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NURS 6501 Module 1 Assignment: Case Study Analysis

Week 1: Cellular Processes and the Genetic Environment

One of the more common biology analogies refers to cells as the “building blocks” of life. This rightfully places an emphasis on understanding cells, cellular behavior, and the impact of the environment in which they function.

Such an understanding helps explain how healthy cell activity contributes to good health. Just as importantly, it helps explain how breakdowns in cellular behavior and alterations to cells lead to health issues.

This week, you examine cellular processes that are subject to alterations that can lead to disease. You evaluate the genetic environments within which these processes exist as well as the impact these environments have on disease.

Cellular Processes and the Genetic Environment Example

A disease process can be explained at molecular, cellular, histological, organ, and organ system levels. In this biological hierarchy, the cellular and molecular processes contribute significantly to the development of disease at the advanced macroscopic levels. The role of the immune system must be considered when describing disease processes because immunity is the custodian of biological wellness at the cellular level. This paper aims to describe the association between the cellular processes and the genetic environment in normal bio-physiological processes and their interactions with the immune system in disease states.

Cellular Processes and Alterations Within Cellular Processes

Most cells in the human body communicate, grow and multiply in a well-organized fashion to contribute to the proper functioning of the tissues, organs, and organ systems. Cells communicate with each other through molecules and second messenger molecules within the cells. This communication enables the cells to respond to noxious stimuli and initiate death when programmed. Additionally, this communication also enables the cells to maintain a balanced internal and external homeostasis and regulate their growth.

At the genetic level, these cells depend greatly on the master information and commands from the nucleic material from the nucleus and ribosomes to control cellular processes. How the cells react and normal and abnormal communication and growth depend on their genetic makeup. The role of mitochondria is vital in maintaining growth, metabolism, and cell death (Birsoy & Sancak, 2019). Cell division and energy production utilization require normal mitochondrial functioning

Impact of The Genetic Environment on Disease

Genetic and epigenetic processes within the cell control the cellular processes. The cellular nucleus transcribes genetic information into the DNA through replication, after which the ribosomes will use this information to make proteins for intracellular and intercellular communication, growth, and multiplication. Therefore, alteration in the processes of gene transcription, DNA translation, and protein synthesis can cause ineffective communication, uncontrolled growth and multiplication, or even cell death. This can be explained by the impact of gene mutations on cancers and autoimmune diseases (Kumar et al., 2021). These genetic alterations and mutations can arise from the external environment through chemicals that interfere with the gene patterns, leading to wrong communication and disordered growth.

Roles Genetics Plays in Disease Processes

Genetics plays an important role in the disease process because it will determine how the cell prepares for defense against disease or responds when these disease states occur. Faulty genetic sequences can be transcribed and translated to pathogenic proteins. The role of genetics in disease processes can be multifaceted in that genetic mutations, genetic susceptibility, and variations in genetic expressions can be implicated in various diseases. Ultimately, it all narrows down the gene transcription and translations to control communication growth and response to disease.

Cells and Disease

The basic units of life are the cells; thus, they are fundamental in disease states. At the cellular level, abnormalities in communications and signaling, disordered growth patterns, disruption of normal cellular metabolisms and respiration, and inadequate defense against noxious stimuli and damage are pathogenetic processes that lead to disease (McCance & Huether, 2019). The involvement of more cells leads to tissue pathology, which leads to organ damage and systemic disease when the damage advances. The central role in this cascade is attributed to the cells’ abilities to control and maintain their normal physiologic processes, as described earlier.

Altered Physiology

Derangements in the aforementioned processes lead to altered physiology. Cellular structure, gene expression, protein activity, and cell metabolism constitute the key physiological processes that maintain cellular and multisystem functioning (Birsoy & Sancak, 2019). Damage to cellular physical structure leads to poor communication and cellular response to the damage that constitutes the disease process. Faulty gene expression can lead to uncooled cell growth, as seen with cancers and benign neoplasms (Mbemi et al., 2020). Altered cell metabolisms lead to cell death through programmed (apoptosis) and non-programmed (necrosis) cell death deaths.

Alterations in the Immune System

When the immune cells fail to distinguish between the pathogen and host cells, it may attack the host cells, leading to autoimmune disorders. The immune system can also respond aggressively or inappropriately to harmless antigens, leading to inflammation such as those seen in allergic processes. During inflammation, bystander cells can be destroyed in this normal body response to noxious stimuli. Altered cellular physiology and genetics can lead to deficiency in mounting immune responses such as inflammation or communication through cytokines and cell surface molecules.

Racial Variables

Races and ethnicities determine a person’s way of life, including marriages and, thus, inheritance of genes. Therefore, bad or mutated genes can be passed from one generation to the next in cases of intra-ethnic marriages. Races and ethnicities also determine a person’s health behavior and beliefs about illness. This affects their health-seeking behaviors and disease perceptions, thus poor health choices and low literacy levels. A race can be situated in a unit geographical area exposed to similar environmental factors such as air and water pollution and radiation that affect their genetic information leading to various illnesses.

