NURS 6501 Knowledge Check Concepts of Endocrine Disorders

Sample Answer for NURS 6501 Knowledge Check Concepts of Endocrine Disorders 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:

• Diabetes
• Hyper- and hypothyroidism
• Adrenal disorders
• Parathyroidism (hyper and hypo)
• Checks & balances / negative feedback
• Syndrome of Inappropriate Antidiuretic Hormone
• Pheochromocytosis
• Diabetes insipidus
• Diabetic ketoacidosis

Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm Exam.

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 5 OF WEEK 6

Complete the Knowledge Check by Day 5 of Week 6.

A Sample Answer For the Assignment: NURS 6501 Knowledge Check Concepts of Endocrine Disorders

Title: NURS 6501 Knowledge Check Concepts of Endocrine Disorders

Question 1  

Needs Grading 

	A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling.    Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.      Question 1 of 4:    Describe the positive symptoms of schizophrenia and relate those symptoms to the case study patient.
	Selected Answer:   Some of the positive symptoms of schizophrenia are olfactory, auditory, somatic-tactile hallucinations. conversing and commenting voices. Patients may also experience delusions of reference, control, mind reading, persecution, grandiosity, and guilt, and somatic symptoms of thought withdrawal, insertion, and broadcasting. Some of the thought disorder symptoms that most schizophrenic patients exhibit include incoherence, derailment, distractible speech, illogicality, and circumstantially. Bizzare behaviors exhibited include an agitated and aggressive status, being repetitively stereotyped, sexual, and social behavior. The patient in this case scenario presented with persecution, auditory hallucinations, and a disheveled appearance.  Correct Answer:     Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal.  Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior.  This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.  Response Feedback:   [None Given]

Question 2  

Needs Grading 

	A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling.   Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.    Question 2 of 4:  Explain the genetics of schizophrenia.
	Selected Answer:   Schizophrenia can be inherited when an individual inherits the disease alleles. The genes found on different chromosomes can penetrate and recognize the primary cause of schizophrenia. The risk of schizophrenia is associated with advanced paternal age. Its risk also increases in biological relatives who have schizophrenia than adopted relatives. Among first-degree relatives of individuals with schizophrenia, its risk is 10%. For a scenario where both parents are schizophrenic, the risk of the child being diagnosed with schizophrenia is 40%. For monozygotic twins, the concordance for schizophrenia is 40%-50% while for dizygotic twins is 10%.     Correct Answer:     The causes of schizophrenia are not known. There are probably at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia.  The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins.  Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.  Response Feedback:   [None Given]

Question 3  

Needs Grading 

	A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling.     Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.    Question 3 of 4:    The APRN reviews recent literature and reads that neurotransmitters are involved in the development of schizophrenia. What roles do neurotransmitters play in the development of schizophrenia?
	Selected Answer:   Initially, it was hypothesized that schizophrenia stemmed from abnormally high levels of dopamine; a brain neurotransmitter. This proposition arose from pharmacological studies which demonstrated that antipsychotics can block dopamine receptors in the brain.  The studies also found a strong correlation between the clinical potency of first-generation anti-psychotics and their affinity for D2 dopamine receptors. Another system of neurotransmitters that underlies the pathophysiology of schizophrenia is glutamate; an excitatory neurotransmitter and how it acts on the NMDA receptor subtype. According to this hypothesis, it is proposed that schizophrenia may occur when glutamate receptors are under-activated. The concertation of glutamate in CSF decreases when the synthesis of cortical glutamate also decreases.     Correct Answer:     Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms.  Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block both dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors.  Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.  Response Feedback:   [None Given]

