NU606 Advanced Pathophysiology
Week 1 Discussion
Icebreaker Activity
Please introduce yourself to the class. Instead of just the normal "where you live, number of children and pets you have," let’s make this fun by answering the following questions:
Ask a young child to define pathophysiology. No prompting: just ask them to tell you what it is and why it’s important. You’ll be amazed at some of the responses you get.
Why do you think pathophysiology is important in diagnosing and treating disease? Share an example from your nursing practice that exemplifies this relationship.
A large part of the study of pathophysiology is studying how cells adapt and change. What is one cellular adaptation you have seen in practice or that is prevalent in a disease/condition that an APRN in your certification track might encounter? For example, WHNP might encounter cellular changes in screening patients for HPV.
NU606 Advanced Pathophysiology
Week 2 Discussion
Instructions
Review the Case Study Discussion Scenario. For this discussion you will respond to ALL of the questions within either Part A, B, or C based the team you have been assigned.
Case Study Discussion Scenario
Mr. K. B. is age 81 and has had gastritis with severe vomiting for three days. He has a history of heart problems and is presently feeling dizzy and lethargic. His eyes appear sunken, his mouth is dry, he walks unsteadily, and he complains of muscle aching, particularly in the abdomen. He is thirsty but is unable to retain food or fluid. A neighbor has brought Mr. K. B. to the hospital, where examination shows that his blood pressure is low, and his pulse and respirations are rapid. Laboratory tests demonstrate elevated hematocrit, hypernatremia, decreased serum bicarbonate, serum pH 7.35, and urine of high specific gravity (highly concentrated).
Initial Post
It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post.
Based on your assigned team, create an initial post by answering all questions for your assigned part, making sure to address all components of all questions.
By Day 3, post your initial response to your assigned part of the case study as a reply to the appropriate discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least 2 scholarly references other than your text or course materials. Your post should be limited to 500 to 750 words and comprehensively address the questions posed.
Team A-Part 1: Day 1 – Early Stage
Week 2 Discussion Team A Worksheet (Word)
Initially, Mr. K .B. lost water, sodium in the mucus content, and hydrogen and chloride ions in the hydrochloric acid portion of the gastric secretions. Alkalosis develops for two reasons; the first being the direct loss of hydrogen ions and the second being the effects of chloride ion loss. When chloride ion is lost in the gastric secretions, it is replaced by chloride from the serum (see Figure 2.9 in your textbook). To maintain equal numbers of cations and anions in the serum, chloride ion and bicarbonate ion can exchange places when needed. Therefore, more bicarbonate ions shift into the serum from storage sites in the erythrocytes to replace the lost chloride ions. More bicarbonate ions in tserum raise serum pH, and the result is hyperchloremic alkalosis.
Describe the locations of intracellular and extracellular fluids. Which makes up a higher proportion of body fluid?
Which cell compartments are likely to be affected in this case by early fluid loss?
Explain how a loss of sodium ions contributes to dehydration. Why does this dehydration affect cell function?
Describe the early signs of dehydration in Mr. K. B.
What serum pH could be expected in Mr. K. B. after his early vomiting?
Describe the compensations for the losses of fluid and electrolytes that should be occurring in Mr. K. B.
How does the proportion of fluid in the body (from the previous question) change with age?
Explain why Mr. K .B. may not be able to compensate for losses as well as a younger adult.
Team B-Part 2: Days 2 to 3 – Middle Stage
Week 2 Discussion Team B Worksheet (Word)
As Mr. K. B. continues to vomit and is still unable to eat or drink any significant amounts, loss of the duodenal contents, which include intestinal, pancreatic, and biliary secretions, occurs. No digestion and absorption of any nutrients occurs. Losses at this stage include water, sodium ions, potassium ions, and bicarbonate ions. Also, intake of glucose and other nutrients is minimal. Mr. K. B. shows elevated serum sodium levels.
What is the normal function of sodium in the body?
Explain why serum sodium levels appear to be high in this case.
Explain how high serum sodium levels might affect the intracellular fluid and extracellular fluid volumes.
Using your knowledge of normal physiology, explain how continued fluid loss is likely to affect the following:
Blood volume
Cell function
Kidney function
State the primary location (compartment) of potassium.
How are sodium and potassium levels controlled in the body?
Given Mr. K. B.'s history, why might potassium imbalance have more serious effects on him?
