Case Study Analysis
In the assigned case study, the 55-year-old male high school teacher presents with symptoms suggesting a diagnosis of myocardial infarction (MI). He has a history of asthma, which he thought contributed to the mild cough. However, the cough got worse, with symptoms of chest pain, lightheadedness, problems with breathing, and sweating excessively. The patient was unconscious by the time healthcare providers started attending to him. At the emergency unit, the patient’s EKG results revealed elevated ST segments and high levels of cardiac biomarkers such as creatinine kinase and troponin. The patient’s vitals also indicated reduced respiratory and pulse rates.
Cardiovascular And Cardiopulmonary Pathophysiologic Processes
The patient presents with symptoms and lab findings supporting the diagnosis of Myocardial Infarction (MI). This condition can be described as sudden myocardial tissue ischemic death (Saleh & Ambrose, 2018). MI usually results from coronary vessel thrombotic occlusion due to vulnerable plaque rapture. The ischemia triggers profound ionic and metabolic perturbation in the myocardium tissue leading to rapid depression of the systolic function (Khoury et al., 2020). The ischemia also alters the functioning of the myocardia mitochondria causing necrosis and apoptosis of the cardiomyocytes. The demand and myocardium oxygen supply imbalance contribute to the heart being overworked leading to chest pain (Gabriel-Costa, 2018). Lack of adequate supply of oxygen to the brain contributed to lightheadedness and excessive sweating. Breathing difficulties were a result of the compensatory mechanism overworking the respiratory system to restore the oxygen balance.
Racial and Ethnic Variables
Minority groups such as black Americans and Asians have reported the highest prevalence of cardiovascular complications such as MI as compared to whites (Graham et al., 2018). This has mainly been attributed to increased risk factors among the black communities such as smoking, drinking alcohol, sedentary lifestyle, consumption of unhealthy foods, and obesity among others. Consequently, due to health disparities, the increased prevalence of cardiovascular complications among minority communities has been associated with social factors like reduced access to quality health, education, a safe living environment, and healthy foods. The stress level among black communities is also high, increasing the risk of stroke.
How Processes Interact to Affect the Patient
Atypical MI usually manifests as coagulation necrosis which is normally followed by myocardial fibrosis. Most patients with ischemia also present with contraction band necrosis that is normally followed by reperfusion or accompanied by immense stimulation of the adrenergic system mostly with associated myocytolysis (Konijnenberg et al., 2020). The left coronary artery system occupies more space than the right. As a result, MI affecting this system will most likely cause extensive injury, resulting in substantial impairment of myocardial function, low output, and pulmonary congestion (Smit et al., 2019). Left coronary artery occlusion can also lead to left posterosuperior hemiblock or left anterior hemiblock abnormal conduction evidenced by the alterations in the frontal axis of the ECG like elevated ST segment.
Conclusion
The male adult patient in the provided case study presents with signs of MI. He presents with several symptoms attributed to the imbalance between oxygen supply and demand to the myocardium, and other body tissues. Due to variations in certain social factors like low socioeconomic status and poverty, black communities among other ethnic minorities tend to suffer the greatest burden of cardiovascular complications like MI as compared to whites.
References
Gabriel-Costa, D. (2018). The pathophysiology of myocardial infarction-induced heart failure. Pathophysiology, 25(4), 277–284. https://doi.org/10.1016/j.pathophys.2018.04.003
Graham, G. N., Jones, P. G., Chan, P. S., Arnold, S. V., Krumholz, H. M., & Spertus, J. A. (2018). Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction. JAMA Network Open, 1(7), e184240. https://doi.org/10.1001/jamanetworkopen.2018.4240
Khoury, M. K., Gupta, K., Franco, S. R., & Liu, B. (2020). Necroptosis in the Pathophysiology of Disease. The American Journal of Pathology, 190(2), 272–285. https://doi.org/10.1016/j.ajpath.2019.10.012
Konijnenberg, L. S. F., Damman, P., Duncker, D. J., Kloner, R. A., Nijveldt, R., van Geuns, R.-J. M., Berry, C., Riksen, N. P., Escaned, J., & van Royen, N. (2020). Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovascular Research, 116(4), 787–805. https://doi.org/10.1093/cvr/cvz301
Saleh, M., & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7(1), 1378. https://doi.org/10.12688/f1000research.15096.1
Smit, M., Coetzee, A. R., & Lochner, A. (2019). The Pathophysiology of Myocardial Ischemia and Perioperative Myocardial Infarction. Journal of Cardiothoracic and Vascular Anesthesia, 34(9). https://doi.org/10.1053/j.jvca.2019.10.005
Sample Answer for NURS 6501 Module 1 Assignment: Case Study Analysis Included After Question
An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
Develop a 1- to 2-page case study analysis in which you:
- Explain why you think the patient presented the symptoms described.
