Discussion 1 – Week 2

Maladaptive Responses to Immune Disorders

Maladaptive responses to disorders are compensatory
mechanisms that ultimately have adverse health effects for patients. For
instance, a patient’s allergic reaction to peanuts might lead to anaphylactic
shock, or a patient struggling with depression might develop a substance abuse
problem. To properly diagnose and treat patients, advanced practice nurses must
understand both the pathophysiology of disorders and potential maladaptive
responses that some disorders cause.

Consider immune disorders such as HIV, psoriasis,
inflammatory bowel disease, and systemic lupus E. What are resulting maladaptive
responses for patients with these disorders?

To prepare:

· Review
Chapter 5 and Chapter 7 in the Huether and McCance text. Reflect on the concept
of maladaptive responses to disorders.

· Select two
of the following immune disorders: HIV, psoriasis, inflammatory bowel disease,
or systemic lupus E (SLE).

· Identify the
pathophysiology of each disorder you selected. Consider the compensatory
mechanisms that the disorders trigger. Then compare the resulting maladaptive
and physiological responses of the two disorders.

· Select one
of the following factors: genetics, gender, ethnicity, age, or behavior.
Reflect on how the factor might impact your selected immune disorders.

By Day 3

Post a brief description of the pathophysiology of your
selected immune disorders. Explain how the maladaptive and physiological
responses of the two disorders differ. Finally, explain how the factor you
selected might impact the pathophysiology of each disorder.

Read a selection of your colleagues’ responses.

By Day 5

Respond to at least two of your colleagues on two different
days who selected different immune disorders and/or factors than you, in the
following ways:

· Share
insights on how the factor you selected impacts the pathophysiology of the
immune disorder your colleague selected.

· Expand on
your colleague’s posting by providing additional insights or contrasting
perspectives based on readings and evidence.

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Discussion 2 – Week 2

Arthritis

While arthritis impacts nearly 50 million adults in the
United States, it is not a disease that is limited to adulthood. Consider the
case of Ashley Russell. At the age of 14 months, Ashley was diagnosed with
juvenile rheumatoid arthritis. As a baby, her parents noticed that her knee was
always swollen and that she often wanted to be carried instead of walking on
her own (Cyr, 2012). After seeking medical care, Ashley’s underlying disorder
was discovered. Arthritis in children is not uncommon. According to the CDC
(2011), an estimated 294,000 children under age 18 have some form of arthritis
or rheumatic condition. Due to the prevalence of the disorder in both children
and adults, you must understand the pathophysiology and symptoms of arthritis
in order to properly diagnose and prescribe treatment.

To prepare:

· Review
Chapter 37 in the Huether and McCance text and Chapter 24 in the McPhee and
Hammer text. Identify the pathophysiology of osteoarthritis and rheumatoid
arthritis. Consider the similarities and differences of the disorders.

· Select two
of the following patient factors: genetics, gender, ethnicity, age, or
behavior. Reflect on how the factors you selected might impact the
pathophysiology of the disorders, as well as the diagnosis of and treatment for
the disorders.

By Day 4

Post a description of the pathophysiology of osteoarthritis
and rheumatoid arthritis, including the similarities and differences between
the disorders. Then explain how the factors you selected might impact the
pathophysiology of the disorders, as well as the diagnosis of treatment for the
disorders.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different factors than you, in one or more of the following
ways:

· Offer alternative diagnoses and
prescription of treatment options for osteoarthritis and rheumatoid arthritis.

· Share an
insight from having read your colleague’s posting, synthesizing the information
to provide new perspectives.

References:

Centers for Disease Control and Prevention. (2011).
Arthritis-related statistics. Retrieved from
http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm

Cyr, J. (2012). 7-year-old from Aroostook County chosen as
youth ambassador for Bangor Arthritis Walk. Bangor Daily News. Retrieved from
http://bangordailynews.com/2012/05/10/health/7-year-old-from-aroostook-county-chosen-as-youth-ambassador-for-bangor-arthritis-walk/

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Discussion – Week 3

Pain

The neurological system affects all parts and functions of
the body through nerve stimulation. Nerves also control the sensation and
perception of pain. While pain can be described in a variety of ways, it is
essentially labeled according to its duration and source. As an advanced
practice nurse evaluating a patient, you need to consider the following
questions: Does the pain quickly come and go, or is it persistent and ongoing?
Does the pain arise at the source of injury or in another location? In this Discussion,
you compare three common types of pain—acute, chronic, and referred.

