Solution Manual For Pathophysiology 6th Edition by Jacquelyn L. Banasik

TEACH FOR NURSES LESSON PLAN Chapter 1: Introduction to Pathophysiology CHAPTER OBJECTIVES 1. Define pathophysiology.

2. Explain how etiology and pathogenesis are used to predict clinical manifestations of disease and response to therapy.

3. Define normal and abnormal physiologic parameters.

4. Identify the general factors affecting the expression of disease in a particular person.

5. Describe the kinds of information about disease that can be gained through an understanding of the concepts of epidemiology.

STUDENT RESOURCES understand 

Textbook Chapter 1 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 1* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

      

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

before class



Nursing Curriculum Standards (below)

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35-2

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Discuss the principles of pathophysiology and its four interrelated topics (etiology, pathogenesis, clinical manifestations, and treatment implications).



Discussion Topic: Have students identify diseases with idiopathic, iatrogenic, and multifactorial causes and discuss the importance of identifying risk factors for diseases



Statistical Normality

Explain how measurements of structural, physiologic, biochemical, and genetic parameters provide a basis for disease screening and identification of risk factors.

Activity: Have students shadow a nurse at a clinic or medical facility who is providing care to a diverse population. Instruct students to identify patients’ individual factors of relevance in determining what is abnormal or in making a diagnosis

Individual Factors Influencing Normality PATTERNS OF DISEASE IN POPULATIONS

Discuss epidemiology and how it relates to disease susceptibility and distribution.



Online Activity: Have students visit http://www.cdc.gov/chronicdisease/ index.htm and explore the Centers for Disease Control and Prevention’s resources dealing with the prevention of chronic diseases.

Activity: Have students identify the agency in their area that provides epidemiology services; then have an epidemiologist visit the class.

FRAMEWORK FOR PATHOPHYSIOLOGY Etiology Pathogenesis Clinical Manifestations Treatment Implications CONCEPTS OF NORMALITY IN HEALTH AND DISEASE

Concepts of Epidemiology



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IN-CLASS / ONLINE CASE STUDY JT is a 34-year-old woman who comes to the clinic for a wellness exam. Her friend has just been found to have heart disease. She asks you what type of diseases she might be at risk for. She has heard that a C-reactive protein (CRP) test measures inflammation and would help diagnose whether she is a risk for cardiovascular disease. You counsel her on the following: 1. You know that the CRP test is very sensitive but that is not specific. Explain what this means for JT. Answer: Sensitivity and specificity will help determine whether she will be at risk. Because CRP is highly sensitive, it will tell her that she has inflammation going on and that any inflammation could increase her CRP level. You will need to search for evidence of other causes of, and look at other markers for, cardiovascular disease.

2. You decide to also discuss with JT individual factors that could affect her risks for cardiovascular disease. Discuss how each of the following variables may affect her. a. Cultural Answer: Cultural beliefs change how we look at symptoms of disease. What we eat and drink often directly relates to our cultural beliefs. Furthermore, in an area where health care is not readily available, such as an impoverished area, people may not seek health care. b. Age Answer: As we age, we are more affected by the aging process and become more at risk for select disease processes. Cholesterol levels rise as we age, and our diets change when we enter the work force, often when we add more fast food or quick meals containing more fats to our diets. In the aging years, our level of activity generally decreases, carrying with it its own effects on our risk for disease. c.

Ethnic Answer: Certain ethnicities are predisposed to different diseases. Understanding which diseases you are at risk for can help you decide how to best prevent them or diagnose and treat them.

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NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES 

Patient-Centered Care o Individual Factors Influencing Normality o Cultural Considerations o Age Differences o Gender Differences o Situational Differences o Time Variations

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

HEALTH CARE RECIPIENT CONCEPTS THEME: Attributes and Resources  CONCEPT: Development o Exemplar: Age Differences THEME: Personal Preferences  CONCEPT: Culture o Exemplar: Cultural Considerations

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Patterns of Disease in Populations o Concepts of Epidemiology

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35-5 o o

Aggregate Factors Levels of Prevention

TEACH FOR NURSES LESSON PLAN Chapter 2: Homeostasis, Allostasis, and Adaptive Responses to Stressors CHAPTER OBJECTIVES 1. Describe the relationship between homeostasis and allostasis.

2. Describe how the sympathetic nervous system and neuroendocrine system respond to stress.

3. Identify the key features of Selye’s General Adaptation Syndrome.

4. Identify factors affecting the stress response.

5. Describe how allostatic overload contributes to the development of disease.

STUDENT RESOURCES understand

       

Textbook Chapter 2 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 2* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

35-6

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

HOMEOSTASIS AND ALLOSTASIS Homeostasis Allostasis STRESS AS A CONCEPT The General Adaptation Syndrome and Allostasis Stressors, Gender and Developmental Influences, and Risk Factors NEUROHORMONAL MEDIATORS OF STRESS AND ADAPTATION

Explain the concept of stress, its function, and its relationship to allostasis and homeostasis.





Activity: Have a stress management counselor visit the class to discuss how different people respond to stress and ways nurses can identify people who may be predisposed to poor stress management.

Online Activity: Have students visit http://www.mayoclinic.com/health/stress-management/MY00435 and identify stress management tools and resources.

Catecholamines: Norepinephrine and

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Epinephrine Adrenocortical Steroids: Cortisol and Aldosterone Endorphins, Enkephalins, and Immune Cytokines Sex Hormones: Estrogen, Testosterone, and DHEA Growth Hormone, Prolactin, and Oxytocin ADAPTATION, COPING, AND ILLNESS Adaptation, Resilience, and Coping

Discuss the ways the body adapts and copes with varying degrees of stress and the role of illness in exasperating stress on the body.

Review Box 2-1 (Examples of Homeostatic Systems)



Discussion Topic: Discuss the impact of stress on the body. Use Figure 2-3 as a visual aid.

Activity: Divide students into groups and give each group a description of an individual manifesting symptoms of stress. Have each group develop a stress management plan for the individual.

Allostatic Overload and Illness

IN-CLASS/ONLINE CASE STUDY MR is a 21-year-old male student who has been working increased hours to make enough money to pay for tuition. He has not been getting much sleep. In the last couple days, he has had a cough and runny nose. On his way home, he was involved in a car wreck that left him without a car and sent him to an emergency department for treatment of a laceration.

3. Based on Selye’s General Adaptation Syndrome (GAS), explain the three stages and how they would manifest in MR. Answer:

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35-8 Alarm: MR would be more aware of what is going on and be experiencing the “fight or flight response.” The hypothalamic-pituitary-adrenal (HAP) axis is activated. Initially, the hypothalamus recognizes a problem and releases corticotropin-releasing hormone and stimulates the adrenal medulla to release epinephrine and norepinephrine, which in return increases the patient’s heart rate, respiratory rate, and blood pressure. Cortisol and aldosterone are released from the adrenal cortex, and a cascade of events is started.

Resistance and/or adaptation: With the increase in stress hormones the body will try to adapt by increasing glucose, free fatty acids, and amino acids. Glucose and free fatty acids are needed for fuel and energy, and amino acids are needed for repair and maintenance of daily functions.

Exhaustion: Over time these adaptive responses might wear out, and the body will suffer from this. If the needs are too great, MR might develop hypertension, his cold could get worse, or his laceration might not heal. Over time the demands build up, and this is called the allostatic load in which the body cannot adapt anymore and is unable to meet the demands that have been placed on it. MR might find himself getting more tired, having more colds, and having other sequelae.

4. In the moments right after the car wreck, MR likely did not feel much pain at the site of his laceration. Why? Answer: Stress naturally activates the inhibition of pain through the release of small peptides called endorphins and enkephalins.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES 

Patient-Centered Care o Stressors, Gender and Developmental Influences, and Risk Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

HEALTH AND ILLNESS CONCEPTS

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THEME: Homeostasis and Regulation  Concept: Cellular Regulation o Exemplar: Homeostasis and Allostasis o Exemplar: Box 2-1: Examples of Homeostatic Systems o Exemplar: Table 2-1: Stages of the General Adaptation Syndrome THEME: Resilience  Concept: Stress o Exemplar: Stress as a Concept o Exemplar: Figure 2-1: Steps of Selye’s alarm stage of the general adaptation syndrome o Exemplar: Figure 2-2: Neuroendocrine interactions in response to a stressor. Receptors are excited by stressful stimuli and relay the information to the hypothalamus. The hypothalamus signals the adrenal cortex (by way of the anterior pituitary) and the sympathetic pathways (by way of the autonomic nervous system). The stress response is then mediated by the catecholamines (i.e., epinephrine and norepinephrine) and by the glucocorticoids (predominantly cortisol). o Exemplar: Box 2-2: Physical and Behavioral Indicators of High Stress o Exemplar: Figure 2-3: Effects of allostatic overload on body organs and systems.  Concept: Coping o Exemplar: Neurohormonal Mediators of Stress and Adaptation o Exemplar: Table 2-2: Brief Summary of Effects of Catecholamines on Tissues and Organs of the Body o Exemplar: Table 2-3: Major Effects of Glucocorticoids in the Stress Response o Exemplar: Adaptation, Coping, And Illness

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Stressors and Risk Factors

TEACH FOR NURSES LESSON PLAN Chapter 3: Cell Structure and Function

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CHAPTER OBJECTIVES 1. Describe the major cellular structures and their functions.

2. Describe how cells acquire and use energy.

3. Explain how substances are transported across the cell membrane.

4. Explain why some cells can produce action potentials yet others cannot.

5. Describe how cells in a multicellular organism communicate with one another.

6. Identify the normal mechanisms of cellular growth control.

STUDENT RESOURCES understand

       

Textbook Chapter 3 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 3* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-11

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus PLASMA MEMBRANE

Content Highlights Identify components of the plasma membrane.

Learning Activities  

Membrane Structure Lipid Bilayer Membrane Proteins ORGANIZATION OF CELLULAR COMPARTMENTS Cytoskeleton Nucleus Endoplasmic Reticulum Golgi Apparatus Lysosomes and Peroxisomes Mitochondria

Discuss the organization and function of cellular compartments.



Activity: Have students visit http://www.cellsalive.com/ and access the “Cell Biology” section and some of the available exercises.

Discussion Topic: Refer students to Figure 3-1 (Structure of a typical eukaryotic cell showing intracellular organelle) and discuss each cell structure element and function.

Activity: Have students review the components of a cell by matching the structures with their functions.

Synthesizes and metabolizes lipids Contains degradative enzymes Contains genetic material Processes and packages proteins and lipids Synthesizes proteins Maintains cell shape Makes ATP

Answer: Endoplasmic reticulum Lysosome Nucleus Golgi apparatus Ribosome Cytoskeleton Mitochondrion

Synthesizes and metabolizes lipids Contains degradative enzymes Contains genetic material Processes and packages proteins and lipids Synthesizes proteins Maintains cell shape Makes ATP

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35-12

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

CELLULAR METABOLISM Glycolysis Citric Acid Cycle Oxidative Phosphorylation FUNCTIONS OF THE PLASMA MEMBRANE Membrane Transport of Macromolecules Membranes Transport of Small Molecules Cellular Membrane Potentials INTERCELLULAR COMMUNICATION AND GROWTH

Discuss the principle means of intracellular communication and responses.



Online Activity: Have students visit http://www.biology.arizona.edu/cell_bio/cell_bio.html for useful tutorials on cell membranes, cell signaling, and the cytoskeleton.

Cell Signaling Strategies Cell Surface Receptor– Mediated Responses Intracellular Receptor– Mediated Responses Regulation of Cellular Growth and Proliferation

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IN-CLASS / ONLINE CASE STUDY LB is a 68-year-old man with diabetes and hypertension. He is being admitted to the hospital with an elevated K+ level (hyperkalemia) and a low calcium level (hypocalcemia).

1. LB is getting started on dialysis emergently because of the elevated K+ level. Knowing that K+ has a major impact on the myocardial muscle cell, explain how K+ effects the resting membrane potential and what effects you would see in his heart with an elevated level and a low level.

Answer: Normal resting membrane potential (RMP) for the cardiac cell is 90 mv. It is controlled by the concentration of potassium across the cell membrane. Potassium levels are 30 times greater than inside the cell. At rest, the ions are balanced between the inside and outside of the cell with the negative forces inside the cell holding onto the K+.

The myocardial cells are very excitable, and their RMP can be affected very easily and quickly.

2. Calcium is a major cation. What effect will high calcium have on myocardial contraction? (See the discussion on digitalis.)

Answer: Myocardial contraction is dependent on intracellular Ca2+ concentration. The level of calcium in the cell is low and is regulated by two calcium pumps. They remove calcium from the cell cytoplasm so it can be used. This process uses ATP. If the calcium level goes too high, its effects can be detrimental to the cell.

In the myocardial cell, the Na+-K+ pump is used to transport Ca2+ out of the cell. When a patient is given digitalis, it directly affects the Na+-K+ pump and causes an increase in Na+ and a decrease in Ca2+ removal from the cell. This increases the force of contraction and increases cardiac output.

TEACH FOR NURSES LESSON PLAN

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Chapter 4: Cell Injury, Aging, and Death CHAPTER OBJECTIVES 6. Describe the usual cellular responses to reversible injury.

7. Differentiate reversible and irreversible cellular injuries.

8. Distinguish necrosis and apoptosis.

9. Identify the kind of injuries to which cells are susceptible.

10.

Describe the usual physiologic changes of aging and explain how these are differentiated from disease.

STUDENT RESOURCES understand

       

Textbook Chapter 4 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 4 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-15

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

REVERSIBLE CELL INJURY

Discuss the signs of irreversible cell injury and the characteristics of each type.

Learning Activities Discussion Topic: Review hydropic swelling using the flowchart below titled “Cell Swelling Algorithm.”

Hydropic Swelling Intracellular Accumulations CELLULAR ADAPTATION Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia

Describe the common adaptive responses.



Activity: Have students complete the table to match the processes and examples with the type of cellular adaptation: Process Example Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia

Answer: Atrophy

Process Decrease in cell size (and organ size) caused by disuse or withdrawal of growth factors or hormones

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Example Muscle tissue in a patient confined to bed

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Hypertrophy

Hyperplasia

Metaplasia

IRREVERSIBLE CELL INJURY

Describe the two processes that may contribute to cell death in response to injury.

Increase in cell size (and organ size) usually caused by increased workload Increased number of normal cells in response to physiologic or excessive hormonal or growth factor stimulation Replacement of normal cells with another normal cell type

Left ventricle in hypertension

Enlarged prostate (not malignant)

Lower esophagus in person with gastroesophageal reflex disease Dysplasia Growth of cells of Cervix exposed to abnormal size, shape, human papilloma virus or organization that are infection as seen on Pap not malignant smear  Activity: Have students complete the table below to match the characteristics and examples with the type of necrosis:

Necrosis Characteristics Apoptosis

Examples

Coagulative necrosis Liquefactive necrosis Caseous necrosis Fat necrosis Answer:

Coagulative necrosis

Characteristics

Examples

Protein denaturation with change from gelatinous and transparent to firm and opaque

Ischemic injury to the heart or kidneys

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35-17

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Liquefactive necrosis

Cells are digested by their own degradative enzymes so the tissue becomes soft

Caseous necrosis

Cells disintegrate but are not completely digested, resulting in a soft granular clump resembling cheese Lipases break down triglycerides, releasing fatty acids that combine with calcium and magnesium to form opaque, white, soap-like lesions

Fat necrosis

ETIOLOGY OF CELLULAR INJURY Ischemia and Hypoxic Injury Nutritional Injury

Describe the common causes of cellular injury.



Acute pancreatitis

Activity: Have students complete the table below to match the symptoms and pathophysiology to the chemical causing the cellular injury: Symptoms Pathophysiology Lead Carbon monoxide Ethanol

Infectious and Immunologic Injury

Answer:

Chemical Injury

Lead

Physical and Mechanical Injury

Ischemic injury to neurons and the glial cells in the brain Pulmonary tuberculosis

Carbon monoxide

Symptoms

Pathophysiology

Seizures, delirium, paralysis, renal failure Headache, drowsiness, confusion, cherryred skin, coma

Interferes with neurotransmitter synthesis; impairs renal function Binds with hemoglobin and blocks oxygen from doing so

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Ethanol

Fatty change in the liver; hepatitis; cirrhosis

Interferes with mitochondrial function; causes necrosis of hepatocytes

Online Activity: Have students visit http://www.biology.arizona.edu/chh/ to review problem sets and tutorials on toxicology and lung toxicology.

CELLULAR AGING Cellular Basis of Aging Physiologic Changes of Aging SOMATIC DEATH

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Cell Swelling Algorithm

IN-CLASS/ONLINE CASE STUDY TL is a 62-year-old man who was in a car wreck and who has been hospitalized for compartment syndrome from a left leg crush injury. He has areas of necrosis (tissue ischemia) seen along his calf. Tissue necrosis is areas of dead cells. It is imperative that the necrosis does not increase.

1. Discuss the following etiologies of cellular injury and death and what can be done for TL to maximize his care.

Ischemia and hypoxic injury

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35-20 Answer: TL is at most risk of hypoxic injury. Cells cannot produce energy (ATP) without an adequate supply of oxygen. In compartment syndrome, the cells are unable to get a supply of oxygen and metabolic wastes build up, preventing glycolysis. The cell will go into anaerobic metabolism with a buildup of pyruvate that will turn into lactic acid. This can lead to lactic acidosis. Lactic acid levels can be monitored by drawing lactic acid levels. If there has been prolonged hypoxia, reperfusion of the area can also lead to cell death.

Calcium is one of the waste products and with a low level of ATP stores this can lead to cell apoptosis.

Ischemia can also release extra free radicals, which in turn damages cell membranes and slows down healing.

Nutritional injury Answer: TL will be also affected by nutritional injury. Cellular functions depend on adequate nutrition from all sources (fats, carbohydrates, proteins, and vitamins). Patients in the hospital are not always able to take in enough nutrition for healing and then have trouble synthesizing amino acids to make proteins. In TL’s situation, he will need this to decrease cell death and promote wound healing. It is important to make sure his diet meets all the demands needed for wound healing, and a dietician would be able to make a plan to do this.

Infectious and immunologic injury Answer: TL is at risk for an infection from his crush injury caused by bacteria in the area, and the stress of the condition can affect his immune system. Bacteria exert their destructive effects in many ways, including through destructive enzymes that digest cellular enzymes and connective tissues; others may release either exotoxins or endotoxins. Enzymes and chemicals released by white blood cells destroy organisms but also kill normal cells nearby. Correct antibiotic coverage is imperative in this case to prevent the buildup of bacteria and the further death of cells.

NURSING CURRICULUM STANDARDS

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35-21

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Nutritional Injury THEME: Protection and Movement o Concept: Tissue Integrity o Exemplar: Reversible Cell Injury o Exemplar: FIGURE 4-1: Cellular swelling in kidney tubule epithelial cells. (A) Normal kidney tubule with cuboidal cells; (B) early ischemic changes showing surface blebs and swelling of cells. o Exemplar: FIGURE 4-2 General mechanisms of intracellular accumulation: (1) abnormal metabolism as in fatty change in the liver, (2) mutations causing alterations in protein folding and transport so that defective proteins accumulate, (3) deficiency of critical enzyme responsible for lysosomal degradation, and (4) an inability to degrade phagocytosed particles such as coal dust. o Exemplar: FIGURE 4-3: Gross appearance of a fatty donor liver (A) compared with a normal nonfatty donor liver (B). o Exemplar: FIGURE 4-4: Roles of chaperone proteins in protein refolding and ubiquitin in protein degradation after stress-induced protein damage. o Exemplar: FIGURE 4-5: Accumulations of silicon dust in tissues of the lung. o Exemplar: FIGURE 4-6: The adaptive cellular responses of atrophy, hypertrophy, hyperplasia, metaplasia, and dysplasia. o Exemplar: Cellular Adaptation. o Exemplar: FIGURE 4-7: (A) Hypertrophy of cardiac muscle in the left ventricular chamber. (B) Compare with the thickness of the normal left ventricle. This is an example of cellular adaptation to an increased cardiac workload. o Exemplar: FIGURE 4-8: Comparison of cellular changes in necrosis and apoptosis. o Exemplar: Irreversible Cell Injury. o Exemplar: FIGURE 4-9: The four primary types of tissue necrosis. (A) Coagulative; (B) liquefactive; (C) fat; (D) caseous. o Exemplar: FIGURE 4-10: Cellular injury as a consequence of intracellular calcium overload.

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35-22 o

o o o

o o o o o o

Exemplar: FIGURE 4-11: Each cell displays a set of receptors that enable it to respond to extracellular signals that control growth, differentiation, and survival. (A) Extracellular signals are provided by the neighboring cells, secreted signaling molecules, and the extracellular matrix. (B) Withdrawal of these survival signals induces the cell to initiate apoptosis.

Exemplar: FIGURE 4-12: Induction of apoptosis by Fas ligand. (A) Target cell binds to Fas ligand on a signaling cell. (B) Active Fas receptors organize and activate caspases. (C) The caspases degrade the nucleus and trigger cell death.

Exemplar: Etiology Of Cellular Injury.

Exemplar: FIGURE 4-13: Withdrawal of survival factors, various cell injuries, and protein overload or misfolding; or through extrinsic cell injury pathways (death receptors), such as binding to Fas or tumor necrosis factor receptors. A number of intracellular regulatory proteins may inhibit or promote the activation of caspases, which, when activated begin the process of cellular degradation and apoptotic cell fragmentation. Fragments are internalized by phagocytic cells.

Exemplar: FIGURE 4-14: Mechanisms of ischemia-induced cell injury. Cellular damage often occurs through the formation of reactive oxygen radicals.

Exemplar: FIGURE 4-15: Types of electromagnetic radiation.

Exemplar: FIGURE 4-16: The mechanism of radiation-induced genetic and cell injury.

Exemplar: FIGURE 4-17: Signs and symptoms of acute radiation sickness.

Exemplar: FIGURE 4-18: The end caps of the chromosomes are called telomeres. In most body cells, the telomeres progressively shorten with each cell replication until a critical point is reached, at which time the cell becomes dormant or dies.

Exemplar: Cellular Aging.

TEACH FOR NURSES LESSON PLAN Chapter 5: Genome Structure, Regulation, and Tissue Differentiation CHAPTER OBJECTIVES 11.

Describe how genetic information is stored in the cell and transmitted to progeny during replication.

12.

Describe how the simple 4-base structure of DNA serves as a template for synthesis of proteins that may contain 20 varieties of amino acids.

13.

Describe the role that genes play in determining cell structure and function.

14.

Explain how gene expression is regulated.

15.

Identify the mechanisms by which the cells of an organism, which all contain identical genes, become differentiated into divergent cell types.

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35-23 16.

Identify the general structures and functions of the four main tissue types: epithelial, connective, muscle, and nerve.

STUDENT RESOURCES understand

       

Textbook Chapter 5 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 5 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus STRUCTURE AND

Content Highlights Discuss the basic structure and function of

Learning Activities 

Activity: Have students complete the algorithm below (Protein Synthesis Algorithm

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35-24

TEACHING STRATEGIES Content Focus FUNCTION OF DNA

Content Highlights DNA, RNA, and chromosomes and DNA replication, transcription, and translation.

Learning Activities 

Structure of DNA  DNA Replication Genetic Code



Completion Exercise).

Online Activity: Have students visit http://www.pbs.org/wgbh/nova/body/ cracking-the-code-of-life.html to learn about the basic structure of DNA. Activity: Have students visit http://learn.genetics.utah.edu/content/basics and, under “MORE ABOUT DNA & GENES, select “Build a DNA Molecule,” and follow the instructions to complete the exercise.

Discussion Topic: Discuss the process of replication

Transcription Translation REGULATION OF THE GENOME Transcriptional Controls DIFFERENTIATION OF TISSUES Cell Diversification and Cell Memory Mechanisms of Development Differentiated Tissues

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35-25

Protein Synthesis Algorithm Completion Exercise

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35-26

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35-27

Protein Synthesis Algorithm Answer

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35-28

IN-CLASS / ONLINE CASE STUDY You are talking to your neighbor, JR, who asks you about stem cells and what type of cells they can make. She tells you that she heard it could make heart tissue and even an ear. You offer to tell her about different tissues in the body.

1. How do you explain cell diversification to JR? Answer: Differentiation of cells starts in the embryo. After these cells have been identified as to their type, they will change. Cellular memory is maintained as future cells divide to replace cells that have died. When a cell is a skin cell, it will always divide into a skin cell.

Genome history and environment control this process.

2. What are the four main tissue categories, and how do they differ?

Answer: Epithelial cells cover the most external surfaces of the body and line all organs, glands, and blood vessels. They become like the tissue that they are found with, as with the stratified cells found in the epidermis. They are formed by stem cells at the base of the epidermis. As they age, they move to the top and become keratinized and slough off. Epithelial cells are also differentiated into simple epithelium cells, where they are only single layers, and you will find these in tissues that involve absorption and into pseudostratified layers that may look like more than one cell, but they are actually different-sized cells that make it look thicker.

Connective tissue cells are the majority of tissue cells and include: bone cells, fat cells, and blood cells. These issue cells act as a scaffold where cells gather to form organs. They are thought to play a role in tissue repair in every organ in the body. There are three major classifications; loose, dense, and supportive tissue. Loose connective tissue contains proteins such as collagen, elastin and reticular fibers. These fibers are found in skin, tendons, and ligaments. The elastin allows the aorta to expand and still return to its previous shape.

Dense or supportive connective tissue is composed mostly of collagen and is found in tissues that are known for strength such as cartilage, tendon, bone, and ligaments. These fibers are organized and densely packed. Cartilage cells or chondrocytes are found

Copyright © 2019, Elsevier Inc. All rights reserved.

35-29 in the trachea, joints, nose, ear, vertebral discs, organs, and young skeletons. These tissues do not need a blood supply. The bone tissue continually model and remodel themselves. Osteoblasts form new bone, and osteoclasts break down bone.

Hematopoietic tissue is responsible for the forming of blood-forming tissues. The blood cells are erythrocytes; to transport oxygen, thrombocytes; for blood coagulation, and leukocytes: mediates immune function.

Muscle tissue is tissue that is specialized for contraction. Muscle cells are usually long and thin and are made up of actin and myosin that form the contractile apparatus. There are four main types: (1) skeletal, which is responsible for voluntary movement; (2) cardiac muscle, a striated muscle that works as a syncytium; (3) smooth muscle, which is located in organs (mainly the blood vessels) and are called involuntary muscle that responds to the autonomic nervous system; and (4) nervous tissue, which is fast and that can generate impulses very rapidly.

TEACH FOR NURSES LESSON PLAN Chapter 6: Genetic and Developmental Disorders CHAPTER OBJECTIVES 17.

18.

19.

20.

21.

22.

Explain how genes are transmitted from parent to offspring.

Describe how pedigree analysis is used to determine if a trait is inherited as autosomal dominant, autosomal recessive, or X linked.

Explain how abnormal meiosis might lead to alterations in chromosome number or structure.

Describe the inheritance patterns and general clinical features of some common genetic disorders.

Describe the role of the environment in the development of congenital disorders.

Identify the available methods of genetic testing.

STUDENT RESOURCES

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35-30

understand

       

Textbook Chapter 6 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 6* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus PRINCIPLES OF INHERITANCE

Content Highlights Distinguish phenotypes and genotypes and the role of chromosomes in humans.

Learning Activities 

Discussion Topic: Refer students to Figure 6-6 and discuss what a Punnett square demonstrates.

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35-31

TEACHING STRATEGIES Content Focus DNA Mutation and Repair GENETIC DISORDERS CHROMOSOMAL ABNORMALITIES

Content Highlights

Discuss the causes of chromosomal defects.

Learning Activities



Online Activity: Have students visit http://www.pbs.org/wgbh/nova/miracle/divide.html# and to view an animated comparison of meiosis and mitosis.

Activity: Have students complete the table below:



Aberrant Number of Chromosomes

Meiosis

Mitosis

Answer: Meiosis

Mitosis

Abnormal Chromosome Structure Examples of Autosomal Chromosome Disorders



Examples of Sex Chromosome Disorders







MENDELIAN SINGLE-GENE

Discuss causes of mendelian single-gene disorders



Involves crossing over and gene reassortment between homologous chromosomes Produces haploid germ cells Involves two nuclear divisions Produces four daughter cells





 

Involves one nuclear division Produces diploid somatic cells Produces two daughter cells Does not involve crossing over

Activity: Have students complete the chart below:

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35-32

TEACHING STRATEGIES Content Focus DISORDERS

Content Highlights

Learning Activities

and distinguish from other chromosomal disorders.

Autosomal dominant inheritance X-linked recessive inheritance Autosomal recessive inheritance Delayed onset of symptoms

Autosomal Dominant Disorders Autosomal Recessive Disorders

Abnormal CFTR transporter protein, a chloride ion transporter Occurs only in males

Sex-Linked (X-Linked) Disorders

Progressive muscle weakness; unable to walk by age 12 years Progressive dementia, uncontrolled limb movements Thick secretions, recurrent respiratory tract infections, malnutrition

Answer: Huntington disease Duchenne muscular dystrophy Cystic fibrosis Huntington disease Cystic fibrosis

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Autosomal dominant inheritance X-linked recessive inheritance

Autosomal recessive inheritance Delayed onset of symptoms Abnormal CFTR transporter protein, a chloride ion

35-33

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Duchenne muscular dystrophy Duchenne muscular dystrophy Huntington disease Cystic fibrosis

NONMENDELIAN SINGLEGENE DISORDERS Anticipation Mitochondrial Gene Mutation Genomic Imprinting POLYGENIC AND MULTIFACTORIAL DISORDERS ENVIRONMENTALLY INDUCED CONGENITAL DISORDERS Periods of Fetal Vulnerability

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transporter Occurs only in males

Progressive muscle weakness; unable to walk by age 12 years Progressive dementia, uncontrolled limb movements Thick secretions, recurrent respiratory tract infections, malnutrition

35-34

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Teratogenic Agents Other Disorders of Infancy DIAGNOSIS, COUNSELING, AND GENE THERAPY Prenatal Diagnosis and Counseling Genetic Analysis and Therapy Recombinant DNA Technology

IN-CLASS/ONLINE CASE STUDY KS comes for a clinic visit to determine whether she is pregnant. She is very concerned because she suspects there may be a genetic disease in her family. On further questioning, you find out that her brother’s son has the disorder. Her brother’s other children (a boy and a girl) are unaffected. KS’s parents, grandparents, and other siblings (a brother and two sisters) do not have manifestations of the disorder. Her brother’s wife has said that she thinks one of her distant relatives may have had the disease.

1. If the disorder is indeed inherited as a single-gene defect, would it be autosomal dominant, autosomal recessive, or X linked?

Answer: Autosomal recessive Rationale: It would be autosomal recessive because no other family members show signs of being affected by the disorder. The disorder cannot be X linked because unaffected males do not carry the defective X-linked gene. In an autosomal dominant disorder, one of KS’s parents would have been affected.

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35-35

2. Based on what you would see in a pedigree chart, what is the likelihood that KS has the defective gene?

Answer: KS has a 50% chance of carrying the defective gene.

Rationale: KS has a one in two chance of carrying the affected gene regardless of whether both parents are heterozygous or one parent is heterozygous and one is homozygous.

NURSING CURRICULUM STANDARDS

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Sexuality and Reproduction  Concept: Reproduction o Exemplar: FIGURE 6-1: Scanning electron micrograph of a chromosome showing the two sister chromatids attached at the centromere. Sister chromatids separate during meiosis with one chromatid being distributed to each daughter cell. o Exemplar: FIGURE 6-2: A standard map of the banding pattern of each of the 23 chromosomes of the human. Somatic cells contain two copies of each chromosome. The centromere region is marked by the line. o Exemplar: FIGURE 6-3: Comparison of meiosis and normal mitotic cell division, showing only one homologous chromosome pair.

In meiosis, the homologous chromosomes form a pair and exchange sections of DNA in a process called crossing over. Two nuclear divisions are required in meiosis to form the haploid germ cells. o Exemplar: FIGURE 6-4: Crossing over during meiotic prophase i results in a reassortment of genes between homologous chromosomes. o Exemplar: Genetic Disorders. o Exemplar: Chromosomal Abnormalities.

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35-36 o o o o o o o o o o o o o o o o o o o

o o o

Exemplar: FIGURE 6-5: Metaphase chromosome showing location of centromere and long and short arms of the chromatids.

Gene loci are described by the chromosome number, location on short (p) or long (q) arm, region, and band.

Exemplar: FIGURE 6-6: Punnett square shows the distribution of parental genes to their offspring. This example shows the mating of two heterozygous individuals. A, Dominant gene; a, recessive gene.

Exemplar: FIGURE 6-7: Steps of DNA repair. In step 1 the damaged section is removed; in steps 2 and 3 the original DNA sequence is restored.

Exemplar: FIGURE 6-8: Schematic illustration of mutations that alter the messenger RNA sequence and the resulting protein amino acid sequence. (A) Point mutation alters one amino acid. (B) Frameshift mutation alters all downstream amino acids.

Exemplar: FIGURE 6-9: Mechanism of nondisjunction leading to aneuploidy. For simplicity, only one pair of chromosomes is shown.

Exemplar: FIGURE 6-10: Types of chromosomal rearrangement.

Exemplar: FIGURE 6-11: Typical clinical manifestations of trisomy 21 (Down syndrome) Exemplar: FIGURE 6-12: Typical clinical manifestations of Klinefelter syndrome.

Exemplar: Table 6-1: Frequency of Trisomy 21 (Down Syndrome) in Relation to Maternal Age. Exemplar: FIGURE 6-13: Typical clinical manifestations of Turner syndrome.

Exemplar: Mendelian Single-Gene Disorders Exemplar: FIGURE 6-14: (A) Common symbols for pedigree analysis. (B) Typical family pedigree chart.

Exemplar: FIGURE 6-15: Typical pattern of inheritance of an autosomal dominant trait (e.g., Marfan syndrome). (A) Pedigree chart. (B) Punnett square.

Exemplar: Table 6-2: Autosomal Dominant Disorders, Exemplar: Nonmendelian Single-Gene Disorders Exemplar: FIGURE 6-16: Clinical manifestations of Marfan syndrome. Skeletal deformities such as pectus excavatum and abnormal curvature of the thoracic spine are common findings.

Exemplar: FIGURE 6-17: Typical pattern of inheritance of an autosomal recessive trait (e.g., cystic fibrosis, sickle cell anemia). (A) Pedigree chart. (B) Punnett square.

Exemplar: Table 6-3: Autosomal Recessive Disorders Exemplar: FIGURE 6-18: Schematic illustration of the cystic fibrosis transmembrane conductance regulator (CFTR) located in an epithelial cell. CFTR is a transmembrane protein that transports chloride from the cytoplasm into the lumen of the bronchiole.

Mutations in the CFTR transporter gene are believed to cause the thick secretions typical of cystic fibrosis.

Exemplar: FIGURE 6-19: Typical inheritance pattern for X-linked disorders. The risk of disease varies according to the gender of the offspring.

Exemplar: FIGURE 6-20: Pedigree chart for the transmission of the X-linked disease hemophilia A in the royal families of Europe, Exemplar: Table 6-4: X-Linked Recessive Disorders

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35-37 o

Exemplar: FIGURE 6-21: Angelman and Prader-Willi syndromes are examples of genetic imprinting, where the location of a mutation on the maternal or paternal homologous chromosome produces a different outcome o Exemplar: Polygenic and Multifactorial Disorders o Exemplar: Environmentally Induced Congenital Disorders o Exemplar: Table 6-5: Causes of Congenital Malformations in Humans o Exemplar: Table 6-6: Pregnancy Categories for Medication Administration o Exemplar: FIGURE 6-22: Vulnerable periods of fetal organ development o Exemplar: FIGURE 6-23: Major clinical findings in the TORCH (toxoplasmosis, others, rubella, cytomegalovirus, herpes) complex of infective congenital disorders o Exemplar: Diagnosis, counseling, and gene therapy, diagnosis, counseling, and gene therapy o Exemplar: FIGURE 6-24: Fluorescence in situ hybridization assay showing an interphase nucleus. The red probe is hybridized to chromosome 21 and the green probe is hybridized to chromosome 13. Three copies of chromosome 21 are identified, confirming the diagnosis of trisomy 21.

TEACH FOR NURSES LESSON PLAN Chapter 7: Neoplasia CHAPTER OBJECTIVES 1. Distinguish between neoplastic cells from normal cells.

2. Distinguish between benign and malignant tumors.

3. Explain how overexpression of proto-oncogenes might lead to abnormal cellular proliferation.

4. Explain how underexpression of tumor suppressor genes might lead to abnormal cellular proliferation.

5. Identify the properties gained during tumor progression that contribute to malignant behavior and metastasis.

6. Describe how tumor grading and staging are used to characterize cancers and guide the selection of cancer therapies.

7. Describe how lifestyle and carcinogen exposure contribute to cancer risk.

8. Describe the effects of cancer on the body.

9. Identify treatment options available for benign and malignant tumors.

STUDENT RESOURCES

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35-38

understand

       

Textbook Chapter 7 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 7* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus BENIGN VERSUS MALIGNANT GROWTH

Content Highlights Distinguish between benign and malignant tumors and review tumor terminology.

Learning Activities  

Online Activity: Have students visit www.cancer.gov to become familiar with the U.S. government’s primary agency for cancer research.

Discussion Topic: Show students photographs of benign and malignant

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35-39

TEACHING STRATEGIES Content Focus Characteristics of Benign and Malignant Tumors

Content Highlights

Learning Activities tumors, note their organized structure, and compare the two tumor types.  Activity: Have students complete the chart below: Benign Tumor Malignant Tumor

Tumor Terminology The Malignant Phenotype Answer: Benign Tumor  Usually has a capsule that separates tumor from the surrounding tissue  Is composed of cells that are well differentiated and appear relatively normal  Does not invade surrounding tissue  Does not metastasize to lymph nodes or distant issues



Malignant Tumor  Tends to metastasize to lymph nodes and distant tissues  Exhibits rapid growth  Composed of cells that are undifferentiated and exhibit large nuclei, frequent mitotic figures, and little organization  Does not have a capsule and tends to invade surrounding tissue

Activity: Have students complete the chart below: Cancer Type Cell Origin Arises from connective tissue cells Arises from germ line cells

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35-40

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Arises from lymphoid cells Arises from epithelial cells Arises from leukocyteforming cells Arises from bone Arises from epithelial cells in a gland Arises from liver cells Arises from pigmentproducing cells in the skin Answer: Cancer Type Sarcoma Teratoma Lymphoma Carcinoma Leukemia Osteogenic sarcoma Adenocarcinoma Hepatocellular carcinoma Malignant melanoma

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Cell Origin Arises from connective tissue cells Arises from germ line cells Arises from lymphoid cells Arises from epithelial cells Arises from leukocyteforming cells Arises from bone Arises from epithelial cells in a gland Arises from liver cells Arises from pigmentproducing cells in the skin

35-41

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

EPIDEMIOLOGY AND CANCER RISK FACTORS Tobacco Use Nutrition GENETIC MECHANISMS OF CANCER Proto-Oncogenes Tumor Suppressor Genes MULTISTEP NATURE OF CARCINOGENESIS Initiation Promotion Progression METASTASIS Patterns of Spread

Discuss the abnormal characteristics that contribute to the spread of cancer through metastasis.



Activity: Have students complete the algorithm below (titled “Pathogenesis of Metastasis Algorithm Completion”).

Angiogenesis Grading and Staging of Tumors EFFECTS OF CANCER ON THE BODY CANCER THERAPY Surgery

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35-42

TEACHING STRATEGIES Content Focus

Content Highlights

Radiation Therapy Drug Therapy Immunotherapy Gene and Molecular Therapy Stem Cell Transplantation

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-43

Pathogenesis of Metastasis Algorithm Completion Exercise

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35-44

Pathogenesis of Metastasis Algorithm Answer

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35-45

IN-CLASS/ONLINE CASE STUDY JF is a 26-year-old woman in the clinic today for her annual physical examination. As you take her medical history, it becomes apparent that she is quite concerned about her risk for developing breast cancer. Her mother and a maternal aunt both developed breast cancer in their late 40s.

JF has heard that genetic testing can be done to see whether she carries “breast cancer genes.”

1. Assuming JF is talking about the BRCA1 and BRCA2 genes, explain the role that these genes have in the genetic mechanisms of breast cancer.

Answer:  

BRCA1 and BRCA2 are tumor suppressor genes.

Cancer is thought to develop when tumor suppressor genes become inactivated or proto-oncogenes become inappropriately activated.

2. If genetic testing reveals that JF does carry the BRCA1 gene, what does this mean for her risk of developing breast cancer?

Answer: Because she has a family history, JF would have an 85% risk for the development of breast cancer.

3. What proportion of breast cancer cases can be attributed to inherited forms?

Answer: Inherited forms of breast cancer account for 5% to 10% of all breast cancer cases.

4. What other cancer would JF be at risk for given the presence of the BRCA1 gene? How significant is that risk?

Answer: She would have a 40% to 60% risk of ovarian cancer as well.

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35-46 5. What other risk factors should be investigated to evaluate JF’s risk for breast cancer? (Go to the discussion of breast cancer in your text, Chapter 33.)

Answer:     

Increasing age is a significant risk factor for breast cancer.

Onset of menstrual period (menarche) when younger than 12 years and late menopause (after 55 years of age) are risk factors because they produce prolonged exposure to estrogen and progesterone.

Breastfeeding seems to be a protective factor against breast cancer, as is having given birth. Never having had a child increases the risk.

A history of other cancers or radiation exposure increases breast cancer risk.

The use of estrogen plus progesterone oral contraceptive pills increases risk as does postmenopausal estrogen replacement therapy. The progesterone-only pill is not associated with increased risk.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care Epidemiology and Cancer Risk Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Nutrition

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35-47 

Concept: Cellular Regulation o Exemplar: Benign versus Malignant Growth o Exemplar: FIGURE 7-1: (A) Normal Papanicolaou smear from the uterine cervix showing large, flat epithelial cells with small nuclei. (B) Typical histologic appearance of anaplastic tumor cells showing variation in cell size and shape, with large, hyperchromic nuclei. o Exemplar: Epidemiology and Cancer Risk Factors o Exemplar: Genetic Mechanisms of Cancer o Exemplar: FIGURE 7-2: United States 2012 estimated new cancer cases (A) and estimated cancer deaths (B) in 10 leading sites by gender. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. o Exemplar: FIGURE 7-3: Death rates for cancer of the lung, broncus, trachea, and pleura, by age at and year of death, 1930-1998.

(A) Male death rates. (B) Female death rates. o Exemplar: FIGURE 7-4: Annual cancer deaths attributable to smoking in males and females in the United States o Exemplar: FIGURE 7-5: Possible effects of proto-oncogene activation on growth signaling pathways. (A) Production of growth factors (mitogens). (B) Production of growth factor receptors. (C) Intracellular pathway disturbances. (D) Activation of transcription factors for growth. o Exemplar: FIGURE 7-6: Mechanisms of proto-oncogene activation. (A) Retroviral insertion. (B) Proto-oncogene mutation. (C) Regulatory sequence mutation. (D) Proto-oncogene amplification. RT, Reverse transcriptase. o Exemplar: FIGURE 7-7: Overactivity of proto-oncogenes may be due to normal production of an abnormal protein (mutation in coding sequence) or excessive production of a normal protein (gene amplification or chromosome rearrangement), o Exemplar: FIGURE 7-8: Both DNA copies (alleles) of the Rb tumor suppression gene must be dysfunctional for occurrence of retinoblastoma. Inheriting a defective Rb gene predisposes an individual to the development of cancer because only a single mutational event is required to inactivate pRb function. o Exemplar: FIGURE 7-9: The Rb protein functions to bind transcription factors in the nucleus and keep them from participating in the transcription of cell cycle–related genes. pRb is induced to release its hold on the E2F transcription factors when it is sufficiently phosphorylated by cyclin-dependent kinases (Cdk). Cyclin-dependent kinases are activated by cyclin proteins that accumulate when growth factors bind to receptors and stimulate growth pathways. Other signals, such as transforming growth factor- (TGF-), inhibit the activity of cyclin/Cdk through activation of inhibitory proteins such as p16. A loss of pRb function removes the “major brake” on cell division. P, Phosphate group; EGF, epidermal growth factor. o Exemplar: Multistep Nature of Carcinogenesis o Exemplar: FIGURE 7-10: Role of P53 (TP53) in maintaining the integrity of the Genome. Damage to DNA in cells with functional P53 stalls the cell cycle so that DNA can be repaired. If repair fails, then the cell undergoes apoptosis to prevent the proliferation of DNA-damaged cells. If the P53 is not functional, genetically unstable cells may be allowed to survive and proliferate. o Exemplar: FIGURE 7-11: Theoretical steps in the development of cancer include initiation, promotion, and progression.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-48 o o o o o

o o o o

Exemplar: FIGURE 7-12: Development of colorectal cancer illustrates the concept of multistep carcinogenesis. Derangement of several genes is likely to occur in most types of cancer.

Exemplar: FIGURE 7-13: Fluorescent images from human colon cancers.

Exemplar: Metastasis, Exemplar: FIGURE 7-14: The metastatic cascade of events.

Exemplar: FIGURE 7-15: Mechanisms of tumor invasion allow tumor cells to escape the site of origin, penetrate the basement membrane, and travel to distant sites. (A) Tumor cells decrease cell-to-cell attachments via cadherins that allow detachment and migration toward the basement membrane. (B) Enzymes that degrade proteins are released into the area to form a rift. (C) The tumor cell migrates away from the site of origin using laminin and fibronectin receptors to pull through the tissue. (D) Finally, the cell moves through a rift in the matrix.

Exemplar: Effects of Cancer on the Body Exemplar: FIGURE 7-16: PET scan that detects uptake of radioactively labeled glucose is overlaid onto a CT scan background image. The yellow spots in the abdomen and mediastinum are indicative of multiple metastases of non-Hodgkin lymphoma.

Exemplar: FIGURE 7-17: General emaciated appearance in cancer cachexia.

Exemplar: FIGURE 7-18: Cancer cells express abnormal antigens (tumor-associated antigens) on their cell surface that can activate immune cells or be used as targets for monoclonal antibodies. Numerous medications are now available that use monoclonal antibodies to target cellular proteins relevant to several different types of cancer.

THEME: Protection and Movement  Concept: Pain o Exemplar: Effects of Cancer on the Body THEME: Maladaptive Behavior o Concept: Addiction o Exemplar: FIGURE 7-4: Annual cancer deaths attributable to smoking in males and females in the United States

BSN ESSENTIALS BSN Essentials  Essential VII: Clinical Prevention and Population Health o Epidemiology and Cancer Risk Factors

TEACH FOR NURSES LESSON PLAN Copyright © 2019, Elsevier Inc. All rights reserved.

35-49

Chapter 8: Infectious Processes CHAPTER OBJECTIVES 1. Explain how the human microbiome regulates the environment of mucosal surfaces and protects from pathogens.

2. Identify opportunistic infections and when they develop.

3. Describe the conditions that compromise host defenses against microorganisms.

4. Identify the factors that influence the virulence of infectious agents.

5. Explain how environmental factors such as climate, poverty, global travel, and bioterrorism influence the risk of infectious disease.

6. Identify the important microorganisms that affect humans, including bacteria, viruses, fungi, and parasites, and explain how differences in structure and life cycle affect infectious processes.

STUDENT RESOURCES understand

       

Textbook Chapter 8 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 8* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

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35-50

before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus HOST-MICROBE RELATIONSHIP The Human Microbiome

Content Highlights

Learning Activities

Emphasize the infection is one of the most common causes of death worldwide and identify the specialized mechanisms that allow infections to be pathogenic to humans.

Host Characteristics Pathogen Characteristics TRANSMITTION OF INFECTION

 

The Chain of Transmission

Online Activity: Have students visit http://www.cdc.gov/hai to learn more about healthcare associated infections.

Activity: Have students complete the table below to review the transmission of infection:

Emerging Infectious Diseases

Fomite Portal of exit Vector Reservoir Portal of entry Mode of transmission

Weapons of Bioterrorism

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35-51

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Pathogen Colonization Answer: Inanimate object that transmits a pathogen to a new host How a pathogen leaves a reservoir An insect or other nonhuman carrier that transfers a pathogen Where a pathogen reproduces until it is transmitted to a susceptible host How a pathogen enters a susceptible host How a pathogen travels from a reservoir to a susceptible host Organism that can cause infection and disease Pathogen lives in or on the host but does not cause infection 

Fomite

Portal of exit Vector

Reservoir

Portal of entry Mode of transmission Pathogen Colonization

Activity: Have students complete the table below to review the risk factors for infection: Impairs phagocytosis and provides an environment for pathogen growth Impairs both neutrophil function and cell-medicated immunity

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35-52

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Bypasses the flushing action at the external opening of the urethra Bypasses the protective mucus and cilia in the respiratory tract Breaches the epidermal barrier Suppresses multiple components of the immune system Answer: Hyperglycemia from diabetes Protein-calorie malnutrition Indwelling urinary catheter Endotracheal tube

COMMON PATHOGENIC ORGANISMS

Identify the four major types of organisms that cause human infections.

Impairs phagocytosis and provides an environment for pathogen growth Impairs both neutrophil function and cell-medicated immunity Bypasses the flushing action at the external opening of the urethra Bypasses the protective mucus and cilia in the respiratory tract Breaches the epidermal barrier Suppresses multiple components of the immune system

Cut, abrasion, or burn High corticosteroids from stress or medication Discussion Activity: Have students distinguish among bacteria, viruses, fungi, and parasites.

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35-53

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Bacteria Viruses Fungi Parasites

IN-CLASS/ONLINE CASE STUDY EH is a 68-year-old man who comes into the clinic complaining of a fever with a temperature of 103°F. He has had a cough for the past 3 days that is producing some thick, green-brown mucus. The physician thinks he most likely has bacterial pneumonia. EH also has a history of having rheumatoid arthritis and being immune compromised because he is on an immunosuppressant methotrexate. He notes that over the past year, he has lost weight unintentionally and thinks he is underweight.

1. Understanding epidemiologic concepts of the chain of transmission of organisms from host to victim, describe how EH could have been infected and why he might have been susceptible.

Answer: EH could have been infected by another human who was infected with the bacteria via airborne droplets or hand-to-mouth contamination. The bacteria then entered and stayed in the nasal passages or the oral mucosa, where they live, grow and multiply.

EH was more susceptible to entry of the bacteria because of his autoimmune and immunocompromised state.

2.

Describe the epithelial barriers that were overcome by EH’s bacteria.

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35-54 Answer: EH has a bacterial pneumonia in the lungs. The bacteria overcame the epithelial barrier in the nasal and oral mucosa. Bacteria can progress down the trachea into the lungs, where they easily multiply. In the lungs, alveolar macrophages are ready to trap and kill the bacteria along with coughing and the cilia lining the trachea, but they were all unable to do their job to prevent the increasing numbers of bacteria that led to infection.

3. Explain how each of the following factors increases EH’s risk for getting a bacterial pneumonia.

Answer: Nutritional state: EH has lost 30 lb over the past year, and the possibility of protein energy malnutrition (PEM) can lead to an inability of the cells to respond to bacteria either through decreased cell-mediated immunity and a decreased ability to make more antibodies such as IgA. Chronic illness: EH has rheumatoid arthritis an autoimmune disease that increases his risk of infection by bacteria. He is taking an immunosuppressant that makes him more susceptible.

Age: As EH ages, his ability to fight infections is limited secondary to the immune system inability to respond as quickly, allowing the bacteria to gain control. There is a decrease in T-lymphocyte functions and the thymus gland might disappear with age. Pulmonary infections are one of the most common sites of infections in the elderly Immunosuppression: EH has an autoimmune disease (rheumatoid arthritis) and is taking an immunosuppressant. This, along with the decreasing ability of the immune system as we age, sets up EH a bacterial infection.

4.

After considering each of the risk factors, list four things that you would suggest to EH to help prevent infections in the future.

Answer:  Have EH meet with a nutritionist and discuss ways to increase protein into his diet.  Have EH eat six small meals per day to make sure he is taking in nutrition throughout the day.  Have EH stay away from others (family and friends) who are ill and stay home when he is feeling sick.

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35-55 

Remind EH that if he starts taking corticosteroids, he is at an increased risk of getting infections, so he should be extra vigilant if that occurs.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Risk Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Nutritional Status

BSN ESSENTIALS BSN Essentials  Essential VII: Clinical Prevention and Population Health o Risk Factors o Role of Immunization

TEACH FOR NURSES LESSON PLAN

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35-56

Chapter 9: Inflammation and Immunity CHAPTER OBJECTIVES 1. Identify the major organs and cellular components of the body’s defense against foreign antigens.

2. Describe how immune cells communicate through cell-to-cell interactions and through secreted cytokines.

3. Distinguish innate and adaptive immune mechanisms.

4. Describe how macrophages, granulocytes, and lymphocytes work together to locate, recognize, and eliminate pathogens.

5. Explain the role of MHC class I and II proteins in cell-mediated immunity.

6. Describe why an immune response is usually more effective on subsequent exposure to an antigen than after the first exposure.

7. Describe how noncellular immune system components, including antibodies, complement, and clotting factors, aid the immune response.

STUDENT RESOURCES understand

       

Textbook Chapter 9 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 9* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

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35-57

before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus COMPONENTS OF THE IMMUNE SYSTEM

Content Highlights

Learning Activities

Identify the structures of the immune system, their function, and their role in inflammation and immunity.



Online Activity: Have students visit http://www.nlm.nih.gov/medlineplus/immunesystemanddisorders.html for more information and visual aids about immune system disorders.

Discuss the characteristics and function of the leukocytes.



Activity: Have students complete the following table to sort the immune cells into categories that describe how they participate in immune defense.

EPITHELIAL BARRIERS MONONUCLEAR PHAGOCYTE SYSTEM LYMPHOID SYSTEM Primary Lymphoid Organs Secondary Lymphoid Organs LEUKOCYTES Neutrophils

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35-58

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Granules release chemicals

Phagocytic cell, also secretes

Answer Granules release chemicals  Mast cell  Basophil  Eosinophil

Phagocytic cell, also secretes  Macrophage  Monocyte  Neutrophil

Eosinophils Basophils and Mast Cells Monocytes and Macrophages Dendritic Cells Lymphocytes CHEMICAL MEDIATORS OF IMMUNE FUNCTION Complement Kinins Clotting Factors Cytokines and Chemokines INNATE DEFENSES AND INFLAMMATION

Discuss the inflammatory response purposes, manifestations, and causes.



Activity: Have students complete the following table to compare adaptive and innate immunity: Innate Immunity Adaptive Immunity

Answer:

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35-59

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Innate Immunity   



Macrophage Mast cell Each cell can respond to many different antigens Neutrophil

INFLAMMATION Increased Vascular Permeability Emigration of Leukocytes Phagocytosis Chronic Inflammation HEALING INFLAMMATORY EXUDATES SYSTEMIC MANIFESTATIONS OF INFLAMMATION

Copyright © 2019, Elsevier Inc. All rights reserved.

  



Adaptive Immunity T helper cell Cytotoxic T cell Each cell can respond to only one antigen Plasma cell

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TEACHING STRATEGIES Content Focus SPECIFIC ADAPTIVE IMMUNITY

Content Highlights Discuss the function and mechanisms of the specific immune system.

Learning Activities 

Discussion Topic: Use the algorithm below (labeled Specific Adaptive Immunity Algorithm) to illustrate and facilitate a discussion regarding the sequence of events that occur in the adaptive immunity process.

MAJOR HISTOCOMPATIBILITY COMPLEX ANTIGEN PRESENTATION

BY MHC MHC Class I Presentation MHC Class II Presentation MECHANISMS OF CELLMEDIATED IMMUNITY +

T Helper Cells (CD4 ) +

Cytotoxic T Cells (CD8 ) MECHANISMS OF HUMORAL IMMUNITY Antigen Recognition by B Cells

Antibody Structure

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35-61

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Class Switching and Affinity Maturation Antibody Functions

PASSIVE AND ACTIVE IMMUNITY Passive Immunity

Discuss when passive and active immunity occur.



Activity: Have students complete the following table to compare passive and active immunity: Passive Immunity

Active Immunity

Active Immunity

Answer: Passive Immunity

Active Immunity





  

Maternal IgG antibodies cross placenta and enter fetus Infant receives IgA antibodies in breast milk Man with tetanus receives tetanus antitoxin Adult receives human immune globulins after

Copyright © 2019, Elsevier Inc. All rights reserved.





Child receives tetanus vaccine Adult receives tetanus booster shot Child has measles and develops antibodies against measles antigens

35-62

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities bone marrow transplant

INTEGRATED FUNCTION AND REGULATION OF THE IMMUNE SYSTEM

INTEGRATED RESPONSE TO MICROBIAL ANTIGEN INTEGRATED RESPONSE TO VIRAL ANTIGEN REGULATION OF IMMUNE FUNCTION

Copyright © 2019, Elsevier Inc. All rights reserved.

35-63

Specific Adaptive Immunity Algorithm

IN-CLASS/ ONLINE CASE STUDY GO is a 28-year-old housewife who was watching TV last night when she heard that there was an outbreak of hepatitis A at a local restaurant and that they were looking for patrons who had eaten there on February 10. She tells you that she had eaten there that night and ate from the salad bar. She asks what she should do.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-64 1. Discuss the difference between passive immunity and active immunity. Explain what would be the best course of action for GO. Answer: Passive immunity: is when you give a person a vaccine that is made up of plasma containing antibodies against a specific antigen. This is done for people who are immunodeficient and when a person, such as GO, is exposed to the antigen and has a high susceptibility to contracting the disease. IgG is the major antibody used to treat exposures to antigens such as hepatitis A. Mothers pass IgG immunoglobulins to the fetus giving them passive immunity. Human immunoglobulin contains mostly IgG and is made up of pooled plasma of many adults. This will give GO coverage for up to 6 months Active immunity provides protection when you are exposed to an active infection such as hepatitis A. This requires the maturation of and maintenance of memory B cells. If exposed, a second time the antibody response is quick. Immunizations can trick the body into thinking it has been exposed to an antigen or infection. Hepatitis vaccine is used and given in a series of vaccines, so it will take a while for the immunity to active. Active immunity would not work in time for GO so will not help in her current situation.

Because GO has been exposed to the hepatitis A virus, she should receive human immunoglobulin and then be started on active immunity by starting the hepatitis A series. She will then have immunity both today and in the future.

NURSING CURRICULUM STANDARDS

QSEN/ NLN COMPETENCIES QSEN  Patient-Centered Care o Clotting Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-65

THEME: Homeostasis and Regulation  Concept: Thermoregulation o Exemplar: Systemic Manifestations of Inflammation

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Clotting Factors

TEACH FOR NURSES LESSON PLAN Chapter 10: Alterations in Immune Function CHAPTER OBJECTIVES 1. Describe the potential mechanisms whereby erroneous reaction of the immune system with self tissue leads to autoimmune diseases.

2. Explain how type I, II, III, and IV hypersensitivity reactions differ according to the immune cell types involved and the mechanism of tissue injury.

3. Identify the common features of autoimmune disorders and certain types of hypersensitivity disorders.

4. Explain how hypersensitivity disorders are detected, prevented, and treated.

5. Differentiate the etiologic processes of primary and secondary immune deficiency disorders.

6. Describe the clinical features of the common immunodeficiency disorders.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

35-66

understand

       

Textbook Chapter 10 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 10* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

EXCESSIVE IMMUNE RESPONSES

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-67

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

AUTOIMMUNITY Genetic Factors Environmental Triggers Pharmacotherapies HYPERSENSITIVITY Type I Hypersensitivity

Discuss hypersensitivity and the mechanisms triggering hypersensitive responses.

 

Type IIa Hypersensitivity  Type IIb Hypersensitivity Type III Hypersensitivity Type IV Hypersensitivity

Discussion Topic: In a class discussion work with students to create a chart distinguishing the four types of hypersensitivity.

Online Activity: Have students visit http://www.niaid.nih.gov/topics/Pages/default.aspx and identify resources for patients and clinicians regarding allergies.

Activity: Have students complete the following chart to match the terms (type I, type II, type III, and type IV) to their descriptions: Description These hypersensitivities involve activation of complement All hypersensitivities except this one involve antibodies.

These hypersensitivities involve cell membrane antigens.

All hypersensitivities except this one may be autoimmune.

These hypersensitivities may involve foreign antigens.

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35-68

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Answer: Types II and III Type IV Type II and IV Type I

Type I, II, III and IV

Description These hypersensitivities involve activation of complement All hypersensitivities except this one involve antibodies.

These hypersensitivities involve cell membrane antigens.

All hypersensitivities except this one may be autoimmune.

These hypersensitivities may involve foreign antigens.

DEFICIENT IMMUNE RESPONSES

PRIMARY IMMUNODEFICIENCY DISORDERS

Discuss the congenital phenotypes included in primary immunodeficiency disorders.



Activity: Have students complete the following chart to match the primary immunologic defect and the clinical manifestations in the correct boxes of the chart.

B-Cell and T-Cell Combined Disorders T-Cell Disorders

B-Cell Disorders

Defect WiskottAldrich syndrome Selective IgA deficiency

Copyright © 2019, Elsevier Inc. All rights reserved.

Clinical Manifestation

35-69

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Severe combined immunodefi ciency (SCID) Di George syndrome Answer Defect WiskottAldrich syndrome

Selective IgA deficiency

Severe combined immunodefi ciency (SCID) Di George syndrome

Decreased IgM antibody production, platelet dysfunction Decreased IgA, loss of secretory immune function Decreased number of T cells, dysfunction of B cells Thymus aplasia, parathyroid gland defect

SECONDARY IMMUNODEFICIENCY DISORDERS

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Clinical Manifestation Infections by encapsulate bacteria, thrombocytopenia Gastrointestinal, lung, and sinus infections; frequent allergies Severe bacterial, viral, fungal, and parasite infections

Gastrointestinal infections, pneumonia, tetany

35-70

IN-CLASS/ONLINE CASE STUDY EO is an 8-year-old girl with a history of asthma and allergy to bee stings. She has been brought to the clinic complaining of a throat infection.

Her health care provider prescribes a course of penicillin to manage her current infection and cautions her parents to watch her closely for a reaction.

1.

What type of reaction is the health care provider concerned about and why?

Answer: The health care provider is concerned about a type I hypersensitivity reaction, which is a normal immune response triggered inappropriately toward an allergen (antigen).

Allergies have a strong genetic component. EO has a history of allergy to bee stings and asthma that may be allergen-triggered.

2.

Explain the role of IgE and mast cells in type I hypersensitivity reactions. Why might EO react adversely to the antibiotic with the first use?

Answer: Mast cells with IgE receptors bind the Fc portion of an IgE antibody, making the mast cell responsive to particular allergens.

Cross-linking of two IgE receptors to one allergen on mast cells causes and increase in intracellular calcium; the mast cells then degranulate, releasing histamine and other chemicals.

Type I hypersensitivity reactions are specific to a particular antigen. Normally, insufficient antibody is produced with the first exposure to initiate a reaction. However, molecularly similar antigens from the environment may serve to sensitize a person.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-71 Memory T and B cells store the record of allergic exposures. With reexposure, larger quantities of antibodies are produced, and the body reacts strongly and quickly.

3.

What would you tell EO’s parents to look for when they are assessing for a reaction?

Answer: Reactions usually occur within 15 to 30 minutes after exposure to the allergen and may include hives, localized swelling, tightening of the throat, wheezing, shortness of breath, tachycardia, and hypotension.

4.

What actions would you suggest the parents take if a reaction does occur?

Answer: o Administer epinephrine hydrochloride (EpiPen). Epinephrine is the drug of choice in emergency treatment for acute anaphylactic reactions. o Do not administer any more doses of antibiotic. o Take the child to the emergency department. In an anaphylactic reaction, massive histamine release causes vasodilation, circulatory collapse, and severe bronchoconstriction. This type of reaction can be life threatening.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Autoimmunity o Hypersensitivity

Copyright © 2019, Elsevier Inc. All rights reserved.

35-72

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Secondary Immunodeficiency Disorders THEME: Protection and Movement o Concept: Immunity o Exemplar: Excessive Immune Responses o Exemplar: Autoimmunity o Exemplar: Hypersensitivity o Exemplar: Table 10-2: The Four Types of Hypersensitivity o Exemplar: FIGURE 10-1: Type I hypersensitivity reaction o Exemplar: Box 10-1: Possible Causes of Human Allergic Reactions or Anaphylaxis o Exemplar: FIGURE 10-2: Type II hypersensitivity reactions o Exemplar: FIGURE 10-3: Type II hypersensitivity reaction in a person with myasthenia gravis. Having limited receptors available for acetylcholine impairs neuromuscular transmission. o Exemplar: FIGURE 10-4: Type III hypersensitivity reaction o Exemplar: Table 10-4: Diseases Associated with Type III Hypersensitivity o Exemplar: FIGURE 10-5: Type IV hypersensitivity reaction o Exemplar: Table 10-5: Granulomatous Disease Associated with Type IV Hypersensitivity o Exemplar: Table 10-6: Primary Congenital Immunodeficiency Disorders o Exemplar: Deficient Immune Responses o Exemplar: Primary Immunodeficiency Disorders o Exemplar: Secondary Immunodeficiency Disorders

Copyright © 2019, Elsevier Inc. All rights reserved.

35-73

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Prevention o Pharmacotherapeutic Prevention

TEACH FOR NURSES LESSON PLAN Chapter 11: Malignant Disorders of White Blood Cells CHAPTER OBJECTIVES 1. Describe how the various types of leukemia, lymphoma, and plasma cell myelomas differ based on the type of malignant transformation.

2. Describe how the clinical presentations, prognosis, and management of types of acute and chronic leukemia differ.

3. Explain why malignant disorders of white blood cells are commonly associated with bone marrow depression.

4. Describe how Hodgkin disease is clinically and histologically differentiated from other types of lymphoma.

5. Describe the purpose and process of staging procedures for lymphomas.

6. Identify the clinical and laboratory findings that would suggest a diagnosis of plasma cell myeloma.

STUDENT RESOURCES understand

       

Textbook Chapter 11 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 11* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

35-74

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus CLASSIFICATION OF HEMATOLOGIC NEOPLASMS ETIOLOGY OF MYELOID AND LYMPHOID NEOPLASMS GENERAL PRINCIPLES OF MANAGEMENT Diagnosis of Hematologic Neoplasms

Content Highlights

Discuss the treatment options and methods for preventing and managing complications resulting from the disease progression or treatment.

Learning Activities



Activity: Divide students into groups and assign each group a hematologic neoplasm. Have each student create a patient scenario describing the likely manifestations of a patient with the assigned neoplasm. Then have each group present its scenario to the class and have the class guess the described hematologic neoplasm.

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35-75

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 

Principles of Treatment Prevention and Management of Complications MYELOID NEOPLASMS

Discuss the characteristics and clinical manifestations of myeloid neoplasms.



Chronic Myeloid Leukemia

Discussion Topic: Have students discuss the importance of balancing the risks and benefits of treatment options. Have students discuss the clinician’s role in assisting the family or patient with making treatment decisions.

Activity: Have students complete the following table: Acute Myeloid Chronic Myeloid Leukemia Leukemia

Acute Myeloid Leukemia Answer: Acute Myeloid Leukemia  Young adults  Bleeding tendencies from decreased platelets  Cells poorly differentiated  Abrupt onset LYMPHOID NEOPLASMS Chronic Lymphoid Leukemia Acute Lymphoblastic Leukemia/Lymphoma Hairy Cell Leukemia

Distinguish leukemias from lymphomas.



Chronic Myeloid Leukemia  Splenomegaly from splenic hematopoiesis  Cells fully differentiated  Gradual onset  Philadelphia chromosome

Online Activity: Have students visit http://www.lls.org/ and browse patient and clinician resources.  Activity: Divide students into groups and have them complete the following table: Cell Type Signs and Symptoms AML ALL CML

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35-76

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Plasma Cell Myeloma (Multiple Myeloma)

CLL Multiple myeloma

Hodgkin Disease

Answer:

B-Cell, T-Cell, and NK-Cell Lymphoma (Non-Hodgkin)

AML

ALL

CML

CLL

Multiple myeloma

Cell Type Undifferentiated myelogenous blast cell Undifferentiated lymphocytic blast cell Partially differentiated myelogenous precursor cell Partially differentiated lymphocytic precursor cell

Malignant plasma cells

Signs and Symptoms Infection, anemia, and bleeding in middle age Infection, anemia and bleeding in childhood Fatigue, weight loss, low grade fever, night sweats, splenomegaly and abdominal discomfort Fatigue, weight loss, low grade fever, night sweats, adenopathy, splenomegaly, and abdominal discomfort in older adults Bone pain, pathologic factures, hypercalcemia, renal failure

IN-CLASS/ONLINE CASE STUDY AS was recently diagnosed with Hodgkin disease and scheduled for a staging procedure. His previous axillary lymph node biopsy result was positive for Reed-Sternberg cells. The surgeon charted the results of the staging procedure as “stage I.”

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35-77

1.

What is the purpose of the staging procedure for AS?

Answer: Staging system establishes a correlation between anatomic extent of disease and prognosis.

Staging is used to determine the most appropriate type of treatment; local, regional, or disseminated.

2.

How does Hodgkin lymphoma spread in the body, and what does “stage 1” signify in AS?

Answer: Hodgkin disease arises in a single mutant cell located in a single node or chain of nodes and spreads characteristically to anatomically contiguous nodes.

Stage I: Involvement of a single lymph node region is associated with a high cure rate.

3.

What is the difference between Hodgkin disease and non-Hodgkin lymphoma?

Answer: The primary difference between Hodgkin disease and non-Hodgkin lymphoma is the presence or absence of Reed-Sternberg cells.

These large malignant cells are found in Hodgkin disease and are thought to be a type of malignant B lymphocyte.

Non-Hodgkin lymphoma also usually develops in the lymph nodes but can originate in any lymphatic tissue or organ. It is commonly found in older adults and, in general, there is a greater incidence in men than women. It is increasingly seen in patients with AIDS. It involves T, B, or natural killer cells and has a poorer long-term survival than HD because most patients have advanced disease at the

Copyright © 2019, Elsevier Inc. All rights reserved.

35-78 time of diagnosis. It does not spread in an orderly fashion along a lymphatic series of nodes and is not usually localized. The gastrointestinal tract, liver, and bone marrow are more likely to be involved. The B symptoms of Hodgkin’s are not commonly seen.

Hodgkin disease is usually localized as a single axial group of nodes (cervical, mediastinal, paraaortic) and continuous spread along the string of nodes is the norm. B symptoms (fever, weight loss, night sweats) are common. It is common in persons older than 50 years and in those ages 15 to 35 years of age, and there is a greater occurrence in men.

4.

What is the prognosis and predicted therapy for AS now that he has been diagnosed with stage I Hodgkin disease?

Answer: o o

5.

The overall 10-year survival rate is 90%.

Stages I and II may be managed with radiation therapy alone unless a large mediastinal mass is present, which is not the case for AS. When a large mediastinal mass is present, a combination of chemotherapy and radiation therapy is indicated.

What side effects might AS expect from this therapy?

Answer: o o o

Radiation, like chemotherapy, may result in bone marrow suppression, leading to anemia, thrombocytopenia, and leukopenia.

Anemia produces a decrease in oxygen-carrying capacity, reducing activity tolerance. There is an increased risk of bleeding with thrombocytopenia and of infection with leucopenia.

Both chemotherapy and radiation therapy increase the risk of developing later malignancies.

NURSING CURRICULUM STANDARDS

Copyright © 2019, Elsevier Inc. All rights reserved.

35-79

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o General Principles of Management

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: FIGURE 11-1: Division of hematologic neoplasms into myeloid and lymphoid lineages. PV, Polycythemia vera. o Exemplar: Myeloid Neoplasms o Exemplar: FIGURE 11-3: Maturation pathways of myeloid cells showing the different types of leukemia associated with various stages of development. M1, M2, and M3 types result in granulocytic leukemia; M4 has characteristics of monocytic and granulocytic leukemia; M5 is monocytic; M6 is associated with erythroid leukemia; and M7 is associated with megakaryocytic leukemia. RBC, Red blood cell. o Exemplar: FIGURE 11-4: Balanced translocation between chromosomes 9 and 22 results in the formation of a Philadelphia chromosome. The translocation causes two genes, abl and bcr, to become juxtaposed, resulting in a fusion gene. This fusion gene, bcr-abl, is thought to be essential for the development of chronic myeloid leukemia. o Exemplar: FIGURE 11-5: Peripheral blood smear from a patient with chronic myeloid leukemia (CML). Note that a greater degree of neutrophil segmentation is found in CML than in acute myelogenous leukemia (see FIGURE 11-6), reflecting a more advanced stage of development. o Exemplar: Lymphoid Neoplasms o Exemplar: FIGURE 11-6: Peripheral blood smear showing typical cells of acute myelogenous leukemia o Exemplar: FIGURE 11-7: Maturation pathways of T and B lymphocytes showing the stages at which lymphocyte development is typically arrested in leukemia. Different markers are present on the surface of B cells and T cells at progressive stages of development, which are helpful in identifying the neoplastic cell type and maturity. o Exemplar: FIGURE 11-8: Bone marrow aspirate showing small lymphocytes with condensed nuclear chromatin typical of chronic lymphocytic leukemia, B cell type

Copyright © 2019, Elsevier Inc. All rights reserved.

35-80 o o o o o



Exemplar: FIGURE 11-9: Peripheral blood smear showing typical cells of acute lymphocytic leukemia Exemplar: FIGURE 11-10: Peripheral blood smear showing cells typical of hairy cell leukemia Exemplar: FIGURE 11-14: Schematic drawing showing the orderly, contiguous, and predictable spread of Hodgkin disease Exemplar: FIGURE 11-15: Hodgkin/Reed-Sternberg cells.

Exemplar: FIGURE 11-16: Hodgkin disease (stage IIA). Marked enlargement of cervical lymph nodes is present in this patient. It is usually painless and may be confined to only one area or may affect two or more areas. o Exemplar: FIGURE 11-17: Depiction of the locations of malignant cells in the various stages of lymphoma using the Ann Arbor staging system o Exemplar: FIGURE 11-18: Typical radiation fields for lymphoma. Different fields of radiation may be used depending on the location of disease.

Concept: Gas Exchange o Exemplar: Prevention and Management of Complications

THEME: Protection and Movement o Concept: Pain o Exemplar: Prevention and Management of Complications

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Prevention and Management of Complications

TEACH FOR NURSES LESSON PLAN Chapter 12: HIV Disease and AIDS CHAPTER OBJECTIVES 1. Identify the common modes of HIV transmission and describe how infection can be prevented.

2. Describe the scope of the HIV/AIDS epidemic in the United States and the world.

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35-81 3. Explain how infection with HIV leads to progressive immunodeficiency and AIDS. 4. Explain how knowledge of the HIV life cycle led to the development of multidrug treatment strategies.

5. Describe how CD4+ cell counts and various clinical findings are used to classify the stages of HIV disease and AIDS. 6. Describe the common systemic manifestations of AIDS and associated opportunistic infections.

7. Identify the current treatment recommendations for HIV disease and AIDS.

STUDENT RESOURCES understand

       

Textbook Chapter 12 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 12 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-82 * Sold separately from textbook.

TEACHING STRATEGIES Content Focus EPIDEMIOLOGY History

Content Highlights Discuss the three methods HIV is transmitted.

Learning Activities 

Online Activity: Have students visit http://www.cellsalive.com/hiv0.htm and have them complete the Overview Human Immunodeficiency Virus (HIV) lesson.

Types of HIV Transmission Prevention of Transmission ETIOLOGY HIV Structure HIV Binding and Infection PATHOGENESIS Effect of HIV on Immune Cells at the Cellular Level Viral Production and Cell Death Progression of HIV Infection from Seroconversion to AIDS CDC HIV Classification

Copyright © 2019, Elsevier Inc. All rights reserved.

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TEACHING STRATEGIES Content Focus System DIAGNOSTIC TESTING MONITORING THE PROGRESSION OF HIV CLINICAL MANIFESTATIONS

Content Highlights

Learning Activities

Discuss how laboratory tests assist in monitoring the progression of HIV.



Discussion Topic: Use the algorithm below (Sequence of HIV Replication Algorithm) to explain the sequence of HIV replication.

Explain how HIV affects the integumentary, pulmonary, gastrointestinal (GI), neurologic, and ocular systems.



Activity: Have students complete the Joan Silvia Case Example below.

Systemic Manifestations Gastrointestinal Manifestations Pulmonary Manifestations Mucocutaneous Manifestations Gynecologic Manifestations Neurologic Manifestations Ocular Manifestations Cardiovascular Manifestations Manifestations in Other Systems

Copyright © 2019, Elsevier Inc. All rights reserved.

35-84

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Manifestations in Children TREATMENT Antiretroviral Therapy Recommendations

Discuss different treatment options for HIV.



Activity: Divide students into groups and have each group present a different treatment option or regimen for HIV/AIDS and its pros and cons to the class.

Nucleoside Reverse Transcriptase Inhibitors Nonnucleoside Reverse Transcriptase Inhibitors Protease Inhibitors Fusion Inhibitors CCR5 Antagonists Integrase Transfer Inhibitors Other Treatments and Vaccines

Copyright © 2019, Elsevier Inc. All rights reserved.

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Sequence of HIV Replication Algorithm

Copyright © 2019, Elsevier Inc. All rights reserved.

35-86

Joan Silva Case Example Joan Silva, age 35 years, comes to her primary care provider with a history of recurrent vaginal infections. She also mentions weight loss and generalized fatigue that has been worsening over the past 4 months. She has been previously healthy, takes no medications other than oral contraceptives and calcium supplements, and has no other significant medical history. Joan states she became sexually active at the age of 19 years and has had four partners in her lifetime. She has never used any form of barrier protection during intercourse. She is currently in a 4-year monogamous relationship with a 37-year-old man who is in good health.

Joan Silva Physical Examination Thin, anxious woman in no distress Temperature, 38°C (100.4°F) orally; pulse, 96 beats/min and regular; blood pressure, 138/76 sitting; respiratory rate, 15 breaths/min Head/Eyes/Ears/Throat: No alopecia; pupils equal and reactive; fundi without lesions; tympanic membranes clear; cheesy white exudate on tongue and pharynx Neck: Mild anterior cervical adenopathy; no thyromegaly Lungs: Clear to auscultation and percussion Cardiac: Regular rate and rhythm without murmurs or gallops Abdomen: Nontender without masses Pelvic: Thick white vaginal discharge; venereal warts present Extremities: Without edema; pulses full throughout Neurologic: Cranial nerves, strength, sensation, reflexes, and gait all intact

Joan Silva Laboratory Results HIV antibody test: Positive, confirmed by Western blot

Copyright © 2019, Elsevier Inc. All rights reserved.

35-87 Complete blood count: Decreased lymphocytes, CD4+ = 170 cells/microliter Potassium hydroxide preparation of oral and vaginal exudate: yeast Questions: 1. Does Joan meet the diagnostic criteria for AIDS? Explain your answer.

2. What organism is the most likely cause of the whitish areas in her mouth and the vaginal discharge?

3. What is a common name for oral candidiasis?

4. Why does Joan have oral and vaginal candidiasis?

5. Why is it important to perform a Pap smear on Joan to monitor for cervical dysplasia?

6. What does the term opportunistic infection mean?

7. Why does her low CD4+ cell count put Joan at high for opportunistic infections?

Answers: 1. Yes, Joan does have AIDS. She has documented HIV infection and has a CD4 count less than 200 cells/microliter. This meets the criteria for the diagnosis of AIDS. 2. Candida albicans, a type of fungus (yeast) 3. Thrush 4. Her CD4 cell count is now low enough that she is at risk for infections with organisms that are part of the normal flora. Vaginal candidiasis is often the initial infection in women who develop AIDS. 5. Human papillomavirus, which causes venereal warts, is a risk factor for cervical dysplasia. Because of the immunosuppression of AIDS, cervical dysplasia and cervical cancer are common.

6. An infection with microorganisms that do not usually cause infection in people who are immunocompetent.

7. CD4 cells are T helper cells that produce cytokines that regulate many aspects of innate and adaptive immunity. Without this function, her immune system cannot mount an effective response to defend against microorganisms.

IN-CLASS/ONLINE CASE STUDY ML is a 26-year-old homosexual man admitted to the hospital for progressive respiratory distress, fever, weakness, and chronic diarrhea. He tested HIV positive about 3 years ago, but his infection remained asymptomatic until 2 months before admission. Pneumocystis jiroveci (carinii)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-88 pneumonia was suspected and confirmed by culture. Laboratory analysis demonstrates a low CD4+ count of 185 cells/mL. HAART treatment with the antiretrovirals azidothymidine (AZT, efavirenz [Sustiva]) and ritonavir (Norvir) was started 2 months ago.

1.

ML’s mother is concerned about the potential for catching HIV from her son. What can you tell her about the risk factors and transmission of HIV, and how she might protect herself from infection?

Answer: o HIV, the causative agent of AIDS, is not transmitted by casual contact such as kissing or hugging. It is usually transmitted through infected blood or semen. o HIV has been transmitted through contaminated needles, unprotected sexual contact, contaminated blood transfusion, artificial insemination, and in utero to developing fetuses by infected mothers. o Handwashing and the use of disposable gloves are sufficient for contact with blood or contaminated equipment. Gloves, gowns or plastic aprons, masks, and eye protection should be used if contact with splashing with secretions is likely. o HIV can be killed with a 10% bleach solution.

2.

What is the significance of the CD4+ count?

Answer: o o

A CD4+ count of less than 200/μL indicates that his HIV infection has advanced to AIDS. A CD4+ count of 499 or less/μL means immunocompetence is significantly reduced and there is a high risk of opportunistic infections appearing.

3. P. jiroveci pneumonia is an opportunistic infection to which immunocompetent people are immune. What other opportunistic infections are commonly seen in patients with AIDS? Are there any data to suggest that ML may have one of these?

Copyright © 2019, Elsevier Inc. All rights reserved.

35-89 Answer: o o

Common infections include those associated with such organisms as viruses (cytomegalovirus), fungi (Candida spp., Histoplasma spp.), and bacteria (Mycobacterium tuberculosis/avium, and staphylococcus).

Chronic diarrhea is suggestive of infection of the GI tract, which is commonly caused by Cryptosporidium, a protozoan.

4.

ML’s sexual partner recently tested negative for HIV. What conclusions can be made about his HIV status?

Answer: o o

He may not be infected with HIV. He may be infected with HIV, but it is too early to detect antibodies with ELISA (has not seroconverted).

5. A medical student asks you to draw a picture of HIV virion and a CD4+ cell and to explain the mechanism of intracellular infection and the role of reverse transcriptase. What would you show on the drawing and explain about the process?

Answer: The process of infection includes (1) fusion of virus between it gp120 and the CD4+ cell receptor and interaction with coreceptors like CCR5; (2) injection of the viral capsid into the cell; (3) transcription by reverse transcriptase of viral RNA to viral DNA, which is used as a template to make double=stranded DNA, which migrates to nucleus; (4) incorporation of viral DNA into host genome by integrase (formation of provirus); (5) transcription and translation of viral DNA into viral components using host cell’s normal processes; (6) cleaving of viral proteins by protease and assembly into functional units so that new viruses are now mature; and (7) budding off of virions from the CD4 + cell into the bloodstream where they infect other host CD4+ cells.

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NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Prevention of Transmission

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Gas Exchange o Exemplar: FIGURE 12-11: Pneumocystis jiroveci (carinii). A chest radiograph shows bilateral lower lobe interstitial infiltrates.

THEME: Protection and Movement o Concept: Immunity o Exemplar: Epidemiology o Exemplar: FIGURE 12-1: Estimated AIDS incidence and deaths among persons with AIDS, by year of diagnosis or death and yearend prevalence, United States, 1985 to 2014. Data were adjusted for delays in reporting of cases and deaths. o Exemplar: FIGURE 12-2: HIV particle showing the p24 capsid protein surrounding the two strands of viral RNA o Exemplar: Etiology o Exemplar: FIGURE 12-3: Schematic view of a retrovirus particle. The core is surrounded by an envelope that is derived from host membranes enriched with viral glycoproteins (gp120, gp41). Interaction of the envelope glycoproteins with a host-encoded cell surface receptor (CD4) is shown. o Exemplar: FIGURE 12-4: Scanning electron micrograph (low magnification) of a population of HIV-infected lymphocytes o Exemplar: FIGURE 12-5: Early HIV infection, M tropic. In HIV infection, the virus must bind both a CD4 receptor and a coreceptor to fuse with the host cell. In the M-tropic phase, the key coreceptor is CCR5. o Exemplar: FIGURE 12-6: HIV life cycle. A schematic representation from the time of initial HIV fusion with a host cell, to integration into the host cell’s DNA, and ending with the replication of a new virion.

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35-91

o o o o

o o o o o o o o o o o o o

o Exemplar: Pathogenesis Exemplar: FIGURE 12-7: HIV-1/lymphadenopathy virus found in a hemophiliac patient with AIDS. Virus particles range in size from 90 to 120 nm. Viral budding and the production of new virions are facilitated by protease.

Exemplar: FIGURE 12-8: Scanning electron micrograph of HIV-1–infected CD4+ lymphocytes showing virus budding from the plasma membrane of the lymphocytes Exemplar: FIGURE 12-9: High magnification of a CD4+ lymphocyte infected with HIV-1. Note the large number of budding HIV virions, which can lead to host cell death by membrane tearing or syncytium formation.

Exemplar: FIGURE 12-10: Progression of HIV infection. The clinical stages of HIV disease correlate with a progressive spread of HIV from the initial site of infection to lymphoid tissues throughout the body. The immune response of the host temporarily controls acute infection but does not prevent the establishment of chronic infection of cells in the lymphoid tissues. Cytokine stimuli induced by other microbes serve to enhance HIV production and progression to AIDS. CTLs, Cytotoxic T lymphocytes.

Exemplar: Box 12-1: Conditions Indicative of AIDS in HIV-Infected Persons Exemplar: Box 12-2: Tests Used to Evaluate Progression of HIV Infection Exemplar: Box 12-3: Common Agents of Infection in Patients with AIDS Exemplar: Clinical Manifestations Exemplar: FIGURE 12-11: Pneumocystis jiroveci (carinii). A chest radiograph shows bilateral lower lobe interstitial infiltrates.

Exemplar: FIGURE 12-12: Herpes zoster in an HIV-infected individual Exemplar: FIGURE 12-13: Oral hairy leukoplakia, a manifestation of Epstein-Barr virus infection in HIV-infected individuals, Exemplar: FIGURE 12-14: Candida albicans in an HIV-infected person Exemplar: FIGURE 12-15: HIV-associated Kaposi sarcoma in the macular stage Exemplar: FIGURE 12-16: HIV-associated Kaposi sarcoma in the nodular stage Exemplar: FIGURE 12-17: Cervical dysplasia. Women with AIDS require more frequent monitoring because cervical dysplasia commonly occurs and progresses rapidly.

Exemplar: Treatment Exemplar: FIGURE 12-18: Antiretroviral therapy. The stages in the life cycle of HIV in which antiretroviral therapy is effective are shown.

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Prevention of Transmission

Copyright © 2019, Elsevier Inc. All rights reserved.

35-92

TEACH FOR NURSES LESSON PLAN Chapter 13: Alterations in Oxygen Transport CHAPTER OBJECTIVES 1. Describe the factors necessary for normal red blood cell production.

2. Explain how oxygen and carbon dioxide are transported in the circulation.

3. Explain how laboratory tests are used to detect anemia and polycythemia.

4. Describe the general effects of anemia on body systems.

5. Explain how history, clinical manifestations, and laboratory studies are used to differentiate the various forms of anemia.

6. Explain how history, clinical manifestations, and laboratory studies used to differentiate the various forms of polycythemia.

7. Describe the appropriate treatment measures for each of the common types of anemia and polycythemia.

STUDENT RESOURCES understand

       

Textbook Chapter 13 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 13 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

35-93

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

COMPOSITION OF BLOOD Organic and Inorganic Components Cellular Components STRUCTURE AND FUNCTION OF RED BLOOD CELLS Hematopoiesis Hemoglobin Synthesis Nutritional

Describe the structure of red blood cells and function.



Activity: Have students complete the table below to match the term to the correct description: Term Description Hemoglobin F Spleen Erythropoietin Thrombocyte Erythrocyte Erythropoiesis

Copyright © 2019, Elsevier Inc. All rights reserved.

35-94

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Requirements for Erythropoiesis

Hemoglobin A Bone marrow

Energy and Maintenance of Erythrocytes

Answer: Term

Red Cell Production

Hemoglobin F Spleen Erythropoietin

Red Cell Destruction Thrombocyte Erythrocyte Erythropoiesis Hemoglobin A Bone marrow

Description Fetal hemoglobin Where red blood cells are destroyed Hormone that stimulates bone marrow to make red blood cells Platelet Red blood cells Formation of red blood cells Normal adult hemoglobin Where red blood cells are made

GAS TRANSPORT AND ACID-BASE BALANCE Oxygen Transport Carbon Dioxide Transport Alterations in Oxygen Transport ANEMIA

Discuss the diagnosis, manifestations, types, and treatment of anemia.



Discussion Topic: Ask students if they know someone who has had anemia and to describe what caused anemia in that particular person. Have them list that person's signs and symptoms of anemia while maintaining confidentiality.



Activity: Have students select one of the types of anemia that they have studied. Have them write a paragraph or two that could be understood by a

Copyright © 2019, Elsevier Inc. All rights reserved.

35-95

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 46-year-old man with two years of college education explaining why he is so tired all of the time. Tell them to include some of the pathophysiology of that specific type of anemia in their explanation. 

Activity: Have students complete the table below to review the lab tests used to evaluate anemias: Interpretation

Clinical Utility

Blood Smear Hemoglobin Reticulocyte Mean corpuscular volume (MCV) Mean corpuscular hemoglobin (MCH) and hemoglobin concentration (MCHC) Hematocrit

Answer:

Blood Smear

Interpretation

Clinical Utility

Examination of red blood cell

Identifies specific erythrocyte

Copyright © 2019, Elsevier Inc. All rights reserved.

