NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

Sample Answer for NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes Included After Question

NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

NR 507 Week 2 Discussion 1 Respiratory Disorders and Alterations in Acid Base Balance, Fluid and Electrolytes

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A five-month-old Caucasian female is brought into the clinic as the parent indicates that she has been having ongoing foul-smelling, greasy diarrhea. She seems to be small for her age and a bit sickly but, her parent’s state that she has a huge appetite. Upon examination you find that the patient is wheezing and you observe her coughing. After an extensive physical exam and work-up, the patient is diagnosed with cystic fibrosis.

What is the etiology of cystic fibrosis?
Describe in detail the pathophysiological process of cystic fibrosis.
Identify hallmark signs identified from the physical exam and symptoms.
Describe the pathophysiology of complications of cystic fibrosis.
What teaching related to her diagnosis would you provide the parents?

A Sample Answer For the Assignment: NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

Title: NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

In addition to the textbook, utilize at least one peer-reviewed, evidence based resource to develop your post.

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Jul 16, 2018Jul 16 at 1:24pm

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Dr. Arredondo and class,

What is the etiology of cystic fibrosis?

This topic is of great interest to me because of this subject that I will be doing my presentation on, so I did a detailed search. The peer review article revealed that according to Munder& Tummler (2015), cystic fibrosis lung disease result from impaired chloride and bicarbonate epithelial transport, defective mucociliary transport, and acidification of the airway-surface liquid. In many ways, the pathophysiological process differs according to the different evidenced-based practice. “The pathophysiology of cystic fibrosis is deduced from the loss or dysfunction of CFTR in the apical epithelial membrane” Stoltz, (2015). The contributing factor is an attenuated bacteria-killing capability has reported in monocytes and macrophages isolated from people with cystic fibrosis.

The response to the peer review is” We agree with Munder and Tümmler that abnormal function in myeloid cells (i.e., neutrophils, monocytes, or macrophages) may contribute to impaired host defense in cystic fibrosis.” Stoltz, 2015. The article contains other pertinent information to describe the depth of this disease. “Specific cell types involved (monocytes, neutrophils, or macrophages) and proposed mechanisms for defects (e.g., organelle acidification, complement-mediated phagocytosis, and intraphagosomal production of hypochlorous acid) vary substantially among studies.” Stoltz (2015).

Describe in detail the pathophysiological process of cystic fibrosis.

Cystic fibrosis is the abnormal secretions that obstruct the respiratory, digestive, and reproductive tract. According to (McCance et al., 2013) research shows that there may be additional CF-associated primary defects, such as a natural proinflammatory state and abnormal local immune defenses in the lungs. “Cystic fibrosis is also associated with cystic fibrosis transmembrane conductance regulator (CFTCR) gene mutation results in the abnormal expression of cystic fibrosis transmembrane conductance regulator (CFTCR) protein, which is a cyclic adenosine monophosphate (cAMP)–activated chloride channel present on the surface of many types of epithelial cells.” (McCance et al., 2013). These cells include the lining of the airways, bile ducts, the pancreas, sweat glands, and the vas deferens. Even though cystic fibrosis affects multisystem it ultimately most often affects the lung, which is the most critical site of involvement that leads to respiratory failure and death.

Identify hallmark signs identified from the physical exam and symptoms.

Cystic fibrosis often occurs primarily in the white population; it affects 1 in 29 whites in the united states. The symptoms typically start with the respiratory and digestive systems. Respiratory symptoms include a persistent cough or wheeze, sputum production, and recurrent or severe pneumonia, and chronic sinusitis and nasal polyps. “Persistence of infection incites chronic local inflammation, airway damage, bronchiectasis, microabscess formation, and foci of hemorrhagic pneumonia.

Describe the pathophysiology of complications of cystic fibrosis.

There is progressive damage to the typical architecture of the lung with a decline in pulmonary function.” (McCance et al., 2013. CF causes reduced hydration of airway mucus which results in increased adherence of mucus to the epithelium, making it easier for bacteria to stick to and increasing the chances of infection (McCance et al., 2013)

What teaching related to her diagnosis would you provide the parents?

Due to the severity of the disease, it will be overwhelming and devastating to the parents, as an advanced clinical nurse I will provide them with all the information and videos available. I would also refer them to join a group of parents with children of a similar diagnosis. Advising the patient to prevent infection, adequate nutrition, and an increase in caloric intake is the primary goal to maintain a healthy lifestyle. Lastly, I would provide them with my information for them to call with any further questions.

Ingrid

References: NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

Antje Munder, M.D. Burkhard Tümmler, M.D., Ph.D.
Hanover Medical School, Hannover, Germany (2015)
[email protected]

David A. Stoltz, M.D., Ph.D. David K. Meyerholz, D.V.M., Ph.D.
Michael J. Welsh, M.D.
University of Iowa Carver College of Medicine, Iowa City, IA (2015)

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.

Jul 21, 2018Jul 21 at 11:34am

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Hi Ingrid,

Your post on cystic fibrosis (CF) is very informative. Your post explains the etiology, pathophysiology, and symptoms of cystic fibrosis in detail. I think we should also look to studying EBP nursing care plans to better assist our patients diagnosed with cystic fibrosis. Living with cystic fibrosis comes with many medical, social, and financial challenges for patients, their caretakers, and family members. Having a productive and fulfilling life with cystic fibrosis is possible, as long as patients are educated about how to cope with the condition. The Cystic Fibrosis Foundation (2018) outlines four areas they would like CF patients to focus on so they can live a their best lives: daily life, treatments and therapies, transitions, and CF resources. The Adult Guide to Cystic Fibrosis is a resource that helps adults with CF manage their lives, as adults with CF outnumber children with the disease. This guide discusses and makes recommendations for basic lung care, menopause, having a social life, birth control, pregnancy, exercise, traveling, having a career, and more. FNPs should also study this guide in order to create individual care plans for their CF patients.

Griesenbach and Alton (2015) mention that several therapies have progressed including amongst novel antibiotics (inhaled tobramycin and macrolides) and novel mucolytics (dornase alpha–a recombinant DNase) and hypertonic saline that have been approved through clinical trials and offered as mainstream treatment. New CF drug developments have progressed to CFTR correctors to treat classes I-III mutations (Griesenbach and Alton, 2015). Our understanding of cystic fibrosis pathophysiology and genetics has expanded tremendously and has led to vast improvements for patients. Griesenbach and Alton (2015) note the recent licensing of ivacaftor, a drug targeting the molecular defect in the CFTR protein in approximately 5 percent of cystic fibrosis patients, is one of the current treatments making a difference in treatment efforts.

References: NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

Griesenbach, U., & Alton, E. W. F. W. (2015). Recent advances in understanding and managing cystic fibrosis transmembrane conductance regulator dysfunction. F1000Prime Reports, 7, 64. http://doi.org/10.12703/P7-64

National Cystic Fibrosis Foundation. (2018). Adult Guide to Cystic Fibrosis. Retrieved from

https://www.cff.org/Life-With-CF/Daily-Life/Adult-Guide-to-CF.pdf

Jul 21, 2018Jul 21 at 5:57pm

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Hi Ingrid,

I love your idea of a support group as I have worked in Hospice and was a Director of Nursing in Hospice. Support groups really help as caregivers can share much information and strategies that worked best for them as well as coping skills. I also think that one loses a loved one, the bond from that group becomes even stronger as they reach out to one another. I believe in the spiritual component as well as the holistic care of patient, families, and the community. There is a link and hope that comes about. I have seen those that have lost family members, especially children and through the connection of the group, have gained strength to which they help others with similar conditions. Also, education is a key factor. Evidence-based research is important but I also believe that people have to be on the same page with goals. If a patient has different goals, one can lead a horse to water but you cannot make them drink. I have seen this over and over again while doing EMS and Home Nursing. When I meet the patients while doing home-nursing, I ask them what goal do they have and do they have an emergency plan. This helps me as a clinician to see what they want and if their goal is realistic. It also helps me to develop a plan that is patient focused and addresses their wants and needs but also is realistic placing safety first. I really enjoyed your informative post.

Jul 22, 2018Jul 22 at 10:03am

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Hello Ingrid,

As I read your discussion I noted the management of CF I think a multisystem approach is imperative because there are so many other systems and complications that go along with CF such as Pulmonary, Chronic infection, Bronchiectasis, Pneumothorax, Oxygen

dependence Gastro-intestinal disease, Constipation and obstruction, Nutritional difficulties, Liver and gallbladder disease, Reflux and decreased motility. Then there is the Psycho-social aspect of Depression, Anxiety, Adjustment disorders, Substance abuse and addiction, Relationship problems, Work-related difficulties Treatment issues, Treatment burden, Compliance, Phobias (e.g., needle phobia). Other related conditions, CF-related diabetes, Osteoporosis, Male infertility all related to having CF(Nazareth & Walshaw, 2013). Although continuously evolving, the process should be multi-factorial, coordinated, and gradual; it should involve professional caregivers, the young person, and their family. With the multi-system complications due to CF comes a multi-disciplinary approach to the patient. With a good team of doctors and nurses, CF can help the patient live a healthy life as much as possible.

Reference NR 507 Week 2 Discussion 1: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes

Nazareth, D., & Walshaw, M. (2013). Coming of age in cystic fibrosis – transition from pediatric to adult care. Clinical Medicine (London, England), 13(5), 482-486. doi:10.7861/clinmedicine.13-5-482

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