NURS 6501 Module 1 Assignment Case Study Analysis Paper

NURS 6501 Module 1 Assignment Case Study Analysis Paper

NURS 6501 Module 1 Assignment Case Study Analysis Paper

Patients with diabetes often present with hypertension, a risk factor for other diabetic complications, including cardiovascular events. In this case study, the patient presents with chronic kidney disease and heart failure symptoms. Understanding the pulmonary and cardiovascular processes that lead to these conditions is crucial for practitioners in making diagnostic and treatment decisions. The purpose of this paper is to evaluate the pathophysiological processes related to pulmonary and cardiovascular processes presented in the case study.

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The cardiovascular and cardiopulmonary pathophysiologic processes

Cardiac troponins are the sole biomarkers for determining the presence of acute myocardial infarction (AMI) (Stark et al., 2022). In people with chronic kidney disease, as presented in the case study, troponin elevation is related to cardiac injury rather than acute ischemia. The mechanism involved in the pathophysiological pathway starts with cardiac injury associated with heart failure or coronary heart disease (Wu, 2018). Injury causes blockage of blood flow through the coronary arteries, preventing oxygen supply to the heart muscles. Similarly, such damage can also occur in the pulmonary veins, causing a pulmonary embolism, which prevents the lungs from supplying the lungs to the heart. The patient cites edema, a clinical manifestation of pulmonary embolism (Chauin, 2021). When the blood supply to the heart is limited, a mismatch occurs between the available oxygen and the amount of oxygen required by the myocytes. Failure to meet the oxygen demand causes cell death and necrosis as the cell membranes rupture. The raptured cells spill the intracellular contents into the extracellular space, which goes into the bloodstream (Pouru et al., 2020). Among the spilled substances are the troponins, which are measured to confirm an acute myocardial infarction. Hence, troponin elevation in the patient is due to the series of cardiac and pulmonary processes ignited by the injury of a cardiac muscle.

Racial/ethnic factors

Racial/ethnicity is a risk factor for cardiovascular conditions such as heart disease or heart failure. African-Americans, followed by Hispanics, are more vulnerable to heart failure than Whites. For instance, an African American with diabetes will be at high risk of developing heart disease or heart attack compared to a White patient with diabetes (Muncan, 2018). Hence, people from the African-American community are likely to experience worsening complications of diabetes-related to cardiovascular events.

How the processes affect the patient

The patient presents with several symptoms, including jaw pain that radiates to the neck, proteinuria, little voiding, high blood pressure, and non-fasting glucose of 410. These conditions point to uncontrolled blood sugar levels. High blood sugar levels and high blood pressure are risk factors and complications of each other, leading to processes that affect the patient. For example, a combination of high blood pressure and uncontrolled glucose levels in people with diabetes results in chronic kidney disease (CKD) (Vieira et al., 2029). Furthermore, uncontrolled hypertension worsens CKD, which might cause kidney failure. The effects of CKD manifest in edema, proteinuria, and elevated levels of non-fasting glucose. Similarly, hypertension is linked to cardiovascular events such as heart disease or heart failure. Hypertension causes damage to the arteries supplying blood to the brain, which either rapture or become blocked, interfering with blood flow. In severe cases, this causes heart failure, whose effects in the patient include high troponin levels and chest/jaw pain radiating to the back of the neck.

Conclusion

The patient presents with a complex case of diabetes, chronic kidney disease, and heart failure. The symptoms reported are due to these conditions. The pathophysiology that leads to the release of troponin starts with the hypertensive condition that causes cardiac injury, which initiates a series of events characterized by a reduced supply of oxygenated blood to the heart and other parts of the body, including the brain. Racial/ethnic origins affect physiological processes in people with diabetes because of susceptibility to cardiovascular events associated with African-Americans and Hispanics.

References

Chauin, A. (2021). The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis. Vascular Health and Risk Management, 17, https://doi.org/10.2147/VHRM.S327661.

Muncan, B. (2018). Cardiovascular disease in racial/ethnic minority populations: illness burden and overview of community-based interventions. Public Health Rev, 39, 32. https://doi.org/10.1186/s40985-018-0109-4.

Pouru, J., Jaakkola, S., Biancari, F., Kiviniemi, T., Nuotio, I., & Airaksinen, K. (2020). Association of Heart Rate With Troponin Levels Among Patients With Symptomatic Atrial Fibrillation. JAMA Netw Open, 3(9):e2016880. doi:10.1001/jamanetworkopen.2020.16880.

Stark, M., Kerndt, C., & Sharma, S. (2022). Troponin. Treasure Island (FL): StatPearls Publishing.

Vieira, M. B., Neves, J., Leitão, L., & Baptista, R. (2029). Impaired Fasting Glucose and Chronic Kidney Disease, Albuminuria, or Worsening Kidney Function: A Secondary Analysis of SPRINT. The Journal of Clinical Endocrinology & Metabolism, 104(9), 4024–4032, https://doi.org/10.1210/jc.2019-00073.

Wu, A. H. (2018). Release of cardiac troponin from healthy and damaged myocardium. Frontiers in Laboratory Medicine, 1(3), 144-150. https://doi.org/10.1016/j.flm.2017.09.003.

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Scenario 6: A 42-year-old female presented to the dentist complaining intermittent right upper toothache pain over a week which intensified 1 day ago and seemed to radiate to the back of her neck. At the time of her appointment the dentist refused to treat the patient’s toothache pain with anything other than oral antibiotics because her blood pressure was 210/155. The patient presented to her local ER where she reported that she had been experiencing edema and voiding very little despite her increase in fluid intake. Her labs revealed a non-fasting blood glucose level of 410, proteinuria and an initial, elevated troponin level of 0.3. Her vital signs were blood pressure 225/150, pulse 86, respirations 18, and temperature of 97.7. Medications included Lasix 20mg po daily, coreg 12.5mg daily, losartan 25mg daily, clonidine 0.1mg po TID, metformin 875mg po BID and Humulin 70/30 insulin 15U in the morning and 10U in the evening subq.

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:

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.