Sample Answer for NURS 6501 WEEK 2 CASE STUDY ANALYSIS Included After Question
NURS 6501 WEEK 2 CASE STUDY ANALYSIS
An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.
Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.
Photo Credit: Getty Images/Hero Images
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.
Grading Criteria
To access your rubric:
Module 1 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Module 1 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 2
To participate in this Assignment:
Module 1 Assignment
A Sample Answer For the Assignment: NURS 6501 WEEK 2 CASE STUDY ANALYSIS
Title: NURS 6501 WEEK 2 CASE STUDY ANALYSIS
The case study that is offered illustrates the situation of a 42-year-old man who visited the clinic complaining of discomfort, redness, and swelling in his right calf. A trimmer unintentionally slashed his leg. The patient used water to clean the area before covering it with a large bandage. He had a fever, chills, and a red, swollen leg after a few days. This discussion describes the pathophysiology underlying the patient’s symptoms, the genes involved, the immunosuppressive process, and its impact on various bodily functions.
Patient’s Symptoms
In the example case study, the patient who had been cut by a trimmer cleaned and dressed the wound. Nonetheless, the patient’s symptoms a few days after the occurrence showed that a wound infection was present. Microbes from the individual’s endogenous flora, which is present on the skin, including gram-positive cocci (particularly staphylococci), infected the wound (Ashton, & Francis, 2019). As the bacteria penetrate the epidermis, an immune reaction is set off, and cytokines and neutrophils cause an inflammatory reaction. This causes symptoms in the affected region such as pain, redness, and swelling. These signs and symptoms point to a staphylococcus cellulitis-wound infection as the cause.
Genes Involved in Disease Development
The emergence of bacterial, viral, and parasitic illnesses is influenced by several genetic variables. As previously noted, the staphylococcus bacteria caused the patient in the case study to exhibit signs of cellulitis-wound infection. Many genetic variables influencing the emergence of bacterial infections have been discovered by genome-wide association studies (GWAS) (Goldenberg et al., 2021). For instance, the control of inflammation and cell death is linked to receptor-interacting protein kinase 1 and 3. According to studies, type I and type II interferons are in charge of controlling how the immune system reacts to bacterial and viral illnesses. In addition to these hereditary variables, others include the following: C-Reactive Protein, Defensin Beta 4A, Ribonuclease A Family Member 3, FMS Related Receptor Tyrosine Kinase 3, and Tumor Necrosis Factor (Kumburu et al., 2019).
The Process of Immunosuppression
Immune system malfunction, whether hormonal or cellular, is a hallmark of immunosuppression. In the case of innate immunity, altered monocyte/macrophage, neutrophil, and natural killer (NK) cells are linked to defective cellular levels (Li et al., 2020). The altered T or B cells are responsible for the inadequate cellular levels of innate or adaptive immunity (Roth et al., 2021). The process of immunosuppression is linked to hormonal changes in soluble substances that affect innate immunity (mediated by chemokines or complements) or adaptive immunity (mediated by changes in cytokines or antibodies) (George et al., 2020). The invading microbe’s propensity is determined by the immune system compartments that are damaged, and the acquired illness typically spreads. The immune system defects are typically congenital, making it difficult for the patient to fight off illnesses.
Conclusion
The staphylococcal infection that caused the symptoms in the patient in the case study given presented with an infected wound. According to studies, the body’s inflammatory immunological reaction to germs invading it is what causes the symptoms. Also, it has been demonstrated that several genetic variables, including those already mentioned, have a substantial role in the emergence of bacterial infections.