State the normal range of pH for the following:
Blood
Urine
Team C-Part 3: Day 3 Admission to the Hospital – Advanced Stage
Week 2 Discussion Team C Worksheet (Word)
After a prolonged period of vomiting, metabolic acidosis develops. This change results from a number of factors:
Loss of bicarbonate ions in duodenal secretions
Lack of nutrients, leading to catabolism of stored fats and protein with production of excessive amounts of ketoacids
Dehydration and decreased blood volume, leading to decreased excretion of acids by the kidney
Decreased blood volume, leading to decreased tissue perfusion, less oxygen to cells, and increased anaerobic metabolism with increased lactic acid
Increased muscle activity and stress, leading to increased metabolic acid production
These factors lead to an increased amount of acids in the blood, which bind with bicarbonate buffer result in decreased serum bicarbonate and decreased serum pH or metabolic acidosis.
List several reasons why Mr. K. B. is lethargic and weak.
Predict the serum level of carbon dioxide or carbonic acid in this case. Explain your prediction.
If Mr. K. B. continues to lose body fluid, why might serum pH decrease below 7.35?
If serum pH drops below 7.35, what signs would be observed in Mr. K. B.?
If serum pH drops below 7.35, would this be considered compensated or decompensated? Explain the pathophysiology that contributes to this.
What are the very slow, shallow respirations that occur with metabolic acidosis called? How are they likely to affect the following?
PCO2
Serum pH
Describe the effect of acidosis on serum potassium levels.
Mr. K. B. will be given replacement fluid therapy. Why is it important that sodium and potassium be given as well as water?
Reply Posts
Please reply to two peers that posted an initial response from a different team than your own (for example, if you initially posted to Team A Part 1, you will create a reply post to one peer from Team B Part 2 and a reply post to one peer from Team C Part 3). Each reply must use at least one scholarly reference other than your textbook. After reading a selection of your peers’ posts:
Consider the pathophysiology that is occurring in each stage; how might that present in Mr. K. B.? Remembering the difference between signs and symptoms from Week 1, identify three signs and three symptoms he might be exhibiting in that stage. Explain why these would develop in each stage, and support your answers with evidence.
Finally, identify which section of the SOAP note each would be documented in.
NU606 Advanced Pathophysiology
Week 3 Discussion
Initial Post
It is understood that thoughtful responses to your topic question will take some time and thought. Please organize your thoughts before creating your initial post.
This week you are responsible for answering one question from your team's question set, as assigned in the Announcements section of this course.
By Day 3, post your initial response for your assigned question by answering the question comprehensively and sharing a unique teaching tool or visual aid with your peers. Post your initial response as a reply to the appropriate thread. Your post should be limited to 500 words or less and, in addition to your text and course materials, use evidence based, peer-reviewed journals that have been published within the past three to five years.
Team A: Normal Immune Response
Compare active natural immunity and passive artificial immunity, describing the causative mechanism and giving an example.
Predict three reasons why the immune system might not respond correctly to foreign material in the body. What can happen when this occurs?
What is the purpose of a booster vaccination? Give an example and how an allergic reaction might occur in this situation.
Describe the purpose of gamma globulins. Will this affect an individual who receives massive transfusions? Why or why not?
Explain the purpose of including allergies in a health history. Why is it important to update at every visit?
Predict why a person usually has chickenpox only once in a lifetime but may have influenza many times. How would you describe this to a patient's mother who is hesitant to receive a varicella vaccine? What about to an elderly patient hesitant to receive an influenza vaccine?
Explain why a newborn infant is protected from infection by the measles virus immediately after birth but later will be given the measles vaccine. How does this relate to prenatal care?
Team B: Abnormal Immune Response
Explain the process by which an attack of hay fever follows exposure to pollen. How do treatments for hay fever relate to this process?
Explain why anaphylaxis is considered life threatening and describe the mechanism in which anaphylaxis occurs. How does treatment for anaphylaxis relate to this process?
Differentiate between a diagnosis of being HIV+ and a diagnosis of having AIDS. How might you explain this to a patient?
Describe the pathophysiology of a type III hypersensitivity reaction. Give an example and describe possible treatment options.
Identify one autoimmune disease and explain how the causative mechanism differs from a normal defense.
Why are opportunistic infections common with AIDS? Give two examples and why these are less common in immunocompetent patients?
State three methods of transmitting HIV and three methods by which the virus is not transmitted. How would you explain this an adolescent?
Team C: Infection
Explain why a person whose blood test shows an abnormally low leukocyte count should be given an antimicrobial drug before a tooth extraction. Give one example of a condition where this prophylaxis would be indicated.
Explain how routine laboratory tests might not show the presence of mycoplasma, rickettsia, or protozoans in the body. How are these microbes best detected?
Compare the prodromal period with the acute period of infection, using your own experience as an example (perhaps the last time you had a cold).
List three local signs of infection and three systemic signs; explain what is causing these signs. Are these objective or subjective findings?
Describe two mechanisms by which antibacterial drugs act on microorganisms. Explain the benefit of narrow-spectrum over broad-spectrum drugs.
Explain why secondary bacterial infection is common in persons with influenza. Which secondary infections are most common?
NU606 Advanced Pathophysiology
Week 4 Discussion
Initial Post
It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post. To assist you in your work for this discussion, please use the worksheet linked in each of the team threads to organize your thoughts. Then simply copy and paste the text from the document into your initial post.
Based on your assigned team, create an initial post by answering ALL questions for your assigned case (Team A, B, or C), making sure to address all components of all questions.
By Day 3, post your initial response to your assigned case study as a new discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should be limited to 500 to 750 words and comprehensively address the questions posed.
Team A
Week 4 Discussion Team A Worksheet (Word)
PJ is a three-year-old boy who pulled a pot of boiling water over his head, arms, and chest, resulting in a mixed burn to the anterior surface of his head and arms, chest, and feet. He presents with his mother in the emergency department. His mother is quite upset and says nothing like this has happened before. PJ is visibly upset and appears in pain, but is responsive and behaving appropriately for the situation.
What factors determine the classification of burns? What type(s) of burn is most likely for this victim?
Describe the process taking place in the burned area during the first hours after the injury.
How will the physicians in the emergency room determine the percentage of the body that may be burned? What special considerations may be involved when evaluating a child?
Discuss the additional effects associated with burns, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia, and the treatments involved.
PJ’s mother asks you how she can help him get better. Identify and explain three interventions she can implement to promote healing.
As he was healing, PJ developed a bacterial infection on his right arm. Explain three predisposing factors to this infection.
How will this burn injury affect PJ's growth and development? What are some of the social needs in this case?
Team B
Week 4 Discussion Team B Worksheet (Word)
JL, a 50-year-old woman, fell and broke the left tibia at the ankle. She is in the emergency department, waiting for the fracture to be immobilized. The leg hurts and she notes that the ankle is red and swollen. A diagnosis of a simple fracture and sprain (damage to ligaments) is made.
Describe the pathophysiology of her pain and swelling as related to both the fracture and the strain. Why is the area red and swollen? Is this an acute or chronic process?
What can JL expect in the days to come as inflammation resolves and healing begins? What can she expect when the cast is removed? (Hint: Will she be back to normal?)
What is the rationale for immobilizing the fractured bone? Include in your explanation a discussion of why movement of the affected area is painful.
She is told to come back to the fracture clinic in 24 hours to have her cast checked. What could happen to the inflamed tissue if the edema increases in the casted area? What warning signs and symptoms will you look for?
She reports feeling fatigued and anorexic and has a low-grade temperature. What is the cause of these symptoms?
Is this injury at high risk for developing osteomyelitis? Provide rationale for your answer.
JL asks you if there is anything she can do to help herself get better. Identify and explain three interventions she can implement to promote healing.
Team C
Week 4 Discussion Team C Worksheet (Word)
Ms. M is 42 years old and has had rheumatoid arthritis for six years. At baseline, her fingers are stiff and show slight ulnar deviation. She has come to see you as she is currently experiencing an exacerbation, and her wrists are red and swollen. She finds it to be painful when something such as clothing touches the skin over her wrists. Her elbows and knees are also stiff and painful, especially after she has been resting. She is feeling extremely tired and depressed and has not been eating well.
Describe the pathophysiologic process that leads to the appearance and the pain occurring at her wrists. Is this an acute or chronic process? Could it be both?
Describe the pathophysiology contributing to the stiff, deformed fingers. What terms can be used to describe this?
Explain why some activity relieves the pain and stiffness of rheumatoid arthritis and why the pain tends to be worse with immobility. Is this true for other inflammatory or musculoskeletal conditions?
Describe several factors contributing to Ms. M’s systemic symptoms. Is this an acute or chronic process?
Explain how each of the following medications interact with the pathophysiology of rheumatoid arthritis and help return Ms. M to a more homeostatic state.
NSAIDs
Glucocorticoids
Disease-modifying agents
Biologic agents.
If we didn’t already know that Ms. M had rheumatoid arthritis, what other conditions would be on the differential for this patient? Think about what other conditions can present with erythematous, painful, swollen joints. Identify two such conditions and describe the most common signs and symptoms.
What are some possible long-term effects of chronic inflammation in conditions such as rheumatoid arthritis and other inflammatory conditions?
NU606 Advanced Pathophysiology
Week 5 Discussion
Initial Post
It is understood that thoughtful responses to your topic question will take some time and thought. Please organize your thoughts before creating your initial post.
