pathophysiology
Mr. Craft (Case Study A)Ms. Craft, age 59, was brought by ambulance to the emergency room because she thought she was dying. She had difficulty breathing, was dizzy if she attempted to sit
up, and felt a sense of impending doom. Ms. Craft assumed that she was having a heart attack, and so did the admitting emergency room personnel.But the case was more complicated. Physical examination showed Ms. Craft to have weakness, malaise, warm skin, and hypotension. Ms. Craft said she felt nauseous. A
blood glucose value was diagnostic for diabetes. Cardiac markers did not show that she was having a heart attack, nor did an EKG. When her history was taken, Ms. Craft
said she had not seen a doctor in several years and was unaware that she had diabetes.Her respirations were deep and rapidKussmaul respirations.QUESTIONSMs. Craft probably had:A. metabolic alkalosis.
B. metabolic acidosis.
C. respiratory acidosis.
D. respiratory alkalosis.In what way would the diabetes have contributed to her condition

PathophysiologyC155 WUT2 POINTERS & RESOURCES
? PA CANNOT be done in power point presentation
? There is NO page requirements for the assessment average length of paper is +/- 20 pages
? Task instructions should be used for the format of the paper. Keep your format in the
same chronological order as the task instructions. This allows ease for evaluator to
identify your answers and grade your paper. In addition, it will keep you focused on
what information is needed as you write your paper.
? This research paper is considered a high stakes performance assessment and it is at the
evaluator’s discretion whether the paper will pass. We are not allowed to proofread the
paper. Course mentors are here to help provide you with interpretation of the task
requirement and get you on the right track, once you have identified which task
requirement you are having trouble with.
? Directions for the Author must be read before reading the Pointers. Rubrics will only
help you understand how your work will be graded.
? DO NOT skip the CoS, information provided in one disease state may be carried
over/applied to another disease state. Reading through all the links provided as well as
all the case studies his highly recommended.
? The PA DOES require researching OUTSIDE the CoS
? PA requires evaluation of disease process from micro to macro level. Thus be sure to be
able to connect the dot between how the disease state affects the individual to the family
to the community (economic impact).
? Some task requirements are very similar, thus answers will overlap. Remember:
RESTATING is always better than having to revise.
? Information derived from the interviews is acceptable to include as an in-text citation,
however, it cannot be included in the bibliographic reference page provided on the last
page of the document.
? There is no page requirement for the PA, however, the primary objective is that you
answer what is being asked with expert perspective and providing great
detail/substantial discussion
? No more than 30% of paper may be cited, if submitted and greater than 30% of paper is
cited, paper will be returned and counted as one submission. Please reach out to CWE
for help with paraphrasing.
A. Investigated Disease Process
Investigate one of the following disease processes: traumatic brain injury, depression, obesity,
asthma, or heart disease.
? Topic choices include: ASTHMA, HEART DISEASE, TRAUMATIC BRAIN INJURY,
DEPRESSION, OR OBESITY
? The competency of the course is for graduate to evaluate high-volume/high prevalence,
high impact disease processes thus students should not further narrow down their topic
choices. Instead topics should focus on the disease as a whole and in the general adult
population.
? The ONLY topic that should be narrowed down is HEART DISEASE due to its broad
nature. Even then, it can only be narrowed down to a limited extent, for example CHF,
CAD, or Cardiomyopathy. When narrowing down heart disease, the topic should still
be a high-volume and high impact disease process in the general adult population as well.
A1. Pathophysiology
This task requires you to analyze the pathophysiology of the disease process you selected in part
A.
? Pathophysiology does indeed include the cellular level, provide as much detail as
possible
? If disease state could be further classified into different stages, discussion of
stages/stratification would provide substantial detail to your paper
? If no exact mechanism is known for your disease state, discuss the theories believed
causing the disease state
A2. Clinical Guidelines vs. Standards of Practice
This task requires you to discuss the standard of practice for the selected disease process.
