s symptoms and diagnostic studies were classicfor hyperglycemic ketoacidosis associated with DM. The glycosylated hemoglobin showed thathe had been hyperglycemic over the last several months. The results of his arterial bloodgases (ABGs) test on admission indicated metabolic acidosis with some respiratorycompensation. He was treated in the 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 noevidence of diabetic renal disease, often a late complication of diabetes.During the first 72 hours of hospitalization, the patientwas monitored with frequent serum glucose determinations. Insulin was administered accordingto the results of these studies. His condition was eventually stabilized on 40 units of Humulin Ninsulin daily. He was converted to an insulin pump and did very well with that. Comprehensivepatient instruction regarding self[1]blood glucosemonitoring, insulin administration, diet, exercise, foot care, and recognitionof the signs and symptoms of hyperglycemia and hypoglycemia wasgiven.Critical Thinking Questions1. Why was this patient in metabolic acidosis?2. Do you think the patient will eventually be switched toan oral hypoglycemic agent?3. How would you anticipate this life changing diagnosis isgoing to affect your patient according to his age and sex? 4. The parents of your patient seem to be confused and notknowing what to do with this diagnoses. What would you recommend to them?Esophageal RefluxCase Studies 4A 45-year-old woman complained of heartburn and frequentregurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by asevere cough. The results of her physical examination were negative.Studies ResultsRoutine laboratory studies NegativeBarium swallow (BS), p. 941 Hiatal hernia Esophageal function studies (EFS), p. 624Lower esophageal sphincter (LES) pressure4 mm Hg (normal: 10–20 mm Hg)Acid reflux Positive in all positions (normal: negative)Acid clearing Cleared to pH 5 after 20 swallows (normal: <10 swallows)Swallowing waves Normal amplitude and normal progressionBernstein test Positive for pain (normal: negative)Esophagogastroduodenoscopy (EGD), p. 547 Reddened,hyperemic, esophageal mucosaGastric scan, p. 743 Reflux of gastric contents to the lungsSwallowing function, p. 1014 No aspiration during swallowingDiagnostic AnalysisThe barium swallow indicated a hiatal hernia. Although manypatients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitatedesophageal function studies. She was found to have a hypotensive LES pressure along with severeacid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein testresult indicated esophagitis caused by severe reflux. The esophagitis was directly visualizedduring esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration ofgastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake,she did not aspirate, as evident during the swallowing function study. The patient wasprescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her dietwas limited to small, frequent, bland feedings. She was instructed to sleep with the head of herbed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medicalmanagement, she underwent a laparoscopic surgical antireflux procedure. She had nofurther symptoms.Critical Thinking Questions1. Why would the patient be instructed to avoid tobacco andcaffeine?2. Why did the physician recommend 6 weeks of medicalmanagement?3. How do antacid medication work in patients withgastroesophageal reflux?4. What would you approach the situation, if your patientdecided not to take the medication and asked you for an alternative medicine approach?