As an advanced practice nurse, you will examine patients presenting  with a variety of disorders.


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.
  • Identify the  pathophysiology of the disorders  presented in each of the three scenarios, including their  associated  alterations. Consider the adaptive responses to the alterations.
  • Review the examples of  “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.
  • Review the Application Assignment Rubric found under  Course Information

To Complete

Write a 2- to 3-page paper  excluding the title page, reference page and Mind Map that addresses the  following:

  • For each of the three scenarios explain the  pathophysiology,       associated alterations and the patients’ adaptive  responses to the       alterations caused by the disease processes.   You are required to discuss all three       scenarios within the paper  component of this assignment.
  • Construct one mind map on a selected disorder  presented in one of  the scenarios. Your Mind Map must include the epidemiology,   pathophysiology, risk factors, clinical presentation, and diagnosis of  the  disorder, as well as any adaptive responses to alterations.