This week, you are responsible for answering one question from your team’s question set, as assigned in the Announcements section of this course.
By Day 3, post your initial response for your assigned question by answering the question comprehensively and sharing a unique teaching tool or visual aid with your peers. Post your initial response as a reply to the appropriate thread. Your post should be limited to 500 to 750 words and, in addition to your textbook and course materials, use evidence-based, peer-reviewed journals that have been published within the past three to five years.
Week 5 Discussion 1: Question-Based Discussion—Team A (Skin Disorders)
A-1: Define the following terms, provide an image of an example, and identify one condition where each may occur:
Macule
Papule
Nodule
Pustule
Vesicle
Plaque
A-2: Define the following terms, provide an image of an example, and identify one condition where each may occur:
Crust
Lichenification
Keloid
Fissure
Ulcer
Erosion
Comedone
A-3: Describe the typical lesions of atopic dermatitis. Where are these located in infants? What about adults? Identify three ways these lesions can be managed to help return the skin to homeostasis.
A-4: Impetigo and herpes simplex are common skin disorders and can have a similar dermatologic presentation. Describe the etiology of each condition. Explain one classic identifying feature for each condition, and discuss how they can be differentiated from one another.
A-5: Tinea corporis and scabies are common skin disorders and can have a similar dermatologic presentation. Describe the etiology of each condition. Explain one classic identifying feature for each condition, and discuss how they can be differentiated from one another.
A-6: Explain why squamous cell carcinoma has a better prognosis than malignant melanoma. Identify three characteristics of malignant changes in a skin lesion as well as four warning signs of skin cancer.
A-7: Describe what a keratosis is, and give two specific examples. For each example, discuss the following: presentation/appearance, etiology, prevention. What is the most common complication from these lesions?
Week 5 Discussion 1: Question-Based Discussion—Team B (Normal Skin/Lymph)
B-1: Describe the basic path of the lymphatic circulation. You may use a visual aid to assist you.
B-2: Describe the normal functions of the lymph nodes, the thymus gland, the tonsils, and the spleen. What happens when each does not function normally and moves away from homeostasis?
B-3: Explain three ways the skin acts as a defense mechanism. For each of these, identify one condition that develops when this defense mechanism fails.
B-4: Where are resident or normal skin flora located related to the skin and its appendages? Identify three normal skin flora and discuss their importance to homeostasis.
B-5: It is well known that handwashing is critical to preventing the spread of infection. Explain how excessive handwashing may in some cases increase the potential for a bacterial skin infection. Give two examples where this might occur.
B-6: Describe the role of sebaceous glands and eccrine glands in maintaining homeostasis within the dermatologic system. For each of these, identify one condition that develops when homeostasis is not maintained.
B-7: Describe the structure of a hair follicle, including any gland associated with it. How do these glands promote homeostasis? What conditions can develop when homeostasis is not maintained.
Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)
C-1: Compare and contrast Hodgkin and non-Hodgkin lymphomas based on pathophysiology, signs and symptoms, diagnosis, and treatments.
C-2: Explain why infections occur frequently in patients with lymphomas. Is this true for patients with other lymph disorders?
C-3: Describe the prognoses for a person with a stage I and stage IV Hodgkin lymphoma. Use rationale to explain your reasoning. How would you explain this to a patient/family?
C-4: Outline the conditions of Hodgkin’s lymphoma at each of the four stages as defined by the Ann Arbor staging system.
C-5: Describe the condition of lymphedema. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
C-6: Describe the condition of multiple myeloma. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
C-7: Describe the condition of Castleman disease. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
NU606 Advanced Pathophysiology
Week 6 Discussion
Initial Post
It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post. To assist you in your work for this discussion, please use the worksheet linked in each of the team threads to organize your thoughts. Then simply copy and paste the text from the document into your initial post.
Based on your assigned team, create an initial post by answering ALL questions for your assigned case (Team A, B, or C), making sure to address all components of all questions.
By Day 3, post your initial response to your assigned case study as a new discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should be limited to 500 to 750 words and comprehensively address the questions posed.
Team A
Week 6 Discussion Team A Worksheet (Word)
Describe the three stages of hemostasis.
Explain the difference between the terms microcytic and megaloblastic. Identify one condition where each may occur.
Compare the general effects of the general states of anemia and polycythemia in terms of hemoglobin level, hematocrit, general appearance, and possible complications. There can be different causes for these conditions. Compare their general presentation, regardless of cause.
In patients with leukemia, the mouth and mucosa of the digestive tract are usually inflamed and ulcerated because of anemia, the effects of chemotherapy, and the presence of infections, such as candidiasis. Explain how this situation would affect food and fluid intake, and list some possible subsequent effects on the patient with leukemia.
