Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of
disorders. You must, therefore, understand how the body normally functions so that you
can identify when it is reacting to changes. Often, when changes occur in body systems,
the body reacts with compensatory mechanisms. These compensatory mechanisms, such
as adaptive responses, might be signs and symptoms of alterations or underlying
disorders. In the clinical setting, you use these responses, along with other patient factors,
to lead you to a diagnosis.
Consider the following scenarios:
Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because
Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is
usually healthy and has no significant medical history. She was in her usual state of good
health until 3 days ago when she started to get fussy, would not eat her breakfast, and
would not sit still for her favorite television cartoon. Since then she has had a fever off
and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her
ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in
for evaluation. A physical examination reveals a height and weight appropriate 2-year-old
female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes
are slightly reddened on the periphery, but otherwise normal in appearance. The throat is
erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily
palpable and clearly tender to touch on the left side. The child indicates that her throat
hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a
pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.
Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He
reports that he has never had a problem like this before, but about 2 weeks ago he noticed
that both his hands seemed to be really red and flaky. He denies any discomfort, stating
that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not
understand why they are so red. His wife told him that he might have an allergy and he
should get some steroid cream. Jack has no known allergies and no significant medical
history except for recurrent ear infections as a child. He denies any traumatic injury or
known exposure to irritants. He is a maintenance engineer in a newspaper building and
admits that he often works with abrasive solvents and chemicals. Normally he wears
protective gloves, but lately they seem to be in short supply so sometimes he does not use
them. He has exposed his hands to some of these cleaning fluids, but says that it never
hurt and he always washed his hands when he was finished.

Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative
assistant at a local hospital. Her medical history is significant for hypertension, which has
been controlled for years with hydrochlorothiazide. She reports that lately she is having a
lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is
losing her appetite. She emphasizes that she is not hungry like she used to be. The only
significant change that has occurred lately in her life is that her 87-year-old mother
moved into her home a few years ago. Mom had always been healthy, but she fell down a
flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of
mobility and independence and needs to rely on her daughter for assistance with activities
of daily living. Martha says it is not the retirement she dreamed about, but she is an only
child and is happy to care for her mother. Mom wakes up early in the morning, likes to
bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time
into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating
less. She is worried about her own health though and wants to know why, at her age, she
suddenly needs less sleep.
To Prepare
 Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
 Identify the pathophysiology of the disorders presented in each of the three scenarios,
including their associated alterations. Consider the adaptive responses to the alterations.
 Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal
Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of
the disorders you identified from the scenarios. Use the examples in the media as a guide
to construct a mind map for the disorder you selected. Consider the epidemiology,
pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well
as any adaptive responses to alterations.

To Complete
Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that
addresses the following:
 For each of the three scenarios explain the pathophysiology, associated alterations and
the patients’ adaptive responses to the alterations caused by the disease processes.  You
are required to discuss all three scenarios within the paper component of this assignment.
 Construct one mind map on a selected disorder presented in one of the scenarios. Your
Mind Map must include the epidemiology, pathophysiology, risk factors, clinical
presentation, and diagnosis of the disorder, as well as any adaptive responses to
alterations.