Select one of the case studies below for your assignment. In your discussion, be sure to apply knowledge of the physiologic alterations in bodily systems in response to disease processes

Case Study 1: Disorders of Hemostasis

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a 2-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take. Unfortunately, just 3 days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

1. Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona’s DVT? Why was Leona already at risk for thrombus development?
2. How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?
3. How do atherosclerosis and immobility promote changes in blood coagulation?
4. When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?

Case Study 2: Disorders of Red Blood Cells

Henry is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure but likes to get out whenever he can work in his daughter’s backyard garden. Over the last few months, he began to go outside less often. He said that he was feeling unusually tired and he was running out of breath doing the simplest of tasks. He also said that his head ached, and he often felt dizzy. His daughter took him to his doctor who performed a complete physical examination and diagnosed Henry with anemia.

1. From what you know of Henry’s history, what type of anemia do you suspect he has? How would Henry’s red blood cells appear on a peripheral blood smear?
2. What is the physiologic basis that would explain why Henry’s anemia would cause him to have the symptoms he is experiencing?
3. Predict the cellular adaptations erythrocytes undergo when chronic hypoxia is present. How would this be evident on an oxygen-hemoglobin dissociation curve?

Case Study 3: Structure and Function of the Cardiovascular System

Bertha is 81 years old, and was admitted to the hospital after contracting community-acquired pneumonia. She had been bedridden for 3 days, so her nurse arranged for a physiotherapist to assist her out of bed to help her slowly regain her mobility. Bertha decided not to wait for the physiotherapist, and after arising in the morning, she eased herself out of the bed and stood up. Suddenly, Bertha’s vision dimmed, and she felt light-headed and dizzy. A passing nurse saw her fall back to the bed and rushed to help her. The nurse comforted Bertha, and then suspecting orthostatic hypotension, went to find a sphygmomanometer to check her blood pressure.

1. Prolonged bed rest decreases plasma levels and vasomotor tone, which can both lead to orthostatic hypotension. How do changes in vascular resistance and radius affect blood flow? Assuming Bertha is otherwise healthy, how does her heart activity change to compensate for the orthostatic hypotension she experienced?
2. Considering the venous circulation, how is blood from the lower extremities returned to the heart?
3. Why did Bertha’s capillary fluid pressure (or hydrostatic pressure) change when she moved from a lying to standing position?

Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation

Deborah is 56 years old, smokes a half a pack of cigarettes a day, and is overweight. Her friend wants her to come to a local women’s fitness class she attends once a week. She knows Deborah’s dad had died of an acute myocardial infarction when he was 56, and she fears, seeing Deborah’s lifestyle, the same fate awaits her friend. What she did not know was that Deborah had also been to her doctor for her annual physical where she was told her LDLs were 180 mg/dL, HDLs were 36 mg/dL, and cholesterol was 239 mg/dL.

1. What are Deborah’s known risk factors for coronary heart disease?
2. Deborah’s doctor referred her to a dietician for strict dietary therapy, hoping the intervention would raise her HDL and lower her LDL and cholesterol levels. Why is diet modification necessary to control and moderate the lipids indicated?
3. Deborah’s doctor also gave her pamphlets describing strategies to stop smoking and a list of exercise ideas she might want to try. How is smoking thought to contribute to atherosclerotic plaque formation? Why would exercise have a positive effect on Deborah’s lipid profile?
4. Atherosclerosis is thought to be an inflammatory disorder. What is the role of macrophages in the formation of atherosclerotic plaques? What is the significance of elevated serum hs-CRP levels in at-risk individuals?

Case Study 5: Disorders of Cardiac Conduction and Rhythm

Jack, an apartment superintendent, grabbed a quick cup of coffee and then put on his coat to shovel snow off the front sidewalk. He is 56 years old and has experienced two episodes of angina over the past 3 years. This time when he was shoveling the snow, he felt palpitations in his chest. It was as though his heart had stopped and then began to beat rapidly as if to catch up. Afraid of what he was feeling, he went inside and called for an ambulance. When the paramedics arrived, they took an ECG and told Jack he was going to be fine. He was taken to hospital to be seen by an emergency physician and was released later that afternoon.

1. The ECG taken by the paramedics showed Jack was experiencing premature ventricular contractions. In general terms, how do PVCs appear on an ECG? What factors contributed to the onset of PVCs in Jack’s situation?
2. Describe the physiologic events in PVC. How is cardiac output disrupted with the presence of PVCs?
3. Because of Jack’s history, his PVCs leave him at risk for events such as ventricular tachycardia or ventricular fibrillation. Compare and contrast these two arrhythmias. Why are they particularly dangerous?