Team B
Week 6 Discussion Team B Worksheet (Word)
State three major functions of plasma proteins, and list the component responsible for each.
Explain the difference between petechiae and ecchymoses. Identify one condition where each may occur.
Explain how a deep vein thrombosis in a large vein in the leg can result in a life-threatening condition such as a stroke or myocardial infarction.
Katie has been diagnosed with leukemia, and she is wondering if it is safe to go to the dentist. Her WBC and platelet counts are still low from chemotherapy. What are the risks associated with invasive procedures while her counts are decreased? How would you explain these to Katie? Include discussion of why bleeding and multiple opportunistic infections are common in patients with leukemia.
Team C
Week 6 Discussion Team C Worksheet (Word)
Predict those organs that would be expected to have a large capillary network. What criteria did you use in making this prediction?
Explain the difference between leukocytosis and erythrocytosis. Identify one condition where each may occur.
Explain how DIC develops, and identify three signs of its development.
You are taking care of John, a 55-year-old male who has recently been diagnosed with myelodysplastic syndrome. He asks you what this means and if he is going to die. How will you explain the pathophysiology of this condition to John? What can you share with him about prognosis?
Replies
Select posts from two peers that addressed a case from a different team than you. For example, students from Team A reply to one post from Team B and one post from Team C. Each reply must use at least one scholarly reference other than your textbook.
Thinking about your certification track and anticipated practice area:
Describe a patient that you might encounter where you could apply the information learned in your peer’s post.
What “signs” and “symptoms” would you expect this patient to exhibit? Identify at least four, describe the finding, and classify each as subjective or objective data.
Please refer to the Grading Rubric for details on how this activity will be graded. The described expectations meet the passing level of 80%. Students are directed to review the Discussion Grading Rubric for criteria which exceed expectations.
NU606 Advanced Pathophysiology
Week 7 Discussion
Initial Post
For this week’s discussion board initial post, please develop a visual aid, diagram, image, or similar device that addresses the following questions. Include a brief explanation/description of the content covered in addition to your visual aid; the explanation can be recorded or written. Please be sure to use evidence-based, peer-reviewed journals that have been published within the past three to five years in addition to your textbook and course materials as you develop your post.
Explain what stroke volume is and how it is related to the cardiovascular system; address, particularly, stroke volume, heart rate, and blood pressure.
Identify two disorders of the cardiovascular system that affect stroke volume, heart rate, and BP, and explain how the disease state and pathophysiologic process alters these components away from their homeostatic state.
Describe how these changes can result in cardiac remodeling. What signs and symptoms do patients experience as this occurs?
Discuss whether this remodeling is reversible and/or preventable. What can be done to correct the pathologic process and return the cardiovascular system to its homeostatic state.
NU606 Advanced Pathophysiology
Week 8 Discussion
Case Study Discussion – Respiratory Disorders
Initial Post
It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post.
Based on your assigned team, create an initial post by answering all questions in your team’s case study, making sure to address all components of all questions.
By Day 3, post your initial response to your assigned part of the case study as a reply to the appropriate discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should comprehensively address the questions posed.
Team A
Week 8 Discussion Team A Worksheet (Word)
Mr. CY, age 71, has had significant emphysema for six years. He has reduced his cigarette smoking since mild congestive heart failure was diagnosed (right-sided heart failure; refer to Chapter 12). He has been admitted to the hospital with a suspected closed pneumothorax and respiratory failure.
Describe the pathophysiologic changes in the lungs with emphysema and explain how these affect oxygen and carbon dioxide levels in the blood.
Explain how emphysema can lead to heart failure. What signs and symptoms would you expect to develop in Mr. CY? Classify each as a subjective or objective finding.
Explain how a pneumothorax has probably occurred in the presence of emphysema.
Explain how a pneumothorax can cause respiratory failure. Describe the pathophysiologic effects on lung function and gas exchange in your answer. Include the criteria for respiratory failure.
Explain why caution must be exercised in administering oxygen to Mr. CY.
The impaired respiration Mr. CY experiences as a result of his emphysema causes immobility. Immobility can lead to other respiratory complications. Identify two of these conditions and describe preventative measures for each.
Describe several respiratory therapy interventions that might help Mr. CY return his body to a more homeostatic state.
Emphysema, as experienced by this patient, is an obstructive pulmonary disease, which is different than restrictive pulmonary diseases. Compare and contrast the pathophysiology, manifestations, and interventions to help return to homeostasis for obstructive and restrictive respiratory disorders.
