Factors That Influence Disease

31 May Factors That Influence Disease

Question

Week 1 discussion

Factors That Influence Disease

In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies.

To prepare:

Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.

Select a disorder from the following list:

Adrenal insufficiency (Addison’s disease)

Atherosclerosis

Cholelithiasis (gallstones)

Colon cancer

Cystic fibrosis

Hemophilia

Nephrolithiasis (kidney stones)

Osteoporosis

Parkinson’s disease

Tuberculosis

Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.

Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur.

By Day 3

Post a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different disorders and factors than you, in the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the disorder your colleague selected.

Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.

Week 2 discussion

DQ1

Maladaptive Responses to Immune Disorders

Maladaptive responses to disorders are compensatory mechanisms that ultimately have adverse health effects for patients. For instance, a patient’s allergic reaction to peanuts might lead to anaphylactic shock, or a patient struggling with depression might develop a substance abuse problem. To properly diagnose and treat patients, advanced practice nurses must understand both the pathophysiology of disorders and potential maladaptive responses that some disorders cause.

Consider immune disorders such as HIV, psoriasis, inflammatory bowel disease, and systemic lupus E. What are resulting maladaptive responses for patients with these disorders?

To prepare:

Review Chapter 5 and Chapter 7 in the Huether and McCance text. Reflect on the concept of maladaptive responses to disorders.

Select two of the following immune disorders: HIV, psoriasis, inflammatory bowel disease, or systemic lupus E (SLE).

Identify the pathophysiology of each disorder you selected. Consider the compensatory mechanisms that the disorders trigger. Then compare the resulting maladaptive and physiological responses of the two disorders.

Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor might impact your selected immune disorders.

By Day 3

Post a brief description of the pathophysiology of your selected immune disorders. Explain how the maladaptive and physiological responses of the two disorders differ. Finally, explain how the factor you selected might impact the pathophysiology of each disorder.

Read a selection of your colleagues’ responses.

By Day 5

Respond to at least two of your colleagues on two different days who selected different immune disorders and/or factors than you, in the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the immune disorder your colleague selected.

Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.

DQ2

Arthritis

While arthritis impacts nearly 50 million adults in the United States, it is not a disease that is limited to adulthood. Consider the case of Ashley Russell. At the age of 14 months, Ashley was diagnosed with juvenile rheumatoid arthritis. As a baby, her parents noticed that her knee was always swollen and that she often wanted to be carried instead of walking on her own (Cyr, 2012). After seeking medical care, Ashley’s underlying disorder was discovered. Arthritis in children is not uncommon. According to the CDC (2011), an estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition. Due to the prevalence of the disorder in both children and adults, you must understand the pathophysiology and symptoms of arthritis in order to properly diagnose and prescribe treatment.

To prepare:

Review Chapter 37 in the Huether and McCance text and Chapter 24 in the McPhee and Hammer text. Identify the pathophysiology of osteoarthritis and rheumatoid arthritis. Consider the similarities and differences of the disorders.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of and treatment for the disorders.

By Day 4

Post a description of the pathophysiology of osteoarthritis and rheumatoid arthritis, including the similarities and differences between the disorders. Then explain how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of treatment for the disorders.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different factors than you, in one or more of the following ways:

Offer alternative diagnoses and prescription of treatment options for osteoarthritis and rheumatoid arthritis.

Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives.

Week 3 discussion

Pain

The neurological system affects all parts and functions of the body through nerve stimulation. Nerves also control the sensation and perception of pain. While pain can be described in a variety of ways, it is essentially labeled according to its duration and source. As an advanced practice nurse evaluating a patient, you need to consider the following questions: Does the pain quickly come and go, or is it persistent and ongoing? Does the pain arise at the source of injury or in another location? In this Discussion, you compare three common types of pain—acute, chronic, and referred.

To prepare:

Review this week’s media presentation on the neurological system, as well as Chapter 13 in the Huether and McCance text.

Identify the pathophysiology of acute, chronic, and referred pain. Consider the similarities and differences between these three types of pain.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.

