HLTAAP002 Confirm Physical Health Status- Hypertension and COPD

Questions

Case Study 1

Mr John Allen is a 62 year old male with a history or hypertension and COPD (emphysema). Both conditions are managed with medication and regular consultations with his GP.

John has presented to the Emergency Department with a three day history of fever, coughing, shortness of breath and a productive cough, he reports his sputum as dark green and thick. He also mentions that he has been suffering from episodes of chest pain on exertion. Recently, whilst walking up a flight of stairs, he felt crushing central chest pain which radiated to his jaw. After resting for a few minutes he found the pain disappeared.

John is a smoker, moderately obese and sits for long periods of time. His diet is poor and his father died, aged 55 of a heart attack.

The Emergency Registrar has also suggested John have a FluVax, due to his current state of health

Answer the following:

1. Briefly outline the main structures of the cardiovascular system
2. Provide a brief overview of the normal function of the cardiovascular system
3. Briefly outline the main structures of the respiratory system
4. How do the cardiovascular and respiratory systems interact?
5. Briefly explain the changes age has upon the respiratory and cardiovascular systems
6. Explain the pathophysiology of angina & emphysema (include common signs & symptoms)
7. Explain the common risk factors shared between angina and emphysema
8. Outline your assessment of John and your immediate actions
9. Name some other health professionals involved in Johns care and their role (medical and allied health)
10. Explain the concept of Artificially Acquired Immunity

Case Study 2

Isabella Pearson is a 30 year old who has presented to her GP with a six week history of feeling jittery and unwell.

She reports her symptoms as follows –

Weight loss
Increased appetite
Loose bowel actions
Restlessness and an inability to sleep
Hand tremors
Heart palpitations

Her GP conducts a thorough head to toe assessment and orders a series of blood tests to aid in their diagnosis, the results are as follows –

TSH level is 1.00mlU/L (normal range 0.5 – 4.2mlU/L)
Free T4 40 pmol/L (normal range 10-20 pmol/L)
Free T3 16 pmol/L (normal range 3.5 – 6.0 pmol/L)

Her blood tests reveal a diagnosis of Hyperthyroidism (Graves Disease)

1. Provide an outline of the main structures of the endocrine system
2. Write a brief overview of the normal function of the endocrine system
3. Describe the pathophysiology of hyperthyroidism (Graves Disease) and risk factors
4. Discuss Isabella’s signs and symptoms and link to pathophysiology
5. Briefly outline the main structures of the digestive system
6. Briefly write a brief overview of the normal function of the digestive system (include metabolism and nutrition)
7. Briefly provide an over view of the man function of the immune system
8. Briefly define the pathophysiology of an autoimmune disease
9. Outline your assessment of Isabella and your immediate actions
10. Name some other health professionals involved in Isabella’s care and their role (medical and allied health)

Case Study 3

Daisy Mae is a 21 year old female who presents to her GP with a long standing history of blurred vision, bilateral numbness in both legs, urinary urgency, poor memory and problems with balance.

Daisy is married, has two young children aged 1 & 2 and she works part time in the family business. Daisy is very active taking care of her family and participates in regular sporting activities. She does not smoke, maintains a healthy diet and has no other relevant past medical history.

Daisy reports an increase in her symptoms since the birth of her youngest child, at times the symptoms improve but she notices at times they affect her activities of daily living. She reports also that she has been experiencing intermittent severe jaw pain, much like a tooth ache.

After a thorough head to toe physical assessment, her treating Doctor orders a series of tests, including an MRI (magnetic resonance imaging) and lumbar puncture. The results show multiple lesions and scarring on daisy spinal cord, a diagnosis of Multiple Sclerosis (MS) is made. Daisy is promptly referred to a neurologist with speciality in treating patients with MS.

1. Provide a brief overview of the function of the nervous system
2. Describe the pathophysiology of multiple sclerosis (MS)
3. Discuss daisy’s signs and symptoms and link to the pathophysiology
4. Outline the main structures of the urinary system
5. Provide a brief overview of the function of our special senses.
6. Explain how the special senses of (smell, taste, vision, equilibrium and hearing) may be affect in people with multiple sclerosis (MS) and link to pathophysiology.
7. Define the terms edentulous and dentate
8. Daisy is complaining of a tooth ache, explain how oral health disease may be impacting upon her.
9. Outline you assessment of daisy and your immediate actions
10. Name some other health professionals involved in Daisy’s care and their role (medical and allied health)

Answers

Case study 1

1. The cardiovascular system has the heart, blood vessels and blood that function as a whole for building up the liquid transport network. The heart is the powerful workhouse of the body that has four internal chambers; two on the left and two on the right side. The two chambers at the top of the heart are called the right atrium and left atrium. The two chambers located at the bottom of the heart are known as the right ventricle and the left ventricle. The blood vessels are the hollow tubes carrying blood to and from the heart. Blood is the transport fluid of the circulatory system (Boore et al., 2016).

