NURS 6501 CASE STUDY ANALYSIS WEEK 4

Walden University NURS 6501 CASE STUDY ANALYSIS WEEK 4– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6501 CASE STUDY ANALYSIS WEEK 4assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6501 CASE STUDY ANALYSIS WEEK 4

Whether one passes or fails an academic assignment such as the Walden University NURS 6501 CASE STUDY ANALYSIS WEEK 4 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6501 CASE STUDY ANALYSIS WEEK 4

The introduction for the Walden University NURS 6501 CASE STUDY ANALYSIS WEEK 4 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6501 CASE STUDY ANALYSIS WEEK 4

After the introduction, move into the main part of the NURS 6501 CASE STUDY ANALYSIS WEEK 4 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6501 CASE STUDY ANALYSIS WEEK 4

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6501 CASE STUDY ANALYSIS WEEK 4

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6501 CASE STUDY ANALYSIS WEEK 4

Case Study Analysis: Cardiovascular and Respiratory Systems

A 76-year-old female patient who presents with symptoms of peripheral edema, abdominal swelling, weight gain, and shortness of breath. The patient has orthopnea (needs to use two pillows in order to get enough air). She has a medical history of congestive heart failure and she is noncompliant to diuretic medication due to its effect on increasing urinary frequency.

Cardiovascular Pathophysiology

Congestive Heart Failure

The patient has a medical history of congestive heart failure (CHF). CHF is a chronic medical condition where there is an abnormality in cardiac structure or function resulting in inability of the heart to fill with or eject blood at a rate that commensurate with the requirements of the metabolizing tissues (Ariyaratnam et al., 2021). It presents with fluid retention, fatigue, and dyspnea. The patient has been noncompliant to diuretic medication. Diuretics are essential medications in CHF since they help relieve the body of excessive fluid. Since the patient does not take the medication due to its effect in increasing urinary frequency, excessive fluid accumulates in the body leading to peripheral edema. Noncompliance to medications further worsens the heart failure.

Fluid Retention and Peripheral Edema

In CHF, the heart’s pumping mechanism is affected leading to reduced cardiac output. The body activates neurohormonal systems such as the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) which increase reabsorption of sodium and water from the kidneys (Ariyaratnam et al., 2021). The consequence is further increase in fluid overload leading to increased blood volume and aggravate peripheral edema. It is essential for the clinician to enquire about other medications of heart failure. Is the patient taking ACE inhibitors? Medication analysis helps to understand the causation of the symptoms. Abdominal swelling also indicates excessive fluid accumulation in the body. Some fluid accumulates within the abdomen.

Cardiopulmonary Pathophysiology

Pulmonary Congestion

CHF may present with diastolic, systolic, or both dysfunctions. Inefficiency to pump blood from the heart and to fill adequately contributes to blood backing up in the pulmonary circulation. Increased fluids in the pulmonary circulation cause increased pulmonary venous pressure. Elevated pressure in the pulmonary capillaries cause leakage of fluids into the interstitial spaces and alveoli of the lung, leading to pulmonary congestion (Boorsma et al., 2020). Fluid in the lungs impair gaseous exchange and shortness of breath. While lying in recumbence, there is fluid distribution from splanchnic and lower extremities to the lung which in the case of this patient worsens the pulmonary congestion. Orthopnea necessitates this patient to use two pillows to alleviate breathing difficulties.

Interaction between Cardiovascular and Cardiopulmonary Pathophysiology

In the case of this patient, the pathophysiology of cardiovascular and cardiopulmonary systems interact to affect the patient’s clinical presentation. Congestive heart failure compromises the pumping mechanism of the heart leading to reduced cardiac output. Reduced cardiac outputs leads to more fluid shifting to the pulmonary circulation. Boorsma et al. (2020) stated that fluid accumulation in the pulmonary systems including in the alveoli of the lungs leads to pulmonary congestion. Pulmonary congestion leads to impaired gaseous exchange and dyspnea. Boorsma et al. (2020) mentioned that pulmonary congestion further worsens the impairment in the cardiac pumping mechanism, further worsening the CHF. Fluid retention and overload leads to a combined manifestation of cardiac dysfunction and respiratory distress. CHF leads to fluid retention which makes it difficult for the patient to breathe freely when lying flat on bed. Orthopnea involves an impact of cardiac dysfunction on breathing while the patient is in a certain position. Understanding how the two systems interact helps optimize interventions to ensure that the patient’s condition improves appropriately.

