Category: Nursing

NURS 6521 Mid-Term Exam Summary & Study Guide

NURS 6521

Mid-Term Summary & Study Guide

 

100-question Exam which will assess your knowledge on the Learning Resources from Weeks 1-6

Time limit of 2 hours

Multiple choice or multiple selection

NURS 6521 Mid-Term Exam Summary & Study Guide

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Pharmacokinetics:

Understand the implications of changing renal function on creatinine and drug dosing.

What is the impact of the following on drug levels and dosing: NURS 6521 Mid-Term Exam Summary & Study Guide

Cirrhosis

Protein binding

Drug interactions

Half-life

Routes of Administration and Dosage Forms:

Understand the different routes of administration and dosage forms and some of the challenges and benefits associated with these routes and forms.

Understand when it is OK to crush (or not crush) certain dosage forms and why NURS 6521 Mid-Term Exam Summary & Study Guide.

Which routes of administration have the fastest and slowest rates of absorption?

Know the relative onset, monitoring and appropriate use of various dosage forms including:

Patches (ie; fentanyl, rivastigmine)

Suppositories (ie; acetaminophen)

Sublingual tablets

Tablets

Liquid (know common measures)

Injectables

Sublingual

Nasogastric

Elixir (contains alcohol)

 

Therapeutics:  
Gastrointestinal, Cardiac, Respiratory, Neurology, Musculoskeletal

Understand the mechanism of action, side effects, appropriate use and contraindications for the classes of drugs and individual drugs listed below. Also, know the key patient education points including cautions, expected effects, and appropriate use (with food, empty stomach, etc.).

Anti-diarrheals (diphenoxylate HCl with atropine sulfate, loperamide, bismuth subsalicylate)

Laxatives (fiber, osmotics, stimulants, other) NURS 6521 Mid-Term Exam Summary & Study Guide

Therapy for various gastrointestinal disorders including antiemetics, ulcers, irritable bowel syndrome, Crohn’s ulcerative colitis (ie; alosetron, PPIs like omeprazole, Mesalamine, ranitidine, etc.)

Cough, cold, and sinus therapies including antihistamines and cough suppressants (ie; dextromethorphan, loratadine, fexofenadine, nasal decongestants

Cardiac Medications – Digoxin (understand toxicity, dosing, use), Statins, Colestipol, Nitroglycerin

Blood pressure medications (calcium channel blockers, ACE Inhibitors, diuretics, beta-blockers, nitroprusside, others)

Diuretics (spironolactone, furosemide, hydrochlorothiazide)

Inhalers (albuterol, ICS, LABA, anticholinergics) NURS 6521 Mid-Term Exam Summary & Study Guide.

Asthma – Theophylline, zafikurlast, steriods and others

Gout and arthritis therapies (allopurinol, etanercept, sulfinpyraxone, methotrexate)

Antineoplastics (etoposide, 5FU, cisplatin, bicalutamide, others)

Agents for thyroid disease (Levothyroxine, methimazole and others)

Multiple sclerosis therapies (Dantrium, Glatirimer, Baclofen, Tizanidine, others)

Antiepileptics (phenytoin, ethosuximide, diazepam, others)

Osteoporosis (calcitonin, others)

Hypoglycemics (glyburide, glipizide, metformin, insulin, etc.)

Meds for Hyperlipidemia

Anticholinergics/Cholinergics

Pain (opioids, muscle relaxants, NSAIDs, acetaminophen, topical lidocaine, etc.)

Orlistat

Adrenergic agonists

NURS 6521 Mid-Term Exam Summary & Study Guide

 

Terminology:

Efficacy

Pharmacokinetics

Pharmacodynamics

Drug tolerance

Addiction

Dependence

Withdrawal

First pass effect

Idiosyncratic response

Medication Reconciliation

NURS 6521 Mid-Term Exam Summary & Study Guide

 

Other Topics:

Which drug classes produce withdrawal if stopped abruptly? When is withdrawal life threatening?

Understand the appropriate use of herbal therapies

Understand components of cultural competence

How can adverse drug events be minimized?

Why do drugs require clinical study and FDA approval?

Know common teaspoon, tablespoon, and milliliter conversions

Know DEA schedules and examples of therapies in each scheduled class (1-5). What are the special prescribing restrictions for these various classes?

Which medications should be taken with food? Which on an empty stomach?

What is the purpose of the MedWatch Program?

Symptoms and treatment of drug intoxication from cocaine, opioids, marijuana

Appropriate use of reversal agents for digoxin, opioids, etc.

Antihistamines

H1, H2 blockers

NURS 6521 Mid-Term Exam Summary & Study Guide

NURS 6512 Midterm Exam Review (Week 1-6)

Building A Complete Health History

Communication techniques used to obtain a patient’s health history

Recording and documenting patient information

SOAP note documentation

NURS 6512 Midterm Exam

Subjective vs objective information when documenting

Ethical decision making and beneficence

 

Diversity and Health Assessments

Cultural awareness and diversity

Socioeconomic, spiritual, and lifestyle factors affecting diverse populations

Functional assessments

NURS 6512 Midterm Exam

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Assessment Tools and Diagnostic Tests in Adults and Children

Growth, Development, and Measurements in children and adults

Nutritional assessment to include recommended water intake and energy requirements

Macronutrients vs Micronutrients

Significance of a food diary NURS 6512 Midterm Exam

BMI measurements for normal, overweight, obesity, morbid obesity

Pernicious Anemia

Examination techniques and equipment

Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of stethoscope, otoscope, ophthalmoscope

 

Assessment of the Skin, Hair, and Nails

Skin lesion characteristics

Documenting skin lesions using “ABCD” rule

Anatomy and physiology of skin layers

Abnormal nail findings in older adults NURS 6512 Midterm Exam

Psoriatic skin lesions

Vesicular skin characteristics

Normal vs abnormal hair distribution during aging

Characteristics of hair distribution

Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

Cranial Nerves associated with the HEENT system

Normal assessment findings of an adolescent’s nose and throat

Normal examination findings of an infant’s fontanelles

NURS 6512 Midterm Exam

Examination findings of a patient with hypothyroid and hyperthyroid

Techniques for examining the HEENT systems

Examination findings for a patient with sinus symptoms

Appropriate tuning fork frequencies to approximate vocal frequencies

Examining the oral mucosa

Hearing loss findings when examining the elderly patient

Examination techniques used to examine the trachea and thyroid

 

Assessment of the Abdomen and Gastrointestinal System

Organs involved in the alimentary tract

Correct assessment order for examining the abdomen

Examination technique and findings of the liver

Examination findings associated with appendicitis

Examining McBurney’s sign

Assessment of abdominal pain in women

Landmarks for abdominal examination

Characteristics of bowel sounds heard during auscultation

NURS 6512 Midterm Exam

Acute Pericarditis Discussion Essay

Discussion 2

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 Acute Pericarditis Discussion Essay. 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. Acute Pericarditis Discussion Essay Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

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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 Acute Pericarditis Discussion Essay.

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discussion 2, Moule 2

1. The most likely diagnosis for Jackie Johnson is acute viral pericarditis. She presented to the ED with “flu-like illness”, with fever, nasal drainage, and cough. Given her neg. medical history and description of chest pain, this would also fit with viral pericarditis. Also, it was noted on auscultation, a three-component high-pitch squeaking sound, a friction rub, is a hallmark sign of pericarditis Acute Pericarditis Discussion Essay.

2. The differential diagnoses would include M.I., P.E., Pneumonia, COVID, and Aortic Dissection. Chest pain in a 35-year-old female would be worked up with a thorough physical exam, complete patient history, and diagnostic testing because the M.I., P.E., Pneumonia, COVID, and Aortic Dissection all can have chest pain as a presenting complaint.

3. Viral infections (especially infections with coxsackieviruses and echoviruses), and probably are responsible for many cases classified as idiopathic. (Norris, 2019).  Infections may be bacterial, fungal, or viral. Other causes can be Neoplasms, high dose radiation to the chest, uremia, hypersensitivity, or autoimmune diseases such as acute rheumatic fever (the most common cause of pericarditis in children), lupus, and rheumatoid arthritis. Causes may also include previous cardiac injury, post-M.I. or surgery, that leaves the pericardium intact but causes blood to leak into the pericardium. (Lippincott, 2005). Viral pericarditis is the most likely diagnosis. Acute Pericarditis Discussion Essay.

