Below are three case scenarios. For each scenario determine: 1) Most likely enzyme deficiency and which amino acid(s) is no longer metabolized 2) If any amino acids become essential as a result of the deficiency 3) Potential vitamin supplements that may be useful for the condition and what steps in the metabolism they could potentially help with. Scenario 1: A full-term girl was born by normal vaginal delivery and was released from the hospital at three days of age. At nine days of age a screening test for branched-chain amino acids came back positive and the child was readmitted to the hospital for further evaluation. There was no history of any genetic disease in either family, and both older siblings were well. Scenario 2: A 69-year-old woman presented with a 30-year history of lower back and large joint pain of the hips and shoulders. On examination blue-grey, pigmented macules were present over the cartilaginous portions of the ears and on the sclera. Past medical history included aortic stenosis. Scenario 3: A 4-day old infant is being followed in your clinic. Her birth weight was 5.9 pounds and the pregnancy and birth (vaginal delivery) were normal. Results from newborn screening demonstrated a phenylalanine (Phe) level of 6.6 mg/dL (normal range: 1-2 mg/dL).

Mr smith a 52 year old patient, is admitted to the coronary care unit with the diagnosis of acute inferior myocardial infarction. the patient has a history of smoking two packs of cigarettes for 35 years, and he drinks a six pack of beer on weekend nights, but does not drink the rest of the week. he is the sole financial support for his family. he is a consultant for a company and is out of town during the week days. mr smith has gained 20 pounds. he is 5 foot, 6 inches, weighing 200 pounds. his diet consists mostly of fast foods. he rarely exercise. his wife care for their three teenage children. the eldest son, 17 years of age, totaled the family car when drinking and driving 2 days ago and he is in the local children’s hospital in the intensive care unit in critical condition. mr smith developed chest pains and slumped over in his chair during an argument with his wife about their teenage daughter, who is 15 years of age and wanted to get birth control pills. the wife is in the waiting room while the nurses settle mr smith into his room. the youngest son, 13 years of age, is at a friends house. the teenage daughter is staying at the bedside of the criticall i’ll eldest son. the wife blames her eldest son for her husband’s heart attack and told the emergency department nurse that she does not care to see her son i’ll. a. what maladaptive response to stress may have contributed to mr smith’s development of an illness b. based on the case study, what family assessment data may be used to determine coping strategies being currently used by the family. c. what nursing interventions should be used to promote effective coping for the patient and his family?

Mr. edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. mr. edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. he came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure- relieving cushion at home. according to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. a. what nursing considerations should be made for mr. edwards related to his disability? b. what health promotion and prevention education does mr. edwards need?

Which of the tollwing essential glands in the neck may be compromised during a thyroidectomy? a. thymus b. pituitary c. parotid d. parathyroid