References
Ashton, M. W., & Francis, D. M. A. (2019). Infection of the extremities. Textbook of Surgery, 415–422. https://doi.org/10.1002/9781119468189.ch46
George, M. D., Baker, J. F., Winthrop, K. L., Goldstein, S. D., Alemao, E., Chen, L., Wu, Q., Xie, F., & Curtis, J. R. (2020). Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery. Annals of the Rheumatic Diseases, 79(5), 573–580. https://doi.org/10.1136/annrheumdis-2019-216802
Goldenberg, M., Wang, H., Walker, T., & Kaffenberger, B. H. (2021). Clinical and immunologic differences in cellulitis vs. pseudocellulitis. Expert Review of Clinical Immunology, 17(9), 1003–1013. https://doi.org/10.1080/1744666x.2021.1953982
Kumburu, H. H., Sonda, T., van Zwetselaar, M., Leekitcharoenphon, P., Lukjancenko, O., Mmbaga, B. T., Alifrangis, M., Lund, O., Aarestrup, F. M., & Kibiki, G. S. (2019). Using WGS to identify antibiotic resistance genes and predict antimicrobial resistance phenotypes in MDR Acinetobacter baumannii in Tanzania. Journal of Antimicrobial Chemotherapy, 74(6), 1484–1493. https://doi.org/10.1093/jac/dkz055
Li, L., Yu, R., Cai, T., Chen, Z., Lan, M., Zou, T., Wang, B., Wang, Q., Zhao, Y., & Cai, Y. (2020). Effects of immune cells and cytokines on inflammation and immunosuppression in the tumor microenvironment. International Immunopharmacology, 88, 106939. https://doi.org/10.1016/j.intimp.2020.106939
Roth, S., Cao, J., Singh, V., Tiedt, S., Hundeshagen, G., Li, T., Boehme, J. D., Chauhan, D., Zhu, J., Ricci, A., Gorka, O., Asare, Y., Yang, J., Lopez, M. S., Rehberg, M., Bruder, D., Zhang, S., Groß, O., Dichgans, M., & Hornung, V. (2021). Post-injury immunosuppression and secondary infections are caused by an AIM2 inflammasome-driven signaling cascade. Immunity, 54(4), 648-659.e8. https://doi.org/10.1016/j.immuni.2021.02.004
A Sample Answer 2 For the Assignment: NURS 6501 WEEK 2 CASE STUDY ANALYSIS
Title: NURS 6501 WEEK 2 CASE STUDY ANALYSIS
The case study is of patient AO with a history of obesity and recent weight gain of 9 pounds. The patient has a diagnosis of hypertension and hyperlipidemia. The currently prescribed drugs include, Atenolol 12.5 mg daily, Doxazosin 8 mg daily, Hydralazine 10 mg QID, Sertraline 25 mg daily and Simvastatin 80 mg daily. This paper will discuss how age might influence the patient’s pharmacokinetic and pharmacodynamic processes and how changes in the processes might affect the patient’s recommended drug therapy.
How Age Influence the Pharmacokinetic and Pharmacodynamic Processes
Old age is associated with impairment in the function of various regulatory processes that facilitate the integration of functions between cells and organs. Pharmacokinetic changes that occur with age include decreased absorption of oral drugs and time of onset of action is delayed with advanced age due to decreased gastric secretion, gastrointestinal motility, gastrointestinal flow and increased pH (Schlender et al., 2016). Moreover, there is a decrease in renal and hepatic clearance and an increase in distribution of lipid-soluble drugs resulting in a prolonged elimination half-life in people with advanced age (Schlender et al., 2016). As a result, dosage should be decreased for drugs eliminated through the hepatic system in elderly patients. Pharmacodynamic changes include increased sensitivity to various classes of drugs such as cardiovascular, anticoagulant and psychotropic drugs.
Atenolol is a Beta-1 selective blocker indicated in the management of hypertension. The drug should be used with caution in geriatric patients to prevent toxicity as a result of high concentrations of Atenolol in the blood (Sarfraz et al., 2015). Besides, the dose of Atenolol should be prescribed with caution in an elderly patient by starting with a low dose due to decreased renal, hepatic and cardiac function in old age (Mukker, Singh & Derendorf, 2016). Doxazosin is an alpha blocker used in the treatment of hypertension and also in benign prostatic hyperplasia. The drug should be avoided in individuals above the age of 60 years in treatment of hypertension. Doxazosin use is associated with a high risk of orthostatic hypotension (Mukker, Singh, & Derendorf, 2016). If Doxazosin has to be used in geriatric patients, the initial dose should have a low dosage and it is recommended that the dosage is gradually adjusted.
Sertraline is an antidepressant in the class of Selective Serotonin Reuptake Inhibitors (SSRIs). Old age influences Sertraline pharmacodynamic processes. Geriatric patients may develop hyponatremia and hence a patient’s sodium levels should be closely monitored (Bhat, Thanusubramanian & Balaji, 2017). Furthermore, advanced age is associated with decreased clearance and a prolonged half-life of Sertraline and long-term administration of the drug in geriatric patients would result in late achievement of steady state concentrations.
How Changes in the Pharmacokinetic and Pharmacodynamic Processes Might Impact the Patient’s Recommended Drug Therapy
Atenolol is highly dependent on hepatic metabolism and a decrease in hepatic clearance can result in an increased drug concentration and eventually toxicity. The drug regimen with Atenolol may need to be altered by stopping the drug if the patient has hepatic impairment. In addition, Atenolol is excreted via the kidneys and severe impairment of renal function in the patient may result in eliminating the drug from the treatment plan (Goeres, Williams, Eckstrom & Lee, 2014). Doxazosin is extensively metabolized in the liver and a condition affecting the liver such as liver impairment may result in the dosage of Doxazosin being reduced or the drug being eliminated from the treatment plan.
Hydralazine is primarily metabolized in the liver and the drug’s metabolism may be affected by liver impairment. As a result, if the patient develops liver impairment, the dose may have to be reduced or the drug withdrawn (Goeres et al., 2014). Sertraline is metabolized by cytochrome P450 hepatic enzymes. It is recommended that the dose of Sertraline be decreased by 50% in patients with mild hepatic impairment. In patients with moderate to severe hepatic impairment, the drug is not recommended. Consequently, Sertraline dose may have to be reduced by half if the patient develops mild hepatic impairment or stopped if there is moderate to severe hepatic impairment. Simvastatin is converted to its active metabolite by hepatic enzymes thus its dose may require to be altered in a patient with liver impairment.
How I Might Improve the Patient’s Drug Therapy Plan
The patient is experiencing weight gain despite being in a moderate intensity statin therapy with Simvastatin 80 mg to manage hyperlipidemia. I will improve the hyperlipidemia treatment poll by changing to Atorvastatin 40 mg daily dose. Atorvastatin will also help in lowering the risk of stroke, diabetes type 2 and coronary heart disease in the patient since he has a history of hypertension (Wilmot et al., 2015). Beta blockers are associated with elevated lipid levels and Atenolol could be contributing to the patient’s weight gain (Goeres et al., 2014). I would remove Atenolol from the therapy plan and substitute it with Amlodipine 5 mg daily dose. Atenolol has drug interactions with Hydralazine that require close monitoring and may be contributing to ineffective control of high blood pressure (Goeres et al., 2014). Consequently, I will substitute Atenolol with Amlodipine.
Amlodipine will facilitate lowering blood pressure as well as the risk of fatal and non-fatal myocardial infarctions, strokes and cardiovascular events. Moreover, the drug is associated with improving the lipid profile and may contribute in lowering the low-density lipid cholesterol levels and promoting weight loss (Goeres et al., 2014). Lastly, I will remove Sertraline from the treatment plan since the patient has no history of depression or anxiety disorder. Besides, Sertraline is associated with fluid retention, and increased appetite, resulting in weight gain (Bhat, Thanusubramanian & Balaji, 2017). Stopping the drug might help in preventing weight gain in the patient.
References
Bhat, H. D., Thanusubramanian, H., & Balaji, O. (2017). Sertraline induced hyponatremia. Asian Journal of Pharmaceutical and Clinical Research, 1-2.
Goeres, L. M., Williams, C. D., Eckstrom, E., & Lee, D. S. (2014). Pharmacotherapy for hypertension in older adults: a systematic review. Drugs & aging, 31(12), 897-910.
Mukker, J. K., Singh, R. S. P., & Derendorf, H. (2016). Pharmacokinetic and pharmacodynamic considerations in elderly population. In Developing Drug Products in an Aging Society (pp. 139-151). Springer, Cham.
Sarfraz, R. M., Khan, H. U., Mahmood, A., Ahmad, M., Maheen, S., & Sher, M. (2015). Formulation and evaluation of mouth disintegrating tablets of atenolol and atorvastatin. Indian journal of pharmaceutical sciences, 77(1), 83.
Schlender, J. F., Meyer, M., Thelen, K., Krauss, M., Willmann, S., Eissing, T., & Jaehde, U. (2016). Development of a whole-body physiologically based pharmacokinetic approach to assess the pharmacokinetics of drugs in elderly individuals. Clinical pharmacokinetics, 55(12), 1573-1589.
Wilmot, K. A., Khan, A., Krishnan, S., Eapen, D. J., & Sperling, L. (2015). Statins in the elderly: a patient‐focused approach. Clinical cardiology, 38(1), 56-61.