NURS-6501N-21-Advanced PathophysiologyQuestion 1 Scenario 1 A.docx

NURS-6501N-21-Advanced Pathophysiology
Question 1
Scenario 1: Acute Lymphoblastic Leukemia (ALL)
An 11-year-old boy is brought to the clinic by his parents who
states that the boy has not been eating and listless. The mother
also notes that he has been easily bruising without trauma as he
says he is too tired to go out and play. He says his bones hurt
sometimes. Mother states the child has had intermittent fevers
that respond to acetaminophen.
Maternal history negative for pre, intra, or post-partum
problems.
PMH: Negative. Easily reached developmental milestones.
PE: reveals a thin, very pale child who has bruises on his arms
and legs in no particular pattern.
LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%,
and platelet count of 80,000/mm3. The CMP demonstrated a
blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9
mg/dl.
DIAGNOSIS: acute leukemia and renal failure and immediately
refers the patient to the Emergency Room where a pediatric
hematologist has been consulted and is waiting for the boy and
his parents.
CONFIRMED DX: acute lymphoblastic leukemia (ALL) was
made after extensive testing.
Question:
Explain what ALL is?
ANSWER
Question 2
Scenario 1: Acute Lymphoblastic Leukemia (ALL)
An 11-year-old boy is brought to the clinic by his parents who
states that the boy has not been eating and listless. The mother
also notes that he has been easily bruising without trauma as he
says he is too tired to go out and play. He says his bones hurt

sometimes. Mother states the child has had intermittent fevers
that respond to acetaminophen.
Maternal history negative for pre, intra, or post-partum
problems.
PMH: Negative. Easily reached developmental milestones.
PE: reveals a thin, very pale child who has bruises on his arms
and legs in no particular pattern.
LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%,
and platelet count of 80,000/mm3. The CMP demonstrated a
blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9
mg/dl.
DIAGNOSIS: acute leukemia and renal failure and immediately
refers the patient to the Emergency Room where a pediatric
hematologist has been consulted and is waiting for the boy and
his parents.
CONFIRMED DX: acute lymphoblastic leukemia (ALL) was
made after extensive testing.
Question:
Why does ARF occur in some patients with ALL?
ANSWER
Question 3
Scenario 2: Sickle Cell Disease (SCD)
A 15-year-old male with known sickle cell disease
(SCD) present to the ER in sickle cell crisis. The patient is
crying with pain and states this is the third acute episode he has
had in the last 10-months. Both parents are present and appear
very anxious and teary eyed. A diagnosis of acute sickle cell
crisis was made.
Question:
Explain the pathophysiology of acute SCD crisis.
Why is pain the predominate feature of acute crises??
ANSWER
Question 4

Scenario 2: Sickle Cell Disease (SCD)
A 15-year-old male with known sickle cell disease
(SCD) present to the ER in sickle cell crisis. The patient is
crying with pain and states this is the third acute episode he has
had in the last 10-months. Both parents are present and appear
very anxious and teary eyed. A diagnosis of acute sickle cell
crisis was made.
Question: Discuss the genetic basis for SCD.
ANSWER
Question 5
Scenario 3: Hemophilia
8-month infant is brought into the office due to a swollen right
knee and excessive bruising. The parents have noticed bruising
about a month ago but thought the bruising was due to the
attempts to crawl. They became concerned when the baby woke
up with a swollen knee. Infant up to date on all immunizations,
has not had any medical problems since birth and has met all
developmental milestones.
FH: negative for any history of bleeding disorders or
other major genetic diseases.
PE: within normal limits except for obvious bruising on the
extremities and right knee. Knee is swollen but no warmth
appreciated. Range of motion of knee limited due to the
swelling.
DIAGNOSIS: hemophilia A.
Question:
What is the pathophysiology of Hemophilia?
ANSWER
CHAPTER 26
Strategic Issues in Missions — An Asian

Perspective
Hwa Yung
Some time ago, while spending a few months in
Britain, I met a dignified Chinese lady in
the
kitchen of our hostel. A full professor from a
Chinese university in a highly specialized
field
of information technology, she was doing some
advanced research at the local university, one
of the most prestigious in the country. Here was a
person who epitomizes the future of China.
On finding out that I teach theology, she said:
“You people must come to China and
preach
the gospel.” Startled by her statement, I asked
her whether she was a Christian. I was even
more amazed when she said, “No.” I then asked
her why she said what she did. Her answer
stunned me. She replied: “China needs God. If
China does not know God, thereis no hope
for her future.”
I must confess that I have still not quite
gotten over the conversation. It was a
Macedonian call to the church worldwide. But
before we rush to China with all the
missionaries and resources at our disposal, we need to
ponder for a moment the words of
John Sung, the greatest evangelist and revivalist of
twentieth-century China. Sung was not
unappreciative of the sacrificial labor of many
Western missionaries who gave their lives to
bring the gospel to China. Nevertheless, by

the 1920s and 1930s, he noted that often it
was
missionary control and dependency on Western
funds that prevented the Chinese church
from growing. Repeatedly he urged the budding
Chinese church to cut its apron strings
and
move on toward independence and maturity. Asked
shortly before his death in 1944 about
the future of the Chinese church, Sungrevealed
that God had showed him that a greatrevival
was coming. But the missionaries would all have
to leave first. The history of the last
fifty
years shows that this was the most profound
prophecy concerning the Chinese church in
the
twentieth century.1
Asia, with some3.7 billion people and less than 9
percent of whom are Christians, clearly
needs the gospel. But Sung’s prophetic statement
reminds us that we cannot go on doing
things in the same old manner. What then is
the way forward? For what it is worth, here
are
somethoughts on the matter.
Three Trends and Three Issues Affecting Asian
Missions
To begin with, those wanting to think
strategically about Asian missions should
note three
important global trends. First, sometime in the
1980s, the number of Christians in the non-

Western world exceeded that in the West for the
first time in modern history. Figures given
Chilcote, P. W., & Warner, L. C. (Eds.). (2008). The study of
evangelism : Exploring a missional practice of the church. Wm.
B. Eerdmans Publishing Co..
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by David Barrett show that in A.D. 2000,
the number of Christians in Europe and
North
America was about 750 million (39 percent),
compared to almost 1.2 billion (61 percent)
for
the whole non-Western world. This shift of
the center of gravity of the church from
the
Western into the non-Western world is not merely
demographic. It is also reflected in the

vitality and growing influence of non-Western
Christianity. One can see these in the joy of
African Christian worship, the fervency of Korean
church prayer life, and the dynamism of
evangelism in Latin American Pentecostalism,
Indian rural house churches, etc. Parallel to
this is the perceived decline of Western Christianity,
in the face of powerful secularist and
liberal pressures within an increasingly post-
Christian milieu.
Perhaps the clearest illustration of this two-sided
trendis Lambeth 1998, when Anglican
bishops from all over the world met together.
The burning issue then was whether
homosexuality is an acceptable Christian moral
alternative. In the end, this was
overwhelmingly rejected because almost all the
African and Asian bishops opposed it. The
Times of London (August 6, 1998) commented:
Yesterday’s resolution, adopted by an
overwhelming majority, was a surprising and
uncharacteristically trenchant
dismissal of the liberal position … But the
outcome also reflects the growing weight at
Lambeth of doctrinally
conservative Third World bishops.
Lambeth 1998 may well mark a watershed in global
Christianity. It was probably the first
time in modern history, at a Christian gathering of
international significance, that an agenda
strongly driven by Western churches was decisively
rejected by the whole body under the
influence of non-Western leadership.

