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
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
GRADING RUBRIC:
Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following:Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms.–
Excellent 28 (28%) – 30 (30%)
Good 25 (25%) – 27 (27%)
Fair 23 (23%) – 24 (24%)
Poor 0 (0%) – 22 (22%)
Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.–
Excellent 28 (28%) – 30 (30%)
Good 25 (25%) – 27 (27%)
Fair 23 (23%) – 24 (24%)
Poor 0 (0%) – 22 (22%)
Explain any racial/ethnic variables that may impact physiological functioning.–
Excellent 23 (23%) – 25 (25%)
Good 20 (20%) – 22 (22%)
Fair 18 (18%) – 19 (19%)
Poor 0 (0%) – 17 (17%)
Written Expression and Formatting – Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.–
Excellent 5 (5%) – 5 (5%)
Good 4 (4%) – 4 (4%)
Fair 3 (3%) – 3 (3%)
Poor 0 (0%) – 2 (2%)
Written Expression and Formatting – English Writing Standards:Correct grammar, mechanics, and proper punctuation–
Excellent 5 (5%) – 5 (5%)
Good 4 (4%) – 4 (4%)
Fair 3 (3%) – 3 (3%)
Poor 0 (0%) – 2 (2%)
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.–
Excellent 5 (5%) – 5 (5%)
Good 4 (4%) – 4 (4%)
Fair 3 (3%) – 3 (3%)
Poor 0 (0%) – 2 (2%)
Total Points: 100
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
Alternative Expert Answer and Explanation
Alterations in the Cardiovascular and Respiratory Systems
When handling patients with cardiovascular or respiratory disorders, one has to have a clear understanding of the underlying factors that may influence the condition of the patient.
The Cardiovascular and Cardiopulmonary Pathophysiologic Processes
From the case study provided, the symptoms displayed by the patient can be attributed to several cardiovascular and cardiopulmonary pathophysiologic processes. For instance, the cause of breath shortness can be linked to the complex connection between the cardiovascular system, respiratory system, and neural responses. These symptoms arose when the patient was in need of more air, however, the pulmonary ventilation failed to match the demand required by the patient.
The pathophysiological process that led to the pleuritic chest pain was as a result of the inflamed membrane separating the lungs (Pollack et al., 2019). When inflamed membranes rub against one another during the breathing process, then the resultant effect is a sharp pain located in the chest. On the other hand, when the movement of the heart was distorted, there was palpation leading to an abnormal heart rate.
Racial/Ethnic Variables that may Impact Physiological Functioning
Race/ethnicity is one of the features that affect a patient’s physiological functioning. For example, the hormonal system in charge of controlling blood pressure, the renin-angiotensin-aldosterone system (RAAS), varies in functionality between different racial groups. According to Joseph et al. (2020), the RAA system in African Americans has been found to remain active even after the restoration of blood pressure to normal levels.
This can be a recipe for the development of irregular blood pressure levels. Another example is the PPARγ gene, which is more prevalent in Caucasians as compared to African Americans (Bai et al., 2018) is responsible for regulating the metabolism of fatty acids in the body. Similarly, the gene is also responsible for regulating blood pressure levels, in conjunction with drugs belonging to the thiazolidinediones class
How the Processes Interact to Affect the Patient
The RAA system acts by reducing the functioning of the cardiovascular system as a mode of regulating high blood pressure. When the RAA system continues remaining active after the restoration of blood pressure to normal levels, there is a likelihood that the pleural membrane will be inflamed thus leading to chest pains as experienced by the patient. Similarly, the inactiveness of the PPARγ gene can result in dyspnea due to an increase in pressure on the cardiovascular system.
References
Bai, X., Xu, C., Wen, D., Chen, Y., Li, H., Wang, X., … & Jin, J. (2018). Polymorphisms of peroxisome proliferator-activated receptor γ (PPARγ) and cluster of differentiation 36 (CD36) associated with valproate-induced obesity in epileptic patients. Psychopharmacology, 235(9), 2665-2673. https://doi.org/10.1007/s00213-018-4960-2
Joseph, J. J., Zhou, X., Zilbermint, M., Stratakis, C. A., Faucz, F. R., Lodish, M. B., … & Lin, S. (2020). The Association of ARMC5 with the Renin-Angiotensin-Aldosterone System, Blood Pressure and Glycemia in African Americans. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgaa290
Pollack Jr, C. V., Cantor, R. M., & Riese, V. G. (2019). Pleurisy. In Differential Diagnosis of Cardiopulmonary Disease (pp. 809-817). Springer, Cham. https://doi.org/10.1007/978-3-319-63895-9_56
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