As a practice nurse, you will examine patients presenting with a variety of disorders. You must,
therefore, understand how the body normally functions so that you can identify when it is
reacting to changes. Often, when changes occur in body systems, the body reacts with
compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might
be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use
these responses, along with other patient factors, to lead you to a diagnosis.
Consider the following scenarios:
Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because
Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually
healthy and has no significant medical history. She was in her usual state of good health until 3
days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her
favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF
and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to
103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a
height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot
and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal
in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical
nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her
throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a
pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Scenario 2: Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that
he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands
seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a
little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife
told him that he might have an allergy and he should get some steroid cream. Jack has no known
allergies and no significant medical history except for recurrent ear infections as a child. He
denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a
newspaper building and admits that he often works with abrasive solvents and chemicals.
Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he
does not use them. He has exposed his hands to some of these cleaning fluids, but says that it
never hurt and he always washed his hands when he was finished.
Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at
a local hospital. Her medical history is significant for hypertension, which has been
controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of
trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her
appetite. She emphasizes that she is not hungry like she used to be. The only significant change
that has occurred lately in her life is that her 87-year-old mother moved into her home a few
years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip.
Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to
rely on her daughter for assistance with activities of daily living. Martha says it is not the
retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom
wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that
Martha is sleeping and eating less. She is worried about her own health though and wants to
know why, at her age, she suddenly needs less sleep.
To Prepare
• Identify the pathophysiology of the disorders presented in each of the three scenarios, including
their associated alterations. Consider the adaptive responses to the alterations.
• Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastrooesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one
of the disorders you identified from the scenarios. Use the examples in the media as a guide to
construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology,
risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses
to alterations. To Complete Write a 2- to 3-page paper • For each of the three scenarios explain the pathophysiology, associated alterations and the
patients’ adaptive responses to the alterations caused by the disease processes. You are required
to discuss all three scenarios within the paper component of this assignment.

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