Analyze pathophysiologic mechanisms associated with selected disease states.

What are the most important factors that influence supply?
November 30, 2020
How are the four concepts in nursing’s metaparadigm
November 30, 2020

Analyze pathophysiologic mechanisms associated with selected disease states.

Discussion Part One

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

6 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic

and disease states. (PO 1, 4)

Discussion

Discussion Part One (graded)

John is a 19-year-old college football player who presents with sneezing, itchy eyes, and nasal congestion that worsens at night. He states that he has a history of asthma, eczema and allergies

to pollen. There is also one other person on the football team that has similar symptoms. His vitals are BP 110/70, P 84, R 18, T 100 F. Write a differential of at least five (5) possible items from the most likely to less likely. For each disease include information about the epidemiology, pathophysiology and briefly argue why this disease fits the presentation and why it might not fit the presentation

Week 1: Altered Immune System and Altered Inflammatory Response – Discussion

Part Two

A patient has been admitted into the emergency room that was in the passenger side of a car that collided with another car head on. The patient is pale, barely conscious and has a weak and thready pulse. An IV is started. The vitals are BP 80/50, P 140, T 96.0 and R 26. As the team fights to keep the patient alive they have to remove the spleen. Blood is given but it has been mistyped. A transfusion reaction occurs. Describe the type of hypersensitivity reaction that has occurred and discuss the molecular pathophysiology of the specific type of hypersensitive reaction you have chosen.

In the event that this patient survived the car accident and the transfusion reaction which organs are most likely to be damaged and why?

Week 1: Altered Immune System and Altered Inflammatory

Response – Discussion Part Three

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1,

4 Distinguish risk factors associated with selected disease states.(PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Discussion

A 44-year-old patient presents with lump in the chest of approximately 2 cm in diameter. There is a slight dimple over the location of the lump and when the lump is manipulated it seems to be attached to the surrounding tissue. A lumpectomy is performed and the mass is sent to pathology. The pathology report comes back and the mass is confirmed to be an estrogen receptor negative, a progesterone receptor negative and a her2/neu receptor positive breast cancer.

What are some of the risk factors for breast cancer?

What tumor suppressor genes are associated with breast cancer?

What tumor oncogenes are associated with breast cancer?

Compare and contrast tumor suppressor genes from oncogenes?

Week2

Week 2: Respiratory Disorders and Alterations in Acid/Base Balance,

Fluid and Electrolytes – Discussion Part One

This week’s graded topics relate to the following Course Outcomes (COs).

Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

Distinguish risk factors associated with selected disease states. (PO1)

Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

Distinguish risk factors associated with selected disease states. (PO1)

Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Discussion Part One (graded)

A five-month-old Caucasian female is brought into the clinic as the parent complain that she has been having ongoing foul-smelling , greasy diarrhea. She seems to be small for her age and a

bit sickly but, her parent’s state that she has a huge appetite. Upon examination you find that

the patient is wheezing and you observe her coughing.

Write a differential diagnosis of at least five (5) disorders and explain why each might be

a possibility and any potential weaknesses of each differential.

Why is it that the later in age this disease manifest itself, the less severe the disease is?

What tests would you run to clarify your differential and potentially come to a definitive

diagnosis?

If the same child was African in ancestry would this change your initial differential? Why

or why not?

Week 2: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes – Discussion Part Two

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

Write a differential of at least five (5) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above.

Remember, to list the differential in the order of most likely to less likely.

Based upon what you have at the top of the differential how would you treat this patient?

Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why?

Week 2: Respiratory Disorders and Alterations in Acid/Base Balance,

Fluid and Electrolytes – Discussion Part Three

This week’s graded topics relate to the following Course Outcomes (COs).

Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

Distinguish risk factors associated with selected disease states.

Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

Distinguish risk factors associated with selected disease states. (PO

Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

A nursing student comes into your office because they are struggling with the concept of pulmonary function. They know you as an experienced FNP and so they are comfortable asking if you could clarify the terms residual volume (RV), functional reserve capacity (FRC), total lung capacity (TLC) inspiratory reserve volume (IRV), and expiratory reserve volume (ERV).

Give her a definition of each?

List three (3) disorders that can alter the residual volume and explain how they do so?

Week 3: Cardiovascular, Cellular, and Hematologic Disorders – Discussion

Week 3

Part One

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states

A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing. Assuming, she is drug seeking he sends her home. She comes back to the ER 4 hours later and now you see the patient. She explains that she was running track this past afternoon at school and that despite being very hot (100 F) she pushed on. Afterwards, she starts feeling extensive pain in her chest and abdomen. She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T = 99.9 F, R = 28. The pain seems out of proportion to the physical findings.

