Running Division: Integrated Pathophysiology Integrated Pathophysiology Paper Confidential RNSG 2463 Instructor Date Integrated Pathophysiology 2 Resigned Data Mr. F. is a seventy-three year generationd Caucasian courageous who is twice divorced and lives uncommon in Sweetwater, Texas. He has brace manifestation remedy, and brace gundivided manifestation. Twain of his parents are gone; his fertileher died at the generation of sixty-nine of prospecify cancer, his dame at the generation of seventy-brace of a pat. He is self-employed, keeping a persomal meanness abridgeing audience coercion encircling thirty years now. Mr. F. tands five-foot and nine inches amending and weighs brace hundred sixty pounds, exhibiting temperebuke corpulence and has been coercion the elapsed twenty-five years. He has a hankerstanding reality of hypertension; almost twenty years as polite as a reality of diabetes mellitus cast brace coercion twelve years, never having been insulin dependant. He has a smoking reality of encircling fifty years smoking brace herds per day and has been diagnosed a inspectt years gundivided with continuous irrelevant pulmonary ailment, making him oxygen-dependant coercion brace years. He claims to solely drain alcohol on a collective basis.
Prior to his vulgar similarity, he regular that he has referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent been disposed with his diabetic nourishment, that he does referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent obstruct his order glucose regularly nor has he been subjoined his medication victuals as he should. His conclusive doctors ordinance was brace years gone. On July 6, 2008, Pitch Medical Services was denominated to Mr. F. ’s abode by a associate who rest him in bed, aware, bepolicy expressive incoherently. He had a nasal canula in fix at three liters per exact. His glucometer executed by pitch indivisiblenel showed a order sugar of thirty-six.
He was then dedicated a bolus of dextrose fifty percent; he then rendered to awareness, bepolicy complained of some correct implement and leg dilution. He had 3+ pitting edema bilaterally to inferior extremities as polite as 1+ presacral edema. He was then enraptured to Rolling Plains Memorial Hospital pitch opportunity. Upon arrival to the hospital, his maintenance signs were as ensues; order constraining- 200/103, nucleus rebuke- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per exact. His correct policyd dilution seemed to dictate per resigned.

He deprived muddiness, vertigo and tinnitus. Symptoms executed at the pitch opportunity showed a colorless order cell calculate of 7. 8, hemoglobin of 12. 4, hematocrit of 37. 2, MCV of 95, and the platelet calculate parallel with coagulation studies showed to be regular. His renal compressiveness was abregular at a BUN of 68 and a creatinine of 6. 1. His potassium flatten was 5. 4 and CO2 was 22. 3. His sodium flatten was 133, phosphorus flattens were exorbitant at 6. 1, globulins were exorbitant at 4. 3, troponin flatten was slightly exorbitant at 0. 14 and CPK was regular. His BNP NT-Cast was very-much exorbitant at 9674. parallel with his hemoglobin A1C was at 5. 8. Thyroid studies were Integrated Pathophysiology 3 rest to be regular. The whole cholesterol was 127, with HDL solely at 24, LDL at 79 and triglycerides at 136. A exalt symptom examine orthodox by practice of chest x-ray has shkeep cardiomegaly with calm venous plethora. The EKG shows indigent R wave rebuke and nonspecific ST wave changes from ceegoing. The echocardiogram showed 2+ mitral valve regurgitation with calm aortic stenosis and to-boot an dispossession policy of counteract 50%. A renal sonogram shows enervated cystic changes.
A CT inspect of his division orthodox calm colorless substance changes bepolicy no other irregularities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190. 3. The resigned deprived problems with urination such as number, conjuncture, dysuria, revulgar urinary believe transmitted or renal stones. Home medications embraced; Potassium chloride 10 mEq t. i. d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b. i. d. coercion a whole of 20 mg daily, Albuterol inhaler, Furosemide 80 mg in the am and 40 mg in the pm. Mr. F. was admitted into the intensive regard item from the pitch opportunity.
Diseases/Pathophysiology Mr. F. ’s vulgar ailment processes are ancient hypertension, corpulence, COPD, Diabetes mellitus, continuous renal insufficiency, and congestive nucleus insufficiency. Hypertension is defined as a order constraining greater than 140/90 mm Hg (Ignatavicius & Compositionman, 2006). It is sourced by acceptions in cardiac quenchedput, whole peripheral hindrance, or twain. The cardiac quenchedput is the compass of order that is ejected by the nucleus each exact. Peripheral hindrance is a hindrance to the disposition of order quenched policy of the nucleus. It can be considered either important or unimportant.
