NR507 Advanced Pathophysiology
Week 2 Discussion
Purpose
The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Explain the pathophysiology of heart failure by analyzing a patient's symptoms. (CO1)
Differentiate between systolic and diastolic heart failure. (CO1)
Explain the significance of physical exam and diagnostic findings in the diagnosis of heart failure. (CO4)
Requirements:
Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
Respond to at least one peer and all faculty questions directed at you, using appropriate resources, before Sun., 11:59 pm MT.
Case Scenario:
A 72-year-old male presents to the primary care office with shortness of breath, leg swelling, and fatigue. He reports that he stopped engaging in his daily walk with friends three weeks ago because of shortness of breath that became worse with activity. He decided to come to the office today because he is now propping up on at least 3 pillows at night to sleep. He tells the NP that he sometimes sleeps better in his recliner chair. PMH includes hypertension, hyperlipidemia and Type 2 diabetes.
Physical Exam:
BP 106/74 mmHg, Heart rate 110 beats per minute (bpm)
HEENT: Unremarkable
Lungs: Fine inspiratory crackles bilateral bases
Cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd heart sound; jugular venous distention. Bilateral pretibial and ankle 2+pitting edema noted
ECG: Sinus rhythm at 110 bpm
Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection fraction of 25%
Diagnosis: Heart failure, secondary to silent MI
Discussion Questions:
Differentiate between systolic and diastolic heart failure.
State whether the patient is in systolic or diastolic heart failure.
Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea.
Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%.
NR507 Advanced Pathophysiology
Week 5 Discussion
Purpose
The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Compare and contrast the pathophysiology of diverticular disease (diverticulosis) and acute diverticulitis. (CO1)
Identify risk factors for acute diverticulitis and the clinical signs and symptoms associated with the disease. (CO3)
Explain the significance of physical exam and diagnostic findings in the diagnosis of heart failure. (CO4)
Requirements:
Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
Respond to at least one peer and all faculty questions directed at you, using appropriate resources, before Sun., 11:59 pm MT.
Case Scenario:
An 84-?year-old?-female who has a history of diverticular disease presents to the clinic with left lower quadrant (LLQ) pain of the abdomen that?is accompanied?by with constipation, nausea, vomiting and a?low-grade?fever (100.20?F) for 1 day.
On physical exam the patient appears unwell. She has signs of dehydration (pale mucosa, poor skin turgor with mild hypotension [90/60 mm Hg] and tachycardia [101 bpm]). The remainder of her exam is normal except for her abdomen where the NP notes a distended, round contour. Bowel sounds a faint and very hypoactive. She is tender to light palpation of the LLQ but without rebound tenderness. There is hyper-resonance of her abdomen to percussion.??
The following diagnostics reveal:??
Stool for occult blood is positive.
Flat plate abdominal x-ray demonstrates a bowel-gas pattern consistent with an ileus.?
Abdominal CT scan with contrast shows no evidence of a mass or abscess. Small bowel in distended.?
Based on the clinical presentation, physical exam and diagnostic findings, the patient is diagnosed with acute diverticulitis and she is admitted to the hospital. She is prescribed intravenous antibiotics and fluids (IVF). Her symptoms improved and she could tolerate a regular diet before she was discharged to home. ??
Discussion Questions:
Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.
Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis. ?
List 3 risk factors for acute diverticulitis.
Discuss why antibiotics and IV fluids are indicated in this case.
NR507 Advanced Pathophysiology
Week 7 Discussion
Purpose
The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Compares and contrasts the pathophysiology between Alzheimer's disease and frontotemporal dementia. (CO1)
Identifies the clinical findings from the case that supports a diagnosis of Alzheimer's disease. (CO3)
Explain one hypothesis that explains the development of Alzheimer's disease (CO3)
Discuss the patient's likely stage of Alzheimer's disease (CO4)
Requirements
Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
Respond to at least one peer and all faculty questions directed at you, using appropriate resources, before Sun., 11:59 pm MT.
