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- QUESTION
Week 2: Compensatory Mechanisms
Introduction
Whether a person realizes it or not, his or her body regularly uses compensatory mechanisms such as adaptive and maladaptive responses. These compensatory mechanisms help the body respond to stressors or triggers. Perhaps you have heard a patient complain that his or her food “just didn’t go down right,” resulting in a coughing spell. Maybe you have treated a child with scabs on his or her arms and legs. These are automatic physiological responses that a person cannot control and that may sometimes result in adverse health effects, such as hives. As an advanced practice nurse, it is important that you are able to identify the root of compensatory mechanisms and underlying responses. Which compensatory mechanisms are related to which disorders? Is the presenting mechanism positive and adaptive, or is it maladaptive and in need of control? What are appropriate management strategies?
Since the physical and emotional impact of musculoskeletal, autoimmune, and integumentary disorders varies from patient to patient, associated alterations and symptoms vary as well. For this reason, you must have a solid understanding of these disorders in order to properly diagnose patients.
This week you examine compensatory mechanisms and physiological responses of disorders and the pathophysiology of musculoskeletal disorders. You also explore the impact of patient factors on the pathophysiology of disorders and resulting compensatory mechanisms, and the impact of patient factors on the disorders.
Objectives
By the end of the week, you will be able to:
- Compare maladaptive and physiological responses of immune disorders
- Evaluate the impact of patient factors on the pathophysiology of immune disorders
- Compare the pathophysiology of osteoarthritis and rheumatoid arthritis
- Evaluate the impact of patient factors on arthritis
- Analyze the pathophysiology of disorders
- Assess adaptive responses to alterations
- Evaluate clinical considerations of disorders
- Understand and apply key terms, concepts, and principles related to adaptive and compensatory mechanisms
- Understand and apply key terms, concepts, and principles related to alterations of the musculoskeletal, autoimmune, and integumentary systems
Please proceed to the Resources.
Application: Adaptive Response
As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.
Consider the following scenarios:
Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.
Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.
To prepare:
- Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.( this is the text book for the class)
- Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
- Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
To complete:
Write a 2- to 3-page paper that addresses the following:
- Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
- Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. (the disorder that I will like the mind map is on tonsillitis)
Readings
- Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby. ◦Chapter 5, “Innate Immunity: Inflammation and Wound Healing”
This chapter examines how the body responds to injury and infection by exploring the first, second, and third lines of defense. It also covers wound healing and alterations of the wound healing process.
◦Chapter 6, “Adaptive Immunity”
This chapter examines the third line of defense, adaptive immunity. It also covers the roles of antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B and T lymphocytes in the immune response.
◦Chapter 7, “Infection and Defects in Mechanism of Defense”
This chapter covers the epidemiology, clinical presentation, and treatment of disorders resulting from infection, deficiencies in immunity, and hypersensitivity. It also examines the pathophysiology of an important immune disorder—HIV/AIDS.
◦Chapter 8, “Stress and Disease”
This chapter evaluates the impact of stress on various body systems and the immune system. It also examines coping mechanisms and disorders related to stress.
◦Chapter 9, “Biology, Clinical Manifestations, and Treatment of Cancer”
This chapter explores the developmental process of cancer and factors that impact the onset of cancer at the cellular level. It also describes various treatment options.
◦Chapter 10, “Cancer Epidemiology”
This chapter reviews genetic, environmental, behavioral, and diet-related risk factors for cancer. It also examines types of cancers that result from risk factors.
◦Chapter 11, “Cancer in Children”
This chapter focuses on the presentation and prognosis of childhood cancers. It examines the impact of genetic and environmental factors on these cancers.
◦Chapter 36, “Structure and Function of the Musculoskeletal System”
This chapter covers the structure and function of bones, joints, and skeletal muscle. It also explores effects of aging on the musculoskeletal system.
◦Chapter 37, “Alterations of Musculoskeletal Function”
This chapter examines the pathophysiology, clinical manifestations, and evaluation and treatment of bone, joints, and skeletal muscle disorders. Additionally, it explores musculoskeletal tumors, osteoarthritis, and rheumatoid arthritis.
◦Chapter 38, “Alterations of Musculoskeletal Function in Children”
This chapter includes musculoskeletal disorders that affect children, such as congenital defects, bone infection, juvenile idiopathic arthritis, muscular dystrophy, musculoskeletal tumors, and nonaccidental trauma.
◦Chapter 39, “Structure, Function, and Disorders of the Integument”
This chapter begins with an overview of the structure and function of skin. It then covers effects of aging on skin, as well as disorders of the skin, hair, and nails.
◦Chapter 40, “Alterations of Integument in Children”
This chapter covers alterations of the integument that affect children. These include acne vulgaris, dermatitis, infections of the skin, insect bites and parasites, vascular disorders, and other skin disorders.
- McPhee, S. J., & Hammer, G. D. (2012). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical. ◦Chapter 3, “Disorders of the Immune System”
This chapter explores the anatomy and physiology of the immune system. It also explores the pathophysiology of various immune disorders such as primary immunodeficiency diseases and AIDS.
◦Chapter 8, “Diseases of the Skin”
This chapter begins with an overview of the anatomy and physiology of skin. It also explores the pathophysiology of various types of skin lesions and inflammatory skin diseases.
◦Chapter 24, “Inflammatory Rheumatic Disease”
This chapter explores the pathogenesis of inflammation and its role in rheumatic diseases. It also examines the clinical presentation, etiology, pathophysiology, and clinical manifestations of rheumatic diseases such as gout and rheumatoid arthritis.
Media
- Zimbron, J. (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://www.medmaps.co.uk/beta/
Gastro-oesophageal reflux disease. [Image]. Used with permission of MedMaps.
This media provides examples of mind maps for dementia, endocarditis, and gastro-oesophageal reflux disease (GERD).
Optional Resources
- Arthritis Foundation. (2012). Retrieved from http://www.arthritis.org/
- Lupus Foundation of America. (2012). Retrieved from http://www.lupus.org/newsite/index.html
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| Subject | Nursing | Pages | 12 | Style | APA |
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Answer
Analysis of Pathophysiology of Disorders and Associated alterations
Introduction
When examining a patient who exhibits a variety of disorders, an understanding of the normal body functions is key for health practitioners. This is because it helps them identify patients’ body reactions to changes. The knowledge of compensatory body mechanisms, adaptive responses and signs and symptoms will help in the diagnosis of patients’ disorders. Based on the symptoms, signs and clinical manifestations in the scenarios 1,2and 3 given, it is deducible that disorders depicted are Tonsillitis, Irritant contact dermatitis and Stress disorders respectively.
An Explanation of Pathophysiology of the Disorders and Associated Changes
Scenario 1
This scenario is about Jennifer, who is 2 years old. The scenario presents a number of signs and symptoms: temperatures of between 101oF and 103.2oF and fussiness that has lasted for three days, even after being given ibuprofen. Additionally, on physical examination, she is found to have a hot and dry skin, somewhat sore periphery of tympanic membrane, erythematous throat that has 4+ diffuse exudates and a tender and painful to touch left-side tangible anterior cervical node. Jennifer complains of throat aching a lot and that it is often painful during swallowing of any kind. Most importantly, she has a temperature of 102.8ºF, pulse rate of 128 beats/minute and a respiratory rate of 24. By these signs and symptoms, the disorder depicted here is Tonsillitis.
Explanation about Tonsillitis
Tonsillitis is an inflammatory tonsilar disease, common in young children, that is caused by viral or bacterial infections. The common virus that causes it is the group A haemolytic streptococcus, however Adenoviruses, Influenza virus, Epstein-Barr virus, parainfluenza viruses, Enteroviruses and Herpes simplex virus may also cause it. In some cases, it may be too severe to cause upper airway blockade (Little & Williamson, 1999). The signs and symptoms of this disease are throat pain or tenderness, redness of tonsils, yellow or white coating on tonsils, painful ulcers or blisters on the throat, loss or hoarseness of voice, headache, loss of appetite, ear pain and difficulty breathing or through the mouth (Mathias & Maibach, 1998). Other symptoms include swollen glands in the jaw area or neck, fever, chills and bad breath.
By Jennifer case, the related signs and symptoms are difficulty in swallowing, painful throat, fussiness, fever, erythematous throat with 4+ diffuse exudates and the adaptive responses like increased body temperature and pulse rate.
There does not exist a specific treatment for Tonsillitis as it depends on the causative agent. Nonetheless, the symptoms may be reduced by: taking ibuprofen or paracetamol to help reduce pain, drinking sufficient amount of fluids and getting adequate rest (Little & Williamson, 1999). Additionally, if results show that the Tonsillitis is caused by a bacterial infection then taking oral antibiotics is necessary.
Scenario 2
Jack is 27-years-old maintenance engineer with in one newspaper building. He accepts that he has always used abrasive chemicals and solvents. Normally, Jack wears protective gloves nevertheless due to a short in the supply of these protective gloves lately, he has always work with the abrasives with bare hands. This exposed his hands to some of these abrasive fluids, which he reports never hurt him and that he washed his hands whenever he finished using these fluids. He reported noticing irritation and redness of his hands, which he has experienced for about two weeks. According to him, he has history of repeated ear infection and has no known allergy. An examination of the two hands revealed irritation and redness. From this, it is inferable that by these clinical manifestations and history, the disease described is Irritant Contact Dermatitis.
Explanation about Irritant Contact Dermatitis
Irritant contact dermatitis is a non-immunologic and inflammatory condition of the skin that is caused by exposure to irritants like soaps, detergents, chemicals and industrial-agents causing skin inflammation and lesion (Huether & McCance, 2012). According to Center for Disease Control and Prevention (CDC), 80% of irritant contact dermatitis is caused by work-related contact with dangerous agents that irritate the human skin after being exposed to chemical substances and agents (Center for Disease Control and Preventions, 2015).
Irritant Contact Dermatitis may be severe due to the duration of contact and exposure. In this scenario, the related change in Jack’s case is direct interaction with abrasive chemicals, solvents and hand exposure to washing fluids devoid of protective gloves. The adaptive responses here are hand irritation, redness and flaky skin. Feery et al (2001) suggest that treatment ought to begin with educating Jack to dress in gloves at all times, informing him to use hand ointments and topical medicines prescribed to him by a physician and instructing him to clean his hands with cool water.
Scenario 3
Martha a 65-years-old woman who just retired from her employment as an administrative assistance at one of the local health facilities. Martha has for a long time suffered from hypertension that has been regulated for years with hydrochlorothiazide. She reports that she is able to care and perform all her daily duties and care for her 87-years-old mother who fell and broke her hips. On the contrary, Martha complains of having problem with her sleeps, loss of appetite, racy heartbeat and verbalized dissatisfaction of what she had envisioned retirement plan would mean for her life. In regard to this description, it is possible to infer that the disorder illustrated is stress based on the complaints and history about Martha.
Explanation about Stress Disorder
Stress is the reaction of the body of a person’s to emotional and physical tensions due to a frustration, anger, nervousness or an event triggered by personal changes and problems or challenges in the life of the person (Feery et al, 2001). Stress comes whenever a person feels he/she cannot survive with daily demands and challenges caused by a sudden event or change in his/her life and disrupts and impacts one’s plan. The associated changes in this scenario, Martha’s disorder is caused by her stress about the fall of the mother and the point that she is left without any other option but to take care of mother’s daily needs and activities, with no other source of assistance since she is the only child. The related response is this scenario are difficulty during sleeping, loss of appetite and her sensation of the racy heartbeat.
Rajagopalan and Anderson (2007) reason that stress involves body and mind and that treatments and interventions for physical and psychological stress ought to be based on personal education, ensuring that there is no participation in problem-causing events, biofeedback and relaxation techniques. Martha should be therefore ought to be educated on the significance of resting, exercising and eating right (Robinson & Purdie, 2000). She should also be encouraged to pursue help for her mother from mothers’ care facilities available.
A Mind Map for Tonsillitis
References
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Centers for Disease Control and Prevention (2015). Skin exposure and effects. Workplace Ed.). St Louis, MO: Mosby Feery, B. J. Forsell, P. & Gulasekharam, M. (2001). Streptococcal sore throat in general practice: a controlled study. Med J Aust Journal, 1(26), 989-991. Huether, S., & McCance, K. (2012). Understanding pathophysiology. (Laureate custom safety and health topics. Retrieved on March o1, 2016 from http://www.cdc.gov/niosh/topics/skin/ Little, P.S. & Williamson, I. (1999). Are antibiotics appropriate for sore throats? Costs outweigh the benefits. BM Journal, 309(6), 1010-1011 Mathias, C.G. & Maibach, H. I. (1998). Dermatotoxicology monographs I. Cutaneous irritation: factors influencing the response to irritants. Clin. Toxicol Journal. 13 (3), 333-346 Rajagopalan, R. & Anderson, R. (2007). Impact of patch testing on dermatology-specific quality of life in patients with allergic contact dermatitis. Journal Contact Dermat, 8(3), 215-221 (III) Robinson, S.R. & Purdie, G.L. (2000). Reducing post-tonsillectomy pain with cryoanalgesia: a randomized controlled trial. Laryngoscope Journal, 110(7), 1128-1131. |