Running head: MILESTONE ONE 1 MILESTONE ONE 4 Milestone One Introduction of Individual In 1816, the author of such beloved books as "Emma" and "Pride and Prejudice" came down with a large group of puzzling diseases including fatigue, back pain, skin discoloration, "bilious attacks" and fever. Only one year later, she was dead at 41 years old. Much theory has been dedicated to Jane Austen's infection in the years since, with the most widely recognized diagnosis being that she had Addison's sickness, a malfunction of the adrenal organs that wasn't known to medicine until quite a while after her demise (White, 2009). Even though delayed in its onset, the confusion is known to cause changes in skin color during its late stages, which may clarify Austen's cases that her complexion had turned "black and white and every wrong color." Identification of Pathophysiology Mineralocorticoid deficiency Sodium reabsorption and excretion of potassium from the body are stimulated by mineralocorticoids, whereby if mineralocorticoids are not produced, it leads to decreased production of potassium and increased excretion of sodium, primarily through sweat, urine, saliva and times in gastrointestinal tract. A high serum concentration of potassium and low sodium concentration may be detected as a result. Symptoms such as but not limited may result where there is high water loss and urinary salt: hypotension, decreased circulatory volume, acidosis, plasma hypertonicity, severe dehydration, and finally, circulatory collapse. Nevertheless, when adrenocorticotropic hormone (ACTH) leads to adrenal inadequacy due to its low production, the circulatory problems are less severe, and the electrolyte levels are somewhat normal or mildly deranged (Bancos et al., 2015). Glucocorticoid deficiency Insufficiency of Glucocorticoid production leads to hypotension and severe insulin sensitivity as well as interferes with protein, fat, and carbohydrate metabolism. From protein, carbohydrates are formed when there is inadequate production of cortisol, and also hypoglycemia and reduced liver glycogen result. As a result of neuromuscular function, the person feels weak. Circulatory failure may result due to myocardial weakness and dehydration because there is reduced cardiac output. Additionally, glucocorticoid deficiency leads to reduced production of cortisol which affects ACTH production to a decreased level and elevated the amount of blood beta-lipotropin, which has melanocyte-stimulating activity and, when combined with ACTH, causes the hyperpigmentation of skin and mucous membranes characteristic of Addison disease (Bancos et al., 2015). Therefore, hyperpigmentation is not caused by the adrenal deficiency secondary to pituitary failure. Clinical Manifestations Addison’s disease manifestation starts gradually. Symptoms such as weight loss, loss of appetite, muscle weakness, fatigue, and chronic are examples of disease characteristics. In about 50% of reported cas ...

1. Running head: MILESTONE ONE
1
MILESTONE ONE
4
Milestone One
Introduction of Individual
In 1816, the author of such beloved books as "Emma" and
"Pride and Prejudice" came down with a large group of puzzling
diseases including fatigue, back pain, skin discoloration,
"bilious attacks" and fever. Only one year later, she was dead at
41 years old. Much theory has been dedicated to Jane Austen's
infection in the years since, with the most widely recognized
diagnosis being that she had Addison's sickness, a malfunction
of the adrenal organs that wasn't known to medicine until quite
a while after her demise (White, 2009). Even though delayed in
its onset, the confusion is known to cause changes in skin color
during its late stages, which may clarify Austen's cases that her
complexion had turned "black and white and every wrong
color."
Identification of Pathophysiology
Mineralocorticoid deficiency
Sodium reabsorption and excretion of potassium from the body
are stimulated by mineralocorticoids, whereby if
mineralocorticoids are not produced, it leads to decreased
production of potassium and increased excretion of sodium,
primarily through sweat, urine, saliva and times in
gastrointestinal tract. A high serum concentration of potassium
and low sodium concentration may be detected as a result.
Symptoms such as but not limited may result where there is
high water loss and urinary salt: hypotension, decreased
circulatory volume, acidosis, plasma hypertonicity, severe
dehydration, and finally, circulatory collapse. Nevertheless,

2. when adrenocorticotropic hormone (ACTH) leads to adrenal
inadequacy due to its low production, the circulatory problems
are less severe, and the electrolyte levels are somewhat normal
or mildly deranged (Bancos et al., 2015).
Glucocorticoid deficiency
Insufficiency of Glucocorticoid production leads to hypotension
and severe insulin sensitivity as well as interferes with protein,
fat, and carbohydrate metabolism. From protein, carbohydrates
are formed when there is inadequate production of cortisol, and
also hypoglycemia and reduced liver glycogen result. As a
result of neuromuscular function, the person feels weak.
Circulatory failure may result due to myocardial weakness and
dehydration because there is reduced cardiac output.
Additionally, glucocorticoid deficiency leads to reduced
production of cortisol which affects ACTH production to a
decreased level and elevated the amount of blood beta-
lipotropin, which has melanocyte-stimulating activity and, when
combined with ACTH, causes the hyperpigmentation of skin and
mucous membranes characteristic of Addison disease (Bancos et
al., 2015). Therefore, hyperpigmentation is not caused by the
adrenal deficiency secondary to pituitary failure.
Clinical Manifestations
Addison’s disease manifestation starts gradually. Symptoms
such as weight loss, loss of appetite, muscle weakness, fatigue,
and chronic are examples of disease characteristics. In about
50% of reported cases, victims have diarrhea, vomiting, and
nausea (Bancos et al., 2015). The patient’s blood pressure falls
drastically when standing, causing dizziness or fainting. Skin
discoloration is part of Addison's disease with a spot of dark
tainting or hyperpigmentation covering naked body parts. In
most cases, these dark skin spots are visible in pressure points,
elbows, or scars such as mucous membranes, lips, toes,
knuckles, knees, and elbows. Patients can develop depression
and irritability as a result of Addison's disease. This is due to
increased craving of foods with salt leading to salt loss. In
children, hypoglycemia is more prevalent than in adults. There

3. are irregular menstrual cycles in women.
Since the manifestations progress gradually, they are typically
disregarded until an unpleasant event like an ailment or a
mishap makes them worse. This is called an Addisonian crisis
or intense adrenal deficiency. In many patients, side effects are
severe enough to look for treatment before an emergency
happens. Nonetheless, in around 25% of patients, manifestations
initially show up during an Addisonian crisis (Bancos et al.,
2015).
References
Bancos, I., Hahner, S., Tomlinson, J., & Arlt, W. (2015).
Diagnosis and management of adrenal insufficiency. The Lancet
Diabetes & endocrinology, 3(3), 216-226.

4. White, K. G. (2009). Jane Austen and Addison's disease: an
unconvincing diagnosis. Medical humanities, 35(2), 98.
NUR 315 Milestone Two: Draft Guidelines and Rubric
In Milestone Two, you will submit a draft of your final project.
In Milestone One of the final project, you will have chosen a
well-known individual from history or
current popular literature, with instructor approval, who has a
known physiological—as opposed to psychiatric or
psychological—disease or illness. In Milestone
Two, you will analyze that disease or illness using a systematic
approach. You will also develop a plan of care for that disease
or illness.
Prompt: In your analysis, you will describe the pathophysiology
for your selected disease or illness, propose historical
explanations for variations in findings
(when applicable), and demonstrate use of nursing conceptual
models to frame your discussion of adaptation and stressors
collectively for system analysis.
Your plan of care should utilize the PIE (planning, intervention,
and evaluation) format. The planning (P) section should include
at least two short-term and two
long-term goals that are most appropriate for your chosen case,
and each goal should have measurable criteria and have a
hypothetical target date or time. The
intervention (I) section should include interventions or nursing
actions that directly relate to the selected case’s goals and that
are specific in action and
frequency. The number of interventions should be appropriate
for helping to meet individual goals. Finally, the evaluation (E)

5. section of the plan of care should
include proposed measures for determining success of the plan
and an evaluation of the potential success of the plan, based on
those measures. You may write
the plan of care in either narrative format or as a table with
appropriate in-text citation used to support the plan of care.
Guidelines for Submission: Your paper must be submitted as at
least a 6 to 10 page Microsoft Word document with double
spacing, 12-point Times New Roman
font, one-inch margins, and at least two peer-reviewed sources
cited in APA format.
Critical Elements Proficient (100%) Needs Improvement (75%)
Not Evident (0%) Value
Introduction Thoroughly introduces the
individual and the associated
pathophysiology by defining
and describing how the
pathophysiology changes
normal state, and defining and
assessing the clinical
manifestations
Briefly identifies and introduces
the chosen individual, defines
and describes how the
pathophysiology changes
normal state, and defines and
assesses the clinical
manifestations, or one of these
elements is missing

6. Does not introduce the
individual, define or describe
the pathophysiology, or assess
the clinical manifestations, or
more than one of these
elements is missing
15
History Comprehensively describes
historical explanations for
variations in pathophysiology,
identifies physiological stressors
and mechanisms that affect the
course of the disease, and
assesses historical impact of
patient care technology
Briefly describes historical
explanation for variation,
identifies physiological stressors
and mechanisms that affect the
course of the disease, and
assesses historical impact of
patient care technology, or one
of these elements is missing
Does not describe historical
explanation, identify
physiological stressors or
mechanisms, or assess the
historical impact of patient care
technology, or more than one
of these elements is missing
15

7. Planning Concisely articulates two short-
term and two-long term goal
statements, comprehensively
analyzes nursing concerns, and
identifies appropriate patient
care technologies
Articulates fewer than two
short-term and two long-term
goal statements, briefly
analyzes nursing concerns, and
identifies patient care
technologies
Does not articulate goal
statements, analyze nursing
concerns, or identify
appropriate patient care
technologies
15
Intervention Clearly identifies and justifies
appropriate nursing
interventions and class of
medication and assesses
patient care technologies for
health promotion and patient
safety
Identifies but does not justify
nursing interventions and class

8. of medication and assesses
patient care technologies but
does not explain reasoning
Does not identify (or identifies
inappropriate) nursing
interventions or class of
medication and does not assess
patient care technologies
15
Evaluation Clearly articulates an evaluation
for plan of care, including
identification of necessary data,
and performs said evaluation
Evaluates plan of care, but does
not explain why method of
evaluation and data were
chosen
Does not evaluate plan of care
or uses inappropriate methods
15
Research Adequately supports claims and
explanations with use of
appropriate evidence-based,
peer-reviewed research
Supports most claims and
explanations with use of
evidence-based, peer-reviewed
research

9. Does not support claims and
explanations with use of
evidence-based, peer-reviewed
research, or literature
referenced is inappropriate
15
Articulation of
Response
(APA/Mechanics)
Submission has no major errors
related to citations, grammar,
spelling, syntax, or organization
Submission has major errors
related to citations, grammar,
spelling, syntax, or organization
that negatively impact
readability and articulation of
main ideas
Submission has critical errors
related to citations, grammar,
spelling, syntax, or organization
that obstruct understanding
10
Earned Total 100%