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Section 1: Integumentary system
Skin is the largest organ in human body and plays an active part in regulating a temperature of body. Some of the key regulatory features performed by this system involve following points,
1. Blood supply system helps in temperature regulation as heat loss is allowed from the dilated vessels while the constricted ones act to retain heat.
2. Sweat glands situated in the skin helps in the process of cooling the temperature of a body by means of evaporation of water affecting the loss of heat(Regan et al. 2015).
3. Skins also play a key role in maintaining homeostasis which is the medium of being in equilibrium with the external environment and adjust body temperature in accordance.
4. Arrector pili that are attached to hair follicles and any small muscles make contraction and causes standing of hair. This activity helps in cooling of body temperature.
5. An activity such as radiation of body heat and convection process also regulated by skin and that is essential in regulating body healthcare.
Basal cell carcinoma is characterized by means of rising of skin which is normally painless and presence of running blood vessels over it while squamous cell carcinoma is a malignant tumor as means of stratified epithelium. One of the key causes that are related to the basal cell carcinoma involves overexposure to sunlight as this cause thymine dimer formation and damages DNA and this crosslinked change in DNA cannot be excised(Faniku, Wright & Martin, 2015). Cumulation of continuous such damage leads to formation of mutation of and causes carcinoma. In case of squamous cell carcinoma, alteration in the p53 protein, effect of UV radiation on DNA change and species which are oxygen related, RAS gene and its abnormal functionality are some of the causes of causing this carcinoma. It can also result from alteration of growth factor in epidermis while basal cell carcinoma can arise due to contact with other lesions of body such as squamous cell carcinoma.
A. Pathophysiology of thermal burn is slow regulated process and thermal burn induces release of number of factors also. These factors increase the amount of permeability of skin capillaries. This results in pouring out of proteins and fluids into the place that is damaged in nature. For any burn related wound that is 30% or more with respect to body surface, involves very high rate of fluid loss. Change in permeability increases after 8th hour from exposure to burn and retains normality after 36 hours(Jeong, Kim & Lee, 2014). Diffusion of water and other essential elements returns to circulation process while proteins remains trapped in the interstitial spaces of cells. These spaces are ultimately removed by means of lymphatics after total cure of thermal burn wound.
B. Clinical manifestations related to thermal burn can be critical and must be brought to notice of a doctor in case of following
1. Formation of large blisters
2. Oozing of wounds referring to involvement of infection in concerned area
A. Color of skin is dependent on presence of a particular pigment in skin called melanin. This acts to regulate not only the color of skin but also the color of hair and eyes. There are two types of melanin present in skin of which one is known as eumelanin and the other known as pheomelanin. Presence of eumelanin acts to give skin a brown color while presence of pheomelanin acts to give skin a red color. Some factors are involved in the process of regulating the amount of synthesis of melanin such as higher and regular basis of exposure to sun results in greater secretion of melanin pigment that results in darker color of skin(Geng et al. 2016).
B. Clinical manifestation of skin color involves vitiligo that causes loss of color from a particular part of skin and UV radiation can cause drastic change in skin color and nature of pigmentation.
A. Melanoma is also referred as malignant neoplasm of skin resulting from proliferation and trasformation of melanocytes in an uncontrolled manner. In the aspect of pathophysiology, external exposure such as UV rays and internal susceptibility of genes such as CDKN2A, CDK4, MC1R causes higher amount of mutation accumulation related to genetic substances. This activates oncogenes and genes for suppressing tumors. Such activation process helps in proliferation of melanocytes resulting in evasion of immunological system and results metastasis(Faniku, Wright & Martin, 2015).
B. There are some basic difference between mole of melanoma and ordinary mole and expert is needed to make proper recognition of this. Two common clinical manifestation of melanoma involves following,
C. Spot in skin that is changing size as well as color based on rate of proliferation of melanocytes.
D. Redness of the area outside the mole border due to presence of blood in that area.
Section 3: Blood system
There are four basic types of blood and these are called as blood groups. These groups involves following,
1. Blood group A
2. Blood group B
3. Blood group AB
4. Blood group O
In the aspect of compatibility of these blood groups, each group has its specific measures. Compatibility measures for each group are given below,
1. For blood group A, it can donate blood to such recipients who have blood group of A and AB and can receive blood from donors who have blood group of A and O.
2. For blood group B, it can donate blood to such recipients who have blood group of B and AB and can receive blood from donors who have blood group of B and O.
3. For blood group AB, it can donate blood to such recipients who have blood group of AB only and can receive blood from all possible donors such as blood group A, B, AB and O. Thus AB blood type is known as universal recipient(Epstein et al. 2013).
4. For blood group O, it can donate blood to all recipients such as blood group of A, B, AB and O and can receive blood from donors who have blood group of O only. Thus O blood type is known as universal donor.
A. Clinical manifestation of mild transfusion reaction involves the process of itching and chances of lung problem. Both of these issues are not involved in the process of acute cases and can be controlled in case of implication of simple factors.
B. For itching of skin, one of the main pathophysiological mean involved is the case of transfused blood being contaminated with some bacteria. Presence of bacteria often induces the immunological system of body and causes different infectional diseases based on type of infection got transfused(Johnson et al. 2013).
For lung injury, it is the antibodies that are present in the plasma of donor cells that cause damage to immune cells present in lungs. Such damage of lung involves in the process of fluid building in lungs and reduces ability of respiration as supply of oxygen to body gets reduced.
A. Rh factor of blood is commonly known as ‘Rhesus factor’ as blood of Rhesus monkey was the first evidence that proved the presence of this factor. There are 50 antigens that act to define this system of which D, C, c, E and e are five most important ones. A person is called Rh negative in case of absence of D factor only. This factor is highly significant as it act to control hemolytic disease occurs mainly in newborn(Tenzer et al. 2013).
B. In case of Rh negative patient receives Rh positive blood, it affects previous sensitization of Rh negative antigens. Hemolysis of the red blood cells occurs in such patients as the patient previously had anti D antibodies in his blood which gets mixed with Rh D antigen of positive blood. Thus severe damage to blood system will be evident.
C. In case of pregnant women, mixture of Rh negative antigen that is already present in placenta of pregnant women and Rh positive antibody of second child can cause severe problem to child. In such cases, hemolysis of blood cells occurs in the child as red blood cells get broken down and causes death of that child.
Anemia refers to the lower production of red blood cells and this can happen even without hemolysis process. Thus some of the clinical manifestation of anemia involves increased amount of fatigue and the other one involves tissue hypoxia.
- In case of increased amount of fatigue lower amount supply of oxygen to the muscles is the main cause. In such case production of hemoglobin from bone marrow gets decreased and thus number of Hb molecules present in red blood cells to carry oxygenated blood gets reduced and for that supply of oxygen to muscles gets reduced and increases lactic acid production in muscles. This leads of higher amount of fatigue(Pober & Sessa, 2015).
In case of tissue hypoxia, the aspect of the erythrocyte cell cycle is very important. Erythroid precursor development is directly related to Hb to oxygenate in regarding tissues. Thus differentiation of erythroid from stem cells to progenitor cells to finally in normoblasts via erythroblasts requires specific growth factors as well as cytokines. Newly formed reticulocytes formulate mature erythrocytes by means of RNA digestion and this overall process gets hampered in case of anemia and these results in hypoxia of tissue.
In the aspect of administration of blood, it can certainly help in the process of improving oxygen level of a patient. Administration of blood typically involves blood transfusion and involves increased amount of blood in body that helps in increasing Hb count in blood(Epstein et al. 2013). In such case, number of Hb molecules present in red blood cells to carry oxygenated blood gets increased and for that supply of oxygen to lungs gets increased only. Better flow of blood in veins also helps in maintaining this higher level of oxygen flow through veins causing improvement in the level of oxygen in a particular person.
Section 4: Musculoskeletal System
A comminuted fracture is related to such incidents where breaking of bone occurs into numbers greater than two. As high amount of energy is required for fragmenting bones into such parts, impactful trauma and serious accidents are involved in this process. On the other hand, compound fracture refers to such cases in which pieces of bone that are broken protrudes out of the wound and gets exposed. Thus this process is associated with higher chances of infection compared to comminuted fracture(Del Grande et al. 2014). Falling from higher place or playing sports can effect in the process of compound nature of fracture. Compound fracture requires 4-6 weeks to be healed in proper manner while comminuted fracture takes at least 6 weeks in order to get cured in proper manner.
Neurovascular system is the combination of nervous and vascular system and combination of both these systems are very important in order to assess neurovascular detorian in proper manner. In this regard, it is very important to consider early assessment as taking late measures can impact in deficit of permanent nature such as loss of a limb. In the process of making proper assessments related to neurovascular system, consideration of 5P is important and these are aspect of pain, issue of pallor, aspect of pulse, paralysis and paresthesia(Neumann, 2013). Neurovascular observations thus involves monitoring of blood supply to brain and upper portion of spinal cord as often it is seen that neurovascular injury results in less amount of blood supply.
- It is the increased amount of intracompartmental pressure that actually causes the compartment syndrome. There are two distinct type of compartment syndrome involves trauma of being affected by fracture of bone or muscle injury and the second one is exertional one related to repeated physical activity loads. This typically affects the process of circulation and also the tissues involved. Rise in pressure quotient of a certain tissue involves in decreasing actual size of compartment and aspect of hemorrhage is also related to this process(Colaianni et al. 2016). Blood flow in capillaries also gets impaired due to a rise in venous pressure and resistance activities peripheral vascular tissues.
- Thus in the process of providing education to patients involves stating about the consequences of this clinical condition on nursing and healthcare. No negligence should be involved in the case a feeling of a decreased amount of sensation and severe pain in a particular area is felt. Surgery is the best remedy in such cases to release the excess amount of pressure and benefits of must be well guided to them.
- The mechanism behind embolism of fat and aspect of FES is of high regard as fat embolism of asymptomatic nature is found very often in case of pulmonary circulation after the occurrence of surgical events. The developmental process of FES is directly related to the mechanical stress involved in a major trauma as emboli of fat being released cause microvasculature to occlusion and triggers a specific response that is based on the dysfunction of pulmonary or neurologic concerns. Studies have shown that more than 30% of people possess foramen ovale and that is enough evidence to highlight passing procedure of fat emboli in the pulmonary circulation(Bershadsky et al. 2015).
- An embolus that is made up of fatty acid is commonly termed as fat emboli. This is clinically significant as a glob of fat passes in the bloodstream and gets lodged their. This can cause higher amount of breathing problem as oxygen carrying capacity gets lowered in such cases. Released fat of bone marrow or lipid metabolism after a huge trauma causes such deposition of fat in the bloodstream and causes a problem in the pulmonary circulation.
- Osteoporosis and osteoarthritis are two completely different terms as osteoporosis refers to the loss of bone that increases fracture related risks while osteoarthritis involves joint degeneration process. Regarding pathophysiology of both these clinical condition, it is the accumulation of acidic residues resulting in higher pH value is one of the key factors involved in the process of osteoarthritis which is related to the connective tissues. On the contrary no such pH regulated process is involved in this process and these impacts in a painless condition. It gets painful in case of osteoarthritis as presence of inflammation is there.
- In case of osteoporosis, there is no particular clinical manifestation as there is no feeling of pain involved in the process unless a fracture of bone is developed in the course. Symptomatic fractures involving vertebral column involves pain and loss of height. This is typically involved as loss of bone calcium takes place(Colaianni et al. 2016).
- In case of osteoarthritis, increased amount of acidic pH act behind inflammation of bones. Some of the clinical manifestations involve stiff nature of joints and high amount of pain in the concerned joints. This involves in restriction of locomotion due to very limited or overuse of particular part of bones. Accumulation of acidic residues and inflammation causes restrictive nature of locomotion.
Section 5: Organ - Liver/Pancreas/Gallbladder
- Jaundice is caused by means of hyperbilirubinemia that is characterized by yellowish color of skin and eyes. In normal condition, breakdown of hemoglobin causes increase in the amount of bilirubin to unconjugated bilirubin. This unconjugated bilirubin gets to bind with blood albumin and gets transported to liver. In liver this unconjugated bilirubin are taken by hepatocytes and joins with glucuronic acid in order to increase water solubility. Then this conjugated bilirubin is released in duodenum by means of bile where some of bacteria act to form urobilinogen from this bilirubin(Schnabl & Brenner, 2014). Some amount of this urobilinogen is released as faecal matter while most is reabsorbed and extracted by hepatocyte cells in the liver. This leads to reformation of bilirubin and thus level of bilirubin increases.
- In the aspect of stating about the clinical manifestations related to jaundice, most common one involves involvement of yellow tinge in the skin. That is primarily due to the presence of such high level of bilirubin of body. Another common clinical manifestation involves pale nature of stool due to higher absorbance of bilirubin and lower amount being excreted as faecal matter.
Cirrhosis is related to the complication of liver in which loss of cells of liver is encountered. This can be characterized by many functions which are abnormal in nature. Cirrhosis is related to dying of liver cells and formation of scar tissues. Pain in the right upper quadrant due to cirrhosis involves some pathophysiological actions. This involves some of the cells that do not die attempts to replace dead cells by means of rapid multiplication and for that a cluster of new cells occurs in scar tissue. Some of chemicals such as alcohol, certain type of medicine and fat help in this process(Qin et al. 2014). Some of the toxic metals such as iron and copper also causes problem in the aspect of cirrhosis of liver. These aspects provide a deep impact in overall amount of accumulation of toxin. Due to non degradable nature of these substances, it even causes genetic diseases. Lymphoma and chronic myeloid leukaemia is also regarded as important in the aspect of discussing primary cirrhosis that ultimately causes pain in the right upper quadrant.
Ascites involves the collection of fluid that is of pathologic nature in the cavity of abdomen. It is the total body sodium and and water excess that is represented by means of ascitic fluid. In most of the cases, the occurrence of such incident involves er hypertension of hepatic portals that is involved in the liver cirrhosis process. A series of incident takes place between portal hypertension and sodium retention done by renal system. Increase in the value of nitric oxide is directly proportional to portal hypertension and this increased value of nitric oxide effects splanchnic vasodilation and peripheral vasodilation(Popper & Schaffner, 2013).
- Thus in the process of providing education to patients involves stating about the consequences of this clinical condition on health. No negligence should be involved in case of maintenance of diet. Conservation of energy will be told to such patients as it helps in maintaining fluid levels. Intake of timely medication is also a key concern in this process.
Portal hypertension is also related to liver complication and is characterized by resistance to blood flow of portal area into liver. Cirrhosis and larger amount of intrahepatic vascular resistance is related due to structural change caused by fibrosis. Increase in the tone of vascular system and microcirculation is related to the process of portal hypertension. Portal hypertension results in increased amount vasodilation of arteries causing increased flow of blood to portal circulation(Qin et al. 2014).
- Significance of portal circulation lies in its activity as it act to capture substances from digestive tract and transfers to liver for further processing. Thus it is very important to consider proper functionality of liver and ensure proper flow of blood is present in portal circulation system.
- Cirrhosis of liver that is based on alcohol consumption causes extensive damage to liver cells that cannot be rejuvenated while in case of nonalcoholic liver cirrhosis can be managed if proper action is taken regarding control of poisonous substances. Cirrhosis of non alcoholic matter involves developing much faster as in case of alcoholic cirrhosis, the process is much slow as extensive effect is seen(Schnabl & Brenner, 2014).
- Non alcoholic cirrhosis involves breast enlargement in male due to increased level of estrogen caused by dysfunction of liver. Another fact involves skin itching due to increase of bile salts in liver.
Alcoholic cirrhosis involves increased rate of vomiting with presence of blood and enlargement of liver due to occurrence of high rate of cell proliferation.
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