[ANSWERED] A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations

Name: Academic Research Bureau
Item: Academic Research Bureau
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Author: Shawn Chamberlain

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Module 2 Assignment: Case Study Analysis

An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Scenario: A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). your Case Study Analysis related to the scenario provided, explain the following

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.

By Day 7 of Week 4

Submit your Case Study Analysis Assignment by Day 7 of Week 4

Expert Answer and Explanation

Cardiovascular and Cardiopulmonary Pathophysiologic Processes

The clinical interventions have seen some specific advancements that have improved medical professionals’ ability to provide safe and quality care to patients. However, medical professionals have found it hard to manage cardiovascular diseases despite the advancements present in the field of medicine as of now. Reamy, Williams, and Odom (2017) argue that the challenge of managing cardiovascular diseases can be reflected in the higher number of patients with the diseases being readmitted to hospitals even after holistic and intensive care. Also, a great number of patients have died of cardiovascular disease despite getting quality and safe medical interventions (McCance & Huether, 2019). Researchers have found that to provide better care to patients with cardiovascular diseases, clinicians should know the pathophysiologic processes resulting in the symptoms.

The Cardiovascular and Cardiopulmonary Pathophysiologic Processes

Various cardiovascular and cardiopulmonary processes resulted in the symptoms presented by the patient. The shortness of breath was caused by interactions between the cardiovascular system, oxygen carriers, neural responses, and the respiratory system (Coccia, Palkowski, Schweitzer, Motsohi, & Ntusi, 2016). The symptom occurred when the drive to breath was not matched by pulmonary ventilation. The process is often triggered by the mismatch between the lungs, chest wall structures, receptors in the airways, and the central respiratory motor activity. The patient experienced pleuritic chest pain because the two large layers of tissues separating the patient’s lungs were inflamed (Inamdar & Inamdar, 2016). The patient felt chest pain because the pleural membrane layers were swollen and rubbing against each other when he breathes. According to Ashton and Raman (2015), there are no clinical reasons for the symptoms of palpitations. However, the authors note that palpation occurs when the cardiac rhythm or rate changes or when the heart moves abnormally in the chest.

Racial/Ethnic Variables that may Impact Physiological Functioning

Many existing genetic variables may impact the physiological functioning of patients. One such variable is peroxisome proliferator activated‐receptor γ (PPARγ). One of the functions of this variable is regulating the fat cell. Also, activated PPARγ works with thiazolidinediones to block the channel activity of calcium smooth muscle cells, lower blood pressure, promote the secretion of the vasodilator C‐type natriuretic peptide, and prevents the release of the vasoconstrictor substance endothelin‐1 (Cai et al., 2018). This variable is highly activated in an ethic group with European decent compared to the African American ethnic group. Another variable that may impact physiological function is the renin-angiotensin-aldosterone system (RAAS). This variable is vital in connecting vascular dysfunction, vascular disease, and obesity. When RAAS is activated, it helps prevent heart failure by maintaining blood pressure and then turns offs when BP has been restored (Mascolo et al., 2017). African American descent has tissue RAAS that stays active even when the homeostasis balance has been restored, which can affect the cardiovascular process.

How the Processes Interact to Affect the Patient

If the patient is of the African American ethnic group, the tissue RAAS can cause congestive heart failure, shortness of breath, and inflammation. It stays for long without deactivating when BP has been stabilized, affecting the function of the cardiovascular organs. Also, the interaction between the gene and pleural membrane can trigger inflammation of the pleuritic tissues by increasing the ventricular myocardial mass, which will lead to chest pain. Inactivated PPARγ can result in increased pressure in the cardiovascular system, mismatching the drive to breath, and pulmonary ventilation. As a result, the patient will experience severe shortness of breath and hypertension.

References

Ashton, R., & Raman, D., (2015). Disease Management. Dyspnea. Cleveland Clinic. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/

Cai, W., Yang, T., Liu, H., Han, L., Zhang, K., Hu, X., … & Leak, R. K. (2018). Peroxisome proliferator-activated receptor γ (PPARγ): A master gatekeeper in CNS injury and repair. Progress in neurobiology, 163, 27-58. https://doi.org/10.1016/j.pneurobio.2017.10.002

Coccia, C. B., Palkowski, G. H., Schweitzer, B., Motsohi, T., & Ntusi, N. A. B. (2016). Dyspnoea: Pathophysiology and a clinical approach. SAMJ: South African Medical Journal, 106(1), 32-36. DOI:10.7196/SAMJ.2016.v106i1.10324

Inamdar, A. A. & Inamdar, A. C. (2016). Heart failure: Diagnosis, management, and utilization, 5(7). doi:10.3390/jcm5070062

Mascolo, A., Sessa, M., Scavone, C., De Angelis, A., Vitale, C., Berrino, L., … & Capuano, A. (2017). New and old roles of the peripheral and brain renin–angiotensin–aldosterone system (RAAS): Focus on cardiovascular and neurological diseases. International Journal of Cardiology, 227, 734-742. https://doi.org/10.1016/j.ijcard.2016.10.069

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Reamy, B. V., Williams, P. M., & Odom, M. R. (2017). Pleuritic chest pain: sorting through the differential diagnosis. American Family Physician, 96(5), 306-312. https://www.aafp.org/afp/2017/0901/p306.html