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You will assess patients with a variety of diseases as an advanced practice nurse.
You must therefore understand how the body regularly works in order to recognize when it is reacting to changes.
When changes occur in biological systems, the body frequently responds with compensation mechanisms.
These compensating processes, such as adaptive reactions, could be indications of changes or underlying illnesses.
In the clinical setting, these responses, together with other patient variables, are used to help you make a diagnosis.
Consider the following examples:
Jennifer, a 2-year-old girl, arrives with her mother.
Jennifer has been “running a temperature” for the last three days, which worries Mom.
Jennifer, according to her mother, is generally healthy and has no serious medical history.
She was in her typical good health until three days ago, when she became cranky, refused to eat her breakfast, and refused to sit still for her favorite television cartoon.
She has had a fever on and off since then, ranging from 101oF to today’s high of 103.2oF.
Mom has been giving her ibuprofen, but when her fever reached 103.2oF today, she thought she needed to be evaluated.
A physical examination reveals a 2-year-old female of proper height and weight who appears critically ill.
Her skin is scorchingly hot and parched.
The tympanic membranes are slightly reddish along the edges, but otherwise appear normal.
The throat is erythematous, and there are 4 or more tonsils and widespread exudates.
On the left side, the anterior cervical nodes are easily perceptible and visibly painful to touch.
The youngster expresses that her throat hurts “a lot” and that swallowing is hard.
A temperature of 102.8oF, a pulse rate of 128 beats per minute, and a respiratory rate of 24 beats per minute are shown by vital signs.
Scenario number two:
Jack, a 27-year-old man, complains of hand redness and irritation.
He claims to have never had a problem like this before, but around two weeks ago he noticed that both of his hands were quite red and flaky.
He denies any discomfort, claiming that they are occasionally “a little bit hot,” but generally they are great.
He has no idea why they are so red.
His wife suggested that he acquire some steroid cream because he might have an allergy.
Except for recurring ear infections as a child, Jack has no known allergies or significant medical history.
He denies any severe injuries or known irritant exposure.
He works as a maintenance engineer in a newspaper building and admits to working with abrasive solvents and chemicals on a regular basis.
Normally, he uses safety gloves, but they appear to be in short supply lately, so he sometimes does not use them.
He has been exposed to some of these cleaning fluids, but says it never hurt and that he always washed his hands afterward.
Martha, a 65-year-old woman, recently retired from her position as an administrative assistant at a nearby hospital.
Her medical history is notable for hypertension, which she has been managing for years using hydrochlorothiazide.
She reports that she has been having a lot of difficulties sleeping lately, that she has a “racing heartbeat,” and that she is losing her appetite.
She adds that she is not as hungry as she formerly was.
Her 87-year-old mother moved into her home a few years ago, which was the only substantial shift in her life recently.
Mom had always been in good health until she tripped down a flight of stairs and shattered her hip.
Her recuperation was challenging because she has lost a lot of movement and independence and must rely on her daughter for help with everyday duties.
Martha admits that it is not the retirement she had hoped for, but as an only child, she is content to care for her mother.
Mom gets up early in the morning, bathes every day, and has always eaten five little meals per day.
Martha has to devote a significant amount of time to care for her mother, so the fact that she is sleeping and eating less is almost a “bonus.”
She is concerned about her own health, however, and wonders why, at her age, she suddenly requires less sleep.
To Get Ready
Examine the three scenarios, as well as Chapter 6 of Huether and McCance’s book.
Determine the pathophysiology of the ailments depicted in the scenarios, as well as the accompanying modifications.
Consider the adaptive reactions to the changes.
In this week’s Learning Resources, look at the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media.
Then, from the situations, choose one of the illnesses you recognized.
Make a mind map for the disorder you’ve chosen using the examples in the media as a guide.
Consider the disorder’s epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis, as well as any adaptive reactions to changes.
Write a 2- to 3-page paper addressing the following topics:
Explain the pathophysiology of the ailments illustrated in the situations, as well as the changes that occur as a result of them.
Make careful to describe the patients’ adaptive reactions to the changes.
Create a mind map of your chosen disorder.
Include the disorder’s history, pathophysiology, risk factors, clinical presentation, and diagnosis, as well as any adaptive reactions to changes.
NB:In addition, the 2-3 page paper assignment should include the pathophysiology of the three conditions illustrated in the scenarios, followed by a selection of one disorder for which you must create a mind map.
A rubric should be attached to the end of the paper.
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