What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least four (4) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.

Now, as she is in the ER she begins to exhibit stroke like features. ? Does this change your differential? How do you treat this patient now? Are they any preventative actions that could have been taken?

Week 3: Cardiovascular, Cellular, and Hematologic Disorders –

Discussion Part Two

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Jesse is a 57-year-old male who presents with gradual onset of dyspnea on exertion and fatigue. He also complains of frequent dyspepsia with nausea and occasional epigastric pain. He states that at night he has trouble breathing especially while lying on his back. This is relieved by him sitting up. His vitals are 180/110, P = 88, T = 98.0 C, R = 20.

Write a differential in this case and explain how each item in your differential fits and how it might not fit.

What tests would you order? What immediate treatment would you consider giving this patient and what treatment when he went home? Assume your first differential is definitive.

Now, he comes back to your clinic 3 months later and both his ankles are slightly swollen. What possible explanations are there for this observation?

Week 3: Cardiovascular, Cellular, and Hematologic Disorders –

Discussion Part Three

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

A new patient is brought into the office for their annual evaluation. The child is a 6-year-old and

appears a bit small for their age but not so small that any alarm bells are set off. The vitals are: P

= 116, R = 22, T = 98.6 , BP = 110/50. (The normal vitals in a 6-year-old are P = 75 – 120, R =

16 – 22, T = 98.6 , BP = (85-115)/(48-64). Examination of the lungs is normal, HEENT is normal,as is the abdominal exam. The heart however, seems laterally displaced and there appears to be only a continuous murmur which can be described as crescendo/decrescendo systolic murmur that extends into diastole. Because, you were trained at Chamberlain College of Nursing you immediately know that this is probably a patent ductus arteriosus.

Explain the murmur from a mechanistic view of the hearts physiological functioning?

What is the epidemiology of a patent ductus arteriosus?

How is a patent ductus arteriosus treated?

Week 4: Alterations in Renal Function – Discussion Part One

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1

Mrs. Orndorf is a 28-year-old woman married for 3 years who has just returned from an outdoor camping trip with her husband, with symptoms of dysuria with a burning sensation, urgency to urinate, and frequent urination. She said, “I have had similar symptoms three times over the last 2 years. Pubic and low back discomfort awoke me two nights ago and that is why I am here.” On physical examination, her temperature was 98.6° F, blood pressure was 114/64 mm Hg, pulse was 68 beats per minute, and the respiratory rate was 12 breaths per minute. Other than a tender abdominal pelvic area, the examination was unremarkable.

• What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least four (4) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.

• According to the first item in your differential, what are the risk factors for this disorder?

• What are some treatments for this disorder?

Week 4

Week 4: Alterations in Renal Function – Discussion Part Two

Discussion

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology , developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

A 56-year-old female comes into the clinic complaining of intermittent severe pain that radiates from the flank to the groin and sometimes to theinner thigh. Upon further questioning she tell you that she has an urge to always go to the restroom and that she sometime sweats and feels nauseous. A urinalysis provides traces of blood, a few white blood cells and no bacteria.

• What is your differential diagnosis? Discuss in detail the pathophysiology of each item in your differential and how it might fit in describing this case.

• The x-ray comes back and there is nothing abnormal except a slightly dilated ureter. Does this change your differential or narrow it?

• How would you treat the pain in this case?

Week 4: Alterations in Renal Function – Discussion Part Three

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

A 60-year-old patient comes into your office with a history of hypertension and a myocardial infarction 13 years ago. You notice that both of her ankles are swollen and that her skin seems shiny. She first noticed her ankle swelling 9 months ago and it has gotten progressively worse. She has a smell of ammonia on her. She also has a 2 year history of diabetes.

• What are at least five systemic effects of chronic kidney disease?

• How would you modify the diet and what is the rationale to the changes of the diet that you make?

Week 5

Week 5: Alterations in Endocrine Function – Discussion Part One

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

Sodium (Na+) 156 mEq/L

Potassium (K+) 4.0 mEq/L

Chloride (Cl–) 115 mEq/L

Arterial blood gases (ABGs) pH- 7.30; Pco2-40; Po2-70; HCO3-20

Normal values

Sodium (Na+) 136-146 mEq/L

Potassium (K+) 3.5-5.1 mEq/L

Chloride (Cl–) 98-106 mEq/L

Arterial blood gases (ABGs) pH- 7.35-7.45

Pco2- 35-45 mmHg

Po2-80-100 mmHg

HCO3–22-28 mEq/L

• List five (5) reasons on why she may have become bed ridden?