? To be able to answer this you need to be able to understand the difference between
Clinical Guidelines, which is the National Standard of Practice, vs. Standard of Practice
for a community/institution/State. Clinical guidelines (National Standards of Practice)
are established by various organizations for certain disease states and are based on
examination of evidence within the paradigm of evidence-based medicine (i.e.; The
American Heart Failure Association compiles the clinical guidelines for heart
failure/heart disease). A healthcare provider is obligated to know the medical guidelines
of his or her profession, and has to decide whether or not to follow the recommendations
of the guideline for an individual treatment. Clinical guidelines identify, summarize, and
evaluate the highest quality evidence and most current data about prevention, assessment,
diagnosis, patient education, treatment/therapy including medications, follow-up care,
prognosis, risk/benefit and cost-effectiveness. Then they define the most important
questions related to clinical practice and identify all possible decision options and their
outcomes. Some guidelines contain decisions or algorithms to be followed. Guidelines
integrate identified decision points and respective courses of action with the clinical
judgment and experiences of practitioners. Many guidelines place the treatment
alternatives into classes to help providers in deciding which treatment to use.
Standards of practice is a consensus of what healthcare providers actually do for certain
disease states. These maybe developed within local organizations, i.e.: the office, the
hospital, or the state in which you work. Many times the physicians/healthcare providers
will base their standards of practice on clinical guidelines, thus resulting in the same
guidelines. However, this is not always the case.
? For state information, contact your state department of health or any local organizations
specific to your disease state to provide any data regarding your disease state in your state
A2a. Evidence-Based Pharmacological Treatment
This task requires you to discuss the evidence-based pharmacological treatments in your state
AND how they affect management of the selected disease in your community.
? Include names and classes of medications, mechanism of actions, possible side effects,
and monitoring parameters would be good ways to add details to your paper
? If there is a method/guideline/algorithm for how the pharmacological treatment is
selected for your disease state, this would definitely be a good area to add/include the
information
? Regarding “how they affect the management,” think about whether it improves the
disease process in your community, especially if the patient was compliant? Also reflect
on the psychological, social, and economical effects of the medications on the patient and
does it affect other aspects of treatment for the disease state?
A2b. Clinical Guidelines/National Practices
This task requires you to discuss clinical guidelines for assessment, diagnosis, and patient
education for the selected disease process.
? Ensure that you are discussing the guidelines in terms of assessment, diagnosis, and
patient education
? Refer to specialist organizations in the field of the disease state you have chosen for
clinical guidelines. For example, for heart failure go to American Heart Association
(AHA) or the American College of Cardiology Foundation (ACCF)
A2c. Comparing Standards of Practice With State or National Practices/Clinical
Guidelines
This task requires you to compare the standard practice for managing the disease within your
community with state or national practices.
? The main task of A2c is to compare the difference between community (your
institution), state, and/or national (clinical guidelines) practices. As stated above, many
times the physicians/healthcare providers/organizations will base their standards of
practice on clinical guidelines, thus resulting in the same guidelines. However, this is not
always the case. If the clinical guidelines (National standards of practice) were used to
formulate standards of practice for an institution/state, even if it is the same you will need
to restate the information. In A2c, after you have stated whether the standards of practice
are the same/differ, provide a discussion of how they are the same if they are similar. If
they differ, provide discussion on the contrast. Just think of it this way, if you had a
patient come in with asthma symptoms what would you do in your institution (A2-
standard of practice) and how does it compare to the clinical guidelines/national practices
(A2b), in terms of assessment, diagnosis, patient education, treatment, follow-up
care, etc.
TASKS A2-A2c IN SUMMARY:
Task A2- asks you for: Standard of Practice-Discuss the standard of practice for the
selected disease process.
Task A2a: asks you for: Pharmacological Treatments-Discuss the evidence-based
pharmacological treatments in your state and how they affect management of the selected
disease in your community.
Task A2b: asks you for Clinical Guidelines-Discuss the clinical guidelines for
assessment, diagnosis, and patient education for the selected disease process.
Task A2c: asks you to compare the standard practice for managing disease within your
community with state or clinical guidelines/national practices.
So for A2, the recommendation is to discuss about the standard of practice in your
state. For A2a, discuss Pharmacological Treatments. For A2b, discuss Clinical
Guidelines (National Standards of Practice). Then for A2c, discuss the Standards of
Practice for your specific institution (community) and then compare it with either state
practices (which was done in A2) or clinical guidelines/National practices (which was
done in A2b)***REMEMBER BOTH STANDARD OF PRACTICE AND CLINICAL
GUIDELINES SHOULD REFERENCE ASSESSMENT, DIAGNOSIS, TREATMENT,
FOLLOW-UP/CARE, ETC TO PROVIDE A GOOD COMPARISON***.
A3. Characteristics and Resources For Well Managed Patient
This task requires you to discuss characteristics of AND resources for a patient who manages
the selected disease well, including access to care, treatment options, life expectancy, and
outcomes
? Characteristics can be personal i.e. compliance or characteristics relating to symptom of
well managed diseases i.e. increase energy level for well managed obesity
? In discussion for resources ensure that access to care and treatment options are
referenced and that resource organizations and services available to patient are mentioned
if available to patient
? Don’t forget to provide life expectancy and outcomes data as well
A3a. Disparities in Management Nationally and Internationally
This task requires you to analyze disparities between management of the selected disease on a
national AND international level.
? The most common mistake is that students are not looking at disparities in the
management of the disease
? For example, how does the strategy in managing obesity differ in Europe versus the
strategy of managing obesity in the United States? Looking up management of your
disease state in 2 to 3 different countries and compare and contrast the strategies of
management in the different countries would provide ample data for your discussion
? As for sources, take a look at medical journals published in other countries i.e. The
Lancet Global health, British Medical Journals, Canadian Medical Association Journals,
etc.
? Another great way to find information is to just perform a Google search with “European
CHF guidelines” or “China asthma guidelines” to see if there are any international
medical websites as well as articles with such information
? Reflect on cultural, social, political and economic factors and discuss on how they may
relate to the disparity in management of the disease state you have chosen
A4. Factors That Contribute to Management of Disease
This task requires you to discuss three or four factors (e.g., financial resources, access to care,
insured/uninsured, Medicare/Medicaid) that contribute to a patient being able to manage the
selected disease
? Make sure your discussion includes factors referenced in parenthesis such as financial
resources, access to care, insured/uninsured, Medicare/Medicaid
A4a. Lack of Factors Leading to Unmanaged Disease
This task requires you to explain how a lack of the factors discussed in part A4 leads to an
unmanaged disease process.
? The factors listed in parenthesis are very closely related, however, you SHOULD NOT
lump them together in discussion. You MUST talk about each INDIVIDUAL FACTOR
LISTED IN PARENTHESIS
? You need to break down those factors listed in parenthesis further down and think of one
or two points within those factors that may lead to unmanaged disease, the diagram
below should provide a good visual of your discussion:
B. Disease in Patient, Families, and Population
This task requires you to analyze HOW the selected disease process affects patients, families,
and populations in your community.
? Reflect on psychological, functional, social, economic (productivity as well as heathcare
costs/resources) aspects of how they affect the patient, family and economy/community.
Then provide discussion on how it all is interrelated.
B1. Costs For Patient, Families, and Populations
This task requires you to discuss the FINANCIAL COSTS associated with the selected disease
process FOR patients, families, and populations from DIAGNOSIS to TREATMENT.
? Outside research may be required to find this information
? Ensure you include cost from diagnosis to all treatment options availbale for disease state
? Reflect on loss of income as well
C. Promotion of Best Practices
This task requires you to discuss HOW you will PROMOTE best practices for managing the
selected disease in your current healthcare organization.
? It is more so asking HOW you and your institution and/or co-workers can IMPROVE
the quality of care provided to patients with the disease state you have chosen, PRIOR
TO IMPLEMENTING STRATEGIES.
? Provide general modalities in which you can promote the disease state
? Please note that the different methods of educating would be considered modes of
promotion
C1. Strategies to Implement Best Practices
This task requires you to discuss three strategies you could use to implement best practices for
managing the selected disease in your current healthcare organization.
