Patho/Soc final

List two "types" of hyponatremia and a possible cause for each; then give 2 potential manifestations for all types of hyponatremia

1)Hypertonic (translocational) hyponatremia Cause: Osmotic shift of water from the ICF to the ECF 2)Hypovolemic hypotonic hyponatremia Cause: linked to someone who's lost both sodium and water equally but then only replaces the waterManifestations: Headache, Seizure

Describe why a patient with Diabetes Mellitus will develop hypoglycemia; what manifestations will develop; and how might this occur (or be occurring) in your case study patient?

he hormone insulin lowers glucose levels when glucose is elevated. Taking more insulin than you need can cause your blood sugar level to drop too low and result in hypoglycemia.Manifestations- sweating, anxietyAltered cerebral function-Headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur.Activation of the autonomic nervous system-activation of the parasympathetic nervous system often causes hunger. The initial parasympathetic response is followed by activation of the sympathetic nervous system; which causes anxiety, tachycardia, sweating, and a cool and clammy skin due to constriction of the skin vessels.

Define and discuss the general adaptation syndrome. What is the potential negative effect of the overstimulation of a person's stress response?

(GAS) is the 3-stage process that describes the physiological changes the body goes through under stress. Alarm stage: sympathetic and HPA (hypothalamic-pituitary-adrenal) stimulation. Resistance stage: body selects the most effective & economic defense & get back to homeostasis. Exhaustion- If the stress is prolonged, the resources are depleted and systemic damage occurs. Over stimulation leads to alterations in regulation of of the stress response. Dysregulation of physiological mediators leads to excessive exposure to stress hormones which becomes toxic over time. Leads to harmful effects of long-term low-grade inflammation. The brain's stress response control mechanisms become altered causing an increase in the reaction of the prefrontal cortex and a decrease in its connection to the regulating effects of the amygdala. Gene expression becomes affected without altering DNA sequence.

What is the number one cause of death for diabetic patients? How does the culture and structure of the US medical care system contribute to this problem? Clearly develop answer using concepts from the book and/or films to help.

Atherosclerosis of coronary arteries. The culture and structure of the medical system contributes to this because it is a suppressive system that does not treat diseases with intent to prevent or cure, but rather withholds treatment in many cases until the disease progresses to an emergent situation. The for profit system we have forces the economically challenged to struggle to take care of their chronic conditions like diabetes while they must make decisions between food and medicine. The medical industrial complex gains from the chrisis situations which result, but no one makes huge profits by helping diabetics control their blood glucose levels at optimal levels.

Describe what occurs in an autosomal dominant and an autosomal recessive disorder; provide an example for each

Autosomal Dominant: Only one mutated copy of the gene in each cell is sufficient for a person to be affected; can inherit from an affected parent. Example: Marfan Syndrome. polycystic kidney disease. Autosomal recessive: both copies of the gene in each cell has mutations. The parents each carry one copy . Example: Sickle cell anemia.

Explain the specific mechanisms of damage that is done to blood vessels and nerves in a patient with Diabetes Mellitus; and what examples of this are (or may be) occurring in your patient?

3 main mechanisms for microvascular disease. Polyol pathway- glucose is transformed to highly osmotic sorbitol readily, but doesn't proceed to fructose quickly enough. Excess sorbitol causes cell dysfunction inhibiting absorbtion of myoinositol. Myoinositol deficiency inhibits free radical scavanging causing oxidative stress and cellular damage. Enzymatic glycosylation- insulin deficiency & glucose excess. protein glycosylation of basement membrane of cells in blood vessel wall. Membrane becomes electrically neutral and slit pores enlarge allowing blood proteins to pass. Nonenzymatic glycosylation- Glucose excess is all than is necessary. Create Advanced Glycosylation End products causes stiffening of blood vessel walls and begin process of atherosclerosis.

Describe the possible risk factors for stroke (all kinds), and then briefly describe the differences in manifestations between acute ischemic and hemorrhagic stroke.

Modifiable risk factors- smoking, heavy alcohol use. Non-modifiable risk- age, race A hemorrhagic stroke happens when a weak blood vessel ruptures and bleeds into the brain A person will likely experience a sudden onset headache or head pain. Almost always catastrophic resulting in coma and or death. Acute ischemic manifestations- reduction in blood flow to the brain- sudden numbness or weakness of the face, arm, or leg on one side of the body. Loss of vision in one or both eyes.

According to the article "Culture as a social determinant of health: Examples from Native Communities," to improve health outcomes, providers must practice what the author refers to as culture safety (or culturally safe care). What is cultural safety, and how does this approach help improve quality of care for diverse patient populations (think about the patients from the various Case Versions)?

Cultural safety is an environment that is spiritually, socially and emotionally safe, as well as physically safe for people; where there is no assault challenge or denial of their identity, of who they are and what they need.This would make everyone's treatment be at a flatline and equal because sometimes providers do not even mention certain secondary intervention due to assuming what one can and can't afford based off cultural aspects.This would definitely create holistic care due to going against the status quo of just prescribing and sending them out.

The experts in Escape Fire discuss the concept dark matter. Define this concept in general and as it relates to the US medical care system. Then, discuss dark matter as it relates to pharmaceuticalization and the related consequences for diabetics.

It is the unseen hidden forces driving the costs and the decision making of patient care in healthcare. The medical industrial complex, insurance company profit strategies, and corporate executive compensation are parts of the dark matter in medicine. Pharmaceuticalization drives up the costs of healthcare and often harms outcomes. Over reliance on medication to control diabetes can give the false impression to patients that they do not have to alter their health behaviors because the medicine will fix the problem. This is good for corporate profits, but bad for patients.

Briefly describe what is involved in macrovascular complications of Diabetes Mellitus - include in your description an example or a specific condition often associated with macrovascular damage; AND address any possible macrovascular complications that may occur in your case study patient.

Macrovascular refers to the large blood vessels of the heart, brain, and legs. The commonest manifestation of the macrovascular disease is in the coronary arteries and the legs. Atherosclerosis of the coronary arteries is common in most people with diabetes and is the commonest cause of death in people with diabetes.This greater prevalence has been attributed to the associated cardiovascular risk factors that are part of the metabolic syndrome and which may have been present for many years before the diagnosis of type 2 diabetescardiovascular disease

escribe the "pathophysiology" of Acute Respiratory Distress Syndrome AND give a situation in which it may develop

pathologic lung changes that include diffuse epithelial cell injury with increased permeability of the alveolar-capillary membrane (Fig. 23-15). The increased permeability permits fluid, plasma proteins, and blood cells to move out of the vascular compartment into the interstitium and alveoli of the lung.15,69 Diffuse alveolar cell damage leads to accumulation of fluid, surfactant inactivation, and formation of a hyaline membrane that is fibrous and impervious to gas exchange.respiratory rate and effort of breathing increase. Arterial blood gas analysis establishes the presence of profound hypoxemia that is refractory to supplemental oxygen.hypoxemia results from the impaired matching of ventilation and perfusion and from the greatly reduced diffusion of blood gases across the thickened alveolar membranesoccurs after an initiating event such as trauma, aspiration, or pancreatitis.

Explain what a paraneoplastic syndrome is and then give two specific examples of occurrences in lung cancers

Pattern of organ dysfunction related to immune-mediated or secretory effects of a neoplasia. Peptide hormones are produced by cancer cells of a cell that does not ordinarily produce them.altered immune response initiated by the production of onconeural antigens by the cancer cells. The immune system recognizes the onconeural antigens as foreign and mounts an immune response. the immune attack controls the growth of the cancer.- 2 examples: SIADH occurs in small cell lung cancer. and hypercalcemia occurs in squamous cell carcinoma from secretion of parathyroid-like peptide.

Define and discuss the Health Belief Model. Explain how this model helps us understand why some people change their behaviors while others do not change their behaviors. (4 Factors)

Perception is key The likelihood of participating in health promoting/protective behaviors is influenced by beliefs about a condition & exposure rather than objective facts. The value placed on specific outcomes The belief that a given condition results in the outcome People way the odds Four factors Feeling susceptible or vulnerable to a condition The perceived seriousness of the consequences for the condition Belief that protective action will significantly lower risk for condition One or more triggers occur

Define positive stress response, tolerable stress response, and toxic stress response and provide an example of an occurrence that produces each stress response. Then, explain the relationship between our biology, the environment, and health outcomes in relation to the impact of toxic stress response on health outcomes.

Positive stress response is the good stressor like an upcoming wedding, promotion, and a pregnancy. Tolerable stress response serious but temporary stress buffered by supportive relationships example: death of family member, a serious illness/injury, or natural disaster. Toxic stress response prolonged activation of stress in the absence of a protective and supportive relationship example: physical or emotional abuse, neglect, or exposure to violence. Example :Toxic stress can cause several health out comes like depression, eating disorders which lead to diabetes, obesity, anorexia, or bulimia. The environment by which a person lives can be related to toxic stress if a person lives in a situation where they are subjected to the negative stress like abuse or neglect or even financial burden.

Define the concepts fundamental cause and proximate risk factor and explain how they are interrelated with regard to influencing health outcomes

Proximate Risk factors of disease and illness refer to health-related individual behaviors and include diet, exercise, use of tobacco and alcohol, control of stress , and other aspects Fundamental causes of disease and illness refer to underlying social conditions such as socioeconomic status, social inequality, community and neighborhood characteristics, exposure to stress life events, and access to a supportive social network Fundamental causes help to shape health and disease by influencing/increasing the participation in proximate risk factors. If everyone smokes in the house then its likely that a child may pick up smoking.

Explain rational choice theory. How does rational choice theory contribute to an understanding of your patient's current health status

Rational choice theory - View sick individuals as people who have preferences and goals in life, who often meet constraints in satisfying these preferences, and who must make choices from available options. The rational individual will identify possible options, determine the advantages and disadvantages of each option, and then select the option that will maximize the opportunity to satisfy preferences. A sick individual, for example might consider the cost availability and convenience of seeing a medical doctor and recall the satisfaction or dissatisfaction produced in prior visit.

Define the concept resilience. Briefly explain how turning points and/or some relationships help foster resilience and buffer against the potential negative impacts of adversity and trauma.

Resilience - the capacity to recover quickly from difficulties; toughness.Some relationships provide people with hope; they counter negatives with positives which helps the individual stay on track and focused

Define the concept social distance. Which variable does Boulton argue has the greatest impact on communication between the provider and the patient?

Social distance The degree to which doctors and patients are similar or different to each other in social class determines the degree to which there is social distance between them. The greater the social distance the greater the difference in communication styles is likely to be. The greater the social distancethe greater the complications are likely to be in effective communication. Mary Boulton argues: Patients and physicians who are from similar social class (and, therefore educational backgrounds) are more likely to share similar communication styles. Patients and physicians from different social class backgrounds are more likely to have different communication styles finding it difficult to communicate effectively

Define the concept upstream factors. Clearly identify and explain all 4 categories of upstream factors (as they are covered in this course).

Upstream Factors - Macro-level factors that have a direct impact on individual behaviors o The availability of protective or harmful consumer products (tobacco, high fat foods, sterile needles, and condoms) o Physical structures/physical characteristics of products (childproof medical containers, seat belts, and well lit neighborhood streets) o Social structures and policies (enforcement of fines for selling tobacco to those who are underage and provision of community day-care services) o Media and cultural messages ( advertisements for alcohol products)

Explain the Sympathetic and Parasympathetic Nervous Systems clearly explaining physiologic changes that occur when each system is activated in relation to understanding the physiologic impact of stress on health.

a. Sympathetic Nervous System - the accelerator i. Arouses and prepares body for action ii. Directs the adrenal glands to release stress hormones - adrenaline and noradrenaline iii. Liver provides increased sugar to bloodstream to provide necessary energy iv. Increases respiration to increase oxygen intake v. Diverts blood from internal organs to our muscles - slowing digestion and suppressing the immune system Vasoconstriction vi. Dilates pupils for more light vii. Decreases salivation and increases perspiration to cool down body viii. Adaptive when working properly b. Parasympathetic Nervous System-the brake i. Calms the body preparing it for rest ii. "Rest and Digest" iii. Conserves energy as hormones leave the bloodstream iv. Slows breathing, lowers blood sugar, decreases heart rate and blood pressure v. Increases digestion and immune functioning Constricts pupils

Describe the condition of a hyperglycemic hyperosmolar state. How does that condition affect fluid, sodium, and potassium levels?

A partial or relative insulin deficiency may initiate the syndrome by reducing glucose utilization while inducing a glucagon-stimulated increase in hepatic glucose output. With massive glycosuria, obligatory water loss occurs. If the person is unable to maintain adequate fluid intake because of associated acute or chronic illness or has excessive fluid loss, dehydration develops. As the plasma volume contracts, renal insufficiency develops and the resultant limitation of renal glucose losses leads to increasingly higher blood glucose levels and an increase in severity of the hyperosmolar state. Sodium is low; potassium low; fluids - low

Describe the characteristics of the metabolic syndrome - include how and why this condition is related to Diabetes Mellitus. Did your case study patient exhibit signs of metabolic syndrome? Give details to support your answer.

Abdominal obesity High levels of Triglycerides Low levels of High-density lipoproteins (HDL) High Blood pressure High Fasting plasma glucose Systemic inflammation (C-reactive protein.) Abnormal function of vascular endothelium. Macrovascular disease How and why related to DM Insulin resistance develops from metabolic syndrome which can cause T2DM Our patient was overweight and insulin resistant.

Briefly describe 3 characteristics of acute inflammation AND 2 characteristics of chronic inflammation

Acute: rapid onset, localized, and intense- Chronic: self-perpetuating, long lasting

Briefly describe the characteristics and manifestations of dilated cardiomyopathy (that is, what does the heart look like, and how is preload, afterload, contractility, and cardiac output affected)

All 4 chambers are enlarged and flabby. Preload- increased. Afterload- little to no change, Contractility- decreased, CO- decreased

Define escape fire as it relates to medicine. Explain one escape fire to help address rising rates of Type II diabetes

An escape fire in medicine is the use of existing resources in innovative ways to address problem areas. These resources can exist within medicine or in other areas and be integrated with medical care. An escape fire to address the rising rates of Type 2 diabetes would be to make healthier foods cheaper for the poorer population who cannot afford the higher costs of eating better foods. Empowering individuals to more effectively practice self-care by making resources available and educating them on effective strategies and practices.

First, give 1 possible cause of metabolic acidosis, and explain 2 possible manifestations (that is, what are they and why do they occur)

Cause: Over production of metabolic acids, Increased chloride concentration or kidney failure. Manifestations- increased respiration, weakness because of the decrease in serum pH and bicarbonate levels due to hydrogen gain or bicarbonate loss.

Define and discuss the concept adverse childhood experiences and protective relationships. Cleary explain how ACEs and protective relationships influence adult health outcomes.

Defined as childhood exposure to abuse and household dysfunction. These experiences can include things like physical and emotional abuse, neglect, caregiver mental illness and household violence. The more ACEs a child experiences, the more likely he or she is to suffer from things like heart disease, diabetes, and substance abuse later in life. Adults with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. For instance, chronic smoking as adults have a greater risk of smoke related diseases. Depression is another risk factor. When a child experiences multiple ACEs over time the experiences will trigger an excessive and long-lasting stress response in to adulthood.

here are 3 types of Distributive Shock - First, explain (in general) what occurs in distributive shock; then, list and explain what occurs each of the 3 types

Explain Distributive Shock - loss of blood vessel tone; enlargement of the peripheral vascular compartment; displacement of the vascular volume away from the heart and central circulation. The capacity of the vascular compartment expands to the extent that normal volume of blood does not fill the circulatory system. 3 types and what occurs: Neurogenic: drop-in sympathetic control of blood vessel tone due to a defect in the vasomotor center in the brain stem or the sympathetic outflow to the blood vessels. Anaphylactic- histamines are released into the blood which causes vasodilation of arterioles and venules along with a marked increase in capillary permeability. Septic- Vasodilation caused by inflammatory mediators and hypotension combined cause septic shock. systemic immune response to severe infection plus the clinical manifestations of the systemic inflammatory response (e.g., fever, tachycardia, and elevated white blood cell count [leukocytosis]).

List the 3 primary mechanisms of cellular injury; then pick one and describe [0the characteristics of the injury caused (i.e. what is happening at the cellular level)

Free radicals, impaired calcium homeostasis, and hypoxia- Hypoxia- deprives the cell of oxygen and interrupts metabolism and the generation of ATP. Decrease in pH because lactic acid accumulates in the cell.

rovide two functions of potassium and then explain how it is regulated in the body (what are the substances and processes that control potassium). Pg. 177

Function 1: Plays a role in pH by acting as a "buffer" to increase levels of H+ Function 2: Plays a significant role in the kidney's ability to concentrate urine Potassium balance is normally regulated by dietary intake, urine output, and transcompartmental shifts between the ICF and ECF compartments. renin, aldosterone, Angiotensin,

Based on the argument from social epidemiologists that some groups are at greater risk for disease than other groups, explain why some groups are at greater risk for developing Type II Diabetes Mellitus than other groups.

Fundamental cause of important personal resources such as knowledge, money, power, prestige and beneficial social connections are not available to the less educated and therefore lower socioeconomic individuals.

To what degree do you think social support impacted the disease process/progression of your patient? (Think beyond what information is clearly provided in the case. Think about what you learned in general about your patient based on their social status-you are making some inferences based on how you developed your patient's story.)

Highly impacted his disease. Social support refers to resources that people receive from their social relationships and social and their membership of groups. This support may be emotional (e.g., caring, concern, sympathy and encouragement), cognitive (e.g. information and advice useful dealing with problems), or material (e.g., child care and transportation

Define the concept suppressive system. Why is a suppressive system like the US medical care system problematic in relation to chronic illnesses?

In our suppressive system, symptoms of chronic illnesses are treated as they occur rather than treating the underlying cause of the disease. This allows chronic degenerative diseases to develop and create emergent crisis rather than healing occurring. Rather than putting effort into a curative problem, or focusing on the individual as a whole - our medical system only puts a bandaid on the issues to keep a profit off of the treatment given. This means that those who are suffering from chronic illnesses are not getting holistic treatment utilizing all available options to bring wellness such as CAM practices or dealing with psychosocial issues that may be the actual cause of the disease process.

Describe the specific roles each of the following hormones plays in glucose regulation: insulin, glucagon, epinephrine, growth hormone, and cortisol (a glucocorticoid).

Insulin- it promotes glucose uptake by target cells and provides for glucose storage as glycogen, (2) it prevents fat and glycogen breakdown (3) it inhibits gluconeogenesis (synthesis of glucose from amino acids, glycerol, & lactic acid) and increases protein synthesis- Glucagon- stimulate the release of glucose from the liver, which causes blood glucose levels to return to normal (Glycogenolysis)- Epinephrine- has the potent effect of stimulating glycogenolysis (glycogen converted to glucose) in the liver, thus causing large quantities of glucose to be released into the blood - Growth hormone - Growth hormone decreases cellular uptake and use of glucose, thereby increasing the level of blood glucose.- Cortisol-stimulates gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. moderately decreases tissue use of glucose.

Thinking about what you learned from Money & Medicine, Escape Fire and Chapters 14 & 15, explain how the structure of the American healing system may have contributed to the patient's deteriorating health condition. Clearly identify and explain any concepts from the unit that help you explain your answer.

The American healing system is set up as a dual track system which is characterized by private or public track to access medical resources and care. Patients of a public system are more likely to rely on hospital emergency apartment for primary care due to limited availability of other medical care options. Since Mr. R was considered low income and is within the public system, he more than likely lacked the stable relationship with medical care providers Long term consequences of being uninsured. Lack of health care over time causes disease to progress more rapidly and cause more damage. States like Mississippi refused to expand Medicaid under the Affordable Care Act. Withholding of charity care by hospitals seeking profitability for their shareholders.

Describe the symptoms (manifestations) that will develop as a result of autonomic neuropathies in a Diabetes Mellitus patient; and provide examples of how this may (or could) be occurring in your case study patient .

The autonomic neuropathies involve disorders of the sympathetic and parasympathetic nervous system function such as: impaired vasomotor function, decreased cardiac responses, inability to empty bladder, gastrointestinal motility problems, and sexual dysfunction. Example- Mr. R : low bp - syncope sexual dysfunction

List 2 of the 4 areas of the body most affected by lead poisoning; and describe the manifestations for each of these areas that may occu

The nervous system-manifestations- acute encephalopathy (brain disease), with vomiting and impaired consciousness.; Demyelination of peripheral nerves may occur in adults.- GI tract- manifestations- "Lead colic" acute abdominal pain.

Explain Talcott Parsons' concept, sick role. While Parsons saw the assumption of the sick role as temporary, we know that many people living with chronic illnesses never exit the sick role. Explain why this occurs and why it is problematic for the larger social system.

The sick role is a temporary social role that is substituted for one's normal social role. Characterized by certain behavioral expectations, rights and exemptions shapes by society, groups, and cultural traditions. Considered deviant behavior to the functionalist because it interferes with a member of society's carrying out their expected role in the functioning of society. People are living longer with chronic degenerative diseases today than they were in the 1950's. This has created a set of individuals who are unable to regain wellness to the point that they will ever be able to fully return to the social role they held prior to their illness. This is problematic only if you view the chronically ill as unproductive burdens on society.

Define therapeutic communication and discuss at least on variable that can hinder therapeutic communication

Therapeutic communication 1.Reduces uncertainty 2.Provides a basis for action 3.Strengthens the physician-patient relationship 1) Physician engages in full and open communication with the patient and feels free to ask questions about psychosocial as well as physical conditions. 2) Patient provides full and open information to the physician and feels free to ask questions and seek clarity. 3) A genuine rapport develops between the physician and the patient. Setting of medical encounter-Most physician-patient contacts occur in the physician's office or in a hospital-settings that are not conducive to making the patient feel at ease

Define the following concepts: toxic stress, protective relationships, and resilience. Then, discuss how protective relationships can help build resilience against toxic stress and childhood adversity. Provide an example.

Toxic stress is prolonged, frequent stress such as abuse for a long period of time without familial or social support. Resilience is the ability to mentally or emotionally cope with a crisis or to return to pre-crisis status quickly.. Protective relationships give those suffering under abuse a place to care for and eliminate feelings of helplessness and self-efficacy. For example, childhood abuse has been associated with a lack of pursuing educations

Describe the characteristics, onset, and development of each of the types Diabetes Mellitus (as described in the assigned article) - be certain to identify which type was present in your case study patient.

Type 1:Insulin deficiency.Type 1 diabetes the body does not produce insulin. T1DM is a Genetic disease of the immune system... Genes that make up the major histocompatibility system and control the immune system malfunction or are abnormal; they can impair the immune system's ability to recognize itself.Ultimately, The immune system attacks the pancreatic beta cells and destroys them causing insulin deficiency and diabetes Type 2: is a combination of insulin resistance and insulin deficiency.It's A group of diseasesYour body doesn't use insulin properly.Insulin resistance occurs in the peripheral cells of the body and liver. It is caused by genetic factors in the peripheral cells and liver cells as well as environmental factors. The environmental factors include aging, sedentary, lifestyle and obesity. As insulin resistance develops the beta cells increase insulin production to compensate and maintain the blood glucose level in the narrow range needed for normal bodily function. If insulin resistance persists or increases over time it will fail. When insulin resistance but insulin secretion decreases and blood glucose levels begin to rise, true diabetes has developed.Insulin deficiency may be due to beta-cell exhaustion from the hypersecretion of insulin, glucose and lipid toxicity to the beta cells, or genetic factors.Mr. Raymond had Type 2 diabetes