35-96

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Hemoglobin

Reticulocyte

Mean corpuscular volume (MCV) Mean corpuscular hemoglobin (MCH) and hemoglobin concentration (MCHC) Hematocrit

size, shape, and color using a microscope The concentration of hemoglobin in the blood The number of immature erythrocytes in the blood

Indicates the size of the red cells Indicates the amount of hemoglobin in the red blood cells

The percentage of the blood volume composed of red blood cells

GENERAL EFFECTS OF ANEMIA

Copyright © 2019, Elsevier Inc. All rights reserved.

abnormalities, such as sickle cells or spherocytes Decreased in all anemias

Decreased in disorders that decrease erythropoiesis; increased in acute blood loss and hemolytic anemias Used to differentiate macrocytic, microcytic, and normocytic anemias Used to differentiate hypochromic from normochromic anemias

Decreased in all anemias

35-97

TEACHING STRATEGIES Content Focus ANEMIA RELATED TO DECREASED RED CELL PRODUCTION

Content Highlights Identify the types of anemia related to decreased red cell production.



Activity: Have students complete the table below to review the clinical manifestations of specific anemias: Type-Specific Symptoms

Aplastic Anemia

Underlying Mechanisms

Pernicious anemia Aplastic anemia

Anemia of Chronic Renal Failure Anemia Related to Vitamin B12 (Cobalamin) or Folate Deficiency

Answer:

Iron Deficiency Anemia

ANEMIA RELATED TO INHERITED DISORDERS OF THE RED CELL

Learning Activities

Identify the types of anemia related to inherited disorders of red cells.

Type-Specific Underlying Symptoms Mechanisms Pernicious Paresthesias, Neurons dysfunction 12 anemia ataxia, without vitamin B hallucinations Aplastic Excessive Decreased platelets anemia menstrual and neutrophils due to bleeding, bone marrow stem bruising, cell destruction nosebleeds, frequent bacterial infections  Online Activity: have students visit http://www.hematology.org/Patients/Anemia/ and identify educational information and resources for patients.

Thalassemia Sickle Cell Anemia

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TEACHING STRATEGIES Content Focus

Content Highlights

Hereditary Spherocytosis Glucose-6-Phosphate Dehydrogenase Deficiency ANEMIA RELATED TO EXTRINSIC RED CELL DESTRUCTION OR LOSS Hemolytic Disease of the Newborn Antibody-Mediated Drug Reactions Acute Blood Loss Other Extrinsic Abnormalities TRANSFUSION THERAPY POLYCYTHEMIA Polycythemia Vera Secondary Polycythemia

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-99

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Relative Polycythemia

IN-CLASS/ONLINE CASE STUDY MB is a generally healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, she is noted to have the following vital signs: heart rate, 118 beats/min; blood pressure, 128/60 mm Hg; oral temperature, 37°C; and respiratory rate, 26 breaths/min.

Her skin and nail beds are pale. Laboratory results demonstrate hematocrit (Hct), 31%; hemoglobin (Hb), 10 g/dL; mean corpuscular hemoglobin concentration, 27; mean corpuscular volume, 70; and total iron binding capacity, 600 mg/dL. 1. What type of hematologic disorder would you suspect based on MB’s history, physical examination, and laboratory values? Why? Answer: 

Iron deficiency anemia caused by low Hct, low Hb, microcytic hypochromic red blood cells (RBCs) and increased total iron binding capacity, tachycardia, pale nail beds and skin, and generalized fatigue

2. What other history data would be helpful in determining the cause of this disorder?

Answer:    

Possibly pica or an iron-poor diet Glossitis Pale conjunctiva Heavy menses or other source of chronic bleeding

3. Which of MB’s clinical signs are reflective of the body’s effort to compensate for the decreased oxygen carrying capacity seen with this condition?

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35-100

Answer:  

Increased respiratory rate Increased heart rate

4. If MB has normal blood oxygen levels (PaO2 = 100), what is the oxygen content of her blood?

Answer: 

Fully bound O2 is considered to be nearly 100% saturated, so plugging the numbers into the formula for CaO2 = (PaO2 × 0.003) + (Hb × 1.34 × sat.) = CaO2 = (100 × 0.003) + (10 × 1.34 × 1.0) = 13.7 mL/dL.

5. MB is counseled to increase her dietary intake of iron-containing foods. What kinds of food would be recommended?

Answer:      

Liver, meat, eggs Lentils Dark green leafy vegetables Nuts Legumes Seafood

6. MB is given a prescription for ferrous sulfate 300 mg three times per day. How long do you anticipate this therapy will continue?

Answer: 

Therapy for 4 to 6 months is common.

NURSING CURRICULUM STANDARDS

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35-101

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Fluid and Electrolyte Balance o Exemplar: Anemia of Chronic Renal Failure  Concept: Acid Base o Exemplar: Anemia of Chronic Renal Failure  Concept: Gas Exchange o Exemplar: Anemia, o Exemplar: FIGURE 13-16: Alterations in the erythropoietin feedback circuit. Any factor decreasing oxygen delivery to the oxygen sensor cells results in increased secretion of erythropoietin and a compensatory increase in erythrocyte production as illustrated in (A) for anemia, with a decrease in erythrocyte mass; and in (B) for hypoxia, with a decrease in arterial oxygen saturation. An increase in erythrocyte mass, as occurs with polycythemia vera (C), decreases erythropoietin production. o Exemplar: General Effects of Anemia o Exemplar: Box 13-1: Classification of Anemia and Polycythemia o Exemplar: Anemia Related to Decreased Red Cell Production o Exemplar: FIGURE 13-17: Burr cells found in acute kidney disease o Exemplar: Anemia Related to Inherited Disorders of the Red Cell o Exemplar: FIGURE 13-18: Pathophysiology of -thalassemia. o Exemplar: FIGURE 13-19: Sickle cell anemia: effects of sickling. HbS, hemoglobin S; RBC, red blood cell. o Exemplar: FIGURE 13-20: (A) Blood smear showing sickle cells in sickle cell anemia. (B) Scanning electron micrograph of deoxygenated sickled red cells. o Exemplar: Box 13-2: Complications of Sickle Cell Anemia o Exemplar: Anemia Related to Extrinsic Red Cell Destruction or Loss o Exemplar: FIGURE 13-21: Schistocytes are fragments of red blood cells produced by hemolytic pathologies

TEACH FOR NURSES LESSON PLAN Copyright © 2019, Elsevier Inc. All rights reserved.

35-102

Chapter 14: Alterations in Hemostasis and Blood Coagulation CHAPTER OBJECTIVES 1. Describe how platelets and factors of the clotting cascade contribute to hemostasis.

2. Identify the findings from the patient history, physical examination, or laboratory studies that would indicate a potential bleeding disorder.

3. Explain how laboratory tests are used to differentiate the various coagulation disorders.

4. Identify the vascular alterations that result in abnormalities of hemostasis.

5. Identify the common causes of platelet deficiencies, excesses, and dysfunction.

6. Identify the common causes of inherited and acquired disorders of coagulation.

STUDENT RESOURCES understand

       

Textbook Chapter 14 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 14 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-103

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

THE PROCESS OF HEMOSTASIS Stages of Hemostasis Platelets Blood Coagulation Factors Fibrin Clot Fibrinolysis EVALUATION OF HEMOSTASIS AND COAGULATION

Describe the circumstances in which evaluation of a patient for a bleeding tendency is indicated.



Online Activity: Have students visit http://www.mhhe.com/biosci/esp/2002_general/Esp/folder_structure/tr/ m1/s7/trm1s7_3.htm and view the animation lesson depicting hemostasis and coagulation.

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35-104

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Clinical Assessment 

Activity: Have students visit http://themedicalbiochemistrypage.org/blood-coagulation.html for a detailed explanation of hemostasis and coagulation.



Activity: Have students complete the table below to review thrombocytopenia: General Pathophysiology Mechanism

Laboratory Tests

VASCULAR AND PLATELET DISORDERS Vascular Disorders Platelet Disorders

Identify and describe the major vascular and platelet disorders.

HIT ITP Chemotherapy Massive transfusion Mechanical heart valve Answer:

HIT

General Mechanism Decreased platelet survival

ITP

Decreased platelet survival

Chemotherapy

Decreased platelet production Platelet dilution

Massive

Copyright © 2019, Elsevier Inc. All rights reserved.

Pathophysiology Immune-mediated platelet aggregation caused by antibody formation to drugplatelet complexes Antibody binding to platelets triggers their destruction Drug-induced death of bone marrow megakaryocytes Blood stored more than

35-105

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities transfusion

COAGULATION DISORDERS Hemophilia Von Willebrand Disease Vitamin K Deficiency Bleeding in Infancy Acquired Vitamin K Deficiency Disseminated Intravascular Coagulation (DIC) Hepatic Disease

Describe the coagulation disorders.

24 hours is low in platelets; massive transfusion of this blood dilutes circulating platelets Mechanical heart Decreased Trauma to platelets by valve platelet survival mechanical valve action  Discussion Topic: Use the algorithm below titled “Disseminated Intravascular Coagulation (DIC)” to review this systemic thrombohemorrhagic disorder. 

Activity: Have students complete the table below to review coagulation disorders: Pathophysiology Clinical Manifestations Hemophilia Liver disease DIC

Answer: Hemophilia

Liver disease

DIC

Pathophysiology Inherited deficiency of specific clotting factors Inadequate synthesis of clotting factors and associated thrombocytopenia Widespread clotting and fibrinolysis with consumption of clotting factors and platelets

Copyright © 2019, Elsevier Inc. All rights reserved.

Clinical Manifestations Nosebleeds, easy bruising, bleeding into joints, excessive bleeding from cuts Easy bruising, excessive bleeding from cuts, signs of liver disease Internal and external bleeding, thrombosis, poor tissue perfusion

35-106

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35-107

Disseminated Intravascular Coagulation (DIC) Algorithm

IN-CLASS/ONLINE CASE STUDY NS is a 32-year-old woman who had been sick with a cold virus for 10 days. She states that she had flu symptoms of cough, sore throat, and fatigue. It has been 3 weeks since the cold, and she continues to be fatigued and finds it hard to get enough energy to do things. She comes into

Copyright © 2019, Elsevier Inc. All rights reserved.

35-108 see her MD. NS tells you she has noted that she has been bruising easily. She hit her arm accidentally on the edge of a counter, and now she has a large bruise. She has also noted little purple spots all over her hands and chest. On exam, you note that she does have a large bruise on her right arm and petechiae and purpura over her chest and hands. You draw some lab work, and it comes back with a platelet count of 40,000mm3.

7. NS has been diagnosed with Idiopathic thrombocytopenic purpura (ITP). Explain what it is and who can get it.

Answer:    

ITP is an immune mediated condition that causes the patient to lose platelets. Unlike other causes of thrombocytopenia, it is not caused by drugs or toxins but is instead usually triggered by an acute viral infection.

It affects both sexes but is found more often in woman. The acute form is seen in all ages, and the chronic form usually is seen in adults 20 to 50 years of age.

The antiplatelet antibody will cross the placenta in a pregnant woman and can lead to thrombocytopenia in the newborn.

ITP may be associated before or with other autoimmune diseases such as systemic lupus erythematosus or AIDS.

8. Discuss the four mechanisms of thrombocytopenia.

Answer:  

 

Decreased platelet production: Megakaryocytes produce platelets, and when there is a decrease in this blood line, the platelet count will go down. This is usually seen with drug toxicity, chemotherapy, radiation therapy, and folate deficiency. Aplastic anemia leads to a decrease in all blood lines. Cancer in the bone marrow will metastasize and cause a thrombocytopenia.

Decreased platelet survival: Platelets live for 10 days. Some situations decrease platelet survival such as: Autoimmune causes such as ITP or an antibody to heparin infusions, or increased consumption such as disseminated intravascular coagulation (DIC) when the person has multiple little emboli that are being destroyed and when there is trauma to the platelets when they come into contact with artificial valves or prostheses.

Splenic sequestration: The spleen holds approximately 30% of the circulating platelets at one time. With splenomegaly, the spleen can hold up to 70% of the platelets, so less will be circulating.

Intravascular dilution of circulating platelets: This is seen in patients who have had massive transfusions with blood stored for more than 24 hours, so fewer platelets are functional.

9. What symptoms would you expect to see in a patient with ITP, and which tests would be used to confirm the diagnosis?

Answer:

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35-109   

Often there are no symptoms. When the platelet count goes below 100,000mm3, a few symptoms will be seen, such as increased bruising from little insults.

As the platelet count drops to less than 50,000mm3, petechiae and purpura may be seen on the chest and hands and maybe on the arms and legs. If it continues to drop, bleeding gums and possible intracranial bleeding will occur.

A platelet count and smear will be done. A bleeding time will be done, which will be prolonged. Coagulation studies partial thromboplastin time, prothrombin time, and international normalized ratio will be done, and because these do not measure platelets, they should all be within the normal range.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Blood Coagulation Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Clotting o Exemplar: The Process of Hemostasis o Exemplar: Table 14-1: The Clotting Factors o Exemplar: Evaluation of Hemostasis and Coagulation o Exemplar: Vascular and Platelet Disorders o Exemplar: Coagulation Disorders

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35-110 o

Exemplar: FIGURE 14-10: Pathophysiology of disseminated intravascular coagulation. Clotting and bleeding occur simultaneously, resulting in organ ischemia and hemorrhagic shock.

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Blood Coagulation Factors

TEACH FOR NURSES LESSON PLAN Chapter 15: Alterations in Blood Flow CHAPTER OBJECTIVES 1. Differentiate the structures of arteries, veins, capillaries, and lymphatics, and explain how these differences reflect the functions of each.

2. Explain the relationship among vessel resistance, blood pressure, and blood flow.

3. Explain how vascular resistance is regulated centrally by the autonomic nervous system and locally by tissues.

4. Identify the determinants of transcapillary exchange of fluids, electrolytes, and nutrients.

5. Explain how arterial and venous obstructions develop.

6. Describe the clinical consequences of acute and chronic arterial obstruction.

7. Describe the clinical consequences of superficial and deep venous obstructions.

STUDENT RESOURCES

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35-111

understand

       

Textbook Chapter 15 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 15 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus ORGANIZATION OF THE CIRCULATORY AND

Content Highlights Provide an overview of the circulatory system.

Learning Activities 

Online Activity: Have students visit http://people.eku.edu/ritchisong/301notes5.htm for a basic review of

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35-112

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

LYMPHATIC SYSTEMS

cardiovascular anatomy and physiology.

Vessel Structure Lymphatic Structure PRINCIPLES OF FLOW Hemodynamics of the Circulatory System CONTROL OF FLOW Control of Blood Flow Control of Lymphatic Flow GENERAL MECHANISMS THAT CAUSE ALTERED FLOW

Identify the conditions that can result in altered flow.



Discussion Topic: Explain how thromboembolic disorders affect blood flow in arteries, veins or both. Discuss three major risk factors for thrombus formation: endothelial injury, stasis of blood flow, and hypercoagulability.

Describe the conditions that result in alterations in arterial flow.



Activity: Instruct students to use references beyond their textbook to explore the normal secretory function of the endothelium and how that changes with endothelial damage. Have them explain how endothelial dysfunction leads to the formation of a fatty streak. Instruct them to list at least three professional

Blood Vessels: Obstructions Blood Vessels: Structural Alterations Lymphatic Vessels ALTERATIONS IN ARTERIAL FLOW Arteriosclerosis/Athero

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35-113

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

sclerosis Thromboangiitis Obliterans (Buerger Disease)

references. 

Activity: Have students complete the table below to review Prevention of Atherosclerosis.

Modifiable Not Modifiable

Raynaud Syndrome Aneurysms Acute Arterial Occlusion

Answer: Modifiable    

High LDL cholesterol Smoking High blood pressure Physical inactivity

Not Modifiable   

 ALTERATIONS IN VENOUS FLOW Valvular Incompetence Varicose Veins Chronic Venous Insufficiency Deep Vein Thrombosis ALTERATIONS IN LYMPHATIC FLOW

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African-American Increased age Male or postmenopausal female Positive family history

35-114

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Lymphedema

IN-CLASS / ONLINE CASE STUDY MC is a 54-year-old woman who tells you that when her hands get cold, they turn white and become colder and then turn blue. In a couple more minutes, her hands turn red and become very painful, with pain that feels like she is being poked with pins and needles.

1. Explain to MC what Raynaud disease is and describe its etiology.

Answer: 

Raynaud disease is vasoconstriction of most vessels in the fingers that obstruct blood flow, causing the hand to go white. It can also be seen in the toes, ears, and nose. It usually starts in the teen years and can be triggered by stress and commonly cold environments. When the vasoconstriction continues, the affected area does not get oxygen, and the blood is desaturated and is evidenced by cyanosis. Next the blood rushes back and perfusion is resumed, and the fingers become red. The lack of perfusion effects the nerve endings, which causes pain and numbness.



Raynaud disease is more common in women, presenting between puberty and menopause. It is also seen in families and is thought to have a genetic component.

2. Discuss what treatments that might be helpful to her.

Answer:

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35-115 All therapies are centered around circulation, and calcium channel blockers are the most common drugs used because of their vasodilatory effect on the arteries. Biofeedback and relaxation techniques have also showed some promise but are not as effective as calcium channel blockers. Sympatholytic drugs have been shown to be better than placebos. Prostaglandin therapy has also shown some promise.

3. What should you advise MC to avoid?

Answer:    

Cold temperatures Vibration Nicotine Stress

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Risk Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-116 THEME: Homeostasis and Regulation  Concept: Fluid and Electrolyte Balance o Exemplar: Arteriosclerosis/Atherosclerosis  Concept: Perfusion o Exemplar: FIGURE 15-7: Lymphatic Network. The lymphatic system is integrally related to the systemic vascular system. Excess fluid and plasma diffuse between the capillaries, interstitial spaces, and lymphatic vessels. Because lymphatic capillaries have larger spaces between endothelial cells, they can remove excess interstitial fluid or plasma that venous capillaries cannot reabsorb. o Exemplar: Control of Blood Flow o Exemplar: Arteriosclerosis/Atherosclerosis o Exemplar: Box 15-2: Clinical Manifestations of Arterial Peripheral Vascular Disease 

Concept: Clotting o Exemplar: Deep Vein Thrombosis

THEME: Protection and Movement o Concept: Tissue integrity o Exemplar: Control of Flow o Exemplar: General Mechanisms that Cause Altered Flow o Exemplar: Alterations in Arterial Flow o Exemplar: FIGURE 15-17: Pathophysiologic process of intermittent claudication and its relief o Exemplar: FIGURE 15-18: Arterial ulcer o Exemplar: Alterations in Venous Flow o Exemplar: Alterations in Lymphatic Flow

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Risk Factors

Copyright © 2019, Elsevier Inc. All rights reserved.

35-117

TEACH FOR NURSES LESSON PLAN Chapter 16: Alterations in Blood Pressure CHAPTER OBJECTIVES 1. Describe how changes in cardiac output and systemic vascular resistance affect blood pressure.

2. Explain how blood pressure is regulated on a short- and long-term basis.

3. Identify the risk factors for the development of primary hypertension.

4. Describe how secondary hypertension is defined and identify the common etiologies.

5. Explain how hypertension is detected, classified, and managed.

6. Describe the end-organ consequences of inadequately controlled hypertension.

7. Differentiate between hypertensive emergency and hypertensive urgency and explain how they are managed.

8. Identify the risk factors for orthostatic hypotension and explain how the condition is managed.

STUDENT RESOURCES understand

       

Textbook Chapter 16 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 16 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

35-118

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

ARTERIAL BLOOD PRESSURE Determinants of Systemic Blood Pressure Measurement of Blood Pressure MECHANISMS OF BLOOD PRESSURE REGULATION Short-term Regulation of Systemic Blood Pressure Long-term Regulation of Systemic Blood Pressure

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-119

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Normal Fluctuations in Systemic Blood Pressure HYPERTENSION

Describe the types and manifestations of hypertension.

1.

Online Activity: Have students visit http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=bldp rs and view the presentation on HBP and the Cardiovascular System.

2.

Discussion Topic: Have students identify the risk factors for hypertension and lifestyle changes that can reduce risks.

Secondary Hypertension

3.

Hypertensive Emergencies and Urgency

Activity: Divide students into groups and provide each group with a description of a patient with hypertension. Have students develop a patient education and management plan for their patient.

4.

Activity: Provide students with the following underlying causes of secondary hypertension and ask them to identify the mechanisms by which those causes raise blood pressure: Renal vascular disease Renal parenchymal disease Adrenocortical tumors Adrenomedullary tumors (pheochromocytoma) Drugs

Definition and Classification Primary Hypertension

5.

6.

7.

8.

9.

Answers: 10. Decreased blood flow to the kidney causes persistent increases in RAA activity.

11. Damage to glomeruli or tubules leads to increased RAA activity and decreased sodium and water excretion.

12. Increased production of cortisol and aldosterone leads to sodium and water retention and potassium excretion.

13. Increased production of catecholamines causes dramatic increases in cardiac output and peripheral resistance.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-120

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 14. Examples: estrogen-containing contraceptives, estrogen, corticosteroids, decongestants, and amphetamines

LOW BLOOD PRESSURE

IN-CLASS/ONLINE CASE STUDY

KH is a 67-year-old African-American man with primary hypertension and diabetes mellitus. He is currently taking an angiotensin-converting enzyme (ACE) inhibitor and following a salt-restricted weight loss diet. He is about 30 lb over his ideal weight. At his clinic visit, his blood pressure is noted to be 135/96 mm Hg. His heart rate is 70 beats/min. He has no complaints. His wife brought a blood pressure cuff and stethoscope with her in the hope of learning to take her husband’s blood pressure at home.

1. What risk factors for primary hypertension are evident from KH’s history and physical data?

Answer:   



Diabetic: Diabetes is an important risk for hypertension.

Ethnicity: Hypertension affects African American adults at a disproportionately higher rate.

Obesity: Obesity is associated with increased intravascular volume and elevated cardiac output. It is a risk factor alone, and it increases the risk for hyperlipidemia, salt sensitivity, and insulin resistance. It is responsible for 655 to 75% of the risk for hypertension.

Diet: Diets low in calcium and potassium and elevated in fat and sodium have been found to increase the risk of hypertension.

2. What is the rationale for treating KH with an ACE inhibitor? What is the mechanism of action? What part of the blood pressure formula do they affect?

Answer:

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35-121    

ACE inhibitors are an excellent choice because of the compelling indication of diabetes.

ACE inhibitors block enzymes that convert angiotensin I to angiotensin II even though the kidney may continue to produce renin.

The effect is a reduction in blood pressure by affecting the angiotensin II–induced vasoconstriction and increased blood volume induced by the resulting release of aldosterone.

This medication, through the reduction in blood volume, would affect preload, which affects stroke volume. Decreased vasoconstriction reduces systemic vascular resistance.

3. KH’s hypertension is not adequately controlled. What other intervention might be considered?

Answer: 

Exercise. Inactivity is a risk factor for hypertension and closely associated with obesity as well.

4. What tips can you give KH’s wife to improve the accuracy of her blood pressure measurement technique?

Answer:     

 

Take the blood pressure at roughly the same time of day.

Have him refrain from smoking, eating, or ingesting caffeine 30 minutes before the reading. Encourage him to use the bathroom before the reading.

Have him sit in a position that provides support to the lower back, with his bare arm resting near heart level.

The blood pressure cuff should be of the correct size. You should check this since she brought it with her today.

Teach her to palpate the radial artery as she inflates the cuff and note the value at which it disappears. She should then wait for 15 to 30 seconds before inflating the cuff to 30 mm Hg above the value she identified. She should slowly deflate the cuff while she listens for the sounds to appear; then she should note that value (systolic pressure) and continue to deflate until the sounds disappear, again noting the value (diastolic pressure) It would be best if she waits several minutes and repeats the process, averaging the results.

As a note, blood pressure varies with environmental temperature, time of day and year, timing of meals, physical activity, posture, smoking, and emotional factors.

NURSING CURRICULUM STANDARDS

Copyright © 2019, Elsevier Inc. All rights reserved.

35-122

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Risk Factors o Treatment Interventions

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation o Concept: Nutrition  Exemplar: Hypertension o

Concept: Perfusion o Exemplar: Hypertension o Exemplar: Table 16-5: Risk Factors for the Development of Primary Hypertension o Exemplar: FIGURE 16-6: Effects of chronic hypertension and atherosclerosis on target end-organs o Exemplar: FIGURE 16-7: Treatment recommendations for primary hypertension. o Exemplar: Box 16-1: Drug Classifications Used to Treat Hypertension and the Variables They Affect o Exemplar: Table 16-6: Lifestyle Modifications to Prevent and Treat Primary Hypertension in Adults o Exemplar: Box 16-2: Common Pathologic Causes of Secondary Hypertension in Children and Adults o Exemplar: Box 16-3: Substances Known to Contribute to High Blood Pressure

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Risk Factors

Copyright © 2019, Elsevier Inc. All rights reserved.

35-123

o Table 16-6: Lifestyle Modifications to Prevent and Treat Primary Hypertension in Adults

TEACH FOR NURSES LESSON PLAN Chapter 17: Cardiac Function CHAPTER OBJECTIVES 1. Describe how the events of the cardiac cycle are reflected in pressure and volume changes within the cardiac chambers.

2. Identify factors affecting the blood supply to myocardial tissue.

3. Explain how sarcomere cross-bridge formation leads to muscle cell contraction.

4. Describe the process of excitation-contraction coupling in heart muscle cells.

5. Explain how action potentials generated and conducted in myocardial and pacemaker cells.

6. Describe how the electrocardiogram relates to impulse conduction through the heart.

7. Explain how heart rate, preload, afterload, and contractility affect cardiac output and cardiac workload.

8. Identify the diagnostic tests used to evaluate cardiac structure and function.

STUDENT RESOURCES understand

       

Textbook Chapter 17 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 17 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

35-124

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus CARDIOVASCULAR ANATOMY

Content Highlights Review the physiology and function of the cardiovascular system.

Learning Activities 

Online Activity: Have students visit http://library.med.utah.edu/kw/pharm/hyper_heart1.html for a visualization of the flow of blood through the heart and the cardiac cycle.



Activity: Have students arrange the following answer choices to list the blood flow through the heart. Tell them to begin with the inferior vena cava and sequence the flow of blood through the heart and lungs.

Heart Circulatory System

Options (have students put in order starting with 1 to 13): aorta, pulmonary veins, left ventricle, right ventricle, right atrium, aortic valve, pulmonary valve, pulmonary capillaries, tricuspid valve, left atrium, mitral valve, inferior vena cava, and pulmonary arteries.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-125

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Answer: 1. inferior vena cava, 2. right atrium, 3. tricuspid valve, 4. right ventricle, 5. pulmonary valve, 6. pulmonary arteries, 7. pulmonary capillaries, 8. pulmonary veins, 9. left atrium, 10. mitral valve, 11. left ventricle, 12. aortic valve, 13. aorta

CARDIAC CYCLE Isovolumic Contraction Ventricular Ejection Isovolumic Relaxation Atrial Events Aortic and Pulmonary Artery Events CORONARY CIRCULATION Anatomy of the Coronary Vessels Regulation of Coronary Blood Flow CARDIAC MYOCYTES Myocyte Structure Structure of the Contractile Apparatus Characteristics of Contractile Filaments MOLECULAR BASIS OF

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35-126

TEACHING STRATEGIES Content Focus

Content Highlights

CONTRACTION Overview of Contraction Sliding Filament/CrossBridge Theory of Muscle Contraction Role of Calcium in Muscle Contraction Energy of Muscle Relaxation CARDIAC ENERGY METABOLISM Oxygen Utilization Substrate Utilization CARDIAC ELECTROPHYSIOLOGY Cardiac Resting Potential Cardiac Action Potential Rhythmicity of Myocardial Cells Specialized Conduction System of the Heart Autonomic Regulation of

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-127

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Rhythmicity ELECTROCARDIOGRAPHY

Discuss the administration and purpose of electrocardiograms (ECGs).



Online Activity: Have students visit https://ecglibrary.com/norm.php to view a normal ECG. Then have them visit https://ecglibrary.com/infmi.php (which shows acute inferior myocardial infarction) and https://ecglibrary.com/ami.html (which shows acute anterior myocardial infarction) to compare.

Review the diagnostic procedures for cardiac function.



Discussion Topic: Have students observe administration of the different tests of cardiac function. Then have a class discussion where they compare the various tests and identify when each test is necessitated.

DETERMINANTS OF CARDIAC OUTPUT Determinants of Heart Rate Determinants of Stroke Volume Cardiac Workload ENDOCRINE FUNCTION OF THE HEART TESTS OF CARDIAC FUNCTION Electrocardiography Magnetic Resonance Imaging and Computed Tomography Echocardiography Nuclear Cardiography Cardiac Catheterization/ Coronary Angiography

Copyright © 2019, Elsevier Inc. All rights reserved.

35-128

IN-CLASS/ONLINE CASE STUDY

FD is an 86-year-old woman who has been admitted for a myocardial infarction. She was taken to the cardiac catheterization lab and found to have a 75% occlusion of the right coronary artery.

1. Which areas of the heart are affected by the right coronary artery?

Answer: The right atrium and sinus node in 55% of people, the right ventricle and intraventricular septum, atrioventricular (AV) node, and bundle of His

2. Because FD is 86 years old, keep in mind that there are changes that take place in a geriatric patient. Explain how this could affect the heart rate and cardiac output.

Answer: o As FD aged, there was a decrease in the number of myocytes and fibrosis of the conduction pathways such as the sinoatrial (SA) and AV nodes and bundle of His. With a decrease of pacemaker cells, the SA node becomes less responsive to stimulation by the adrenergic system. If she is stressed, the SA node will need more time to accelerate, and when it finally does, it takes longer to recover. When the heart takes time to increase in rate, her cardiac output will not increase as needed. o The myocardium has a decrease in conduction tissue, and this can also lead to increased myocardial irritability. o As FD aged, her left ventricle became hypertrophied, and the valves became thickened and more rigid. This, along with decreased muscle strength and rigidity, led to a decreased compliance and contractility, which led to a decreased cardiac output.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-129 3. FD’s daughter asks why she is having a nuclear cardiography. What do you explain to her?

Answer: The blood tagged by the radioactive substances can be followed as it circulated throughout the heart. The areas of the heart where there is decreased perfusion will show up with decreased flow and are called cold spots. Hot spots are the areas where there has been heart damage. Very little radioactive material thallium and technetium-99 are used. Numerous slices of the heart are done. Frequently, a gated pool scan is done to assess left ventricular function.

TEACH FOR NURSES LESSON PLAN Chapter 18: Alterations in Cardiac Function CHAPTER OBJECTIVES 1. Describe the role of injury, inflammation, and lipid oxidation in coronary plaque initiation and progression.

2. Identify the factors that alter the balance between myocardial oxygen supply and demand.

3. Differentiate the clinical features of the coronary heart disease syndromes.

4. Explain how valvular disorders alter cardiac pressure dynamics and workload.

5. Describe the similarities and differences among the cardiomyopathies and myocarditis.

6. Distinguish pericarditis and pericardial effusions with regard to cause and significance.

7. Identify the factors that determine whether a congenital heart defect will produce cyanosis.

STUDENT RESOURCES

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35-130

understand

       

Textbook Chapter 18 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 18 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus CORONARY HEART DISEASE

Content Highlights Discuss the etiology, pathophysiology and manifestations of coronary heart disease.

Learning Activities 

Discussion Topic: Have students identify management goals and a treatment plan for a patient with coronary heart disease.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-131

TEACHING STRATEGIES Content Focus Etiology of Coronary Heart Disease Risk Factors and Mechanisms of Coronary Atherosclerosis Pathophysiology of Ischemia Clinical Features and Management of Coronary Syndromes

Content Highlights

Learning Activities 

Activity: Have students develop a treatment plan for the following management goals for acute coronary syndrome: 1. Resuscitation and stabilization 2. Reperfusion of myocardium 3. Prevention of complications 4. Improvement in quality of life and reduction of risk for subsequent events Answers: 1. Administration of thrombolytic therapy, emergent percutaneous transluminal coronary intervention (PTCI) in eligible patients, or emergent coronary artery bypass grafting (CABG or other surgery) 2. Careful monitoring and rapid intervention for complications; antiplatelet and other antithrombotic drugs; angiotensin-converting enzyme inhibitor drugs; beta-adrenergic blocker drugs 3. Patient and family education; Lifestyle modification; antihyperlipidemic drugs; cardiac rehabilitation; close follow-up with health care provider 

Activity: Have students complete the table below to match the risk factors with their common characteristics of coronary heart disease.

Risk Factor Characteristics Predisposes to hypertension, hyperlipidemia, diabetes Associated with differences in circulating estrogens and androgenic hormones Results from genetic factors and/or high dietary intake of saturated fats Contributes to endothelial dysfunction, hypertension, insulin resistance Results from genetic factors or inadequate intake of folate Stimulates catecholamine release, causes endothelial dysfunction

Copyright © 2019, Elsevier Inc. All rights reserved.

35-132

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Increases LDL cholesterol Associated with endothelial dysfunction and arterial damage from insulin resistance Causes endothelial dysfunction and increased myocardial workload

Answer: Risk Factor

Characteristics

Obesity Gender

Predisposes to hypertension, hyperlipidemia, diabetes Associated with differences in circulating estrogens and androgenic hormones

Hyperlipidemia

Results from genetic factors and/or high dietary intake of saturated fats Contributes to endothelial dysfunction, hypertension, insulin resistance Results from genetic factors or inadequate intake of folate Stimulates catecholamine release, causes endothelial dysfunction Increases LDL cholesterol

Physical inactivity Hyperhomocystein emia Smoking Diet high in saturated fat Diabetes

Copyright © 2019, Elsevier Inc. All rights reserved.

Associated with endothelial dysfunction and arterial damage from insulin resistance

35-133

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Hypertension

Causes endothelial dysfunction and increased myocardial workload

ENDOCARDIAL AND VALVULAR DISEASES Disorders of the Mitral Valve Disorders of the Aortic Valve Diseases of the Endocardium MYOCARDIAL DISEASES Myocarditis Cardiomyopathy PERICARDIAL DISEASES Pericardial Effusion Pericarditis CONGENITAL HEART DISEASES

Discuss the importance of determining whether the congenital defect is acyanotic or cyanotic.



Activity: Have students complete the table below to review the clinical manifestations of congenital heart defects: Acyanotic Cyanotic

Embryologic Development

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35-134

TEACHING STRATEGIES Content Focus

Content Highlights

Etiology and Incidence of Congenital Heart Disease

Learning Activities

Answer: Acyanotic   

Pathophysiology of Congenital Heart Disease Acyanotic Congenital Defects



Cyanotic Congenital Defects



Atrial septal defect Coarctation of aorta Patent ductus arteriosus Pulmonary stenosis

Cyanotic   

Truncus arteriosus Transposition of great arteries Tetralogy of Fallot

Online Activity: Have students visit http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/Congen ital-Heart-Defects_UCM_001090_SubHomePage.jsp to learn more about congenital heart defects.

IN-CLASS/ONLINE CASE STUDY CJ is a 16-year-old high school student who is in the clinic for a sports physical before beginning basketball practice. He has no known significant medical history, takes no medications, and has no allergies. Subjective data reveal only that CJ is short of breath earlier than most boys on the team. He attributes this to needing to get into better physical condition. The physical exam is unremarkable except for a grade III systolic murmur heard over the entire precordium. An echocardiogram and cardiac catheterization reveal a ventricular septal defect (VSD) with moderate pulmonary hypertension.

1. A VSD is usually an acyanotic defect. Why is this?

Answer:

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35-135 

The oxygenated blood in the high-pressured left ventricle is being shunted to the lower pressured right ventricle, so this blood is in essence preoxygenated and will not cause cyanosis.

2. What is the mechanism of pulmonary hypertension? What may result if it is prolonged?

Answer: 



His pulmonary hypertension is due to increased blood volume within the pulmonary circuit caused by the VSD, so it has a secondary etiology. Pressure is the product of cardiac output (CO) and vascular resistance. In this case, pressure is high secondary to increased CO. In the case of primary pulmonary hypertension, the cause is increased pulmonary vascular resistance.

Pulmonary hypertension can lead to cor pulmonale and right-sided heart failure.

3. What other disorders besides VSD can produce a systolic murmur? How can character of the murmur and pattern of radiation be used to differentiate among these etiologic factors?

Answer:  

Systolic murmurs can be produced by mitral valve prolapse, aortic or pulmonary stenosis, or mitral or tricuspid regurgitation.

Heart sounds are produced in different areas of the heart and have different characteristics. Aortic stenosis presents as a midsystolic murmur with a crescendo-decrescendo pattern, and it radiates to the neck. Mitral regurgitation is pansystolic, high pitched, and radiates to the left axilla. Murmurs from mitral regurgitation and VSD are difficult to distinguish.

4. Is it necessary to close a VSD? What are the common complications of untreated VSD? Answer:  

No, it’s not always imperative to close VSDs, depending on patient’s age, the size of the defect, and the degree of shunt. Some VSDs close spontaneously at a young age, but others generally require surgical correction.

Common complications include pulmonary hypertension, cardiomegaly, atrial dysrhythmias, and right-sided heart failure. If pulmonary hypertension develops, the shunt may reverse to a right-to-left pattern and cause hypoxemia.

NURSING CURRICULUM STANDARDS

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35-136

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Box 18-1: Risk Factors for Coronary Heart Disease

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Fluid and Electrolyte Balance o Exemplar: Coronary Heart Disease o Exemplar: Congenital Heart Diseases 

Concept: Perfusion o Exemplar: FIGURE 18-5: Factors that decrease coronary blood supply or increase myocardial oxygen demand can upset the balance and lead to ischemia and anginal pain o Exemplar: Acute Coronary Syndrome o Exemplar: FIGURE 18-6: The etiologies of acute coronary syndromes (ACSs) are difficult to differentiate by presenting symptoms because all involve some degree of myocardial ischemia. The electrocardiogram (ECG) is used to distinguish those patients with ST elevation from those with no ST elevation. Serum levels of cardiac biomarkers are then used to make a final diagnosis. Most patients with ACS characterized by ST elevation are diagnosed with MI (STEMI), and a proportion of patients with no ST elevation also will have elevated serum markers and are diagnosed with MI (NSTEMI). Patients who do not exhibit serum enzyme elevations are usually diagnosed with unstable angina. o Exemplar: FIGURE 18-7: This photograph of a 5- to 7-day-old posterolateral infarction clearly shows a large, pale yellow lesion surrounded by a dark red zone of inflammation o Exemplar: FIGURE 18-8: (A) Typical ECG infarction pattern showing abnormally large Q wave, ST elevation, and inverted T wave.

(B) Typical ECG in acute inferior myocardial infarction. Note the Q waves and ST-segment elevation in leads II, III, and aVF.

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35-137 o

o o

Exemplar: FIGURE 18-9: Time course of serum marker protein elevations after acute myocardial infarction. The MB band of creatine kinase (CK-MB) and troponin I are the most specific of the protein markers. Myoglobin is an early marker but is not very specific.

Exemplar: FIGURE 18-10: Summary of events After myocardial infarction. ATP, adenosine triphosphate; CK-MB, MB band of creatine kinase; ECG, electrocardiography; SNS, sympathetic nervous system.

Exemplar: FIGURE 18-11: Compensatory responses to increase stroke volume (SV) and maintain cardiac output (CO) after myocardial infarction.

THEME: Protection and Movement o Concept: Inflammation o Exemplar: Pericardial Diseases

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Box 18-1: Risk Factors for Coronary Heart Disease

TEACH FOR NURSES LESSON PLAN Chapter 19: Heart Failure and Dysrhythmias: Common Sequelae of Cardiac Diseases CHAPTER OBJECTIVES 1. Identify the common predisposing factors for development of heart failure.

2. Distinguish heart failure with systolic dysfunction from heart failure with preserved diastolic dysfunction.

3. Explain how the compensatory responses triggered in heart failure work to restore cardiac output and how they might lead to remodeling and progression.

4. Describe the clinical manifestations of heart failure.

5. Explain how preload, afterload, and contractility are managed therapeutically in a patient with heart failure.

6. Describe the characteristic electrocardiographic features of the common cardiac dysrhythmias.

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35-138 7. Identify the clinical significance and usual treatment of each of the common cardiac dysrhythmias.

STUDENT RESOURCES understand

       

Textbook Chapter 19 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 19 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-139

TEACHING STRATEGIES Content Focus HEART FAILURE Pathogenesis and Diagnosis

Content Highlights Discuss the manifestations and causes of heart failure.

Learning Activities 



Compensatory Mechanisms, Remodeling, and Progression Clinical Manifestations Class and Stage of Heart Failure

Discussion Topic: Refer to Figure 19-2 in the text and identify the three major compensatory mechanisms in heart failure.

Activity: Have students complete the table below to review clinical manifestations of left heart failure: Backward Effects Forward Effects

Answer: Backward Effects

Forward Effects

   

   

Treatment



Cough Dyspnea Orthopnea Paroxysmal nocturnal dyspnea

Oliguria Tachycardia Fatigue Confusion, restlessness, anxiety

Activity: Have students complete the table below to review clinical manifestations of right heart failure: Backward Effects Forward Effects

Answer: Backward Effects 

Peripheral edema

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Forward Effects 

Tachycardia

35-140

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities   



Distended jugular veins Hepatomegaly Anorexia

  

Fatigue Oliguria Confusion, restlessness, anxiety

Activity: Have students assist a nurse with the care of a patient with heart failure. Instruct them to list the patient's risk factors or the cause of the disorder and describe the clinical manifestations in that specific person. Compare and contrast this situation with the information in their textbook. How is it the same? How is it different? What might have contributed to the differences?

Remind them to maintain confidentiality.

CARDIAC DYSRHYTHMIAS Dysrhythmia Mechanisms

Discuss cardiac rhythm abnormalities.



Online Activity: Have students visit http://www.gwc.maricopa.edu/class/bio202/cyberheart/ekgqzr2.htm and take the arrhythmias quiz.

Dysrhythmia Analysis Abnormal Rates of Sinus Rhythm Abnormal Site of Impulse Initiation Conduction Pathway Disturbances Treatment

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35-141

IN-CLASS/ONLINE CASE STUDY AO is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. AO also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl (potassium chloride), and sublingual nitroglycerin.

1. Which type of heart failure (left or right sided) is usually associated with dyspnea? What other clinical findings are likely to be present with left-sided heart failure?

Answer:      

Left-sided heart failure is usually associated with exertional dyspnea and paroxysmal nocturnal dyspnea.

Signs of pulmonary congestion such as basilar crackles, orthopnea, and cough.

Chest radiography shows cardiomegaly.

With systolic failure, an echocardiogram would show an ejection fraction less than 40.

Increased heart rate and S3 heart sound on auscultation.

Forward effects include anxiety, confusion, restlessness, oliguria, and fatigue.

2. What compensatory mechanisms are likely to be operative in AO to enhance cardiac output?

Answer:   

Baroreceptors detect low blood pressure and cardiac output and activate the sympathetic system, resulting in increased heart rate. Eventually, the ß receptors will downregulate, and this mechanism will be less effective.

Prolonged stretch on the myocardium results in myocardial hypertrophy.

Renin-angiotensin system activation causes decreased glomerular filtration rate and fluid retention, which results in increased preload.

3. What is the most likely cause of AO’s pedal edema?

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35-142 Answer:  

Prolonged left-sided failure causes an increase in back pressure on the right ventricle and eventual biventricular involvement.

Right-sided failure causes pedal edema.

4. What is the likely cause of AO’s exertional chest pain? What laboratory tests would be useful to confirm this diagnosis?

Answer:   

Exertional chest pain is likely caused by angina.

Cardiac enzymes in this type of angina (no tissue death) would be normal (normal CK with normal isoenzymes; normal troponins; normal myoglobin).

Resting electrocardiogram shows no ST elevation, which would be indicative of acute ischemia.

5. What is the rationale for the use of each of AO’s medications in managing her heart disease?

Answer: 

 



Furosemide is a loop diuretic that activates prostaglandins in the kidney to dilate vessels and causes the excretion of Na+ (and water follows passively) and K+. These result in: o Improved renal perfusion o Decreased preload and central venous pressure, reducing ventricular filling pressure and left ventricular end-diastolic pressure, which reduces cardiac work and blood pressure Potassium is given to replace that lost as a result of the effects of furosemide.

Digitalis is a cardiac glycoside that functions as follows: o Positive inotropic: increases force and velocity of myocardial contractions to increase stroke volume o Negative chronotropic: decreases heart rate o Negative dromotropic: decreases automaticity at sinoatrial node, atrioventricular node, and bundle of His and prolongs atrial and ventricular refractory periods o Promotes diuresis caused by improved kidney perfusion o Confined to systolic failure, the mortality rate is unaffected by this treatment but does improve quality of life.

Sublingual nitroglycerin is a nitrate used acutely to treat episodes of stable angina. It acts to: o Dilate coronary arteries by relaxing the smooth muscles that surround the vessel o Relax systemic veins to decrease preload, resulting in decreased cardiac workload and therefore oxygen demand.

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35-143

NURSING CURRICULUM STANDARDS

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Fluid and Electrolyte Balance o Exemplar: Heart Failure

TEACH FOR NURSES LESSON PLAN Chapter 20: Shock CHAPTER OBJECTIVES 1. Identify the pathogenesis of shock.