To prepare:

· Review this
week’s media presentation on the neurological system, as well as Chapter 13 in
the Huether and McCance text.

· Identify the
pathophysiology of acute, chronic, and referred pain. Consider the similarities
and differences between these three types of pain.

· Select two
of the following patient factors: genetics, gender, ethnicity, age, or
behavior. Reflect on how the factors you selected might impact the
pathophysiology, diagnosis, and prescription of treatment for acute, chronic,
and referred pain.

By Day 3

Post a description of the pathophysiology of acute, chronic,
and referred pain, including similarities and differences between them. Then,
explain how the factors you selected might impact the pathophysiology,
diagnosis, and prescription of treatment for acute, chronic, and referred pain.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different factors than you, in the following ways:

· Share
insights on how your colleague’s factors impact the pathophysiology of pain.

· Suggest
alternative diagnoses and treatment options for acute, chronic, and referred
pain.

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Discussion – Week 4

Cardiovascular Disorders

Veins and arteries are vital elements of the cardiovascular
system. They carry the blood supply through the body and are essential for
proper function. Sometimes veins and arteries malfunction, resulting in
cardiovascular disorders. Malfunctions of arteries and veins are similar to
malfunctions of a water hose. Consider the structure and function of a hose. A
tap releases water, which then travels through the hose and comes out the other
end. If the hose has been dormant for several months, dirt and rusty particles
might build up inside, resulting in a restricted flow of water. Similarly,
buildup of plaque inside the coronary arteries restricts blood flow and leads
to disorders such as coronary heart disease. This disease is one of the most common
cardiovascular disorders, and according to the National Heart, Lung and Blood
Institute (2011), is the leading cause of death for men and women in the United
States. In this Discussion, you examine the pathophysiology of cardiovascular
disorders such as coronary heart disease.

To prepare:

· Review this
week’s media presentation on alterations of cardiovascular functions, as well
as Chapter 23 in the Huether and McCance text. Identify the pathophysiology of
cardiovascular disorders.

· Select one
patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the
factor you selected might impact the pathophysiology of cardiovascular
disorders.

· Select one
of the following alterations of cardiovascular disorders: peripheral arterial
disease, myocardial infarction, coronary artery disease, congestive heart
failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead
to the alteration you selected.

By Day 3

Post a description of the pathophysiology of cardiovascular
disorders, including how the factor you selected might impact the
pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the
alteration you selected for patients with the factor you identified.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different alterations and factors than you, in one or more of
the following ways:

· Share
insights on how the factor you selected impacts the cardiovascular alteration
your colleague selected.

· Offer and
support an alternative perspective using readings from the classroom or from
your own research in the Walden Library.

· Validate an
idea with your own experience and additional research.

Reference:

National Heart Lung and Blood Institute. (2011). What is
coronary heart disease? Retrieved from
http://www.nhlbi.nih.gov/health/health-topics/topics/cad/

Discussion 1 – Week 5

Discussion 1:
Cardiovascular Disorders

At least once a year, the media report on a seemingly
healthy teenage athlete collapsing during a sports game and dying of heart
complications. These incidents continue to outline the importance of physical
exams and health screenings for teenagers, especially those who play sports.
During these health screenings, examiners check for cardiovascular alterations
such as heart murmurs because they can be a sign of an underlying heart
disorder. Since many heart alterations rarely have symptoms, they are easy to
miss if health professionals are not specifically looking for them. Once
cardiovascular alterations are identified in patients, it is important to refer
them to specialists who can further investigate the cause.

Consider the following scenario:

A 16-year-old male presents for a sports participation
examination. He has no significant medical history and no family history
suggestive of risk for premature cardiac death. The patient is examined while
sitting slightly recumbent on the exam table and the advanced practice nurse
appreciates a grade II/VI systolic murmur heard loudest at the apex of the
heart. Other physical findings are within normal limits, the patient denies any
cardiovascular symptoms, and a neuromuscular examination is within normal
limits. He is cleared with no activity restriction. Later in the season he collapses
on the field and dies.

To prepare:

· Review the
scenario provided, as well as Chapter 24 in the Huether and McCance text.
Consider how you would diagnose and prescribe treatment for the patient.

· Select one
of the following patient factors: genetics, ethnicity, or behavior. Reflect on
how the factor you selected might impact diagnosis and prescription of
treatment for the patient in the scenario.

By Day 3

Post a description of how you would diagnose and prescribe
treatment for the patient in the scenario. Then explain how the factor you
selected might impact the diagnosis and prescription of treatment for that
patient.

Read a selection of your colleagues’ responses.

