NURS 6501 Week 2 Assignment Case Study Analysis
NURS 6501 Week 2 Assignment Case Study Analysis
Case Study Analysis
The purpose of this paper is to describe the cardiovascular and cardiopulmonary pathophysiologic processes underlying the symptoms presented by the patient, explore how these processes interact to affect the patient’s health, and discuss potential racial/ethnic variables that may impact physiological functioning. The cardiovascular and cardiopulmonary systems are integral to overall health and understanding the cardiovascular and respiratory systems is crucial for accurate disease diagnosis and effective treatment. These systems work closely together, and various factors can impact their functioning. Additionally, considering racial and ethnic variables can provide insights into the physiological functioning of individuals. In this case study analysis, we will examine the symptoms presented by a 65-year-old patient who is 8 days post-op after a total knee replacement. The patient complains of shortness of breath, pleuritic chest pain, and palpitations, with an EKG revealing new-onset atrial fibrillation and a right ventricular strain pattern.
A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF)
Cardiovascular and Cardiopulmonary Pathophysiologic Processes
Atrial Fibrillation (AF)
Atrial fibrillation is characterized by rapid and irregular contractions of the atria, resulting in disrupted blood flow (Veselá et al., 2023). In the case study, the recent knee replacement surgery and physiological stress associated with the postoperative period may have contributed to the development of AF. Various factors, including electrolyte imbalances, stress, inflammation, and autonomic dysregulation, can trigger AF in postoperative states (Johns Hopkins Medicine, 2021). The irregular atrial contractions lead to reduced cardiac output, compromising the efficiency of blood circulation.
Implications of Reduced Cardiac Output
The reduced cardiac output resulting from atrial fibrillation has several implications for the patient’s symptoms (Veselá et al., 2023). Palpitations are a common manifestation due to the irregular and rapid heartbeat associated with AF. Additionally, the compromised cardiac output can lead to decreased oxygen supply to various tissues, causing symptoms such as shortness of breath and fatigue (PR Newswire, 2022).
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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.
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.
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.
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
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.
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.
The Role genetics plays in the disease.
Strep throat is an infection in the throat and tonsils caused by group A Streptococcus bacteria according to (CDC, 2021) Strep throat is a disease commonly seen in children and can be recurrent. For that reason, it becomes a big concern for the consequences kids affected with such disease can be at risk if there are no antibiotics available, according to the journal of La Jolia Institute of Immunology (Jennifer M. Dan, 2019). A study completed by Dan (2019) showed that the children with recurrent GAS tonsillitis, the disease was likely to run in the family, thus the role genetics played in this illness.
Why the patient is presenting with the specific symptoms described.
The symptoms the patient presented where as stated in the scenario: Sore throat for 3 days, low grade fever with a temp of 99.6F, reddened posterior pharynx, 3+ enlarged tonsils with white exudate; positive anterior and posterior cervical adenopathy, and a positive strep test. These symptoms are the results of the inflammatory response, the second line of defense; it occurs as a response to tissue injury or infection (McCance & Huether, 2019); these are the observable characteristics of a vascular response as described as redness, swelling, heat and pain, which are the cardinal signs of inflammation (McCance & Huether, 2019).These signs are immediately activated when the cells and the tissues are damaged, regardless of the cause; but in this case, a strep infection.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred
The patient presented with a reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Erythema of the pharynx suggests an inflammatory or infectious process or any other causes, which in case is present on the patient in the scenario. This physiologic response presented in the scenario occurred because the physical barrier that protects against the damage has been breached, and consequently activated the inflammatory response (McCance & Huether, 2019).
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics) would change your response.
Because of the recurrence of the strep throat, this disease has been characterized as genetics as it runs in the family (Jennifer M. Dan, 2019). However, because of the genetic susceptibility to the disease will be identify. Genetic susceptibility to the disease allows the bacteria to target the immune system to prevent people from developing immunity. It’s a classic case of genetic
- (2021, October 6). Division of Healthcare Quality Promotion. Retrieved from Center For Disease prevention and Control: https://www.cdc.gov/antibiotic-use/sore-throat.html
Jennifer M. Dan, C. H.-D.-k. (2019, february 6). Recurrent Group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant T follicular helper cells. La Jolia Institute for Immunology, 6.
McCance, K. L., & Huether, S. E. (2019). PATHOPHYSIOLOGY. The Biologic Basis for Disease in Adults and Children. 8th edition. St Louis: Elsivier.
By Day 7 of Week 2
Submit your Case Study Analysis Assignment by Day 7 of Week 2.
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Case Study Analysis
End-stage renal disease is a chronic condition with increasing global rates. The mainstream treatments mainly include dialysis and kidney transplants. Kidney transplants are highly effective and restore patient’s quality of life. However, it predisposes patients to unwanted outcomes should they experience a kidney rejection. Therefore, this essay examines a case study of a 34-year-old Hispanic-American male patient that has experienced acute kidney rejection.
Why the Patient Presented the Described Symptoms
The patient in the case study was well until after six months of the transplant when he started experience a range of symptoms. They include weight gain, decreased urine output, fatigue, and fever. These symptoms led to his diagnosis with acute kidney transplant rejection. The patient developed weight gain because of increased body fluid volume level. Accordingly, the kidneys are largely involved in the excretion of excessive body fluids (Hassanein & Augustine, 2022). The acute rejection impaired with the normal fluid balance regulation by the kidneys, leading too much fluids in the body, hence, weight gain.
The patient also developed decreased urinary output. The decrease is attributable to a reduced kidney functioning rate. The kidneys do not excrete the excessive body fluids volume, leading to decreased urinary output. Besides excreting excess fluids, kidneys also facilitate the excretion of toxins such as ammonia and urea from the body. Impaired renal function lead to the accumulation of these toxins in the body. Patients experience symptoms such as difficulty in concentration and fatigue. In addition, severe kidney damage causes anemia, which is associated with symptoms such as fatigue (Carminatti et al., 2019). Kidney injury also lowers the patient’s immunity. This predisposes him to sepsis, as evidenced by fever.
Genes Associated with the Development of the Disease
Genes play a crucial role in the development of kidney transplant rejection. One of the genes is the human cytokine synthesis inhibitor or interleukin 10 (IL-10). IL-10 is a gene that a gene involved in the inhibition of inflammatory processes following organ donation. However, it can also inhibit the maturation of antigen cells that are crucial for preventing inflammatory processes in organ rejection. Gene disparities between the donor and receiver also contributed to the development of the acute kidney rejection. Often, the receiver’s genes and antibodies perceive the new kidney foreign, leading to attempts to eliminate it causing rejection. The genes that mediate this process include class I and II HLA genes. The other gene is IL-10 polymorphism. IL-10 polymorphism causes organ rejection by inhibiting the release of IL-10, which heightens immune system’s damage of the donated organ (Reindl-Schwaighofer et al., 2019; Yazdani et al., 2019). Combined, these genes elevate the individual’s risk of developing kidney transplant rejection.
The Process of Immunosuppression and Effect on Body Systems
Immunosuppression is a situation where the body’s ability to fight against infections and disease causing microorganisms is reduced. The causes of immunosuppression are varied. They include chronic conditions such as cancer and end-stage renal disease, medications, nutritional deficiencies, and exposure to harmful radiations. These causes depress the ability of the bone marrow to produce white blood cells, hence, vulnerability to diseases. One of the effects of immunosuppression on the body is increased vulnerability to infections and recurrent infections. Severe cases may result in mortalities (Salminen, 2020; Tang et al., 2020).
In summary, the patient in the case study developed symptoms due to kidney failure and immunosuppression. Genes play a role in kidney transplant rejection. Immunosuppression lowers the body response mechanisms to infections and increases the risk of mortalities in severe cases. Interventions to minimize the risk of immunosuppression in hospitalized patients should be explored.
Carminatti, M., Tedesco-Silva, H., Silva Fernandes, N. M., & Sanders-Pinheiro, H. (2019). Chronic kidney disease progression in kidney transplant recipients: A focus on traditional risk factors. Nephrology, 24(2), 141–147. https://doi.org/10.1111/nep.13483
Hassanein, M., & Augustine, J. J. (2022). Chronic Kidney Transplant Rejection. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK549762/
Reindl-Schwaighofer, R., Heinzel, A., Kainz, A., van Setten, J., Jelencsics, K., Hu, K., Loza, B.-L., Kammer, M., Heinze, G., Hruba, P., Koňaříková, A., Viklicky, O., Boehmig, G. A., Eskandary, F., Fischer, G., Claas, F., Tan, J. C., Albert, T. J., Patel, J., … Oberbauer, R. (2019). Contribution of non-HLA incompatibility between donor and recipient to kidney allograft survival: Genome-wide analysis in a prospective cohort. The Lancet, 393(10174), 910–917. https://doi.org/10.1016/S0140-6736(18)32473-5
Salminen, A. (2020). Activation of immunosuppressive network in the aging process. Ageing Research Reviews, 57, 100998. https://doi.org/10.1016/j.arr.2019.100998
Tang, F., Tie, Y., Tu, C., & Wei, X. (2020). Surgical trauma-induced immunosuppression in cancer: Recent advances and the potential therapies. Clinical and Translational Medicine, 10(1), 199–223. https://doi.org/10.1002/ctm2.24
Yazdani, S., Callemeyn, J., Gazut, S., Lerut, E., de Loor, H., Wevers, M., Heylen, L., Saison, C., Koenig, A., Thaunat, O., Thorrez, L., Kuypers, D., Sprangers, B., Noël, L.-H., Van Lommel, L., Schuit, F., Essig, M., Gwinner, W., Anglicheau, D., … Naesens, M. (2019). Natural killer cell infiltration is discriminative for antibody-mediated rejection and predicts outcome after kidney transplantation. Kidney International, 95(1), 188–198. https://doi.org/10.1016/j.kint.2018.08.027
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