PATIENT: I HAVE BEEN TERRIBLE CHEST AND ARM PAIN FOR THE PAST 2 HOURS AND I THINK I AM HAVING A HEART ATTACK

INSTRUCTIONS FOR ASSIGNMENT:
This is an essay type with 13 questions. Each question (1-13) will have an essay case question (case scenario). After each essay question, you will be asked to respond with your answer from the question it is asking at the end of the case scenario. If you need anymore clarification, please do not hesitate to ask. Below are the 13 questions. Each question will have a case scenario and a question to answer at the end of each case scenario given. PLEASE NOTE THIS IS AN ADVANCED PATHIOPHYSIOLOGY COURSE. ANSWER ALL QUESTIONS (1-13), AND THE MECHANISM INVOLVED AS WELL AS RELATED TO PATHOPHYSIOLOGY MECHANISM.

ESSAY QUESTIONS (1-13).
CASE SCENARIO 1 SCENARIO:
PATIENT: I HAVE BEEN TERRIBLE CHEST AND ARM PAIN FOR THE PAST 2 HOURS AND I THINK I AM HAVING A HEART ATTACK.
HISTORY OF PRESENT ILLNESS (HPI). Mr. HAMMOND IS A 57-YEAR-OLD AFRICAN MALE WHO PRESENTS TO THE EMERGENCY DEPARTMENT WITH A CHIEF COMPLAINT OF CHEST PAIN “it feels like AN ELEPHANT IS SITTING ON MY CHEST”. HE RATES THE PAIN 8/10. NOTHING HAS MADE THE PAIN BETTER OR WORSE. HE DENIES ANY PREVIOUS EPISODES OF CHEST PAIN. DENIES NAUSEA, DYSPNEA, OR LIGHTHEADEDNESS. HE WAS GIVEN 0.4 MG NITROGLYCERIN TABLET SUBLINGUALLY X1 WHICH DECREASES, BUT NOT STOPPED THE PAIN.
LIPID PANEL REVEALS TOTOAL CHOLESTEROL 324 MG/DL, HIGH DENSITY LIPOPROTIEN (HDL) 31 MG/DL, LOW DENSITY LIPOPROTIEN (LDL) 122 MG/DL, TRIGLYCERIDES 402 MG/DL, VERY LOW-DENSITY LIPOPROTIEN (VLDL) 54 MG/DL
CASE SCENARIO 1 QUESTION: WHY IS HDL THE “GOOD” CHOLESTEROL? WHEN ANSERING THIS QUESTION PLEASE NOTE THIS IS AN ADVANCED PATHIOPHYSIOLOGY COURSE. ANSWER QUESTIONS (1-13), AND THE PATHOPHYSIOLOGY MECHANISM INVOLVED AS WELL.
QUESTION 2: EXTENSION OF QUESTION 1, BUT AT THE END OF THE QUESTION, INSTRUCTOR IS ASKING A DIFFERENT QUESTION RELATED TO SAME CASE SCENARIO.
CASE 2 SCENARIO:
PATIENT: I HAVE BEEN HAVING TERRIBLE CHEST AND ARM PAIN FOR THE PAST 2 HOURS AND I THINK I AM HAVING A HEART ATTACK
HISTORY OF PRESENT ILLNESS (HPI): Mr. HAMMOND A 57 YEAR OLF AFRICAN AMERICAN MALE WHO PRESENTS TO THE EMERGENCY DEPARTMENT WITH A CHIEF COMPLAINT OF CHEST PAIN “IT FEELS LIKE AN ELEPHANT IS SITTING ON MY CHEST”. HE RATES HIS PAIN AS 8/10. NOTHING HAS MADE THE PAIN BETTER OR WORSE. HE DENIES ANY PREVIOUS EPISODES OF CHEST PAIN. DENIES NASUEA, DYSPNEA, LIGHTHEADEDNESS. HE WAS GIVEN 0.4 MG NITROGLYCERIN TABLET SUBLIGUALLY X1 WHICH DECREASED BUT DID NOT STOP THE PAIN.
LIPID PANEL REVEALS TOTAL CHOLESTEROL 324 MG/DL, HIGH DENSITY LIPOPROTEIN (HDL) 31 MG/DL, LOW DENSITY LIPOPROTEIN (LDL) 122 MG/DL, TRIGLYCERIDES 402 MG/DL, VERY LOW-DENSITY LIPOPROTEIN (VLDL) 54 MG/DL.
HIS DIAGNOSIS IS AN ACUTE INFERIOR WALL MYOCARDIAL INFARCTION.
CASE SCENARIO 2 QUESTION: EXPLAIN THE ROLE OF INFLAMATION HAS IN THE ROLE IN THE DEVELOPENT OF ATHEROSCLEROSIS?
CASE SCENARIO 3
A 45-YEAR-OLD WOMAN WITH A HISTORY OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PRESENTS TO THE EMERGENCY ROO (ER) WITH COMPLAINTS OF SHARP RETROSTERNAL CHEST PAIN THAT WORSENS WITH DEEP BREATHING OR LYING DOWN. SHE REPORTS A 3 DAY HISTORY OF LOW -GRADE FEVER, LISTLESSNESS AND SAYS SHE FEELS LIKE SHE HAD THE FLU. PHYSICAL EXAM REVEALS TACHYCARDIA AND PLEURAL FRICTION RUB. SHE WAS DIAGNOSED WITH ACUTE PERICARDITIS.
CASE SCENARIO 3 QUESTION: WHAT DOES THE ADVANCED PRACTICE NURSE (APRN) RECOGNIZE AS THE RESULT OF THE PLEURAL FRICTION RUB?
CASE SCENARIO 4
A 15-YEAR-OLD ADOLESCENT MALE COMES TO THE CLINIC WITH HIS PARENTS WITH A CHIEF COMPLAINT OF FEVER, NASUEA, VOMITING, POORLY LOCALIZED ABDOMINAL PAIN, ARTHRAGIAS, AND SWOLLEN LYMPH NODED. STATES HE HAS FELT LOUSY FOR A COUPLE OF WEEKS. THE FEVER HAS BEEN AS HIGH AS 102 F. HE PARENTS THOUGHT HE HAD THE FLU AND TOOK HIM TO AN URGENT CARE CENTER. HE WAS GIVEN TAMIFLU AND SENT HOME. HE SAID THE TAMIFLU DIDN’T SEEM TO WORK. STATES HAS A SLIGHT SORE THROAT A COUPLE OF WEEKS AGO AND ATTRIBUTED IT TO THE FLU. PHYSICAL EXAM REVEALED THIN YOUNG MAN WHO APPEARS TO BE UNCOMFORTABLE BUT NOT ACUTELY ILL. POSTERIOR PHARYNX REDDENED AND TONSILS +3 WITHOUT EXUDATE. +ANTERIOR AND POSTERIOR CERVICAL LYMPHADENOPATHY. TACHYCARDAI AND A NEW ONSET 2/6 HIGH PITCHED, CRESCENDO-DECRESCENDO SYSTOLIC EJECTION MURMUR AUSCULTATED AT THE LEFT STERNAL BORDER. RAPID STREP+. THE PATIENT WAS DIAGNOSED WITH RHEUMATIC HEART DISEASE (RHD)
CASE SCENARIO 4 QUESTION: EXPLAIN HOW A POSITIVE TEST HAS CAUSED THE PATIENT’S SYMTOMS.

CASE SCENARION 5:
THE APRN SEES A 74-YEAR-OLD OBESE FEMALE PATIENT WHO IS 2 DAYS POST-OP AFTER UNDERGOING LEFT TOTLA HIP REPLACEMENT. THE PATIENT HAS HAD SEVERE POST-OP NAUSEA AND VOMITTING AND HAS BEEN UNABLE TO GO TO PHYSICAL THERAPY. HER MUCUS MEMBRANES ARE DRY. THE PATIENT SAYS SHE FEELS LIKE THE SKIN ON HER LEGS 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).
CASE SCENARIO 5 QUESTION: DESCRIBE THE FACTORS THAT COULD HAVE CONTRIBUTED TO THE DEVELOPMENT OF A DVT IN THIS PATIENT. EXPLAIN HOW EACH OF THE FACTORS COULD CAUSE DVT?
CASE SCENARIO 6:
A 45-YEAR-OLD WOMAN IS 10 DAYS STATUS POST PARTIAL SMALL BOWEL RESECTION FOR CROHNS DISEASE AND HAS BEEN RECUPERATING AT HOE, SHE SUDDENLY DEVELOPES SEVERE SHORTNESS OF BREATH, BECOMES WEAK, AND HER BLOOD PRESSURE DROPS TO 80/40 mm/Hg. (PREVIOUS READINGS-130/80). THE PULSE OXIMETRY IS 89% ON ROOM AIR. THE APRN SUSPECTS THE PATIENT EXPERIENCED A MASSIVE PULMONARY EMBOLISM.
CASE SCENARIO 6 QUESTION: EXPLAIN WHY A LARGE PULMONARY EMBOLUS INTERFERS WITH OXYGENATION?
CASE SCENARIO 7:
A 45-YEAR-OLD WOMEN IS 10 DAYS POST PARTIAL SMALL BOWEL RESECTION FOR CHROHNS DISEASE AND HAS BEEN RECUPERSTING AT HOME. SHE SUDDENLY DEVELOPS SEVERE SHORTNESS OF BREATH, BECOMES WEAK, AND HER BLOOD PRESSURE DROPS TO 8-/40 (PREVIOUS READINGD 130/80). THE PULSE OXIMETRY IS 89% ON ROOM AIR. WHILE WAITING FOR THE EMERGENCY MEDICAL SERVICE TO ARRIVE THE APRN PLACES EKG LEADS AND THE EKG DEMONSTRATES RIGHT VENTRICULAR STRAIN.
CASE SCENARIO 7 QUESTION: EXPLAIN WHY A LARGE PULMONARY EMBOLISM CAUSES RIGHT VENTRICULAR STRAIN?
CASE SCENARIO 8:
A 12-YEAR-OLD GIRL IS BROUGHT TO THE EMERGENCY ROOM BY HER MOTHER WITH COMPLAINTS OF SHORTNESS OF BREATH (SOB), WHEEZING, TACHYPNEA, TACHYCARDIA, AND NON-PRODUCTIVE COUGH. THE MOTHER STATES THAT THEY HAD JUST COME FROM A FALL FESTIVAL WHERE THE ENTIRE FAMILY ENJOYED THE HAYRIDE. THE SYMPTOMS BEGAN SHORTLY AFTER THEY LEFT THE FESTIVAL BUT GOT BETTER A COUPLE HOURS AFTER THEY RETURNED HOME. THE SYMPTOMS BEGAN AGAIN 6 HOURS LATER AND SEEM TO BE WORSE. THE MOTHER STATES THERE IS NO HISTORY OF ALLERGIES OR FREQUENT RESPIRATORY INFECTIONS. THE CHILD IS UP TO DATE ON ALL VACCINATIONS. THE CHILD WAS DIAGNOSED WITH ASTHMA. THE NURSE PRACTIONER THMATIC RESPONSE TO THE MOTHER THAT HER CHILD WAS EXHIBITING SYMTOMS OF ASTHAM AND PROBABLE HAS AN EARLY ASTHMATIC RESPONSE AND A LATE ASTHMATIC RESPONSE.
CASE SCENARIO 8 QUESTION: EXPLAIN EARLY ASTHMATIC RESPONSES AND THE CELLS RESPONSIBLE FOR THE RESPONSES?
CASE SCENARIO 9:
A 12-YEAR-OLD CHILD IS BROUGHT TO THE EMERGENCY ROOM BY HER MOTHER WITH COMPLAINTS OF SHORTNESS OF BREATH, WHEEZING, TACHYPNEA, TACHYCARDIA, AND A NON-PRODUCTIVE COUGH. THE MOTHER STATES THEY HAD JUST COME FROM A FALL FESTIVAL WHERE THE ENTIRE FAMILY ENJOYED A HAYRIDE. THE SYMTOMS BEGAN SHORTLY AFTER THEY LEFT THE FESTIVAL BUT GOT BETTER A COUPLE HOURS AFTER THEY RETURNED HOME. THE SYMTOMS BEGAN AGIN 6 HOURS LATER AND SEEM TO BE WORSE. THE MOTHER STATES THAT THERE IS NO HISTORY OF ALLERGIES OR FREQUENT RESPIRATORY INFECTIONS. THE CHILD IS UP TO DATE ON ALL VACCINATIONS. THE CHILD WAS DIAGNOSED WITH ASTHMA. THE NURSE PRACTIONER EXPLAINED TO THE MOTHER THAT HER CHILD WAS EXHIBITING SYMTOMS OF ASTHMA AND PROBABLY HAD AN EARLY ASTHMATIC RESPONSE AND A LATE RESPONSE.
CASE SCENARIO 9 QUESTION: EXPLAIN LATE ASTHAMTIC RESPONSES AND THE CELLS RESPONSIBLE FOR THE RESPONSE?
CASE SCENARIO 10:
A 64-YEAR-OLD MAN WITH A 40 PACK/YEAR HISTORY OF CIGARETTE SMOKING HAS BEEN DIAGNOSED WITH EMPHYSEMA.
CASE SCENARIO 10 QUESTION: EXPLAIN THE PATHOPHYSIOLOGY OF EMPHYSEMA AND HOW IT RELATED TO CHRONIC OBSTRUCTIVE PULMOANRY DISEASE (COPD)?
CASE SCENARIO 11:
A 64-YEAR-OLD MAN WITH A 40 PACK/YEAR HISTORY OF CIGARETTE SMOKING HAS BEEN DIAGNOSED WITH EMPHYSEMA. HE ASKS THE APRN IF THIS MEANS HE HAS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)?
CASE SCENARIO 11 QUESTION: EXPLAIN THE PATHOPHYSIOLOGY OF CHRONIC BRONCHITIS AND HOW IT RELATED TO COPD?

CASE SCENARIO 12:
Mr. JONES IS A 78-YEAR-OLD MAN WHO PRESENTS TO THE CLINIC WITH A CHIEF COMPLAINT OF FEVER, CHILLS, AND COUGH. HE ALSO REPORTS SOME DYSPNEA. HE HAS A HISTROY OF RIGHT SIDED CVA, COPD, DYSLIPEMIA, AND HTN. CURRENT MEDICATIONS INCLUDE ATORVASTATIN 40 MG BY MOUTH, LISINOPRIL, AND FLUTICASONE/SALMETEROL. HE REPORTS MORE USE OF HIS ALBUTREROL RESCUE INHALER.
VITAL SIGNS: TEMP 101.8F, PULSE 108, RESPIRATIONS 21. Pa02 (PARTIAL OXYGEN SATURATION) ON ROOM AIR IS 86% AND OXYGEN VIA NASAL CANULA ON 4L IS 94%, CMP, WNL, WBC 18.4. PHYSICAL EXAM REVEALS THIN, ANXIOUS GENTLEMAN WITH MILD HEMIPARESIS PN LEFT SIDE DUE TO CVA. HEENT WITHIN NORMAL LIMITS (WNL) EXCEPT FOR DIMINISHED GAG REFLEX UNEVEN ELEVATION OF THE UVULA, CV-HR 108 RRR WITH OUT MURMURS, RUB, OR CLICK, NO BRUITS. RESPIRATIONS COURSE RHONCHI THROUGHOUT LUNG FIELDS, CXR (CHEST X-RAY) REVEALS CONSOLIDATION IN RIGHT LOWER LOBE. HE WAS DIAGNOSED WITH COMMUNITY AQUIRED PNEUMONIA (CAP).
CASE SCENARIO 12 QUESTION: PATIENT WAS HYPOXIC AS EVIDENCED BY LOW Pa02. EXPLAIN THE PATHOLOGIC PROCESSES THAT CAUSED THIS PATIENT’S HYPOXEMIA?
CASE SCENARIO 13:
A 65-YEAR-OLD WOMANWITH MODERATELY SEVERE COPD COMES TO THE PULMONARY CLINIC FOR HER QUATERLY CHECK UP. THE APRN REVIEWING THE CHART NOTES THAT THE PATIENT HAS LOST 5% OF HER BODY WEIGHT SINCE HER LAST VISIT. THE APRN QUESTIONS THE PATIENT AND THE PATIENT ADMITS TO NOT HAVING MUCH OF AN APPETITE AND SHE ALSO ADMITS TO MISSING SOME MEALS BECAUSE IT TAKES TOO MUCH WORK TO COOK AND CONSUME DINNER.
CASE SCENARIO 13 QUESTION: THE APRN RECOGNIZES THAT COPD HAS A DELETERIOUS EFFECT ON PATIENTS. EXPLAIN WHY PATIENTS WITH COPD ARE AT RISK FOR MALNUTRITION?