Ethnic/ Racial Variables Impacting Physiological Functioning

It is essential to consider racial and ethic variables that influence physiological functioning. Racial and ethnic disparities in healthcare affect the morbidity and mortality of congestive heart failure and other conditions affecting the cardiovascular and cardiopulmonary systems. Lewsey & Breathett (2021) mentioned that genome research found that human beings are 99.9% similar regardless of race or ethnic background. The finding makes it clear that the high prevalence of heart failure and adverse outcomes among racial minorities is barely a result of genetic factors (Lewsey & Breathett, 2021). “Self-identified African-American or Black patients, and Hispanic patients have disproportionately high prevalence of HF in comparison to other racial groups” (Lewsey & Breathett, 2021).

African Americans, American Indians, and Hispanics harbor a majority of modifiable risk factors such as obesity, hypertension, and diabetes (Lewsey & Breathett, 2021). The main reason for the conditions include poor socio-economic status which makes it difficult for ethnic and racial minorities to adopt healthy lifestyle. The racial minorities have limited knowledge on dietary considerations such as avoiding high-fat foods which increase the risk for atherosclerosis and later heart failure. A majority of racial minorities have no formal education and have limited health literacy on the causative factors of heart failure. Health illiteracy makes a patient become noncompliant to medications. In the case of this patient, she stops taking diuretic because it makes her urinate more. She does not understand that she needs to loose that fluid for her heart and lungs to be healthy.

Conclusion

Cardiovascular and cardiopulmonary systems operate in a vicious cycle with failure of one contributing to failure or dysfunction of the other. In this patient, both systems contribute to worsening of the physiological functioning of the other. Racial and ethnic factors influence the physiological functioning of the two systems. A racial group that adopts sedentary lifestyle and poor diet may gradually negatively impact the functioning of the two systems.

References

Ariyaratnam, J. P., Lau, D. H., Sanders, P., & Kalman, J. M. (2021). Atrial Fibrillation and Heart Failure: Epidemiology, Pathophysiology, Prognosis, and Management. Cardiac Electrophysiology Clinics, 13(1), 47-62. https://doi.org/10.1016/j.ccep.2020.11.004

Boorsma, E. M., Ter Maaten, J. M., Damman, K., Dinh, W., Gustafsson, F., Goldsmith, S., … & Voors, A. A. (2020). Congestion in Heart Failure: A Contemporary Look at Physiology, Diagnosis and Treatment. Nature Reviews Cardiology, 17(10), 641-655. https://doi.org/10.1038/s41569-020-0379-7

Lewsey, S. C., & Breathett, K. (2021). Racial and Ethnic Disparities in Heart Failure: Current State and Future Directions. Current Opinion in Cardiology, 36(3), 320. https://doi.org/10.1097%2FHCO.0000000000000855

Sample Answer 2 for NURS 6501 CASE STUDY ANALYSIS WEEK 4

The NURS 6501 CASE STUDY ANALYSIS WEEK 4 case study portrays a 45-year-old female presenting with complaints of dyspnea, fevers, and a productive cough having thick green sputum for three days. She is a known COPD patient and has a chronic cough that has worsened and disrupted her sleep. She states that the sputum has become too thick and hard, and she is unable to expectorate. Chest auscultation findings include hyperresonance, rhonchi, and coarse rales in all lung fields. Chest X-ray shows an increased AP diameter and a flattened diaphragm. The purpose of this paper is to discuss the pathophysiologic processes in the cardiovascular and pulmonary systems causing the symptoms and racial/ethnic factors that may affect physiological functioning. 

Cardiovascular and Cardiopulmonary Pathophysiologic Processes Causing the Symptoms 

The patient’s symptoms can be attributed to inflammation of the bronchi and bronchioles due to exposure to irritants, such as cigarette smoke. The irritants elicit inflammation of the airways, vasodilation, mucosal edema, congestion, and bronchospasm (Brandsma et al., 2020). The patient has had chronic inflammation due to a long history of COPD. The inflammation increased the number and size of mucous glands, resulting in the production of copious amounts of thick mucus, which explains the patient’s symptoms of thick mucus and chronic cough (Choi & Rhee, 2020). Besides, the bronchial walls thicken, obstructing airflow.  

The bronchial wall thickening and excessive mucus obstruct some smaller airways and constrict larger ones. This explains the patient’s dyspnea. The excessive mucus becomes a breeding ground for microbes resulting in chronic low-grade infection. The most common infections are caused by Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae (Choi & Rhee, 2020). The patient’s fevers and green sputum are due to the low-grade infection, which could be caused by one of these bacteria.  