By Day 3

Post a description of the pathophysiology of acute, chronic, and referred pain, including similarities and differences between them. Then, explain how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different factors than you, in the following ways:

Share insights on how your colleague’s factors impact the pathophysiology of pain.

Suggest alternative diagnoses and treatment options for acute, chronic, and referred pain.

Week 4 discussion

Cardiovascular Disorders

Veins and arteries are vital elements of the cardiovascular system. They carry the blood supply through the body and are essential for proper function. Sometimes veins and arteries malfunction, resulting in cardiovascular disorders. Malfunctions of arteries and veins are similar to malfunctions of a water hose. Consider the structure and function of a hose. A tap releases water, which then travels through the hose and comes out the other end. If the hose has been dormant for several months, dirt and rusty particles might build up inside, resulting in a restricted flow of water. Similarly, buildup of plaque inside the coronary arteries restricts blood flow and leads to disorders such as coronary heart disease. This disease is one of the most common cardiovascular disorders, and according to the National Heart, Lung and Blood Institute (2011), is the leading cause of death for men and women in the United States. In this Discussion, you examine the pathophysiology of cardiovascular disorders such as coronary heart disease.

To prepare:

Review this week’s media presentation on alterations of cardiovascular functions, as well as Chapter 23 in the Huether and McCance text. Identify the pathophysiology of cardiovascular disorders.

Select one patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of cardiovascular disorders.

Select one of the following alterations of cardiovascular disorders: peripheral arterial disease, myocardial infarction, coronary artery disease, congestive heart failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead to the alteration you selected.

By Day 3

Post a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different alterations and factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the cardiovascular alteration your colleague selected.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Week 5 discussion

DQ1

Cardiovascular Disorders

At least once a year, the media report on a seemingly healthy teenage athlete collapsing during a sports game and dying of heart complications. These incidents continue to outline the importance of physical exams and health screenings for teenagers, especially those who play sports. During these health screenings, examiners check for cardiovascular alterations such as heart murmurs because they can be a sign of an underlying heart disorder. Since many heart alterations rarely have symptoms, they are easy to miss if health professionals are not specifically looking for them. Once cardiovascular alterations are identified in patients, it is important to refer them to specialists who can further investigate the cause.

Consider the following scenario:

A 16-year-old male presents for a sports participation examination. He has no significant medical history and no family history suggestive of risk for premature cardiac death. The patient is examined while sitting slightly recumbent on the exam table and the advanced practice nurse appreciates a grade II/VI systolic murmur heard loudest at the apex of the heart. Other physical findings are within normal limits, the patient denies any cardiovascular symptoms, and a neuromuscular examination is within normal limits. He is cleared with no activity restriction. Later in the season he collapses on the field and dies.

To prepare:

Review the scenario provided, as well as Chapter 24 in the Huether and McCance text. Consider how you would diagnose and prescribe treatment for the patient.

Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact diagnosis and prescription of treatment for the patient in the scenario.

By Day 3

Post a description of how you would diagnose and prescribe treatment for the patient in the scenario. Then explain how the factor you selected might impact the diagnosis and prescription of treatment for that patient.

Read a selection of your colleagues’ responses.

By Day 5

Respond to at least two of your colleagues who selected a different factor than you, in one of the following ways:

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Share insights based on your own experience and additional research.

DQ2

Anaphylactic Shock

The treatment of anaphylactic shock varies depending on a patient’s physiological response to the alteration. Immediate medical intervention and emergency room visits are vital for some patients, while others can be treated through basic outpatient care.

Consider the January 2012 report of a 6-year-old girl who went to her school nurse complaining of hives and shortness of breath. Since the school did not have any medication under her name to use for treatment and was not equipped to handle her condition, she was sent to an emergency room where she was pronounced dead. This situation has raised numerous questions about the progression of allergic reactions, how to treat students with severe allergies, how to treat students who develop allergic reactions for the first time, and the availability of epinephrine in schools. If you were the nurse at the girl’s school, how would you have handled the situation? How do you know when it is appropriate to treat patients yourself and when to refer them to emergency care?