Impact of Patient Characteristics on Disorders

Patient characteristics that can impact disorders and physiology include but are not limited to race, age, sex, and weight. As people age, their body physiology deteriorates as they enter advanced elderly states (McCance & Huether, 2019). Slow response to external disease stimulus contributes to the advancement of some diseases. Sometimes, the sex determines the occurrence of some disorders due to variations in biochemical makeup and qualities between the male and female sexes. Obesity is a key determinant for various chronic illnesses, especially cardiovascular diseases.

Association of Genes in the Development of Disease

. The famous saying that genes load the gun but the lifestyle and environment pull the trigger justifies the role of genetics in disease processes. The genetic makeup of a person makes them genetically susceptible to some illnesses (Tukker et al., 2021). Familial illnesses such as sickle cell anemia, familial hypercholesterolemia, and Tay Sachs disease, among others, rely on genetic inheritance patterns that make the biological offspring of affected people more susceptible to these diseases.

Immunosuppression and Its Body Systems Impact

Reduction in the body’s immune system’s capacity to fight off pathogens results in various disease processes. Radiation, infections, and certain genetic expressions can cause immunosuppression. Immunosuppression leads to increased incidence and recurrence of infections, decreased capacity to prevent neoplastic changes, and delayed healing processes and tissues. The immune system plays a critical role in fighting off neoplastic cells such as melanoma, lymphoma, and other malignancies (Kumar et al., 2021). Opportunistic diseases rely on immune system suppression by HIV viruses.

Conclusion

This paper has covered a variety of topics, including the role of genetics in disease development, the impact of patient characteristics on disorders and altered physiology, and the process of immunosuppression and its effects on the body. The evaluation of cellular processes and alterations has also been discussed. Understanding the complex relationships between genetics, disease, and the immune system is important in understanding disease processes and interventions to prevent these diseases.

NURS 6501 Module 1 Assignment: Case Study Analysis References

Birsoy, K., & Sancak, Y. (2019). The role of metabolism in cellular processes. Molecular Biology of the Cell, 30(6), 733. https://doi.org/10.1091/mbc.E19-01-0004

Kumar, V., Abbas, A. K., & Aster, J. C. (2021). Robbins Basic Pathology (V. Kumar, A. K. Abbas, & J. C. Aster, Eds.; 10th ed.). Elsevier – Health Sciences Division.

Mbemi, A., Khanna, S., Njiki, S., Yedjou, C. G., & Tchounwou, P. B. (2020). Impact of gene-environment interactions on cancer development. International Journal of Environmental Research and Public Health, 17(21), 8089. https://doi.org/10.3390/ijerph17218089

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.

Tukker, A. M., Royal CD, Bowman, A. B., & McAllister, K. A. (2021). The Impact of Environmental Factors on Monogenic Mendelian Diseases. Toxicological Sciences?: An Official Journal of the Society of Toxicology, 181(1). https://doi.org/10.1093/toxsci/kfab022

Alterations in Cellular Processes Discussion Responses

Response 1

Hello. I agree with your discussion. It was a splendid analysis of the case study. I would add a few perspectives to your analysis. The fact that the patient has protein malnutrition is undeniable. In my view, his protein malnutrition could have arisen from different etiologies – some acquired while some causes could have a genetic component to them (McCance & Huether, 2018). Firstly, she has poor intake from lack of dentures leading to inadequate absorption of protein.

Secondly, she has a malabsorption syndrome that leads to poor absorption of proteins, thus protein malnutrition. This situation could have arisen from genetic conditions such as hereditary folate malabsorption, inflammatory bowel disease (IBS), and intestinal lymphangiectasia (Zuvarox & Belletieri, 2021). The genetic background of the patient’s clinical condition would result from the inheritable diseases in this patient’s list of possible etiologies.

References

McCance, K. L., & Heather, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby. https://shop.elsevier.com/books/pathophysiology/mccance/978-0-323-40281-1

Zuvarox, T., & Belletieri, C. (2021). Malabsorption Syndromes. In StatPearls [Internet]. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/31971746/

NURS 6501 Module 1 Assignment: Case Study Analysis Response 2

Hello. You have posted an elaborate discussion there. Alongside an anaphylactic reaction, the patient also had an underlying infectious process going on. His disease complication is iatrogenic and would be foreseen of food and drug allergies history would reveal the presence of penicillin allergies. Anaphylactic reactions, as you have mentioned, are type 1 hypersensitivity reactions. I agree that the pathophysiology of his presentation was based on an anaphylactic reaction leading to edema.

These symptoms would most likely be triggered by increased permeability in inflammatory reaction, causing fluid leakage into third spaces. Genetics would have a role in his pathogenetic process, and atopy best explains the role of genetics in his symptoms’ development (American Academy of Allergy, Asthma, and Immunology, 2020). An interplay between environmental, personal characteristics, and genetics would also be possible in pathophysiology (McCance & Huether, 2018). Infections are environmental in this case.

