Peer Responses:
Due: Monday, 11:59 pm PT
Number: A Minimum of 2 to Peer Posts, at least one on a different day than the main post
Length: A minimum of 150 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Discussion: Respond to Posts in Your Own Thread
Below are peer posts to respond to.
Week 3: Hyperlipidemia Case Study
Quynhnhu le posted Apr 17, 2024 7:18 PM
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A 64-year-old obese female presents for a routine medication check. Her diagnosis is hyperlipidemia with lab values: HDL 79, LDL 250, Triglycerides 210.
1. Explain Poiseuille Law and Ohm’s Law.
Poiseuille law was originally developed to describe how fluid flows through a cylindrical pipe. In terms of pathophysiology, it is used to indicate blood flow through a vessel. It uses an equation where the wall stress in an artery can be calculated using the viscosity of the blood and radius of the vessel (Saqr, Mansour, Tupin, Hassan & Otha, 2019). This gives us the explanation that resistance to flow is related to the length of the vessel and viscosity of the blood and inversely related to the radius of the blood vessel (Saqr et al., 2019). Ohm’s law on the other hand is a theory in electric circuit theory that states that electric current running between two points is equal to voltage and inversely proportional to resistance (Tang, Riley, Marschmann & Brodie, 2021). Researchers can use this relationship to describe substrate-receptor binding relationships and gradient-driven exchanges of water, gasses and energy (Tang et al., 2021).
2. Is there an inverse relationship between HDL and atherosclerosis? Explain.
Yes, because atherosclerosis is related to low levels of HDL and high levels of LDL. We see this relationship because LDL are responsible for delivery of cholesterol to the tissues and when there is a high amount in the bloodstream, excess LDL migrate to the walls of blood vessels and through inflammation (phagocytosis by macrophages) causes the creation of atherosclerosis and plaque formation (Rogers, 2023). HDL on the other hand at high levels are associated with a reduction in coronary risk because they are responsible for “reverse cholesterol transport” which returns cholesterol from the tissues to liver for processing and eventual elimination via the bile. HDL also help repair endothelial tissue and decrease the risk of thrombosis (Rogers, 2023).
3. Explain arteriosclerosis.
Arteriosclerosis is an umbrella term used to characterize thickening and hardening of the vessel wall (Rogers, 2023). Atherosclerosis is a form of arteriosclerosis that is caused by the accumulation of lipid and macrophage activity within an arterial wall, leading to the formation of a plaque (Rogers, 2023). Due to this occurrence, the arteries become thickened and hardened as a response to stress and can eventually lead to restriction of blood flow or obstruction of blood flow altogether to important tissues and organs (Rogers, 2023). These plaques that form can also break off and form an embolus that travels through the body and become lodged somewhere important and lead to myocardial infarction, cerebrovascular injury, or death (Rogers, 2023).
4. What do the individual lab values represent?
HDL 79, LDL 250, Triglycerides 210
Normal levels of HDL: 40-60, greater than 60 is high
Normal levels of LDL:100-129, with high being 200-499
Normal triglyceride level: is less than 150, with high being 200-499 (Rogers, 2023).
This patient has an HDL of 79 which is considered “high” and can be beneficial for cardiovascular health but in conjunction with the elevated levels of LDL and triglycerides in this patient along with her obesity, this may be indicative of a high risk for coronary artery disease. Triglycerides are packaged into chylomicrons in the small intestine and can also be stored in adipose or muscle tissue, which might be a product of or contributing to the patient’s obesity (Rogers, 2023). LDL and triglyceride elevation creates endothelial injury and plaque formation in the blood vessels causing atherosclerosis and development of coronary artery disease, furthermore the fat can deposit in her heart, liver and muscle (Rogers, 2023). It is also stated that rather than measuring levels of HDL in the blood, it would be better to measure HDL functionality to determine coronary artery risk, but that this is significantly more difficult to measure (Rogers, 2023). These lab values represent that the patient has a complex lipid profile and further work up and tests should be conducted to test for any underlying diseases she may have, and her risk of cardiovascular disease.
References:
Rogers, J.L. (2023). McCance & Huether;s Pathophysiology The Biologic Basis for Disease in Adults and Children. Elsevier, St. Louis MO. IBSN: 978-0-323-78987-5
Saqr, K. M., Mansour, O., Tupin, S., Hassan, T., & Ohta, M. (2019). Evidence for non-Newtonian behavior of intracranial blood flow from Doppler ultrasonography measurements. Medical & Biological Engineering & Computing, 57(5), 1029-1036. https://doi-org.usu.idm.oclc.org/10.1007/s11517-018-1926-9
Tang, J., Riley, W. J., Marschmann, G. L., & Brodie, E. L. (2021). Conceptualizing Biogeochemical Reactions With an Ohm’s Law Analogy. Journal of Advances in Modeling Earth Systems, 13(10), 119. https://doi-org.usu.idm.oclc.org/10.1029/2021MS002469
Kersteen Flores posted Apr 17, 2024 1:35 PM
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In this case, a 70-year-old woman with a medical history including chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (DM), hypertension, and dyslipidemia presents with breathing difficulties and a cough. Her vital signs show a temperature of 102.3°F and a heart rate of 102 beats per minute. Oxygen levels are low at 84% on room air and slightly improve to 90% with a nasal cannula. Laboratory results reveal a normal bicarbonate level of 23 mEq/L, while a chest X-ray indicates consolidation in the left lower lobe. These findings suggest the presence of a respiratory infection, potentially pneumonia, in the context of the patient’s COPD. The fever, tachycardia, hypoxia, and X-ray results indicating consolidation point to an acute exacerbation of COPD complicated by pneumonia. Prompt treatment with appropriate antibiotics targeting the suspected infection, along with measures to improve oxygenation and symptom management, is imperative. Given the patient’s age and medical history, close monitoring and a multidisciplinary approach to care are necessary to address potential complications effectively.
Connecting to the discussion on pneumonia, both hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) display distinctive characteristics and causes. HAP is an exogenous infection caused by nosocomial pathogens obtained from hospital settings or other healthcare environments which usually becomes evident two days or more after admission (Kim et al., 2022). Prior research has indicated that advanced age and underlying respiratory conditions like COPD, asthma, and interstitial lung disease, as well as various multi-organ system disorders, elevate the susceptibility to HAP (Kim et al., 2022). Additionally, risk factors for HAP include aspiration, intubation, and the use of mechanical ventilation. In contrast, CAP originates outside healthcare facilities without recent exposure to such healthcare facilities. CAP is often not perceived as a top concern by the general public, despite its significant mortality rate. Studies have shown that a third of patients succumb to pneumonia-related complications within one year after being discharged from the hospital (Aliberti et al., 2021). Streptococcus pneumoniae continues to be the leading cause of CAP, although its incidence is decreasing (Shoar & Musher, 2020). This decline has been more pronounced in the United States compared to other regions. Following Streptococcus pneumoniae, Haemophilus influenzae emerges as the second most prevalent cause of CAP, followed by Staphylococcus aureus and Gram-negative bacilli (Shoar & Musher, 2020).
Transitioning to the ventilation-perfusion (V/Q) matching, which refers to the regional alignment of fresh gas flow with the flow of deoxygenated capillary blood, stands as the primary mechanism influencing the effectiveness of pulmonary gas exchange (Hopkins, 2020). Impaired V/Q matching is a prominent feature in various lung diseases such as COPD, pulmonary hypertension, asthma, pulmonary edema, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). In a healthy lung, the V/Q ratio is typically balanced, with an approximate ratio of 1, indicating that nearly equal volumes of air and blood reach the gas exchange areas of the lung (Hopkins, 2020). Consequently, the oxygen content of room air (20.9 mL/100 mL air) closely aligns with the oxygen-carrying capacity of the blood (~20.6 mL/100 mL blood) (Hopkins, 2020). This equilibrium ensures efficient gas exchange, facilitating the transfer of oxygen from the lungs to the bloodstream.
