SU NSG5003 All Weeks Discussions Latest 2019 April Question # 00600110 Course Code : NSG5003 Subject: Health Care Due on: 04/06/2019 Posted On: 04/06/2019 04:55 AM Tutorials: 1 Rating: 4.9/5

NSG5003 Advanced Pathophysiology

Week 1 Discussion

Myocardial
Infarction

Mr. Smith,
a 60 year-old man with coronary heart disease, experienced frequent bouts of
angina pectoris. One day while moving a piece of heavy furniture, he
experienced excruciating pain over his left chest. He began sweating heavily,
became short of breath, and then collapsed. He was transferred to the emergency
room at a nearby hospital. Mr. Smith’s EKG was diagnostic of myocardial
infarction. A coronary angiography was performed and an occlusion was found in
a in the descending branch of the left coronary artery. Intravenous drugs were
administered to dissolve the clot that was causing the obstruction. His
cardiologist informed him that some of his heart muscle had died as a result of
the myocardial infarction.

Discussion
Questions:

1. Discuss
the risk factors for a myocardial infarction.

2. As per
your analysis, what type of cell injury did Mr. Smith sustain and why?

3.
Differentiate between reversible and non-reversible cell injury.

4. Discuss
the pathophysiological changes that occur during a myocardial infarction.

5.
Correlate the subjective and objective findings of a myocardial infarction with
the disease

NSG5003 Advanced Pathophysiology

Week 2 Discussion

Alterations
in Immunity

Janet, a 20
year-old college student, is experiencing a five-week history of itchy eyes and
nasal congestion with watery nasal discharge. She also complains of a
“tickling” cough, especially at night, and she has had episodes of repetitive
sneezing. Janet gets frequent “colds” every spring and fall.

Physical
Examination

Vital
Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18

Skin:
Flaking erythematous rash on the flexor surfaces of both arms

Head, Eyes,
Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly
swollen with frequent tearing; outer nares with red, irritated skin; internal
nares with red, boggy, moist mucosa and one medium-sized polyp on each side;
pharynx slightly erythematous, with clear postnasal drainage

Lungs:
Clear to auscultation and percussion

Discussion
Questions:

1. Provide
three differential diagnoses based on Janet’s subjective and objective data and
discuss your reasoning for each.

2. What
additional history questions would be useful in your evaluation of Janet?

3. Discuss
the pathophysiological process of your primary diagnosis.

4.
Differentiate the types of hypersensitivity mechanisms.

5. As per
your analysis, what type of hypersensitivity reaction is Janet experiencing?

NSG5003 Advanced Pathophysiology

Week 3 Discussion

Cancer,
Genetics, and Genomics

Rachel
comes from a family with a history of breast cancer on her mother’s side.
Rachel’s mother died of breast cancer when she was very young. Rachel has two
sisters, Lisa and Kristin. Rachel has remained close to Lisa, but she no longer
has a relationship with Kristin. At a routine checkup, Rachel is told about the
availability of genetic testing for identifying a predisposition to breast
cancer. Her doctor recommends the test to Rachel given her family history.
Rachel has the genetic testing done and finds that she has a mutated breast
cancer 1, early onset (BRCA1) gene. Her doctor tells her she is at high risk
for developing breast and ovarian cancer. Rachel’s doctor suggests she ask her
sisters to be tested also, so they can take the proper preventative measures.
Rachel feels comfortable sharing this information with Lisa, but she has not
spoken to Kristin in many years. Rachel tells her doctor that she is not in
contact with Kristin and will not make an effort to tell her about BRCA1 and
genetic testing. Rachel’s doctor feels confident that she can locate Kristin
but worries about breaching patient confidentiality if she goes against
Rachel’s wishes.

If you were
Rachel’s healthcare provider, what would you do? Provide a rationale for your
response. Include the pathological processes associated with breast cancer.
What role does the BRCA1 gene contribute to managing the patient’s care?
Describe and explain the role of the BRCA1 and breast cancer 2, early onset
(BRCA2) gene in contribution as a risk factor for breast cancer. Analyze the
risk factors for breast cancer and possible interventions to preventive health
management for women and men.

NSG5003 Advanced Pathophysiology

Week 4 Discussion

Cardiovascular
Case Study

John is a
76-year-old man with a long history of stable angina and hypertension. He is
prescribed nitroglycerin tablets as needed for chest pain and lisinopril for
his hypertension. John has noticed that his chest pain is occurring with
increasing frequency and less activity is required to initiate the symptoms;
however, the pain subsides quickly with rest and one or two nitroglycerin
tablets.

John is
awakened from sleep with chest pain and shortness of breath. The pain is much
more severe than his usual anginal pain and radiates to the jaw and the left
arm. He experienced some nausea and became diaphoretic and pale. Upon admission
to the local emergency department, he was noted to have significant ST-segment
elevation on a 12-lead electrocardiogram (ECG).

Discussion
Questions:

1. What
diagnosis is consistent with John’s history and physical exam?

2. Please
differentiate between a STEMI and Non-STEMI.

3. What are
the pathophysiological findings specifying an MI?

4.What are
the differences between angina, silent ischemia, and myocardial ischemia?

5.Provide a
description of the three factors associated with Sudden Cardiac Death.

6.What are
the possible complications post-MI might the NP be aware of when caring for
John?

NSG5003 Advanced Pathophysiology

Week 5 Discussion

Emphysema

Charlene is
a 55-year-old female who has had emphysema problems for many years. She has a
20-year history of tobacco use. Today, Charlene was seen in the clinic due
today increased shortness of breath and non-productive cough over the past
three days. She has an SaO2 of 90% with most recent pulmonary function test
findings indicating the following: FVC- 70% FEV1-69% FEV1/FVC ratio-69%.

