NU 606- Week 1 Assignment Case Study Putting it all Together
NU 606- Week 1 Assignment Case Study Putting it all Together
Instructions
After having read Chapters 1-3 and reviewed the learning materials for this week, please complete the following case study. Remember that your answers may be combined with medical terminology, but they must be defined and explained in physiological terminology.
Mrs. K.B. is age 64 and has been a patient of yours for many years. You are calling her today to tell her the results of her Pap test which was done last week during her routine annual checkup in your office. The test showed marked dysplasia of cervical cells but no sign of infection. Unfortunately, when you call, there is no answer.
Since you saw Mrs. K.B. last week she has had gastritis with severe vomiting for 3 days. She has a history of heart problems and is presently feeling dizzy and lethargic. Her eyes appear sunken, her mouth is dry, she walks unsteadily, and she complains of muscle aching, particularly in the abdomen, and she is concerned about her chronic back pain as well and how she is going to handle her pain if she can’t keep her medication down. She is thirsty but is unable to retain food or fluid. A neighbor has brought Mrs. K.B. to the hospital, where examination shows that her blood pressure is low, and her pulse and respirations are rapid. Laboratory tests demonstrate elevated hematocrit, hypernatremia, decreased serum bicarbonate, serum pH 7.35, and urine of high specific gravity. This case study illustrates a combination of fluid, electrolyte, and acid-base imbalances. Specific laboratory values are not given to focus on the basic concepts. For clarity, this case study is discussed in multiple parts. Further information about the specific problems involved is given in each part and is followed by a series of questions.
Part 1
Later in the afternoon, you receive a phone call from Mrs. K.B.’s daughter Sara who tells you that she has been admitted to the hospital with vomiting. Sara is asking about her mother’s test results. Please answer the following questions regarding your conversation with Sara.
Sara is requesting her Mother’s test results and she seems to know that her Mom had a Pap test last week. Sara is really concerned because her Mom had an abnormal Pap test a few years ago and her sister also has a history of Ovarian Cancer. How do you handle this conversation with Sara?
In thinking about how you might discuss these results with Mrs. K.B. or Sara, explain how each of these terms might apply to this scenario: prognosis, latent stage, remission, exacerbations, and predisposing factors.
Explain cellular adaptations and in particular, dysplasia and how testing and or additional testing is done regarding this condition.
Part 2: Day 1
Initially, Mrs. K.B. lost water, sodium in the mucus content, and hydrogen and chloride ions in the hydrochloric acid portion of the gastric secretions.
Alkalosis develops for two reasons, the first being the direct loss of _______________ ions, and the second being the effects of chloride ion loss. When chloride ions are lost in the gastric secretions, it is replaced by chloride from the serum (See Fig. 2.9 in Chapter 2 of your Gould text). To maintain equal numbers of cations and ____________ in the serum, chloride ions, and bicarbonate ions can exchange places when needed. Therefore, more bicarbonate ions shift into the serum from storages sites in the _______________ to replace the lost chloride ions. More bicarbonate ions in the serum raise serum pH, and the result is hypochloremic alkalosis.
Which compartments are likely to be affected in this case by early fluid-loss?
Explain how a loss of sodium ions contributes to dehydration.
Describe the early signs of dehydration in Mrs. K.B.
Describe the compensations for the losses of fluid and electrolytes that should be occurring in Mrs. K.B.
Explain why Mrs. K.B. may not be able to compensate for losses as well as a younger adult.
Part 3: Days 2-3
As Mrs. K.B. continues to vomit and is still unable to eat or drink any significant amounts, loss of the duodenal contents, which include intestinal, pancreatic, and biliary secretions, occurs. No digestion and absorption of any nutrients occurs.
Losses at this stage include water, sodium ions, potassium ions, and bicarbonate ions. Also, intake of glucose and other nutrients is minimal. Mrs. K.B. shows elevated serum sodium levels.
Sara has been at the hospital all morning waiting for the provider to come by with an update. Sara is rubbing her Mom’s back and she continues to complain back pain.
Explain why serum sodium levels appear to be in high in this case
Explain how high serum sodium levels might affect the intracellular fluid
Using your knowledge of normal physiology, explain how continued fluid loss is likely to affect the following:
Blood volume
Cell function
Kidney function
Given Mrs. K.B.’s history, why might a potassium imbalance have more serious effects on her?
As the provider, when you enter the room, you find Sara rubbing her Mom’s back – you introduce yourself and what is the first thing that you would then need to do?
In regard to Mrs. K.B.’s back pain, what type of questions or history would you like to obtain?
Mrs. K.B. reports using herbal compresses at home to help her back pain and that she usually takes two “extra-strong” Acetaminophen tablets every 4 hours and a Tylenol #3 whenever the pain is severe. Sara states that she has tried to get her Mom to use “more natural” treatments for her back but she “loves her Tylenol.”
When considering sources for Herbal and Natural Remedies there are many to choose from but not all are FDA approved, and who has time to vet every website. Take a look at Natural Medicines, which is in the Research Guides at the Regis Library. What type of Natural Medicine treatment would you recommend for Mrs. K.B. knowing that her back pain is due to arthritis that was diagnosed 10 years prior, that could offer her relief from her back pain?
What should Mrs. K.B. and Sara understand about the dosage of acetaminophen that she is taking?
Finally, Sara commented that her Mom seems to be suffering more frequently from insomnia but claims that her medication controls her back pain. Could the Tylenol #3 tablets be interring with her sleep and if so how is this occurring?
Part 4: Day 3
Mrs. K.B. has spent the night in the ED due to a bed shortage and she is finally admitted to Med-Surg.
After a prolonged period of vomiting, metabolic acidosis develops. This change results from several factors.
Loss of bicarbonate ions in duodenal secretions
Lack of nutrients leading to ______________ of stored fats and protein with production of excessive amounts of ketoacids
Dehydration and decreased blood volume leading to decreased excretion of acids by the __________________
Decreased blood volume leading to decreased tissue perfusion, less oxygen to cells, and increased _________________ metabolism with increased lactic acid.
Increased muscle activity and stress leading to increased metabolic acid production.
These factors lead to an increased amount of acids in the blood, which bind with bicarbonate buffer and result in decreased serum bicarbonate and decreased serum pH or metabolic _________________.
List several reasons why Mrs. K.B. is lethargic and weak.
Predict the serum level of carbon dioxide, lactic acid, pH, pO2, K+, Na+, LFTs—note you should indicate low, normal or high and explain why in a brief sentence to indicate you understand the pathophysiology of the process.
If Mrs. K.B. continues to lose body fluid, why might serum pH decrease below 7.35?
If serum pH drops below 7.35 what signs would be observed in Mrs. K.B.
Describe the effect of acidosis on serum potassium levels.
Mrs. K.B. will be given replacement fluid therapy. Why is it important that sodium and potassium be given as well as water?
Check Out Also: NU 606- Week 3 Discussion Problem-Based Learning Case
Please refer to the Grading Rubric for details on how this activity will be graded.
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.