Question 4  

Needs Grading 

	A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling.     Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.    Question 4 of 4:  The APRN reviews recent literature and reads that structural problems in the brain may be involved in the development of schizophrenia. Explain what structural abnormalities are seen in people with schizophrenia.
	Selected Answer:   Advanced studies in neuroimaging reveal that there are significant brain differences between individuals diagnosed with schizophrenia and those without schizophrenia. People with schizophrenia have large ventricles, hippocampus changes, and a decreased brain volume in the medial temporal areas.  MRI studies reveal that there are anatomical abnormalities in limbic and neocortical regions that interconnect with the tracts of the white matter.     Correct Answer:     Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, there is decreased brain volume in medial temporal areas, and changes are seen in the hippocampus.  Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in schizophrenia.  Brain imaging showed reductions in whole-brain volume and in left and right prefrontal and temporal lobe volumes in many people who are at high genetic risk for schizophrenia. The changes in prefrontal lobes are associated with increasing severity of psychotic symptoms.  MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume.  Response Feedback:   [None Given]

Question 5  

Needs Grading 

	A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.     Question 1 of 6:    Discuss the role genetics plays in the development of bipolar 2 disorders.
	Selected Answer:   Family and twin studies provide a strong basis for mood disorders.  For dizygotic and monozygotic twins, the bipolar concordance rates are 28% and 62% respectively. Even for adopted relatives from a biologic family of mood disorders, there is a high likelihood of developing manic-depressive or major depression as compared to control adoptees. Both schizophrenia and bipolar are associated with loci on chromosomes 22 and 18. Most individuals with bipolar who exhibit psychotic behaviors are highly deficient in reelin expression which is linked to the genetic loci on chromosome 22.     Correct Answer:     The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies all indicate that bipolar disorder has a significant genetic component. Firstdegree relatives of a person with bipolar disorder are approximately 7 times more likely to develop bipolar disorder than the rest of the population, and the heritability of bipolar I disorder (BPI) has recently been estimated at 0.73.  Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on the chromosome 22, which confers susceptibility to schizophrenia. Given that, there still are large variations in clinical symptoms suggests that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders.  Response Feedback:   [None Given]

Question 6  

Needs Grading 

	A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.   Question 2 of 6:    Explain how the hypothalamic-pituitary-adrenal (HPA) system may be associated with bipolar type 2 disease.
	Selected Answer:   The HPA has an integral role in coping. Individuals with major depression have elevated secretion of glucocorticoid. This suggests that the mechanisms that are responsible for the secretion of hormones in HPA are major contributors to the pathophysiology of depression.   The secretion of adrenocorticotropic hormone increases when there is an exaggerated release of corticotrophin-releasing factor which is accompanied by a subsequent elevation of cortisol in circulation. These mechanisms are also associated with increased deficits in the cortico-limbic regulation, overactivity of the amygdala, and a compromised regulatory role of the hippocampus. Most patients with mood disorders aulos have a diminished sensitivity of glucocorticoid receptors and this is attributable to elevated inflammatory cytokines that disrupt the physiological feedback regulatory mechanism of the HPS axis.        Correct Answer:     The HPA system plays an essential role in an individual’s ability to cope with stress. Chronic stress induced activation of the HPA system and elevate glucocorticoid secretion are found in many people with bipolar disease. function. Exaggerated release of corticotrophin-releasing factor contributes to increased adrenocorticotropic hormone secretion and a subsequent elevation of circulating cortisol. These disturbances are most likely attributable to deficits in cortico-limbic regulation with consequent amygdala over activity and a compromised hippocampal regulatory role. Also, glucocorticoid receptors appear to have diminished sensitivity in mood disorders possibly due to elevation of inflammatory cytokines, thereby disrupting physiological feedback regulation on the HPA axis and immune system.  Response Feedback:   [None Given]