To prepare:

Review “Anaphylactic Shock” in Chapter 23 of the Huether and McCance text, “Distributive Shock” in Chapter 10 of the McPhee and Hammer text, and the Jacobsen and Gratton article in the Learning Resources.

Identify the multisystem physiologic progression that occurs in anaphylactic shock. Think about how these multisystem events can occur in a very short period of time.

Consider when you should refer patients to emergency care versus treating as an outpatient.

Select two patient factors different from the one you selected in this week’s first Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the process of anaphylactic shock.

By Day 4

Post an explanation of the physiological progression that occurs in anaphylactic shock. Then, describe the circumstances under which you would refer patients for emergency care versus treating as an outpatient. Finally, explain how the patient factors you selected might impact the process of anaphylactic shock.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who selected at least one different factor than you in one of the following ways:

Share insights on how the factor your colleague selected impacts the pathophysiology of anaphylactic shock.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Week 6 discussion

Respiratory Alterations

In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.

Consider the following three scenarios:

Scenario 1:

Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.

Scenario 2:

Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

To prepare:

Review the three scenarios, as well as Chapter 26 and Chapter 27 in the Huether and McCance text.

Select one of the scenarios and consider the respiratory disorder and underlying alteration associated with the type of cough described.

Identify the pathophysiology of the alteration that you associated with the cough.

Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the disorder.

By Day 3

Post a description of the disorder and underlying respiratory alteration associated with the type of cough in your selected scenario. Then, explain the pathophysiology of the respiratory alteration. Finally, explain how the factors you selected might impact the disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different scenario than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the disorder your colleague identified.

Ask a probing question regarding the disorder that your colleague identified.

Suggest an alternative disorder for the scenario your colleague selected.

.

Week 7 discussion

Anemia

In clinical settings, advanced practice nurses often encounter patients with blood disorders such as anemia. Consider the case of a 17-year-old girl who is rushed to the emergency room after suddenly fainting. The girl’s mother reports that her daughter has had difficulty concentrating for the past week, frequently becomes dizzy, and has not been eating normally due to digestion problems. The mother also informs the nurse that their family has a history of anemia. With the family history of anemia, it appears that this is the likely diagnosis. However, in order to properly diagnose and treat the patient, not only must her symptoms and family history be considered, but also factors such as gender, ethnicity, age, and behavior. This poses the question: How do patient factors impact the incidence and prevalence of different types of anemia?

To prepare:

Review Chapter 20 in the Huether and McCance text. Reflect on the pathophysiological mechanisms of iron deficiency anemia.

Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.

Consider the similarities and differences between iron deficiency anemia and the type of anemia you selected.

Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact these anemic disorders.

By Day 3

Post an explanation of the pathophysiological mechanisms of iron deficiency anemia and the anemia you selected. Compare these two types of anemia, as well as their potential causes. Finally, explain how genetics, gender, ethnicity, age, and behavior might impact the anemic disorders you selected.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different types of anemia than you, in the following ways:

Share insights on how the anemia you selected is similar to or different from the one your colleague selected.

Discuss how genetic, gender, ethnic, age, and behavioral factors impact the diagnosis and prescription of treatment for anemic patients.

Week 8 discussion

Digestive Disorders

Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare?

To prepare:

Review Chapter 34 in the Huether and McCance text and Chapter 13 in the McPhee and Hammer text.

Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.

Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.

Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.

By Day 3

Post an explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder. Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different treatments and factors than you, in the following ways:

Offer alternative common treatments for the disorders.

Share insight on how the factor you selected impacts the treatment of alterations of digestive function.

Week 9 discussion

Diabetes

According to the American Diabetes Association (2011), 25.8 million children and adults have been diagnosed with diabetes in the United States. Approximately 2 million more are diagnosed every year, with another 79 million people considered to be in a pre-diabetes state. These millions of people are at risk of several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. Since diabetes has a major impact on the health of millions of people around the world, it is essential for nurses to understand the pathophysiology and associated alterations of this disorder. In this Discussion, you compare two types of diabetes—diabetes mellitus and diabetes insipidus.

