Category: Nursing homework help

Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.

Case scenario
A 34-year-old Hispanic American male with end-stage renal disease received kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101˚F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

Review the Marshall et. al. (2017) Reading Excerpt linked above.
What challenges to completion do you anticipate you will encounter in your doctoral program? What strategies for successful completion do you anticipate will be the most useful for you, and how will you work toward implementing these strategies to meet your goals?
.

The PICOT question is a consistently formatted question or “formula” for developing answerable, researchable questions. A well written PICOT question makes the rest of the literature search and research process of finding and evaluating evidence much more straightforward.
PICOT question:
P: Patient Population (age, gender, ethnicity, individuals with a certain disorder)
I: Intervention or Issue of Interest (exposure to a disease, risk behavior, prognostic factor)
C: Comparison of Intervention or Issue of interest with current or former interventions
O: Improved Outcome (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)
T: Time Frame (not every question will have a time)
You will be submitting a PICOT question. Consider the type of research you are interested in or if you are doing something new at work and wonder why the change, review the various PICOT question formats to create a PICOT question for your research this term.
Submit ONE fully written PICOT Question and add the identification of the P – I – C – O & (T, if applicable).

You are the Nurse Leader/Administrator at a long-term care facility (not hospital). The rates of resident falls have been increasing over the last 6 months to a year in your facility causing some serious injuries for some of the residents. You, as a doctorate of nursing prepared leader, have to adequately describe the issue & create a Process Improvement project using the Six Sigma (DMAIC) process to address and solve the problem. During this part, you will address the DMA – Define, Measure & Analyze stages. A MINIMUM of 5 relevant evidence based sources (best are peer-reviewed articles) should be used and published within the last 5 years. Below are the (DMA) relevant issues to include in your Process Improvement Project:
DEFINE:
•Define the issue: What process are you trying to improve?
•Describe the team and stakeholders
•Plan out the project
•Make a plan for the change
MEASURE:
•What metrics will you measure
•How will you measure success
•How will you collect baseline data
ANALYZE:
•How will you analyze the data you collect
•What will you use to display data
•What is the reason for your wastes, delays, etc
ANSWER
**DMAIC Process Improvement Project: Reducing Resident Falls in a Long-Term Care Facility**
**Define**
**Issue:**
The rate of resident falls has been increasing over the last 6 months to a year in the long-term care facility, causing some serious injuries for some of the residents.
**Team and stakeholders:**
The team will include the Nurse Leader/Administrator, nurses, nursing assistants, physical therapists, occupational therapists, and environmental services staff. Other stakeholders include residents and their families, as well as the facility’s administration and management team.
**Plan:**
The team will meet to develop a plan for the project. The plan will include the following steps:
1. Identify the root causes of resident falls.
2. Develop and implement interventions to reduce the risk of falls.
3. Monitor and evaluate the effectiveness of the interventions.
**Change plan:**
The team will develop a change plan to implement the interventions. The change plan will include the following steps:
1. Communicate the plan to the team and stakeholders.
2. Educate the team on the new interventions.
3. Provide training and support to the team as needed.
4. Monitor the implementation of the interventions and make adjustments as needed.
**Measure**
**Metrics:**
The team will measure the following metrics:
* The number of resident falls per month
* The number of resident falls with injuries per month
* The severity of resident falls (e.g., minor, moderate, severe)
**Success:**
Success will be measured by a decrease in the number of resident falls per month and a decrease in the number of resident falls with injuries per month.
**Baseline data:**
The team will collect baseline data on the number of resident falls per month and the number of resident falls with injuries per month. This data will be used to compare the effectiveness of the interventions.
**Analyze**
**Data analysis:**
The team will use statistical analysis to compare the baseline data to the data collected after the interventions are implemented. This will help to determine the effectiveness of the interventions.
**Data display:**
The team will use charts and graphs to display the data. This will make it easier to visualize the data and identify trends.
**Root causes:**
The team will use a variety of methods to identify the root causes of resident falls, such as root cause analysis and Pareto charts.
**Waste, delays, etc.:**
Once the root causes of resident falls have been identified, the team can develop interventions to address them. For example, if the team identifies that medication side effects are a root cause of falls, they can develop interventions to reduce the risk of medication side effects.
**Evidence-based sources:**
* **Preventing Falls in Long-Term Care Facilities: A Review of the Literature** (2019)
* **The Effect of a Multifactorial Intervention on Resident Falls in a Long-Term Care Facility** (2020)
* **The Impact of a Fall Prevention Program on Resident Falls in a Long-Term Care Facility** (2021)
* **The Effectiveness of a Fall Prevention Program for Residents of Long-Term Care Facilities: A Systematic Review** (2022)
* **Fall Prevention in Long-Term Care Facilities: A Best Practice Guide** (2023)
**Conclusion**
This DMAIC process improvement project can be used to reduce resident falls in a long-term care facility. The project will involve the team working together to identify the root causes of falls, develop and implement interventions, and monitor and evaluate the effectiveness of the interventions. By following this process, the team can make significant progress in reducing the number of resident falls and improving the safety of the facility.

Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.
APA format
1) Minimum 10 pages (No word count per page)- Follow the 3 x 3 rule: minimum of three paragraphs per page
You must strictly comply with the number of paragraphs requested per page.
The number of words in each paragraph should be similar
Part 1: minimum 2 pages (24 hours)
Part 2: minimum 2 pages (24 hours)
Part 3: minimum 3 pages (24 hours)
Part 4: minimum 3 pages (24 hours)
Submit 1 document per part
2)¨******APA norms
The number of words in each paragraph should be similar
Must be written in the third person
All paragraphs must be narrative and cited in the text- each paragraph
The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information.
Bulleted responses are not accepted
Don’t write in the first person
Do not use subtitles or titles
Don’t copy and paste the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
Submit 1 document per part
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references (APA format) per part not older than 5 years (Journals, books) (No websites)
Part 3 and 4: Minimun 6 references (APA format) per part not older than 5 years (Journals, books) (No websites)
All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to
6) You must name the files according to the part you are answering:
Example:
Part 1.doc
Part 2.doc
__________________________________________________________________________________
Part 1: Diversity in healthcare
The St. Fleur family is well respected in the Haitian community because they are religious with great moral values. They moved to the United States because of political issues in Haiti. Ronald, the youngest son of this family, is 27 years old and lives at home with his mother and father. Recently, he began having fevers and subsequently developed pneumonia. He was admitted to the hospital, where laboratory tests were HIV positive. Ronald was in shock when the doctor informed him that he was HIV positive. He confessed to the doctor that he was gay, but he could not tell his family. He said that he did not want to bring shame to the family. Because he couldn’t be in a formal relationship disowning to his family and the Haitian community’s view of homosexuality, he has been very promiscuous over the years.
2. What are Haitians’ views of homosexuality? (One paragraph)
a. Explain
2. If Ronald’s parents were to learn of his positive HIV status, how might they react if they are religious and traditional? (Two paragraphs)
a. Explain
3. Identify and explain three major culturally congruent strategies a healthcare provider can implement to address HIV prevention practices in the Haitian community (Tree paragraphs)
a. Major culturally congruent strategy (One paragraph)
b. Major culturally congruent strategy (One paragraph)
c. Major culturally congruent strategy (One paragraph)
Part 2: Psychopathology
Scenario:
Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere, except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive.
Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty.
Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Sue is alarmed at the changes in her sister and arranges for Kel to visit a health care worker at the medical clinic.
1. Generate a primary diagnosis using the DSM5 criteria and ICD 10 codes (Two paragraphs)
a. DSM5 (One paragraph)
b. ICD-10 (One paragraph)
2. Generate a differential diagnosis using the DSM5 criteria and ICD 10 codes (Two paragraphs)
a. DSM5 (One paragraph)
b. ICD-10 (One paragraph)
3. Formulate and prioritize a treatment plan (One paragraph)
4. Identify and discuss appropriate screening instruments for a patient who has suicidal ideation. (One paragraph)
Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.
Part 3: Advanced primary family care
Topic: Endocrine
INITIAL VISIT NOTES:
SUBJECTIVE: Maxwell is a 40 – year – old homosexual African – American male and corporate lawyer who has been our patient for the last three years. At that time, he had not been to a primary care provider since graduating from law school. The patient admitted to a sedentary lifestyle, a weight gain of 25 pounds within the past two years, and occasional fatigue and headache.
Past medical history: None significant.
Past surgical history: Significant for a tonsillectomy at the age of 7.
Family history: Significant for thyroid disease, hypertension, type 2 diabetes, hyperlipidemia, and obesity.
OBJECTIVE: Vital s signs: 220 pounds with a height of 6 ft 1 inch and a body mass index of 29. Blood pressure: 140/88; radial pulse: 78; temperature: 98.7; and respiratory rate: 16.
Physical 3xamination: Significant for acanthosis nigricans and central adiposity.
Diagnostic test results: Fasting lipids revealed total cholesterol of 182, a low-density lipoprotein level of 106, a high-density lipoprotein level of 57, and a triglyceride level of 95. His fasting blood glucose was 95, and his A1c was 5.6. His thyroid-stimulating hormone level was 0.24. A routine electrocardiogram documented normal sinus rhythm and rate.
Diagnoses: Stage 1 hypertension (due to the elevation of blood pressure) and hypothyroid disease (since the thyroid stimulating hormone level was abnormally low).
Plan: The patient was started on both hydrochlorothiazide 25 mg by mouth daily and levothyroxine 0.25 mcg by mouth daily. He was counseled regarding lifestyle modifications, including preparing and eating a low-sodium and low-fat diet. Maxwell was encouraged to start a routine exercise program of at least 30 minutes of modest aerobic activity, such as walking as if to catch a bus. He was also encouraged to lose 5% – 7% of his body weight. These lifestyle modifications have proven effective in diabetes prevention and maintenance and control of blood pressure and lipid levels. The patient was informed regarding the mechanism of action of both medications, duration of action, contraindications, and adverse effects. The patient was also instructed to take levothyroxine on an empty stomach first thing in the morning.
THREE – MONTH FOLLOW – UP VISIT
THREE-MONTH FOLLOW UP VISIT NOTES:
Vital signs: Blood pressure of 128/76.
Diagnostic test results: Thyroid stimulating hormone level = 3.37. Basic metabolic panel: Blood urea nitrogen level of 14; creatinine level of 0.98; sodium level of 137; potassium level of 3.5; and chloride level of 104.
Plan: The patient was given a list of potassium-containing foods and reminded to eat 1 or 2 daily due to a low potassium level. He was instructed to continue to take the hydrochlorothiazide.
TWO YEARS LATER
RECENT VISIT (2 years later)
SUBJECTIVE: Maxwell has been very busy climbing the corporate ladder and has not been in for a physical 3xamination or lab work for two years. He complains of extreme fatigue for the past two months and low libido. He states that he always feels fatigued, and sleep does not seem to relieve it. He can work but has limited socialization and participation in outside activities due to fatigue. He reports sleeping for 8 – 10 hours a night, with his sleep being interrupted by a need to go to the bathroom at least twice. He awakens fatigued. Sexually, he has a morning erection but not as strongly as in previous months. He has limited sexual desire. He can have an erection with intercourse, but it is less of an erection than previously. He states that he has been in a monogamous relationship for the past two years. He admits to a 15 – pound weight gain over the past two years. He reports that he experiences occasional constipation and some cold intolerance. He denies fever, night sweats, and tobacco or drug use and reports socially drinking several glasses of red wine per week.
Past medical history: Unchanged. / Past surgical history: Unchanged.
Family history: His father died recently from a heart attack.
Medications: Hydrochlorothiazide, 25 mg PO QD; levothyroxine, 0.50 mcg PO; multivitamin, one capsule PO QD; and fish oil capsules, 2000 mg PO QD. There are no known drug allergies or no known food allergies.
OBJECTIVE: Vital signs: Temperature: 98.6; radial pulse: 76; blood pressure: 134/80; oxygen saturation: 99%; height: 6 ft 1 inch; weight: 235 lb (15 – lb weight gain); and body mass index: 31. Physical 3xam is unremarkable except for the following findings:
Skin: Poor skin turgor; acanthosis nigricans.
Mouth: Dry oral mucosa.
Abdomen: Central adiposity.
Lymph: No significant lymphadenopathy.
Rectal: Hemoccult negative for occult blood.
1. Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? (One paragraph)
2. Explain the most likely differential diagnosis (One paragraph)
a. Why
3. What is your plan of treatment(Tow paragraphs)
a. Pharmacology (One paragraph)
b. Nonpharmacology (One paragraph)
4. Explain referrals (One paragraph)
5. Does the patient’s psychosocial history impact how you might treat this patient? (One paragraph)
a. Explain
6. What if the patient were over age 65? (One paragraph)
7. What if the patient was over the age of 80? (One paragraph)
8. Are there standardized guidelines that should be used to assess and treat this patient?(One paragraph)
Part 3: Advanced primary family care
Topic: Endocrine
INITIAL VISIT NOTES:
SUBJECTIVE: Maxwell is a 40 – year – old homosexual African – American male and corporate lawyer who has been our patient for the last three years. At that time, he had not been to a primary care provider since graduating from law school. The patient admitted to a sedentary lifestyle, a weight gain of 25 pounds within the past two years, and occasional fatigue and headache.
Past medical history: None significant.
Past surgical history: Significant for a tonsillectomy at the age of 7.
Family history: Significant for thyroid disease, hypertension, type 2 diabetes, hyperlipidemia, and obesity.
OBJECTIVE: Vital s signs: 220 pounds with a height of 6 ft 1 inch and a body mass index of 29. Blood pressure: 140/88; radial pulse: 78; temperature: 98.7; and respiratory rate: 16.
Physical 3xamination: Significant for acanthosis nigricans and central adiposity.
Diagnostic test results: Fasting lipids revealed total cholesterol of 182, a low-density lipoprotein level of 106, a high-density lipoprotein level of 57, and a triglyceride level of 95. His fasting blood glucose was 95, and his A1c was 5.6. His thyroid-stimulating hormone level was 0.24. A routine electrocardiogram documented normal sinus rhythm and rate.
Diagnoses: Stage 1 hypertension (due to the elevation of blood pressure) and hypothyroid disease (since the thyroid stimulating hormone level was abnormally low).
Plan: The patient was started on both hydrochlorothiazide 25 mg by mouth daily and levothyroxine 0.25 mcg by mouth daily. He was counseled regarding lifestyle modifications, including preparing and eating a low-sodium and low-fat diet. Maxwell was encouraged to start a routine exercise program of at least 30 minutes of modest aerobic activity, such as walking as if to catch a bus. He was also encouraged to lose 5% – 7% of his body weight. These lifestyle modifications have proven effective in diabetes prevention and maintenance and control of blood pressure and lipid levels. The patient was informed regarding the mechanism of action of both medications, duration of action, contraindications, and adverse effects. The patient was also instructed to take levothyroxine on an empty stomach first thing in the morning.
THREE – MONTH FOLLOW – UP VISIT
THREE-MONTH FOLLOW UP VISIT NOTES:
Vital signs: Blood pressure of 128/76.
Diagnostic test results: Thyroid stimulating hormone level = 3.37. Basic metabolic panel: Blood urea nitrogen level of 14; creatinine level of 0.98; sodium level of 137; potassium level of 3.5; and chloride level of 104.
Plan: The patient was given a list of potassium-containing foods and reminded to eat 1 or 2 daily due to a low potassium level. He was instructed to continue to take the hydrochlorothiazide.
TWO YEARS LATER
RECENT VISIT (2 years later)
SUBJECTIVE: Maxwell has been very busy climbing the corporate ladder and has not been in for a physical 3xamination or lab work for two years. He complains of extreme fatigue for the past two months and low libido. He states that he always feels fatigued, and sleep does not seem to relieve it. He can work but has limited socialization and participation in outside activities due to fatigue. He reports sleeping for 8 – 10 hours a night, with his sleep being interrupted by a need to go to the bathroom at least twice. He awakens fatigued. Sexually, he has a morning erection but not as strongly as in previous months. He has limited sexual desire. He can have an erection with intercourse, but it is less of an erection than previously. He states that he has been in a monogamous relationship for the past two years. He admits to a 15 – pound weight gain over the past two years. He reports that he experiences occasional constipation and some cold intolerance. He denies fever, night sweats, and tobacco or drug use and reports socially drinking several glasses of red wine per week.
Past medical history: Unchanged. / Past surgical history: Unchanged.
Family history: His father died recently from a heart attack.
Medications: Hydrochlorothiazide, 25 mg PO QD; levothyroxine, 0.50 mcg PO; multivitamin, one capsule PO QD; and fish oil capsules, 2000 mg PO QD. There are no known drug allergies or no known food allergies.
OBJECTIVE: Vital signs: Temperature: 98.6; radial pulse: 76; blood pressure: 134/80; oxygen saturation: 99%; height: 6 ft 1 inch; weight: 235 lb (15 – lb weight gain); and body mass index: 31. Physical 3xam is unremarkable except for the following findings:
Skin: Poor skin turgor; acanthosis nigricans.
Mouth: Dry oral mucosa.
Abdomen: Central adiposity.
Lymph: No significant lymphadenopathy.
Rectal: Hemoccult negative for occult blood.
1. Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? (One paragraph)
2. Explain the most likely differential diagnosis (One paragraph)
a. Why
3. What is your plan of treatment(Tow paragraphs)
a. Pharmacology (One paragraph)
b. Nonpharmacology (One paragraph)
4. Explain referrals (One paragraph)
5. Does the patient’s psychosocial history impact how you might treat this patient? (One paragraph)
a. Explain
6. What if the patient were over age 65? (One paragraph)
7. What if the patient was over the age of 80? (One paragraph)
8. Are there standardized guidelines that should be used to assess and treat this patient?(One paragraph)