4. The chest pain is due to a result of pericardium inflammation. The inflammation of the adjacent pleura may account for the worsening pain with deep breathing and coughing. (Hammer & McPhee, 2019) Acute Pericarditis Discussion Essay. With prolonged inflammation, the pericardium can become fibrotic and scarred, with calcium deposits, and this, in turn, can lead incomplete filling of the ventricles  resulting in constrictive pericarditis (Hammer & McPhee, 2019)

5. Upon discharge from the ED or from an inpatient status, her plan of care should be close follow up with her primary MD or possibly cardiology, depending on labs, EKG, chest x-ray, echo, etc. She may possibly need education on stress management due to her job as an advertising executive. Instructions are given on a healthy diet and exercise. She will be on a short course of NSAIDs and possibly colchicine. If NSAIDs are ineffective and no infection exists, corticosteroids can be given. (Lippincott,2005). Her social support, we can assume is her husband, and I would stress healthy life habits for them as a couple. Acute Pericarditis Discussion Essay

References

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of Disease. New York: McGraw-Hill Education.

Lippincott, W. &. (2005). Handbook of Pathophysiology. Philadelphia: Wolters Kluwer.

Norris, T. L. (2019). Porth’s Pathophysiology Concepts of Altered States. Philadelphia: Wolters Kluwer. Acute Pericarditis Discussion Essay

N512 Acute Pericarditis

Mrs. Johnson is a thirty-five-year-old married Black female. Of importance, she presents with chest pain, rated as an eight on a scale of 1-10, that is sharp, located behind the sternum and radiates to the back. Pain increases on inhalation and is made better with leaning forward. Medical history non-contributory. Denies active medications and tobacco, alcohol, and drug use. N512 Acute Pericarditis Vitals reveal mild tachycardia. Patient confirms flu-like illness, but currently afebrile. Physical exam positive for mucus in nasal passage, erythematous oropharynx, and high-pitched squeaking sound.

Mrs. Johnson’s likely diagnosis is acute pericarditis. She presents with the classic indications of pericarditis pain (Hammer & McPhee, 2019):

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Sharp and retrosternal in nature

N512 Acute Pericarditis

Worsens with deep breathing, coughing, lying flat

Improved with sitting upright and leaning forward

A high pitched three component squeaking sound is also heard on cardiac examination. She could potentially have infection, acute myocardial infarction, thoracic cavity trauma. Although medication side effects can potentially cause some of these symptoms, she reports no medication use to include street drugs. N512 Acute Pericarditis According to Hammer and McPhee, “Viruses, particularly, the coxsackieviruses, are the most common cause of acute pericarditis. Viruses are also probably responsible for “idiopathic” pericarditis” (2019). Other potential viral culprits include echovirus, adenoviruses, parvovirus B19, HIV, influenza as well as multiple herpes viruses such as EBV and CMV. There is also evidence of bacterial infections as etiologies, but it is not usually seen in developed countries (Dababneh & Siddique, 2020) N512 Acute Pericarditis. Based on clinical presentation of shotty anterior cervical lymphadenopathy, the most likely etiology is viral infection. This is further strengthened by the patient’s report of recent flu-like illness. According to Dababneh & Siddique, “Due to the parietal layer’s rich innervation, any inflammatory process mediated by an infectious, autoimmune or traumatic insult can result in severe retrosternal chest pain, as is commonly seen in acute pericarditis. N512 Acute Pericarditis This explains why the vast majority of presentations (>90%) have chest discomfort” (2020). A thorough post discharge plan of care would include:

Educating patient on indicators of worsening disease processes. When to notify primary care provider, when to seek emergency help

Take prescribed medicines as directed. First line of treatment is most often NSAIDS. Some cases will also require treatment with antibiotics and/ or steroids.

Eat a healthy diet. Drink appropriate fluids. Get enough sleep/exercise. N512 Acute Pericarditis

Manage stress. According to the case study she is married. Utilize family support to decrease anxiety and tension. Assess job responsibilities as a potential source of stress and implement ways to lower strain.

References

Dababneh, E., & Siddique, M. S. (2020). Pericarditis. In 
StatPearls
. StatPearls Publishing. N512 Acute Pericarditis

Hammer, G. & McPhee, S. (2019). 
Pathophysiology of disease: An introduction to clinical medicine
 (8th ed.). New York, NY: McGraw-Hill Education /Medical

 

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain N512 Acute Pericarditis. 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. N512 Acute Pericarditis 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 N512 Acute Pericarditis.

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

The symptoms experienced by 35-year-old Jackie Johnson is suggestive of acute pericarditis which I strongly support based upon her history.  Her presenting complaint is sharp retrosternal chest pain radiating to the back which worsens with deep breaths and improves when leaning forward, 8 out of 10 on the pain scale.  She further complains of “flu-like illness”, fever, rhinorrhea, and cough for several days and denies any previous medical or medication history.  Her cardiac examination revealed that she was tachycardic with a pulse rate of 105 and a three-component high-pitched squeaking sound.  Pericarditis is the inflammation of the pericardium which is a fluid-filled sac surrounding the heart and is commonly diagnosed in a primary care setting based on physical examination, and electrocardiogram (ECG), and patient history such as the symptoms experienced by Jackie Johnson (Rahman & Saraswat, 2017) N512 Acute Pericarditis.

Some differential diagnosis would include myocardial infarction (MI), pulmonary embolism, and pneumonia to name a few (Rahman & Saraswat, 2017).  Chest pains are quite common in an MI so cardiac enzymes and an ECG would be needed to rule this out.  Pulmonary embolism also can present with chest pains so a D-dimer blood test and lung scans can rule this out. N512 Acute Pericarditis The patient also complained of cough, fever, and  “flu-like” symptoms which can be caused by pneumonia so a chest x-ray, blood cultures, and a complete blood count can confirm this diagnosis.  “The characteristic ECG findings in patients with acute pericarditis are a diffuse elevation of the ST-segment and ST-segment depression in lead aVR and depression of the PR segment, especially in leads V5 and V6 (Saricam & Saglam, 2016).

There are multiple causes for pericarditis and the most common is a viral disease caused by the coxsackievirus but bacterial, mycotic organisms, and tuberculosis can be the causal factors in addition to other medical conditions such as neoplasms and autoimmune diseases such as rheumatoid arthritis (Hammer & McPhee, 2019).  Based on Jackie Johnson’s complaint of “flu-like” symptoms, she may have a viral cause for her pericarditis.  Her chest pain was probably caused by the inflammation of the pericardium and the three-component high-pitched squeaking sound in her heart was likely due to pericardial friction rub (Hammer & McPhee, 2019) N512 Acute Pericarditis.

Before discharge planning, I will have a conversation with the physician, patient, and spouse to be clear on the medication, follow-up appointment, psycho-social considerations, and activity restrictions.  With this information, I will teach the patient about the medications and side effects, notifying her physician if there is any worsening of symptoms, make sure she has a follow-up appointment, offer her psychological counseling if needed, advise her of social support groups, and stress the importance of rest and avoidance of strenuous activities (Rahman & Saraswat, 2017).

References

 

Hammer, G. & McPhee, S. (2019). 
Pathophysiology of disease: An introduction to clinical medicine
 (8th ed.). New York, NY: McGraw-Hill Education /Medical

Rahman, A., & Saraswat, A. (2017). Pericarditis.
 Australian Family Physician, 46
(11), 810-814. Retrieved from https://search-proquest-  com.americansentinel.idm.oclc.org/docview/1961747048?pq-origsite=summon N512 Acute Pericarditis

Saricam, E., & Saglam, Y. (2016). Potentially missed acute pericarditis: Atypical pericarditis.
 The American Journal of Emergency Medicine, 34
(12), 2451-2453. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1016/j.ajem.2016.09.020  Retrieved from https://search-proquest-com.americansentinel.idm.oclc.org/docview/1961747048?pq-origsite=summon N512 Acute Pericarditis

N512 Advanced Pathophysiology Acute Pericarditis

Jackie Johnson is described as a married 35-year-old African American female who has presented to the emergency room with: Chest pain, which she rates 8 out of 10 on a scale ranging from 1 to 10. The pain is verbalized to be sharp in nature, worsens with deep breaths, is retrosternal, and is improved when “leaning forward”. In addition, she also indicates having had “flu like illness” within the past few days such as fever, rhinorrhea, and cough. She denies any additional medical history and is not taking any medication. Also, she denies any alcohol, tobacco, or drug use. Of note, she is reported to work as an Advertising Executive. N512 Advanced Pathophysiology Acute Pericarditis.

Upon physical examination findings 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 are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx N512 Advanced Pathophysiology Acute Pericarditis. 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.

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Given the patients report and the physical examination obtained, factors aside from medical findings to keep in mind when moving forward are: A highly stressful job, her sex, her race, and her marital status, which may contribute to stress levels as well.

After assessment of the findings presented, J.J’s likely Diagnosis is Acute Pericarditis, which is an inflammation of the pericardium, caused by the sac’s layers becoming inflamed and possibly rubbing against the heart (American Heart Association, 2016). A client with acute pericarditis will complain of chest pain that worsens with deep breaths or while coughing when lying down and is relieved by positional changes, such as leaning forward or sitting up (Hammer & McPhee, 2019) N512 Advanced Pathophysiology Acute Pericarditis. Also, a clinical finding in patients with acute pericarditis is a high-pitched squeaking sound upon cardiac auscultation, which may be indicative of pericardial rub (
Hammer & McPhee, 2019
). The presence of pericardial rub often indicates complications of pericarditis such as an increase in fluid between the layers of the pericardium which causes the rubbing between the pericardium and heart, pericardial effusion (Hammer & McPhee, 2019), this best explains the pathophysiological mechanism causing the chest pain for J.J currently. N512 Advanced Pathophysiology Acute Pericarditis J.J’s cardiac exam shows tachycardia, as evidenced by a heart rate of 105, with a three-component high pitched squeaking sound, which is a finding indicative of acute pericarditis, but may also be indicative of complications related to pericarditis (American Heart Association, 2016).

Causes of pericarditis include viral, bacterial, protozoal, and mycotic infections (Hammer & McPhee, 2019) or its cause can be idiopathic. Per J.J’s report of  “flu like illness for the past few days” which include fever, rhinorrhea, and cough lead me to believe that a likely cause of the pericarditis is a virus. The mild erythematous oropharynx, and shotty anterior cervical lymphadenopathy noted during the physical exam are also indicative of viral cause.

Though acute pericarditis is the likely diagnosis for J.J given her relatively healthy history, further assessment and diagnostic testing should be obtained to confirm and or rule out other cardiac related illnesses that may present with similar symptoms. In the case of J.J, the symptoms presented do not coincide with clinical manifestations exhibited in other cardiac related illnesses N512 Advanced Pathophysiology Acute Pericarditis. Her blood pressure is within normal limits, her respirations are normal, O2 Sat is WNL, jugular veins are not distended, and is not experiencing dyspnea. The clinical findings exhibited: elevated heart rate, mild erythematous oropharynx, shotty anterior cervical lymphadenopathy, tachycardia with 3-component high pitched squeaking sound are all symptoms that point to pericarditis. However, we must also take into consideration that there are non-cardiac related conditions that can also present in the form of chest pain
(
Fass, R., & Achem, S.R, 2011).  Psychological disorders such as panic, anxiety, and depression can also clinically manifest with chest pain (Huffman, J., Pollack, M., & Stern, T., 2002). Given J.J’s high demanding job, we can suspect that she experiences high levels of stress that can contribute to anxiety, but in order to further diagnose this, more information needs to be obtained N512 Advanced Pathophysiology Acute Pericarditis.

Considering that, “Heart disease and stroke are the No. 1 killers in women, and affects African American women disproportionately, making diabetes, smoking, high blood pressure, high cholesterol, physical inactivity, obesity and a family history of heart disease all greatly prevalent among African-Americans and are major risk factors for heart disease” N512 Advanced Pathophysiology Acute Pericarditis (American Heart Association, 2016), I would want to investigate further into family history, and monitoring of cholesterol as well as potential for hypertension.

In order to increase J.J’s prognosis, a thorough assessment should be completed including an ECG, Chest X-ray, echocardiogram, and obtaining labs for signs of inflammation (American Heart Association, 2016). In addition, perhaps also including cholesterol screening would be helpful collateral information to better treat J.J. Currently, her blood pressure appears to be within normal limits, but I would want to monitor this as well. N512 Advanced Pathophysiology Acute Pericarditis Lastly, I’d also want to examine J.J’s psychological and mental status to rule out anxiety related disorders, which could have also contributed to her chest pain.

Acute Pericarditis has been known to clear up on its own with simple treatment (American Heart Association, 2016).  Treatment, however, will be dependent on the cause (American Heart Association, 2016). Upon discharge, the recommendation for J.J will likely be anti-inflammatory medication in higher doses than usual, such as Motrin, or Aleve in order to alleviate the pain, and rest (American Heart Association, 2016), since she has no other known medical history and is relatively young. She should follow up with a cardiologist to monitor for recurrence. N512 Advanced Pathophysiology Acute Pericarditis

 

References:

American Heart Association (2016, March 31)
. Retrieved from

https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis

Fass, R., Achem, S.R. (2011).  
Noncardiac Chest Pain: Epidemiology, Natural Course and              Pathogenesis
.
  
Journal of Neurogastroenterology and Motility,
17:110-123.
https://doi.org/10.5056/jnm.2011.17.2.110

Hammer, G., & McPhee, S. (2019). 
Pathophysiology of disease: An introduction to clinical medicine 
 (8
t
 ed.). New York, NY: McGraw-Hill Medical.

Huffman, J., Pollack, M., & Stern, T. (2002). 
Panic Disorder and Chest Pain: Mechanisms,

Morbidity, and Management. 
Primary Care Companion to The Journal of Clinical

 Psychiatry
, 4(2):54-62.doi: 10.4088/pcc.v04n0203 N512 Advanced Pathophysiology Acute Pericarditis

Discussion 2

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 N512 Advanced Pathophysiology Acute Pericarditis. 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. N512 Advanced Pathophysiology Acute Pericarditis

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 Acute Pericarditis

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. N512 Advanced Pathophysiology Acute Pericarditis

Acute Pericarditis Jackie Johnson diagnosis Discussion 2

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. Acute Pericarditis Jackie Johnson diagnosis 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 Acute Pericarditis Jackie Johnson diagnosis.

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.

Acute Pericarditis Jackie Johnson diagnosis

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

JJ has chest pain that is sharp and retrosternal. This pain radiates to her back and is pleuritic in nature, as it is worse when she takes a deep breath. This pain is improved when she leans forward. The driving factor towards the likely diagnosis is the three-component high pitched squeaking sound with cardiac auscultation. This is a pericardial rub. With all these factors combined, JJ likely has acute pericarditis Acute Pericarditis Jackie Johnson diagnosis.

Continual inflammation of the pericardium can often lead to fibrosis and can eventually lead to constrictive pericarditis. Jugular vein distention and an increase in the jugular vein pressure can be noted. Due to these symptoms, a differential diagnoses can include items such as constrictive pericarditis, pneumonia, GI reflux issues and even a pulmonary embolism, according to Hammer and McPhee (2019) Acute Pericarditis Jackie Johnson diagnosis.

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The most common causes of pericarditis are infections. Coxsackievirus is the most prominent viral cause, according to Hammer and McPhee (2019). Other causes can be bacterial, such as tuberculosis, pneumococcal, or staphylococcal, protozoal, such as amebiasis, or mycotic (fungal), such as actinomycosis, or coccidioidomycosis (Hammer & McPhee, 2019) Acute Pericarditis Jackie Johnson diagnosis. Tests should be ran such as an EKG, CBC, BMP, troponin and lipase levels, and a CXR. I would suspect she has a viral case, due to her flu-like symptoms and an erythematous oropharynx. She also has clear mucus in her nasal passages. If these tests were to be ran, it would be likely she would an elevated WBC, erythrocyte sedimentation rate, or CRP level. Her EKG would be typical. The CXR can be helpful in ruling out other causes in the differential.

According to Hammer and McPhee (2019), pericarditis is an inflammation of the pericardium, and this inflammation affects the adjacent pleura. This can inflict pain when deep breathing or coughing.

Post-discharge, she should take good care of herself to prevent constrictive pericarditis or recurrent pericarditis. According to Imazio et al. (2016), 20-50% of all patients who are treated for pericarditis get it a subsequent time. She should continue to take all medications that she was prescribed, which can be colchicine or steroids, making sure to taper off these medications appropriately Acute Pericarditis Jackie Johnson diagnosis. According to Rahman (2017), low doses of colchicine can be safe, while higher doses or prolonged use can be toxic. She can also take NSAIDs, which can provide symptom control, faster remission rates, and reduction of subsequent recurrences, according to Imazio et al. (2016). These should only be taken if it is not contraindicated to take with her other medications. She should make follow up appointments to make sure this issue is solved.

Interestingly enough, there was a recent study done in 2020 by Fox et al. They found that multiple people who have had no past medical history who have had COVID-19 ended up having either pericarditis, effusive pericarditis, myopericarditis, or pericardial effusion when it was all said and done. There are no current recommendations for managing this, except colchicine, hydroxychloroquine, steroids or antivirals. If this case study is happening in present-day, it would be important to monitor signs and symptoms of pericarditis if the patent had COVID-19. 
Acute Pericarditis Jackie Johnson diagnosis

References:

Fox, K., Prokup, J. A., Butson, K., & Jordan, K. (2020). Acute effusive pericarditis: A Late complication of COVID-19. Cereus, 12(7).

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Medical.

Imazio, M., Lazaros, G., Brucato, A., & Gaita, F. (2016). Recurrent pericarditis: new and emerging therapeutic options. Nature Reviews: Cardiology, 16.

Rahman, A. (2017). Pericarditis. AFP, 46(11). Acute Pericarditis Jackie Johnson diagnosis

Jackie Johnson Acute Pericarditis discussion

Jackie Johnson is described as a married 35-year-old African American female who has presented to the emergency room with: Chest pain, which she rates 8 out of 10 on a scale ranging from 1 to 10 Jackie Johnson Acute Pericarditis discussion. The pain is verbalized to be sharp in nature, worsens with deep breaths, is retrosternal, and is improved when “leaning forward”. In addition, she also indicates having had “flu like illness” within the past few days such as fever, rhinorrhea, and cough. She denies any additional medical history and is not taking any medication. Also, she denies any alcohol, tobacco, or drug use. Of note, she is reported to work as an Advertising Executive. Jackie Johnson Acute Pericarditis discussion

Upon physical examination findings 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 are 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. Jackie Johnson Acute Pericarditis discussion Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

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Given the patients report and the physical examination obtained, factors aside from medical findings to keep in mind when moving forward are: A highly stressful job, her sex, her race, and her marital status, which may contribute to stress levels as well Jackie Johnson Acute Pericarditis discussion.

After assessment of the findings presented, J.J’s likely Diagnosis is Acute Pericarditis, which is an inflammation of the pericardium,
 caused by the sac’s layers becoming inflamed and possibly rubbing against the heart (American Heart Association, 2016). A client with acute pericarditis will complain of chest pain that worsens with deep breaths or while coughing when lying down and is relieved by positional changes, such as leaning forward or sitting up (Hammer & McPhee, 2014). Also, a clinical finding in patients with acute pericarditis is a high-pitched squeaking sound upon cardiac auscultation, which may be indicative of pericardial rub (
Hammer & McPhee, 2014
) Jackie Johnson Acute Pericarditis discussion. The presence of pericardial rub often indicates complications of pericarditis such as an increase in fluid between the layers of the pericardium which causes the rubbing between the pericardium and heart, pericardial effusion (Hammer & McPhee, 2014), this best explains the pathophysiological mechanism causing the chest pain for J.J currently.  J.J’s cardiac exam shows tachycardia, as evidenced by a heart rate of 105, with a three-component high pitched squeaking sound, which is a finding indicative of acute pericarditis, but may also be indicative of complications related to pericarditis (American Heart Association, 2016). Jackie Johnson Acute Pericarditis discussion

Causes of pericarditis include viral, bacterial, protozoal, and mycotic infections (Hammer & McPhee, 2014) or its cause can be idiopathic. Per J.J’s report of  “flu like illness for the past few days” which include fever, rhinorrhea, and cough lead me to believe that a likely cause of the pericarditis is a virus. The mild erythematous oropharynx, and shotty anterior cervical lymphadenopathy noted during the physical exam are also indicative of viral cause.

Though acute pericarditis is the likely diagnosis for J.J given her relatively healthy history, further assessment and diagnostic testing should be obtained to confirm and or rule out other cardiac related illnesses that may present with similar symptoms. In the case of J.J, the symptoms presented do not coincide with clinical manifestations exhibited in other cardiac related illnesses. Her blood pressure is within normal limits, her respirations are normal, O2 Sat is WNL, jugular veins are not distended, and is not experiencing dyspnea. The clinical findings exhibited: elevated heart rate, mild erythematous oropharynx, shotty anterior cervical lymphadenopathy, tachycardia with 3-component high pitched squeaking sound are all symptoms that point to pericarditis. However, we must also take into consideration that there are non-cardiac related conditions that can also present in the form of chest pain 
(
Fass, R., & Achem, S.R, 2011). Jackie Johnson Acute Pericarditis discussion Psychological disorders such as panic, anxiety, and depression can also clinically manifest with chest pain (Huffman, J., Pollack, M., & Stern, T., 2002). Given J.J’s high demanding job, we can suspect that she experiences high levels of stress that can contribute to anxiety, but in order to further diagnose this, more information needs to be obtained Jackie Johnson Acute Pericarditis discussion.

Considering that, “Heart disease and stroke are the No. 1 killers in women, and affects African American women disproportionately, making diabetes, smoking, high blood pressure, high cholesterol, physical inactivity, obesity and a family history of heart disease all greatly prevalent among African-Americans and are major risk factors for heart disease” (American Heart Association, 2016), I would want to investigate further into family history, and monitoring of cholesterol as well as potential for hypertension. Jackie Johnson Acute Pericarditis discussion

In order to increase J.J’s prognosis, a thorough assessment should be completed including an ECG, Chest X-ray, echocardiogram, and obtaining labs for signs of inflammation (American Heart Association, 2016). In addition, perhaps also including cholesterol screening would be helpful collateral information to better treat J.J. Currently, her blood pressure appears to be within normal limits, but I would want to monitor this as well. Lastly, I’d also want to examine J.J’s psychological and mental status to rule out anxiety related disorders, which could have also contributed to her chest pain.

Acute Pericarditis has been known to clear up on its own with simple treatment (American Heart Association, 2016).  Treatment, however, will be dependent on the cause (American Heart Association, 2016). Upon discharge, the recommendation for J.J will likely be anti-inflammatory medication in higher doses than usual, such as Motrin, or Aleve in order to alleviate the pain, and rest (American Heart Association, 2016), since she has no other known medical history and is relatively young. She should follow up with a cardiologist to monitor for recurrenceJackie Johnson Acute Pericarditis discussion.

 

References:

American Heart Association (2016, March 31)
. Retrieved from

https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis

Fass, R., Achem, S.R. (2011).  
Noncardiac Chest Pain: Epidemiology, Natural Course and            Pathogenesis
.
  
Journal of Neurogastroenterology and Motility,
17:110-

123.
https://doi.org/10.5056/jnm.2011.17.2.110

Hammer, G., & McPhee, S. (2014). 
Pathophysiology of disease: An introduction to clinical                    medicine 
 (8
th
 ed.). New York, NY: McGraw-Hill Medical.

Huffman, J., Pollack, M., & Stern, T. (2002). 
Panic Disorder and Chest Pain: Mechanisms,

Morbidity, and Management. 
Primary Care Companion to The Journal of Clinical

            Psychiatry
, 4(2):54-62.doi: 10.4088/pcc.v04n0203 Jackie Johnson Acute Pericarditis discussion

Jackie Johnson Acute Pericarditis Discussion 2

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” Jackie Johnson Acute Pericarditis discussion 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. Jackie Johnson Acute Pericarditis discussion 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. Jackie Johnson Acute Pericarditis discussion

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discussion 2 – Pleuritic Chest Pain

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Case: 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. Jackie Johnson Acute Pericarditis discussion On review of systems, she has noted a “flu-like 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 are 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. Jackie Johnson Acute Pericarditis discussion

Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Upon initial presentation, a clue that the chest pain may be pleuritic in nature is related to the symptoms the patient describes as sharp pain that increases while taking a deep breath, and the pain is located retrosternal with movement of the chest pain to the back. These are classic symptoms of pleuritic chest pain (Hammer & McPhee, 2019; Reamy, Williams, & Odom, 2017). Upon further examination with a repositioning test, the patient voices improvement of chest pain when leaning forward which validates that somatic nerves of the parietal pleura are sensitized with inflammation that is commonly seen in pleuritic chest pain. Further assessment of a “pericardial rub” (an audible high-pitched or squeaking noise as sticky inflammatory fluid in the pericardial sac moves between the visceral and parietal pericardial layers) lends another layer of confirmation, that the patient’s chest pain is pleuritic and possibly due to pericarditis because a pericardial rub is also found to be a classic sign used in developing a diagnosis of pericarditis (Gupta, 2019; Hammer & McPhee, 2019) Jackie Johnson Acute Pericarditis discussion.

Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Pleuritic chest pain can be caused by other conditions. The most serious and life-threatening conditions such as pulmonary embolism, myocardial infarction, aortic dissection, pneumonia, and pneumothorax, have similar signs and symptoms, and diagnostic clinically reasoning can help the practitioner discern, contrast and compare between them quickly to anticipate and plan for life saving interventions. For example, approximately 5% to 21% of emergency department patients are found to have a pleuritic chest discomfort with a pulmonary embolism. In fact, 66% of patients experienced pleuritic chest pain which was associated with a pulmonary embolism (Reamy, Williams, & Odom, 2017, 306). On the other hand, sharp chest pain is usually not cardiac. Also, if you have a pretty good clue of the diagnosis, such as in this case, pericarditis, then you would want to consider the possible related complications such as pericardial effusion, constrictive pericarditis and cardiac tamponade. However, over 80% of pericarditis cases have good outcomes, so searching for other causes may not always be warranted (Imazio, 2020) Jackie Johnson Acute Pericarditis discussion.

It is important to look at other causes, associated signs and symptoms, and complete tests that can help you validate a definitive diagnosis. 
For instance, an EKG may show occasional ST elevation in pericarditis, whereas, in contrast, adjacent leads will show consistent ST elevation along with elevated cardiac enzymes in myocardial infarction. Jackie Johnson Acute Pericarditis discussion And a chest x-ray is often normal with myocardial infarction, but may show cardiomegaly in pericarditis (Reamy, Williams, & Odom, 2017, p. 310).

The working diagnoses, I would probably consider, after a through physical exam and history is pericarditis. Differential diagnoses of a new or old myocardial infarction,  pulmonary embolism, or pneumonia could possibly be considered. Diagnostic evidence such as a chest x-ray will help to identify the size of the heart, the condition of the pericardium, and the condition of the lungs which will aid in discerning a probable diagnosis.

Provide and discuss what the most common causes of this disease are, and which is most likely in this patient? Jackie Johnson Acute Pericarditis discussion

The most common causes of  pericarditis is inflammation caused by 
infections
 from virus (primarily the coxsackievirus), bacteria, protozoal, and mycotic; 
collagen-vascular related diseases
, such as systemic lupus erythematosus, rheumatoid arthritis; 
neoplasm
;
 metabolic,
 such as renal failure; 
injury
 such as myocardial infarction, post myocardial infarction, and trauma; 
idiopathic 
in which the disease presents itself without a defining reason (Hammer & McPhee, 2019, p. 320). Since the patient has had recent flu symptoms and anterior cervical lymphadenopathy with symptoms classic for pericarditis, her condition is mostly likely caused by a viral infection Jackie Johnson Acute Pericarditis discussion.

Identify the pathophysiologic mechanism for her chest pain.

Pericarditis is caused by inflammation of the pericardial sac. The inflammation builds up sticky fluid that grinds against the pericardial surfaces of the visceral and parietal surfaces. The inflammation will initiate growth of polymorphonuclear leukocytes, cause pus type accumulation, and buildup of fibrin material (Hammer & McPhee, 2019). There are no pain receptors in the visceral pleura; however, in response to inflammation, the parietal pleura’s pain receptors are stimulated, and the parietal pleurae and lateral hemidiaphragm can sensitize cutaneous nerves towards the surface of the skin. Swelling and inflammation to these innervated areas can cause increased pain such as with respiratory movement (Reamy, Williams, & Odom, 2017) Jackie Johnson Acute Pericarditis discussion.

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Ms. Johnson is a young and currently working a successful job. It would be good to explore with Ms. Johnson her support system at home, and consider involving a significant other in the education related to her diagnosis and treatment plan. With an unremarkable work-up, discussing with Ms. Johnson home self-care options would probably be safe if she is agreeable to following the home care guidelines, and follow-up for re-evaluation as scheduled. Home therapy would possibly include activity restrictions to include no strenuous exercise, treatment regimen with NSAIDs and colchicine for one to two weeks. Jackie Johnson Acute Pericarditis discussion Follow-up with the patient via a phone conference in one week, and then a follow-up office visit in two weeks would be a good way to monitor if she is responding to the therapy (Imazio, 2020).

References:

Gupta, J. (2019, June). 
Cardiac Auscultation
. Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/approach-to-the-cardiac-patient/cardiac-auscultation

Hammer, G. D., & McPhee, S. (2019). 
Pathophysiology of Disease: An Introduction to Clinical Medicine
(8 ed.). New Youk: McGraw-Hill Education Medical. Jackie Johnson Acute Pericarditis discussion

Imazio, M. (2020, February 21). 
Acute pericarditis: Treatment and prognosis
. Retrieved https://www.uptodate.com/contents/acute-pericarditis-treatment-and-prognosis

Reamy, B. V., Williams, P. M., & Odom, M. R. (2017, September 1). Pleuritic chest pain: Sorting through the differential diagnosis. 
American Family Physician
, 306-312. Retrieved from https://www.aafp.org/afp/2017/0901/p306.html Jackie Johnson Acute Pericarditis discussion

Type 1 Diabetes Chelsea Warren Shadow health Transcript

Transcript

Started:
 Jan 27, 2021 | 
Total Time:
 118 min

All Lines (121)
Interview Questions (71)
Statements (27)
Exam Actions (23)

 Checked ID band

Exam Action

01/27/21 5:21 PM PST

 Assessed vitals

Exam Action

01/27/21 5:21 PM PST

 Checked ID band

Exam Action

01/27/21 5:21 PM PST

Hello, I am nurse xxx. What is your name? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 5:32 PM PST

Hiiiii.

What is your name?

Question

01/27/21 5:32 PM PST

Chelsea Warren.

Nice. Welcome to the clinic Chelsea

Empathize

01/27/21 5:32 PM PST

Thank you.

What brought you to the clinic today?

Question

01/27/21 5:33 PM PST

Duh. Diabetes.

Sorry about that

Empathize

01/27/21 5:33 PM PST

Thanks, I appreciate it.

How do you feel?

Question

01/27/21 5:34 PM PST

I feel way better now. I am super ready to go home.

Good to hear

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Empathize

01/27/21 5:34 PM PST

Ummmm thanks.

Are you having pain right now?

Question

01/27/21 5:35 PM PST

No. No pain.

That is great Chelsea

Empathize

01/27/21 5:36 PM PST

Thank you.

Do you feel comfortable?

Question

01/27/21 5:38 PM PST

Yeah, I feel comfortable. I just wanna go home. I’m way better now.

Why were you admitted?

Question

01/27/21 5:38 PM PST

Like . . . two days ago I was at a riding lesson and I felt really bad all of a sudden. Me and Ms. Saint George thought I got too hot, but then I puked — er, threw up. I don’t remember the rest very well, but my dad brought me here, and then the doctors said I had DKA or whatever.

Sorry about that incident

Empathize

01/27/21 5:39 PM PST

Ummmm thanks.

What was the duration of the symptoms? (No matching questions found.)

Question

01/27/21 5:40 PM PST

how long did the symptoms last?

Question

01/27/21 5:40 PM PST

I guess I felt bad for like, 10 days before the DKA.

Have you been urinating more often?

Question

01/27/21 5:41 PM PST

I was going a lot before the DKA thing. But it seems back to normal now.

Were you almost more thirsty?

Question

01/27/21 5:42 PM PST

I’m not super thirsty very often, but for like 10 days before the diabetic key-do . . . the DKA thing, before that I was soooo thirsty. I could not drink enough water. I literally could not.

Have you been feeling more thirsty?

Question

01/27/21 5:42 PM PST

Well, before the DKA, I was super duper thirsty for like . . . 10 days. I didn’t know what was wrong, I just started drinking so much water. It felt like my mouth was always dry.

Excessive thirst is a symptom of DKA

Educate

01/27/21 5:43 PM PST

Oh, ok. I think I get it.

Are you fatigued?

Question

01/27/21 5:43 PM PST

I feel way better now, but before the DKA I was really tired. I didn’t wanna do anything. I felt like a slug. That happened for like . . . I dunno. Like 10 days before the DKA. It was super weird.

Are you always feeling fatigued?

Question

01/27/21 5:44 PM PST

I mean I’m not normally tired. I was super tired before the DKA, but I didn’t know that’s what was wrong with me.

Any appetite changes?

Question

01/27/21 5:44 PM PST

My appetite is fine now, but before the diabetic key . . . the DKA thing . . . I didn’t want to eat, like, anything. My mom thought maybe I was getting sick or hitting a growth spurt or something.

Am glad your appetite is back Chelsea.

Empathize

01/27/21 5:45 PM PST

Thanks, I appreciate it.

When did you start feeling sick?

Question

01/27/21 5:45 PM PST

I’ve been feeling pretty bad for a while. Since like ten days ago. I started feeling really bad right before dad took me to the hospital. That was two days ago.

What type of diabetes do you have?

Question

01/27/21 5:46 PM PST

Type 1. The kid kind.

That is correct.

Educate

01/27/21 5:46 PM PST

There’s so much to learn. I feel like my brain is full! But thanks for telling me.

What is your favorite diet? (No matching questions found.)

Question

01/27/21 5:47 PM PST

What is your typical diet?

Question

01/27/21 5:47 PM PST

My mom, Nora, is like, a total health nut. Breakfast is yogurt and fruit, lunch on the weekends is salad and chicken, and then she always does some kind of healthy grilled meat and veggies. Dad . . . well, he’s a little more chill about it. I mean, he’s a lot busier so he can’t cook as much.

Well, it is good to have high intake of fruits and vegetables

Educate

01/27/21 5:48 PM PST

This is a lot to take in, but I think I get it.

What is your usual breakfast?

Question

01/27/21 5:48 PM PST

When I’m staying with my mom, normally we eat yogurt and fruit for breakfast. When I stay with Dad, he likes to make pancakes or waffles sometimes.

What do you usually eat for lunch?

Question

01/27/21 5:49 PM PST

Well, I eat lunch at school. Shadow Academy has pretty good food, actually. When I’m staying with mom, on the weekends she’ll make a big salad with chicken. For lunch with my dad, we usually go out for a sandwich.

It is good to follow the recommended diet for people with diabetes

Educate

01/27/21 5:50 PM PST

Ok. Ok. I got it.

Do you exercise?

Question

01/27/21 5:50 PM PST

Yeah. I ride horses a few times a week, and there’s also gym class at school. Sometimes on the weekends Dad wants me to go running with him, but I hate it.

That is nice. Exercise is very important for your health

Educate

01/27/21 5:50 PM PST

There’s so much to learn. I feel like my brain is full! But thanks for telling me.

Don’t worry about that

Empathize

01/27/21 5:51 PM PST

Thank you.

D o you smoke tobacco?

Question

01/27/21 5:51 PM PST

No way! What would Sparkle think of me?

Yeah, smoking is bad for your health

Educate

01/27/21 5:52 PM PST

Ok. Ok. I got it.

Have you ever vaped or used an ecigarette?

Question

01/27/21 5:52 PM PST

Puff on a USB stick that turns your lungs into popcorn? I’ll pass.

Do you drink alcohol?

Question

01/27/21 5:53 PM PST

OMG I dunno. I’m 11! I’ve never tried it.

Yeah, alcohol is bad for your health

Educate

01/27/21 5:53 PM PST

This is a lot to take in, but I think I get it.

Do you have a headache?

Question

01/27/21 5:54 PM PST

Headaches? I don’t really get those.

Did your nausea improve?

Question

01/27/21 5:54 PM PST

Yup — I don’t feel nauseated anymore.

That is nice.

Empathize

01/27/21 5:56 PM PST

Ummmm thanks.

Are you feeling sick?

Question

01/27/21 5:56 PM PST

I feel way better now. I felt really bad two days ago, but I’m back to normal now.

Are you going to be sick?

Question

01/27/21 5:56 PM PST

I don’t feel like that anymore. I haven’t thrown up in two days.

Are you feeling constipated?

Question

01/27/21 5:57 PM PST

Nope. That’s normal, thanks.

How long have you been urinating more frequently?

Question

01/27/21 5:58 PM PST

I was peeing a lot more like . . . 10 days before I had the diabetic key . . . the DKA thing.

Do you feel dizzy?

Question

01/27/21 5:58 PM PST

Nuh uh.

Do you feel tingling anywhere?

Question

01/27/21 5:58 PM PST

No, nothing like that.

Do you have a wound?

Question

01/27/21 5:58 PM PST

Uh, I don’t think so. I don’t really get hurt that often, though.

What is your relationship to the patient?

Question

01/27/21 5:59 PM PST

Chelsea is my daughter.

What is your daughter’s diagnosis?

Question

01/27/21 6:00 PM PST

She’s been diagnosed with type 1 diabetes.

WHEN WAS YOUR DAUGHTER DIAGNOSED WITH DIABETES?

Question

01/27/21 6:00 PM PST

Well, when I took Chelsea to the emergency room the doctors ran some tests and asked me about her symptoms. She was confused and disoriented. Honestly, I didn’t know what was going on with her until the doctors told us she has type 1 diabetes. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Oooh, sorry about that

Empathize

01/27/21 6:00 PM PST

Uh, thanks.

When was your daughter hospitalized?

Question

01/27/21 6:01 PM PST

We came to the hospital two days ago. She had diabetic ketoacidosis when we came in, but I think she’s feeling a lot better now.

Did your daughter have complications with her diabetes?

Question

01/27/21 6:01 PM PST

We came to the hospital two days ago. She had diabetic ketoacidosis when we came in, but I think she’s feeling a lot better now.

How was your daughter feeling?

Question

01/27/21 6:02 PM PST

Chelsea was feeling pretty bad when we first got here. I thought maybe she had a stomach bug, because she was throwing up. She was also kind of confused — just not herself. She was pretty out of it. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Sorry about that. Its hard seeing your child unwell

Empathize

01/27/21 6:02 PM PST

Thank you.

Has your daughter’s weight changed lately?

Question

01/27/21 6:03 PM PST

Well, her horseback riding lesson two days ago was the first time I’d seen her in two weeks. She was staying with her Mom. When I saw her at her riding lesson, I thought she looked a little thinner than normal.

How much weight has your daughter lost?

Question

01/27/21 6:04 PM PST

I think she lost around five pounds. It happened in the last two weeks, when she was staying with her mom. She’s not normally this thin.

Do you know anything about type 1 diabetes?

Question

01/27/21 6:05 PM PST

Just what I’ve learned here in the hospital. We’ve had a lot of different people come in and talk to us . . . and I’ve been reading a lot of articles on my phone. I’ve been reading about insulin, and uh, carb counting, but I don’t think it’s all sunk in.

It is good to have good knowledge about the disease so that you can manage your daughter’s condition effectively

Educate

01/27/21 6:05 PM PST

I see.

What is your daughter’s typical diet? (Clarified to What is your daughter’s diet like?.)

Question

01/27/21 6:06 PM PST

It’s actually pretty normal, I suppose. Pancakes and fruit for breakfast are my speciality. I’ll either fix a sandwich and chips for lunch or she’ll get lunch at school. Dinner varies between take-out or my world famous chili. (Clarified to what my daughter’s diet is like.) Type 1 Diabetes Chelsea Warren Shadow health Transcript

It is recommended to avoid high intake of carbs and fatty foods. Please follow the appropriate debates diet.

Educate

01/27/21 6:07 PM PST

Okay.

How many carbohydrates does your daughter eat a day?

Question

01/27/21 6:08 PM PST

I . . . I don’t think she eats many carbs. I haven’t counted yet, but we stick to pretty healthy foods. We don’t eat a lot of sugar.

What medications does your daughter take for her diabetes? (No matching questions found.)

Question

01/27/21 6:09 PM PST

What medications does your daughter take? (No matching questions found.)

Question

01/27/21 6:09 PM PST

Any treatment? (No matching questions found.)

Question

01/27/21 6:10 PM PST

Are you married?

Question

01/27/21 6:10 PM PST

Chelsea’s mom, Nora, and I are divorced. We split custody 50/50, so Chelsea stays with me for two weeks at a time, and then stays with her mom for two weeks. We try to set a good example and, you know, do the civil co-parenting thing.

Okay, I know divorce is hard even for the kids. But it is good to see Chelsea has the love of both her parents even after the divorce

Empathize

01/27/21 6:11 PM PST

Mmmhmmm.

How is your daughter’s relationship with her mother? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 6:12 PM PST

Chelsea and Nora are really close.

That is great

Empathize

01/27/21 6:13 PM PST

Uh, thanks.

Has your daughter been hospitalized before?

Question

01/27/21 6:13 PM PST

This is Chelsea’s first visit to a hospital. No surgeries . . . I mean, she hasn’t even broken a bone before.

Does any one in your family have diabetes?

Question

01/27/21 6:14 PM PST

Well, Mother has type 2 diabetes. She was diagnosed a little bit after Chelsea was born. Other than that, nothing else.

Do you take medications?

Empathize

01/27/21 6:14 PM PST

Thanks, I appreciate it.

Do you take medications?

Question

01/27/21 6:15 PM PST

Um, I mean, I guess I take insulin every day, if that’s what you mean.

Do you monitor your blood glucose levels? (Clarified to Do you check your blood sugar at home?.)

Question

01/27/21 6:15 PM PST

Other people have been checking it for me. I haven’t done it myself yet. (Clarified to if I check my blood sugar.)

Okay. It is good to closely monitor your glucose levels

Educate

01/27/21 6:16 PM PST

Oh, ok. I think I get it.

thanks for answering the questions Chelsea. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Empathize

01/27/21 6:16 PM PST

Thank you.

Do you have a high heart beat?

Educate

01/27/21 6:17 PM PST

There’s so much to learn. I feel like my brain is full! But thanks for telling me.

Do you have a high heart beat? (Clarified to Does your heart race?.)

Question

01/27/21 6:17 PM PST

Nope, my heart feels fine. (Clarified to if my heart races.)

Do you have fever?

Question

01/27/21 6:17 PM PST

No, I don’t think I have a fever.

I will now perform a physical assessment

Educate

01/27/21 6:18 PM PST

Oh, ok. I think I get it.

 Checked ID band

Exam Action

01/27/21 6:18 PM PST

 Assessed vitals

Exam Action

01/27/21 6:18 PM PST

Do you feel any pain?

Question

01/27/21 6:30 PM PST

No. No pain.

 Assessed growth

Exam Action

01/27/21 6:30 PM PST

 Assessed growth

Exam Action

01/27/21 6:31 PM PST

 Inspected IV site

Exam Action

01/27/21 6:31 PM PST

 Assessed vitals

Exam Action

01/27/21 6:32 PM PST

Do you have any needs right now? (Clarified to Do you need anything?.)

Question

01/27/21 7:01 PM PST

I guess, uh . . . I guess I need to know more about this diabetes stuff. I find it all kinda confusing, but I want to know more. (Clarified to if I need anything.)

Diabetes is a metabolic disease. With the right diet, appropriate exercise and adherence to medication and close monitoring of the blood glucose levels, the condition can be managed very well.

Educate

01/27/21 7:02 PM PST

Ok. Ok. I got it.

 Inspected IV site

Exam Action

01/27/21 7:02 PM PST

 Educate Chelsea in the most therapeutic manner on what supplies she will need to administer insulin.

Exam Action

01/27/21 7:03 PM PST

Chelsea, before you administer insulin, you will need a new, packaged syringe, a vial of insulin, alcohol wipes, and access to a special container for storing your used syringe. Do you have any questions? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 7:06 PM PST

Okay, got it.

Actually, what do you mean by a special container?

It is called a sharps container. Before you go home, we will make sure that each of your parents gets one, and that you know where to find one at school.

Question

01/27/21 7:07 PM PST

Okay, thanks.

 Educate in the most therapeutic manner on how to prepare a syringe for injection.

Exam Action

01/27/21 7:07 PM PST

Ned, take the syringe out of its packaging, and pull the cap off of the needle on the syringe. Pull the plunger of the syringe back until it is level with the correct dose. The numbers are printed on the side of the syringe.

Question

01/27/21 7:08 PM PST

Understood. This is how I will prep Chelsea’s syringe when I am going to administer Chelsea’s insulin.

Hey, I thought I was going to be doing that.

 You have not selected the most therapeutic way to deliver this information. The incorrect response you selected has been removed. Try again with the remaining responses.

Exam Action

01/27/21 7:08 PM PST

 Educate in the most therapeutic manner on how to prepare a syringe for injection.

Exam Action

01/27/21 7:08 PM PST

Chelsea, take the syringe out of its packaging, and pull the cap off of the needle on the syringe. Pull the plunger of the syringe back until it is level with the correct dose. The numbers are printed on the side of the syringe.

Question

01/27/21 7:09 PM PST

Take the syringe out of the package, get the cap off the needle, pull the plunger back to my correct dose. Roger, dodger.

 Educate Chelsea on the first steps in filling the syringe with insulin.

Exam Action

01/27/21 7:09 PM PST

Put the bottle of insulin on a flat surface, and hold it steady with one hand. With your other hand, push the needle straight into the insulin bottle and slowly push the plunger down. This will inject the air in the syringe into the bottle. Don’t pull the syringe out yet. Any questions?

Question

01/27/21 7:10 PM PST

No questions. So far, so good.

 Educate Chelsea on completing the process of filling the syringe with insulin.

Exam Action

01/27/21 7:10 PM PST

With the needle still in the insulin vial, turn both upside down, so that the bottom of the vial is pointing at the ceiling. Slowly draw the plunger down so that insulin fills the syringe. Keep the tip of the needle in the insulin, and make sure you don’t bend the needle. Do you have any questions? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 7:10 PM PST

I still get it.

 Educate Chelsea on how to evacuate air bubbles from the syringe.

Exam Action

01/27/21 7:10 PM PST

The needle is still in the bottle at this point. Tap the side of the syringe with your finger to make any bubbles rise to the top. Then, you can push the plunger just enough to force the air out through the needle.

Question

01/27/21 7:11 PM PST

Makes sense to me.

Now that I think about it, what’s wrong with air?

Injecting yourself with insulin is safe, but if there are bubbles in the syringe, they will take up space, and you won’t inject enough insulin.

Question

01/27/21 7:11 PM PST

Understood.

 Educate Chelsea on prepping the insulin injection site.

Exam Action

01/27/21 7:11 PM PST

After removing the needle from the vial, use an alcohol pad to clean the injection site. Let the site dry, otherwise it might sting a little. Pinch approximately 1 inch of skin, not too hard. Insert the needle into the pinched skin at the proper angle and slowly push the plunger in until it is empty. Leave the needle in your skin for five seconds. Any questions?

Question

01/27/21 7:12 PM PST

Huh, okay.

 Educate Chelsea on how to complete the injection process.

Exam Action

01/27/21 7:12 PM PST

Once you take the needle out, keep an eye on the area you injected. If you see any bleeding, use a tissue to clean it up. If you see any insulin leak out, check back with your provider to go over the injection process again.

Question

01/27/21 7:12 PM PST

Watch out for leaks, and clean up the blood. I got it.

 Now it’s time for Chelsea to demonstrate what she’s learned.

Exam Action

01/27/21 7:12 PM PST

Ok, Chelsea, do you feel ready to practice injecting insulin? We’re going to use sterile saline to practice, since you don’t need a dose of insulin right now.

Question

01/27/21 7:12 PM PST

Yep! Let’s do this.

Are you sure you’re ready for this, sweetie?

I got it, Dad. Don’t worry.

 Chelsea demonstrates the proper technique for how to prep and fill a syringe. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Exam Action

01/27/21 7:13 PM PST

Next.

Question

01/27/21 7:13 PM PST

 Chelsea demonstrates the proper technique for giving herself an injection.

Exam Action

01/27/21 7:13 PM PST

Next.

Question

01/27/21 7:13 PM PST

 You complete education with Chelsea on how to effectively manage her diabetes, having successfully covered areas such as glucose monitoring using a glucometer, how to manage risk factors such as hypoglycemia and hyperglycemia, how her diet impacts her diabetes, what to do on sick days, and how to create an action plan at her school. Chelsea and Ned both verbalize that they feel ready to manage Chelseas new chronic illness. Ned says he feels confident that he and his ex-wife will be able to manage Chelsea’s diabetes for the next few days, until their appointment with an endocrinologist. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Low-grade Cervical Dysplasia -cellular alteration & prognosis

A common finding with Papanicolaou tests (aka pap smear or pap test) is low-grade cervical dysplasia, most often occurring in the squamocolumnar junction, the area of the cervix where the squamous and columnar cells meet (Lim, Lee, Cho, Hong, Lim, 2016) Low-grade Cervical Dysplasia -cellular alteration & prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis Alterations expected at the cellular level would show chaotic, non-uniform growth of cervical cells, as well as loss of organization of grouped cells (Hammer & McPhee, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis.

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Low-grade cervical dysplasia, otherwise referred to as low-grade squamous epithelial lesions,  are most often attributed to human papillomavirus (HPV), with more than 90% of cases, regardless of etiology, spontaneously regressing (Tornesello, Buonaguro, Giorgi-Rossi, & Buonaguro, 2013). Specific high-risk serotypes of HPV have a more significant impact on cervical cells, increasing risk for malignancy if left untreated (Hammer & McPhee, 2019). With more than 100 strains, HPV is broken into “low risk” and “high risk” categories Low-grade Cervical Dysplasia -cellular alteration & prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis The difference between the two seems to be how the HPV genome encodes oncoproteins, E6 and E7, and the level of expression of each (Hammer & McPhee, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis

For the best odds at the most favorable prognosis, options and suggested screenings should be discussed with S.V., with a personalized plan in alignment with her needs and preferences, considering her personal and familial health history Low-grade Cervical Dysplasia -cellular alteration & prognosis. Possible options could include an HPV screen to determine if this is a factor (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). If HPV is present and deemed to be “low risk” to cervical health, a 6 month repeat pap smear (Behnamfar, Zafarbakhsh, & Allameh, 2015), an HPV screen, or a combination of both may be scheduled Low-grade Cervical Dysplasia -cellular alteration & prognosis (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis. With negative findings at that time, based on S.V.’s age of 35, screening could be resumed at the CDC recommendation of every three years for just a pap smear, or every 5 years for a negative primary HPV or negative co-testing (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis

References:

Behnamfar, F., Zafarbakhsh, A., & Allameh, T. (2015). Study of 2 years follow-up of referral patients with abnormal pap smear.
 Journal of Research in Medical Sciences, 20
(12) doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.4103/1735-1995.172981 Low-grade Cervical Dysplasia -cellular alteration & prognosis

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (2019 August 20). 
Cervical Cancer: What should I know about screening?
 Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Hammer, G. & McPhee, S. (2019). 
Pathophysiology of disease: An introduction to clinical medicine
 (8th ed.). New York, NY: McGraw-Hill Education /Medical

Lim, S., Lee, M. J., Cho, I., Hong, R., & Lim, S. C. (2016). Efficacy of p16 and ki-67 immunostaining in the detection of squamous intraepithelial lesions in a high-risk HPV group.
 Oncology Letters, 11
(2), 1447. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.3892/ol.2015.407

Tornesello, M. L., Buonaguro, L., Giorgi-Rossi, P., & Buonaguro, F. M. (2013). Viral and cellular biomarkers in the diagnosis of cervical intraepithelial neoplasia and cancer. 
BioMed research international
, 
2013
, 519619. https://doi.org/10.1155/2013/519619 Low-grade Cervical Dysplasia -cellular alteration & prognosis Low-grade Cervical Dysplasia -cellular alteration & prognosis

 

Low-grade Cervical Dysplasia -cellular alteration & prognosis
Discussion 1

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.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Low-grade Cervical Dysplasia -cellular alteration & prognosis

The terms cervical dysplasia and cervical intraepithelial neoplasia can be used interchangeably. Malignancies of the epithelial region are termed carcinomas. Dysplasia is a broad term that can refer to the abnormal development of cells. Cervical dysplasia is a pathologic finding associated with a predisposition and can progress further, according to Hammer and McPhee (2019). This disease can be found with a cervical biopsy or examination.

There are some alterations at the cellular level with this disease. It can start with either genomic instability, impaired DNA repair, or lack of cell cycle checkpoint control. It then turns to enhanced proliferation, abnormal cell cycle control, and autonomous growth. This leads to an evasion of the immune system and later, tissue. There is enhanced cell motility and the ability to gain access to blood vessels, which can eventually lead to the ability to recruit vascularization to support the growth of a tumor (Hammer & McPhee, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis.

S.V’s prognosis is fairly good. Cervical intraepithelial neoplasia is graded by levels 1, 2 and 3. Level 1 is considered low grade. Because of this, S.V. has the highest rate of spontaneous regression, according to Flagg et al. (2016). Since she caught it early, she should have access to aggressive treatment early on.

There is a 40% incidence rate in women with HPV related cervical dysplasia. Without proper treatment and screening, this can progress to invasive cervical carcinoma, according to Hammer and McPhee (2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis This means that the basement membrane has been broken and can now metastasize to other areas of the body. Usually, epithelial neoplasms spread to regional nodes. Receiving the HPV vaccine is a valuable tool considering the prognosis of this disease, according to Hong et al. (2016). High-grade lesions are less likely to form if the vaccine is given. According to Flagg et al. (2016), declines in cervical dysplasia are most noted in countries with higher insurance coverage, thus leading more people to receive the vaccine. Low-grade Cervical Dysplasia -cellular alteration & prognosis

 

References:

Flagg, E. W., Torrone, E. A., & Weinstock. H. (2016). Ecological association of human papillomavirus vaccination with cervical dysplasia prevalence in the United States. American Journal of Public Health, 106(12). Low-grade Cervical Dysplasia -cellular alteration & prognosis

Hammer, G.D. & McPhee, S.J., (2019). Pathophysiology of disease: An introduction to clinical medicine (8
th
 ed.). New York, NY: McGraw-Hill Education/Medical.

Hong. C., Liu, X., & Xu, L. (2016). Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis. Experimental and therapeutic medicine, 12 (1).

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See Van does have a heightened risk for cervical cancer based on her ethnicity. Cervical cancer is among the top 5 cancers affecting Asian-American and Pacific Islander (AAPI) women (Hee Yun et al, 2015). Noting this factor before discussing her results and treatment plan is important because it could impact her decision for future testing. This patients Pap smear showed dysplasia which shows, a reversion to more immature cells without a committed identity (Hammer & McPhee, 2019). There are several ways that this diagnosis can be handled, some of the treatment methods depend on what the patient wants and what options are provided for them to choose from.  In the Hmong-American culture it is important to note that, spiritually-based health beliefs can be a barrier to cancer screening because the individual will try to turn to spiritual remedies instead of seeking preventive Western care, such as a Pap test (Hee Yun et al, 2015) Low-grade Cervical Dysplasia -cellular alteration & prognosis. See Van may already have a predisposition to avoid modern testing and medicine due to her cultural beliefs. Cervical dysplasia, without proper screening for early detection and treatment, can progress to invasive cervical carcinoma (Hammer & McPhee, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis This is important to share with the patient as one of the options is to wait and see if new changes occur on the next Pap smear. If a pap test is positive recommendations can include an immediate colposcopy, repeat cytology at 6 and 12 months, or HPV testing with a referral for colposcopy (Rebar et al. 2019). If further testing revealed a need for treatment then there are other options including cryosurgery, laser ablation, and loop electrosurgical excisional procedure for preinvasive lesions. Overall, her prognosis could be very good if she chooses to undergo further testing and treatment, however, if she chooses to wait or not seek treatment then the cervical dysplasia may progress into cervical cancer leading to further complications and poorer prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis

References:

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine 8e (8th ed.). Mcgraw-hill Education / Medical.

Hee Yun Lee, Pa Nhia Yang, Do Kyung Lee, & Rahel Ghebre. (2015). Cervical Cancer Screening Behavior among Hmong-American Immigrant Women. American Journal of Health Behavior, 39(3), 301–307. https://doi-org.americansentinel.idm.oclc.org/10.5993/AJHB.39.3.2

Rebar Cherie R., Heimgartner Nicole M., Gersch Carolyn J, (2019). Pathophysiology made incredibly easy! (6th ed.). Wolters Kluwer. Low-grade Cervical Dysplasia -cellular alteration & prognosis

Chelsea Warren Focused Exam: Type 1 Diabetes Shadow health Documentation

Documentation / Electronic Health Record

 

Nursing Note

Student Documentation

Model Documentation

Patient Status

Chelsea is currently stable. She reports feeling better. No current nausea or vomiting She is alert and well oriented She expressed a desire to go home She said she has not administered insulin on her own or performed glucose monitoring on her own

Chelsea’s current condition is stable. She is feeling better than she has been lately. No current nausea or vomiting. Chelsea is alert and curious, and expressed an eagerness to go home. She said that she has not administered her own insulin yet, or done her own glucose monitoring.

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History of Present Illness

The patient had diabetic ketoacidosis two days ago, when she was hospitalized. When she was horseback riding, she started being nauseous and vomited in her father’s car. The father brought her to the ED and she was diagnosed with DKA and type 1 diabetes. Her blood glucose is now stable. Before the DKA, Chelsea was feeling sick for about 10 days. The father reported that she had lost about 5 pounds in 2 weeks. Chelsea Warren Focused Exam: Type 1 Diabetes Shadow health Documentation Chelsea has been having increased thirst and excessive urination before the DKA.

Chelsea had diabetic ketoacidosis two days prior. She was at a horseback riding lesson and started feeling nauseated; when her dad picked her up she threw up in his car. That evening, Ned said that his daughter seemed really out of it and was not acting like herself. He brought her to the ED, and she was diagnosed with DKA and type 1 diabetes. Chelsea’s blood glucose is more stable now. Prior to the DKA, Chelsea said she felt sick for about 10 days. Her dad, Ned, said that she lost five pounds in the two weeks since he’s seen her. She experienced increased thirst and increased urination / a higher volume of urine during the 10 days leading up to her DKA. Chelsea said her mother thought she was “going through a growth spurt” or coming down with a cold Chelsea Warren Focused Exam: Type 1 Diabetes Shadow health Documentation.

Assess Patient Knowledge

Chelsea is…Chelsea Warren Focused Exam: Type 1 Diabetes Shadow health Documentation