? Implementation refers to strategy or demonstration to facilitate best practices it would be
more specific then promotion
? For example, if you were talking about heart failure having a protocol (including aceinhibitors,
beta-blockers, measurements of daily weights) in place for physicians to check
off prior to discharge to ensure proper, quality, and consistent care was given would be
considered a best practices implementation.
C2. Method of Evaluationg Implementation Strategies
This task requires you to discuss an appropriate method to evaluate the implementation of
EACH of the strategy from part C1.
? Provide detailed, effective, measurable method to evaluate the implementation for
EACH of the strategy discussed above
? So let’s go back to that example above about having a specific heart failure protocol; So
in section C your mode of promoting best practices would be establishing clinical
pathway(s); your implementation/strategy would be having the heart failure protocol
in place for physicians to check off prior to discharge; then evaluation method would
be collecting data on the compliance of the check off list for the heart failure
protocol in place
D. Sources
? For assistance with APA formatting/citation/referencing,
articulation/grammar/punctuation/paraphrasing and presentation of your material, please
do not hesitate to contact the Center for Writing Excellence at
https://sites.google.com/a/wgu.edu/cwe/
RESOURCES:
***These are just some resources to get you started. If the article does not open, jot down the
information and see if article can be accessed through WGU’s library
***Remember this is a graduate level course, when writing this or other performance
assessments for this program keep in mind that you are expected to perform your own
independent research and may have to go outside of the COS to find the information you will
need to fulfill the requirements for the assessment
TBI
1. http://www.aann.org/pdf/cpg/aanntraumaticbraininjury.pdf
2. www.cdc.gov/ncipc/pub-res/tbi_toolkit/
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303645/
4. http://www.cfp.ca/content/58/3/257.full
OBESITY
1. http://www.cdc.gov/healthyyouth/physicalactivity/pdf/roleofschools_obesity.pdf
2. http://www.ncbi.nlm.nih.gov/pubmed/20054170
3. http://easo.org/guidelines-publications
4. http://www.cmaj.ca/content/176/8/S1.full
5. http://www.obesitynetwork.ca/clinical-guidelines
NATIONAL AND INTERNATIONAL RESOURCES
1. http://www.who.int/en/
2. http://www.who.int/nmh/publications/ncd_report_full_en.pdf
3. http://www.who.int/topics/primary_health_care/en/
4. http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf
5. www.cdc.gov
6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367222/
HEART DISEASE
1. http://www.hfsa.org/hf_guidelines.asp
2. http://www.aafp.org/afp/2010/0301/p654.html
3. http://www.cardiosource.org/science-and-quality/practice-guidelines-and-qualitystandards.aspx
4. http://www.heartfailureguideline.org/_assets/document/Guidelines.pdf
DEPRESSION
1. https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf
2. http://www.canmat.org/resources/CANMAT%20Depression%20Guidelines%202009.pdf
3. http://www.ncbi.nlm.nih.gov/pubmed/3651979
4. http://informahealthcare.com/doi/abs/10.1080/j.1440-
1614.2004.01377.x?journalCode=anp
ASTHMA
1. http://www.cdc.gov/asthma/faqs.htm
2. http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/
3. https://online.epocrates.com/u/2951782/Asthma+in+children/FollowUp/Overview
4. http://www.cdc.gov/asthma/stateprofiles/asthma_in_ca.pdf
5. http://ginasthma.org/local/uploads/files/GINA_Pocket2013_May15.pdf
6. http://www.webmd.com/asthma/features/lowering-costs-asthma-treatment
7. http://www.european-lungfoundation.org/include/viewFile.php?idtf=16460&path=99%2FWEB_CHEMIN_16460_
1246281781.pdf
8. http://www.jthoracdis.com/article/view/1657/html
9. http://www.asthma.partners.org/NewFiles/BoFAChapter15.html
10. http://hospital.uillinois.edu/Patient_Care_Services/Pulmonary/Our_Areas_of_Expertise/
Asthma/Emotional_and_Social_Effects.html
11. http://discoverasthma.com/asthma-and-life-expectancy.php
UNINSURED ADULTS IN THE UNITED STATES
1. http://jama.jamanetwork.com/article.aspx?articleid=193207