A second observable trend is the changing
shape of the international cross-cultural
missions force. The following summarizations are
based on the total number of missionaries
from Protestant, Anglican, and independent
churches given in the last two editions of
Operation World.2
By A.D. 2000, the numbers from the non-
Western world had overtaken those from
the
Western world. Other evidences further support
this pattern. For example, North American
missions appear to be facing a serious
problem today of not having enough recruits
to replace
those who are retiring. At the same time,Urbana
2000, a traditionally predominantly white
American conference in the past, saw the
presence of at least 26 percent of the twenty
thousand or so students made up of Asian
Americans or Asian nationals studying in
North
America.
Much of the energy for Christian missions in
the twenty-first century will probably come
from the non-Western world. In the West, the
liberal churches will become increasingly
irrelevant. Evangelical and Pentecostal-charismatic
churches will continue to contribute, but
even so it will not be like what it was before.
Living in an increasingly post-Christian
environment, much of their spiritual energy will be
sapped by having to face an increasingly

hostile spiritual and social environment outside
the church, and the growing problem of
moral compromise within.
The third trend concerns how the wold is
being reshaped today. Harvard professor
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Samuel Huntington, in The Clash of
Civilizations, argues that fundamental realignments
are
taking place in the post–Cold War era.3 In
the past, the battles were fought first
between
kings, then later between nation states, and

finally between ideologies in the Cold War
period. Now in the post–Cold War period, the clashes
will be largely between civilizations, of
which he identifies eightmajor ones: Western,
Orthodox or Slavic, Latin American,Sinicor
Confucian, Islam, Hindu, Japanese, and African.
Huntington’s thesis has been seriously
discussed and critiqued by many. But after the
terror attacks of September 11, 2001, even
skeptics have to admit its validity to somedegree.
In otherwords, civilizational patterns of thinking
and action will drivemuch of the world
in the next few decades. This has tremendous
ramifications for missions. For example, the
last couple of decades have witnessed the increasing
resurgence of all the traditional religious-
cultural groupings, including radical Islam with
groups like al-Qaeda, and fundamentalist
Hinduism with India’s BJP, among others. Invariably,
this means that pressures on Christians
in places where they are minorities will increase
rather than decrease. Thus the empowerment
and sustenance of persecuted churches will
become an increasingly important missions
agenda.
Apart from thesethreetrends, the Asian church
also facesthreeserious issues. To begin
with, the rapid growth of non-Western Christianity
in the last half-century does not mean
that everything is well. In many places in
Asia, serious problems exist. For example, in
spite of
the wildfire church growth, especially in 1960s
and 1970s, Protestant churches in South Korea

are facing a crisis today. Church growth
began slowing in the 1980s, and plateaued or
began
declining in the early1990s. Contributory factors
suggested include divisions, lack of social
involvement, overemphasis on megachurches, inadequate
pastoral oversight, distrust of
leadership, and nominalism.4 In the last few years,
charges of autocratic leadership, nepotism,
and misuse and embezzlement of church funds
have not helped to arrest the declining
pastoral image. Clearly, in many parts of the
non-Western church, Christian fundamentals
are not in place, especially in relation to
commitment, holiness, and character formation.
Secondly, the gospel for too long has been proclaimed
in a truncated form. This problem
did not begin with the fundamentalist-modernist
debates of the early twentieth century,
which led to the sharp dichotomy between
evangelism and sociopolitical concerns. The roots
go back to the domestication of Christian theology by
Greek philosophy, which underlies the
dualistic distinctions between soul and body, spirit
and matter, and evangelism versus
sociopolitical action.
Consequently, the gospel is oftenpresented in a
distorted manner, with half of it being
proclaimed at best. For example, in the 1920s,
precisely at a time when China was opened
to
foreign influence for the first time in hundreds of
years, many intellectuals rejected
Christianity. China was looking for national

salvation. But the conservatives preached a
gospel that promised only spiritual salvation, never
mind the plunder and destruction of
China through Western and Japanese imperialism in
the nineteenth and twentieth centuries.
On one hand, Chinese leaders saw the gospel as
yet another superstition, totally irrelevant to
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the future of China. On the other, the
modernists’ social gospel offered much in
terms of
education, science, medicine, and the modernization of
China. But it had no real answer for
China’s spiritual need, and therefore lacked the

power to effect moral transformation and
cultural rejuvenation. Hence that too was rejected. So
long as we fail to showthat the gospel
speaks holistically to all of life, many in
Asia will simply deem it irrelevant.
China’s rejection of the gospel in the 1920s
also illustrates a third missiological problem,
that of an alien Jesus. Whenever the gospel is
presented in a manner that the hearer cannot
understand, because of the foreignness of the
language and thought forms, and in ways that
fail to address the felt needs of the hearer or
a culture, then an alien Jesus is being
proclaimed.
Apart from a truncated gospel, other
illustrations can easily be found. For example,
many
missionaries working in Asia today still have
real problems with the supernatural and
miraculous realm. They find it difficult to
comprehend that almost everywhere in the
non-
Western world where the church is growing
rapidly, the form of Christianity found in
those
places tends to take signsand wonders and
deliverance ministries seriously. In their negative
response to such manifestations of spiritual power,
thesemissionaries oftenforget that their
own versions of the gospel are products of
Enlightenment Christianity, which Charles Kraft
has described as “powerless.”5 If Asia is to hear
and understand the gospel, then we need to
ask how we can avoid presenting a Jesus
who is alien.

Five Proposals for the Way Forward
How are we to respond to the above trends
and issues? I suggest that we need to
consider
seriously five things in our missions agenda.
1. Empowering the indigenous churches. We must
use all means possible to empower
indigenous churches. The goal is to enable them to
move on toward genuine independence so
that they can take their place as equal
partners in the global Christian community. The
reasons are obvious. For a start, given the
growing importance of non-Western churches,
helping them to move toward increasing
effectiveness would be one sure way to advance
world missions. Further, it is also the best
method to tackle the continuing problem of
paternalism in missions. The latter unfortunately is
still verymuch alive in various places,
with complaints directed not just against some
Western missionaries, but also against many
from the newer sending churches in Asia. So
long as this persists, the Holy Spirit will not be
free to do his work and indigenous churches
cannot mature. The prophecy of John Sung
about widespread revival coming to the
Chinese church only after all missionaries have
left
should serve as a sharp reminder to all.
Missionaries — whether Western or Asian —
must
stop overestimating their own sense of self-importance
so that the Spirit can have his way.

2. Challenging indigenous leaders on the issues
of discipleship and character. Crucial to the
growth and maturity of the indigenous churches is
the need for leaders with genuine
Christian commitment and character. In many parts of
Asia, the churches are not short of
leaders, but rather the right kind.The Korean church
was probably the most vibrant in Asia
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in the last few decades. Yet we saw that even there
the gospel fundamentals are oftennot in
place. The failure usually begins at the
leadership level. Thus, perhaps more than anything

else, the greatneed in the Asian church today is
for able leaders who also embody Christian
character and exemplify servanthood. Here Asian
Christians can learnmuch from the best of
the West.
Certainly, scandals among church leaders and
shallowness of Christian discipleship and
holiness are also found in the Western church.
Nevertheless, it needs to be said that
Christian
character takestime to grow. Thus in the best of
the Western tradition, where holiness of life
and Christian commitment have been nurtured
over generations, we often find wonderful
examples of Christian character. For example, we know
of many Western families who have
modeled missionary commitment and sacrificial service
over several generations. Such things
are far less common in the non-Western world,
simply because therehas not been the same
long years of Christian traditioning and nurture.
The implication here for our Western
friends is clear. Guard against paternalism at
every point. But do not be afraid to
exemplify
for us discipleship, commitment, holiness and
character, if thesehave been granted to you.
3. Recovery of a holistic gospel. Earlier we
noted that the underlying dualism of
Western
theology produced a truncated gospel. Indeed, David
Bosch notes that since the time of
Augustine, the individualization and spiritualization
of salvation have become endemic in

Western theology. This, he says, “could not
but spawn a dualistic view of reality, which
became second nature in Western Christianity
— the tendency to regard salvation as a
private matter and to ignore the world.”6 This
was the particular weakness of evangelical
Christianity which Lausanne II in Manila (1989)
sought to address, when it took the phrase,
“the whole gospel for the whole world,” as
part of its theme.
The recovery of a holistic gospel will require us
first to exorcise Greek dualism from our
thinking. As Francis Schaeffer noted,
True Christianity is not Platonic. Much, however, of
what passes for Christianity does have the ring of
Platonic thinking
in it … the body is bad and is to be
despised. The only thingthat matters is the soul.
But the Bible says God made the
whole man, the whole man is to know
salvation, and the whole man is to know
the Lordship of Christ.7
The gospel is holistic because biblical Christianity
speaks to every human need.
Secondly, in our theological formulations, we need to
reclaim “kingdom” categories. The
central theme of Jesus’ preaching in the
Gospels is the “kingdom of God,” and
the central
theme of the rest of the New Testamentis that
“Jesus is Lord/King.” We need, therefore, to
reconceptualize or, at least, reemphasize mission

as the proclamation of Jesus’ lordship over
all of life — individuals, as well as whole
communities; in every sphere of human
life, be it
spiritual, psychological, socioeconomic, or ecological;
and both now and in the world to
come! It is interesting that one mission leader,
who has been visiting churches all over Asia,
told me recently that the one word that increasingly
sums up the mission task for many Asian
church leaders is “transformation.” And
transformation it seems, is exactly what the
Chinese
professor mentioned earlier is also seeking.
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4. Contextualizing the gospel. Unless genuine
efforts are made at contextualizing the
proclamation of the gospel and the practice of
the faith, Christianity will continue to be
widely perceived as a Western religion. This matter
has been discussed repeatedly, yet much
of Asian Christianity remains in Western
captivity. This can be seen in the Gothic
cathedrals
in downtown Seoul, in tribal Christians in
rural Malaysia worshiping God dressed up like
American “angels” dancing with tambourines, in
seminary training based almost entirely on
Western textbooks and methodologies rooted in
Enlightenment rationalism, and so forth.
We seem to misunderstand the protest of the
anti-Christian intellectuals of China in the
1920s when they screamed, “Onemore Christian, one
less Chinese!” We have not heeded the
plea of Sadhu Sundar Singh, possibly the most
influential Indian Christian who ever lived,
when he said that his people needed the “water
of life” but “they do not want it in
European
vessels.”8
However, if Huntington’s thesis on the
intensification of civilizational clashes in the
coming years is correct, then the issue of
contextualization must indeed be addressed with
greater urgency and at greater depth. Because, to
think in civilizational terms invariably
means to think contextually. We cannot go
into the details of contextualization here, but
someexamples will help.

First, we must begin with the everyday concerns of
the church, such as its hymns and
worship, evangelistic and pastoral methods, architecture,
etc. Second, it would require us to
be sensitive to cultural and civilizational tensions in
our missionary approaches. A good
example of such sensitivity is found in the
approach being taken by one established
Western
mission agency. One of their leaders mentioned in
conversation that they are building a third
missionary training college in Hong Kong.
But why Hong Kong? His reply is instructive.
Their deep concern for Muslims has led them to
conclude reluctantly that the thousand-plus
years of conflict between the Western and Muslim
civilizations means that any breakthrough
among Muslims is unlikely to come from the
West.
Thirdly, Asia includes four of the largest mission
fields today — the Buddhist, Confucian,
Hindu, and Islamic worlds. Yet, to this day, there
are relatively little serious apologetics,
theologies, and ethical discussions formulated in
response to the challenges of thesecultures
and worldviews. Unless we do our homework
here, it is difficult to see how major
evangelistic
breakthroughs can occur. Tom Houston, the former
international director for Lausanne,
appears to be making a similar pointin an
unpublished paper entitled “Mobilizing a
Church
on the Move — Global Clashes: Global