Team B
Week 8 Discussion Team B Worksheet (Word)
Baby M is a four-month-old who presented to the emergency department with wheezing and difficulty breathing. Her mother reports she has had a fever at home and has been getting worse over the last several hours. She exhibits tachypnea and chest retractions, and you can here both audible and auscultated wheezes. After consulting with the team, it is determined that Baby M most likely has bronchiolitis.
What is the most common etiology of bronchiolitis? What patient population is most at risk for this condition?
What symptoms from the scenario support the diagnosis of bronchiolitis? Explain the pathophysiologic process causingese symptoms, and identify each as subjective or objective.
What is meant by “chest retractions”? Think about the pathophysiology of what is occurring in her lungs, then describe the location of the following retraction types: intercostal, suprasternal, supraclavicular, substernal, and sub cos.
Baby M’s mother asks you to give her some antibiotics to help her get better. What is your best response to her? How will you explain how you can help Baby M get better?
Baby M is admitted to the hospital for management. As her provider, you understand she is disposed to developing pneumonia secondary to the process occurring in her lungs.
What signs and symptoms would you expect to change and/or develop if Baby M were to develop pneumonia? What will you instruct her parents and caregivers to be on the lookout for?
Identify the three major classifications of pneumonia. Which one do you think Baby M is most at risk for?
Compare and contrast these three different types of pneumonia, including causative organisms, pathophysiology, distribution in the lungs, onset, and significant signs and symptoms.
If Baby M does develop pneumonia, how would this change the interventions needed to help return her body to a homeostatic state?
Team C
Week 8 Discussion Team C Worksheet (Word)
CJ is a 22-year-old with a history of asthma since childhood. He was tested for allergies and demonstrated marked responses to a number of animals, pollens, and molds. CJ also has a history of asthma related to exposure to very cold weather.
Describe the pathophysiology of an acute asthma attack in CJ following exposure to cats.
Describe the early signs and symptoms of an acute asthma attack, and relate each of these to the pathophysiologic changes taking place in the lungs. Identify each as a subjective or objective finding.
If you were updating a medical and drug history for CJ, list several significant questions you should ask.
Is asthma considered an obstructive or restrictive respiratory condition? Explain your answer.
Explain how a beta2-adrenergic agent is helpful in treating asthma and how it is usually administered.
In addition to beta2-adrenergic agents, identify one other pharmacologic and one other non-pharmacologic intervention that can be used to help manage acute asthma attacks and correct the pathophysiology that is occurring. Explain how each helps return the body to a homeostatic state.
What is the term for a prolonged asthma attack? Explain the pathophysiology that occurs and how this can lead to respiratory distress and failure. Identify three signs or symptoms of impending respiratory distress.
Identify two preventative measures that CJ can take to help manage his disease and keep his body in a homeostatic state. Explain how this will impact the disease process.
NU606 Advanced Pathophysiology
Week 9 Discussion
Team A (Sensory Disorders)
Week 9 Discussion Team A Worksheet (Word)
Sensory Disorders
Infection and trauma can happen to both the cornea and the conjunctiva. Which is more serious? Using pathophysiology, explain why.
Compare wide-angle and narrow-angle glaucoma, including the pathophysiology and signs of each.
Describe the two types of macular degeneration and current treatments.
Patients who have experienced a blow to the back of the head often report “seeing stars.” Using pathophysiology, explain why this happens.
Otitis media is much more common in infants and young children. Thinking about the structure and function of the ear, explain why this is.
Why does Ménière's syndrome cause both hearing loss and vertigo?
Team B
Week 9 Discussion Team B Worksheet (Word)
General Neurologic Dysfunction
In some neurologic disorders, postsynaptic membrane permeability is increased. Does this make the neuron more easily stimulated or less excitable? Using pathophysiology, explain why.
Cholinergic drugs are often used to help correct neurologic pathologic processes. Briefly describe where a cholinergic drug acts and how it affects the postsynaptic receptors. Give two examples of its possible effects on function.
Describe two possible areas of CNS damage that might cause flaccid paralysis. What signs and symptoms would a patient with this condition exhibit?
There are many different conditions that can cause increased intracranial pressure (ICP); identify two. What are the early signs and symptoms of increased ICP? What will you look for in a patient to help determine if they have increased ICP?
Describe how vital signs change from early increased ICP to later stages.
Which is more critical: a lesion in the brainstem or in the cerebral hemisphere? Using pathophysiology, explain why.
Team C (Neurologic Trauma/Disorders)
Week 9 Discussion Team C Worksheet (Word)
Neurologic Trauma/Disorders
What is a subdural hematoma? In your definition, be sure to include location, common causes, and time to development. What signs and symptoms would you expect a patient with a subdural hematoma to exhibit?
Spinal cord injury can occur anywhere along the spine. Is injury to the cervical spine or lumbar spine more critical? Using pathophysiology, explain why.
What is the difference between communicating and noncommunicating hydrocephalus? This can occur in infants, often with no focal signs. Explain why this is.
What is the difference between a partial and a general seizure? Give an example of each, and describe what you might expect to observe from a patient experiencing each type.
Describe where you might expect to find plaques that cause the following early signs of multiple sclerosis: diplopia, tremors in the legs, facial weakness.
Describe three common manifestations that can be observed in a person with Parkinson's disease. Why might these make it difficult for patients to maintain adequate nutrition and hydration? What potential complications may ensue?
NU606 Advanced Pathophysiology
Week 10 Discussion
Teaching Presentation—Team A (Diabetes Types 1 and 2)
Team A
Week 10 Discussion Team A PowerPoint Template Worksheet (PPT)
Diabetes Type 1 and 2
Describe the pathophysiology of both type 1 and type 2 diabetes.
Describe the risk factors for the development of both type 1 and type 2 diabetes.
List three complications of diabetes; describe the pathophysiology of each, and explain appropriate preventative measures.
Explain what HgbA1C is, what it measures, and how it is important to the management of diabetes.
Identify two medications used to treat diabetes; discuss how they interrupt the pathology and help return the patient to a more homeostatic state.
Team B (Thyroid Disorders)
Week 10 Discussion Team B PowerPoint Template Worksheet (PPT)
Thyroid Disorders
Describe the pathophysiology of both hyperthyroidism and hypothyroidism.
Compare and contrast the signs and symptoms and hormone levels of both hyperthyroidism and hypothyroidism.
Define goiter; discuss how it develops and what potential complications can arise.
Why do weight loss and insomnia occur with hyperthyroidism? Why are cold intolerance and bradycardia common with hypothyroidism?
Identify the most common treatment for both hyperthyroidism and hypothyroidism. Discuss how they interrupt the pathology and help return the patient to a more homeostatic state.
Team C (Pituitary/Adrenal Disorders)
Week 10 Discussion Team C PowerPoint Template Worksheet (PPT)
Pituitary/ Adrenal Disorders
Describe the pathophysiology of both Addison disease and Cushing syndrome.
Compare and contrast the signs and symptoms and expected lab findings of both Addison disease and Cushing syndrome.
Explain how diagnostic tests could distinguish a pituitary Cushing syndrome from an adrenal Cushing syndrome.
Discuss three potential complications that can develop from long-term use of glucocorticoids.
Compare dwarfism, gigantism, and acromegaly, including the pathophysiology of abnormal hormone secretion, age affected, and common signs and symptoms related to the hormone change.
NU606 Advanced Pathophysiology
Week 11 Discussion
Team A Renal Disorders
Explain why hematuria and proteinuria reflect a glomerular problem rather than a tubular problem in the kidney.
Explain the change in filtration if excess glucose is present in the blood entering the kidney.
Explain factors that may contribute to elevated blood pressure in a patient with renal disease.
Compare acute and chronic renal failure with respect to cause, reversibility, and urinary output at onset.
Why is there an increased risk of drug toxicity in the later stages of renal failure?
Why is protein intake restricted in patients with kidney disease?
Compare the causes and pathophysiology of acute pyelonephritis, APSGN, and nephrotic syndrome.
Team B Urinary Disorders
Explain how decreased fluid intake or dehydration predisposes to calculi in the urinary tract.
Explain what the presence of the following in the urine indicates: blood (microscopic and gross), protein, pus, casts, and glucose.
Compare the signs/symptoms of cystitis and pyelonephritis. Which of these indicate that kidney involvement (local or systemic) is occurring?
Where is the urinary bladder located relative to the uterus and rectum in a woman? Briefly explain two possible implications of this location.
Why does male anatomy make it likely that a reproductive system infection may extend into the urinary system?
Explain the difference in causes of frequent voiding associated with cystitis versus those associated with renal insufficiency.
How might urinary tract infections lead to calculus formation?
Team C Reproductive Disorders/STIs
Compare the typical signs of acute bacterial prostatitis, chronic bacterial prostatitis, and acute nonbacterial prostatitis.
Compare BPH and prostatic cancer in terms of the characteristic location of the tumor and the early signs. What are the risk factors for each condition?
Describe each of the following: (1) second-degree uterine prolapse, (2) cystocele, and (3) retroversion of the uterus. Explain the secondary problems that may occur with second- or third-degree prolapse.
How can infection in the vagina can cause PID? What signs and symptoms would you expect? Why is this considered a serious condition?
Describe the causative organisms for (1) chlamydial infection, (2) gonorrhea, (3) syphilis, (4) trichomoniasis, and (5) genital herpes.
Compare the early manifestations of chlamydial infection, gonorrhea, trichomoniasis, syphilis, and genital herpes. Why are these STIs difficult to control (that is, why is it hard to reduce the incidence)?
Describe three factors predisposing patients to vaginal candidiasis and identify the causative organism.
NU606 Advanced Pathophysiology
Week 12 Discussion
Gastrointestinal Disorders
Team A: Gastroenteritis
Week 12 Discussion Team A Worksheet (Word)
Baby K., age 14 months, has vomiting and diarrhea and is crying continuously because of what appears to be severe abdominal pain. As part of your history, you discover Baby K. had some milk custard that may not have been properly stored. The most likely diagnosis is gastroenteritis, secondary to Staphylococcus aureus from the milk custard.
Briefly describe how S. aureus in the custard could cause vomiting and diarrhea.
What fluid and electrolyte imbalances would you expect in Baby K.? Please describe how at least one fluid and one electrolyte imbalance could develop in this situation.
Describe the signs of dehydration that can be expected in a child of this age. What about in an older child?
Explain the process and factors involved by which a young child can quickly develop vascular collapse if vomiting and diarrhea are severe.
Explain why water alone would not be adequate treatment for Baby K.
What other gastrointestinal conditions could cause vomiting and diarrhea in a young child? How will you definitively determine what condition is causing her symptoms?
Team B: Peptic Ulcer and Peritonitis
Week 12 Discussion Team B Worksheet (Word)
Ms. X., age 76, has been admitted to the emergency department with severe generalized abdominal pain and vomiting. No significant findings were immediately evident to indicate a cause, so she was admitted. Six hours later, Ms. X.'s blood pressure began to drop, and her pulse was rapid but thready. Exploratory abdominal surgery revealed a perforated gastric ulcer and peritonitis.
Describe the process by which an ulcer develops. Are ulcers limited to the stomach or can they occur elsewhere in the GI system? If so, where?
Suggest several possible factors contributing to ulcer formation. What questions would you want to as Ms. X. to determine her risk for gastric ulcers?
Explain why peptic ulcer may not be diagnosed in an early stage of development. In other words, why were there not any initial significant findings?
During her admission, Ms. X. continued to decompensate, and developed bacterial peritonitis. Describe the process of perforation of an ulcer and how this can lead to complications, including bacterial peritonitis.
Explain why Ms. X. showed signs of shock. Which type of shock would you expect?
Ms. X. was given antibiotics, intravenous fluids, and intravenous alimentation (total parenteral nutrition). Explain how each of these treatments functions to return Ms. X. to a more homeostatic state.
Team C: Hepatitis B and Cirrhosis
Week 12 Discussion Team C Worksheet (Word)
You are caring for J.B., age 35, who has had chronic hepatitis B for nine years. The origin of his acute infection was never ascertained. He is not married, lives alone, and sometimes has trouble managing his disease.
Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?
If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?
Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.
What serum markers remain high when chronic hepatitis B is present?
Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?
J.B.'s cirrhosis is now well advanced. He has developed ascites, edema in the legs and feet, and esophageal varices. His appetite is poor, he is fatigued, and he has frequent respiratory and skin infections. Jaundice is noticeable. He has been admitted with hematemesis and shock resulting from ruptured esophageal varices.
Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.
NU606 Advanced Pathophysiology
Week 13 Discussion
Research Article Critique
Initial Post
Consider the material that was presented this week. Find a peer-reviewed, research article related to topics found in Chapters 20 and/or 21. This discussion post will be a bit longer than you are used to, but it is your only assignment this week. Please use the following list as a template to structure your post; include the questions as headers in your post so your peers can follow along. Once you have introduced your topic, use the remaining questions to help you critique your article. Please be sure to answer all questions. The last paragraph should be a conclusion tying all the content together.
Article Critique Questions:
One paragraph that introduces your topic and explains why it is important to you
Author, year, title, journal
Purpose of the article: research, theoretical, program implementation
From what discipline was the literature review drawn?
What were the gaps, issues, purposes identified from the synthesis of the literature?
What design and methods were used for the purpose of the project?
Were the sample, size, and setting (or choice of articles) adequate for the project?
What were the findings and conclusions?
What are the implications for future research?
How could the information in this article be applied to advanced nursing practice?
Would you recommend this article to others as an example to add to the understanding of this information?
Conclusion/summary paragraph
Upload your article critique along with your article in PDF format to this discussion forum in your initial post.
