NR 507 Week 3 Discussions Cardiovascular, Cellular, and Hematologic Disorders

Week 3: Cardiovascular, Cellular, and Hematologic Disorders

 

Discussion Part One

 

This week’s graded topics relate to the following Course Outcomes (COs).

 

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

 

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

 

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

 

4 Distinguish risk factors associated with selected disease states. (PO 1)

 

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

 

6 Distinguish risk factors associated with selected disease states. (PO 1)

 

7 Explore age-specific and developmental alterations in physiologic and disease states

 

A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing. Assuming, she is drug seeking he sends her home. She comes back to the ER 4 hours later and now you see the patient. She explains that she was running track this past afternoon at school and that despite being very hot (100 F) she pushed on. Afterwards, she starts feeling extensive pain in her chest and abdomen. She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T = 99.9 F, R = 28. The pain seems out of proportion to the physical findings.

 

What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least four (4) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.

 

Now, as she is in the ER she begins to exhibit stroke like features. ? Does this change your differential? How do you treat this patient now? Are they any preventative actions that could have been taken?

 

Discussion Part Two

 

This week’s graded topics relate to the following Course Outcomes (COs).

 

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

 

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

 

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

 

4 Distinguish risk factors associated with selected disease states. (PO 1)

 

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

 

6 Distinguish risk factors associated with selected disease states. (PO 1)

 

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

 

Jesse is a 57-year-old male who presents with gradual onset of dyspnea on exertion and fatigue. He also complains of frequent dyspepsia with nausea and occasional epigastric pain. He states that at night he has trouble breathing especially while lying on his back. This is relieved by him sitting up. His vitals are 180/110, P = 88, T = 98.0 C, R = 20.

 

Write a differential in this case and explain how each item in your differential fits and how it might not fit.

 

What tests would you order? What immediate treatment would you consider giving this patient and what treatment when he went home? Assume your first differential is definitive.

 

Now, he comes back to your clinic 3 months later and both his ankles are slightly swollen. What possible explanations are there for this observation?

 

Discussion Part Three

 

This week’s graded topics relate to the following Course Outcomes (COs).

 

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

 

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

 

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

 

4 Distinguish risk factors associated with selected disease states. (PO 1)

 

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

 

6 Distinguish risk factors associated with selected disease states. (PO 1)

 

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

 

A new patient is brought into the office for their annual evaluation. The child is a 6-year-old and appears a bit small for their age but not so small that any alarm bells are set off. The vitals are: P = 116, R = 22, T = 98.6 , BP = 110/50. (The normal vitals in a 6-year-old are P = 75 – 120, R = 16 – 22, T = 98.6 , BP = (85-115)/(48-64).

 

Examination of the lungs is normal, HEENT is normal, as is the abdominal exam. The heart however, seems laterally displaced and there appears to be only a continuous murmur which can be described as crescendo/decrescendo systolic murmur that extends into diastole. Because, you were trained at Chamberlain College of Nursing you immediately know that this is probably a patent ductus arteriosus.

 

Explain the murmur from a mechanistic view of the hearts physiological functioning?

 

What is the epidemiology of a patent ductus arteriosus?

 

How is a patent ductus arteriosus treated?

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