As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.
Consider the following scenarios:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.
�Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
�Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
�Review the “Mind Maps;Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
Write a 2- to 3-page paper that addresses the following:
�Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
�Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
Jennifer in this scenario is suffering from tonsillitis. This is an infection that results into inflammation of the tonsils that are two pads of tissue that are oval in shape and are at the back of the throat. Most tonsillitis cases are virus related (Haemophilus influenza), but the common causes of tonsillitis are bacterial (Streptococcus pyRogenes and Group A, Staphylococcus aureus) and this represents Jennifer’s case. Tonsillitis is common among preschool to mid-teenage years, and the signs and symptoms are sore throat, headache, enlarged tonsils, foul breath due to pus or the white, yellow streaks on the tonsils, scarlet fever (rash beginning on the trunk), and swollen neck lymph nodes. Otitis media (ear infection) abscess on the tonsils (quinsy) (Luxner, 2005).
Tonsils have the same composition as adenoids as they are all made of tissues similar to lymph nodes and lymph glands. Acute infection is due to one of the viral and bacterial pathogens and the chronic form of the disease results into a persistent infection and may lead to the formation of tonsil stones (Luxner, 2005). The greatest concern regarding tonsils is the airway obstruction that they can cause and requires immediate attention if it affects breathing or if the patient is unable to swallow liquids or saliva voluntarily. The appropriate treatment of tonsillitis depends is dependent on the causative agent; therefore, it is essential to get a prompt and accurate diagnosis. The adaptive response for the mom here was giving Jennifer Ibuprofen to deal with the fever (Luxner, 2005).
Jack In scenario 2 is suffering from eczema and more specifically hand dermatitis. Hand dermatitis or hand eczema arises from a myriad of causes that include the constitutional factors in genetics, injury (contact with irritants), and allergy (Golden & Shaw, 2013). Hand dermatitis is often caused by work (occupational dermatitis) and particularly common in industries involving cleaning catering, metalwork, health care, hairdressing, and mechanical work. The condition varies in severity and may affect different part of the hand the back, palm, or both sites (Golden & Shaw, 2013).
Hand dermatitis diagnosis relies more on physical examination and the history of the patient rather laboratory testing. It presents with several varying degrees of pruritic and tender erythematous. Papules and plaques become scaly and crusty hence are ill defined and sharply demarcated with vesicles and bullae sometimes mixing with plaques or are morphological (Golden & Shaw, 2013).
Hand eczema of starts as mild complain that is usually intermittent. The affected area of the skin initially become red and dry and then develops to itchy papules that are in from of bumps, followed by blisters that are filled with fluids, scaling, exudation, and later edema. If the dermatitis becomes long standing may lead to deformed fingers nails especially if located at the ends of the fingers. The condition can spread to other sites in particular the forearms and feet (Golden & Shaw, 2013).
The dermatitis here (irritant contact dermatitis)( is due to the repeated contact with mechanical and chemical irritants that lead to the release of cytokines, decreases surface lipids, and denatures the keratin producing cells that result into decreased barrier functioning and a decrease epidermal water content. The adaptive response for Jack was to wash his hands to prevent irritant contact (Golden & Shaw, 2013).
Martha is scenario 3 is suffering from caregiver burnout. This is a condition that emaciates from long-term accumulated stress. The condition occurs when one is feeling overwhelmed and unable to meet the daily demands that are constant. As the stress builds up one looses interest and motivation that pushed the individual to undertake the role at hand in the first place. The emotional and psychological overload is what affects the individual (caregiver) as many caregivers do not have time for themselves and begin to show signs of caregiver “burnout.” The caregiver’s health, mind body, and spirit benefit the loved one; however, she does nothing that benefits him or herself (American Heart Association, 2012).
The caregiver experiences a lot of stress, and it is common for caregivers to let their health suffer for the sake of others. Therefore, the common symptoms here include excessive alcohol use, use of medications or sleeping pills, changes in appetite, depression, hopelessness, feelings of alienation, lack of energy to do things, losing physical and emotional control, and neglect or treat the person being taken care of roughly. He caregiver also has trouble sleeping, and difficulty in concentration and missing appointments. Martha’s adapts to the alterations in her health and lifestyle by agreeing that although it was not the retirement she had planned for. However, as she is the only child she is happy to see her mom wake up early in the morning, take a birth and eats small meals throughout the day (American Heart Association, 2012).
|Clinical Presentation Excessive alcohol useUse of medications or sleeping pillsChanges in appetiteDepressionHopelessnessFeeling of alienationLack of emotional control difficulty in concentrating|
|Risk Factors IsolationGenderDuration of caregivingFinancial stressAge of care giver Age of care recipient|
|Epidemiology Common among caregiver in hospital andhospice settings.Common among palliative caregivers|
|Cause Accumulation of long term stress.|
American Heart Association. (2012). What Is Caregiver Burnout? Answers by Heart: Life and Risk Reduction, 1-2.
Golden, S., & Shaw, T. (2013). Hand Dermatitis: Review of Clinical Features and Treatment Options. Seminars in Cutaneous Medicine and Surgery, 147-157.
Luxner, K. L. (2005). Delmar’s Pediatric Nursing Care Plans. Cengage Learning.