N518 Group Case Study
History of Present Illness: M.K. is a 35-year-old Caucasian woman who presents to her PCP complaining Of a dull but persistent headache, a significant weight gain over the past six weeks, significant facial hair growth, menstrual abnormalities, and both an excessive thirst and appetite. She also feels very depressed, does not have much energy, and has stopped performing all the activities that she had previously enjoyed (tennis, bridge, and shopping for new clothes). M.K. is married, has ah adolescent son (age 16) and daughter (age 13) and has been in relatively good health throughout her life. She is the third oldest of four children. One of her brothers was diagnosed with type 1 diabetes mellitus at age 11 and was recently evaluated for hypertension. Her two sisters are in good health. Her father is a cancer survivor of childhood leukemia and her mother has a history of rheumatoid arthritis and breast cancer.
The patient does not smoke and only consumes alcohol in moderation at social func- tions. She has several allergies (ragweed and cat dander) and is not taking any medications otherthan a daily multivitamin tablet and ibuprofen (as needed) for headache,
Physical Exam and Laboratory Tests:
The patient is an alert but anxious, moderately overweight white female with a noticeably round, full face. T -98.3°F orally; P = 85 beats/min and regular; RR -14 breaths/min and unlabored; BP = 185/105 mm Hg left arm, sitting; Ht = 5 0 ; Wt —141 lbs.
KEEN I , Skin, Neck
• Head exam normal except for significant facial hair growth
• Fundi without lesions, PERRLA
• Nares, tympanic membranes, and pharynx clear
• Skin appears hyperpigmented and thin with some bruising on the arms and hands
• Gingiva show localized areas of hyperpigmentation
• Neck supple
• No bruits
• Fat deposits in dorsocervical region
• Thyroid non-palpable
• No palpable cervical, supraclavicular, infraclavicular, or axillary adenopathy
• Exams unremarkable
• Protuberant with striae and minimal bruising
• Bowel sounds heard in all four quadrants
• No abdominal bruits, masses, tenderness, or organomegaly
• Symmetric breasts
• No signs of dimpling, discoloration, or nipple discharge
• Two small, mobile, cystic nodules palpable in the UOQ of right breast suggest benign con- dition, probably fibrocystic change
• Mammogram pending
• No edema
• Both upper and lower extremities show areas of hyperpigmentation
• Pulses full in both feet
• Muscular atrophy significant in all four limbs
• Alert and oriented
• Cranial nerves II—XII intact (including excellent visual acuity)
• Strength 3/5 throughout
• Sensory to light touch, proprioception, and vibration normal
• DTRs r-2 and symmetric
• Gait within normal limits
Laboratory Test Results
l. aboraiory Test Results
Seruni]jai J45meq/L Urinary free cortisol 190 pg/24 hrs
Serum 3.1meq/L pH arterial, whole blood: 7.46
Serum Q — 105meq/L Serum testosterone 160 hg/dL
Serum glucose fasting 170mg/dL Het 41%
PlasmaACTH 290pg/mL RBC 5.9 lOfymm^
Serum cortisol 8 AM 1 73pg/dL WBC differential: 75%:neutrophils, 15%; lymphocytes, 7% monocytes/macrophages, 2% eosinophils, 1% basophils
Patient Case Question 1, Assuming that the patient has hypercortisolism, briefly explain the pathophysiology pf the abnormal blood pressure.
Patient Case Question 2. Is this patient technically underweight, ovet~weight, obese, or is her
weight considered healthy and normal?
Patient Case Question 3. Assuming that MX. has hypercortisolism, what are two possible causes of this patient’s persistent, dull head pain?
Patient Case Question 4. Explain the pathophysiology that underlies/20/yr/ipsm in this patient.
Patient Case Question 5. Do laboratory test results suggest that hypercortisolism in
MX. is ACTH-dependent or ACTH-independent?
Patient Case Question 6. What is the significance of the serum K+ concentration and the pH of the arterial blood?
Patient Case Question?. Note that hyperpigmentation of the skin and gingiva was a physical finding in this patient. Is this clinical manifestation more characteristic of ACTH-dependent or ACTH-independent Cushing syndrome?
Patient Case Question 8. What is the treatment of choice for curing hypercortisolism in this patient?
Discussion Forum and Rubric Advanced Pathophysiology 518 Summer 2021
Please use the following criteria to guide your posting and participation in the Discussion Forums.
During the Course, there will be one (1) group discussion forum (Refer to Schedule). Your group will provide a comprehensive post answering the questions to the posted case study and at least one reply (crosspost) to another group (see schedule for exact dates/times). These must be completed and submitted prior to the specified dates/times. You will be expected to post a thorough and complete discussion of the questions presented in the case study. References must include at least one outside peer reviewed reference and your book i.e. - no less than one iournal reference in addition to your textbook.
All group communication will be conducted in the -Group Chat Space” in the course. Failure to participate in your group, will result in an automatic zero for the assignment.
The grades you receive on this Discussion Forum will account for 20% of your final grade.
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Title of Post
This should be the introduction paragraph. In this paragraph, you will introduce the reader to what the paper is about. The last sentence should state exactly what the rest of the paper will discuss.
Pathophysiology of Hypertension
Assuming that the patient has hypercortisolism, briefly explain the pathophysiology of the abnormal blood pressure.
Is this patienttechnicaly underweight, overweight, obese, oris her weight considered healthy and normal*!
Causes of Head Pain
Assuming that M.K. has hypercortisolism, what are two possible causes of this patient’s persistent, dull head pain?
Pathophysiology of Polydipsia
Explain the pathophysiology that underlies polydipsia in this patient.
Type of Hypercortisolism
Do laboratory test results suggest that hypercortisolism in M.K. is ACT11-dcpendent or ACTH-independent?
Significance of Serum Potassium
What is the significance of the serum K+ concentration and the pH of the arterial blood?
Note that hyperpigmentation of the skin and gingiva was a physical finding in this patient. Is this clinical manifestation more characteristic of ACTH-dependent or ACTH-independent Cushing syndrome?
What is the treatment of choice for curing hypercortisolism in this patient?
This is your conclusion. Please remember that the paper must be cited appropriately.
Anything that is not your opinion or common knowledge must be cited. All references cited in the paper must be on the reference list and all references; on the reference list should be cited in the paper. You should paraphrase everything that you can unless paraphrasing will change the context/meaning of what is being presented. If you are unable to paraphrase, you should quote your source. If you quote, you must include quotations and a page number.
Your references in a discussion forum with not format correctly and this is not a problem. Just make sure that you reference appropriately even if your reference list is not exactly AP A with a hanging indent.
Intercollegiate Consortium for a Master of Science in Nursing
Rubric for Assessing Student Postings on the Discussion Forums
Number of Points Grasp of Key Concept Citation for Support using APA format Interpretation of Discussion Materia] Clarity of Expression of Posting
92.5- 100.0 Exceptional “A” Demonstrates excellence in grasping key concepts and includes outside resources. Provides ample citations for support of opinions from class readings and additional readings Readily offers new interpretations of discussion material Ideas are expressed clearly and concisely; uses appropriate vocabulary
84.5-92.4 Effective Shows evidence of understanding of most major concepts Provides support of opinions primarily from class readings Show some skill in support for opinions Some signs of disorganization with expression of ideas
76.5 - 84.4 Needs improvement “C” Has shallow grasp of the material Provides minimal support for statements from readings Offers inadequate levels of support for statements Only occasional ideas surfaces clearly
69.5-76.4 Unacceptable “D” Shows no significant understanding of material Opinions cited without support from readings Offers poor support for statements Ideas are expressed uncleariy; Does not respond readily to prompting
Su m of scores
Adapted from S Pryor & L. Roussel/akc, Ijs & skp 3/07 Comments: