ASSESSMENT TASK 1 CLINICAL CASE SCENARIO ANALYSIS
ASSESSMENT TASK 1 CLINICAL CASE SCENARIO ANALYSIS
SET 1, CASE 1 ROTATOR CUFF TEAR
(1) In the clinical case scenario, which symptoms (experienced by the patient like chest pain) and signs (observed by another person like swelling or redness) are consistent with the diagnosis? Word limit: 100 words GLORIA.
Symptoms consistent with a rotator cuff tear:
Nine-month history of sharp and deep pain on the anterolateral aspect of her left shoulder. (May & Garmel, 2023)
Pain aggravated by lying on and abduction/flexion of the left shoulder (Australia, 2022)
Difficulty dressing up, washing herself, reaching, and lifting with the left arm. (May & Garmel, 2023)
Signs consistent with a rotator cuff tear:
Painful arc sign and drop arm test were positive on the left. Weakness in internal and external rotation, abduction, and flexion of the left glenohumeral joint. Tenderness over the deltoid tuberosity, left deltoid, supraspinatus, infraspinatus, and teres muscles. (May & Garmel, 2023)
(2) Given the symptoms and signs in the clinical case scenario, which organs, tissues and/or body parts are involved or affected by the homeostatic disturbance? Word limit: 100 words
GLORIA
This clinical case scenario involves the musculoskeletal system involving the shoulder joint which is classified as a ball and socket joint (May & Garmel, 2023) and the rotator cuff which is composed of four muscles; the supraspinatus, infraspinatus, teres minor and subscapularis that originate from the scapula and insert into the superior humeral head through tendons for improved function and stability of the shoulder (Craig et al., 2017). A tear of the rotator cuff happens when one or multiple of these tendons rupture or separate from the humerus (Craig et al., 2017).
(3) What processes are involved that can explain the homeostatic disturbance/s in the clinical case scenario? Word limit: 500 words KIRRILLY
The clinical case of the 53-year-old female presenting with multiple cuff tears in the left shoulder involves several processes contributing to the imbalance of homeostasis. Homeostasis refers to a state of balance in the bodys systems, striving to maintain equilibrium and sustainability even when there is occurrence of internal and external changes. When there is an imbalance of homeostasis, it can lead to disease and in these pathological conditions such as musculoskeletal injury and healing response, inflammatory response, neuromuscular dysfunction, degenerative changes, and pain perception and central sensitisation.
The patients symptoms and signs stated are identifying an injury to left shoulders rotator cuff muscle which is associated with a musculoskeletal injury.
References:
Write your references here. Limit: 10 references
https://openurl.ebsco.com/EPDB%3Agcd%3A3%3A25950307/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A47600433&crl=c
https://onlinelibrary.wiley.com/doi/full/10.1002/jor.24455
GENERAL ROTATOR CUFF TEAR CONTEXT AND CAUSES textbook
https://link-springer-com.ezproxy.lib.uts.edu.au/book/10.1007/978-3-319-33355-7
Good websites:
https://www.ncbi.nlm.nih.gov/books/NBK547664/
https://search.lib.uts.edu.au/discovery/fulldisplay?docid=cdi_proquest_miscellaneous_733387582&context=PC&vid=61UTS_INST:61UTS&lang=en&adaptor=Primo%20Central&tab=Everything&query=any%2Ccontains%2Csigns%20and%20symptoms%20of%20rotator%20cuff%20tear
https://pdf.sciencedirectassets.com/272720/1-s2.0-S1058274607X00752/1-s2.0-S1058274606002035/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEK3%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIGmx1Z9fSz%2BsdVcAx4uao43vwZrTVk7XXKMx1m2GLZFDAiEA0lInExFfuK0JhRs1a4tWdmmTcKKHoNx0hVzxBqtJ21IqvAUI5f%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARAFGgwwNTkwMDM1NDY4NjUiDFJlzt%2BA4VRuIRt2biqQBTpBJMbgjNQQkGiGGaXU5a9WQeyEEMW9kbOyz1fSYu0dEWFojo58YUq4x%2BnIxWEDhwZfW4ypVJ1m2wpmmXPhucZ8pXEc1nZ7cPz70LQXmhYS37Tpaj6bKcHGIq14tzYS2%2Bmv75BvQEasQcdVa%2FyHarTkZD1fL25NdFZ1SUHgZ0%2BY6zTjcOVBYi%2B9y2aSM8gj%2FtI6BMM4eGKQaJ5Ye8RfJ1pdUg3NODT1LvcD28gDeQY8xRZ%2BVgxwwcZy89AQ2bzQgT4TiQj4S2t8k3IhGcx6wkqTgu1REUvX9zMPb9J7Uj%2BwvSZFgBqFqA6NUvJRkDMQK530NboG4xr3mD9jrUw2ij1bHZgZ9VgJjo4A7DS9dTygDSbvpy16UsvjkITUO4aTLpcpO4PFutXpXcC8434i%2FFmutZlJc693M%2FI3jR54%2BZSUc2Vh7KZD%2Fu%2FcptI%2B78ayFeJvM58ygNL1R0xfLzMBQ3ZISq88zn4%2Bc%2FHxvBAzIXalbAqUcraayvtGaoJvGEZQx8r3qveWYIBHHbhvOLWX9Ww0OePYhLHWxvbzu7N86sx1zdCg%2FizsFgI7FKTTYTZpPFDhw8CVsqU5mUuoYfNvURKMBOy66g8htO67XLkLK8hp%2FkTAplgla7pfMqhLGBFjKGt%2BsvsCYCycqj0T9yu0Oiw2KcS4CItvXguq%2FwSmB2t5cR1SO2Gs1374x8xIjFiDnE4RYMK7c4AdFl6a51zjqnvYuHAWEk3mOB4M%2BxORloE%2B730ZDaodcGXn8VRWQ2UTvdObt8Qued8AWLtoUC6Ted6FX0frPWWD4nmZ3Q8Re5LYIaD4jlj1Eb47yzAKwrgI2YqyudulZ04T9SY3yOnUm4R4nmsW5H0FOhU7Rap%2FJQZoMM26grEGOrEBGwuDtdperGZXEdOF7CLcHt8Iorvf%2B%2FjmwyaE7Z2dK3jJUJfcLbyxmn9X9uH7X3fMvGt2dYDCNCXk2hTqR3VW4vlidl1ILt%2FlJdmgVNKC4n%2B8yubbNg6RT%2FWm1Ul7Av3%2BoXZxS2hl4k6RPNo98t72R%2ByoBqQlpo3P0rPcPQo38byNd6RHbqr8CSpZqLDWBwTqaqo9%2Bfd9BkME8rDrIY7kkSedoVGbWBUSAJqY8RT82vRo&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20240418T043744Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTY5K2UOBNH%2F20240418%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=905271943ded49801fda2ad35d2cd25b5da5c4e930be7dc3aa0669b1c6507349&hash=3c2b3520ba3ad8a20fd9e9a8f868ffe5e9ab8ef7f2c0db2609c24163ba22abfc&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S1058274606002035&tid=spdf-4d6ba573-373e-44f2-ac30-3e51eed4c07c&sid=34d401725e18b040d318c9666ca9412b6371gxrqa&type=client&ua=1b135d51515301585559&rr=8761f61958de5733&cc=au
Idk why the website is so long lol
SET 1, CASE 2 CEREBRAL BLEED
(1) In the clinical case scenario, which symptoms (experienced by the patient like chest pain) and signs (observed by another person like swelling or redness) are consistent with the diagnosis? Word limit: 100 words
Write your answers here.
Please cite a book or a journal article to support your answer. Use in-text referencing. GLORIA
Symptoms consistent with a cerebral bleed:
severe headache (Chandler et al., 2018)
Nausea (Chandler et al., 2018)
right arm and leg weakness and numbness (Chandler et al., 2018)
Signs consistent with a cerebral bleed:
reduced grip strength of the right hand (Chandler et al., 2018)
He answers questions but appears sleepy (decreased consciousness) (Chandler et al., 2018)
blood pressure of 220/120 mmHg (hypertension) (Magid-Bernstein et al., 2022)
(2) Given the symptoms and signs in the clinical case scenario, which organs, tissues and/or body parts are involved or affected by the homeostatic disturbance? Word limit: 100 words
Write your answers here.
Please cite a book or a journal article to support your answer. Use in-text referencing. BRIANNA
Body parts affected: right limbs and brain function.
The impairment in brain function is evident when the patient is being asked questions, he is able to answer questions, but appears sleepy. Cerebral bleeds typically have an effect on brain function and can cause speech problems (Information et al., 2018). The limbs on the right side of his body had been impacted by the bleed (Chandler et al., 2018). This is evident in the reduced grip strength of his right hand and overall weakness and numbness in his right limbs (Chandler et al., 2018), he was also dangling his arm when paramedics arrived.
