N512 Advanced Pathophysiology
Module 1 Discussion
See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal. Her provider diagnosed her with low-grade cervical dysplasia. What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.
N512 Advanced Pathophysiology
Module 2 Discussion
Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.
In this discussion:
Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
Identify the pathophysiologic mechanism for her chest pain.
Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.
N512 Advanced Pathophysiology
Module 3 Discussion
Darla Thomas, a 25 y.o. African-American previously well woman, presents to her primary care Nurse Practitioner’s office with complaints of episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that they have worsened lately, occurring two or three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or nocturnal symptoms. The family history is notable for a father with asthma. She is single and works as a secretary in a high-tech firm. She lives with a roommate, who moved in approximately 2 months ago. The roommate has a cat. The patient smokes occasionally when out with friends, drinks socially, and has no history of drug use. Examination is notable for mild end-expiratory wheezing. Pulmonary function tests are ordered to confirm the diagnosis.
In this discussion:
Discuss what you think this patient’s likely diagnosis is. Why do you support this “likely” diagnosis?
Identify the pathogenetic mechanisms that are responsible for this patient’s symptoms of wheezing, shortness of breath, and chest tightness.
What might you expect the results of her pulmonary function tests to be? Why?
Provide and discuss a plan of care for her. What would be your priority patient education outcomes? How would you achieve these outcomes?
N512 Advanced Pathophysiology
Module 4 Discussion
Marisol Arroyo, age 23 y.o., and unmarried, accompanies her mother, Julia, who is a 68 y.o., divorced Latina female, to her appointment with her primary care Nurse Practitioner. Both Marisol and her mother, who live together, have noted that her ever-present forgetfulness seems to be worsening. Just yesterday she walked to the corner store for a few items, which she obtained, but even though she had been to this store many times over the years, she found herself unable to get home without directions. Marisol also notes that her mother’s hygiene is changing, that she is becoming more and more quarrelsome, and that she forgets information she had been told as little as 10 minutes earlier. The Nurse Practitioner is attempting to rule out whether this patient may have some form of dementia or delirium.
In this discussion:
Describe and discuss the unique pathophysiology of Dementia of the Alzheimer’s Type.
If this patient is diagnosed with Alzheimer’s dementia, describe and discuss with your colleagues a potential clinical course, and prognosis for her.
Describe and discuss your plan of care for this patient with both short-term and long-term plans considering current social supports and health-care access.
N512 Advanced Pathophysiology
Module 5 Discussion
Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief.
In this discussion:
Discuss with your colleagues the pathophysiological development of nephrolithiasis.
Provide a rationale for whether this patient should be further evaluated for renal surgery at this time.
Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge.
N512 Advanced Pathophysiology
Module 6 Discussion
Luv Taub, a 32-year-old, married Hmong woman, presents to her primary care Nurse Practitioner complaining of a persistent burning sensation in her chest and upper abdomen. The symptoms are worse at night while she is lying down and after meals. She enjoys many years of cooking and eating “hot and spicy foods” common in her culture. She has tried drinking hot cocoa to help her sleep. She is a smoker and frequently relies on benzodiazepines for insomnia. She notes a sour taste in her mouth every morning. Physical examination is normal.
In this discussion:
Discuss this patient’s likely diagnosis. Why do you support this “likely” diagnosis?
Describe the pathophysiology of this disorder.
Discuss a plan of care for this patient.
What is the anticipated prognosis for this patient? What lifestyle factors might alter her short- and long-term outcomes?
N512 Advanced Pathophysiology
Module 7 Discussion
Leonard Mays, a 58 y.o., Caucasian, homeless man with long-standing insulin-treated type 2 diabetes has been diagnosed with right lower extremity cellulitis. He has taken a prescribed oral antibiotic for the past week but has not noticed much improvement. For the last 2 days, he has complained of intermittent fevers and chills, nausea with poor oral intake, and proximally spreading erythema over his right leg. On the evening of admission, a worker at the homeless shelter notices that he is markedly confused and calls 911. In the emergency room, he is oriented only to his name. The patient is tachypneic, breathing deeply at a rate of 24/min. He is febrile at 38.8°C. He is normotensive, but his heart rate is elevated at 112 bpm. On examination, this patient is a delirious, unkempt man with a fruity breath odor. His right lower extremity is markedly erythematous and exquisitely tender to palpation. Serum chemistries reveal glucose of 488 mg/dL, potassium of 3.7 mg/dL, and sodium of 132 m/dL. Urine dip-stick is grossly positive for ketones.
In this discussion:
Describe and discuss with your colleagues the pathophysiology of ketoacidosis in this diabetic patient. What is causing his altered mental status?
Describe the pathogenetic mechanism of his respiratory pattern.
Describe and discuss a plan of care for this patient during his first few days in the hospital.
Describe a plan of care for him at discharge (he will likely be admitted to the “medical floor” of the homeless shelter, which has the services of an Nurse Practitioner three times per week and a registered nurse four times per week). Include plans for at least one population-focused intervention.
N512 Advanced Pathophysiology
Module 8 Discussion
Derek Smith, a 31 y.o., Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.
