Tag: Clinical-Nursing

NURS-6521 Week 2 Assignment: Case Studies

For each of the scenarios below, answer the questions using your learning resources, Medscape, and clinical practice guidelines (ie JNC 8, AHA, ACC etc). Lecturio is an optional resource but highly recommended. Be sure to thoroughly answer ALL questions. When recommending medications, write out a 
complete medication order
. What would you send to a pharmacy? 
Include the following information: drug, dose, route, frequency, duration (if applicable), quantity, # of refills and indication for use.  An example of a complete prescription is as follows:
 
lisinopril 10mg #30 tabs, take 1 tab PO once daily for high blood pressure, refills: 2
.
 Also state if you would continue, discontinue or taper the patient’s current medications. Review and discuss ALL labs and possible interactions. Use 
at least 3 sources
 for 
each scenario
 and cite sources using APA format; include in-text citations. You do not need an introduction or conclusion paragraph. Please also review assignment rubric.  
 

 
 

SCENARIO 1

What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?
 

Hyzaar (losartan/hydrochlorothiazide) 50/25 mg PO daily #30 3 RF
 

Lotrel (amlodipine/lisinopril) 5/40 mg PO daily #30 3 RF
 

hydralizine 25 mg PO QID #120 1 RF
 

digoxin 1.25 mg PO daily #30 1 RF
 

Repatha 140 mg IV every 2 weeks #1 1 RF
 

SCENARIO 1 SOLVED

 

SCENARIO 2

Does fentanyl have a high or low 
first pass effect
? Please discuss why this is important to know and how it relates to 
bioavailability
. What route has 100% bioavailability? In addition to parenterally, how can this medication be given to counter the first pass effect? Write a sample prescription for this medication.
Scenario 2 solved

 

SCENARIO 3

Where are the majority of cytochrome P450 (CYP) enzymes located? Using the Medscape pill identifier, enter the following characteristics to identify the medication. What CYP enzyme metabolizes this medication? How can this information be applied to medication therapy management? Write a
sample prescription for the identified medication and strength
. 
 

Imprint (292)  Shape (Oval)  Color (Brown)  Form (Tablet)  Scoring (None) 
 

 
 

SCENARIO 4

 
DL is a 48-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on losartan 50 mg po daily, linagliptin (Tradjenta) 5 mg PO daily and red yeast rice supplement. Fasting lipid profile shows Total Cholesterol 245 mg/dL, LDL 165 mg/dL, HDL 41 mg/dL, and Triglycerides 175 mg/dL. He is 5’10” and weighs 223 lbs. What treatment plan would you implement for DL? Include a complete medication order. What are GOAL Total Cholesterol, LDL, HDL, and Triglyceride levels? What is DL’s BMI per Medscape calculator? What patient monitoring and education would you provide? How many risk factors for Coronary Artery Disease (CAD) does DL have?
Identify them specifically
.
 

 

Assignment: Case Studies

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the case study posted in “Announcements” by your Instructor for this Assignment

Review the information provided and answer questions posed in the case study

When recommending a medication, write out a complete prescription for the medication

Whenever possible, use clinical practice guidelines in developing your answers when possible

Include at least three references to support your answer and cite them in APA format.

By Day 7 of Week 1

Submit the Assignment.

submission information

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submitting your final assignment
, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK1Assgn1_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
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 and select 
Submit Assignment
 for review.

Rubric

NURS_6521_Week2_Assignment_Rubric

NURS_6521_Week2_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation NURS-6521 Week 2 Assignment: Case Studies

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

Total Points: 
100

SCENARIO 4

 
DL is a 48-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on losartan 50 mg po daily, linagliptin (Tradjenta) 5 mg PO daily and red yeast rice supplement. Fasting lipid profile shows Total Cholesterol 245 mg/dL, LDL 165 mg/dL, HDL 41 mg/dL, and Triglycerides 175 mg/dL. He is 5’10” and weighs 223 lbs. What treatment plan would you implement for DL? Include a complete medication order. What are GOAL Total Cholesterol, LDL, HDL, and Triglyceride levels? What is DL’s BMI per Medscape calculator? What patient monitoring and education would you provide? How many risk factors for Coronary Artery Disease (CAD) does DL have? Identify them specifically.
 

 

Scenario 4

The treatment plan I would implement for 48-year-old patient DL would take care of his type II diabetes, the risk of kidney disease, hypertension, hypercholesterolemia, and the risk of heart disease (Jameson et al., 2022). The complete medication order will be as follows:

Acetyl salicylic acid (Aspirin) 81 mg tablets 1 (one) tablet PO daily, #30, RF 2

Atorvastatin (Lipitor) 20 mg tablets 1 (one) tablet PO daily, #30, RF 2

Linagliptin (Tradjenta) 5 mg tablets 1 (one) tablet PO daily, #30, RF 2

Losartan (Cozaar) 50 mg tablets 1 (one) tablet PO daily, #30, RF 2

Zestoretic (lisinopril/hydrochlorothiazide) 10/12.5 mg tablets 1 (one) tablet PO daily, #30, RF 2

The GOAL total cholesterol is below 200 mg/dL, LDL cholesterol is below 100 mg/dL, HDL cholesterol is above 60 mg/dL and triglycerides are below 150 mg/dL (Jameson et al., 2022). According to the Medscape calculator, patient DL’s body mass index (BMI) is 32 kg/m
2
 (Medscape, 2025e). This means that he is obese (obesity class 1).

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The patient monitoring for this patient would include at-home random blood sugar checks, HbA1c checks every three months, three-monthly EKG, daily at-home blood pressure checks, three-monthly cholesterol checks, and three-monthly BMI calculation. The education that I would provide include smoking cessation, commencement of routine isotonic aerobic exercise such as walking for 30 minutes every day, and taking a diet low in fat and carbohydrates, but rich fresh fruits and vegetables. Finally, the risk factors for coronary artery disease (CAD) that this patient has includes:

Cigarette smoking.

A sedentary lifestyle.

Elevated LDL cholesterol and triglycerides.

References

Błaszczyk, B., Czuczwar, S.J., & Miziak, B. (2024). Cenobamate, a new promising antiseizure medication: Experimental and clinical aspects.
International Journal of Molecular Sciences,
25
(23), 1-14. 
https://doi.org/10.3390/ijms252313014

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2022).
Harrison’s principles of internal medicine, 21
st
 ed
. McGraw-Hill Education.

Medical School Headquarters (2024).
Prescription writing 101: Highlights and takeaways
.

Prescription Writing 101 (with Example Prescriptions)

Medscape (2025c).
Fentanyl transdermal
.
https://reference.medscape.com/drug/duragesic-fentanyl-transdermal-999646

Medscape (2025d).
Pill identifier
.
https://reference.medscape.com/pill-identifier

Medscape (2025e).
Calculator: BMI and BSA (Mosteller)
.
https://reference.medscape.com/calculator/28/bmi-and-bsa-mosteller

OSCEstop Education (2024).
Outpatient prescriptions
.
https://oscestop.education/learning/outpatient-prescriptions/

Rosenthal, L.D., & Burchum, J.R. (2020).
Lehne’s pharmacotherapeutics for advanced practice providers, 2
nd
 ed
. Elsevier.

SCENARIO 3

Where are the majority of cytochrome P450 (CYP) enzymes located? Using the Medscape pill identifier, enter the following characteristics to identify the medication. What CYP enzyme metabolizes this medication? How can this information be applied to medication therapy management? Write a sample prescription for the identified medication and strength. 
 

Imprint (292)  Shape (Oval)  Color (Brown)  Form (Tablet)  Scoring (None) 
 

 

Scenario 3

The liver is the largest organ specialized in detoxification of chemical agents ingested in the body. This is why it has the highest concentration of the cytochrome P450 or CYP enzymes (Rosenthal & Burchum, 2020). These are the enzymes that metabolize medications taken orally. According to the Medscape pill identifier (Medscape, 2025d), the particulars of the medication given yield a possible 93 different medications with different nuances of the color brown. The most befitting one chosen for this exercise is the anticonvulsant cenobamate (Xcopri). It undergoes extensive metabolism by in the liver.

Cytochrome P450 (CYP) enzymes metabolize cenobamate by oxidation. The specific CYP enzymes that metabolize cenobamate in the liver are CYP2A6, CYP2E1, and CYP2B (Błaszczyk et al., 2024). This information can be applied to medication therapy management in that it will help tailor the dose to the patient’s needs. Cenobamate also inhibits other CYP enzymes, and this information can also help medication therapy management by preventing drug-drug interactions. A sample prescription of cenobamate is as follows:

Cenobamate (Xcopri) 200 mg tablets 1 (one) tablet PO daily, #30, RF 1

SCENARIO 2

Does fentanyl have a high or low 
first-pass effect
? Please discuss why this is important to know and how it relates to 
bioavailability
. What route has 100% bioavailability? In addition to parenteral, how can this medication be given to counter the first-pass effect? Write a sample prescription for this medication.
 