Discussion
Questions:

1. What
physical findings might be indicative of a patient with emphysema?

2. What is
the purpose and interpretations of the pulmonary function test?

3. What are
the pathophysiological findings specifying emphysema?

4. What are
the three functions of the respiratory center located in the brain stem?

5. Please
provide a description of the oxyhemoglobin dissociation curve?

6. What are
the pathophysiological findings specifying bronchitis?

NSG5003 Advanced Pathophysiology

Week 6 Discussion

Hematological
Case Study

Sarah is in
today with a chief complaint of feelings of fatigue, pallor, dyspnea on
exertion, and palpitations. Her laboratory report indicates that her
hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high;
and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.

Answer the
following questions regarding Sarah’s anemia and provide the pathophysiology
associated with the body’s response to this disease process.

1. What are
the laboratory tests to be ordered in patients suspected of anemia?

2. What are
the clinical manifestations noted in a patient with pernicious anemia?

3. What
nonpharmacological therapies are associated with the treatment of pernicious
anemia?

4. What the
lab findings indicative iron deficiency anemia?

5. Please
share possible complications of untreated pernicious anemia.

6. What is
the purpose of the Schilling test?

NSG5003 Advanced Pathophysiology

Week 7 Discussion

Digestive
System Case Study

DC comes to
the emergency room complaining of acute abdominal pain. She states the pain
came after dinner at an all-you-can-eat buffet and has been increasing
steadily. The pain is located in her right upper quadrant and is “boring” into
her back. She says she feels “gassy” and bloated.

What are
your differential diagnoses? Include the pathological process involved with
your diagnosis. What tests would you order to confirm your diagnosis?

What
treatments or interventions would be the first line of protocol for your
diagnosis?

NSG5003 Advanced Pathophysiology

Week 8 Discussion

Overview of
the Mechanisms of Kidney Function

Ms.
Cornwall is admitted with pyelonephritis. She has chills, and her temperature
is 101°F. She is complaining of flank pain, frequency, and dysuria. Her urine
has white blood cell casts and shows growth of Escherichia coli (E. coli).

Based on
the above scenario, answer the following questions:

Why does
she have bacteria and white blood cell casts in her urine? Include the
pathophysiological response of body for your analysis.

What are
the differences when comparing prerenal acute renal injury, intrarenal acute
renal injury, and postrenal acute renal injury? Give examples of each and
pathological processes related to each disease process.

NSG5003 Advanced Pathophysiology

Week 9 Discussion

Neurological
System Case Study – #1

Mrs. Smith
is an 85 year female with a history of Hypertension, diabetes and osteoarthritis.
Her daughter who cares for her reports that she became suddenly confused
beginning last night. She knows her daughter but has been unable to remember
her grandchildren’s names. She continuously asks her daughter “What are those
kids doing in our house?” .Her mother was in and out of bed all night and slept
very little. Her daughter does say that her mother seemed better this morning,
but on the way to your office she became more confused again. Review of systems
is significant for a dry cough for the past few days. She has not had a fever.
Her appetite has been poor. Her exam is normal except for some fine crackles in
her left lung base. Mrs. Smith’s daughter says” My dad had Alzheimer’s and now
it looks like I am going to have to go through that with my mother”

1) What are
the possibilities for change in Mrs. Smith’s current mental status?

2) What is
your top differential diagnosis? Give 3 reasons why you chose that diagnosis.

3) How can
you differentiate depression, dementia and delirium?

4) Explain
to Mrs. Smith’s daughter what treatment is needed and what you think her
prognosis is.

Neurological
System Case Study – #2

A 40 year
old male comes to see you for follow up. He states that he had a seizure at
home yesterday and was taken to the emergency room. He is accompanied by his
wife who witnessed the seizure. He states he has never had a seizure in the
past.

Discussion
Questions:

1) What
would you ask him and his wife regarding the seizures, and why?

2) What
would be the most important parts of a physical exam in this patient and why?

3) What lab
or radiology tests would you want to do and why? He tells you he has no
insurance so be sure to defend the importance of a particular test.

NSG5003 Advanced Pathophysiology

Week 10 Discussion

Diabetes

1) Describe
the 3 types of diabetes Insipidus.

2) What lab
values would you expect to see with each type?

3) Describe
the causes/potential causes of each type and how the treatment varies between
the 3 types and why

4) What
would indicate a “red flag “symptom in any of them and require urgent treatment

Case Study:

A 30 yr.
old female comes to see you for complaints of fatigue. She is 8 months
post-partum and delivered a healthy baby. She thought her fatigue was initially
due to post-partum, but states that the fatigue is worsening. She is also
bothered by some weight gain over the past few months.

1) What
else would you want to ask in her review of systems?

2) What
specifics would you look for on physical exam?

3) How
would you explain to her the most likely cause of her symptoms and why this is
happening?

Case Study:

A 55 year
old obese male (BMI 33.1) comes to see you with complaints of weight gain and
fatigue. His history is significant for hypertension and hyperlipidemia. These
are controlled with medications. You check a random fasting blood sugar in the
office and it is 150 fasting. His point of care HgBA1C is 6.6

1) Explain
how his obesity contributes to the beta cell dysfunction seen with Type 2 DM

2) Explain
how GLP 1 receptor agonists improve glucose control in the diabetic patient.

3) What are
the pros can cons of dipeptidyl peptidase IV (DPP-IV) inhibitors versus GLP 1
receptor