To prepare for this Discussion:

Review Chapter 18 in the Huether and McCance text and Chapter 18 in the McPhee and Hammer text. Identify the pathophysiology of diabetes mellitus and diabetes insipidus. Consider the similarities and differences between resulting alterations of hormonal regulation.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Think about how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

By Day 3

Post an explanation of the pathophysiology of diabetes mellitus and diabetes insipidus. Describe the differences and similarities between resulting alterations of hormonal regulation. Then explain how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the pathophysiology of diabetes mellitus and diabetes insipidus.

Offer alternative diagnoses and prescription of treatment options for diabetes mellitus and diabetes insipidus.

Validate an idea with your own experience and additional research.

Reference:

American Diabetes Association. (2011). Diabetes statistics. Retrieved from http://www.diabetes.org/diabetes-basics/diabetes-statistics/

Week 10 discussion

Urinary Tract Infections

Urinary tract infections (UTIs) are caused by bacteria—most often Escherichia coli. However, certain viruses, fungi, and parasites can also lead to infection. The infection can affect the lower and upper urinary tract, including the urethra, prostate (in males), bladder, ureter, and kidney. Due to the progression of the disease and human anatomy, symptoms present differently among the sexes as well as among age groups. It is important to understand how these factors, as well as others, impact the pathophysiology of UTIs. Advanced practice nurses must have this foundation in order to properly diagnose patients.

To prepare:

Review Chapter 29 in the Huether and McCance text. Identify the pathophysiology of lower and upper urinary tract infections. Consider the similarities and differences between the two types of infections.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.

By Day 3

Post a description of the pathophysiology of lower and upper urinary tract infections, including their similarities and differences. Then explain how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected at least one different factor than you, in one or more of the following ways:

Offer alternative diagnoses and prescription of treatment options for urinary tract infections.

Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives.

Week 11 discussion

Disorders of the Reproductive Systems

While the male and female reproductive systems are unique to each sex, they share a common function—reproduction. Disorders of this system range from delayed development to structural and functional abnormalities. Since many reproductive disorders not only result in physiological consequences but also psychological consequences such as embarrassment, guilt, or profound disappointment, patients are often hesitant to seek treatment. Advanced practice nurses need to educate patients on disorders and help relieve associated stigmas. During patient evaluations, patients must feel comfortable answering questions so that you, as a key health care provider, will be able to diagnose and recommend treatment options. As you begin this Discussion, consider reproductive disorders that you would commonly see in the clinical setting.

To prepare for this Discussion:

Review Chapter 22 and Chapter 23 in the McPhee and Hammer text, as well as Chapter 32 in the Huether and McCance text.

Select two disorders of the male and/or female reproductive systems that interest you. Consider the similarities and differences between the disorders.

Select one of the following factors: genetics, ethnicity, age, or behavior. Think about how the factor you selected might impact the diagnosis of and treatment for the reproductive disorders.

By Day 3

Post a description of the two reproductive disorders you selected, including their similarities and differences. Then explain how the factor you selected might impact the diagnosis of treatment for the reproductive disorders.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different disorders or factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the disorder your colleague selected.

Offer alternative diagnoses and prescription of treatment options for the disorder your colleague selected.

Validate an idea with your own experience and additional research.

Week 2 assignment

Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

Review the Application Assignment Rubric found under Course Information

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.

Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

By Day 7

This Assignment is due.

Week 4 assignment

Assignment: Disorders of the Veins and Arteries

Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT.

To Prepare

Review the section “Diseases of the Veins” (pp. 598-599) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.

To Complete

Write a 2- to 3-page paper that addresses the following:

Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.

Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Week 6 assignment

Assignment: Asthma

Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation.

To Prepare

Review “Asthma” in Chapter 27 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation.

To Complete

Write a 2- to 3-page paper that addresses the following:

Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.

Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.

Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Week 8 assignment

Gastrointestinal Tract: Disorders of Motility

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

To Prepare

Review this week’s media presentation on the gastrointestinal system.

Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.

Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.

Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.

To Complete

Write a 2- to 3-page paper that addresses the following:

Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.

Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Week 10 assignment

The Pathophysiology of Disorders

During the last 5 weeks, you have explored various body systems: neurological, cardiovascular, respiratory, and hematological. These four systems work together along with other body systems to complete a myriad of functions. For this reason, when disorders occur within one body system, it can create potentially devastating effects throughout the entire body. For instance, Parkinson’s disease is a disorder of the central nervous system, yet its alterations actually affect multiple body systems from the cardiovascular system to the gastrointestinal system. In this Assignment, you examine alterations associated with disorders, as well as the impact of the alterations on multiple body systems.

To Prepare

From the list below, select a disorder of interest to you:

Alzheimer’s disease

Asthma in children

Chronic obstructive pulmonary disease (COPD)

Congestive heart failure

Hepatic disease (liver disease)

Hypertension

Hyperthyroidism and hypothyroidism

Seizures

Sepsis

Identify alterations associated with your selected disorder. Consider the pathophysiology of the alterations. Think about how these alterations produce pathophysiological changes in at least two body systems.

Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as the diagnosis and treatment of your selected disorder.

Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology and clinical presentation of your selected disorder.

To Complete

Develop a 5- to 10-slide PowerPoint presentation that addresses the following:

Describe your selected disorder, as well as associated alterations. Explain the pathophysiology of the alterations, including changes that occur in at least two body systems.

Explain how genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as diagnosis and treatment of your selected disorder.

Construct a mind map for the disorder you selected. Include the epidemiology, pathophysiology of alterations, risk factors, and clinical presentation, as well as the diagnosis and treatment of the disorder.

By Day 7

Submit the Pathophysiology of Disorders Assignment. This Assignment was presented in Week 8 and is due.

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 1 quiz

Question 1

A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process?

Question 2

What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present? Her features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair.

Question 3

Sodium and water accumulation in an injured cell are a direct result of:

Question 4

A patient who has diarrhea receives a hypertonic saline solution intravenously to replace the sodium and chloride lost in the stool. What effect will this fluid replacement have on cells?

Question 5

An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide?

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 2 quiz

Question 1

A 70-year-old female presents with a hip fracture. She is diagnosed with osteoporosis. One factor that most likely contributed to her condition is:

Question 2

A 4-month-old female is diagnosed with atopic dermatitis (AD). Which of the following assessment findings by the nurse will most likely support this diagnosis?

Question 3

A patient has chicken pox. How does the varicella replicate?

Question 4

A 5-year-old female takes a hike through the woods during a school field trip. Upon returning home, she hugs her father, and he later develops poison ivy. Which of the following immune reactions is he experiencing?

Question 5

When bacterial pathogens enter a patient’s body, they can defend themselves from an immune response by:

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 3 quiz

Question 1

When a patient has a peculiar sensation that immediately precedes a seizure, what term should the nurse use to describe this sensation?

Question 2

An older adult is admitted to the ER following a fall. The patient complains of pain in the back. The patient has a history of osteoporosis. The nurse would expect the patient’s injury and subsequent pain is most likely due to:

Question 3

A 50-year-old male suffers a severe head injury when his motorcycle hits a tree. His breathing becomes deep and rapid but with normal pattern. What term should the nurse use for this condition?

Question 4

When a patient has a fever, which of the following thermoregulatory mechanisms is activated?

Question 5

A nurse should document on the chart that chronic pain is occurring when the patient reports the pain has lasted longer than:

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 4 quiz

Question 1

A 60-year-old male undergoes surgery for a bone fracture. Which of the following nursing measures would be most effective for preventing pulmonary embolism (PE) in this patient?

Question 2

Which of the following patients is at highest risk for developing pulmonary embolism (PE)?

Question 3

A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is:

Question 4

A 35-year-old male presents with pulmonary hypertension. Testing reveals he is in right heart failure. Which of the following is the most likely diagnosis the nurse will see listed on the chart?

Question 5

A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. Which of the following is the most likely diagnosis to be recorded on the chart?

