Developing Integrated Health Sciences: NUR5023/24/25
Myocardial Infarction (MI) is also called a heart attack. In this condition blood flow inside the heart is abruptly restricted resulting in causing tissue damage. MI is characterised by the blockage of the coronary artery in the heart. Some of the significant reasons associated with MI are coronary artery disease, which is characterised as the narrowing or blockage of the coronary artery. The blockage in the coronary artery is also called Atherosclerosis, which is a condition under which plaque builds up inside the arteries. This plaque is found to be specifically made up of fat, cholesterol, calcium as well as other substances found in the blood. With the gradual building up of the plaque, coronary arteries become narrow and the flow of oxygen-rich blood through the arteries becomes difficult. Due to the rupture of the plaque in the artery, a blood clot (thrombus) can be formed that could result in causing a complete blockage of the artery and causes a heart attack. According to evidence, some of the major reasons or the risk factors for MI are diabetes, hypertension, smoking, sedentary lifestyle, obesity, and hyperlipidemia. Symptoms of MI include chest pain nausea, vomiting, dizziness, pain radiating to the left arm and law, as well as disorientation and diaphoresis. MI can further result in causing heart failure, irregular heartbeat as well as sudden cardiac arrest.
Anatomy and Physiology
The anatomical and or physiological changes that occur in the MI include blockage of one or more of the coronary arteries. Blockage in the major branch of the coronary artery results in causing tissue death, which further result in releasing the chemicals that stimulate sensory fibres. Secondly, Atherosclerosis is also considered the major anatomical or physiological change that takes place in MI, which is characterised by the blockage of the coronary arteries. In this condition, plaque is formed in the arteries, which mainly builds up because of the deposition of lipids, fat, dead WBC and other cellular waste. Narrowing of the artery walls is found to restrict the flow of blood. However, when the plaque accumulation is severe it can rupture, resulting in a blood clot in the artery that further blocks the blood flow completely. A blocked artery means a lack of oxygen supply (Ischaemia) and a lack of oxygen for the tissues (causing cellular damage, infraction). Decreased levels of the oxygenated blood results in causing decreased oxygenation of the myocardium. This condition further results in the decreased ability to produce ATP in mitochondria leading to the ischemic cascade. Therefore, the final event in cell death (apoptosis) or myocardial infarction.
Medication and Therapeutic Interventions
The main medications that are recommended for MI include Aspirin and Morphine. Aspirin is mainly considered the blood thinner and is used for breaking the blood clots, and managing pain and inflammation. Morphine is considered a potent analgesic, which provides hemodynamic benefits, but it is also found to be associated with increased cardiovascular events within a year. Therefore, John would be provided with Aspirin as this would help in preventing blood from clotting and morphine would help John to manage pain. Another medication for MI included nitrate, such as Nitroglycerin. This medication will also be given to John as nitrates are to relax the venous system, such as reducing the ventricular preload. This process is very effective in reducing the workload of the heart and demands a lower level of oxygen, thus contributing to reducing ischemic pain. Nitrates also help in increasing the level of nitric acid which is important for vasodilation and increasing the flow of blood to the myocardium.
Percutaneous coronary intervention may include the use of anti-coagulant for preventing the formation of clots, angioplasty to stretch open the narrow arteries, coronary artery bypass surgery, to restore the circulation of blood in the case where the artery could not be unblocked, as well as a heart transplant. However, the treatment approach extends to the return of the patient to home, as John would be recommended with appropriate diet and lifestyle advice, which is important to ensure that he takes a healthy diet, participate in physical exercise, as they are important to prevent the formation of plaque and promote heart health. John would also be provided with the recommendation to use Anticoagulants (warfarin) because it will help in the secondary prevention of heart attack. John will also be recommended Statins for lowering the level of cholesterol and preventing the risk of heart attack, as will John, who would be recommended ACE inhibitors and Beta-blockers for addressing the problem of hypertension.
