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INSTRUCTIONS FOR THE MID TERM EXAM TO RECEIVE FULL CREDIT FOR THIS EXAM, YOU MUST DO ALL OF THE FOLLOWING:  It must be in complete sentences, paragraph form, and grammatically correct.  Answers that are word for word from a source or in long quotes will not be accepted.  It must be in Times Roman with minimum font of 12.  No abbreviations will be accepted. Incorrect = Pu Correct = Polyuria  It must be turned in by the due date and time EXAMS WILL BE ACCEPTED PAST THE DUE DATE and TIME!  It must be submitted through the assignment feature attached as a file. Make sure that you name the file as , “Last Name_ MIDTERM EXAM  Your documents should be in doc or docx format.  Include any sources used to answer the questions using APA format  Answer all of the questions correctly! MIDTERM EXAM CASE #1 Maria is a sedentary, 68-year-old woman who is overweight. She complains that her hands and feet are always cold, and she tires quickly when cleaning the house. At her most recent visit to her doctor, her blood pressure was 184/98 mm Hg. She has edema around her ankles and legs, and her physician is concerned about an echocardiogram that indicates Maria has an enlarged heart. 1. Identify and discuss two reasons why Maria will have tissue ischemia. How, specifically, might this lead to hypoxia? (10 points) 2. What two early and reversible changes occur to tissue cells when they are hypoxic? (5 points) 3. What specific type of cellular adaptation has taken place in Maria’s enlarged heart? What made you come to this conclusion? (5 points) 4. Predict why Maria’s heart has become enlarged. Why doesn’t this enlargement give her the same cardiac strength and endurance as a well-trained athlete? (10 points) CASE #2 You are working in a community health center and caring for a 5-year-old child who was diagnosed as having a right ear infection. When collecting the history, the mother states the child has had a fever of 102°F for 2 days, has been irritable, and complained of feeling tired. The child has been drinking fluids well but not eating. The physician describes the tympanic membrane as erythematous, bulging with fluid levels, and dull. You collect the following vital signs: Temperature 102 Pulse. 110, and Respiration rate 18. 1. Which of the clinical manifestations given are associated with a localized inflammatory response? What physiological factors are responsible for the development of these manifestations? (15 POINTS) 2. If the physician ordered a complete blood count, what would you expect to see if there is a bacterial infection? (10 POINTS) CASE #3 Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced she was overweight because her clothes felt tight on her. She complained that even her hands and feet were fat. Her physician explained that a protein in her blood was low. It was further explained that, as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away. 1. What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema? (15 points) 2. Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she wasn’t on bed rest. Explain how this might affect her edematous tissues. (10 points) CASE #4 Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a 2-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia for the trip she always wanted to take. Unfortunately, just 3 days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. Compression ultrasonography revealed popliteal vein thrombosis. Doppler color flow imaging depicted absent flow in the area. 1. Explain, using you knowledge of hypercoagulability, what condition does Leona have and why was the trip to Australia a contributing factor to Leona’s condition? Why was Leona already at risk for this condition? (10 points) 2. How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis? (5 points) 3. Compare and contrast how atherosclerosis and immobility promote changes in blood coagulation. (5 points) 4. When Leona was in the hospital, she received heparin therapy. Explain why this course of action was taken to treat her condition? (5 points)

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