Important hypertension has no disclosed efficient realityors other than affinity to genetic prejudgment, corpulence, coercionce, acceptiond alcohol intake, diabetes, and or sodium and introduce grasp in which whole acception the whole compositionload of the nucleus and acception melting compass with in the vascular room (Zerwekh, Claborn & Gaglione, 2006). Unimportant hypertension is exorbitant order constraining with an identifipotent source that may embrace bepolicy referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent faulty to; renal stenosis, natural nucleus defects, Cushing’s syndrome, pheochromocytoma, untreated doze apnea, MAOIs, chemical stimulants such as cocaine, methamphetamines coercioneseeing. or pregnancy induced (Zerwekh, Claborn & Gaglione, 2006). Corpulence is a ailment amid divers ailments with divers varying sources. According to Ignatavicius and Compositionman (2006), an rich indivisible weighs at meanest 20% overhead the conspicuous designation of the regular stroll coercion mental association gravity and refers to an immoderebuke total of association fertile in which can be arranged unequally and source an vest of problems according to the division, Integrated Pathophysiology 4 chiefly android corpulence with debauchery fertile at the waist and abdomen; this mould carries the amendingest sanity expose.
Continuous Irrelevant Pulmonary Ailment is a transitional and unalterpotent circumstances characterized by diminished inspiratory and expiratory compressiveness of the lungs (Mosby’s, 2002). Emphysema parallel with continuous bronchitis is complications that administer to COPD. The etiology is raise frequently than referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributable, a hanker reality of smoking cigarettes or other coercionms of smoking tobacco. The lungs promote elasticity and watch to source hyperinflation attributpotent to the alveoli in the lung losing its elastin, in which then narrows and yields a exterior area that retrenchs and is no hankerer compressivenessing uprightly coercion comprehensive gas diversify.
The collated disposition that is incappotent to be eager uprightly behoves trapped and sources the decay of the smaller dispositionways denominated bronchioles. With the lungs hyperinflated, this flattens the diaphragm, thus causing the indivisible to husband completey muscles to expiration, increasing the respiratory rebuke to expend. Resigneds with COPD keep bouts with continuous bronchitis which is an inflammation of the bronchi and bronchioles triggered usually by tobacco fume.
The irritants from the fume source inflammation, with vasodilation, mucosal edema, and bronchospasms; the acceptiond inflammation acceptions the bigness of the mucosal glands and yield catholic totals of inarticulate mucus, causing the bronchial walls to inarticulateen and impdisposition dispositiondisposition (Ignatavicius & Compositionman, 2006). Diabetes Mellitus comes in divers coercionms; the deep peculiarity is exorbitant order glucose attributpotent to complications in the insulin secretion or possession or twain (Ignatavicius & Compositionman, 2006).
When diagnosed with diabetes other than cast undivided, the beta cells in the islets of Langerhans that yield insulin and the alpha cells that yield glucagon, which calculateeract undivided another, either retrench in genesis of these hormones or can haply yield at a regular counteract. If there is regular genesis of these hormones, deeply insulin (the hormundivided that enravishments glucose into the cells), it is usually cellular hindrance to insulin that is causing the diabetes.
When the cells are referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent receiving the indispenspotent glucose deficiencyed coercion cellular compressiveness and metabolism, the association is incappotent to husband the glucose, provision carbohydrates, fertiles and proteins; accordingly the unused glucose debris in the order causing hyperglycemia and regulatory mechanisms in the association watch to source the exempt of raise glucagon which source the exempt of provisiond glucose in the liver into the orderdisposition as polite, accordingly increasing the order glucose flatten equal raise. Homeostasis is Integrated Pathophysiology 5 nterrupted, regularityically causing impairment. The etiology of cast brace diabetes can be a completeiance of divers realityors; nevertheless the polite disclosed auxiliary is corpulence. Continuous renal insufficiency is a transitional, unalterpotent sort defective, and sort compressiveness does referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent reccounteract (Ignatavicius & Compositionman, 2006). The sorts are in impute of defecateing the metabolic wastes in the orderdisposition that comes from cellular metabolism throughquenched the association as polite as reabsorption of indispenspotent electrolytes.
When hanker-term damgeneration is sustained in the cells of the sorts (nephrons) by realityors such as hankerstanding hypertension, compressiveness is transitionally altered exhibited by the indigence to excrete the nitrogenous wastes; accordingly they collate in the sorts and order disposition. Altered glomerular sublimation rebuke, abregular urine genesis, indigent introduce sweating, electrolyte imbalances, and metabolic irregularities betide as a enlargement of renal insufficiency. The association’s power to enervate urine is retrenchd; accordingly urine quenchedput retrenchs causing melting counteractload.
The insufficiency betides in stages with the conclusive nature end-stgeneration renal ailment in which whole renal compressiveness equaltually ceases. Congestive nucleus insufficiency to-boot disclosed as left-sided nucleus insufficiency may enlargement from hypertensive coronary artery and valvular ailments arising in-particular from the mitral and aortic valves. When CHF betides from any etiology such as regularityic hypertension and structural changes, the ventricles of the nucleus are incappotent to conbelieve and or relent uprightly causing order to congest abquenched the nucleus.
As a enlargement of this plethora in and abquenched the nucleus, texture perfusion diminishes and order collates in the pulmonary vessels. Cardiac quenchedput equaltually retrenchs and reparatory mechanisms such as dissimilar pregnant regularity stimulation, the renin-angiotensin regularity activation in the sorts (RAS), other neurohumoral responses and myocardial hypertrophy get betide (Ignatavicius & Compositionman, 2006).
The hypoxic specify of the textures inflame the pregnant regularity which acceptions the nucleus rebuke and order constraining attributpotent to vasoconstriction and this stimulation acceptions venous order render to the nucleus, which in revolve stretches the myocardial fibers causing dilation and equaltually inarticulateening of the walls of the nucleus and chambers amid it, accordingly causing expansion (cardiomegaly). The nucleus then tries to conbelieve hardeneder and equaltually exhausts and reduces the coercionce of the abridgeions; accordingly decreasing cardiac quenchedput.
The vasoconstriction of the arteries acceptions the succeedingload which is the hindrance that the nucleus must interrogate. This mean quenchedput sources a retrench in order disposition to the sort’s which enlargements in the activation of the RAS in revolve sources sodium and introduce grasp. Cardiac preload and succeedingload acception causing abridgeile dysfunction. Integrated Pathophysiology 6 Integration Mr. F. reputed that he has been rich coercion almost twenty-five years. A inspectt years succeeding the coercioncible gravity reach, he was diagnosed with hypertension.
At his keep similarity, his lifestyle of amending fertile, cholesterol, salt and sugar intake as polite as a hanker reality of smoking cigarettes left diminutive to be desired and keep contributed coercionciblely to his vulgar circumstances. Several years succeeding having been diagnosed with hypertension, he was taged he had diabetes and COPD. Upon his late hypoglycemic result, he was diagnosed then as having continuous renal insufficiency with congestive nucleus insufficiency. Whole of these diagnoses fasten polite in unitedly, starting with corpulence. When a indivisible is rich, the debauchery gravity, chiefly abquenched the waist and abdomen as seen in Mr.
F. sources the compositionload on the nucleus to acception attributpotent to the debauchery adipose texture extreme the visceral organs and gravity in unconcealed. Nature rich puts undivided at amending expose realityors coercion enlargeing hypertension and nucleus ailment as Mr. F. has. Corpulence to-boot fixs undivided at amending expose coercion enlargeing diabetes cast brace attributpotent to the reality that adipose texture and cells that collate keep a amending watchency to behove insulin strong as polite as the extreme cells and texture; accordingly the association can referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent husband the glucose and hyperglycemia betides.
A prolonged era of insulin hindrance equaltually administers to the beta cell insufficiency causing retrenchd insulin genesis. The selfselfsame amending fertile, cholesterol, and sodium nourishment that contributed to the resigned’s corpulence in the primeval fix, causing his nucleus to keep to composition hardeneder, raise than slight sourced him to enextensive hypertension. The reality of his non-consent with his medication victuals coercion hypertension and diabetes, 100 herd per year smoking usageuationuation as polite as insubordination with prescribed diabetic nourishment, administer to his exalt complications of renal insufficiency and conclusively CHF.
With prolonged hypertension and in-particular tempestuous diabetes mellitus, diabetic nephropathy changes the sorts in a practice that reduces sort compressiveness and equaltually, renal insufficiency. Continuous amending order glucose flattens source hypertension in sort order vessels and debauchery sort perfusion (Ignavicius &Workman, 2006). This acception in constraining amid the sorts source the order vessels to reach quenched that wholeows catholic particles such as albumins and proteins to coercionm deposits in the sorts and their order give.
This narrows the vessels and retrenchs oxygenation to extreme sort texture; accordingly causing hypoxia and equaltually unalterpotent cell liberate. As this progresses, scarred texture coercionms and the power to defecate urine from the order ceases causing renal insufficiency. Once in renal insufficiency, the resigned’s sorts were referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent potent to rale the melting compass by comprehensive sweating, accordingly the debauchery melting was pooled tail into the vascular Integrated Pathophysiology 7 room. This melting compass counteractload sourced an acceptiond cardiac compositionload which equaltually administers to congestive nucleus insufficiency.
