Case Study Assignment: NURS 6501 Module 2&3 Analysis
Case Study Assignment: NURS 6501 Module 2&3 Analysis
This week we will have another scenario to base our assignment on it is listed below:
A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations.
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On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF).
- Using the above mentioned scenario you are to complete a knowledge check. Per the instructions: You will complete a 10- to 20-question Knowledge Check to gauge your understanding of this module’s content.
- This Knowledge Check will give you an opportunity to review a given scenario or situation to help you to determine cause and effect of a given disorder from a pathophysiology perspective. Please note that this is a formative practice for you to help you better prepare for your Midterm and Final Exams.
Please reach out if you have any questions.
NURS 6501 Week 2: Altered Physiology
With a place squarely in the spotlight for patients diagnosed with all manner of disease, APRNs must demonstrate not only support and compassion, but expertise to guide patients’ understanding of diagnoses and treatment plans.
This expertise goes beyond an understanding of disease and sciences, such as cellular pathophysiology. APRNs must become experts in their patients, understanding their medical backgrounds, pertinent characteristics, and other variables that can be factors in their diagnoses and treatments.
This week, you examine alterations in the immune system and the resultant disease processes. You consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
Learning Objectives for NURS 6501 Module 2 Assignment Case Study Analysis
Students will:
- Evaluate cellular processes and alterations within cellular processes
- Analyze alterations in the immune system that result in disease processes
- Identify racial/ethnic variables that may impact physiological functioning
- Evaluate the impact of patient characteristics on disorders and altered physiology
Alterations Within Cellular Process Example Paper
A 16-year-old boy comes to the clinic with the chief complaint of a sore throat for three days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections, or pneumonia. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78, and regular respirations of 18. HEENT normal with the exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy.
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Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg PO q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips and difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.
In the aforementioned case study, the patient presented with acute pharyngitis. Pharyngitis refers to the inflammation of mucus membranes of the oropharynx. Manifestations of uncomplicated pharyngitis include fever, painful cervical adenopathy, tonsillar exudates, and pharyngeal erythema (Wolford et al., 2022). It is predominantly caused by viral or bacterial infectious processes. A positive rapid strep test, in his case, favors a bacterial etiology.
According to Wolford et al. (2022), Group A beta-hemolytic streptococci is the most common cause of bacterial acute pharyngitis and accounts for up to 36% of the cases. Subsequently, the boy has been prescribed antibiotics, principally amoxicillin which is recommended for bacterial eradication in patients with strep pharyngitis. Upon taking the first capsule, the patient develops an immediate hypersensitivity reaction.
Genetics
The patient in the case study above is allergic to penicillin. Type 1 hypersensitivity reactions include atopic diseases, which run in families. Drug hypersensitivity reactions can be allergic or non-allergic. However, these reactions usually occur as a result of cumulative interaction and interplay of various environmental and genetic factors.
For instance, more than half of children born in atopic families develop an allergic disease as opposed to one in five children with no family history of allergies (Amo et al., 2019). Additionally, various genes act diversely in different families to predispose to drug hypersensitivity reactions. For instance, the PHF11 gene on chromosome 13q14 has been linked consistently with drug hypersensitivity reactions.
Specific Symptoms, Why, and Physiologic Response
The patient presented with swelling of lips and tongue, difficulty breathing, and audible wheezing. Swelling of the lips and tongue are characteristics of allergic angioedema. According to Justiz Vaillant et al. (2022), allergic angioedema is a type 1 hypersensitivity reaction and can be triggered by foods such as nuts and medications such as penicillin.
In this scenario, the patient has an exaggerated immune response in response to amoxicillin. Severe angioedema may progress to anaphylaxis. The difficulty in breathing and audible wheezing are a result of histamine-mediated bronchoconstriction. If not treated, the patients usually develop anaphylactic shock, which is life-threatening and may lead to death.
Involved Cells and the Process
According to McCance and Huether (2019), type 1 hypersensitivity reactions are IgE- mediated and involve the release of large amounts of histamines and later leukotrienes by mast cells. Immune cells that are involved in this allergic reaction are T helper cells of types 1, 2, and 17. T helper 1 cells produce IL-2 and interferon-gamma and enhance a cell-mediated immune response, while T helper 2 cells produce IL-4 and IL-13, which enhance the production of antigen-specific-IgE.
Meanwhile, T helper 17 cells produce IL-17, IL-21, and IL-22. The drug is presented to these T cells via dendritic cells. Finally, the antigen binds to TCR receptors on the T cells and activates these immune cells (McCance & Huether, 2019).
Gender and other characteristics such as age, genetics, geography, and race influence the distribution of allergic diseases such as hypersensitivity reactions. For instance, most of these reactions are highly prevalent in childhood. In the United States, Puerto Ricans have the topmost prevalence, followed by blacks, whites, Asians, and ultimately Mexicans.
References
Amo, G., Martí, M., García-Menaya, J. M., Cordobés, C., Cornejo-García, J. A., Blanca-López, N., Canto, G., Doña, I., Blanca, M., Torres, M. J., Agúndez, J. A. G., & García-Martín, E. (2019). Identification of novel biomarkers for drug hypersensitivity after sequencing of the promoter area in 16 genes of the Vitamin D pathway and the high-affinity IgE receptor. Frontiers in Genetics, 10, 582. https://doi.org/10.3389/fgene.2019.00582
Justiz Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate hypersensitivity reactions. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513315/
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biological basis for disease in adults and children. Elsevier.
Wolford, R. W., Goyal, A., Syed, S. Y. B., & Schaefer, T. J. (2022). Pharyngitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519550/
NURS 6501 Module 2 Assignment Case Study Analysis Learning Resources
Required Media (click to expand/reduce)
Immunity and Inflammation
Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk
Note: The approximate length of the media program is 14 minutes.
Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds
Note: The approximate length of the media program is 37 minutes.
Acid-Base Balance #1
MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE
Note: The approximate length of the media program is 13 minutes.
Acid-Base Balance #2
MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI
Note: The approximate length of the media program is 15 minutes.
Hyponatremia
MedCram. (2017, December 23). Hyponatremia explained clearly [LK1] (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M
Note: The approximate length of the media program is 15 minutes.
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 3, 7, and 8 that relate to alterations in immunity, hyponatremia, and acid/base balance.
Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com
To Register to View the Content
- Go to https://evolve.elsevier.com/
- Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
- Complete the registration process.
To View the Content for This Text
- Go to https://evolve.elsevier.com/
- Click on Student Site.
- Type in your username and password.
- Click on the Login button.
- Click on the plus sign icon for Resources on the left side of the screen.
- Click on the name of the textbook for this course.
- Expand the menu on the left to locate all the chapters.
- Navigate to the desired content (checklists, videos, animations, etc.).
Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.
NURS 6501 Week 4: Alterations in the Cardiovascular and Respiratory Systems
INTRODUCTION
Cardiovascular and respiratory disorders can quickly become dangerous healthcare matters, and they routinely land among the leading causes of hospital admissions. Disorders in these areas are complicated by the fact that these two systems work so closely as contributors to overall health. APRNs working to form a similarly close partnership with patients must demonstrate not only support and compassion, but expertise to guide the understanding of diagnoses and treatment plans. This includes an understanding of patient medical backgrounds, relevant characteristics, and other variables that can be factors in their diagnoses and treatments.
This week, you examine alterations in the cardiovascular and respiratory systems and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
LEARNING OBJECTIVES
Students will:
- Analyze processes related to cardiovascular and respiratory disorders
- Analyze alterations in the cardiovascular and respiratory systems and the resultant disease processes
- Analyze racial/ethnic variables that may impact physiological functioning
- Evaluate the impact of patient characteristics on disorders and altered physiology
An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.
Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.
An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment
In your Case Study Analysis related to the scenario provided, explain the following
- The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
- BY DAY 7 OF WEEK 4
- Submit your Case Study Analysis Assignment by Day 7 of Week 4
- Reminder:The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templatesLinks to an external site.). All papers submitted must use this formatting.
Week 4 Case Study Assignment
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Hello Class,
Week 4 Case Study Assignment:
A 55-year-old high school teacher begins experiencing a cough after a parent-teachers conference. Initially it was a mild cough and the teacher thought nothing of it since he had a history of asthma. As he was driving home, the cough became more intense, and he began experiencing chest tightness. He used his rescue inhaler as usual but did not get any relief. Minutes later he began experiencing chest pain, unlike the tightness that he experienced with his asthma.
He began to sweat profusely, experience light-headedness and difficulty breathing. He attempted to pull into a park but passed out and struck the curve causing his vehicle to come to a stop. A passerby saw the incident and called 9-1-1. On the scene, the paramedic found the man unconscious. His EKG revealed ST segment elevation in the anterior leads (V3 and V4), his pulse was shallow, and respirations were 10 breaths/min. Upon arrival to the ER, a troponin level was 13ng/l and his CK level was 265 U/L.
LEARNING RESOURCES
- McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
- Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
- Chapter 35: Structure and Function of the Pulmonary System; Summary Review
- Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery hypertension); Summary Review
Note: The above chapters were first presented in the Week 3 resources. If you read them previously you are encouraged to review them this week.
- Alterations in the Cardiovascular and Respiratory Systems – Week 4 (15m) Transcript Attached
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 32, 33, 35, and 36 that relate to cardiorespiratory systems and alteration in cardiorespiratory systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/Links to an external site.
