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NURS 6501 Week 2 Module 1 Assignment Case Study Analysis

NURS 6501 Week 2 Module 1 Assignment Case Study Analysis

NURS 6501 Week 2 Module 1 Assignment Analyze a Case Study

Physiological Modifications

The signs and symptoms are a result of the infection with which the patient was diagnosed, which caused the patient to become septic. Increased blood flow to the area results in the redness seen in the wound. Due to the increased number of neutrophils, white blood cells, nutrient factors, and enzymes deposited in the infected area to aid in the fight against the infection, the area will swell (Hughes, 2016). Chemicals emitted by white blood cells, combined with increased activity at

the site, may result in localized heat and tenderness. Interleukin 10 (IL 10) is a pro-inflammatory cytokine that protects the host and promotes normal tissue homeostasis. Additionally, it is known as Cytokine Synthesis Inhibitory Factor (CSIF).

NRAMP1 is primarily expressed in macrophages and monocytes and is involved in iron metabolism and host resistance to specific pathogens. It also regulates natural resistance to infection. IL 4 is a cytokine that induces young helper T cells to differentiate into Th2 cells (Cianfarani, Zambruno, Castiglia, & Odorisio, 2017).

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Interleukin 4 has anti-inflammatory properties and inhibits tumor necrosis factor production. Immunosuppression can result in an increased susceptibility to opportunistic infections due to an immune deficiency in the body, and even the tiniest pathogens can become pathogenic when the immune system is compromised (Larouche, Sheoran, Maruyama, & Martino, 2018). Immunosuppression may be induced in the body to decrease the risk of allograft rejection and increase the likelihood of survival following transplantation. Allograft vasculopathy may develop spontaneously.

References

Top of the Line

M. A. Hughes (March 24, 2016).
Wound infection: a knowledge gap that must be addressed
British Journal of Nursing, Volume 25, Number 6.)
DOI: 10.12968/bjon.2016.25.6.S46

NURS 6501 Week 2 Module 1 Assignment Case Study AnalysisThe case study focuses on a 14 –year –old female who required urgent care. The patient was in the company of her mother. The mother stated that the girl was facing an abnormal number of funny-looking red spotless and had an abnormal number of bruises on her legs. However, the mother objected that the trauma was related to the bruises noted after two weeks. She also noted that the girl had been experiencing a bad rest at home for the past three weeks, led by a bad case of mono. The girl was identified to have bleeding gums when brushing her teeth in the morning. The lab report identified that the girl had a normal WBC differential and hgb and hct.

However, platelet abnormal lab results are based on the platelet count of 100,000/mm3. Bleeding in her gums was also noticed when she brushed her teeth in the morning. A complete workup on the peripheral blood smear immune thrombocytopenic purpura was recommended at the ED. The paper focuses on factors that interfere with fertility and gives the reason for the rise of STD/PID due to the inflammatory markers.

Pathophysiology of Immune Thrombocytopenia Purpose (ITP)

According to Chen et al. (2022), immune thrombocytopenia purpura (ITP) pathophysiology is complex since it consists of T-cell and B-cell abnormalities. There are four causes of thrombocytopenia mechanism, which are consumption, hyperproliferation, destruction, and sequestration. In addition, the mechanism involves a significant proportion of cases and increases platelet destruction, which is an impaired platelet production. Therefore, the megakaryopoiesis and thrombopoiesis defect is experienced due to increased platelet destruction (Grodzielski et al., 2019).

The phagocytosis process helps remove the sanitized platelet, which occurs in the sequestration of the anti-platelet IgG antibodies (Carter, 2018). The sanitized platelet happens a few hours compared to the normal platelet half-life of 8 to 9 days. The drug-induced ITP absorption happens in the platelet cell membrane (McCance & Huether, 2019). Therefore, the autoantibodies react against the platelet glycoproteins. Platelet destruction can also occur when abnormal apoptosis occurs in the bone marrow (McCance & Huether, 2019).

Clinical Manifestation of Immune Thrombocytopenia Purpose (ITP)

Initially, ITP was perceived as a minor injury. However, the purpura and petechiae development occurred every several days, leading to an increase in bleeding from the mucosal site (McCance & Huether, 2019). Patients with ITP show signs like blood in the urine, bleeding gums, and increased bleeding. The main cause of accelerated platelet consumption is increased splenic sequestration or decreased bone marrow production (McCance & Huether, 2019). The lab test helps predict the diagnosis, evaluating the anti-glycoprotein erythrocyte and leukocyte count.

Genetic/Ethnic Considerations of Immune Thrombocytopenia Purpose (ITP)

ITP highly occurs in women (Kjaer et al., 2020). In comparison to acute, the chronic ITP is progressively worse. Acute ITP lasts for approximately one to two months and is common in children (Kjaer et al., 2020). It is not common for a patient to present the intracranial bleeding for the organs or any other sites.ITP is also likely to occur in the newborn as thrombocytopenia.

Conclusion

The patient presents ITP, which is associated with the previous diagnosis of Mononucleosis. It is important to review a patient platelet, which helps determine the anti-platelet antibodies when performing a diagnostic test. ITP highly occurs in women between 20 to 40 years.

References

Carter, C. M. (2018). Alterations in blood components. Comprehensive Toxicology, 249. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7152208/

Chen, D. P., Lin, W. T., Wen, Y. H., & Wang, W. T. (2022). Investigation of the correlation between immune thrombocytopenia and T cell activity-regulated gene polymorphism using functional study. Scientific Reports12(1), 1-8. https://www.nature.com/articles/s41598-022-10631-z

Grodzielski, M., Goette, N. P., Glembotsky, A. C., Constanza Baroni Pietto, M., Méndez-Huergo, S. P., Pierdominici, M. S., … & Marta, R. F. (2019). Multiple concomitant mechanisms contribute to low platelet count in patients with immune thrombocytopenia. Scientific Reports9(1), 1-10. https://www.nature.com/articles/s41598-018-38086-1

Kjær, M., Geisen, C., Akkök, Ç. A., Wikman, A., Sachs, U., Bussel, J. B., … & Skogen, B. (2020). Strategies to develop a prophylaxis for the prevention of HPA-1a immunization and fetal and neonatal alloimmune thrombocytopenia. Transfusion and Apheresis Science59(1), 102712. https://www.sciencedirect.com/science/article/pii/S147305021930285X

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

Top of the Line

F. Cianfarani, G. Zambruno, D. Castiglia, et al (July 01, 2017).
Altered Wound Healing Pathophysiology in Recessive Dystrophic Epidermolysis Bullosa
American Journal of Pathology, vol. 187, no. 7, pp. 1445-1453.
https://doi.org/10.1016/j.ajpath.2017.03.003

Top of the Line

J. Larouche, S. Sheoran, K. Maruyama, and M. M. Martino (July 01, 2018).
Mechanisms and Novel Therapeutic Targets in Immune Regulation of Skin Wound Healing.
Advances in Wound Care, 7, no. 7 (2007), pp. 209-231.
https://doi.org/10.1089/wound.2017.0761

The assigned case study demonstrates a middle age female patient with chief complaints of dyspnea, fever, and cough with thick green sputum production for 3 days. The patient also has a history of COPD and chronic cough, which has gotten worse over the past few days affecting her sleep. Upon examination, it was noted that the patient’s diaphragm had flattened, AP diameter increased, hyper resonance on auscultation with rhonchi, and coarse rales throughout all lung fields. The purpose of this discussion is to provide an analysis of the patient described above and the cardiovascular and cardiopulmonary pathophysiologic processes that contributed to the patient’s symptoms.

Pathophysiologic Processes

The patient presents with a history of COPD and chronic cough with thick green sputum. The current symptoms of dyspnea, cough, and fever indicate exacerbation of COPD with complications of a respiratory infection (Hikichi et al., 2018). The patient’s shortness of breath resulted from the obstructed airways secondary to inflammation, sputum hypersecretion, and airway remodeling. Reduced elastic recoil of the lung caused by emphysema and airway obstruction leads to dynamic hyperinflation and incomplete air expelling (Santus et al., 2019). Accumulation of the mucus leads to coughing by the patient as an attempt to try and clear the airways. The increased production of thick green sputum and fever are signs of bacterial infection in COPD exacerbation.

Racial/Ethnic Variables

            There is limited evidence on the racial/ethnic variables in the characteristics and progress of COPD. Non-Hispanic whites have however been reported to have the highest burden associated with symptoms of chronic bronchitis and cardiovascular diseases as comorbidities of COPD (Park et al., 2021). African Americans on the other hand, have reported the highest incidences of dyspnea due to lifestyle habits like smoking and reduced exercise capacity (Lee et al., 2018). Korean patients on the other hand were more likely to be underweight as compared to other ethnic groups, hence reduced COPD symptoms and complications (D’Cruz et al., 2020). Generally, the ethnic variables in COPD are due to sociodemographic differences in lifestyle habits, education, and cultural beliefs among other factors.

How Process interact to Affect the Patient

As discussed above, the pathophysiology of COPD involves the interaction of both cardiovascular and cardiopulmonary processes. Impairments in the cardiopulmonary functioning leading to COPD are associated with several risk factors including smoking, exposure to chemicals, race, age, and history of asthma (Hikichi et al., 2018). Such risk factors contribute to pathologic changes in the small (peripheral) bronchioles, large (central) airways, and lung parenchyma. Structural changes of the airways include ciliary abnormalities, focal squamous metaplasia, atrophy, inflammation, airway smooth muscle hyperplasia, and bronchial wall thickening leading to chronic bronchitis (Santus et al., 2019). Permanent enlargement of the airspaces from the distal to the terminal bronchioles also leads to a significant decline in the surface area of the alveoli available for gas exchange causing emphysema. The above mechanisms contribute to the patient’s symptoms such as shortness of breath, chronic cough, increased sputum production, and fever.

Conclusion

The middle-aged patient in the provided case study presents with symptoms indicating COPD exacerbation. Several cardiopulmonary processes contribute to the development of the patient’s condition such as the small (peripheral) bronchioles, large (central) airways, and the lung parenchyma. However, with a comprehensive understanding of the pathophysiology of the patient’s condition, it will be easier for the clinician to develop the most effective treatment plan.

 References

D’Cruz, R. F., Murphy, P. B., & Kaltsakas, G. (2020). Sleep-disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes. Journal of Thoracic Disease12(S2), S202–S216. https://doi.org/10.21037/jtd-cus-2020-006

Hikichi, M., Hashimoto, S., & Gon, Y. (2018). Asthma and COPD overlap the pathophysiology of ACO. Allergology International67(2), 179–186. https://doi.org/10.1016/j.alit.2018.01.001

Lee, H., Shin, S. H., Gu, S., Zhao, D., Kang, D., Joi, Y. R., Suh, G. Y., Pastor-Barriuso, R., Guallar, E., Cho, J., & Park, H. Y. (2018). Racial differences in comorbidity profile among patients with chronic obstructive pulmonary disease. BMC Medicine16(1). https://doi.org/10.1186/s12916-018-1159-7

Park, H. Y., Lee, H., Kang, D., Choi, H. S., Ryu, Y. H., Jung, K.-S., Sin, D. D., Cho, J., & Yoo, K. H. (2021). Understanding racial differences of COPD patients with an ecological model: two large cohort studies in the US and Korea. Therapeutic Advances in Chronic Disease12, 204062232098245. https://doi.org/10.1177/2040622320982455

Santus, P., Pecchiari, M., Tursi, F., Valenti, V., Saad, M., & Radovanovic, D. (2019). The Airways’ Mechanical Stress in Lung Disease: Implications for COPD Pathophysiology and Treatment Evaluation. Canadian Respiratory Journal. https://www.hindawi.com/journals/crj/2019/3546056/

‌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.

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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.

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 genetics26(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 today67, 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. Gastroenterology156(5), 1282-1298. https://doi.org/10.1053/j.gastro.2018.12.033.

He, X. (Ed.). (2020). Immunosuppression. BoD–Books on Demand.