Discussion 1: Cardiovascular Alterations

At least once a year, the media report on a seemingly healthy teenage athlete collapsing during a sports game and dying of heart complications. These incidents continue to outline the importance of physical exams and health screenings for teenagers, especially those who play sports. During these health screenings, examiners check for cardiovascular alterations such as heart murmurs because they can be a sign of an underlying heart disorder. Since many heart alterations rarely have symptoms, they are easy to miss if health professionals are not specifically looking for them. Once cardiovascular alterations are identified in patients, it is important to refer them to specialists who can further investigate the cause.
Consider the following scenario:

A 16-year-old male presents for a sports participation examination. He has no significant medical history and no family history suggestive of risk for premature cardiac death. The patient is examined while sitting slightly recumbent on the exam table and the advanced practice nurse appreciates a grade II/VI systolic murmur heard loudest at the apex of the heart. Other physical findings are within normal limits, the patient denies any cardiovascular symptoms, and a neuromuscular examination is within normal limits. He is cleared with no activity restriction. Later in the season he collapses on the field and dies.

To prepare:

• Review the scenario provided, as well as Chapter 24 in the Huether and McCance text. Consider how you would diagnose and prescribe treatment for the patient.

• Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact diagnosis and prescription of treatment for the patient in the scenario.

1. a description of how you would diagnose and prescribe treatment for the patient in the scenario.

2. Then explain how the factor you selected might impact the diagnosis and prescription of treatment for that patient.

Discussion 2: Anaphylactic Shock

The treatment of anaphylactic shock varies depending on a patient's physiological response to the alteration. Immediate medical intervention and emergency room visits are vital for some patients, while others can be treated through basic outpatient care.
Consider the January 2012 report of a 6-year-old girl who went to her school nurse complaining of hives and shortness of breath. Since the school did not have any medication under her name to use for treatment and was not equipped to handle her condition, she was sent to an emergency room where she was pronounced dead. This situation has raised numerous questions about the progression of allergic reactions, how to treat students with severe allergies, how to treat students who develop allergic reactions for the first time, and the availability of epinephrine in schools. If you were the nurse at the girl's school, how would you have handled the situation? How do you know when it is appropriate to treat patients yourself and when to refer them to emergency care?

To prepare:

• Review "Anaphylactic Shock" in Chapter 23 of the Huether and McCance text, "Distributive Shock" in Chapter 10 of the McPhee and Hammer text, and the Jacobsen and Gratton article in the Learning Resources.

• Identify the multisystem physiologic progression that occurs in anaphylactic shock. Think about how these multisystem events can occur in a very short period of time.

• Consider when you should refer patients to emergency care versus treating as an outpatient.

• Select two patient factors different from the one you selected in this week's first Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the process of anaphylactic shock.

1. an explanation of the physiological progression that occurs in anaphylactic shock.

2. Then, describe the circumstances under which you would refer patients for emergency care versus treating as an outpatient.

3. Finally, explain how the patient factors you selected might impact the process of anaphylactic shock.

Course readings

• Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

o Chapter 22, "Structure and Function of the Cardiovascular and Lymphatic Systems"

This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.

o Chapter 23, "Alterations of Cardiovascular Function"

This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.

o Chapter 24, "Alterations of Cardiovascular Function in Children"

This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart diseases from acquired cardiovascular disorders.

• McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.

o Chapter 10, "Cardiovascular Disorders: Heart Disease"

This chapter begins by exploring the normal structure and function of the heart. It then examines the etiology, pathophysiology, and clinical manifestations of five heart disorders: arrhythmias, congestive heart failure, valvular heart disease, coronary artery disease, and pericardial disease.

• Jacobsen, R. C., & Gratton, M. C. (2011). A case of unrecognized prehospital anaphylactic shock.Prehospital Emergency Care, 15(1), 61-66.

Retrieved from the Walden Library databases.

This article provides information relating to the diagnosis and management of anaphylactic shock. It also explores difficulties encountered when diagnosing uncommon clinical presentations of anaphylactic shock.