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 5 quiz

Question 1

A nurse is teaching a patient about anaphylactic shock. Which information should the nurse include? The onset of anaphylactic shock is usually:

Question 2

A nurse is planning care for a patient in shock. Which principle should the nurse remember? During shock states, glucose uptake is usually:

Question 3

A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of assessment findings would the nurse expect the patient to exhibit?

Question 4

A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. While planning care, which characteristic changes should the nurse remember?

Question 5

While planning care, the nurse remembers which principle? In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely.

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 6 quiz

Question 1

A 6-month-old female presents with rhinorrhea, cough, poor feeding, lethargy, and fever. She is diagnosed with bronchiolitis. Which of the following will the nurse most likely observe on the culture report?

Question 2

A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When a staff member asks why the patient’s airways are obstructed, how should the nurse respond? The airways are obstructed because of:

Question 3

A 25-year-old male presents with chronic bronchitis of 5 months’ duration. When obtaining the patient’s history, which of the following findings is most likely to cause this condition?

Question 4

A newborn has respiratory distress syndrome. When obtaining the patient’s history, which of the following is the most important predisposing factor for this condition?

Question 5

If an individual with respiratory difficulty were retaining too much carbon dioxide, which of the following compensatory responses would the nurse expect to be initiated?

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 7 quiz

Question 1

A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?

Question 2

A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

Question 3

For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:

Question 4

A nurse is caring for a patient who cannot clot. Which end product of the clotting cascade is this patient unable to make?

Question 5

A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is:

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 8 quiz

Question 1

A 40-year-old female presents complaining of pain near the midline in the epigastrium. Assuming the pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:

Question 2

An 8-week-old male was recently diagnosed with cystic fibrosis. Which of the following digestive alterations would be expected?

Question 3

In alcoholic cirrhosis, hepatocellular damage is caused by:

Question 4

Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension?

Question 5

Kwashiorkor is a severe dietary deficiency of:

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 9 quiz

Question 1

A patient wants to know what can cause ACTH to be released. How should the nurse respond?

Question 2

A student asks the instructor which of the following is the most potent naturally occurring glucocorticoid. How should the instructor respond?

Question 3

A patient has researched lipid-soluble hormones on the Internet. Which information indicates the patient has a good understanding? Lipid-soluble hormone receptors cross the plasma membrane by:

Question 4

A 45-year-old female has elevated thyroxine production. Which of the following would accompany this condition?

Question 5

A 40-year-old male undergoes surgery for a PTH-secreting tumor in which the parathyroid is removed. Which of the following would the nurse expect following surgery?

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 10 quiz

Question 1

A 2-year-old male is diagnosed with Wilms tumor. Which of the following clinical conditions is often associated with this disease?

Question 2

A nurse is preparing to teach about the loop of Henle. Which information should be included? The descending segment of the loop of Henle primarily allows for:

Question 3

A nurse is describing the trigone. Which information should be included? The trigone is defined as:

Question 4

When the nurse discusses the glomerulus and Bowman capsule together, it is referred to as the renal:

Question 5

A 5-year-old male was diagnosed with glomerulonephritis. History reveals that he had an infection 3 weeks before the onset of this condition. The infection was most likely located in the:

<pclass=”msonormal” style=”box-sizing: border-box;”>Week 11 quiz

Question 1

A syndrome often associated with cystocele is:

Question 2

A student asks the instructor which of the following hormones stimulates follicular maturation. How should the instructor respond?

Question 3

A nurse is teaching the staff about female hormones. Which hormone promotes the formation of channels in the mucus of the cervical os to facilitate sperm movement into the uterus?

Question 4

A 38-year-old female was recently diagnosed with cancer. She learns that her mother almost miscarried while pregnant with her and was given diethylstilbestrol (DES) to prevent it. Which of the following cancers does she most likely have?

Question 5

A 21-year-old female is infected with human papillomavirus (HPV) following unprotected sexual intercourse with a male she recently met. She is now at higher risk of developing which of the following cancers?

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