The fraction of inspired oxygen (FiO2) denotes the proportion of oxygen within a gas mixture (Fuentes & Chowdhury, 2020). For instance, the FiO2 of ambient air is 21%, indicating that oxygen constitutes 21% of the gas mixture. This percentage remains consistent at various altitudes, implying that the FiO2 of atmospheric air remains 21%, regardless of an individual’s elevation. Increasing FiO2 can enhance oxygenation levels by enhancing the amount of oxygen available for inhalation (Kojima et al., 2022). This elevated FiO2 effectively elevates the oxygen concentration within the inspired air, then leading to improved oxygenation of the blood in the alveoli. As a result, this heightened oxygen availability promotes the passage of oxygen through the membrane separating the air sacs from the blood vessels, eventually boosting the levels of oxygen saturation in the blood (Kojima et al., 2022).
Concluding with a comparison between emphysema and pneumonia, while both conditions involve respiratory distress, they diverge in their underlying mechanisms, clinical presentations, and risk factors. Emphysema represents a phenotype of COPD distinguished by the breakdown of lung tissue. While genetic alpha-1 antitrypsin deficiency (AATD) serves as a causal factor for emphysema, smoking stands out as the primary risk factor for non-AATD-related emphysema (Janssen et al., 2019). It primarily affects the alveoli and airways, leading to progressive dyspnea and reduced exercise tolerance over time. On the other hand, pneumonia is described as a lung infection typically affecting the alveolar space (Lim, 2022). A confirmed diagnosis of pneumonia entails recognizing four key elements: symptoms and signs indicative of a respiratory tract infection, observable radiological alterations, identification of a likely pathogen, and a treatment response or clinical progression consistent with pneumonia (Lim, 2022). It commonly presents with acute symptoms such as fever, productive cough, chest pain, and respiratory distress.
Essentially, as we navigate through various respiratory illnesses, a blend of skillful diagnosis and treatment interventions come together to create comprehensive and careful approaches, emphasizing the importance of individualized care in the field of lung medicine.
References
Aliberti, S., Cruz, C. S. D., Amati, F., Sotgiu, G., & Restrepo, M. I. (2021). Community-acquired pneumonia. The Lancet, 398(10303), 906-919. https://doi.org/10.1016/S0140-6736(21)00630-9
Fuentes, S., & Chowdhury, Y. S. (2020). Fraction of inspired oxygen. Europe PMC.
Hopkins, S. R. (2020). Ventilation/perfusion relationships and gas exchange: Measurement approaches. Comprehensive Physiology, 10(3), 1155. https://doi.org/10.1002%2Fcphy.c180042
Janssen, R., Piscaer, I., Franssen, F. M., & Wouters, E. F. (2019). Emphysema: Looking beyond alpha-1 antitrypsin deficiency. Expert Review of Respiratory Medicine, 13(4), 381-397.
Kim, B. G., Kang, M., Lim, J., Lee, J., Kang, D., Kim, M., Kim, J., Park, H., Min, K. H., Cho, J., & Jeon, K. (2022). Comprehensive risk assessment for hospital-acquired pneumonia: Sociodemographic, clinical, and hospital environmental factors associated with the incidence of hospital-acquired pneumonia. BMC Pulmonary Medicine, 22, 1-11. https://doi.org/10.1186/s12890-021-01816-9
Kojima, Y., Sendo, R., Okayama, N., & Hamasaki, J. (2022). Fraction of inspired oxygen with low-flow versus high-flow devices: A simulation study. Cureus, 14(5).
Lim, W. S. (2022). Pneumonia – Overview. Encyclopedia of Respiratory Medicine, 185-197. https://doi.org/10.1016/B978-0-12-801238-3.11636-8
Shoar, S., & Musher, D. M. (2020). Etiology of community-acquired pneumonia in adults: A systematic review. Pneumonia, 12, 1-10. https://doi.org/10.1186/s41479-020-00074-3
