Instructions: Read the case study below and answer each question using complete
ID: 85376 • Letter: I
Question
Instructions: Read the case study below and answer each question using complete sentences. In questions involving medications, please document the following information about the medication you select (trade name, generic name, dosage, indication for use, side-effects, and contraindications).
You are spending your vacation visiting your 65-year-old grandmother. Though she has had hypertension and diabetes for 20 years, she has been active and relatively well. One morning, you notice that she looks very puffy in her face, legs, feet, and hands. When you asked if she felt well, she stated that she felt a little “lightheaded” when she got up out of bed and was feeling a bit weak. Concerned that there is something wrong, she goes to see her regular health care provider. Her blood pressure was 100/60 and pulse was 96. Upon evaluation of a routine urine screen, she is told that she has proteinuria.
How does proteinuria develop?
What significant aspects of your grandmother’s history may represent a likely cause of the development of proteinuria?
Knowing the Hypertension and Diabetes affects the kidneys, what is the relationship between proteinuria and alterations in fluid balance?
Name and discuss one medication that may be used to treat grandmother’s hypertension.
Name and discuss one medication that may be used to treat grandmother’s puffy face, legs, feet, and hands.
What are the three primary long term complications of diabetes? AND How are they affecting grandmother?
Explanation / Answer
Hi,
The grandmother case: The grandmother has been diagnosed with Proteinuria. Let us try to learn more about this condition.
Proteinuria, as the name suggests, protein in the urine, rather abnormally high amount of protein in the urine. It is usually associated with problems with the kidney. The failure in filtering the blood results in protein getting into the urine. This condition is the first sign of kidney damage due to diabetes or high blood pressure.
The grandmother had high blood pressure and diabetes since 20 years. Both of these conditions are responsible for the proteinuria.
Diabetes causes high blood sugar levels. These induce higher inflammatory reactions in the blood and in tissues (like produce more ROS). This results in damaged glomeruli. The damaged glomeruli filtration fails and larger molecules can now pass through the membrane into the urine. Thus the abnormally high amount of proteins gets into the urine.
To treat her hypertension, we can use Thiazide diuretics. These act on the kidneys to help the body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. Thiazide diuretics include hydrochlorothiazide (Microzide), chlorthalidone and others. A common side effect of diuretics is increased urination.
The swelling of hand, palm, feet are called as Edema. It is caused due to excess fluid is trapped in the body's tissue. Though edema can be caused by various reasons, in our grandmother case, it is caused by kidney failure. To treat the edema, most commonly used in diuretics, an example would be furosemide. It is also used to treat high blood pressure.
Long-term problems of diabetes include
In our grandmother case, the kidneys have been damaged badly.The kidney is already malfunctioning and she will have acute kidney damage. If diabetes is not kept under control, grandmother would get cardiovascular problems ( Since she has high blood pressure too). Th