NURS 6501 Module 5 Case Study Analysis

NURS 6501 Module 5 Case Study Analysis

NURS 6501 Module 5 Case Study Analysis

NURS 6501 Module 5 Case Study Analysis

The patient presents with symptoms of gout, including swelling, fever, and intense pain. According to Fenando & Widrich (2020), acute gout usually affects one joint and for this patient, it is the right first metatarsophalangeal (MTP) joint. This paper will explore the musculoskeletal and neurological pathological processes accounting for the symptoms and how they affect the patient. Additionally, it will examine ethnic or racial variables of the patient and their impact on psychological functioning.

Urate crystals form in tissues, particularly in the area surrounding the foot, arm, and knee joint, causing gout. One of the main causes of gout is hyperuricemia, which has high serum urate levels. By making urate less soluble, it encourages urate crystal development and nucleation (Fenando & Widrich, 2020). Ultimately, the overproduction together with inadequate elimination of uric acid results in an increase in acid levels which is deposited in the joints. When urate crystals cause the formation and activation of cytosolic protein complexes, inflammation or swelling, as seen in the patients, results (Fenando & Widrich, 2020). The complexes start the process that causes the joint to become inflamed, which is accompanied by excruciating pain and fever.

Obesity, high blood pressure, and Type II diabetes mellitus increase the patient’s chance of developing gout. However, there is a significant chance that acute gout could be brought on by circumstances that increase urate concentrations. In the patient’s situation, the antihypertensive drug hydrochlorothiazide (HCTZ) works by raising uric acid levels, which raises the likelihood of developing gout (Ben Salem et al., 2017). Drug-induced hyperuricemia and gout are caused by the drug’s decrease in uric acid secretion, which raises serum uric acid levels. These events led to an acute gout episode that manifested through the patient’s right first metatarsophalangeal (MTP) joint and resulted in swelling on the right great toe. This episode was caused by the patient’s heightened risk for gout. The plan of action would be to lessen the discomfort and inflammation that it causes while also getting tested for chronic gout (Engel et al., 2017).

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Compared to females of all ages, males are at a greater risk of gout. Studies show that black men and women are more predisposed to development of gout as compared to whites (Singh et al., 2018). Racial differences are linked to elevated urate levels as well as other diseases including hypertension.

References

Ben Salem, C., Slim, R., Fathallah, N., & Hmouda, H. (2017). Drug-induced hyperuricaemia and gout. Rheumatology, 56(5), 679-688. https://doi.org/10.1093/rheumatology/kew293

Engel, B., Just, J., Bleckwenn, M., & Weckbecker, K. (2017). Treatment Options for Gout. Deutsches Arzteblatt International, 114(13), 215–222. https://doi.org/10.3238/arztebl.2017.0215

Fenando A, Widrich J. [Updated 2020 Jun 29]. Gout (Podagra) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 https://www.ncbi.nlm.nih.gov/books/NBK546606/

Singh, J. A., Bharat, A., Khanna, D., Aquino-Beaton, C., Persselin, J. E., Duffy, E., … & Khanna, P. P. (2018). Racial differences in health-related quality of life and functional ability in patients with gout. Rheumatology, kew356. https://doi.org/10.1093/rheumatology/kew356

Concepts of Neurological and Musculoskeletal Disorders

The case analysis is based on a 67 years old man who presents to the HCP with chief complaints of arm tremors. The patient has some tremors in the leg. According to the son, the father was stiff, taking him longer to perform simple tasks. Based on a physical examination, the patient hand was at rest, and the fingers exhibited movement. He exhibited a mask-like appearance since his face was not mobile while his gaits were uneven. In addition, the patient shuffled when he walked while his knees and hips flexed forward. Therefore, he exhibited a cog wheeling movement. The patient also identified that he had extreme sweating when engaging in activities. The paper NURS 6501 Module 5 Case Study Analysis will provide the neurological and musculoskeletal pathophysiologic process based on the patient’s symptoms.

Neurological and Musculoskeletal Pathophysiology Processes

The patient is diagnosed with Parkinson’s disease. Parkinson’s disease affects movement; thus, a

NURS 6501 Module 5 Case Study Analysis
NURS 6501 Module 5 Case Study Analysis

progressive nervous system disorder (McCance & Huether, 2019). Therefore, Parkinson’s disease is caused by degeneration of the brain, causing the impairment or death of the neurons in the body (McCance & Huether, 2019). This leads to the depletion of dopamine due to the formation of the substantia nigra. Notably, when the neurons are normal, dopamine production takes place. Patients with Parkinson’s disease lack dopamine, which effectively improves the blood flow in the body (Taylor et al., 2020).
Therefore, the patient experienced tremors, stiffness, and difficulties walking due to dopamine insufficiency in the body. This shows that dopamine is effective in achieving smooth muscle movement. In addition, a patient with depleted dopamine is also likely to experience other nonmotor symptoms such as autonomic –neuroendocrine changes (Chung et al., 2018).

Moreover, patients who have Parkinson’s disease lose the nerve endings responsible for producing the norepinephrine. The chemical helps control the main function in the body, such as blood pressure and heart rate, thus a messenger to the sympathetic nervous system (Chung et al., 2018). The patient with Parkson’s has a brain cell that consists of Lewy bodies that impact the movement, mood, or behavior (Chung et al., 2018). Lewy bodies are abnormal clumped proteins that develop in the nerve cells and are located in the substantia nigra of a person’s brain.

Racial/Ethnic Variables

Parkinson’s disease is common to neurodegenerative disease among the elderly. The large insurance database identifies that the most affected ethnicity is the Hispanic, with the highest incidence, followed by the black with the lowest (Hayes, 2019). Based on gender, males experience Parkinson’s disease more than women, while the number of patients diagnosed increases with age (McCance & Huether, 2019). The main reason for the increase in the risk of Parkinson’s among men is due to the toxicant exposure, head trauma, and the X linkage of the genetic risk factors (Hayes, 2019).

Interaction of the Processes

A patient with Parkinson’s disease suffers limited movement. This is due to degeneration of the basal

NURS 6501 Module 5 Case Study Analysis
NURS 6501 Module 5 Case Study Analysis

ganglia, which causes a decline in level of dopamine that is inhibited in acetylcholine (Yaday & Kumar, 2022). However, levels of acetylcholine remain active, leading to imbalance in inhibitory neuronal activity and excitatory (Yaday & Kumar, 2022). Therefore, excess neurons cause the ability to generate the voltage of the rapid membrane, whose response is a very small stimulus.

Conclusion

Parkinson’s disease affects a person’s movement since it is a progressive nervous system disorder. Several factors increase the risk of developing Parkinson’s disease, including age, ethnicity, and gender. Men are most likely to suffer from the disease, which can also be hereditary. The early signs of the disease include tremors and trouble in movement.

References

Chung, S. J., Yoo, H. S., Oh, J. S., Kim, J. S., Ye, B. S., Sohn, Y. H., & Lee, P. H. (2018). Effect of striatal dopamine depletion on cognition in de novo Parkinson’s disease. Parkinsonism & related disorders, 51, 43-48. https://www.sciencedirect.com/science/article/pii/S1353802018301147 Hayes, M. T. (2019). Parkinson’s disease and parkinsonism. The American journal of medicine, 132(7), 802-807. https://www.sciencedirect.com/science/article/pii/S0002934319302359 McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. Taylor, J. P., McKeith, I. G., Burn, D. J., Boeve, B. F., Weintraub, D., Bamford, C., … & T O’Brien, J. (2020). New evidence on the management of Lewy body dementia. The Lancet Neurology, 19(2), 157-169. https://www.sciencedirect.com/science/article/pii/S147444221930153X Yadav, D., & Kumar, P. (2022). Restoration and targeting of aberrant neurotransmitters in Parkinson’s disease therapeutics. Neurochemistry International, 105327. https://www.sciencedirect.com/science/article/pii/S0197018622000523

Scenario 1: 74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact.

Mild to moderate dysarthria. Able to protect airway.

Scenario 2: Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.

Scenario 3: A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.

Scenario 4: A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease.

Please do a 1 to 2-page case study analysis. In your Case Study Analysis related to the scenario provided, explain the following:

  • Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
  • Any racial/ethnic variables that may impact physiological functioning.
  • How these processes interact to affect the patient.

Module 5 Assignment: Case Study Analysis

An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.

Photo Credit: jijomathai – stock.adobe.com

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. 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 the 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 scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

  • Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
  • Any racial/ethnic variables that may impact physiological functioning.
  • How these processes interact to affect the patient.

Introduction

This case study analysis examines the presentation of a 24-year-old female administrative assistant who presents to the emergency department with severe right-sided headaches. The patient reports experiencing these headaches on six occasions in the last two months, with each episode lasting 2-3 days and significantly impacting her ability to concentrate at work. Additionally, she complains of nausea, photophobia (light sensitivity), and has vomited three times in the last 3 hours. The severity of her headache is rated as 10/10 at the time of presentation, and while she has attempted to alleviate her symptoms with ibuprofen and acetaminophen, her relief has been partial.

This analysis will explore the underlying neurological and musculoskeletal pathophysiologic processes that may account for the patient’s symptoms and consider any potential racial/ethnic variables that could impact physiological functioning in the context of her condition. Furthermore, the interaction between these processes and how they contribute to the patient’s overall presentation will be investigated. By analysing these aspects, we aim to gain a comprehensive understanding of the factors at play in this patient’s case and provide valuable insights for effective diagnosis and treatment.

Neurological Pathophysiologic Processes in Migraine

Migraine is a complex headache disorder involving neurological dysfunction. The patient’s presentation of severe right-sided headache, photophobia, nausea, and vomiting is characteristic of migraine. Migraines are thought to be triggered by cortical spreading depression, a phenomenon where there is a wave of neuronal depolarization followed by prolonged suppression of neuronal activity. This process likely occurs in the brainstem and thalamus, which are responsible for sensory processing, including pain (Mignot et al., 2023).

Photophobia and nausea are linked to abnormal brainstem processing of visual and vestibular information. The thalamus, known for relaying sensory information to the cortex, may also play a role in the amplification of pain signals during migraines (Kuburas & Russo, 2023). Additionally, the abnormal release of neurotransmitters, such as serotonin and calcitonin gene-related peptide (CGRP), contributes to the dilation of blood vessels and inflammation in the brain, leading to the characteristic throbbing headache. Serotonin, in particular, plays a vital role in regulating pain pathways and mood, and alterations in serotonin levels have been associated with migraine susceptibility.

Day 7 of Week 8

Submit your Case Study Analysis Assignment by Day 7 of Week 8.

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.

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The Role Genetics Plays in the Disease

The disease being described is streptococcal pharyngitis (or strep throat). The prevalence of strep throat is affected by environmental factors such as close contact with others in a group setting (daycares, schools, or large families) (Centers for Disease Control and Prevention, 2023). However, in some cases, children experience numerous strep throat infections throughout their childhood that may be explained by certain genetic factors. For example, in children with recurring tonsillitis, differences in human leukocyte antigen (HLA) class 2 alleles were noted, as well as a decreased immunological response to group A streptococcus when compared to a control group (Dan et al., 2019). In this particular case, it is doubtful that genetics played a significant role, as the patient had no prior medical history or any indication of recurring strep throat.

Why the Patient is Presenting with the Specific Symptoms Described

While 99.6 F is technically not a fever, it is a possible indicator of infection. When a cellular injury occurs, pyrogens are released due to the presence of cytokines, which signals the hypothalamus to increase core body temperature (McCance & Huether, 2019, p. 87). This can be an effective defense due to the narrow temperature range at which cells can function. This would increase the body’s metabolic demands, which is likely why the patient has a pulse of 78. These would be considered systematic manifestations of inflammation. The reddened pharynx and white exudate on the tonsils are localized manifestations of inflammation. The redness is due to vasodilation, and the white exudate is due to the accumulation of leukocytes (McCance & Huether, 2019, p. 209). These responses often result in localized pain, hence the sore throat.

The Physiologic Response to the Stimulus and why this Response Occurred

The swelling of the lips and tongue, difficulty breathing, and wheezing response triggered by the initial amoxicillin dose is known as a type 1 or anaphylactic hypersensitivity reaction (Justiz-Vaillant & Zito, 2019). These reactions occur when the body produces an unnecessarily large or inappropriate immunological reaction to a foreign substance.

The Cells that are Involved in this Process

The anaphylactic reaction is known as an IgE-mediated reaction (McCance & Huether, 2019, p. 256). The process begins with the activation of a dendritic cell by an antigen. This causes the release of cytokines, which activates eosinophils and B-cells to produce plasma cells. Additionally, the degranulation of mast cells (a type of white blood cell) occurs, causing the release of histamines and proteases. This process results in the spasming of smooth muscle, vasodilation, and vascular leakage.

How Another Characteristic Would Change the Response

Allergies tend to be hereditary (Nih.gov, 2017). A subtle difference in genetics is why some people are deathly allergic to some things while others remain unphased. I am unsure what effect gender would have on this scenario, but I look forward to seeing what my colleagues come up with.

 References

Centers for Disease Control and Prevention. (2023). Strep throat: All you need to know. Centers for Disease Control and Prevention. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.htmlLinks to an external site.

Dan, J. M., Havenar-Daughton, C., Kendric, K., Al-kolla, R., Kaushik, K., Rosales, S. L., Anderson, E. L., LaRock, C. N., Vijayanand, P., Seumois, G., Layfield, D., Cutress, R. I., Ottensmeier, C. H., Lindestam Arlehamn, C. S., Sette, A., Nizet, V., Bothwell, M., Brigger, M., & Crotty, S. (2019). Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science Translational Medicine11(478), eaau3776. https://doi.org/10.1126/scitranslmed.aau3776Links to an external site.

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513315/

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

Nih.gov(2017). Allergies: Overview. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK447112/

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “M5Assgn+last name+first initial.(extension)” as the name.
  • Click the Module 5 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Module 5 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 “M5Assgn+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.

NURS 6501 Module 5 Case Study Analysis Grading Criteria

To access your rubric:

Module 5 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Module 5 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Module 5 Assignment

What’s Coming Up in Module 6?

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

In Module 6, you will identify processes related to psychological disorders. You will also examine the neurobiology of various psychological issues and consider variables that may impact physiological functioning and altered physiology.

Week 8 Case Study Analysis

The case study concerns a 72-year-old female who developed an acute onset of slurred speech that abated within an hour. Head CT shows an old left-sided infarct in the temporal region, while CT of the carotids shows a 35% blockage on the left and 40% on the right. The purpose of the paper will be to explain the neurological and musculoskeletal pathophysiological processes contributing to the patient’s clinical features. In addition, it will address the racial/ethnic variables impacting physiological function and describe how these processes interact to affect the patient.

The Neurological and Musculoskeletal Pathophysiologic Processes Accounting For These Symptoms

The patient’s symptoms can be attributed to Transient ischemic attack (TIA). TIA is characterized by transient neurologic symptoms without evidence of acute infarction. The patient had a TIA attack associated with a focal neurologic deficit and speech disturbance in a vascular territory because of an underlying cerebrovascular disease (Ortiz-Garcia et al., 2022). In this case, the patient has a history of stroke, which likely contributed to the symptoms. The neurological pathophysiology causing the patient’s symptoms is the transient disruption of arterial blood flow due to the narrowing of the carotid artery. Blockage of the carotids with a 35% blockage on the left and 40% on the right indicates carotid stenosis.

Plaque or fatty deposits along the inner arterial wall cause the narrowing of the carotids, which results in decreased blood flow to the brain (Perry et al., 2022). The insufficient blood flow to the brain contributed to the patient’s slurred speech, weakness on one side of the body with temporary paralysis, and gait disturbance. The patient’s motor impairment can be attributed to musculoskeletal pathophysiological changes (McCancem & Huether, 2019). The typical motor impairments in TIA include unilateral motor weakness, gait disturbance, limb paralysis, and loss of coordination (Kuriakose & Xiao, 2020). This explains why the patient slumped over to the right side and could not get to an upright position or stand.

Racial/Ethnic Variables That May Impact Physiological Functioning

TIA incidence is higher in Blacks than Whites in the US. Kamel et al. (2020) found that among US participants in the study, blacks faced a higher risk of early stroke recurrence following a minor ischemic stroke or TIA. This is even after adjusting demographics, comorbidities, and medication adherence. It has been found that Black and Mexican American persons have higher TIA incidence rates than non-Hispanic Whites (Lioutas et al., 2021). Therefore, the patient has a high risk of recurring TIAs or stroke if she is Black or Mexican.

How These Processes Interact To Affect the Patient

TIA cause temporary neurologic dysfunction because of a brief disruption in cerebral blood flow. Cerebral vasospasm or systemic arterial hypertension can interact to cause neurologic dysfunction. Besides, the processes affect the patient by causing visual, sensory, motor, and speech deficits. Visual deficits include blurred/ double vision, one-eye blindness, and tunnel vision (Simmatis et al., 2019). Sensory deficits include numbness in the face, arm, or hand and vertigo. Motor deficits include weakness in the upper or lower limbs and gait disturbance, while speech deficits include aphasia and slurred speech.

Conclusion

The patient’s symptoms are due to a TIA attack, which causes a focal neurologic deficit and speech disturbance due to insufficient blood flow to the brain. TIAs are more common and have a higher recurrence in Blacks. The pathophysiologic processes in TIA interact to cause visual, sensory, motor, and speech deficits.

Week 9 Knowledge Check: Psychological Disorders

In the Week 9 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 6. 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 6

Week 8: Concepts of Neurological and Musculoskeletal Disorders – Part 2

As homeowners know all too well, there is a continuous need for maintenance and repair. Some efforts are precautionary in nature, while others are the result of issues that surface over time.

Similarly, musculoskeletal disorders can develop over time. For some disorders, such as osteoporosis, precautionary treatments are a potential option. But much like issues that surface in a home over time, many musculoskeletal issues can be very serious concerns, and they can have a significant impact on patients’ lives.

This week, you continue to examine fundamental concepts of neurological and musculoskeletal disorders. You explore common disorders that impact these systems and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.

Learning Objectives

Students will:

  • Analyze processes related to neurological and musculoskeletal disorders
  • Identify racial/ethnic variables that may impact physiological functioning
  • Evaluate the impact of patient characteristics on disorders and altered physiology

Learning Resources

Note: The below resources were first presented in Week 7. If you have previously reviewed them, you are encouraged to read or view them again here.

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 15: Structure and Function of the Cardiovascular and Lymphatic Systems (stop at Aging and the nervous system)
  • Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
  • o   Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function; pp. 504–511, pp. 516–530 (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
  • Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
  • Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
  • Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review

Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

Required Media (click to expand/reduce)

Khan Academy. (2019b). Ischemic stroke. Retrieved from ttps://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke

Note: The approximate length of the media program is 8 minutes.

Osmosis.org. (2019, June 12). Osteoporosis – causes, symptoms, diagnosis, treatment, pathology [Video file]. Retrieved from https://www.youtube.com/watch?v=jUQ_tt_zJDo

Note: The approximate length of the media program is 9 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 15, 16, 18, and the sections of Chapters 44 and 45 that relate to the neurological and musculoskeletal systems. 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/

Case Study Analysis

An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. 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 the elements that may be factors in the diagnosis, and you explain the implications to patient health.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

  • Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
  • Any racial/ethnic variables that may impact physiological functioning.
  • How these processes interact to affect the patient.

By day 7 of Week 8

Submit your Case Study Analysis Assignment by Day 7 of Week 8.

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

Links to an external site.). All papers submitted must use this formatting.

A 32-year-old woman arrives at the ED with, vomiting, nausea, fever, chills, and vaginal discharge. Symptoms lasted three days. Her LLQ and lower back hurt. She denies urinary incontinence, peculiar urine, and increased urination.

She claims monogamy. Her WBC, sedimentation, and CRP were elevated. Abdominal exam indicates LLQ pain. A pelvic exam indicates putrid green discharge, a reddish cervix, adnexal pain, and the chandelier sign. Gram-negative diplococci in ER wet preps. The purpose of this paper is to analyze the case of the patient above and mention a diagnosis of PID and how it is associated with infertility.

Factors that Affect Fertility (STDs).

After checking her vitals and determining that this patient’s body temperature and pulse rate were increased, PID was identified as the cause. Both chlamydia and gonorrhea, if not treated, have the potential to spread to the uterus and fallopian tubes. This may result in pelvic inflammatory disease, often known as PID, which can cause inflammation, scarring, and obstruction in the patient’s reproductive organs, like fallopian tubes (Chitneni et al., 2020).

Tubal scarring may cause the fallopian tubes to become blocked, preventing eggs from being transported to the uterus. Those who have had trauma to their fallopian tubes are often at an increased risk of developing an ectopic pregnancy.

Inflammatory Markers Rise in STD/PID.

STIs damage the vaginal mucosa, which protects against invasive bacteria and viruses. Receptors on the cell surface or within the cell identify STI infections, causing mucosal inflammation (Rizk et al., 2020). In the example, inflammatory biomarkers like CRP and ESR are elevated. STIs may cause mucosal reactions that can cause discharge, blistering, and warts among others. This response seeks to eliminate infections, but it often fails or causes pathology that weakens the barrier and allows HIV to enter submucosal target cells.

Prostatitis and Systemic reaction

Inflammation is often seen in prostatitis, a disorder that affects the prostate gland. Prostatitis often causes discomfort in the groin, pelvis, or genitalia as well as unpleasant or difficult urinating. Although not all cases of prostatitis are caused by bacterial infections, some cases of the condition are (Li et al., 2021). Acute bacterial prostatitis is often caused by common bacterial strains. The spread of the virus may have originated in the urinary or reproductive systems.

Splenectomy and ITP

ITP patients’ immune systems kill platelets as alien items. The spleen removes damaged platelets, therefore eliminating it may enable more platelets to circulate (Tahir et al., 2020). Patients with persistent, severe ITP have a splenectomy. After failing various treatments, leading US ITP experts undertake splenectomy. A nuclear medicine department does an indium-labeled platelet spleen scan to see whether the spleen is degrading platelets. If this test shows that the immune system is largely killing platelets elsewhere, a splenectomy won’t help.

Anemia

When blood produces fewer normal, healthy RBCs than usual, anemia results. With hemoglobin and hematocrit, MCV can be used to categorize anemia as microcytic (MCV below normal range), normocytic, or macrocytic (MCV above normal range) (Tvedten, 2022). Based on the underlying cause, additional forms of anemia include aplastic, hemolytic,  and sickle cell anemia.

Conclusion

PID is a common infection that affects sexually active women. Most of the time, STIs like gonorrhea and chlamydia are to blame. If PID is not treated, it can make a person unable to have children. So, if the problem is severe and keeps coming back, the patient might have to have surgery.

References

Chitneni, P., Bwana, M. B., Owembabazi, M., O’Neil, K., Kalyebara, P. K., Muyindike, W., Musinguzi, N., Bangsberg, D. R., Marrazzo, J. M., Haberer, J. E., Kaida, A., & Matthews, L. T. (2020). Sexually Transmitted Infection Prevalence Among Women at Risk for HIV Exposure Initiating Safer Conception Care in Rural, Southwestern Uganda. Sexually Transmitted Diseases47(8), e24–e28. https://doi.org/10.1097/olq.0000000000001197

Li, C., Xu, L., Lin, X., Li, Q., Ye, P., Wu, L., Wang, M., Li, L., Li, L., Zhang, Y., Li, H., & Qin, G. (2021). Effectiveness and safety of acupuncture combined with traditional Chinese medicine in the treatment of chronic prostatitis. Medicine100(49), e28163. https://doi.org/10.1097/md.0000000000028163

Rizk, B., Borahay, M. A., & Abdel Maguid Ramzy. (2020). Clinical Diagnosis and Management of Gynecologic Emergencies. CRC Press.

Tahir, F., Ahmed, J., & Malik, F. (2020). Post-splenectomy Sepsis: A Review of the Literature. Cureus12(2). https://doi.org/10.7759/cureus.6898

‌Tvedten, H. (2022). Classification and Laboratory Evaluation of Anemia. Schalm’s Veterinary Hematology, 198–208. https://doi.org/10.1002/9781119500537.ch25

NURS_6501_Module5_Case Study_Assignment_Rubric

NURS_6501_Module5_Case Study_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms.
30 to >27.0 ptsExcellentThe response accurately and thoroughly describes the patient symptoms. … The response includes accurate, clear, and detailed explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation. 27 to >24.0 ptsGoodThe response describes the patient symptoms. … The response includes accurate, explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation. 24 to >22.0 ptsFairThe response describes the patient symptoms in a manner that is vague or inaccurate. … The response includes explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by explanations that are vague or based on inappropriate evidence/research. 22 to >0 ptsPoorThe response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. … The response does not include explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms, or the explanations are vague or based on inappropriate evidence/research.
30 pts
This criterion is linked to a Learning Outcome Explain how the highlighted processes interact to affect the patient.
30 to >27.0 ptsExcellentThe response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 27 to >24.0 ptsGoodThe response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 24 to >22.0 ptsFairThe response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research. 22 to >0 ptsPoorThe response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
30 pts
This criterion is linked to a Learning Outcome Explain any racial/ethnic variables that may impact physiological functioning.
25 to >22.0 ptsExcellentThe response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 22 to >19.0 ptsGoodThe response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 19 to >17.0 ptsFairThe response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations that are based on inappropriate evidence/research. 17 to >0 ptsPoorThe response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
25 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 ptsExcellentParagraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.5 ptsGoodParagraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. …The purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 to >3.0 ptsFairParagraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … The purpose, introduction, and conclusion of the assignment are vague or off topic. 3 to >0 ptsPoorParagraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. … No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors. 4 to >3.5 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 to >3.0 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors. 3 to >0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 to >4.0 ptsExcellentUses correct APA format with no errors. 4 to >3.0 ptsGoodContains a few (1 or 2) APA format errors. 3 ptsFairContains several (3 or 4) APA format errors. 3 to >0 ptsPoorContains many (≥ 5) APA format errors.
5 pts
Total Points: 100

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