A 28 year old man visits his physician complaining of an intense, sharp pain in his back and side. In a conversation with his physician, the patient confesses to eating a low carb diet high in animal proteins such as red meat, chicken, fish and cheese, such as Atkins. Results of a complete urinalysis are shown below. Chemical/Physical Analysis Color Appearance Specific Gravity pH Yellow Clear 1.025 5.0 Microscopic Analysis >100 RBC/HPF 0-3 WBC/HPF 20-30 Bacteria/HPF 0-5 Squamous Epithelial Cells/HPF Unidentified Crystals Glucose Protein: Ketones 150mg/dL Bilirubin Negative Negative Trace Urobilinogen Blood Nitrite Leukocyte Normal Large Negative Negative

1. Is there a discrepancy between the leukocyte and nitrite on the reagent dipstick compared to the results reported in the microscopic analysis?  Explain why or why not?

2. How is it possible for this patient to have a positive urine ketone with a negative urine glucose?

3. Suggest an explanation for blood in the urine. Cite the page number in Strasinger or other source that assists your decisions.

A 45-year-old woman with type I diabetes mellitus is admitted to the hospital and has been given a preliminary diagnosis of nephropathy. She has not been feeling well for the past week and has bilateral pitting edema in her lower limbs. Her admission urinalysis results are as follows. Color: colorless Clarity: clear Large amount of white foam noted SG: 1.010 pH: 5 Blood: small Protein: 500 mg/dL SSA: 4+ Leukocytes: negative Nitrite: negative Glucose: 250 mg/dL Ketones: negative Bilirubin: negative Urobilinogen: 0.5 mg/dL Microscopic: 10-20 hyaline casts/ LPF; 2-5 waxy casts/LPF; 1-3 fatty casts/LPF 0-3 oval fat bodies/ HPF;

1. Which results are abnormal compared to expected reference ranges?

2. Why is glucose present in this patient’s urine? Explain briefly. Cite the page number in Strasinger or other source that assists your decisions.

3. What is the likely cause of the patient’s edema? Explain briefly. Cite the page number in Strasinger or other source that assists your decisions.

Jackie is a 42 year old female with type 1 DM (since age 6). Jackie is presenting complaint is painful feet according to the clinic admin staff. She has been a Type one diabetic since childhood: Nursing Practitioner has seen her before because of poor glycemic control but sees she has been doing a lot better in the past few years and her HbA1C is pretty stable. Jackie was in clinic 4 Month’s ago to see Dr. Mike. Mike. His notes include a diagnosis of acute renal failure as her serum creatinine was 148. He was concerned about her transitioning into chronic renal failure and had asked that she come back in a week for repeat bloodwork. It doesn’t look like that happened. He also notes that she was experiencing some symptoms of peripheral neuropathy but there were no visible signs of circulatory changes. There is an admission note from 1996 scanned in that reflects a brief hospitalization on the acute mental health unit for suicidal ideation and a subsequent note from psychiatry that she was treated successfully for depression at that time.

1. You are meeting with Jackie for the first time, the goal of this visit is health promotion and maintenance, what are the three priority questions you will ask Jackie? (You may only ask three questions, so make sure you are focusing on the priority of care)

2. What are your Three priority health promotion and maintenance concerns for Jackie?

3. Create a plan of care to address the needs of Jackie

A major role of the professional nurse is to evaluate the learning needs of individuals, families, and populations.

1. How do the Social Determinants of Health impact an individual’s learning needs? What are some ways to overcome social determinant barriers to promote the health and wellness of patients or clients?
2. As a professional nurse, fully describe 2 ways that you can be an advocate for policy change to improve the health and wellness of those effected by social determinant barriers.