As an advanced practice nurse, you will examine patients presentingwith a variety of disorders. You must, therefore, understand how thebody normally functions so that you can identify when it is reacting tochanges. Often, when changes occur in body systems, the body reacts withcompensatory mechanisms. These compensatory mechanisms, such asadaptive responses, might be signs and symptoms of alterations orunderlying disorders. In the clinical setting, you use these responses,along with other patient factors, to lead you to a diagnosis.
Consider the following scenarios:
Jennifer is a 2-year-old female who presents with hermother. Mom is concerned because Jennifer has been “running atemperature” for the last 3 days. Mom says that Jennifer is usuallyhealthy and has no significant medical history. She was in her usualstate 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 favoritetelevision cartoon. Since then she has had a fever off and on, anywherebetween 101oF and today’s high of 103.2oF. Mom has been giving heribuprofen, but when the fever went up to 103.2oF today, she felt thatshe should come in for evaluation. A physical examination reveals aheight and weight appropriate 2-year-old female who appears acutelyunwell. Her skin is hot and dry. The tympanic membranes are slightlyreddened on the periphery, but otherwise normal in appearance. Thethroat is erythematous with 4+ tonsils and diffuse exudates. Anteriorcervical nodes are readily palpable and clearly tender to touch on theleft side. The child indicates that her throat hurts “a lot” and it ispainful to swallow. Vital signs reveal a temperature of 102.8oF, a pulseof 128 beats per minute, and a respiratory rate of 24 beats per minute.
Jack is a 27-year-old male who presents with rednessand irritation of his hands. He reports that he has never had a problemlike this before, but about 2 weeks ago he noticed that both his handsseemed to be really red and flaky. He denies any discomfort, statingthat sometimes they feel “a little bit hot,” but otherwise they feelfine. He does not understand why they are so red. His wife told him thathe might have an allergy and he should get some steroid cream. Jack hasno known allergies and no significant medical history except forrecurrent ear infections as a child. He denies any traumatic injury orknown exposure to irritants. He is a maintenance engineer in a newspaperbuilding and admits that he often works with abrasive solvents andchemicals. Normally he wears protective gloves, but lately they seem tobe in short supply so sometimes he does not use them. He has exposed hishands to some of these cleaning fluids, but says that it never hurt andhe always washed his hands when he was finished.
Martha is a 65-year-old woman who recently retiredfrom her job as an administrative assistant at a local hospital. Hermedical history is significant for hypertension, which has beencontrolled for years with hydrochlorothiazide. She reports that latelyshe is having a lot of trouble sleeping, she occasionally feels like shehas a “racing heartbeat,” and she is losing her appetite. Sheemphasizes that she is not hungry like she used to be. The onlysignificant change that has occurred lately in her life is that her87-year-old mother moved into her home a few years ago. Mom had alwaysbeen 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 andindependence and needs to rely on her daughter for assistance withactivities of daily living. Martha says it is not the retirement shedreamed about, but she is an only child and is happy to care for hermother. Mom wakes up early in the morning, likes to bathe every day, andhas always eaten 5 small meals daily. Martha has to put a lot of timeinto caring for her mother, so it is almost a “blessing” that Martha issleeping and eating less. She is worried about her own health though andwants to know why, at her age, she suddenly needs less sleep.
- Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
- Identify the pathophysiology of the disorderspresented in each of the three scenarios, including their associatedalterations. Consider the adaptive responses to the alterations.
- Review the examples of “Mind Maps—Dementia,Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media inthis week’s Learning Resources. Then select one of the disorders youidentified from the scenarios. Use the examples in the media as a guideto construct a mind map for the disorder you selected. Consider theepidemiology, pathophysiology, risk factors, clinical presentation, anddiagnosis of the disorder, as well as any adaptive responses toalterations.
- Review the Application Assignment Rubric found under Course Information
Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:
- For each of the three scenarios explain thepathophysiology, associated alterations and the patients’ adaptiveresponses to the alterations caused by the disease processes.You are required to discuss all three scenarios within the papercomponent of this assignment.
- Construct one mind map on a selected disorder presented in one ofthe scenarios. Your Mind Map must include the epidemiology,pathophysiology, risk factors, clinical presentation, and diagnosis ofthe disorder, as well as any adaptive responses to alterations.