The nurse is caring for a patient in septic shock due secondary to pneumonia. The nurse knows that evidence-based guidelines for the treatment of septic shock include which interventions? (Select all that apply, one, some, or all.)

A patient has been admitted with septic shock related to tissue necrosis. The nurse knows the initial goal for medical management for this patient is which intervention?

A patient in cardiogenic shock is being treated in the critical care unit. Which findings would the nurse expect to note in the patient to support this diagnosis? (Select all that apply, one, some, or all.)

A patient has been admitted with septic shock due to urinary sepsis. The practitioner inserts a pulmonary artery (PA) catheter. Which hemodynamic value demonstrates that the patient is in the compensatory stage of shock?

Upload an image of your drawings. Show the steps in the urea cycle that result in the formation of Arg from citrulline.  Include substrate and product structures and any necessary cofactors, and circle the N atom in the structure of Arg that becomes  one of the N atoms in ornithine.  (5 points) The urea cycle is intertwined with the citric acid cycle.  Diagram how these cycles are connected (i.e. what structures are common to both cycles) and indicate how a citric acid cycle compound becomes a N atom donor for urea production.  Just show the reactions, names or structures of compounds are fine. (4 points) The final reaction that forms urea in the urea cycle is catalyzed by the enzyme arginase. Beginning with this reaction, show how the amino acid Arg is converted to the 5-carbon compound found in the citric acid cycle via an amino transferase catalyzed formation of an aldehyde intermediate. Show the structures involved along with required cofactors and give the reaction type for each step (enzyme names are not required), i.e. carboxylation hydration, oxidation, etc.  (4 points)

Upload an image of your drawings.   One of the intermediates in the biosynthesis of epinephrine is the amino acid L-dopa, which has two phenolic OH groups at the 3 and 4 positions of the benzene ring of Phe. Following the PLP mediated decarboxylation of L-dopa, the side chain alkyl group is hydroxylated to form the hormone norepinephrine. The final step in the biosynthesis of epinephrine is N-methylation of norepinephrine to form epinephrine by SAMe (S-adenosy methionine). Outline the series of reactions that would take a carbon atom from either Ser or Gly and deliver it as a methyl group to norepinephrine to form epinephrine. Show all necessary cofactors. You may use names, structures, or acceptable abbreviations. (4 pts.) Following the transfer of a methyl group, SAMe is converted to homocysteine. High levels of homocysteine in the blood have been correlated with coronary heart disease, stroke, atherosclerosis, neural tube defects, and dementia in the elderly. Homocysteine can react with Ser with the loss of water to form cystathionine. Cystathionine is cleaved to form Cys and α-ketobutyrate in a PLP dependent reaction. Show the series of reactions that converts 

Upload an image of your drawings. About 30% of Thr in humans is degraded by the threonine dehydratase reaction. This reaction is parallel to the serine dehydratase reaction. The product of this Thr reaction is α – ketobutyrate (CH3CH2COCO2-). Write out the mechanism for this reaction. 

Mini case study: Alex is a 15-year-old Caucasian male, who is unable to perform strenuous exercise because he lacks the enzyme to effectively breakdown glycogen in the muscles. Alex’s blood was tested for alanine content. In a normal person, you would expect that blood alanine would increase during strenuous anaerobic exercise. But in Alex’s blood samples, there is a decrease in alanine concentration, leading you to believe that Alex’s muscle cells are taking up alanine rather than releasing it. Why would blood alanine concentrations increase in a normal person? (2 pts.) Hint: Think of the muscle fuel supply, the connection between pyruvate and alanine, and the role of nitrogen metabolism in the liver as well as, the liver’s role in gluconeogenesis.  Why do blood alanine concentrations decrease in Alex? (2 pts.)

Three α -ketoacids, a 3-C atom pyruvate, a 4-C atom oxaloacetate, and a 5-C atom α-ketoglutarate, are found in the glycolytic pathway and the citric acid cycle. Give three metabolic fates (name or abbreviation of end product or pathway) of the 3-carbon acid. Give three metabolic fates (name or abbreviation of end product or pathway) of the 4-carbon acid.

A 20-year-old man was stabbed in the chest with a jackknife (pocket knife) with a blade five centimeters long. The stab wound in the left fourth intercostal space was approximately two centimeters lateral to the body of the sternum. What chamber of the heart would likely be injured?