Mr. F. ’s smoking reality was the important source of his COPD; nevertheless it is exacerbated by the gathering of melting in his vascular room attributpotent to renal insufficiency, the controlfeiture of elasticity of vascular regularity and congestive nucleus insufficiency. The medication prescribed coercion Mr. F. ’s diabetes was Metformin 500 mg daily. This medication important possession was to retrench hepatic glucose genesis. The debauchery insulin in the order triggers genesis of glucagon in which signals the liver to exempt provisiond glucose, in revolve hyperglycemia enlargements. This medication was radical attributpotent to Mr. F. s exorbitant BUN and creatinine which is where this medication is metabolized and excreted as polite as his specify of CHF. Lasting this medication could source toxicity. The fantastic medication he was fixd on was a mean dose of Actos which is metabolized in the liver and does referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent source hypoglycemia as Metformin may. To write his hypertension, Nifedipine was prescribed and it acts to inferior order constraining by inhibiting calcium enravishment into myocardial cells and soften muscle cells amid the vascular room enlargementing in vasodilation calculateeracting the vasoconstriction sourced by hypertension.
In adduction to Nifedipine, the resigned is prescribed an ACE inhibitor designated Ramipril. This ACE inhibitor compositions on the renin-angiotensinogen regularity ultimately causing regularityic vasodilation. This medication referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent solely retrenchs the order constraining, it retrenchs cardiac succeedingload in resigneds with CHF. Ramipril is metabolized in the liver, accordingly implied coercion resigneds at expose or in renal insufficiency. Furosemide is a loop diuretic that is chiefly salubrious in resigneds with edema attributpotent to hypertension, renal ailment as polite as CHF.
Furosemide acceptions the renal sweating of introduce as polite as sodium and other electrolytes, thus reduces the melting compass in the vascular room. It to-boot has a vasodilating becomingty that are salubrious in this resigneds victuals; nevertheless a potassium addition must be dedicated attributpotent to the potassium decadence sourced by this loop diuretic. This resigned’s dose of Furosemide was coercionciblely acceptiond attributpotent to the requirement of ridding his association of the accumulating melting and stabilizing his order constraining which in revolve get frustrate exalt damgeneration to his sort’s. Potassium is indispenspotent coercion becoming abridgeility of the nucleus.
Mr. F. is on Potassium chloride 10 mEq t. i. d. to construct up coercion the controlfeiture attributpotent to the loop diuretic becomingty. The Albuterol inhaler is used to expatiate the bronchi thus increasing exterior area of the disposition practices to enpotent oxygen and CO2 diversify. This inhaler can exacerbate hypertension, palpitations and keep a indirect cardiac issue as polite as source hyperglycemia; accordingly must be used cautiously. Integrated Pathophysiology 8 Prediction of Quenchedcomes Although Mr. F. ’s quick circumstances was stabilized, his prognosis appears indigent at this purpose attributpotent to his reality of insubordination.
Equal though he has retrenchd his cigarette usageuationuation to undivided herd per day, his circumstances get probably deteriorebuke regular he could wholely drop from smoking. While expressive with the resigned, he assures that this has got his notice and he get redeep disposed from here on quenched. The damgeneration at this purpose is unalterable; accordingly deeptaining waiting compressiveness as it is now behoves a fantastic pre-eminence, signification that consent is indispenspotent at this purpose coercion this resigned as lasting to be nondisposed get definitely administer to his mortality.
Aggressive diabetic counseling as polite as subscription of adhering to his vulgar medication victuals is sharp coercion this resigned’s action. Other disciplines that should be concerned to fix a amend prognosis coercion Mr. F. are undivideds such as a nourishmentician to remedy with fast and snack planning per diabetic protocol, lasting respiratory therapy to remedy in oxygenation and eatables, visible therapy to build the resigneds controlce and frustrate venous stasis hence order clots, and perchance equal occupational therapy to help him with deeptaining defiant activities of daily remedy.
Routine folmean up ordinances with his physician as polite as specialist coercion cardiac and pulmonary compressiveness are ascititious to his quenchedcome. A diabetic prop clump would be mental coercion this resigned as he appears to be a indivisible in deficiency of a prop team. Lifestyles are hardenedened to disagree, bepolicy when undivided gets tailed into a retreat, it can be executed, equal in the most nondisposed resigneds differently liberate is impending. Integrated Pathophysiology 9
References Deglin, J. H. & Vallerand, A. H. (2007). Davis’s Drug Guide, Tenth Edition. Philadelphia: F. A. Davis Audience. Ignatavicius, D. D. & Compositionman, M. L. (2006). Medical Surgical Nursing, Critical Thinking coercion Collaborative Regard. St. Louis: Elsevier Saunders. Mosby’s Medical, Nursing, & Wholeied Sanity Dictionary (6th ed. ). St. Louis: Mosby, Inc. Zerwekh, J. , Claborn, J. C. & Gaglione, T. (2006). Mosby’s Pathophysiology Memory Referpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributpotent attributableecards, Visual, Mnemonic, and Memory Remedys coercion Nurses. St. Louis: Mosby, Inc.

~~~For this or similar assignment papers~~~