Module 2 Assignment: Case Study Analysis SAMPLE
The burden of cardiovascular and cardiopulmonary diseases continues to increase at a worrying trend in the U.S. Most of the diseases are attributed to lifestyle changes; though, genetic factors could also be predisposing factors (Moonesinghe et al., 2019). The current case involves a 65-year-old who is 8 days post op after knee replacement. The patient presents with shortness of breath, palpitations and pleuritic chest pain. An ECG was done on the patient and it indicated an onset of atrial fibrillation and right ventricular strain. The purpose of this paper will be to explain various aspects of the case study including the cardiovascular and cardiopulmonary pathophysiological processes, racial variables as well as the interactions of the said processes.
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Pathophysiology
Cardiovascular and cardiopulmonary diseases are characterized by insufficiency in the blood supply to all parts of the body. In this case, the patient presented with shortness of breath and pleuritic chest
NURS 6501 Module 2 Assignment Case Study Analysis Walden
pain on palpitation which could be attributed to a lack of enough oxygen supply in the lungs (Lefevre-Scelles et al., 2020). An embolism refers to the blockage in one of the arteries due to a blood clot of accumulation of fats (Kaptein et al., 2021). The condition results in inflammation in the pleural membrane that causes sharp and intense pain. The shortness of breath is due to a lack of enough oxygen in the body (Ishaaya & Tapson, 2020).
Genetic factors influence the risk of cardiovascular and cardiopulmonary diseases. The burden of the disease is high among African Americans due to variants in the ARMC5 gene (Zilbermint et al., 2018). The rs116201073 variant is common among blacks and contributes to their increased risk for cardiovascular disease (Zilbermint et al., 2019).
The race of the patient is not indicated; however, immobility and old age could have contributed to the development of the symptoms. The atrial fibrillation in the ECG report indicates a failure in the heart muscles due to the strain caused by an embolism (Ahmed & Zhu, 2020).
Conclusion
The case involves patients with symptoms of pulmonary embolism. The heart strains because of the increased demand for oxygen supply. The pain experienced by the patient result from both inflammation and lack of oxygen.
References
Ahmed, N., & Zhu, Y. (2020). Early detection of atrial fibrillation based on ECG signals. Bioengineering, 7(1), 16. https://doi.org/10.3390/bioengineering7010016
Ishaaya, E., & Tapson, V. F. (2020). Advances in the diagnosis of acute pulmonary embolism. F1000Research, 9, 44. https://doi.org/10.12688/f1000research.21347.1
Kaptein, F., Kroft, L., Hammerschlag, G., Ninaber, M., Bauer, M., Huisman, M., & Klok, F. (2021). Pulmonary infarction in acute pulmonary embolism. Thrombosis Research, 202, 162-169. https://doi.org/10.1016/j.thromres.2021.03.022
Lefevre-Scelles, A., Jeanmaire, P., Freund, Y., Joly, L., Phillipon, A., & Roussel, M. (2020). Investigation of pulmonary embolism in patients with chest pain in the emergency department: A retrospective multicenter study. European Journal of Emergency Medicine, 27(5), 357-361. https://doi.org/10.1097/mej.0000000000000680
Moonesinghe, R., Yang, Q., Zhang, Z., & Khoury, M. J. (2019). Prevalence and cardiovascular health impact of family history of premature heart disease in the United States: Analysis of the national health and nutrition examination survey, 2007–2014. Journal of the American Heart Association, 8(14). https://doi.org/10.1161/jaha.119.012364
Zilbermint, M., Gaye, A., Berthon, A., Hannah-Shmouni, F., Faucz, F., Minority, H. N., Davis, A., Gibbons, G., Lodish, M., & Stratakis, C. (2018). ARMC5 variants and risk of hypertension in African Americans: Minority Health-GRID study. Endocrine Abstracts. https://doi.org/10.1530/endoabs.56.oc10.3
Zilbermint, M., Gaye, A., Berthon, A., Hannah‐Shmouni, F., Faucz, F. R., Lodish, M. B., Davis, A. R., Gibbons, G. H., & Stratakis, C. A. (2019). ARMC5 variants and risk of hypertension in blacks: MH‐GRID study. Journal of the American Heart Association, 8(14). https://doi.org/10.1161/jaha.119.012508
NURS 6501 Module 2 Assignment: Case Study Analysis Walden
An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.
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Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.
Photo Credit: yodiyim / Adobe Stock
An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in 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 the elements that may be factors in the diagnosis, and you explain the implications to patient health. NURS 6501 Module 2 Assignment: Case Study Analysis Walden
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following
The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.
By Day 7 of Week 4
Submit your Case Study Analysis Assignment by Day 7 of Week 4
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. NURS 6501 Module 2 Assignment: Case Study Analysis Walden
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “M2Assgn+last name+first initial.(extension)” as the name.