NURS 6501 Module 1 Assignment: Case Study Analysis References

American Academy of Allergy, Asthma, and Immunology. (2020, July 23). Too much of an allergy-related gene makes anaphylaxis worse. Aaaai.Org. https://www.aaaai.org/Tools-for-the-Public/Latest-Research-Summaries/The-Journal-of-Allergy-and-Clinical-Immunology/2020/gene

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby. https://shop.elsevier.com/books/pathophysiology/mccance/978-0-323-40281-1

Learning Resources

Required Readings (click to expand/reduce)

NURS 6501 Module 1 Assignment: Case Study Analysis

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (pp. 289–303; stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/

Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls

Required Media (click to expand/reduce)

Module 1 Overview with Dr. Tara Harris

Dr. Tara Harris reviews the structure of Module 1 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Discussion and Assignment. (4m)

Immunity and Inflammation

Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk

Note: The approximate length of the media program is 14 minutes.

Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds

Note: The approximate length of the media program is 37 minutes.

Acid-Base Balance #1

MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE

Note: The approximate length of the media program is 13 minutes.

Acid-Base Balance #2

MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI

Note: The approximate length of the media program is 15 minutes.

Hyponatremia

MedCram. (2017, December 23). Hyponatremia explained clearly (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M

Note: The approximate length of the media program is 15 minutes.

Online Media from?Pathophysiology: The Biologic Basis for Disease in Adults and Children

Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/store?role=student

To Register to View the Content

Go to https://evolve.elsevier.com/cs/store?role=student
Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
Complete the registration process.

To View the Content for This Text

Go to https://evolve.elsevier.com/
Click on Student Site.
Type in your username and password.
Click on the Login button.
Click on the plus sign icon for Resources on the left side of the screen.
Click on the name of the textbook for this course.
Expand the menu on the left to locate all the chapters.
Navigate to the desired content (checklists, videos, animations, etc.).

Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.

Discussion: Alterations in Cellular Processes

Photo Credit: Getty Images

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

By Day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.
Why the patient is presenting with the specific symptoms described.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics) would change your response.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

NURS 6501 Week 2: Altered Physiology

With a place squarely in the spotlight for patients diagnosed with all manner of disease, APRNs must demonstrate not only support and compassion, but expertise to guide patients’ understanding of diagnoses and treatment plans.

This expertise goes beyond an understanding of disease and sciences, such as cellular pathophysiology. APRNs must become experts in their patients, understanding their medical backgrounds, pertinent characteristics, and other variables that can be factors in their diagnoses and treatments.

This week, you examine alterations in the immune system and the resultant disease processes. You consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.

Learning Objectives

Students will:

Evaluate cellular processes and alterations within cellular processes
Analyze alterations in the immune system that result in disease processes
Identify racial/ethnic variables that may impact physiological functioning
Evaluate the impact of patient characteristics on disorders and altered physiology

Learning Resources

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review

Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.

?Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.
Note: This article was presented in the Week 1 resources. If you read it previously you are encouraged to review it this week.

Required Media (click to expand/reduce)

Immunity and Inflammation

Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk

Note: The approximate length of the media program is 14 minutes.

Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds

Note: The approximate length of the media program is 37 minutes.

Acid-Base Balance #1

MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE

Note: The approximate length of the media program is 13 minutes.

Acid-Base Balance #2

MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI

Note: The approximate length of the media program is 15 minutes.

Hyponatremia

MedCram. (2017, December 23). Hyponatremia explained clearly [LK1] (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M

Note: The approximate length of the media program is 15 minutes.

Online Media from?Pathophysiology: The Biologic Basis for Disease in Adults and Children

Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/store?role=student

To Register to View the Content

Go to https://evolve.elsevier.com/cs/store?role=student
Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
Complete the registration process.

To View the Content for This Text

Go to https://evolve.elsevier.com/
Click on Student Site.
Type in your username and password.
Click on the Login button.
Click on the plus sign icon for Resources on the left side of the screen.
Click on the name of the textbook for this course.
Expand the menu on the left to locate all the chapters.
Navigate to the desired content (checklists, videos, animations, etc.).

Case Study Analysis – Module 1 Assignment

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare for NURS 6501 Module 1 Assignment: Case Study Analysis:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.

By Day 7 of Week 2

Submit your Case Study Analysis Assignment by Day 7 of Week 2.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.

NURS 6501 Module 1 Assignment: Case Study Analysis Rubric Detail

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS 6501 Module 1 Case Study Assignment Rubric

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List View

Excellent
Good
Fair
Poor

Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:

Explain why you think the patient presented the symptoms described.

28 (28%) – 30 (30%)

The response accurately and thoroughly describes the patient symptoms.
The response includes accurate, clear, and detailed reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.

25 (25%) – 27 (27%)

The response describes the patient symptoms.
The response includes accurate reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.

