Case Study num11

You are doing a clinical on the medical-surgical floor of a local hospital when Mr. B arrives from the emergency room. Mr. B is a 32-year-old who was thrown off his bicycle in an accident; he has three fractured ribs and a punctured lung. In the ER, they inserted a chest tube to drain air and fluid out of his pleural cavity, allowing his lungs to re-expand. He had one dose of Demerol 3 hours ago for pain and a second dose just before transfer, according to the telephone report from the ER nurse.

1. How does removing air from the chest allow the lungs to expand?  

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Mr. B has been transferred to your floor to wait and see whether the chest tube allows his lungs to completely re-expand. But when he arrives, he is in severe respiratory distress. He says “I felt better before I came into the ER! Is this tube doing anything?”

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You tell the Clinical Nurse Specialist (CNS). As the two of you move him into the bed, you notice that his chest tube bottle is lying on its side on the gurney, with air going into it. When you point this out to the CNS, she immediately grabs the bottle and sets it upright on the floor. You see air start bubbling through the fluid right away. “That was the problem!” she says. “They lost the water seal, and air was going into his chest from the bottle. You would not believe how many times that happens on transport.”

When you examine Mr. B, you have trouble detecting his lung sounds on the left. Even stranger, his apical heart sound is in the wrong place--it is over toward the right side of his chest. His respiration rate and heart rate are both increased, and he is struggling to breathe. “Let's give him a little oxygen. He’ll be a lot better in a half-hour,” says the CNS. “Check back on him.”

2. Why would accumulation of air in his pleural space cause his heart sounds to be in the wrong place?

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While Mr. B is recovering, you check on your other patients. Mrs. H, a 57-year-old first-day post-cholecystectomy patient, is also showing signs of rapid breathing, increased heart rate, and decreased pulse oximeter readings. You ask if she has been using her incentive spirometer to make sure she breathes deeply, and she says, “It hurts my belly incision. There wasn’t anything wrong with my lungs anyway.”

“There will be if you don't use it! You really need to do that at least once an hour. It's to keep your alveoli from collapsing.”

“Why would they collapse? The doctors didn't do anything to them, unless that anesthesia gas was toxic.”

3. Why would a post-surgical patient's lungs collapse if there was nothing wrong with them before surgery?

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4. Explain the role of surfactant in the lungs.

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Harold has had a history of malnutrition secondary to a severe eating disorder. He fatigued very easily, suffers from SOB and dizziness. A CBC shows a hematocrit below 35% and a blood smear shows macrocytic red blood cells. What is Harold’s presumptive diagnosis? How can the immediate condition be treated? What is meant by macrocytic? What is the normal CBC range for a male?

You are walking down the street and are startled by a car which backfires in the street. Briefly describe the process of sensing and responding to this auditory stimulus. Be very specific about the efferent pathway that will be involved in your response. Include nervous system division, neurotransmitter(s) that will be utilized and stimulations of effector(s).

During the 18th century, many scholars became interested in biological diversity, human origins, and our position within the classification of plants and animals. Why do you think this interest arose at this time, at least in Europe? Think of historical events that led to the realization that the world is more diverse than previously thought?

Suppose you perform an alien autopsy on a creature from Area 51. You discover that instead of having a sodium/potassium pump, it has a sodium/magnesium pump. It works just the same, but pumps an ion of magnesium in place of each ion of potassium. Will the resting membrane potential (RMP) be more positive or more negative? Will the electrical gradient be larger or smaller? Explain your answer. (Hint: Magnesium has a charge of +2)       

why the spinal cord is organized in the way it is white matter surrounding gray matter?

Bulk flow of water and solutes forced from the glomerulus into the glomerular (Bowman’s) capsule because of high pressure is known as the process of:

A. diffusion

B. filtration

C. active transport

D. osmosis

Tell the following as a story. Use your own words saying each vessel as you would a list of roads you would drive on to get to the shore and back from campus.  

Trace a red blood cell from the left ventricle to the left 5^th toe and back to the left ventricle.

Discuss the role of vitamin K dependent factors in haemostasis, citing the importance of running liver function test in cases of haemostatic abnormality?

Tell the following as a story in your own words listing each vessel as you would a list of roads you would drive on to get to the beach and back from campus.  

Trace a red blood cell from the left ventricle to the right 5^th finger (pinky) and back to the left ventricle.

7. A signal molecule binds to a receptor and upregulates IP3. In this scenario... choose all correct (10 pts)

A) The signal molecule must be lipophilic

B) The signal molecule is the first messenger and IP3 is the second messenger

C) The receptor is a G-protein coupled receptor

D) The receptor is a catalytic receptor

5. True/False –regarding receptor proteins (RP) (10 pts)

A) RPs exhibit specificity, saturation, and competition, similar to carrier proteins.

B) RPs may be peripheral membrane proteins or may be nuclear or cytosolic proteins.

C) RPs function as the sensors in reflex pathways.

D) Activated RPs may repress rather than upregulate a gene.

E) Upregulation or downregulation of RPs occurs via receptor number.

In 500-1000 words (1-2 pages, double-spaced), provide an explanation of "Socioeconomic Status/Poverty and climate change – i.e. extreme weather (harsher winters and summers) and droughts, as two outcomes of climate change, disproportionately affect poorer individuals" and why/how it affects populations as a matter of public health. You can use the provided examples above as a starting point, but they cannot be the only example you provide.

1. What is the functional relationship between the integumentary and skeletal systems?
2. How does failure to maintain homeostasis in the integumentary system affect bone formation and remodeling processes? Be sure to discuss how the different types of bone cells respond to different factors (e.g., ions, hormones, cellular signaling molecules, etc.) and what the driving force behind maintaining homeostasis in the bone remodeling process.
3. Describe the pathogenesis of osteoporosis and explain why it is considered a multifactorial disease.
4. How do current therapies address these failures to maintain homeostasis and ameliorate the effects of osteoporosis?