Assignment Task
RESEARCH AND EVIDENCE
The student is able to integrate research and evidence based guidelines in a scholarly way
Maximum score25
ANALYSIS AND CRITICAL THINKING
The student demonstrates evidence of critical thinking in their answer
Maximum score25
WRITING The student writing is consistent with the ACN guidelines
Maximum score5
REFERENCING The student demonstrates knowledge of referencing according to the ACN guidelines
Maximum score10
electronically viathe Turnitin portal. Case study: SaritaSarita is a 22-year-old overseas student who has been living in Australia for 18 months. She has been very fit, participating in many athletic events since childhood. Except for glandular fever as a teenager, Sarita has an unremarkable medical history. Over the past weeks she has experienced significant lethargy, anorexia, general aches and pains and non-specific bruising. She was reviewed by her GP who ordered blood tests and prescribed analgesics and anti-inflammatory medications. As her symptoms were not improving, Sarita was admitted yesterday for further investigations in view of an abnormal blood count.
Clinical assessment reveals:
HR 95 beats/minute
BP 100/60 mmHg
RR 18 breaths/minute
Temperature 38.2ºC
SpO2 92%
Blood pathology Suggested normal range
WBC 40 000 (4800–10 800 cells/?l [mm3] of blood)
Hb 85 g/L
Platelets 12 000 (150 000–400 000 cells/?l [mm3] of blood)
Sarita has been given the diagnosis of acute lymphocytic leukaemia and is awaiting further results and a management plan. Today she is anxious and has developed nose bleeds, a cough and a fever 38.2ºC. She is also suffering from an upper respiratory tract infection. Her mother has arrived from from India to be with her.
Management includes:
IV Fluids
3 units of packed cells
Ibuprofen
Panadeine FORTE®
CXR
The purpose of this assessment is to demonstrate your knowledge and understanding of complex pathophysiology related to a young person presenting with a significant immune disorder. This case analysis will enable you to explore the concepts of immune dysfunction, stress response, pain pathways and the associated clinical signs and symptoms. Sarita’s presentation is in the case studies folder and will be used to guide your discussion. Please complete all three parts.
Part A (750 words)
Physical examination shows that Sarita has pain and tenderness consistent with enlarged spleen. She also states that she is experiencing right lateral chest pain; exacerbated on inspiration. Panadeine forte and Ibuprofen were prescribed.
• Explain the types of pain Sarita is experiencing: outlining the pain pathways and the associated neurotransmitters.
• Discuss the positive and negative consequences of her prescribed analgesics on her clinical status. What impact will these medications have on her existing comorbidities, such as infection and bleeding.B (750 words)
As a result of her hospitalisation and symptoms, Sarita is experiencing physical and psychological stress or the “alarm stage” of stress response.
• Analyse the effects of the alarm and resistance stages on Sarita’s immune and cardiovascular systems
• Explain how prolonged stress response could lead to neuro-endocrine exhaustion phase and irreversible systemic dysfunction such overwhelming sepsis.
Part C (1000 words)
Sarita’s diagnosis of leukaemia, the presence of infection as well her clinical findings show that the disease is advanced and potentially life threatening.
• Discuss the immune aspects and cellular changes associated with Sarita’s leukaemia
• Outline Sarita’s risk of bleeding and potential sites of haemorrhage (e.g. mucous membranes) that need to be assessed if her heart rate continues to rise
• Explain how intravascular fluids and pack cells will stabilise Sarita and prevent further deterioration in her condition. What parameters will need continued monitoringResources
As we have seen in previous themes, homeostasis is maintained through various feedback mechanisms. Understanding the physiology that supports homeostasis, we are better able to interpret the complex array of body’s responses to stress and illness related to homeostatic imbalance.
Loss of homeostasis impacts most body systems and is mediated via the autonomic nervous system. In particular, stress response is generated through the activity of the parasympathetic and the sympathetic nervous systems
Parasympathetic nervous system – we look at the components of the parasympathetic nervous system, the impact of cholinergic and anticholinergic medications on neurotransmission and implications for the compromised patient.
Sympathetic nervous system – we examine the role of the sympathetic nervous system in the stress response, and the implications of adrenergic and noradrenergic drugs on neurotransmission and the stress response.
Pain as a stressor – this explores the concept of pain, types of pain and physiological pathways of pain in relation to the stress response.
Content in the theme will explore:
disruption to homeostatic control
stress response and the ramifications on clinical assessment findings
actions and impact of commonly used drugs on patients experiencing the stress response
physiological impact of cholinergic and noradrenergic drugs
types of pain and the relationships between chronic and acute pain and the stress response
clinical assessment findings and predict changes in relation to the patient’s response to stress. Loss of homeostasis
Maintenance of homeostatic equilibrium requires the communication pathways between body systems to function smoothly. The nervous and endocrine systems utilise neural electrical impulses or bloodborne hormones as information carriers to enable them to work together. Homeostasis can be disrupted by pathogens, diseases and toxins. Nervous system generally responds rapidly to counteract the disrupting elements. The endocrine system is slower to act and can have more lasting consequences.
Examples of body functions under constant equilibrium are PB, blood pH, temperature, ventilation etc. All body components; from cells to body organs contribute in some aspect of homeostasis and the preservation of normal body functions. For example; high performance athletes push their bodies to the limit to change their cellular and organ function. They can derive significant physical benefits from intensive training. However, over-training can overwhelm the body’s homeostatic processes, resulting in injury and health breakdown. (Tortora & Derrickson 2019, p. 11)
Our innate resistance to stress and the body’s healing powers can be disrupted by many factors such as: genetic makeup, the environment, our behaviour and even our psychological disposition. Our internal environment is under constant challenge to avoid disorders and restore health if diseases do occur. (Tortora & Derrickson 2019, p. 17)
heme 5 Learning guide – Topics 1-2
Pathogens and body temperature response
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