This is a Mystery Disease Assignment. Context: Jeanne is a 32-year-old African A
ID: 137111 • Letter: T
Question
This is a Mystery Disease Assignment.
Context:
Jeanne is a 32-year-old African American woman who’s pregnant with twins near term comes for her weekly exam. Her prenatal tests show that she is not diabetic. The alpha-fetoprotein levels indicate no neural tube defects, and an amniocentesis showed no birth defects or Rh factor problems. The babies seem active and about the same size. No history of birth heart defects in either side of the family.
During a routine heart exam via stethoscope, the doctor hears what sounds like a heart murmur, but it is difficult to single out with twins. So, the doctor monitors Jeanne very closely for the remainder of the pregnancy.
At birth, Jeanne delivers fraternal twins. The female is cyanotic with a much faster respiratory rate. The male has a heart rate of about 120, his heart sounds normal, and his color is pink. The female remains cyanotic. Her breathing is much faster and deeper than her brother’s, and she starts coughing. She has a heart rate of 160 and a heart murmur—and there is a whirring sound between the lub and the dub.
Assessment Results:
Parameter
Female Patient
Male Patient
Color of ?nger tips and lips
Blue (Cyanotic)
Pink
Heart rate (b/m)
160
120
Heart sounds
Lub whirrrrrr dup
Normal
Blood pressure
85/55
110/70
Arterial PO2
100
100
Behavior
Lethargic; sleepy
Normal
Breathing
Heavy, rapid, congested
Normal
Feeding
Disinterested
Normal
The baby girl’s ’s congestion is becoming progressively worse and she is coughing. And, although she is lethargic, the coughing is keeping her awake.
Findings: Breathing is heavy rapid and congested which is secondary to congestive heart failure.
o Heart murmur
o central cyanosis
o Tachypnea
o Blood pressure gradient
We believe her diagnosis to be CHF which occur in children under 2 months.
QUESTIONS
Question 1: (25 points) Pathophysiology: Even if your diagnosis is not the actual one, as long as you have a good explanation for the ONE you chose, you WILL GET FULL CREDIT. There are 4 criteria you should always address in this answer. 1) How does the disease/condition make the person feel sick (6 points), 2) what is a treatment for it (6 points), 3) how does the treatment work to counter the disease/condition (6 points), 4) how does it affect the
patient’s symptoms (6 points).
(Remember**** this section is worth 25 points. So, be careful here and provide sufficient details !!!!)
Question 2: Follow-up – 5 points
In this section, you describe different things you would look for and ask about in a follow up appointment with the patient. You will be responsible for determining how the patient is responding.
Parameter
Female Patient
Male Patient
Color of ?nger tips and lips
Blue (Cyanotic)
Pink
Heart rate (b/m)
160
120
Heart sounds
Lub whirrrrrr dup
Normal
Blood pressure
85/55
110/70
Arterial PO2
100
100
Behavior
Lethargic; sleepy
Normal
Breathing
Heavy, rapid, congested
Normal
Feeding
Disinterested
Normal
Explanation / Answer
Answer1-
1.In this disease condition the heart muscle pumps well ,but the route that blood takes is inefficient.It occurs when too much of blood goes to the lungs,which the lungs and evntually the heart find difficult to handle.
This happens with certain kinds of holes or connections with which some babies are born.so, it produces the abnormal heart sounds and breathing problems which causes to heart murmur and faster and deeper breathing.
2.Treatment may require medications or procedures- in babies with ventricular septal defect, medications can be given temporarily to allow the hole to get smaller or close on its own or give the baby a little time to grow prior to heart surgery.
3.medications to encounter the disease are ,diuretics which helps the kidney to eliminate extra fluid In lungs.
-ACE inhibitors ,beta blockers, lowering the blood pressure which decreases the workload of the heart by decreasing the amount of pressure against which it has to pump.
-Digoxin is used to help make the heart squeeze better,and help pump more efficiently.
*Treatment also include devices,such as ventricular assist devices or the syncardia total artificial heart.These devices can help stabilize and support patients while they are waiting for the donor heart to become available for transplantation.
4.By administering above medications ,devices and the transplantation helps heart muscle to pump well and reduces the work load on the heart and lungs .
Answer 2- FOLLOW UP-
-regular Health check ups and medications are important.
-advice lifestyle changes to improve quality life (avoid excess weight gain, smoking and alcohol in developmental stages).
-regular appointments with dietitian ,pharmacists and exercise specialists are needed.
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