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NURS6501 Discussion Adrenal insufficiency

NURS6501 Discussion Adrenal insufficiency

Hello colleague. Thanks for the insightful discussion on the use of prednisone to manage acute exacerbation of COPD. I have learned from the discussion that prednisone is an oral glucocorticoid used in managing acute exacerbation of COPD that works by reducing the inflammatory response. The suppression in the inflammatory response results in the decreased airway mucus production and thus easing the breathing process. The prednisone does not induce direct adverse effects during the acute use; though, prolonged use could result in adrenal suppression (Sivapalan et al., 2019). The therapeutic goal should be to produce the most desirable outcomes and reduce the undesirable outcomes. As a result, patients on prolonged use should be monitored for the adrenal insufficiency characterized by hypoglycaemia, hypotension and even nigh time awakening among others. The adverse outcomes may be more detrimental in patients with underlying conditions such as diabetes and hypertension. The patients’ history should be taken to identify critical history information that could be contraindicated for the prescription of prednisone.

The information on the side effects of a medication is important for a prescriber since it guides them on when and when not to prescribe a given medicine. The GOLD guideline supports the use of prednisone in the management of COPD(Sivapalan et al., 2019). However, the prescriber must consider the functioning of the other body systems before prescribing the medication. Also, it is apparent that prednisone interacts with vitamin D and calcium positively and this means that it offers protective role against osteoporosis. However, patients on warfarin should not be initiated on prednisone because of the enhanced effects. Such patients are likely to be at high risk for increased bleeding due to the thinned blood. However, in situations where the two medications have to be combined, it is important to monitor the patient’s INR values.

 

 

Reference

Sivapalan, P., Ingebrigtsen, T. S., Rasmussen, D. B., Sørensen, R., Rasmussen, C. M., Jensen, C. B., Allin, K. H., Eklöf, J., Seersholm, N., Vestbo, J., & Jensen, J. S. (2019). COPD exacerbations: The impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months. BMJ Open Respiratory Research6(1), e000407. https://doi.org/10.1136/bmjresp-2019-000407

NURS6501 Advanced Pathophysiology

Week 9 Discussion

Diabetes

According to the American Diabetes Association (2011), 25.8 million children and adults have been diagnosed with diabetes in the United States. Approximately 2 million more are diagnosed every year, with another 79 million people considered to be in a pre-diabetes state. These millions of people are at risk of several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. Since diabetes has a major impact on the health of millions of people around the world, it is essential for nurses to understand the pathophysiology and associated alterations of this disorder. In this Discussion, you compare two types of diabetes—diabetes mellitus and diabetes insipidus.

To Prepare

Review Chapter 19 in the Huether and McCance text and Chapter 18 in the Hammer and McPhee text. Identify the pathophysiology of diabetes mellitus and diabetes insipidus. Consider the similarities and differences between resulting alterations of hormonal regulation.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Think about how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

NURS6501 Discussion Adrenal insufficiency

By Day 3

Post an explanation of the pathophysiology of diabetes mellitus and diabetes insipidus. Describe the differences and similarities between resulting alterations of hormonal regulation. Then explain how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

Also Check Out: NURS 6501 A patient has severe mental retardation caused by a deletion of part of chromosome 5. What genetic disorder will the nurse see documented in the chart?

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NURS6501 Advanced Pathophysiology

Week 11 Discussion

Disorders of the Reproductive Systems

While the male and female reproductive systems are unique to each sex, they share a common function—reproduction. Disorders of this system range from delayed development to structural and functional abnormalities. Since many reproductive disorders not only result in physiological consequences but also psychological consequences such as embarrassment, guilt, or profound disappointment, patients are often hesitant to seek treatment. Advanced practice nurses need to educate patients on disorders and help relieve associated stigmas. During patient evaluations, patients must feel comfortable answering questions so that you, as a key health care provider, will be able to diagnose and recommend treatment options. As you begin this Discussion, consider reproductive disorders that you would commonly see in the clinical setting.

To Prepare

Review Chapter 22 and Chapter 23 in the Hammer and McPhee text, as well as Chapter 33 and 34 in the Huether and McCance text.

Select two disorders of the male and/or female reproductive systems that interest you. Consider the similarities and differences between the disorders.

Select one of the following factors: genetics, ethnicity, age, or behavior. Think about how the factor you selected might impact the diagnosis of and treatment for the reproductive disorders.

By Day 3

Post a description of the two reproductive disorders you selected, including their similarities and differences. Then explain how the factor you selected might impact the diagnosis of treatment for the reproductive disorders.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

 

NURS6501 Advanced Pathophysiology

Week 2 Assignment

Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

Cystic fibrosis (CF) is a genetically inherited disease of the sweat and mucus glands that primarily affects the pulmonary system and gastrointestinal (GI) tract (Mayo Clinic, n.d). Each person receives one cystic fibrosis transmembrane conductance regulator (CFTR) gene that is passed from the father and mother resulting in two total CFTR genes (CDC, n.d.). CF is a recessive disorder which means that both parents must pass the defective gene for the child to have CF (McCance & Huether, 2019). If just one parent passes the defective gene, the child will be a carrier and have the possibility of passing to their children (McCance & Huether, 2019). There is a 25% chance that future children will either have CF or not have CF and a 50% chance that they could be carriers of CF.

 

Symptom Explanation

 

Patients with CF have a defective CFTR protein that is unable to transport chloride (an element in salt) to the cell surface (Cystic Fibrosis Foundation, n.d.). When salt cannot move through the cells as it normally should, higher amounts of salt are found on the skin resulting in a salty taste (Cystic Fibrosis Foundation, n.d.). Salt and water typically travel together through the body, but in CF this balance in the cells is disrupted and there is a lack of water due to the defective CFTR protein which causes thick and sticky secretions in the affected organs. The baby’s bloating is caused by these thickened secretions that can block the ducts in the pancreas and cause irregular bowel movements, pain, cramping, and even intestinal blockages (Cystic Fibrosis Foundation, n.d.). When the pancreas has obstructed ducts, it prevents the movement of pancreatic enzymes through the digestive tract which causes problems with the absorption of needed nutrients for proper growth of the baby (McCance & Huether, 2019).

 

Physiologic Response to Stimulus

 

The pancreatic ducts get clogged by the thicker secretions and this causes a decrease in the digestive enzymes that are secreted by the pancreas. When there are not enough digestive enzymes to properly break down the food, there is a problem absorbing nutrients needed for proper growth such as fats, proteins, and fat-soluble vitamins such as A, D, E, and K (Cystic Fibrosis Foundation, n.d.). Incomplete digestion leads to bloating, cramping, diarrhea, vitamin deficiency, and difficulty gaining weight.

 

Involved Cells

 

Epithelial cells are largely responsible for ion and fluid absorption and secretion (Saint-Criq, & Gray, 2017). In patients with CFTR protein defects, there are problems with sodium, chloride, and water absorption and secretion. The chloride can not be transported correctly which causes an imbalance between the electrolytes and water and ultimately leads to thickened secretions that cause problems throughout the organs.

 

Other Characteristics

More information is needed related to race, as Caucasians have a higher risk of developing CF, and African Americans, Asians, and Hispanics have a lower risk (Cystic Fibrosis Foundation, n.d.). Having a sibling, cousin, or other close family members also increases the risk of CF (Cystic Fibrosis Foundation, n.d.). In this scenario, it seems the older sibling may also have CF, but further testing is needed for proper diagnosis.

 

 

References

 

Cystic Fibrosis. (n.d.). CDC.  https://www.cdc.gov/genomics/disease/cystic_fibrosis.htm.

 

Cystic fibrosis – Symptoms and causes – Mayo Clinic. (2021).  https://www.mayoclinic.org/diseases-conditions/cystic-fibrosis/symptoms-causes/syc-20353700.

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