Questions and Answers

Questions and Answers

1. Describe the pathophysiology of gout

Gout is a disease that happens when higher levels of urate crystals pile up and accumulate in the joints, soft tissues and bones resulting in severely painful inflammation.  The urate crystals forms due to elevated levels of uric acid in the blood, which is produced when the body breaks down purines. In standard cases, uric acid in the body passes to the urine through the kidney but when too much uric acid is produced in the body which builds up forming and crystalizes to sharp urate crystals which are deposited in the soft tissues, bones and, joints resulting to painful welling causing a gout attack.

2. Explain why a person with gout is more likely to develop renal calculi

A patient suffering from gout have a higher risk of renal calculi because of high levels of uric acids which forms acidic tomes. The low urine PH creates a conducive environment for the excess uric acid produced to build up forming stones. Additionally. Gout condition increases the risk of development of calcium oxalate stone which is a common type of renal calculi. Additionally, gout occurs due to swelling forming urate crystals which can also form in the kidneys creating painful kidney stones. The urate crystal in the kidney can develop significant sizes and cause severe kidney malfunction.

3. What is Lyme disease and what patient factors may have increased his risk of developing Lyme disease?

Lyme disease which is a highly infectious disease caused by the bacteria Borrelia burgdorferi, which is transmitted to people through bites by an infected tick.  For a tick to transmit the infection, it should be present in the body for 36 hours, and Stan was clearing the bushes a week ago. In the case scenario of Stan, the factors that increase the risk of developing Lyme disease for is his job of removing some bushes from his backyard a week ago which means he spent time in the bushes. He might be bitten by an infected tick and have no memory of the bite causing transmission of bacteria to his body.

4. What is Osteoporosis and how does it develop

Osteoporosis is a disease of the bones which results in a person developing porous bones that breaks easily. Osteoporosis develops when the body has low bone mass due to making of too little bone or when a body loses too much bone due to deterioration of the bone structure and tissue making the bones weak and prone to the risk of fractures and breaking. Any fall or simple activities such as sneezing can cause the bones to break because of their porous nature which makes them brittle and fragile. Lack of calcium for a long time increases the risk of developing Osteoporosis because inadequate calcium leads to a low density of bones.

5. Explain why patients with rheumatoid arthritis exhibit these symptoms and how does it differ from osteoarthritis.

The case scenario explains that the patient symptoms are pain, stiffness, swelling in her hands and, fatigue and the healthcare professional diagnosis her with rheumatoid arthritis.  It is an autoimmune disease which occurs when the immune systems of the body malfunctions and starts attacking the synovium which is a membrane lining surrounding the joint rather than attacking the intruding agents in the body causing pain, stiffness, tenderness in one or more joints and fatigue. When it is not treated, it causes osteoarthritis. Osteoarthritis, on the other hand, is a condition that develops when the smooth cartilage found in the joint is destroyed and wears out, causing pain and eliminates the bones.

6. Why did the APRN order an HLA—B27 lab? how would that result assist in understanding what ankylosing spondylitis

Ankylosing spondylitis is a rare condition of arthritis that affects the spine causing stiffness and pain in the spine. It is a chronic condition and begins in the lower back and spreads in the upper part in the neck and damages the joints in the body parts.  It is positively linked to genetic factors but does not have a known cause. The patient who has the HLA-B27 gene have a higher prevalence of are at a significantly increased risk of getting ankylosing spondylitis.

7. Why did the APRN feel a wrist splint would be helpful? What patient characteristics lead to this diagnosis

Lateral epicondylitis which is widely known as Tennis Elbow, is a syndrome condition which develops due to the overuse of the elbow. Lateral epicondylitis is a tendinopathy injury which creates when there are damages to the extensor muscles of the forearm which originates from the lateral epicondylar areas in the distal humerus. A Wrist splint is crucial to help reduce the syndrome because it acts and supports through the provision of rest to extensor muscles reducing insertion stress. In this case, the patient is a tennis player in high school, and his team competed and went to the regional level, therefore he practices and plays a lot causing the condition.  Even though his pains seem to go aware after rest and is elevated after taking Naprosyn, he should get adequate help to be able to continue playing tennis. Playing tennis is a factor which leads to this diagnosis because he uses his elbow a lot.

