As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.
Consider the following scenarios:
Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for Assessment. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.
Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative Helpant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for Helpance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.
To Prepare
Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
Review the Application Assignment Rubric found under Course Information
To Complete
Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:
For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.
Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
References need doi or https all nothing less than 5 years. The mind map requires an image of one of the scenarios.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.
Sample Essay Solution
Advanced Pathophysiology
Jennifer is a two-year-old girl who is currently experiencing a fever. Children have a fever due to underlying bacterial or viral infection. In normal situations the body temperature of a child should be approximately 98.8°F. However, in the case of Jennifer the temperature has increased to 103.2°F. The significant difference in temperature she is severely sick and requires immediate medical attention (Tran, Danchin, Pirotta & Steer, 2018). The baby has also expressed another significant change which includes getting fussy. The fussy baby thus shows there is something wrong that happened three days ago. When the baby gets fussy it means she is demanding for attention or crying due to discomfort (De Barse et al., 2016). She has also refused to take breakfast, which is not the norm. The changes that have occurred is that the bacterial or viral infection has reduced the level of appetite.
The baby has been provided with ibuprofen as a medication for the fever. The drug is used for children above 6 months to treat fever or pain. However, the drug was not effective since rather than lowering the temperature it hiked it to 103.2°F. Ibuprofen works in the body by inhibiting the production of prostaglandins that are released by the body during an illness (De Barse et al., 2016). An increase in the temperature means the child requires further medical care. On the other hand, the skin of the child is hot and dry, which is unusual. The hot skin means that it is evident the fever has significantly increased over the last three days. The dry skin also unusual and could be due to the underlying illness in a child (Tran, Danchin, Pirotta & Steer, 2018). For example, the high temperature might affect the skin leading to the dryness. The response of the skin during fever is to appear dry to avoid excessive loss of moisture in the body.
The normal color of a tympanic membrane is grey. However, due to the illness is has turned out to be slightly reddened on the periphery. The change in color is an indicator that the baby is unwell. The tympanic membrane can appear red in case of infection (Tran, Danchin, Pirotta & Steer, 2018). The reason is due to the pulse building up behind it that leads to a change of color. The appearance is normal and thus it has not started bulging like in severe cases. The condition is affected by the fever due to the increased activities in the body of trying to fight the infection. The throat is erythematous, which is not the usual appearance (De Barse et al., 2016). It also has tonsils and diffuse exudates which shows the possibility of an infection. When the tonsils are infected they develop a white coating. In normal situations the normal color of the tonsils is pink, which means the change of color is due to a possible viral or bacterial infection (De Barse et al., 2016). Additionally, the most common cause of sore throat is viral infection such as flu or cold. The sore throat is also another reason why a baby could experience fluctuating temperatures.
Skin Irritation
The second is of Jack who works with abrasive solvent and chemicals. He has confessed to not using the protective gloves while handling cleaning fluids. He has no medical history of any allergy (Yamamoto, Matsumura, Hirata & Nagamune, 2019). The changes in the skin have been caused by the reaction between the skin and chemical components of the cleaning fluids. He is experiencing redness and irritation in his hands. In normal situations the hands should not be red or cause any irritation. The redness is due to the increased blood flow on the surface of the skin in an attempt to counter the chemical components (Yamamoto, Matsumura, Hirata & Nagamune, 2019). The reaction could also inhibit poor circulation of blood in the hands thus causing the redness. It is also crucial to note the irritation is due to the reaction of the epidermal cells with the chemical compounds.
When the epidermal cells are exposed to foreign particles they react in different ways. One of the ways is by releasing pro-inflammatory cytokines which are used to counter the chemical components (Yamamoto, Matsumura, Hirata & Nagamune, 2019). In normal cases, the skin does not produce the pro-inflammatory cytokines. Therefore, this is one of the adaptive responses of the skin in a bit to counter the effect of the chemicals on the skin. The skin is designed to ensure it reacts to such components using innate immunity that is only activated during such circumstances. Another critical response is skin barrier disruption which is essential in minimizing the negative effects of the chemicals on the epidermal cells (Yamamoto, Matsumura, Hirata & Nagamune, 2019). The irritation and redness is an indicator that the normal functioning process of the skin has been affected negatively. Jack is also denying any discomfort since the nerves in the skin are responding the brain indicating there is presence is unusual activity.
Jack should be cautious to always wear protective gears since exposure to the cleaning fluids is one of the major reasons why the hands have been affected. In the current changes to the physical functioning of the skin plus the adaptive responses, they show there are foreign particles that have interfered with the normal functioning (Yamamoto, Matsumura, Hirata & Nagamune, 2019). The solvents are not friendly with the skin thus causing the discomfort, redness, and irritation that Jack is experiencing.
Hypertension in Old Age
Martha is suffering from hypertension or simply high blood pressure. The high blood pressure is as a result of various factors which the body responds to in different ways. One of the causes of the condition is old age (Picon et al., 2017). Martha is over 65 years old and she currently retired from her administrative tasks. She has been taking medication to tone down the negative effects of the condition. The racing heartbeat is because the heart is pumping harder than it should. She is also experiencing more heartbeats per minute compared to her age. One of the side effects of the drug she has been taking is lack of sufficient sleep. Patients who take hydrochlorothiazide experience lack of sleep since it is a diuretic (Picon et al., 2017). Therefore, although Martha is worried that she is having less sleep compared to other days, it is important to acknowledge that the drug is affecting her (Williams et al., 2018). Additionally, old age is catching up with her thus making it hard to enjoy the sleep she was used to. On the other hand, the lack of appetite is also due to the hydrochlorothiazide drug.
Mind Map
The following is a mind map for Martha’s hypertension case. Figure 1.1 presents a mind map.
Hypertension Mind Map
Conclusion
The three scenarios present how the body responds to various functional changes due to a bacterial or viral infection. It also shows how the body reacts to various medications plus their side effects. The case of Jennifer is delicate since she is two years old and is currently experiencing a severe fever and sore throat. The conditions reduce her level of appetite. Jack has irritation and redness due to the effect of the chemicals that trigger the skin to produce pro-inflammatory cytokines. Martha is experiencing a running heart which is due to the old age plus lack of sleep due to the side effects of the diuretic drug she is taking.
References
De Barse, L. M., Cano, S. C., Jansen, P. W., Jaddoe, V. V., Verhulst, F. C., Franco, O. H., … & Tharner, A. (2016). Are parents’ anxiety and depression related to child fussy eating?. Archives of Disease in Childhood, 101(6), 533-538.
Picon, R. V., Dias-da-Costa, J. S., Fuchs, F. D., Olinto, M. T. A., Choudhry, N. K., & Fuchs, S. C. (2017). Hypertension management in Brazil: usual practice in primary care—a meta-analysis. International Journal of Hypertension, 2017.
Tran, J., Danchin, M., Pirotta, M., & Steer, A. C. (2018). Management of sore throat in primary care. Australian Journal of General Practice, 47(7), 485.
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., … & Kahan, T. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021-3104.
Yamamoto, M., Matsumura, R., Hirata, Y., & Nagamune, H. (2019). A comparative study of skin irritation caused by novel bis-quaternary ammonium compounds and commonly used antiseptics by using cell culture methods. Toxicology in Vitro, 54, 75-81.