Case Scenario
A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.
His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.
Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression
Allergies: No known allergies
Medications: None
Family History
Father deceased at age 78 of decline related to Alzheimer's disease
Mother deceased at age 80 of natural causes?
No siblings
Social History
Denies smoking
Denies alcohol or recreational drug use?
Retired lawyer
Hobby: Golf at least twice a week
Review of Systems
Constitutional: Denies fatigue or insomnia
HEENT: Denies nasal congestion, rhinorrhea or sore throat.??
Chest: Denies dyspnea or coughing
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
Musculoskeletal: denies falls or loss of balance; denies joint point or swelling
General Physical Exam??
Constitutional: Alert, angry but cooperative
Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
Wt. 178?lbs., Ht.?6'0", BMI 24.1
HEENT
Head normocephalic; Pupils equal and reactive to light bilaterally; EOM's intact
Neck/Lymph Nodes
No abnormalities noted ?
Lungs?
Bilateral breath sounds clear throughout lung fields.
Heart?
S1 and S2 regular rate and rhythm, no rubs or murmurs.?
Integumentary System?
Warm, dry and intact. Nail beds pink without clubbing. ?
Neurological
Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia
Diagnostics
Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
MRI: hippocampal atrophy
Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer's type dementia.
Discussion Questions
Compare and contrast the pathophysiology between Alzheimer's disease and frontotemporal dementia.
Identify the clinical findings from the case that supports a diagnosis of Alzheimer's disease. ?
Explain one hypothesis that explains the development of Alzheimer's disease
Discuss the patient's likely stage of Alzheimer's disease.
NR507 Advanced Pathophysiology
Week 1 Assignment
Purpose
The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with Allergic Rhinitis. Students will examine all aspects of the patient's assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Analyze the case to arrive at the type of hypersensitivity reaction that the patient is exhibiting. (CO1)
Explain the pathophysiology of the identified hypersensitivity reaction. (CO1)
Identify all subjective and objective information provided in the case. (CO3)
Explain, using pathophysiology, the rationale for each subjective and objective finding. (CO1, CO3)
Identify two types of medications that are strongly recommended for the treatment of allergic rhinitis according to the clinical practice guidelines on the management of allergic rhinitis. (CO2, CO5)
Explain the mechanism of action of the two medication classifications and include how the symptoms of allergic rhinitis are alleviated when taken. (CO2, CO5)
Requirements:
Content Criteria:
Read the case study listed below.
Refer to the rubric for grading requirements.
Utilizing the Week 1 Case Study Template (Links to an external site.), provide your responses to the case study questions listed below.
You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
You must use the Clinical Practice Guideline (CPG) for the management of allergic rhinitis to answer the treatment recommendation questions. The guideline can be found at the following web address: https://journals.sagepub.com/doi/10.1177/0194599814561600 (Links to an external site.) .You may also use a medication administration reference such as Epocrates to provide medication names.
Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.
Case Study Scenario
A 35-year-old woman presents to the primary care office with a history of nasal congestion that has worsened over time and recurrent sinus infections. She considered herself healthy until about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness that "seems to never go away". She noticed that her rhinorrhea greatly improved when she attended her family reunion on a two-week Caribbean cruise but returned after being home a few days. She lives with her husband and 5- year-old child. They have two household pets: a dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago. Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema, allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and inflamed nares.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
Identify the correct hypersensitivity reaction.
Explain the pathophysiology associated with the chosen hypersensitivity reaction.
Identify at least three subjective findings from the case.
Identify at least three objective findings from the case.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each.
Describe the mechanism of action for each of the medication classes identified above.
Identify two treatment options that are NOT recommended (I.e., recommended against).