8. What is a seizure and how is status epilepticus so dangerous for patients

A seizure is a health condition which involves an unexpected, uncontrolled and abnormal electrical in the brain interrupting the standard signals of the brain, causing changes in consciousness, behaviours, feelings or movements. Regular seizures interfere with the usual connections among the brain nerve cause epilepsy. A patient has status epilepticus if they experience episode lasting for longer or many attacks in a short time without returning to an average level of consciousness. It is considered as a severe condition which requires medical emergency as it causes consequences such as permanent brain damage or death.

9. What is multiple sclerosis and how does it cause the above patient symptoms

Multiple sclerosis is a chronic health condition which involves the central nervous system. It occurs when the immune system attacks myelin a protective layer found around the nerve fibres causing inflammation, swelling and lesions, making it hard for the brain to send any signals to the body. In the case of 32 years old patients who are diagnosed with multiple sclerosis, the symptoms she displays. These signs are common in women; blurry vision is due to defect to the optical nerve, which disrupts vision. Slight tremors, tingling, and, numbness occurs because Multiple sclerosis affects the spinal cord and brain nerves. Fuzzy thinking causes dizziness and problems in coordination when the balancing nerves are affected. Difficulty concentrating is due to cognitive issues as it affects mental nerves.

10. What is the underlying pathophysiology of Myasthenia Gravis (MG)

Myasthenia gravis is an autoimmune illness which affects the neuromuscular junction (NMJ). It occurs when the antibodies attack postsynaptic membrane, impairing the neuromuscular transmission, causing fatigue and weakness of the skeletal muscle. The condition also arises due to the malfunction of the immune system whereby the body produces antibodies which attacks the receptors on the neuromuscular junction muscle surface, causing muscle weakness. For a patient with myasthenia gravis, the antibodies fight the postsynaptic acetylcholine receptors, instead of fighting foreign bodies.

11. What is Alzheimer’s disease and how does amyloid-beta factor into the development and progression of the disease

Alzheimer’s is a progressive form of dementia which becomes worse for the patient over time. Alzheimer’s disease is a condition that affects memory and thinking, which in turn affecting behaviours and difficulty remembering most recent things but remembering long-past things. The progressive diseases develop gradually over the years as a person begins to lose interest in abilities and conversations and inability to respond to the environment. The amyloid-beta, which is a protein fragment, increases the risk of developing Alzheimer’s disease because the protein begins destroying synapses before it clumps into plaques causing death to nerve cell.

12. Explain the difference between primary and secondary spinal code injury (SCI)

Spinal cord injury happens when damage occurs to the spinal cord, which hinders communication between the body and mind blocking the motor, sensory, reflex messages past beyond the damaged spinal cord. Primary spinal code injury occurs due to an initial traumatic event which causes mechanical disruption and distraction of neural elements, mainly due to the spine fracture or dislocation, causing severe injuries. Secondary spinal code injury occurs due to different biological and functional changes such as complicated swelling, inflammatory and, vascular changes.

13. What is spinal shock and how it is different  from neurogenic shock

Spinal shock is a medical health condition which comprises of the clinical syndrome, which involves loss of motor, reflex and, sensory functionality of the lower part of the spinal cord primarily due to spinal cord injury. It causes loss of autonomic tone, causing other conditions such as hypotension and ileus. On the other hand, the neurogenic shock is identified as a spinal cord injury which causes autonomic deregulation. It occurs due to loss of sympathetic tone, causing an unopposed parasympathetic response. While spinal shock significant symptoms are reversible loss of all sensation and motor reflex function of the spinal cord below the level of injury, neurogenic shock describes the hemodynamic changes that happen due to spinal cord injury above T6.

14. Explain the difference between primary and secondary traumatic brain injuries (TBI)?

In traumatic brain injury (TBI), primary brain injury is a condition of harm that happens in the initial insult causing displacement of the physical structure of the brain. The secondary brain injury occurs continuous and gradually through a cellular process. Primary TBI is induced by mechanical force the injury resulting in focusing and diffusing the trauma during an injury. At the same time, Secondary TBI arises from physiologic but not mechanical responses to the initial primary injury. Also, primary brain injury is damage which happens to the brain during a traumatic injury affecting the muscles and blood vessels, mainly due to a skull fracture or brokenness. A secondary injury arises from injuries acquired from direct damages.

15. The ICU staff calls the APRN because the patient ICPhas risen to 22 mmHg. The APRN recognizes the urgent need to lower the ICP. The APRN institutes measures to decrease the ICP and increase the Cerebral Perfusion Pressure (CPP). What are the factors that determine Cerebral Perfusion Pressure?