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NURS_6501_Module2_Case Study_Assignment_Rubric
| NURS_6501_Module2_Case Study_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following: Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Explain any racial/ethnic variables that may impact physiological functioning. |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||
NURS_6501_Module2_Case Study_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following: Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms.
30 to >27.0 pts
Excellent
The response accurately and thoroughly describes the patient symptoms. … The response includes accurate, clear, and detailed reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation.
27 to >24.0 pts
Good
The response describes the patient symptoms. … The response includes accurate reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation.
24 to >22.0 pts
Fair
The response describes the patient symptoms in a manner that is vague or inaccurate. … The response includes reasons for the cardiovascular and/or cardiopulmonary pathophysiologic processes, with explanations that are vague or based on inappropriate evidence/research.
22 to >0 pts
Poor
The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. … The response does not include reasons for either the cardiovascular or cardiopulmonary pathophysiologic processes, or the explanations are vague or based on inappropriate or no evidence/research.
30 pts
This criterion is linked to a Learning Outcome Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
30 to >27.0 pts
Excellent
The response includes an accurate, complete, detailed, and specific explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
27 to >24.0 pts
Good
The response includes an accurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
24 to >22.0 pts
Fair
The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
22 to >0 pts
Poor
The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
30 pts
This criterion is linked to a Learning Outcome Explain any racial/ethnic variables that may impact physiological functioning.
25 to >22.0 pts
Excellent
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.
22 to >19.0 pts
Good
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.
19 to >17.0 pts
Fair
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations based on inappropriate evidence/research.
17 to >0 pts
Poor
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
25 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 to >3.0 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.
3 to >2.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment are vague or off topic.
2 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. … No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
4 to >3.0 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3 to >2.0 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.
2 to >0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
5 to >4.0 pts
Excellent
Uses correct APA format with no errors.
4 to >3.0 pts
Good
Contains a few (1 or 2) APA format errors.
3 to >2.0 pts
Fair
Contains several (3 or 4) APA format errors.
2 to >0 pts
Poor
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100
NURS 6501 Module 3: Knowledge Check Quiz
Question 14 pts
Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain is described as burning, non-radiating, and worse after meals. Denies N&V, weight loss, or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and has 6-7 cups of coffee per day. She denies illicit drug use, vaping, or unprotected sexual encounters.
A breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
Questions:
- Explain what contributed to the development of this patient’s history of PUD?
The patient’s peptic ulcer disease is most likely multifactorial. One of the confirmed risk factors in this patient is Helicobacter pylori infection. H. pylori infection has been confirmed by a positive breath test for urease. This gram-negative flagellated spiral bacterium is an established cause of peptic ulcer disease, among other illnesses such as acute and chronic gastritis. Another risk factor in the above patient is tobacco smoking. The patient has 35 packs per year of smoking, and this is a significant risk for PUD. Thirdly, the patient’s elderly age, above 64 years, is another risk for peptic ulcer disease.
The patient also takes alcohol, especially 1-2 glasses of wine daily, and this contributes to the development of PUD. The patient’s use of nonsteroidal anti-inflammatory drugs, especially ibuprofen, is a risk factor for PUD development in this patient. The patient’s coffee consumption cannot be associated with her PUD. According to a review article by Nehling (2022), there has been no substantial evidence linking coffee consumption or use of any caffeinated drinks with acid-related gastrointestinal diseases such as peptic ulcer disease
McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.
Nehlig, A. (2022). Effects of coffee on the Gastrointestinal tract: A narrative review and literature update. Nutrients, 14(2), 399. https://doi.org/10.3390/nu14020399
Question 24 pts
Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain is described as burning, non-radiating, and worse after meals. Denies N&V, weight loss, or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributory
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and has 6-7 cups of coffee per day. She denies illicit drug use, vaping, or unprotected sexual encounters.
A breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
Question:
- What is the pathophysiology of PUD/ formation of peptic ulcers?
This patient’s peptic ulcer disease is multifactorial. The pathophysiology of PUD in the above patient was orchestrated by an imbalance between muco-protective and destructive factors. The above factors led to the weakening of muco-protective defense mechanisms in the stomach and duodenum. When these barriers are eroded by the aforementioned factors, the mucosa is exposed to gastric acid, which leads to PUD.
Muco-protective factors include gastric mucus, stable blood flow, intact epithelial cell lining, and prostaglandin production. Acids and toxins destroy these barriers. Helicobacter pylori release toxins that irritate the already defenseless mucosa to cause an inflammatory response. NSAIDs decrease prostaglandin production by inhibiting cyclooxygenase production.
Thus, the use of these medications increases acid production and decreases gastric mucus production. Stress such as physiological and psychological stress can increase acid production. All these factors lead to mucosa erosion. The outcome is epigastric pain, vomiting, nausea, hematemesis, and sometimes melena stool
McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.
