Check Point 1

Question 1

Discuss the vascular and cellular changes in inflammation? (Knee Injury Casestudy)

Answer 1

Andy’s fall damages the tissue located around the right knee causing the mast cells and platelets to release chemical mediators including Kinins, Histamine, prostaglandins, cytokines, and leukotrines into the blood and interstitial fluid.

Question 2

Identify the local effects of inflammation and explain a rationale for each. (Knee Injury Casestudy)

Answer 2

Redness - Caused by increased blood flow into the damaged area.
Heat - Caused by increased blood flow into the damaged area.
Swelling - Caused by the shift of protein and fluid into the interstitial space.
Pain - results from the increases pressure of fluid on the nerves especially in enclosed areas, and by the local irritation of nerves by chemical mediators such as bradykinins.

Question 3

What clinical manifestations might Andy describe if the inflammatory process becomes systemic? (knee injury casestudy)

Answer 3

Fever and Fatigue - possible infection due to skin abrasion or break that bacteria could have possibly entered.
Fever - results from the release of pyrogens or fever producing substances from white blood cells or macrophages.
Nausea - is directly related to the pain you’re in
Malaise - overall immune response
headache - Irritation of nerve endings.

Question 4

What are Andy’s Identifiable holistic factors. (Knee injury casestudy)

Answer 4

Unable to work
24 year old athletic male on bed rest
No money
all of the above can lead the pt to become depressed.

Question 5

Explain the basic pathophysiology of this disease? (SLE caseStudy)

Answer 5

SLE is characterized by the presence of large numbers of circulating autoantibodies against DNA, platelets, erythrocytes, various nucleic acids, and other nuclear materials (antinuclear antibodies [ANAs])

Question 6

Explain why SLE is considered an autoimmune disease? (SLE casestudy)

Answer 6

When self-tolerance is lost, the immune system is unable to differentiate self from foreign material. The autoantibodies then trigger an immune reaction leading to inflammation and necrosis of tissue. Some individuals may lose their immune tolerance following tissue destruction and subsequent formation of antibodies to the damaged cell components. Aging may lead to loss of tolerance to self-antigens. There also appears to be a genetic factor involved in autoimmune diseases, as evidenced by increased familial incidence.

Question 7

Why does inflammation lead to necrosis?

Answer 7

When self-tolerance is lost, the immune system is unable to differentiate self from foreign material. The autoantibodies then trigger an immune reaction leading to inflammation which causes severe damage and therefore leads to necrosis of tissue. Some individuals may lose their immune tolerance following tissue destruction and subsequent formation of antibodies to the damaged cell components.

Question 8

Describe three (3) common clinical manifestations of this disease and the rationale for this physiological change?

Answer 8

Polyarthritis, with swollen, painful joints, without damage; arthralgia

Pleurisy - inflammation of the pleural membranes, causing chest pain

Raynaud’s phenomenon - periodic vasospasm in fingers and toes, accompanied by pain.

Carditis - inflammation of any layer of the heart, commonly pericarditis.

Question 9

Describe three (3) lab or diagnostic findings that would assist in making the diagnosis. Provide a rationale for a change in each.

Answer 9

The presence of numerous ANAs (anti-nuclear antibodies), especially anti-DNA, as well as other antibodies in the serum is indicative of SLE. Lupus erythematosus (LE) cells, mature neutrophils containing nuclear material in the blood are a positive sign.

Complement levels are typically low, and the erythrocyte sedimentation rate (ESR) is high, indicating the inflammatory response.

Frequently counts of erythrocytes, leukocytes, lymphocytes, and platelets are low.

Additional immunologic tests for various antibodies may be required to confirm the diagnosis.

also, all organs and systems need to be examined for inflammation and damage.

Question 10

Explain why SLE may be difficult to diagnose and treat.

Answer 10

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that affects a number of systems; therefore it can be difficult to diagnose and treat. Also, the specific cause has not been established. A single lupus gene has not been identified, but genes increasing susceptibility to autoimmune disorders have been identified.

Question 11

What types of psychological needs would you anticipate for Ms. Monroe? What other assessment data would you need to provide for these needs?

Answer 11

Psychoses, depression, mood changes, seizures

Clinical manifestations diagnosis result in psychological issues.

Question 12

Describe the process taking place in the burned area during the first hours after the injury.

Answer 12

Acute inflammatory response release chemical mediators resulting in major fluid shift, edema, and decrease blood volume.

Question 13

Discuss how to determine the percentage of body surface area that is burned. Predict Andy’s percent of affected BSA using the given assessment data.

Answer 13

Torso – 18%

Arms – 18%

Face – 4.5%

Total surface area burned = 40.5% (Figure 2-12)

Question 14

Describe clinical manifestations Andy might experience and related causes.

Answer 14

Inflammation – an acute response due to damage to the skin, pain, shock (complication) – is because of low blood pressure and low blood volume, edema fluid shifted into interstitial space, temporary loss of function due to swelling and inflammation, blistering of skin, dizziness and headache, irritable, seizure, altered mental status due to dehydration, hypothermia, and low blood pressure because of decreased blood volume.

Question 15

How is this process of inflammation similar to and different from Andy’s previous knee injury?

Answer 15

They both became inflamed and caused the release of chemical mediators. The knee injury only affected that area, whereas the burn affected the whole body. The burn causes a high risk of infection because the skin is exposed/broken; the knee injury did not break the skin. His knee injury was more localized and the burn is more systemic.

Question 16

Andy begins to wheeze, cough up mucus, and is short of breath. Explain why this
has likely developed.

Answer 16

He may have inhaled toxic fumes which is irritating his respiratory system. His body is producing mucus to protect his respiratory system. SOB – fluid shift which causes more fluid in the lungs making it harder to breathe. The chemical inhalants would compete with the oxygen he needs, the chemicals will bind with the hemoglobin instead of oxygen which makes it harder to breathe. Wheezing – constriction to the airway due to inflammation in the respiratory tract, also due to mucus in the lungs

Question 17

Andy develops a bacterial infection on his right hand. Explain three predisposing factors to this. Describe potential complications of delayed wound healing.

Answer 17

Predisposing factors encompass the tendencies that promote development of a disease in an individual.

Poor hand washing due to break in the skin. He has a knee injury that his body is already trying to fight puts him more at risk. Just having an open wound exposes him to multiple infections (cover unless cleaning). Not cleaning the wound properly can also increase the tendencies that promote development of a disease in an individual at risk. Need adequate circulation to increase healing and reduce infection. Malnutrition can put him at risk for infection. If not treated correctly, can create an ulcer. Also can lead to necrosis.

Question 18

How will this burn injury affect Andy’s ability to work? What are some of the

social needs in this case? (Remember: Andy works at home and works on lawn mowers)

Answer 18

Working outside is a risk with him having new skin. Also cannot work because of pain. Scarring – altered body image. His extremities can become contracted from healing inhibiting his range of motion. Limited mobility, may need physical therapy. Free counseling service.

Question 19

How would you anticipate the healing process to differ based on the wound’s location and severity (consider Andy’s burns to his face, arms, and chest)?

Answer 19

Skin grafts, occupational therapy (ADL’s), skin substitutes

Question 20

How would scarring after a burn affect 2-year-old?

Answer 20

The growth of children is often affected during the acute phase of burn recovery due to increased stress and metabolic needs are compromised. Additionally, surgery or graphs may be required to accommodate growth. The surgery eases the effects of scarring.

Question 21

What are the risk factors involved for developing breast cancer?

Answer 21

Genetics( high family incidence) 
exposure to radiation
chemicals 
hormones(estrogen) 
age 
diet

Question 22

How would the immune system prevent the development of cancer?
The Neutrophils would detect the abnormal cells as “foreign” and make the 1st effort to begin to fight off these cells.

Answer 22

Cancer suppressor genes present in the body can inhibit neoplastic growth. The immune system appears to offer protection by reacting to changes in the membranes of some tumor cells, which are seen as “foreign.” The immune response includes both cell-mediated and humoral immunity (see Chapter 3). Cytotoxic T lymphocytes, natural killer (NK) cells, and macrophages are involved in immune surveillance and the destruction of “foreign” or abnormal cells. Temporary or long-term immunodeficiency has been shown to increase the risk of cancer. For example, human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) decreases the number of T lymphocytes. Cancers such as Kaposi’s sarcoma and lymphomas occur frequently in AIDS patients (see Chapter

When the membrane of malignant neoplastic cells is abnormal, the immune system may be able to identify these cells as “foreign” and remove them, thus playing an important role in the prevention of cancer. However, not all cancer cells are identifiable as foreign, therefore they may not be removed. (Chapter 3)

Question 23

Discuss the differences between a malignant and benign tumor and how they may be used in diagnosing the cancer.

Answer 23

he benign tumor is often encapsulated and expands but does not spread . It is usually freely moveable on palpation. Tissue damage results from compression of adjacent structures such as blood vessels. A benign tumor is not considered life threatening unless it is in an area such as the brain where the pressure effects can become critical.

Question 24

According to Ms. H’s clinical history, identify the stage of breast cancer.

Answer 24

Ms. H has Stage III because the tumor is larger than 5 cm in diameter; N1 and N2 nodes are involved; The tumor may be fixed. Also she has no metastasis (spread to other organs).

Question 25

Discuss what other signs and symptoms Mrs. H. may expect to experience if the tumor returns. Identify whether the clinical manifestation are local or systemic signs of cancer.

Answer 25

The expanding mass compresses nearby blood vessels, leading to necrosis and an area of inflammation around the tumor, and increases pressure on surrounding structures. Malignant cells do not adhere to each other but often break loose from the mass, infiltrating into adjacent tissue. Tumor cells often secrete enzymes such as collagenase, which break down protein or cells, adding to the destruction and facilitating the tumor’s spread into adjacent tissue. Inflammation and the loss of normal cells lead to a progressive reduction in organ function.

Local Effects—pain, obstruction, tissue necrosis (oxygen from blood supply is blocked), ulcerations

Systemic Effects—weight loss, anemia, fatigue, infection, bleeding (due to low platelet count), cachexia (severe tissue wasting), paraneoplastic syndrome (additional problems associated with tumors)

Question 26

Other than the biopsy used in this case, discuss what other diagnostic tests could have been used to diagnose the cancer.

Answer 26

CBC, X-ray, ultrasound, MRI, CT, Biopsy, tumor markers

Question 27

Discuss the reasons why the axillary lymph nodes were removed and it was recommended that the patient continue with chemotherapy and radiation.

Answer 27

Metastasis means spread to distant sites by blood or lymphatic channels. In this case the tumor cells erode into a vein or lymphatic vessel, travel through the body, and eventually lodge in a hospitable environment to reproduce and create one or more secondary tumors. So most physicians remove the lymph nodes when performing a mastectomy. Patient will continue with treatment plans as a precaution in case a few cancer cells have broken away to a lymph node or adjacent tissue.