- Identify the genes that may be associated with the development of the disease.
- Explain the process of immunosuppression and the effect it has on body systems.
By Day 7 of Week 2
Submit your Case Study Analysis Assignment by Day 7 of Week 2.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “M1Assgn+last name+first initial.(extension)” as the name.
- Click the Module 1 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Module 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “M1Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
A Sample Answer For the Assignment: NURS 6501 Module 1 Assignment: Case Study Analysis
Title: NURS 6501 Module 1 Assignment: Case Study Analysis
Introduction: Scenario
The goal of this paper is to provide an explanation for the symptoms observed in the given case scenario. a 34-year-old Hispanic male with end-stage renal illness who required a kidney transplant from a cadaver donor due to the absence of a matching family member. Additionally, I will be finding genes that may be involved in the development of the disease, as well as the immunosuppressive process and its influence on the body. In this situation, the patient acquired symptoms as a result of possible adverse effects from the transplant process and medications supplied.
Presented Symptoms and Pathophysiology
The patient acquired symptoms as a result of the transplant procedure’s potential complications and the drugs supplied. According to evidence-based research, kidney transplantation is the most effective medical option for individuals with chronic end-stage renal illness since it is the most sought and cost-efficient way of renal replacement. Acute organ rejection occurred as a result of the recipient’s immunological response against the donor’s distinct MHC surface antigens. This frequently occurs within days to months of an organ donation. There is a potential that the patient experienced rejection following the transplant, resulting in renal failure, which led to the patient’s weight gain and decreased urine output (Kuan & Schwartz, 2021). Additionally, sensitivity of the body to the alien organ resulted in a rise in temperature and weariness.
The Identification of Disease-Associated Genes
The immune reaction of the patient to the surgery and drugs is dependent on several factors, including genetic makeup, which might result in symptoms such as oliguria, increased weight gain, fever, and weariness (McCance & Huether, 2019). rs25487 of the XRCC1 gene is one of the particular genes involved in the development of renal disease. The gene predisposes individuals to end-stage renal disease. Additionally, the GSTP1 gene is associated with the levels of C-reactive protein and ferritin. Individuals carrying the gene, Abd EL-Hassib et al. (2021), have an elevated risk of oxidative and carbonyl stress. C-reactive proteins levels are elevated in patients with end-stage renal disease, which are markers of increased inflammation. Additionally, they exhibit a high level of oxidative stress.
Conclusion
Immunosuppression impairs the body’s ability to mount an immunological response to infections (Benvenuto et al., 2018). This can be accomplished by decreasing the amount of T-helper cells, which recognize foreign things and activate other immune cells to combat the pathogen (Tielemans et al., 2019). Additionally, the impact can be created in bone marrow. Additionally, it decreases inflammation in the body and accompanying symptoms. However, it may be harmful to the body due to an increased vulnerability to infection (Brown et al., 2017).
Finally, because the human system is interrelated, when one organ is harmed, the others may suffer as well. In this situation, the patient experienced organ rejection, which could result in increased inflammation. Reduced urinary output was a sign of renal failure.
References
Abd EL-Hassib, D. M., Zidan, M. A., El Amawy, M. M., Hegazy, H. A., & Ameen, S. G. (2021). Polymorphism of XRCC1 Arg399Gln may predict for development of end-stage renal disease. A PCR confirmed case-control study. Meta Gene, 29, 100915. https://doi.org/10.1016/j.mgene.2021.100915
Benvenuto, L. J., Anderson, M. R., & Arcasoy, S. M. (2018). New frontiers in immunosuppression. Journal of Thoracic Disease, 10(5), 3141-3155. https://doi.org/10.21037/jtd.2018.04.79
Brown, S. A., Tyrer, F. C., Clarke, A. L., Lloyd-Davies, L. H., Stein, A. G., Tarrant, C., Burton, J. O., & Smith, A. C. (2017). Symptom burden in patients with chronic kidney disease not requiring renal replacement therapy. Clinical Kidney Journal, 10(6), 788-796. https://doi.org/10.1093/ckj/sfx057
Kuan, K., & Schwartz, D. (2021). Educational case: Kidney transplant rejection. Academic Pathology, 8, 237428952110068. https://doi.org/10.1177/23742895211006832
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for
disease in adults and children (8th ed.).
Tielemans, M. M., Van Boekel, G. A., Van Gelder, T., Tjwa, E. T., & Hilbrands, L. B. (2019). Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients. Transplantation Reviews, 33(2), 55-63. https://doi.org/10.1016/j.trre.2018.11.001
The introducing symptoms of the patient in the given case are predictable with Wound disease. Symptoms like redness, swelling, torment, and fever of 100.6 0 F are demonstrative of wound disease, most likely with Staphylococci.
Why the patient presented with the symptoms described?
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A Sample Answer 2 For the Assignment: NURS 6501 Module 1 Assignment: Case Study Analysis
Title: NURS 6501 Module 1 Assignment: Case Study Analysis
An inappropriate wash of the wound directly: Not long after the injury, the patient washed distinctly with water from a garden
hose, however not with cleanser or germicide. Tainted water or hose could have filled in as a source of disease to the injury, and ill-advised washing could have prompted the endurance of the creature on the injury surface (Rizani, 2015).
Wound payable to string trimmer: Since the customer in the given case had an injury because of String trimmer, which could hold Staphylococcus aurous from soil or plant materials, it could be the source from which Staphylococcus aurous entered the injury.
Cover with large Band-Aid: Improper washing followed by covering with enormous band-aid could have caught the bacteria on the injury surface, which advanced to wound contamination. Since, Staphylococci are also present as skin flora, covering with bandage could have encouraged the development of bacteria on the injury and brought about disease
Consequently, all the above components could have added to wound disease as obvious from the redness, growing, torment, chills. Fever is because of the immune reaction towards the disease (Grumezescu, 2018). It should be quickly treated with anti-toxins, which if in any case, can prompt inconveniences, for example, Toxic Shock disorder. NURS 6501 Module 1 Assignment: Case Study Analysis
Treatment
The wound should be cleaned and appropriately dressed with care. Anti-microbial, for example, Penicillins or its subordinates. Vancomycin can be utilized if there should be an occurrence of obstruction or when the disease spreads.
References
Grumezescu, V. (2018). Treatment Strategies for Infected Wounds. Molecules, 23(9). doi:10.3390/molecules23092392
Rizani, N. (2015). Modern wound dressing for wound infection: an overview. Indonesian Journal of Tropical and Infectious Disease, 53-59. NURS 6501 Module 1 Assignment: Case Study Analysis
Week 2: Altered Physiology
With a place squarely in the spotlight for patients diagnosed with all manner of disease, APRNs must demonstrate not only support and compassion, but expertise to guide patients’ understanding of diagnoses and treatment plans.
This expertise goes beyond an understanding of disease and sciences, such as cellular pathophysiology. APRNs must become experts in their patients, understanding their medical backgrounds, pertinent characteristics, and other variables that can be factors in their diagnoses and treatments.
This week, you examine alterations in the immune system and the resultant disease processes. You consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
Learning Objectives
Students will:
Evaluate cellular processes and alterations within cellular processes
Analyze alterations in the immune system that result in disease processes
Identify racial/ethnic variables that may impact physiological functioning
Evaluate the impact of patient characteristics on disorders and altered physiology
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 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.
Note: This article was presented in the Week 1 resources. If you read it previously you are encouraged to review it this week.
Required Media (click to expand/reduce)
Foundational Concepts of Cellular Pathophysiology – Week 2 (8m)
Walden University. (n.d.). Instructor feedback. https://mym.cdn.laureate-media.com/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/
Immunity and Inflammation
Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk
Note: The approximate length of the media program is 14 minutes.
Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds
Note: The approximate length of the media program is 37 minutes.
Acid-Base Balance #1
MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE
Note: The approximate length of the media program is 13 minutes.
Acid-Base Balance #2
MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI
Note: The approximate length of the media program is 15 minutes.
Hyponatremia
MedCram. (2017, December 23). Hyponatremia explained clearly [LK1] (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M
Note: The approximate length of the media program is 15 minutes.
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 3, 7, and 8 that relate to alterations in immunity, hyponatremia, and acid/base balance.
Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/store?role=student
To Register to View the Content
Go to https://evolve.elsevier.com/cs/store?role=student
Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
Complete the registration process.
To View the Content for This Text
Go to https://evolve.elsevier.com/
Click on Student Site.
Type in your username and password.
Click on the Login button.
Click on the plus sign icon for Resources on the left side of the screen.
Click on the name of the textbook for this course.
Expand the menu on the left to locate all the chapters.
Navigate to the desired content (checklists, videos, animations, etc.).
Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
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| Participation
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| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |