Running Topic: Integrated Pathophysiology Integrated Pathophysiology Paper Confidential RNSG 2463 Instructor Date Integrated Pathophysiology 2 Resigned Data Mr. F. is a seventy-three year pristine Caucasian courageous who is twice divorced and lives waiting in Sweetwater, Texas. He has span progeny livelihood, and span insensible progeny. Twain of his parents are insensible; his brawnyher died at the antiquity of sixty-nine of pronaradmonish cancer, his woman at the antiquity of seventy-span of a clap. He is self-employed, holding a persomal dung narrowing concourse coercion encircling thirty years now. Mr. F. tands five-foot and nine inches haughty and weighs span hundred sixty pounds, exhibiting sober brawnyness and has been coercion the departed twenty-five years. He has a desirestanding narrative of hypertension; approximately twenty years as polite as a narrative of diabetes mellitus archearchekind span coercion twelve years, never having been insulin dependant. He has a smoking narrative of encircling fifty years smoking span throngs per day and has been diagnosed a lacking years gsingle with continuous irrelevant pulmonary distemper, making him oxygen-dependant coercion span years. He claims to singly absorb alcohol on a gregarious reason.
Prior to his exoteric approximation, he continuanceical that he has refertalented been handy with his diabetic nourishment, that he does refertalented inhibit his order glucose constantly nor has he been subjoined his medication viands as he should. His decisive doctors provision was span years gone. On July 6, 2008, Indigence Medical Services was named to Mr. F. ’s dwelling by a everyy who set him in bed, sensible, excepting momentous incoherently. He had a nasal canula in settle at three liters per specific. His glucometer manufactured by indigence idiosyncraticnel showed a order sugar of thirty-six.
He was then consecrated a bolus of dextrose fifty percent; he then retaliateed to sensibleness, excepting complained of some just instrument and leg decrepitude. He had 3+ pitting edema bilaterally to inferior extremities as polite as 1+ presacral edema. He was then ecstasyed to Rolling Plains Memorial Hospital indigence rigorousness. Upon apparition to the hospital, his subsistence signs were as ensues; order exigency- 200/103, rigorousihood trounce- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per specific. His just objectd decrepitude seemed to direct per resigned.
He destitute abundance, vertigo and tinnitus. Cues manufactured at the indigence rigorousness showed a stainless order cell calculate of 7. 8, hemoglobin of 12. 4, hematocrit of 37. 2, MCV of 95, and the platelet calculate parallel with coagulation studies showed to be recognized. His renal operation was abrecognized at a BUN of 68 and a creatinine of 6. 1. His potassium roll was 5. 4 and CO2 was 22. 3. His sodium roll was 133, phosphorus rolls were haughty at 6. 1, globulins were haughty at 4. 3, troponin roll was subordinately haughty at 0. 14 and CPK was recognized. His BNP NT-Archekind was extremely haughty at 9674. parallel with his hemoglobin A1C was at 5. 8. Thyroid studies were Integrated Pathophysiology 3 set to be recognized. The entirety cholesterol was 127, with HDL singly at 24, LDL at 79 and triglycerides at 136. A excite cue consider inspired by method of chest x-ray has shhold cardiomegaly with lenient venous redundancy. The EKG shows impecunious R thrive series and nonspecific ST thrive changes from controlmer. The echocardiogram showed 2+ mitral valve regurgitation with lenient aortic stenosis and as-well-mannered an dispossession constituent of estimate 50%. A renal sonogram shows discursive cystic changes.
A CT examine of his topic inspired lenient stainless substance changes excepting no other unnaturalities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190. 3. The resigned destitute problems with urination such as abundance, exigency, dysuria, reexoteric urinary confide infectious or renal stones. Home medications conceived; Potassium chloride 10 mEq t. i. d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b. i. d. coercion a entirety of 20 mg daily, Albuterol inhaler, Furosemide 80 mg in the am and 40 mg in the pm. Mr. F. was admitted into the intensive anxiety item from the indigence rigorousness.
Diseases/Pathophysiology Mr. F. ’s exoteric distemper processes are pristine hypertension, brawnyness, COPD, Diabetes mellitus, continuous renal demand, and congestive rigorousihood demand. Hypertension is defined as a order exigency ocean than 140/90 mm Hg (Ignatavicius & Genesisman, 2006). It is objectd by extensions in cardiac quenchedput, entirety peripheral opposition, or twain. The cardiac quenchedput is the genesis of order that is ejected by the rigorousihood each specific. Peripheral opposition is a opposition to the tide of order quenched object of the rigorousihood. It can be considered either primitive or unimportant.
Primitive hypertension has no public causative occurrenceors other than pertinency to genetic unfairness, brawnyness, strain, extensiond alcohol intake, diabetes, and or sodium and inspire appropriation in which every extension the entirety genesisload of the rigorousihood and extension soft genesis with in the vascular interval (Zerwekh, Claborn & Gaglione, 2006). Unimportant hypertension is haughty order exigency with an identifitalented object that may conceive excepting refertalented unsatisfactory to; renal stenosis, incarnate rigorousihood defects, Cushing’s syndrome, pheochromocytoma, untreated drowse apnea, MAOIs, chemical stimulants such as cocaine, methamphetamines expectation. or pregnancy requisite (Zerwekh, Claborn & Gaglione, 2006). Brawnyness is a distemper amid abundant distempers with abundant varying objects. According to Ignatavicius and Genesisman (2006), an fertile idiosyncratic weighs at meanest 20% overhead the haughtyer word of the recognized order coercion mental whole power and refers to an overmuch whole of whole brawny in which can be nice heterogeneous and object an dress of problems according to the arrangement, Integrated Pathophysiology 4 specially android brawnyness with abundance brawny at the waist and abdomen; this mould carries the haughtyest soundness lavish.
Continuous Irrelevant Pulmonary Distemper is a altertalented and immuttalented requisite characterized by diminished inspiratory and expiratory rigorousness of the lungs (Mosby’s, 2002). Emphysema parallel with continuous bronchitis is complications that guide to COPD. The etiology is over repeatedly than referable, a desire narrative of smoking cigarettes or other coercionms of smoking tobacco. The lungs surrender elasticity and guard to object hyperinflation imputtalented to the alveoli in the lung losing its elastin, in which then narrows and amounts a deportment area that retrenchs and is no desireer operationing justly coercion strong fog diversify.
The inferd zeal that is unqualified to be astounded justly befits trapped and objects the subsidence of the smaller zealways named bronchioles. With the lungs hyperinflated, this flattens the diaphragm, thus causing the special to husband friend muscles to exhalation, increasing the respiratory trounce to discharge. Resigneds with COPD enjoy bouts with continuous bronchitis which is an inflammation of the bronchi and bronchioles triggered usually by tobacco steam.
The irritants from the steam object inflammation, with vasodilation, mucosal edema, and bronchospasms; the extensiond inflammation extensions the bigness of the mucosal glands and amount vast wholes of luteous mucus, causing the bronchial walls to luteousen and impzeal zealtide (Ignatavicius & Genesisman, 2006). Diabetes Mellitus comes in abundant coercionms; the ocean speciality is haughty order glucose imputtalented to complications in the insulin secretion or enjoyment or twain (Ignatavicius & Genesisman, 2006).
When diagnosed with diabetes other than archearchekind single, the beta cells in the islets of Langerhans that amount insulin and the alpha cells that amount glucagon, which calculateeract single another, either retrench in genesis of these hormones or can haply amount at a recognized estimate. If there is recognized genesis of these hormones, oceanly insulin (the hormsingle that ecstasys glucose into the cells), it is usually cellular opposition to insulin that is causing the diabetes.
When the cells are refertalented receiving the certain glucose demanded coercion cellular operation and metabolism, the whole is unqualified to husband the glucose, garner carbohydrates, brawnys and proteins; restraint-this-reason the unused glucose dross in the order causing hyperglycemia and regulatory mechanisms in the whole guard to object the exempt of over glucagon which object the exempt of garnerd glucose in the liver into the ordertide as polite, restraint-this-reason increasing the order glucose roll unifashion over. Homeostasis is Integrated Pathophysiology 5 nterrupted, methodically causing hurt. The etiology of archearchekind span diabetes can be a league of abundant occurrenceors; referablewithstanding the polite public coadjutor is brawnyness. Continuous renal demand is a alterable, immuttalented relationship deterioration, and relationship operation does refertalented recestimate (Ignatavicius & Genesisman, 2006). The relationships are in advise of refineing the metabolic wastes in the ordertide that comes from cellular metabolism throughquenched the whole as polite as reabsorption of certain electrolytes.
When desire-term damantiquity is sustained in the cells of the relationships (nephrons) by occurrenceors such as desirestanding hypertension, operation is alterablely altered exhibited by the want to excrete the nitrogenous wastes; restraint-this-reason they infer in the relationships and order tide. Altered glomerular sublimation trounce, abrecognized urine genesis, impecunious inspire exudation, electrolyte imbalances, and metabolic unnaturalities take-establish as a fruit of renal demand. The whole’s rigorousness to attenuate urine is retrenchd; restraint-this-reason urine quenchedput retrenchs causing soft estimateload.
The demand take-places in stages with the decisive substance end-stantiquity renal distemper in which every renal operation uniformtually ceases. Congestive rigorousihood demand as-well-mannered public as left-sided rigorousihood demand may fruit from hypertensive coronary artery and valvular distempers arising chiefly from the mitral and aortic valves. When CHF take-places from any etiology such as methodic hypertension and structural changes, the ventricles of the rigorousihood are unqualified to conconfide and or loosen justly causing order to congest encircling the rigorousihood.
As a fruit of this redundancy in and encircling the rigorousihood, structure perfusion diminishes and order infers in the pulmonary vessels. Cardiac quenchedput uniformtually retrenchs and compensatory mechanisms such as antagonistic terse method stimulation, the renin-angiotensin method activation in the relationships (RAS), other neurohumoral responses and myocardial hypertrophy succeed take-establish (Ignatavicius & Genesisman, 2006).
The hypoxic naradmonish of the structures embitter the terse method which extensions the rigorousihood trounce and order exigency imputtalented to vasoconstriction and this stimulation extensions venous order retaliate to the rigorousihood, which in depend stretches the myocardial fibers causing dilation and uniformtually luteousening of the walls of the rigorousihood and chambers amid it, restraint-this-reason causing extension (cardiomegaly). The rigorousihood then tries to conconfide rigorouser and uniformtually exhausts and reduces the coercionce of the narrowions; restraint-this-reason decreasing cardiac quenchedput.
The vasoconstriction of the arteries extensions the ensueingload which is the opposition that the rigorousihood must interrogate. This frugal quenchedput objects a retrench in order tide to the relationship’s which fruits in the activation of the RAS in depend objects sodium and inspire appropriation. Cardiac preload and ensueingload extension causing narrowile dysfunction. Integrated Pathophysiology 6 Integration Mr. F. reputed that he has been fertile coercion approximately twenty-five years. A lacking years ensueing the weighty power gain, he was diagnosed with hypertension.
At his hold approximation, his lifestyle of haughty brawny, cholesterol, salt and sugar intake as polite as a desire narrative of smoking cigarettes left dirty to be desired and enjoy contributed weightyly to his exoteric requisite. Several years ensueing having been diagnosed with hypertension, he was tpristine he had diabetes and COPD. Upon his fresh hypoglycemic episode, he was diagnosed then as having continuous renal demand with congestive rigorousihood demand. Every of these diagnoses retain polite in contemporaneously, starting with brawnyness. When a idiosyncratic is fertile, the abundance power, specially encircling the waist and abdomen as seen in Mr.
F. objects the genesisload on the rigorousihood to extension imputtalented to the abundance adipose structure embracing the visceral organs and power in public. Substance fertile puts single at haughty lavish occurrenceors coercion enucleateing hypertension and rigorousihood distemper as Mr. F. has. Brawnyness as-well-mannered settles single at haughty lavish coercion enucleateing diabetes archearchekind span imputtalented to the occurrence that adipose structure and cells that infer enjoy a haughty guardency to befit insulin firm as polite as the embracing cells and structure; restraint-this-reason the whole can refertalented husband the glucose and hyperglycemia take-places.
A prolonged continuance of insulin opposition uniformtually guides to the beta cell demand causing retrenchd insulin genesis. The selfselfsame haughty brawny, cholesterol, and sodium nourishment that contributed to the resigned’s brawnyness in the primeval settle, causing his rigorousihood to enjoy to genesis rigorouser, over than slight objectd him to enucleate hypertension. The occurrence of his non-yielding with his medication viands coercion hypertension and diabetes, 100 throng per year smoking inurement as polite as nonobservance with prescribed diabetic nourishment, guide to his excite complications of renal demand and decisively CHF.
With prolonged hypertension and chiefly violent diabetes mellitus, diabetic nephropathy changes the relationships in a method that reduces relationship operation and uniformtually, renal demand. Continuous haughty order glucose rolls object hypertension in relationship order vessels and abundance relationship perfusion (Ignavicius &Workman, 2006). This extension in exigency amid the relationships object the order vessels to incline quenched that everyows vast particles such as albumins and proteins to coercionm deposits in the relationships and their order provide.
This narrows the vessels and retrenchs oxygenation to embracing relationship structure; restraint-this-reason causing hypoxia and uniformtually immuttalented cell dissolution. As this progresses, scarred structure coercionms and the rigorousness to refine urine from the order ceases causing renal demand. Once in renal demand, the resigned’s relationships were refertalented talented to rale the soft genesis by strong exudation, restraint-this-reason the abundance soft was pooled end into the vascular Integrated Pathophysiology 7 interval. This soft genesis estimateload objectd an extensiond cardiac genesisload which uniformtually guides to congestive rigorousihood demand.
Mr. F. ’s smoking narrative was the primitive object of his COPD; referablewithstanding it is exacerbated by the assembly of soft in his vascular interval imputtalented to renal demand, the cefeiture of elasticity of vascular method and congestive rigorousihood demand. The medication prescribed coercion Mr. F. ’s diabetes was Metformin 500 mg daily. This medication primitive enjoyment was to retrench hepatic glucose genesis. The abundance insulin in the order triggers genesis of glucagon in which signals the liver to exempt garnerd glucose, in depend hyperglycemia fruits. This medication was alterable imputtalented to Mr. F. s haughty BUN and creatinine which is where this medication is metabolized and excreted as polite as his naradmonish of CHF. Persistent this medication could object toxicity. The strange medication he was settled on was a frugal dose of Actos which is metabolized in the liver and does refertalented object hypoglycemia as Metformin may. To negotiate his hypertension, Nifedipine was prescribed and it acts to inferior order exigency by inhibiting calcium ecstasy into myocardial cells and flatten muscle cells amid the vascular interval fruiting in vasodilation calculateeracting the vasoconstriction objectd by hypertension.
In adduction to Nifedipine, the resigned is prescribed an ACE inhibitor named Ramipril. This ACE inhibitor genesiss on the renin-angiotensinogen method flushtually causing methodic vasodilation. This medication refertalented singly retrenchs the order exigency, it retrenchs cardiac ensueingload in resigneds with CHF. Ramipril is metabolized in the liver, restraint-this-reason implied coercion resigneds at lavish or in renal demand. Furosemide is a loop diuretic that is specially advantageous in resigneds with edema imputtalented to hypertension, renal distemper as polite as CHF.
Furosemide extensions the renal exudation of inspire as polite as sodium and other electrolytes, thus reduces the soft genesis in the vascular interval. It as-well-mannered has a vasodilating possessions that are advantageous in this resigneds viands; referablewithstanding a potassium appendix must be consecrated imputtalented to the potassium wasting objectd by this loop diuretic. This resigned’s dose of Furosemide was weightyly extensiond imputtalented to the indigence of ridding his whole of the accumulating soft and stabilizing his order exigency which in depend succeed frustrate excite damantiquity to his relationship’s. Potassium is certain coercion right narrowility of the rigorousihood.
Mr. F. is on Potassium chloride 10 mEq t. i. d. to constitute up coercion the cefeiture imputtalented to the loop diuretic possessions. The Albuterol inhaler is used to scourteous the bronchi thus increasing deportment area of the zeal methods to entalented oxygen and CO2 diversify. This inhaler can exacerbate hypertension, palpitations and enjoy a denying cardiac goods as polite as object hyperglycemia; restraint-this-reason must be used cautiously. Integrated Pathophysiology 8 Prediction of Quenchedcomes Although Mr. F. ’s intelligent requisite was stabilized, his prognosis appears impecunious at this top imputtalented to his narrative of nonobservance.
Unifashion though he has retrenchd his cigarette inurement to single throng per day, his requisite succeed probably deteriotrounce original he could entiretyly cease from smoking. While momentous with the resigned, he assures that this has got his regard and he succeed reocean handy from here on quenched. The damantiquity at this top is immutable; restraint-this-reason oceantaining waiting operation as it is now befits a strange pre-eminence, significance that yielding is certain at this top coercion this resigned as persistent to be nonhandy succeed definitely guide to his termination.
Aggressive diabetic counseling as polite as subscription of adhering to his exoteric medication viands is probing coercion this resigned’s course. Other disciplines that should be concerned to secure a improve prognosis coercion Mr. F. are singles such as a nourishmentician to ceefend with moderation and snack planning per diabetic protocol, persistent respiratory therapy to ceefend in oxygenation and food, natural therapy to uplift the resigneds ability and frustrate venous stasis hence order clots, and mayhap unifashion occupational therapy to aid him with oceantaining fractions activities of daily livelihood.
Routine folfrugal up provisions with his physician as polite as specialist coercion cardiac and pulmonary operation are vital to his quenchedcome. A diabetic aid assemblage would be mental coercion this resigned as he appears to be a idiosyncratic in demand of a aid team. Lifestyles are rigorous to deviate, excepting when single gets ended into a cavity, it can be manufactured, unifashion in the most nonhandy resigneds incorrectly dissolution is impending. Integrated Pathophysiology 9
References Deglin, J. H. & Vallerand, A. H. (2007). Davis’s Drug Guide, Tenth Edition. Philadelphia: F. A. Davis Concourse. Ignatavicius, D. D. & Genesisman, M. L. (2006). Medical Surgical Nursing, Critical Thinking coercion Collaborative Anxiety. St. Louis: Elsevier Saunders. Mosby’s Medical, Nursing, & Everyied Soundness Dictionary (6th ed. ). St. Louis: Mosby, Inc. Zerwekh, J. , Claborn, J. C. & Gaglione, T. (2006). Mosby’s Pathophysiology Memory Referableecards, Visual, Mnemonic, and Memory Ceefends coercion Nurses. St. Louis: Mosby, Inc.
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