NR507 Advanced Pathophysiology
Week 3 Assignment
Purpose
The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with respiratory disease. . Students will examine all aspects of the patient's assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Examine the case scenario and analyze the spirometry results to determine the most likely respiratory diagnosis. (CO1)
Explain the pathophysiology of the respiratory disease. (CO1)
Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)
Apply evidence-based practice guidelines to classify the severity of the respiratory disorder and employ an appropriate treatment plan. (CO1, CO5)
Requirements:
Content Criteria:
Read the case study listed below.
Refer to the rubric for grading requirements.
Utilizing the Week 3 Case Study Template (Links to an external site.), provide your responses to the case study questions listed below.
You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
You must use the current Clinical Practice Guideline (CPG) for the management and prevention of COPD (GOLD Criteria) to answer the classification of severity and treatment recommendation questions. The most current guideline may be found at the following web address: https://goldcopd.org/ (Links to an external site.). At the website, locate the current year’s CPG and download a personal copy for use. You may also use a medication administration reference such as Epocrates to provide medication names.
Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.
Case Study Scenario
Chief Complaint
A.C., is a 61-year old male with complaints of shortness of breath.
History of Present Illness
A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for which he did not seek care. He was evaluated by cardiology and underwent a successful and uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Prior to today, his last visit with your practice was 3 years ago when he was seen for acute bronchitis and smoking cessation counseling.
Past Medical History?
Hypertension?
Hyperlipidemia?
Atherosclerotic coronary artery disease
Smoker
Family History
Father deceased of acute coronary syndrome at age 65
Mother deceased of breast cancer at age 58.?
One?sister, alive, who is a 5 year breast cancer survivor.
One son and one daughter with no significant medical history.?
Social History
35 pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiac intervention.?
Denies alcohol or recreational drug use?
Real estate agent??
Allergies
No Known Drug Allergies?
Medications
Rosuvastatin?20 mg?once daily by mouth?
Carvedilol 25 mg twice daily by mouth
Hydrochlorothiazide 12.5 mg once daily?by mouth
Aspirin 81mg daily by mouth
Review of Systems
Constitutional: Denies fever, chills or weight loss. + Fatigue.
HEENT: Denies nasal congestion, rhinorrhea or sore throat.??
Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in the AM.
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
General Physical Exam??
Constitutional: Alert and oriented male in no apparent distress.??
Vital Signs:?BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93%?
Wt. 180?lbs.,?Ht.?5'9"
HEENT?
Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.?
Ears: Tympanic membranes intact.?
Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.?
Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting.?Oral mucous membranes dry.?
Neck/Lymph Nodes?
Neck supple without JVD.?
No lymphadenopathy, masses or carotid bruits.?
Lungs?
Bilateral breath sounds clear throughout lung fields. + Bilaterally wheezes noted with forced exhalation along with a prolonged expiratory phase. No intercostal retractions.
Heart?
S1 and S2 regular rate and rhythm, no rubs or murmurs.?
Integumentary System?
Skin cool, pale and dry. Nail beds pink without clubbing. ?
Chest?X-Ray?
Lungs are hyper-inflated bilaterally with?a flattened?diaphragm. No effusions or?infiltrates.
Spirometry
|
|
Predicted
|
Pre-bronchodilator
|
% Predicted
|
Post-bronchodilator
|
% Predicted
|
Change
|
|
FVC (L)
|
5.64
|
5.23
|
93
|
5.77
|
102
|
9%
|
|
FEV1 (L)
|
4.57
|
2.92
|
64
|
3.01
|
66
|
2%
|
|
FEV1/FVC (%)
|
81
|
56
|
69
|
52
|
64
|
-5%
|
|
TLC
|
5.5
|
6.9
|
125
|
6.9
|
125
|
0%
|
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?
Explain the pathophysiology associated with the chosen pulmonary disease.
Identify at least three subjective findings from the case which support the chosen diagnosis.
Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
Classify the patient's disease severity. Is this considered stable or unstable?
Identify two (2) "Evidence A" recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
Describe the mechanism of action for each of the medication classes identified above.
Identify two (2) "Evidence A" recommended non-pharmacological treatment options for this patient.
NR507 Advanced Pathophysiology
Week 6 Assignment
Purpose
The purpose of this assignment is to apply endocrine pathophysiological concepts to explain assessment findings of a patient with Diabetes. Students will examine all aspects of the patient's assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Examine the case scenario and analyze the exam and lab findings results to determine the patient's type of diabetes. (CO1)
Explain the pathophysiology of the type of diabetes. (CO1)
Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)
Apply evidence-based practice guidelines to develop an appropriate treatment plan. (CO1, CO5)
Due Date: Sunday by 11:59 PM MT of Week 6
Total Points Possible: 100
Requirements:
Content Criteria:
Read the case study listed below.
Refer to the rubric for grading requirements.
Utilizing the Week 6 Case Study Template (Links to an external site.), provide your responses to the case study questions listed below.
You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
You must use the current Clinical Practice Guideline (CPG) for the Standards of Medical Care in Diabetes -Abridged for Primary Care Providers provided by the American Diabetes Association to determine the patient's type of diabetes and answer the treatment recommendation questions. The most current guideline can be found at the following web address: https://professional.diabetes.org/content-page/practice-guidelines-resources (Links to an external site.). At the website, locate the current year’s CPG for use.
Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.
Case Study Scenario
Chief Complaint
J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.
History of Present Illness
J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.
Past Medical History?
Hypertension
Hyperlipidemia
Obesity
Family History
Both parents deceased
Brother: Type 2 diabetes?
Social History
Denies?smoking
Denies alcohol or recreational drug use
Landscaper??
Allergies
No Known Drug Allergies?
Medications
Lisinopril 20 mg once daily by mouth
Atorvastatin 20 mg once daily by mouth
Aspirin 81 mg once daily by mouth
Multivitamin once daily by mouth
Review of Systems
Constitutional: - fever, - chills, - weight loss.
Neurological: denies dizziness or disorientation
HEENT: Denies nasal congestion, rhinorrhea or sore throat.??
Chest: + Tachypnea. Denies cough.
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
General Physical Exam??
Constitutional: Alert and oriented male in no acute distress ??
Vital Signs:?BP-136/80, T-98.6 F, P-78, RR-20
Wt. 240?lbs.,?Ht.?5'8", BMI 36.5
HEENT?
Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.?
Ears: Tympanic membranes intact.?
Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.?
Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.?
Neck/Lymph Nodes?
Neck supple without JVD.?
No lymphadenopathy, masses or carotid bruits.?
Lungs?
Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart?
S1 and S2 regular rate and rhythm; tachycardia; no rubs or murmurs.?
Integumentary System?
Skin warm, dry; Nail beds pink without clubbing. ?
Labs
|
Test
|
Patient’s Result
|
Reference
|
|
Glucose (fasting)
|
132
|
60-120 mg/dL
|
|
BUN
|
20
|
7-24 mg/dL
|
|
Creatinine
|
0.8
|
0.7-1.4 mg/dL
|
|
Sodium
|
141
|
135-145 mEq/L
|
|
Potassium
|
3.7
|
3.5-5.0 mEq/L
|
|
Chloride
|
97
|
95-105 mEq/L
|
|
HCO3
|
24
|
22-28 mEq/L
|
|
A1C
|
7.2
|
|
|
Urinalysis
Protein
Glucose
Ketones
|
Negative
Positive
Negative
|
|
|
Oral glucose tolerance test (OGTT)
|
220 mg/dL
|
|
J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
Explain the pathophysiology associated with your chosen diagnosis
Identify at least three subjective findings from the case which support the chosen diagnosis.
Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
Identify two (2) "Evidence A" recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
Describe the mechanism of action for each of the medication classes identified above.
Identify two (2) "Evidence A" recommended non-pharmacological treatment options for this patient.
Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations
