Week 6: Grand Rounds Assignment Using Kaltura No unread replies. No replies. Purpose The purpose of this assignment is to enhance the student’s clinical reasoning, confidence and learning of multiple pharmacological agents through facilitated discussion. Description In Week 6, you will create a PowerPoint Grand Rounds presentation on the topic assigned to you by the faculty member. In Week 7, you will lead a discussion based on your presentation as well as interact with peers in discussions related to their Grand Rounds presentations. Course Outcomes Through this assignment, the student will demonstrate the ability to: 1. Describe the most commonly prescribed drugs use in primary care for the chose condition. 2. Utilize clinical guidelines, research articles or other materials to support your findings. 3. Identify any practice barriers, issues, or problems (including cultural diversity and healthcare literacy). 4. Discuss best practices for optimal outcomes. Due Dates: Week 6: Grand Rounds PowerPoint Presentation due by Sunday 11:59 p.m. MT at the end of Week 6. In Week 6- you only need to post your Kaltura presentation in the discussion thread. You do not need to reply to your peer’s presentations.
NR 507 Week 2 Quiz 2
Evolve Chapter 3 Review Questions Mccance: Pathophysiology, 7 th Edition Questions 1.When considering water balance, which statement is the correct balance? 2. It is true that hyperchloremia: 3. It is true that hyponatremia: 4.Which statement is trueregarding potassium balance? 5.Which statement is trueregarding hypokalemia? 6. Hypernatremia is defined as levels above: 7.Which statement is trueregarding magnesium? 8.Which statement describes acidemia? 9. Common causes of edema formation (increased filtration of fluid from capillaries and lymph into surrounding tissues) include which of the following? ( Select all that apply.) 10. Which of the following are clinical manifestations of hypokalemia? ( Select all that apply.) 11.Which treatments are appropriate for hyperkalemia? (Select all that apply.) 12. One third of the body’’s fluid is
Week 1 Discussion
A five-month-old Caucasian female is brought into the clinic as the parent indicates that she has been having ongoing foul-smelling, greasy diarrhea. She seems to be small for her age and a bit sickly but, her parent’s state that she has a huge appetite. Upon examination you find that the patient is wheezing and you observe her coughing. After an extensive physical exam and work-up, the patient is diagnosed with cystic fibrosis. Dr. Arredondo and class, 1.What is the etiology of cystic fibrosis?
ADVANCE PATHO Discussion Part Three
Discussion Part Three (graded) Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis?
Cystic Fibrosis Foundation, 2016). CF is a multiorgan disease, it affects mostly lungs, pancreas, liver, intestines, sinuses, and sex organs. Lungs are the most critical site of involvement, and respiratory failure is almost always the cause of death. The symptoms and severity of CF can vary. Some people have serious problems from birth. Others have a milder version of the disease that doesn’t show up until they are teens or young adults. According to Cystic Fibrosis Foundation (2016), the people with CF have inherited two copies of the defective CF gene, one copy from each parent. Both parents must have at least one copy of the defective gene. When two people who are carries have a child, there is a 25 percent chance of having a child with CF. CF is diagnosed through various tests, such as gene, blood, and sweat tests. There is no cure for CF, but treatments have improved greatly in recent years. Today, with improved treatments, some people who have CF are living into their forties, fifties, or older (MedlinePlus, 2017). Describe in detail the pathophysiological process of cystic fibrosis. Cystic fibrosis is an inherited disease that causes thickened mucus to form in the lungs, pancreas and other organs. The gene for cystic fibrosis is on the long arm of chromosome. Genes are composed of strands of nucleotides, which are made up of base pairs. When the sequence of nucleotides changes, the CFTR gene becomes mutated and the CFTR protein produced is defective. The CFTR protein can be a chloride ion channel regulated by cyclic adenosine monophosphate, and therefore it can act as a regulator of other electrolyte channels (Cystic Fibrosis Foundation, 2016). The CFTR protein has different roles in different types of epithelial cells. Normally, this protein allows chloride ions to exit the mucus-producing cells. After chloride leaves the cells, water follows and thins the mucus. However, if the CFTR protein has been damaged, as in cystic fibrosis, the chloride ions are not allowed out of the mucus-producing cells. As a result, the mucus thickens and becomes sticky and obstructs the various pathways (McCance, Huether, Brashers, & Rote, 2014). This obstructive process also prevents bacteria from being cleared from the cells and thus increases the potential for infection. In the lungs, the mucus clogs the airways and traps bacteria leading to infections, extensive lung damage, and eventually, respiratory failure. In the pancreas, the mucus prevents the release of digestive enzymes that allow the body to break down food and absorb vital nutrients
NR507 WEEK 2 Discussion
Discussion Part Two (graded) Tammy is a 33-year-old who presents for Assessment of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves. Write a differential of at least three (3) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely. Based upon what you have at the top of the differential how would you treat this patient? Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why? Respiratory Disorders Bronchitis The most common cause of the acute cough of clinical significance is bronchitis. The cough is, at the beginning, nonproductive and later it becomes productive of mucous or mucopurulent sputum. Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs (Holzinger, Beck, Dini, Stöter, & Heintze, 2014
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The disease that I have been assigned is rabies. Rabies is an acute viral infectious disease affecting animals and humans and causes social and public health problems around the world. Rabies is an infectious viral disease caused by the Lyssavirus genus, that belongs to the Rhabdoviridae family and is transmitted through the animal’s saliva with their bites, broken skin, scratches and mucous membrane (Centers for Disease Control and Prevention, 2019). Some of these animals that carry the rabies virus include dogs, cats, bats, skunks, foxes, and raccoons. The rabies virus enters the peripheral nerves system (PNS) and then continue to the central nervous system (CNS) and most of the cases causing death. There are different types of rabies such as the furious, or encephalitic rabies, which is most common, the patient is more likely to experience hyperactivity and hydrophobia and the paralytic rabies which paralysis is a dominant symptom (Jackson, 2018). Risk factors for rabies include infected animals, traveling or living in developing countries, working in a laboratory with the virus, and practicing activities like exploring caves or camping (Jackson, 2018). A role of a Family Nurse Practitioner is to provide education regarding rabies, how is transmitted and steps that can be taken to prevent. Healthcare provider should educate patients is proper ways to prevent rabies and the importance of seeking medical care as soon as possible. Public education has an extremely important role in rabies control: including encouraging responsible pet ownership and ensuring appropriate health service-seeking behavior following potential exposure (Hasanov et al., 2018). Some steps that can be taken to prevent rabies include vaccinating the animals, not feeding wild animals and stay at a safe distance when observing them, stay away from animals having signs of rabies, not to bring wild animals to home, if an animal is suspected to be infected, stay away from it and contact the local authorities, wash any wound with soap and water, and maintaining good hygiene (Centers for Disease Control and Prevention, 2019).
NR 507 Week 6 Discussion: PART 1: You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg. There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder. What is the most likely genetic disease that this presents and why? What is the molecular basis of this disease? Before, calling the police what should the initial clinician have done? PART: Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved. He has been blowing his nose quite frequently and “sores” have developed around his nose. His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.” She is worried because the lesions are now also on his forearm
Miid term study guide Epigenetics 1. Defects in the encoding of histone-modifying proteins Chromatin compaction and organization help to regulate gene expression, determining and maintain the cell identity. 2. Epigenetics and its role on human development Disease and other phenotypic variation are caused by mechanisms other than changes in the DNA sequences. Epigenetics is the study of heritable changes in gene expression or phenotype caused by mechanisms other than changes in DNA sequence. 3 Totipotent cells and its ability to differentiate into any type of cell Stem cells are cells with the potential to develop in to many different cells type during early development and growth. 4 Prader-Willi syndrome and Angelman syndrome? Imprinting associated with a deletion of about 4mb of the long arm of chromosome 15. Fathe r – prader- willi syndrum. Short stature, hypotonia, small hands and feet , obesity, mr and hypogonadism. Mother angelman —-mr, seizsure ataxia. Cellular Proliferation 5 5-Azacytidine and the treatment of cancer A demethylating agent has been used as a therapeutic drug in the tx of leukemia and myelodysplastic syndrome. 6 the role of inactive MLH1 in the development of some forms of inherited colon cancer A major cause of one form of inherited colon cancer hereditary nonpolyposis colorectal cancer HNPCC is the methylation of the promotor region of the gene, MLH1whose protein products repairs damaged DNA. When MLH1 becomes inactive damaged DNA accumulates eventually resulting in colon tumors. 7 Effects of ethanol on neural stem cells ability to differentiate into functional neurons 69 118
8 Inflammation as an etiology for cancer-note conditions in which this may occur 403 Cancer 9 In terms of epigenetic modifications, the role of environmental stressors associated with development of cancer 408 Defects in Mechanism of Defense 10 Hemolytic defects in the newborn Hemolytic disease of the new born HDN RESULTS FROM INCOMPATIBILITY BETWEEN THE MATERNAL AND THE FETAL BLOOD, WHICH MAY INVOLVE DIFFERENCE IN rh FACTORS OR BLOOD TYPE ABO). Maternal antibodies entr the fetal circulation and cause hemolysis of fetal erythrocytes. Because the immature liver is unable to conjugate and excrete the excess bilirubin that results from the hemolysis, icterus neonatorum, or kernicterus or both can develop.