• Based on these reasons what tests would you order?

• Describe the molecular mechanism of the development of ketoacidosis.

Week 5: Alterations in Endocrine Function – Discussion Part Two

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states

A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. The vomiting has become more frequent this past week and he is beginning to lose weight.

• What is your differential diagnosis at this time?

• Is there any genetic component to the top of your differential?

• What tests would you order?

Week 5: Alterations in Endocrine Function – Discussion Part Three

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis?

Week 6

Week 6: Dermatologic and Musculoskeletal Disorders – Discussion Part

One

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states

You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder.

• What is the most likely genetic disease that this presents and why?

• What is the molecular basis of this disease?

• Before, calling the police what should the initial clinician have done?

Week 6: Dermatologic and Musculoskeletal Disorders – Discussion Part Two

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO

Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved. He has been blowing his nose quite frequently and “sores” have developed around his nose. His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.” She is worried because the lesions are now also on his forearm. Johnny’s past medical and family histories are normal. He has been febrile but is otherwise asymptomatic. The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm. There is no regional lymphadenopathy.

• Write a differential of at least five (5) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.

• Based upon what you have at the top of the differential how would you treat this patient? differential diagnosis for this clinical presentation and justify it.

• When would you allow the student back to school? Elaborate on your reasoning?

Week 6: Dermatologic and Musculoskeletal Disorders – Discussion Part Three

Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 0C, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms.

• What is the differential diagnosis?

• What are some of the complications of this disease, assume that the top of your differential is the definitive?

• Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease?

Week 7

Week 7: Behavioral, Neurologic, and Digestive Disorders – Discussion Part

One

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

You are at the local mall and you see a patient who appears to be homeless by his physical appearance and you witness the person “walk 50 feet to a table sit down, and after 5 seconds he gets up and walks to a tree and urinates on it” He repeats this action 5 times apparently oblivious to his surroundings. When the police come he ignores them as if they aren’t there. Later, you go to work and sitting in exam room 3 is the same person! Now, he is your patient, when you talk to him he has no recollection of his behavior by the mall.

• What is your differential diagnosis?

• What tests do you order?

• An MRI comes back and there seems to be a lesion in the temporal lobe does this change your differential? The EEG also comes back with unusual excitatory activity. What is your definitive diagnosis? In retrospect did anything bias your first differential?

Week 7: Behavioral, Neurologic, and Digestive Disorders – Discussion

Part Two

Your patient is a 77-year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well. Her daughter has noticed a stepwise decline. While shopping for groceries with her daughter she became separated from daughter in the aisles. She became confused and angry when store employees and others tried to assist her. Her current medications are Hydrochlorothiazide, Lisinopril and Atorvastatin.

• What is your differential diagnosis based on the information you now have?

• What other questions would you like to ask her now? (Questions can be asked of patient first, and then of reliable historian separately.)

• How would you treat this patient and discuss why you give each medication or therapy you give.

Week 7: Behavioral, Neurologic, and Digestive Disorders –

Discussion Part Three

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

A 19-year-old freshman in college has been brought to your office by campus security. The patient had been standing on top of the school chapel proclaiming that he was the prophet of God and that God was speaking to him. In fact he claimed to actually hear God’s voice. When he is in your office you notice that he is speaking very fast, can’t seem to sit still and his sentences at times don’t seem to make sense. He states, “I saw the professor sit on the ham sandwich and eat the raw calculus in his mind”

• What is your differential diagnosis, how does it fit how might it not fit?

• Based on the top of your differential what is the epidemiology of that disorder?

Week 8

Week 8: Genomes, Genetic Alterations, and Reproductive

Disorders – Reflection

Reflect on personal and professional growth toward achieving competence as a family nurse practitioner. (PO 5, 10)

Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #, MSN Essential VIII, and Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies

Program Outcome #4: Evaluate the design, implementation, and outcomes of strategies developed to meet healthcare needs (MSN Essentials III, IV, VIII). MSN Essential VIII: Clinical Prevention and Population Health for Improving Health

•Recognizes that the master’s-prepared nurse applies and integrates broad, organizational, client-centered, and culturally appropriate concepts in the planning, delivery, management, and evaluation of evidence-based clinical prevention and population care and services to individuals, families, and aggregates/identified populations.

Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies

1. Critically analyzes data and evidence for improving advanced nursing practice.

2. Integrates knowledge from the humanities and sciences within the context of nursing science.

3. Translates research and other forms of knowledge to improve practice processes and outcomes.

4. Develops new practice approaches based on the integration of research, theory, and practice knowledge.

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