Click the Module 2 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Module 2 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 “M2Assgn+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 2 Assignment Rubric
Check Your Assignment Draft for Authenticity
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Submit your Module 2 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 4
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Module 2 Assignment
What’s Coming Up in Module 3?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 3, you will analyze processes related to gastrointestinal and hepatobiliary disorders through case study analysis. To do this, you will analyze alterations in the relevant 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. NURS 6501 Module 2 Assignment: Case Study Analysis Walden
Week 5 Knowledge Check: Gastrointestinal and Hepatobiliary Disorders
In Week 5 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 3. 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 3
Week 4: Alterations in the Cardiovascular and Respiratory Systems
Cardiovascular and respiratory disorders can quickly become dangerous healthcare matters, and they routinely land among the leading causes of hospital admissions. Disorders in these areas are complicated by the fact that these two systems work so closely as contributors to overall health. APRNs working to form a similarly close partnership with patients must demonstrate not only support and compassion, but expertise to guide the understanding of diagnoses and treatment plans. This includes an understanding of patient medical backgrounds, relevant characteristics, and other variables that can be factors in their diagnoses and treatments.
This week, you examine alterations in the cardiovascular and respiratory systems and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
Learning Objectives
Students will:
Analyze processes related to cardiovascular and respiratory disorders
Analyze alterations in the cardiovascular and respiratory systems and the resultant disease processes
Analyze 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 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
Chapter 35: Structure and Function of the Pulmonary System; Summary Review
Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery hypertension); Summary Review
Note: The above chapters were first presented in the Week 3 resources. If you read them previously you are encouraged to review them this week.
Inamdar, A. A. & Inamdar, A. C. (2016). Heart failure: Diagnosis, management, and utilization, 5(7). doi:10.3390/jcm5070062
Note: The above article was first presented in the Week 3 resources. If you read it previously you are encouraged to review it this week.
Required Media (click to expand/reduce)
Pneumonia
MedCram. (2015, September 14). Pneumonia explained clearly by MedCram [Video file]. Retrieved from https://www.youtube.com/watch?v=nqyPECmkSeo
Note: The approximate length of the media program is 13 minutes.
(Previously reviewed in Week 3)
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 32, 33, 35, and 36 that relate to cardiorespiratory systems and alteration in cardiorespiratory systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/
Rubric Detail
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Content
Name: NURS_6501_Module2_Case Study_Assignment_Rubric
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Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following:
Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms.
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 both the cardiovascular and cardiopulmonary pathophysiologic processes 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 both the cardiovascular and cardiopulmonary pathophysiologic processes 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 cardiovascular and/or cardiopulmonary pathophysiologic processes, 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 either the cardiovascular or cardiopulmonary pathophysiologic processes, or the explanations are vague or based on inappropriate or no evidence/research.
Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
Points Range: 28 (28%) – 30 (30%)
The response includes an accurate, complete, detailed, and specific explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
Points Range: 25 (25%) – 27 (27%)
The response includes an accurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
Points Range: 23 (23%) – 24 (24%)
The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
Points Range: 0 (0%) – 22 (22%)
The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.
Explain any racial/ethnic variables that may impact physiological functioning.
Points Range: 23 (23%) – 25 (25%)
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.
Points Range: 20 (20%) – 22 (22%)
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.
Points Range: 18 (18%) – 19 (19%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations based on inappropriate evidence/research.
Points Range: 0 (0%) – 17 (17%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.
Points Range: 3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment are vague or off topic.
Points Range: 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English Writing Standards:
Correct grammar, mechanics, and proper punctuation
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors.
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS_6501_Module2_Case Study_Assignment_Rubric
Scenario 1:
A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction
Role Genetics Play in Disease
The patient is negative for recurrent colds, influenza, ear infections or pneumonia which shows that genetics did not have an impact on the patient being positive for strep throat. Genetics can play a role in recurrent infections. According Burgner et al. (2006), susceptibility to infection and many other human diseases arises from the complex interaction of environmental and host genetic factors (p. 653). Recurrent infection by pyogenic bacteria suggests a defect in antibody, complement, or phagocyte function, reflecting the role of these parts of the immune system in host defense against such infection (Janeway et al., 2001). Patients may have genetic factors that impact the immune response to certain diseases. Infectious diseases, like other phenotypes, may exhibit familial aggregation: a greater frequency of the disease in relatives of infected individuals compared with relatives of those without disease (Burgner et al., 2006, p. 654). Though genetics can play a role in recurrent infections, that was not the case for this patient and his strep throat appears to be acute rather than chronic.