Question 7  

Needs Grading 

	A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.   Question 3 of 6:    Discuss the role inflammatory cytokines play in the development and exacerbation of bipolar type 2 symptoms
	Selected Answer:   Currently, existing evidence reveals that social and psychologic stressors increase the production of inflammatory cytokines which contribute to the pathogenesis of mental illnesses. Peripheral cytokines can also contribute to alterations in the functioning of microglia when they enter the brain via circumventricular organs or compromise the primary role of the blood-brain barrier. This can directly traffic inflammatory molecules and cells between the brain and periphery leading to inflammation of the brain. The oxidative stress chemical milieu and inflammatory signals tend to precipitate a change in the functioning of astroglia. Similarly, altered astroglia can diminish the neutrophilic production of the GDNF (glial cell line-derived neurotrophic factor) and BDNF (brain-derived neurotrophic factor) leading to the production of glutamate and cytokines.  The release of glutamates suppresses the extra-synaptic N-methyl D-aspartate (NMDA) receptors and subsequent suppression of the synthesis of BDNF. As a potent NMDA agonist, QA can further potentiate excitotoxicity.     Correct Answer:     Studies have fully demonstrated the association between manic and depressive episodes and a pro-inflammatory state involving both the innate and adaptive immune system. Peripheral inflammatory signals can gain access to the CNS through several pathways including areas of the brain not covered by the blood-brain barrier (BBB) such as the circumventricular organ, afferent vagal fibers may convey the peripheral cytokines and other inflammatory mediators to their nuclei, including nucleus tractus solitararius, BBB cells have the ability to import cytokines via active transport and peripheral immune cells such as macrophages.  Inflammatory cytokines activate microglia in the brain causing them to intensify the inflammatory response by releasing reactive oxygen species, reactive nitrogen species, cytokines and chemokines. This chemical milieu of oxidative stress and inflammatory signals precipitates a change in astroglial function. Also, altered astroglia diminish their neurotrophic production including brain derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) and start extruding cytokines and glutamate. Glutamate released from the astroglia accesses extra-synaptic N-methyl D-aspartate (NMDA) receptors, causing suppression of BDNF synthesis and activation of the proapoptotic cascade. QA is a potent NMDA agonist that may further potentiate excitotoxicity.  Response Feedback:   [None Given]

Question 8  

Needs Grading 

	A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.   Question 4 of 6:    Discuss the role of the amygdala in bipolar disorder.
	Selected Answer:   The amygdala modulates anxiety and fear. Patients who have anxiety disorders n exhibit a high amygdala response to cues of anxiety. Other structures of the limbic system and the amygdala are connected to the prefrontal cortex regions. The amygdala’s hyperresponsiveness can also be associated with decreased thresholds of activation when an individual responds to perceived social threats. Abnormalities of the activation of the prefrontal-limbic system also reverse with the clinical responses to pharmacologic and psychologic interventions .  Correct Answer:     With the development of functional and structural imaging, more brain structures are now under review. Imaging studies indicate decreased cerebral blood flow and glucose metabolism in the dorsolateral and dorsomedial prefrontal cortex of individuals affected by major depression or bipolar disorder. The brain amygdala appears key in modulating fear and anxiety. Patients with anxiety disorders often show heightened amygdala response to anxiety cues. The amygdala and other limbic system structures are connected to prefrontal cortex regions. Hyperresponsiveness of the amygdala may relate to reduced activation thresholds when responding to perceived social threat. Prefrontal-limbic activation abnormalities have been shown to reverse with clinical response to psychologic or pharmacologic interventions.  Response Feedback:   [None Given]

Question 9  

Needs Grading 

	A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.   Question 6 of 6:  How does neurochemical dysregulation contribute to bipolar disorders?
	Selected Answer:   According to the monoamine theory of depression, the underlying pathogenesis of depression is depleted levels of norepinephrine, serotonin, and dopamine in the CNS.  On the other hand, individuals with mania have high monoamine levels.     Correct Answer:     The monoamine theory of depression predicts that the underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the central nervous system. In contrast, people with mania have elevated concentrations of monoamine.  Response Feedback:   [None Given]

