A Typical Cold free essay sample

Mary and Bill adopted a three-year-old toddler named Sam two weeks ago. Sam is good-natured and very inquisitive. Typically, before the finalization of an adoption, children are required to undergo a routine examination by a physician. However, the required examination is not meant to be a complete health screening, and many conditions are not even checked. Therefore, Mary and Bill are bringing Sam to Trinity Medical Center for a standard physical examination by a pediatrician to assess his health status. Patient History Very little information was known about Sam’s parents. However, it was known that they died in an automobile accident when Sam’s father suffered a massive heart attack. In the past two weeks Sam has done very well adjusting to his new environment. Moreover, he has had all the proper immunizations for his age. Sam’s adoptive parents, Mary and Bill, have noticed some greasy/oily stools in his diaper. In addition, they are concerned about his wheezing (when breathing). Physical Examination Vital Signs Age: 3 yrs. , 1 month Weight: 28 lbs. (lower 10%-tile) Height: 3 ft. 1 inch Pulse: 115 beats/minute Respirations: 30 breaths/minute Blood Pressure: 95/60 (systolic/diastolic) mmHg General Appearance Happy, energetic child Head and Neck Runny nose but his ears are clear of fluid Lungs Cracking sounds are present Coughing and wheezing are noticeable Cardiovascular Normal Abdominal No swelling is present Genitourinary Not assessed Extremities Full mobility is present Pulse found in arms and legs Neurological Normal reflexes Physician Comments Have a complete blood count and chest x-ray done. Also, schedule a follow-up appointment for tomorrow to review the lab results and chest x-ray. Objectives for PBL group 1. Assign people positions/roles for the case study such as group leader, typist, secretary, and editor. 2. Brainstorm on what you (a) know about the case, and (b) do not know, but would like to know about the case. 3. Formulate your initial ideas (or hypotheses) about what is wrong with Sam. 4. Identify and define terms and concepts you do not understand. 5. Write an approximately one-page group report that includes (a) the roles each person is assigned to, (b) your initial hypothesis and the evidence that led to its formulation, and (c) the terms and concepts that were initially identified as being unknown to you. Make sure you properly cite the source when explaining a concept. 6. You will be given Part II upon completion of Part I. Go to Part II—â€Å"The Follow-up Visit† A Typical Cold? by Brent J. F. Hill Part II—The Follow-up Visit Scenario Today is Sam’s follow-up medical appointment. The weather is very hot and humid, which makes it almost unbearable to be outside. Sam’s parents parked their car in the parking lot of Trinity Medical Center and went into the air-conditioned comfort of the pediatric clinic. They were immediately seen by the pediatrician, and Mary expressed her concern over the color of Sam’s sputum. Mary was upset that she had forgotten to tell the pediatrician the other day about this fact. The sputum Sam had been coughing up was green and viscid. While talking with Mary and Bill about Sam’s sputum, the pediatrician looked over at Sam and noticed a white â€Å"frosting† on his face (the â€Å"frosting† is an indication of salty build-up on the drying edge of sweat). The pediatrician asked Mary and Bill if they had noticed this salty build-up before. â€Å"That must be why his skin tastes a bit salty when I kiss him on his check,† Mary replied. The pediatrician then went over the blood count and chest x-ray results (described below) with Mary and Bill. After describing the chest x-ray results to them, the pediatrician had a hypothesis about Sam’s chest x-ray results. To test her hypothesis the pediatrician ordered a sweat chloride test (the result is listed below). Blood Lab Results White blood cell count: values within normal limits. White blood cell differential: lymphocytes, monocytes, eosinophils, and basophils are within normal limits. There is a slight elevation in neutrophils. Red blood cell count: values within normal limits Hematocrit: values within normal limits Platelet count: values within normal limits Chest x-ray Results Some hyperinflation and bronchial wall thickening is apparent. Sweat Chloride Test Results Indeterminate Objectives for Your PBL Group Session 1. Identify the most important concepts (â€Å"learning issues†) from both Part I and Part II that you need to investigate to diagnosis the causes for Sam’s symptoms. 2. Divide up the â€Å"learning issues† for each group member to investigate. The group leader will need to turn in a list of your â€Å"learning issues† which identifies by name the group member assigned to each one. Part II Individual Report 1. Define terms and concepts you don’t understand while investigating your â€Å"learning issue. † 2. Thoroughly explain your â€Å"learning issue. † 3. Do you have a different hypothesis about the case after investigating your â€Å"learning issue†? Provide the reasons or evidence for the change in your thinking or for why you still consider your initial hypothesis to be the most valid one. Cite all the sources you used. Make sure that you include in-text citations as well as a bibliography at the end of your report. Go to Part III—â€Å"Your Explanation of Sam’s Condition† A Typical Cold? by Brent J. F. Hill Part III—Your Explanation of Sam’s Condition Upon completing Part II, each member of your group is now the â€Å"expert† for a particular learning issue that is involved with Sam’s condition. Hopefully, this research has either reaffirmed your hypothesis about Sam’s condition or enabled you to formulate a new hypothesis. If you are unsure whether you are â€Å"on the right track,† please check with the instructor. Your next task is to prepare a group report that addresses the points detailed below. Objectives and Issues to Address in Preparing Your Final Group Report 1. What type of disease is Sam suffering from? Cystic fibrosis 2. What tissues and organs does this disease affect? Once you identify all the tissues and organs, briefly explain their respective dysfunction. It affects the lungs, liver, gallbladder, intestines, sweat glands, reproductive organs, and the pancreas. In the lungs bacteria grow in the mucous area causing infection and blockage of passageway. In the liver it can cause clogging and prevent it from working properly eventually causing liver failure. It affects the sweat glands by the amount of body salt lost in perspiration is highly elevated, causing salt retention problems during exercise and hot weather The intestines are sometimes the first affected organs that develop thick secretions that form in the intestines causing a life-threatening blockage of the intestines known as a meconium ileus. Cystic fibrosis affects the reproductive system differently in men and women. The disease can cause men to be infertile because of the thick secretions in sperm not allowing it to pass through the body. Women may have decreased fertility because of thick cervical mucus blockage It causes the pancreatic duct to clog not allowing proper digestion for food in the body. 3. Does this disease affect exocrine or endocrine glands; please explain your answer. In addition, what role do goblet cells play in this disease state? It affects the exocrine glands, causing them to secrete an excess of mucus and other secretions. Exocrine glands secrete substances onto body surfaces both internally and externally. . Goblet cell hyperplasia (the hypersecretion of mucus) and metaplasia (the replacement of a specialized cell with a another specialized cell) that play an important factor. 4. Explain the reasoning behind the appearance of his sputum. There is a lot of thick, viscous mucus around the lungs and respiratory system causing it hard to breath it can affect the liver function as well as the gallbladder function. Bile which is a dark green/brown color is produced by the liver but stored in the gallbladder. When CF affects the functioning of the liver it also loses its bile which can be mixed in with the thick mucus which causes the mucus to turn a different color. Also, if mucus is sitting in the respiratory tract for a long time it can turn colors and can also turn green if there is an infection involved and in the results it did say that Sam had excessive numbers of neutrophils which mean he has an infection in the immune system. 5. Typically, a pulmonary function test will not be given until about age 7. However, if Sam was given a pulmonary function test it will demonstrate a decreased FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity). Based on these hypothetical pulmonary function test results, answer the following questions: 1. What can you infer about the surface area and/or diffusion distance for gas exchange in Sam’s lungs? The surface area and diffusion distances for gas exchange in Sam’s lungs are significantly decreased due to the thick mucus that lines his lung walls and his decreased lung strength as a result of consistent coughing in developing lungs. How does the presence of sputum relate to Sam’s pulmonary function tests? The presence of sputum relates to Sam’s pulmonary function test in that the sputum lining his lung walls decreased surface area and expansion ability. Without the presence of this sputum and his lungs time to heal, Sam could perform much better in the test with treatment. 3. Do these tests correlate with Sam’s chest x-ray results? Make sure you explain your answer. The pulmonary tests do relate to the chest x-ray, bronchial wall thickening and hyperinflation could indeed cause the pulmonary test to be so poor as those causes significantly damage breathing strength and efficiency. 6. Explain how this disease affects the function of the pulmonary system on a cellular level. You might want to diagram a cell to help with the explanation. Make sure you specifically address osmosis (water movement) and ion transport of the cell. In a non-cystic fibrosis individual chloride channels are found in the cells lining the epithelium of the respiratory and gastrointestinal tract. These are the same cells that are coated by mucus. The chloride channels function to let chloride out of the epithelial cells. So in the cells from non cystic fibrosis individual the chloride channels open periodically to allow the cell to maintain a normal balance of chloride ion between the inside and outside of the cell. In a cystic fibrosis individual the chloride channels do not function and chloride ions build up inside the cell. 7. Explain why the sweat chloride test (Part II) is used as a diagnostic tool for Sam’s disease. In addition, suggest why the pediatrician should order a â€Å"nasal potential difference measurement† to be taken. The sweat chloride test was used as a diagnostic tool because when people with CF take sweat tests, the result is positive, and it is always positive. Although only an intermediate chloride level does not immediately diagnose one with CF, it one of very many important tests used to diagnose. A NPD measurement could also be taken to show an electrophysiologic abnormality in junction only to CF, correlating to and further helping to diagnose it. Explain and give the reasoning behind two treatment options. To help unclog his chest and nasal cavities, an aerosolized mucolytic could be used to help thin the mucus and help him cough and breathe easier and less painfully. For his greasy/oily stools, a pancreatic enzyme medication could be given to help aid in digestion and intestinal obstruction. If neither of these are effective or more simply needs to be done, there are many other options such as antibiotics and anti inflammatory drugs. Part III Final Group Report.