Sample Answer for NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK Included After Question
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
- myocardial infarction
- endocarditis
- myocarditis
- valvular disorders
- lipid panels
- coagulation
- clotting cascade
- deep vein thrombosis
- hypertension
- heart failure
- COPD
- asthma
- pneumonias
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
BY DAY 7 OF WEEK 3
Complete the Knowledge Check by Day 7.
Attempt History
| Attempt | Time | Score | |
| LATEST | Attempt 1 | 2,086 minutes | 20 out of 20 |
Score for this quiz: 20 out of 20
Submitted Dec 13, 2022 at 11:46pm
This attempt took 2,086 minutes.
A Sample Answer For the Assignment: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Title: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Question 1
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?
Your Answer:
The scenario is of a 56-year-old Caucasian male client diagnosed with an acute inferior wall myocardial infarction. He presented with progressive severe chest pain radiating to the left arm, chest heaviness, and shortness of breath. There is no history of similar presentations in the past. The chest pain was partially relieved by sublingual nitroglycerin. A lipid profile showed deranged findings consistent with dyslipidemia. These included elevated total cholesterol, increased low-density lipoprotein, high triglycerides, increased very low density lipoprotein, and reduced high density lipoprotein levels (Hedayatnia et al., 2020). Dyslipidemia is a known risk factor for myocardial infarction, and other cardiovascular diseases such as coronary artery disease, angina, and cerebrovascular disorders (Hedayatnia et al., 2020). This may be the predisposing factor to the patient’s myocardial infarction through underlying atherosclerosis.
Cholesterol level is a predictors of the risk of cardiovascular diseases. High-density lipoprotein is considered good cholesterol with various beneficial protective roles. These include the removal of excess cholesterol from peripheral vasculature through reverse transport to the liver, antioxidative, anti-inflammatory, vasodilatory, antithrombotic, and cytoprotective anti-apoptotic roles (Cosmas et al., 2018). It prevents the oxidation of low-density lipoproteins with consequent production of pro-inflammatory oxidized lipids. The vasodilatory role is achieved through increased expression and activation of endothelial nitric oxide synthase which increases levels of nitric oxide. Antithrombosis results from the reduction of thrombin production and inhibition of platelet activation. It is important to restore high-density lipoprotein functionality and levels to minimize cardiovascular disease risk (Jormad et al., 2020). These is through interventions such as regular exercises, a healthy low-lipid diet, bariatric surgery, and HDL-tailored therapies.
References
Hedayatnia, M., Asadi, Z., Zare-Feyzabadi, R., Yaghooti-Khorasani, M., Ghazizadeh, H., Ghaffarian-Zirak, R., Nosrati-Tirkani, A., Mohammadi-Bajgiran, M., Rohban, M., Sadabadi, F., Rahimi, H.-R., Ghalandari, M., Ghaffari, M.-S., Yousefi, A., Pouresmaeili, E., Besharatlou, M.-R., Moohebati, M., Ferns, G. A., Esmaily, H., & Ghayour-Mobarhan, M. (2020). Dyslipidemia and cardiovascular disease risk among the Mashad study population. Lipids in Health and Disease, 19(1). https://doi.org/10.1186/s12944-020-01204-y
Jomard, A., & Osto, E. (2020). High-density lipoproteins: Metabolism, function, and therapeutic potential. Frontiers in Cardiovascular Medicine, 7. https://doi.org/10.3389/fcvm.2020.00039
Kosmas, C. E., Martinez, I., Sourlas, A., Bouza, K. V., Campos, F. N., Torres, V., Montan, P. D., & Guzman, E. (2018). High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs in Context, 7, 1–9. https://doi.org/10.7573/dic.212525
A Sample Answer 2 For the Assignment: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Title: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Question 2
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?
Myocardial Infarction
A 56-year-old Caucasian male presented with retrosternal chest pain radiating to the left arm, chest tightness, and dyspnea. The pain was slightly relieved by sublingual nitroglycerin with no known exacerbating factors. A lipid panel showed high LDL, total cholesterol, VLDL, triglycerides, and low HDL levels. A diagnosis of acute myocardial infarction was made. This may be attributed to atherosclerosis, the most common contributor to cardiovascular diseases such as myocardial infarction, coronary artery disease, and peripheral artery disease (Wolf et al., 2019). Prevention of atherosclerosis is thus integral to the prevention of secondary cardiovascular complications.
Atherosclerosis is a chronic vascular disease. It is characterized by atherosclerotic plaque formation through the accumulation of lipids, various cells, and tissue debris in the vascular intima with subsequent tissue hypoxia from occlusion or plaque rupture (Kong et al., 2022). Chronic inflammation and autoimmune response to oxidized low-density lipoproteins, heat shock proteins, and other innate antigens play an integral role in atherosclerosis (Kobiyama et al., 2018). Various inflammatory signaling pathways such as NLRP3 inflammasome and Notch have been implicated in the promotion or regression of atherosclerosis (Kong et al., 2022). The role of inflammation is further evidenced by the presence of inflammatory and B and T immune cell infiltrates in atherosclerotic plaques.
Atherosclerosis begins with the uptake and accumulation of LDL into the intima. Oxidation of LDL occurs, a process that attracts inflammatory cells such as macrophages with the resultant triggering of inflammation through the release of proinflammatory cytokines (Wolf et al., 2018). Plaque stability and disease progression are dependent on the degree of the immune response, inflammatory cells, and thickness of atherosclerotic cap thickness (Kobiyama et al., 2018). Inflammation thus has a major contribution to the initiation and progression of atherosclerosis.
References
Kobiyama, K., & Ley, K. (2018). Atherosclerosis. Circulation Research, 123(10), 1118–1120. https://doi.org/10.1161/circresaha.118.313816
Kong, P., Cui, Z.-Y., Huang, X.-F., Zhang, D.-D., Guo, R.-J., & Han, M. (2022). Inflammation and atherosclerosis: Signaling pathways and therapeutic intervention. Signal Transduction and Targeted Therapy, 7(1). https://doi.org/10.1038/s41392-022-00955-7
Wolf, D., & Ley, K. (2019). Immunity and inflammation in atherosclerosis. Circulation Research, 124(2), 315–327. https://doi.org/10.1161/circresaha.118.313591
A Sample Answer 3 For the Assignment: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Title: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Question 3
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?
Your Answer:
The patient in this scenario is a 35-year-old female patient diagnosed with acute pericarditis. She has a history of systemic lupus erythematosus. She presented with sharp retrosternal chest pain that was exacerbated by deep breathing and lying down. Additionally, she reported experiencing low-grade fever, listlessness, and flu-like symptoms. Additionally, tachycardia and pleural friction rub were found on further assessment. A pleural friction rub is a distinct grating or creaky sound resulting from the movement of inflamed and roughened pleural surfaces against one another during respiration (Adderly et al., 2022). It is a common manifestation of pleural disorders that cause pleural effusion, pleuritis, or serositis (Adderly et al., 2022). Competency and adequate skills in identifying this presentation are thus integral in the diagnosis of such conditions.
Systemic lupus erythematosus is a chronic autoimmune inflammatory disease. It is multifactorial from the interaction of various environmental and genetic factors and is characterized by multisystemic involvement (Ali et ., 2018). This results in a wide range of clinical manifestations caused by autoantibody production, complement activation, and immune complex deposition and dependent on the affected organ system (Ali et al., 2018). Serositis is a common manifestation of systemic lupus erythematosus. It encompasses pleuritis characterized by pleuritic chest pain, pleural rub, and evidence of pleural effusion and pericarditis (Carrion-Barbera et al., 2019). The patient has a history of SLE and a diagnosis of acute pericarditis has already been made. The findings of a pleural friction rub and sharp chest pain may be suggestive of concurrent pleuritis. This may indicate a flare-up of SLE with multiorgan involvement thus the need to investigate further for any additional system involvement.
References
Adderley, N., & Sharma, S. (2022). Pleural Friction Rub. In StatPearls. StatPearls Publishing.
Ali, A., Sayyed, Z., Ameer, M. A., Arif, A. W., Kiran, F. N. U., Iftikhar, A., Iftikhar, W., Ahmad, M. Q., Malik, M. B., Kumar, V., Dass, A., Sami, S. A., Sapna, F. N. U., & Waqas, N. (2018). Systemic lupus erythematosus: An overview of the disease pathology and its management. Cureus. https://doi.org/10.7759/cureus.3288
Carrion-Barbera, I., Salman-Monte, T. C., Castell, S., Castro-Dominguez, F., Ojeda, F., & Monfort, J. (2019). Successful treatment of systemic lupus erythematosus pleuropericarditis with belimumab. European Journal of Rheumatology, 6(3), 150–152. https://doi.org/10.5152/eurjrheum.2019.17169
A Sample Answer 3 For the Assignment: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Title: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Question 4
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)
Your Answer:
An elderly 81-year-old obese lady developed deep venous thrombosis confirmed by a duplex ultrasound 48 hours after a left total hip replacement operation. She presented with severe nausea and vomiting that resulted in dry mucous membranes. She presented with typical features of deep venous thrombosis such as leg swelling, calf tenderness, and redness on the operated leg (Mazzolai et al., 2018). The development of deep venous thrombosis is a common complication following total hip replacement surgery (Yu et al., 2021). The consequences include prolonged hospital stay, adverse patient outcomes, predisposition to pulmonary embolism, and high economic implications.