Question 34 pts
Scenario 2: Gastroesophageal Reflux Disease (GERD)
A 44-year-old morbidly obese female comes to the clinic complaining of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but the patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
FH: non-contributory
Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn
SH: 20 PPY of smoking, ETOH rarely, denies vaping
Diagnoses: Gastroesophageal reflux disease (GERD).
Question:
- If the client asks what causes GERD how would you explain this as a provider?
I would let this patient know that her gastroesophageal reflux disease (GERD) was multifactorial in that not only one factor would have led to her illness. She would know that in GERD, the contents of the stomach move up the esophagus through the lower sphincter in the junction between the esophagus and the stomach. The stomach contents are majorly acidic and thus will cause corrosion of the esophageal inner lining, leading to inflammation.
Factors such as obesity, pregnancy, smoking, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause GERD. In some individuals, hiatal hernia, a condition in which part of the stomach or whole of the stomach moves into the chest cavity, can cause GERD. Also, when the movement of gastric contents is slowed or delayed, GERD can develop. Therefore, gastroparesis, gastric ulcers, and duodenal ulcers can cause GERD.
McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.
Question 44 pts
Scenario 3: Upper GI Bleed
A 64-year-old male presents to the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid-epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
- What are the variables here that contribute to an upper GI bleed?
This patient’s advanced age and a likely peptic ulcer disease are key risks for his upper GI bleed. Peptic ulcer disease has ulcer pits that, if not allowed to heal properly, can bleed. With advanced age comes various risks that increase the likelihood of having an upper GI bleed. The pieces of evidence of upper GI bleeding in this patient are passing dark tarry stool, epigastric pain, nausea, and weakness. Weakness can arise from anemia or shock from this type of bleeding. Intake of beets could have given the stool an abnormal color. Therefore, the endoscopy is warranted to ascertain the presence and cause of upper GI bleeding in this patient.
McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.
Question 54 pts
Scenario 4: Diverticulitis
A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning.
The diagnosis is lower GI bleeding secondary to diverticulitis.
Question:
- What can cause diverticulitis in the lower GI tract?
Outpouching that occurs on the bowel wall is called diverticula. Diverticula can occur in anyone, but the presence is mostly detected when symptoms of active disease are present. These diverticula can become infected or can have inflammation to cause diverticulitis. Diverticulitis can be caused by various factors such as reduced fiber in the diet, obesity, smoking, advanced age, lack of physical exercise, and medication use. Abnormal colonic motility and alteration in intestinal microbiota can contribute to diverticulitis. Sometimes, visceral hypersensitivity is implicated. Medications such as aspirin and NSAIDs also predispose one to diverticulitis.
McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.
Week 6: Concepts of Endocrine Disorders
WEEK 6: AT A GLANCE
CONCEPTS OF ENDOCRINE DISORDERS
INTRODUCTION
Endocrine disorders are complex matters, and there is not always a one-size-fits-all treatment. Particularly in matters requiring the adjustment of hormone levels, treatment may require a custom approach tailored to individual patients. An understanding of these complications is essential to supporting these individual treatment plans.
This week, you examine alterations in the endocrine system and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
LEARNING OBJECTIVES
Students will:
- Analyze concepts and principles of pathophysiology across the lifespan
LEARNING RESOURCES
- McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children(8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 21: Mechanisms of Hormonal Regulation, including Summary Review
- Chapter 22: Alterations of Hormonal Regulation, including Summary Review
- Chapter 23: Obesity and Disorders of Nutrition, including Summary Review
- American Diabetes Association (2020). Standards of medical care of patients with diabetes mellitus. Diabetes CareLinks to an external site., 26(suppl 1), pp. s33-s50. https://care.diabetesjournals.org/content/26/suppl_1/s33
- Orlander, P. R. (2018). HypothyroidismLinks to an external site.. Retrieved from https://emedicine.medscape.com/article/122393-overview
- Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelinesLinks to an external site.. Journal of the American Society of Nephrology, 28(5), 1340–1349
- Document: NURS 6501 Midterm Exam Review (PDF)Download NURS 6501 Midterm Exam Review (PDF)
Note: Use this document to help you as you review for your Midterm Exam in Week 6.
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Module 4 Overview with Dr. Tara Harris
Dr. Tara Harris reviews the structure of Module 4 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Midterm. (3m
Transcript below:
TARA HARRIS: Hi. Welcome to Module 4 of Advanced
Pathophysiology NURS 6501. I’m Dr. Tara Harris, and I will
provide you with an overview. During Module 4, we will
discuss endocrine disorders. This module only covers week 6. During week 6, you will
analyze concepts and principles of pathophysiology
across the lifespan as it relates to
endocrine disorders. You have several required
readings and articles. You also have required media
that you can access online. You will need to focus on videos
and animations in chapters 21 through 23 as they relate to
endocrine system and disorders. You can access this through
the [? elsevier ?] website. There is also an optional
resource that you can access. This is actually an
interactive tutorial that you can use at
home, and you also have access to this through
the Walden University website. During week 6, you will have
a knowledge check questions. These will be 10 to 20 questions
to gauge your understanding of this module’s content. The week 6 knowledge checks
will include clue questions related to endocrine disorders. You will be provided
with immediate feedback after you have
posted your answers. These knowledge
check questions are to be completed and
submitted by day 7 of week 6. This week, you also
have your midterm exam. Your midterm will cover topics
from weeks 1, 2, 3, 4, 5, and 6. You have two hours
to complete the exam, and you have 100 questions
within this exam. Your exam will automatically
shut off after the two hour mark . Please complete this
exam in one sitting. Do not stop and
restart the exam. Should your system remain
idle for a period of time, it may shut off,
and you will not be able to complete the exam. You must submit your midterm
exam by day 7 of week 6.
Concepts of Endocrine Disorders – Week 6 (24m) Transcript below
ELISABETH BUCHANAN:
Hello, everyone and welcome to Advanced
Pathophysiology, week six. My name is Dr. Buchanan. This week’s topic of
discussion is concepts of the endocrine disorders. Very interesting topic. Before we get started
on the overview. Let’s look at a few things that
are reminders for week six. We want to make sure
that you’re understanding the Knowledge Check is due
by day seven of week six. However to prepare
you for your midterm, we want to make
sure that you try to get it done at least 48 hours
before so that at least you can reach out if you
have any questions. You develop a conceptual
learning pattern instead of a memorizing pattern. And it helps you to critically
think outside and around the box on your midterm exam. Note that you would
also need your materials from previous knowledge checks. So make sure you review all
those before your midterm exam as well. Let’s look at some of the topics
that we’re going to go over. One of them is very prominent
in our culture, diabetes. We also have hyperthyroidism
and hypothyroidism, adrenal disorders,
parathyroidism, both hyper and hypo. The checks and balances
and the negative feedback we’re talking about the
homeostasis within the system. Whenever there is a check
and balance out of place, then we know we have suffering
normally of the renal. –syndrome of inappropriate
antidiuretic hormone, pheochromocytosis,
diabetes insipidus, and diabetic ketoacidosis. Let’s start with diabetes. So that’s something that’s
very prominent in our culture. We see it quite a bit, all ages. We’re getting to see it more
so in our younger generation. One of the things that I would
like and suggest that you do. On your resources, make sure
that you go and look at those, there is an arrow to the
right of those resources. Click on that and
that will take you to some of the study guidelines
and comparative table values that I’m sure you’ll use. There is some really
good ones in there. Another place that you can look
at for diabetic information for your patients is the
American Diabetic Association. Wonderful. Absolutely wonderful tools there
that you should be able to see. So let’s go over some
of the diabetic problems or some of the things
that we see in diabetes just as a brief overview. Some of the things that you want
to make sure that you always ask as far as risk
factors, you want to look at their
physical inactivity. You want to look at their
first degree relatives. Do they have diabetes? You want to look at the high
risk ethnic populations. You want to look at women
who have delivered babies weighing greater than 9 pounds
and had gestational diabetes at the time of
their prenatal care. Hypertension, you want
to look at if they are greater than or equal on
a systolic of 140 greater than or equal to a systolic of 90
or on hypertensive therapy. A lot of times you’re going to
see diabetes and hypertension go together. I almost know there are research
papers out there where you’re going to see where diabetes
can actually have influence on their blood pressure. So if their diabetes is high
for that evening that day or whenever you’re probably
more than likely going to see hypertension play
a role in being higher than their normal
number as well. Whenever they’re sick. We know their diabetes
is going to go higher. So probably blood pressure
could go higher as well. We want to look at impaired
glucose tolerance test. We’re going to look at
other clinical conditions such as insulin resistance. Somebody that’s
severe morbidly obese. We’re going to look at history
of cardiovascular disease, somebody with atherosclerosis,
coronary artery disease, problems
peripheral swelling, edema, kidney malfunction. The one thing that
I want to let you know too, when we look
at these risk factors, we’re looking at age of
initiation in a lot of them even in asymptomatic children. We want to look at anybody
10 years of age or older, puberty also. So be conscientious
