Week 2: Compensatory Mechanisms
Whether a person realizes it or not, his or her body
regularly uses compensatory mechanisms such as adaptive and maladaptive
responses. These compensatory mechanisms help the body respond to stressors or
triggers. Perhaps you have heard a patient complain that his or her food “just
didn’t go down right,” resulting in a coughing spell. Maybe you have treated a
child with scabs on his or her arms and legs. These are automatic physiological
responses that a person cannot control and that may sometimes result in adverse
health effects, such as hives. As an advanced practice nurse, it is important
that you are able to identify the root of compensatory mechanisms and
underlying responses. Which compensatory mechanisms are related to which
disorders? Is the presenting mechanism positive and adaptive, or is it
maladaptive and in need of control? What are appropriate management strategies?
Since the physical and emotional impact of musculoskeletal,
autoimmune, and integumentary disorders varies from patient to patient,
associated alterations and symptoms vary as well. For this reason, you must
have a solid understanding of these disorders in order to properly diagnose
patients.
This week you examine compensatory mechanisms and
physiological responses of disorders and the pathophysiology of musculoskeletal
disorders. You also explore the impact of patient factors on the
pathophysiology of disorders and resulting compensatory mechanisms, and the
impact of patient factors on the disorders.
Learning Objectives
Students will:
Compare maladaptive and physiological responses of immune
disorders
Evaluate the impact of patient factors on the
pathophysiology of immune disorders
Compare the pathophysiology of osteoarthritis and rheumatoid
arthritis
Evaluate the impact of patient factors on arthritis
Analyze the pathophysiology of disorders
Assess adaptive responses to alterations
Evaluate clinical considerations of disorders
Understand and apply key terms, concepts, and principles
related to adaptive and compensatory mechanisms
Understand and apply key terms, concepts, and principles
related to alterations of the musculoskeletal, autoimmune, and integumentary
systems
Photo Credit: Ariel Skelley/Blend Images/Getty IMages
Learning Resources
Required Readings
Huether, S. E., & McCance, K. L. (2017). Understanding
pathophysiology (6th ed.). St. Louis, MO: Mosby.
Chapter 6, “Innate Immunity: Inflammation and Wound Healing”
This chapter examines how the body responds to injury and
infection by exploring the first, second, and third lines of defense. It also
covers wound healing and alterations of the wound healing process.
Chapter 7, “Adaptive Immunity”
This chapter examines the third line of defense, adaptive
immunity. It also covers the roles of antigens and immunogens, the humoral
immune response, cell-mediated immunity, and the production of B and T
lymphocytes in the immune response.
Chapter 8, “Infection and Defects in Mechanism of Defense”
This chapter covers the epidemiology, clinical presentation,
and treatment of disorders resulting from infection, deficiencies in immunity,
and hypersensitivity. It also examines the pathophysiology of an important
immune disorder—HIV/AIDS.
Chapter 9, “Stress and Disease”
This chapter evaluates the impact of stress on various body
systems and the immune system. It also examines coping mechanisms and disorders
related to stress.
Chapter 10, “Biology of Cancer”
This chapter explores the developmental process of cancer
and factors that impact the onset of cancer at the cellular level. It also
describes various treatment options.
Chapter 11, “Cancer Epidemiology”
This chapter reviews genetic, environmental, behavioral, and
diet-related risk factors for cancer. It also examines types of cancers that
result from risk factors.
Chapter 12, “Cancer in Children and Adolescents”
This chapter focuses on the presentation and prognosis of
childhood cancers. It examines the impact of genetic and environmental factors
on these cancers.
Chapter 38, “Structure and Function of the Musculoskeletal
System”
This chapter covers the structure and function of bones,
joints, and skeletal muscle. It also explores effects of aging on the
musculoskeletal system.
Chapter 39, “Alterations of Musculoskeletal Function”
This chapter examines the pathophysiology, clinical
manifestations, and evaluation and treatment of bone, joints, and skeletal
muscle disorders. Additionally, it explores musculoskeletal tumors,
osteoarthritis, and rheumatoid arthritis.
Chapter 40, “Alterations of Musculoskeletal Function in
Children”
This chapter includes musculoskeletal disorders that affect
children, such as congenital defects, bone infection, juvenile idiopathic
arthritis, muscular dystrophy, musculoskeletal tumors, and nonaccidental
trauma.
Chapter 41, “Structure, Function, and Disorders of the
Integument”
This chapter begins with an overview of the structure and
function of skin. It then covers effects of aging on skin, as well as disorders
of the skin, hair, and nails.
Chapter 42, “Alterations of Integument in Children”
This chapter covers alterations of the integument that
affect children. These include acne vulgaris, dermatitis, infections of the
skin, insect bites and parasites, vascular disorders, and other skin disorders.
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology
of disease: An introduction to clinical medicine (8th ed.). New York, NY:
McGraw-Hill Education.
Chapter 3, “Disorders of the Immune System”
This chapter explores the anatomy and physiology of the
immune system. It also explores the pathophysiology of various immune disorders
such as primary immunodeficiency diseases and AIDS.
Chapter 8, “Diseases of the Skin”
This chapter begins with an overview of the anatomy and
physiology of skin. It also explores the pathophysiology of various types of
skin lesions and inflammatory skin diseases.
Chapter 24, “Inflammatory Rheumatic Disease”
This chapter explores the pathogenesis of inflammation and
its role in rheumatic diseases. It also examines the clinical presentation,
etiology, pathophysiology, and clinical manifestations of rheumatic diseases
such as gout and rheumatoid arthritis.
Required Media
Zimbron, J. (2008).
Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD)
[PDF]. Retrieved from http://www.medmaps.co.uk/beta/
Gastro-oesophageal reflux disease. [Image]. Used with
permission of MedMaps.
This media provides examples of mind maps for dementia,
endocarditis, and gastro-oesophageal reflux disease (GERD).
Optional Resources
Arthritis Foundation. (2012). Retrieved from
http://www.arthritis.org/
Lupus Foundation of America. (2012). Retrieved from
http://www.lupus.org/newsite/index.html
Review the animations, case studies, and review questions on
the evolve textbook support link. http://evolve.elsevier.com/huether
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.
Review the Application Assignment Rubric found under Course
Information
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.