By Day 5

Respond to at least two of your colleagues who selected a
different factor than you, in one of the following ways:

· Make a
suggestion based on additional evidence drawn from readings or after synthesizing
multiple postings.

· Share
insights based on your own experience and additional research.

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Discussion 2 – Week 5

Discussion 2: Anaphylactic
Shock

The treatment of anaphylactic shock varies depending on a
patient’s physiological response to the alteration. Immediate medical
intervention and emergency room visits are vital for some patients, while
others can be treated through basic outpatient care.

Consider the January 2012 report of a 6-year-old girl who
went to her school nurse complaining of hives and shortness of breath. Since
the school did not have any medication under her name to use for treatment and
was not equipped to handle her condition, she was sent to an emergency room
where she was pronounced dead. This situation has raised numerous questions
about the progression of allergic reactions, how to treat students with severe
allergies, how to treat students who develop allergic reactions for the first
time, and the availability of epinephrine in schools. If you were the nurse at
the girl’s school, how would you have handled the situation? How do you know
when it is appropriate to treat patients yourself and when to refer them to
emergency care?

To prepare:

· Review
“Anaphylactic Shock” in Chapter 23 of the Huether and McCance text,
“Distributive Shock” in Chapter 10 of the McPhee and Hammer text, and the
Jacobsen and Gratton article in the Learning Resources.

· Identify the
multisystem physiologic progression that occurs in anaphylactic shock. Think
about how these multisystem events can occur in a very short period of time.

· Consider
when you should refer patients to emergency care versus treating as an
outpatient.

· Select two
patient factors different from the one you selected in this week’s first
Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the
factors you selected might impact the process of anaphylactic shock.

By Day 4

Post an explanation of the physiological progression that
occurs in anaphylactic shock. Then, describe the circumstances under which you
would refer patients for emergency care versus treating as an outpatient.
Finally, explain how the patient factors you selected might impact the process
of anaphylactic shock.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who selected at
least one different factor than you in one of the following ways:

· Share insights
on how the factor your colleague selected impacts the pathophysiology of
anaphylactic shock.

· Offer and
support an alternative perspective using readings from the classroom or from
your own research in the Walden Library.

· Validate an
idea with your own experience and additional research.

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entering your message. Then click on the Submit button to post your message.

Reference:

Moisse, K. (2012). Death of allergic student raises
questions about school’s responsibility. Retrieved from
http://abcnews.go.com/Health/AllergiesFood/year-virginia-girl-dies-allergic-reaction-school/story?id=15295949#.T7qD0sWPRBk

Discussion – Week 6

Respiratory Alterations

In clinical settings, patients often present with various
respiratory symptoms such as congestion, coughing, and wheezing. While
identifying a symptom’s underlying illness can be challenging, it is essential
because even basic symptoms such as persistent coughing can be a sign of a more
severe disorder. Advanced practice nurses must be able to differentiate between
moderate and severe respiratory disorders, as well as properly diagnose and
prescribe treatment for their patients. For this reason, you must have an
understanding of the pathophysiology of respiratory disorders.

Consider the following three scenarios:

Scenario 1:

Ms. Teel brings in her 7-month-old infant for evaluation.
She is afraid that the baby might have respiratory syncytial virus (RSV) because
she seems to be coughing a lot, and Ms. Teel heard that RSV is a common
condition for infants. A detailed patient history reveals that the infant has
been coughing consistently for several months. It’s never seemed all that bad.
Ms. Teel thought it was just a normal thing, but then she read about RSV.
Closer evaluation indicates that the infant coughs mostly at night; and, in
fact, most nights the baby coughs to some extent. Additionally, Ms. Teel
confirms that the infant seems to cough more when she cries. Physical
examination reveals an apparently healthy age- and weight-appropriate,
7-month-old infant with breath sounds that are clear to auscultation. The
infant’s medical history is significant only for eczema that was actually quite
bad a few months back. Otherwise, the only remarkable history is an allergic
reaction to amoxicillin that she experienced 3 months ago when she had an ear
infection.

Scenario 2:

Kevin is a 6-year-old boy who is brought in for evaluation
by his parents. The parents are concerned that he has a really deep cough that
he just can’t seem to get over. The history reveals that he was in his usual
state of good health until approximately 1 week ago when he developed a
profound cough. His parents say that it is deep and sounds like he is barking.
He coughs so hard that sometimes he actually vomits. The cough is productive
for mucus, but there is no blood in it. Kevin has had a low-grade temperature
but nothing really high. His parents do not have a thermometer and don’t know
for sure how high it got. His past medical history is negative. He has never
had childhood asthma or RSV. His mother says that they moved around a lot in
his first 2 years and she is not sure that his immunizations are up to date.
She does not have a current vaccination record.

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a
cough. She is normally a healthy young lady with no significant medical
history. She takes no medications and does not smoke. She reports that she was
in her usual state of good health until approximately 3 weeks ago when she
developed a “really bad cold.” The cold is characterized by a profound, deep,
mucus-producing cough. She denies any 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. Maria 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.

To prepare:

· Review the
three scenarios, as well as Chapter 26 and Chapter 27 in the Huether and
McCance text.

· Select one
of the scenarios and consider the respiratory disorder and underlying
alteration associated with the type of cough described.

· Identify the
pathophysiology of the alteration that you associated with the cough.

· Select two
of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect
on how the factors you selected might impact the disorder.

By Day 3

Post a description of the disorder and underlying
respiratory alteration associated with the type of cough in your selected
scenario. Then, explain the pathophysiology of the respiratory alteration.
Finally, explain how the factors you selected might impact the disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected a different scenario than you, in one or more of the
following ways:

· Share
insights on how the factor you selected impacts the disorder your colleague
identified.

· Ask a
probing question regarding the disorder that your colleague identified.

· Suggest an
alternative disorder for the scenario your colleague selected.

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Discussion – Week 7

Anemia

In clinical settings, advanced practice nurses often
encounter patients with blood disorders such as anemia. Consider the case of a
17-year-old girl who is rushed to the emergency room after suddenly fainting.
The girl’s mother reports that her daughter has had difficulty concentrating
for the past week, frequently becomes dizzy, and has not been eating normally
due to digestion problems. The mother also informs the nurse that their family
has a history of anemia. With the family history of anemia, it appears that
this is the likely diagnosis. However, in order to properly diagnose and treat
the patient, not only must her symptoms and family history be considered, but
also factors such as gender, ethnicity, age, and behavior. This poses the
question: How do patient factors impact the incidence and prevalence of
different types of anemia?

To prepare:

· Review
Chapter 20 in the Huether and McCance text. Reflect on the pathophysiological
mechanisms of iron deficiency anemia.

· Select one
of the following types of anemia: pernicious anemia, folate deficiency anemia,
sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia.
Identify the pathophysiological mechanisms of the anemia you selected.

· Consider the
similarities and differences between iron deficiency anemia and the type of
anemia you selected.

· Reflect on
how patient factors such as genetics, gender, ethnicity, age, and behavior
might impact these anemic disorders.

By Day 3

Post an explanation of the pathophysiological mechanisms of
iron deficiency anemia and the anemia you selected. Compare these two types of
anemia, as well as their potential causes. Finally, explain how genetics,
gender, ethnicity, age, and behavior might impact the anemic disorders you
selected.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different types of anemia than you, in the following ways:

· Share
insights on how the anemia you selected is similar to or different from the one
your colleague selected.

· Discuss how
genetic, gender, ethnic, age, and behavioral factors impact the diagnosis and
prescription of treatment for anemic patients.

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Discussion – Week 8

Digestive Disorders

Many patient symptoms can be tied to multiple disorders,
which may lead to misdiagnoses. For instance, consider two digestive disorders
of the gastrointestinal tract—inflammatory bowel disease and irritable bowel
syndrome. These two disorders are commonly confused because they present
similar symptoms. As an advanced practice nurse, you must know the differences
to properly diagnose and treat the disorders. How does the pathophysiology of
inflammatory bowel disease compare to the pathophysiology of irritable bowel
syndrome? How do treatments for the two disorders compare?

To prepare:

· Review
Chapter 34 in the Huether and McCance text and Chapter 13 in the McPhee and
Hammer text.

· Identify the
pathophysiological mechanisms of inflammatory bowel disease and irritable bowel
syndrome. Think about similarities and differences between the disorders.

· Consider
common treatments for inflammatory bowel disease and irritable bowel syndrome.
Reflect on whether treatments for one disorder would work for the other
disorder.

· Select one
of the following patient factors: genetics, gender, ethnicity, age, or
behavior. Reflect on how the factor you selected might impact the
pathophysiology of and treatments for each disorder.

By Day 3

Post an explanation of the pathophysiological mechanisms of
inflammatory bowel disorder and irritable bowel syndrome, including
similarities and differences. Then describe common treatments, addressing
whether treatments for one disorder would work for the other disorder. Finally,
explain how the patient factor you selected might impact the pathophysiology of
and treatments for each disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different treatments and factors than you, in the following
ways:

· Offer
alternative common treatments for the disorders.

· Share
insight on how the factor you selected impacts the treatment of alterations of
digestive function.

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Discussion – Week 9

Diabetes

According to the American Diabetes Association (2011), 25.8
million children and adults have been diagnosed with diabetes in the United
States. Approximately 2 million more are diagnosed every year, with another 79
million people considered to be in a pre-diabetes state. These millions of
people are at risk of several alterations, including heart disease, stroke,
kidney failure, neuropathy, and blindness. Since diabetes has a major impact on
the health of millions of people around the world, it is essential for nurses
to understand the pathophysiology and associated alterations of this disorder.
In this Discussion, you compare two types of diabetes—diabetes mellitus and
diabetes insipidus.

To prepare for this Discussion:

· Review
Chapter 18 in the Huether and McCance text and Chapter 18 in the McPhee and
Hammer text. Identify the pathophysiology of diabetes mellitus and diabetes
insipidus. Consider the similarities and differences between resulting alterations
of hormonal regulation.

· Select two
of the following patient factors: genetics, gender, ethnicity, age, or
behavior. Think about how the factors you selected might impact the diagnosis
and prescription of treatment for these two types of diabetes.

By Day 3

Post an explanation of the pathophysiology of diabetes
mellitus and diabetes insipidus. Describe the differences and similarities
between resulting alterations of hormonal regulation. Then explain how the
factors you selected might impact the diagnosis and prescription of treatment
for these two types of diabetes.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different factors than you, in one or more of the following
ways:

· Share
insights on how the factor you selected impacts the pathophysiology of diabetes
mellitus and diabetes insipidus.

· Offer
alternative diagnoses and prescription of treatment options for diabetes
mellitus and diabetes insipidus.

· Validate an idea with your own experience
and additional research.

Reference:

American Diabetes Association. (2011). Diabetes
statistics. Retrieved from
http://www.diabetes.org/diabetes-basics/diabetes-statistics/

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Discussion – Week 10

Urinary Tract Infections

Urinary tract infections (UTIs) are caused by bacteria—most
often Escherichia coli. However, certain viruses, fungi, and parasites can also
lead to infection. The infection can affect the lower and upper urinary tract,
including the urethra, prostate (in males), bladder, ureter, and kidney. Due to
the progression of the disease and human anatomy, symptoms present differently
among the sexes as well as among age groups. It is important to understand how
these factors, as well as others, impact the pathophysiology of UTIs. Advanced
practice nurses must have this foundation in order to properly diagnose
patients.

To prepare:

· Review
Chapter 29 in the Huether and McCance text. Identify the pathophysiology of
lower and upper urinary tract infections. Consider the similarities and
differences between the two types of infections.

· Select two
of the following patient factors: genetics, gender, ethnicity, age, or
behavior. Reflect on how the factors you selected might impact the
pathophysiology of the infections, as well as the diagnosis of and treatment
for the infections.

By Day 3

Post a description of the pathophysiology of lower and upper
urinary tract infections, including their similarities and differences. Then
explain how the factors you selected might impact the pathophysiology of the
infections, as well as the diagnosis of and treatment for the infections.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected at least one different factor than you, in one or more of the
following ways:

· Offer
alternative diagnoses and prescription of treatment options for urinary tract
infections.

· Share an
insight from having read your colleague’s posting, synthesizing the information
to provide new perspectives.

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entering your message. Then click on the Submit button to post your message.

Discussion – Week 11

Disorders of the Reproductive Systems

While the male and female reproductive systems are unique to
each sex, they share a common function—reproduction. Disorders of this system
range from delayed development to structural and functional abnormalities. Since
many reproductive disorders not only result in physiological consequences but
also psychological consequences such as embarrassment, guilt, or profound
disappointment, patients are often hesitant to seek treatment. Advanced
practice nurses need to educate patients on disorders and help relieve
associated stigmas. During patient evaluations, patients must feel comfortable
answering questions so that you, as a key health care provider, will be able to
diagnose and recommend treatment options. As you begin this Discussion,
consider reproductive disorders that you would commonly see in the clinical
setting.

To prepare for this Discussion:

· Review
Chapter 22 and Chapter 23 in the McPhee and Hammer text, as well as Chapter 32
in the Huether and McCance text.

· Select two
disorders of the male and/or female reproductive systems that interest you.
Consider the similarities and differences between the disorders.

· Select one
of the following factors: genetics, ethnicity, age, or behavior. Think about