Week 3 Discussion
Heart failure occurs when the heart is unable to pump enough blood around the body and therefore is not capable of supplying enough blood flow through the body. Heart failure is a progressive syndrome that is characterized by the heart’s inability to pump blood efficiently to meet the needs of the body (Schub & Oji, 2018). Heart failure can result from abnormalities of systolic, diastolic function, or both. Heart failure can be caused by many factors like cardiac structural defects like congenital defects, valvular disorders, rhythm abnormalities such as persistently high heart rate, and high metabolic demands such as thyrotoxicosis. Also, risk factors such as age, smoking, obesity, diabetes, hypertension, renal failure, and excessive alcohol use can contribute to heart failure. Systolic heart failure occurrs when the muscle of the left side of the heart contracts poorly and empties inadequately, causing an increase in diastolic volume and pressure and a decreased ejection fraction. Systolic heart failure is determined by the failure of the circulatory system to deliver enough oxygen for metabolic needs (Katz, 2018). Systolic dysfunction is common in heat failure due to myocardial infarction, myocarditis, and dilated cardiomyopathy (Katz, 2018). Diastolic heart failure is when the left ventricle loses its ability to relax normally. Which results in the heart not being able to fill with blood during the resting period. Diastolic heart disease is characterized by thickening and stiffening of the ventricular wall, which increases resistance to the diastolic filling of part or all the heart (Heering & Oji, 2018). Diastole heart failure is affected by a number of factors, including ischemia, heart rate, the velocity of relaxation, cardiac compliance, hypertrophy, and segmental wall coordination of the heart muscle (Heering & Oji, 2018)
Week 4 Discussion
The kidneys play an important role in the regulation of electrolyte and acid-base balance. Chronic renal failure is characterized by a progressive, irreversible decline in kidney function that impairs the ability to maintain metabolic, fluid, and electrolyte balance (Schub & Schiebel, 2017). Renal failure is often complicated by elevations in potassium, phosphate, and magnesium and decreases in sodium and calcium. Additionally, chronic renal failure patients often present with an anion gap metabolic acidosis. Renal failure affect electrolytes by elevating potassium, phosphate, and magnesium, urea, creatinine, uric acid, sulfate, phosphate, phosphorus, lipids, cholesterol, neutral fats, and some amino/organic acids, and decreasing sodium, calcium, and albumin. Patients with chronic kidney disease (CKD) and end-stage kidney failure (ESRD) are prone to develop acid-base and electrolyte imbalances. Derangements, such as metabolic acidosis,
Chamberlian NR507 final exam 2016 Question 1 . Continued therapy of pernicious anemia (PA) generally lasts how long? 6 to 8 weeks 8 to 12 months Until the iron level is normal The rest of one’s life Question 2.: What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx?Nasal turbinatesAlveolar macrophagesCilia Irritant receptors on the nares : The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins?IgEIgGIgMT cells : Obesity creates a greater risk for dehydration in people because: Adipose cells contain little water because fat is water repelling. The metabolic rate of obese adults is slower than the rate of lean adults. The rate of urine output of obese adults is higher than the rate of output of lean adults. The thirst receptors of the hypothalamus do not function effectively. Question 6 . : Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? Norepinephrine Epinephrine Cortisol Adrenocorticotropic hormone (ACTH) Question 7.: What is the treatment of choice for pernicious anemia (PA)? Cyanocobalamin by oral intakeVitamin B12 by injectionFerrous fumarate by Z-track injectionFolate by oral intake : Which sexually transmitted infection frequently coexists with gonorrhea?SyphilisHerpes simplex virusChlamydiaChancroid : During an infection, why do lymph nodes enlarge and become tender? B lymphocytes proliferate.The nodes are inflamed.The nodes fill with purulent exudate.The nodes are not properly functioning.
Epidemiology of Celiac Disease Overall the prevalence of Celiac Disease (CD) varies, but there are a number of reports which show that CD is on the rise in different geographic areas (Catassi, Gatti, & Alessio, 2014). Improved diagnostic techniques and disease awareness are part of the reason for the increase in prevalence of CD (Catassi et al., 2014). A US study recently showed that prevalence of CD was around 0.2% in 1975, and has had a five-fold increase in the last 25 years (Castassi et al., 2014). Although the reasoning for these changes is unclear, it is believed to be related to environmental components of CD such as, infant feeding patterns, changes in quality and quantity of ingested gluten, a wide range of intestinal infections and so forth (Catassi et al., 2014). The incidence of CD has greatly increased over the past 30 plus years and is not as easily explained (Catassi et al., 2014). Pathophysiology of Celiac Disease Adaptive and innate immune responses to dietary gluten are both involved in the pathophysiology of Celiac Disease (CD) (Lebwohl, Lydvigsson, & Green, 2015). Environmental factors, predominately gluten, with genetic and immune factors results in development of CD (Lebwohl et al., 2015). Gluten is a protein found in rye, wheat, and barely. CD is a chronic inflammatory disease of the small intestine
Advanced Pathophysiology Week 2 Quiz Question 1 2 / 2 pts Which are indications of dehydration? Correct! Tachycardia and weight loss Decreased hemoglobin and hematocrit Muscle weakness and decreased deep tendon reflexes Polyuria and hyperventilation Marked water deficit is manifested by symptoms of dehydration: headache, thirst, dry skin and mucous membranes, elevated temperature, weight loss, and decreased or concentrated urine (with the exception of diabetes insipidus). Skin turgor may be normal or decreased. Symptoms of hypovolemia, including tachycardia, weak pulses, and postural hypotension, may be present. Question 2 2 / 2 pts At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure. capillary oncotic pressure is lower than the interstitial hydrostatic pressure. interstitial oncotic pressure is higher than the interstitial hydrostatic pressure. Correct! capillary hydrostatic pressure is higher than the capillary oncotic pressure. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial, because capillary hydrostatic pressure is higher than the capillary oncotic pressure. Question 3 2 / 2 pts Which enzyme is secreted by the juxtaglomerular cells of the kidney when circulating blood volume is reduced? Angiotensin II Aldosterone Angiotensin I Correct!
Renin When circulating blood volume or blood pressure is reduced, renin, an enzyme secreted by the juxtaglomerular cells of the kidney, is released in response to sympathetic nerve stimulation and decreased perfusion of the renal vasculature. Question 4 2 / 2 pts In hyperkalemia, cardiac rhythm changes are a direct result of Correct Answer cardiac cell hypopolarization. cardiac cell repolarization. You Answered cardiac cell hyperexcitability. depression of the sinoatrial (SA) node. If extracellular potassium concentration increases without a significant change in intracellular potassium, the resting membrane potential becomes more positive (i.e., changes from –90 to –80 mV) and the cell membrane is hypopolarized (the inside of the cell becomes less negative or partially depolarized [increase excitability]). (Electrical properties of cells are discussed in Chapter 1.) Question 5 2 / 2 pts Why are infants susceptible to significant losses in total body water (TBW)? Because they are unable communicate adequately when they are thirsty Because more than half of an infant’s body weight is water Correct! Because an infant’s kidneys are not mature enough to counter fluids losses Because infants have a slow metabolic rate Infants are particularly susceptible to significant changes in TBW because of their high metabolic rate and the accelerated turnover of body fluids caused by their greater body surface area in proportion to total body size. Loss of fluids from diarrhea can represent a significant proportion of body weight. Renal mechanisms that regulate fluid and