Racial/Ethnic Variables Impacting Physiological Functioning 

Cigarette smoking is considered the greatest risk factor for COPD. The prevalence of tobacco smoking is highest among Alaskan Natives and Northern Plains American Indians. It is also higher among African Americans (Hikichi et al., 2019). Therefore, individuals from these ethnic/racial groups with a history of smoking or exposure to second-hand smoke have a high risk of developing inflammation of the airways resulting in COPD. 

How These Processes Interact To Affect the Patient 

The pathophysiologic processes in COPD significantly affect the patient due to limitation in airflow caused by constriction of airways and obstruction of airflow. Consequently, oxygenation of all body tissues is affected. Reduced oxygenation can cause tissue anoxia and necrosis (Brandsma et al., 2020). The patient develops major complications due to reduced gas exchange and oxygenation levels, including hypoxemia, acidosis, respiratory infection, dysrhythmias, and cardiac failure. 

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NURS 6501 CASE STUDY ANALYSIS WEEK 4 Conclusion 

The patient’s symptoms can be attributed to inflammation of the airways by irritants. The inflammation causes increased mucus production, which clogs the airways limiting airflow and gas exchange, resulting in cough, dyspnea, and production of thick mucus. Cigarette smoke is a major irritant, and therefore ethnic groups with a high smoking rate such as African Americans, American Indians, and Alaskan Natives have a higher prevalence of COPD.  

References 

Brandsma, C. A., Van den Berge, M., Hackett, T. L., Brusselle, G., & Timens, W. (2020). Recent advances in chronic obstructive pulmonary disease pathogenesis: from disease mechanisms to precision medicine. The Journal of pathology, 250(5), 624–635. https://doi.org/10.1002/path.5364 

Choi, J. Y., & Rhee, C. K. (2020). Diagnosis and Treatment of Early Chronic Obstructive Lung Disease (COPD). Journal of clinical medicine, 9(11), 3426. https://doi.org/10.3390/jcm9113426 

Hikichi, M., Mizumura, K., Maruoka, S., & Gon, Y. (2019). Pathogenesis of chronic obstructive pulmonary disease (COPD) induced by cigarette smoke. Journal of thoracic disease, 11(Suppl 17), S2129–S2140. https://doi.org/10.21037/jtd.2019.10.43 

Sample Answer 3 for NURS 6501 CASE STUDY ANALYSIS WEEK 4

The case study presents a 38-year-old female patient who arrives at the emergency room with symptoms of dyspnea and left leg pain. The patient has a medical history of systemic lupus erythematosus and has recently traveled by airplane. Additionally, she is using oral contraception. This paper elucidates the pulmonary pathophysiologic processes and explores the influence of racial/ethnic variables on these processes, highlighting their combined impact on the patient in question.

Pulmonary Pathophysiologic Processes

The patient exhibits dyspnea and left leg pain, which are typical symptoms of systemic lupus erythematosus (SLE). SLE can lead to various pulmonary conditions, including pleural effusion/pleuritis. This condition is characterized by chest pain, cough, dyspnea, and fluid accumulation in the pleural space (Dörner & Furie, 2019). Pleuritis, with or without pleural effusion, is a prevalent manifestation of acute pulmonary involvement in SLE. Immune complex deposits in different organs primarily cause the pathology in SLE. This activates complement and other inflammatory mediators, resulting in symptoms like leg pain and inflammation (Aringer, 2020).          

Racial/Ethnic Variables

Compared to non-Hispanic Whites, Black and White Hispanics have a higher incidence and severity of SLE (Barber et al., 2021). SLE is three times more common in African-American women than in White women, and although the prevalence of SLE in Hispanic women is unknown, it is greater than in White women (Tsokos, 2020). A large percentage of Amerindian ancestry is correlated with an increased number of risk alleles for SLE, and there is abundant evidence that distinct susceptibility genes for SLE exist between Blacks and Whites or Hispanics (Fanouriakis et al., 2020).

Interaction of Processes

The patient’s medical history of systemic lupus erythematosus, recent airplane travel, and use of oral birth control may all contribute to her current clinical condition. Combined hormonal contraceptives, like the birth control pill, may be appropriate for certain lupus patients. However, caution should be exercised in individuals with highly active disease or heightened susceptibility to blood clots, such as those with positive antiphospholipid antibodies and previous instances of blood clots, among other risk factors (Basta et al., 2020). Extended periods of sitting can pose challenges for individuals with joint or muscle pain. Individuals with lupus may have an increased susceptibility to the formation of blood clots due to prolonged periods of sitting. It is advisable to take stretch breaks every hour while driving for extended periods, stand up, and frequently engage in movement during prolonged flights.

