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The Emergency doctor has reviewed Mr Papas and asked the nurse to obtain a sputum sample. The doctor has documented that Mr Papas is to receive oxygen if the SpO2 readings are below. The doctor has also prescribed the Fluvax vaccination.

List the main structures of the respiratory system and state the function of the respiratory system.

List the main structures of the lymphatic system and state the function of the lymphatic system.

Outline the major changes that occur in the respiratory system as we age.

Explain the pathophysiology of lymphoedema.

Define the term “COPD” and list three (3) signs or symptoms of COPD.

State three (3) risk factors associated with COPD.

Outline three (3) nursing assessments you would conduct on Mr Papas and state one (1) immediate nursing intervention that would result from your nursing assessments.

Functions of endocrine system

Functions of endocrine system

  • Corticotrophin hormone secreted by pituitary gland takes part in controlling the hormone  production and its secretion by adrenal glands
  • Parathyroid hormone released by parathyroid gland plays an important role in bone formation and secretion of Calcium and phosphorus
  • Glucagon and insulin produced in pancreas takes part in increasing and decreasing the level of sugar in body
  • Aldosterone is the hormone that excreted form Adrenal gland. It takes part in regulation the balance of salt and water by instructing the kidneys to excrete potassium (Morley, 2018)

Pathophysiology of Graves ’ disease

Graves’ disease is an autoimmune disease associated with hyperthyroidism. The autoimmunity is mediated by B and T lymphocytes directed by 4 antigens such as thyroglobulin, sodium iodide symporter, and thyroid peroxidase and thyroprotein receptor. The antigen-specific immune response has occurred in this disease.  The autoimmune response is mediated by autoantibodies leads to hyperthyroidism mediated by transfer of thyroprotein rector protein in blood from the parents to the foetus

The thyroid stimulating antibodies triggers cyclic AMP mediate secretion of TH and thyroglobulin and stimulation of iodine uptake, synthesis of protein and growth of thyroid gland. Some of the other molecules also are associated with Graves’ disease like CD4 T lymphocyte which mediates the Fas expression. There are some genes associated in different types of autoimmune disorder such as CD40, TSH receptor; CTLA-4, thyroglobulin, and PTPN22 (Yeung, Habra, & Chiu, 2018)

The digestive system also is known as gastrointestinal tract is extends from mouth to anus. It breaks the food into nutrients and absorbs the nutrients in to blood and further excreted the waste material out of the body. Organs of this system produces hormones associated with removing toxic material from bloodstream.

Cardiovascular system

The minimal changes occurred in the amount of the thyroid hormone result in cardiovascular abnormalities, insomnia, and increased heart-rate.

Digestive system

Hyperthyroidism attacks on cells of intestinal linings, increases fluid-secretion, leads to diarrhoea and unnecessary hunger.

Integumentary system

Increased basal metabolic rate results in heat-intolerance, moist skin, and hair loss.

Nursing interventions

  • A cool and quiet environment can be provided
  • Propranolol can be administered to control the increased heart rate
  • Iodine preparations can be administered to inhibit thyroid hormone release

Risk Factors

  1. Genetic factor: this disease can be transferred from parents to children
  2. Age: this disorder is prominent in the person older than twenty
  3. Smoking (NewMax, 2011).

Isabella’s blood test reports are abnormal which revealed that the level of thyroid stimulating hormones was lower (0.4 mIU/L than normal), free thyroxine level was 30 pmol/L and free Triiodothyronine level was16 pmol/L.

 Heart Rate was higher (tachycardia) and increased respiratory rate of 26 which is considered abnormal. Her systolic blood pressure was 140 and the Diastolic rate was 70. She has oxygen saturation level of 100 % and temperature higher (100.4 in Fahrenheit) than normal.   

Health professional

  • Endocrinologist: Endocrinologist is a specialist to treat the condition related to hormonal imbalance. They help the patient to control the hyperthyroidism.
  • Anaesthesiologist: Plays an important role to control the sleeplessness and carefully administer anesthesia to the patient with thyroid disease
  • Nutritionist: Nutritionists are specifically trained in providing assistance related to their diet. They maintain the healthy and balanced diet.

Structure of respiratory system

The structure of respiratory system includes mouth, nose, bronchi, lungs, trachea.

  • Bronchi:  subdivided in bronchioles situated in both left and right lungs.
  • The tracheais a tube-like structure connecting throat to the bronchi.  
  • Lungs: situated in thorax part of the human body contains bronchioles and pulmonary alveolus.

Functions of Respiratory system

  • Mouth, nose & nasal-cavity: warm, filtration of air
  • Trachea: caries air from throat to the lungs. Cilia in Trachea capture dust particles and excrete them through coughing.
  • Bronchi: Allow air from the external environment to the lungs through bronchioles
  • Bronchioles: to make sure that the air coming from bronchi is reaching to the each alveoli
  • Alveoli: permits transport of gases O2and CO2.

Structure of the lymphatic system

  • Lymph vessels: these are the site for fluid drainage. Large vessels consist of valves to stop backflow of blood towards the heart
  • Lymph node: small round shape bodies of the lymphatic system transported along the clusters of lymphatic vessels in armpits, neck, chest, groin, and abdomen.
  • Lymph: A colorless liquid body fluid which is distributed by the lymphatic system. It mainly Contains WBCs (White Blood Cells).
  • Lymphoid tissues: contains lymphocytes and dendritic cells

Functions of the lymphatic system

  • It is the site for many immunological functions
  • Responsible for excretion of interstitial watery liquid from tissues to lymph fluid.
  • Absorbs and carries fatty acid and fat molecules in form of chylomicrons from the digestive system
  • Carries WBCs and dendritic cells into lymph nodes where initiation of adaptive immune response takes place

Effects of age on the respiratory system

  • Deduction of Peak airflow and exchange of gases
  • Lung functions such as the amount of air that inhaled and exhaled inside the body are decreases
  • Respiratory muscles weaken  
  • Diaphragm and other muscle support respiration weakens
  • Thinning of bones and rib cage shape changes.
  • The lungs defense mechanism has been declined with the age (lechtzin, 2018

When the blood transport from the heart out of the body, the plasma containing protein, waste substances or dead cells and water enter in interstitial spaces where fluids have been filtered by the lymphatic system. The lymphatic system may return the fluid to the blood. If any loss of integrity is there in any part occurs results in accumulation of lymph fluid in interstitial spaces which can further cause edema.

Pathophysiology of Graves’ disease

The change in capillary pressure, osmotic pressures, and integrity of muscles of skeleton system contribute to lymphedema development. The congenital abnormalities occur in lymphatic system can also cause lymphedema. This disorder can be occurred anywhere and at any point in the body where lymph drainage takes place (Cruz, 2014).

COPD is the abbreviation for the chronic obstructive pulmonary disease. It is associated with the inflammation in lungs which leads to obstruction in the transport of air into and out of both the lungs.


  • Shortening of breath
  • Wheezing problem
  • Weight loss

Risk factors

  • Smoking cigarettes and/or tobacco
  • Pollution
  • Genetic condition
  • Age
  • Exposure to fumes comes from burning fuels
  • Occupational exposure to the chemicals


  1. Pain Assessment can be done to check the pain level in the joints of the patient
  2. Sputum Test: included volume of sputum, if any bacterial infections
  3. Measuring  fever by using a thermometer

Immediate nursing intervention

Antibiotics should be administered as prescribed by the physician (Koutoukidin, Stainton, & Hughson, 2016) and pain should be decreased immediately, painkillers can be used.

Health professionals

  1. The general physician or primary care physician: to deal with fever and other complications
  2. Emergency care physician: to provide immediate assistance and recovery. They also deal with influenza.
  3. Respiratory therapist: experts in pulmonary medicine and trained to deal with the patient having pulmonary problems. Mr Papas admitted with the breathing difficulty and a respiratory therapist may help in this case.

Artificial Acquired immunity

Artificially acquired immunity includes an exposure of a person to foreign antigen or antibody which belongs to someone else, to generate an immunity.  

Artificially acquired active immunity is the protection produced where the person is exposed to antigens in a vaccine intentionally so that the active immune response can be produced. Artificially acquired passive immunity is the injecting an injection containing antibodies belongs to some else.

  • Kidneys: An adult kidney is nearly 12 cm long and 6 cm wide. There is a medial indentation in kidneys called renal hilum. At the hilum, various other structures located such as ureters, blood vessels, and nerves. Each kidney is enclosed with fibrous capsule and provides a glistening appearance to the kidney. (Marieb, 2009).
  • Ureters: long, thin tube-like structure with smooth muscles. It is 25-30 cm long.  
  • Urethra: it is narrow and nearly 4 centimeters long extends from the neck of the bladder to external urethral orifice vaginal areas. It is shorter than male urethra which 17.5 to 29

Functions of the urinary system


  • Functions of the urinary system
  • Blood volume regulation
  • Production of red blood cells
  • Vitamin D synthesis
  • Eliminate the waste material and foreign substances out of the body

Bladder:  store urine in to excrete it out of the body

Urethra: acts as a passage for the urine

Uterus: to prevent the backflow of urine.

 Structure of the female reproductive system

  • Ovaries: a small glands pair with the shape of an almond. Located on left and right part of the pelvic cavity
  • Fallopian tube: a pair of the muscular tube. Extend from the uterus to edge of ovaries. FT ends in the infundibulum
  • Uterus: the uterus is muscular hollow and pear-shaped.  It connects with fallopian tube and vagina.
  • Vagina: elastic, muscular tube-like structure which connects cervix to exteriors part of the body
  • Vulva: surrounds external ends of urethral openings. It includes mons pubis, clitoris and labia minor and majora.

Stress incontinence

Stress incontinence (SI) is the unintentional urine loss. It happens when any physical movement such as sneezing, running, coughing and lifting heavy weight create pressure on bladder. It is common in females than males.  

Relationship between childbirth and Stress Incontinence

SI is common in women give births. During the pregnancy uterus expands due to the pressure has been occurs on bladder. The pressure is exerted because of continued growth of the baby. This results in easier excretion of urine out of the bladder due to sneezing, coughing, or exercising. In some women’s the injured tissues does not repaired fully. In this case the stress incontinence is common.

Stress incontinence is the unintentional urine loss. It happens when any physical movement such as sneezing, running, coughing and lifting heavy weight create pressure on the bladder. It is common in females than males

Causes of Urinary Tract Infection

  1. Bacterial: The infection occurs in bladder usually caused by bacteria Escheria Coli. This type of bacteria found in GI tract
  2. Sexual intercourse:  It may cause cystitis. Which is due to the short distance between urethra and anus and openings of the urethra to the bladder?
  3. Birth control: switching birth control results in hormone shift which may cause changes in normal bacteria in the vagina.

Pathophysiology of pyelonephritis

Pyelonephritis is caused by the presence of E. coli in kidneys. It is of two types: active and chronic. Acute pyelonephritis is results of primary infections caused by the bacteria and chronic state is occurred due to the untreated infection. Chronic pyelonephritis (CP) normally causes a defect in the urinary tract. And can spread in other organs like kidney tissue. The inflammation response triggered by the bacteria results in edema. AP includes tissues inflammation, cell necrosis, and abscess formation. It also causes pus formation anywhere in the kidney. Fibrosis and scars may develop due to the inflammation and further spread in the intestinal area. In CP the infection also infects the transferred in uterus form bladder due to the unclosed papillae in the kidney. Inflammation and fibrosis also cause pelvis and calices deformity.  Continues infection may lead to the impaired kidney functioning.

Heart rate is: 88 (normal)

Respiratory rate is: 24 (abnormal)

Blood pressure:

  • Systolic pressure is 110
  • Diastolic pressure is 60

Body temperature is 38 which considered high

Pulse Oximetry is 100 % on room temperature

  • Specific Gravity (SG): 1020 (Abnormal)
  • PH: 5 (Lower than normal which indicates an environment that conducive to kidney stone).
  • Protein-large (high amount of protein)
  • Blood-large (high amount of blood excreted with urine)
  • Leucocytes- moderate (white blood cells amount is moderate in urine, associated with infection)
  • Nitrites- positive (Nitrates converted to nitrites by bacteria, a positive sign of bacterial infection)

Nursing interventions

  1. Encourage the patients to consume a high amount of liquid to promote the renal blood flow and to excrete the bacteria out of the body.
  2. Coffee, colas, tea and alcohol consumption should be avoided
  3. Use of antispasmodic agents that may help to relieve the irritation in the bladder. Analgesic and heat can be administered to relieve the pain
  1. Urologist: to provide relief form urinary tract infection
  2. Urogynecologist: Specialised in females  urinary system and pelvic conditions in females
  3. Dietician or nutritionist: to maintain the nutrition intake by providing a healthy diet to the patient


Morley, J. E. (2018). Endocrine function. Retrieved from:

Yeung, S. J., Habra, M. A., & Chiu, A. C. (2018). Grave’s disease. Retrieved from:

NewsMax (2011). Risk factors and complications of Graves’ disease. Retrieved from:

Lechtzin, Noah (2018). Effects of aging on the respiratory system. Retrieved from:

Cruz, B. (2014). Lymphedema: Pathophysiology, Diagnosis & Management. Master of Science in Nursing (MSN) student scholar. 9. Retrieved from:

Koutoukidin, G., Stainton, K., & Hughson, J.  (2016). Tabbners Nursing Care: Theory and practice. (7th ed.). Australia: Elsevier Health Science.

Marieb, E. N. (2013). Essentials of human anatomy & physiology. (9th ed.). San Francisco: Pearson Education.

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