Hello everyone,

Heart failure (HF) is a chronic, progressive condition in which the heart cannot effectively circulate enough blood to meet the body’s needs. It occurs due to structural or functional issues that disrupt the heart’s ability to fill or eject blood properly. The pathophysiology of HF involves neurohormonal activation, including the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, leading to fluid retention, vasoconstriction, and myocardial remodeling (McDonagh et al., 2021).

Janessa’s symptoms, such as shortness of breath, weakness, and dizziness, may suggest HF, as reduced cardiac output and impaired tissue perfusion contribute to these manifestations. However, the absence of lung congestion and the presence of pale mucous membranes are not typical HF symptoms. HF is often associated with pulmonary congestion, which presents crackles on auscultation and symptoms like orthopnea or paroxysmal nocturnal dyspnea. The finding of pale mucous membranes suggests a different underlying cause such as anemia.

While HF may partially explain Janessa’s symptoms, the lack of fluid retention, including edema or pulmonary congestion, makes it a less likely primary diagnosis. However, anemia and HF can coexist, as anemia increases cardiac workload and reduces oxygen delivery, exacerbating HF symptoms (Groenewegen et al., 2020).

For my peers assigned asthma, you might suggest that Janessa’s shortness of breath is due to airway obstruction and inflammation. However, her clear lung sounds and absence of wheezing do not strongly support an asthma diagnosis.

Diagnostic testing that would be most appropriate to investigate HF:

• B-type Natriuretic Peptide: Elevated levels indicate HF.
• Echocardiogram: This assesses left ventricular ejection fraction (LVEF) and structural abnormalities.
• Electrocardiogram: Identifies arrhythmias or ischemic changes.
• Chest X-ray: Detects pulmonary congestion or cardiomegaly.
• Complete Blood Count: Evaluates for anemia, which may contribute to her symptoms.
• Serum Electrolytes and Renal Function Tests: Assess complications related to HF, such as hyponatremia or kidney dysfunction.

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. European Journal of Heart Failure, 22(8), 1342-1356. https://doi.org/10.1002/ejhf.1929

McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., … & Anker, S. D. (2021). 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599-3726. https://doi.org/10.1093/eurheartj/ehab368

 

J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Describe your clinical experience for this week. This is for a children/family clinical. Please make case about 17 year old female

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources within 5 years 2020-2025. 

Describe your first clinical experience for the week

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.