Pathophysiology Synthesis for Suicide Assignment Paper

Suicide is the act of taking one’s own life due t underlying causes such as depression or post-traumatic stress disorder (APA, 2013; Sadock et al., 2015). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classes suicidal ideation as one of the manifestations of depression and other depressive disorders. Associated symptoms such as for major depressive disorder (MDD) usually include low self-esteem, a feeling of worthlessness, insomnia, and lack of enjoyment of pleasurable activities previously enjoyed. Pathophysiology Synthesis for Suicide Assignment Paper

The pathophysiology of suicide stems from the blunting of the reward pathways in the brain. The ventral tegmental area (VTA) found in the midbrain is the anatomical site in which the reward and pleasure sentiments and feelings are generated. The main pleasure neurotransmitter that is released in this area to mediate pleasure feelings is dopamine (Stahl, 2013). Pleasurable stimuli cause the release of an increased amount of dopamine in the VTA. The VA is linked to the areas of the brain that are in control of memory and behavior. In response to favorable stimuli, the brain releases the dopamine to make someone feel pleasure. Through the connections to memory and behavior centers, a correlation is made between the stimulus and the pleasure and this ensures that the experience is stored in the brain and the behavior is repeated in the future.

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In the case of suicide, the above pleasure pathway is interfered with such that the release of dopamine in the VTA is inhibited. What results is depressed mood almost all the time and a feeling of low self worth that makes one feel that they have no purpose continuing to live. This is suicidal ideation and it makes the patient start having thoughts about death and dying. They then plan to take their own lives and either carry out the plan or just continue having it in their thoughts. Several attempts can be made on suicide unsuccessfully. However, if not treated it is just a matter of time before the patient succeeds.  Pathophysiology Synthesis for Suicide Assignment Paper

Synthesis of the Pathophysiology and Pharmacology Associated with Stroke

Stroke is the condition in which there is a deficiency of oxygen to certain part of the brain due to either a rupture of a cerebral blood vessel or its occlusion. It is a medical emergency. The lack of oxygen then results because the oxygenated blood from the heart is not able to reach that particular part of the brain. There are two types of stroke – hemorrhagic stroke and ischemic stroke (Hammer & McPhee, 2018). The analysis of each of these types is what sheds light on the pathophysiology of each type of stroke.

The most important cause of hemorrhagic stroke is hypertension or high blood pressure. The reason is that long-term hypertension compromises the integrity of the walls of arteries supplying the brain such that they become weak and frail. Hypertension is precipitated by risk factors such as overweight and obesity (Hammer & McPhee, 2018). At one point in time, these frail and weak artery walls may rupture due to the sustained high blood pressure. This causes spillage of blood into the brain parenchyma causing damage to that part of the brain that is affected. That is the pathophysiology of hemorrhagic stroke.

Alternatively, blood pressure also causes damage to the interior layer (tunica intima) of arteries and this results in tiny bruises in the arteries. Slowly, platelets begin to aggregate at the sites of injury and that may lead to the formation of a clot in that part of the brain. As the clot grows in size, it occludes the artery and finally cuts off blood supply to that part of the brain. This is what causes ischemic stroke. Pathophysiology Synthesis for Suicide Assignment Paper

Some of the manifestations of stroke include hemiparesis, difficulty walking, difficulty with speech, numbness of one side of the face, lower limbs, or upper limbs. There may also be complete paralysis if the stroke is complete. Pharmacotherapy for hemorrhagic stroke includes treatment of the underlying hypertension with agents such as calcium channel blockers, beta blockers, and ACE inhibitors. Anticonvulsants and angiotensin receptor blockers are also given. For the ischemic stroke, the mainstay of therapy is anticoagulation (Katzung, 2018). This helps during the emergency management.

Synthesis of the Pathophysiology for a Shadow Health Patient: Debbie O’Connor

This is the synthesis of chronic obstructive pulmonary disease or COPD as diagnosed in a Shadow Health patient during simulation. The patient was a female named Debbie O’Connor who presented with shortness of breath and a productive cough for one week (GOLD, 2017). She has a history of smoking one and a half packs of cigarettes in a day for the last 20 years. This gives her a total of 30 pack years. Spirometry confirmed this diagnosis in terms of expiratory volumes. COPD is in reality a combination of emphysema and bronchitis.

