This Discussion has 3 parts:
- Define lymphedema.
- What is elephantiasis?
- Provide the differential diagnosis of mumps versus cervical adenitis.
- Thorax and Lungs
- Define and provide an example of a disease/situation where this sign/symptom might be present:
- Paroxysmal nocturnal dyspnea
- Kussmaul breathing
- Periodic breathing (Cheyne-Stokes).
- Support your answer with a previous experience you have encountered in your career.
- Define and provide an example of a disease/situation where this sign/symptom might be present:
- Cardiovascular System
- Name and write the location of the five traditionally designated auscultatory areas and explain why it is heard there.
- A pregnant patient (32 weeks’ gestation) is having difficulty with dependent edema and painful varicosities. What can you suggest to help this patient’s problem and explain rationale?
- Your initial post should be at least 500 words, formatted and cited in proper current APA style with support from at least 2 academic sources.
St Thomas University
Part 1: Lymphatic
The lymphatic system is an essential part of the immune system. It is composed by organs such as the thymus, bone marrow, spleen, tonsils, appendix, and Peyer’s patches of the small intestine, which make and process specialized white blood cells that fight infection and cancer. The lymphatic system consists of three parts lymphatic vessels, lymph nodes, and two collecting ducts that transport liquid throughout the body.
When the lymphatic system is not be able to perform its function properly, we encounter lymphatic disorders like Lymphedema, a condition caused by the blockage of one the ducts in the lymphatic system. The dysfunctional lymphatic system becomes less capable of performing the complete resorption of large protein molecules, and these remain in the interstitial space. The consequent tissue fibrosis and the increasing accumulation of fluid and proteins in this space can trigger neurological alterations such as pain or paresthesia, distortion in the shape of the limb, and increased risk of related complications (2022).
Another condition of the lymphatic system is Lymphatic filariasis, commonly known as Elephantiasis which is an infection caused by one of the three species of nematodes. Lymphatic filariasis happens when an infected mosquito bites a person and deposits the larvae on the skin. The larvae travel to the lymphatic system, where they mature. The main symptom is the swelling of the affected area mostly extremities and genitalia.
Cervical Adenitis is another disorder of the lymphatic system which is produced by an infection. In the majority of cases, is a transient inflammatory response to a generalized or local infection. Depending of the clinical presentation can indicate an infection in many cases, when bilateral, can be because of viral upper respiratory infection or streptococcal pharyngitis when is a single cervical adenitis the heath concern is more focus with the gland. Cervical Adenitis can be mistaken with Mumps but despite their similarity in manifestation they are very different. Mumps is caused by an acute viral infection causing the swelling of one or two salivary glands. Mumps is diagnosed by the swelling of the salivary glands and a IgM serum detected test that is conducted by swabbing the chicks of the affected patient. A positive IgM can indicate and current or recent infection.
Part 2: Thorax and Lung
Asthma is a condition were the airway narrow and swell causing difficulty to breath. This condition can be exacerbated by fiscal activity or allergen such as dust, smoke etc. Asthma symptoms occur when the airway swell and the muscles around tighten. Sign and symptoms of asthma include orthopnea, tachypnea, hyperpnea, chest tightness or pain, and even death. Early treatment and recognition of early signs is key to prevent further or irreversible complications.
Part 3: Cardiovascular System
Auscultation of the heart starts by knowing your patient and having some knowledge of patient background. Initial assessment and information gathering is key in any interaction between patient and nurse. When you listen to the heart you do so by listening the valves. The hearth has 4 valves, the aortic second intercostal space right in the external border, pulmonic second intercostal space left external border, tricuspid left external border fourth intercostal space, and mitral midclavicular on the left side of the chest in the fifth intercostal space, which are four of the five points of auscultation. The fifth point is the Erb’s point located in the third intercostal space left of the sternal border. The cardiac sound goes from S1 to S4 and refer to the sound the valves produce when they open and close. The base of the heart is where the aortic and pulmonic S2 sound will be loudest. The apex is where the tricuspid and mitral S1 sound is loudest upon auscultation. The apex region will also be where S3 and S4 sounds(extra heart sounds not usually noted in normal assessments) and mitral stenosis murmurs may be auscultated, if present (2022).
Part 3.1 What can you suggest helping a pregnant woman with Varicose veins and swelling in the legs?
Pending edema during pregnancy, specially in the last trimester is common. Changes in the properties of the blood cause some fluid to accumulate in the tissues, which promotes swelling in some parts of the body. Although this swelling is common due to fluid retention, it is important to consult the doctor to determine if the pregnant woman should follow a diet that reduces or completely eliminates salt, which is usually one of the main causes of fluid retention. When we see a patient with this symptom is important to discard that the patient might be having pregnancy complications like preeclampsia which can be very dangerous for the mother and the baby. It is possible that the pregnant woman also complaint of painful varicosities veins this is produced by the changes in the volume of blood in the body. Varicose vain usually improve after pregnancy but there are some interventions like improving blood circulation with exercises, walking, changing positions and braking the habit of crossing the legs.
Perez, C. S., Mestriner, C., Ribeiro, L. T. N., Grillo, F. W., Lemos, T. W., Carneiro, A. A., Guirro, R. R. de J., & Guirro, E. C. O. (2022). Relationship between lymphedema after breast cancer treatment and biophysical characteristics of the affected tissue.
https://doi.org/10.1371/journal.pone.0264160 (Links to an external site.)
(2022). The Heart: Five Areas for Listening.
Union Test Prep.
https://uniontestprep.com/nclex-rn-exam/blog/the-heart-five-areas-for-listening (Links to an external site.).
Daniela Abreu Abreu
St. Thomas University
NUR-418-AP3 Health Assessment and Promotion
Instructor: Rafael Rojas
September 7, 2022
Lymphatic Chest and Heart
Lymphedema is a debilitating and chronic condition characterized by excessive fluid rich in interstitial protein. Therefore, this condition causes unilateral or bilateral swelling of the legs or arms. It occurs due to the imbalance in the amount of lymphatic circulation and requires lymphatic flow (Rockson, 2017).
Elephantiasis is a rare condition brought by a filarial worm characterized by the enlargement of a part of the human body, usually in the limbs. Some of the other areas affected by elephantiasis include a human’s external genitals. This condition occurs due to the swelling of the tissues caused by the lymphatic system’s obstruction, resulting in the accumulation of lymph fluid in the body’s affected part (Duckworth et al., 2018).
Different diagnosis of mumps versus cervical adenitis
Mumps can be diagnosed by identifying the swelling of the salivary glands depending on other symptoms. The medical officer will conduct a virus culture swabbing of the inner part of the throat or cheek to collect cells and mucus. The culture will then be sent to the lab for testing. Mumps can also be identified by sampling urine or cerebrospinal fluid acquired with a spinal tap or lumbar puncture (Harvard Health Publishing, 2019). On the other hand, cervical adenitis is defined as the inflammation of the lymph node around the neck. It is characterized by an infection in the person’s throat, sinuses, mouth, or any other area of the face, neck, or head. A physical examination is performed to assess for symptoms such as mild cervical lymphadenopathy, fever, neck pain, torticollis, or neck stiffness.
Thorax and Lungs
Examples of diseases/situations where one might find the following symptoms
Dyspnea is a symptom related to diseases of the lungs and heart. Therefore, these symptoms can be due to heart failure, asthma, COPD (Chronic obstructive pulmonary disease), pneumonia, psychogenic conditions, and interstitial lung disease. Orthopnea is the lack of breath in a person that affects them most while lying down. However, it is a symptom of diseases such as lung disease and heart failure. Orthopnea is also a symptom of pulmonary edema or ventricular heart failure. Apnea is caused by high blood pressure, Parkinson’s disease, congestive heart failure, and type 2 diabetes. However, other diseases such as asthma, chronic lung condition, and hormonal disorder can increase the risk of apnea.
Paroxysmal nocturnal dyspnea is identified as a symptom of heart failure. Therefore, it occurs due to cardiac and respiratory conditions. Paroxysmal nocturnal dyspnea causes the person to have difficulty breathing while sleeping and improves when one sits upright. Tachypnea is a symptom where one lacks oxygen but has a lot of carbon dioxide in the body. However, the symptom is found in acidosis, sepsis, and lung conditions (Park & Khattar, 2020). Congestive heart failure is known to cause tachypnea. Bradypnea is a symptom where the breathing rate becomes abnormal. Some of the conditions that lead to bradypnea include lung disorders, including chronic bronchitis, pneumonia, pulmonary edema, and emphysema.
Hyperpnea is the body’s response when it requires more oxygen. Therefore, hyperpnea may occur due to medical conditions such as sepsis or heart failure. Hyperpnea is mainly caused by the ventilation of excessive physiologic dead spaces. Kussmaul breathing is a symptom found in diabetic ketoacidosis, a life-threatening condition that affects diabetics. The symptoms can occur in both type 1 and type 2 diabetes. Periodic breathing (Cheyne-Stokes) is a symptom associated with stroke or heart failure. This symptom can also be caused by brain injuries, brain tumors, kidney failure, or chronic pulmonary edema.
Location of the five traditionally designated auscultatory areas and explain why it is heard there. The aortic valve is found between the ascending aorta and the left ventricle in the heart. The aortic valve is heard well at the upper sternal border on the right side since it radiates towards the right supraclavicular part. The pulmonic area is located at the right side of the ventricle or somewhat slightly on the aortic valve’s left side. The pulmonary valve is heard at the opposite side of the aortic area at the second or third intercostal space.
The tricuspid area is found between the right ventricle and the right atrium. Therefore, it is at the 4th intercostal space, the left side of the sternal border. The tricuspid is not frequently heard but is located at the lower or middle sternal border. The Mitral area is heard in the fifth intercostal space. However, it is found between the left ventricle and the left atrium. The Erb’s point is found and heard in the 3rd intercostal space at the lower left sternal border.
A pregnant patient (32 weeks of gestation) is having difficulty with dependent edema and painful varicosities. What can you suggest to help this patient’s problem and explain the rationale? There are three different treatments for varicose veins, including surgery, nonpharmacological, and pharmacological treatments. To treat edema, the pregnant woman should increase her fluid intake, decrease caffeine intake, increase potassium intake, wear comfortable clothing, elevate the feet, and rest as much as possible (Young & Jewell, 2019).
Duckworth, A. L., Husain, J., & DeHeer, P. (2018). Elephantiasis Nostras Verrucosa or “Mossy Foot Lesions” in Lymphedema Praecox. Journal of the American Podiatric Medical Association, 98(1), 66–69.
https://doi.org/10.7547/0980066 (Links to an external site.)
Park, S. B., & Khattar, D. (2020). Tachypnea – StatPearls – NCBI Bookshelf. NCBI.
https://www.ncbi.nlm.nih.gov/books/NBK541062/ (Links to an external site.)
Harvard Health Publishing. (2019). Mumps. Harvard Health.
https://www.health.harvard.edu/a_to_z/mumps-a-to-z (Links to an external site.)
Rockson, S. G. (2017). Lymphedema. The American Journal of Medicine, 110(4), 288–295.
https://doi.org/10.1016/s0002-9343(00)00727-0 (Links to an external site.)
Young, G. L., & Jewell, D. (2019). Interventions for varicosities and leg edema in pregnancy. Cochrane Database of Systematic Reviews, 22(2). https://doi.org/10.1002/14651858.cd001066.