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  • Length: A minimum of 180 words per post, not including references
  • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years

Number 1 post: WR

  For novice Advanced Practice Registered Nurses, utilizing a structured higher order thinking process to determine all the differential diagnosis possibilities seems critical, or at least until one has enough experience that the process is ingrained. The process of determining differential diagnosis leads the practitioner towards formulating an accurate conclusion about how to diagnose when the symptoms of multiple conditions are present concurrently. The process of narrowing down the possibilities can be overwhelming depending on the situation. Research may yield hundreds of articles spanning decades.

Using a combination of processes and strategies in determining the differential diagnosis will improve efficiencies, timeliness, patient safety, and treatment effectiveness. The APRN shall perform a physical examination, produce a list of possible interim differential diagnoses, conduct diagnostic tests, and/or refer to specialty providers. There are benefits to performing the physical examination and obtaining a health history. These activities will generate a more comprehensive list of symptoms and physical findings. In urgent situations, this may not be feasible and counterproductive in life threatening situations. The test results will help to confirm provisional differential diagnoses and possibly uncover conditions that were not previously considered. Diagnostic tests and interventions require time, access, money, and insurance coverage, and in some cases pose health risks to the patient.

It is an expectation that the practitioner continuously evaluates when and if sufficient data is available to make a formal diagnosis, and to ensure the benefits of testing outweigh the risks to the patient. The provider may also send the patient out for a referral as part of the process when he/she has exhausted all of the possibilities in their scope of knowledge/experience. One provider is quoted as saying “I am far more concerned about doing too little than doing too much. It’s the scan, the test, the operation that I should have done that sticks with me—sometimes for years” (Balogh, Miller, & Ball, 2015).

Number 2 post: PG

It is intriguing to come to a hospital setting with multiple symptoms of a disorder or condition one may encounter without knowing what is going on in the body. For example, many individuals may experience a headache or stomach ache, which could cause the symptoms one is experiencing. As healthcare providers, one must determine the logical cause of the disease or disorder to make a differential diagnosis due to similar symptoms associated with many conditions. The purpose of this discussion is to explore Differentiate Diagnosis (DD) and three types of differential diagnosis strategies used in the clinical setting. The three types are 1) inductive reasoning, 2) deductive reasoning, and 3) clinical reasoning. Furthermore, the risks and benefits of the three types of DD processes are discussed.

Jain (2017) mentioned differential diagnosis as making a list of possible diseases to help guide one in looking for the condition in the patient. Cadet et al. (2019) informed the differential diagnosis includes a thorough workup for the arrival of the diagnosis. Gheorghiu and Barkley (2017) indicated that nurses should know associated risks with the assessment and history in the diagnosis. For example, heart failure or kidney failure may be diagnosed with diabetes. Nonetheless, Dlugasch and Story (2021) discussed that differential diagnosis is essential and that a multidisciplinary approach is beneficial in the treatment plan of care. Health history, interviews, effective communication, physical assessment, screenings, lab tests, biopsies, radiology, ultrasounds, scans, or blood work helps guide the diagnosis (Dlugasch & Story, 2021). Moreover, if an essential element is left out, an individual may not be diagnosed correctly (Cadet et al., 2019)

A healthcare provider may use strategies including deductive, inductive, or clinical reasoning to arrive at a diagnosis (Reinoso et al., 2018). Deductive reasoning involves starting with the general input and moving toward the specific diagnosis (Reinoso et al., 2018). However, this may cause problems because the hypothesis begins early, as the chief complaint, and the information gathered is tested against the idea (Reinoso et al., 2018). On the other hand, in inductive reasoning, the health provider may start with the specific and move toward the general. Moreover, the reason starts with input from observations that matches a set pattern or an algorithm to confirm the hypothesis (Reinoso et al., 2018). Reinoso et al. (2018) mentioned this type of reasoning tool might be helpful with expert-derived algorithms related to statistically essential cases. However, a disadvantage to this type of reasoning could be that it may be somewhat confusing to novice Advanced Practices Nurses (Reinoso et al., 2018). Finally, in clinical reasoning, the health care provider critically thinks through the symptoms, lab tests, or presentations to arrive at a diagnosis (Reinoso et al., 2018). However, the problem with clinical reasoning per Reinoso et al. (2018) is that one may confuse clinical reasoning with clinical decision making (slightly differently).

In closing, the differential diagnosis may involve the presentation of familiar diseases or disorders. Therefore, healthcare providers like Advanced Practice Nurses should follow an orderly strategy in determining the differential diagnosis. Methods may include interviewing the client, effective communication, health history, physical exam, labs, blood work, biopsies, scans, x-rays, and collaboration with other experts in determining the differential diagnosis and treatment plan. Also, deductive, inductive, and clinical reasoning may be helpful avenues in selecting a differential diagnosis.

Number 3 post: JL

The function of cells affects the way our body operates, and any alterations or dysfunctions cause disease manifestation and progression. Cells are the building blocks of our body that form organs, tissues, and organ systems (Dlugasch & Story, 2021). Cells group together to form tissues which then form together to produce organs and then communicate to develop organ systems. Their communication and purpose are vital to their survival. Basic cell components include the cell membrane, cytoplasm, and organelles (including the nucleus) which each play a part in the structure and function of each cell (Dlugasch & Story, 2021). The cytoplasm is the liquid portion of the cell that supports the organelles and where the work transpires. Organelles are responsible for the work that maintains life. The nucleus is considered the control center containing genetic information and is responsible for regulating growth, metabolism, and reproduction (Dlugasch & Story, 2021). The cell membrane is the fatty layer around the cell that serves as a boundary that is semipermeable. The human body functions, reproduces, exchanges material, and thrives because of cells.

Case Study Wk1-15-year-old male presents after ingestion of windshield wiper fluid

Windshield wiper fluid becomes toxic when ingested due to its composition of ethylene glycol which is an alcohol that is colorless, odorless, and sweet. The toxicity of this alcohol is mediated by its metabolites, glycolic acid, and oxalate (Ahmed et al., 2020). Ethylene glycol is absorbed through the gastrointestinal tract rapidly after ingestion with serum concentrations peaking soon after consumption (Iqbal et al., 2021). Neurological and gastrointestinal symptoms manifest early while renal failure and death occur if not treated promptly. Ethylene glycol poisoning causes a high anion gap, metabolic acidosis, and an elevated osmolal gap but in some cases the osmolal gap is almost normal which can delay treatment and diagnosis (Ahmed et al., 2020). Some patients present with cognitive deficits and unremarkable physical signs. Ethylene glycol levels are send out labs so a thorough history if available and extensive in-house labs are essential to initial treatment and detection. Unfortunately, providers must use overall suspicion of ingestion as a cause for preliminary treatment and diagnosis due to uncorrelated lab values and findings. An elevated osmalal gap of more than 10mOSm/kg indicates the presence of solutes in the serum which suggests toxic alcohols (Ahmed et al., 2020). Often, the anion gap is normal but the osmolal gap is high, but as ethylene glycol is metabolized the accumulation of toxic acids leads to an increase in anion gap and a decrease in osmolal gap (Sugunaraj et al., 2017). Hypernatremia exists due to the increased osmolal gap and systemic acidosis, causing high sodium levels, which is treated with sodium bicarbonate. Ethylene glycol is first oxidized by alcohol dehydrogenase and then to glycolaldehyde, which is then oxidized by aldehyde dehydrogenase to glycolic acid, which is the primary cause for the associated metabolic acidosis (Iqbal et al., 2021). Early detection and treatment coupled with extensive diagnostic studies are essential to reverse the effects of ingesting this toxic alcohol.

 

Number 4 post: RV

Part 1- Cellular Biology

The basic configuration of all living things is what we called, cells. The human body is composed of trillions of cells. Moreover, they provide structure for the body, take nutrients from food, convert them into energy, and carry out specialized functions. Cell morphology is the division of science dealing and allocating with the cell’s structure and is elemental in recognizing cells’ size, shape, design, and form. Cells are the most straightforward and vital unit of all living/biological organisms. In biology, cell morphology relates to the morphological structures of the cell(s) and associates the underlying context of this basic unit of life.

Additionally, it employs microscopy to classify the shape, pattern, structure, form, color, texture, and size (Cell morphology. Bruker, 2021). For instance, cell morphology pertains to the shape of bacteria if cocci, bacilli, spiral, and the size of bacteria. It is essential to determine cell morphology in bacterial taxonomy and grouping.

 

There are three categories in cell morphology: fibroblastic, epithelial-like cells, and lymphoblast-like cells. Fibroblastic cells have elongated in shapes, epithelial-lie cells are polygonal in form with more regular dimensions, and lymphoblast-like cells are spherical (Cell morphology. Thermo Fisher Scientific – U.S., n.d.). Morphological characteristics play an essential key role in identifying and diagnosing cancer cells. Morphological analysis may be helpful to screen cancer cell populations and stem cells (Prasad & Alizadeh, 2018). For instance, normal cells have regular, ellipsoid shapes, while cancer cells are often irregular and contoured. One of the most critical structures in a cell is the nucleus. The nucleus is a cell’s center and is the unique organelle found in a eukaryotic cell. It is where almost all DNA replication and RNA synthesis occurs (U.S. National Library of Medicine, 2021). Likewise, cell morphology is also essential in cell motility and ultimately tumor invasiveness.

 

CASE STUDY: A 72-year-old male presents with a reduced ejection fraction, D/T left ventricular hypertrophy.

Left ventricular hypertrophy (LVT) means that the heart’s main pump (left ventricle) has become thick and enlarged. The heart muscle may not get sufficient oxygen supply, and the heart could not pump enough as it supposed to be (Kosaraju et al., 2021). High blood pressure or other heart problems such as cardiomyopathy or aortic valve stenosis are typically affected by high blood pressure.

 

Cellular adaptation refers to transformations constructed by a cell in response to adverse environmental changes. Its reversible reactions allow cells to survive and continue to function adequately. Hypertrophy is an increase in cell size. Therefore, if enough cells in organ atrophy, the entire organ will decrease in size.

 

Cell death happens physiology in the form of apoptosis or pathologically in the states of necrosis if the cell cannot adapt to the adverse environmental changes (Cellular changes and adaptive responses – knowledge @ amboss. ambossIcon, n.d.). Pathologic hypertrophy is due to increased workload and is in cardiac muscle because of hypertension. Unlike most other cells in the body, heart muscle cells don’t divide. Additionally, many adult cells can’t divide, the body can’t replace lost cells, which causes disease (ScienceDaily, 2018).

 

Atrophy– occurs due to tissue degeneration caused by decreased work demands on the cell—a decrease in protein synthesis and cell content. Hypertrophy– occurs when cells increase in tissue size (not the number) via enlargement of cells, leading to an increase in the affected organ size. Hyperplasia– An increase in the number of cells (not the size of the cells), increased tissue mass, prominent to the rise in the affected organ/tissue size. Dysplasia, also called atypical hyperplasia, occurs when cells transform into disordered growth of cells of a different size, shape, and appearance. Severe dysplasia often becomes irreversible and develops into a carcinoma site. Metaplasia– occurs when another less mature cell type replaces one adult cell. For example, due to a Vitamin A deficiency (Dlugash & Story, 2021).