Scenario 2 SOLVED

The first pass effect of fentanyl is very high. It is extensively metabolised in the liver and the intestines by cytochrome P450 isoenzymes to the metabolite norfentanyl (Rosenthal & Burchum, 2020). This is important to know because it will determine the dose and ultimately the amount of active drug that reaches their cellular site of action. Metabolised drug does not have the same strength as the same quantity that was taken orally. Bioavailability refers to the amount of drug or its active metabolite that reaches the cellular site of action within the body and produces its effects (Rosenthal & Burchum, 2020). Knowing about first-pass effect and its extent for every drug taken orally helps in determining the optimum dose.

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The route that always assures 100% bioavailability is the parenteral route, as it bypasses the liver. According to Rosenthal and Burchum (2020), transmucosal, transdermal, and sublingual routes are other ways of administering fentanyl that can avoid or reduce the first-pass effect. A sample fentanyl prescription for severe chronic cancer pain is as follows (Medscape, 2025c):

Fentanyl skin patch (Duragesic) 100 mcg/hr patches, apply 1 (one) patch q72h, #10 RF 1

Does fentanyl have a high or low first pass effect?

References

Medscape (2025c).
Fentanyl transdermal
.
https://reference.medscape.com/drug/duragesic-fentanyl-transdermal-999646

Rosenthal, L.D., & Burchum, J.R. (2020).
Lehne’s pharmacotherapeutics for advanced practice providers, 2
nd
 ed
. Elsevier.

Scenario 1 

What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?
 

Hyzaar (losartan/hydrochlorothiazide) 50/25 mg PO daily #30 3 RF
 

Lotrel (amlodipine/lisinopril) 5/40 mg PO daily #30 3 RF
 

hydralizine 25 mg PO QID #120 1 RF
 

digoxin 1.25 mg PO daily #30 1 RF
 

Repatha 140 mg IV every 2 weeks #1 1 RF
 

 

Scenario 1 – SOLVED
– What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?

The clear error in all the five prescriptions in this scenario is that the quantity of the medication strength shown that is to be taken each time (i.e. the number or fraction of tablet to be taken; or the number of vials to be injected) is not indicated (Medical School Headquarters, 2024; OSCEstop Education, 2024). Only the quantity to be dispensed and the refills are shown. For Hyzaar, the dosage strength of HCT given as 25 mg is also wrong. The correct available tablet strength is 50/12.5 mg. Lotrel is the brand name for amlodipine/benazepril. The correct brand name for amlodipine/ lisinopril is Lisonorm, and the correct tablet strength is 5/10 mg. A digoxin dose of 1.25 mg is too high and dangerous. The correct maintenance dose in this case should be 0.125 mg (Rosenthal & Burchum, 2020). The correct prescriptions are thus as follows (Medscape, 2025a; Rosenthal & Burchum, 2020):

Hyzaar (losartan/hydrochlorothiazide) 50/12.5 mg tablets 1 (one) tablet PO daily, #30, 3 RF

Lisonorm (amlodipine/lisinopril) 5/10 mg tablets 1 (one) tablet PO daily, #30, 3 RF

Hydralizine (Apresoline) 25 mg tablets 1 (one) tablet PO QID, #120, 1 RF

Digoxin (Lanoxin) 0.125 mg tablets 1 (one) tablet PO daily, #30, 1 RF

Evolocumab (Repatha) 140 mg/mL autoinjector, 1 (one) IV every 2 weeks, #1, 1 RF

Losartan is an angiotensin II receptor blocker, while HCT is a thiazide diuretic (Rosenthal & Burchum, 2020). Losartan acts by countering the vasoconstriction effects of angiotensin II, thereby causing vessel relaxation and reduction in blood pressure. HCT acts in the renal tubules distally to prevent reabsorption of sodium chloride and hence water. Angiotensin I must be converted into the vasoconstrictor angiotensin II through the catalysis of the enzyme angiotensin converting enzyme or ACE. Lisinopril acts by inhibiting this conversion (Rosenthal & Burchum, 2020). It is therefore an ACE inhibitor by classification.

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Amlodipine belongs to the class of antihypertensive medications referred to as calcium channel blockers. It acts by interfering with transmembrane Calcium ion transportation into the cells of blood vessels and the heart muscle (Rosenthal & Burchum, 2020). Hydralazine is in a medication class called vasodilators. It is an arteriolar transmembrane calcium channel blocker; an effect that causes arterial vasodilation. Digoxin is a digitalis and a cardiac glycoside by classification. It acts by inhibiting the sodium pump in heart muscle, causing a corresponding increase in intracellular calcium concentrations and force of heart contractions (Rosenthal & Burchum, 2020). Lastly, evolocumab is a monoclonal antibody also known as a PCSK9 inhibitor. It acts by inhibiting the actions of PCSK9 (Medscape, 2025b), thereby lowering the levels of dangerous low-density lipoprotein cholesterol or LDL-C.   What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?

 

References

Medscape (2025a).
Hydralazine
.
https://reference.medscape.com/drug/apresoline-hydralazine-342400#0

Rosenthal, L.D., & Burchum, J.R. (2020).
Lehne’s pharmacotherapeutics for advanced practice providers, 2
nd
 ed
. Elsevier.

NURS-6501 Week 10 case study Patient is a 21-year-old female with no medical history. She reports vaginal discomfort and discharge for approximately 3 days.

Case Study Analysis

This is the case study of a 21-year-old female who denies the presence of any previous medical or surgical history. She admits to being sexually active and at present has a partner with whom she started an intimate relationship two months ago. She is on contraceptive pills for birth control but currently presents with a complaint of vaginal discharge accompanied by vaginal discomfort for about three days now. The laboratory tests conducted show that she is not pregnant. Most importantly, a cervical swab taken for a polymerase chain reaction or PCR test returned positive for
Chlamydia trachomatis
. This is the bacterium that causes the sexually transmitted infection (STI) chlamydia (Jameson et al., 2022). It is a gram-negative intracellular anaerobe that reproduces within calls that have a nuclear membrane enclosing genetic material (Mohseni et al., 2023). The purpose of this paper is to answer questions related to the above case study.

The Pathophysiology of Chlamydia

As has been pointed out above,
C. trachomatis
 is gram-negative. It is can also only survive inside cells which it infects. These cells include those of the cervical epithelium, endometrium, and urethra in men amongst others (Mohseni et al., 2023). But the bacterium is also an obligate anaerobe. This means that it can only survive in environments that are devoid of oxygen. It thus differs significantly from facultative anaerobes such as
Pseudomonas aeruginosa
 in that these others can create energy n the form of adenosine triphosphate (ATP) with or without oxygen (Jameson et al., 2022). The pathophysiology of
C. trachomatis
 therefore occurs intracellular.

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After infection is contracted through contact with infected bodily fluids through sex (oral, vaginal, or anal) or passage through the birth canal for a newborn, epithelial cells in the cervix, uterus, Fallopian tubes, urethra (in men), or conjunctiva are invaded (Jury et al., 2023; Sturd & Rucks, 2023). The bacterium then takes over the resources within the cells and uses them to reproduce and release even more bacteria to infect more epithelial cells. In females such as in this case study; symptoms such as vaginal discharge, painful coitus, and lower abdominal pain will ensue.

Intracellular Development of Chlamydia

The intracellular development of chlamydia begins when the primary morphological form referred to as the elementary body or EB enters the cell. This is the infectious form of the bacterium which also does not replicate. However, it differentiates once inside the cell to the replicative and non-infectious form referred to as the reticulate body or RB (Sturd & Rucks, 2023). The RBs continue their differentiation and replicate to form new EBs that are released so that they can infect new epithelial cells.

Two Forms of Chlamydia

Morphologically, there are two basic forms of the bacterium
Chlamydia trachomatis
 (Sturd & Rucks, 2023). These are the elementary body (EB) and the reticulate body (RB). As already stated, the former is infectious and does not reproduce, whereas the latter is the infectious form and replicates to form new infectious forms of EB.

Immune Evasion

According to Sturd and Rucks (2023), the EBs and RBs evade the detection of the host’s immune system through what are known as the inclusion membrane proteins (Incs). These act as intracellular mediators of metabolic pathways that inhibit any host defence mechanisms that may be activated to fight the invading bacterial molecules.

Host’s Response to Infection

Because of the deterrent activity of the Incs on the host’s immune mechanisms, the host’s response to infection is severely limited in the case of
C. trachomatis
. This explains why a big percentage of those who are infected by this bacterium are usually asymptomatic. When response is present, females produce an abnormal vaginal discharge. The lymph nodes may also be affected causing inflammation and lymphogranuloma venereum (Jury et al., 2023; Mohseni et al., 2023; Sturd & Rucks, 2023). Other responses include the development of trachoma and eventual blindness if not treated well.

Pathogen Recognition Receptors

If the host’s immune response succeeds in evading the suppressing power of the Incs, the available pathogen recognition receptors within the cells are of two types. These are the ones that will detect the bacterium and initiate the inbuilt immune reaction. They are the TLRs (Toll-like receptors) and the NLRs or NOD-like receptors (Chen et al., 2019). These receptors enable the disease to show its signs and symptoms, as pro-inflammatory mediators (below) are released. NURS-6501 Week 10 case study Patient is a 21-year-old female with no medical history. She reports vaginal discomfort and discharge for approximately 3 days.

Pro-inflammatory Cytokines

These pro-inflammatory cytokines are usually produced along with chemokines by the cells that are infected by chlamydial elementary bodies or EBs (Chen et al., 2019). They include tissue necrotic factor alpha (TNF-α) and interleukin 8 (IL-8). According to Chen et al. (2019), the mediators above in the form of cytokines and chemokines cause the aggregation of immune cells where infection has occurred. The outcome is local inflammation and destruction of the local tissues.

The Risk Factors for STIs

The risk factors for STIs include (Jameson et al., 2022; Rodrigues et al., 2022):

Poverty (low socioeconomic status) as a social determinant of health.

Having many sexual partners and not using protection with them.

The use of drugs, alcohol, and illegal substances.

A past history of STIs.

The Potential Complications of Chlamydia

The potential complications of
C. trachomatis
 include (Jameson et al., 2022; Mohseni et al., 2023; Rodrigues et al., 2022):

Secondary infertility in both men and women.

Reactive arthritis.

Pelvic inflammatory disease o PID in females.

Increased probability of ectopic pregnancy.

Neonatal pneumonia.

Conclusion

The STI known as Chlamydia and caused by the bacterium
C. trachomatis
 is a serious cause of usually asymptomatic morbidity in both men and women. However, when symptoms do occur, healthcare costs increase due to its consequences. Among its far-reaching ones are infertility, newborn morbidity, and blindness due to trachoma amongst others.

References

Chen, H., Wen, Y., & Li, Z. (2019). Clear victory for Chlamydia: The subversion of host innate immunity. Frontiers in Microbiology, 10:1412.
http://dx.doi.org/10.3389/fmicb.2019.01412

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2022).
Harrison’s principles of internal medicine, 21
st
 ed
. McGraw-Hill Education.

Jury, B., Fleming, C., Huston, W.M., & Luu, L.D.W. (2023). Molecular pathogenesis of
Chlamydia trachomatis
.
Frontiers in Cellular and Infection Microbiology, 13
(0), 1-12.
https://doi.org/10.3389/fcimb.2023.1281823

Mohseni, M., Sung, S., & Takov, V. (2023). Chlamydia.
National Library of Medicine
.
https://www.ncbi.nlm.nih.gov/books/NBK537286/

Rodrigues, R., Sousa, C., & Vale, N. (2022).
Chlamydia trachomatis
 as a current health problem: Challenges and opportunities.
Diagnostics,
12
(
8), 1795; 
https://doi.org/10.3390/diagnostics12081795

Sturd, N., & Rucks, E.A. (2023). Microbe of the month:
Chlamydia trachomatis
.
Trends in Microbiology, 31
(5), 535-536.
https://doi.org/10.1016/j.tim.2022.11.002

 

NURS-6501 Week 10 case study Patient is a 21-year-old female with no medical history. She reports vaginal discomfort and discharge for approximately 3 days.

Week 10 case study

Patient is a 21-year-old female with no medical history. She reports vaginal discomfort and

discharge for approximately 3 days. She is sexually active and has a new partner within the

last 2 months. She denies fever, nausea or severe pain. The only medication the patient is

taking is birth control.

DIAGNOSTIC:

Cervical swab PCR test is positive for chlamydia trachomatis

Urinalysis –

Color – yellow

Clarity – clear

pH – 7.0

Blood – negative

Nitrites – negative

Leukocytes – negative

POC Pregnancy – neg

Questions:

1. Describe the pathophysiologic process of chlamydia, including the two forms,

intracellular development, and immune evasion.

2. Explain the host’s response to the infection, including pathogen recognition

receptors and proinflammatory cytokines.

3. Explain the risk factors for STDs.

4. Explain the potential complications of Chlamydia.

Resources

CDC – https://www.cdc.gov/chlamydia/about/index.html

WHO – https://www.who.int/news-room/fact-sheets/detail/chlamydia

UTF-8Molecular level pathophys Chlamydia

NURS-6501 Week 10 case study Patient is a 21-year-old female with no medical history. She reports vaginal discomfort and discharge for approximately 3 days.

NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days

Week 8 Case Study

Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days. Reports he is unable to bear weight on that leg. He is now also having toe pain. Symptoms started after the weekend when he attended a BBQ where he had 4 beers with his meal. He denies fever, rash, or injury. BMI is 32. History of HTN, takes Hydrochlorothiazide, and works as a floor installer.

Aspiration of synovial fluid:

Monosodium urate (MSU) crystals are positive

Lab results

Lab

Result

Reference Range

Uric Acid

8

3.5 and 7.2 mg/dL

ESR

65

0-15 mm/hr

CRP

10.5

<0.3 mg/dL   Questions: Identify key symptoms presented that will help to determine the diagnosis. Explain the musculoskeletal pathophysiologic processes of why the patient presents these symptoms. Explain how obesity plays a role in the progression of osteoarthritis/gout in the knee joints. Explain risk factors that may contribute to the development of the disease.   NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days     Case Study Analysis- Musculoskeletal System The patient is a 44-year-old male presenting with complaints of swelling, pain, and redness in his left knee for 2 days now. This is associated with an inability to bear weight on the leg. He also complains about the pain. He reports that the symptoms began after he had four beers with his food at a BBQ cookout he had attended. He denies any fever, rash, or history of injury to the leg. He is on HCTZ for HTN and has a BMI of 32. His synovial fluid aspiration shows positive MSU, and his lab results indicate elevated uric acid at 8, elevated ESR of 65, and high CRP of 10.5. Identify key symptoms presented that will help to determine the diagnosis. The patient’s symptomatic presentation included pain, swelling, redness, and inability to use the limb. He also complains of pain in his big toe. These are symptoms of an inflammatory reaction, which when combined with the patient’s history will help arrive at a diagnosis. Assessing the patient’s symptoms such as the pain location and characteristics are important in making a diagnosis. Explain the musculoskeletal pathophysiologic processes of why the patient presents these symptoms. The patient’s presentation of pain, swelling, and redness in the knee and pain in the great toe are symptoms of an inflammatory reaction that can occur with any injurious process. However, he reports a history of alcohol consumption before the onset of his symptoms, and a synovial fluid aspiration revealed positive monosodium urate crystals (MSU). His lab results also show elevated CRP, ESR, and uric acid. This indicates the process of inflammatory reaction in acute gout presentation (Ahn & So, 2024). The pathophysiologic process involves the accumulation of monosodium urate crystals and their deposition in the joints and soft tissues.  In gout, the pathophysiologic process is brought about by hyperuricemia resulting in increased uric acid production or decreased excretion by the kidneys (Fenando et al., 2022). Dietary practices like excess alcohol and meat consumption also increase the production of uric acid because they are high in purines (Zhang et al., 2022). Hyperuricemia causes the formation of monosodium urate crystals through uric acid super-saturation in blood. These crystals are needle-shaped and thus their deposition in the joints and soft tissues triggers an immune reaction and an inflammatory response. This causes neutrophils and other immune cells to infiltrate the area leading to an inflammatory reaction presenting with pain, swelling redness, and an inability to use the affected limb (Ahn & So, 2024). ORDER A HUMAN-WRITTEN PAPER HERE Explain how obesity plays a role in the progression of osteoarthritis/gout in the knee joints. Obesity plays an important role in the progression of gout and osteoarthritis in the knee joints through many factors primarily by increasing the mechanical stress inflicted on the joints and by inflicting systemic inflammation (Nedunchezhiyan et al., 2022). In osteoarthritis, the pressure exerted on the knees caused by the excess weight in obesity causes further damage to the cartilage thus more damage to the knee joints. There is also an increased inflammatory reaction in obesity due to chronic inflammation in obesity, which causes more cartilage damage and worsening symptoms. Obesity is also associated with the rapid progression of osteoarthritis and more severe joint damage than in individuals with a healthy weight (Shumnalieva et al., 2023) NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days.  For its effect on gout progression, obesity has been associated with an increased risk of uric acid accumulation. This is because obesity may be associated with an impairment of renal functions thus affecting the elimination of uric acid leading to hyperuricemia. It is also associated with increased production of uric acid, which is a major risk factor for gout thus increasing the disease progression (Fenando et al., 2022). Obesity can also worsen the symptomatic progression of gout by increasing the inflammatory reaction since it is a chronic inflammatory state. This can exacerbate the pathophysiologic process of gout. Explain risk factors that may contribute to the development of the disease. Many factors may contribute to the development of gouty arthritis including hyperuricemia, obesity, high blood pressure, chronic renal disease, some medications, family history, age, gender, and certain lifestyle practices such as alcohol consumption and a diet rich in purines (Fenando et al., 2022). Elevated serum uric acid levels are a primary risk factor for gout development since the excess uric acid becomes supersaturated leading to the formation of monosodium urate crystals, which deposit in the joints, cartilage, and other soft tissues leading to gout. Hypertension itself can result in hyperuricemia by causing renal damage thus decreasing uric acid excretion by the kidneys. Certain medications like diuretics, commonly used in the management of hypertension, also increase the risk of developing gout (Asghari et al., 2024). Alcohol consumption and high intake of purine-rich foods like red meat also increase the production of uric acid, predisposing to the development of gout (Helget & Mikuls, 2022). Other factors that predispose to gouty arthritis include having a family history of gout and gender, in which males are more likely to develop gout compared to women. References Ahn, E. Y., & So, M. W. (2024). The pathogenesis of gout.  Journal of Rheumatic Diseases ,  32 (1), 8-16.  https://doi.org/10.4078/jrd.2024.0054 Asghari, K. M., Zahmatyar, M., Seyedi, F., Motamedi, A., Zolfi, M., Alamdary, S. J., Fazlollahi, A., Shamekh, A., Mousavi, S. E., Nejadghaderi, S. A., Mohammadinasab, R., Ghazi-Sha’rbaf, J., Karamzad, N., Sullman, M. J., Kolahi, A., & Safiri, S. (2024). Gout: Global epidemiology, risk factors, comorbidities, and complications: a narrative review. BMC Musculoskeletal Disorders ,  25 (1).  https://doi.org/10.1186/s12891-024-08180-9 Fenando, A., Rednam, M., Gujarathi, R., & Widrich, J. (2022, December 27).  Gout – StatPearls – NCBI bookshelf . National Center for Biotechnology Information.  https://www.ncbi.nlm.nih.gov/books/NBK546606/ Helget, L. N., & Mikuls, T. R. (2022). Environmental triggers of hyperuricemia and gout.  Rheumatic Disease Clinics of North America ,  48 (4), 891-906.  https://doi.org/10.1016/j.rdc.2022.06.009 Nedunchezhiyan, U., Varughese, I., Sun, A. R., Wu, X., Crawford, R., & Prasadam, I. (2022). Obesity, inflammation, and immune system in osteoarthritis.  Frontiers in Immunology ,  13 .  https://doi.org/10.3389/fimmu.2022.907750 Shumnalieva, R., Kotov, G., & Monov, S. (2023). Obesity-related knee osteoarthritis—Current concepts.  Life ,  13 (8), 1650.  https://doi.org/10.3390/life13081650 Zhang, Y., Chen, S., Yuan, M., Xu, Y., & Xu, H. (2022). Gout and diet: A comprehensive review of mechanisms and management.  Nutrients ,  14 (17), 3525.  https://doi.org/10.3390/nu14173525 NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days     Case Study Analysis An understanding of the musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that this system may have on another. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other. Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role. An understanding of the symptoms of alterations in musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans. In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health. Resources   Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources. WEEKLY RESOURCES To prepare: By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor. The Assignment (1- to 2-page case study analysis) Develop a 1- to 2-page case study analysis by answering the questions provided following the case scenario. NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days By day 7 of Week 8 Submit  your Case Study Analysis Assignment by  Day 7 of Week 8. Reminder:  The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at  https://academicguides.waldenu.edu/writingcenter/templates Links to an external site. ). All papers submitted must use this formatting. submission information Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the  Turnitin Drafts  from the  Start Here  area. To submit your completed assignment , save your Assignment as  WK8Assgn2_LastName_Firstinitial Then, click on  Start Assignment  near the top of the page. Next, click on  Upload File  and select  Submit Assignment  for review.   Rubric NURS_6501_Week 8_Case Study_Assignment_Rubric NURS_6501_Week 8_Case Study_Assignment_Rubric Criteria Ratings Pts This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following: Explain the musculoskeletal pathophysiologic processes of why the patient presents these symptoms. NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days 30   to >
27.0
 pts
Excellent
The response accurately and thoroughly describes the patient symptoms. … The response includes accurate, clear, and detailed explanations of the musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation.

27
 
to >
24.0
 pts
Good
The response describes the patient symptoms. … The response includes accurate, explanations of the musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation. NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days

24
 
to >
22.0
 pts
Fair
The response describes the patient symptoms in a manner that is vague or inaccurate. … The response includes explanations of the musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by explanations that are vague or based on inappropriate evidence/research.

22
 
to >
0
 pts
Poor
The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. … The response does not include explanations of the musculoskeletal pathophysiologic processes of patients who present these symptoms, or the explanations are vague or based on inappropriate evidence/research.

30
 pts

This criterion is linked to a Learning Outcome
Explain how obesity plays a role in the progression of osteoarthritis in the knee joints.

30
 
to >
27.0
 pts
Excellent
The response includes an accurate, complete, detailed, and specific explanation of how obesity plays a role in the progression of osteoarthritis in the knee joints and is supported by evidence and/or research, as appropriate, to support the explanation.

27
 
to >
24.0
 pts
Good
The response includes an accurate explanation of how obesity plays a role in the progression of osteoarthritis in the knee joints and is supported by evidence and/or research, as appropriate, to support the explanation.

24
 
to >
22.0
 pts
Fair
The response includes a vague or inaccurate explanation of how obesity plays a role in the progression of osteoarthritis in the knee joints, with explanations that are based on inappropriate evidence/research.

22
 
to >
0
 pts
Poor
The response includes a vague or inaccurate explanation of how obesity plays a role in the progression of osteoarthritis in the knee joints, with explanations that are based on inappropriate or missing evidence/research.

30
 pts

This criterion is linked to a Learning Outcome
Explain risk factors that may contribute to the development of the disease.

25
 
to >
22.0
 pts
Excellent
The response includes an accurate, complete, detailed, and specific explanation of risk factors that may contribute to the development of the disease, and is supported by evidence and/or research, as appropriate, to support the explanation.

22
 
to >
19.0
 pts
Good
The response includes an accurate explanation of risk factors that may contribute to the development of the disease, and is supported by evidence and/or research, as appropriate, to support the explanation.

19
 
to >
17.0
 pts
Fair
The response includes a vague or inaccurate explanation of risk factors that may contribute to the development of the disease, and/or explanations that are based on inappropriate evidence/research.

17
 
to >
0
 pts
Poor
The response includes a vague or inaccurate explanation of risk factors that may contribute to the development of the disease, or the explanations are based on inappropriate or no evidence/research.

25
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. Content is supported by current evidence-based sources.

5
 
to >
4.0
 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … Content is supported by current evidence-based sources.

4
 
to >
3.5
 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. …Some content is supported by current evidence-based sources.

3.5
 
to >
3.0
 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Some content is supported by current evidence-based sources.

3
 
to >
0
 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. … No content is supported by current evidence-based sources. 5  pts This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days 5   to >
4.0
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

4
 
to >
3.5
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5
 
to >
3.0
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

3
 
to >
0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5
 
to >
4.0
 pts
Excellent
Uses correct APA format with no errors.

4
 
to >
3.0
 pts
Good
Contains a few (1 or 2) APA format errors.

3
 pts
Fair
Contains several (3 or 4) APA format errors.

3
 
to >
0
 pts
Poor
Contains many (≥ 5) APA format errors.

5
 pts

Total Points: 
100 NURS 6501 week 8 assignment Case Study Analysis – Patient is a 44-year-old male presenting with swollen, painful, red left knee for 2 days

NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago

Week 4 case study

Case Study: Occupational Pulmonary Fibrosis

Case Presentation:

Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago. Oxygen dependent at 5L/min (non-compliant). Bilateral inspiratory crackles (“Velcro crackles”) at lung bases noted; no wheezing but has significantly reduced breath sounds. He has digital clubbing, and noted even walking to the kitchen or bathroom he has to use his walker as fear of “running out of air” and falling. He states he wakes up at night gasping for air at times and has to sleep in his chair in the living room and “I can’t even go to bed”. He states all throughout the day he does nothing but cough but states no sputum.

His history notes he had asthma as a child and COPD diagnosed at the age of thirty from what was diagnosed at that time as “chronic bronchitis” [bronchial inflammation]. “I hate walking around with that cord like a dog-leash all day just to breath” “I don’t think I need it” and “I have been around smoke and smoked my whole life” [unfiltered – cigarettes]; “I just use an inhaler as I have for years when they diagnosed me with COPD”. He worked for over 30 years as a concrete mixer driver, frequently exposed to silica dust from cement. Over the last two years, his symptoms worsened, requiring continuous emergency room visits and treatment. Despite treatment with steroids and agents, his pulmonary function continued to decline, leading to his recent placement on organ list for bilateral lung transplant.

Pulmonary Function Tests (PFTs) FVC: 48% predicted (severely reduced); DLCO: 35% predicted (severely impaired gas exchange); FEV1/FVC Ratio: Normal (>80%).

Vitals: BP 128/76 mmHg, HR 92 bpm, RR 24/min, SpO₂ 89% on room air 91% on 5-liters O2; Weight: 240 pounds x 1 year ago now with unintentional weight loss at 170 pounds.

BY RUBRIC:

Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following: Explain pathophysiologic mechanisms responsible for the patient symptoms and why patient is susceptible to more frequent infections.

Explain the pulmonary pathophysiologic processes of how smoking can lead to the changes seen in the lungs.

Explain any racial/ethnic variables that may impact physiological functioning. — Explain factors in the patient’s history and lifestyle that could have contributed to the development of COPD.

(SOLVED) NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago

Case Study Analysis – Occupational Pulmonary Fibrosis

The Case Study

The patient is a 58-year-old disabled construction worker presenting with progressive exertional dyspnea and a persistent dry cough in the last 5 years. He was diagnosed with COPD and his symptoms have worsened over the past 2 years requiring frequent emergency room visits and treatment.

The pulmonary pathophysiologic processes of how smoking can lead to the changes seen in the lungs

The pathophysiologic processes causing the symptoms of COPD involve lung damage, which compromises airflow. In this case, the various offending mechanisms in COPD like cigarette smoke or other airway pollutants cause inflammation and obstruction of the airways and damage to the lung tissues (Haddad & Sharma, 2023). This leads to difficulty in breathing, coughing, and dyspnea. The airway inflammation causes air sac destruction and shrinkage, making them unable to expand thus limiting airflow. The inflammation also triggers mucus production, which blocks the airway and limits air exchange. These factors together create a ventilation-perfusion mismatch, leading to poor oxygenation as seen in the patient’s low SPO2, low FVC, and reduced DLCO (Rodrigues et al., 2021).

GET A PLAGIARISM-FREE PAPER HERE

Explain any racial/ethnic variables that may impact physiological functioning.
Many racial/ethnic factors influence the pathophysiological functioning in COPD including genetic factors, socioeconomic factors, environmental factors, and lifestyle factors. These factors impact the pathophysiology of COPD either by increasing the risks of COPD, the recovery process, and influencing their response to treatment and outcomes. For instance, genetics play an important role in the development and maturation of lungs as well as in inflammatory responses to triggers like asthma. As a result, certain genetic variances predispose an individual to diseases like COPD more than other people (Cho et al., 2024). An example is the gene coding for alpha-1 antitrypsin. Alpha-1 antitrypsin is an enzyme inhibitor, which serves to protect the lung parenchyma from injury and damage by injurious agents that lead to COPD. Certain individuals have a deficiency of alpha-1 antitrypsin, which makes their lungs more prone to damage from inhalation pollutants such as cigarette smoke and other harmful environmental contaminants like dust. It is more common in white individuals compared to other races. This increases their risk of developing COPD together with increased morbidity and mortality from the disease (Hernandez-Pacheco et al., 2024).Another variable that impacts the pathophysiology of COPD is socioeconomic factors in which individuals of lower socioeconomic status are at a greater risk of developing COPD due to several factors like poor access to healthcare, higher exposure to environmental pollutants like smoke, and higher smoking habits. In this instance, the patient was exposed to environmental contaminants at work, which predisposed him to COPD (Assari et al., 2020). Other variables impacting COPD include environmental exposures like dust and fumes, cigarette smoking habits that vary among different ethnicities, and environmental pollutants, which vary according to ethnicity because certain ethnicities are more predisposed to poorer living conditions and pollution.
Explain factors in the patient’s history and lifestyle that could have contributed to the development of COPD.
One important factor in his history that could have contributed to the COPD is his occupational history as a construction worker where he was a concrete mixer driver for 30 years, exposing him to silica dust from the cement. He also reports a long history of smoke exposure and a history of asthma, which also predisposes him to COPD (B. Ozoh et al., 2023). Other factors predisposing the patient to COPD include his obesity, male sex, and respiratory infections due to asthma
NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago.

References

Assari, S., Chalian, H., & Bazargan, M. (2020). Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. 
Research in Health Science
, 
5
(1), p48. 
https://doi.org/10.22158/rhs.v5n1p48

Ozoh, O., K. Dede, S., A. Ekete, O., O. Ojo, O., & G. Dania, M. (2023). Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria. 
Ghana Medical Journal
, 
57
(3), 175-182. 
https://doi.org/10.4314/gmj.v57i3.3

Cho, M. H., Hobbs, B. D., & Silverman, E. K. (2024). 
The genetics of COPD
. PMC Home. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC11197974/

Haddad, M., & Sharma, S. (2023, July 20). 
Physiology, lung – StatPearls – NCBI bookshelf
. National Center for Biotechnology Information. 
https://www.ncbi.nlm.nih.gov/books/NBK545177/

Hernandez-Pacheco, N., Kilanowski, A., Kumar, A., Curtin, J. A., Olvera, N., Kress, S., Bertels, X., Lahousse, L., Bhatta, L., Granell, R., Marí, S., Bilbao, J. R., Sun, Y., Tingskov Pedersen, C., Karramass, T., Thiering, E., Dardani, C., Kebede Merid, S., Wang, G., … Melén, E. (2024). Exploring the genetics of airflow limitation in lung function across the lifespan – a polygenic risk score study. 
eClinicalMedicine
, 
75
, 102731. 
https://doi.org/10.1016/j.eclinm.2024.102731

Rodrigues, S. D., Cunha, C. M., Soares, G. M., Silva, P. L., Silva, A. R., & Gonçalves-de-Albuquerque, C. F. (2021). Mechanisms, pathophysiology, and currently proposed treatments of chronic obstructive pulmonary disease.
Pharmaceuticals
, 
14
(10), 979. 
https://doi.org/10.3390/ph14100979
  
NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago

Advanced Pathophysiology of Acute Myelogenous Leukemia (AML) – NURS-6501 Week 2 Case Study Scenario

Week 2 Case Study Scenario

Case Study 2: Advanced Pathophysiology of Acute Myelogenous Leukemia (AML
)
A 45-year-old male presents to the hematology clinic with symptoms of progressive fatigue,
frequent bruising, and recurrent nosebleeds over the past few weeks. On physical examination,
he appears pale and has petechiae on his lower extremities. Blood tests reveal a white blood cell
count of 50,000/mm³ with 60% blasts, hemoglobin of 8.5 g/dL, and platelets of 25,000/mm³. A
bone marrow biopsy confirms the diagnosis of AML, showing hypercellularity with 70%
myeloblasts. Cytogenetic analysis reveals a FLT3-ITD mutation, placing him in the intermediate-
risk category.

In 1 -2 pages, answer the questions below in detail. You must use current evidence-based
resources to support your answers. Follow APA guidelines. Follow the grading rubric.

Questions:
1.
What is the primary cellular abnormality in AML?
2.
How does the accumulation of leukemic blasts affect normal hematopoiesis?
3.
What role do genetic mutations play in the development of AML?
4.
Why do patients with AML often present with symptoms like fatigue, infections, and
bleeding?
5.
What is the significance of Auer rods in the diagnosis of AML?
6.
What is the impact of AML on the immune system?
7.
How do treatment strategies target the pathophysiological mechanisms of AML?

 

Advanced Pathophysiology of Acute Myelogenous Leukemia (AML) – NURS-6501 Week 2 Case Study Scenario

Case Study Analysis

The severe blood malignancy known as acute myelogenous leukemia (AML) impairs the bone marrow’s capacity to produce healthy blood cells.  The symptoms of a 45-year-old male patient include increased fatigue, easy bruising, and frequent nosebleeds.  Laboratory tests show low hemoglobin levels, decreased platelet counts, and an increased white blood cell count with notable blast cells.  The diagnosis of AML is confirmed by a bone marrow biopsy, which shows hypercellularity with a significant proportion of myeloblasts.  He is classified as intermediate-risk due to the FLT3-ITD mutation, which is revealed by additional genetic investigation.  Understanding the anomalies in AML cells, as well as their genetic causes and immunological effects, is essential for the diagnosis and treatment of this illness.

Myeloblasts are immature white blood cells that do not go through the normal maturation processes, and their unrestrained multiplication is the cause of AML.  The development of these immature cells is disrupted by this shortage; as they aggregate in the bone marrow, they prevent the generation of healthy platelets, white blood cells, and red blood cells (Döhner et al., 2022).  Patients suffer from a range of symptoms as a result, from fatigue to heightened susceptibility to infections and bleeding episodes.  Hematopoiesis, the process by which blood cells normally grow, is severely disrupted by the quantity of leukemic blasts.

The excessive accumulation within investors obstructs adequate production rates for regular blood cell types leading to anemia which often causes lethargy due to decreased oxygen transport capabilities in the body. Furthermore, neutropenia results from insufficient functional white blood cell quantity contributing greatly to susceptibility toward infections while thrombocytopenia makes avenue for bruising easily despite minimal trauma hence explaining phenomena such as petechiae or recurrent nasal hemorrhages observed in this patient case (Borthakur & Kantarjian, 2021).

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Genetic mutations play a key role in AML development. The FLT3-ITD mutation found in this patient is associated with increased cell proliferation and poor prognosis. This mutation causes continuous activation of signaling pathways that promote cancer cell survival and growth. Other mutations, such as NPM1 or RUNX1, may also contribute to disease progression and treatment resistance (Williams et al., 2021).  Identifying these mutations helps in selecting the best treatment approach.

Patients with AML often experience fatigue, infections, and bleeding due to the shortage of normal blood cells. Fatigue results from anemia, as fewer red blood cells are available to carry oxygen throughout the body. Frequent infections occur because leukemic blasts replace normal white blood cells, which weakens the immune system. Bleeding problems arise from the lack of platelets, leading to symptoms like easy bruising, nosebleeds, and petechiae, as seen in this patient (Döhner et al., 2022).

Auer rods are important in diagnosing AML. They are rod-shaped structures found inside myeloblasts and are made up of fused lysosomes containing myeloperoxidase, an enzyme specific to myeloid cells. The presence of Auer rods confirms AML and helps differentiate it from other types of leukemia.

AML significantly affects the immunological system.  A shortage of healthy white blood cells weakens the immunological response.  This makes infections more likely, even from little wounds or common microorganisms.  Infections become more severe and more difficult to treat when the body’s defenses against viruses and fungi are compromised (Barrett, 2020).  Inflammation linked to AML can also further impair immunological function.

The molecular level of AML is the focus of treatment.  Chemotherapy is a common treatment used to destroy leukemic blasts and restore normal blood cell production.  One kind of targeted drug used to slow the disease’s progression and stop abnormal FLT3 signaling in patients with the FLT3-ITD mutation is midostaurin.  In order to reestablish normal hematopoiesis and increase survival prospects, some patients may need a bone marrow transplant to replace damaged cells with healthy donor cells (Döhner et al., 2022).

Conclusively, AML is a serious blood malignancy brought on by myeloblasts growing out of control.  Fatigue, infections, and bleeding are some of the symptoms caused by the disease’s disruption of normal blood cell synthesis.  Genetic abnormalities like FLT3-ITD are important in the development of AML and have an impact on therapy choices. The presence of Auer rods confirms AML diagnosis, and the immune system is severely weakened due to a lack of functional white blood cells. Treatment strategies focus on eliminating leukemic cells through chemotherapy, targeted therapy, and bone marrow transplantation. Understanding the underlying cellular processes in AML is crucial for effective management and patient education Advanced Pathophysiology of Acute Myelogenous Leukemia (AML) – NURS-6501 Week 2 Case Study Scenario.

 

References

Barrett, A. J. (2020). Acute myeloid leukaemia and the immune system: Implications for immunotherapy. British Journal of Haematology, 188(1), 147-158.
https://doi.org/10.1111/bjh.16310

Borthakur, G., & Kantarjian, H. (2021). Core binding factor acute myelogenous leukemia-2021 treatment algorithm. Blood Cancer Journal, 11(6).
https://doi.org/10.1038/s41408-021-00503-6

Döhner, H., Wei, A. H., Appelbaum, F. R., Craddock, C., DiNardo, C. D., Dombret, H., Ebert, B. L., Fenaux, P., Godley, L. A., Hasserjian, R. P., Larson, R. A., Levine, R. L., Miyazaki, Y., Niederwieser, D., Ossenkoppele, G., Röllig, C., Sierra, J., Stein, E. M., Tallman, M. S., … Löwenberg, B. (2022). Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood, 140(12), 1345-1377.
https://doi.org/10.1182/blood.2022016867

Williams, L., Doucette, K., Karp, J. E., & Lai, C. (2021). Genetics of donor cell leukemia in acute myelogenous leukemia and myelodysplastic syndrome. Bone Marrow Transplantation, 56(7), 1535-1549.
https://doi.org/10.1038/s41409-021-01214-z. 
 Advanced Pathophysiology of Acute Myelogenous Leukemia (AML) – NURS-6501 Week 2 Case Study Scenario

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)

Alterations in Cellular Processes

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts. You must use current evidence-based resources (Primary and secondary) to support your initial posting and all responses to your colleagues.

resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

by day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

Which genetic mutations are commonly associated with the disease?

Why is the patient presenting with the specific symptoms described?

Discuss the pathophysiological mechanisms of the disease in detail.

What do the blood test results tell us about the disease and disease progression?

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)

Which genetic mutations are commonly associated with the disease?

There are an abundant number of genes associated with Acute myelocytic leukemia (AML). There are four categories of driver mutations—transcription factor mutations, signaling protein mutations, epigenome mutations, and TP53, or genes that help regulate p53. FLT3, NPM1, and CEBPα are three specific gene mutations that can occur with AML that are well studied (Makkar et al., 2023).

Why is the patient presenting with the specific symptoms described?

The genetic alteration in the myeloid stem cell disrupts the production of specialized myelocytic blood cells, affecting the resulting blood components (Rogers, 2022).  Myelocytic blood cell specializations are red blood cells, platelets, and myeloblast. Myeloblast cells are precursor cells that create granulocytes—white blood cells. A common characteristic of AML is that white blood cells are abundant in the blood, specifically called leukocytosis. The overabundance of blast cells crowd out the other cells in the blood. Lack of red blood cells or malformation of red blood cells causes anemia, and would be the cause of the fatigue. Lastly, the platelets are affected like the red blood cells, either crowded out by blast cells or mutated. Due to this process, thrombocytopenia occurs, and the body cannot clot the blood effectively—explaining the nose bleeds and bruising.

Discuss the pathophysiological mechanisms of the disease in detail.

AML occurs when one or more gene mutations disrupt the hematopoiesis pathway within the bone marrow (Rogers, 2022). An example of a transcription mutation is the gene RUNX1. RUNX1 is a protein used for many cellular processes, and mutations in this gene disrupt the pathway for hemopoiesis, which can cause malformations (Kellaway et al., 2022). Some RUNX1 mutation formations are more serious than others, but all give a high risk for AML if AML does not occur from the gene mutation alone. PTPN11 is a signaling protein that regulates cells, cell growth, and differentiation (Makkar et al., 2023). The next mutation category is epigenome mutations, TET2 is an example, and this protein’s primary function is to be a catalyst for 5-methylcytosine to 5-hydroxymethylcytosine (Makkar et al., 2023).  The final category of mutations is TP53, or genes that help regulate p53. TP53 is a code for the P53 tumor suppressor protein, and disrupting either of these proteins would no longer allow the gene’s function (Rogers, 2022).

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All of the gene mutations that can occur in the many cellular pathways in the body lead to a disruption of cell function. There are a few different ways mutations can occur—chemotherapy or other toxins, Down syndrome or other hereditary conditions, and another cause is an underlying condition such as bone marrow disease (Rogers, 2022).

The cell mutations lead to an overproduction of immature myeloblasts that cannot undergo granulopoiesis or become granulocytes (Rogers, 2022). Overproduction of blast cells takes resources, energy, and space from the other cell production, causing leukocytosis, anemia, and thrombocytopenia.

What do the blood test results tell us about the disease and disease progression?