Why the patient is presenting with the specific symptoms described
The patient’s immunologic response to strep throat which included low grade temperature of 99.6, reddened posterior pharynx with white exudate on +3 enlarged tonsils, and anterior and posterior cervical adenopathy where all the patient’s immunologic response to disease rather than the patient’s genetics. Strep throat is not a genetic disease, it is a bacterial disease. Streptococcus pyogenes is transmitted via respiratory droplets or skin contact with carriers or their environment (Peter et al., 2017, p. 730). The patient’s symptoms were all a response to strep throat. After a person is infected with strep through, they go through a short incubation period, fever and sore throat develop, with an erythematous pharynx, cervical lymphadenopathy and tonsillar enlargement (Peters et al., 2017, p. 731). Streptococcus pyogenes causes overproduction of SAg-activated T cells which cause fever and inflammation (McCance and Huether, 2019, p. 245). The patient also presents with reddened pharynx with white exudate which are all a response to the patient’s immune system. The second line of defense is the inflammatory response which protect the body from further injury (McCance and Huether, 2019, p. 191). The patient also white exudate which is part of the inflammatory response in early or mild inflammation with very few plasma proteins or leukocytes (McCance and Huether, 2019, p. 210). So, the redness in the pharynx, the white exudate, and the enlarged tonsils are all a reaction to inflammation in the throat related to the introduction of the bacteria Streptococcus group A.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred
Once the patient tested positive for strep throat, he was given the antibiotic Amoxicillin. Patient took the medication and immediately had an allergic reaction. The fact that the patient had a reaction within minutes this showed that the patient had an immediate hypersensitivity reaction (McCance and Huether, 2019, p. 256). The patient’s allergic reaction included swelling, difficulty breathing, and wheezing which are all signs of an anaphylaxis reaction. The most rapid and severe immediate hypersensitivity reaction is anaphylaxis (McCance and Huether, 2019, p. 256). This type of reaction usually occurs immediately after being exposed to a substance that a patient is allergic to. Symptoms of systemic anaphylaxis include difficulty breathing and contraction of bronchial smooth muscle which can be the reason the patient was wheezing (McCance and Huether, 2019, p. 256). The patients swollen lips and tongue were caused by cutaneous anaphylaxis which results in local symptoms such as swelling (McCance and Huether, 2019, p. 256).
The cells that are involved in this process
The cells involved in the patient developing an allergic reaction are mediated by antigen specific IgE and the products of the tissue mast cells (McCance and Huether, 2019, 256). The patient cells quickly reacted to the Amoxicillin. The patient having immediate swelling of the lips and tongue is due to the products of mast cell degranulation which happens due to an acute inflammatory response (McCance and Huether, 2019, p. 256). The patient also having immediate difficulty breathing and audible wheezing which were caused by bronchial constriction. The most potent mediator is histamine which impacts target cells acting through the H1 receptors which can cause bronchial constriction (McCance and Huether, 2019, p. 256). Type II allergic hypersensitivities are usually against allergic happens that bind to the surface of the cells and elicit an IgG or IgM response which happens with many drugs like penicillin’s (McCance and Huether, 2019, p. 266). Amoxicillin is in the same drug class of penicillin. In allergic reactions to penicillin, the immunogenic antigen is a metabolite of penicillin catabolism that binds to the plasma membranes of erythrocytes or platelets and induces an antibody response that destroys cells (McCance and Huether, 2019, p. 266).
How another characteristic (e.g., gender, genetics) would change your response
Many characteristics of the patient could change the response. The patient was a 16-year-old male which in this age group it is common for them to have strep throat. If the patient was a newborn or an elderly patient this could impact how their immune system may react to the bacteria. Also, if the patient was immunodeficient this would also change his course of treatment because he may need a more aggressive approach. If the patient had any genetic dispositions that would put him at higher risk for infection would also change the type of care given to the patient. If the patient has used several antibiotics due to recurrent infections this would help me to identify an appropriate antibiotic to prevent MRSA. If the patient had a history of hypersensitivity to antibiotics this would have also changed the course of his treatment. Gender would not impact the change in response to a bacterial infection, but it would help me look out for different side effects from antibiotics like yeast infections.
References
Burgner, D., Jamieson, S. E., & Blackwell, J. M. (2006). Genetic susceptibility to infectious diseases: Big is beautiful, but will bigger be even better? The Lancet Infectious Diseases, 6(10), 653-663. doi:10.1016/s1473-3099(06)70601-6
Janeway, C., A., Shlomchik, M., J., Travers, P., Walport, M. (2001). Immunobiology, 5th edition: The Immune System in Health and Disease. Garland Publishing.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier
Peters, J., Price, J., & Llewelyn, M. (2017). Staphylococcal and streptococcal infections. Medicine, 45(12), 727-734. doi:10.1016/j.mpmed.2017.09.010