Conclusion

The patient has a history of systemic lupus erythematosus (SLE). However, she experiences flare-up symptoms due to risk factors, such as prolonged sitting during air travel. When managing this patient, it is essential to consider the genetic factors that contribute to the disease, particularly in patients from diverse racial backgrounds.    

References

Aringer, M. (2020). Inflammatory markers in systemic lupus erythematosus. Journal of Autoimmunity, 110, 102374. https://doi.org/10.1016/j.jaut.2019.102374

Barber, M. R., Drenkard, C., Falasinnu, T., Hoi, A., Mak, A., Kow, N. Y., Svenungsson, E., Peterson, J., Clarke, A. E., & Ramsey‐Goldman, R. (2021). Global epidemiology of systemic lupus erythematosus. Nature Reviews Rheumatology, 17(9), 515–532. https://doi.org/10.1038/s41584-021-00668-1

Basta, F., Fasola, F., Triantafyllias, K., & Schwarting, A. (2020). Systemic Lupus erythematosus (SLE) therapy: the old and the new. Rheumatology and Therapy, 7(3), 433–446. https://doi.org/10.1007/s40744-020-00212-9

Dörner, T., & Furie, R. (2019). Novel paradigms in systemic lupus erythematosus. The Lancet, 393(10188), 2344–2358. https://doi.org/10.1016/s0140-6736(19)30546-x

Fanouriakis, A., Tziolos, N., Βertsias, G., & Boumpas, D. T. (2020). Update οn the diagnosis and management of systemic lupus erythematosus. Annals of the Rheumatic Diseases, 80(1), 14–25. https://doi.org/10.1136/annrheumdis-2020-218272

Tsokos, G. C. (2020). Autoimmunity and organ damage in systemic lupus erythematosus. Nature Immunology, 21(6), 605–614. https://doi.org/10.1038/s41590-020-0677-6

The patient’s chief complaint of shortness of breath, cough with thick green sputum production, and fevers, along with her medical history of COPD, suggest an exacerbation of her chronic condition. The CXR findings of flattened diaphragm and increased AP diameter indicate the presence of hyperinflation, which is a characteristic feature of COPD. The auscultation findings of hyper resonance and coarse rales and rhonchi throughout all lung fields suggest the presence of airway obstruction and inflammation.

COPD is a chronic inflammatory lung disease that is characterized by the progressive obstruction of airflow, resulting in symptoms such as cough, sputum production, and shortness of breath. The pathophysiology of COPD involves the destruction of lung tissue, airway inflammation, and mucus hypersecretion, which lead to the narrowing of the airways and the development of hyperinflation. The hyperinflation of the lungs in COPD is caused by the loss of elastic recoil of the lung tissue, which makes it difficult for the patient to exhale and leads to air trapping in the lungs. This results in an increased work of breathing and the development of dyspnea.

The patient’s fevers suggest the presence of an infection, which is a common trigger for exacerbations of COPD. The thick green sputum production is also indicative of an infection, which may be bacterial or viral in nature. The presence of airway obstruction and inflammation in COPD makes the patient more susceptible to infections, as the mucus buildup in the airways provides a favorable environment for bacterial growth.

There are several racial/ethnic variables that may impact physiological functioning in patients with COPD. Studies have shown that African Americans and Hispanics have a higher prevalence of COPD and are more likely to experience exacerbations and hospitalizations compared to Caucasians. This may be due to differences in genetic susceptibility, environmental exposures, and healthcare access and utilization.

The cardiovascular system and the respiratory system are closely interconnected, and the pathophysiological processes that affect one system can have significant effects on the other. In COPD, the chronic inflammation and hypoxia that result from airway obstruction can lead to pulmonary hypertension, right ventricular hypertrophy, and cor pulmonale. These cardiovascular complications can further exacerbate the patient’s symptoms and increase the risk of morbidity and mortality.

