McCance, K., & Huether, S. (2014). Pathophysiology: The biologic basis for disease in adults and children. (7th Ed.). St. Louis, MO: C.V. Mosby, ISBN 978-0-323-08854-1.
Case 430N: 18 y/o woman with wheezing and a shortness of breath.
An 18 y/o African American woman college freshman without significant past medial history came to the student health clinic complaining of wheezing and shortness of breath. She says that her wheezing has been present intermittently over the past 6 months and seems to begin when she is around cigarette smoke or near animals but gradually clears when these exposures are removed. She has been markedly more symptomatic during the recent period of very cold weather. The wheezing does not seem to be related to exercise. This morning she awoke wheezing and while sitting in class this morning became gradually worse – her friends made her come into the clinic.
Past History: She recalls having had chickenpox as a child. She received the usual immunizations. She vaguely recalls getting shots for allergies as a child.
Social History: She denies any use of cigarettes, marijuana or other inhalational exposure. She has an occasional beer on weekends. Not sexually active.
Family History: Father and mother in good heath, no cancer or heart disease in the family. Two younger brothers in good health.
Allergies: Penicillin & Sulfa drugs (always been told to say that)
Physical Exam: A young well-developed (wd)/well-nourished (wn) female in moderate respiratory distress, BP 120/80, Pulse 90 and regular, Resp 20/min. Wt: 135 lbs; Ht: 5’ 6”
HEENT:PERRLA, no sinus tenderness, no oral lesions.
Neck:Supple, no masses, no bruits
Chest:Diffuse inspiratory and expiratory wheezes with mild prolongations of the expiratory phase.
Heart:PMI normal, no murmurs, suggestion of split-S2
Abdomen:Soft, no organomegally, BS normal
Extremities:No rashes, pulses equal and full.
- Develop a problem list and differential.
- What further procedures or tests would you order now?
Chest X-ray read as normal
Spirometry results – Before and after Bronchodilator therapy
CBC: Hct: 39%, WBC: 9,800/mm3 Differential: Neutrophils: 62%, Lymphs: 28%, Mono: 8%, Eosin: 2%.
- What are the acute changes found by pulmonary function testing?
- What are the various types of asthma?
- What is the pathophysiology of airway obstruction in this disease?
- What are the basic tenets of therapy for asthma?
- What is status asthmaticus?
- What are the classic morphologic changes of asthma?
- What is the allergic bronchopulmonary aspergillius (ABPA) syndrome? What are the clinical manifestations? Describe the pathologic changes of ABPA?
2) Format Issues: Please answer each question below the individual question (don’t combine the entire section into one large paragraph – it makes it harder for your grader to find the answers or what you planned to be your answer). It does not have to be in APA format, but your references should be typed in APA format.
- Initial SECTION: The information…from case and nurse in the first section (10 pts): For this section, you just restate the things in the case (risk factors) that would lead you to the diagnosis or one of the differential diagnoses. Then you ask the nurse some things…that would help you with the diagnosis. Don’t ask about things that do not apply or are NOT risk factors for your diagnoses. For example, for NEC, you may want to ask about the stools. But also don’t ask things about the exam –you would go and exam the infant and find out yourself. You can ask about previous exams yesterday, but don’t ask if the abdomen is red or tympanic…because you should not ask that, but see it on your exam when you go and examine the baby. I only want the info here that you would really ask the nurse at the bedside!
- Patho of the Disorder (10pts): What happens that causes the disorder to occur? In the development? Or the external factors? What causes it (in your own words, so I know that you understand it). If you read about the patho in the couple articles you find – like in Neonatal Network or Journal of Perinatology or Pediatrics – having read about it a couple times, then you should start having an idea of how it occurs and why this baby has it. So describe the pathophysiology or cause of the disorder. Explain it step by step – even if we don’t know the exact cause, but we know that “there has to be gut ischemia first, then bacteria have to show up and feedings exacerbate it. For example “The bacteria enter the bowel via the area damaged by ischemia…the bacteria enter the lining of the gut and multiply and release gas, which can accumulate within the bowel wall. If the necrosis from the ischemia is severe or the damage by bacteria is severe, then it can perforate the muscular layer of the bowel wall and cause a perforation.” That is the kind of explanation I want. You do not have to describe the cytokines or leukotrienes like PAF, TNF, interleukins, growth factors, etc. Just state there is inflammation and the inflammatory mediators show up. I really want to know that you understand it. AND YOU MUST WRITE IN YOUR OWN WORDS!! NO QUOTES AND NO PLAGIARISM!!
- Physiology of the Symptoms (10 pts): What causes the symptoms that were discusses as important with this disorder? So for NEC, you explain that aspirates and distension occur due to a paralytic ileus that occurs with any damage to the gut. Fever, lethargy, and apnea/bradys occur because of the overwhelming septicemia that develops. I hope that is making sense. (no symptom physiology/patho = Minus 10 pts each section)
4) Differential & Definitive Diagnosis: This is usually just a list of some possible diagnoses that could have some of these same symptoms. Your favorite should be on the list. Then state why you picked the one from the list that is the most logical and just explain why you picked it….
5) Laboratory Findings: If you order something, it should be something that helps you with your specific diagnosis. If you order it, you must explain what the result would be if the patient did have that diagnosis…what would you find? Important that you know this, not just ordering a bunch of studies, but you need to know what the normal and abnormals are for each study you order.
6) ADULT CASES: (see sample in the case study module)
7) APA & CITATIONS/REFERENCES: You do not need to use APA format, or double spacing, but leave room between your questions and answers for us to place comments in the grading system “Crocodoc”. Explanations about accessing the CROCODOC grader is in the course RESOURCE section! Make sure you can read your instructor comments when she returns your paper. You DO NEED citations throughout the paper for anything that has statistics, numbers, or things you didn’t know before you looked it up. If the information is in every resource you look at – the same information – and pretty much all nurses know this inforamtion, then you do not need to cite it. If it is your own head knowledge, written in your own words, you do not need to cite it. If you use a couple resources for their ideas, then cite them both for those ideas within the paper. Citations should be at the point where the ideas are referred to (not just at the end of the paragraphs). REFERENCES: The minimal amount required is 2 articles and your textbook! Also, use of the eMedicine website (which is really good) but this can’t be your article to summarize, or the UpToDate website for adult references. These will help you (like an encyclopedia) with all the basic information. But find 2 ARTICLES that help explain the pathophysiology for your summaries for the extra credit points. Also, websites that are NOT peer-reviewed should NEVER be used for scholarly work, therefore, no Wikipedia PLEASE!!! No citations = Minus 5pts & Minus 5 pts for no references = TOTAL 10 points off if no references used!! DON’t forget the references!!
8) ARTICLE SUMMARIES X 2 for EXTRA CREDIT
Use 2 articles in your case studies and summarize them, write up the summaries into a 2 paragraphs about what you learned from the article –make sure you put the name of the articles on each on each one. If it wasn’t very good, say so. If you learned a lot that helped you with the case, say that. Explain what you learned….not just that you did learn. Write these 2 summaries and upload each copy of the article in PDF format (not scanned copies please and no links please….), Only upload the 2 articles that you write summaries on.
Please answer all questions including the the ones about the articles.
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