NURS 6501 Module 2 Knowledge Check – Question 1

NURS 6501 Module 2 Knowledge Check – Question 1

Case Scenario: Myocardial Infarction

Chief Complaint (CC): I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal). My dad had a heart attack when he was 56-years-old, and I am scared because I am 56-years-old.

History of Present Illness (HPI): The patient is a 56-year-old Caucasian male presenting to the Express Hospital Emergency Department. He complains of chest pain radiating down his left arm. This pain started in the morning, has been progressively worsening, and is located in the mid-sternal area. He describes it as a sensation of pressure on his chest, rating the pain as 9/10. No alleviating or exacerbating factors have been identified. The patient denies any previous episodes of chest pain, as well as symptoms such as nausea or lightheadedness. He was administered one sublingual 0.4 mg tablet of nitroglycerin, which reduced his pain to 7/10.

NRNP 6541: Primary Care of Adolescents and Children Midterm Exam

Lipid panel results show Total Cholesterol 424 mg/dl, high-density lipoprotein (HDL) 26 mg/dl, Low-Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, and Very Low-Density Lipoprotein (VLDL) 64 mg/dl.

The diagnosis is an acute inferior wall myocardial infarction.

Question: What is considered the “good cholesterol,” and what is its role?

The “good cholesterol” is high-density lipoprotein (HDL). HDL functions by removing cholesterol from the bloodstream and transporting it back to the liver for removal from the body. It also possesses anti-inflammatory, anti-atherosclerotic, and endothelial protective properties. HDL promotes reverse cholesterol transport (RCT), which aids in breaking down atherosclerotic lesions, reducing the risk of stroke or heart disease (Kosmas et al., 2018).

NURS 6501 Module 2 Knowledge Check – Question 2

Case Scenario: Myocardial Infarction

Chief Complaint (CC): I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal). My dad had a heart attack when he was 56-years-old, and I am scared because I am 56-years-old.

History of Present Illness (HPI): The patient is a 56-year-old Caucasian male presenting to the Express Hospital Emergency Department. He complains of chest pain radiating down his left arm. This pain started in the morning, has been progressively worsening, and is located in the mid-sternal area. He describes it as a sensation of pressure on his chest, rating the pain as 9/10. No alleviating or exacerbating factors have been identified. The patient denies any previous episodes of chest pain, as well as symptoms such as nausea or lightheadedness. He was administered one sublingual 0.4 mg tablet of nitroglycerin, which reduced his pain to 7/10.

Lipid panel results show Total Cholesterol 424 mg/dl, high-density lipoprotein (HDL) 26 mg/dl, Low-Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, and Very Low-Density Lipoprotein (VLDL) 64 mg/dl.

The diagnosis is an acute inferior wall myocardial infarction.

Question: How does inflammation contribute to the development of atherosclerosis?

Atherosclerosis primarily develops through a repeated process of arterial wall lesions caused by lipid retention in the intima layer. This retention occurs within a matrix that includes proteoglycans, which leads to modifications and chronic inflammation at vulnerable sites within the artery. Inflammation plays a pivotal role in the progression of atherosclerosis, with immune and non-immune cells interacting through inflammatory mediators. Without addressing the underlying risk factors, the inflammatory process continues, resulting in chronic, non-resolving inflammation (Pahwa & Ishwarlal Jialal, 2021).

Question 3

A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness, and flu-like symptoms. Physical exam reveals tachycardia and a pleural friction rub. She is diagnosed with acute pericarditis.

Question: What does the APRN recognize due to the presence of a pleural friction rub?

The presence of a pleural friction rub indicates pleural involvement, which results from the movement of inflamed pleural surfaces against each other during chest wall motion. This friction produces a grating sound, audible during both inspiration and expiration, and may be accompanied by a sandpaper-like sensation on palpation. Pleural friction rub is often associated with sharp, intense pain that worsens with deep breathing (Adderley & Sharma, 2021).

NURS 6501 Module 2 Knowledge Check – Question 4

Scenario 4: Deep Venous Thrombosis (DVT)

An 81-year-old obese female patient, 48 hours post-op left total hip replacement, presents with severe nausea and vomiting, preventing her from attending physical therapy. Her mucous membranes are dry. She complains that the skin on her left leg feels too tight. Examination reveals a swollen, tense, and red-colored calf. A duplex ultrasound confirms the presence of a deep venous thrombosis (DVT).

Question: Explain what contributed to the development of a deep venous thrombosis (DVT) in this patient, considering her history.

The development of a deep venous thrombosis (DVT) is influenced by risk factors categorized under Virchow’s triad, which includes hypercoagulability, stasis, and endothelial injury. This patient exhibits several contributing factors: recent surgery (post-op status), dehydration due to persistent nausea and vomiting, and obesity. These factors collectively promote activation of the clotting cascade, platelet aggregation, and thrombus formation, leading to partial or complete occlusion of the vein and subsequent venous stasis and potential ischemia (Waheed et al., 2021).

Question 5

Scenario 5: COPD

A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. She asks if this means she has chronic obstructive pulmonary disease (COPD).

Question: Explain the pathophysiology of emphysema and its relationship to COPD.

Emphysema primarily affects the air spaces up to the terminal bronchioles and is caused by chronic exposure to noxious gases, such as those from cigarettes and biomass fuels. These noxious substances trigger the accumulation of inflammatory cells, including cytokines and proteases. This inflammation leads to tissue remodeling and destruction, which ultimately contributes to the development of COPD (Parul Pahal et al., 2022). Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and structural changes in the lungs due to chronic inflammation, leading to narrowed airways and reduced lung recoil. Emphysema is a prominent component of COPD, emphasizing their close relationship.