In this discussion:
Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.
Describe and discuss the immunosuppression caused by this underlying disease.
Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.
Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday).
N512 Advanced Pathophysiology
Assignment 1
The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).
Lisa Anderson, a 22 y.o., Caucasian single parent, is referred for genetic counseling by her pediatric Nurse Practitioner. She has a 3-year-old boy with developmental delay and small joint hyperextensibility. The pediatric Nurse Practitioner has diagnosed fragile X-associated mental retardation. She is currently pregnant with her second child at 14 weeks of gestation. The family history is unremarkable.
Please use the following headings/subheadings as a guide to draft your paper:
Introduction (including a brief purpose statement)
Identify the genetic mutation responsible for fragile X-associated mental retardation.
Describe and discuss how it causes the clinical syndrome of developmental delay, joint hyperextensibility, large testes, and facial abnormalities.
Identify which parent is the probable carrier of the genetic mutation?
Explain why this parent and the grandparents are phenotypically unaffected.
Discuss the likelihood that the unborn child will be affected?
VII. Conclusion
In regards to APA format, please use the following as a guide:
Include a cover page and running head (this is not part of the 4-5 page limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Spelling, grammar, and organization are appropriate
Include a reference list (this is not part of the 4-5 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)
N512 Advanced Pathophysiology
Assignment 2
Emil Mowry is a 62 y.o., single, Latino rancher who did not complete high school. He remembers rolling his first cigarette when he was 11 years old. He does not remember ever wanting to quit smoking. For the last five years he has had increasing difficulty breathing. Emil was diagnosed by his Family Nurse Practitioner as having emphysema. He was told that he has Chronic Obstructive Pulmonary Disease (COPD). He did not ask his Nurse Practitioner what this means, but he plans to look it up on the Internet.
The purpose of this assignment is to create an evidence-based patient-centered educational brochure on the pathophysiology and clinical manifestations of, and common treatment options for, COPD that could be used by Nurse Practitioners or Nurse Educators with their patients newly-diagnosed with this disorder. The proposed brochure should include graphics and citations from your textbook and the external, scholarly-practice literature.
You may present the content in the electronic format of your choice: single sheet, folded, tri-fold. In other words, you may use MS Word Document, MS Publisher, or any other software to develop your educational brochure. Since your audience are patients, please keep in mind the literacy and numeracy level (some literature suggests no more than 8th grade level literacy and numeracy). Also, please refer to the Assignment Rubric below for grading criteria and to help you complete this assignment.
In regards to APA format, please use the following as a guide:
Include transitions in your brochure, if needed (i.e. headings or subheadings)
Use in-text references throughout the brochure
Spelling, grammar, and organization are appropriate
Include a reference list (this could be at the end of the brochure or you may submit a separate document listing your references)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)
N512 Advanced Pathophysiology
Assignment 3
The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).
James Alvarez is a 52 y.o., recently divorced, Latino male; new patient who arrives at the community health clinic for an appointment with a primary care Nurse Practitioner. His chief complaint of abdominal pain and vomiting, fatigue, and weight loss. He notes that although he has experienced overall weight loss, his stomach “looks huge.” As his history is taken, he notes no alcohol use. In speaking with him, the Nurse Practitioner notices a yellow tinge to the whites of his eyes. During examination, the Nurse Practitioner notes organomegaly in the right upper quadrant.
Please use the following headings/subheadings as a guide to draft your paper:
Introduction (including purpose statement)
What would be your priority diagnosis for Mr. Alvarez?
Identify the organ and describe the pathophysiological processes, which may have caused the organomegaly.
Develop a comprehensive and holistic plan of care for this patient based on James' diagnosis.
Conclusion
Within your description, place in bold font the key pathophysiological concepts (terms).
Include recommendations for follow-up with the Nurse Practitioner.
Incorporate a population-based component to Mr. Alvarez' plan of care.
In regards to APA format, please use the following as a guide:
Include a cover page and running head (this is not part of the 4-5 page limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Spelling, grammar, and organization are appropriate
Include a reference list (this is not part of the 4-5 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)
N512 Advanced Pathophysiology
Final Project
This assignment entails the development of a Power Point Presentation (PPP) on your choice of an immunodeficiency disease incorporating evidence-based practice literature and reliable electronic sources. The presentation shall include at least 10 slides, excluding the title and reference slides.
Submission Parameters:
Please use the following criteria to develop your PPP:
Introductory slide with at least 3 presentation objectives
Description of an immunodeficiency disease
A description of the disorder’s pathophysiology and clinical presentation.
A description of the associated laboratory, radiological, or other referral diagnostic tests required with supporting references.
Presentation of a comprehensive, holistic plan of care.
Conclusion
Provide brief concluding statements
List of References in APA format (6 references minimum)
You are encouraged to use the Notes section associated with each slide to provide more extensive discussion/narratives of the slide content.
In regards to APA format, please use the following as a guide:
Use references throughout the Power Point Presentation
Apply appropriate spelling, grammar, and organization throughout the Presentation
Include a reference list at the end of the Presentation
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)