2. Identify the common cellular and tissue responses to shock of any cause.

3. Explain how the body tries to compensate for insufficient cardiac output during shock states.

4. Explain how the complications of shock affect body functioning.

5. Identify the common causes of cardiogenic, hypovolemic, obstructive, and distributive shock.

6. Explain how clinical and hemodynamic findings differ among types of shock.

7. Describe the role of the immune system in septic shock and the progressive stage of other types of shock.

8. Explain how shock is managed.

9. Explain why shock has a high mortality rate.

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35-144

STUDENT RESOURCES understand

       

Textbook Chapter 20 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 20 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

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35-145

Content Focus PATHOGENESIS OF SHOCK

Content Highlights

Learning Activities

Describe the characteristics of shock.



Discussion Topic: Refer students to Figure 20-3 in the text to review compensatory mechanisms in shock.

Identify the different types of shock.



Online Activity: Have students visit http://emedicine.medscape.com/article/152191-overview for an overview of cardiogenic shock.

Impaired Tissue Oxygenation Compensatory Mechanisms and Stages of Shock TYPES OF SHOCK Cardiogenic Shock Obstructive Shock Hypovolemic Shock Distributive Shock



Activity: Have complete the table below to review the four main types of shock: Type of Shock Underlying Pathophysiology Cardiogenic Obstructive Hypovolemic Distributive

Answer: Type of Shock Cardiogenic Obstructive Hypovolemic Distributive 

Underlying Pathophysiology Severely decreased myocardial contractility Mechanical blockage of cardiac filling Inadequate circulating blood volume Excessive vasodilation

Activity: Divide students into groups and give each group a description of a patient with a different type of shock. Have each group identify the type of shock and develop a treatment plan for the patient.

ASSESSMENT AND HEMODYNAMIC MONITORING

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35-146

TEACHING STRATEGIES Content Focus

Content Highlights

Cardiac Output Arterial Oxygen Content Distribution of Blood Flow Hemodynamic Monitoring COMPLICATIONS OF SHOCK Acute Respiratory Distress Syndrome Disseminated Intravascular Coagulation Acute Renal Failure Multiple Organ Dysfunction Syndrome

IN-CLASS/ONLINE CASE STUDY

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Learning Activities

35-147 CC is a previously healthy 27-year-old man admitted to the critical care unit after an accident in which he was hit by a car and dragged along the pavement for nearly 100 feet. He sustained a frontal contusion; fractured clavicle and ribs; and extensive abrasions on his arms, legs, side, back, and buttocks. On admission, he was tachycardic, hypotensive, unresponsive, and ventilating poorly. He was placed on a mechanical ventilator and given IV fluids for the treatment of his shock. CC responded well to fluids, with an increase in blood pressure and an improvement in urine output.

1. Based on his case history and responsiveness to fluid therapy, what type of shock was CC experiencing?

Answer:   

Because of the extensive abrasions from the trauma, this patient most likely lost a significant amount of blood volume, resulting in hypovolemic shock.

The decreased intravascular blood volume leads to decreased venous return followed by decreased cardiac output, decreased tissue perfusion, and decreased oxygen delivery.

The degree of hypovolemic shock has been divided into four classes based on factors such as amount of blood loss, mental status, urine output, heart rate, and capillary blanch test.

2. What other clinical findings would be helpful in confirming the type of shock? Why? Answer:   

Hemodynamic monitoring is helpful in distinguishing hypovolemic shock from cardiogenic shock.

In cardiogenic shock, preload is high, and cardiac output is low. In hypovolemic shock, preload and cardiac output are low.

Neurogenic shock can be the result of brain injury—another factor in this patient’s case. Whereas patients with neurogenic shock typically respond better to vasoconstricting drugs, pharmacologic agents are not indicated in hypovolemic shock.

Restoration of circulating volume is most essential in hypovolemic shock.

3. Because of his many open wounds and invasive lines, CC is at risk for sepsis and septic shock. What clinical findings would suggest that this complication has developed?

Answer:

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35-148 

 



The presence of microorganisms in the bloodstream can confirm sepsis. Normally, the body’s mechanisms can fight off the bacteria and prevent widespread infection. But because of the trauma, this patient’s immune system will be compromised, and he may not be able to adequately fight infection.

Obtaining blood cultures. By performing this test, the provider can determine the exact organism that may be causing the infection and manage accordingly. Gram-negative bacteria are responsible for most cases of septic shock.

Another indicator may be an increased white blood cell count, especially neutrophils. To fight infection, the body will produce more in an effort to eradicate the source of the infection. The clotting cascade, complement system, and kinin system may all be activated in the immune response.

Initially, a high cardiac output (from immune-mediated vasodilation and sympathetic activation of the heart) would be seen. The patient will be febrile, pink, and warm. Even though cardiac output is high, cellular hypoxia will be present because of the maldistribution of blood flow. This will be evidenced by a high SvO2.

4. What is the link between sepsis and multiple organ dysfunction syndrome (MODS)?

Answer: 

MODS is associated with a systemic inflammatory response. The immune reactions of sepsis cause the prolonged or ongoing inflammatory response. The inflammatory response causes hypoxic injury to cells; leaky capillaries; damage from enzymes; and activation of the complement, kinin, and clotting system, which results in tissue destruction and organ dysfunction. When more than one organ dysfunction develops, MODS is the result.

NURSING CURRICULUM STANDARDS

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation

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35-149 o

Concept: Perfusion o Exemplar: Pathogenesis of Shock o Exemplar: FIGURE 20-1: Shock is a complex process involving cellular hypoxia, free radical formation, and systemic inflammation.

All forms of shock are associated with impaired tissue oxygenation, which triggers a cascade of events leading to tissue injury and death. ATP, adenosine triphosphate. o Exemplar: FIGURE 20-2: Excess production of nitric oxide is an important mechanism of vascular failure in shock. The tumor necrosis factor- and interleukin-1 cytokines are promoters of inducible nitric oxide synthase. These cytokines are released from macrophages that have been activated by tissue injury or toxins. IL-1, interleukin-1; TNF-, tumor necrosis factor-. o Exemplar: FIGURE 20-3: Compensatory mechanisms are triggered in shock to help maintain arterial blood pressure despite a fall in cardiac output. E, epinephrine; HR, heart rate; NE, norepinephrine; SNS, sympathetic nervous system. o Exemplar: FIGURE 20-4: In early stages of hypovolemia, blood pressure is stable even though cardiac output is falling. When volume losses equal about 25% of the total blood volume, blood pressure falls precipitously. o Exemplar: FIGURE 20-5: Classical manifestations of shock. ADH, antidiuretic hormone; SBP, systolic blood pressure. o Exemplar: FIGURE 20-6: Cardiogenic shock results in decreased tissue perfusion and cardiogenic pulmonary edema because of reduced myocardial function, usually associated with left ventricular failure. SNS, sympathetic nervous system. o Exemplar: FIGURE 20-7: Pathogenesis of hypovolemic shock o Exemplar: FIGURE 20-8: Pathophysiologic process of septic shock. Septic shock is characterized by immune-mediated mechanisms of cellular injury and organ dysfunction. IL-1, interleukin-1; TNF-, tumor necrosis factor-. o Exemplar: FIGURE 20-9: Properly positioned pulmonary artery catheter showing the proximal port in the right atrium and the distal port in the pulmonary artery. Cardiac output determinations can be made by injecting hypothermic solution into the proximal port and measuring the degree of warm-up near the distal port. A balloon at the end of the catheter can be intermittently inflated to measure pulmonary capillary occlusion pressure. When the balloon is inflated, it will float into a small artery and wedge there. Then the distal port measures the pressure in the capillary, which is a direct reflection of left atrial pressure.

THEME: Protection and Movement o Concept: Infection o Exemplar: Septic Shock o Exemplar: Table 20-4: Definitions Related to Sepsis o Exemplar: FIGURE 20-8: Pathophysiologic process of septic shock. Septic shock is characterized by immune-mediated mechanisms of cellular injury and organ dysfunction. IL-1, interleukin-1; TNF-, tumor necrosis factor-.

TEACH FOR NURSES LESSON PLAN

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35-150

Chapter 21: Respiratory Function and Alterations in Gas Exchange CHAPTER OBJECTIVES 1. Describe how the structures involved in gas exchange in the lungs differ from conducting structures.

2. Identify the factors that determine the work of breathing.

3. Describe how alveolar ventilation and oxygenation are estimated and assessed.

4. Identify the factors that affect the distribution of ventilation and perfusion in the lungs.

5. Describe how oxygen and carbon dioxide are transported in the circulation.

6. Identify pathophysiologic factors that might alter ventilation-perfusion matching in the lungs.

7. Explain how the outcomes of ventilation-perfusion mismatching can be assessed clinically.

8. Identify the pulmonary function test abnormalities that are characteristic of obstructive pulmonary disorders.

9. Identify the risk factors and complications of pulmonary venous thromboembolism and hypertension.

10. Identify the various types of pulmonary malignancies.

STUDENT RESOURCES understand

       

Textbook Chapter 21 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 21 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

35-151

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

FUNCTIONAL ANATOMY

Provide an overview of the respiratory system.

Development of the Pulmonary System

Learning Activities 



Online Activity: Have students visit http://www.wisconline.com/objects/ViewObject.aspx?ID=AP15104 to access an interactive animation from Wisconsin Online.

Activity: Have students complete the “Respiratory System Physiology Fill-inthe-Blank Activity” below.

Upper Airway Structures Lower Airway Structures Pulmonary Circulation Age-Related Variations VENTILATION Lung Volumes and Capacities

Discuss the process of ventilation and lung function.



Online Activity: Have students visit http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/pd/bsounds.htm to listen to breath sounds.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-152

TEACHING STRATEGIES Content Focus

Content Highlights

Dead Space Minute Ventilation Alveolar Ventilation/Oxygenation Mechanics of Breathing Airway Resistance Lung Compliance Distribution of Ventilation Neurologic Control of Ventilation PULMONARY BLOOD FLOW Pulmonary Vasculature Distribution of Blood Flow Ventilation-Perfusion Ratios Hypoxic Vasoconstriction

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-153

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

DIFFUSION AND TRANSPORT OF RESPIRATORY GASES Barriers to Diffusion Oxygen Transport Carbon Dioxide Transport ALTERATIONS IN PULMONARY FUNCTION

Review the major complications of pulmonary function.

1.

2.

Hypoventilation and Hyperventilation Hypoxemia and Hypoxia Acute Respiratory Failure (ARF)

Activity: Have students complete “Hypoventilation and Hyperventilation Fill-in-the-Blank Activity” below.

Discussion Topic: Have students divide into groups. Have them identify and define the causes of the following types of hypoxia: anemic, histotoxic, circulatory, and hypoxic

Answers: 3. Anemic hypoxia: Defined as decreased oxygen-carrying capacity of blood.

Causes include iron deficiency anemia and sickle cell anemia.

4. Histotoxic hypoxia: Defined as a toxin preventing cells from using oxygen.

Causes include cyanide poisoning.

5. Circulatory hypoxia: Defined as low cardiac output that reduces blood flow to tissue. Causes include cardiac arrest, heart failure, shock, and hemorrhage.

6. Hypoxic hypoxia: Defined as decreased PaO2 but normal oxygen-carrying capacity of blood. Causes include airway obstruction, hypoventilation, and high attitude.

DIAGNOSTIC TESTS Pulmonary Function Testing Bronchial Provocation

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35-154

TEACHING STRATEGIES Content Focus

Content Highlights

Tests ALTERATIONS IN PULMONARY VASCULATURE Pulmonary Hypertension Pulmonary Venous Thromboembolism PULMONARY MALIGNANCIES

Respiratory System Physiology Fill-in-the-Blank Activity Terms from which students can choose:  Partial pressure  Carbon monoxide  Carbon dioxide  Surface tension  Mucus  Pleural fluid  Dilate  Surfactant  Constrict  Normal  Cilia  Cartilage  Forced  Oxygen

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-155 

Pseudopods

Fill-in-the-Blanks: 1. _____________________ keeps alveoli from collapsing by reducing ____________.

2. The blood delivers ________ to the lungs and picks up _______________ to take to the rest of the body.

3. Parasympathetic nervous system activity causes bronchioles to__________________.

4. Residual volume is the amount of air left in the lungs after ____________ exhalation.

5. _____________ on respiratory epithelial cells move the coating of ________ upward for disposal.

6. Sympathetic nervous system activity causes bronchioles to ________________.

7. Small bronchioles do not have ____________ to keep them open.

Respiratory System Physiology Fill-in-the-Blank Activity Answers: 1. surfactant, surface tension 2. carbon dioxide, oxygen 3. constrict 4. forced 5. cilia, mucus 6. dilate 7. cartilage Hypoventilation and Hyperventilation Fill-in-the-Blank Activity Terms from which students can choose:  Hyperventilation  Remain the same  Hypoventilation  Hunger  Anxiety  Pain  Increase  Decrease  Hypercapnia Fill-in-the-Blanks: 1. Hypoxia stimulates ___________________.

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35-156 2.

3.

4.

5.

6.

A common cause of hyperventilation is _____________________.

Drugs that depress the neurons that drive ventilation cause _________________.

Hypoventilation causes the PaCO2 to ________________________.

Depending on its location and the individual’s response, _____________________ may cause either hypoventilation or hyperventilation.

The technical term for increased PaCO2 is _________________.

Hypoventilation and Hyperventilation Fill-in-the-Blank Activity Answers: 1. Hyperventilation 2. Anxiety 3. Hypoventilation 4. Increase 5. Pain 6. Hypercapnia

IN-CLASS/ONLINE CASE STUDY

TV is hospitalized with deep vein thrombosis (DVT) in her left leg as a complication of abdominal surgery. She is being treated with bedrest and anticoagulant therapy. On the third postoperative day, she suddenly experiences severe dyspnea and is placed on supplemental oxygen. A blood gas is drawn, which demonstrates hypoxemia and mild respiratory alkalosis.

1. Considering TV’s history, what is the most likely cause of her respiratory distress? Why? Answer:   

She is most likely experiencing pulmonary emboli.

The sudden onset is the key to considering this complication.

More than 90% of pulmonary emboli arise from DVTs in the lower extremities.

2. What diagnostic findings would help confirm this diagnosis?

Answer: Copyright © 2019, Elsevier Inc. All rights reserved.

35-157    

A V/Q scan could be done to confirm diagnosis. An area of absent perfusion is diagnostic.

Helical angiography is replacing V/Q scans.

Chest x-ray examination will be normal; pleural effusion may occur in a small percentage of patients.

Pulmonary angiography is the most definitive test, but it is invasive, so it is rarely done.

3. What is the pathogenesis of the hypoxemia in this disorder?

Answer: 

The embolism occludes perfusion through the pulmonary vasculature; the degree of hypoxemia varies with the degree of impaired circulation.

4. How will TV’s respiratory disorder likely be treated?

Answer:   



Treatment mainstays are supplemental oxygen and heparin by continuous IV infusion.

She will continue to be on bedrest to reduce the likelihood of further emboli.

Heparin prevents the formation of new clots. If the embolism significantly compromises pulmonary function, thrombolytic therapy is sometimes considered, but TV would not be a candidate because her recent abdominal surgery increases her risk of bleeding.

Surgery may be indicated if a large thrombus results in hemodynamic instability (thrombectomy), but it carries significant risk.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment o Box 21-4: Factors Predisposing to Pulmonary Embolism of Virchow’s Triad

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NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Acid Base o Exemplar: Acute Respiratory Failure  Concept: Clotting o Exemplar: Pulmonary Venous Thromboembolism  Concept: Gas Exchange o Exemplar: Oxygen Transport o Exemplar: FIGURE 21-17: Oxyhemoglobin dissociation curve showing factors affecting hemoglobin’s affinity for oxygen. Curve B is the standard curve under normal conditions. Curve A shows a shift to the left, which represents an increased affinity of hemoglobin for oxygen. Curve C demonstrates a shift to the right, which represents a decreased affinity. o Exemplar: Hypoxemia and Hypoxia

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Box 21-4: Factors Predisposing to Pulmonary Embolism of Virchow’s Triad

TEACH FOR NURSES LESSON PLAN Chapter 22: Obstructive Pulmonary Disorders CHAPTER OBJECTIVES 1. Describe the clinical manifestations and common causes of acute airway obstruction.

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35-159 2. Describe the pathogenesis and clinical manifestations for conditions that cause obstruction of the airway lumen.

3. Explain the role of inflammation in the development of asthma.

4. Explain how the underlying genetic defect in cystic fibrosis leads to pulmonary and exocrine gland dysfunction.

5. Explain how smoking causes both the alveolar destruction of emphysema and the bronchial damage of chronic bronchitis.

6. Describe the rationale for using drugs such as 2 agonists, acetylcholine antagonists, leukotriene inhibitors, corticosteroids, and mast cell stabilizers to manage obstructive pulmonary disorders.

STUDENT RESOURCES understand

       

Textbook Chapter 22 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 22 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-160

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

OBSTRUCTION FROM CONDITIONS IN THE WALL OF THE LUMEN

Identify the major obstructions resulting from alterations in the wall of the lumen.

Acute Bronchitis



Chronic Bronchitis

Emphysema OBSTRUCTION OF THE AIRWAY LUMEN





Asthma

OBSTRUCTION RELATED TO LOSS OF LUNG PARENCHYMA

Learning Activities

Discuss the manifestations, symptoms and diagnosis of emphysema.



Identify the different obstructions of the airway lumen.



Online Activity: Have students visit http://www.lung.org/ourinitiatives/healthy-air/sota/health-risks/ to learn about “The Health Effects of Ozone and Particle Pollution.”

Discussion Topic: Show students the Airway Remodeling example below to illustrate and discuss the effect on respiratory function.

Activity: Have students complete the “Pathophysiology of Asthma Teaching Activity” below.

Activity: Have students complete the “Chronic Bronchitis and Emphysema Activity” below to add the correct symptom or manifestation to the correct obstruction.

Activity: Have students complete the “Summary of Obstructive Pulmonary Disorders Activity” below.

Bronchiectasis Bronchiolitis Cystic Fibrosis Acute Tracheobronchial Obstruction Epiglottitis Croup Syndrome

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Airway Remodeling Discussion Topic

Copyright © 2019, Elsevier Inc. All rights reserved.

35-162 Over time, the continued inflammation and abnormal chemical environment of asthma cause physical changes in the bronchi and bronchioles that are known as airway remodeling.

Compare the normal bronchiole with the bronchiole from a person who has chronic asthma. Note the increased amount of mucus in the bronchial lumen in asthma. Look for these changes that contribute to accumulation of mucus:  

Increased number of goblet cells in the mucosa Hypertrophy of submucosal mucus glands

Note these additional aspects of airway remodeling in asthma:   

Thickened basement membrane Mucosal layer contains many inflammatory cells Airway smooth muscle layer is thicker due to hypertrophy and hyperplasia

Discuss how airway remodeling affects respiratory function.

Pathophysiology of Asthma Teaching Activity Have students write their responses to the teaching scenarios below.

“Why should I take these asthma drugs?” asks Mr. Arles. “I survived several asthma attacks already and I do not like to take drugs.” Respond as if you are speaking directly to him.

2. “What is airway remodeling?” asks Mr. Mendez. “I remodel kitchens and bathrooms, but I cannot imagine remodeling my own body.” Respond as if you are speaking directly to him.

3. “I understand about inflammation in my airways now,” says Mrs. Nganda. “But what does airway hyperresponsiveness mean?” Respond as if you are speaking directly to her.

1.

Answers to Pathophysiology of Asthma Teaching Activity 1. It is important for you to take these asthma medications, because the more asthma attacks you have, the more physical changes can happen in your air passageways. We call these changes airway remodeling. The changes caused by asthma are

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reversible in the beginning, but they can become permanent if asthma is not well controlled. That is why preventing asthma attacks with medications is beneficial for you.

2. Airway remodeling makes permanent changes in the walls of your air passageways. It does not tear down the walls, like you might do when remodeling a house, but it makes the walls of your air passageways thicker. It puts more mucus glands in them, so that you make more mucus and cough more. The changes of airway remodeling make it more difficult to breathe and more difficult to manage your asthma symptoms.

3. Airway hyperresponsiveness means that your airways are more likely to respond to irritants by getting inflamed and constricting than normal airways are. So chemicals or particles in the air that might not bother other people can trigger an asthma episode for you.

Chronic Bronchitis and Emphysema Activity Answer options:          

Chronic productive cough, copious purulent sputum Effort is absent until end-stage disease Minimal cough, scant mucoid sputum Occurs early in disease Stocky, overweight Absent until end-stage disease Thin, barrel chest Crackles, wheezes Visible effort early in disease Decreased

Emphysema

Chronic Bronchitis

Typical body build Cough and sputum

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35-164

Lung sounds Use of respiratory accessory muscles Cor pulmonale

Answers to Chronic Bronchitis and Emphysema Activity Emphysema

Chronic Bronchitis

Typical body build

Thin, barrel chest

Stocky, overweight

Cough and sputum

Minimal cough, scant mucoid sputum Decreased

Chronic productive cough, copious purulent sputum Crackles, wheezes

Use of respiratory accessory muscles

Visible effort early in disease

Effort is absent until end-stage disease

Cor pulmonale

Absent until end-stage disease

Occurs early in disease

Lung sounds

Summary of Obstructive Pulmonary Disorders Activity   

Emphysema (Type A COPD) Bronchiectasis Cystic fibrosis

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35-165   

Chronic bronchitis (Type B COPD) Epiglottitis Bronchiolitis



Asthma

Obstruct Airway Lumen Directly

Destroy Lung Parenchyma

Alter Wall of Airway

Answer to Summary of Obstructive Pulmonary Disorders Activity Obstruct Airway Lumen Directly    

Bronchiolitis Epiglottitis Cystic fibrosis Bronchiectasis

Destroy Lung Parenchyma 

Emphysema (type A COPD)

Alter Wall of Airway  

Asthma Chronic bronchitis (type B COPD)

IN-CLASS/ONLINE CASE STUDY

RS has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH, 7.32; PaCO2, 60 mm Hg; PaO2, 50 mm Hg; and HCO3-, 30 mEq/L. His hematocrit is 52% with normal red blood cell indices. He is using an inhaled ß2 agonist and theophylline to manage

Copyright © 2019, Elsevier Inc. All rights reserved.

35-166 his respiratory disease. At this clinic visit, it is noted on a chest x-ray examination that RS has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia.

1. What clinical findings are likely in RS as a consequence of his COPD? How would these differ from those of emphysematous COPD? Answer:     

Enlarged right heart on x-ray examination; potentially, peripheral edema and other signs and symptoms of right-sided heart failure Secondary polycythemia Hypoxemia and hypercarbia Persistent cough productive of thick sputum, wheezing, coarse rales, and chest tightness In emphysema, there is alveolar wall and small airway destruction. Patients are usually thin, have little sputum, have an increased A:P chest ratio, and maintain normal ABGs until late in the disease.

2. Interpret RS’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia?

Answer:  

Partially compensated respiratory acidosis (low pH, elevated PaCO2, low PaO2, and elevated bicarb) Chronic hypoxia stimulates excess red blood cell production to increase oxygen carrying capacity.

3. What is the rationale for treating RS with theophylline and a ß2 agonist?

Answer: 

A ß2 agonist is an inhaled bronchodilator used for relief of acute dyspnea or wheezing and is the first step in management of COPD. Theophylline is a systemic bronchodilator used to attain better nocturnal oxygen saturation and pulmonary function.

Together they provide a strengthened bronchodilator effect so that the patient can sustain better oxygen saturation.

4. What effects would his respiratory disease have on his cardiovascular function?

Answer:

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35-167   

Within the vascular bed of the lungs, poorly ventilated areas producing hypoxemia result in a compensatory vasoconstriction to limit perfusion there and maximize it to ventilated alveoli. This results in pulmonary hypertension.

Pulmonary hypertension increases the work of the right side of the heart, causing it to hypertrophy (cor pulmonale). Over time, this could result in heart failure.

Increased muscle mass and cardiac work requires more oxygen, which may be limited because of his coronary artery disease.

This may result in angina or even a myocardial infarction.

5. Considering both his COPD and pneumonia, in what position would RS have the worst ventilation/perfusion (V/Q) matching?

Answer: 

As COPD progresses over several years, the changes in the small airways begin to impair ventilation, but perfusion remains fairly adequate, resulting in a V/Q imbalance and hypoxemia. Normally, a patient with right lower lobe pneumonia would get the best V/Q matching by sitting upright or lying on the left side and the worst by lying on the right side. Lying on his right side would impair RS’s V/Q matching because the greatest blood flow would occur in the area of worst ventilation.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-168 THEME: Homeostasis and Regulation  Concept: Gas Exchange o Exemplar: Asthma

TEACH FOR NURSES LESSON PLAN Chapter 23: Restrictive Pulmonary Disorders CHAPTER OBJECTIVES 1. Describe how fibrotic lung disorders develop.

2. Explain how the pathogenesis of acute (adult) respiratory distress syndrome is similar to that of infant respiratory distress syndrome.

3. Explain how abnormal accumulations in the pleural space affect lung function.

4. Identify the neuromuscular disorders associated with reduced lung compliance.

5. Identify the chest wall deformities that are associated with reduced lung compliance.

6. Describe the pathogenesis of pneumonia.

7. Describe the pathogenesis of severe acute respiratory syndrome (SARS).

8. Describe the pathogenesis of Middle East respiratory syndrome (MERS).

9. Describe the pathogenesis of tuberculosis.

STUDENT RESOURCES understand

       

Textbook Chapter 23 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 23 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

35-169

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

LUNG PARENCHYMA DISORDERS FIBROTIC INTERSTITIAL LUNG DISEASES

Review the different fibrotic interstitial lung diseases.



Activity: Have students complete the “Fibrotic Interstitial Lung Diseases” fill-inthe-blank activity below.

Diffuse Interstitial Lung Disease, Sarcoidosis Hypersensitivity Pneumonitis Occupational Lung

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Diseases ATELECTATIC DISORDERS Acute (Adult) Respiratory Distress Syndrome Infant Respiratory Distress Syndrome

Distinguish acute respiratory distress syndrome from infant respiratory distress syndrome.

 

Activity: Have students complete the “Acute (Adult) Respiratory Distress Syndrome” fill-in-the-blank activity below.

Online Activity: Have students visit http://www.nlm.nih.gov/medlineplus/ency/article/001563.htm for more information about infant (neonatal) respiratory distress syndrome.

PLEURAL SPACE DISORDERS Pneumothorax Pleural Effusion NEUROMUSCULAR, CHEST WALL, AND OBESITY DISORDERS NEUROMUSCULAR DISORDERS Poliomyelitis Amyotrophic Lateral Sclerosis Muscular Dystrophies Guillain-Barré Syndrome Myasthenia Gravis CHEST WALL DEFORMITIES Kyphoscoliosis Ankylosing Spondylitis

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Flail Chest Disorders of Obesity INFECTION OR INFLAMMATION OF THE LUNG

Review the major infections of the lung.



Discussion Topic: Instruct students to consider the people who live in your geographic area. Identify a group of people who are at high risk for tuberculosis and discuss their specific risk factors.

Pneumonia Severe Acute Respiratory Syndrome Middle East Respiratory Syndrome Pulmonary Tuberculosis

Fibrotic Interstitial Lung Diseases Fill-in-the-Blank Activity Terms from which students can choose:  Macrophages  Only one type  Farmer’s lung  Granulomas  increased  Late  Early  Decreased  Caseations  Inorganic  Silicosis  All types  Organic

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Fill-in-the-Blanks: 1. Loss of lung ____________ reduces functioning lung volume.

2. The ___________ of ARDS does not improve with supplemental oxygen.

3. Alveoli in ARDS fill with ____________ fluid.

4. Activated _____________ release chemical mediators that damage alveolar-capillary membranes.

5. ARDS frequently occurs one or two days after a severe episode of low ____________.

6. Increased capillary ___________ allows alveolar exudates to form.

7. Decreased ___________ contributes to atelectasis in ARDS.

Answers: 1. compliance 2. hypoxemia 3. proteinaceous 4. neutrophils 5. blood flow 6. permeability 7. surfactant

IN-CLASS/ONLINE CASE STUDY

ND is an 82-year-old woman who lives in a skilled nursing facility. She has rheumatoid arthritis, coronary artery disease, chronic bronchitis, and hypertension. She uses a wheelchair and tends to spend most of her days in bed. She smoked for 52 years but quit 14 years ago. She has lost 10 lb in the past month and has had a productive cough for about 2 weeks that has copious amounts of white to yellow mucous. Over the past 3 days, she has refused to get out of bed and has been refusing to eat or drink. This morning she is confused, has a fever, and is coughing continuously. Her sputum now is rust colored. Her lungs sounds are coarse rhonchi throughout with crackles and diminished lung sounds in her right middle lobe area. Her vital signs are blood pressure, 86/54 mm Hg; heart rate, 98 beats/min; respirations, 28 breaths/min; and temperature, 102.4°F. She is being admitted to the hospital.

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35-173 1. Pneumonia can be classified many different ways. Discuss the different classifications and identify which classification of pneumonia best fits ND’s situation.

Answer:  Community-acquired pneumonia is when a patient’s pneumonia is developed while not in the hospital setting. The most common forms are bacterial in nature.  Hospital-acquired pneumonia is when pneumonia develops after 24 hour of hospitalization.  Pneumonias can also be divided into the causative organisms, such as bacterial, atypical, and viral. Bacterial organisms are broken down into gram-positive and gram-negative organisms. Streptococci and staphylococci bacteria are the most common gram-positive bacteria. The most common gram-negative organisms are Klebsiella spp., Haemophilus influenza, and Pseudomonas aeruginosa. Atypical pneumonias are Mycoplasma, Legionnaire, and Pneumocystis (carinii) jiroveci pneumonia.  ND most likely has a community-acquired pneumonia staphylococcus or streptococcus infection.

2. What is the most probable cause of ND’s pneumonia?

Answer:  ND is elderly and is immobilized. She primarily stays in bed and is not ambulating. She is immunosuppressed by her autoimmune disease and is chronically ill.  ND’s long history of smoking and her damaged lungs make it easier for the bacteria to multiply and harder for her to expectorate the mucous.

3. What diagnostic tests would you expect to be done to diagnose ND’s pneumonia?

Answer:  ND should have sputum culture with culture and sensitivity, complete blood count to check white blood cell count, and chest radiography.

4. Describe what “CURB 65” is and whether ND meets the criteria.

Answer:  “CURB 65” is a set of data points that will help you decide whether or not to admit the patient to the hospital. Usually this is used if a gram-negative bacteria is considered in a patient who has been hospitalized or has a chronic illness such as ND does.  The data points are: (1) confusion, (2) BUN > 19.6 mg/dL, (3) respiratory rate >30 breaths/min, (4) systolic blood pressure <90 mm Hg diastolic blood pressure BP ≤ 0 mm Hg, and (5) age ≥ 65 years.  ND has four of the five data points and should be hospitalized.

NURSING CURRICULUM STANDARDS

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QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment o Table 23-7: Differentiating Features of Types of Pneumonia

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.  

THEME: Homeostasis and Regulation Concept: Nutrition o Exemplar: Disorders of Obesity Concept: Gas Exchange o Exemplar: Acute (Adult) Respiratory Distress Syndrome o Exemplar: Infant Respiratory Distress Syndrome THEME: Protection and Movement  Concept: Infection o Exemplar: Infection or Inflammation of the Lung o Exemplar: Pneumonia o Exemplar: Severe Acute Respiratory Syndrome o Exemplar: Middle East Respiratory Syndrome o Exemplar: Pulmonary Tuberculosis

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Treatment

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TEACH FOR NURSES LESSON PLAN Chapter 24: Fluid and Electrolyte Homeostasis and Imbalances CHAPTER OBJECTIVES 1. Identify the physiologic and pathophysiologic conditions that predispose an individual to disturbances in fluid intake.

2. Compare and contrast the compositions of plasma and interstitial fluids.

3. Explain what regulates water and electrolyte movement between plasma and interstitial fluids and across cell membranes.

4. Identify the usual and pathologic routes of fluid exit from the body.

5. Identify the conditions under which extracellular volume deficit and excess are likely to occur, and describe the characteristic clinical findings.

6. Identify the conditions under which hyponatremia (water excess) and hypernatremia (water deficit) are likely to occur, and describe the characteristic clinical findings.

7. Identify the capillary-level mechanisms that cause edema.

8. Identify the physiologic and pathophysiologic conditions that can lead to alterations in electrolyte intake, absorption, distribution, or excretion. Explain how these differ between specific electrolytes.

9. Describe the characteristic clinical findings of plasma excesses and deficits of potassium, calcium, magnesium, and phosphate ions.

STUDENT RESOURCES understand

       

Textbook Chapter 24 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 24 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

35-176

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus BODY FLUID HOMEOSTASIS Fluid Intake and Absorption Fluid Distribution Fluid Excretion

Content Highlights Discuss the process of body fluid homeostasis.

Learning Activities   

Activity: Have students complete the “Cell Membranes” fill-in-the-blank activity below.

Activity: Have students complete the “Fluid Distribution” fill-in-the-blank activity below.

Discussion Topic: Have the students distinguish interstitial fluid from intracellular fluid. Sample answer is provided below.

Fluid Loss Through Abnormal Routes FLUID IMBALANCES Extracellular Fluid

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Volume Body Fluid Concentration Both Volume and Concentration Interstitial Fluid Volume PRINCIPLES OF ELECTROLYTE HOMEOSTASIS Electrolyte Intake and Absorption Electrolyte Distribution Electrolyte Excretion Electrolyte Loss Through Abnormal Routes ELECTROLYTE IMBALANCES

Review the different types of electrolyte imbalances.

Plasma Potassium



Online Activity: Have students visit http://faculty.washington.edu/chudler/ap.html for a clear explanation of resting membrane potential and action potential.

Plasma Calcium Plasma Magnesium Plasma Phosphate

Cell Membranes Fill-in-the-Blank Activity Terms from which students can choose:  Plasma Copyright © 2019, Elsevier Inc. All rights reserved.

35-178          

Sodium Threshold Potassium Active Lipids Proteins Water Action Nuclear Passive

Fill-in-the-Blanks: 1. Resting membrane potential is determined primarily by the ___________ concentration gradient across the cell membrane.

2. The process of osmosis involves movement of _______________ across a cell membrane.

3. Facilitated diffusion is __________ transport through membrane __________.

4. Channels and carriers that allow charged particles to move across cell membranes are made of ______________.

5. Movement of ions across a cell membrane in a process that requires ATP is called ______________ transport.

6. An action potential occurs when the cell depolarizes to __________ potential.

7. A cell membrane also is called a ____________ membrane.

Answers: 1. Potassium 2. Water 3. Passive, Proteins 4. Proteins 5. Active 6. Threshold 7. Plasma

Fluid Distribution Fill-in-the-Blank Activity Terms from which students can choose:  Active transport  Proteinaceous

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35-179     

Hydrostatic Hydraulic Filtration Osmotic Osmosis

Fill-in-the-Blanks: 1. The distribution of fluid between the extracellular and intracellular fluids occurs by the process of _________.

2. Interstitial fluid _________________ pressure refers to the push of the interstitial fluid against the outside of the capillary walls.

3. Capillary ______________ pressure refers to the inward-pulling force of particles in the vascular fluid.

4. Capillary ______________ pressure refers to the outward push of the vascular fluid against the capillary walls.

5. Interstitial fluid ____________ pressure refers to the inward-pulling force of particles in the interstitial fluid.

6. The distribution of fluid between the vascular and interstitial fluids occurs by the process of ____________.

Answers: 1. Osmosis 2. Hydrostatic 3. Osmotic 4. Hydrostatic 5. Osmotic 6. Filtration

Discussion Topic (distinguishing interstitial fluid from intracellular fluid) Interstitial Fluid    

High sodium Low protein High bicarbonate and chloride Low potassium

Intracellular Fluid    

Low sodium High protein High magnesium and phosphates High potassium

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IN-CLASS / ONLINE CASE STUDY AC is a 79-year-old man living in a long-term care facility. He has had multiple medical diagnoses, including heart failure (HF), chronic obstructive pulmonary disease (COPD), and a stroke. He is bedridden and receiving enteral tube feedings. He has chronic diarrhea thought to be related to his tube feedings. He receives digoxin and furosemide (Lasix) to manage his heart failure.

1. AC is prone to several acid-base and fluid-electrolyte disorders. Explain why he is at risk for each of the following disorders, and what the laboratory and clinical findings would likely be. a. Saline excess Answer: 

HF commonly leads to extracellular volume overload because of poor perfusion of kidneys leading to stimulation of the renin-angiotensin-aldosterone system and resulting fluid volume retention. There are no laboratory findings that assist with this diagnosis. Clinical findings are most useful and include weight gain, edema, jugular venous distention, bounding pulse, crackles in the lungs, and hypertension.

b. Hypokalemia Answer: 

Diuretic therapy with furosemide is a risk factor for the development of hypokalemia because it causes loss of potassium in the urine. A tube feeding diet without appropriate supplemental intake may contribute. Hypokalemia is a laboratory diagnosis with findings of a serum level less than 3.5 mEq/L. Signs and symptoms include neuromuscular weakness and cardiac dysrhythmias. Hypokalemia in association with digitalis can produce a greater risk of digitalis toxicity.

c. Hypercalcemia Answer: 

Hypercalcemia can be a consequence of bedrest coupled with inadequate fluids or excessive calcium supplementation.

However, hypercalcemia should always be regarded as a harbinger of cancer and should invoke a cancer evaluation.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-181 Hypercalcemia is a laboratory diagnosis, and ionized calcium should be measured if the patient’s disease is symptomatic.

Symptoms include decreased neuromuscular excitability and decreased deep tendon reflexes. d. Hypernatremia Answer: 

Hypernatremia occurs when there is a water deficit, and the major risks are from excessive diuresis with furosemide, potentially hypertonic tube feedings with inadequate replacement of water losses. Hypernatremia is a laboratory diagnosis evidenced by serum sodium greater than 145 mEq/L. Signs and symptoms include confusion and poor skin turgor.

e. Respiratory acidosis Answer: 

Respiratory acidosis occurs when ventilation is impaired to the point that the patient retains CO2. COPD is a risk factor for this disorder, either chronic bronchitis or advanced emphysema. Respiratory acidosis is a laboratory diagnosis evidenced by low pH and high PaCO2. Acidosis produces neurologic depression.

2. How would AC attempt to compensate for respiratory acidosis if it occurs?

Answer: 

Compensation for respiratory acidosis is through renal production of more bicarbonate ions.

3. What acid-base imbalance might occur as a result of AC’s chronic diarrhea?

Answer: 

Intestinal fluids are usually high in bicarbonate ions, so chronic diarrhea may result in the excessive loss of bicarbonate. This would produce metabolic acidosis, which is usually a normal ion gap acidosis.

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35-182

TEACH FOR NURSES LESSON PLAN Chapter 25: Acid-Base Homeostasis and Imbalances CHAPTER OBJECTIVES 1. Explain the chemical and functional importance of the bicarbonate buffer system.

2. Describe the role of the respiratory system in regulating carbonic acid (carbon dioxide).

3. Describe the role of the kidneys in regulating bicarbonate ion and acids other than carbonic acid.

4. Explain how the lungs compensate for acid-base imbalances caused by altered levels of metabolic acids.

5. Explain how the kidneys compensate for acid-base imbalances caused by altered levels of carbonic acid.

6. Explain how arterial blood gas values are used to categorize an acid-base disorder as acidosis or alkalosis, respiratory or metabolic, compensated or uncompensated.

7. Identify the pathophysiologic conditions that predispose an individual to each of the four primary acid-base imbalances.

STUDENT RESOURCES understand

       

Textbook Chapter 25 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 25 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

35-183

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus ACID-BASE HOMEOSTASIS

Content Highlights

Learning Activities

Review the process of acid-base homeostasis.



Activity: Have students complete the “Respiratory Contribution to Acid-Base Homeostasis” fill-in-the-blank activity below.

Distinguish metabolic acidosis from metabolic alkalosis.



Online Activity: Have students visit http://www.wisconline.com/objects/ViewObject.aspx?ID=NUR4604 to review acid-base imbalances and their etiologies.

Activity: Instruct students to perform a literature search in a database of professional journal articles on one of the following topics: tumor lysis syndrome, pancreatitis, chronic alcoholism, bulimia, or chronic diarrhea.

Focus on fluid and electrolyte imbalances that are common with these conditions. Read at least three articles written for health professionals and summarize how the condition you chose leads to fluid and electrolyte imbalances. Cite your references.

Discussion Topic: Ask students if they have a patient, friend, or family member who has developed one or more fluid or electrolyte imbalances, describing the factors that led to development of each specific imbalance.

Buffers Respiratory Contribution Renal Contribution ACID-BASE IMBALANCES Mixed Acid-Base Imbalances





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35-184

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities Have them categorize these factors using the frameworks presented in Chapters 24 and 25 of this textbook (e.g., increased or decreased intake, shifts, increased or decreased excretion). What were the signs and symptoms? How did they compare with those listed in the textbook? Why might there have been some differences?

Respiratory Contribution to Acid-Base Homeostasis Fill-in-the-Blank Activity Terms from which students can choose:  Hypoventilation  Hyperventilation  Carbonic  Decrease  Too much  Too little  Metabolic  Increase Fill-in-the-Blanks: 1. The respiratory response to increased blood pH is ______________.

2. The respiratory response to decreased blood pH is ______________.

3. If a person hypoventilates, carbonic acid will ______ in the blood.

4. The lungs excrete ___________ acid through exhalation.

5. If carbonic acid increases in the blood, the rate and depth of respiration will _____________ to excrete it.

6. A person who hyperventilates will excrete __________ carbonic acid.

7. A drug that suppresses respiration can cause carbonic acid to ________ in the blood.

Answers: 1. Hypoventilation

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35-185 2.

3.

4.

5.

6.

7.

Hyperventilation Increase Carbonic Increase Too much Increase

IN-CLASS / ONLINE CASE STUDY LS is brought to the emergency department for management of acute mushroom poisoning. Her respirations are slow and shallow, and she is nonresponsive. She is admitted to the critical care unit to be closely monitored for the development of respiratory failure and renal failure, which often accompany mushroom poisoning. Her urine output is decreased to about 20 mL/hr. Her laboratory values are serum K+ = 5.7 mEq/L; arterial blood gases (ABGs): pH = 7.13, PaCO2 = 56 mm Hg, PaO2 = 89 mm Hg, and HCO3- = 18 mEq/L. 1. What is the most likely cause of LS’s potassium imbalance? Explain the role of the kidney in potassium excretion.

Answer:  The most likely cause of LS’s potassium imbalance is renal failure.  When the kidney is functioning normally, 90% of the total daily intake of potassium is excreted by the kidney.

2. What is the relationship between acid-base balance and serum potassium level?

Answer:   

Acidosis contributes to hyperkalemia.

Alkalosis contributes to hypokalemia.

When the patient is in acidosis, as LS is, there is an increase in hydrogen ions taken into the cell, which causes potassium to be exchanged into the plasma to maintain electrical neutrality.

3. What is the reason for LS’s low urine output? How should her fluids be managed?

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35-186 Answer:  

She is most likely experiencing an intrarenal form of renal failure with acute tubular necrosis from the poisoning.

Her fluids should be monitored closely to avoid system overload. Her kidneys are not functioning properly, and overloading them with fluid will make her condition worse.

4. Categorize and explain the probable cause of LS’s acid-base disorder.

Answer:   

LS has a mixed acidosis.

She is in respiratory acidosis as evidenced by the following labs: PaCO2 elevated and pH decreased.

She also has a metabolic acidosis as evidenced by the low pH and HCO3-.

5. Can LS compensate for her acid-base disorder? Why or why not?

Answer: 

She will not be able to compensate on her own because her lungs and the kidneys are malfunctioning.

6. How should her acid-base imbalance be medically managed?

Answer:  

Restoration of adequate alveolar ventilation is needed to remove excess CO2. If LS is unable to breathe adequately on her own with a secure airway and O2 administration, she will need mechanical ventilation.

Ensuring adequate oxygenation may improve any lactic acidosis that is contributing to the metabolic acidosis. She may need dialysis and HCO3- replacement until her kidneys recover.

TEACH FOR NURSES LESSON PLAN Chapter 26: Renal Function

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35-187

CHAPTER OBJECTIVES 1. Describe how the structure of the glomerulus determines the composition of the tubular filtrate.

2. Identify the factors that determine glomerular filtration rate.

3. Explain how individual nephrons regulate their glomerular filtration rates.

4. Describe how solutes and water are transported across the renal tubular epithelium.

5. Describe the role of the kidney in fluid, electrolyte, and acid-base balance.

6. Explain how renal function changes across the life span.

7. Describe how laboratory and diagnostic tests are used to evaluate renal function and disease.

STUDENT RESOURCES understand

       

Textbook Chapter 26 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 26 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

35-188

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus RENAL ANATOMY

Content Highlights

Learning Activities

Review the components of the urinary system.



Activity: Have students complete the “Renal Function Activity” below.

Provide an overview of the physiologic functioning of the nephron.



Discussion Topic: Refer students to Figure 26-4 in the text and discuss the structure and function of the nephron.

Online Activity: Have students visit http://www.biologypages.info/K/Kidney.html to learn more about the functions of the segments of a nephron.

Renal Parenchyma Renal Lymphatics and Innervation Renal Blood Supply OVERVIEW OF NEPHRON STRUCTURE AND FUNCTION Glomerulus Proximal Convoluted Tubule



Loop of Henle Distal Convoluted Tubule Collecting Duct REGULATION OF GLOMERULAR FILTRATION Physics of Filtration

Copyright © 2019, Elsevier Inc. All rights reserved.

35-189

TEACHING STRATEGIES Content Focus

Content Highlights

Factors Affecting Filtration Pressure Tubuloglomerular Feedback Effects of Glucose and Amino Acids Role of Mesangial Cells TRANSPORT ACROSS RENAL TUBULES Reabsorption of Glucose Regulation of Acid-Base Balance Secretion of Potassium REGULATION OF BLOOD VOLUME AND OSMOLALITY Antidiuretic Hormone Aldosterone, Angiotensin II, Natriuretic Peptides, Urodilatin, Uroguanylin, and Guanylin Diuretic Agents ENDOCRINE FUNCTIONS Erythropoietin Vitamin D

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

35-190

TEACHING STRATEGIES Content Focus

Content Highlights

AGE-RELATED CHANGES IN RENAL FUNCTION

Distinguish age-related renal changes of infants and older adults.

Infant Adult and Elderly

Learning Activities



Online Activity: Have students visit http://php.med.unsw.edu.au/embryology/index.php?title=Lecture__Renal_Development to view an animation of renal development in infants.

TESTS OF RENAL STRUCTURE AND FUNCTION Urine and Blood Studies Diagnostic Tests

Renal Function Activity Answer options:  Collecting ducts  Loop of Henle  Autoregulation  Proximal tubules  Distal tubules  Sodium and water  Efferent  Glomerulus  Concentrate  Dilute

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35-191      

Water Myogenesis Potassium Afferent Hydrostatic Vitamin D

Questions (have students use the terms in the above answer options): 1. The process that maintains blood flow when arterial blood pressure changes is called __________.

2. Antidiuretic hormone acts on the _____________ to cause reabsorption of __________________.

3. Filtration occurs at the _______________.

4. Blood enters the glomerulus through the _____________________________ arteriole.

5. Long loops of Henle help to ___________________ the urine.

6. Much of the water and sodium from the glomerular filtrate is reabsorbed in the ____________________.

7. Aldosterone acts on the _______________ to cause reabsorption of _________________.

8. Glomerular filtration rate is greatly influenced by glomerular capillary _______________ pressure.

Answers to Re nal Function Activity

1.

2.

3.

4.

5.

6.

7.

8.

The process that maintains blood flow when arterial blood pressure changes is called autoregulation.

Antidiuretic hormone acts on the collecting ducts to cause reabsorption of water.

Filtration occurs at the glomerulus Blood enters the glomerulus through the afferent arteriole.

Long loops of Henle help to concentrate the urine.

Much of the water and sodium from the glomerular filtrate is reabsorbed in the proximal tubules.

Aldosterone acts on the distal tubules to cause reabsorption of sodium and water.

Glomerular filtration rate is greatly influenced by glomerular capillary hydrostatic pressure.

IN-CLASS/ONLINE CASE STUDY ND is a 72-year-old man who is 2 days postoperative for a bowel obstruction. His urine output over the past 4 hours is less than 100 cc/hr. The physician has ordered normal saline IV at 200 cc/hr.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-192 1. The nephron is the functional unit of the kidney. List the three main functions the nephron is responsible for.

Answer: -

Filtration of water-soluble substances from the blood Reabsorption of electrolytes, water, and filtered nutrients Secretion of wastes or excess substances

2. The physician orders the following diagnostic and laboratory tests: kidney, ureter and bladder radiography (KUB), intravenous pyelography (IVP), creatinine, and blood urea nitrogen (BUN). Explain how each one can help in the diagnosis of kidney disease.

Answer: -

KUB is an x-ray examination that looks at the size, shape and structures of the kidneys, ureters, and bladder structures. You are able to see stones, foreign bodies, neoplasms, and radiopaque objects such as stents and clips.

-

IVP is when an iodine-containing radiopaque dye is injected into a vein and will be processed through the kidney and excreted out the urine. It also looks at the renal structures and evaluates the renal excretion. It is important to remember that the dye is nephrotoxic, and a fair number of people may have dye allergies.

-

Creatinine is a byproduct of muscle metabolism and is used to evaluate renal function. It is affected by the rate of creatinine produced by breakdown from muscles and the glomerular filtration rate (GFR) and removal of creatinine.

-

BUN is a byproduct of protein metabolism. It is excreted in the kidney. In renal failure, the BUN rises, and it is also noted to rise with dehydration or fluid deficit, increased protein intake ,and catabolism.

3. ND has an elevated BUN and creatinine. The physician orders a creatinine clearance. Explain how this is done and what information will it give you to help diagnose ND’s renal problem.

Answer: The creatinine clearance is used to measure the GFR. Even though a creatinine level gives you an idea of renal function, the GFR is more inclusive of the what is going on at the nephron level. As the GFR decreases, the accuracy of the test goes down. It is done by collecting urine for 24 hours and drawing a creatinine level during the collection.

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35-193

NURSING CURRICULUM STANDARDS

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Fluid and Electrolyte Balance o Exemplar: Antidiuretic Hormone

TEACH FOR NURSES LESSON PLAN Chapter 27: Intrarenal Disorders CHAPTER OBJECTIVES 1. Explain how the locations of renal pain, findings on urinalysis, and results of other diagnostic tests are used to differentiate the causes of kidney disease.

2. Describe how renal tumors are differentiated, detected, and managed.

3. Differentiate autosomal dominant and autosomal recessive forms of polycystic kidney disease.

4. Describe the risk factors and clinical findings associated with pyelonephritis.

5. Identify the physiologic and pathophysiologic disorders that predispose to the formation of renal calculi of differing compositions.

6. Differentiate the various forms of glomerulonephritis.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-194 7. Identify the laboratory and clinical findings that suggest a diagnosis of nephrotic syndrome.

STUDENT RESOURCES understand

       

Textbook Chapter 27 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 27 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-195

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

COMMON MANIFESTATIONS OF KIDNEY DISEASE Pain Abnormal Urinalysis Findings Other Diagnostic Tests CONGENITAL ABNORMALITIES Renal Agenesis and Hypoplasia Cystic Kidney Diseases NEOPLASMS

Review the different types of neoplasms.





Activity: Divide students into groups and have each group prepare a presentation about a neoplasm. They should discuss the clinical manifestations, systemic manifestations, method of diagnosis, and treatment options. Have each group present the information to the entire class.

Online Activity: Have students visit http://www.cancer.gov/cancertopics/types/wilms/ for more information about Wilms tumor and other childhood kidney tumors.

INFECTION

OBSTRUCTION

Discuss manifestations and types of obstruction.

 

GLOMERULAR DISORDERS

Provide an overview of glomerulonephritis and



Discussion Topic: Have students identify the risk factors for developing renal calculi and how these risk factors can be mitigated.

Activity: Have students review the case example below and answer the related questions.

Discussion Topic: Refer students to the image below titled “Nephrotic

Copyright © 2019, Elsevier Inc. All rights reserved.

35-196

TEACHING STRATEGIES Content Focus (GLOMERULOPATHIES)

Content Highlights its different types.

Learning Activities Syndrome”.

Glomerulonephritis Nephrotic Syndrome

Case Example: Jeanette James, age 52 years, developed acute flank pain that came and went in waves. It became so intense that she was pacing the floor and moaning. Her husband drove her to the emergency department (ED), where her laboratory tests showed a small amount of hematuria and a slight increase in white blood cell count in her blood. Her pain rating was a 9 on a scale from 1 to 10 (with 10 being the highest). Mrs. James was given intravenous morphine and passed several small stones in her urine during the next few hours.

Instructions: Have students answer the following questions about Mrs. James' situation to increase their understanding of nephrolithiasis.

1.

2.

3.

4.

5.

6.

What is the two-word technical term for kidney stones?

What is the technical term that means just one kidney stone?

What caused the pain that sent Mrs. James to the ED? Why did the pain Mrs. James experienced come and go in waves?

What adverse effects could arise if a renal calculus completely blocks a ureter? Why? Why is it important for Mrs. James to learn to increase her fluid intake to 8 to 10 glasses of fluid per day?

Answers: 1. Renal calculi 2. Renal calculus 3. At least one of the renal calculi was too large to move easily through the ureter. It stretched the ureter and irritated its lining, causing pain.

4. Ureters have peristalsis-like activity, which causes more pressure on the stone at some times than others.

5. Hydroureter and hydronephrosis could occur because the kidney continues to produce urine even if the ureter is blocked. The blockage could cause urine to accumulate, dilating the ureter first and then the renal pelvis.

6. Drinking 8 to 10 glasses of fluid per day will keep her urine dilute, which will help to keep renal calculi from forming.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-197

Copyright © 2019, Elsevier Inc. All rights reserved.

35-198

Nephrotic Syndrome

Discussion Topics: Normal kidney: If you look at the top drawing, you will see part of a glomerular capillary in a normal kidney. The endothelial cells that form the capillary wall sit on a basement membrane through which filtered substances must pass to reach the glomerular (Bowman) capsule and enter

Copyright © 2019, Elsevier Inc. All rights reserved.

35-199 the renal tubules. This basement membrane and the podocyte slit pores (not shown in the drawing) have a negative charge. Because albumin molecules also are negatively charged, they are repelled by the negatively charged membrane and do not enter the capsule.

Nephrotic syndrome: The bottom drawing illustrates what happens when the glomerular basement membrane loses its negative charge.

Albumin molecules cross the membrane easily because there is no negative charge to repel them.

IN-CLASS/ONLINE CASE STUDY

JH is a 12-year-old boy diagnosed several months ago with nephrosis following postinfectious glomerulonephritis secondary to an episode of pneumococcal pneumonia. He has been coming to the clinic to have his condition monitored and therapies adjusted as needed. At his latest clinic visit, a decrease in urine output, increasing lethargy, hyperventilation, and generalized edema are noted. Trace amounts of protein are detected in JH’s urine by dipstick. Blood is drawn for laboratory analysis, and the results are as follows: pH = 7.36 PaCO2 = 33 mm Hg PaO2 = 100 mm Hg HCO3 – = 18 mEq/L Hct = 30% Na+ = 130 mEq/L K+ = 5.4 mEq/L BUN = 58 mg/dL creatinine = 3.9 mg/dL albumin = 2.0 g/dL 1. How would a pneumococcal infection lead to glomerulonephritis? How can glomerulonephritis result in nephrosis?

Answer: 



Postinfectious glomerulonephritis is the result of an immune complex reaction. The antibodies made against the bacteria bind to bacterial antigens and then precipitate out into capillary beds of the glomeruli. The inflammation that follows injures the glomerular basement membranes and reduces capillary flow. The resulting decrease in glomerular filtration rate and increase in membrane permeability are responsible for the manifestations of acute glomerulonephritis.

Nephrosis involves the loss of protein in the urine (about 2 g/day) due to damage to the glomeruli.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-200

2. Based on JH’s laboratory values, is he still experiencing nephrosis or is his condition progressing to renal failure?

Answer: 

JH looks to be developing uremia. The BUN and creatinine are significantly elevated, he has a compensated metabolic acidosis, his K+ is elevated, and his hematocrit is low. These signs are all associated with renal failure. The low albumin and hyponatremia are indicative of the continuing protein loss of nephrosis.

3. What additional physical or laboratory findings would be helpful in determining JH’s degree of renal impairment?

Answer:  

Because he has renal disease, obtaining a creatinine clearance with a urine collection to most accurately determine glomerular filtration rate would be helpful Other findings would include edema, pruritus, hypertension, urinalysis for actual amount of protein loss, and red blood cell count with indices to assess for anemia.

4. How will JH’s therapy change if his condition has progressed from nephrosis to uremia?

Answer: 

In nephrosis, the patient is encouraged to consume a high-protein diet. In uremia, a low-protein diet is recommended, and precautions to avoid fluid volume overload are needed as urine output falls. Restrictions on salt and potassium intake may be instituted. Diuretics will be used as long as the kidney responds to them to reduce fluid volume excess.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES Copyright © 2019, Elsevier Inc. All rights reserved.

35-201 QSEN  Patient-Centered Care o Box 27-1 Risk Factors for Renal Cell Carcinoma o Box 27-2 Risk Factors for Urinary Tract Infections o Table 27-6 Types of Nephrolithiasis, Relative Incidence, and Specific Risk Factors o Box 27-4 General Interventions for Nephrolithiasis

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Box 27-5 Dietary Modifications for Nephrolithiasis  Concept: Elimination o Exemplar: Renal Calculi (Nephrolithiasis) o Exemplar: Box 27-3 General Contributing Factors to Nephrolithiasis THEME: Protection and Movement o Concept: Infection o Exemplar: Infection o Concept: Pain o Exemplar: Pain

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Box 27-1 Risk Factors for Renal Cell Carcinoma o Box 27-2 Risk Factors for Urinary Tract Infections o Table 27-6 Types of Nephrolithiasis, Relative Incidence, and Specific Risk Factors

Copyright © 2019, Elsevier Inc. All rights reserved.

35-202

TEACH FOR NURSES LESSON PLAN Chapter 28: Acute Kidney Injury and Chronic Kidney Disease CHAPTER OBJECTIVES 1. Explain how the prerenal, intrinsic, and postrenal types of acute kidney injury differ in etiology, prognosis, clinical manifestations, and management.

2. Describe the characteristic clinical and laboratory findings in each of the three stages of acute tubular necrosis (acute intrarenal renal failure).

3. Explain the relationship between the degree of nephron loss, reductions in glomerular filtration rate, and the stages of chronic kidney disease.

4. Describe the similarities and differences between acute kidney injury and end-stage chronic kidney disease.

5. Describe the characteristic findings of uremic syndrome.

6. Explain how acute kidney injury can be prevented and how it is treated.

7. Explain how the progression of chronic kidney disease is retarded.

8. Describe how end-stage renal disease is treated.

STUDENT RESOURCES understand

       

Textbook Chapter 28 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 28 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

35-203

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus ACUTE KIDNEY INJURY Etiology and Pathophysiology

Content Highlights Discuss the clinical manifestations and symptoms of acute kidney injury.

Learning Activities  

Activity: Have students complete the exercise below titled “Causes of Acute Kidney Injury Exercise.”

Discussion Topic: Distinguish three different phases of acute tubular necrosis.

Clinical Presentation of Acute Tubular Necrosis CHRONIC KIDNEY DISEASE Risk Factors Pathophysiology of Progression of Chronic

Discuss the clinical manifestations and symptoms of chronic kidney injury.

 

Activity: Have students complete the exercise below titled “Stages of Chronic Kidney Disease Activity.”

Online Activity: have students visit http://www.kidney.org/kidneydisease/ aboutckd.cfm to learn more about chronic kidney disease.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-204

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Kidney Disease Stages of Chronic Kidney Disease Complications of Chronic Kidney Disease CLINICAL MANAGEMENT

Causes of Acute Kidney Injury Activity Prerenal

Intrarenal

Postrenal

Causes of Acute Kidney Injury Activity Answers Prerenal

Intrarenal

Postrenal

   

   

  

Shock Dehydration Heart failure Hemorrhage

Pyelonephritis Acute ischemia Nephrotoxins Rhabdomyolysis

Neurogenic bladder Enlarged prostate Ureteral strictures

Copyright © 2019, Elsevier Inc. All rights reserved.

35-205

Stages of Chronic Kidney Disease Activity Instructions: Have students match the stage of chronic kidney disease to the correct clinical effects.

Stages from which students should choose: 1. Decreased renal reserve 2. End-stage 3. Renal insufficiency Stage

Clinical Effect Metabolic acidosis May not be diagnosed Managed with diet and medication Requires dialysis or renal transplant Decreased glomerular filtration rate Polyuria Nocturia Azotemia No signs or symptoms Uremic syndrome Reduced ability to concentrate urine No azotemia Mild azotemia

Stages of Chronic Kidney Disease Activity Answers Stage

Clinical Effect

End stage Metabolic acidosis Decreased renal reserve May not be diagnosed

Copyright © 2019, Elsevier Inc. All rights reserved.

35-206 Renal insufficiency End stage End stage Renal insufficiency Renal insufficiency End stage Decreased renal reserve End-stage Renal insufficiency Decreased renal reserve Renal insufficiency

Managed with diet and medication Requires dialysis or renal transplant Decreased glomerular filtration rate Polyuria Nocturia Azotemia No signs or symptoms Uremic syndrome Reduced ability to concentrate urine No azotemia Mild azotemia

IN-CLASS/ONLINE CASE STUDY PW is 23 years old. He was the victim of a hit-and-run auto-pedestrian accident and sustained multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. PW’s vital signs and hematocrit suggest that he has had a blood loss of about 2500 mL. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 mL/hr, with a high urine osmolality and low urine sodium.

1. What type of renal failure is PW likely developing? What data support this conclusion?

Answer:  

Prerenal acute renal failure because of blood loss, which may lead to poor renal perfusion Low urine output, high urine osmolality, and low urinary sodium are findings associated with this etiology of acute renal failure.

2. Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring?

Answer:

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35-207

 

Prolonged prerenal acute renal failure produces ischemia of the renal parenchyma and the development of acute tubular necrosis.

Adequate extracellular volume replacement with blood or isotonic fluids to ensure adequate circulating blood volume and perfusion pressure to the kidney is essential.

3. In addition to urine output, what laboratory data should be monitored to assess changes in PW’s renal function?

Answer:   

Serum blood urea nitrogen (BUN), creatinine, and potassium should be monitored. An increase indicates decreased renal function.

Creatinine clearance can be measured to more accurately assess glomerular filtration rate.

Serum sodium may be useful in determining the correct intravenous fluid composition to administer.

4. If PW’s renal function does not return to normal but continues to be diminished, what are the subsequent stages of his renal disorder, and what clinical problems do they present?

Answer:   

He may progress to acute tubular necrosis.

Oliguric stage may persist for up to 2 weeks. Fluid overload is now the problem, along with elevated K+, Mg++, and PO4= levels.

Fluid intake is restricted, as are electrolytes and protein. As BUN and creatinine levels increase, he may show signs and symptoms of uremia. Metabolic acidosis develops from retained wastes.

Hypovolemia is the risk during the diuretic stage, and fluid must now be replaced. Hypokalemia especially, will require replacement. BUN and creatinine levels remain elevated.

During the recovery period, renal function normalizes. Given his age and lack of concomitant conditions, PW is likely to fully recover.

NURSING CURRICULUM STANDARDS

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QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Risk Factors o Box 28-2 Risk Factors for Chronic Kidney Disease o Clinical Management o Box 28-4 Therapeutic Goals in Chronic Kidney Disease

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Fluids and Electrolytes o Exemplar: Table 28-1 Rifle Classification for Staging Acute Kidney Injury o Exemplar: Box 28-1 Types of Acute Kidney Injury o Exemplar: Box 28-2 Risk Factors for Chronic Kidney Disease o Exemplar: Table 28-5 Stages of Chronic Kidney Disease According to Glomerular Filtration Rate o Exemplar: Acute Kidney Injury o Exemplar: Chronic Kidney Disease  Concept: Acid-Base Balance o Exemplar: Chronic Kidney Disease o Exemplar: Acute-on-Chronic Kidney Disease o Exemplar: Chronic Kidney Disease in Older Adults  Concept: Nutrition o Exemplar: Malnutrition o Concept: Perfusion o Exemplar: Hypertension and Cardiovascular Disease

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35-209

THEME: Protection and Movement o Concept: Fatigue o Exemplar: Anemia o Exemplar: Depression o Concept: Pain o Exemplar: Pain

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Risk Factors o Box 28-2 Risk Factors for Chronic Kidney Disease

TEACH FOR NURSES LESSON PLAN Chapter 29: Disorders of the Lower Urinary Tract CHAPTER OBJECTIVES 1. Explain how the pathophysiologic characteristics and management of stress, urgency, and mixed incontinence differ.

2. Describe the manifestations and management of overactive bladder syndrome and painful bladder syndrome or interstitial cystitis.

3. Describe how congenital abnormalities of the urinary collecting system are detected and treated.

4. Identify the risk factors and clinical manifestations for bladder cancer.

5. Explain how urethritis and cystitis are prevented and managed.

6. Describe how stones in the lower urinary tract present clinically.

STUDENT RESOURCES

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35-210

understand

       

Textbook Chapter 29 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 29 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

LOWER URINARY TRACT Functional Anatomy

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Learning Activities

35-211

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Physiology of Micturition Diagnostic Tests LOWER URINARY TRACT SYMPTOMS AND SYNDROMES NEUROGENIC BLADDER CONGENITAL DISORDERS

Discuss the manifestations and management of congenital urinary disorders.



Activity: Have students complete the Case Example Activity below.

NEOPLASMS

Review the major urinary cancers.



INFLAMMATION AND INFECTION

Identify the mechanisms and manifestations of urinary inflammation.



OBSTRUCTION Lower Urinary Tract Calculi

Review the diagnosis and treatment of bladder obstructions.



Online Activity: Have students visit http://www.cancer.gov/cancertopics/ types/bladder to learn more about bladder cancer.

Activity: Instruct students to perform a literature search in a database of professional journal articles on Escherichia coli and cystitis. Focus on the mechanisms by which E. coli attaches to the urothelium and why that is important. Write a summary for your classmates and include at least three references beyond your textbook.

Discussion Topic: Ask students to choose a patient, friend, or family member who has had a bladder disorder. Tell them to list the person’s risk factors and describe the clinical manifestations in that specific person. Compare and contrast this situation with their textbook and the information provided in this module. How is it the same? How is it different? What might have contributed to the difference? Be sure to maintain confidentiality.

Case Example Activity Jessica Peyton, age 4 years, began wetting her bed again after being dry at night for the past 3 months. She cried when she urinated and was crabby and lethargic. Jessica’s mother had seen these signs before and recognized them as manifestations of yet another urinary tract infection (UTI). She took Jessica to a pediatric nurse practitioner who had just opened an office nearby. After taking a thorough health history, the nurse

Copyright © 2019, Elsevier Inc. All rights reserved.

35-212 practitioner obtained a urine sample, diagnosed cystitis, and prescribed an antibiotic. She also referred Jessica to a urologist, who discovered that Jessica has vesicoureteral reflux (VUR).

Instructions: Answer the questions about Jessica in the Case Example activity below.

1. What findings in the urine sample would be characteristic of cystitis?

2. Why would a UTI cause Jessica to develop nocturnal enuresis?

3. Why did the nurse practitioner suspect that Jessica had VUR? 4. Explain what VUR is.

5. Why does VUR predispose to UTI? Case Example Activity Answers: 1. Cloudy urine, white blood cells, red blood cells, bacteria, and possibly nitrites, depending on the type of bacteria.

2. Urinary urgency and frequency caused by bladder inflammation can cause a sleeping child to wet the bed.

3. Recurrent UTIs in children are often caused by VUR. 4. During urination, contraction of the bladder refluxes some urine backward into a ureter through an incompetent vesicoureteral valve.

After urination, the urine flows back into the bladder.

5. The continuous presence of urine in the bladder (stasis of urine) increases risk of infection if bacteria gain entry.

IN-CLASS/ONLINE CASE STUDY DK, a 42-year-old woman, is being seen in the clinic for complaints of urinary frequency, urgency, and burning. She reports that her urine appears cloudy and smells abnormal. A urine dipstick confirms these observations and reveals leukocyte esterase and is positive for nitrites. DK is given a prescription for antibiotics.

1. What is the most likely cause of DK’s signs and symptoms?

Answer:  Lower urinary tract infection or cystitis

2. Was empiric antibiotic therapy (prescribed without a culture and sensitivity) the appropriate treatment? What organism is the most common cause of this disorder?

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35-213 Answer:  

Yes. Empiric antibiotics are indicated for symptomatic uncomplicated urinary tract infections in adults.

Escherichia coli causes the majority of urinary infections.

3. What factors may have predisposed DK to the development of this disorder?

Answer:        

Sexually active woman Use of contraceptive diaphragm or spermicidal agents Failure to void after intercourse Incorrect personal hygiene (should be wiping from front to back) Female anatomy Catheters, tubes, or a foreign object placed in the urinary tract for long periods Pregnancy Diabetes mellitus

4. If DK does not respond to empiric antibacterial therapy, what should be done?

Answer:  

A culture and sensitivity should be done to determine the specific organism and appropriate targeted antimicrobial therapy.

If she takes the medication as instructed yet still has signs and symptoms, an in-depth urologic examination is indicated.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care

Copyright © 2019, Elsevier Inc. All rights reserved.

35-214 o o o o o o

Risk Factors Treatment Diagnosis and Treatment Box 29-1 Risk Factors for Incontinence Box 29-2 Environmental Risk Factors for Bladder Cancer Box 29-3 Risk Factors for Cystitis

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Elimination o Exemplar: Lower Urinary Tract Symptoms and Syndromes THEME: Protection and Movement o Concept: Inflammation o Exemplar: Inflammation and Infection

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Risk Factors o Box 29-1 Risk Factors for Incontinence o Box 29-2 Environmental Risk Factors for Bladder Cancer o Box 29-3 Risk Factors for Cystitis

TEACH FOR NURSES LESSON PLAN

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Chapter 30: Male Genital and Reproductive Function CHAPTER OBJECTIVES 1. Describe the role of Sertoli cells in spermatogenesis.

2. Explain the function of Leydig cells.

3. Identify the branch of the autonomic nervous system responsible for penile erection.

4. Identify the branch of the autonomic nervous system responsible for penile ejaculation.

5. Identify the genitourinary structures that develop embryologically from the wolffian ductal system in males.

6. Explain how the hypothalamic-pituitary gonadotropic hormones influence male reproductive function.

7. Explain how the processes of capacitation and acrosome reaction affect the fertilization process.

STUDENT RESOURCES understand

       

Textbook Chapter 30 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 30 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

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35-216

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus ANATOMY Upper Genitourinary Tract Lower Genitourinary Tract

Content Highlights Review the physiology and function of the male anatomy.

Learning Activities  

Discussion Topic: Refer students to textbook Figures 30-2 through 30-6 to review male genitourinary anatomy.

Online Activity: Have students visit http://www.emedicinehealth.com/ understanding_the_male_anatomy/article_em.htm for more information about male anatomy.

Auxiliary Genital Glands External Genitalia EMBRYOLOGY Nephric System Vesicourethral Unit Gonads Genital Duct System External Genitalia

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TEACHING STRATEGIES Content Focus

Content Highlights

MALE REPRODUCTIVE PHYSIOLOGY

Review the structure and function of the male reproductive system.

Learning Activities 



Hypothalamic-PituitaryTesticular Axis

Online Activity: Have students visit http://www.biology.arizona.edu/ Human_Bio/problem_sets/Human_Reproduction/human_reproduction.html to complete Human Reproductive Problem sets.

Online Activity: Have students visit http://www.webmd.com/sexrelationships/guide/male-reproductive-system to learn more about the male reproductive system.

Spermatogenesis Anatomy of Spermatozoa Transport of Spermatozoa

IN-CLASS/ONLINE CASE STUDY SL, a 44-year-old man, comes to the clinic with problems with emptying of his bladder and difficulties starting and maintaining an erection. His history is significant for a lumbar back strain 6 months ago from falling hard down onto his bottom after missing a chair. He had problems with sciatica down his right leg to his big toe. He was put on nonsteroidal antiinflammatory drugs and prednisone for 2 weeks. All his symptoms improved except for the feeling that he never completely empties his bladder and the difficulty in starting or maintain an erection.

1. Discuss the nerve supply to the bladder and urethra.

Answer: 

Receive blood supply from both the sympathetic and parasympathetic nervous system.

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35-218     

Sympathetic nerve system (SNF) fibers originate from T11 and T12 and L1 and L2 and innervate both the bladder and urethra. These fibers are seen in the bladder base and proximal end of the urethra. This facilitates urine storage.

Parasympathetic nerve supply (PNS) originates from the sacral portion of the spine, specifically (S2–S4) PNS fibers surround the bladder, and in males, it they also form the prostatic plexus.

These fibers innervate the penis and clitoris.

PNS fibers induce contraction and bladder emptying.

2. Discuss the blood and nerve supply to the penis.

Answer:  Arterial blood supply is from the hypogastric arteries that supply the paired internal pudendal arteries.  The cavernous artery supplies the corpus cavernosum with urethral artery supplying bulb of the corpus spongiosum.  Dorsal artery supplies the glans.  PNS come from sacral nerves S2 to S4 and the SNS from the hypogastric plexus.  PNS simulation causes a decrease in vascular resistance with more blood supply to the penis and ultimately an erection.  SNS fibers cause contraction of the involuntary sphincter of the bladder and prevents retrograde ejaculation of semen into the bladder.  SNS fibers innervate seminal vesicles of the prostate and cause ejection of seminal fluid into the urethra.

TEACH FOR NURSES LESSON PLAN Chapter 31: Alterations in Male Genital and Reproductive Function CHAPTER OBJECTIVES 1. Identify the common causes of and clinical findings in priapism.

2. Identify the common causes of primary and secondary impotence.

3. Describe the usual clinical manifestations and significance of testicular cancer, testicular torsion, cryptorchidism, and hydrocele or spermatocele.

4. Identify the clinical manifestations that would lead to a suspicion of prostatitis and explain how confirmed prostatitis would be treated.

5. Explain how benign prostatic hyperplasia can be distinguished from prostate cancer.

6. Identify the clinical manifestations indicative of prostatic enlargement.

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STUDENT RESOURCES understand

       

Textbook Chapter 31 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 31 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

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35-220

Content Focus

Content Highlights

DISORDERS OF THE PENIS AND MALE URETHRA

Describe the major alterations of the penis and male urethra.

Learning Activities 



Discussion Topic: Ask students if they have a patient, friend, or family member who has developed a genital or reproductive disorder. Then ask them to describe the risk factors that may have led to the development of the specific problem. Explain how these risk factors may have resulted in development of the disorder. What were the signs and symptoms? How did they compare with those listed in this textbook? Why might there have been some differences? Remind students to be sure to maintain confidentiality.

Activity: Have students perform a literature search in a database of professional journal articles on one of the following topics: a sexually transmitted infection, benign prostatic hypertrophy (BPH), or prostate cancer.

Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated.

Instruct them to cite their references.

CONGENITAL ANOMALIES ACQUIRED DISORDERS INFECTIOUS DISORDERS NEOPLASTIC DISORDERS DISORDERS OF THE SCROTUM AND TESTES CONGENITAL DISORDERS ACQUIRED DISORDERS

Provide an overview of acquired penile disorders.



Activity: Have students complete the Three Acquired Penile Disorders activity below.

Provide an overview of acquired prostate disorders.



Online Activity: Have students visit http://www.merckmanuals.com/professional/genitourinary_disorders/benign _prostate_disease/benign_prostatic_hyperplasia_bph.html?qt=&sc=&alt= to learn more about BPH.

INFECTIOUS DISORDERS NEOPLASTIC DISORDERS DISORDERS OF THE PROSTATE

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Three Acquired Penile Disorders Activity Priapism

Phimosis, Paraphimosis

Peyronie Disease

Three Acquired Penile Disorders Activity Answer Priapism

Phimosis, Paraphimosis

Peyronie Disease

 



 

 

Penile engorgement Associated with sickle cell anemia Engorgement of corpora cavernosa Usually idiopathic or associated with medications

  

Chronic inflammation, adhesions Cannot reduce foreskin Cannot retract foreskin Associated with poor hygiene



Fibrosis of erectile tissue Abnormal penile curvature Painful, incomplete erections

IN-CLASS/ONLINE CASE STUDY DP is a 63-year-old man who has been experiencing progressive difficulty with initiating the urinary stream and frequently needs to get up three or more times during the night to urinate. A prostate-specific antigen (PSA) is obtained and a prostate examination performed. The PSA is not significantly elevated. The prostate is enlarged.

1. What is the likely cause of DP’s urinary problem? What are the risk factors?

Answer: 

The problem is likely to be benign prostatic hyperplasia (BPH), which is enlargement of the prostate gland resulting from abnormal overgrowth of the prostate tissue.

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35-222   

As the tissue increases in size, it compresses the urethra and produces symptoms of bladder outlet syndrome.

The occurrence of the disease with aging suggests a relationship to changes in the male endocrine system.

BPH is a common disorder that affects 80% of men older than 60 years.

2. What is the danger of leaving this untreated?

Answer:   

The symptoms may be minimal at first but could progress to complete urinary obstruction.

Urinary retention with urinary stasis, increasing the risk of infection Urinary reflux, thickening of the bladder wall, hydroureter, hydronephrosis, and postrenal acute renal failure

3. What further testing would be helpful in evaluating the degree of urinary obstruction?

Answer:    

Urethral catheterization or ultrasound bladder scan to document a postvoid volume Radiographic evidence of hypertrophy and computed tomography scan documenting obstruction BUN and creatinine to assess renal function Medication history for those that cause urinary retention

4. What are the treatment options for DP? Answer:    

Medications that could be tried first are alpha blockers, all of which can be used to help relax the smooth muscle of the bladder and prostate, or 5-alpha reductase inhibitors, which alter the hormonal environment and shrink the gland.

Minimally invasive procedures, such as microwave therapy and needle ablation, may be done in a urologist’s office.

Prostatectomy or transurethral resection of the prostate (TURP) is a surgical procedure to remove the obstructing prostate or prostate tissue.

Laser therapy is now available, superseding TURP procedures in some areas.

5. How would his treatment be different had he been diagnosed with prostatic cancer?

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35-223 Answer:    

Treatment would be guided by the stage of the tumor and by DP’s age and overall state of health.

“Watchful waiting” would be an option if he were asymptomatic and probably older.

Primary interventions are surgery, radiation, or cryotherapy. Radical surgery carries a high risk of impotence.

More advanced disease requires the addition of hormone therapy to reduce testosterone.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Diagnoses and Treatment o Treatment o Etiology and Treatment o Etiology, Clinical Manifestations, and Treatment o Clinical Manifestations and Treatment o Clinical Manifestations, Diagnosis, and Treatment o Table 31-1 Medical Therapy Options for the Treatment of Premature Ejaculation

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Sexuality and Reproduction  Concept: Sexuality o Exemplar: Figure 31-4 (A) Phimosis. (B) Paraphimosis

Copyright © 2019, Elsevier Inc. All rights reserved.

35-224 o o o o o o o o

Exemplar: Priapism Exemplar: Phimosis and Paraphimosis Exemplar: Peyronie Disease Exemplar: Urethral Strictures Exemplar: Premature Ejaculation Exemplar: Table 31-1, Medical Therapy Options for the Treatment of Premature Ejaculation Exemplar: Acquired Disorders Exemplar: Prostate Cancer

THEME: Protection and Movement  Concept: Infection o Exemplar: Epididymitis o Exemplar: Fournier Gangrene

TEACH FOR NURSES LESSON PLAN Chapter 32: Female Genital and Reproductive Function CHAPTER OBJECTIVES 1. Identify the major structures of the internal and the external female reproductive tract.

2. Identify the major hormonal events of the female reproductive cycle.

3. Identify the hormones involved in breast development during pregnancy and lactation and describe their specific functions.

4. Identify the physiologic changes associated with pregnancy.

5. Describe the gestational events occurring in the fetus during each of the three trimesters of pregnancy.

6. Identify the hormonal changes leading to menopause.

7. Describe the physiologic changes and complications that may result from menopausal hormone deficiencies.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

35-225

understand

       

Textbook Chapter 32 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 32 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus REPRODUCTIVE STRUCTURES

Content Highlights Identify the female reproductive organs.

Learning Activities 

Discussion Topic: Refer students to Figures 32-1, 32-2, 32-4, and 32-5 in the text to review the female reproductive structures.

Copyright © 2019, Elsevier Inc. All rights reserved.

35-226

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 

Organization of the Female Reproductive Organs 

MENSTRUAL CYCLE

Review the stages of the menstrual cycle.



BREAST

Describe the structure of the female breast.



Structure of the Breast

Online Activity: Have students visit http://www.biology.arizona.edu/Human_Bio/problem_sets/Human_ Reproduction/human_reproduction.html to complete Human Reproductive Problem sets.

Online Activity: Have students visit http://www.nlm.nih.gov/medlineplus/ femalereproductivesystem.html to review the female reproductive system.

Online Activity: Have students visit http://www.mayoclinic.com/health/ ovulation/MM00108 to view an animation of ovulation.

Online Activity: Have students visit http://www.mayoclinic.com/health/ breast-cancer-early-stage/BC00001 to view a slide show of female breast anatomy.

Breast Development Lactation PREGNANCY Early Human Development Implantation Fetal Membranes and Placenta Development of the Human Embryo and Fetus Parturition

Copyright © 2019, Elsevier Inc. All rights reserved.

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Response of the Mother’s Body to Pregnancy MENOPAUSE

IN-CLASS/ONLINE CASE STUDY RB is a 35-year-old woman who has recently married. She comes to see her primary provider to discuss the possibility of becoming pregnant. RB would like to know how to tell when she would be most likely to conceive.

1. Assuming RB has a 28-day cycle, discuss the hypothalamus and pituitary glands role in menstruation cycle.  

On approximately day 8 to day 10 of the cycle, the hypothalamus releases luteinizing hormone–releasing hormone, which in turn causes the anterior pituitary to release luteinizing hormone (LH).

Follicle-stimulating hormone (FSH) is released at the same time in tandem with LH, and the two act synergistically to cause increased swelling of the follicle to promote ovulation.

2. Discuss the process occurring during the ovarian cycle:  

During menses, the primary follicle in the ovary. Estrogen is released around day 4 of menses and peaks at day 12.

With the release of estrogen, the follicle begins to mature and enlarge during the follicular phase.

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35-228   

Ovulation happens at day 14.

Progesterone levels increase starting at day 16 during the luteal phase, and the follicle becomes a corpus luteum that continues to secrete estrogen and progesterone.

Day 24 starts the premenstrual phase where the corpus luteum begins to shrink and estrogen and progesterone levels decrease quickly.

3. Discuss what happens during the endometrial cycle:   

At the end of the premenstrual phase, the arteries in the uterine wall contract, and the lining of the uterine wall becomes ischemic; as these cells die, the tissue is sloughed off.

Prostaglandins are released during menstruation; this is felt to be a reason for the sloughing.

Approximately around day 12, with the release of estrogen and progesterone, the endometrial wall thickens.

NURSING CURRICULUM STANDARDS

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Sexuality and Reproduction  Concept: Reproduction o Exemplar: Reproductive Structures o Exemplar: Menstrual Cycle o Exemplar: Pregnancy o Exemplar: Menopause

TEACH FOR NURSES LESSON PLAN Copyright © 2019, Elsevier Inc. All rights reserved.

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Chapter 33: Alterations in Female Genital and Reproductive Function CHAPTER OBJECTIVES 1. Identify the differentiating factors of the common menstrual disorders.

2. Identify the common etiologic factors leading to uterine prolapse, uterine retrodisplacement, cystocele, and rectocele.

3. Describe how the pain of endometriosis can be differentiated from that of dysmenorrhea.

4. Explain the rationale for routine Papanicolaou testing for cervical cancer.

5. Identify the factors contributing to the high mortality rate of ovarian cancer.

6. Identify the clinical findings indicating the development of pregnancy-induced hypertension, placenta previa, and abruptio placentae in a pregnant woman.

7. Explain how benign and malignant breast lumps can be clinically differentiated.

STUDENT RESOURCES understand

       

Textbook Chapter 33 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 33 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

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before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

MENSTRUAL DISORDERS Amenorrhea Abnormal Uterine Bleeding Patterns Dysmenorrhea ALTERATIONS IN UTERINE POSITION AND PELVIC SUPPORT Uterine Prolapse Retrodisplacement of the Uterus Cystocele Rectocele

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

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TEACHING STRATEGIES Content Focus INFLAMMATION AND INFECTION OF THE FEMALE REPRODUCTIVE TRACT

Content Highlights Review the major infections of the female reproductive tract.

Learning Activities 

Pelvic Inflammatory Disease 

Vulvovaginitis Bartholinitis

Discussion Topic: Ask students if they have a patient, friend, or family member who has developed a genital or reproductive disorder. Then ask them to describe the risk factors that may have led to the development of the specific problem. Explain how these risk factors may have resulted in development of the disorder. What were the signs and symptoms? How did they compare with those listed in this textbook? Why might there have been some differences? Remind students to be sure to maintain confidentiality.

Activity: Have students perform a literature search in a database of professional journal articles on one of the following topics: a sexually transmitted infection, pelvic inflammatory disease, preeclampsia, or breast cancer. Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated. Instruct them to cite their references.

BENIGN GROWTHS AND ABERRANT TISSUE OF THE FEMALE REPRODUCTIVE TRACT Uterine Leiomyomas Ovarian Cysts Endometriosis CANCER OF THE FEMALE GENITAL STRUCTURES

Review the major cancers of the female reproductive tract.



Activity: Have students complete the Cancers of the Female Reproductive Tract activity below.

Cancer of the Cervix Endometrial Cancer

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Ovarian Cancer Vaginal Cancer Cancer of the Vulva DISORDERS OF PREGNANCY Pregnancy-Induced Hypertension Hyperemesis Gravidarum Placenta Previa and Abruptio Placentae Spontaneous Abortion DISORDERS OF THE BREAST

Identify the major breast disorders.

 

Activity: Have students complete the Breast Disorders Teaching activity below.

Online Activity: Have students visit http://www.cancer.gov/cancertopics/ wyntk/breast/page7 to learn more about breast cancer.

REACTIVEINFLAMMATORY BREAST DISORDERS Mammary Duct Ectasia Breast Abscess Fat Necrosis

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Reactions to Foreign Material BENIGN BREAST DISORDERS Fibrocystic Breast Disease Specific Benign Neoplasms MALIGNANT DISORDER OF THE BREAST Cancer of the Breast

Cancers of the Female Reproductive Tract Activity Have students choose from the following options:  Usually asymptomatic, vaginal discharge or bleeding  Family history of gynecologic cancer, personal history of breast cancer, no previous pregnancies  Obesity, infertility, early menarche, late menopause  Postmenopausal bleeding  HPV infection, multiple sexual partners  Usually asymptomatic, painless ascites, abdominal pain Risk Factors

Clinical Manifestations

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Cervical cancer Endometrial cancer Ovarian cancer

Cancers of the Female Reproductive Tract Activity Answers

Cervical cancer Endometrial cancer Ovarian cancer

Risk Factors

Clinical Manifestations

HPV infection, multiple sexual partners Obesity, infertility, early menarche, late menopause Family history of gynecologic cancer, personal history of breast cancer, no previous pregnancies

Usually asymptomatic; vaginal discharge or bleeding Postmenopausal bleeding Usually asymptomatic; painless ascites, abdominal pain

Breast Disorders Teaching Activity Have students draft responses to the following patient scenarios.

1. “I can’t believe I have a breast abscess and I am not even breastfeeding!” says Ms. Digg, “The doctor said these abscesses are harder to treat than the breastfeeding ones. Why?” Answer her directly.

2. “I was so relieved when the doctor told me I do not have breast cancer that I couldn’t listen to the rest of his explanation,” says Mrs. Culp. “Tell me what causes duct ectasia.” Answer her directly.

3. “That makes sense,” says Mrs. Culp. “But why would that make my nipple invert?” Respond as if speaking directly to her.

Breast Disorders Teaching Activity Answers 1. Usually, a breast abscess that develops during breastfeeding has only one kind of bacteria in it. So the doctor can prescribe one antibiotic that kills that type of bacteria. However, most breast abscesses that develop when a woman is not breastfeeding have several different kinds of bacteria in them, so they are more complicated to treat.

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2. Inside the breast, you have collecting ducts into which the milk flows before it reaches the nipple. Sometimes, especially after menopause, secretions and debris clog the duct, and it gets inflamed. The body tries to heal it, and scar tissue forms around the area, forming the lump that you felt.

3. Scar tissue usually contracts as it matures. Because the duct ectasia is in the collecting ducts under your nipple, when the scar tissue contracted, it pulled your nipple inward.

IN-CLASS/ONLINE CASE STUDY JY is a 43-year-old woman who has detected a lump in the upper outer quadrant of her left breast while performing her monthly self-breast examination. She is examined by her primary physician, who finds a single, mobile, painless lump. A biopsy of the lump is done and shows probable malignancy. JY is scheduled for surgery. There is no evidence of regional lymph node involvement. JY’s tumor is thought to be responsive to estrogen.

1. Based on the above information, what type of breast surgery is indicated for JY? Answer:  

Lumpectomy because JY has only one lump, and her nodes were negative for involvement Simple radical mastectomy might be appropriate if the ratio of lump to breast mass ratio is large.

2. What treatment besides surgery is JY likely to receive?

Answer: 

Chemotherapy, radiation therapy, or both

3. JY is concerned that her daughter, now 15 years old, is at increased risk for breast cancer. What might you tell her?

Answer:  

Having a mother who developed breast cancer does add a risk factor for her daughter.

Her malignant tissue should be evaluated for the BRCA mutations because this would increase her own risk for subsequent breast cancers and ovarian cancer as well. Because of the increased risk for mother and daughter, both would require close monitoring.

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4. Because JY did not have lymph node involvement, what is her prognosis? How would this change had she been found to have malignant cells in her lymph nodes? What if she had been found to have metastasis to her spine?

Answer:   

JY’s 5-year survival rate is 98%.

Had the nodes been positive, this rate falls to 85%.

The presence of metastases reduces the 5-year survival rate to 26%.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Prevention o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Sexuality and Reproduction  Concept: Reproduction o Exemplar: Menstrual Disorders o Exemplar: Alterations in Uterine Position and Pelvic Support o Exemplar: Inflammation and Infection of the Female Reproductive Tract o Exemplar: Benign Growths and Aberrant Tissue of the Female Reproductive Tract

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

o Exemplar: Cancer of the Female Genital Structures o Exemplar: Disorders of Pregnancy Concept: Sexuality o Exemplar: Disorders of the Breast o Exemplar: Reactive-Inflammatory Breast Disorders o Exemplar: Benign Breast Disorders o Exemplar: Malignant Disorder of the Breast

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Prevention o Hormonal Factors o Reproductive Factors o Dietary Factors o Other Factors

TEACH FOR NURSES LESSON PLAN Chapter 34: Sexually Transmitted Infections CHAPTER OBJECTIVES 1. Describe the characteristic clinical manifestations and lesions of gonorrhea and chlamydial infection.

2. Describe how the pathologic changes and clinical manifestations of syphilis differ during the incubation, primary, secondary, and tertiary phases.

3. Distinguish the lesions of herpes simplex, syphilis, and lymphogranuloma venereum.

4. Identify which sexually transmitted diseases remain localized, and which have systemic consequences.

5. Describe the causative organisms and characteristic lesions of the following localized sexually transmitted diseases: chancroid, granuloma inguinale, molluscum contagiosum, and condylomata acuminata (genital warts).

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STUDENT RESOURCES understand

       

Textbook Chapter 34 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 34 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

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Content Focus URETHRITIS, CERVICITIS, SALPINGITIS, AND PELVIC INFLAMMATORY DISEASE

Content Highlights Review the major sexually transmitted infections (STIs).

Learning Activities   

Gonococcal Infection Nongonococcal Infection



Activity: Have students complete the Gonorrhea and Chlamydial Infection activity below.

Discussion Topic: Have students distinguish the clinical manifestations of all of the STIs in this chapter.

Activity: Have students perform a literature search in a database of professional journal articles on one of the following topics: a STI, benign prostatic hypertrophy, prostate cancer, pelvic inflammatory disease, preeclampsia, or breast cancer. Read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated. Cite your references.

Online Activity: Have students visit http://www.nlm.nih.gov/medlineplus/ sexuallytransmitteddiseases.html to learn more STIs.

DISEASES WITH SYSTEMIC INVOLVEMENT Syphilis Lymphogranuloma Venereum Herpesvirus Infections DISEASES WITH LOCALIZED LESIONS Ulcerative Lesions Nonulcerative Lesions ENTERIC INFECTIONS

Gonorrhea and Chlamydial Infection Activity Have students draft responses to the following review questions.

1. Both gonorrhea and chlamydia infection are transmitted in what way?

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35-240 2.

3.

4.

5.

What is ophthalmia neonatorum and how is it transmitted?

How do the clinical manifestations of gonorrhea differ in men and women if the infection does produce signs and symptoms?

Both gonorrhea and chlamydia infection cause inflammation of what tissues?

Briefly describe the pathogenesis of gonorrhea once it has invaded the host epithelial cells.

Gonorrhea and Chlamydial Infection Activity Answers 1. They are transmitted from one person to another through direct contact with infected mucous membranes during sexual activity. They also may be transmitted from an infected mother to an infant during vaginal birth.

2. It is an infection of the conjunctiva of the newborn that is transmitted during the birth process from an infected mother to the newborn baby. The usual pathogens are Neisseria gonorrhoeae or Chlamydia trachomatis.

3. Both sexes develop dysuria. Women also develop purulent vaginal discharge and may have abnormal vaginal bleeding. Men, however, have symptoms of urethritis with purulent urethral discharge 4. The columnar epithelial tissue, usually of the reproductive organs; however, they also affect the pharynx, rectum, and conjunctiva.

5. The invasion triggers the inflammatory response in the submucosa with subsequent development of exudate consisting mostly of neutrophils. As the disease process becomes more advanced, abscesses and cysts develop, leading to fibrosis with scarring of the tissues.

IN-CLASS/ONLINE CASE STUDY HL and TL are husband and wife, both 32 years old, and are coming to see their provider because TL just found out she has a herpes simplex virus (HSV) type II. She is unsure where she got it, and HL does not think he has ever had it. TL tells you she was seen 3 weeks ago at a clinic in Hawaii and was treated for herpes. She had noted blisters around her labia and vulva that became very sore. She also noted that she had a lump that was very tender in her right inguinal area. HL is quite concerned because he was told that he might show up with symptoms later.

1. HL asks when he would most likely come down with HSV II and what he should look for. How should you respond?

Answer:  Incubation period for HSV is 3 to 7 days.  Vesicles (blisters) are found most often on the glans penis, foreskin, or shaft.  Oral lesions may be found on the mouth an anus.

2. Both HL and TL ask what causes it and if they can get it again. How should you respond?

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Answer:  

After the initial infection heals, the virus remains dormant in the body.

Active disease can be triggered by immunosuppression, stress, and illness.

3. TL and HL are ready to start a family and wonder what effect HSV will have on the baby. What should you tell them?

Answer:  

HSV may be transmitted to the baby from the mother during a vaginal delivery.

If TL has an active case at delivery, she will need to have a cesarean section.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Sexuality and Reproduction  Concept: Sexuality o Exemplar: Urethritis, Cervicitis, Salpingitis, and Pelvic Inflammatory Disease o Exemplar: Diseases with Systemic Involvement o Exemplar: Diseases with Localized Lesions

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35-242 o

Exemplar: Enteric Infections

TEACH FOR NURSES LESSON PLAN Chapter 35: Gastrointestinal Function CHAPTER OBJECTIVES 1. Identify the major structures of the gastrointestinal (GI) tract and their corresponding functions.

2. Describe how the autonomic nervous system influences GI motility.

3. Explain how segmental and propulsive movements influence the digestive and absorptive functions of the small intestine.

4. Identify the major secretions of each of the following secretory cells and glands: salivary, gastric, intestinal epithelium, pancreas, and gallbladder.

5. Describe how and where the complex carbohydrates, proteins, and lipids are digested and absorbed.

6. Describe how and where water and electrolytes are absorbed.

7. Identify the alterations in GI function that occur in association with very young or very old age.

STUDENT RESOURCES understand

       

Textbook Chapter 35 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 35 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

35-243

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

STRUCTURE AND ORGANIZATION OF THE GASTROINTESTINAL TRACT

Review the anatomy and function of gastrointestinal (GI) system.

Learning Activities 

 Embryology  Functional Anatomy

Online Activity: Have students visit http://www.dnatube.com/video/8362/ Animation-of-the-digestive-system and view the animation on the digestive system.

Discussion Topic: Refer students to Figures 35-1 to 35-3 to review the physiology of the GI system.

Activity: Have students complete the Function of the Gastrointestinal System activity.

GASTROINTESTINAL MOTILITY Characteristics of the Intestinal Wall

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TEACHING STRATEGIES Content Focus

Content Highlights

Neural Control Hormonal Control Movement in the Gastrointestinal Tract Movement of Nutrients SECRETORY FUNCTIO Secretion of Gastrointestinal Juices Gastrointestinal Hormones DIGESTION AND ABSORPTION Digestion of Carbohydrates Digestion of Lipids Digestion of Proteins Absorption GASTROINTESTINAL FUNCTION ACROSS THE LIFE SPAN

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

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TEACHING STRATEGIES Content Focus

Content Highlights

Maturation Age-Related Changes

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

Function of the Gastrointestinal System Activity Have students use the terms below to complete the sentences correctly.              

all parts rugae peristalsis secretion very little liver decrease villi ileocecal pyloric absorption pancreas bile increase

Complete the sentences with the correct term (from above).

1. The ______________ sphincter controls gastric emptying.

2. Parasympathetic nerves ____________ GI motility and secretion.

3. The intestinal _________________ increase the surface area for digestion and absorption of nutrients.

4. The gallbladder concentrates and stores ______________, which is produced by the _____________.

5. The major function of the colon is ____________ of water and electrolytes.

6. Distention of the intestine by a bolus of food triggers ________________.

7. The ____________ valve prevents backflow of large intestine contents into the small intestine.

8. Sympathetic nerves innervate ______________ of the GI tract and ___________________ motility and secretion.

Answers 1. pyloric 2. increase 3. villi 4. bile, liver

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39-247 5.

6.

7.

8.

absorption peristalsis ileocecal all parts, decrease

IN-CLASS/ONLINE CASE STUDY JM is a 55-year-old man who tells you that he has had indigestion for quite a while. He decides it is time to try and understand the roll of digestion, particularly in the stomach and small bowel.

1. How would you describe to JM the process of digestion in relation to food entering the stomach and progressing into the duodenum?

Answer:         

Food enters stomach and becomes distributed in concentric circles around the edges of the stomach.

Food moves from the area around the esophagus to the stomach walls.

Peristaltic contractions happen every 20 seconds and move food toward the pyloric antrum. The contractions become more vigorous and this help to mix the food with the gastric secretions. These secretions become a white sludge called chyme.

The pressure increases with these contractions and overrides the pressure in the duodenum. The chyme moves into the duodenum.

The stretch of the stomach caused by the bolus of food and the release of gastrin, a potent hormone in the stomach, leads to increased contractions and peristaltic movement.

Depending on what food or liquids you have ingested, the time to move through the stomach varies from an hour to several hours Reflex nervous signals send a message back to the stomach to slow down peristalsis and slow gastric emptying.

Protein, some fat byproducts, hypertonic, hypotonic, highly acidic chyme also slow gastric emptying.

Delay in gastric emptying is a protective response to prevent overloading the digestive track and decreasing the absorptive properties of digestion.

2. How would you explain to JM the process of absorption in the small intestine?

Answer:

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39-248  

Peristaltic waves move chyme along the small bowel to the ileocecal valve, distributing the chyme along the wall, where it facilitates absorption of nutrients.

In certain disease states, such as Crohn disease, irritation of the intestinal mucosa causes peristaltic rush, and chyme is moved quickly, which can decrease absorption time.

3. How would you explain to JM where each hormone is secreted and its action?

Answer:   

Gastrin: Released in stomach and stimulates the gastric glands to secrete its substance, primarily hydrochloric acid that aids in digestion.

Secretin: It is stimulated by the increased level of hydrochloric acid in the duodenum and travels to the pancreas and cause the release of large volumes of sodium bicarbonate that neutralizes the chyme. Secretin also stimulates the liver to secrete more bile.

Cholecystokinin: Increased fatty acids and proteins in the duodenum stimulate the release of cholecystokinin, which in turn causes the gallbladder to release its stores of bile.

TEACH FOR NURSES LESSON PLAN Chapter 36: Gastrointestinal Disorders CHAPTER OBJECTIVES 1. Identify the common causes of these general manifestations of gastrointestinal (GI) disorders: pain, nausea, vomiting, diarrhea, and constipation.

2. Describe the predisposing factors and characteristics common to inflammatory disorders of the GI tract.

3. Identify the common causes of and clinical findings in functional and mechanical bowel obstructions.

4. Identify the common causes of and clinical findings in GI malabsorption disorders.

5. Identify the warning signs that may indicate cancer of the GI tract.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-249

STUDENT RESOURCES understand

       

Textbook Chapter 36 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 36 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

Copyright © 2019, Elsevier Inc. All rights reserved.

39-250

Content Focus MANIFESTATIONS OF GASTROINTESTINAL TRACT DISORDERS

Content Highlights Identify the major manifestations of the gastrointestinal (GI) tract disorders.

Learning Activities 

 Dysphagia

Discussion Topic: Have students identify the four types of diarrhea and the corresponding mechanisms and clinical examples. See Discussion Topic for Four Types of Diarrhea below for sample answers.

Activity: Have students complete the Teaching People about Gastrointestinal Reflux Disease activity below.

Esophageal Pain Abdominal Pain Vomiting Intestinal Gas Alterations in Bowel Patterns DISORDERS OF THE MOUTH AND ESOPHAGUS ORAL INFECTIONS Stomatitis ESOPHAGEAL DISORDERS

Review the manifestations of the major esophageal disorders.



Activity: Have students complete the Gastroesophageal Reflux Disease (GERD) Activity below.

Gastroesophageal Reflux Hiatal Hernia Mallory-Weiss Syndrome Esophageal Varices

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TEACHING STRATEGIES Content Focus

Content Highlights

ALTERATIONS IN INTEGRITY OF THE GASTROINTESTINAL TRACT WALL INFLAMMATION OF THE STOMACH AND INTESTINES Gastritis Gastroenteritis Peptic Ulcer Disease INFLAMMATORY BOWEL DISEASE Ulcerative Colitis Crohn Disease ENTEROCOLITIS Antibiotic-Associated Colitis (Pseudomembranous Colitis) Necrotizing Enterocolitis

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Appendicitis Diverticular Disease ALTERATIONS IN MOTILITY OF THE GASTROINTESTINAL TRACT MOTILITY DISORDERS Irritable Bowel Syndrome

Review the symptoms and treatment of motility disorders.



Online Activity: Have students visit http://www.mayoclinic.com/health/ irritable-bowel-syndrome/MM00461 to view a video on irritable bowel syndrome.

Intestinal Obstruction Volvulus Intussusception Megacolon Hirschsprung Disease DISORDERS OF MALABSORPTION MUCOSAL DISORDERS Celiac Disease Tropical Sprue MALABSORPTION

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TEACHING STRATEGIES Content Focus

Content Highlights

DISORDERS AFTER SURGICAL INTERVENTION Dumping Syndrome Short-Bowel Syndrome NEOPLASMS OF THE GASTROINTESTINAL TRACT ESOPHAGEAL, GASTRIC, AND SMALL INTESTINAL CANCERS Esophageal Cancer Gastric Carcinoma, Small Intestinal Neoplasms COLONIC POLYPS AND COLON CANCER Colon Polyps Colon Cancer PSYCHOSOCIAL ASPECTS OF GASTROINTESTINAL DISORDERS STRESS OF LIFESTYLE CHANGES

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Learning Activities

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Discussion Topic for Four Types of Diarrhea Type of Diarrhea

Mechanism

Osmotic

Excess particles in intestinal lumen cause water entry by osmosis

   

Secretory

Excessive intestinal secretion and inhibition of reabsorption of fluid and electrolytes Proteinaceous exudate, mucus, and blood in lumen from inflamed intestinal wall draws in water by osmosis; inflamed tissue has impaired absorption Increased intestinal motility decreases absorption by decreasing intestinal transit time



Exudative

Increased motility

Clinical Examples Lactose intolerance Unabsorbed food Enzyme deficiencies Osmotic laxatives Enterotoxins and other bacterial toxins

 

Inflammatory bowel disease Neoplasms

 

Resection or bypass of intestine Irritable bowel syndrome

Teaching People about Gastrointestinal Disorders Activity Have students draft a response to the scenarios below.

1. “My wife is in the ICU with a head injury, and now she is bleeding from stress ulcers!” says Mr. Wang. “She is unconscious; how can she have stress? I am the one who has stress!” Respond directly to him.

2. “What is Barrett esophagus?” says Mrs. Cloude. “Is that like heartburn with GERD?” Respond as if you are speaking directly to her.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-255 3. “What is the difference between alcoholic hepatitis and alcoholic cirrhosis?” asks another nurse. Respond as if you are speaking directly to her.

4. “My uncle has liver cancer and so does my mom,” says Sandi, “but the doctor said his cancer is primary and hers is metastatic. What does that mean?” Respond as if you are speaking directly to her.

5. “Why do the enzymes digest the pancreas in pancreatitis?” asks Mr. Tran. “I thought the pancreas normally makes those enzymes all the time.” Respond as if you are speaking directly to him.

Answers 1. You both definitely have a lot of stress right now. Your wife is unconscious, but her body is experiencing a lot of physical stress that causes some physiological changes. Stress ulcers are multiple little areas of injury in the lining of the stomach that occur in people who have injuries serious enough that they need to be in the ICU. Stress ulcers do not cause any pain, although they can bleed. We are taking the best care possible of your wife. Now let us talk about your stress. What ways do you have of managing it?

2. Barrett esophagus occurs in people who have heartburn with GERD, but it is not the same as heartburn. The term describes physical changes that have occurred in the esophagus cells which do not live well in a location where there is a lot of acid. If acid reflux occurs again and again, the body replaces the normal esophagus cells with another type of normal cells that can endure the acid. Barrett esophagus is not cancer, but it is a warning sign that that portion of the esophagus is at high risk of cancer.

3. With alcoholic hepatitis, the liver is inflamed and there are necrotic cells caused by the alcohol damage, so the person has signs and symptoms of acute inflammation and liver dysfunction. The liver often regenerates and recovers from hepatitis if the person stops drinking. With alcoholic cirrhosis, alcohol damage triggers overgrowth of connective tissue (fibrosis) that distorts the liver. Although hepatocytes regenerate, they are not connected properly to blood vessels or bile ducts, so the person has hepatocyte dysfunction. In addition, liver fibrosis obstructs the portal vessels that flow into the liver, causing pressure to rise in the portal system. Portal hypertension and hepatocyte dysfunction cause the signs and symptoms of cirrhosis. Cirrhosis usually is considered to be irreversible.

4. Cancer starts in one location, and then cancer cells can break off and travel to a new location, where they form another tumor, in a process called metastasis. The first place where cancer starts is called the primary tumor. So, the cancer in your uncle’s body started in his liver. The cancer in your mother’s body started in another location, and cells from that primary tumor broke off and moved to your mother’s liver. That is why her liver cancer is called metastatic.

5. Some of the enzymes that the pancreas normally makes are inactive enzymes and they are not activated until they reach the intestines, where they digest food. However, in pancreatitis, those enzymes become activated inside the pancreas and start digesting the pancreas, causing damage and pain.

Gastroesophageal Reflux Disease (GERD) Activity

Copyright © 2019, Elsevier Inc. All rights reserved.

39-256 Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, has heartburn, and experiences occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.

Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax.

The nurse practitioner diagnoses GERD and tells Mr. Berger to do the following:     

Take proton-pump inhibitor drugs to reduce gastric acid.

Elevate the head of your bed.

Avoid eating large meals, especially near bedtime.

Begin a weight-loss program.

Reduce his use of caffeine and alcohol.

Instructions: Answer the following questions about Mr. Berger and GERD. 1. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

2. What is the mechanism by which obesity contributes to GERD? 3. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime?

4. What is metaplasia? Why does it occur?

5. Why might reducing his use of caffeine and alcohol decrease Mr. Berger’s symptoms?

6. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD? 7. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

8. In addition to discomfort, what is a danger of untreated GERD? Answers 1. Movement of the proximal stomach into the thorax is hiatal hernia, which is associated with GERD. 2. Obesity increases intraabdominal pressure, which predisposes to reflux through the lower esophageal sphincter.

3. Large meals distend the stomach and increase intra-abdominal pressure. Lying down to sleep removes the beneficial effect of gravity in preventing reflux.

4. Metaplasia is replacement of one normal cell type with another normal cell type that normally does not occur in that location. It is an adaptation that enables tissues to survive in the presence of an adverse cellular environment.

5. Caffeine and alcohol reduce the closure strength of the lower esophageal sphincter.

6. These symptoms are not specific to GERD. They can occur in achalasia, GERD, and hiatal hernia, among other disorders.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-257 7. Elevating the head of the bed will use the effects of gravity to resist esophageal reflux.

8. Repeated irritation of the distal esophagus by gastric acid can cause the metaplastic changes of Barrett esophagus, which is an important risk factor for esophageal cancer.

IN-CLASS/ONLINE CASE STUDY TS is 67 years old, with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. He denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool and vomiting blood. He denies history of gastroesophageal reflux disease (GERD) and ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. The dysphagia he describes thus: “Food gets stuck in my throat, and I can’t get it down.” The feeling occurs only after he has ingested solid food; liquids are not a problem.

There is burning chest pain associated with meals. He is scheduled for an upper gastrointestinal endoscopy.

1. What is the likely cause of his dysphagia?

Answer: 

Dysphagia is difficulty swallowing. Because it is affecting solids but not liquids, it is likely to be a stricture (narrowing) or a blockage, possibly a tumor.

2. What advice should he be given regarding his OTC medication at this time?

Answer:  

Naproxen is a nonsteroidal antiinflammatory drug that must be taken with food and water to prevent irritation and mucosal bleeding.

If he is having trouble swallowing solids, he may have trouble with getting the pills stuck in the esophagus, which could lead to esophageal erosions and severe bleeding.

3. What are the usual signs and symptoms of GERD? How will it be managed?

Answer:

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39-258   

GERD usually manifests as heartburn, regurgitation, chest pain, and dysphasia. The heartburn and regurgitation may be worse after eating or lying down.

Smoking, spicy foods, overeating, obesity, and chemicals that reduce lower esophageal sphincter tone tend to exacerbate GERD. The symptoms are commonly relieved by antacids and acid blocking drugs. Severe GERD can lead to esophageal erosions and strictures. Chronic GERD can result in premalignant changes (Barrett esophagus).

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment o Etiology and Risk Factors

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Elimination o Exemplar: Diarrhea o Exemplar: Constipation o Exemplar: Colon Cancer THEME: Protection and Movement  Concept: Inflammation

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39-259 o o o

Exemplar: Inflammation of the Stomach and Intestines Exemplar: Gastritis Exemplar: Inflammatory Bowel Disease

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Etiology and Risk Factors

TEACH FOR NURSES LESSON PLAN Chapter 37: Alterations in Function of the Gallbladder and Exocrine Pancreas CHAPTER OBJECTIVES 1. Describe how bile is produced, stored, and secreted.

2. Describe how pancreatic enzyme secretion is regulated.

3. Identify the factors that predispose to formation of cholesterol gallstones.

4. Explain the relationship between cholecystitis and cholelithiasis.

5. Describe the clinical and laboratory findings indicative of acute pancreatitis.

6. Identify the serious complications that may result from acute pancreatitis.

7. Describe how the etiologic factors, clinical presentation, and management of chronic pancreatitis differ from those of acute pancreatitis.

8. Discuss the signs, symptoms, and treatment for pancreatic cancer.

STUDENT RESOURCES

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39-260

understand

       

Textbook Chapter 37 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 37 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

STRUCTURE AND FUNCTION OF THE

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

39-261

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

PANCREATICOBILIARY SYSTEM EMBRYOLOGY OF THE PANCREATICOBILIARY SYSTEM PHYSIOLOGY OF BILE FUNCTIONAL ANATOMY OF THE PANCREAS DISORDERS OF THE GALLBLADDER

Review the manifestations of gallbladder disorders.

 

Activity: Have students complete the Disorders of the Gallbladder and Pancreas activity below.

Activity: Have students complete the Gallbladder and Pancreas Teaching activity below.

PATHOPHYSIOLOGY OF CHOLESTEROL GALLSTONE FORMATION CHOLELITHIASIS AND CHOLECYSTITIS DISORDERS OF THE PANCREAS PANCREATITIS

Discuss the manifestations of pancreatitis.

 

Online Activity: Have students visit http://emedicine.medscape.com/article/ 181364-overview to learn more about Acute Pancreatitis.

Discussion Topic: Discuss the relationship between acute pancreatitis and heavy alcohol intake.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-262

Disorders of the Gallbladder and Pancreas Activity Match the disease process with its pathophysiology or clinical manifestations.

Set 1: Pathophysiology Match ____ Acute inflammation caused by cystic duct obstruction ____ Exocrine and endocrine dysfunction with malabsorption and diabetes Answer Options: 1. Chronic pancreatitis 2. Acute pancreatitis 3. Cholecystitis

Set 2: Pathophysiology Match ____ Precipitation of cholesterol with intermittent biliary colic ____ Inflammation and autodigestion caused by gallstones or alcohol abuse Answer Options: 1. Acute pancreatitis 2. Cholecystitis 3. Cholelithiasis

Set 3: Clinical Manifestations Match ____ Severe epigastric pain, emesis, elevated serum lipase and amylase ____ Frequently asymptomatic ____ Severe right upper abdominal pain, fever

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39-263

Answer Options: 1. Cholelithiasis 2. Acute pancreatitis 3. Cholecystitis

Answers Set 1: Pathophysiology Match _3_ Acute inflammation caused by cystic duct obstruction _1_ Exocrine and endocrine dysfunction with malabsorption and diabetes

Set 2: Pathophysiology Match _3_ Precipitation of cholesterol with intermittent biliary colic _1_ Inflammation and autodigestion caused by gallstones or alcohol abuse

Set 3: Clinical Manifestations Match _2_ Severe epigastric pain, emesis, elevated serum lipase and amylase _1_ Frequently asymptomatic _3_ Severe right upper abdominal pain, fever

Gallbladder and Pancreas Teaching Activity Have students draft responses to the scenarios below.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-264 1. “Why did my dad’s doodoo float and smell bad before he went to the hospital?” asks Sam, age 7 years. “My doodoo does not float.” His father has acute pancreatitis. Respond as if speaking directly to Sam. 2. “The doctor said they saw gallstones on the whole-body scan, but I do not have any pain,” says Mrs. White. “How is that possible?”

Respond as if you are speaking directly to her.

3. “Why are amylase and lipase elevated in the blood with acute pancreatitis?” asks a new nurse on the medical unit where you work.

Respond as if you are speaking directly to her.

Answers 1. Your dad’s doodoo floated because it had too much fat in it. That made it smell bad, too. We all have a body part called a pancreas that helps us remove fat from the doodoo and use it in the body. Your dad’s pancreas is sick right now, so it could not do its job, and the fat stayed in his doodoo. Your doodoo does not float because your pancreas is doing its job well. We are taking good care of your dad, so that his pancreas will have a chance to get better.

2. The gallbladder is like a little sack that holds bile, a thick digestive fluid. Gallstones can form in the gallbladder and stay there without causing any symptoms as long as they do not have sharp edges that injure the wall of the gallbladder when it contracts to release the bile. Gallstones cause pain if they injure the gallbladder wall or if they leave the gallbladder and have difficulty traveling down the tubes that carry bile to the intestines. Otherwise, they can stay in the gallbladder, and you feel no pain.

3. As you know, cells in the pancreas normally make and secrete pancreatic amylase and lipids, which go into the intestines through the pancreatic and other ducts. In pancreatitis, some of these cells die and rupture, releasing the amylase and lipase into the interstitial fluid, from which they diffuse into the blood. Elevated amylase and lipase tell us that there is necrosis in the pancreas.

IN-CLASS/ONLINE CASE STUDY LB is a 45-year-old white woman with three children—ages 4, 6, and 10 years. She works long hours as an instructor at a local college to support her children and husband, who is disabled. She has had a 6-month history of severe bouts of abdominal pain associated with indigestion, gas, and steatorrhea. Fatty foods seem to exacerbate the symptoms. LB is about 40 lb overweight. A computed tomography scan of LB’s abdomen revealed multiple stones in her gallbladder. She was scheduled for a cholecystectomy.

1. What risk factors does LB have that predispose her to development of gallstones?

Answer:  

Gallstones are twice as common in women as in men, and whites are at greater risk than many ethnic groups; only Native Americans have a higher incidence.

Obesity or rapid weight loss predispose to gallstone formation.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-265

2. Why are fatty foods often associated with an exacerbation of symptoms?

Answer:   

The gallbladder is a small sac that holds bile, a digestive juice produced by the liver, that is used to break down dietary fats.

The gallbladder extracts water from its store of bile until the liquid becomes highly concentrated.

The presence of fatty foods triggers the gallbladder to “squeeze” its bile concentrate into the small intestine. Meals high in fat content cause the gallbladder to contract more, often causing more pain.

3. What is the relationship between gallstones and cholecystitis?

Answer:   

Cholecystitis is an inflammatory condition of the gallbladder. It is associated with gallstones in 90% of cases.

Cholecystitis occurs when a stone becomes impacted in the cystic duct and inflammation develops behind the obstruction.

With cholecystitis, there is usually constant severe pain in the right upper abdomen. With gallstones, most people experience no symptoms until the cystic duct is blocked by a stone.

4. What options are there for the surgical removal of the gallbladder? What other options are available for the treatment of cholecystitis?

Answer:  

 

Laparoscopic removal is less extreme, using four small incisions to access and remove the gallbladder. There is less scarring and postoperative pain, and LB would be able to return to work sooner.

An open cholecystectomy requires a large incision to allow visualization and removal of the gallbladder. This means more scar tissue formation and more postoperative pain, and it prolongs the hospitalization and recovery. It would be used if there were an anatomic anomaly, stones in the common bile, or extensive adhesions.

Gallstones can be dissolved chemically, and this may be an option for older adult patients or those too debilitated to be good candidates for surgery Another option is the use of extracorporeal shock wave lithotripsy, fracturing the stones into smaller particles that are more easily passed. The procedure cannot be performed if the stones are too large, so this limits usage.

5. Laparoscopic cholecystectomy is selected. Will LB continue to secrete bile after her surgery? How?

Copyright © 2019, Elsevier Inc. All rights reserved.

39-266

Answer: 

The liver will continue to produce bile as it did before the gallbladder was surgically removed (cholecystectomy). However, when the gallbladder is no longer there to store it, the bile will flow directly from the liver to the small intestine.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Diagnosis and Treatment o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Pancreatitis

TEACH FOR NURSES LESSON PLAN

Copyright © 2019, Elsevier Inc. All rights reserved.

39-267

Chapter 38: Liver Diseases CHAPTER OBJECTIVES 1. Describe the role the liver plays in nutrient metabolism, bile synthesis, storage of vitamins and minerals, urea synthesis, clotting factor synthesis, and detoxification.

2. Identify which manifestations of liver disease that are due to hepatocellular failure, and which are due to portal hypertension.

3. Explain how the different types of viral hepatitis vary with regard to mode of transmission and severity of symptoms.

4. Identify the clinical and laboratory findings that would lead to a diagnosis of liver cirrhosis.

5. Identify the treatment modalities which are available to patients with end-stage liver failure.

STUDENT RESOURCES understand

       

Textbook Chapter 38 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 38 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

39-268

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

STRUCTURE AND FUNCTION OF THE LIVER GENERAL MANIFESTATIONS OF LIVER DISEASE

Identify the manifestations of liver disease.



Activity: Have students complete the Jaundice Activity below.

Review the different types of hepatitis.



Discussion Topic: Have students identify the clinical manifestations of the various types of hepatitis. See Discussion Topic Hepatitis below.

Hepatocellular Failure Portal Hypertension Portal Systemic Encephalopathy Complications of Advanced Liver Disease DISORDERS OF THE LIVER HEPATITIS

Copyright © 2019, Elsevier Inc. All rights reserved.

39-269

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Acute Viral Hepatitis



Chronic Hepatitis



Activity: Have students complete the Clinical Course of Acute Symptomatic Viral Hepatitis Activity below.

Online Activity: Activity: Have students perform a literature search in a database of professional journal articles on hepatitis. Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated. Instruct them to cite their references.

CIRRHOSIS Alcoholic Liver Disease TOXIC LIVER DISORDERS Metal Storage Diseases Toxic Metabolic Agents OTHER STRUCTURAL LIVER CONDITIONS TRANSPLANTATION Evaluation of the Transplantation Patient Posttransplantation Management AGE-RELATED LIVER DISORDERS LIVER DISEASES AND PEDIATRIC

Copyright © 2019, Elsevier Inc. All rights reserved.

39-270

TEACHING STRATEGIES Content Focus

Content Highlights

CONSIDERATIONS Abnormal Bilirubin Metabolism in the Neonatal Period Infectious and Acquired Hepatitides in Children Congenital Liver Disease LIVER DISEASES AND GERIATRIC CONSIDERATIONS

Jaundice Activity Answer options:  unconjugated  bilirubin  fat  bile  ammonia  sclerae  teeth  urine  conjugated Complete the sentences below with the options above.

1. Dark-colored urine is caused by __________ bilirubin.

2. Gallstones that obstruct the common bile duct cause increased _____________ bilirubin.

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

39-271 3.

4.

5.

6.

Hepatocytes normally produce ___________ bilirubin, which is excreted primarily in the ____________.

A person who has jaundice and dark-colored urine has elevated ____________ bilirubin.

Jaundice is caused by accumulation of ____________ in the blood and tissues.

In a person who has dark skin, the best place to see jaundice is the _______________.

Answers 1. conjugated 2. conjugated 3. conjugated, bile 4. conjugated 5. bilirubin 6. sclerae

Discussion Topic Hepatitis Virus Hepatitis A Hepatitis B

Major Routes of Transmission Fecal–oral; also parenteral, sexual Parenteral, sexual, perinatal

Hepatitis C

Parenteral; also sexual, perinatal

Hepatitis D (delta virus)

Parenteral, sexual

Hepatitis E

Fecal–oral; also parenteral

Special Characteristics

Prevention

Often mild and self-limited

Hygiene, safe water and food, immune globulin (passive), vaccine (active) Blood and body fluid precautions, safe sex, needle exchange programs, pretransfusion blood screening, immune globulin (passive), HBV vaccine (active) Blood and body fluid precautions, safe sex, needle exchange programs, pretransfusion blood screening

May become chronic and lead to cirrhosis or hepatocellular carcinoma

Often asymptomatic; may become chronic and lead to cirrhosis and hepatocellular carcinoma Requires concurrent HBV infection; Blood and body fluid precautions, safe sex, needle concurrent infection with HBV and hepatitis D exchange programs, pretransfusion blood screening, virus increases risk of fulminant liver failure HBV vaccine (active) Often asymptomatic; fulminant liver failure in Hygiene, safe water and food pregnant women

Clinical Course of Acute Symptomatic Viral Hepatitis Activity Copyright © 2019, Elsevier Inc. All rights reserved.

39-272

Answer options           

Person is infectious near end of phase Person not infectious Fatigue, anorexia, malaise Person is infectious in initial portion Gradual return to health Jaundice appears Feels better but looks worse Energy and well-being return Virus is replicating but no signs and symptoms Muscle aching, low-grade fever, headache Dark urine, light-colored feces

Have students note the correct manifestation in the column of the corresponding phase of acute viral hepatitis.

Incubation

Preicteric

Icteric

Convalescence

Incubation

Preicteric

Icteric

Convalescence







Answer



Virus is replicating, but no signs and symptoms Person is infectious near end of phase



Muscle aching, low-grade fever, headache Fatigue, anorexia, malaise

  

Dark urine, light-colored feces Feels better but looks worse Jaundice appears Person not

 

Person not infectious Gradual return to health

Copyright © 2019, Elsevier Inc. All rights reserved.

39-273 infectious

IN-CLASS/ONLINE CASE STUDY FC is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal (GI) bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 1.8. FC’s family reports that his mental functioning has deteriorated significantly over the past few months.

1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to hepatocellular failure? Which are secondary to portal hypertension?

Answer:  Onset of symptoms is usually insidious.  Common signs and symptoms include weakness, fatigue, muscle wasting, anorexia, ascites, bruising, weight loss, jaundice, abnormalities in blood glucose levels, elevated serum lipids, feminization, palmar erythema, and spider nevi or telangiectasia.

These are primarily caused by hepatocellular failure.  Portal hypertension includes varices (enlarged veins including hemorrhoids and gastroesophageal), enlarged spleen.  Some manifestations may be related to both portal hypertension and hepatocellular failure in combination. These include GI bleeding, caput medusa, ascites and peripheral edema, and anemia.

2. Why is FC at particular risk for GI bleeding?

Answer:  

The liver is needed in the synthesis of clotting factors; with hepatocellular failure, severe hypoprothrombinemia can develop.

Upper GI bleeding may result from varices, portal hypertension, or gastroduodenal ulcer.

3. What is the probable cause of FC’s progressive mental deterioration? How might his mental deterioration be medically managed?

Answer:

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39-274

  

The probable cause of FC’s mental deterioration is portal-systemic encephalopathy resulting from the failure of the liver to detoxify noxious agents because of hepatocellular dysfunction.

Ammonia is the most readily identified toxin and its rising serum level correlates with the decline in cerebral function.

It is managed by reducing protein intake (to reduce the production of metabolic wastes); lactulose, a nonabsorbable synthetic disaccharide that enhances ammonia excretion in the stool; antibiotics to reduce normal intestinal flora involved in protein breakdown and ammonia production.

4. What problems might be precipitated by FC’s abrupt cessation of alcohol intake while hospitalized?

Answer:  

Deliriums tremens, an acute organic psychosis that usually manifests within 24 to 72 hours of the last drink.

It is characterized by mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizure, and cardiovascular abnormalities.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Diagnosis, Treatment, and Prevention o Prevention o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-275

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Maladaptive Behavior o Concept: Addiction o Exemplar: Alcoholic Liver Disease

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Diagnosis, Treatment, and Prevention o Prevention

TEACH FOR NURSES LESSON PLAN Chapter 39: Endocrine Physiology and Mechanisms of Hypothalamic-Pituitary Regulation CHAPTER OBJECTIVES 1. Explain how the lipid or water solubility of hormones affects their transport in the circulation.

2. Describe the general mechanisms of action of lipid-soluble and water-soluble hormones on target cells.

3. Explain how target cells regulate their responsiveness to endocrine hormones.

4. Explain how feedback mechanisms control the secretion of hormones.

5. Identify the anterior and posterior pituitary hormones, their target tissues, and their negative feedback mechanisms.

6. Describe how thyroid and steroid hormones are synthesized.

7. Describe the normal actions on target cells of antidiuretic hormone, growth hormone, thyroid hormone, and steroid hormones.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

39-276

understand

       

Textbook Chapter 39 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 39 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus HORMONE STRUCTURE AND ACTION

Content Highlights Review the chemical structure and mechanisms of hormone action.

Learning Activities 

Activity: Have students complete the Hormone Action Activity below.

Copyright © 2019, Elsevier Inc. All rights reserved.

39-277

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Chemical Structure of Hormone Classes Mechanisms of Hormone Action HORMONE REGULATION Hormone Synthesis, Secretion, and Metabolism Regulation of Receptor Responses HYPOTHALAMICPITUITARY ENDOCRINE SYSTEM

Provide an overview of the function of the pituitary endocrine system.



Online Activity: Have students visit http://www.hormone.org/hormones-andhealth/the-endocrine-system to learn more about the endocrine system.

Hormones of the Posterior Pituitary Gland Hormones of the Hypothalamus and Anterior Pituitary Gland Gonadotropins THYROID HORMONES Thyroid Hormone Synthesis and Secretion

Copyright © 2019, Elsevier Inc. All rights reserved.

39-278

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Thyroid Action on Target Cells STEROID HORMONES Steroid Hormone Synthesis and Secretion Steroid Action on Target Cells

CATEGORIES OF ENDOCRINE DISEASE

Review the categories of endocrine disease.

Hyposecretion



Discussion Topic: Use the image below to lead students in a discussion of altered hormone secretion.



Activity: Have students perform a literature search in a database of professional journal articles on one of the categories of endocrine disease.

Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated. Instruct them to cite their references.

Hypersecretion Hyporesponsiveness

Hormone Action Activity Match the hormones and their actions.

Hormones (answer options):  ACTH  Aldosterone  GHRH  GH  Insulin  Glucagon

     

TRH ADH CRH TSH Epinephrine Cortisol

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39-279  

Adrenal androgens T4, T3

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___ Causes the adrenal cortex to secrete glucocorticoids ____ Increases cell replication and influences many metabolic processes ____ Masculinizing hormones released from adrenal cortex ____ Causes anterior pituitary to release a hormone that stimulates the adrenal cortex ____ Increases heart rate and contractility, decreases GI motility and secretion, and increases blood glucose ____ Increases blood glucose, decreases inflammation, and breaks down body proteins ____ Causes renal reabsorption of water ____ Causes glucose and amino acids to enter cells, decreasing blood glucose ____ Increase cellular metabolism ____ Raises blood glucose ____ Causes renal reabsorption of sodium and water and excretion of potassium ____ Causes anterior pituitary to release a hormone that stimulates the thyroid gland ____ Causes thyroid gland to release thyroid hormones Answers ACTH Causes the adrenal cortex to secrete glucocorticoids GH Increases cell replication and influences many metabolic processes Adrenal androgens Masculinizing hormones released from adrenal cortex

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CRH Causes anterior pituitary to release a hormone that stimulates the adrenal cortex Epinephrine Increases heart rate and contractility, decreases GI motility and secretion, and increases blood glucose Cortisol Increases blood glucose, decreases inflammation, and breaks down body proteins ADH_ Causes renal reabsorption of water Insulin_ Causes glucose and amino acids to enter cells, decreasing blood glucose T4, T3__ Increase cellular metabolism Glucagon__ Raises blood glucose Aldosterone_ Causes renal reabsorption of sodium and water and excretion of potassium TRH_ Causes anterior pituitary to release a hormone that stimulates the thyroid gland TSH_ Causes thyroid gland to release thyroid hormones

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Altered Hormone Secretion Discussion Topic

Endocrine disorders may arise from altered hormone secretion or from altered tissue responses to hormones. Altered hormone secretion falls into three categories: 





Hyposecretion of hormones o Decreased secretion of hormone from the gland that normally secretes it may be caused by decreased stimulation from releasing or stimulating hormones, destruction of the gland by infection, infarction, or nonsecreting tumor, atrophy of the gland, agenesis (lack of development of the gland), surgical removal, or other factors.

Hypersecretion of hormones o Increased secretion of hormone from the gland that normally secretes it may be caused by increased stimulation from releasing or stimulating hormones, stimulation by abnormal factors, hyperplasia, of the gland, a secreting tumor in the gland, or other factors.

Ectopic production of hormones o Secretion of hormone from an abnormal location that normally does not secrete hormones, such as small cell carcinoma of the lung, is not regulated by negative feedback mechanisms.

Copyright © 2019, Elsevier Inc. All rights reserved.

44-283 As the figure indicates, hyposecretion of a hormone causes the target cells in the peripheral tissues to receive less hormone than normal; therefore, they will display insufficient physiological action of that hormone. Conversely, both hypersecretion and ectopic production of a hormone cause the target cells in the peripheral tissues to receive more hormone than normal; therefore, they display excessive physiological action of that hormone.

IN-CLASS/ONLINE CASE STUDY LS is a 42-year-old man who has been diagnosed with adrenal hyposecretion. He was told that he will need to wear a medical alert bracelet. LS asks why this is the case. He plans to take the medications and does not like the idea of others knowing that he has a medical issue.

1. How would you explain the difference between the inner (medulla) and outer (cortex) of the adrenal gland?

Answer:  The adrenal medulla the inner portion and secretes epinephrine and norepinephrine. They are released when a stimulus comes from the sympathetic nervous system.  The adrenal cortex has three zones.  The outer cortex (zona glomerulosa) produces mineralocorticoid aldosterone.  The middle (zona fasciculata) releases glucocorticoid cortisol.  The inner (zona reticularis) produces DHEA. 2. Explain why aldosterone has a shorter half-life than cortisol: Answer: 

Cortisol is bound to a protein when released (transcortin and albumin), but aldosterone is not and has a shorter half-life.

3. Discuss the effects glucocorticoids and mineralocorticoids have on the body.

Answer:

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44-284 Glucocorticoids (Cortisol)      

Affect glucose metabolism Cortisol is of the most prolific hormones affecting most tissues in the body Increase blood sugars when levels are low and when the body is stressed Increase glucose synthesis in the liver from: glycogen, fat stores, and amino acids Increase protein catabolism by releasing protein stores from muscles Increase cholesterol by breaking down fat (lipolysis)

Mineralocorticoids (Aldosterone)   

Maintain salt and water balance Promote Na+ reabsorption and K+ excretion in the renal tubules Released when renal perfusion is decreased and the renin-angiotensin system is activated

4. After discussing the above with LS, how would you explain why he should wear a medical bracelet?

Answer:   

Cortisol is an important part of glucose metabolism.

It is needed to increase glucose when his body is stressed, and it facilitates an increased release of glucose from glycogen stores.

Aldosterone is needed to maintain the balance of salt and water, and with deficiencies, he could have trouble with low volume and become hypotensive and dizzy.

TEACH FOR NURSES LESSON PLAN Chapter 40: Disorders of Endocrine Function CHAPTER OBJECTIVES 1. Explain how primary and secondary endocrine disorders can be differentiated.

2. Identify the etiologic factors that would lead to clinical manifestations of hormone excess or deficiency.

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44-285 3. Describe the etiologic factors, clinical findings, and management of excess and deficiency of the following endocrine hormones: growth hormone, thyroid hormone, adrenocortical hormones, adrenal medullary hormones, parathyroid hormone, and antidiuretic hormone.

STUDENT RESOURCES understand

       

Textbook Chapter 40 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 40 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

Copyright © 2019, Elsevier Inc. All rights reserved.

44-286

TEACHING STRATEGIES Content Focus BASIC CONCEPTS OF ENDOCRINE DISORDERS

Content Highlights Provide an overview of endocrine disorders.

Learning Activities  

Etiology of Endocrine Disorders

Online Activity: Have students visit http://www.endocrineweb.com to learn more about endocrine disorders.

Activity: Have students complete the Basic Concepts of Endocrine Disorders Fill-in-the-Blank Activity below.

Classification of Endocrine Disorders GROWTH HORMONE DISORDERS THYROID HORMONE DISORDERS

Differentiate hypothyroidism and hyperthyroidism.

 

Discussion Topic: Have students distinguish clinical manifestations of both hypothyroidism and hyperthyroidism.

Activity: Have students complete the Case Example Activity below.

ADRENOCORTICAL HORMONE DISORDERS ADRENAL MEDULLA DISORDER PARATHYROID GLAND DISORDERS Regulation and Actions of Parathyroid Hormone ANTIDIURETIC HORMONE DISORDERS

Basic Concepts of Endocrine Disorders Fill-in-the-Blank Activity Terms from which students can choose: Copyright © 2019, Elsevier Inc. All rights reserved.

44-287

 

         

 

adenohypophysis postreceptor neurohypophysis decreased receptors ectopic exogenous excessive prereceptor primary secondary deficient increased targets

Fill-in-the-Blanks: 1. A tumor that destroys a gland will cause ____________ hormone effects.

2. A problem in the anterior pituitary that causes decreased secretion of cortisol is a(n) __________ endocrine disorder.

3. A problem in the adrenal gland that causes decreased secretion of aldosterone is a(n) _____________ endocrine disorder.

4. Another name for the anterior pituitary is ______________.

5. Secretion of hormones from an abnormal location that normally does not secrete hormones is called _______________ production of hormones.

6. A problem in the adrenal gland that causes decreased secretion of cortisol is a(n) _______________ endocrine disorder.

7. Hormones must bind to ____________ to act on their target issues.

8. Hormone resistance may be due to ________________numbers of receptors, or ______________ defects.

9. Ectopic hormone production causes ______________ hormone effects.

Respiratory System Physiology Fill-in-the-Blank Activity Answers: 1. deficient 2. secondary 3. primary 4. adenohypophysis

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5. ectopic 6. primary 7. receptors 8. decreased, postreceptor 9. excessive Case Example Activity Marty Miller, age 26 years, who is training to run her fifth marathon, has gradually increasing dyspnea on exertion, fatigue, and weight gain. She has no children and is not now pregnant. Her nurse practitioner suspects a thyroid hormone disorder.

Instructions: Answer the following questions about Marty’s pathophysiology: 1. What are other symptoms about which you should ask Marty? Why? 2. If Marty has developed hypothyroidism, what might be found on examination?

3. The nurse practitioner drew blood to measure Marty’s thyroid-stimulating hormone (TSH) levels. What gland secretes TSH? 4. If Marty has hypothyroidism, what do you expect the TSH results to be? Why? 5. Marty is started on thyroid replacement therapy. Why should you teach her the signs and symptoms of hyperthyroidism as well as those of hypothyroidism?

6. When her thyroid disorder was undiagnosed, was Marty at risk for thyroid storm? Why, or why not?

Answers: 1. Cold intolerance, dryness and thickening of the skin, hair texture changes, menstrual irregularity, difficulty with mental activities, lethargy, hoarseness, and constipation. Her fatigue and weight gain are consistent with hypothyroidism, although they could be caused by many other conditions.

2. Goiter, bradycardia, dry skin, coarse, brittle hair, puffy nonpitting edema of the face 3. The anterior pituitary gland 4. TSH levels are elevated in primary hypothyroidism. The anterior pituitary produces high levels of TSH because it does not receive negative feedback from normal blood levels of thyroid hormones.

5. Although T3 and T4 levels should be monitored, she needs to be able to recognize when her thyroid hormone levels are too high so that she can contact her nurse practitioner.

6. No. Thyroid storm occurs with undiagnosed or underdiagnosed hyperthyroidism. Marty’s thyroid gland was not able to produce normal amounts of thyroid hormones and could not have produced the massive amounts of thyroid hormones that cause thyroid storm. The only way that Marty could develop thyroid storm is by taking a sizeable overdose of her thyroid hormone replacement.

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IN-CLASS/ONLINE CASE STUDY BJ is a 54-year-old attorney who, for several months, has been experiencing generalized headaches that have responded poorly to nonnarcotic analgesics. He is also experiencing visual disturbances, including blurred vision and double vision. On questioning, BJ reports that he has gained 20 lb over 2 years despite having had no change in activity or eating patterns. About his weight gain, BJ jokes, “I guess it’s all in my feet. I had to buy new shoes, and my shoe size went from a size 10 to a size 12.” It was determined that BJ should have a computed tomography scan of his head to assess for a pituitary adenoma resulting in the hypersecretion of growth hormone (GH).

1. What information from the above scenario would support this possible etiology?

Answer: 

Headache, visual disturbances, weight gain, increased foot size

2. What other signs or symptoms might be apparent if BJ does indeed have a pituitary adenoma?

Answer:    

Increased diameter of fingers, large hands Hyperglycemia Colon polyps, potentially malignant Cardiomegaly, goiter, enlarged tongue and voice changes

3. BJ is diagnosed with pituitary adenoma and undergoes a transsphenoidal hypophysectomy to remove the tumor. After surgery, he has huge urinary outputs of 500 to 600 mL/hr. What is the most likely cause of his high urine output? What other clinical data support this diagnosis?

Answer: 

This is most likely diabetes insipidus because of swelling around the posterior pituitary and failure of antidiuretic hormone (ADH, vasopressin) feedback and secretion.

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44-290  

Other data include a low urine specific gravity, absence of glucose in the urine, hypernatremia and increased serum osmolality, and a decrease in urine output following exogenous administration of ADH. Hypernatremia and water deficit could also produce thirst, dry mucous membranes, poor skin turgor, hypotension and tachycardia, lethargy, confusion, and seizures.

4. BJ receives subcutaneous 1-deamino-8-d-arginine vasopressin (ddAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?

Answer:   

ddAVP is a synthetic analog of ADH (vasopressin) and mimics the effect of the hormone on the renal distal tubules and collecting ducts.

This treatment should rapidly normalize the urine output and cause it to be less dilute (increase the specific gravity) and normalize the serum sodium and osmolality.

Vital signs and other indicators of water deficit and hypernatremia should resolve.

5. It is expected that after his transsphenoidal hypophysectomy, all of BJ’s anterior pituitary hormones will be deficient (panhypopituitarism). What type of hormone replacement will be needed?

Answer: 

Hormones secreted by the anterior pituitary, other than GH, result in the release of other hormones. It is these target hormones that would have to be replaced (thyroid hormone and glucocorticoid hormone replacement). Glucocorticoid hormone would maintain the health of the adrenal glands, and replacement of aldosterone or androgens would not be necessary. GH is not usually replaced in adults, although it may be if osteoporosis or decreased muscle mass is an issue.

6. What information should be given to BJ about the expected duration of hormone therapy and monitoring of treatment efficacy?

Answer:  

His ADH deficiency may be temporary or permanent.

Other hormone replacements may be lifelong and require ongoing monitoring.

7. During periods of stress, BJ is likely to require an adjustment in hormone therapy. Which hormone is most critical and why?

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Answer: 

Patients with adrenocortical deficiency who are unable to produce an increased amount of glucocorticoids during stress are at risk for cardiovascular collapse (Addisonian crisis, acute adrenal insufficiency). An increase in glucocorticoid dose may be necessary during stress.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Fluids and Electrolytes o Exemplar: Adrenocortical Hormone Disorders o Exemplar: Adrenocortical Insufficiency o Exemplar: Syndrome of Inappropriate Antidiuretic Hormone Secretion 

Concept: Thermoregulation o Exemplar: Thyroid Hormone Disorders

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

Concept: Glucose Regulation o Exemplar: Hypercortisolism

TEACH FOR NURSES LESSON PLAN Chapter 41: Diabetes Mellitus CHAPTER OBJECTIVES 1. Identify the hormones involved in the regulation of serum glucose level and describe the physiologic conditions under which each would be secreted.

2. Describe the differentiating characteristics of type 1 and type 2 diabetes.

3. Explain how the pathophysiologic processes differ among the various types of diabetes.

4. Identify the clinical findings associated with hyperglycemia and explain how they differ from those of hypoglycemia.

5. Describe how diabetes mellitus is diagnosed, monitored, and managed.

6. Identify the acute and chronic complications of diabetes mellitus.

STUDENT RESOURCES understand

       

Textbook Chapter 41 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 41 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

44-293

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

REGULATION OF GLUCOSE METABOLISM Hormonal Regulation Neural Regulation Exercise Stress

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

GLUCOSE INTOLERANCE DISORDERS Classification of Glucose Intolerance Disorders Pre-Diabetes Diabetes Mellitus Screening for Diabetes CLINICAL MANIFESTATIONS AND COMPLICATIONS

Identify the major symptoms and complications of diabetes.

 

Discussion Topic: Have students distinguish the three characteristic clinical manifestations of diabetes. See guidelines below.

Activity: have students complete the Hyperosmolar Coma vs. Diabetic Ketoacidosis Activity below.

Acute Hyperglycemia Diabetic Ketoacidosis Nonketotic Hyperglycemic Hyperosmolar Syndrome Chronic Hyperglycemia Vascular Complications Neuropathic Complications Complications in Pregnancy

Copyright © 2019, Elsevier Inc. All rights reserved.

44-295

TEACHING STRATEGIES Content Focus TREATMENT AND EDUCATION

Content Highlights Review the major treatment options for diabetes.

Learning Activities 

Nutrition Obesity and Eating Disorders Exercise



Activity: Have students choose a patient, friend, or family member who has diabetes. Describe the following: type of diabetes, initial signs and symptoms when diabetes was diagnosed, and any acute or chronic complications the person has experienced. Choose one sign or symptom or complication and briefly explain its pathophysiology. Be sure to maintain confidentiality.

Online Activity: Perform a literature search in a database of professional journal articles on the pathophysiology of one of the following: diabetic retinopathy, diabetic nephropathy, or diabetic autonomic neuropathy. Write a brief summary for your classmates and include at least three current references beyond your textbook.

Pharmacologic Agents Stress Management Assessment of Efficacy PEDIATRIC CONSIDERATIONS Goals of Therapy Acute Complications Chronic Complications Treatment, GERIATRIC CONSIDERATIONS Goals of Therapy

Copyright © 2019, Elsevier Inc. All rights reserved.

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Acute Complications Chronic Complications Treatment

Three Characteristic Clinical Manifestations of Diabetes Discussion Topic Diabetes of any type is characterized by hyperglycemia, which causes three characteristic clinical manifestations:   

Polyuria Polydipsia Polyphagia

Polyuria, excessive urination, occurs because sugar in the urine causes osmotic diuresis. Normally, the urine does not contain sugar. When the blood glucose concentration is not elevated, all of the glucose that is filtered into the renal tubules at the glomerulus is reabsorbed into the blood in the proximal tubules, as indicated in the figure. However, this reabsorption process has a limit, called a transport maximum. When the blood sugar is very high, the transport maximum is exceeded. More glucose is filtered at the glomerulus than the proximal tubule cells can reabsorb, so sugar remains in the renal tubules. The sugar particles attract water by osmosis, which increases the volume of urine that is formed.

Hence, polyuria is a classic sign of hyperglycemia.

Polydipsia, excessive thirst, accompanies hyperglycemia for several reasons. The high extracellular glucose concentration may cause osmotic changes in the brain cells that trigger the thirst sensation (osmoreceptor-mediated thirst). In addition, decreased blood volume from profound polyuria also triggers thirst (angiotensin-mediated and baroreceptor-mediated thirst). In the scenario at the beginning of this module, Tony’s thirst caused him to drink an entire case of soda in one day.

Polyphagia, excessive eating, arises because insulin is not maintaining intracellular stores of nutrients. This lack stimulates the hypothalamic neurons that trigger hunger. In type 1 diabetes, polyphagia most often occurs simultaneously with weight loss.

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44-297 Polyuria, polydipsia, and polyphagia are associated with hyperglycemia from any cause, so they may appear with undiagnosed diabetes of any type or when the blood sugar is not managed completely during treatment.

Hyperosmolar Coma vs. Diabetic Ketoacidosis Activity Answer options:        

Decreased level of consciousness caused by osmotic cell shriveling Insulin is low Ketoacids Decreased level of consciousness caused by decreased pH Blood glucose >600 mg/dL Insulin is absent Blood glucose of 300 to 600 mg/dL No ketoacids

Diabetic Ketoacidosis

Hyperosmolar Coma

Answer Diabetic Ketoacidosis    

Decreased level of consciousness caused by decreased pH Ketoacids Blood glucose of 300 to 600 mg/dL Insulin is absent

Hyperosmolar Coma    

Insulin is low Decreased level of consciousness caused by osmotic cell shriveling No ketoacids Blood glucose >600 mg/dL

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44-298

IN-CLASS/ONLINE CASE STUDY DK is an 18-year-old high school student who began to experience weight loss despite a ravenous appetite and resulting increased dietary intake. She has to make frequent trips to the bathroom to urinate and has difficulty concentrating on her work because of fatigue. She drinks large volumes of coffee to help with a constant dry mouth and to combat her fatigue. At a clinic appointment, it was noted that DK’s weight has dropped from 140 lb to 128 lb. She is 5 feet, 7 inches tall. Her urine specimen shows glycosuria and ketonuria. A chemstick blood glucose level is 412 mg/dL. DK had eaten breakfast 3 hours before the chemstick blood test.

1. Considering DK’s presenting history and physical data, what form of diabetes mellitus is indicated?

Answer:  Type 1 diabetes mellitus: relatively recent onset of symptoms, age 20 years or younger, rapid weight loss, fatigue, and ketonuria are the key signs differentiating type 1 from type 2  Common to both type 1 and 2: increased appetite (polyphagia), polyuria, dry mouth (dehydration), glucosuria, hyperglycemia 2. What are the physiologic mechanisms involved with the polydipsia, polyuria, and polyphagia in diabetes mellitus?

Answer:   

Polydipsia = hyperglycemia → blood hyperosmolality → cells shrink, and renal glucose threshold is exceeded → glucosuria → dehydration → increased thirst triggered by thirst center in the brain Polyuria = hyperglycemia → blood hyperosmolality → renal glucose threshold is exceeded → glucosuria → osmotic diuresis → polyuria Polyphagia = insulin deficiency → catabolism of proteins and fats for energy (instead of glucose) → negative energy balance → increased appetite

3. What immediate and long-term therapy will DK need to manage her disorder?

Answer: 

Insulin in conjunction with frequent blood glucose, urinary ketones, and HbA1c monitoring

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44-299 4. DK will have to frequently monitor her own glucose levels to evaluate her diabetic control. What range of blood glucose should she be advised to aim for?

Answer:   

Less than 120 mg/dL fasting Less than 180 mg/dL postprandial Maintain HbA1c less than 7%

5. DK needs to understand the signs and symptoms of hypoglycemia so that she can quickly intervene to prevent life-threatening complications. How can she recognize hypoglycemia and what should she do when it occurs?

Answer:  

Hypoglycemia is characterized by pallor, diaphoresis, anxiety, tremors, cardiac palpitations, weakness, paresthesias, agitation, confusion, irritability, and hunger.

Management consists of testing blood glucose, administering fast-acting carbohydrate (like orange juice) followed by a complex carbohydrate (e.g., crackers and milk) to prevent rebound hypoglycemia. Have glucose tablets on hand and teach others about administering them or possibly glucagon if nonresponsive.

6. DK’s health care provider plans to routinely monitor glycosylated hemoglobin levels (HbAM1c). What information can be gained from this laboratory test?

Answer:  

Reflects the mean blood glucose level over the past 2 to 3 months HbA1c increases 1% for each 30-mg/dl increase in blood glucose.

7. DK should be aware of the potential acute and long-term complications of diabetes mellitus. What are they?

Answer:  

Acute complications are hypoglycemia and diabetic ketoacidosis.

Microvascular complications are retinopathy, nephropathy, and neuropathy.

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44-300  

Macrovascular complications are hypertensive nephropathy, coronary artery disease or myocardial infarction, peripheral vascular disease, stroke or transient ischemic attack, poor wound healing (foot ulcers), and infections.

Neuropathic complications include sensory (paresthesias) and autonomic (constipation, poor bladder emptying, resting tachycardia, postural hypotension).

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment and Education o Pediatric Considerations o Geriatric Considerations

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Acid-Base Balance o Exemplar: Diabetic Ketoacidosis

TEACH FOR NURSES LESSON PLAN

Copyright © 2019, Elsevier Inc. All rights reserved.

44-301

Chapter 42: Nutritional and Metabolic Disorders CHAPTER OBJECTIVES 1. Identify the primary nutrients and explain how they are metabolized by cells.

2. Explain what basal metabolic rate is and how it is affected by age, body type, and illness.

3. Explain how genetics, epigenetics, and environment contribute to altered metabolism, metabolic syndrome, and obesity.

4. Identify the hormones involved in the control of appetite and nutrient metabolism.

5. Explain how starvation, physiologic stress, aging, and altered health states affect body metabolism.

STUDENT RESOURCES understand

       

Textbook Chapter 42 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 42 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

44-302

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus METABOLIC PROCESSES

Content Highlights Review the two major metabolic processes.

Learning Activities 

Discussion Topic: Refer students to Table 42-1: Examples of Factors affecting Basal Metabolic Rate and ask them to identify ways of mitigating factors adversely impacting the basal metabolic rate.



Online Activity: Have students visit http://www.eatright.org/Public to explore nutrition resources.

Activity: Have students role-play to become comfortable explaining the definition of carbohydrates, lipids, and proteins to patients or clients.

Anabolism and Catabolism Metabolic Rate NUTRIENT METABOLISM Carbohydrates



Lipids Proteins REGULATION OF APPETITE AND NUTRIENT METABOLISM Role of Genetics, Epigenetics and

Copyright © 2019, Elsevier Inc. All rights reserved.

44-303

TEACHING STRATEGIES Content Focus

Content Highlights

Environment Hormonal Regulation of Nutrient Intake and Appetite Hormonal Regulation of Nutrient Storage, Distribution and Metabolism OBESITY AND METABOLIC SYNDROME Obesity Metabolic Syndrome METABOLIC RESPONSES TO STARVATION AND PHYSIOLOGIC STRESS Starvation and ProteinEnergy Malnutrition Physiologic Stress NUTRITIONAL CONSIDERATIONS FOR AGING AND ALTERED HEALTH STATES Aging Infection, Sepsis, and Fever

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Surgery Trauma Burns Cancer Immobility

IN-CLASS/ONLINE CASE STUDY Marc is a 15-year-old boy with short stature and delayed sexual development (height, 60 inches; weight ,110 lb, Tanner stage II). Marc’s younger brother, age 13 years, is taller and more developed than Marc. Evaluation for bone age demonstrates an approximate age of 12 years.

1. What are the potential causes of short stature in this case?

Answer:        

Idiopathic or normal variant short stature Growth hormone deficiency (GHD) Hypogonadism Hypothyroidism Diabetes mellitus type 1, poorly controlled Hypothalamic or pituitary tumor Malnutrition Intrauterine growth retardation

2. What further history, physical, and laboratory data would be helpful in determining the cause?

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Answer:   

History should include family history (parental heights, relatives with short stature, genetic syndromes), history of prenatal insults, social and nutritional components.

Physical examination should include examination of sexual development, nutritional status, disproportionate body size, and observation for stigmata of genetic syndromes.

Laboratory data to be considered include complete blood count for evidence of anemia, inflammation, infection, malignancy, and bone marrow suppression; electrolytes, blood urea nitrogen, urinalysis to assess renal status; erythrocyte sedimentation rate to screen for inflammatory bowel disease or other chronic inflammatory disorders; thyroxine (T4) and thyroid-stimulating hormone (TSH) to exclude hypothyroidism; blood test to check levels of growth hormone, insulin-like growth factor I and II (IGFI, IGF-II) and IGF binding protein-3 (IGFBP-3) to rule out GHD; growth hormone (GH) provocation tests; blood tests for testosterone levels drawn in the morning and repeated if below normal to rule out hypogonadism.

3. Under what conditions might GH replacement be indicated? What are the benefits and risks of this therapy?

Answer:     

Early management of GHD with an adequate dose of GH will, in most cases, normalize growth to a near-normal adult height.

GH is given by frequent injections (3–7 days/week), which may be a consideration of risk.

GH therapy can restore lean body mass, reduce excess or abnormal body fat, prevent hypoglycemia, and allow the child to reach his genetic height potential.

GH therapy is essentially safe.

Risk of hypothyroidism, hyperinsulinism, glucose tolerance, and type 2 diabetes require ongoing evaluation.

4. Under what conditions might testosterone be given? What are the benefits and risks of this therapy?

Answer:   

Testosterone injections are an effective and safe treatment for constitutionally delayed growth and may increase height in the short term.

Benefits include increased lean muscle-to-fat ratio, bone density, and energy.

Risks include acne, edema, gynecomastia, impotence, and decreased ultimate achievement in height caused by speeding closure of the epiphyseal plates.

Copyright © 2019, Elsevier Inc. All rights reserved.

44-306

5. What does bone age of 12 years suggest about the potential for achieving further linear bone growth?

Answer: 

Growth potential is maintained with delayed bone age, and the child has good potential to reach normal adult stature.

NURSING CURRICULUM STANDARDS

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Metabolic Syndrome o Exemplar: Obesity THEME: Protection and Movement  Concept: Infection o Exemplar: Infection, Sepsis, and Fever

TEACH FOR NURSES LESSON PLAN Chapter 43: Structure and Function of the Nervous System

Copyright © 2019, Elsevier Inc. All rights reserved.

44-307

CHAPTER OBJECTIVES 1. Explain how the central nervous system (CNS), peripheral nervous system, and autonomic nervous system interrelate.

2. Explain how the CNS is protected and supported.

3. Identify the structures located in each of the four principal areas of the brain: cerebrum, diencephalon, cerebellum, and brainstem.

4. Identify the neurologic functions that have been mapped to particular locations in the brain.

5. Describe how the properties of neuronal action potentials and neuronal communication through synapses relate to the functions of the nervous system.

6. Explain how the somatotopic organization of sensory receptors, sensory pathways, and muscle control is maintained in the CNS. 7. Describe how voluntary muscle activity is initiated and executed.

8. Explain how the properties of the mind, including thought, memory, learning, consciousness, and sleep, relate to the physiologic substance of the nervous system.

STUDENT RESOURCES understand

       

Textbook Chapter 43 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 43 Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

44-308

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

STRUCTURAL ORGANIZATION CENTRAL NERVOUS SYSTEM

Provide an overview of the structure and function central nervous system (CNS).

Support and Protection of the Central Nervous System





Online Activity: Have students visit http://www9.biostr.washington.edu/ cgi-bin/DA/PageMaster?atlas:Neuroanatomy+ffpathIndex:Splash^Page+2 to access photographs with quizzes, three-dimensional composites, and some animations of brain anatomy.

Discussion Topic: Refer students to Figures 43-1 through 43-18 in the text to review the structural organization of the CNS.

The Brain The Spinal Cord PERIPHERAL NERVOUS SYSTEM

Provide an overview of the structure and function of the peripheral nervous system.

Cranial Nerves Spinal Nerves AUTONOMIC NERVOUS

Copyright © 2019, Elsevier Inc. All rights reserved.

44-309

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

SYSTEM NEURONAL STRUCTURE AND FUNCTION NEURONS AND SUPPORTIVE CELLS

Review the components and functions of the two principal cell types.



Online Activity: Direct students to http://people.eku.edu/ritchisong/ 301notes2.htm for additional review of the neurons and the nervous system.

Neurons Glia NEURONAL COMMUNICATION Membrane Potentials Synaptic Transmission Neurotransmitters Neuronal Circuits NEURAL DEVELOPMENT, AGING, AND INJURY Development Aging Injury SENSORY FUNCTION

Copyright © 2019, Elsevier Inc. All rights reserved.

44-310

TEACHING STRATEGIES Content Focus

Content Highlights

SENSORY RECEPTORS SENSORY PATHWAYS SOMATOSENSORY CORTEX MOTOR FUNCTION MOTOR NEURONS SPINAL REFLEXES CENTRAL CONTROL OF MOTOR FUNCTION CONSCIOUSNESS, MEMORY, AND SLEEP CONSCIOUSNESS AND MEMORY SLEEP

IN-CLASS/ONLINE CASE STUDY

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

44-311 CF comes to see you and talk about his grandmother, KF, who is 89 years of age. She is not as responsive as she used to be. When he went to see her, he could tell that she was forgetting to take her medications, and he noticed that her tremor had increased. He asks you if it is time for KF to stop driving.

1. How would you explain to CF the changes in the brain with aging?

Answer:  Decreased cerebral flow leads to a decrease in oxygen utilization and increased permeability of the blood–brain barrier.  There will be a decrease in number of neurons and neurofibrillary tangles in the hippocampus that leads to a decrease in white and gray matter.  This can lead to gyral narrowing, sulci widening, and ventricular dilation.

2. How would you explain to CF why her tremors have increased?

Answer:  There is a change in the secretion and metabolism of neurotransmitters with a decrease in dopamine and norepinephrine and an increase in monoamine oxidase.  Decreased dopamine leads to decreased inhibitory motor functions.

3. How would you explain to CF why it is best that KF not drive anymore?

Answer:  Dendrites shrink, which lead to slowed impulses and decreased neuromuscular coordination and an increase in forgetfulness and cognitive processing.  Degeneration of the myelin sheath leads to decreased motor neuron conduction and decreased reaction time.

TEACH FOR NURSES LESSON PLAN Chapter 44: Acute Disorders of Brain Function CHAPTER OBJECTIVES

Copyright © 2019, Elsevier Inc. All rights reserved.

44-312 1. Describe the proposed mechanisms and potential consequences of secondary brain injury.

2. Identify the brain components that determine intracranial pressure and describe under what conditions each might contribute to elevated intracranial pressure.

3. Explain how level of consciousness and cranial nerve reflexes are used to assess changes in neurologic status in the brain-injured patient.

4. Describe each of the common manifestations of types of traumatic brain injury (focal, polar, diffuse) and hemorrhage (epidural, subdural, subarachnoid).

5. Describe how the three most common causes of stroke (thrombi, emboli, and hemorrhage) differ with regard to risk factors, prevention strategies, and acute management.

6. Explain how the clinical manifestations of ischemic stroke vary depending on the location of cerebral artery obstruction.

7. Describe the common long-term sequelae of stroke and explain how they are managed.

8. Explain the causes and usual presentations of cerebral aneurysm and arteriovenous malformation.

9. Describe how meningitis and encephalitis differ with regard to usual infective organisms, cerebrospinal fluid analysis findings, clinical manifestations, and treatment.

STUDENT RESOURCES understand

       

Textbook Chapter 44 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 44* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

44-313

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus MECHANISMS OF BRAIN INJURY

Content Highlights

Learning Activities

Review the various mechanisms of brain injury.



Activity: Have students complete the Mechanisms of Brain Injury Activity below.

Review the manifestations of brain injury.



Activity: Have students complete the Manifestations of Brain Injury Activity below.

Ischemia and Hypoxia Increased Intracranial Pressure MANIFESTATIONS OF BRAIN INJURY Level of Consciousness Glasgow Coma Scale Cranial Nerve Reflexes TRAUMATIC BRAIN INJURY EPIDEMIOLOGY

Copyright © 2019, Elsevier Inc. All rights reserved.

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

TYPES OF TRAUMATIC BRAIN INJURY PRIMARY INJURY Intracranial Hematomas SECONDARY INJURY TREATMENT CEREBROVASCULAR DISEASE AND STROKE

Describe the symptoms and treatment for cerebrovascular disease and stroke.



Discussion Topic: Ask students if they have a patient, friend, or family member who has had a brain injury or cardiovascular disease and stroke and have them describe the risk factors that may have led to the development of the specific problem. Explain how these risk factors may have resulted in development of the disorder. What were the signs and symptoms? How did they compare with those listed in this textbook? Why might there have been some differences? Remind students to be sure to maintain confidentiality.



Online Activity: Have students perform a literature search in a database or professional journal articles on one of the topics covered in this chapter.

Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated.

Instruct them to cite their references.

EPIDEMIOLOGY ISCHEMIC STROKE HEMORRHAGIC STROKE TREATMENT STROKE SEQUELAE

Copyright © 2019, Elsevier Inc. All rights reserved.

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Motor and Sensory Deficits Language Deficits Cognitive Deficits CEREBRAL ANEURYSM AND ARTERIOVENOUS MALFORMATION CENTRAL NERVOUS SYSTEM INFECTIONS

Mechanisms of Brain Injury Activity Answer options:  autoregulation  neurotransmitters  concentration  potassium  volume  lipids  cell swelling  ATP

      

demand reperfusion free radicals enzymes calcium supply reflow

Have students use the key terms to complete the sentences below: 1. Increased intracranial pressure arises from factors that increase the ___________ of brain tissue, blood, or cerebrospinal fluid.

2. Secondary injury that occurs after reestablishing blood flow to an ischemic area of the brain is called _____________ injury.

3. Excitatory _________________, such as glutamate, overstimulate and damage neurons by causing intracellular _____________ overload and production of _______________ that damage membranes.

Copyright © 2019, Elsevier Inc. All rights reserved.

44-316 4.

5.

6.

7.

Failure of _______________ in the brain leads to an imbalance between blood flow and oxygen ________________.

Mitochondrial dysfunction in ischemic neurons causes decreased synthesis of _____________ and intracellular accumulation of _________________.

Cerebral edema may be interstitial or caused by _______________________.

Calcium overload in neurons activates _______________________that damage cell membranes.

Answers: 1. volume 2. reperfusion 3. neurotransmitters, calcium, free radicals 4. autoregulation, demand 5. ATP, calcium 6. cell swelling 7. enzymes

Manifestations of Brain Injury Activity Answer options:  dysconjugate  unconscious  comatose  nystagmus  extension  lethargic  II and III  obtunded

      

stuporous conscious confused III, IV, and VI dilated pinpoint flexion

Copyright © 2019, Elsevier Inc. All rights reserved.

Have students use the key terms to complete the sentences below: 1.

2.

3.

4.

5.

6.

The pupil reflex tests the function of the brainstem and cranial nerves ________________.

A person who is unable to be aroused, even by vigorous painful stimuli, is _______________.

Persistent jerky movements of the eyes are called _________________.

A person who is disoriented and unable to problem-solve is _____________________.

A person who is aroused by vigorous stimuli but falls asleep again is ______________.

Whereas decorticate posturing is abnormal _________________ of the upper extremities, posturing is abnormal _____________ of the upper extremities; extension of the lower extremities occurs in both types of posturing.

7. The oculovestibular reflex is tested only in _________________ individuals.

8. Increased intracranial pressure can cause fixed, ____________ pupils.

Answers: 1. II and III 2. comatose 3. nystagmus 4. confused 5. stuporous 6. flexion, extension 7. unconscious 8. dilated

IN-CLASS/ONLINE CASE STUDY MG is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104 °F, lethargy, headache, and stiff neck. Laboratory analysis of a spinal tap demonstrates increased white blood cells in the cerebrospinal fluid (CSF).

1. What is the most likely cause of MG’s signs and symptoms? What is the origin and pathogenesis? What other laboratory findings would be consistent with this etiology?

Answer:  MG most likely has bacterial meningitis.  Meningitis is the inflammation of the meninges, the membranes covering the brain and spinal cord.

Copyright © 2019, Elsevier Inc. All rights reserved.

45-318   

It may begin with an infection of the ears or sinuses, or endogenous organisms of the nasopharynx may invade the CSF. The organisms may access the CSF via openings in the dura after head injury or neurosurgery.

Most likely organisms are Streptococcus pneumonia or Neisseria meningitidis. Infections caused by Haemophilus influenza were common in children before the development of a vaccine.

Laboratory diagnosis of bacterial meningitis is made primarily on the basis of CSF characteristics. The CSF is normally clear, but with bacterial meningitis, the white blood cell count is increased (often more than 1000/µL), with neutrophil predominance, making the fluid appear cloudy. The glucose level is decreased (<40 mg/dL), and the protein level is increased (often >100 mg/dL). Gram stain and culture of the CSF are important laboratory tests in determining the appropriate antimicrobial therapy.

2. What are common complications of this disorder, and how would one assess for their occurrence?

Answer:     

Sensory changes are more frequently noted. Visual impairment, including optic neuritis, may follow bacterial meningitis.

Deafness is also common. Assessments of vision and auditory studies should be initiated after recovery.

Seizures may occur during or after meningitis. Seizure precautions should be initiated and family members taught to watch for them as well as what to do if they occur.

Muscle weakness, headaches, and encephalitis are also possible, requiring assessments subsequent to recovery.

Personality changes may be noted. Family members are most likely to observe these.

The organisms may be transmitted into the bloodstream, causing colonization in the lungs (pneumonia) or the heart (endocarditis). Manifestations associated with either of these should be assessed.

3. What is the usual treatment for this disorder?

Answer:    

Most of the damage is not caused by the infection itself but rather by the inflammation it initiates.

Prompt initiation of targeted antimicrobial therapy is essential.

When the cause is bacterial, the destruction of the organisms may add to the inflammation. Concurrent glucocorticoid therapy is recommended by many for this reason.

The efficacy of therapy should be followed throughout the course of treatment, including signs and symptoms, microbiological findings, and CSF examination.

Copyright © 2019, Elsevier Inc. All rights reserved.

45-319

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Management o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Intracranial Regulation o Exemplar: Increased Intracranial Pressure o Exemplar: Levels of Consciousness (LOC) o Exemplar: Cerebrovascular Disease and Stroke THEME: Protection and Movement  Concept: Infection o Exemplar: Meningitis/Encephalitis THEME: Mood and Cognition  Concept: Cognition o Exemplar: Traumatic Brain Injury o Exemplar: Cerebrovascular Disease and Stroke

TEACH FOR NURSES LESSON PLAN

Copyright © 2019, Elsevier Inc. All rights reserved.

45-320

Chapter 45: Chronic Disorders of Neurologic Function CHAPTER OBJECTIVES 1. Explain how the various types of seizures are recognized, classified, and treated.

2. Explain how Alzheimer dementia is diagnosed and managed.

3. Identify the similarities between Alzheimer dementia and vascular dementia.

4. Describe the proposed neurotransmitter alterations in Parkinson disease and explain how drugs are used to restore balance.

5. Describe the similarities and differences between multiple sclerosis and amyotrophic lateral sclerosis.

6. Describe how congenital disorders, such as cerebral palsy, hydrocephalus, and spina bifida, are manifested in the newborn.

7. Explain how the level of spinal cord injury relates to expected functional losses and clinical manifestations.

8. Identify the roles of immune mechanisms in Guillain-Barré syndrome, amyotrophic lateral sclerosis, and multiple sclerosis.

9. Describe the causes of facial paralysis in Bell palsy and explain how this condition is different from other chronic disorders of neurologic function.

STUDENT RESOURCES understand

       

Textbook Chapter 45 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 45* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

45-321

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus BRAIN AND CEREBELLAR DISORDERS

Content Highlights

Learning Activities

Provide an overview of the brain and cerebellar disorders.



Online Activity: Have students complete the tutorial for CNS Degenerative Diseases located at http://library.med.utah.edu/WebPath/TUTORIAL/CNS/ CNSDG.html.

Provide an overview of spinal cord and peripheral nerve disorders.



Discussion Topic: Ask students if they have a patient, friend, or family member who has a spinal cord or peripheral nerve disorder and have them

Seizure Disorder Dementia Parkinson Disease Cerebral Palsy Hydrocephalus Cerebellar Disorders SPINAL CORD AND PERIPHERAL NERVE

Copyright © 2019, Elsevier Inc. All rights reserved.

45-322

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

DISORDERS Multiple Sclerosis Spina Bifida Amyotrophic Lateral Sclerosis



Spinal Cord Injury Guillain-Barré Syndrome Bell Palsy



describe the risk factors that may have led to the development of the specific problem. Explain how these risk factors may have resulted in development of the disorder. What were the signs and symptoms? How did they compare with those listed in this textbook? Why might there have been some differences? Remind students to be sure to maintain confidentiality.

Activity: Have students perform a literature search in a database or professional journal articles on one of the topics covered in this chapter.

Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated.

Instruct them to cite their references.

Online Activity: Have students visit http://www.mayoclinic.org/diseasesconditions/multiple-sclerosis/home/ovc-20131882 to learn more about multiple sclerosis.

Copyright © 2019, Elsevier Inc. All rights reserved.

IN-CLASS/ONLINE CASE STUDY FP is a 66-year-old man hospitalized for surgical management of an enlarged prostate. His chart indicates that he has had Parkinson disease for 5 years before admission and has been managed with a dopamine precursor (levodopa/carbidopa). He also has a seizure history, having experienced a seizure about 20 years ago as a complication of a motor vehicle accident. He took an anticonvulsant medication for many years but stopped taking it about 3 years ago because he was “tired of taking it” and hadn’t had a seizure since the accident.

1. What types of motor difficulties would FP be expected to exhibit related to his Parkinson disease?

Answer:  Akinesia and bradykinesia  Rigidity and cogwheel movements  Resting tremor  Propulsive gait, short shuffling steps  Mask-like face, drooling, dysarthria 2. What is the rationale for managing Parkinson disease with a dopamine precursor?

Answer:   

Virtually all motor symptoms are caused by the loss of dopamine-secreting neurons in the substantia nigra region of the brain.

Drugs can restore dopamine at the synapse.

Dopamine doesn’t cross the blood-brain barrier well, but L-dopa does. Carbidopa prevents peripheral conversion of L-dopa to dopamine, so that more is available to the brain and there are fewer cardiovascular side effects.

3. What safety and activities-of-daily-living problems might FP have encountered while hospitalized?

Answer:   

Increased risk for falls because of maneuvering and balance problems caused by muscle rigidity, decreased range of motion, and shuffled gait Increased risk for choking and aspiration because of difficulty with chewing and swallowing Difficulty with bathing, dressing, and eating because of muscle rigidity, decreased range of motion, weakness, and fatigue

Copyright © 2019, Elsevier Inc. All rights reserved.

48-324

4. If FP experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?

Answer:        

Airway, breathing, circulation Changes in level of consciousness Presence of prodrome or aura Time of onset and duration of seizure Description of progression of seizure activity Autonomic indicators Postictal behaviors Seizure would be managed with oxygen, maintenance of a patent airway, and protection from injury. Anticonvulsant medication would be initiated.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Diagnosis and Treatment o Clinical Manifestations and Treatment o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

Copyright © 2019, Elsevier Inc. All rights reserved.

48-325 A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Protection and Movement  Concept: Mobility o Exemplar: Parkinson Disease o Exemplar: Multiple Sclerosis o Exemplar: Spinal Cord Injury THEME: Mood and Cognition  Concept: Cognition 1. Exemplar: Dementia

TEACH FOR NURSES LESSON PLAN Chapter 46: Alterations in Special Sensory Function CHAPTER OBJECTIVES 1. Describe the general functions and structures of the ear and eye.

2. Describe the general manifestations of hearing impairment.

3. Explain how conductive and sensorineural mechanisms of hearing loss differ in etiology and treatment.

4. Identify the predisposing factors, clinical manifestations, and management of otitis media.

5. Describe the general manifestations of visual impairment.

6. Describe the causes, clinical manifestations, and management of common visual disorders, including errors of refraction, strabismus, cataract, and retinopathies.

7. Distinguish between open-angle and acute angle-closure glaucoma.

8. Differentiate the two forms of macular degeneration.

9. Describe the causes, clinical manifestations, and management of smell and taste disorders.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

48-326

understand

       

Textbook Chapter 46 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 46* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus HEARING AND BALANCE STRUCTURE AND

Content Highlights Review the anatomy and function of the ear.

Learning Activities 

Discussion Topic: Refer students to Figure 46-1 to identify the structure of

Copyright © 2019, Elsevier Inc. All rights reserved.

48-327

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

FUNCTION OF THE EAR

the ear.

External Ear Middle Ear Inner Ear Balance GENERAL MANIFESTATIONS OF HEARING IMPAIRMENT HEARING IMPAIRMENT DISORDERS

Provide an overview of hearing impairment disorders.



Conductive Hearing Impairment Sensorineural Hearing Impairment



Activity: Ask students if they have a patient, friend, or family member who has a hearing impairment disorder and have them describe the risk factors that may have led to the development of the specific problem. Explain how these risk factors may have resulted in development of the disorder. What were the signs and symptoms? How did they compare with those listed in this textbook? Why might there have been some differences? Remind students to be sure to maintain confidentiality.

Online Activity: Have students visit http://www.cdc.gov/niosh/topics/ noise/ to learn about noise and hearing loss prevention.

OTITIS MEDIA INTERVENTIONS FOR INDIVIDUALS WITH HEARING IMPAIRMENT VISION STRUCTURE OF THE EYE

Review the anatomy and function of the eye.



Discussion Topic: Refer students to Figure 46-4 to review the structure of the eye.

Copyright © 2019, Elsevier Inc. All rights reserved.

48-328

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

VISUAL PATHWAYS

GENERAL MANIFESTATIONS OF VISUAL IMPAIRMENT DISORDERS OF THE EYE

Provide an overview of vision disorders.

Errors of Refraction Age-Related Disorders



Activity: Have students perform a literature search in a database or professional journal articles on one of the vision disorders covered in this chapter. Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated. Instruct them to cite their references.

Retinopathy Glaucoma Visual Field Deficits INTERVENTIONS FOR INDIVIDUALS WITH VISION IMPAIRMENT SMELL AND TASTE

IN-CLASS/ONLINE CASE STUDY NL is a 22-year-old woman who comes to you with complaints of ringing in her ears and dizziness. She tells you that she has not been ill, but the dizziness comes and goes. She denies any relationship to position change. She notes she was in a car wreck about 6 months ago.

1. What is Meniere disease?

Copyright © 2019, Elsevier Inc. All rights reserved.

48-329

Answer:  Excessive accumulation of endolymph in the membranous labyrinth, with the eventual rupture of the membrane  The neural ends of the cochlea will degenerate.  Possible causative agents are allergies, viral and bacterial infections (syphilis), head trauma, metabolic diseases, and chronic stress.  Seen in both men and woman between the ages of 20 and 50 years 2. What are the signs and symptoms of Meniere disease?

Answer:     

Tinnitus, fluctuating hearing loss, vertigo, and a sensation of fullness in the ear. It usually starts with tinnitus, progressing to hearing loss and then to vertigo.

Common to have periods of remissions and exacerbations Hearing loss is mainly low tones and can progress to permanent loss.

Mainly unilateral but may progress to bilateral after 7 years Nystagmus is seen in later stages of the disease and is seen in the contralateral ear.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Clinical Manifestations and Treatment o Diagnosis and Treatment o Interventions for Individuals with Hearing Impairment o Interventions for Individuals with Vision Impairment

Copyright © 2019, Elsevier Inc. All rights reserved.

48-330

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Protection and Movement  Concept: Sensory Perception o Exemplar: Disorders of the Eye o Exemplar: Cataracts o Exemplar: Retinopathy o Exemplar: Glaucoma

TEACH FOR NURSES LESSON PLAN Chapter 47: Pain CHAPTER OBJECTIVES 1. Explain how the processes of transduction, transmission, perception, and modulation relate to the phenomenon of nociception.

2. Describe how the neurotransmission of pain signals is modulated at the receptor, spinal cord, and brain.

3. Describe how acute pain and chronic pain differ with regard to cause and clinical manifestations.

4. Explain why some painful sensations are perceived at a distance from the site of injury (referred).

5. Explain why it is important to adequately manage pain.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

48-331

understand

       

Textbook Chapter 47 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 47* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

PHYSIOLOGY OF PAIN

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

48-332

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Transduction Transmission Perception Modulation TYPES OF PAIN

Provide an overview of the different types of pain and how they manifest.









Activity: Have students perform a literature search in a database or professional journal articles on one of the types of pain discussed in this chapter. Have them read at least three articles written for health professionals and summarize the eventual consequences of this disease if left untreated. Instruct them to cite their references.

Activity: Ask students if they have a patient, friend, or family member who is dealing with acute or chronic pain. Have them describe the signs and symptoms. How did they compare with those listed in this textbook? Why might there have been some differences? Remind students to be sure to maintain confidentiality.

Online Activity: Have students visit http://www.bayareapainmedical.com to animations illustrating pain. Click the animations button to see the presentations.

Discussion Topic: Discuss how children manifest pain as compared to adults. Then discuss how one’s background or culture may affect how they respond to and express pain.

ACUTE PAIN Headache CHRONIC PAIN Fibromyalgia Syndrome CANCER-RELATED PAIN

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48-333

TEACHING STRATEGIES Content Focus

Content Highlights

NEUROPATHIC PAIN Trigeminal Neuralgia Diabetic Neuropath Postherpetic Neuralgia ISCHEMIC PAIN REFERRED PAIN PHYSIOLOGIC RESPONSES TO PAIN PAIN IN THE YOUNG AND THE ELDERLY TREATMENT MODALITIES PHARMACOLOGIC AND NONPHARMACOLOGIC PAIN MANAGEMENT Interrupting Peripheral Transmission of Pain Modulating Pain Transmission at the Spinal Cord Altering the Perception and Integration of Pain

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

48-334

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

IN-CLASS/ONLINE CASE STUDY AS is a 32-year-old woman who complains of headaches that she has been experiencing for the past few months. The pain is constant, and when she is having it, she has nausea and occasionally will vomit. She tells you that when she gets them, she will put herself in a dark room and try to keep quiet. AS is sure she has migraines but asks you to tell her about them.

1. How would you describe to AS what a migraine is?

Answer:  Migraines are one of the most common forms of headache.  It is now thought to be a dysfunction of the brainstem in the craniovascular afferent fibers.  Inflammatory chemicals are released that lead to vasodilation.  Migraine triggers stimulate the inflammatory chemicals and are thought to have some genetic predisposition.  After the brainstem has been activated, it causes pain signals to be sent to the thalamus and cerebral cortex.

2. What symptoms would you advise AS to expect?

Answer:  Unilateral throbbing with nausea and vomiting is seen with photophobia, phonophobia, and lacrimation.  Auras, such as flashing lights or other visual changes, are sometimes experienced.  Neck tenderness and stiffness may be felt along with vertigo and changes in bowel patterns.

3. What would you tell AS about the International Headache Society’s diagnostic criteria?

Answer:

Copyright © 2019, Elsevier Inc. All rights reserved.

48-335   

They are criteria used by many health care providers to diagnose migraines Headaches lasting between 4 and 72 hours and including at least two of the following symptoms: unilateral location, pulsating quality, moderate or severe intensity, or be aggravated by physical activity.

The person must have nausea, vomiting, photophobia, or phonophobia. If aura is involved, it will last no more than 60 minutes— usually around 5 to 20 minutes.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment Modalities o Diagnosis and Treatment o Pharmacologic and Nonpharmacologic Pain Management

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Protection and Movement  Concept: Pain o Exemplar: Types of Pain o Exemplar: Cancer-Related Pain o Exemplar: Headaches

TEACH FOR NURSES LESSON PLAN

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48-336

Chapter 48: Neurobiology of Psychotic Illnesses CHAPTER OBJECTIVES 1. Describe the “positive” and “negative” symptoms of schizophrenia.

2. Identify the genetic, gestational, and neurologic risk factors that are related to schizophrenia.

3. Explain how the dopamine D1 and D2 receptors are related to positive and negative symptoms of schizophrenia.

4. Describe how schizophrenia is managed.

5. Identify the hallmark symptoms of major depression.

6. Describe the neurobiology of major depression.

7. Identify the subtypes of bipolar disorder.

8. Explain how major depression and bipolar disorder are managed.

STUDENT RESOURCES understand

       

Textbook Chapter 48 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 48* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

48-337

before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus THOUGHT DISORDER, DELIRIUM, AND DEMENTIA

Content Highlights Discuss the manifestations and treatment and management options for the major thought disorders.

Learning Activities  

Schizophrenia  Major Depressive Disorder Bipolar Disorder 

Activity: Have students complete the Neurobiological Basis of Schizophrenia Activity below.

Activity: Have students complete the Bipolar Disorder Teaching Activity below.

Discussion Topic: Have students describe a clinical situation involving a neuropsychological disorder that they have observed in a patient, friend, or family member. List the signs and symptoms, including any progression or time sequences. Tell them to briefly discuss similarities and differences between the clinical situation they observed and the description of this disorder in their course materials. Be sure to maintain confidentiality.

Online Activity: Have students perform a literature search in a database of professional journal articles on research into genetic components (or lack thereof) for the neuropsychological disorder of your choice. Tell them to write a summary for their classmates. Tell them to include at least two references other than their textbook.

WOMEN AND MENTAL ILLNESS CULTURAL CONSIDERATIONS

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48-338

TEACHING STRATEGIES Content Focus

Content Highlights

GERIATRIC CONSIDERATIONS

Neurobiological Basis of Schizophrenia Activity Terms from which students should choose:  schizophrenia  delusional disorder  AMPA  increase  enlarged  split  amygdala  influenza  dopamine  genetic  chickenpox  decrease  D2  open  shrunken

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

Have students use the terms provided to complete the sentences below.

1. Disturbances and deterioration in cognitive, social, and emotional functioning are characteristic of ________________.

2. Schizophrenia means ______________ mind.

3. Schizophrenia involves excess activity of the neurotransmitter ________________ in one brain pathway and deficient action of that same neurotransmitter in another brain pathway.

4. Imaging studies show that the ventricles in the brain of people with schizophrenia are _________________, and temporal lobe volume is decreased.

5. Medications that _____________ dopamine activity reduce the positive symptoms of schizophrenia.

6. The behavioral centers of the limbic system that contain dopaminergic neurons include the ___________________ nucleus accumbens, and anterior caudate nucleus.

7. Excessive dopamine action in brain pathways that have large number of _______________ receptors is thought to be responsible for positive symptoms of schizophrenia, such as hallucinations and delusions.

8. Research looking at twins suggested that schizophrenia may have _____________ aspects.

9. Researchers suggest that gestational exposure to ______________________ during the second trimester of pregnancy may cause deficient neuronal cell migration and connectivity, leading to schizophrenia.

Answers: 1. schizophrenia 2. split 3. dopamine 4. enlarged 5. decrease 6. amygdala 7. D2 8. genetic 9. influenza

Bipolar Disorder Teaching Activity Have students draft responses to the patient scenarios below.

1. “Mr. Gould’s diagnosis is bipolar disorder, and his record says ‘dysphoria’ today,” says a nurse. “What is dysphoria?” Respond as if you are speaking directly to her.

2. “What is impulsivity?” asks another nurse. “When would it be evidence in bipolar disorder?” Respond as if you are speaking directly to her.

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1-340 3. “Mr. Thuy is really mean!” says a nurse. “I know he has bipolar disorder, and I understand the mania, but he is so sarcastic that I have trouble being therapeutic around him.” Respond directly to her.

4. Mr. Lee has been awake for 4 days, believes that he alone has the solutions to world hunger and global warming, and is telephoning the president. Explain to a nurse the technical term that describes his situation.

Answers 1. Dysphoria is depression and anguish or unhappiness, so Mr. Gould must be having a depressive episode. Remember that bipolar disorder involves episodes of mania and depression.

2. Impulsivity is engaging in behavior without considering the consequences of that behavior. It would become evident during an episode of mania.

3. What you are describing is one of the manifestations of bipolar disorder: irritability. Try to remember that his unpleasant, sarcastic comments are part of the disorder rather than being directed personally at you.

4. Mr. Lee’s belief that he will save the world is an example of grandiosity during an episode of mania. Grandiosity involves claims of limitless expertise and great self-appraised importance. It often involves insults to others that are not evidence in Mr. Lee’s case, but it might appear if his advice is ignored or not received well.

IN-CLASS/ONLINE CASE STUDY RB is a 62-year-old woman who lives with her retired husband. She is an active volunteer for many church-related activities. Her five children are grown and no longer live in the same town. She has seven grandchildren who visit her frequently. RB has a history of periods of intense energy during which she sleeps little, cleans excessively, and makes grandiose plans for household remodeling. She also has episodes of decreased energy, difficulty initiating tasks, and withdrawal from social contacts. RB has taken lithium for many years to manage her disorder, and it seems to moderate her mood swings.

1. What disorder does RB most likely have and why?

Answer:  Bipolar affective disorder, specifically what appears to be bipolar II  Evidenced by history of cyclic periods of hypomania and depressive episodes  Evidenced by lithium therapy useful in moderating mood swings (true for both I and II) 2. What neurotransmitter abnormalities are thought to be associated with this disorder?

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1-341 Answer:    

Abnormalities in the monoamine neurotransmitters in the brain Specifically, serotonin, norepinephrine, and dopamine An overabundance of norepinephrine and dopamine neurotransmitters would manifest in mania or hypomania.

A deficit of norepinephrine, dopamine, or serotonin neurotransmitters would manifest in a depressive state.

3. What is the rationale for managing RB’s disorder with lithium?

Answer:   

Lithium is the drug of choice for mood stabilization.

It may be insufficient for severe disorder, which may require additional medications.

Precise mechanism unknown, but several have been proposed.

4. How can the adequacy of lithium therapy be monitored?

Answer:    

Serum lithium levels should be monitored because the therapeutic range is narrow.

Decreased symptoms of mania (i.e., increased sleep, normal speech rate and rhythm, improved ability to concentrate and focus, decreased appetite, and improved judgment) Blood urea nitrogen and creatinine should be monitored because lithium can affect renal clearance and can be a precursor to renal failure.

Thyroid levels should be monitored because lithium can cause hypothyroidism, requiring replacement therapy.

5. What other pharmacologic measures might be helpful to manage RB’s depressive episodes?

Answer:  

Anticonvulsants (carbamazepine; divalproex; lamotrigine) are useful in mood stabilization.

Antidepressant therapy is commonly utilized for depressive episodes for clients with bipolar affective disorder but may initiate mood swings or destabilization.

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1-342 

Other antipsychotic medications that have been found beneficial include olanzapine, risperidone, quetiapine, and ziprasidone.

These medications variously impact dopamine, serotonin, and norepinephrine.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Pharmacologic Treatment o Nonpharmacologic Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Mood and Cognition  Concept: Mood and Affect o Exemplar: Major Depressive Disorder o Exemplar: Bipolar Disorder  Concept: Psychosis o Exemplar: Schizophrenia

TEACH FOR NURSES LESSON PLAN Chapter 49: Neurobiology of Nonpsychotic Illnesses

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1-343

CHAPTER OBJECTIVES 1. Describe the neurobiological alterations that have been associated with panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder.

2. Identify the neurobiological alterations that have been associated with attention-deficit/hyperactivity disorder and autism spectrum disorder.

STUDENT RESOURCES understand

       

Textbook Chapter 49 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 49* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

Copyright © 2019, Elsevier Inc. All rights reserved.

1-344 * Sold separately from textbook.

TEACHING STRATEGIES Content Focus ANXIETY DISORDERS

Content Highlights Provide an overview of the manifestations and treatment of the major anxiety disorders.

Learning Activities  

Panic Disorder (PD) Generalized Anxiety Disorder (GAD) Obsessive-Compulsive Disorder (OCD)

 Posttraumatic Stress Disorder (PTSD)



Activity: Have students complete the Neurobiological Basis of Generalized Anxiety Disorder Activity below.

Discussion Topic: Have students describe a clinical situation involving a neuropsychological disorder that they have observed in a patient, friend, or family member. List the signs and symptoms, including any progression or time sequences. Tell them to briefly discuss similarities and differences between the clinical situation they observed and the description of this disorder in their course materials. Tell them to be sure to maintain confidentiality.

Online Activity: Have students perform a literature search in a database of professional journal articles on research into genetic components (or lack thereof) for the neuropsychological disorder of your choice. Tell them to write a summary for their classmates. Include at least two references other than their textbook.

Activity: Have students complete the Neurobiological Basis of ObsessiveCompulsive Disorder Activity below.

Neurodevelopmental Disorders AttentionDeficit/Hyperactivity Disorder (ADHD) Autism Spectrum Disorder (ASD)

Neurobiological Basis of Generalized Anxiety Disorder Activity Terms from which students should choose:

Copyright © 2019, Elsevier Inc. All rights reserved.

1-345               

sleep disturbance depression hyperactive anxiety constant increased hypoactive worry inherited fear congenital decreased frontal heightened serotonin

Have students use the terms provided to complete the sentences below.

1. GAD includes physical ____________________ symptoms as well as chronic worry.

2. Unlike other anxiety disorders, the symptoms of GAD are _____________ rather than episodic.

3. GAD may be partially a(n) _____________________ disorder, as evidenced by twin and family studies.

4. Imaging studies have shown that individuals with GAD have ___________________ glucose metabolism in areas of the brain.

5. These studies have also shown that some areas of the brain undergo both increases and decreases in glucose metabolism, such as cingulate and _______________ cortex.

6. It is believed that one important neurobiological characteristic of individuals with GAD is _________________ brain circuits.

7. Whereas norepinephrine is believed to cause the physical symptoms of GAD, _________________________ is believed to be the primary cause of the psychological symptoms.

8. Behavior symptoms of GAD include fatigue and _______________.

9. The most profound psychological symptom of GAD is uncontrollable ____________________ that causes impaired concentration and irritability.

Answers: 1. anxiety 2. constant 3. inherited

Copyright © 2019, Elsevier Inc. All rights reserved.

1-346 4.

5.

6.

7.

8.

9.

increased frontal hyperactive serotonin sleep disturbance worry

Neurobiological Basis of Obsessive-Compulsive Disorder Activity Have students answer the short answer questions below.

1. What are obsessions?

2. What are compulsions?

3. What are the most common compulsions?

4. What are three comorbid disorders that are common in persons who have obsessive-compulsive disorder (OCD)?

5. One model of OCD suggests that deficiency in serotonin inhibitory action results in an excess of which neurotransmitter?

6. What is hoarding?

7. What do imaging studies of individuals with OCD show in the orbitofrontal cortex?

Answers: 1. Strong, persistent, intrusive, uncontrollable thoughts that manifest as ideas, images, and urges that dominate normal thinking 2. Repetitive, ritualistic actions that are performed with urgency and function to neutralize or prevent anxiety 3. Counting, symmetry, touching, checking, cleaning, and picking 4. Depression, anorexia, and Tourette syndrome 5. Dopamine 6. Difficulty disposing of meaningless, worthless objects such as newspapers 7. Excessive metabolic activity (increased glucose uptake), which is interpreted as neural hyperactivity

IN-CLASS/ONLINE CASE STUDY JE is a 25-year-old man who comes to the clinic with complaints of anxiety. He states that he is not sleeping well and complains that if he awakens in the night, he cannot go back to sleep. He wants to sleep more in the day and has been withdrawing from family and friends. JE states that sometimes his heart races, and he gets diaphoretic and short of breath. You note that when you walked into the room, he was startled and appeared anxious. He tells you he fears that he may die and leave his family without him. JE fears he may have a heart attack even though past

Copyright © 2019, Elsevier Inc. All rights reserved.

1-347 physical examinations have shown he has no real risks for a heart attack. You ask him about his childhood, and he states that he was raised by his mother and that there was some physical abuse by his father.

1. What do you know about panic disorder?

Answer:  Acute anxiety episodes that come on unexpectedly and suddenly and generate a feeling of fear  More often seen in women than men  Has anticipatory anxiety, which is fear of the onset of a panic attack without any consistent trigger  Avoidance is used to gain feelings of control and prevent attacks.  Shown to have a direct link to genetic occurrence  Early childhood stress, such as with abuse and neglect  Signs and symptoms include: o Respiratory distress, heart palpitations, tachycardia, pounding heart, chest pain, smothering feelings, dizziness, light headedness, trembling, abdominal distress o Fear of dying, cardiac arrest, losing control, having a nervous breakdown, and easily startled 2. What do you know about generalized anxiety disorder (GAD)?

Answer:  Worry that is chronic and persistent with physical anxiety symptoms  Quite often seen with depression  GAD comes on slowly and develops over years.  Seen in twins and thought to have some inheritability  Glucose metabolism in the brain is seen to be affected by GAD.  Alterations in GABA receptors appear to produce changes in mood, thinking, and behaviors.  Changes is serotonin pathways has been seen to cause problems with anticipatory and avoidance symptoms.  Signs and symptoms include: o Muscle tension, light headedness, palpitations, sweating o Uncontrolled worry, fearfulness, foreboding and irritation o Sleep disturbance and fatigue o Impaired social and employment functioning 3. What do you know about obsessive-compulsive disorder?

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1-348

Answer:  Severe anxiety disorders  Persistent involuntary thoughts that provoke anxiety and involuntary anxiety management rituals  Keep symptoms to self and do not want others to know  Genetic link with increased risk in first-degree relatives. Range in age of onset is 15 to 39 years with a median of 23 years  Interfere with daily living and are time consuming; interfere with normal functioning  Comorbidities seen with depression, Tourette syndrome, and anxiety  Frontal lobe implicated with OCD are probably a cause of strong emotions.  Signs and symptoms: o Obsessive thoughts that are ideas, images, and urges o Recognize that thoughts may be senseless o Compulsions that are unreasonable, senseless, and excessive, such as counting, touching, symmetry, checking, and cleaning o Hoarding is a form of OCD. 4. Which disorder does JE have?

Answer: 

Based on his symptoms, he most likely has panic disorder.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment o Pharmacologic Treatment o Nonpharmacologic Treatment

Copyright © 2019, Elsevier Inc. All rights reserved.

1-349

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Mood and Cognition  Concept: Anxiety o Exemplar: Panic Disorder o Exemplar: Generalized Anxiety Disorder o Exemplar: Obsessive-Compulsive Disorder (OCD)

TEACH FOR NURSES LESSON PLAN Chapter 50: Structure and Function of the Musculoskeletal System CHAPTER OBJECTIVES 1. Describe the functions of osteoblasts and osteoclasts in bone remodeling.

2. Describe the relationship between joint structure and joint mobility.

3. Explain why articular cartilage is particularly susceptible to degenerative changes.

4. Identify the factors that determine tendon strength and compliance.

5. Explain how the striated structure of skeletal muscle relates to its contractile function.

6. Explain how an action potential in the -motor neuron leads to a contraction in the muscle cells of the motor unit.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

1-350

understand

       

Textbook Chapter 50 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 50* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus STRUCTURE AND FUNCTION OF BONE

Content Highlights Discuss the structure and function of the bone.

Learning Activities  

Discussion Topic: Refer students to illustrations of bone structure and function in Figures 50-1 through 50-6.

Online Activity: Have students visit http://www.wisc-online.com/

Copyright © 2019, Elsevier Inc. All rights reserved.

1-351

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Composition

objects/ViewObject.aspx?ID=NUR4404 and complete the interactive quiz.

Functional Properties Response to Injury, Stress, and Aging STRUCTURE AND FUNCTION OF JOINTS

Discuss the structure and function of the joints.



Online Activity: Have students visit http://www.wisc-online.com/ objects/ViewObject.aspx?ID=OTA2204 and complete the learning module to learn about the anatomy of the hip.

Synarthroses Diarthroses STRUCTURE AND FUNCTION OF ARTICULAR CARTILAGE Composition Functional Properties Response to Injury, Stress, and Aging STRUCTURE AND FUNCTION OF TENDONS AND LIGAMENTS Composition Functional Properties

Copyright © 2019, Elsevier Inc. All rights reserved.

1-352

TEACHING STRATEGIES Content Focus

Content Highlights

Response to Injury, Stress, and Aging STRUCTURE AND FUNCTION OF SKELETAL MUSCLE Composition MECHANICS OF MUSCLE CONTRACTION Sliding Filament Theory Role of Calcium Electromechanical Coupling Types of Muscle Contraction Mechanical Principles Response to Movement and Exercise

IN-CLASS/ONLINE CASE STUDY

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

1-353 ME is a 64-year-old woman who was diagnosed with osteoarthritis and osteoporosis. She has done some reading on the diseases but would like to know more about the pathology of the bone and how these diseases affect it.

1. How would you explain the composition of the bone and its unique qualities?

Answer:  Bone is 90% to 95% collagen fibers.  Bones can remodel (make new bone) as needed by eternal stimuli such as weight bearing or pull on tendons.  Fibroblasts and fibrocytes are responsible for collagen production.  Osteoblasts lay down bone and come from osteoprogenitor cells that are bone stem cells.  Mature bones cells are called osteocytes.  Osteoclasts are needed for bone resorption (releasing of calcium).  Ground substance is needed for deposition of calcium salts.  Bone is 65% to 70% calcium and phosphorus.  Collagen the main fibrous component of bone accounts for 25% to 35% percent of bone weight.

2. What can you tell ME about the bones’ response to injury, stress, and aging?

Answer:  Bones have the ability to remodel after injury.  Wolff’s law: “Bone is laid down where it is needed and resorbed where it is not needed.”  If you do not bear weight, such as with long-term bedrest, the osteoclasts will break down bone, and the net result is less bone mass—osteoporosis.  Increased activity after prolonged inactivity stresses the bones with less bone mass and leads to fractures.  Older adults have more bone resorption.  Decreased calcium and vitamin D deficiency lead to leaching of calcium from the bone.

TEACH FOR NURSES LESSON PLAN Chapter 51: Alterations in Musculoskeletal Function: Trauma, Infection, and Disease

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1-354

CHAPTER OBJECTIVES 1. Explain how the mechanisms of injury are different between noncontractile and contractile soft-tissue injuries.

2. Identify the key factors in the mechanisms of wound healing.

3. Describe the process and duration of normal bone healing after a fracture.

4. Identify the different complications that can occur following a fracture.

5. Describe the manifestations, dangers, and management of compartment syndrome.

6. Identify the clinical findings and management of bone infections.

7. Compare and contrast osteoporosis and osteomalacia or rickets.

8. Identify the terminology used to describe primary bone tumors.

9. Describe the cause and pathogenesis of muscular dystrophy and myasthenia gravis.

10.Describe the clinical features and treatment options in fibromyalgia syndrome.

STUDENT RESOURCES understand

       

Textbook Chapter 51 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 51* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

Copyright © 2019, Elsevier Inc. All rights reserved.

1-355

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

SOFT-TISSUE INJURIES INERT SOFT-TISSUE INJURIES Ligament Injuries Joint Capsule Injuries Internal Joint Derangement Injuries to Fasciae and Bursae Injuries to Nerves, Nerve Roots, or Dura Mater CONTRACTILE SOFT-TISSUE INJURIES

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

1-356

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Injury to Tendons Muscle and Tendon Strains Blunt Trauma Compartment Syndrome Soft-Tissue Healing After Trauma BONE INJURIES AND INFECTIONS BONE AND JOINT TRAUMA

Discuss the different types of bones and fractures.



Types of Bone



Fracture



Dislocations and Subluxations



Activity: Have students complete the Clinical Manifestations of Fractures Activity below.

Discussion Topic: Use the photo below as the basis for a discussion on the factors affecting bone healing.

Activity: Have students describe a clinical situation involving a bone fracture that they have observed in a patient, friend, family member, or themselves. Tell them to use technical terms to describe the fracture (e.g., open or closed; complete or incomplete; other descriptors if known). List the signs and symptoms. Indicate how long it took the fracture to heal and describe briefly the five stages of bone healing. Remind students to be sure to maintain confidentiality.

Online Activity: Have students perform a literature search in a database of professional journal articles on one of the factors that impair bone healing (e.g., smoking, diabetes, corticosteroids). Write a summary for your classmates. Include at least two references beyond your textbook.

INFECTIONS OF THE BONE Osteomyelitis

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TEACHING STRATEGIES Content Focus

Content Highlights

Tuberculosis ALTERATIONS IN BONE STRUCTURE AND MASS BONE STRUCTURE DISORDERS Scoliosis METABOLIC BONE DISEASES Osteoporosis Rickets and Osteomalacia Paget Disease BONE TUMORS Benign Tumors Malignant Bone Tumors DISEASES OF SKELETAL MUSCLE IDOPATHIC INFLAMMATORY MUSCLE DISEASE

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

1-358

TEACHING STRATEGIES Content Focus

Content Highlights

MUSCULAR DYSTROPHY Duchenne Muscular Dystrophy Becker Muscular Dystrophy Facioscapulohumeral Muscular Dystrophy Myotonic Dystrophy OTHER DISORDERS OF MUSCLE Myasthenia Gravis CHRONIC MUSCLE PAIN Fibromyalgia Syndrome

Clinical Manifestations of Fractures Activity Key terms:  pain  cardiac murmur  seizures  unnatural alignment

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

1-359    

fatigue muscle spasms swelling no pain

Sign or Symptom of a Fracture

NOT a Sign or Symptom of a Fracture

Answer Sign or Symptom of a Fracture  Muscle spasms  Unnatural alignment  Pain  Swelling

NOT a Sign or Symptom of a Fracture  Fatigue  Seizures  Cardiac murmur  No pain

Factors Impairing Bone Healing Discussion Topic

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1-360

A number of factors can delay or interrupt bone healing, including the following:          

Increased age Smoking Poor nutritional status Poor calcium intake Vitamin deficiencies: A, C, D, and K Alcohol abuse Disease states: diabetes, anemia Certain medications: corticosteroids, nonsteroidal antiinflammatory drugs, oral anticoagulants, and others Associated complications such as infection, decreased vascular supply to the area of the injury, widespread surgical trauma Inadequate fracture reduction or premature mobilization

How many of these factors can you identify in the photograph? How might bone healing progress if this man should fall and break a hip?

IN-CLASS/ONLINE CASE STUDY

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1-361 JB is a 13-year-old boy who fractured his right arm in a snowboarding accident. Radiography reveals a distal longitudinal fracture of the humerus that extends through the epiphyseal plate. JB has had no previous medical conditions and is otherwise healthy. His fracture requires surgical placement of a plate to stabilize the bone fragments. After the surgery, his arm is casted.

1. Of what significance is the involvement of the epiphyseal plate in the fracture line?

Answer: 

It may cause growth impairment of his right arm.

2. The surgical procedure increases the risk for osteomyelitis. How would this be manifested?

Answer: 

Signs and symptoms of infection may include redness, warmth, increasing pain, drainage, edema, fever, and an odor emanating from the cast.

3. In the early postoperative period, the extremity may swell within the cast, leading to compression of blood supply and compartment syndrome. How would compartment syndrome manifest, and what should be done if it does?

Answer:  

Manifestations are those of acute arterial occlusion (pain, pallor, paresthesias, polar-decreased temperature of extremity distal to cast, and diminished or absent distal pulses).

Immediate actions should include removal of cast and assessment for return of perfusion to the distal extremity.

4. How will it be determined that JB’s fracture has healed?

Answer:  

Radiographs provide visual evidence of bone crossing the fracture site.

The fracture is stable and fully functional, and there is no pain or evidence of movement at the site.

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1-362

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment of Fracture o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Cellular Regulation o Exemplar: Multiple Myeloma THEME: Protection and Movement  Concept: Infection o Exemplar: Tuberculosis  Concept: Mobility o Exemplar: Soft-Tissue Injuries o Exemplar: Inert Soft-Tissue Injuries o Exemplar: Contractile Soft-Tissue Injuries o Exemplar: Bone Injuries and Infections o Exemplar: Bone and Joint Trauma o Exemplar: Infections of the Bone o Exemplar: Alterations in Bone Structure and Mass o Exemplar: Bone Structure Disorders o Exemplar: Metabolic Bone Diseases

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1-363 o o o o o 

Exemplar: Bone Tumors Exemplar: Diseases of Skeletal Muscle Exemplar: Muscular Dystrophy Exemplar: Other Disorders of Muscle Exemplar: Chronic Muscle Pain

Concept: Pain o Exemplar: Compartment Syndrome

TEACH FOR NURSES LESSON PLAN Chapter 52: Alterations in Musculoskeletal Function: Rheumatic Disorders CHAPTER OBJECTIVES 1. Differentiate osteoarthritis and rheumatoid arthritis on the basis of cause, clinical findings, and treatment.

2. Describe the similarities and differences among rheumatoid arthritis, systemic lupus erythematosus, and scleroderma.

3. Identify the infective organisms associated with joint inflammation and Lyme disease.

4. Describe the pathogenesis of gouty arthritis.

5. Distinguish among the three subtypes of juvenile rheumatoid arthritis.

STUDENT RESOURCES understand

       

Textbook Chapter 52 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 52* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

Copyright © 2019, Elsevier Inc. All rights reserved.

1-364

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus LOCAL DISORDERS OF JOINT FUNCTION

Content Highlights Review the manifestations and management of local disorders of joint function.

Learning Activities  

Osteoarthritis

Discussion Topic: Complete the Discussion Topic of the Osteoarthritic Joint below with students.

Online Activity: Have students visit https://www.niams.nih.gov/ Health_Info/Arthritis/arthritis_rheumatic.asp for more information on arthritis and rheumatic diseases.

Infectious Arthritis Lyme Disease SYSTEMIC DISORDERS OF JOINT FUNCTION

Review the manifestations and management of systemic disorders of joint function.



Activity: Have students complete the Systemic Lupus Erythematosus Case Example below.

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1-365

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 

Immune-Mediated Disorders Postinfectious Systemic Disorders

Activity: Have students describe a clinical situation involving a rheumatic disorder that they have observed in a patient, friend, or family member.

List the signs and symptoms, including any progression or time sequences.

Tell them to briefly discuss similarities and differences between the clinical situation they observed and the description of this disorder in their course materials. Be sure to maintain confidentiality.

JOINT DYSFUNCTION SECONDARY TO OTHER DISEASES Psoriatic Arthritis Enteropathic Arthritis Neuropathic Osteoarthropathy Hemophilic Arthropathy Gout Adult-Onset Still Disease PEDIATRIC JOINT DISORDERS Nonarticular Rheumatism Hypermobility of Joints

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1-366

TEACHING STRATEGIES Content Focus

Content Highlights

Juvenile Idiopathic Arthritis

Discussion Topic of the Osteoarthritic Joint

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

1-367

Osteoarthritic Joint

Copyright © 2019, Elsevier Inc. All rights reserved.

1-368

Have students compare the osteoarthritic joint in the drawing with a normal joint. How many of the changes of osteoarthritis listed above can you see in the drawing of the osteoarthritic joint?

Systemic Lupus Erythematosus Case Example Ayisha Jones, a 33-year-old African-American woman studying medicine, has aching in her joints (arthralgia) and a new rash on her face. She states that the rash gets worse when she goes out into the sun. She also feels fatigued and gets a sharp pain in her chest when she breathes deeply. She has had “flareups” of these symptoms from time to time in the past, but this is the worst episode yet.

Ayisha’s diagnosis is systemic lupus erythematosus (SLE).

Instructions: Answer the questions in the activity below to explore your understanding of Ayisha's condition.

1. What is the common descriptive term for Ayisha’s facial rash?

2. Why should Ayisha be taught to avoid sunlight?

3. What does ANA mean?

Copyright © 2019, Elsevier Inc. All rights reserved.

1-369 4. How can SLE cause such widespread tissue damage? What is the pathophysiology?

5. What is a type III hypersensitivity reaction?

Answers: 1. The malar rash of SLE commonly is called a butterfly rash because it has the shape of a butterfly with extended wings.

2. Photosensitivity is common with SLE. Her rash is most prominent on sun-exposed areas of her skin.

3. Antinuclear antibodies (antibodies against normal nuclear antigens).

4. SLE is an autoimmune disease with antibodies against self-antigens, causing type III hypersensitivity reactions and other autoimmune processes in many different body tissues.

6. Type III hypersensitivity is an immune complex reaction in which an antigen–antibody complex lodges in tissue, activating complement and attracting phagocytes that cause tissue damage.

IN-CLASS/ONLINE CASE STUDY BT is a 42-year-old woman who complains of increasing joint pain and stiffness in her hands, wrists, shoulders, and knees. She has been taking aspirin every 4 to 6 hours with little relief. Her physician suggests radiography and blood studies to evaluate her joint dysfunction.

1. Considering the distribution of BT’s joint dysfunction and her age, what is the most likely cause of this dysfunction? What additional history or physical assessment data would support this diagnosis?

Answer: 





Most likely rheumatoid arthritis (RA) because of the patient’s age and gender (2:1 to 3:1 female:male ratio at her age) and the joints involved (hands, wrists, shoulders, and knees). Osteoarthritis (OA) affects mainly an older population with the majority being older than 70 years of age. There does not appear to be a difference in incidence based on gender. The joints involved in OA are the weight-bearing joints (hips, knees, and cervical and lumbosacral joints) as well as the interphalangeal joints of the hands.

Need to get better history concerning the stiffness and swelling. OA is characterized by stiffness usually lasting less than 30 minutes and resolving with activity, and the swelling infrequently is accompanied by inflammation. RA is characterized by stiffness usually starting in the morning and lasting longer than 1 hour, and the area of swelling is soft or spongy, erythematous, and warm.

RA presents as a symmetrical condition, but OA may be limited to one joint, and if several are involved, symmetrical presentation is not noted.

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1-370  

The distal interphalangeal joints of the hands are not affected in RA, but in OA, these are the most commonly involved joints of the hands because of bony spurs producing Heberden nodes.

RA is a systemic disease with manifestations involving the heart, lungs, and eyes. These should also be assessed.

2. What laboratory tests would be helpful in confirming this diagnosis?

Answer:   

Sedimentation rate or C-reactive protein and CBC to differentiate infection from inflammatory process Antibody titer for Rh factor (found in 75%–85% of patients with RA) and anti-CCP antibodies (90%–95% specific for RA) Radiology reports in OA show bone spurs in joint spaces, asymmetrical joint space narrowing, and sclerosis of subchondral bone.

Later, joints may be malaligned and cysts may be noted in subchondral bone. RA includes soft tissue swelling in hand and wrist joints, with erosions of bone at the edges of joints, periarticular osteopenia, joint space narrowing, and ultimately malalignment of bones, including subluxation.

3. BT’s physician orders low-dose steroid therapy (prednisolone) as part of the treatment plan. What is the rationale for using this drug?

Answer: 



It is a glucocorticoid that has a longer half-life (200 minutes) than prednisone (60 minutes) and therefore an increased antiinflammatory potency. It should be used at the lowest possible dosage and the shortest treatment interval to limit the adverse effects involved with long-term steroid use. Used for its antiinflammatory and immunosuppressive properties.

Unlike nonsteroidal antiinflammatory drugs, steroids are more effective in rapidly reducing the pain, stiffness, and swelling of RA.

4. What other measures would be indicated in the management of BT’s disorder?

Answer:  

Monitor for adverse effects of steroid therapy (Cushing syndrome).

Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine or gold should also be initiated early to retard disease progression. If her disease is determined to be more aggressive, methotrexate, leflunomide, or combination therapy could be considered.

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1-371   

Biologic agents that target immune cells also retard progression and reduce patient’s symptoms. Some are appropriate early in the disease process; others are initiated in severe disease.

Teach or counsel for disease process, weight gain secondary to steroid use, nutritional needs, and use of assistive devices as necessary. Provide occupational and physical therapy to maintain mobility.

Provide support or resources for psychosocial issues such as self-image and financial needs.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Thermoregulation o Exemplar: Acute Rheumatic Fever

THEME: Protection and Movement  Concept: Inflammation o Exemplar: Rheumatoid Arthritis o Exemplar: Table 52-1: 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis

TEACH FOR NURSES LESSON PLAN Copyright © 2019, Elsevier Inc. All rights reserved.

1-372

Chapter 53: Alterations in the Integumentary System CHAPTER OBJECTIVES 1. Explain how the aging process affects the integumentary system.

2. Explain why it is important to differentiate primary from secondary skin lesions.

3. Identify which lesion characteristics are assessed to aid in determination of the lesion’s cause.

4. Explain how systemic disorders affect nail and hair growth.

5. Identify which skin disorders are more likely to occur more commonly in certain age groups, including in infants, children, adolescents, and the elderly.

6. Explain how ultraviolet radiation affects the skin.

7. Describe how superficial and deep pressure ulcers differ in clinical and etiologic features.

8. Differentiate malignant melanoma from other skin lesions.

STUDENT RESOURCES understand

       

Textbook Chapter 53 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 53* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

Copyright © 2019, Elsevier Inc. All rights reserved.

1-373

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

AGE-RELATED CHANGES Epidermis Dermis and Subcutaneous Tissue Appendages EVALUATION OF THE INTEGUMENTARY SYSTEM Primary and Secondary Lesions Lesion Descriptors

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Learning Activities

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TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

SELECTED SKIN DISORDERS INFECTIOUS PROCESSES

Review the major infectious skin disorders.



Viral Infections Fungal Infections Bacterial Infections





Discussion Topic: Have students describe a clinical situation involving an integumentary disorder that they have observed in a patient, friend, or family member. List the signs and symptoms, including any progression or time sequences. Tell them to briefly discuss similarities and differences between the clinical situation they observed and the description of this disorder in their course materials. Be sure to maintain confidentiality.

Online Activity: Have students perform a literature search in a database of professional journal articles on research into genetic components (or lack thereof) for the integumentary disorder of your choice. Tell them to write a summary for their classmates. Include at least two references other than their textbook.

Activity: Have students complete the Skin Infectious Processes Activity below.

INFLAMMATORY CONDITIONS Lupus Erythematosus Seborrheic Dermatitis Psoriasis Lichen Planus Pityriasis Rosea Acne Vulgaris Pemphigus

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1-375

TEACHING STRATEGIES Content Focus

Content Highlights

ALLERGIC SKIN RESPONSES Atopic Dermatitis Contact Dermatitis Drug Eruptions Vasculitis PARASITIC INFESTATIONS Scabies Fleas Lice Chiggers Bedbugs Mosquitoes Blood Flukes Ticks Rocky Mountain Spotted Fever Lyme Disease OTHER DISORDERS OF THE

Copyright © 2019, Elsevier Inc. All rights reserved.

Learning Activities

1-376

TEACHING STRATEGIES Content Focus

Content Highlights

DERMIS Scleroderma Sunburn and Photosensitivity Ulcers Altered Cell Growth: Epidermal Proliferation Pigmentation Alterations SPECIAL CHARACTERISTICS OF DARK SKIN

INTEGUMENTARY MANIFESTATIONS OF SYSTEMIC DISEASE SKIN Color Sensation Texture Temperature HAIR

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Learning Activities

1-377

TEACHING STRATEGIES Content Focus

Content Highlights

Growth Amount Color Texture Lubrication NAILS Shape Color Texture TREATMENT IMPLICATIONS TOPICAL TREATMENT Wet Dressings Lotions Gels

Creams

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Learning Activities

1-378

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Ointments Aerosols and Foams INTRALESIONAL INJECTION SELECTION OF A DELIVERY SYSTEM

CORTICOSTEROIDS Systemic Steroids Topical Steroids DEVELOPMENTAL CONSIDERATIONS

Review the relationship between development and aging and skin disorders.



Activity: Have students complete the Developmental Considerations Activity below.

INFANCY CHILDHOOD SKIN DISORDERS Rubella Roseola Infantum Measles Chickenpox Scarlet Fever ADOLESCENCE AND

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1-379

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

YOUNG ADULTHOOD GERIATRIC CONSIDERATIONS

Skin Infectious Processes Activity Terms from which students can choose:            

Impetigo Genital herpes Shingles Candidiasis Tinea Verrucae Thrush Fever blisters Athlete’s foot Boils Leprosy Syphilis

Bacterium

Fungus

Virus

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1-380

Answer Bacterium    

Impetigo Syphilis Leprosy Boils

Fungus    

Tinea Candidiasis Athlete’s foot Thrush

Virus    

Verrucae Shingles Genital herpes Fever blisters

Developmental Considerations Activity Terms from which students can choose:  Infants  Fleshy growths on small stalks  Blotchy macular rash  Darker pigmentation on sacral area  Pruritic macules, vesicles, and scabs  Flat brown-black spots  Older adults  Children Description

Age Group

Lentigines Mongolian spot Skin tags Chickenpox

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1-381

Measles (rubeola)

Answer

Lentigines Mongolian spot Skin tags

Chickenpox Measles (rubeola)

Description

Age Group

Flat brown-black spots Darker pigmentation on sacral area Fleshy growths on small stalks

Older adults Infants

Pruritic macules, vesicles, and scabs Blotchy macular rash

Children

Older adults

Children

IN-CLASS/ONLINE CASE STUDY ES is a 4-year-old girl brought to the clinic after her day care provider noticed a yellowish, crusty lesion with pustules and weeping areas developing on ES’s face near the right nares. A diagnosis of impetigo is made, and topical Bactroban is ordered.

1. What are the usual causative organisms associated with impetigo?

Answer: 

Impetigo is usually caused by Staphylococcus or Streptococcus organisms.

2. What precautions should be taken when caring for ES? Answer: 

Impetigo is highly contagious, so ES will likely not be allowed to return to day care until the condition has resolved.

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1-382 

Wearing disposable gloves when touching the area and meticulous hand washing are essential. Any potential contaminated inanimate objects (fomites) such as used gloves or tissues must be disposed of carefully.

3. What is the rationale for using topical Bactroban therapy in this case?

4. Answer: 

Bactroban is a topical antibiotic that is effective against the usual infective agents. Severe cases involving multiple lesions or systemic signs and fever may require oral antibiotic therapy as well.

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Treatment Implications o Topical Treatment o Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Homeostasis and Regulation  Concept: Thermoregulation o Exemplar: Rocky Mountain Spotted Fever o Exemplar: Scarlet Fever

Copyright © 2019, Elsevier Inc. All rights reserved.

1-383 THEME: Protection and Movement  Concept: Tissue Integrity o Exemplar: Ulcers

BSN ESSENTIALS 

Essential VII: Clinical Prevention and Population Health o Prevention

TEACH FOR NURSES LESSON PLAN Chapter 54: Burn Injuries CHAPTER OBJECTIVES 1. Identify the most common causes of burn injuries.

2. Explain how burn degree and severity are determined.

3. Describe the principles that guide the management of burn injuries.

4. Identify the potential complications associated with burn injuries.

5. Describe the outcomes following burn injuries.

STUDENT RESOURCES

Copyright © 2019, Elsevier Inc. All rights reserved.

1-384

understand

       

Textbook Chapter 54 Animations (Evolve website) Audio glossary (Evolve) Elsevier Adaptive Learning for Chapter 54* Key points (Evolve) Online course (Banasik: Pathophysiology Online for Pathophysiology, 6th edition)* Tutorial (Evolve) Video clips

apply

    

Case Studies (Evolve) Elsevier Adaptive Quizzing* HESI Case Studies* Review Questions (Evolve) Study Guide*

INSTRUCTOR RESOURCES before class



Nursing Curriculum Standards (below)

in class

    

PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) In-Class/Online Case Study (below)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus THERMAL INJURY

Content Highlights Review the assessment, classification, and treatment of different types of burns.

Learning Activities 

Discussion Topic: Refer students to Figure 54-3 to familiarize them with the rule of nines.

Copyright © 2019, Elsevier Inc. All rights reserved.

1-385

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Etiology, Incidence, and Mortality



Risk Factors



Integument Effects

Online Activity: Have students visit http://www.nlm.nih.gov/medlineplus/ency/presentations/100100_1.htm for an overview of skin grafting.

Online Activity: Have students visit https://www.usfa.fema.gov/ downloads/fief/keep_your_home_safe.pdf to learn more about fire safety in the home.

Depth Classification Extent of Injury Severity Classification Acute Management Assessment Burn Shock and Acute Resuscitation Organ Dysfunction Metabolic Changes Cellular Changes Immune Response Elements of Burn Injury Survival Rehabilitation Phase

Copyright © 2019, Elsevier Inc. All rights reserved.

1-386

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

ELECTRICAL INJURY Incidence and Mortality Pathophysiology Management and Complications CHEMICAL INJURY Management and Complications Common Agents and Treatment SPECIAL POPULATIONS Geriatrics Pediatrics Obese

IN-CLASS/ONLINE CASE STUDY LS is a 2-year-old boy who has sustained a scald injury on his lower extremities, buttocks, and genitals after climbing into a bathtub of extremely hot water. His parents quickly removed him from the tub and poured cold water on his burns, wrapped him in a towel, and rushed him to the emergency department. The burn covered about 40% of LS’s body and was diagnosed as a second-degree, superficial partial-thickness burn.

Because of the extent of injury, his age, and the involvement of the genitals, LS was admitted to the burn unit for observation and treatment.

Copyright © 2019, Elsevier Inc. All rights reserved.

1-387 1. LS’s parents want to know if they did the right thing in pouring cold water on the burn at home. What would be the best response in terms of the procedure to follow for a burn injury?

Answer:   

Remove the child from the heat source.

Cool the area with cold water or cold compresses until pain is reduced or alleviated.

Cover with sterile cloth or towel and seek immediate medical attention.

2. Describe the type of skin injury associated with a superficial partial-thickness burn.

Answer: 

A superficial partial-thickness burn penetrates the epidermis and involves part of the dermis. Symptoms include vesicle formation, moist skin that blanches to the touch and is very painful. Such burns are usually caused by scalds.

3. How should this burn be managed?

Answer: 

 

Fluids: using the Parkland formula, 4 mL/% total body surface area (TBSA) burn/kg of body weight of lactated Ringer solution over the first 24 hours (the first half in 8 hours, then another quarter in the next 8 hours, and the last quarter in the final 8 hours titrated to maintain a child’s urine output at 1 mL/kg/hr) Children must be carefully monitored during fluid resuscitation because too little or too much may be administered.

Pain medication as needed; debridement is not necessary, and open therapy is necessary for observation of wounds.

4. Is LS at risk for the development of burn shock based on the extent and severity of injury? How would burn shock be clinically manifested?

Answer:  

LS is at risk of shock secondary to depth of burn and extent of burn (40%).

Hypotension; weakness; irregular breathing; chills; fast, weak pulse; nausea

Copyright © 2019, Elsevier Inc. All rights reserved.

1-388 5. How will this burn injury be likely to affect LS’s nutritional status?

Answer: 



Early initiation of nutrition with sufficient protein and calories; need for both is increased because of the increased metabolic rate associated with burns. The enteral route is preferred, but parenteral supplementation may be needed to avoid negative nitrogen balance.

Nutritional requirements in children are calculated as follows: (60) × (kg of body weight) + (36) × (%TBSA burn) = 24-hour caloric requirement.

6. What laboratory assessments would be helpful in evaluating LS’s metabolic and nutritional response to the stress resulting from his burn injury?

Answer: 

Serum total protein, albumin, and prealbumin

NURSING CURRICULUM STANDARDS

QSEN/NLN COMPETENCIES QSEN  Patient-Centered Care o Risk Factors o Management and Complications o Common Agents and Treatment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).

St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Banasik textbook.

Copyright © 2019, Elsevier Inc. All rights reserved.

1-389 A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.

THEME: Protection and Movement  Concept: Tissue Integrity o Exemplar: Thermal Injury

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