Pathophysiology

Responses to peers or faculty 

COMMENT 1:

Sepsis, a potentially life-threatening multisystem dysfunction, stems from a dysregulated host response to infection (Mayo Clinic, 2023). When an infection occurs, the immune system usually releases substances into the bloodstream to combat it. However, in sepsis, this immune response becomes dysregulated, triggering widespread inflammation throughout the body. This inflammation causes vasodilation and hypotension, leading to low blood pressure and impaired blood flow to vital organs. Also, increased capillary permeability results in fluid leakage, causing edema and compromising tissue oxygenation. Coagulation abnormalities, including hypercoagulability and disseminated intravascular coagulation (DIC), can lead to microthrombi formation and further impair blood flow (Cleveland Clinic, 2023). Consequently, vital organs such as the kidneys, liver, lungs, and heart may malfunction, potentially resulting in acute kidney injury, liver dysfunction, acute respiratory distress syndrome (ARDS), and cardiac dysfunction. Clinical manifestations of sepsis vary widely but commonly include fever or hypothermia, tachycardia, hypotension, altered mental status, and hypoxemia. Patients may also experience generalized weakness, shortness of breath, decreased urine output, nausea, vomiting, diarrhea, chills, and sweating. Sepsis profoundly impacts activities of daily living, often rendering patients bedridden or in need of intensive medical care such as mechanical ventilation, intravenous fluids, and vasopressor support (Cleveland Clinic, 2023). With prompt treatment, many people with sepsis recover completely and return to leading normal lives. But others may experience long-term effects. Long-term, these patients may develop complications such as insomnia, nightmares or hallucinations, panic attacks, joint and muscle pain, decreased cognitive functioning, organ failure (Cleveland Clinic, 2023). These patient are also at a higher risk of developing sepsis again. So, make sure to have any new infections treated immediately.

COMMENT 2:

Sepsis is one of the most common serious infections that can cause multiple system dysfunction. It is the body’s response to infection, releasing immune system components into the bloodstream, causing systemic inflammation and possibly leading to septic shock (Falkner, p 131). The infection-fighting processes cause the organs to work poorly. If sepsis progresses to septic shock, there is a dramatic drop in blood pressure, which can lead to damage to the lungs, kidneys, liver, and other organs. Sepsis can be life-threatening. Sepsis can be divided into four stages: systemic inflammatory response (SIRS), sepsis, severe sepsis, and septic shock. Sepsis begins with bacterial infections from disease or injury, such as pneumonia or trauma. Bacterial infections spread into the bloodstream, causing a systemic inflammatory response (SIRS) throughout the body. Common symptoms of sepsis may include changes in mental status, fast, shallow breathing, lightheadedness, shivering, painful urination from a urinary tract infection from pneumonia, etc. As sepsis worsens, more symptoms and laboratory tests will show changes such as cardiac dysfunction, Platelet count > 100,000 mL, Disseminated intravascular coagulation (DIC), etc. In the septic shock stage, there are Major changes in mental status, for example, extreme confusion. and severe drop in blood pressure. Progression to septic shock raises the risk of death. 

As research shows, severe sepsis affects over 750,000 Americans annually, with over 60% of cases occurring in those over 65 years of age (Ehlenbach, 2018). These elderly, severe sepsis survivors frequently experience cognitive and physical functional impairment affecting their daily activities. Survivors frequently experienced fatigue psychological and cognitive impairments, causing the survivors to withdraw from social activities. This vicious cycle further deteriorates their physical and mental health. Early rehabilitation, creating personalized care plans, and promoting exercise, nutrition, and social support strategies can help mitigate these issues.

COMMENT 3:

Multi-system dysfunction happens when two or more organs (or systems) stop working as they should. Uncontrolled diabetes can cause multi system dysfunction. Elevated blood glucose levels in the body cause damage to the small and large blood vessels. Since blood vessels are responsible for circulating blood throughout the entire body, this will effect the heart, brain, kidneys, peripheral vascular system, and eyes (Faulkner & Green, 2022). High glucose levels damage the inner lining of arteries, and the arteries respond by producing plaque in the vessels (Society for vascular surgery, 2019). This can cause high blood pressure, high cholesterol and triglyceride levels, and excess fat around the waist which is defined as metabolic syndrome (Mayo Clinic, n. d.). Excess plaque in the arteries often leads to heart attacks and strokes. Heart damage usually effects the lungs and other organs due to impaired circulation throughout the body. Peripheral artery disease (PAD) is also a result of excess plaque in the vessels, and pieces of this can break off and travel to the heart, head and lungs. Diabetes causes micro-vascular damage to the kidneys, which leads to kidney failure. The initial symptoms of hyperglycemia and the onset of diabetes are excessive thirst, increased urination, fatigue, and blurred vision. One may not notice symptoms of atherosclerosis immediately, but eventually it can cause chest pain (Coronary artery disease), numbness or weakness in your arms or legs (Stroke or TIA) , pain in legs when walking (PAD). Symptoms of advanced kidney disease cause frequent urination and puffiness and albumin in the urine (Faulkner & Green, 2022).

COMMENT 4:

Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure. As bones become less dense, they weaken and are more likely to break. Bone Health and Osteoporosis Foundation. (2023) Osteoporosis is influenced by both modifiable and nonmodifiable risk factors. Nonmodifiable risk factors include age, gender, genetics, and ethnicity, with older adults, women, and individuals of Caucasian or Asian descent being at higher risk. Family history also plays a significant role in the likelihood of developing osteoporosis. On the other hand, modifiable risk factors encompass lifestyle choices such as diet, physical activity, smoking, and alcohol consumption. Poor calcium and vitamin D intake, sedentary lifestyle, excessive alcohol consumption, and smoking can all increase the risk of osteoporosis.

A nurse can support a patient in managing osteoporosis by providing education on the importance of a balanced diet rich in calcium and vitamin D, and encouraging regular weight-bearing exercises to strengthen bones. The nurse can also assist in developing a personalized plan to quit smoking and reduce alcohol intake. Monitoring the patient’s bone density and ensuring adherence to prescribed medications are crucial components of care. Additionally, the nurse can offer guidance on fall prevention strategies to minimize the risk of fractures. By fostering a supportive and informative environment, the nurse helps the patient adopt healthier lifestyle choices and manage osteoporosis effectively, aiming to restore and maintain optimal bone health. Treatments have been shown to reduce the risk of hip fracture by up to 40%, vertebral fractures by 30-70% and, with some medications, reduce the risk for non-vertebral fractures by 15-20%. Treatment | International Osteoporosis Foundation. (n.d.).

COMMENT 5:

Osteoporosis affects people of all races/ethnicities and both sexes. Currently, it has been estimated that more than 200 million people have osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime (Sözen, 2017). In the United States, an estimated 10 million people age 50 years and older have osteoporosis. Osteoporosis is a condition of decreased bone mineral density that makes the bone porous and increases the risk of fractures (Falkner, p 104). Osteoporosis can be affected by both modifiable and nonmodifiable risk factors. Nonmodifiable risk factors for osteoporosis include age, being over 50, menopause in women, family history of osteoporosis, ethnicity, etc. Those risk factors cannot be controlled or changed. Modifiable risk factors that affect osteoporosis include a diet with Low calcium and vitamin D intake, physical inactivity, unhealthy lifestyle, smoking, alcohol consumption, overweight, anorexia, losing weight through extreme diets, etc. Those modifiable factor influences peak bone mass. Therefore, how to change these modifiable risk factors to change osteoporosis is particularly important. 

Nurses can use many strategies to help patients with osteoporosis. The best way is first to assess their knowledge of the disease and educate them about its harm. Then, nurses can help patients with treatment options for osteoporosis, such as lifestyle changes, quitting smoking and drinking, plans for regular exercise, healthy dietary changes, fall prevention, supplements and medications, etc. Bone density screenings are also necessary for some patients with medical conditions or who take medications that may cause bone loss.

COMMENT 6:

Osteoporosis is a condition characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased risk of fractures (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2021). While some risk factors for osteoporosis are nonmodifiable, such as age, gender, and family history, there are several modifiable risk factors that can be addressed to reduce the risk of developing osteoporosis. These modifiable risk factors include:

1. Inadequate calcium and vitamin D intake: Consuming a diet low in calcium and vitamin D can increase the risk of osteoporosis. Nurses can educate patients about the importance of consuming a diet rich in these nutrients, including dairy products, dark green leafy vegetables, and fortified foods.

2. Sedentary lifestyle: Lack of physical activity can increase the risk of osteoporosis. Nurses can encourage patients to engage in regular weight-bearing exercise, such as walking, jogging, or climbing stairs, to help build and maintain bone density. (Ibrahim, 2019).

3. Cigarette smoking: Smoking can decrease bone density and increase the risk of osteoporosis. Nurses can provide smoking cessation resources to patients who smoke and encourage them to quit.

4. Excessive alcohol consumption: Drinking alcohol in excess can increase the risk of osteoporosis. Nurses can educate patients about the recommended alcohol consumption limits and encourage them to drink in moderation.

5. Medications: Certain medications can increase the risk of osteoporosis, such as corticosteroids, anticonvulsants, and thyroid hormones. Nurses can work with patients and their healthcare providers to evaluate the need for these medications and explore alternative options. (Ibrahim, 2019).

Nonmodifiable Risk Factors for Osteoporosis

While modifiable risk factors can be addressed to reduce the risk of osteoporosis, there are also several nonmodifiable risk factors that cannot be changed. These include:

1. Age: Bone density decreases with age, increasing the risk of osteoporosis.

2. Gender: Women are at a higher risk of osteoporosis than men, due to lower peak bone mass and hormonal changes during menopause.

3. Family history: Having a family history of osteoporosis can increase the risk of developing the condition. (Ibrahim, 2019).

4. Race: White and Asian women are at a higher risk of osteoporosis than other races.

5. Body size: Having a small, thin frame can increase the risk of osteoporosis.