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NUR 606 Week 8 Discussion 1 Case Study Discussion – Respiratory Disorders NUR 606 Week 8 Discussion 1 Case Study Discussion – Respiratory Disorders NUR 606 Week 8 Discussion 1 Case Study Discussion – Respiratory Disorders Due: To facilitate scholarly discourse, create your initial post by Day 3, and reply to at least two of your classmates, on two separate days, by Day 7. Gradebook Category: Discussions Initial Post It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post. Based on your assigned team, create an initial post by answering all questions in your team’s case study, making sure to address all components of all questions. By Day 3, post your initial response to your assigned part of the case study as a reply to the appropriate discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should comprehensively address the questions posed. Team A Week 8 Discussion Team A Worksheet (Word) Mr. CY, age 71, has had significant emphysema for six years. He has reduced his cigarette smoking since mild congestive heart failure was diagnosed (right-sided heart failure; refer to Chapter 12). He has been admitted to the hospital with a suspected closed pneumothorax and respiratory failure. Describe the pathophysiologic changes in the lungs with emphysema and explain how these affect oxygen and carbon dioxide levels in the blood. Explain how emphysema can lead to heart failure. What signs and symptoms would you expect to develop in Mr. CY? Classify each as a subjective or objective finding. Explain how a pneumothorax has probably occurred in the presence of emphysema. Explain how a pneumothorax can cause respiratory failure. Describe the pathophysiologic effects on lung function and gas exchange in your answer. Include the criteria for respiratory failure. Explain why caution must be exercised in administering oxygen to Mr. CY. The impaired respiration Mr. CY experiences as a result of his emphysema causes immobility. Immobility can lead to other respiratory complications. Identify two of these conditions and describe preventative measures for each. Describe several respiratory therapy interventions that might help Mr. CY return his body to a more homeostatic state. Emphysema, as experienced by this patient, is an obstructive pulmonary disease, which is different than restrictive pulmonary diseases. Compare and contrast the pathophysiology, manifestations, and interventions to help return to homeostasis for obstructive and restrictive respiratory disorders. 1. Describe the pathophysiologic changes in the lungs with emphysema and explain how these affect oxygen and carbon dioxide levels in the blood. Emphysema is the destruction of the alveolar walls, loss of elasticity, impaired expiration, barrel chest, and hyperinflation of the lungs, often caused by smoking. The alveoli are constantly expanded. The alveoli are the gas exchange centers of the body. When this is destroyed, both oxygen and carbon dioxide levels in the blood are affected. Oxygen levels are low, and therefore carbon dioxide levels rise due to the lack of exhaling. Hypoxia is the driving force of respiration in patients with emphysema (Hubert & Van Meter, 2018). 2. Explain how emphysema can lead to heart failure. What signs and symptoms would you expect to develop in Mr. CY? Classify each as a subjective or objective finding. Emphysema can lead to heart failure because the pulmonary blood vessels become destroyed due to the increased pressure from vasoconstriction. The right ventricle may fail because of the increased pulmonary pressure in the circulation circuit. According to the Mayo Clinic (2021), signs and symptoms of heart failure are shortness of breath, reduced ability to exercise, persistent cough or wheezing, anorexia, fatigue, and more. Objective signs and symptoms can be observed. These include shortness of breath and persistent cough or wheezing. Subjective signs are reported by the patient. These include shortness of breath, fatigue, anorexia, and reduced ability to exercise. 3. Explain how a pneumothorax has probably occurred in the presence of emphysema. A pneumothorax probably occurred in the presence of emphysema due to chronic inflation and expansion. The air eventually becomes stuck and travels to the pleural space and collapses the lung. 4. Explain how a pneumothorax can cause respiratory failure. Describe the pathophysiologic effects on lung function and gas exchange in your answer. Include the criteria for respiratory failure. According to Hubert & Van Meter (2018), respiratory failure is when the PaO2 is less than 50 mmHg (severe hypoxemia) or the PaCO2 is greater than 50mmHg (hypercapnia) and the serum pH is decreasing. A pneumothorax can cause respiratory failure because air is building up and cannot leave the pleural space. There is increased pressure in the lungs, so the lungs have difficulty expanding. The ribs cannot expand either often due to trauma. When there is a pneumothorax, the overdistended alveoli cannot perform gas exchange. Therefore, the carbon dioxide levels build-up, and the oxygen levels decrease. 5. Explain why caution must be exercised in administering oxygen to Mr. C.Y. Caution must be used when administering oxygen to a patient with emphysema because, as previously mentioned, the respiratory drive is paradoxical. Instead of their respiratory drive being based on carbon dioxide levels, it is now based on hypoxia. If the patient is given too much oxygen, their respiratory drive may decrease/ fail. 6. The impaired respiration that Mr. CY experiences as a result of his emphysema cause immobility. Immobility can lead to other respiratory complications. Identify 2 of these conditions and describe preventative measures for each. Atelectasis is a common respiratory complication after surgery. This is because the drugs given during surgery, help suppress the patient’s respiratory control center. Since the patient is not actively moving around the fluid or mucus in their lungs, a mucus plus can form in the alveoli. To prevent this, an incentive spirometer is often placed at the postoperative patient’s bedside. Additionally, lower respiratory tract infections, such as pneumonia, can occur from prolonged immobility. This is due to the patient’s diminished ability to cough, move mucus, and clear pathogens and irritants. To help prevent this complication from arising, frequent turning and repositioning patients allows them to help clear secretions and break up the mucus. 7. Describe several respiratory therapy interventions that might help Mr. CY and function to return his body to a more homeostatic state. Pulmonary rehabilitation programs that teach patients about pursed-lip breathing, as well as the administration of bronchodilators can help patients increase their exercise endurance and attempt to return to their normal life. Oxygen therapy and lung reduction surgery may be needed further into the disease process but have many risks. Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 606 Week 8 Discussion 1 Case Study Discussion – Respiratory Disorders 8. Emphysema, as experienced by this patient, is an obstructive pulmonary disease, which is different than restrictive pulmonary diseases. Compare and contrast the pathophysiology, manifestations, and interventions to help return to homeostasis for obstructive and restrictive respiratory disorders. Obstructive pulmonary diseases are when patients have difficulty exhaling all the air from their lungs. Examples of this are asthma, COPD (such as emphysema), and cystic fibrosis. Signs and symptoms include wheezing, cough that produces excessive mucus, chest tightness, and shortness of breath. Interventions to help return to homeostasis often include the use of bronchodilators. In restrictive pulmonary disease, patients have difficulty taking a full breath and expanding their lungs. Examples of this are interstitial lung disease, pulmonary fibrosis, and pneumoconiosis. Signs and symptoms include shortness of breath, chronic cough, fatigue, and weight loss. Air hunger is commonly seen in patients with advanced restrictive pulmonary disease. Interventions to help return to homeostasis include corticosteroids and oxygen therapy (Asp, K., 2020). References: Asp, K. C. (2020). Obstructive Lung Disease vs Restrictive Lung Disease: Causes, Diagnosis, and Treatment Options. The Community for Sleep Care Professionals. https://www.aastweb.org/blog/obstructive-lung-disease-vs-restrictive-lung-disease-causes-diagnosis-and-treatment-options Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions (6th ed.). Elsevier. Mayo Clinic. (2021, July 21). Heart failure – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142 Team B Week 8 Discussion Team B Worksheet (Word) Baby M is a four-month-old who presented to the emergency department with wheezing and difficulty breathing. Her mother reports she has had a fever at home and has been getting worse over the last several hours. She exhibits tachypnea and chest retractions, and you can here both audible and auscultated wheezes. After consulting with the team, it is determined that Baby M most likely has bronchiolitis. What is the most common etiology of bronchiolitis? What patient population is most at risk for this condition? What symptoms from the scenario support the diagnosis of bronchiolitis? Explain the pathophysiologic process causingese symptoms, and identify each as subjective or objective. What is meant by “chest retractions”? Think about the pathophysiology of what is occurring in her lungs, then describe the location of the following retraction types: intercostal, suprasternal, supraclavicular, substernal, and sub cos. Baby M’s mother asks you to give her some antibiotics to help her get better. What is your best response to her? How will you explain how you can help Baby M get better? Baby M is admitted to the hospital for management. As her provider, you understand she is disposed to developing pneumonia secondary to the process occurring in her lungs. What signs and symptoms would you expect to change and/or develop if Baby M were to develop pneumonia? What will you instruct her parents and caregivers to be on the lookout for? Identify the three major classifications of pneumonia. Which one do you think Baby M is most at risk for? Compare and contrast these three different types of pneumonia, including causative organisms, pathophysiology, distribution in the lungs, onset, and significant signs and symptoms. If Baby M does develop pneumonia, how would this change the interventions needed to help return her body to a homeostatic state? Week 8 Team B Worksheet Baby M is a 4-month-old who presented to the Emergency Department with wheezing and difficulty breathing. Her mother reports that she has had a fever at home and has been getting worse over the last several hours. She exhibits tachypnea and chest retractions, and you can hear both audible and auscultated wheezes. After consulting with the team, it is determined that Baby M most likely has bronchiolitis. 1.  What is the most common etiology of bronchiolitis? What patient population is most at risk for this condition? Bronchiolitis is a common childhood infection most often caused by the Respiratory Syncytial Virus (RSV). It most often occurs during the late fall and winter months and is transmitted by respiratory droplets/spores. Infants under the age of 2 years or with pre-existing conditions such as prematurity, heart defects, or certain lung defects are at the highest risk for developing complications from bronchiolitis. About 3.4 million children worldwide are hospitalized yearly due to bronchiolitis and is the main reason for hospital admission in infants under 1 year of age (Bradshaw et al., 2018). 2.  What symptoms from the scenario above support the diagnosis of bronchiolitis? Explain the pathophysiologic process that is causing these symptoms and identify each as subjective or objective. The virus causes bronchi and bronchioles to inflame and become edematous due to the increase of secretions (Vanmeter & Hubert, 2018). Baby M has symptoms of bronchiolitis including wheezing, dyspnea, chest retractions, and fever. Subjective signs include Baby M worsening. Objective signs include audible and auscultated wheezes, chest retractions, and tachypnea. 3.  What is meant by “chest retractions”? Think about the pathophysiology of what is occurring in her lungs, describe the location of the following retraction types: intercostal, suprasternal, supraclavicular, substernal, and sub cos. Chest retractions, also called belly breathing, are a classic presentation of an infant in respiratory distress.  Because of the excess secretions caused by RSV, air from the lungs are unable to flow freely, decreasing the pressure in the chest leading to retractions. This is observed when an infant uses accessory muscles in the neck, rib cage, sternum, or abdomen. Bonvissuto (2020) defines the different types of retractions including intercostal retractions are between ribs, suprasternal retractions are noted by the middle of the neck being pulled in, supraclavicular retractions are above the collar bone, substernal are those where the belly is pulled beneath the breast bone, subcostal occurs when the belly pulls in beneath the rib cage. 4.  Baby M’s mother asks you to give her some antibiotics to help her get better. What is your best response to her? How will you explain how you can help Baby M get better? As bronchiolitis and RSV are caused by a virus, antibiotic treatment would not be appropriate unless a secondary infection such as pneumonia develops. Symptomatic care measures should include those to assist in the management of secretions. This can include using a cool-mist humidifier, increasing fluid intake, using nasal saline, and suctioning with a bulb syringe (University of Florida Health, 2019). Baby M is admitted to the hospital for management. As her provider, you understand that she is predisposed to developing pneumonia secondary to the process occurring in her lungs. 5.  What signs and symptoms would expect to change and/or develop if Baby M were to develop pneumonia? What will you instruct her parents and caregivers to be on the lookout for? Baby M will develop breathing difficulties with pneumonia such as cough, fast and labored breathing, flaring of nostrils, wheezing, and intercostal retractions. Baby M’s parents should be educated on the signs and symptoms of pneumonia and monitor Baby M for fever, her appetite, energy level, and if she is crying more than usual. (HealthyChildren.org, 2020). 6.  Identify the 3 major classifications of pneumonia. Which one do you think Baby M is most at risk for? A pneumonia infection is classified based on how it is acquired and can be categorized into community-acquired, hospital-acquired (nosocomial), or aspiration pneumonia. Baby M is most at risk for aspiration pneumonia. 7. Compare and contrast these 3 different types of pneumonia, including causative organisms, pathophysiology, distribution in the lungs, onset, and significant signs and symptoms. The three types of pneumonia are lobar pneumonia, bronchopneumonia, and interstitial pneumonia, also known as primary atypical pneumonia (PAP) (Vanmeter & Hubert, 2018). Lobar pneumonia- involves one or both lobes. It is caused by streptococcus pneumoniae. Cells, fibrin, and fluid leak into the alveoli leading to consolidation, and alveolar walls become inflamed. The onset can be sudden and acute. Signs and symptoms include high fevers and chills, productive cough with rusty sputum, and on auscultation, rales progress to diminished lung sounds in the affected lobe (Vanmeter & Hubert, 2018). Bronchopneumonia- is scattered in small patches. It is caused by multiple bacteria. It often occurs due to previously accumulated secretions or irritation leading to inflammation and alveoli becoming inflamed with a purulent exudate. The onset is typically insidious. Signs and symptoms include a low-grade fever, productive cough with yellow-green sputum, and difficulty breathing (Vanmeter & Hubert, 2018). Interstitial Pneumonia/ Primary atypical pneumonia (PAP)- Is scattered in small patches. Most often, mycoplasma and influenza viruses are the causative factors. Chlamydia pneumoniae can also be the causing factor. It causes necrosis of the bronchial epithelium and interstitial inflammation around the alveoli is present. The onset is variable, with different presentations. The signs and symptoms include fevers, myalgia, headache, and non-productive, hacking cough (Vanmeter & Hubert, 2018). 8. If Baby M does develop pneumonia, how would this change the interventions needed to help return her body to a homeostatic state? If Baby M develops pneumonia, she will be placed on a prescribed antibiotics if the cause is bacterial. Baby M will respond to the antibiotic and symptoms should improve within 12 to 36 hours after the start, and instruction for the parents to take the full course of antibiotics is imperative to the effectiveness of the antibiotic. If Baby M has viral pneumonia, antibiotics will not treat her pneumonia, and instead needs supportive measures such as hydration, fever control, and treatment of wheezing or oxygen needs until her body overcomes the infection.   (Children’s Hospital Colorado, 2021). References: Bradshaw, M. L., Déragon, A., Puligandla, P., Emeriaud, G., Canakis, A.-M., & Fontela, P. S. (2018). Treatment of severe bronchiolitis: A survey of canadian pediatric intensivists. Pediatric Pulmonology, 53(5), 613–618. https://doi.org/10.1002/ppul.23974 Bonvissuto, D. (2020, August 28). What are chest retractions? WebMD. https://www.webmd.com/lung/dont-ignore-breathing-problems HealthyChildren.org (2020). Pneumonia. Retrieved October 17, 2021, from https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Pneumonia.aspx The University of Florida Health. (2019, August 7). Bronchiolitis. https://ufhealth.org/bronchiolitis VanMeter, K. C., & Hubert, R. J. (2018). Gould’s pathophysiology for the health professions. (6th ed.). Elsevier Saunders. Team C Week 8 Discussion Team C Worksheet (Word) CJ is a 22-year-old with a history of asthma since childhood. He was tested for allergies and demonstrated marked responses to a number of animals, pollens, and molds. CJ also has a history of asthma related to exposure to very cold weather. Describe the pathophysiology of an acute asthma attack in CJ following exposure to cats. Describe the early signs and symptoms of an acute asthma attack, and relate each of these to the pathophysiologic changes taking place in the lungs. Identify each as a subjective or objective finding. If you were updating a medical and drug history for CJ, list several significant questions you should ask. Is asthma considered an obstructive or restrictive respiratory condition? Explain your answer. Explain how a beta2-adrenergic agent is helpful in treating asthma and how it is usually administered. In addition to beta2-adrenergic agents, identify one other pharmacologic and one other non-pharmacologic intervention that can be used to help manage acute asthma attacks and correct the pathophysiology that is occurring. Explain how each helps return the body to a homeostatic state. What is the term for a prolonged asthma attack? Explain the pathophysiology that occurs and how this can lead to respiratory distress and failure. Identify three signs or symptoms of impending respiratory distress. Identify two preventative measures that CJ can take to help manage his disease and keep his body in a homeostatic state. Explain how this will impact the disease process. Reply Posts Review all your peers’ posts, as they will help you prepare for the quiz this week. Select posts from two peers that addressed a case study from a different team than you. For example, students from Team A reply to one post from Team B and one post from Team C. Each reply must use at least one scholarly reference other than your textbook. Thinking about your population specific NP track and anticipated practice area: Identify and explain two “pearls of wisdom” or “key concepts/ideas” you learned from reading your peers’ responses. Describe a patient you might encounter in your future practice where you could apply the information learned in your peer’s post. Please refer to the Grading Rubric for details on how this activity will be graded. Posting to the Discussion Forum Select the appropriate Thread. Select Reply. Create your post. Select Post to Forum. CJ is a 22-year-old with a history of asthma since childhood. He was tested for allergies and demonstrated marked responses to a number of animals, pollens, and molds. CJ also has a history of asthma related to exposure to very cold weather. Describe the pathophysiology of an acute asthma attack in CJ following exposure to cats. Describe the early signs and symptoms of an acute asthma attack, and relate each of these to the pathophysiologic changes taking place in the lungs. Identify each as a subjective or objective finding. If you were updating a medical and drug history for CJ, list several significant questions you should ask. Is asthma considered an obstructive or restrictive respiratory condition? Explain your answer. Explain how a beta2-adrenergic agent is helpful in treating asthma and how it is usually administered. In addition to beta2-adrenergic agents, identify one other pharmacologic and one other non-pharmacologic intervention that can be used to help manage acute asthma attacks and correct the pathophysiology that is occurring. Explain how each helps return the body to a homeostatic state. What is the term for a prolonged asthma attack? Explain the pathophysiology that occurs and how this can lead to respiratory distress and failure. Identify three signs or symptoms of impending respiratory distress. Identify two preventative measures that CJ can take to help manage his disease and keep his body in a homeostatic state. Explain how this will impact the disease process.   254 words In reply to Content Services (NT) Re: Team C by Mary Anderson – Monday, 18 October 2021, 4:53 AM Describe the pathophysiology of an acute asthma attack in CJ following exposure to cats. Describe the early signs and symptoms of an acute asthma attack, and relate each of these to the pathophysiologic changes taking place in the lungs. Identify each as a subjective or objective finding. Pathophysiology: the bronchi and bronchioles are triggered by a tyle 1 hypersensitivity response that causes inflammation of the mucosa with edema. This, this causes a contraction of smooth muscle called bronchoconstriction. With an increase secretion of thick mucus in the passages create obstructed airways, partially or totally, and interfere with airflow and oxygenEarly signs and symptoms: cough and dyspnea (objective), along with chest tightness (subjective) due to the edema of the mucous membrane. Wheezing (objective) due to air passing through the narrowing of bronchioles. Tachypnea (objective) and labored breathing as the body is trying to get oxygen and airflow moving. Thick secretions (subjective and objective) from the mucous plus that is formed (Hubert, R. J., & VanMeter, K. C. (2018)).If you were updating a medical and drug history for CJ, list several significant questions you should ask. Do you have any family history of asthma, hay fever, or eczema? Do you have a history of exacerbations? Are there any triggering allergens at your home or work, such as pests, dust, pets? What kind of medication were you prescribed after being diagnosed with asthma? What is the first sign of asthma symptoms? What happens first? How do you know you’re having an attack? What time of the year do you suffer most from allergies / asthma? Is asthma considered an obstructive or restrictive respiratory condition? Explain your answer. Asthma is considered an obstructive pulmonary disease. Asthma attacks, or episodes, are an airflow obstruction within lung that is often reversible either spontaneously or with the treatment. Obstructive lung disease makes it more difficult to breathe, particularly during enhanced exertion or activity. (Asp, K., CRT, & RPSGT. (2020)). Explain how a beta2-adrenergic agent is helpful in treating asthma and how it is usually administered. Beta2-adrenergic agents are helpful due to that they act on receptors to help relax the bronchial smooth muscles, but have minimal affects on the heart. These medications work by providing a measures dose of the medication and work best when taken at the first sign of an attack, can even be used to prevent an attack, and used while exercising or exposed to a known stimulant. These are usually administered in the form of an inhaler that patients can carry with them (Hubert, R. J., & VanMeter, K. C. (2018)). In addition to beta2-adrenergic agents, identify one other pharmacologic and one other non-pharmacologic intervention that can be used to help manage acute asthma attacks and correct the pathophysiology that is occurring. Explain how each helps return the body to a homeostatic state. Pharmacologic: Leukotriene receptor antagonists like Singulair work to block the inflammatory response in the presence of a stimulus. In this case these medications are taken as a preventative factor for patients with asthma and are taken daily. Nonpharmacologic: controlled breathing exercises so that in the presence of an attack breathing can be kept under control, reducing the anxiety that comes with a narrowing airway (Hubert, R. J., & VanMeter, K. C. (2018)). What is the term for a prolonged asthma attack? Explain the pathophysiology that occurs and how this can lead to respiratory distress and failure. Identify three signs or symptoms of impending respiratory distress. Status asthmaticus is a prolonged asthma attack that progresses in severity because of a poor response to standard therapeutic measures. In other works the rescue inhalers and breathing treatments for at home management are not working in reducing the airway restriction. “Premature airway closure during exhalation causes an increase in functional residual capacity and air trapping. Heterogeneous distribution of air trapping results in ventilation-perfusion mismatch and hypoxemia, triggering anaerobic metabolism and lactic acidosis (Chakraborty, R., & Basnet, S. (2021).” Three signs or symptoms: cyanosis, loss of consciousness, and fatigue Identify two preventative measures that CJ can take to help manage his disease and keep his body in a homeostatic state. Explain how this will impact the disease process. Know what is triggering his asthma attack so that he can know what to avoid in the future to prevent any more attacks. By avoiding triggers his will reduce the risk of attacks. Secondly, he can get on a medication regimen that works for him that will prevent attacks from coming on rather than just treating them when they start. References Asp, K., CRT, & RPSGT. (2020). Obstructive lung disease vs restrictive lung disease: Causes, diagnosis, and treatment options. https://www.aastweb.org/blog/obstructive-lung-disease-vs-restrictive-lung-disease-causes-diagnosis-and-treatment-options Chakraborty, R., & Basnet, S. (2021, July 31). Status Asthmaticus. https://www.ncbi.nlm.nih.gov/books/NBK526070/ Hubert, R. J., & VanMeter, K. C. (2018). Gould’s Pathophysiology for the Health Professions (6th ed.). Elsevier. 806 words Order Now