Herzing NU 621 Advanced Pathophysiology Latest

Discussion Question

Read the following case study and answer the posed questions:

Case #1:

History: A 65 year old housewife complains of progressive weight gain of 40 pounds in 1 year, fatigue, dizziness, sluggish memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.

Physical examination: Vital signs: temperature 96.4^oF, pulse 68/minute and regular, BP 108/60, weight 170 lbs, height 5 feet, puffy face, pale, cool, dry skin. The thyroid gland is not palpable, deep tendon reflex time is delayed.

Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.4 ug/dl (N=4.5-12.5), the serum TSH is .9 uU/ml (N=0.2-3.5), and the serum cholesterol is 275 mg/dl (N<200).

1. What is the likely diagnosis and what symptoms made you consider that diagnosis?
2. Which lab data supported the diagnosis?
3. Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship.

Case #2:

J.R. is a 58-year old man who presented with a 6-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed on day of his visit and was 359 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough or fevers. He had no prior history of diabetes and no family history of diabetes.

Admission non-fasting serum glucose 268 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN and creatinine were normal. Physical examination revealed weight of 190 pounds, height 5’6.5″ . The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy.

1. What are the mechanisms of blurred vision which was part of his initial symptoms?
2. Are there correlations between his abnormal blood chemistries and his other symptoms?
3. Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient.

Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Discussion Question

Read the following case study and answer the posed questions

Case #1:  A 64-year-old man presents to the emergency department (Links to an external site.) with abdominal pain and distention, as well as constipation of 8 days’ duration. He denies vomiting, fever, diarrhea, or dysuria. Except for hypertension, he is otherwise healthy with no prior surgeries.

His vital signs are normal except for a borderline pulse of 99 bpm. His physical examination is unremarkable except for his abdomen, which is large, rotund, and tympanitic. There is diffuse tenderness everywhere in the abdomen.

1. What history would you want to obtain?
2. What differential diagnoses would you consider?
3. List and describe the specific diagnostic tests you might order to determine cause of his concern?

Case #2:

Kyle is a 58-year-old man who is experiencing lower abdominal discomfort nausea and diarrhea lasting 2 days. He thought he had eaten something that “disturbed his stomach” but since this has lasted so long, he is afraid it’s something serious.

1. As you obtain a history from this patient what differential diagnoses are you considering. Give rational for your choices.
2. Discuss the pathophysiologic relationship between nausea and vomiting?

Three days after Kyle’s initial visit his labs confirmed a diagnosis of cirrhosis.

3. Discuss the pathophysiologic relationship between cirrhosis and portal hypertension.

Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position and suggestions.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Discussion Question

Read the following case study and answer the posed questions

Case #1: 49-year-female assembly worker at automotive manufacturer presents to your clinic complaining of increasing back pain over the last week. Back pain is in the central low back region and radiates into both gluteal regions – no leg pain. Has been off work for the last 6 months with no improvement in pain.

1. Create a list of possible differential diagnoses?
2. Discuss the evidence you would need to obtain to rule in or rule out each differential?
3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?

Case #2:A 65-year-old Caucasian female has a follow-up appointment with a family orthopedist after visiting the emergency department for a wrist fracture. The orthopedist then turns her case over to you to schedule a bone mineral density (BMD) testing. Results of the BMD test show a T-score of 3.0, indicating osteoporosis. Her past medical history includes mild hypertension which is currently managed with propranolol. She also takes a daily multivitamin. She drinks and smokes occasionally and she has no children or spouse.

1. What is the difference between degenerative bone disease and osteoporosis? Explain the pathology of each.
2. What treatment options should be discussed with the patient?
3. What lifestyle changes should be recommended to the patient?

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Discussion Question

Read the following case study and answer the posed questions

Case #1: For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are characterized by an intense burning pain on one side of his head, accompanied by tearing in his eye and a runny nose. When they strike, the attacks typically occur several times a day and usually last about an hour. James can be headache free for months at a time, but the attacks always return.

1. Describe the pathology of a headache.
2. Based on the different etiologies for headaches which of those fit this patients situation?
3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
4. Based on the history provided and using the following diagnostic tool https://headaches.org/resources/the-complete-headache-chart/ (Links to an external site.) as a quick reference of the guideline, you diagnose migraine without aura. List the evidence that supports your diagnosis.

Case #2: Mr. Smith is a new patient with a history of recent stroke approximately 3 months ago.  He was hospitalized in another state, but you don’t have his records now. The patient’s wife is extremely anxious and worried about him because he hasn’t been “acting right”.  She wants him checked out.  She does not think he had hypertension but adds “he does not like to go to doctors.”

1. Regarding the patient’s available history, create a detailed plan of care for this patient.
2. In recognition of the morbidity of recurrent brain ischemia, the evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or TIA can be found in the current AHA/ASA Recommendations for Antithrombotic Therapy for Noncardioembolic Stroke or TIA https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000024 (Links to an external site.). Based on these current guidelines what goals would you recommend for this patient to insure prevention of another brain ischemic event?

Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Please review the rubric to ensure that your response meets the criteria.