Paper , Order, or Assignment Requirements

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

 

Consider the following scenarios:

 

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

 

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

 

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

 

To prepare:

 

Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

 

To complete:

 

Write a 2- to 3-page paper that addresses the following:

 

Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.

Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

Answer

Review of Dementia, Endocarditis and Gastro-esophageal Reflux Disease

The gastro-esophageal disease, also known as the GERD Disease is a digestive disorder that affects the muscle rings between the stomach and the esophagus (Dawn & Vaezi, 2015). Mostly, it is caused by a condition called the hiatal hernia. It is a prevalent disease that causes the gastro-duodenal contents to be pushed back from the stomach into the esophagus. The patients often experience acid indigestion or heartburns. It can be treated with anti-acids, change of diet and lifestyle. However, in severe cases, the surgery might be required (Dent et al., 2014).

Endocarditis is the infection of the inner lining of the heart chamber and valve (Chan & Embil, 2016). It occurs when bacteria from the body spreads through the bloodstream into the heart. Endocarditis patients suffer from flu, fatigue, aching joints, chest pain or irritation or swelling of hands among others associated alterations.  It can also exhibit a wide range of symptoms and systematic signs. When it comes to a chronic level, it can result in life-threatening complications such as cardiac arrests. Endocarditis can be treated with antibiotics and surgery.

Dementia, according to Patti (2017) is a condition that results from a wide range of disorders associated with damage to brain cells and memory loss. The patients may experience difficulties when performing normal activities. Even still, they may experience an inability to focus, memory loss, poor visual perception and incoherence in communication and language. Dementia can result in conditions like Parkinson Disease, Alzheimer Disease, and Vascular Dementia among others. The condition can be treated with through medication, physical exercise, and change of diet.

 

Dementia Pathophysiology and Alterations

Dementia is normally a symptom of a wide range of structural brain diseases. It causes degeneration of cortical, subcortical and cholinergic neurons in the cerebral cortex. The damage can extend to sensor motor cortical areas and deterioration of the functioning of the cerebral cortex. It is caused by a number of factors including stroke, deprivation of oxygen in the brain cells (vascular dementia), and alcohol use. The risk factors are drugs, age or due to genetic factors. The adaptive responses exhibited by Martha are lack of sleep, increased heartbeat, and loss of appetite.

Endocarditis pathophysiology and Alterations

It mostly develops on the mitral and aortic valve (Brusch et al., 2017). The bacterium delivers the organisms to the aortic and mitral valves. The non-bacterial thrombotic endocarditis is normally caused by various factors such as stress, malnutrition, neoplasia renal failure among others like in Jack’s case. The disease can result in sublingual and splinter hemorrhages that are red and dark on hands. At times, it may cause itching and reddening of hands that at times can feel hot and flaky. During this period, the disease is normally at its early stages.

The Mind Map of GERD Disease

Epidemiology

With specific reference to previous research conducted by PubMed shows that prevalence of GERD disease has increased since 1995 (Serug-EL-HB 2014). The study was conducted on more than 200 individuals examining the response rates. The study showed that in North America the prevalence of the GERD disease was around 18% to 27% while in South America it was around 23%. The studies showed over 15 prevalence of the GERD disease. Even more disturbing, the rate of the disease continues to increase rampantly.

Pathophysiology

• The reflux occurs mostly when the lower esophageal sphincter has low pressure or when there is high abdominal pressure.
• It can also result from high acidic contents that cause inflammation to esophageal

Risk Factors

• Hiatal Hernia
• Smoking and alcohol consumption
• Medication such as morphine
• Increased intra-abdominal pressure
• Impaired LES functioning
• Delayed stomach emptying

Clinical presentation

History of Gastro-esophageal Reflux Disease

• It is a digestive disorder that causes burning sensations in the chest mostly known as heartburn (Patti et al., 2017). The digestive enzymes from the stomach flow back into the esophagus. This causes inflammation of the lining of the esophagus and can result in other associated complications such as esophagitis, and stricture. It is caused by a hiatal hernia that makes the acid to move into the esophagus.

Physical Examination

• Presence of heartburn
• Coughing and wheezing that may result in hoarse voice due to irritation of vocal cords
• Regurgitation of gastric esophageal contents into the pharynx

Adaptive Alterations to the Disorder

• In children for instance with Jennifer’s case, the adaptive responses include running a fever, refusal to eat, hot and dry skin, increased heartbeat, irritability that may be seen in the patient fussing. The child may also experience pain when swallowing and red tympanic membranes. The children may have poor or slow growth rate.

Diagnosis of the GERD Disease

• Risk for imbalanced nutrition less than the one needed by the body
• Altered nutrition that is usually more than body requirements
• Pain

References

Chan K., E. & Embil, J.M. (2016). Endocarditis: Diagnosis and Management. New York:            Springer.

Dawn F., & Vaezi. M. (2015). Diagnosis and Treatment of Gastroesophageal Reflux Disease.      New York: Springer.

Smith, P. (2017). Dementia Care – The Adaptive Response: A Stress Reductionist Approach.          New York: Routledge- Taylor and Francis Group.

Dent J. et al. (2014). Update of Epidemiology of Gastro-esophageal Reflux Disease: A       Systematic Review. Gut, 63(6), 871- 880.

Brusch L. et al. (2017). Infective Endocarditis Clinical Presentation. Retrieved from             https://emedicine.medscape.com/article/216650-clinical

Patti G. M. et al. (2017). Gastroesophageal Reflux Disease Clinical Presentation. Retrieved from    https://emedicine.medscape.com/article/176595-overview