of those age groups when you look at that as well. Some of the diabetes, diagnosing
prediabetes and diabetes mellitus in adults
and adolescents, their plasma glucose fasting,
which means no caloric intake for greater than 8 hours,
anything greater than 126 and/or a random blood
sugar greater than 200, with symptoms including
polyphagia, polyurea, polydipsia, and
unexplained weight loss. So those are things
that you want to look for when you’re
looking at the diabetic or diagnosing a diabetic. When you look at Oral Glucose
Tolerance Test, the OGTT, you want to look at the two
hour plasma glucose anything greater than or equal
to a 200 after a 75 gram of glucose load. A1Cs are a little
tricky because you have a lot of
differentiations out there across the lines of health
care and the insurance world. CMS, Center for Medicare
and Medicaid Services, in their quality checks
when they do risk factors or they look at risk
factors among patients in the geriatric or the
disabled population, they’re looking at anything
less than eight on an A1C. And you’re like, well, wait
a minute that’s pretty high. For us as providers it might be. But anything less than eight to
the Medicare world or Medicare is the mom of all the
insurance industries even though they won’t admit
to it, Medicare world a lot of times anything
less than eight is an indication
of a safety issue– somebody on anticoagulation
therapy, somebody with syncope, somebody with vertigo, somebody
that’s just not stable, somebody that might have
OA, RA, osteoporosis, frailty in general, wheelchair,
using assistive devices. Any of those things and
they have hypoglycemia, they’re probably
going to go down and could cause definitely head
trauma with hemorrhagic issues. So you want to make sure that
if you are wanting tighter controls less than
six, less than 6.5, whatever the parameters based on
evidence based in your practice area are, you want to make
sure that you’re dealing with not only the diabetes. You’re dealing with these safety
issues of that patient as well. So remember anything less than
eight in the insurance world is normal for us. When I say for us, if I was
in insurance world, anything less than 6.5, 6.9 is
probably in the world of you as a provider. You want optimal always
for your patients. But that’s not
always obtainable. Make sure whatever
you want for them is something they can meet. If they find they
can’t meet what you want they’ll either
switch providers. They’ll play doctor shop. They’ll play medicine shop. In other words, they’ll take
a medicine here and there. You prescribe two pills. They’ll take one
today because you know they’re playing
with their blood sugars. So just remember that when you
say somebody is prediabetic, please explain to
them what that means. You give them metformin. You give them a glipizide. You give them something
for their diabetes. Then they in the
insurance world have become pretty much diabetic. Because you are now
giving them therapy. You’re treating their diabetes. If somebody is prediabetic, try
to put them on a 90 day diet and exercise program
giving them an idea of how many carbs for intake. Refer them to a dietitian. Get their blood sugar
or blood pressure down. Have them exercise. But when you say
exercise make sure that you’re not
telling this patient to go out and exercise 30 to
40 minutes every single day or five days a week. If they miss one day,
they feel really horrible most of the time. And they won’t come
and follow up with you because they didn’t do
what you asked them to do. And they know that. And their sugar
levels is not right. It won’t be right. I just know it. my blood test
isn’t going to be normal. So when you set expectations
that you can meet, you’re really not meeting
the value and belief system of the patient. Make sure you evaluate their
belief and value system and not just yours
especially related to the endocrine system. Those hormones, those stress
hormones can be activated. And you can cause a boomerang or
a cascading effect of problems. So remember what you always want
is and what they always want, you have to come the halfway. We can give them the tools. We can write a prescription. We can do as much as
we can educate them. We don’t follow them home. We don’t monitor them 24/7. That’s their job. We have to give them the
tools to own their illness. If we don’t, then that illness
will eventually overtake them. And they’re going
to be a repeated revolving door at the hospital. So make sure you have them own
their illness by you providing them with knowledge
and education and the appropriate
means of evidence based effective treatment. Sorry to get off on that. So we want to make
sure that we look at anybody’s lab tests, A1Cs. Don’t just do those once a year. Medicare, all the
insurances will pay for those three
to four times a year, every three to six months. Try and do that. Give them an objective. If you do an A1C March,
they don’t see you till next January. You’ve got three
holidays in there. You’ve got Halloween,
Thanksgiving, Christmas, and New Year’s. Whether they believe
those or not, those are winter months
regardless of people’s values or belief systems. You’ve got four holidays in
there and/or maybe something else January 1st, the new year. The problem is you
do an A1C check and I almost guarantee
you it’s going to be a sky high off the rocker. They’re going to do
a confession with you and say all the things they
ate during the holidays. They know better and whatever. It’s up to you. I usually try to
space my patients out so that I’m not
measuring it during one of those times of the year. Because you’ve got
to remember if it’s going to measure
three months, those are the three months
of where everybody has a lot of family gatherings. So just be conscientious of
that when you try to measure. But do an A1C more
than once a year. The insurances
have it where they pay for those every three
to six months for a reason. It’s because insurance
industry is driven by evidence based quality practice of care. Standards of care,
standards of care. I can’t say that enough. Recommended immunizations,
obviously the influenza, pneumococcal vaccines. Make sure that the patient
understands their blood pressure controls. You’re looking at
basically anything greater than 130 systolic,
greater than 80 diastolic is a little bit high for
those that are diabetic. 120 over 80 less
than or equal to. Optimal is great but get him
down to a specific means level first and then work with them. Don’t say you’re 20
points high on systolic. We really need you
at the 110 to 120. That’s like telling a
diabetic who’s 200 to 300, we want you down to
110 by next month. A lot of times
they’re unachievable. You’re setting them up to fail. And we don’t want
patients failing because then their
compliance goes down and obviously chronic
disease goes up. Comorbidities go up and the
ER revolving door comes up. When you also look
at self management, make sure you explain to the
patients about healthy choices, medical nutrition
therapy if they get sick, support groups for diabetes,
diagnostic evaluation therapeutic options, ongoing
such as believe it or not sexual problems. Husband and wife
they’re on medication, their love life is down. Psychologically that’s
an impact on them to be compliant for their
physiological needs. Make sure that you
are always addressing psychological with
physiological whenever these patients have these
type of endocrine issues or any issues. Chronic disease in general is
going to cause some impairment to their psychological state. And you need to be addressing
that each and every time that they come in. If you ask them if
they are depressed, if you ask them if they have
anxiety, if you ask them if they have sleep
problems, they’re probably going to tell you no. Because they’ve
got enough going on with somebody that’s
been recently diagnosed with these type of illnesses
and/or cardiovascular disease. They don’t want to add
anything else to the plate. Let alone being called, quote,
the status in our country how bad we look at mental
illness which is very sad. So they don’t want
to be categorized as somebody like that. So as in passing you’re
listening to their heart. How are you sleeping? Are you sleeping pretty good? As you’re listening or
checking their DTRs, so tell me a little bit about
any problems with energy, any problems with
anxiety lately, any problems with concentration. Ask them the questions that you
would normally get on a PHQ-9. But in general don’t read it. In general ask them as
you’re assessing them. So diabetes in general,
a multitude of treatment modalities you can look at. Those should be covered. Make sure that you understand
the insulin concepts. Really when glucose values
get greater than 250 to 300, we’re looking at some insulin. It depends on the patient. If I have a patient I know
evidence based drives us to say what and do what we do. But if I have a patient
that’s adamant they’re going to do x, y, z,
come back in two weeks. Let me see you. Let’s do a fasting
glucose at that time. Two weeks isn’t a
lot of time but hey, you’re keeping them
in tuned with you. So you’re keeping them alert. You say come back in
six months, come back in three months,
sometimes that’s too long. Even if you just say
come back next month, that’s better than three months,
four months or six months because you’re trying
to identify and get them on board with their illness. And if that’s the way you need
to do it by seeing them once a month and kind
of collaborating with them on their therapeutic
regimen and their value and belief system, then
I think that’s going to work better for compliance. So let’s talk a little bit
about hyper and hypothyroidism. On your resources, if you
go over on your resources and over to the right,
on the resources hyper and hypothyroidism. There’s a table there. If you click on that, it’s
going to go to Medscape. And you’re going to be
able to see that table. If you could just
remember two things hyper is accelerating metabolism. Hypo is under
established metabolism. He’s always sleepy. Hypo just wants to sleep. He doesn’t want to do
anything He just wants to have just one of those
lazy days, sedentary days, doesn’t really want to
add, to do anything. His energy release
is pretty much zero. His cell turnover
is pretty much zero. I mean think about it. Your lethargic. You have no interest. You have memory problems. You have a coldness to you. Your hair is coarse. There’s no vitamins,
no minerals going anywhere, your constipation. Think of all the things
that are a drying effect. Your eyes are dry. You have greater cardio. Your heart slows down
because the thyroid drives laziness in all of our system. So hypothyroidism is
going to drive laziness. Hyperthyroidism is going
to have an acceleration. It’s going to be very active. He doesn’t know when to sleep. He’s up. He’s down. Your heart’s tachycardic. It’s going to be racing. You’ve got some
hyper-reflections. You might not have
any type of menses. Your nails are thin. Your hair is fine. You have frequent loss of hair. You have a heat intolerance. Your weight loss could be
pretty modest about 50% whereas in hypothyroidism
you’ve got a weight gain. So he doesn’t do anything
he’s just growing your adipose tissue in a sense. So hyper and hype
need a balance. So your thyroid needs
a balance in order to communicate with everybody. And therefore you
have the medications that are available for that. We do like to check the
thyroid profile test. We like to feel for goiters. You can have a normal lab. But you can have goiters. Don’t forget that. So ultrasound those goiters. Normally a lot of times
are those nodules. A lot of times you’re going
to find incidentals on CT scans when it comes to thyroid. Patient hasn’t palpated them. You haven’t palpated them. There is no sign, no inkling of. Thyroid tests come back normal. The time when you actually see
those nodules on those thyroids is when those patients
end up with a CT scan. And it’s found as an
incidental finding. Then they can do biopsies
on it fine needle biopsy. A lot of times
they are negative. They’re benign. There’s nothing going on. However, think about something
pressuring that thyroid. It could most
definitely cause it to be hypo and sluggish
even those labs tests are negating that. So just keep that in
mind with somebody that has multinodular goiter
or goiters in general. Endocrinologists are wonderful
for questions on that. Endocrinology website
is wonderful as well. Make sure you check vitamin
D levels, thyroid levels, B vitamin levels,
things of that nature. So let’s go on real briefly
to the pheochromocytoma or chromocytosis. When you look at
this, you’re looking at a rare tumor that
usually starts on top of one of the adrenal glands. And it’s usually benign. However the problem is it
makes too many hormones. So it raises your blood
pressure causes tachycardia. Does a lot of things. It causes you to
sweat, headaches. So we have to treat
all of these symptoms. And normally to be honest
the adrenal tumors are found incidental as well
normally during an abdominal or a CT scan. Sometimes of the
back or the spine. So just as an FYI a lot
of times those tumors on the adrenal glands
are found in that realm. Normally they’ll remove them. We can treat them
with medication. For most of my patients I think
I’ve found that most of them have them removed
at some given point. They don’t really remove
the tumors to be honest. They will remove
an adrenal gland. And then the patient has
to be conscientious of that going forward
because he did have a major significant part of
their body taken away that regulates. So they have to make sure
every single person knows that adrenal gland is no longer
there, especially when it comes to steroid taking. Diabetes insipidus,
a very rare disease. And since it is an
uncommon disorder that is an imbalance of fluids
when we talk about the checks and balances. The imbalance makes you thirsty. It leads one to think
they have diabetes. The difference is a lot of
times it causes your kidneys to make too much urine. So basically what they’ll
do is a 24 hour urine catch. You take the little
red container home or you tell your patients. And for 24 hours they are
urinating in a red container. And then they take it back. So that’s one of the
things that they’re doing. So when you look at
pheochromocytosis and diabetes insipidus, sometimes
they’ll marry those two trying to
do a differential diagnosis on those. When you monitor
homeostasis, you’re looking at body temperature. You’re looking at glucose. You’re looking at
toxins that can disrupt the body’s homeostasis. blood pressure that needs to be
maintained for healthy levels of blood pressure. So when cells
maintain homeostasis, they control the movement of
substances across the cell membrane. So that’s a good thing. There’s a balance. That’s that check and balance. The problem is when
you have a negative. So there is too
much of something such as your thyroid,
too much of or not enough of something else. So always those
checks and balances are important that you
check those, know those. And again when
you draw labs, you make sure you know what you’re
drawing when they come back. Don’t just initial data or
look at them in the computer and sign off on him. Make sure that you
know what you ordered and can treat what you ordered. So let’s talk about as far
as the rest of the topics in this discussion. The one thing that you
want to remember is– I’m sorry we forgot about
the hyperparathyroidism. How could we forget
about that guy? Hyperparathyroidism
when you look at it is too much apparent
thyroid hormone. What causes the two types
of hyperparathyroidism is an enlargement of one or
more of the parathyroid glands. They cause a high calcium
level in the blood. And when this happens, surgery
is almost eminent for that as far as the most
common treatment for the primary for
hyperparathyroidism is surgical. Secondary is due
to another disease that causes those low calcium. It could be renal failure. It can be osteoporosis. It could be depression,
the symptoms of it. So basically when you look
at hyperparathyroidism, how we diagnose it, is
multiple means of the disorder. The result of the damage or
the dysfunction in these glands is too much calcium levels
in the blood and urine or too little calcium in
the bones which can lead to the osteoporosis,
tiring, depression, forgetfulness, bone and joint
pain, complaints of an illness but you really can’t
put your finger on it type of thing, nausea,
vomiting, loss of appetite. So definitely look
at these labs. Make sure you check them. And again, the
endocrinologist or one of the best people
that you can talk to If you have any questions
on any of these the one thing that I would suggest on all
of these is your testing. So on secondary
hyperparathyroidism the result of another
condition that can lower those calcium levels. The causes of in your
parathyroid glands to overwork can be multiple things. It can be severe
calcium deficiency, vitamin D deficiency, CKD. Normally you’re going to see
the parathyroidism altered based on CKD. What is CKD? Chronic Kidney Disease. Make sure you know
the person’s EGFR. If you don’t have the
lab value that shows it, do your creatinine equation. You can find those
online as well. All right everyone,
I think that’s it. If you have any questions,
make sure you reach out to any of your instructors. And if you have any
questions, please read the resources that are there. Good luck on your
midterm exam this week. I’m sure you all
will do very well. Just study your knowledge points
and reach out with questions.
The following source provides various tutorials related to maximizing your time management and managing stress. Feel free to access this resource to support you as you move through this course.
- Walden University. (2019). ASC success strategies interactive tutorials.Links to an external site. Retrieved from https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategies