Evaluate the presence and effects of alteration in the homeostatic state secondary to gender, genetic, ethnic and temporal variables

Select one of the case studies below, and include in your discussion an evaluation of the presence and effects of alteration in the homeostatic state secondary to gender, genetic, ethnic, and temporal variables.

Requirements:

1. Make sure all of the topics in the case study have been addressed.
2. Cite at least three sources; journal articles, textbooks or evidenced-based websites to support the content.
3. All sources must be within 5 years.
4. Do not use .com, Wikipedia, or up-to-date, etc., for your sources. 

Case Study 1

Structure and Function of the Respiratory System

Brad is 45 years old and has been working as a coal cutter in a mine for the last 25 years. He likes the job because it pays well and the same mine had employed his father. Like many of his colleagues, Brad has had problems with a chronic cough. He has avoided his annual checkups for fear that he will be told he has “black lung,” or coal worker’s pneumoconiosis. The disease causes fibrosis, decreased diffusing capacity, and permanent small airway dilation. In later stages, pulmonary capillaries, alveoli, and airways are destroyed. 

1. How can the disease described above create a mismatch between ventilation and perfusion? Use your understanding of alveolar dead space and physiologic shunt to explain your answer.
2. Individuals with chronic obstructive pulmonary disease have more difficulty exhaling than inhaling. Why is this so?
3. In general terms, what mechanisms in lung disease can affect diffusing capacity across alveolar membranes? Use the Fick law to explain your answer.

Case Study 2

Respiratory Tract Infections, Neoplasms, and Childhood Disorders 

Patricia was called at work by a woman at the local daycare center. She told Patricia to come and pick up her son because he was not feeling well. Her son, three-and-a-half-year-old Marshall, had been feeling tired and achy when he woke up. While at daycare, his cheeks had become red and he was warm to touch. He did not want to play with his friends, and by the time Patricia arrived, he was crying. Later that afternoon, Marshall’s condition worsened. He had fever, chills, a sore throat, runny nose, and a dry hacking cough. Suspecting Marshall had influenza, Patricia wrapped him up and took him to the community health care clinic.

1. Why did Marshall’s presentation lead Patricia to think he had influenza and not a cold? Why is it important to medically evaluate and diagnose a potential influenza infection?
2. Describe the pathophysiology of the influenza virus. Outline the properties of influenza A antigens that allow them to exert their effects in the host.
3. Marshall may be at risk at contracting secondary bacterial pneumonia. Why is this so? Explain why cyanosis may be a feature associated with pneumonia.

Case Study 3

Disorders of Ventilation and Gas Exchange

Emmanuel and his mother live in an urban community housing complex. The building is worn down and dirty from the urban dust, cockroaches, and mold. Emmanuel is five years of age and has suffered from asthma for the last two years. One evening, his mother poured him some milk and put him to bed. Shortly afterward, Emmanuel woke up wheezing and coughing. As he gasped for air, he became more and more anxious. His mother ran for his inhaler, but he was too upset and restless to use it. Emmanuel’s skin became moist with sweat, and as he began to tire, his wheezing became quieter. His mother called 911 and waited anxiously for the ambulance to arrive. 

1. Emmanuel uses a corticosteroid inhaler for the management of his asthma. What is the mechanism of action of this drug? How is its action different from the β2-agonist inhalants?
2. Why does someone with severe asthma become physically fatigued during a prolonged attack? What are the physiological events that occur during an attack?
3. One of the complications of respiratory fatigue is the development of hypercapnia. How does the body compensate for an increase in CO2? What are the effects of hypercapnia on the central nervous system?

Assignment Requirements:

Before finalizing your work, you should:

• Ensure you have written at least four double-spaced pages.
• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.
• follow the conventions of Standard American English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 6th Edition format.

To see your assignment instructions and grading rubric, go to Course Resources / Grading Rubrics.

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Complete the following:

• African-American case study #2
• Appalachian case study #1

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FRICAN AMERICAN CASE STUDY #2
Mr. and Mrs. Evans are an African American couple who retired from the school
system last year. Both are 65 years of age a
nd reside on 20 acres of
land in a large rural
community approximately 5 miles from a Superfund site and 20 miles from two
chemical plants. Their household consists of
their two daughters, Anna, aged 40 years,
and Dorothy, aged 42 years; their grandc
hildren, aged 25, 20, 19, and 18; and their 2-
year-old great-grandson. Anna and Doro
thy and their children all attended the
university.
Mr. Evans’s mother and three of his
nieces and nephews live next door. Mr.
Evans’s mother has brothers, sisters, ot
her sons and daughters, grandchildren, and
great-grandchildren who live ac
ross the road on 10 acres of land. Other immediate and
extended family live on the 80 acres adjacent
to Mr. Evans’s mother. All members of
the Evans family own the land on which they live.
Mrs. Evans has siblings and extended fa
mily living on 70 acres of land adjacent
to Mr. Evans’s family, who live across the road. Mr. and Mrs. Evans also have family
living in Chicago, Detroit, New York, Sa
n Francisco, and Houston. Once a year, the
families come together for a reunion. Every other month, local family members come
together for a social hour. The family believes in
strict discipline with
lots of love. It is
common to see adult members of the family
discipline the younger children, regardless
of who the parents are.

Mr. Evans has hypertension and diabetes
. Mrs. Evans has hypertension. Both
are on medication. Their daughter Dorothy is
bipolar and is on me
dication. Within the
last 5 years, Mr. Evans has had several re
latives diagnosed with lung cancer and colon
cancer. One of his maternal uncles died last
year from lung cancer. Mrs. Evans has
indicated on her driver’s licen
se that she is an organ donor.
Sources of income for Mr. and Mrs. Ev
ans are their pensions from the school
system and Social Security. Dorothy receives SSI because she is unable to work any
longer. Mr. Evans and his br
others must assume responsibility for their mother’s
medical bills and medication. Although she ha
s Medicare parts A and B, many of her
expenses are not covered.
Mr. and Mrs. Evans, all members of th
eir household, and al
l other extended
family in the community attend a large Bap
tist church in the city. Several family
members, including Mr. and Mrs. Evans, sing
in the choir, are members of the usher
board, teach Bible classes,
and do community ministry.
Study Questions
1.
Describe the organizational st
ructure of this family and identify strengths and  
   limitations of this
family structure
.
2.
Describe and give examples of what you be
lieve to be the family’s values about  
   education.    
       3.  Discuss this family’s
views about child rearing.

       4. Discuss the role that spirituality plays in this family.
5.
Identify two religious or spiritual practices in which members of the Evans
   family may engage for treating hypert
ension, diabetes, and mental illness.
6.
Identify and discuss cultural
views that Dorothy and her parents may have about  
   mental illness and medication.
7.
To what extent are members of the Evans fa
mily at risk for illnesses associated  
   with environmental hazards?
8.
Susan has decided to become an organ donor. Describe how you think the Evans  
   family will respond to her decision.
       9. Discuss views that African Ameri
cans have about advanced directives.
       10. Name two dietary health risks for African Americans.
11.
Identify five characteristics to consider
when assessing the skin of African  
     Americans.      
       12. Describe two taboo views that Afri
can Americans may have about pregnancy.

AMISH CASE STUDY
Elmer and Mary Miller, both 35 years old, liv
e with their five children in the main
house on the family farmstead in one of th
e largest Amish settlements in Indiana.
Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’
cottage. Mary is the youngest of their ei
ght children, and when she married, she and
Elmer moved into the grandparents’ cottage
with the intention that Elmer would take
over the farm when Aaron wanted to retire.
Eight years ago, they traded living space.
Now, Aaron continues to help with
the farm work, despite increasing pain in hi
s hip, which the doctor advises should be
replaced. Most of Mary’s and Elmer’s sibli
ngs live in the area, though not in the same
church district or settlement. Two of Elmer’s brothers and their families recently
moved to Tennessee, where farms are less expensive and where they are helping to
start a new church district.
Mary and Elmer’s fifth child, Melvin,
was born 6 weeks prematurely and is 1
month old. Sarah, aged 13, Martin, aged
12, and Wayne, aged 8, attend the Amish
elementary school located 1 mile from thei
r home. Lucille, aged 4, is staying with
Mary’s sister and her family for a w
eek because baby Melvin has been having
respiratory problems and their physician told
the family he will need to be hospitalized
if he does not get better within 2 days.
At the doctor’s office, Mary suggested
to one nurse, who often talks with Mary
about “Amish ways,” that Menno Martin, an
Amish man who “gives treatments,” may
be able to help. He uses “warm hands” to
treat people and is
especially good with

babies because he can feel what is wrong. Th
e nurse noticed that Mary carefully placed
the baby on a pillow as she prepared to leave.
Elmer and Mary do not carry any hea
lth insurance and are concerned about
paying the doctor and hospital bills associat
ed with this complicated pregnancy. In
addition, they have an appointment for Wayne
to be seen at Rile
y Children’s Hospital,
3 hours away at the University Medical Cent
er in Indianapolis, for a recurring cyst
located behind his left ear. Plans are being
made for a driver to take Mary, Elmer,
Wayne, Aaron, Annie, and two of Mary’s sist
ers to Indianapolis
for the appointment.
Because it is on the way, they plan to stop in
Fort Wayne to see an Amish healer who
gives nutritional advice and does “treatment
s.” Aaron, Annie, and Elmer have been
there before, and the other women are considering having treatments, too. Many
Amish and non-Amish go there and tell others
how much better they feel after the
treatments.
They know their medical expenses seem minor in comparison to the family
who last week lost their barn in a fire
and to the young couple whose 10-year-old child
had brain surgery after a fall from the hayl
oft. Elmer gave mone
y to help with the
expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s
sisters will help to cook for the barn raisi
ng, but Mary will not help this time because
of the need to care for her newborn.
The state health department is concer
ned about the low immunization rates in
the Amish communities. One community-health nurse, who works in the area where
Elmer and Mary live, has volunteered to talk
with Elmer, who is on the Amish school
board. The nurse wants to learn how the health
department can work more closely with

the Amish and also learn more about what
the people know about immunizations. The
county health commissioner thinks this is a wast
e of time and that what they need to do
is let the Amish know that they are creating
a health hazard by ne
glecting or refusing
to have their children immunized.
Study Questions
1.
Develop three open-ended questions or
statements to guide you in your
understanding of Mary and Elmer and what
health and caring mean
to them and to
the Amish culture.
2.    List four or five areas of perinatal
care that you would want to discuss with Mary.
3.    Why do you think Mary placed the baby
on a pillow as she was leaving the doctor’s
office?
4.     If you were the nurse to whom Mrs. Mill
er confided her interest in taking the baby
to the folk healer, what would you do to le
arn more about their simultaneous use of
folk and professiona
l health services?
5.     List three items to discuss with the M
illers to prepare them fo
r their consultation at
the medical center.
6.    If you were preparing the reference fo
r consultation, what would you mention about
the Millers that would help to promote cu
lturally congruent ca
re at the medical
center?
7.    Imagine yourself participa
ting in a meeting with state
and local health department
officials and several local physicians and nur
ses to develop a plan to increase the

immunization rates in the
counties with large Amish
populations. What would you
suggest as ways to accomplish this goal?
8.
Discuss two reasons why many Old Orde
r Amish choose not to carry health
insurance.
9.
Name three health problems with genetic
links that are prevalent in some Amish
communities.
10.
How might health-care providers use the
Amish values of the three-generational
family and their visiting patterns in pr
omoting health in the Amish community?
11.   List three Amish values to consid
er in prenatal education classes.
12.
Develop a nutritional guide for Amish wome
n who are interested in losing weight.
Consider Amish values, daily lifestyl
e, and food production and preparation
patterns.
13.   List three ways in which Amish express caring.

APPALACHIAN CASE STUDY #1
William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an
isolated rural area of northern Appalachia
to Denver, Colorado, because of Gloria’s
failing health. Mrs. Kapp has had pulmonary t
uberculosis for several years. They decided
to move to New Mexico because they heard that the climate was better for Mrs. Kapp’s
pulmonary condition. For an unknown reason, they stayed in Denver, where William
obtained employment making machine parts.
The Kapp’s oldest daughter, Ruth, ag
ed 20, Ruth’s husband, Roy, aged 24, and
their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for
her ailing mother. After 2 months, Roy return
ed to northern Appalachia because he was
unable to find work in Denver. Ruth is 3 months’ pregnant.
Because Mrs. Kapp has been feeling “mor
e poorly” in the last few days, she has
come to the clinic and is accompanied by her husband, William, her daughter Ruth, and
her granddaughter, Rebecca. On admission, Glor
ia is expectorating greenish sputum,
which her husband estimates to be about a teac
upful each day. Gloria is 5 ft 5 in. tall and
weighs 92 pounds. Her temperature is 101.4°F,
her pulse is regular at 96 beats per
minute, and her respirations are 30 per minute
and labored. Her skin is dry and scaly with
poor turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional
historical and demographic da
ta from Mr. Kapp and Ruth. Th
e nurse finds that Ruth has
had no prenatal care and that her first chil
d, Rebecca, was delivered at home with the
assistance of a neighbor. Rebecca is pale and
suffers from frequent bouts of diarrhea and

colicky symptoms. Mr. Kapp declines to offer in
formation regarding his health status and
states that he takes care of himself.
This is the first time Mrs. Kapp has s
een a health-care provider since their
relocation. Mr. Kapp has been treating his wife
with a blood tonic he makes from soaking
nails in water; a poultice he ma
kes from turpentine and lard,
which he applies to her chest
each morning; and a cough medicine he makes from rock candy, whiskey, and honey,
which he has her take a tablespoon of four
times a day. He feels this has been more
beneficial than the prescription medicati
on given to them before they relocated.
The child, Rebecca, has been taking a
cup of ginseng tea for her colicky
symptoms each night and a cup of red ba
rk tea each morning for her diarrhea.
Ruth’s only complaint is the “sick headach
e” she gets three to four times a week.
She takes ginseng tea and Epsom salts for the headache.
Mrs. Kapp is discharged with prescr
iptions for isoniazid, rifampin, and an
antibiotic and with instructions to return in
1 week for follow-up based on the results of
blood tests, chest radiograph, and sputum cultures.
She is also told to return to the clinic
or emergency department if her symptoms
worsen before then. The nurse gives Ruth
directions for making appointments with the pr
enatal clinic for herself and the pediatric
well-child clinic for Rebecca.
Study Questions
1.
Describe the migration patterns of
Appalachians over the last 50 years.
2.
Discuss issues related to autonomy
in the workforce for Appalachians.

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Case Study   II

Jessica is a 32 y/old math teacher who presents to the ER with a friend for evaluation of sudden decrease of vision in the left eye. She denies any trauma or injury. It started this morning when she woke up and has progressively worsened over the past few hours. She had some blurring of her vision 1 month ago and thinks that may have been related to getting overheated, since it improved when she was able to get in a cool, air-conditioned environment. She has some pain if she tries to move her eye, but none when she just rests. She is also unable to determine colors. She denies tearing or redness or exposure to any chemicals. Nothing has made it better or worse.

She is normally healthy. She had chickenpox at age 10 and a tonsillectomy/adenoidectomy at age 11. She has no medical problems. She has never been hospitalized. She has four children, all spontaneous vaginal deliveries.  She completed a bachelor’s degree in mathematics and a master’s degree in education. She quit smoking 10 years ago (two packs daily for 5 years); she drinks an occasional wine cooler, and she denies illicit drug use. Her father has a coronary artery disease (he had a stent placed at age 67) and a mother with hypertension.

She denies fever, chills, night sweats, weight loss, fatigue, headache, changes in hearing, sore throat, nasal or sinus congestion, neck pain or stiffness, chest pain or palpitations, shortness of breath or cough, abdominal pain, diarrhea, constipation, dysuria, vaginal discharge, swelling in the legs, polyuria, polydipsia, and polyphagia.

Patient is alert; she appears anxious. BP 135/85 mm Hg; HR 64bpm and regular, RR 16 per minute, T: 98.5F. Visual acuity 20/200 in the left eye and 20/30 in the right eye. Sclera white, conjunctivae clear. Unable to assess visual fields in the left side; visual fields on the right eye are intact. Pupil response to light is diminished in the left eye and brisk in the right eye. The optic disc is swollen. Full range of motions; no swelling or deformity. Mental status: Oriented x 3. Cranial nerves: I-XII intact; horizontal nystagmus is present. Muscles with normal bulk and tone; Normal finger to nose, negative Romberg. Intact to temperature, vibration, and two-point discrimination in upper and lower extremities. Reflexes: 2+ and symmetric in biceps, triceps, brachioradialis, patellar, and Achiles tendons; no Babinski.

Instructions:

Make a whole history and physical examination in a comprehensive manner with all its elements included: CC, HPI, PMH, FH, SH, MEDICATIONS, ALLERGIES, ROS PER APPARATUS OR SYSTEMNS, HEAD TO TOE PHYSIACL EXAMINATION PER SYSTEMS ( write your presentation in H&P format no paragraph format).

          Based on this information, what is your presumptive nursing diagnosis? All nursing diagnosis that apply to the case written in NANDA format related to … and evidence by…., NO MEDICAL DIAGNOSIS.

  Teaching plan and nursing care plan per each nursing diagnosis on this case.

       Requirements.

    1- All written assignment and documentations must be  in APA 6th edition format.

    2- Double spaces, minimum 4 pages long , minimum 3 up to date bibliography. (UP to date means last 3 years.), Note: you can use your test book as bibliography too, bibliography have to be written in APA format.

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Case study

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