References:

Celli, B. R., & Barnes, P. J. (2019). Exacerbations of chronic obstructive pulmonary disease. European Respiratory Journal, 54(3), 1900506. https://doi.org/10.1183/13993003.00506-2019

Dransfield, M. T., & Rowe, S. M. (2019). Genetics and racial disparities in COPD. Current Opinion in Pulmonary Medicine, 25(2), 115–120. https://doi.org/10.1097/MCP.0000000000000557

Global Initiative for Chronic Obstructive Lung Disease. (2021). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2021 report). https://goldcopd.org/2021-gold-reports/NURS 6501 WEEK 5 Gastrointestinal Disorders

NURS 6501 WEEK 5 Gastrointestinal Disorders

Concept Map Template 

Primary Diagnosis:  Acute diverticulitis 

1. Describe the pathophysiology of the primary diagnosis in your own words.  What are the patient’s risk factors for this diagnosis?

2. 2.  What are the patient’s signs and symptoms for this diagnosis?  How does the diagnosis impact other body systems, and what are the possible complications?

3. 3.  What is another potential diagnosis that presents similarly to this diagnosis (differentials)?

According to Qaseem et al. (2022), other conditions might be considered in the differential diagnosis of acute diverticulitis, such as Crohn’s disease, acute appendicitis, colitis, and colon cancer. 

4. 4.  What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?

Clinical diagnosis of acute diverticulitis may be established only by evaluating the patient’s medical history and physical examination. Leukocytosis and increased levels of acute phase reactants, such as ESR and CRP, may be detected using laboratory testing (Sugi et al., 2020). The preferred radiographic examination for diagnosing acute diverticulitis is a computed tomography (CT) scan of the abdomen and pelvis. It is recommended to use water-soluble oral or rectal contrast, along with intravenous contrast, unless there are any reasons to avoid it. It is advisable to schedule a colonoscopy around six to eight weeks after the symptoms have subsided to exclude the possibility of cancer, inflammatory bowel disease, or colitis, especially if the patient has not had a colonoscopy recently (Rottier et al., 2019). 

5. 5.  What treatment options would you consider?  Include possible referrals and medications.

The conventional approach of treating diverticulitis in an outpatient setting involves abstaining from food intake, increasing fluid consumption, and administering oral antibiotics that target gram-negative rods and anaerobic bacteria. In the United States, the most often prescribed treatment involves the use of quinolones or sulfa medications together with metronidazole or amoxicillin-clavulanate as a single agent. This treatment regimen typically lasts for a duration of 7 to 10 days (Sagar, 2019). Nurses must aid in instructing the patient on adherence to dietary limitations. An infectious disease specialist and a gastroenterologist must ascertain the optimal period of antibiotic treatment, while a general surgeon must establish a care regimen for any pelvic abscess. 

References 

Piccioni, A., Franza, L., Brigida, M., Zanza, C., Torelli, E., Petrucci, M., Nicolò, R., Covino, M., Candelli, M., Saviano, A., Ojetti, V., & Franceschi, F. (2021). Gut microbiota and acute diverticulitis: Role of probiotics in managing this delicate pathophysiological balance. Journal of Personalized Medicine, 11(4), 298. https://doi.org/10.3390/jpm11040298 

Qaseem, A., Etxeandia-Ikobaltzeta, I., Lin, J. S., Fitterman, N., Shamliyan, T. A., & Wilt, T. J. (2022). Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A clinical guideline from the American College of Physicians. Annals of Internal Medicine, 175(3), 399–415. https://doi.org/10.7326/m21-2710 

Rottier, S. J., Van Dijk, S. T., Van Geloven, A. a. W., Schreurs, W. H., Draaisma, W. A., Van Enst, W. A., Puylaert, J. B. C. M., De Boer, M., Klarenbeek, B., Otte, J. A., Felt, R. J. F., & Boermeester, M. A. (2019). Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis. British Journal of Surgery, 106(8), 988–997. https://doi.org/10.1002/bjs.11191 

Sagar, A. (2019). Management of acute diverticulitis. British Journal of Hospital Medicine, 80(3), 146–150. https://doi.org/10.12968/hmed.2019.80.3.146 

Sugi, M., Sun, D., Menias, C. O., Prabhu, V., & Choi, H. H. (2020). Acute diverticulitis: Key features for guiding clinical management. European Journal of Radiology, 128, 109026. https://doi.org/10.1016/j.ejrad.2020.109026 

Turner, G. A., O’Grady, M. J., Purcell, R., & Frizelle, F. (2021). Acute diverticulitis in Young Patients: A review of the changing Epidemiology and etiology. Digestive Diseases and Sciences, 67(4), 1156–1162. https://doi.org/10.1007/s10620-021-06956-w