Feb 23, 2024 NURS 6501 Assignment Case Study Analysis
NURS 6501 Assignment Case Study Analysis
NURS 6501 Assignment Case Study Analysis
One of the most useful components of patient care is a correct diagnosis which leads to offering a patient the correct treatment. Central to correct diagnosis and treatment is an understanding of the cell, and cell behavior as come conditions may have various circumstances and factors affecting their onset, hence making them more complex (Karaca & Aslan, 2018). Therefore, understanding the cells and cell behavior needs to be integrated with ethnic and racial variables, patient characteristics, environment, and genes. This week’s assignment deals with a patient cases study where the symptoms presented by the patient will be analyzed using various discussion questions.
Why the Patient Presented With the Symptoms
The patient has presented with various symptoms such as fevers, constipation, and crampy left lower quadrant pain. After refusing colonoscopy for some time, the patient eventually went for one, which revealed a positive test for adenocarcinoma of the colon. Even though the patient went for colonoscopy after resolution of the acute diverticulitis, the symptoms presented at the clinic point to a recurring case of acute diverticulitis. The patient has the three most common symptoms of diverticulitis (fever, constipation, and pain in the lower left quadrant). The condition is more an individual’s lifetime and therefore could be troubling the patient. The patient also eats a diet lacking in fiber and is obese, which are all factors leading to the development of the condition.
Genes That May Be Associated With the Development of the Condition
According to Strate & Morris (2019), diverticulitis may result from a complex interaction of gut microbiome, genetics, medications, lifestyle factors, and diet. Even though it has been agreed that genetics play a substantial role in the development of the condition, only a few genes have been implicated. However, a recent study reported that one of the genes that can be implicated in the development of diverticulitis is the laminin β 4 gene (LAMB4) (Coble et al.,2017). Prior to the findings regarding LAMB4, the Tumor necrosis factor superfamily member 15 (TNFSF15) gene was also found to be associated with the development of diverticulitis.
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The Process of Immunosuppression and the Effect It Has On Body Systems
Immunosuppression refers to reduced immune system activation. While some parts of the immune system may possess immunosuppressive effects, immunosuppression can be also be induced (Xe, 2020). The process can be induced by the administration of medications belonging to the class of antidepressants, in some cases to allow organ transplant or bone marrow transplant to prevent a possible rejection. The process of immunosuppression may come from the blockage of intracellular pathways necessary for recognizing antigen or other immune response systems or when the immune effector cells are killed (Xe, 2020). Immunosuppression, especially when persistent, exposes an individual to the risk of cancer, especially virus-connected cancers. The effects of immunosuppression induced by ultraviolet ratio or ionizing or pharmaceutical drugs depend on the dosage or the intensity used as higher dosage or intensity lead to enhanced effects on the body systems (Xe, 2020). Even though not common, immunosuppression induced for an organ transplant can lead to metastatic tumor cells or occult tumors within the organs or tissues. The occult metastatic melanoma is dangerous for the individual receiving the transplanted organ and tissue.
Conclusion
In conclusion, as an APRN, it is important to understand effective patient diagnosis for effective treatment. It allows careful analysis of symptoms to come up with the best management strategy. This write-up has explored a case study of a patient presenting with various symptoms. After an analysis, it was noted that the symptoms could be coming from recurring diverticulitis.
References
Coble, J. L., Sheldon, K. E., Yue, F., Salameh, T. J., Harris, III, L. R., Deiling, S., … & Broach, J. R. (2017). Identification of a rare LAMB4 variant associated with familial diverticulitis through exome sequencing. Human molecular genetics, 26(16), 3212-3220. https://doi.org/10.1093/hmg/ddx204.
Karaca, T., & Aslan, S. (2018). Effect of ‘nursing terminologies and classifications’ course on nursing students’ perception of nursing diagnosis. Nurse education today, 67, 114-117. https://doi.org/10.1016/j.nedt.2018.05.011
Strate, L. L., & Morris, A. M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 156(5), 1282-1298. https://doi.org/10.1053/j.gastro.2018.12.033.
He, X. (Ed.). (2020). Immunosuppression. BoD–Books on Demand.
Scenario 3: A 34-year-old Hispanic-American male with end-stage renal disease received kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101˚F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.
Scenario 4: A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101˚ F. He has had multiple episodes like this one over the past 15 years and they always responded to bowel rest and oral antibiotics. He has refused to have the recommended colonoscopy even with his history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyle, and diet lacking in fiber. His paternal grandfather died of colon cancer back in the 1950s as well. He finally underwent colonoscopy after his acute diverticulitis resolved. Colonoscopy revealed multiple polyps that were retrieved, and the pathology was positive for adenocarcinoma of the colon.
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.
Submit your Case Study Analysis Assignment by Day 7 of Week 2.
Module 1 Assignment: Case Study Analysis
An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.
Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.
Photo Credit: Getty Images/Hero Images
An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the 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 cell, gene, and/or process 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 for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.
By Day 7 of Week 2
Submit your Case Study Analysis Assignment by Day 7 of Week 2.
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/templates). All papers submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “M1Assgn+last name+first initial.(extension)” as the name.
Click the Module 1 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Module 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “M1Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
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Module 1 Assignment Rubric
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Module 1 Assignment
What’s Coming Up in Module 2?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 2, you will analyze processes related to cardiovascular and respiratory disorders. To do this, you will analyze alterations in the cardiovascular and respiratory systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.
