Feb 23, 2024 Assignment: Respiratory Disorders NURS 6501
Assignment: Respiratory Disorders NURS 6501
Assignment: Respiratory Disorders NURS 6501
Knowledge Check: Cardiovascular and Respiratory Disorders
Question 1
Scenario 1: Myocardial Infarction
CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”
HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.
Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl
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His diagnosis is an acute inferior wall myocardial infarction.
Question:
Which cholesterol is considered the “good” cholesterol and what does it do?
Your Answer:
High-density lipoprotein (HDL) is also called the “good” cholesterol, while low-density lipoprotein (LDL) is called “bad” cholesterol. HDL absorbs cholesterol in the blood and transports it back to the liver. The liver then flushes the cholesterol from the body. High levels of HDL cholesterol lower the risk of heart disease and stroke. HDL has a diverse protein and lipid composition, contributing to its atheroprotective function (Jomard & Osto, 2020). In the vessel wall, HDL undergoes transcytosis through endothelial cells into the sub-endothelial space, where it efflux cholesterol from foam cells, preventing plaque formation. In addition, HDLs have other beneficial properties, like nitric oxide production stimulation, anti-oxidant capacity, anti-inflammatory, and anti-apoptotic actions.
No reference listed to allow one to cross check for accuracy. Adding to the discussion. HDL functionality encompasses many other potentially beneficial functions, including antioxidant, anti-inflammatory, antithrombotic, anti-apoptotic, and vascular protective effects that may be critical protective pathways for various cells, including those in the kidney parenchyma
The case study depicts a 76-year-old-female patient who presents with complaints of shortness of breath, weight gain, peripheral edema, and abdominal swelling. Her medical history is positive for congestive heart failure, and she states that she has not adhered to her diuretic medications since it causes urinary frequency. The patient now sleeps on two pillows to enhance her breathing pattern.
Cardiovascular and Cardiopulmonary Pathophysiology Processes
Based on the patient’s symptoms and history of congestive heart failure, she is having a diagnosis of congestive heart failure. Heart failure (HF) is caused by various underlying disorders such as hypertension, coronary artery disease, primary myocardial disease, or valvular diseases (Thomas, 2019). HF occurs when the heart fails to eject blood at a rate equal to the requirements of body tissues due to an abnormality of cardiac function (Thomas, 2019). Although it develops from various cardiovascular diseases, it causes various common heart disorders that cause decreased contraction/impaired systole, decreased filling/ impaired diastole, or both.
There are two main types of HF, diastolic heart failure and systolic heart failure. These conditions are diagnosed through the assessment of left ventricular functioning. Diastolic heart failure occurs when there is an alteration in the ventricular filling. On the other hand, systolic heart failure develops when there is an alteration in ventricular construction.
In systolic HF, there is a decrease in the volume of blood ejected from ventricles during contraction, which then stimulates the sympathetic nervous system to produce epinephrine and norepinephrine. This is a compensatory mechanism to support the failing myocardium, but the continued stimulation results in loss of Beta 1 Adrenergic receptor sites and further damage to the myocardium (Rossi, Mascolo & Mollace, 2017). Sympathetic stimulation and decreased renal perfusion stimulate the kidney to release of Renin. Renin converts angiotensinogen to Angiotensin I, which is converted to Angiotensin II by Angiotensin-converting enzyme (Rossi, Mascolo & Mollace, 2017). Angiotensin II is the most potent vasoconstriction and causes the release of Aldosterone hormone. Aldosterone causes sodium and fluid retention and causes further destruction of the myocardium and increases myocardial fibrosis (Rossi, Mascolo & Mollace, 2017). Angiotensin, Aldosterone, and neurohormones cause an increase in preload and afterload, which stresses the ventricular walls resulting in an increased workload of the heart.
Diastolic HF develops when there is a persistently increased heart workload. This causes ventricular hypertrophy as a result of an increase in the number and size of myocardial cells as well as altered myocellular functioning (Oka, Akazawa, Naito & Komuro, 2014). The compensatory responses cause resistance to the ventricular filling. Such resistance results in an increased ventricular filling pressure despite normal or reduced blood volume. A reduced blood volume in the ventricles results in decreased cardiac output (Oka et al., 2014). The high ventricular filling pressures and low cardiac output result in similar neurohormonal responses as in systolic HF (Thomas, 2019). Increased workload causes a decrease in contractility of the myofibrils and eventually decreased cardiac output.
Clinical symptoms produced by the various types of HF are similar. The signs and symptoms of HF are defined based on the effects on the ventricles. Left ventricular failure has different symptoms than right ventricular failure (Thomas, 2019). Left ventricular failure causes pulmonary congestion due to a decreased blood flow from the left atrium into the left ventricle during diastole. This further reduces blood flow from pulmonary vessels. The clinical presentation of pulmonary venous congestion include cough, dyspnea, pulmonary crackles, decreased oxygen saturation levels, and S gallop.
Right ventricular failure result in congestion of viscera and peripheral tissues. Thus develops because the right side cannot pump blood and cannot contain all the blood from venous circulation (Oka et al., 2014). An increase in venous pressure causes jugular vein distension (Thomas, 2019). Symptoms of right-sided heart failure include edema of lower limbs, ascites, fatigue, nausea, anorexia, and weight gain as a result of fluid retention.
References
Oka, T., Akazawa, H., Naito, A. T., & Komuro, I. (2014). Angiogenesis and cardiac hypertrophy: maintenance of cardiac function and causative roles in heart failure. Circulation research, 114(3), 565-571.
Rossi, F., Mascolo, A., & Mollace, V. (2017). The pathophysiological role of natriuretic peptide-RAAS cross talk in heart failure. International journal of cardiology, 226, 121-125.
Thomas, M. (2019). Pathophysiology and management of heart failure. Acute pain, 10, 00.
In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
myocardial infarction
endocarditis
myocarditis
valvular disorders
lipid panels
coagulation
clotting cascade
deep vein thrombosis
hypertension
heart failure
COPD
asthma
pneumonias
Photo Credit: Getty Images/Science Photo Library RF
Complete the Knowledge Check by Day 7 of Week 3
To complete this Knowledge Check:
Module 2 Knowledge Check
What’s Coming Up in Week 4?
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Next week, you will examine the alterations in the cardiovascular and respiratory systems and the resultant disease processes through case study analysis. You will also consider patient characteristics, including racial and ethnic variables, which may impact altered physiology.
Next Week
To go to the next week:
Week 4
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
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