Advanced Pathopharmacological Foundations ePortfolio Essay
Advanced Pathopharmacological Foundations ePortfolio Essay
Pathophysiology Synthesis for Suicide
Suicide is the act of taking one’s own life due t underlying causes such as depression or post-traumatic stress disorder (APA, 2013; Sadock et al., 2015). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classes suicidal ideation as one of the manifestations of depression and other depressive disorders. Associated symptoms such as for major depressive disorder (MDD) usually include low self-esteem, a feeling of worthlessness, insomnia, and lack of enjoyment of pleasurable activities previously enjoyed Advanced Pathopharmacological Foundations ePortfolio Essay.
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The pathophysiology of suicide stems from the blunting of the reward pathways in the brain. The ventral tegmental area (VTA) found in the midbrain is the anatomical site in which the reward and pleasure sentiments and feelings are generated. The main pleasure neurotransmitter that is released in this area to mediate pleasure feelings is dopamine (Stahl, 2013). Pleasurable stimuli cause the release of an increased amount of dopamine in the VTA. The VA is linked to the areas of the brain that are in control of memory and behavior. In response to favorable stimuli, the brain releases the dopamine to make someone feel pleasure. Through the connections to memory and behavior centers, a correlation is made between the stimulus and the pleasure and this ensures that the experience is stored in the brain and the behavior is repeated in the future.
In the case of suicide, the above pleasure pathway is interfered with such that the release of dopamine in the VTA is inhibited. What results is depressed mood almost all the time and a feeling of low self worth that makes one feel that they have no purpose continuing to live. This is suicidal ideation and it makes the patient start having thoughts about death and dying. They then plan to take their own lives and either carry out the plan or just continue having it in their thoughts. Several attempts can be made on suicide unsuccessfully. However, if not treated it is just a matter of time before the patient succeeds.
Synthesis of the Pathophysiology and Pharmacology Associated with Stroke
Stroke is the condition in which there is a deficiency of oxygen to certain part of the brain due to either a rupture of a cerebral blood vessel or its occlusion. It is a medical emergency. The lack of oxygen then results because the oxygenated blood from the heart is not able to reach that particular part of the brain. There are two types of stroke – hemorrhagic stroke and ischemic stroke (Hammer & McPhee, 2018). The analysis of each of these types is what sheds light on the pathophysiology of each type of stroke.
The most important cause of hemorrhagic stroke is hypertension or high blood pressure. The reason is that long-term hypertension compromises the integrity of the walls of arteries supplying the brain such that they become weak and frail. Hypertension is precipitated by risk factors such as overweight and obesity (Hammer & McPhee, 2018). At one point in time, these frail and weak artery walls may rupture due to the sustained high blood pressure. This causes spillage of blood into the brain parenchyma causing damage to that part of the brain that is affected. That is the pathophysiology of hemorrhagic stroke.
Alternatively, blood pressure also causes damage to the interior layer (tunica intima) of arteries and this results in tiny bruises in the arteries. Slowly, platelets begin to aggregate at the sites of injury and that may lead to the formation of a clot in that part of the brain. As the clot grows in size, it occludes the artery and finally cuts off blood supply to that part of the brain. This is what causes ischemic stroke Advanced Pathopharmacological Foundations ePortfolio Essay.
Some of the manifestations of stroke include hemiparesis, difficulty walking, difficulty with speech, numbness of one side of the face, lower limbs, or upper limbs. There may also be complete paralysis if the stroke is complete. Pharmacotherapy for hemorrhagic stroke includes treatment of the underlying hypertension with agents such as calcium channel blockers, beta blockers, and ACE inhibitors. Anticonvulsants and angiotensin receptor blockers are also given. For the ischemic stroke, the mainstay of therapy is anticoagulation (Katzung, 2018). This helps during the emergency management.
Synthesis of the Pathophysiology for a Shadow Health Patient: Debbie O’Connor
This is the synthesis of chronic obstructive pulmonary disease or COPD as diagnosed in a Shadow Health patient during simulation. The patient was a female named Debbie O’Connor who presented with shortness of breath and a productive cough for one week (GOLD, 2017). She has a history of smoking one and a half packs of cigarettes in a day for the last 20 years. This gives her a total of 30 pack years. Spirometry confirmed this diagnosis in terms of expiratory volumes. COPD is in reality a combination of emphysema and bronchitis.
In COPD, long-term smoking causes a weakening of the alveoli and loss of elasticity. The efficiency of gaseous exchange of the alveoli is then compromised. This is an indication of emphysema. Coupled with the above is a state of hypertrophy of the mucus glands in the respiratory system. This cause overproduction of thick sticky mucus that then blocks the airways causing further respiratory distress. Mucociliary clearance is compromised and the mucus accumulates in the airways. This is the reason for the chronic productive cough. A state of chronic inflammation of the respiratory pathways then exists and this worsens the occlusion of the bronchioles due to the inflammatory response. This, now, is bronchitis.
The combination of the bronchitis and the emphysema makes the smoker as in this case experience frequent shortness of breath resulting from the above explained factors. An additional fact in the pathophysiology of this condition is that the parasympathetic division of the autonomic nervous system is also active and hence the smooth muscle of the respiratory tubes undergoes spasms that cause further distress.
Treatment Plan Synthesis of the Pharmacology for a Shadow Health Patient: Debbie O’Connor
According to the GOLD (2017) criteria, a COPD prescription is verified if the post-bronchodilator forced expiratory ratio (FEV1/FVC) is below 0.7. This is the case with this patient’s spirometry findings. It verifies that the patient has GOLD stage 3 COPD, which is severe COPD with a FEV1 of 30-49 percent (GOLD, 2017). This data is in addition to the patient’s other significant COPD manifestations. These were dyspnea, a strong cough, and a smoking history.
The pharmacotherapy for this individual will entail the use of an inhaler to administer the long-acting anticholinergic tiotropium or Spiriva at 18 micrograms (two inhalations) orally once daily (Katzung, 2018). This will be used with a corticosteroid, prednisone 5 mg orally once daily. She will, however, need to have more spirometry tests to evaluate if the results improve with treatment (Kennedy-Malone et al., 2019; Hammer & McPhee, 2018; GOLD, 2017). Secondary prevention health education for this patient will involve quitting smoking, eating a balanced diet, and avoiding strenuous physical exertion.
Due to the severe state of the condition, a consultation and referral to a chest physician will be made for further management. The next steps will depend on whether she was referred or not. If not, she may be seen every two weeks at first. This patient’s problems include dyspnea, physical effort, and performing daily duties (ADLs). Because this patient is in the GOLD group C, there is no need to change her medications at this time (GOLD, 2017).
Write a paper (1,500 – 2,000 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment Advanced Pathopharmacological Foundations ePortfolio Essay.
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Communicable Disease Selection
Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV
Ebola
Measles
Polio
Influenza
Epidemiology Paper Requirements
Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
A minimum of three peer-reviewed or professional references is required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
References
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
Global Initiative for Chronic Obstructive Lung Disease [GOLD] (2017). Pocket guide to COPD diagnosis, management, and prevention: A guide for health care professionals. https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. McGraw-Hill Education.
Kennedy-Malone, L., Plank, L.M., & Duffy, E.G. (2019). Advanced practice nursing in the care of older adults, 2nd ed. Philadelphia, P.A: Davis Company.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 4th ed. Cambridge University Press Advanced Pathopharmacological Foundations ePortfolio Essay.