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Topic: Choose one multisystem dysfunction. Describe pathophysiological changes, abnormal findings, and symptoms of the chosen dysfunction. How does it affect the patient’s activities of daily living?
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.
Example 1 (josy)
Acute Respiratory Distress Syndrome (ARDS) is a severe, life-threatening condition characterized by widespread inflammation in the lungs. The pathophysiological changes in ARDS include:
Inflammatory Response: ARDS is typically triggered by an acute injury or infection that leads to a systemic inflammatory response. This results in the release of inflammatory mediators, increased capillary permeability, and the influx of fluid into the alveoli, impairing gas exchange.
Alveolar Damage: The alveolar-capillary barrier is disrupted, leading to the leakage of protein-rich fluid into the alveolar spaces. This causes alveolar edema, which reduces lung compliance and makes breathing difficult (Thille et al., 2023).
Decreased Surfactant Production: The production of surfactant, which reduces surface tension in the alveoli, is diminished. This contributes to the collapse of alveoli (atelectasis) and further decreases lung compliance.
Fibrosis: In the late stages of ARDS, fibrosis may develop, leading to long-term impairment of lung function and chronic respiratory issues.
Abnormal Findings and Symptoms
Patients with ARDS typically present with the following abnormal findings and symptoms:
Hypoxemia: Severe hypoxemia, or low blood oxygen levels, is a hallmark of ARDS.
Tachypnea and Dyspnea: Rapid breathing (tachypnea) and difficulty breathing (dyspnea) are common as the body attempts to compensate for reduced oxygenation.
Bilateral Pulmonary Infiltrates: Chest X-rays usually show bilateral infiltrates that are not fully explained by cardiac failure or fluid overload.
Decreased Lung Compliance: Pulmonary function tests reveal reduced lung compliance, making it harder for the lungs to expand with each breath.
Cyanosis: Bluish discoloration of the skin and mucous membranes due to inadequate oxygenation.
Impact on Activities of Daily Living (ADLs)
ARDS significantly affects a patient’s ability to perform activities of daily living (ADLs) due to the following reasons:
Impaired Mobility: Due to severe dyspnea and muscle weakness from prolonged hospitalization and mechanical ventilation, patients often experience difficulty in moving around.
Fatigue: Chronic fatigue is common after ARDS, limiting the ability to perform even simple tasks such as dressing, bathing, and eating (Neufeld et al., 2020).
Cognitive Impairment: ARDS survivors frequently suffer from cognitive impairments due to hypoxia and critical illness, which can impact activities such as managing finances, medication, and other complex tasks.
Psychological Distress: Anxiety, depression, and post-traumatic stress disorder (PTSD) are prevalent among ARDS survivors, further hindering their ability to engage in daily activities.
References:
Neufeld, K. J., Leoutsakos, J. M. S., Yan, H., Lin, S., Zabinski, J. S., Weiss, C., … & Needham, D. M. (2020). Fatigue symptoms during the first year following ARDS. Chest, 158(4), 1634-1645.
Thille, A. W., Esteban, A., Fernández-Segoviano, P., Rodriguez, J. M., Aramburu, J. A., Peñuelas, O., … & Frutos-Vivar, F. (2023). Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. American Journal of Respiratory and Critical Care Medicine, 187(7), 761-767.
Example 2 (amber)
The multi-system dysfunction that I choose for this discussion question is sepsis. Sepsis is a complex syndrome characterized by a systemic inflammatory response to infection, leading to widespread physiologic changes. “Sepsis remains a complex and costly disease with high morbidity and mortality” (Seckel, 2024). The pathophysiological changes in sepsis involve an uncontrolled and dysregulated immune response to an infection, resulting in widespread inflammation, compromised microcirculation, tissue damage, and organ dysfunction. Abnormal findings include elevated levels of pro-inflammatory cytokines, vasodilation, increased capillary permeability, coagulation abnormalities, and impaired tissue oxygenation. Symptoms of sepsis may include fever, rapid heart rate, rapid breathing, altered mental status, low blood pressure, and signs of organ dysfunction. Sepsis can significantly affect a patient’s activities of daily living by causing extreme fatigue, weakness, confusion, and difficulty with mobility. “Excessive inflammation in sepsis overwhelms functional tissue resulting in cell death and organ failure” (Richardson & Graham, 2024). In severe cases, sepsis can lead to septic shock, multiple organ failure, and long-term physical and cognitive impairments, further impacting the patient’s ability to perform everyday tasks.
References
Seckel, M. (2024). Sepsis best practices. Nursing, 54 (6), 31-39. doi: 10.1097/NSG.0000000000000010.
Richardson, L. & Graham, J. (2024). Embracing a New Evidence-Based Thought Paradigm of Sepsis. Clinical Nurse Specialist, 38 (4), 171-174. doi: 10.1097/NUR.0000000000000828.
Example 3 (Martha)
Multisystem Dysfunction: Acute Respiratory Distress Syndrome (ARDS)
Acute Respiratory Distress Syndrome (ARDS) is a severe inflammatory condition characterized by rapid onset of widespread inflammation in the lungs. The pathophysiology of ARDS involves damage to the alveolar-capillary barrier, leading to increased permeability, pulmonary edema, and impaired gas exchange. This damage is often triggered by a direct lung injury, such as pneumonia, or indirect injuries, such as sepsis or trauma (Bellani et al., 2020).
Abnormal findings in ARDS include severe hypoxemia (low blood oxygen levels) that is refractory to oxygen therapy, bilateral infiltrates on chest imaging that are not fully explained by cardiac failure or fluid overload, and decreased lung compliance. Symptoms typically manifest as acute onset of dyspnea (shortness of breath), tachypnea (rapid breathing), and hypoxia. Patients may also exhibit signs of respiratory distress, such as the use of accessory muscles for breathing, cyanosis (bluish discoloration of the skin), and altered mental status due to hypoxemia (Matthay et al., 2020).
The impact of ARDS on a patient’s activities of daily living (ADLs) can be profound and long-lasting. Patients with ARDS often require prolonged mechanical ventilation and intensive care, which can lead to muscle weakness, fatigue, and cognitive impairments. Recovery can be prolonged, and many patients experience persistent physical limitations, such as reduced exercise tolerance and the need for supplemental oxygen, which can hinder their ability to perform ADLs like walking, bathing, and dressing. Furthermore, psychological sequelae such as post-traumatic stress disorder (PTSD), anxiety, and depression are common, affecting overall quality of life and independence (Herridge et al., 2020).
References
Bellani, G., Laffey, J. G., Pham, T., Fan, E., Brochard, L., Esteban, A., … & Pesenti, A. (2020). Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA, 315(8), 788-800. https://jamanetwork.com/journals/jama/fullarticle/2492883
Herridge, M. S., Tansey, C. M., Matté, A., Tomlinson, G., Diaz-Granados, N., Cooper, A., … & Cameron, J. I. (2020). Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine, 364(14), 1293-1304. https://www.nejm.org/doi/full/10.1056/NEJMoa1011802
Matthay, M. A., Zemans, R. L., Zimmerman, G. A., Arabi, Y. M., Beitler, J. R., Mercat, A., … & Calfee, C. S. (2020). Acute respiratory distress syndrome. Nature Reviews Disease Primers, 5(1), 18. https://www.nature.com/articles/s41572-019-0133-4
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