NURS 6501 Module 2 Knowledge Check

NURS 6501 Module 2 Knowledge Check

NURS 6501 Module 2 Knowledge Check – Question 1

Scenario 1: Myocardial Infarction

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.  NURS 6501 Module 2 Knowledge Check.

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, it feels like an elephant is sitting on my chest and having a hard time breathing. He rates the pain as 9/10. NURS 6501 Module 2 Knowledge Check Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

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

His diagnosis is an acute inferior wall myocardial infarction.

Question: Which cholesterol is considered the good cholesterol and what does it do?

According to the CDC, HDL is regarded as the good cholesterol as it takes up cholesterol in the blood and transports it back to the liver and is removed from the body. HDL also plays a role in anti-inflammatory anti-atherosclerotic and endothelial protective effects. It promotes RCT which is an anti-atherogenic outcome of HDL which promotes the breakdown of atherosclerotic lesions (Kosmas et al., 2018). HDL also prevents endothelial dysfunction and cell death by tumor necrosis factor-alpha and ox-LDL. Therefore high levels of HDL reduce the risk of stroke or heart disease.

NURS 6501 Module 2 Knowledge Check – Question 2

Scenario 1: Myocardial Infarction

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.

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, it feels like an elephant is sitting on my chest and having a hard time breathing. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

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

His diagnosis is an acute inferior wall myocardial infarction.

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

Atherosclerosis primarily occurs via a repeated process of arterial wall lesions secondary to lipid retention in the intima layer by a matrix that includes proteoglycans leading to modification which as a result aggravates chronic inflammation at the vulnerable sites in the artery and plays a crucial role in the atherogenic progression phases (Pahwa & Ishwarlal Jialal, 2021) NURS 6501 Module 2 Knowledge Check. The immune and non-immune cells cause plague formation via the interplay of inflammatory mediators. Without removal of the underlying risk factor, the inflammatory process persists leading to chronic non-resolving inflammation.

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 says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question: Because of the result of a pleural friction rub, what does the APRN recognize?

Pleural friction rub is often brought about by the pleural disease which is as a result of the movement of roughened and inflamed pleural surfaces against each other during movement of the chest wall. The pleural friction rub described as a grating sound and is heard on both inspiration and expiration (Adderley & Sharma, 2021). On palpation, the examiner might pick up a sandpaper-rubbing type of sensation. It is often accompanied by sudden, sharp intense pain that worsens with inspiration.

 

NURS 6501 Module 2 Knowledge Check – Question 4

Scenario 4: Deep Venous Thrombosis (DVT) A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. NURS 6501 Module 2 Knowledge Check The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question: Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)

The risk factors of DVT are classified under Virchow’s triad which consists of; hypercoagulability, stasis, and endothelial injury. If a patient has either of the mentioned risks there is an activation of the clotting cascade together with aggregation of blood cells particularly the platelets to form a thrombus (Waheed et al., 2021). As a result, there is partial or complete occlusion of the vein resulting in venous stasis lymphedema, and likely ischemia to the surrounding tissue. Some of the risk factors the patient has include; recent surgery intervention dehydration from nausea and vomiting and being obese.

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.  He asks if this means he has chronic obstructive pulmonary disease (COPD).

Question: There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD

Emphysema is a disease that primarily involves the air spaces to the terminal bronchiole. It is caused by chronic and significant exposure to noxious gases from cigarettes biomass fuels, sulfur dioxide, and others. The inhalation of noxious substances results in the accumulation of inflammatory cells including cytokines and proteases which is directly responsible for tissue remodeling and destruction which eventually complicates to COPD (Parul Pahal et al., 2022). NURS 6501 Module 2 Knowledge Check Chronic obstructive lung disease is characterized by limitation of airflow due to exposure to harmful substances. It is associated with structural changes in the lung secondary to chronic inflammation which leads to narrowing of the airway and reduced lung recoil.

 

References

‌Adderley, N., & Sharma, S. (2021, July 31). Pleural Friction Rub. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537118/

Kosmas, C. E., Martinez, I., Sourlas, A., Bouza, K. V., Campos, F. N., Torres, V., Montan, P. D., & Guzman, E. (2018). High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs in Context, 7, 1–9. https://doi.org/10.7573/dic.212525

‌ Pahwa, R., & Ishwarlal Jialal. (2021, September 28). Atherosclerosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507799/

‌ Parul Pahal, Akshay Avula, & Sharma, S. (2022, May 8). Emphysema. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482217/

Waheed, S. M., Pujitha Kudaravalli, & Hotwagner, D. T. (2021, August 11). Deep Vein Thrombosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507708/ NURS 6501 Module 2 Knowledge Check

NURS 6501 Module 2 Knowledge Check

Module 2 Knowledge Check

NURS 6501 Module 2 Knowledge Check – Question 1

Situation 1: Heart Attack

Chief Complaint: I woke up at 6 a.m. with numbness in my left arm and chest pain. The pain is tight here (mid-sternal). My dad had a heart attack when he was 56, and I’m scared because I’m 56 too.

History of Present Illness (HPI): A 56-year-old Caucasian man arrives at Express Hospital Emergency Department with chest pain radiating down his left arm. The pain began in the morning and has worsened, pointing to the mid-sternal area. He describes it as feeling like an elephant sitting on his chest, causing difficulty breathing. He rates the pain as 9/10. The pain hasn’t improved or worsened. He denies prior chest pain, nausea, or lightheadedness. Administered Nitroglycerin 0.4 mg sublingual tablet, reducing pain to 7/10.

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

Diagnosis: Acute inferior wall myocardial infarction.

Question: What cholesterol is considered good, and what’s its role?

HDL is known as good cholesterol as it carries cholesterol from blood to liver for removal. It has anti-inflammatory, anti-atherosclerotic, and endothelial protective effects. It aids in Reverse Cholesterol Transport (RCT), breaking down atherosclerotic lesions. Higher HDL levels reduce stroke and heart disease risk.

NURS 6501 Module 2 Knowledge Check – Question 2

Situation 1: Heart Attack

Chief Complaint: I woke up at 6 a.m. with numbness in my left arm and chest pain. The pain is tight here (mid-sternal). My dad had a heart attack when he was 56, and I’m scared because I’m 56 too.

HPI: A 56-year-old Caucasian man arrives at Express Hospital Emergency Department with chest pain radiating down his left arm. The pain began in the morning and has worsened, pointing to the mid-sternal area. He describes it as feeling like an elephant sitting on his chest, causing difficulty breathing. He rates the pain as 9/10. The pain hasn’t improved or worsened. He denies prior chest pain, nausea, or lightheadedness. Administered Nitroglycerin 0.4 mg sublingual tablet, reducing pain to 7/10.

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

Diagnosis: Acute inferior wall myocardial infarction.

Question: How does inflammation contribute to atherosclerosis?

Atherosclerosis develops via arterial wall lesions due to lipid retention in the intima layer. This leads to inflammation, causing chronic inflammation at vulnerable artery sites. Inflammatory mediators and immune/non-immune cells form plaques. Without risk factor management, non-resolving chronic inflammation persists.

Question 3

A 35-year-old woman with systemic lupus erythematosus (SLE) history presents to ER with sharp retrosternal chest pain worsening with deep breaths or lying down. She reports 5-day low-grade fever, listlessness, and flu-like feelings. Physical exam reveals tachycardia and pleural friction rub. Diagnosis: Acute pericarditis.

Question: What’s recognized due to pleural friction rub?

Pleural friction rub results from inflamed pleural surfaces rubbing during chest wall movement. It creates a grating sound during both inspiration and expiration. On palpation, a sandpaper-like sensation may be felt. It accompanies sudden, sharp pain worsening with inspiration.

NURS 6501 Module 2 Knowledge Check – Question 4

Situation 4: Deep Venous Thrombosis (DVT)

An 81-year-old obese woman, 48 hours post-op left total hip replacement, experiences severe nausea, vomiting, missed physical therapy, and dry mucus membranes. She finds her left leg skin too tight. Exam shows a swollen, tense, red calf. Duplex ultrasound reveals deep venous thrombosis (DVT).

Question: How did patient history contribute to DVT development?

DVT risk factors relate to Virchow’s triad: hypercoagulability, stasis, and endothelial injury. These factors activate clotting and platelet aggregation, forming a thrombus. The patient’s history includes recent surgery, dehydration due to nausea/vomiting, and obesity.

Question 5

Situation 5: COPD

A 66-year-old woman with a 50-pack/year smoking history is diagnosed with emphysema through a CT scan. She inquires if it means COPD.

Question: Explain emphysema’s pathophysiology and its relation to COPD.

Emphysema damages air spaces and terminal bronchioles due to chronic noxious gas exposure. Inflammation from harmful substances leads to tissue remodeling and destruction, complicating into COPD. COPD involves airflow limitation and lung structural changes from chronic inflammation, causing narrowed airways and reduced lung recoil.

References

Adderley, N., & Sharma, S. (2021). Pleural Friction Rub. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK537118/

Kosmas, C. E., et al. (2018). High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs in Context, 7, 1–9. https://doi.org/10.7573/dic.212525

Pahwa, R., & Ishwarlal Jialal. (2021). Atherosclerosis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK507799/

Parul Pahal et al. (2022). Emphysema. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482217/

Waheed, S. M., Pujitha Kudaravalli, & Hotwagner, D. T. (2021). Deep Vein Thrombosis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK507708/