Clinical Scenarios
Scenario 1: Myocardial Infarction (MI)
- Which cholesterol is considered the “good” cholesterol and what does it do?
Proteins known as lipoproteins are responsible for transporting cholesterol in the blood throughout the individual’s body. The two main lipoproteins which transport cholesterol throughout the body, are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDLs are usually regarded as “bad” cholesterol as they make up most of the total cholesterol in the human body, putting the individual at increased risk of stroke, among other heart diseases. HDLs on the other hand is considered “good” cholesterol since they are responsible for absorbing cholesterol and tacking it back to the liver for further metabolism and excretion (Kluck et al., 2021). High levels of HDL cholesterol, more than 40mh/dl, help lower the patient’s risks of heart disease which might otherwise progress to stroke. The metabolic panel for the patient in the provided case study shows a low level of HDL at 26 mg/dl, that might have contributed to her MI.
- How does inflammation contribute to the development of atherosclerosis?
The development of atherosclerosis mainly occurs in three stages. The first stage is the fatty streak, which represents the initiation of atherosclerosis. After this stage, inflammation is responsible for the second and the third stage, as stable plaques are caused by chronic inflammatory infiltrates (Geovanini & Libby, 2018). Consequently, the unstable/vulnerable plaques have also been associated with active inflammatory reactions in the fibrous cup thinning, that afterward predisposes the rapture of the plaque.
Scenario 2: Pleural Friction Rub (PFR)
- Because of the result of a pleural friction rub, what does the APRN recognize?
A pleural friction rub is defined as the adventitious breathing sounds heard during auscultation of the lungs of the patient. A pleural friction rub is normally present when the surface of the inflamed and roughed pleural membrane rubs against one another. The advanced practice registered nurse will be able to recognize grungy and creaky sounds during auscultation. As such, further evaluation of the causation of the rubs will mainly be focused on diseases that contribute to pleural effusion, pleurisy, and serositis (Yamada et al., 2020). The origin of the sound will be identified by the patient based on the location of the pain. The patient in the provided case study is suffering from acute pericarditis, which usually causes inflammation of the pericardium leading to the pleural friction rub.
Scenario 4: Deep Venous Thrombosis (DVT)
- Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)
Deep venous thrombosis (DVT) is usually caused by medical conditions or procedures which damage the veins such as inflammatory disorder or surgery, or damage due to physical injury or infection (Zhu et al., 2021). The patient in the case study provided reported a history of a left total hip replacement surgery. This surgical procedure might have contributed to the damage to the vein which led to the development of DVT. The patient is also obese which is one of the main risk factors for DVT. Other risk factors which might have led to the patient’s condition are her advanced age and sedentary lifestyle.
Scenario 5: COPD
- There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.
Small airway inflammation caused by chronic bronchitis and emphysematous destruction is usually reported among patients diagnosed with COPD. In Emphysema, air spaces usually enlarge peculiarly and permanently distal to the terminal bronchioles, associated with alveolar wall destruction and without obvious fibrosis (Tanabe et al., 2020). Gas exchange is thus reduced among other airway changes responsible for progressive air trapping and impaired expiratory airflow contributing to the presenting signs and symptoms of COPD.
References
Geovanini, G. R., & Libby, P. (2018). Atherosclerosis and inflammation: overview and updates. Clinical Science, 132(12), 1243-1252.
Kluck, G. E., Yoo, J. A., Sakarya, E. H., & Trigatti, B. L. (2021). Good Cholesterol Gone Bad? HDL and COVID-19. International Journal of Molecular Sciences, 22(19), 10182.
Tanabe, N., Vasilescu, D. M., Hague, C. J., Ikezoe, K., Murphy, D. T., Kirby, M., … & Hogg, J. C. (2020). Pathological comparisons of paraseptal and centrilobular emphysema in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 202(6), 803-811.
Yamada, E., Vannan, M. A., & Moscucci, M. (2020). Acute Pericarditis/Pericardial Effusion. In Practical Cardiology (pp. 289-295). Springer, Cham. https://doi.org/10.1007/978-3-030-28328-5_24
Zhu, Y., Chen, W., Li, J., Zhao, K., Zhang, J., Meng, H., … & Zhang, Q. (2021). Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study. Journal of Orthopaedic Surgery and Research, 16(1), 1-8. https://doi.org/10.1186/s13018-021-02259-y
