Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question:

Which cholesterol is considered the “good” cholesterol and what does it do?

 

 

 

 

 

 

Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question:

1.How does inflammation contribute to the development of atherosclerosis?

QUESTION 3

1. Scenario 2: Pleural Friction Rub

A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question:

1.Because of the result of a pleural friction rub, what does the APRN recognize?

QUESTION 4

1. Scenario 4: Deep Venous Thrombosis (DVT)

A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question:

1.Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)

 

 

 

 

 

 

 

 

Scenario 5: COPD

A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. He asks if this means he has chronic obstructive pulmonary disease (COPD).

Question:

1.There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.

 

Questions for week 3

1. Which cholesterol is considered the "good" cholesterol, and what does it do?

High-Density cholesterol Lipid (HDL) is regarded as beneficial due to its capacity to facilitate arterial cholesterol excretion. HDL eliminates dangerous bad cholesterol from the blood vessels and is released into the liver when it travels through the bloodstream. Moreover, HDL possesses antioxidants, antimicrobial and anti-inflammatory capabilities ("LDL and HDL Cholesterol: "Bad" and "Good" Cholesterol," 2021). HDL has just recently been discovered to be able to both attenuate and exacerbate inflammation during atherogenesis. HDL's anti-inflammatory capabilities include regulating cytokine production, adjusting monocyte adhesion, minimizing lipid peroxidation, and modifying other features of endothelial functionality. In addition, greater HDL cholesterol concentrations are connected with a decreased risk of cardiovascular illness than other cholesterol, whereas low concentrations augment the likelihood.

2. How does inflammation contribute to the development of atherosclerosis?

Previously thought to be a simple lipid storage illness, atherosclerosis is essentially a chronic inflammatory response. Recent breakthroughs in basic research have revealed that inflammation plays a critical role in modulating all stages of atherosclerosis, from onset to progression and, eventually, thrombotic consequences  ("Inflammation and Atherosclerosis," 2021). In addition, these scientific discoveries establish crucial connections between risk variables and atherogenesis processes. Clinical investigations demonstrate that this new inflammatory biology is directly applicable to human patients during atherosclerosis. Increasing inflammatory indicators predict the results in myocardial damage independently from the results of individuals with acute coronary syndrome. As demonstrated by C-reactive protein levels, more negligible levels of chronic inflammation retrospectively characterize the risk of atherosclerosis problems and, therefore, contribute to the prognosis of conventional risk variables.

3. Because of the result of a pleural friction rub, what does the APRN recognize?

An adventitious breath sound is detected from a pleural friction rub during lung auscultation. Swollen and coarse-textured pleural surfaces grind against one another when the chest wall moves, generating the pleural rub sound. The sound is non-musical and is characterized as grinding or squeaky noises, and they are best characterized as the sound of stomping on freshly fallen snow. Any of the following conditions can cause a pleural friction rub: pleuritis, pleural effusion, or serositis ("Quiz Questions | Pathophysiology Case Study: Pericarditis," 2021). Depending on their discomfort, patients may be able to specify the location of the rub. A pleural friction rub indicates pleural conditions such as chronic bronchitis, lung embolism, and lung inflammation. However, the absence of these illnesses does not rule out this disorder. In this situation, the APRN acknowledges that there is a severe state of pulmonary friction resulting from the existence of pericarditis heart disease.

4. Given the history of the patient, explain what contributed to the development of a deep venous thrombosis (DVT)

DVT is a disorder in which a blood clot is most commonly detected in the legs in either one of the body's major veins. The primary causes of DVT include surgical or physical injuries to the vein and swelling caused by infections or trauma ("Deep vein thrombosis - Symptoms and causes," 2021). DVT can trigger leg soreness and edema; however,  sometimes, it can go undetected. As a result, in this case, since the woman had undergone a left total hip replacement, one of her deep veins might have been ruptured during the procedure. Moreover, her health may have deteriorated since her physical therapy could not be carried out.

5. There is a clear relationship between emphysema and COPD. Explain the pathophysiology of emphysema and its relationship to COPD.

Emphysema is a disorder characterized by a persistent enlargement of the airways beyond the distal bronchial tubes. Emphysema pathophysiology is defined by a significant decrease in the alveolar surface area. Airflow is limited by two mechanisms when alveoli are destroyed. The first process occurs when alveolar walls are eroded, resulting in a diminution of elastic recoil, inhibiting airflow. The second process is that when the alveolar walls that underpin the structure deteriorate, the airway narrows, further limiting airflow. Emphysema is related to COPD since it involves the breakdown of the air sacs and the membranes connecting them, prompting more air than usual to be trapped in the alveoli in the lungs; thus, causing the lungs to be distended ("Chronic Obstructive Pulmonary Disease (COPD) and Emphysema | Columbia University Department of Surgery," 2021). Excess air in the lungs necessitates more effort to breathe, resulting in breathlessness, as shown in the patient in this scenario.

Outline

Title: Questions for week 3

1. Question One

1. An in-depth description of good cholesterol, also known as High-Density cholesterol Lipid (HDL)

1. The function of HDL in the body

2. Question Two

1. Brief background information about inflammation

1. Role of inflammation in the development of atherosclerosis

3. Question Two

1. Brief description of a pleural friction rub

1. What an APRN can deduce from its diagnosis

4. Question Four

1. A brief definition of deep venous thrombosis (DVT)

1. How the subject developed DVT

5. Question Five

1. A detailed description of the pathophysiology of emphysema

1. Emphysema and its relationship to COPD