Cerebral Perfusion Pressure is the blood flow to the brain and is positively affected by the blood pressure in the arteries and blood vessels as well as intracranial pressure. Low blood pressure and high intracranial pressure causes a limited flow of oxygenated blood to the brain, causing a decrease in Cerebral Perfusion Pressure. On the other hand, high blood pressure and low intracranial pressure causes an increase in Cerebral Perfusion Pressure. Therefore, in this case, scenario, the healthcare professional should increase blood pressure and reduce the high levels of intracranial pressure. Thus, blood pressure is a crucial factor that determines Cerebral Perfusion Pressure.

16. Why did the patient’s symptoms resolve

The case scenario shows a patient with symptoms such as onset facial numbness, dull headache and staggering, which went away on their own. The healthcare professionals’ diagnosis is Ischemic attack which is a mini-stroke which occurs and lasts only a few minutes, and then the symptoms go away. It does not affect the abilities and response of a person. The ischemic attack occurs when there is a brief blockage of oxygen-rich blood supply and flow to part of the brain and when the blood supply restores the brain functions usually causing the symptoms to disappear and resolve on their own. Ischemic attack symptoms and condition come on suddenly, and a person who is fine suddenly develops difficulty speaking and moving a side of the body and the symptoms appear and then disappear within minutes.

17. How does atrial fibrillation contribute to the development of Cerebral Artery Vascular Accident (CVA?

Brain clot is a common cause of the Cerebral Artery Vascular Accident, which is also called a stroke, which then travels to the brain blocking the flow of oxygenated blood to the brain. Atrial fibrillation causes an increased and rapid heartbeat which causes blood to form a pool in the heart creating a clot which travels to the brain preventing proper flow of blood and oxygen. Cerebral Artery Vascular Accident that arises from atrial fibrillation is severe and causes complications significantly when deposit plagues and clots hinder the flow of blood to the brain.

18. Describe how osteoarthritis develops and forms and distinguish primary osteoarthritis and secondary arthritis

Osteoarthritis is a health condition that develops when cartilage cushions at the end of the bones and in the joints continuously deteriorate and are damaged. The slippery and firm tissues are very crucial for joint movements, therefore when it wears down the bones will rub each other’s causing inflammation, pain and damages an also making it hard to move. Osteoarthritis is a kind of arthritis which occurs due to an injury or underlying health condition. Primary osteoarthritis which is also called idiopathic is a condition that develops with age and causes cartilage tear and wears of the joints in one particular site without being caused by any injury and underlying health condition, hence the cause is not known. On the other hand, Secondary osteoarthritis also affects the joint of a particular single point. It is caused and triggered by a specific external or internal injury or an existing disease.

19. What are the underlying causes of fibromyalgia?

Fibromyalgia is a psychiatric disorder widely known as a stress-related health condition comprises of abnormal functioning in the hypothalamic-pituitary-adrenal (HPA) axis. It occurs when the body is not able to suppress cortisol. The causes differ and include genes, especially when it runs in the family, the gene may be passed to children increasing pain sensitivity.  Painful conditions such as arthritis increase chances of developing Fibromyalgia. Emotional and physical abuse results to a higher prevalence of Fibromyalgia in future as abuse changes the brain functionality significantly, handling pain and stress.  Mood disorders and lack of physical activities, especially in women, are linked as risk factors of Fibromyalgia.

20. The APRN tells the patients that the tender points are no longer used to diagnose FM. She suggests that the patient takes the Widespread Pain Index (WPI) and Symptoms Severity Inventory (SSI). The patient asks the APRN what these tests? What is the APRN best answer are?

Diagnosis of Fibromyalgia requires the evidence-based test to confirm a diagnosis. The Widespread Pain Index (WPI) is a test that quantifies the extent of pain in the body and constitutes a scale from 0 to 9 with 0 being the least painful and nine being very painful. A healthcare worker asks the patient the pain level in different body parts, especially for the past week.  If the test reveals pain in both body sides and below and above the waist, then fibromyalgia is identified as the diagnosis condition.  Symptoms Severity Inventory (SSI) on the other hand quantifies the severity of symptoms and consists of a scale of 1 to 12 and diagnosis fibromyalgia depending on the level of symptoms measured which includes cognitive dysfunctionality, fatigue or inadequate sleep among others. 0 indicates no problem, while 12 shows severe and life-threatening health problem.