(3) What processes are involved that can explain the homeostatic disturbance/s in the clinical case scenario? Word limit: 500 words PASCALE
The brain is a vital organ in the human body receiving 600-700 ml of the blood every minute (Brain Circulation, 2015). This blood is essential for delivering glucose, oxygen and other nutrients to the neurons of the brain, and is thus vital for maintaining proper function and enabling metabolic processes. A cerebral bleed, also known as an intracranial haemorrhage, occurs when an artery in the brain bursts and causes bleeding between the brain and skull. There are three commonly encountered sub-types of cerebral bleeds that can be caused by a number of different factors, such as, head trauma, hypertension, brain tumours or amyloid angiopathy (Ker et al., 2019).
Hypertension
Hypertension is diagnosed when blood pressure is consistently 130 and/or 80 mm Hg (Flack & Adekola, 2020) and relates to the force exerted by the blood against the arterial walls. This homeostatic disturbance can be extremely problematic because if untreated chronic high blood pressure can cause changes to the arteries of the brain making them much more likely to rupture and cause a cerebral bleed (Patel, n.d.). The patient was non-compliant with his medication to treat hypertension and upon assessment revealed symptoms of a headache likely caused by his blood pressure of 220/120 mm Hg.
Smoking
Smoking poses significant risks to the health of human beings. Tobacco use is linked to numerous serious health conditions including lung cancer, COPD, diabetes and importantly strokes (Department of Health and Aged Care, 2023). The chemicals present in cigarette smoke induce thickening of the blood, disrupting vascular homeostasis and causing clots within veins and arteries, and therefore inducing cerebral bleeding. Studies from the American Hearts Association showed that Heavy and moderate smokers had 3 times the risk of fatal bleeding in the brain. Vital signs taken on the patient revealed a tachycardic heart rate of 110 bpm. The patients age and long history of smoking puts extensive pressure on the heart due to persistent elevation of the heart rate due to adrenaline released from the nicotine.
Lipidaemia (glucose result 9 mmol/L)
Smoking: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900392/#:~:text=Some%20studies%20found%20that%20cigarette,and%20intracerebral%20hemorrhage%20%5B123%5D.
Age: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082316/
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https://www.umassmed.edu/strokestop/modules/module-3-the-blood-supply-of-the-brain/brain-circulation/
https://www.mdpi.com/1424-8220/19/9/2167
https://www.health.gov.au/topics/smoking-vaping-and-tobacco/about-smoking/effects
GOOD SOURCES
https://www.jkns.or.kr/upload/pdf/jkns-2020-0128.pdf
https://web-p-ebscohost-com.ezproxy.lib.uts.edu.au/ehost/pdfviewer/pdfviewer?vid=0&sid=5b8161de-cb45-403d-b3c7-32f0dc2f326d%40redis
References:
Chandler, F., Kane, J., Blackford, A., Weinberger, M., Wagner, K., Gojo, I., Cohen, M., & Apostol, C. (2018). Early Identification of Intracranial Hemorrhage Using a Predictive Nomogram. Oncology Nursing Forum, 45(2), 177186. https://doi.org/10.1188/18.onf.177-186
Hostettler, I. C., Seiffge, D. J., & Werring, D. J. (2019). Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Review of Neurotherapeutics, 19(7), 679694. https://doi.org/10.1080/14737175.2019.1623671
Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2018). Brain aneurysm: What happens during a brain hemorrhage? In www.ncbi.nlm.nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK541154/
Magid-Bernstein, J., Girard, R., Polster, S., Srinath, A., Romanos, S., Awad, I. A., & Sansing, L. H. (2022). Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circulation Research, 130(8), 12041229. https://doi.org/10.1161/circresaha.121.319949
https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(20)30286-1?rss=yes&fbclid=IwAR19MhbyT9HZp_m6owlS0xQDpwNpBJ_yFKfRloSwnr9lPR5VQrw4yBL26mM%2Baem_AXvLeWvuF10UDbQARNt7ismnvOVCcwDBmGtahAfqaOfjqrT1v9yCml6A8NvDZRHEyMaKYn4UOoJweleK4jGKjIDz0wEIuf8r6T6VIRw70spMGQ
https://pubmed.ncbi.nlm.nih.gov/28986948/#:~:text=The%20BBB%20has%20been%20shown,autonomic%20dysfunction%2C%20such%20as%20hypertension.
https://pubmed.ncbi.nlm.nih.gov/31521481/#:~:text=Hypertension%20is%20diagnosed%20when%20blood,or%20%E2%89%A580%20mm%20Hg.
https://www.cdc.gov/tobacco/sgr/50th-anniversary/pdfs/fs_smoking_cvd_508.pdf
Write your references here. Limit: 10 references
UPDATE: INTRACEREBRAL HEMORRHAGE IS THE SAME AS CEREBRAL BLEED!!
But its not the same as ischemic stroke!!!! IT IS NOT A STROKE
SET 1, CASE 3 TRICUSPID REGURGITATION
(1) In the clinical case scenario, which symptoms (experienced by the patient like chest pain) and signs (observed by another person like swelling or redness) are consistent with the diagnosis? Word limit: 100 words
Symptoms consistent with tricuspid regurgitation:
One-year history of worsening exertional dyspnoea (Qiuyu Martin Zhu & Berry, 2023)
swelling of both lower limbs (Henning, 2022)
Felt sluggish and weak, and had fatigue and palpitations. (Qiuyu Martin Zhu & Berry, 2023)
Signs consistent with tricuspid regurgitation:
Pitting edema of both legs was present. (Henning, 2022)
The liver was enlarged and palpable 2 cm below the rib edge. (Henning, 2022)
Cardiovascular examination revealed the following: a heave over the right and left lower sternal border, a thrill over the left lower sternal border, and a high-pitched holosystolic murmur at the left lower sternal border. (Henning, 2022)
References
Henning, R. J. (2022). Tricuspid valve regurgitation: current diagnosis and treatment. American Journal of Cardiovascular Disease, 12(1), 118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8918740/
Qiuyu Martin Zhu, & Berry, N. (2023). Tricuspid Regurgitation: Disease State and Advances in Percutaneous Therapy. European Cardiology, 18. https://doi.org/10.15420/ecr.2023.09
(2) Given the symptoms and signs in the clinical case scenario, which organs, tissues and/or body parts are involved or affected by the homeostatic disturbance? Word limit: 100 words
BRIANNA
The brain was affected due to decreased cardiac output caused by the tricuspid regurgitation which is evident in the patient as he shows the common TR symptoms of feeling sluggish, weak and fatigued (Henning, 2022).
The liver was affected as it was enlarged and palpable 2 cm below the rib cage. Pitting edema was present in both legs, showing that they were affected by the TR. The heart was affected by the TR. This is evidenced by the heave over the right and left lower sternal border, and the thrill and the high-pitched holosystolic murmur over the left lower sternal border that was present.
(3) What processes are involved that can explain the homeostatic disturbance/s in the clinical case scenario? Word limit: 500 words KOMAL
EXAMPLE
The heart is structured in a way for the blood to move in one direction. Having four chambers, the blood is received through the right atrium which then the blood travels through the ventricles, lungs then back to the left atrium, ventricles then to the rest of the body through the aorta. The mitral valve is situated between the left atrium and ventricle. As the mitral apparatus involves complex structures of mitral valve (posterior and anterior leaflets), chordae tendineae, papillary muscles, left ventricle and atrium, any deformity or changes to these structures can cause mitral regurgitation (Liu X J., Patel, P., 2020).
Mitral regurgitation refers to the inability of the mitral valve to close properly during diastole leading to backward flow of blood (Liu X J., Patel, P., 2020). This leads to a huge concern in maintaining homeostasis as the body is unable to pump enough blood to the body causing; backup of blood coming from the lungs causing pulmonary congestion, reduction of oxygen getting to body cells, formation of blood clots, enlargement of sections of the heart and fluid build up in legs and organs(Liu X J., Patel, P., 2020).
Increased intravascular hydrostatic pressure is known to cause pulmonary congestion due to the backlog of blood within the pulmonary arteries (Deferm et al., 2019). The pressure caused by the accumulation of blood causes pulmonary hypertension which increases the hydrostatic pressure within the blood vessels. This imbalance causes fluid into the interstitial space no by osmosis (Oyama & Adin, 2022) causing pulmonary edema, which is evident as the patient is displaying symptoms of worsening exertional dyspnoea, orthopnoea and upon physical examination displaying signs of fine crackles in the lungs. This inturn causes extreme fatigue as the patient is unable to intake oxygen efficiently (Daniel Joseph Garry et al., 2017) which can induce cyanosis, as the cells are not receiving adequate oxygen (Douedi & Douedi, 2020).
Mitral valve dysfunction causes the Left atrium and ventricle to dilate due to the accumulation of blood between the chambers. This inturn increases the venous pressure within the chambers causing enlargement of the left proportion of the heart causing atrial fibrillation (Daniel Joseph Garry et al., 2017), contributing to the symptoms of palpitations. Enlargement of the heart also occurs due to the extra force needed to pump blood through the body.
Oedema of the legs and organs is often due to the fact that the blood cannot provide enough pressure to pump the blood through the circulatory system efficiently (Tiwary, 2022, pp. 3738). This causes blood and fluid to accumulate within the extremities (legs, often due to gravity) and within the interstitial tissues of organs (Oyama & Adin, 2022). Liver being mainly affected as there is low pressure of blood returning to the heart and backflow of blood into pulmonary arteries, affecting blood flow from both sides.
Notes for komal:
Pitting edema of both legs was present. one-year history of worsening exertional dyspnoea and orthopnoea leading to fatigue, weakness
The liver was enlarged and palpable 2 cm below the rib edge.
Cardiovascular examination revealed the following: a heave over the right and left lower sternal border, a thrill over the left lower sternal border, and a high-pitched holosystolic murmur at the left lower sternal border.
Laboratory studies: Electrocardiograph demonstrated sinus rhythm with evidence of right atrial and ventricular enlargement. Transthoracic and transesophageal echocardiography confirmed enlarged right atrium and ventricle with severe rheumatic tricuspid regurgitation.
Rheumatic valve disease: the most common cause of pure tricuspid regurgitation due to damage to the tricuspid leaflets. The valves undergo fibrous thickening without commissural fusion, fused chordae, or calcific deposits
Komals response:
The blood flows in a single path because of the way the heart is designed. With four chambers, the right atrium receives blood, which then passes via the ventricles, lungs, and back to the left atrium and ventricles before entering the aorta and carrying the blood to the rest of the body.
The patients signs and symptoms point to the heart's incapacity to pump blood forward efficiently, which causes venous congestion, which manifests as peripheral edema, reduced tissue perfusion, thus causing weariness and weakness, and fluid buildup in the lungs, which finally causes dyspnea and orthopnea (Liu X J., Patel, P., 2020). Furthermore, the existence of atrial fibrillation on the ECG and the history of a prior episode of unstable angina imply that an underlying cardiovascular disease is causing the symptoms.
This clinical scenario's homeostatic disruption predominantly affects the cardiovascular system and its interactions with the respiratory and renal systems, among other organs, tissues, and body components. The primary organ impacted is the heart, which displays structural anomalies including severe mitral regurgitation and enlargement of the left atrium and ventricle. These cardiac disorders affect the heart's ability to pump blood normally, which results in decreased blood flow and fluid retention. As a result, there is pulmonary edema and fine crackles on auscultation due to congestion of the lungs. Venous congestion is evident in peripheral organs, such as the liver and lower limbs, where symptoms including hepatomegaly and pitting edema are present.
The mitral valve is situated between the left atrium and the ventricle. As the mitral apparatus involves complex structures of the mitral valve (posterior and anterior leaflets), chordae tendineae, papillary muscles, left ventricle, and atrium, any deformity or changes to these structures can cause mitral regurgitation (Liu X J., Patel, P., 2020). A high core body temperature, a high blood salt content, or a low oxygen concentration are examples of homeostatic imbalances that can cause homeostatic reactions like warmth, thirst, or dyspnea, which drive activities meant to return the body to equilibrium. Pulmonary edema and dyspnea are caused by the disturbance of heart function, which also causes venous congestion and fluid leaking into the lungs (Liu X J., Patel, P.,
2020). Furthermore, hepatomegaly, jugular venous distention, and peripheral edema are all influenced by elevated venous pressure. The sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) are two of the body's compensatory mechanisms that aim to maintain steady cardiac output and blood pressure. On the other hand, prolonged activation of these pathways could exacerbate vasoconstriction, fluid retention, and myocardial remodelling.
Pulmonary congestion and edema impair gas exchange in the lungs, leading to hypoxemia and respiratory (Deferm et al., 2019) symptoms such as dyspnea and orthopnea. Diminished cardiac output leads to diminished renal perfusion, which triggers the RAAS and exacerbates fluid overload by increasing the retention of salt and water. These pathways interact to generate congestive heart failure in severe mitral regurgitation, which is characterised by fluid overload, inadequate tissue perfusion, and neurohormonal dysregulation (Oyama & Adin, 2022).