Diabetes is also called diabetes mellitus in the medical term and is identified as a metabolic disease, which is preventable but not curable. This chronic disease is characterised by the failure of the pancreas to produce enough insulin. Diabetes is mainly divided into two types. First is called type 1 diabetes, in which the pancreases are unable to produce enough insulin hormone that has the responsibility of converting blood glucose into energy. Due to lack of insulin production, the individual is recommended a daily dose of insulin. However, type 2 diabetes is a condition in which the body becomes insulin resistant, due to which the body becomes unable to use the insulin for converting blood glucose into energy. Type 1 diabetes mainly occurs because of the negative working of the immune system of the body. The immune system is considered responsible for fighting bacteria and viruses, however, in the case of type 1 diabetes, the immune system destroys the insulin-producing cells in the pancreas. Some of the major reasons associated with type 2 diabetes include obesity, high blood pressure, smoking, physical inactivity or sedentary lifestyle, race, ethnicity as well as genetic factors. Both forms of diabetes, Type 1 and type 2 could be found as responsible for causing the damage to the blood vessels as well as the peripheral nerves that can result in causing problems in the leg and feet. Lauren is 65 years old woman who has been suffering from diabetes. She had enjoyed walking, but recently she is finding it difficult to walk. Lauren also suffers from a foot problem, which is due to the problem of type 2 diabetes. The increased risk of foot problems in diabetic patients is found to be associated with peripheral artery disease (PAD) and peripheral neuropathy.
Anatomy and Physiology
6% of the people suffering from diabetes experience foot problems that include destruction of the foot tissues, infection as well as ulceration. Peripheral arterial disease is mainly caused because of atherosclerosis (although it is considered the main cause of heart diseases, plaque formation can cause damage to arteries throughout the body), under which plaque is deposited in the arteries and the flow of the blood to the limbs is restricted. Blood vessels that circulate blood to the legs are damaged due to plaque formation cramps and tiredness is experienced in the legs. Due to the plaque formation blood flow is decreased resulting in tissue damage or cell death, as well as nerve injury, resulting in discolouration of the foot. The second reason for the nerve damage in the legs is associated with neuropathy. Neuropathy is the condition under which high levels of sugar in blood result in damaging the small blood vessels that are also called capillaries. With the damage to the peripheral nerves, individuals may experience, numbness, pain and weakness in the legs. Discolouration of the foot is associated with tissue damage because of the restricted blood flow. According to evidence, diabetes neuropathy is considered a multifactorial problem, which specifically occurs because of occluding of the vasa nervorum and endothelial dysfunction.
For the management of type 2 diabetes, Metformin is identified as the first-line treatment. This medication is recommended as it helps in reducing the blood glucose level and also helps in improving the procedure through which the body handles the insulin hormone. However, this medication is mainly prescribed when the patient is unable to manage the condition through diet and exercise. In the case of Lauren, her problem in the foot indicates that exercise is not enough to manage diabetes, rather the increasing sugar level is causing damage to the cells in the lower limb. Due to this, she must take metformin to manage her blood glucose levels. The second medication that is used for the treatment of diabetes is Sulfonylureas. Lauren would also be recommended with this medication as it helps control the blood sugar level and stimulate the production of insulin hormone. Sulfonylureas can be used alone or in combination with metformin.
According to different evidence, it has been identified that improving the intake of nutritional diet, making lifestyle changes (such as participating in regular physical exercise), patient’s health education interventions and blood glucose monitoring could be effective approaches towards managing the symptoms of diabetes. Lauren would be encouraged to take part in regular physical exercises, and would also be referred to the dietician to provide an appropriate diet chart for her. Continuous blood glucose monitoring could be effective for Lauren in understanding the impact of nutritional diet and exercise on her well-being. This would also help in enhancing self-management skills of Lauren. It is very important that she continues with appropriate foot care and can also go through weight loss surgery.
Pneumonia is a condition that is characterised by the infection or inflammation of one or both lungs. This form of lung inflammation can occur due to bacterial or viral infection. Pneumonia can also be characterised as a respiratory condition that develops because of an infection in the lungs. Infection in the air sacs (alveoli) of the lungs can result in filling the air sacs with fluid or pus that can make it hard for the patient to breathe properly, causing excessive cough with phlegm. Age is considered one of the primary risk factors of pneumonia, because, with the age, the strength of the immune system of the body is reduced, making the body vulnerable to bacterial or viral infections. Elizabeth is 80 years old woman, who had been admitted to the hospital after a fall for a hip fracture surgery. However, she is suspected to have acquired Pneumonia. In the case of Elizabeth, her old age and poor immunity can be considered as the reasons behind pneumonia.
Some of the other risk factors related to pneumonia include suffering from chronic respiratory disease, poor immunity as well as smoking. However, hospitalization is also identified as a risk factor for developing pneumonia. Hospital-acquired pneumonia is associated with exposure of the patient to Gram-negative bacteria such as Pseudomonas aeruginosa and Haemophilus influenza or Staphylococcus aureus. Some of the common symptoms of pneumonia include chest pain, cough that results in the production of phlegm, fever with shaking chills, profound sweating, and shortness of breath. All of these symptoms were also identified in the case of Elizabeth. Some of the main complications associated with pneumonia include the entry of bacteria into the bloodstream specifically in high-risk patients. From the blood, bacteria can spread to the lungs and other organs of the body, which can result in organ failure in patients.
Anatomy and Physiology
According to the physiology, it is identified that pneumonia is mainly a form of acute lower respiratory infection, and could be common or severe depending on the immunity, as well as the inter-organ and intercellular signalling network that can help in fighting infection. The infection caused by the bacteria, virus or fungi mainly attacks the lung air sacs and causes inflammation within them resulting in the formation of fluid or pus inside the air sacs (alveoli). Due to this bus, it becomes hard to breathe and it also becomes difficult for the oxygen to enter the bloodstream. Inhalation, aspiration, and hematogenous are identified as the three main mechanisms that are involved in the entry and transfer of bacteria to the lungs. Aspiration of oropharyngeal secretions is identified as the primary route through which bacteria enter the trachea. With the inhalation of the bacteria, they start colonizing the respiratory tract. Formation of the mucus is considered the defence strategy of Goblet cell and bronchial seromucous glands. It is identified that mucous contains immunoglobulin A, cytokines, which work as the protecting element with anti0microbial properties to protect the underlying tissues of the lower respiratory system
The primary aim of the treatment is to relieve the distressing symptoms, prevent complications and employ the appropriate antimicrobial therapy (Winland-Brown and Porter, 2019). The main pharmacological treatment for pneumonia involves the use of antibiotics. The main antibiotic that is used in pneumonia is Macrolide antibiotics which are also identified as the first-line treatment for pneumonia. Macrolide antibiotics that would be given to Elizabeth may include azithromycin (Zithromax) or clarithromycin (Biaxin XL). The use of antibiotics would be the first-line treatment for Elizabeth because antibiotics would help in relieving pain, fever and cough. These antibiotics can be given alone or in combination with beta-lactam which may include amoxicillin. As their condition of Elizabeth is very critical she can also be kept on a ventilator for 48 hours. After her condition is stabilized, non-pharmacological treatment interventions can also be applied, which include increased level of rest and avoiding any form of exercise or exertion. She would be encouraged to rest, speak less and not exert herself as much as possible. It is also important to ensure the appropriate fluid level is maintained, therefore, Elizabeth would be provided with three litres of water every 24 hours. A recommendation for plenty of water and other fluids is given because fluids help in loosening the mucus in the lungs, thus relieving the congestion, and also help in flushing the foreign particles that are obstructing the respiratory tract. She would also be recommended to take an adequate diet rich in calories, protein and micronutrients, as well as food rich in Vitamin A as it helps in improving the integrity of respiratory mucosa.
Ulcerative Colitis is identified as an inflammatory bowel disease due to which ulcers and inflammation are caused in the digestive tract. This form of ulcer and inflammation in the digestive tract are mainly caused by the abnormal reaction of the immune system. This disease can occur in people of any age group, but it is more likely to develop among people between the age group of 15-and 30 years. Ulcers and inflammation first start in the rectum, and from there move to the colon (large intestine) causing inflammation and ulcers. Studies have informed that ulcerative colitis is caused because of genetic and immunological reasons. In the case of Anya, it is identified that her immune system is unable to work properly. This also means that her immune system which was required to attack the foreign bodies and invaders, such as the infections or common cold, is now working oppositely. In the case of ulcerative colitis, the immune system starts reacting negatively by considering food, gut bacteria as well as the cells lining the colon as the intruders, and start attacking them.
Some of the common symptoms associated with ulcerative colitis include diarrhoea, abdominal pain, as well passing of blood through stool. Evidence has informed that the patient may suffer from frequent bowel movements that may be in small volume, but it occurs as the result of irritability in the inflamed rectum. Symptoms related to loss of appetite and weight loss are associated with inflammation, which is also identified in the case of Anya. Genes are considered the major risk factor for the development of this disease because the individual who has a family history of ulcerative colitis is at a 30% or higher risk of developing this condition. For the appropriate diagnosis of ulcerative colitis, it is important to review the symptoms as well as the family history of the patient, and medical tests for making an appropriate diagnosis may include stool test, blood test as well as endoscopy. If Ulcerative colitis is not managed at the appropriate time, it can lead to various complications, such as excessive blood loss resulting in anaemia, severe dehydration because of diarrhoea, swelling in the colon, inflammation in the eyes, joints and skin as well as the increased risk of colon cancer.
Anatomy and Physiology
The lower gastrointestinal tract is found to be divided into the following parts- “the cecum, the ascending colon, the transverse colon, the descending colon, the sigmoid colon and the rectum”. The large intestine, which is also called the colorectum starts from the cecum. The cecum is identified in the form of a 2-3 inches long pouch structure, and it is an organ in which ileal content is collected that comes from the ileocecal valve. At the end of the cecum, the appendix is found, and from the upper end of the cecum ascending colon starts which is situated at the right posterior wall of the abdomen. This is further found below the ribs and under the surface of the liver. At this point ascending colon becomes the transverse colon by turning towards the midline. At the point of the splenic flexure, the colon becomes the descending colon, which is situated at the left of the abdominal wall. This descending colon ends at the rectum, where the inflammation mainly starts. Anya suffers from the incompetence of the ileocecal valve, which has resulted in increased inflammation, pain and symptoms of diarrhoea in her case. In most cases, it is identified that the reflux of noxious inflammatory mediators which starts from the colon results in causing the inflammation which is called superficial mucosal inflammation of the terminal ileum.
The main pharmacological and first-line treatment for ulcerative colitis includes the use of anti-inflammatory drugs. The most significant anti-inflammatory drug used for this purpose is 5-aminosalicylates (5-ASAs) (which can be found under the brand name Azulfidine). Anya will be recommended with 5-aminosalicylates (5-ASAs) to reduce inflammation and related symptoms. This medication can be administered orally as well as rectally or in a combination of both. According to evidence, a combination of oral and rectal medication administration is considered to be more effective. If the symptoms of inflammation would found to persist in the case of Anya even after the initial therapy, then remission therapy would be induced for her, which means she would be provided with corticosteroids. Corticosteroids are found to be beneficial in reducing the negative activity of the immune system and also limit the level of inflammation occurring in the digestive tract. The patient can also be prescribed multivitamins and multi-mineral supplements.
A healthy diet and regular exercise play an important role in managing the symptoms of ulcerative colitis as well as improving the condition of the patient. Therefore, Anya would be recommended to regularly exercise, take walks or do yoga to improve her condition. Diet would be provided to Anya with appropriate consultation with a dietician. Anya’s condition can be triggered due to environmental factors, mainly if she is genetically susceptible, therefore, she would be supported in maintaining the appropriate nutritional balance to prevent environmental triggers. The recommended diet would include fruits, vegetables, and food rich in n-3 fatty acids and low in n-6 fatty acids.
A stroke can be characterised as the condition under which the flow of blood in the human brain is obstructed or the blood vessel is rupture inside the brain, resulting in a blood clot obstructing the blood flow. In other words, stroke can be defined as the abrupt onset of the focal neurological problem, which may last for 24 hours. Computerised tomography (CT) is the most important imaging method for the immediate diagnosis of stroke. Therefore, in the case of Lucy CT scan was done to make the appropriate diagnosis. A stroke or cerebrovascular accident (CVA) may occur because of the acute defect caused by cerebral perfusion and vasculature. The burden of stroke is very high on the population as well as on the healthcare system because it is considered the leading cause of disability and mortality among older adults. Early diagnosis and treatment are considered necessary for preventing morbidity and mortality. Studies have identified that there are various causes and risk factors associated with the occurrence of stroke. Lucy is 69 years old woman, who is diagnosed with a cerebrovascular accident, which is a medical term used for the stroke.
Hypertension is one of the leading causes of ischemic stroke. Among the older adults, it is identified that hypertension is highly prevalent which increases the risk of stroke. Long term treatment with the blood thinners (anti-coagulants) accidental brain trauma, as well as deposition of protein in the blood vessels, can also be the risk factors for stroke. Studies have also informed that ageing is the non-modifiable risk factor for stroke, as three-quarters of all stroke cases occur among people above the age of 65 years. Lucy was also vulnerable to stroke because of her old age. Some of the other risk factors associated with stroke are obesity, diabetes, as well as arterial fibrillation. Some of the common symptoms of stroke may include sudden numbness of the face, legs and arms, difficulty in speaking, trouble to see with one or both eyes as well as trouble walking, and loss of balance and coordination. Lucy also displayed such signs and symptoms as she reported numb face, slurred speech and weakness in her left arm.
Anatomy and Physiology
The main physiological change that occurs in the condition of stroke is the obstruction of the oxygenated flow of blood to the brain. The main blockage in the case of stroke is identified under the middle cerebral artery (Sparaco, Ciolli and Zini, 2019). Another physiological change that could cause stroke is the rupture of the blood vessel. In the case of high cholesterol, diabetes and hypertension, blood vessels may be affected by the deposition of the plaque, and with a high level of deposition, the blood vessel may rupture resulting in the formation of a blood clot in the blood vessel. Obstruction of the blood vessels is also called atherosclerosis, which is characterised as the condition of hardening or narrowing of the arteries. Deposition of the cholesterol plaque results in reducing the diameter of the artery, which results in obstructing the flow of blood (Mayfield Clinic, 2018).
The brain is considered to be very sensitive to ischemia, and stroke can result in further damaging the brain tissues. The first-line treatment for stroke in the case of Lucy would be focused on protecting her from further neuro damage. Therefore, the pharmacological treatment will include the use of amino acid antagonists, calcium channel blockers as well as anticoagulants (Zhou et al, 2018). Anticoagulants are used for preventing further chances of stroke, therefore, the patient is recommended Warfarin which prevents blood clotting and also prevents existing clots from growing larger. Statins are also used in the treatment of stroke because they help in reducing the high cholesterol levels, which are often responsible for building plaque in the arteries and obstructing the flow of blood to the brain (Zhou et al, 2018). Thus, Lucy would be recommended Warfarin and statins, as these medications would prevent her blood from getting thick and statin would prevent the deposition of plaque in her arteries.
Some of the important non-pharmacological treatment approaches may include taking the lifestyle measures, such as restricting salt, participating in the weight loss exercise and adding more fruits and vegetables to the diet (such as the Mediterranean diet). Lucy would be recommended with such diet and physical exercise programmes after recovering from the initial condition because all such measures are found to be associated with managing the blood pressure and keeping it within acceptable limits. An appropriate nutritional diet would also be recommended to Lucy, which is important for managing problems associated with overweight or obesity.
Stage 2 chronic kidney disease is considered mild damage to the kidney. Chronic kidney disease is characterised as the condition under which kidneys gradually lose their functions. This condition is called chronic because the damage to the kidneys happens over a long period. Such damage could be responsible for interrupting the normal function of filtration of the kidney and may result in the waste building up inside the body. Under this condition, it is important to conduct the glomerular filtration rate (eGFR), which is used for measuring the number of amino acids and creatine in the blood. eGFR between 60 and 89 is considered the indication that kidneys are healthy and working well. GFR is also identified as the measurement of how many millilitres of waste fluid can be filtered by the kidney within a minute, and a normal kidney must filter more than 90ml/min. However, in the case of stage 2, there could be other signs of kidney damage even if eGFR is found to be normal. The main signs of kidney damage could be identified in the form of a higher level of protein in the urine. Some of the major causes of 2 stages of chronic kidney disease are diabetes which affects the functioning of the kidneys, obesity as well as acute kidney injury.
Some of the other causes of this condition include long term use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, blockage in the kidney because of kidney stones, as well as systematic lupus erythematosus. Signs and symptoms of chronic kidney disease include dark urine, excessive fatigue, fluid retention in the lower limbs, muscle cramps as well as itchy skin. Risk factors associated with this condition include age, lack of exercise, ethnicity, diabetes, obesity, smoking, excessive consumption of alcohol, stress as well the current use of ACE inhibitors, NSAIDs, ARBs and diuretics. In the case of Martin, the problem can be associated with the long term use of diuretics as well as his age, because it is identified that age is the major risk factor associated with a higher level of cellular degeneration. Complications associated with this condition may include disruption of the central nervous system, circulatory system, Haemolysis, atherosclerosis, bone diseases as well as pulmonary congestion.
Anatomy and Physiology
In the physiology of chronic kidney disease, it is identified that renal reserve is diminished or there is renal insufficiency, which may progress to renal failure in case of inadequate treatment. In the initial stage, it is identified that a renal tissue loses its function, and other tissues may display an increase in the performance. Due to the decreased renal function, the kidney may fail to manage the appropriate fluid balance and electrolyte homeostasis. The kidney also loses the ability to concentrate urine, which is further followed by a decrease in excreting excess levels of potassium, phosphate and other acids. With the progressive condition, the ability of the kidney to dilute the urine is lost. With the decrease of GFR, it is also found that urea and creatinine rise. With the loss of kidney function, the balance of sodium and water may also be lost. However, with the increase in sodium and water, the risk of heart failure also increases. Anatomy of the kidney has shown that when an individual suffers from chronic kidney disease, there is a decrease in the cortical volume in the kidney (in parallel with declining GFR), while the medullary volume increases. The anatomy of the kidney may also show the loss of nephron.
Treatment approaches may include modifications in the current pharmacological treatment approaches, such as restricting the NSAIDs, restricting nicotine, and aminoglycosides. Martin would be provided with NSAID that would help in managing his pain and discomfort. Other treatment strategies may include fluid and electrolyte monitoring and replacement, controlling hypertension through the use of anti-hypertensive drugs and dialysis, and kidney transplant. Martin’s blood pressure would be regularly monitored in case there are any changes. Electrolyte balance would also be maintained though documenting the liquid intake and output. Dialysis is the treatment under which waste products are removed artificially from the blood. Doctors can also do the arteriovenous (AV) fistula, which is the surgical process of joining vein and artery. Non-pharmacological interventions may include quitting smoking, making lifestyle modifications and staying hydrated. After his condition improves, Martin would also be recommended to participate in daily regular exercise and yoga, which are considered to be very beneficial in reducing stress and anxiety.