Question 10  

Needs Grading 

	A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.   Question 6 of 6:    What is the current status of the use of nutraceuticals in management of depression?
	Selected Answer:   There is a gradually developing interest in nutraceutical therapy in the management of depressive and bipolar disorders.  Studies have revealed that adding zinc to a currently existing therapy for depression is significant. Zinc plays a major role in growth and development, immune responses, storage and release of hormones, and neurotransmission. In the brain, zinc is in glutamatergic neurons that modulate circulation in the hippocampus, cortex, and amygdala which affect cognitive and mood functions  Correct Answer:     There is a growing interest in nutraceutical therapy in the treatment of bipolar and depressive disorders. Certain studies have shown that the addition of zinc to an established antidepressant therapies may help. Zinc’s functions included growth, development, immune responses, neurotransmission, and hormone storage and release. In the brain, zinc is found in glutamatergic neurons that modulate the circuitry involving the cortex, amygdala, and hippocampus that affect mood and cognitive functions. There needs to be large scale studies that reliably replicate the antidepressant effects of nutraceuticals for depression.  Response Feedback:   [None Given]

Question 11  

Needs Grading 

	A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something “terrible is going to happen”. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack.      Question 1 of 2:    What are panicogens and how do they contribute to the development of panic attack symptoms?
	Selected Answer:   Although the exact etiology of panic disorder is yet to be known, it is believed that it elicits the physical symptoms of panic attacks by panicogens. Panicogens in this case include carbo dioxide, caffeine, sodium lactate, cholecystokinin, and yohimbine, an adrenergic receptor agonist. Sodium and carbon dioxide lactate change the ph. balance in the brain which individuals prone to panic are sensitive in detecting. A high pH sensitivity amygdala plays a major role in generating perceptions of fear as well as activating the cerebral cortex in the brainstem and temporal lobes which further worsen panic symptoms.     Correct Answer:     While the cause of panic disorders/attacks is not fully understood, it appears that in panic-prone individuals, chemicals called panicogens can elicit the physical symptoms of panic attacks. Panciogens include caffeine, carbon dioxide, cholecystokinin, sodium lactate, and andregenic receptor agonists such as yohimbine. Carbon dioxide and sodium lactate alter brain pH balance that panic prone individuals are especially sensitive in detecting. Heighted pH sensitivity in the amygdala may play a role in generating fearful perceptions and activating the cerebral cortex and neural circuits in the temporal lobe and brainstem. This further facilitates the production of panic symptoms.  Response Feedback:   [None Given]

Question 12  

Needs Grading 

	A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something “terrible is going to happen”. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack.    Question 2 of 2:    How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders?
	Selected Answer:   BZ increases the response of the GABA-A ion channel to GABA which elevates the influx of chloride ion in generating a neuronal inhibitory effect. Binding of BZ receptors in different regions of the brain such as the prefrontal cortex, hippocampus, and insular. Drugs that act by blocking the receptors of benzodiazepines increase anxiety feelings and panic attacks thereby, suggesting changes in inhibitory neuromodulation which plays a major role in panic disorders.     Correct Answer:     BZ increases the GABAA ion channel response to GABA, elevating chloride ion influx and producing a neuronal inhibitory effect. There is a reduction in BZ receptor binding in brain regions including the hippocampus, insular, and prefrontal cortex. Drugs that block the benzodiazepine receptor are reported to increase panic attacks and feelings of anxiety, suggesting that an alteration in inhibitory neuromodulation contributes to panic disorders.  Response Feedback:   [None Given]

Question 13  

Needs Grading 

	A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semester’s end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD).      Question 1 of 2:    Describe the areas of the brain that are associated with social anxiety disorder.
	Selected Answer:   Imaging studies indicate an increase in frontal cortical and limbic activity. When individuals with SAD get exposed to threat facial expressions, they perceive it as though there is an extreme reaction, dislike, and criticism which also applies to the amygdala and its connection to other brain regions. Increased anxiety in SAD can stem from deficits in the inhibitory tone in the prefrontal amygdala cortical regions leading to activation of the amygdala and fear-bias threat-associated processing.     Correct Answer:     Imaging studies demonstrate increased activity in the limbic and frontal cortical area. When people with SAD are exposed to facial expressions of threat, they perceive there is extreme, dislike, rejection or criticism. This implicates the amygdala and its connections to other brain regions. Heightened anxiety in SAD may arise from deficits in an inhibitory tone from the prefrontal cortical areas to the amygdala resulting in increased amygdala activation and a fear bias in threat-related processing. Studies have implicated abnormal signaling that shows decreased white matter connectivity between amygdala and the orbitofrontal cortex.  Response Feedback:   [None Given]

Question 14  

Needs Grading 

	A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semester’s end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD).    Question 2 of 2:  How is oxytocin associated with SAD?
	Selected Answer:   The posterior pituitary gland secretes oxytocin, a hormone that is largely associated with lactation and childbirth. Evidence reveals that oxytocin has anti-anxiety effects which reduce the activation of the HPA, and promotes social attachment which positively influences trust and empathy. Individuals with SAD have decreased levels of oxytocin before and after playing trust games. This not only increases the levels of oxytocin but also promotes reciprocity and cooperation. Decreased oxytocin levels contribute to hyperactivity in the amygdala which is also associated with excessive fear and social avoidance exhibited by individuals with SAD  Correct Answer:     Oxytocin (OXT) is secreted by the posterior pituitary and is most often associated with childbirth and lactation. Increasingly, research has indicated that OCT has antianxiety effects by reducing HPA activation; promoting social attachment, and maternal behavior and increasing empathy and trust. OXT levels are reduced in people with SAD before and after playing a trust game, which normally increases OXT levels and promotes cooperation and reciprocity in those in controls groups. The reduction on OXT may account for the amygdala hyperactivity that goes along with excessive social avoidance and fear in people with SAD.  Response Feedback:   [None Given]

Question 15  

Needs Grading 

	A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD).      Question 1 of 2:    Discuss the role of neurotransmitters in the expression of GAD.
	Selected Answer:   People with GAD have abnormalities in the systems of serotonin and norepinephrine. There is decreased binding to α2-adrenergic receptors, a reduction in CSF serotonin levels, and a decreased paroxetine binding of platelets an SSRI (selective serotonin uptake inhibitor). Patients with GAD also have decreased binding of BZ in the left temporal hemisphere.  Correct Answer:     There is a reduction in α2-adrenergic receptor binding, a decrease in serotonin levels in CSF, and reduced platelet binding of paroxetine, which is a selective serotonin uptake inhibitor. There seems to be a reduction of BZ binding in the left temporal hemisphere.  Response Feedback:   [None Given]

Question 16  

Needs Grading 

	A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD).    Question 2 of 2:    Explain the structural brain changes that occur in people with GAD.
	Selected Answer:   Increased activity in the cingulate cortex is associated with increased anticipatory anxiety. When individuals with GAD are exposed to threats such as masked angry faces, the right amygdala is activated which positively correlates with the extent of severity of anxiety. This finding underscores the primary role of abnormal activity in the amygdala in threat vigilance and attentional bias.      Correct Answer:     Elevated cingulate cortex activity is associated with increased anticipatory anxiety. When people with GAD are exposed to masked angry faces, it induces heightened right amygdala activation which correlated positively with the severity of anxiety. This study underscores the role of abnormal amygdala activity in attentional bias or vigilance to threats.  Response Feedback:   [None Given]

• Question 17  

Needs Grading 

	A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq.  He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD).     Question 1 of 2:    Describe the changes seen in the brain structure in patients with PTSD.
	Selected Answer:   Since the prefrontal cortex and amygdala play significant roles in the storage and retrieval of fearful memories, they are primarily involved in the pathophysiology of PTSD. When exposed to a trauma-related stimulus, an individual with PTSD  has increased activity in the amygdala and decreased activity in the frontal brain cortex. Based on the findings of structural brain imaging studies of PTSD victims, it is also evidenced that individuals with PTSD  have a small hippocampus, a structure that plays a major role in the formation of memory and endocrine functions.  Correct Answer:     PTSD frequently leads to changes in the anatomy and neurophysiology of the brain. Reduced size of the hippocampus is probably both a predisposing factor and a result of trauma. The amygdala, which is involved in processing emotions and modulating the fear response, seems to be overly reactive in patients with PTSD. The medial prefrontal cortex (mPFC), which exhibits inhibitory control over the stress response and emotional reactivity of the amygdala, appears to be smaller and less responsive in individuals with PTSD. These brain structures play an important role in how fearful memories are stored, retrieved, and extinguished.  Response Feedback:   [None Given]

Question 18  

Needs Grading 

	A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq.  He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD).   Question 2 of 2:  Briefly discuss the role glucocorticoids may have on the development of PTSD.
	Selected Answer:   People with PTSD   have normal-low circulating cortisol levels despite a high Corticotropin-Releasing Factor (CRF) and ongoing stress. Cortisol reduces CRF production. With low cortisol levels, the levels of CRF levels increase and this stimulates the release of norepinephrine by the anterior cingulate. Norepinephrine also plays a major role in increasing blood pressure and a rapid heartbeat seen in individuals with flashbacks.     Correct Answer:     People with PTSD tend to have normal to low circulating levels of cortisol despite their ongoing stress and elevated levels of Corticotropin Releasing Factor (CRF). Cortisol leads to decreased production of CRF. If cortisol is low, then CRF continues to be high and stimulates norepinephrine release by the anterior cingulate. This norepinephrine contributes to the rapid heartbeat, and blood pressure elevations seen in people experiencing flashbacks.  Response Feedback:   [None Given]

Question 19  

Needs Grading 

	A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).      Question 1 of 2:    What is primary pathophysiology of OCD?
	Selected Answer:   Among people with OCD, primary studies have indicated that its pathogenesis is associated with increased metabolic activity and flow of blood in the limbic structures, orbitofrontal cortex, thalamus, and caudate with a high right-sided dominance. There is also a pathophysiological brain circuit that comprises the orbitofrontal cortex, anterior thalamus, dorsal anterior cingulate cortex, and in the subregions of the basal ganglia of the putamen and caudate.     Correct Answer:     Neuroimaging studies have shown increases in blood flow and metabolic activity in the orbitofrontal cortex, limbic structures, caudate, and thalamus, with a trend toward right-sided predominance. There is a pathophysiological brain circuit that consists of the anterior thalamus, orbitofrontal cortex, dorsal anterior cingulate cortex, and predominately in the basal ganglia subregions of the caudate and putamen is involved in OCD.  Response Feedback:   [None Given]

Question 20  

Needs Grading 

	A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).    Question 2 of 2:    Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors.
	Selected Answer:   Neuroimaging studies indicate that individuals with OD have dACC hyperactivity. This is attributed to the fact that dACC is thought to be a primary center for receiving negative emotions, reinforces information, and integrates it to direct motivated behavior.        Correct Answer:     Neuroimaging studies have demonstrated hyperactivity of the dACC in people with OCD as compared to controls. The dACC is thought to be a key center that receives negative emotion and reinforcing information and integrates that information to direct motivated behavior.  Response Feedback:   [None Given]

Friday, May 28, 2021 6:31:14 AM EDT 

 

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

• • Diabetes
  • Hyper- and hypothyroidism
  • Adrenal disorders
  • Parathyroidism (hyper and hypo)
  • Checks & balances / negative feedback
  • Syndrome of Inappropriate Antidiuretic Hormone
  • Pheochromocytosis
  • Diabetes insipidus
  • Diabetic ketoacidosis

Photo Credit: Getty Images/Science Photo Library RF

(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm Exam.)

Complete the Knowledge Check By Day 5 of Week 6

To complete this Knowledge Check:

Module 4 Knowledge Check

 

Midterm Exam

This 101-question exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

This exam will be on topics covered in Weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.

(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm exam.)

Photo Credit: Getty Images

To prepare:

To help you review for your midterm exam, access the Midterm Exam Review document found in this week’s Learning Resources as

well as any Knowledge Check feedback you might have received. (Note: You will also need to review all of your materials from each of these weeks to also help you better prepare for your midterm.)

By Day 7 of Week 6

Submit your Midterm Exam.

To complete your exam:

Midterm Exam

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NURS 6501 Knowledge Check Concepts of Endocrine Disorders

What’s Coming Up in Module 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 5, you will analyze processes related to neurological and musculoskeletal disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.

Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders

In the Week 7 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 5. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.

Next Module

To go to the next Module:

Module 5

 

Week 6: Concepts of Endocrine Disorders

Endocrine disorders are complex matters, and there is not always a one-size-fits-all treatment. Particularly in matters requiring the adjustment of hormone levels, treatment may require a custom approach tailored to individual patients. An understanding of these complications is essential to supporting these individual treatment plans.

This week, you examine alterations in the endocrine system and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.

Learning Objectives

Students will:

• Analyze concepts and principles of pathophysiology across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

 

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

• Chapter 21: Mechanisms of Hormonal Regulation, including Summary Review
• Chapter 22: Alterations of Hormonal Regulation, including Summary Review
• Chapter 23: Obesity and Disorders of Nutrition, including Summary Review

American Diabetes Association (2020). Standards of medical care of patients with diabetes mellitus. Diabetes Care, 26(suppl 1), pp. s33-s50. https://care.diabetesjournals.org/content/26/suppl_1/s33

Orlander, P. R. (2018). Hypothyroidism. Retrieved from https://emedicine.medscape.com/article/122393-overview

 

Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelines. Journal of the American Society of Nephrology, 28(5), 1340–1349

 

Document: NURS 6501 Midterm Exam Review (PDF document) 

 

Note: Use this document to help you as you review for your Midterm Exam in Week 6.

 

Required Media (click to expand/reduce)

 

Module 4 Overview with Dr. Tara Harris 

Dr. Tara Harris reviews the structure of Module 4 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Midterm. (3m)

Concepts of Endocrine Disorders – Week 6 (24m)

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 21 through 23 related to the endocrine system and disorders. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Optional Resources (click to expand/reduce)

 

The following source provides various tutorials related to maximizing your time management and managing stress. Feel free to access this resource to support you as you move through this course.

Walden University. (2019). ASC success strategies interactive tutorials. Retrieved from https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategies

 

Scenario 3: Type II DM

A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weight loss. He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.

PMH: HTN – well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.

Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.

Question:

1. How would you describe the pathophysiology of Type II DM?  

 

Your Answer:

Type 2 diabetes is a heterogeneous disorder where insulin resistance occurs, and the beta cells lack the ability to overcome this resistance. Galicia-Garcia et al. (2020)explain that Type 2 DM is caused by a combination of two factors: impaired insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin secretion. In the case of impaired β-cell function, the body experiences decreased insulin secretion, which limits its ability to maintain physiological glucose levels (Galicia-Garcia et al., 2020). On the other hand, an impairment of the feedback loops between insulin secretion and action causes abnormally elevated glucose levels in blood, resulting in hyperglycemia and eventually Type II DM.

 

Question 5

4 / 4 pts

Scenario 4: Hypothyroidism

A patient  walked into your  clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue,  cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful.  She does have blurry vision.

PMH: Non-contributory.

Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92,  12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.

Diagnosis: hypothyroidism.

Question:

What causes hypothyroidism?

 

Your Answer:

Hypothyroidism is caused by various factors including deficient hormone synthesis,

Congenital thyroid defects, Prenatal and postnatal iodine deficiency, and Autoimmune diseases like Hashimoto disease and sarcoidosis (Hegedüs et al. 2022). It is characterized by decreased levels of thyroid hormones (T3 and T4), which causes a slow basal metabolic rate (BMR). The decreased BMR affects lipid metabolism resulting in increased cholesterol and triglyceride levels.

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource