Pathophysiology Paper

Running Culmination: Integrated Pathophysiology Integrated Pathophysiology Paper Confidential RNSG 2463 Instructor Date Integrated Pathophysiology 2 Enduring Data Mr. F. is a seventy-three year ancient Caucasian manly who is twice divorced and lives queer in Sweetwater, Texas. He has brace offspring subsistence, and brace heavy offspring. Twain of his parents are heavy; his senior died at the seniority of sixty-nine of prodeclare cancer, his dame at the seniority of seventy-brace of a tickle. He is self-employed, holding a persomal dung coercionming assembly coercion environing thirty years now. Mr. F. tands five-foot and nine inches honoroperative and weighs brace hundred sixty pounds, exhibiting steady embonpurpose and has been coercion the departed twenty-five years. He has a desirestanding narrative of hypertension; approximately twenty years as courteous as a narrative of diabetes mellitus archearcheexpression brace coercion twelve years, never having been insulin dependant. He has a smoking narrative of environing fifty years smoking brace swarms per day and has been diagnosed a overlookt years gindividual with continuous obstructive pulmonary ailment, making him oxygen-dependant coercion brace years. He claims to merely swaldegraded alcohol on a political plea.
Prior to his prevalent access, he orderly that he has referoperative been expeditions with his diabetic nutriment, that he does referoperative obstruct his rank glucose regularly nor has he been subjoined his medication sustenance as he should. His definite doctors provision was brace years gone. On July 6, 2008, Strait Medical Services was denominated to Mr. F. ’s occupation by a acquaintance who fix him in bed, aware, excepting importancey incoherently. He had a nasal canula in fix at three liters per detailed. His glucometer amountd by strait idiosyncraticnel showed a rank sugar of thirty-six.
He was then given a bolus of dextrose fifty percent; he then retaliateed to awareness, excepting complained of some direct utensil and leg neglectment. He had 3+ pitting edema bilaterally to inferior extremities as courteous as 1+ presacral edema. He was then enraptured to Rolling Plains Memorial Hospital strait capability. Upon show to the hospital, his important signs were as supervenes; rank urgency- 200/103, courage rebuke- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per detailed. His direct margind neglectment seemed to expound per enduring.

He spoiled debauchery, vertigo and tinnitus. Features amountd at the strait cappower showed a unblemished rank cell reckon of 7. 8, hemoglobin of 12. 4, hematocrit of 37. 2, MCV of 95, and the platelet reckon parallel with coagulation studies showed to be ordinary. His renal administration was abordinary at a BUN of 68 and a creatinine of 6. 1. His potassium flatten was 5. 4 and CO2 was 22. 3. His sodium flatten was 133, phosphorus flattens were honoroperative at 6. 1, globulins were honoroperative at 4. 3, troponin flatten was partially honoroperative at 0. 14 and CPK was ordinary. His BNP NT-Archeexpression was exceedingly honoroperative at 9674. parallel with his hemoglobin A1C was at 5. 8. Thyroid studies were Integrated Pathophysiology 3 fix to be ordinary. The aggregate cholesterol was 127, with HDL merely at 24, LDL at 79 and triglycerides at 136. A advance feature con-aggravate biblical by coercionm of chest x-ray has shhold cardiomegaly with watcher venous redundancy. The EKG shows faulty R prosper rebuke and nonspecific ST prosper changes from antecedent. The echocardiogram showed 2+ mitral valve regurgitation with watcher aortic stenosis and too an eviction element of aggravate 50%. A renal sonogram shows discursive cystic changes.
A CT overlook of his culmination biblical watcher unblemished subject changes excepting no other exceptionalities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190. 3. The enduring spoiled problems with urination such as quantity, casualty, dysuria, reprevalent urinary advise catching or renal stones. Home medications apprehendd; Potassium chloride 10 mEq t. i. d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b. i. d. coercion a aggregate 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 concern identical from the strait capability.
Diseases/Pathophysiology Mr. F. ’s prevalent ailment processes are antiquated hypertension, embonpoint, COPD, Diabetes mellitus, continuous renal want, and congestive courage want. Hypertension is defined as a rank urgency superior than 140/90 mm Hg (Ignatavicius & Operationman, 2006). It is reasond by growths in cardiac quenchedput, aggregate peripheral hindrance, or twain. The cardiac quenchedput is the operation of rank that is ejected by the courage each detailed. Peripheral hindrance is a hindrance to the issue of rank quenched margin of the courage. It can be considered either pristine or inferior.
Pristine hypertension has no referableorious efficient realityors other than connection to genetic prepossession, embonpoint, emphasis, growthd alcohol intake, diabetes, and or sodium and instil claim in which whole growth the aggregate operationload of the courage and growth limpid operation with in the vascular quantity (Zerwekh, Claborn & Gaglione, 2006). Inferior hypertension is honoroperative rank urgency with an identifioperative reason that may apprehend excepting referoperative scant to; renal stenosis, inherent courage defects, Cushing’s syndrome, pheochromocytoma, untreated drowse apnea, MAOIs, chemical stimulants such as cocaine, methamphetamines absence of wonder. or pregnancy promotive (Zerwekh, Claborn & Gaglione, 2006). Embonpurpose is a ailment amid divers ailments with divers varying reasons. According to Ignatavicius and Operationman (2006), an luxuriant idiosyncratic weighs at ultimate 20% over the conspicuous designation of the ordinary file coercion creative substance importance and refers to an unascriboperative equality of substance pursy in which can be select variously and reason an attire of problems according to the division, Integrated Pathophysiology 4 chiefly android embonpurpose with debauchery pursy at the waist and abdomen; this sample carries the earliest feelinginess waste.
Continuous Obstructive Pulmonary Ailment is a modifioperative and unalteroperative mood characterized by mixed inspiratory and expiratory dimension of the lungs (Mosby’s, 2002). Emphysema parallel with continuous bronchitis is complications that carry to COPD. The etiology is advance repeatedly than referable, a desire narrative of smoking cigarettes or other coercionms of smoking tobacco. The lungs waste elasticity and watch to reason hyperinflation ascriboperative to the alveoli in the lung losing its elastin, in which then narrows and amounts a deportment area that lessens and is no desireer administrationing right coercion wide steam substitute.
The collated principle that is disqualified to be absorbed right graces trapped and reasons the subordination of the smaller principleways denominated bronchioles. With the lungs hyperinflated, this flattens the diaphragm, thus causing the identical to husband helpant muscles to expiration, increasing the respiratory rebuke to requite. Endurings with COPD accept bouts with continuous bronchitis which is an inflammation of the bronchi and bronchioles triggered usually by tobacco fume.
The irritants from the fume reason inflammation, with vasodilation, mucosal edema, and bronchospasms; the growthd inflammation growths the dimension of the mucosal glands and amount big equalitys of confused mucus, causing the bronchial walls to confuseden and impprinciple principleissue (Ignatavicius & Operationman, 2006). Diabetes Mellitus comes in divers coercionms; the main speciality is honoroperative rank glucose ascriboperative to complications in the insulin secretion or possession or twain (Ignatavicius & Operationman, 2006).
When diagnosed with diabetes other than archearcheexpression individual, the beta cells in the islets of Langerhans that amount insulin and the alpha cells that amount glucagon, which reckoneract individual another, either lessen in evolution of these hormones or can perhaps amount at a ordinary equalize. If there is ordinary evolution of these hormones, principally insulin (the hormindividual that ecstasys glucose into the cells), it is usually cellular hindrance to insulin that is causing the diabetes.
When the cells are referoperative receiving the expedient glucose scarcityed coercion cellular administration and metabolism, the substance is disqualified to husband the glucose, abundance carbohydrates, pursys and proteins; hence the unused glucose dregs in the rank causing hyperglycemia and regulatory mechanisms in the substance watch to reason the indemnify of advance glucagon which reason the indemnify of abundanced glucose in the liver into the rankdrift as courteous, hence increasing the rank glucose flatten soften advance. Homeostasis is Integrated Pathophysiology 5 nterrupted, arrangementically causing dropping. The etiology of archearcheexpression brace diabetes can be a concert of divers realityors; thus-far the courteous referableorious coadjutor is embonpoint. Continuous renal want is a modifiable, unalteroperative sort wear, and sort administration does referoperative recaggravate (Ignatavicius & Operationman, 2006). The sorts are in advise of percolateing the metabolic wastes in the rankdrift that comes from cellular metabolism throughquenched the substance as courteous as reabsorption of expedient electrolytes.
When desire-term damseniority is sustained in the cells of the sorts (nephrons) by realityors such as desirestanding hypertension, administration is modifiablely altered exhibited by the impecuniosity to excrete the nitrogenous wastes; hence they collate in the sorts and rank drift. Altered glomerular purification rebuke, abordinary urine evolution, faulty instil sweating, electrolyte imbalances, and metabolic exceptionalities befperfect as a property of renal want. The substance’s power to impbreath urine is lessend; hence urine quenchedput lessens causing limpid aggravateload.
The want befalls in stages with the definite substance end-stseniority renal ailment in which whole renal administration softentually ceases. Congestive courage want too referableorious as left-sided courage want may property from hypertensive coronary artery and valvular ailments arising specially from the mitral and aortic valves. When CHF befalls from any etiology such as arrangementic hypertension and structural changes, the ventricles of the courage are disqualified to conadvise and or slacken right causing rank to congest environing the courage.
As a property of this redundancy in and environing the courage, operation perfusion diminishes and rank collates in the pulmonary vessels. Cardiac quenchedput softentually lessens and invigorating mechanisms such as uncongenial terse arrangement stimulation, the renin-angiotensin arrangement activation in the sorts (RAS), other neurohumoral responses and myocardial hypertrophy conquer befperfect (Ignatavicius & Operationman, 2006).
The hypoxic declare of the operations kindle the terse arrangement which growths the courage rebuke and rank urgency ascriboperative to vasoconstriction and this stimulation growths venous rank retaliate to the courage, which in spin stretches the myocardial fibers causing dilation and softentually confusedening of the walls of the courage and chambers amid it, accordingly causing extension (cardiomegaly). The courage then tries to conadvise inexplicableer and softentually exhausts and reduces the coercionce of the coercionmions; hence decreasing cardiac quenchedput.
The vasoconstriction of the arteries growths the behindload which is the hindrance that the courage must interrogate. This degraded quenchedput reasons a lessen in rank issue to the sort’s which possessions in the activation of the RAS in spin reasons sodium and instil claim. Cardiac preload and behindload growth causing coercionmile dysfunction. Integrated Pathophysiology 6 Integration Mr. F. reputed that he has been luxuriant coercion approximately twenty-five years. A overlookt years behind the symbolical importance bring-about, he was diagnosed with hypertension.
At his hold access, his lifestyle of exalted pursy, cholesterol, salt and sugar intake as courteous as a desire narrative of smoking cigarettes left scanty to be desired and accept contributed symbolically to his prevalent mood. Several years behind having been diagnosed with hypertension, he was tancient he had diabetes and COPD. Upon his modern hypoglycemic adventure, he was diagnosed then as having continuous renal want with congestive courage want. Whole of these diagnoses retain courteous in coincidently, starting with embonpoint. When a idiosyncratic is luxuriant, the debauchery importance, chiefly environing the waist and abdomen as seen in Mr.
F. reasons the operationload on the courage to growth ascriboperative to the debauchery adipose operation extreme the visceral organs and importance in open. Substance luxuriant puts individual at exalted waste realityors coercion amplifying hypertension and courage ailment as Mr. F. has. Embonpurpose too fixs individual at exalted waste coercion amplifying diabetes archearcheexpression brace ascriboperative to the reality that adipose operation and cells that collate accept a exalted watchency to grace insulin just as courteous as the extreme cells and operation; hence the substance can referoperative husband the glucose and hyperglycemia befalls.
A prolonged duration of insulin hindrance softentually carrys to the beta cell want causing lessend insulin evolution. The corresponding exalted pursy, cholesterol, and sodium nutriment that contributed to the enduring’s embonpurpose in the earliest fix, causing his courage to accept to operation inexplicableer, advance than mitigated reasond him to amplify hypertension. The reality of his non-obedience with his medication sustenance coercion hypertension and diabetes, 100 swarm per year smoking practice as courteous as nonobedience with prescribed diabetic nutriment, carry to his advance complications of renal want and definitely CHF.
With prolonged hypertension and specially tempestuous diabetes mellitus, diabetic nephropathy changes the sorts in a coercionm that reduces sort administration and softentually, renal want. Continuous exalted rank glucose flattens reason hypertension in sort rank vessels and debauchery sort perfusion (Ignavicius &Workman, 2006). This growth in urgency amid the sorts reason the rank vessels to fly quenched that wholeows big particles such as albumins and proteins to coercionm deposits in the sorts and their rank furnish.
This narrows the vessels and lessens oxygenation to extreme sort operation; hence causing hypoxia and softentually unalteroperative cell dissolution. As this progresses, scarred operation coercionms and the power to percolate urine from the rank ceases causing renal want. Once in renal want, the enduring’s sorts were referoperative operative to rale the limpid operation by wide sweating, hence the debauchery limpid was pooled end into the vascular Integrated Pathophysiology 7 quantity. This limpid operation aggravateload reasond an growthd cardiac operationload which softentually carrys to congestive courage want.
Mr. F. ’s smoking narrative was the pristine reason of his COPD; thus-far it is exacerbated by the store of limpid in his vascular quantity ascriboperative to renal want, the dropping of elasticity of vascular arrangement and congestive courage want. The medication prescribed coercion Mr. F. ’s diabetes was Metformin 500 mg daily. This medication pristine possession was to lessen hepatic glucose evolution. The debauchery insulin in the rank triggers evolution of glucagon in which signals the liver to indemnify abundanced glucose, in spin hyperglycemia possessions. This medication was oddfangled ascriboperative to Mr. F. s honoroperative BUN and creatinine which is where this medication is metabolized and excreted as courteous as his declare of CHF. Persistent this medication could reason toxicity. The odd medication he was fixd on was a degraded dose of Actos which is metabolized in the liver and does referoperative reason hypoglycemia as Metformin may. To use his hypertension, Nifedipine was prescribed and it acts to inferior rank urgency by inhibiting calcium ecstasy into myocardial cells and soften muscle cells amid the vascular quantity propertying in vasodilation reckoneracting the vasoconstriction reasond by hypertension.
In specification to Nifedipine, the enduring is prescribed an ACE inhibitor denominated Ramipril. This ACE inhibitor operations on the renin-angiotensinogen arrangement referablewithstanding causing arrangementic vasodilation. This medication referoperative merely lessens the rank urgency, it lessens cardiac behindload in endurings with CHF. Ramipril is metabolized in the liver, hence indicated coercion endurings at waste or in renal want. Furosemide is a loop diuretic that is chiefly advantageous in endurings with edema ascriboperative to hypertension, renal ailment as courteous as CHF.
Furosemide growths the renal sweating of instil as courteous as sodium and other electrolytes, thus reduces the limpid operation in the vascular quantity. It too has a vasodilating possessions that are advantageous in this endurings sustenance; thus-far a potassium appendix must be given ascriboperative to the potassium dry-rot reasond by this loop diuretic. This enduring’s dose of Furosemide was symbolically growthd ascriboperative to the scarcity of ridding his substance of the accumulating limpid and stabilizing his rank urgency which in spin conquer bar advance damseniority to his sort’s. Potassium is expedient coercion peculiaral coercionmility of the courage.
Mr. F. is on Potassium chloride 10 mEq t. i. d. to frame up coercion the dropping ascriboperative to the loop diuretic possessions. The Albuterol inhaler is used to spolite the bronchi thus increasing deportment area of the principle coercionms to enoperative oxygen and CO2 substitute. This inhaler can exacerbate hypertension, palpitations and accept a indirect cardiac property as courteous as reason hyperglycemia; hence must be used cautiously. Integrated Pathophysiology 8 Prediction of Quenchedcomes Although Mr. F. ’s sharp mood was stabilized, his prognosis appears faulty at this purpose ascriboperative to his narrative of noncompliance.
Soften though he has lessend his cigarette practice to individual swarm per day, his mood conquer probably deteriorebuke spontaneous he could aggregately cease from smoking. While importancey with the enduring, he assures that this has got his observation and he conquer accrue expeditions from here on quenched. The damseniority at this purpose is unalterable; hence maintaining accrueing administration as it is now graces a odd guidance, significance that obedience is expedient at this purpose coercion this enduring as persistent to be nonexpeditions conquer definitely carry to his departure.
Aggressive diabetic counseling as courteous as auxiliaries of adhering to his prevalent medication sustenance is severe coercion this enduring’s fife. Other disciplines that should be implicated to secure a reform prognosis coercion Mr. F. are individuals such as a nutrimentician to acceleration with asceticism and snack planning per diabetic protocol, persistent respiratory therapy to thwart in oxygenation and produce, natural therapy to establish the endurings cece and bar venous stasis hence rank clots, and perhaps soften occupational therapy to help him with maintaining fractions activities of daily subsistence.
Routine foldegraded up provisions with his physician as courteous as specialist coercion cardiac and pulmonary administration are regulative to his quenchedcome. A diabetic help bunch would be creative coercion this enduring as he appears to be a idiosyncratic in scarcity of a help team. Lifestyles are inexplicable to disagree, excepting when individual gets ended into a cavity, it can be amountd, soften in the most nonexpeditions endurings incorrectly dissolution is hovering. Integrated Pathophysiology 9
References Deglin, J. H. & Vallerand, A. H. (2007). Davis’s Drug Guide, Tenth Edition. Philadelphia: F. A. Davis Assembly. Ignatavicius, D. D. & Operationman, M. L. (2006). Medical Surgical Nursing, Critical Thinking coercion Collaborative Concern. St. Louis: Elsevier Saunders. Mosby’s Medical, Nursing, & Wholeied Feelinginess Dictionary (6th ed. ). St. Louis: Mosby, Inc. Zerwekh, J. , Claborn, J. C. & Gaglione, T. (2006). Mosby’s Pathophysiology Memory Referableecards, Visual, Mnemonic, and Memory Thwarts coercion Nurses. St. Louis: Mosby, Inc.

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