23 (23%) – 24 (24%)

The response describes the patient s

they control the movement ofsubstances across the cell membrane. So that’s a ...

they control the movement of

substances across the cell membrane. So that’s a good thing. There’s a balance. That’s that check and balance. The problem is when

you have a negative. So there is too

much of something such as your thyroid

too much of or not enough of something else. So always those

checks and balances are important that you

check those

those are the three monthsof where everybody has a lot of family gatherings. So ...

those are the three months

of where everybody has a lot of family gatherings. So just be conscientious of

that when you try to measure. But do an A1C more

than once a year. The insurances

have it where they pay for those every three

to six months for a reason. It’s because insurance

industry is driven by evidence based quality practice of care. Standards of care

standards of care. I can’t say that enough. Recommended immunizations

adrenal disorders parathyroidism ...

adrenal disorders

parathyroidism

osteoarthritis of knees ...

osteoarthritis of knees

NURS 6501 Module 2 Assignment Case Study AnalysisNURS 6501 Module 2 Assignment C ...

NURS 6501 Module 2 Assignment Case Study Analysis

This week we will have another scenario to base our assignment on it is listed below:

A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations.

On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF).

Using the above mentioned scenario you are to complete a knowledge check. Per the instructions: You will complete a 10- to 20-question Knowledge Check to gauge your understanding of this module’s content.
This Knowledge Check will give you an opportunity to review a given scenario or situation to help you to determine cause and effect of a given disorder from a pathophysiology perspective. Please note that this is a formative practice for you to help you better prepare for your Midterm and Final Exams.

Please reach out if you have any questions.

NURS 6501 Week 2: Altered Physiology

Learning Objectives for NURS 6501 Module 2 Assignment Case Study Analysis

Students will:

Evaluate cellular processes and alterations within cellular processes
Analyze alterations in the immune system that result in disease processes
Identify racial/ethnic variables that may impact physiological functioning
Evaluate the impact of patient characteristics on disorders and altered physiology

Alterations Within Cellular Process Example Paper

A 16-year-old boy comes to the clinic with the chief complaint of a sore throat for three days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections, or pneumonia. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78, and regular respirations of 18. HEENT normal with the exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy.

Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg PO q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips and difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

In the aforementioned case study, the patient presented with acute pharyngitis. Pharyngitis refers to the inflammation of mucus membranes of the oropharynx. Manifestations of uncomplicated pharyngitis include fever, painful cervical adenopathy, tonsillar exudates, and pharyngeal erythema (Wolford et al., 2022). It is predominantly caused by viral or bacterial infectious processes. A positive rapid strep test, in his case, favors a bacterial etiology.

According to Wolford et al. (2022), Group A beta-hemolytic streptococci is the most common cause of bacterial acute pharyngitis and accounts for up to 36% of the cases. Subsequently, the boy has been prescribed antibiotics, principally amoxicillin which is recommended for bacterial eradication in patients with strep pharyngitis. Upon taking the first capsule, the patient develops an immediate hypersensitivity reaction.

Genetics

The patient in the case study above is allergic to penicillin. Type 1 hypersensitivity reactions include atopic diseases, which run in families. Drug hypersensitivity reactions can be allergic or non-allergic. However, these reactions usually occur as a result of cumulative interaction and interplay of various environmental and genetic factors.

For instance, more than half of children born in atopic families develop an allergic disease as opposed to one in five children with no family history of allergies (Amo et al., 2019). Additionally, various genes act diversely in different families to predispose to drug hypersensitivity reactions. For instance, the PHF11 gene on chromosome 13q14 has been linked consistently with drug hypersensitivity reactions.

Specific Symptoms, Why, and Physiologic Response

The patient presented with swelling of lips and tongue, difficulty breathing, and audible wheezing. Swelling of the lips and tongue are characteristics of allergic angioedema. According to Justiz Vaillant et al. (2022), allergic angioedema is a type 1 hypersensitivity reaction and can be triggered by foods such as nuts and medications such as penicillin.

In this scenario, the patient has an exaggerated immune response in response to amoxicillin. Severe angioedema may progress to anaphylaxis. The difficulty in breathing and audible wheezing are a result of histamine-mediated bronchoconstriction. If not treated, the patients usually develop anaphylactic shock, which is life-threatening and may lead to death.

Involved Cells and the Process

According to McCance and Huether (2019), type 1 hypersensitivity reactions are IgE- mediated and involve the release of large amounts of histamines and later leukotrienes by mast cells. Immune cells that are involved in this allergic reaction are T helper cells of types 1, 2, and 17. T helper 1 cells produce IL-2 and interferon-gamma and enhance a cell-mediated immune response, while T helper 2 cells produce IL-4 and IL-13, which enhance the production of antigen-specific-IgE.

Meanwhile, T helper 17 cells produce IL-17, IL-21, and IL-22. The drug is presented to these T cells via dendritic cells. Finally, the antigen binds to TCR receptors on the T cells and activates these immune cells (McCance & Huether, 2019).

Gender and other characteristics such as age, genetics, geography, and race influence the distribution of allergic diseases such as hypersensitivity reactions. For instance, most of these reactions are highly prevalent in childhood. In the United States, Puerto Ricans have the topmost prevalence, followed by blacks, whites, Asians, and ultimately Mexicans.

References

Amo, G., Martí, M., García-Menaya, J. M., Cordobés, C., Cornejo-García, J. A., Blanca-López, N., Canto, G., Doña, I., Blanca, M., Torres, M. J., Agúndez, J. A. G., & García-Martín, E. (2019). Identification of novel biomarkers for drug hypersensitivity after sequencing of the promoter area in 16 genes of the Vitamin D pathway and the high-affinity IgE receptor. Frontiers in Genetics, 10, 582. https://doi.org/10.3389/fgene.2019.00582

Justiz Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate hypersensitivity reactions. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513315/

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biological basis for disease in adults and children. Elsevier.

Wolford, R. W., Goyal, A., Syed, S. Y. B., & Schaefer, T. J. (2022). Pharyngitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519550/

NURS 6501 Module 2 Assignment Case Study Analysis Learning Resources

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction);Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review

Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.

Required Media (click to expand/reduce)

Immunity and Inflammation

Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk

Note: The approximate length of the media program is 14 minutes.

Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds

Note: The approximate length of the media program is 37 minutes.

Acid-Base Balance #1

MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE

Note: The approximate length of the media program is 13 minutes.

Acid-Base Balance #2

MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI

Note: The approximate length of the media program is 15 minutes.

Hyponatremia

MedCram. (2017, December 23). Hyponatremia explained clearly [LK1] (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M

Note: The approximate length of the media program is 15 minutes.

Online Media from?Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 3, 7, and 8 that relate to alterations in immunity, hyponatremia, and acid/base balance.

Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com

To Register to View the Content

Go to https://evolve.elsevier.com/
Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
Complete the registration process.

To View the Content for This Text

Go to https://evolve.elsevier.com/
Click on Student Site.
Type in your username and password.
Click on the Login button.
Click on the plus sign icon for Resources on the left side of the screen.
Click on the name of the textbook for this course.
Expand the menu on the left to locate all the chapters.
Navigate to the desired content (checklists, videos, animations, etc.).

Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.

NURS 6501 Week 4: Alterations in the Cardiovascular and Respiratory Systems

INTRODUCTION

Cardiovascular and respiratory disorders can quickly become dangerous healthcare matters, and they routinely land among the leading causes of hospital admissions. Disorders in these areas are complicated by the fact that these two systems work so closely as contributors to overall health. APRNs working to form a similarly close partnership with patients must demonstrate not only support and compassion, but expertise to guide the understanding of diagnoses and treatment plans. This includes an understanding of patient medical backgrounds, relevant characteristics, and other variables that can be factors in their diagnoses and treatments.

This week, you examine alterations in the cardiovascular and respiratory systems and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.

LEARNING OBJECTIVES

Students will:

Analyze processes related to cardiovascular and respiratory disorders
Analyze alterations in the cardiovascular and respiratory systems and the resultant disease processes
Analyze racial/ethnic variables that may impact physiological functioning
Evaluate the impact of patient characteristics on disorders and altered physiology

CASE STUDY ANALYSIS

An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.

The Assignment

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.
BY DAY 7 OF WEEK 4
Submit your Case Study Analysis Assignment by Day 7 of Week 4
Reminder:The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templatesLinks to an external site.). All papers submitted must use this formatting.

Week 4 Case Study Assignment

Adma Grace Wilson-Romans

All Sections

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Hello Class,

Week 4 Case Study Assignment:

A 55-year-old high school teacher begins experiencing a cough after a parent-teachers conference. Initially it was a mild cough and the teacher thought nothing of it since he had a history of asthma. As he was driving home, the cough became more intense, and he began experiencing chest tightness. He used his rescue inhaler as usual but did not get any relief. Minutes later he began experiencing chest pain, unlike the tightness that he experienced with his asthma.

He began to sweat profusely, experience light-headedness and difficulty breathing. He attempted to pull into a park but passed out and struck the curve causing his vehicle to come to a stop. A passerby saw the incident and called 9-1-1. On the scene, the paramedic found the man unconscious. His EKG revealed ST segment elevation in the anterior leads (V3 and V4), his pulse was shallow, and respirations were 10 breaths/min. Upon arrival to the ER, a troponin level was 13ng/l and his CK level was 265 U/L.

LEARNING RESOURCES

Required Readings

NURS 6501 Module 2 Assignment Case Study Analysis

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
- Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
- Chapter 35: Structure and Function of the Pulmonary System; Summary Review
- Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery hypertension); Summary Review

Note: The above chapters were first presented in the Week 3 resources. If you read them previously you are encouraged to review them this week.

Required Media

Alterations in the Cardiovascular and Respiratory Systems – Week 4 (15m) Transcript Attached

Online Media from?Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 32, 33, 35, and 36 that relate to cardiorespiratory systems and alteration in cardiorespiratory systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/Links to an external site.

NURS_6501_Module2_Case Study_Assignment_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following: Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms.

30 to >27.0 pts

Excellent

The response accurately and thoroughly describes the patient symptoms. … The response includes accurate, clear, and detailed reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation.

27 to >24.0 pts

Good

The response describes the patient symptoms. … The response includes accurate reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation.

24 to >22.0 pts

Fair

The response describes the patient symptoms in a manner that is vague or inaccurate. … The response includes reasons for the cardiovascular and/or cardiopulmonary pathophysiologic processes, with explanations that are vague or based on inappropriate evidence/research.

22 to >0 pts

Poor

The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. … The response does not include reasons for either the cardiovascular or cardiopulmonary pathophysiologic processes, or the explanations are vague or based on inappropriate or no evidence/research.

30 pts
This criterion is linked to a Learning Outcome Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

30 to >27.0 pts

Excellent

The response includes an accurate, complete, detailed, and specific explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

27 to >24.0 pts

Good

The response includes an accurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

24 to >22.0 pts

Fair

The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

22 to >0 pts

Poor

The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

30 pts
This criterion is linked to a Learning Outcome Explain any racial/ethnic variables that may impact physiological functioning.

25 to >22.0 pts

Excellent

The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.

22 to >19.0 pts

Good

The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.

19 to >17.0 pts

Fair

The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations based on inappropriate evidence/research.

17 to >0 pts

Poor

The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.

25 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment are vague or off topic.

2 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. … No purpose statement, introduction, or conclusion were provided.

5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

2 to >0 pts

Poor

Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent

Uses correct APA format with no errors.

4 to >3.0 pts

Good

Contains a few (1 or 2) APA format errors.

3 to >2.0 pts

Fair

Contains several (3 or 4) APA format errors.

2 to >0 pts

Poor

Contains many (? 5) APA format errors.

5 pts
Total Points: 100

PreviousNext

NURS 6501 Module 3: Knowledge Check Quiz

Question 14 pts

Scenario 1: Peptic Ulcer

A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain is described as burning, non-radiating, and worse after meals. Denies N&V, weight loss, or obvious bleeding. She admits to frequent belching with bloating.

PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,

Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain

Family Hx-non contributary

Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and has 6-7 cups of coffee per day. She denies illicit drug use, vaping, or unprotected sexual encounters.

A breath test in the office revealed + urease.

The healthcare provider suspects the client has peptic ulcer disease.

Questions:

Explain what contributed to the development of this patient’s history of PUD?

The patient’s peptic ulcer disease is most likely multifactorial. One of the confirmed risk factors in this patient is Helicobacter pylori infection. H. pylori infection has been confirmed by a positive breath test for urease. This gram-negative flagellated spiral bacterium is an established cause of peptic ulcer disease, among other illnesses such as acute and chronic gastritis. Another risk factor in the above patient is tobacco smoking. The patient has 35 packs per year of smoking, and this is a significant risk for PUD. Thirdly, the patient’s elderly age, above 64 years, is another risk for peptic ulcer disease.

The patient also takes alcohol, especially 1-2 glasses of wine daily, and this contributes to the development of PUD. The patient’s use of nonsteroidal anti-inflammatory drugs, especially ibuprofen, is a risk factor for PUD development in this patient. The patient’s coffee consumption cannot be associated with her PUD. According to a review article by Nehling (2022), there has been no substantial evidence linking coffee consumption or use of any caffeinated drinks with acid-related gastrointestinal diseases such as peptic ulcer disease

McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.

Nehlig, A. (2022). Effects of coffee on the Gastrointestinal tract: A narrative review and literature update. Nutrients, 14(2), 399. https://doi.org/10.3390/nu14020399

Question 24 pts

Scenario 1: Peptic Ulcer

PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,

Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain

Family Hx-non contributory

A breath test in the office revealed + urease.

The healthcare provider suspects the client has peptic ulcer disease.

Question:

What is the pathophysiology of PUD/ formation of peptic ulcers?

This patient’s peptic ulcer disease is multifactorial. The pathophysiology of PUD in the above patient was orchestrated by an imbalance between muco-protective and destructive factors. The above factors led to the weakening of muco-protective defense mechanisms in the stomach and duodenum. When these barriers are eroded by the aforementioned factors, the mucosa is exposed to gastric acid, which leads to PUD.

Muco-protective factors include gastric mucus, stable blood flow, intact epithelial cell lining, and prostaglandin production. Acids and toxins destroy these barriers. Helicobacter pylori release toxins that irritate the already defenseless mucosa to cause an inflammatory response. NSAIDs decrease prostaglandin production by inhibiting cyclooxygenase production.

Thus, the use of these medications increases acid production and decreases gastric mucus production. Stress such as physiological and psychological stress can increase acid production. All these factors lead to mucosa erosion. The outcome is epigastric pain, vomiting, nausea, hematemesis, and sometimes melena stool

McCance, K. L., & Huether, S. E. (2022

Assignment 3: NURS 6512 DCE Comprehensive Physical Assessment (Head-to-Toe)Throu ...

Assignment 3: NURS 6512 DCE Comprehensive Physical Assessment (Head-to-Toe)

Throughout this course, you were encouraged to practice conducting various physical assessments on multiple areas of the body, ranging from the head to the toes. Each of these assessments, however, was conducted independently of one another. For this DCE Assignment, you connect the knowledge and skills you gained from each individual assessment to perform a comprehensive head-to-toe physical examination in your Digital Clinical Experience.

To Prepare

Review this week’s Learning Resources, and download and review the Physical Examination Objective Data Checklist as well as the Student Checklists and Key Points documents related to neurologic system and mental status.
Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
Review the DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
Review the Week 9 DCE Comprehensive Physical Assessment Rubric provided in the Assignment submission area for details on completing the Assessment in Shadow Health.

Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric and video presentation in order to fully understand the requirements of this assignment.

DCE Comprehensive Physical Assessment:

Complete the following in Shadow Health:

Episodic/Focused Note for Comprehensive Physical Assessment of Tina Jones (180 minutes)

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 9 Day 7 deadline.

Submission and Grading Information

By Day 7 of Week 9

Complete your Comprehensive (Head-to-Toe) Physical Assessment DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
(Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.
Note: You must pass this assignment with a minimum score of 80% in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment.

Grading Criteria

To access your rubric:

Week 9 Assignment 3 DCE Rubric

NURS 6512 Digital Clinical ExperienceName:Type your narrative-style documentatio ...

NURS 6512 Digital Clinical Experience

Name:

Type your narrative-style documentation for each section of the assignment into the corresponding dialogue boxes below. When you are ready to submit your documentation, ‘Save As’ with this title format: “[LastName_FirstName] Shadow Health Documentation Template – Comprehensive – NURS 6512”

Comprehensive Assessment

Height: 170 cm Weight: 84 kg

BMI: 29 Blood Glucose Level: 100 Temperature: 99F

BP: 128/82 HR: 78

RR: 15

O2: 99%

Vitals

Health History

Miss Jones is a 28-year-old African American single female. She is presenting to the clinic for a pre-employment physical health exam. She is the chief and primary source of information and offers it freely and without any contradictions. Her speech is clear and coherent. She is able to engage and maintains eye contact all through the interview session.

Identifying Data

Ms. Jones is alert and oriented to time, place and person. She is seated comfortably and upright on the interview table and appears to be in no apparent distress. She is well-developed, well- nourished and her hygiene is appropriate.

General Survey

Ms. Jones is presenting to the clinic for a physical health exam required for her new employment. She states that: I came in because I’m required to have a recent physical exam for the health insurance at my new job.

Reason for Visit

Ms. Jones reports that she recently secured employment at Smith, Stevens, Stewart, Silver & Company. As such, she is required to obtain a pre-employment physical health exam prior to starting her job. Her last visit to the clinic was 4 months ago when she had sought her annual gynecological exam. During the visit, the gynecologist diagnosed her with PCOS (polycystic ovarian syndrome), for which the doctor prescribed oral contraceptives.

She reports that she is tolerating the oral contraceptives well. She has type 2 diabetes, which she has managed to control through diet, regular exercise and metformin medication. She reports having started taking the metformin medication 5 months ago. She reports no side effects associated with metformin use at the moment. She also has asthma, for which she uses Flovent inhaler for daily maintenance, and a rescue inhaler (Proventil), when needed. She reports to be in generally good health as she is taking better care of herself now as compared to the past. She is looking forward to starting her new job.

History of Present Illness

Flovent (Fluticasone propionate), 110 mcg, 2 puffs BID for asthma. Last use this morning.

Metformin 850 mg PO BID for diabetes, last use this morning. Drospirenone / ethinyl estradiol PO DQ for PCOS. Last use this morning.

Albuterol 90 mcg/ spray MDI 2 puffs Q4H prn or asthma. Last use three months ago.

Ibuprofen 600 mg PO TID prn for menstrual cramps. Last take six weeks ago.

Acetaminophen 500-1000mg PO prn for headaches.

Medications

Penicillin – symptoms include rash.

Cats and Dust – exposure to allergens results in runny nose, itchy eyes, and increased asthma symptoms.

She denies food or latex allergy.

Allergies

Asthma: Diagnosed at age two and half. Uses albuterol inhaler when around cats. Last asthma attack was six months ago. Which was resolved using the inhaler. Last hospitalized with asthma when in high school. Never been intubated.

Type 2 diabetes: Diagnosed at 24 years. Began metformin treatment 5 months ago. Reports initially having side effects that include gastrointestinal problems, which have since resolved. Uses a glucometer to take daily readings of her blood sugar level. Reports average blood sugar reading as 90.

History of hypertension, which has since normalized following her recent decision to exercise more and eat healthier meals. No history of surgeries.

OB/GYN: Menarche at 11 years. First sexual encounter at 18 years. Identifies as straight, sex with men only. No children. Never been pregnant. Last menstrual period was 2 weeks ago.

Diagnosed with polycystic ovarian syndrome 4 months ago.

Reports having regular menstrual cycle for the past four months, with moderate bleeding. Currently in a new relationship. Sexual contact not yet initiated. Never tested for HIV/AIDS. Last test for STIs was four years ago.

Medical History

Health Maintenance

Family Hx: Mother: Aged 50. Has high cholesterol and blood pressure. Father: Deceased at 58. Cause of death was car accident. Had a history of high blood pressure and cholesterol. Brother: Aged 27. Overweight. Sister: Aged 15. Healthy but asthmatic. Rarely gets asthma attacks. Maternal grandmother: Deceased at 73. Died of stroke. Had a history of high blood pressure and cholesterol. Maternal grandfather: Deceased at 80 of heart attack. Had a history of blood pressure and cholesterol issues. Paternal grandmother: Alive. Aged 82. Has high blood pressure and cholesterol. Paternal grandfather: Deceased of colon cancer. Had a history of high blood pressure and diabetes. No family history of other cancers, thyroid problems, sickle cell anemia, kidney disease or mental illness. Reports paternal uncle had a problem with alcoholism.

Social Hx: Never married. No children. Currently lives at home with the mother and younger sister. Plans to move out to a new apartment in about a month. Intends to begin her new job position at Smith, Stevens, Stewart, Silver, & Company. Has a strong support system of family members. Enjoys doing Bible studies, church community projects and volunteering. No history of tobacco use. No history of substance abuse. Uses alcohol about two to three times a month when out with friends. Reports taking no more than 3 drinks in one sitting. Typical breakfast comprises of fruit smoothie with unsweetened yoghurt. Typical lunch comprises vegetables with brown rice or sandwich on wheat bread on low-fat pita. Typical dinner is roasted vegetables and protein. Typical snack is carrot sticks or an apple. Denies coffee intake. Reports taking diet coke soda, 1 to 2 drinks per day. Participates in such exercises as walking, yoga or swimming, four to five times a week.

Family History

Reports last pap smear was 4 years ago. Last eye check-up was 3 months ago, corrective lenses recommended. Last dental exam was 5 months ago.

Immunizations: Received tetanus booster. Influenza vaccination not up to date. Never received HPV vaccine. She reports that she believes she is up to date with all childhood vaccines. Received meningococcal vaccine in college, at age 19.

Safety: Has smoke detectors installed at home. Uses sunscreen when taking a walk outdoors. Usually takes a cab after a night out. Always wears seatbelt when in an automobile.

N/A

Social History

Reports reduced stress levels. Improved sleep of 8 to 9 hours per night. Reports feeling really good these days. No stress or anxiety. She is alert and oriented to place, person and time. Well groomed. Able to converse freely and is cooperative. She is in a pleasant mood. Her speech is fluent with clear words.

Mental Health History

General: No frequent illnesses. No chills, fever, fatigue or night sweats. Reports having recently lost 10 pounds of weight due to diet changes and exercise.

Review of Systems – General

Objective

HEENT: Head: Normocephalic and atraumatic. Bilateral eyes with equal hair distribution on lashes and eyebrows. No lesions, ptosis or edema. Eyes: Pink conjunctiva, white sclera, no lesions. EOM intact bilaterally. PERRLA bilaterally. No nystagmus. Right eye with mild retinopathic changes. Left fundus with sharp disc margins. No hemorrhage. Snellen: Right and left eye 20/20 with corrective lenses. Ears. Bilaterally intact and pearly gray TMS, positive reflex to light. Whispered words heard bilaterally. Nose: Non-tender frontal and maxillary sinuses on palpation. Nasal mucosa is moist and pink. Septum is midline. Mouth: Oral mucosa with no ulcerations, or lesions. Midline uvula on phonation. Intact gag reflex. Dentition with no carries or infection. Throat: Bilateral tonsils, 2+. Smooth thyroid no nodules present. No goiter. No lymphadenopathy.

Respiratory: Symmetric chest with respiration. Chest bilaterally clear on auscultation. No cough or wheeze. Chest is resonant throughout on percussion. In office spirometry: FVC – 1,78 L FEV1 – 1.549 L.

Cardiovascular: Regular heart rate. S1, S2 present without murmurs, gallops or rubs. Left and right carotids bilaterally equal with no bruits. PMI at the midclavicular line, 5th intercostal space. No heaves, thrills or lifts. Peripheral pulses are equal bilaterally. Capillary refill is less than 3 seconds in all extremities. No peripheral edema.

Abdominal: Abdomen is protuberant and symmetric. No visible masses, scars or lesions. Excessive hair growth on the pubis to umbilicus region. All quadrants with normoactive bowel sounds. Abdomen is tympanic all through. Palpation reveals no tenderness or guarding. No CVA tenderness.

Musculoskeletal: Bilateral upper and lower extremities with strength of 5/5. No swelling, masses or deformity noted. Full range of motion. No pain on movement.

Neurological: Graphesthesia and stereognosis results normal. Bilaterally normal rapid alternating movements. Cerebellar function test is normal. DTRs 2+, bilaterally equal in all extremities. Plantar surfaces with decreased nanofilament sensation.

Skin, Hair & Nails: Face with scattered pustules. Facial hair present on upper lip. Posterior neck with Acanthosis nigricans.

L. C. ...

L. C.