2. The cardiovascular system is responsible for delivering the nutrients and oxygen to the body and picking up waste products that are to be eliminated from the body. It is also responsible for distributing the important proteins and hormones, as well as some other chemicals to different parts of the body. In addition, it helps in maintaining the body temperature, water content of the cell and fluid pH. The heart acts as the pump propelling blood the through the cardiovascular system. Protection of the body by antibodies and complement proteins circulating in the blood is also a function of the cardiovascular system (Peate & Nair, 2015).

3. The respiratory system has three main parts to it; the airway, the lungs and the muscles of respiration. The airway is made of the mouth, nose, larynx, pharynx, bronchi, trachea and bronchioles, and is responsible for carrying air between the body’s exterior and the lungs. The lungs are the functional unit and pass oxygen into the body. The muscles work together for acting as a pump for air passage.

4. The respiratory system and the cardiovascular system work together for ensuring that the organ tissues get adequate oxygen. That is needed for normal cellular functioning. The air that an individual breaths in is held in the lungs after which it is transferred to the blood. The heart then is responsible for circulating the blood, through pumping action that makes oxygenated blood reach the lungs. Moreover, the two functional systems work in collaboration for removing the carbon dioxide from the body, a metabolic waste product (Boore et al., 2016).

5. With ageing, there is a weakening of the respiratory muscles, a decrease in lung function, and a decline in the capability of lung defence mechanism. For cardiovascular system, ageing also leads to decreased functioning. The structures of the heart become rigid, and the muscles of the left ventricle might get thicker. In addition, there is an increase in the size of the heart. As a result, the circulatory process is impaired (Peate & Nair, 2015).

6. Angina is the condition of the heart due to myocardial ischemia caused by a poor balance between oxygen demand and myocardial blood supply. The common signs and symptoms of this condition include retrosternal chest discomfort, pain, and difficultly in breathing. Emphysema is the condition of the lung caused due to damage of the air sacs of the lungs that is alveoli. The main symptom is shortness of breath.

7. The common risk factors between angina and emphysema are smoking and old age. Smoking, chewing tobacco and long-term exposure to smoke are all responsible for both the diseases. The risk increases with the amount of tobacco smoked and the number of years smoked. Age has a directly influences the occurrence of these conditions. Individuals above the age of 55 years are at increased risk of developing angina. For emphysema, people experience the symptoms between the age 40 and 60 years (Hamric et al., 2013).

8. A thorough physical assessment for John is to be carried out immediately. This would include monitoring the vital signs of the patient. An Electrocardiogram and Stress test are necessary. Further, chest X-ray is to be carried out for understanding the condition of the lungs and the heart. Blood tests would confirm the damage to the heart if such is the case. A coronary angiography will be beneficial if the condition of the patient deteriorates. The patient is to be provided with oxygen support for addressing shortness of breath. Collaboration of oxygen therapy and medication administration such as analgesics and nitroglycerin is important. The patient is to be assisted for proper ways of coughing so that secretions can be removed (Moorhead et al., 2014).

9. Other health professionals involved in John’s care are dietician and physical therapist. The dietician would outline the diet for John since he is obese and his diet is poor. The physical therapist would assist in physical exercises since he has a sedentary lifestyle (Butcher et al., 2013).

10. In artificially acquired immunity, the individual is intentionally and artificially exposed either to foreign antigens in active manner or to antibodies in a passive manner for generating protective immune response (Aickelin et al., 2014).

Case study 2

1. The endocrine system is the summation of the glands of the body and the respective hormones produced. The glands are controlled in a direct manner by the stimulation from the nervous system and chemical receptors in hormones and blood. The glands that are a part of the endocrine system include hypothalamus, pituitary gland, thyroid gland, pineal gland, parathyroid gland, adrenal gland, pancreas, gonads and thymus. The hypothalamus is a section of the human brain that has different functions in the nervous system. The pituitary gland is a tissue lump connected to the hypothalamus. The thyroid gland is situated at the base of the neck around the trachea. The adrenal glands are found above the kidney. The increase is present in the abdominal cavity posterior to the stomach (Tang et al., 2017).

2. The primary function of the endocrine system is in relation to maintainence of the homeostasis of the body. Reproduction, cellular metabolism, sexual development, heart rate and digestion are some of the processes that are regulated by the action of the hormones (Boore et al., 2016).

3. Hyperthyroidism is the group of symptoms that is presented as a result of increased levels of thyroid hormones. Graves disease is the common form of hyperthyroidism which is an autoimmune condition. The antibodies are active against the thyroid-stimulating hormone (TSH) receptor. As a result of this the gland is stimulated in an inappropriate manner, thereby increasing the production of the hormone. The risk factor for this condition mainly relates to malfunction of the immune system of the body. the risk factors include family history, gender, age, physical stress, smoking and pregnancy (Biondi, 2015).

4. The symptoms of Isabella relate to the condition of hyperthyroidism. According to Pearce (2014) the symptoms of hyperthyroidism include insomnia, hand tremor, hyperactivity, weight loss in spite of increased appetite, palpitations and diarrhea. Due to the overabundance of the thyroid hormone, most of the physiologic system are affected, such as heart function, metabolism, body temperature and nervous system.

5. The digestive system is made of the digestive tract and the related organs. The digestive tract is the tube of around 7m length and encompassing the mouth, pharynx, oesophagus, stomach, small intestine, large intestine and the anus. The associated digestive organs include the liver, pancreas, salivary gland and gallbladder.

6. The main function of the digestive system include digestion and absorption of the food that individuals consume. The system aids in nutritional gains for the body through metabolism as the food is converted to nutrients. The aim of the system is to provide energy the body and the six primary functions include ingestion of food, secretion of digestive enzymes and fluid, mixing of food particles, digestion food particles, absorption of nutrients and excretion of waste products (Peate & Nair, 2015).

7. The immune system of the body is the defense system that protects the body from foreign particles and agents potentially harmful for human. The series of steps are known as the immune response that are provided against the foreign body. the system is made up of a number of cells, tissues and organs that work as a network for protecting the body. This is done through the recognition and self and subsequent response to non self (Iwasaki & Medzhitov, 2015).

8. Autoimmune disease refers to the condition in which the immune system triggers a response to the body’s system erroneously. One common autoimmune disease is Type 1 diabetes. In the human body the pancreas is responsible for producing the insulin hormone that regulates and maintains blood glucose level. In case of type 1 diabetes, there is a destruction of the cells of the pancreas responsible for producing insulin that islets of Langerhans since the immune system attacks these cells. Culmination of infiltration of lymphocytes also takes part in this process (Potter et al., 2016).

9. The patient is to be considered for an in-depth assessment that would include identifying increased basal metabolic rate in the first place. The skin is to be assessed for warmth and moist condition. The eyes are to be checked for conjunctival irritation, lid lag, and lid retraction. The neck is to be examined carefully for enlarged thyroid gland. Abdomen assessment would include hyperactive bowel sound and neurologic assessment would include hand tremors. The nurse is to monitor the food intake of Isabella and weigh her daily for reporting weight loss. A balanced diet is to be provided to her for promoting weight gain. A cool and quiet environment is to be provided to address her restlessness. Comfort measures are to be given in addition to diversional activities. This would help in reducing anxiety and inability to sleep. For addressing heart palpitations the nurse must administer adrenergic antagonists (Black, 2016).

10. The endocrinologist and the nutritionist would be referred to for Isabella. An endocrinologist is the concerned physician who diagnoses and treats hormone related problems and complications in patients. The nutritionist would address the nutritional deficiency of the patient since she has lost weight considerably (DiCenso et al., 2014).

Case study 3

1. The nervous system has the main function of coordinating and managing all the activities of the human body. It is chiefly responsible for maintaining the normal functioning of the body in addition to enhancing the ability of the body to cope with medical complications. The functions can be divided into three primary categories; a sensory function, an interpretative function and a motor function (Louis et al., 2016). The sensory nerves are responsible for gathering information from the outside environment and the inside of the body. The sensory information is subsequently passed on to the central nervous system for processing and interpretation. Consequently, the motor nerves are accountable for conveying the information from the central nervous system to the glands and muscles.

2. Multiple Sclerosis (MS) is an immune-mediated inflammatory disease known to attack the myelinated axons present in the central nervous system. The immune cells in an active form are responsible for invading the central nervous system, thereby leading to neurodegeneration, inflammation and damage to the tissue. The disease is marked by the destruction of the myelin and the axon to different extents, leading to physical disability (Mahad et al., 2015).

3. The signs and symptoms of Daisy relate to multiple sclerosis. The weakness and numbness in one or more limbs are due to the impaired nervous system’s functioning. Pain and tingling are also associated with this condition. Myelin damage also leads to impairment in vision, and thus a patient has blurred vision. Dizziness and fatigue are due to impaired body functioning. The patient might also suffer problems with bladder functioning (Lublin et al., 2014).

4. The urinary system is made up of the ureters, kidneys, bladder and the urethra. The aim of the renal system is to carry out elimination of waste products from the body and regulate blood pressure and volume. The body has two paired kidneys and formation of urine takes place in the nephrons. It then flows through the collecting ducts into the ureter from the renal pelvis. At the time of urination the urine is discharged from the urethra (Boore et al., 2016).

5. The special senses refer to the senses having specialised organs for their active role. These are vision, hearing, balance, smell and taste. The organs responsible for these functions are eyes, ears, nose, tongue and skin. The overall function of our special senses is establish a connection with the outer world. The purpose is an adequate interpretation of the vicinity environment.

6. Multiple sclerosis has a negative impact on the sensory functioning. Vision blurring, vision loss and colour blindness are due to inflammation of the optic nerve. Scarring in the auditory nerve leads to impairment in hearing. Lesions in the frontal and temporal lobes of the brain lead to impaired taste perceptions. There is an association between impaired smell sense and reduced volume of olfactory bulb and gray matter. The sensory nerve fibres are damaged by the disease too (Mahad et al., 2015).

7. Edentulism refers to the condition in which the person is toothless to some degree. If the person has lost some of the teeth then the condition is called partial edentulis. If the person has lost all of the teeth the the condition is called complete edentulism. Dentate refers to the condition of having teeth or objects that have serrate edges.

8. Oral health disease have a significant impact on the human body’s normal functioning. Firstly, the patient suffers pain and inconvenience in eating. Inability to eat leads to decreased nutritional intake. Further, infection in the oral area can lead to secondary infections that might affect other parts of the body (Halvari et al, 2013).

9. Marie is to be considered for an assessment that would include identification for weakness, walking difficulties, poor balance, stiffness in muscles and spasms, pain and tremor. The emotional needs of the patient are also to be identified. Medications are to be administered to the patient for addressing the pain. Psychological and emotional support is to be provided for ensuring emotional stability. The patient is also to be encouraged to have adequate fluid intake (Ackley et al., 2016)).

10. Apart from the neurologist, the patient is to be referred to a rehabilitation specialist and a nutritionist. The rehabilitation specialist would work for promoting the body functioning of the patient through diverse range of physical therapies and occupational therapies. The nutritionist would guide in maintaining body nutritional requirements (Potter et al., 2016).

References

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Aickelin, U., Dasgupta, D., & Gu, F. (2014). Artificial immune systems. In Search Methodologies (pp. 187-211). Springer US.

Biondi, B. (2015). Impact of Hyperthyroidism on the Cardiovascular and Musculoskeletal Systems and Management of Patients with Subclinical Graves’ Disease. In Graves' Disease (pp. 133-146). Springer New York.

Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health Sciences.

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Lublin, F. D., Reingold, S. C., Cohen, J. A., Cutter, G. R., Sørensen, P. S., Thompson, A. J., ... & Bebo, B. (2014). Defining the clinical course of multiple sclerosis The 2013 revisions. Neurology, 83(3), 278-286.

Mahad, D. H., Trapp, B. D., & Lassmann, H. (2015). Pathological mechanisms in progressive multiple sclerosis. The Lancet Neurology, 14(2), 183-193.

Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2014). Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health Outcomes. Elsevier Health Sciences.

Pearce, E. N. (2014). Overt and subclinical hyperthyroidism are associated with increased mortality whereas subclinical hypothyroidism is associated with decreased mortality. Clinical Thyroidology, 26(5), 120-122.

Peate, I., & Nair, M. (2015). Anatomy and Physiology for Nurses at a Glance. John Wiley & Sons.

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Tang, M. W., Garcia, S., Gerlag, D. M., Tak, P. P., & Reedquist, K. A. (2017). insight into the endocrine System and the immune System: A Review of the inflammatory Role of Prolactin in Rheumatoid Arthritis and Psoriatic Arthritis. Frontiers in immunology, 8, 720.

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