In COPD, long-term smoking causes a weakening of the alveoli and loss of elasticity. The efficiency of gaseous exchange of the alveoli is then compromised. This is an indication of emphysema. Coupled with the above is a state of hypertrophy of the mucus glands in the respiratory system. This cause overproduction of thick sticky mucus that then blocks the airways causing further respiratory distress. Mucociliary clearance is compromised and the mucus accumulates in the airways. This is the reason for the chronic productive cough. A state of chronic inflammation of the respiratory pathways then exists and this worsens the occlusion of the bronchioles due to the inflammatory response. This, now, is bronchitis.  Pathophysiology Synthesis for Suicide Assignment Paper

The combination of the bronchitis and the emphysema makes the smoker as in this case experience frequent shortness of breath resulting from the above explained factors. An additional fact in the pathophysiology of this condition is that the parasympathetic division of the autonomic nervous system is also active and hence the smooth muscle of the respiratory tubes undergoes spasms that cause further distress.

Treatment Plan Synthesis of the Pharmacology for a Shadow Health Patient: Debbie O’Connor

According to the GOLD (2017) criteria, a COPD prescription is verified if the post-bronchodilator forced expiratory ratio (FEV1/FVC) is below 0.7. This is the case with this patient’s spirometry findings. It verifies that the patient has GOLD stage 3 COPD, which is severe COPD with a FEV1 of 30-49 percent (GOLD, 2017). This data is in addition to the patient’s other significant COPD manifestations. These were dyspnea, a strong cough, and a smoking history.

The pharmacotherapy for this individual will entail the use of an inhaler to administer the long-acting anticholinergic tiotropium or Spiriva at 18 micrograms (two inhalations) orally once daily (Katzung, 2018). This will be used with a corticosteroid, prednisone 5 mg orally once daily. She will, however, need to have more spirometry tests to evaluate if the results improve with treatment (Kennedy-Malone et al., 2019; Hammer & McPhee, 2018; GOLD, 2017). Secondary prevention health education for this patient will involve quitting smoking, eating a balanced diet, and avoiding strenuous physical exertion. Pathophysiology Synthesis for Suicide Assignment Paper

Due to the severe state of the condition, a consultation and referral to a chest physician will be made for further management. The next steps will depend on whether she was referred or not. If not, she may be seen every two weeks at first. This patient’s problems include dyspnea, physical effort, and performing daily duties (ADLs). Because this patient is in the GOLD group C, there is no need to change her medications at this time (GOLD, 2017).

References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Global Initiative for Chronic Obstructive Lung Disease [GOLD] (2017). Pocket guide to COPD diagnosis, management, and prevention: A guide for health care professionals. https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. McGraw-Hill Education.

Kennedy-Malone, L., Plank, L.M., & Duffy, E.G. (2019). Advanced practice nursing in the care of older adults, 2^nd ed. Philadelphia, P.A: Davis Company.

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 4^th ed. Cambridge University Press.

Your submission must be your original work. No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the report provided when submitting your task as a guide. Pathophysiology Synthesis for Suicide Assignment Paper

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Upload your completed and signed “CPE Record” for evaluation as a separate attachment. The form should include the following:

• the date each activity was completed

• your electronic signature verifying that all activities have been completed

Note: The “CPE Record” should be uploaded as a separate attachment and should not be included in your e-portfolio.

B. Upload all of the following required deliverables to your e-portfolio and provide a link to your e-portfolio:

• CPE schedule table of tasks and timelines

• feedback and synthesis improvement plan for pathophysiology syntheses

• one, one-page pathophysiology syntheses for Alzheimer disease, cancer, chronic lower respiratory infections, nephritis, or suicide

• three screenshots to document your Phase 1 GoReact video reflection, that includes an image of your reflection video and an image of each of your two peer responses

• written reflection summary of your Phase 1 video reflection below your screenshot

• feedback and synthesis improvement plan for your patient- or healthcare consumer–focused synthesis

• one, one-page patient or healthcare consumer-focused syntheses of the pathophysiology and pharmacology associated with heart disease, accidents, diabetes, influenza and pneumonia, or stroke

• three screenshots to document your Phase 2 GoReact video reflection, that includes an image of your reflection video and an image for each of your two peer responses

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e 2 video reflection below your screenshot

• feedback and synthesis improvement plan for the preceptor- or colleague-focused synthesis and patient- or healthcare consumer–focused treatment plan synthesis

• one, one-page preceptor or colleague-focused synthesis of the pathophysiology for one Shadow Health patients

• one, one-page patient- or healthcare consumer–focused treatment plan synthesis of the pharmacology for one Shadow Health patient

• three screenshots to document your Phase 3 GoReact video reflection, that includes an image of your reflection video and an image for each of your two peer responses

• written reflection summary of your Phase 3 video reflection below your screenshot

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