How to write a Response to Classmate’s discussion essay

Claudia Cruz’s post: Please respond/comment on classmates posting below. No Sources before 2018.

Q1. The patient is evaluated for multiple Pulmonary emboli. What risk factors and clinical findings are commonly associated with Pulmonary Emboli?

Pulmonary emboli.

To analyze the clinical case is essential to understand the pulmonary circulation system; in pulmonary circulation, the blood depleted of oxygen reaches the right atrium via superior and inferior vena cavae, and the blood from the right atrium is bumped into the right ventricle in which is transport to the lung via pulmonary artery left to the left lung and right into the right lung; the arteries divide at the terminal bronchiole developing pulmonary capillary, within the lung the blood moves over alveoli via the capillary beds that consist of an endothelial layer fragile basement membrane in which taking place the gas exchanges, after that the blood moves back to the left atrium completing the pulmonary circulation system (McCane & Huether, 2019).

The patient in the clinical case was diagnosed with multiple pulmonary emboli; the mean of pulmonary emboli is partial or total occlusion of the pulmonary artery or its branches by an embolus resulting from deep venous thrombosis or by tissue fragments, lipids, foreign body, air bubbles and amniotic fluid (McCane & Huether, 2019).

To develop a thromboembolism disorder such as deep venous thrombosis or pulmonary embolism, a Virchow triad is present; hypercoagulability, stasis, and endothelial injury (Kushner et al., 2021) in the hypercoagulability can include coagulation disorders, hormone replacement, pregnancy, oral contraceptives, cancers, stasis of the vessel for immobilization, cardiac failure, obesity and endothelial injury like trauma, infections. Also, a genetic component can be considered a risk factor, such as Leiden mutations, protein C and protein S deficiency, and prothrombin gene mutation.

The patient in the clinical case has a history of trauma in the lower extremity; also, the patient weight is around 140kg, which could be considered obesity; obesity is known as a risk factor for thromboembolism because of venous stasis, chronic inflammation, increased coagulation activity decreased fibrinolytic activity that is present in the obesity ( Ludo et, al, 2020), another risk factor present in the patient is the inability to maintain balance and the immobilization of the patient, increase the stasis of the vessels.

When the thrombus is into the pulmonary circulation, a neurohumoral substance released like catecholamines, angiotensin II, serotonin, and inflammatory elements such as leukotrienes, thromboxane, and free radical; contributing to vasoconstrictions resulting in increased pulmonary artery pressure, the absence in the blood flow caused a disbalance between ventilation and perfusion decreasing surfactant production resulting in atelectasis that contributes to hypoxemia. (McCane and Huether, 2019).

Clinical manifestation presented by the patient that makes clear a diagnosis of pulmonary emboli, besides of patient medical history, is pain and swelling in the calf of the affected leg that is a common manifestation of deep venous thrombosis and shortness of breath. Unexplained anxiety is pathognomonic of pulmonary emboli due to the inability of ventilation, and inadequate perfusion makes a complex gas exchange process in the lung.

References

Kushner A, West WP, Pillarisetty LS. 2021. Virchow Triad. StatPearls Treasure Island. Retrieved Jan, 2022from: https://www.ncbi.nlm.nih.gov/books/NBK539697/

Ludo, F.M., Luuk, M., Scheres, JJ., Stoker, J., Middendorf, S.2020. Prognostic characteristics and body mass index in patients with pulmonary embolism: does size matter? ERJ Open Research. 6: 00163-2019; DOI: 10.1183/23120541.00163-2019

McCance, K.L., Huether, S.E., Brashers, V.L., Rote, N.S. (2019) Pathophysiology: The biologic basis for disease in adults and children. (8th ed.). Maryland Heights, MO: Mosby Elsevier

SOLUTION TO DISCUSSION POST

Response post on pulmonary embolism: Claudia Cruz

Hi, Claudia Cruz, your post on pulmonary embolism is an excellent post well explained with relevant pathophysiology. It is vital to note that pulmonary embolism is a medical disorder that requires medical attention. I concur with your post that pulmonary embolism refers to the occlusion of the pulmonary artery or its corresponding branches by a clot and embolus. The embolus, however, blocks the blood flow to the lungs. It is key to keynote that the origin of the thrombus dislodged in the pulmonary artery originates not only from the deep venous system but also from the renal, upper extremity veins, the pelvic and the right atrium or right ventricle (McCance et al., 2019).

I settle that pulmonary embolism arises from increased alveolar dead space, hypoxemia and hyperventilation. Your clinical case t of focus presents typical clinical findings of pulmonary embolism. The 140kg weight of the patient indicates an obese patient, which is a risk factor for forming a pulmonary embolism. The weight, however, makes the patient unable to maintain balance and immobilize, which increases the blood vessel’s stasis (Ludo et al., 220). Other occlusions of the pulmonary artery trigger inflammatory reactions where leukotrienes, thromboxane and free radicals lead to vasoconstriction triggering hypoxemia. The clinical presentations stipulated by your case of yours thus indicate the diagnosis of pulmonary embolism. Pain and swelling in the calf of the affected leg typical rule-outs pulmonary embolism. It is wise to understand other signs of pulmonary embolism. Other signs of pulmonary embolism include; shortness of breath, chest pain, cough, rapid or irregular heartbeat, clammy or discoloured skin, excessive sweating and rapid or irregular heartbeat.

Additionally, your post on pulmonary embolism depicts the risk factor of pulmonary embolism as decreased fibrinolytic that is present in the obesity case, chronic inflammation and the inability to maintain balance and immobilization of the patient, which increases the stasis of vessels. The post clear outlines the overview of a pulmonary embolism that is easily comprehensible.

References

McCance, K.L., Huether, S.E., Brashers, V.L., Rote, N.S. (2019) Pathophysiology: The biologic basis for disease in adults and children. (8th ed.). Maryland Heights, MO: Mosby Elsevier.

How to write a Response to Classmate’s discussion essay

SOLUTION TO DISCUSSION POST

Response post on pulmonary embolism: Claudia Cruz

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