Foundations of Pathophysiology

Case Study: Scope of Pathophysiology

Mr. Reynolds, age 65, is slowly recovering from a recent heart attack. He has a history of emphysema but is having more difficulty breathing. He dislikes medications and any form of therapy.

Question 1

Using normal anatomy and physiology, discuss how impaired ventilation can interfere with cardiac recovery and function.

Based on the patient’s medical history and his feelings about recovery programs, in conjunction with the patient’s need for medications and other therapies, discuss the need for medication and participation in recovery programs and possible strategies and the roles of other professionals in support of his recovery from the heart attack and to manage his respiratory condition.

Diagnostic Principles

Case Study: Diagnostic Principles – Gastric Ulcer

Ms. W. is a 55-year-old patient who consulted her physician because of recurrent epigastric pain and nausea and two recent episodes of vomiting, in which the emesis was dark-colored and granular in appearance. Her history includes heavy alcohol use, cigarette smoking, and persistent headaches. She has not followed all her physician’s previous recommendations but has been controlling her headaches by taking two aspirins every few hours. Following tests, a bleeding gastric ulcer was diagnosed.

Question 1 Discuss the factors contributing to Ms. W.’s condition.

Question 2 Discuss synergism, antagonism and potentiation as they apply to this case.

Question 3 Discuss the potential effects of increased bleeding from the ulcer.

Question 4 Discuss issues related to patient compliance.

Case Study: Inflammation and Healing – Fracture and Swelling

JL, a 50-year-old woman, fell and broke the left tibia at the ankle. She is in the emergency department, waiting for the fracture to be immobilized. The leg hurts and she notes that the ankle is swelling. A diagnosis of a simple fracture and sprain (damage to ligaments) is made.

Question 1 What is the cause of pain and swelling? What can JL expect in the days to come as inflammation resolves and healing begins?

Question 2

What is the rationale for immobilizing the fractured bone?

Question 3

She is told to come back to the fracture clinic in 24 hours to have her cast checked. What could happen to the inflamed tissue if the edema increases in the casted area?

Question 4

She reports feeling fatigued and anorexic, and has a low-grade temperature. What is the cause of these symptoms?

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
• Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

USE APPRAISAL Assignment as a resource

Response # 1: Carefully read the initial posts made by the other students in your small group.

• Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented. Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers. Please Note: you may not duplicate a differential diagnosis posted by another peer in the discussion thread.