Various mechanisms lead to the development of deep venous thrombosis. These include factors that lead to venous stasis, endothelial injury, and hypercoagulability described as Virchow’s triad (McLendon et al., 2022). Identified risk factors include immobilization, surgery, and trauma (Othieno et al., 2018). Obesity, advanced age, dehydration, thrombocytosis, and a previous history also predispose to deep venous thrombosis (Waheed et al., 2022). The patient in this scenario was elderly, obese, and had just undergone surgery. Surgery activates inflammatory response with the release of cytokines which activates the coagulation system (Yu et al., 2021). The surgery also contributed to immobility due to the resultant bed rest and immobility under anesthesia during the long operation. There is a history of severe nausea and vomiting. This may have led to dehydration evidenced by dry mucous membranes with resultant hypercoagulability. There is no mention of postoperative prophylactic anticoagulant therapy which would have minimized the development of deep venous thrombosis.
References
Mazzolai, L., Aboyans, V., Ageno, W., Agnelli, G., Alatri, A., Bauersachs, R., Brekelmans, M. P., Büller, H. R., Elias, A., Farge, D., Konstantinides, S., Palareti, G., Prandoni, P., Righini, M., Torbicki, A., Vlachopoulos, C., & Brodmann, M. (2018). Diagnosis and management of acute deep vein thrombosis: A joint consensus document from the European Society of cardiology working groups of the aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. European Heart Journal, 39(47), 4208–4218. https://doi.org/10.1093/eurheartj/ehx003
McLendon, K., Goyal, A., & Attia, M. (2022). Deep Venous Thrombosis Risk Factors. In StatPearls. StatPearls Publishing.
Othieno, R., Okpo, E., & Forster, R. (2018). Home versus in-patient treatment for deep vein thrombosis. Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.cd003076.pub3
Waheed, S. M., Kudaravalli, P., & Hotwagner, D. T. (2022). Deep Vein Thrombosis. In StatPearls. StatPearls Publishing.
Yu, X., Wu, Y. & Ning, R. The deep vein thrombosis of the lower limb after total hip arthroplasty: what should we care. BMC Musculoskelet Disord 22, 547 (2021). https://doi.org/10.1186/s12891-021-04417-z
A Sample Answer 4 For the Assignment: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Title: NURS 6052 CARDIOVASCULAR AND RESPIRATORY DISORDERS KNOWLEDGE CHECK
Question 5
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.
Your Answer:
The chronic obstructive disease is a chronic respiratory disease characterized by persistent respiratory symptoms and airflow limitation attributed to airway and alveolar abnormalities (Pahal et al., 2022). Bronchitis and emphysema are types of chronic obstructive pulmonary disease (Pahal et al., 2022). Emphysema primarily affects airspaces distal to the terminal bronchioles and is characterized by abnormal permanent dilatation of airspaces, destruction of septal walls, and loss of lung elasticity (Pahal et al., 2022). The destruction of terminal airspaces is attributed to longstanding exposure to toxic particles and gases that trigger inflammation.
Various risk factors predispose to emphysema and COPD in general. These include smoking, male gender, air pollution, genetic predisposition, recurrent lung infections, allergies, advanced age, and occupational exposure to particles such as silica and coal dust (Sutradhar et al., 2019). Smoking is the strongest predisposing factor with the intensity of smoking and years of smoking being the predictors of disease progression (Pahal et al., 2022). The notable factors present in the patient in this scenario include advanced age and a positive 50-pack-per-year cigarette smoking history.
An imbalance between oxidative and antioxidative processes forms the basis for the pathogenesis of emphysema. Oxidative stress and hyperinflammation in response to noxious stmuli lead to the activation of proinflammatory transcription factors with a resultant heightened inflammatory response and destruction of elastic fibers by metalloproteinases (Rodrigues et al., 2021). The destruction of alveolar walls results in poor lung function due to a diminished gas exchange, permanent airspace enlargement, loss of lung elasticity, hyperinflation, and limitations of expiratory airflow (Rodrigues et al., 2021). Emphysema is thus a subtype of chronic obstructive pulmonary disease.
References
Pahal, P., Avula, A., & Sharma, S. (2022). Emphysema. In StatPearls. StatPearls Publishing.
Rodrigues, S. de, Cunha, C. M., Soares, G. M., Silva, P. L., Silva, A. R., & Gonçalves-de-Albuquerque, C. F. (2021). Mechanisms, pathophysiology, and currently proposed treatments of chronic obstructive pulmonary disease. Pharmaceuticals, 14(10), 979. https://doi.org/10.3390/ph14100979
Sutradhar, I., Das Gupta, R., Hasan, M., Wazib, A., & Sarker, M. (2019). Prevalence and risk factors of chronic obstructive pulmonary disease in Bangladesh: A systematic review. Cureus. https://doi.org/10.7759/cureus.3970