NURS ADVANCED PATHOPHYSIOLOGY

 

Case 1. “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question: Which cholesterol is considered the “good” cholesterol and what does it do?

Answer. High-Density Lipoprotein – helps remove other forms of cholesterol from your bloodstream. Higher levels of HDL cholesterol are associated with a lower risk of heart disease. It picks up excess cholesterol in your blood and takes it back to your liver where it’s broken down and removed from your body.

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Case 2. “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question: How does inflammation contribute to the development of atherosclerosis?

Answer. Inflammation is associated with severity of disease, and complex lesions, which are prone to rupture and cause acute events. It is an active driver of atherosclerotic plaque development and a risk factor for atherosclerotic events.

 

Case 3. A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question: Because of the result of a pleural friction rub, what does the APRN recognize?

Answer. A pleural friction rub is a common finding in patients with pneumonia, pulmonary embolism and pleurisy secondary to viral infection among other causes. Pleural friction rubs need to be distinguished from pericardial friction rub, which is a sign of pericarditis.

 

Case 4. Deep Venous Thrombosis (DVT)

A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question: Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)

Answer. Factors that contributed in the development of DVT include increasing age, prolonged immobility and major surgery. Anything that prevents your blood from flowing or clotting normally can cause a blood clot and the main causes of DVT are damage to a vein from surgery or trauma and inflammation due to infection or injury.

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Case 5. COPD

A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. He asks if this means he has chronic obstructive pulmonary disease (COPD).

Question: There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.

Answer. Emphysema is defined by permanent enlargement of airspaces distal to the terminal bronchioles. This leads to a decline in the alveolar surface area available for gas exchange. Loss of alveoli leads to airflow limitation by 2 mechanisms. First, loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation. Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.