 Response of one peer

1. Evidence indicating the absence of an acute severe infection
2. One of the main evidences indicating that Anna does not have an acute severe infection is because of the normality of all her vital signs. This means that all symptoms that Anna is displaying and experiencing are within the normal range. If there was an infection, Anna would be experiencing wheezing, watery eyes, running nose, itchy eyes, and difficulty breathing. Therefore, there is no evidence that Anna has a severe infection.
3. Type of hypersensitivity action involved
4. Hay fever or allergic rhinitis is a common condition, often caused by exposure to pollen (Baghlaf & Eid, 2021). Therefore, individuals sensitive to pollen can experience immediate and sometimes severe effects or reactions. Therefore, if Anna has allergic rhinitis, the type of hypersensitivity action involved would be immediate hypersensitivity. The main reason is that during the examination, Anna states that she often gets colds whenever the fall and spring seasons arrive when flowers are sprouting and blooming. Hence, once the flowers release pollen and Anna gets exposed to the pollen, she reacts immediately, resulting in coughs.
5. Reasons why Anna’s symptoms did not start immediately
6. Anna has been living a normal life and never displayed symptoms of being allergic to cat dander. The main reason for the delay of symptoms is because Anna was probably at the symptom-free period. During this period, the body is exposed to the offending allergen and is determining how to react (Biermé et al., 2017). Besides, during this stage, the B lymphocytes were releasing a significant number of antibodies to fight the allergens, resulting in a delay in symptoms. Therefore, it is vital for Anna to get further tests to determine her level of sensitivity to cat dander and whether she might be allergic to other allergens that she might be aware of.
7. Class of antibodies that bind to mast cells
8. Antibodies help the body to fight and eliminate foreign matter that could potentially harm the body, affecting one’s health and wellness (Anvari et al., 2018). Immunoglobulin E is a class of antibodies that bind to mast cells, providing a safety barrier that protects the body and keeps it healthy. Oftentimes, Immunoglobulin E attaches themselves to receptors on the surface of blood basophils and mast cells. A unique feature of mast cells that have Immunoglobulin E on the surfaces is that all are sensitized. Moreover, the link between Immunoglobulin E and sensitized cells strengthens, causing a release of mediators that prevent allergic reactions from worsening and protect the body from harm.
9. Psychological mechanisms causing the redness of Anna’s nasal mucosa
10. Usually, allergens attach themselves to the useful and reliable immunoglobulin E antibodies, resulting in the degranulation and the release of inflammatory mediators (Biermé et al., 2017). In Anna’s case, it is likely that some mediators could have promoted the occurrence of vasodilation, resulting in the redness of Anna’s nasal mucosa. If this is the case, the best strategy for Anna would be avoiding the exposure and contact with cat dander to prevent further reaction because of the offending allergen. Alternatively, the physician can prescribe effective drugs like antihistamine drugs to reduce the redness of Anna’s nose and offer much-needed temporary relief.
11. Mechanisms that caused Anna’s clear postnasal drainage
12. One of the symptoms that Anna is displaying is a clear postnasal discharge. The discharge could be the result of the cold Anna experienced during spring and fall, meaning that the discharge can disappear on its own after the two seasons end. The increase of vasodilation and vascular permeabilities are other possible reasons or contributors of the clear postnasal discharge. Therefore, Anna can avoid cats, or the physician can administer drugs to stop the discharge and prevent further reactions to cat dander.
    References 
    Anvari, S., Miller, J., Yeh, C.-Y., & Davis, C. M. (2018). IgE-mediated food allergy. Clinical
    Reviews in Allergy & Immunology, 57(2), 244–260. https://doi.org/10.1007/s12016-018-8710-3
    Baghlaf, M. A., & Eid, N. M. S. (2021). Prevalence, risk factors, clinical manifestation,
    diagnosis aspects and nutrition therapy in relation to both IgE and IgG cow’s milk protein allergies among a population of Saudi Arabia: A literature review. Current Research in Nutrition and Food Science Journal, 9(2), 375–389. https://www.foodandnutritionjournal.org/volume9number2/prevalence-risk-factors-clinical-manifestation-diagnosis-aspects-and-nutrition-therapy-in-relation-to-both-ige-and-igg-cows-milk-protein-allergies-among-a-population-of-saudi-arabia-a-lit/
    Biermé, P., Nowak-Wegrzyn, A., & Caubet, J.-C. (2017). Non-IgE-mediated gastrointestinal
    food allergies. Current Opinion in Pediatrics, 29(6), 697–703. https://doi.org/10.1097/mop.0000000000000554
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Question 1 

The Human Genome Project is an international research project, funded by the U.S. Congress in 1988 and completed in 2003, that has mapped all of the approximately:

25,000 genes in the human DNA

2, 500 genes in the human DNA

32,000 genes in human DNA

15,000 genes in the human DNA

Question 2  

Among the Latino population in the United States, Latinos: (Select all that apply)

a. have a higher prevalence of diabetes than that of the general population

b. in migrant farmworker families have a lifestyle that makes it difficult to obtain proper nutrition, adhere to weight control measures, and procure continuity of health care and medication administration necessary for good diabetes control.

c. have higher rates of end-stage complications

d. have a record of better diabetes control that that of the general population

Question 3  

Depression and stress are areas of concern among adult migrants.  This may be related to: (Select all that apply)

Discussion Question:

A mother with a new set of female twins learns of a genetic test that can be done to determine if the children are carriers of the gene for breast cancer. She submits the sample to the company, receives the results in 2 weeks, and learns that one twin is at risk while the other is not. The mother takes this information to the infants’ pediatrician and asks for further testing on the child with the increased susceptibility and wants to know if preventative treatment can begin now. The mother also enters this information as patient-generated data which has created several red flags in the electronic record’s decision support system. The clinical staff are concerned since the patient with the risk for breast cancer is only weeks old.  Answer the following questions regarding this case:

1. How would you handle this situation from an ethical perspective?
2. How will the mother having this knowledge about the infants affect the way they will be treated developmentally, medically, socially, and economically?
3. Should there be restrictions on the age of individuals receiving genetic testing through companies of questionable reputation?

350 words

APA references