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NARRATOR: In this program, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pathophysiology for the advanced practice nurse. Let’s listen as she provides her insights to this course.
DR. TERRY BUTTARO: So advanced pathophysiology is definitely a difficult course. There’s a lot of memorization as you go through this course, really trying to understand things at the cellular level– how do organs function? What happens, for example, when that organ stops functioning, whether it’s because of an infection or a malignancy? But if you don’t understand this, if you don’t kind of learn, not only the normal, but definitely that pathophysiology part, as an advanced practice nurse, then you’re not going to be able to really put the picture together when someone comes in.
So for example, understanding what the liver does is really important when somebody comes in with abdominal pain or anorexia, because you have to figure out, well, what could this be? So you have to get that history about, well, when did this start? Does it happen all the time? Are there other things going along with this?
And then, when you do your physical exam, you have to understand, well, not only where the liver is and what it does, but what else do you have to look for in the physical exam to determine if there is a problem with the liver. And that’s not only the liver, because the knee bone is connected to the thigh bone. So every organ affects another organ. So it’s essential that we understand that.
And it does require a lot of work. It does require a lot of work. But what you want to do is have this really good understanding about each system so that when somebody comes in, you might not remember exactly, but something clicks. And you say, maybe it’s this. And then you can go look it up to see, well, what diagnostics do I have to do?
And truthfully, advanced pathophysiology takes from health assessment so that when you learn how to do a really good health assessment and good history, and then a good physical exam, you take the important data from the history and from the physical exam, and you put that together. And you say, you know, this doesn’t look so much like the liver. This acts more like the stomach. And that’s how you work out your differential.
And it’s not that there’s every one thing. We all want to keep our minds open to the different pathophysiologic processes in the body to be sure that we’re not attributing one disease to a patient when it could be something else. So we have
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to keep our minds open. So that’s why it’s important. You can’t only learn one system. You have to learn all the systems.
Online learning’s a little bit different than when you actually go to school. It really requires that a student is able to pace themselves and study frequently, because it’s on their own time. And so in some respects, online is really great, because you can do in your own time. You don’t have to travel. You can do it at midnight if you want. I’ve had students before who do some aspects of online when they’re at lunch at work, because they have a little bit of quiet time. And that works out well.
But you also get distracted easily, because you can be home. And there’s tons of distractions at home. So you have to really focus. And you have to study every week. And this is true for all education.
Learning this information is complex. So people certainly have to read, but reading isn’t enough. You have to figure out how you learn best. Are you a visual learner? Are you an auditory learner? Hopefully, you get a little bit of both. And that will help you.
I think using the online system and discussing questions with your fellow students is really helpful. You can say, you know, I read this, but this doesn’t really make sense to me. Why does somebody have heart failure? What’s the difference between systolic and diastolic? I don’t get that. And so another student who might actually be working in a cardiac unit might be able to explain it better in clearer terms to you than the book does.
The other thing is probably making note cards is really important so that you can study in free moments. That can be helpful. Sometimes, podcasts or just actually recording what the highlights are so that you could listen in the car, that can be helpful, too. But it’s really understanding that you cannot let it go to the exam, that learning has to occur every single day.
And for the most part, I would say to students, when the week starts on a Monday, first, look over the outline or the PowerPoint that is available to you online. Then go back and do the readings. And if there’s any kind of exercise, do those exercises, because those exercises are going to help you figure out, well, did I really learn that, or do I have to go back?
And then have a few notes. You don’t have to take copious notes. You don’t want to do that. You only want to take notes on what you don’t understand. But what you don’t understand in either advanced pathophysiology or pharmacology, you want to write something a little quickly.
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So what I usually tell students they absolutely have to know is, so what would the patient complain about with this? What do you have to look for in the physical exam? What are the diagnostics that might be done for this disorder?
And then, what are the medications? What’s the pharmacological treatment that a patient’s going to need for this disorder? And what are you going to have to teach the patients?
So if you can kind of figure out a kind of a formula for [INAUDIBLE] learning about what’s the clinical presentation, what’s the physical exam, what diagnostics go along with the heart failure, for example, what are the medications treated, that will help you. But you also have to know what’s the basic pathophysiologic process for that disorder, because if you don’t understand that pathophysiologic process, you’re not going to understand how the drugs we’re going to give fix it.
So if somebody comes in with heart failure, you know that their heart has failed in some way. That’s all it is. The pump is not working the way it should be. But when the pump doesn’t work well enough, the lungs fill up with fluid, and the patient’s short of breath, and their oxygen level goes down. So how do you get rid of that fluid?
Well, the first medicine, or one of the first, is usually a diuretic. So what are you, as a nurse, going to look for first? You’re going to give that diuretic, that furosemide.
Then you’re going to be listening to the lungs to see, is it getting better? Is their breathing getting better, is their oxygen level getting higher, is their respiratory rate going down? It’s because you’re going to be watching them.
And then there’s many other things. It’s not only one simple thing we do. But it’s putting that whole picture together.
And when you’re studying, whether it’s pathophysiology or it’s advanced pharmacology, you should be trying to have this picture of your patient in your mind. What does this patient look like? What’s going on? How am I going to treat them? And then, how am I going to evaluate the treatment?
So it’s really picking out the clinical presentation for that patient– what do they complain of– and then thinking about what the pathophysiologic process is. And it really is trying to figure that out at the cellular level.
What happens when a patient has cancer? What happens? So lung cancers, for example, they start 30 years often before a patient comes in with symptoms.
So I had a patient come in a couple weeks ago who complained about back pain. And when I asked her about the back pain, she said, well, you know, I’ve had this
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for about six months. It wasn’t too bad in the beginning. But it’s really right across my back here. And I said, well, did you ever smoke? And she said, yeah, I smoked for about 30 years.
So I’m thinking to myself, what could cause this? What causes that kind of pain? It wasn’t pain when she moved. So then thinking about, well, what could happen in that area?
Is it the spinal column that’s causing this? But she didn’t have any numbness and tingling in her arms. She didn’t have a problem with moving her arms. She didn’t have muscle pain.
So then you have to go really way back more to the cellular level, what organs are there. So really, it’s kind of the lungs and the muscle and the spinal column in the back. There’s not a ton of other things.
So you need to figure out, well, how am I going to figure out what this is? And I couldn’t think of a lab test. But an X-ray would at least tell me, well, are her lungs OK? And the X-ray would also at least show what her spine looked like. So that’s why it’s so important to kind of think about pathophysiology and understand what’s happening
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