Week 3 Knowledge Check: Cardiovascular and Respiratory Disorders
In the Week 3 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 2. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.
Next Module
To go to the next Module:
Module 2
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
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
Learning Resources
Required Readings (click to expand/reduce)
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 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.
Note: This article was presented in the Week 1 resources. If you read it previously you are encouraged to review it this week.
Required Media (click to expand/reduce)
Foundational Concepts of Cellular Pathophysiology – Week 2 (8m)
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/cs/store?role=student
To Register to View the Content
Go to https://evolve.elsevier.com/cs/store?role=student
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.
The case study depicts a 55-year-old male with complaints of worsening cough, chest tightness, profuse sweating, lightheadedness, and breathing difficulty. On arrival to the ER, findings include ST segment elevation in the anterior, shallow pulse, respirations of 10 breaths/min, troponin-13ng/l, and CK-265 U/L. The purpose of this paper will be to address cardiovascular and cardiopulmonary pathophysiological processes responsible for the patient’s symptoms.
Cardiovascular and Cardiopulmonary Pathophysiologic Process Resulting in Presenting Symptoms
The patient’s symptoms can be attributed to myocardial infarction (MI). MI occurs due to abrupt and severe oxygen deprivation in the myocardial tissue. The cardiovascular pathophysiologic process causing the symptoms is reduced blood flow in the coronary artery due to the rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus (Saleh & Ambrose, 2018). Infarction develops over minutes to hours when blood flow is abruptly decreased by 80-90%.
The cardiopulmonary processes causing the symptoms occur when the cells are deprived of oxygen. Ischemia develops, cellular injury occurs, and the lack of oxygen results in infarction, or the death of cells, leading to permanent loss of myocardial contractility in the affected area (Smit et al., 2020). Necrosis of myocardial tissue contributes to the patient’s chest pain, breathing difficulty, diaphoresis, lightheadedness, and shallow pulse. The disruption of cell membranes because of hypoxia led to the release of creatinine kinase (CK) and troponin (regulates myocardial contractility process) into the systemic circulation resulting in elevated CK and troponin levels (Smit et al., 2020). The patient has an ST-segment elevation on ECG, which has a specificity of 90% and a sensitivity of 45% for diagnosing MI.
Racial/Ethnic Variables Impacting Physiological Functioning
Racial/ethnic differences have been established in the prevalence of MI. African Americans have a higher rate of MI than whites in the US. Hackler et al. (2019) explain that the factors causing these racial differences include a high burden of risk factors among AAs, like a high prevalence and worse control of hypertension and high rates of smoking and diabetes mellitus. Among AA women, high rates of obesity contribute to MI. Furthermore, a relationship exists between socioeconomic status, risk factors, risk factor control, and racial disparities in MI.
Processes that Interact to Affect the Patient
The pathophysiological processes interact to cause distressing symptoms in the patient. One of the most distressing symptoms is chest pain. The chest pain in MI is severe, diffuse steady substernal pain of a crushing and squeezing nature. It is not alleviated by rest or sublingual vasodilator therapy and may radiate to the arms, shoulders, neck, back, or jaw. Besides, it persists for more than 15 minutes and usually produces anxiety and fear, increasing heart rate, BP, and respiratory rate (Hegazy et al., 2022). Besides, the processes can contribute to complications like myocardial dysfunction, cardiac failure, cardiogenic shock, and cardiac rupture.
Conclusion
The patient developed myocardial necrosis caused by acute coronary artery obstruction, which led to chest discomfort, dyspnea, diaphoresis, lightheadedness, and elevated cardiac markers. AAs have a high prevalence of MI due to their lifestyle practices. The Pathophysiological processes of MI contribute to distressing symptoms like severe chest pain, which affect the patient.
References
Hackler, E., Lew, J., Gore, M. O., Ayers, C. R., Atzler, D., Khera, A., … & De Lemos, J. A. (2019). Racial differences in cardiovascular biomarkers in the general population. Journal of the American Heart Association, 8(18), 1-12. https://doi.org/10.1161/JAHA.119.012729
Hegazy, M. A., Mansour, K. S., Alzyat, A. M., Mohammad, M. A., & Hegazy, A. A. (2022). Myocardial Infarction: Risk Factors, Pathophysiology, Classification, Assessment, and Management. Cardiology Research and Reports, 4(5). https://doi.org/10.31579/2692-9759/056
Saleh, M., & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7, F1000 Faculty Rev-1378. https://doi.org/10.12688/f1000research.15096.1
Smit, M., Coetzee, A. R., & Lochner, A. (2020). The pathophysiology of myocardial ischemia and perioperative myocardial infarction. Journal of Cardiothoracic and Vascular Anesthesia, 34(9), 2501-2512. https://doi.org/10.1053/j.jvca.2019.10.005
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Name: NURS_6501_Module1_Case Study_Assignment_Rubric
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Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:
Explain why you think the patient presented the symptoms described.
Points Range: 28 (28%) – 30 (30%)
The response accurately and thoroughly describes the patient symptoms.
The response includes accurate, clear, and detailed reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.
Points Range: 25 (25%) – 27 (27%)
The response describes the patient symptoms.
The response includes accurate reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.
Points Range: 23 (23%) – 24 (24%)
The response describes the patient symptoms in a manner that is vague or inaccurate.
The response includes reasons for the symptoms, with explanations that are vague or based on inappropriate evidence/research.
Points Range: 0 (0%) – 22 (22%)
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 the symptoms, or the explanat
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