NUR 606 Assignment Population-Specific Case Study

Thank you for an amazing discussion post; I found it to be remarkably interesting. The purpose of this reply post is to reveal two key concepts from your research discussion and explain how I can use that knowledge in future practice as an AGACNP. As a mother of four children, I thought I knew all there was to know about amniocentesis. After reading your discussion post and article, there is more to learn. The first key concept I learned is that amniocentesis, that the following was an indication for a referral for amniocentesis, mothers age, gestational age based on the first day of the last menstrual period (LMP), body mass index (BMI), mother’s blood group, underlying diseases and medical records in previous pregnancies (Tara et al., 2016). I was unaware that body mass index played a role in referring for an amniocentesis. The second key concept I learned from your discussion post and article is that amniotic fluid leakage starts from 24 to 72 hours after amniocentesis and stops during the one-week follow visit (Tara et al., 2016). It surprises me to know how quickly the amniotic fluid can start leaking and that spotting starts at the same time as well. In a study by Thomas (2019), an ounce of amniotic fluid is usually needed. About 80% of women have two attempts of the amniocentesis procedure to get enough fluid for testing. Meaning the syringe attached to the needle is inserted twice, which could bring out those women at higher risk for leakage. As a future AGACNP, I may find myself caring for a woman with amniotic fluid leakage and blood spotting after an amniocentesis if she was to present at urgent care or emergency room. Many patients feel sicker at night, and her OBGYN would be closed, and she would be referred to the nearest emergency room for evaluation. I would then perform a pelvic examination, place her on a fetal monitor, and perform blood work to assess for spontaneous abortion. Thank you for a highly informative post. The part of these discussion posts I like the most is reading about all the different disorders and learning from them.

Resources:

Tara, F., Lotfalizadeh, M., & Moeindarbari, S. (2016). The effect of diagnostic amniocentesis and its complications on early spontaneous abortion. Electronic physician, 8(8), 2787–2792. https://doi.org/10.19082/2787

Thomas, L. (2019). Amniocentesis Procedure. News Medical Life Science https://www.news-medical.net/health/Amniocentesis-Procedure.aspx

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS NUR 606 Assignment Population-Specific Case Study:

Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?

Hepatitis is a group of different viruses that attack the liver cells called hepatocytes. In hepatitis B, the cells become damaged through a cell-mediated immune response to the virus. The antigens of this virus include HBcAg, HBeAg, and HBsAg. Recognizing these antigens in the blood is important for diagnosis and further monitoring the course of Hepatitis B. If these antigens continually stay in the blood, especially HBsAg, then the individual is at a higher risk of chronic hepatitis B. If the antigens rise and then fall, it is most likely acute (Hubert & VanMeter, 2018, p. 461).

If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?

There is no direct treatment that can fully destroy the virus even in the early stages. However, immune therapy (Gamma globulin) can be given to boost the patient’s immune system and help fight the disease. This treatment works best if given immediately, within 7-14 days of exposure.

Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.

Acute hepatitis has three stages: preicteric, icteric, and posticteric. The first stage, preicteric, is subtle may only show signs of elevated AST/ALT (liver enzymes), fever, and muscle aches (Hubert & VanMeter, 2018, p. 462). When the inflammation of the liver persists, the bile duct becomes blocked and leads to a backup of waste including bilirubin. The following phase, the icteric stage, is marked by jaundice due to the increase in bilirubin. Three common signs of the icteric stage include light colored stools, dark urine, and itchy skin (Hubert & VanMeter, 2018, p. 462). J.B. can transmit the virus from the preinteric stage even if asymptomatic. It can be transmitted through blood and other body fluids. Examples of transmission include birth, sex, drug use through a needle, sharing toothbrushes & razors, various medical equipment, or hemodialysis (CDC, 2020).

NUR 606 Assignment Population-Specific Case Study

What serum markers remain high when chronic hepatitis B is present?

HBsAg is a hallmark serum marker of hepatitis. If this antigen consistently remains in the blood after six months, it implies chronic hepatitis B. The presence of anti-HBc is also another marker of chronic infection (Hubert & VanMeter, 2018, p. 462)..

Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

In chronic hepatitis B, the hepatocytes are constantly being inflamed leading to necrosis. As these cells die, fibrous scar tissue forms on the liver leading to obstruction and decreased blood supply causing permanent damage and cirrhosis. The early stages are often asymptomatic and may only have vague mild signs of fatigue, anorexia, weight loss, and diarrhea (Hubert & VanMeter, 2018, p. 458).

Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.

As the liver becomes cirrhotic, its function severely decreases. It cannot produce enough clotting factors or absorb and store iron and vitamin B12 leading to anemia and increased bleeding. Ammonia is a waste product of protein and is metabolized by the liver to be further excreted by the kidneys in urine. When the cirrhotic liver cannot remove the waste, ammonia builds up in the blood causing hepatic encephalopathy leading to muscle twitching and confusion (Eberhardt & Topka, 2017).

Resources:

Centers for Disease Control and Prevention (CDC). (2020, July 28). Hepatitis B Questions and Answers for Health Professionals. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

Eberhardt, O., & Topka, H. (2017). Myoclonic Disorders. Brain sciences, 7(8), 103. https://doi.org/10.3390/brainsci7080103

Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions(6th ed.). Elsevier

NUR 660 Team Week 12 Discussion 1 Case Study Discussion A: Gastroenteritis

Baby K., age 14 months, has vomiting and diarrhea and is crying continuously because of what appears to be severe abdominal pain. As part of your history, you discover Baby K. had some milk custard that may not have been properly stored. The most likely diagnosis is gastroenteritis, secondary to Staphylococcus aureus from the milk custard.

Briefly describe how S. aureus in the custard could cause vomiting and diarrhea.

According to Hubert & VanMeter (2018), inflammation of the gastric mucosa stimulates vomiting and diarrhea results from when the inflammation of the intestines causes increased motility, impaired absorption, and increased secretions. Due to the inadequate storage of the custard, enterotoxin invaded the body. The body’s natural defense is to get rid of the infectious agent, which manifested as vomiting and diarrhea.

What fluid and electrolyte imbalances would you expect in Baby K.? Please describe how at least one fluid and one electrolyte imbalance could develop in this situation.

The loss of fluid, particularly water, from vomiting and diarrhea can lead to dehydration. The vomiting of gastric or intestinal contents most commonly involves the loss of fluid that contains chloride, potassium, sodium, and bicarbonate. Diarrhea can also result in hypokalemia (Tello et al., 2017). Hypovolemia, hyponatremia, hypernatremia, and hypokalemia are common and significant concerns for patients with profound fluid loss, like in Baby K.

Describe the signs of dehydration that can be expected in a child of this age. What about in an older child?

In babies, cardinal signs of dehydration include fewer than six wet diapers per day (for infants), no wet diapers or urination for eight hours (in toddlers), as well as sunken soft spots (fontanel) on the infant’s head. In children of all ages, other signs of dehydration include dry tongue and dry lips, no tears when crying, sunken eyes, dry and wrinkled skin, deep/ rapid breathing, and cool and blotchy hands and feet (Cleveland Clinic, 2021).

Explain the process and factors involved by which a young child can quickly develop vascular collapse if vomiting and diarrhea are severe.

If vomiting and diarrhea are severe, severe dehydration will occur. Vega & Avva (2021) discuss how severely dehydrated patients can present with vascular collapse. These signs include altered mental status, lethargy, tachycardia, hypotension, signs of poor perfusion, weak thready pulses, and delayed capillary refill. The body’s natural response is to protect the vital organs, such as the heart, brain, kidneys, and lungs. Poor perfusion, weak thready pulses, and delayed capillary refill are a result of the blood and remaining fluid protecting the vital organs. Tachycardia and hypotension are a result of the body pumping blood and fluids to the organs to compensate for the losses.

Explain why water alone would not be adequate treatment for Baby K.

Water alone is not an adequate treatment for Baby K because it does not replace the electrolytes lost through vomiting and diarrhea. Oral rehydration therapy, which includes fluids, salts, and other electrolytes, should be used for moderate dehydration and the initiation of intravenous fluids for severe dehydration.

What other gastrointestinal conditions could cause vomiting and diarrhea in a young child? How will you definitively determine what condition is causing her symptoms?

Other gastrointestinal conditions that can cause vomiting and diarrhea in young children are seasonal viral infections, bacterial, or parasitic infections. Viral infections include rotavirus, influenza, and the Norwalk virus. Bacterial infections include E. coli, C. difficile, and Salmonella. These can all cause gastrointestinal upset. To help determine what condition is causing the patient’s symptoms, a quick history of the patient’s symptoms, food log, or any recent travels can be discussed. Blood and stool specimens may also be needed to help diagnose the specific infectious agent.

References:

Cleveland Clinic. (2021). Dehydration in Children: Signs, Treatments. https://my.clevelandclinic.org/health/articles/8276-dehydration-and-your-child

Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions (Access Code and Textbook Package) (6th ed.). Saunders.

Tello, L., & Perez-Freytes, R. (2017). Fluid and Electrolyte Therapy During Vomiting and Diarrhea. The Veterinary clinics of North America. Small animal practice, 47(2), 505–519. https://doi.org/10.1016/j.cvsm.2016.09.013 Vega R. M., & Avva U. (

NUR 606 Assignment Population-Specific Case Study