In this , students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Develop a 2,500-4,000 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Background
Clinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system.
PICOT question.
Literature search strategy employed.
Evaluation of the literature.
Applicable change or nursing theory utilized.
Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Plan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Appendix section, for evaluation tools and educational materials, etc. are created.
Review the feedback from your instructor on the PICOT Question, and Literature Review. Use this feedback to make appropriate revisions to these before submitting.
Prepare this according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This uses a rubric. Please review the rubric prior to beginning the to become familiar with the expectations for successful completion.
You are required to submit this to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.4: Implement patient care decisions based on evidence-based practice.
2.2: Manage patient care within the changing environment of the health care system.

Directions:
Course Reflection
As you reflect on this course, answer the following questions in your discussion.
Describe how you achieved each of the course competencies.
Initial Post
Provide at least one example of new knowledge gained related to each competency and explain how this new knowledge will impact your nursing practice.
Competencies:
Integrate leadership and management principles and attributes in nursing practice.
Use evidence-based practice to guide clinical reasoning and clinical judgement as a basis for nursing decision making.
Collaborate in healthcare delivery systems settings for improved patient outcomes.
Demonstrate principles of professional identity and professionalism for the nurse within the context of regulatory and practice standards.
Analyze agencies that influence the provision of nursing care in the healthcare system.
Formulate decisions based on the legal and ethical underpinnings that improve healthcare.
Note:
“Expand on your peer’s ideas” needs more than 1 – 2 sentences for an acceptable reply.
Refer to a website or article, be sure to cite it in APA format. This prevents plagiarism and allows your fellow students to review the cites and increase the class knowledge base.
Please make your initial post by midweek, and respond to at least one other student’s post by the end of the week. Please check the Course Calendar for specific due dates.

For the initial post, address the following, using the provided headings to format your post:
Verbal

What were some of the questions asked during an interview you have been a part of? Share which ones were helpful and which ones were not.
What source have you found helpful in giving advice regarding the interview process? Share aspects of this source you found helpful.

Nonverbal

What nonverbal cues were used during one of your interviews, and did those nonverbal cues put you at ease or create more tension?
What was worn during the interview, and how did the wardrobe choices impact the experience?
How did the setting have an impact on the interview experience?

References

Place your two APA citations in this section.

If you have not been on an interview, look up three questions an interviewer might ask, and assess those questions. What can be communicated nonverbally? What do you think you should wear? What have you discovered about the impact of the setting? You may need more than one outside source to answer this question effectively if you have not been on an interview.

Consider how clinical judgement, critical thinking and decision making are similar and different and describe these in your own words. How do these processes differ in relation to bedside nursing when compared to that of an advanced practice nurse? Provide an example of how decision making is used by the bedside nurse and that of an advanced practice nurse to illustrate this point. After reading the information on emotional intelligence how would you describe this to someone who has never heard of the term. Can you apply emotional intelligence to a situation in care as an advanced practice nurse in a clinic or hospital?

DUE TODAY 07/14
Respond with at least 150 words (each) to a classmates
Question:
An adult patient with a chronic myelogenous leukemia sits down with you to discuss his questions and concerns about his upcoming bone marrow transplant. He has already received some educational materials and participated in a family conference during which health team members described the procedure and potential complications. He has been told that he has a risk of graft rejection or graft versus host disease (GVHD), but he does not understand the distinction (Chapter 12, Learning Objectives 1, 2, 10, 11).
What are the similarities between graft versus host disease and graft rejection?
What are the pathophysiologic differences between graft versus host disease and graft rejection?
How would these differences be manifested clinically?
Studies have shown a protective effect of mild to moderate GVHD in cancer patients who have had a bone marrow transplant. Based on your understanding, can you explain these findings?
classmate:
GvHD and Graft rejection
What are the similarities between graft versus host disease and graft rejection?
A graft-versus-host disease (GVHD) develops when the recipient's bodily cells are attacked by the graft's immune cells because they see the host as alien. In this case, the "host" refers to the recipient's tissues, whereas "graft" refers to transplanted or donated tissue. Graft rejection typically develops minutes or hours after transplantation and is brought on by specific antibodies against the graft. Graft rejection and graft versus host disease share a number of similarities. First of all, they both involve an attack on the autoimmune system of the body, and this attack involves the donated organs or tissues (Nagler et al., 2021). Also, both conditions are difficult to prevent and hence, people must take precautions to lower the likelihood of contracting such illnesses. Lastly, both conditions can be managed by immunosuppressive medications that include corticosteroids.
What are the pathophysiologic differences between graft versus host disease and graft rejection?
In regards to the pathophysiologic differences, while GVHD is brought on by donor-derived immune cells reacting against allogeneic recipient tissues, graft rejection involves the immunological reactivity of the recipient against transplanted allografts. The recipient's tissues in the GVHD condition are attacked by the graft because it perceives them as foreign substances. This may happen following an organ transplant. On the other hand, according to Nunes and Kanakry, (2019), graft rejection happens when tissues that have been transplanted are rejected. In other words, GVHD is caused by the recipients' immune systems reacting negatively to donor-derived immune cells, while graft rejection is caused by recipients' immune systems reacting negatively to transplants.
How would these differences be manifested clinically?
The differences between the two conditions are manifested when in GVHD, the recipient is rejected by the donor's immune system, while Graft rejection manifests when the transplant recipient's immune system rejects the transplanted tissue. Clinical symptoms of GVHD include dry eyes, skin discolorations, abdominal swelling, shortness of breath, and trouble swallowing. Also, the condition can result in tiredness and weak muscles. On the other hand, the clinical signs of graft rejection include organ swelling or pain, flu-like symptoms such as nausea, coughing, and body pains, as well as general malaise and discomfort (Nagler et al., 2021). Note that, the reduction in active donor T-cells prevents GVHD by properly cross-matching or tissue-typing, graft rejection can be avoided.
Studies have shown a protective effect of mild to moderate GVHD in cancer patients who have had bone marrow transplants. Based on your understanding, can you explain these findings? GVHD is not always a bad event since mild GVHD can be seen as being advantageous if the transplant is performed to treat blood malignancy. The new cells GvHD actively eradicate any remaining cancer cells in the body and hence, a patient's risk of their cancer coming back after transplant may be reduced if they have mild GVHD. According to Hill and Koyama, (2020), patients with cancer who have undergone bone marrow transplantation may benefit from GVHD, because the tissues and organs of the patient are likely to be recognized as foreign by the donor's immune system. Although mild to moderate GVHD is most likely to affect cancer patients, the condition will likely get better with time.