Lab values show that the progression of the patient’s AML is not far along; this disease progresses rapidly and is similar to all types of leukemia (Vakiti et al., 2024). The white blood cell count is low. At this stage, the patient has yet to have formed enough mast cells to fill the bone marrow and start leaking into the blood or the accompanying bone pain to indicate that the bone marrow is full of blast cells (Rogers, 2022). There is dysfunction in apoptosis with ALM, so rapid production with no apoptosis means the build-up of mast cells happens quickly. Once Mast cells start leaking out of the bone marrow, Leukopenia will shift, resulting in leukocytosis even though the WBCs cannot function like proper cells and undergo hematopoiesis.

However, the disease process is far enough to show anemia and thrombocytopenia. With no intervention, the disease would progress, leading to extreme neutropenia because there is very little functional WBC. Indicating an increased risk of a fatal infection (Rogers, 2022).  If infection does not occur, the mast cells can build up high, causing hyperleukocytosis and leukemic cell infiltration (Döhner et al., 2022). Skin conditions can occur in all types of epithelial cells. Petechiae and ecchymosis, along with bruising or bleeding of any kind.  Another progression that can occur, most likely with chemotherapy, is Tumor lysis syndrome (TLS) (Adeyinka et al., 2024). TLS occurs when calls burst, causing a dump of cell contents that cause damage to the kidneys.

 

References

Adeyinka, A., Kaur, A., & Bashir, K. (2024, October 5). Tumor Lysis syndrome. StatPearls – NCBI Bookshelf. 
https://www.ncbi.nlm.nih.gov/books/NBK518985/
Links to an external site.

Döhner, H., Wei, A. H., Appelbaum, F. R., Craddock, C., DiNardo, C. D., Dombret, H., Ebert, B. L., Fenaux, P., Godley, L. A., Hasserjian, R. P., Larson, R. A., Levine, R. L., Miyazaki, Y., Niederwieser, D., Ossenkoppele, G., Röllig, C., Sierra, J., Stein, E. M., Tallman, M. S., . . . Löwenberg, B. (2022). Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood, 140(12), 1345–1377. https://doi.org/10.1182/blood.2022016867

Kellaway, S. G., Coleman, D. J., Cockerill, P. N., Raghavan, M., & Bonifer, C. (2022). Molecular basis of hematological disease caused by inherited or acquired RUNX1 mutations. 
Experimental Hematology
, 
111
, 1–12. 
https://doi.org/10.1016/j.exphem.2022.03.009
Links to an external site.

Makkar, H., Majhi, R. K., Goel, H., Gupta, A. K., Chopra, A., Tanwar, P., & Seth, R. (2023). Acute myeloid leukemia: novel mutations and their clinical implications. 
American journal of blood research
, 
13
(1), 12–27.

Rogers, J. (2022). 
McCance & Huether’s Pathophysiology
 (9th ed.). Elsevier Health Sciences (US). 
https://mbsdirect.vitalsource.com/books/9780323789899
Links to an external site.

Vakiti, A., Reynolds, S. B., & Mewawalla, P. (2024, April 27). 
Acute myeloid leukemia
. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK507875/ CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML).

First, what is acute myelogenous leukemia (AML)? AML is a type of cancer that begins in the bone marrow and affects the production of blood cells. This type of cancer changes the development and growth of immature white blood cells (myeloblasts) (Z, 2024).  This results in the myeloblasts replacing normal blood cells.  The white blood cells are not allowed to mature and becoming functioning white blood cells (Z, 2024). This can lead to abnormalities in a complete blood count. For example, the patient in this case study has a low white blood cell count of 3.3 THOUS/uL, a low platelet count of 70 THOUS/uL, a low hemoglobin count of 7.9g/dL, and a low red blood cell count of 2.39 MIL/uL. These blood test results would also explain why the patient feels fatigue, is having nosebleeds, and is bruising easily. The over production of immature myeloblast cells affect the production of platelets, red blood cells, and white blood cells (Z, 2024).

There are several different pathophysiological mechanisms that are associated with AML. One mechanism would be genetic mutations. The genetic mutations affect genes that aid in cell survival, growth, and differentiation (Alom, 2023). The common mutated genes found are CEBPa, RUNX1, and PML-RARa (DiNardo, 2016). Mutation is also found in the signal transduction pathway with active mutated genes FLT3, NRAS, and KIT. One of the most common genetic abnormalities in AML is FLT3 (DiNardo, 2016). Rapid growth in these active mutated genes is due to the dysregulated signaling pathways (DiNardo, 2016). Another genetic component found in AML is the rearrangement of chromosomes. The rearrangement of chromosomes results in the fusion of certain genes resulting in the formation of a tumor (Zhang, 2017). Lastly, what occurs in the bone marrow is the key component in AML. The interaction between stromal cells and leukemia cells plays a critical part in aiding in the resistance to therapy, survival, and their growth rate (DiNardo, 2016).

The patient with AML is dealing with nosebleeds, bruising and the feeling of fatigue. These symptoms can best be explained due to the leukemia cells affecting the production of healthy blood cells in the bone marrow (Alom, 2023). The bone marrow crowding and rapid growth of leukemia cells causes the push out of healthy blood cells such as platelets and red blood cells (DiNardo, 2016). Platelets play a key role in the body’s ability to clot blood. The patient with a low platelet count would experience nosebleeds and bruising due to the inability to have an adequate about of platelets to aid in blood clotting (DiNardo, 2016). Another, healthy blood cell produced in the bone marrow are red blood cells. Due to the accumulation of abnormal leukemia cells in the bone marrow, there is a lack of production of healthy red blood cells which can cause the patient to experience fatigue. This is due to the blood cells ability to care oxygen throughout the body (DiNardo, 2016).

Ultimately, AML is due to the mutations in stem cells which causes an overpopulating growth of abnormal cells that hinders the production of normal healthy cells (Alom, 2023). Consequently, several different complications result from these mutations such as anemia, infection, hypermetabolism, and hemorrhage (DiNardo, 2016). After reviewing the patients’ lab results, AML with a low white blood cell count can indicate that the disease state is active (Z, 2024). The leukemia cells are actively replacing healthy blood cells in the bone marrow (DiNardo, 2016). The progression of the disease is based on the growth rate of the leukemia cells and the bone marrows inability to produce platelets and healthy red blood cells (DiNardo, 2016). As the leukemia cells continue to grow, the blood will become thick and sticky. This final stage of the disease will increase the patients’ risk for clots, tissue damage, strokes and heart attacks (DiNardo, 2016).

 

References:

Alom, M. M., Faruqe, M. O., Molla, M. K. I., & Rahman, M. M. (2023). Exploring Prognostic Biomarkers of Acute Myeloid Leukemia to Determine Its Most Effective Drugs from the FDA-Approved List through Molecular Docking and Dynamic Simulation. 
BioMed Research International
, 1–26. https://doi.org/10.1155/2023/1946703

DiNardo, C. D., & Cortes, J. E. (2016). Mutations in AML: prognostic and therapeutic implications. 
Hematology. American Society of Hematology. Education Program
, 
2016
(1), 348–355. 
https://doi.org/10.1182/asheducation-2016.1.348
Links to an external site.

Z, Hu., Y, Yang., J, Li., & Z, Hu. (2024). Genetic mutations and immune microenvironment: unveiling the connection to AML prognosis. 
Hematology (Amsterdam, Netherlands)
, 
29
(1), 2346965. 
https://doi.org/10.1080/16078454.2024.2346965
Links to an external site.

Zhang, Haiguo., Zhang, Chengfang., Feng, Rui., Zhang, Haixia., Gao, Min., & Ye, Ling. Investigating the microRNA-mRNA regulatory network in acute myeloid leukemia. 
Oncology Letters
, 
14
(4), 3981–3988. https://doi.org/10.3892/ol.2017.6686

 

 

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)

Acute myeloid leukemia (AML) is the expansion of leukemic stem cells that have acquired self-renewal capacity. An aggregation of leukemic blasts in bone marrow, peripheral blood, and extramedullary tissue will result in AML. AML induces the accumulation of leukemic blasts in bone marrow, peripheral blood, and extramedullary tissues.  (Koolivand et al., 2025).  These changes cause the myeloid cells to make a lot of immature white blood cells called myeloblasts. The myeloblasts can build up in the bone marrow, crowding out healthy blood cells. (Mayo Clinic, 2025). When these aggressive immature myeloid cells expand in the bone marrow, the result is hematologic compromise. (Kurzer & Weinberg, 2023). Without enough healthy blood cells circulating through the patient’s bloodstream, patients experience low oxygen levels in the blood, easy bruising and bleeding, and frequent infections. (Mayo Clinic, 2025). The symptoms the patient is presenting with are fatigue, unexplained bruising, and frequent nose bleeds. The blood tests reveal leukocytosis, anemia, and thrombocytopenia. Frequent nose bleeds and unexplained bleeding are a result of thrombocytopenia, and fatigue is a result of anemia.

According to Kurzer & Weinberg (2023), the World Health Organization Classification of Hematopoietic Neoplasms and The International Consensus Classification System now define a variety of AML subsets based on mutation in the deriver genes such as NPM1, CEBPA, TP53, ASXL1, BCOR, EZH2, RUNX1, SRSF2, STAG2, U2AF1, and ZRZR2. Although several studies have been performed to detect genetic mutations responsible for AML pathogenesis, the treatment methods have not significantly changed in the past two decades, as most genetic defects are still unknown. (Koolivand et al., 2025).   The primary variable used by physicians to assess the disease prognosis for AML is the karyotype. (Koolivand et al., 2025).  Mean platelet volume can be considered a predictive or prognostic marker in patients with AML. (Albayrak, et al. 2021).  The patient has a high mean platelet volume of 13.5 fl. Patients with higher mean platelet volumes at the time of diagnosis should be evaluated carefully. (Albayrak, et al. 2021).

References

Albayrak, M., et al. (2021). Mean platelet volume is a predictive and prognostic marker for patients with acute myeloid leukemia: a two-center retrospective analysis. Leukemia & Lymphoma. 62(11). Retrieved from http://doi.org/10.1080/10428194.2021.1929962

Koolivand, Z. et al. (2025). Inducing apoptosis in acute myeloid leukemia; mechanisms and limitations. 
Heliyon. 11.
 Retrieved from: 
https://doi.org/10.1016/j.heliyon.2024.e41355
Links to an external site.

Kurzer, J. & Weinberg, O. (2023). Updates in molecular genetics of acute myeloid leukemia. 
Seminars in Diagnostic Pathology. 40
(3). Retrieved from: 
http://doi.org/10.1053/j.semdp.2023.01.002
Links to an external site.

 

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)

Acute Myelogenous Leukemia

Genetic mutations disrupt normal gene processes due to multiple factors. One will examine specific symptoms, pathophysiological mechanisms, and laboratory results of genetic mutations in acute myelogenous leukemia.

Patient X

A 45-year-old male was recently diagnosed with
acute myelogenous leukemia (AML)
. The patient’s symptoms, frequent nosebleeds, bruising, and fatigue, represent a dysfunction of the bone marrow’s production and maturation of myeloid cells. The laboratory results confirm the states of cytopenias (e.g., anemia, infections, and/or bleeding or bruising), which may also be associated with abnormal values like metabolic abnormalities, thrombocytopenia, and leukocytosis (Schiffer & Gurbuxani, 2023). One will further investigate the genetic mutation of AML.

Genetic Mutation

Hu, Yang, Li, and Hu (2024) expressed that the instability of haematopoietic stem/progenitor cells by stem cell mutations can hinder the differentiation of the bone marrow. Usually, these differentials are classified as blast cells and can be further categorized by precursors (Rogers, 2022). Specific cellular alterations like mutations of the nucleophosmin 1 (NPM1) gene represent the most frequent molecular alteration in acute myelogenous leukemia (AML), especially in patient’s with AML who have a normal karyotype (Kongta, Panyasit, Jansaento, & Duangmano, 2022). Now, one will discuss the presentation of symptoms.

Presentation of Symptoms and Laboratory Results

Common symptoms of AML are due to the clonal expansion of immature “blast cells,” which results in the inefficient circulation of erythropoiesis (Debnath & Nath, 2024). Unfortunately, the body can not maintain homeostasis because of the accumulation of leukemia-stimulating cells. One will notice that the patient’s lab results reflect a cellular quiescence, resulting in uneven distribution of cells, decreased WBC, red blood cells, increased mean platelet volume, and corpuscular hemoglobin.

Pathophysiological Mechanisms

Acute myeloid leukemia involves an acquired somatic mutation and epigenetic changes in the bone marrow microenvironment (Schiffer & Gurbuxani, 2023). The process incorporates the mutation of cellular regulation, proliferation, differentiation, and survival by altering gene encodes, rewriting transcription and signaling pathways of proteins, and changing cell cycles (growth and apoptosis). AML is a complex disease that causes myeloid blast corruption, which makes treatment difficult.

Conclusion

Genetic mutations disrupt the normal functions and pathways of the cellular process. Acute myeloid leukemia results in multiple disorders that contribute to the immature production of circulating cells.

 

Reference
s

Debnath, A., & Nath, S. (2024). Prognosis and treatment in acute myeloid leukemia: a comprehensive review. 
Egyptian Journal of Medical Human Genetics
, 
25
(1), 1–15. 
https://doi.org/10.1186/s43042-024-00563-w
Links to an external site.

Hu Z, Yang Y, Li J, & Hu Z. (2024). Genetic mutations and immune microenvironment: unveiling the connection to AML prognosis. 
Hematology (Amsterdam, Netherlands)
, 
29
(1), 2346965. 
https://doi.org/10.1080/16078454.2024.2346965
Links to an external site.

Kongta, R., Panyasit, N., Jansaento, W., & Duangmano, S. (2022). Development of E-ice-COLD-PCR assay combined with HRM analysis for Nucleophosmin1 gene mutation detection in acute myelogenous leukemia. 
PLoS ONE
, 
17
(9), 1–15. 
https://doi.org/10.1371/journal.pone.0274034
Links to an external site.

Rogers, J. (2022). 
McCance & Huether’s Pathophysiology
 (9th ed.). Elsevier Health Sciences (US). 
https://mbsdirect.vitalsource.com/books/9780323789899
Links to an external site.

Schiffer, C. A., & Gurbuxani, S. (2023, December 19). Acute Myeloid Leukemia:  Classification. (R. A. Larson & A. G. Rosmarin, Eds.). Retrieved February 26, 2025,.

 

 

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)

AML Description
 

AML is characterized by the clonal proliferation of undifferentiated myeloid precursors, known as blasts, within the bone marrow compartment (Vakiti, et al., 2024). This disease can be genetic in nature or acquired due to changes in a person’s genetic structure caused by various environmental factors, smoking, radiation, therapy, and being immunocompromised.
 

Genetic Mutations Associated with Disease
 

Genetic abnormalities that characterize favorable risk disease include chromosomal translocations t(8;21)(q22;q22.1) or inv(16)(p13.1q22). Patients who lack FLT3-ITD (internal tandem duplication) mutations without mutated NPM1 or with CEBPA (bZIP in-frame) mutations are also categorized as favorable risk (Vakiti, et al., 2024).
 

Why is Patient Presenting with Specific Symptoms Described
 

Fatigue can be caused by anemia due to a low red blood cell count. There are not enough red blood cells to assist in carrying oxygen throughout the body, therefore causing fatigue. Platelets are not being formed due to the stem cells lack of differentiation thus causing frequent nose bleeds and bruising. 
Platelets maintain hemostasis by adhering to the vascular endothelium, aggregating with other platelets, and initiating the coagulation cascade, leading to the production of a fibrin mesh, which effectively prevents significant blood loss (Fountain, et al., 2023)
 

Pathophysiological Mechanisms of Disease
 

Transcription factor mutations (e.g., CEBPA) prevent normal myeloid cell maturation, causing an accumulation of undifferentiated blasts (Döhner et al., 2022). Leukemic blasts overpopulate the bone marrow, suppressing normal hematopoiesis and leading to anemia, neutropenia, and thrombocytopenia.
 

Blood Test  Results and Disease Progression
 

This person’s white blood cell count is low, possibly due to bone marrow suppression does putting this person at risk for infectio . Additionally, the red blood cell count and hemoglobin is low, causing anemia. The platelet count is also low, thus causing thrombocytopenia. The disease progression is aggressive, due to risk for infection, anemia, and bleeding.
 

References
 

Döhner, H., Weisdorf, D. J., & Bloomfield, C. D. (2022). Acute myeloid leukemia. The New England Journal of Medicine, 386(12), 1082-1094. 
https://doi.org/10.1056/NEJMra2200579
Links to an external site.
 

Fountain, J. H., & Lappin, S. L. (2023). Physiology, platelet. In StatPearls. StatPearls Publishing. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK470328/
Links to an external site.
 

Vakiti, A., Reynolds, S. B., & Mewawalla, P. (2024). Acute myeloid leukemia. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507875/
 

CASE: A 45-year-old male presents to the clinic with fatigue, unexplained bruising, and frequent nosebleeds. Blood tests reveal leukocytosis, anemia, and thrombocytopenia. A bone marrow biopsy confirms the diagnosis of acute myelogenous leukemia (AML)