Gospel.” Houston was making a missiological
response to Huntington. He notes that the church
became universal in Europe and North
America because whole civilizations became
Christian, not just individuals and small pockets
of believers here and there. If Huntington is
correct that civilizational consciousness will
predominate, then similarly we need to thinkin terms
of evangelizing whole civilizations to
bring them under the Lordship of Christ.
This means that we cannot continue preaching a
merely Western gospel. Rather we must empower
Christians from every civilization to go
back to their own peoples in culturally appropriate
ways. “They are the only ones who will be
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able to take the imperialist face awayfrom
evangelization.”9
5. Developing genuine partnership between
Western and non-Western churches. The
centers of Christian growth are now largely found
in the non-Western world. Yet despite this
fundamental shift, for the moment the centers of
power remain largely in the West:
denominationaland organizational structures, institutions
and established mission agencies,
publishing houses, academically trained personnel,
and, above all, money. This imbalance can
grossly distort our perceptions of the global
church realities, and consequently the way we
work.
For example, in almost every global
ecclesiastical and missiological gathering, Western
participants are in the majority. This gives the
impression that Westerners are the key players,
when in reality the recent growth of non-
Western churches has come largely through
national initiative and leadership. Thus the old
paternalism is perpetuated in another guise.
Sometimes, this is clumsily insensitive. One major
international organization, in planning a
major missiological conference, states that it
wants a majority of participants to come
from
the non-Western world. Yet, the same pamphlet
shows that almost all the organizing
committee members are Western. And when the
fees of such gatherings are set at levels

which only the rich can afford, it ensures that
the participants, agendas, perspectives, and
ultimately the conclusions will be largely Western.
Consequently, we remain blinded to
changing global realities and locked into outmoded
courses of action.
To address adequately the issueof partnership
would require us to seriously deal with a
whole range of questions. For example, in terms
of finance and trained personnel, how and
what can the West contribute to augment the
meager resources of many non-Western
churches? At the same time, how can this be
done without giving rise to a dependency
mentality on the one hand, and the perpetuation of
missionary control on the other. With
respect to developing leadershipfor non-Western
churches up to the highest levels, what can
we learn form John Stott’s work through
the Langham Trust of training national scholars
with Ph.D.s? And would international agencies,
traditionally under Western control, dare to
incorporate non-Westerners fully into their leadershipon
the basisof genuine mutuality?
Moreover,we must resist the temptation to think
that benefits flow only one way. Thus,
we must also pursue questions like how can missionaries
(not merely immigrants) from the
non-Western world help revitalize moribund Western
churches? How can the example of
Lambeth 1998 be a model of action for non-
Western churches to help Western churches fight
the increasingly tough doctrinal and moral battles
in a post-Christian environment? How can

insights from non-Western Christianity help to reshape
Western Christian thinking, at times
distorted by Greek dualism, Enlightenment rationalism,
and cultural biases, in a more biblical
direction?
In a globalized world, the days of
parochial thinking and action in world missions
are
clearly over.Moreover,the task is far too big for
any one group to dare thinkthat they can
manage it all on their own. The way forward has to
be one of genuine Christian partnership
between Western and non-Western churches, and
between the rich and the poor, whether
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materially or spiritually. The key question is how
can the vast resources of the Western
church on the one hand, and the vitality and
dynamism of non-Western Christianity on the
other, be fused together into a powerful
synergistic whole for world evangelization? As
we
ponder the possibility that the twenty-first century
may indeed be the “great century” for the
advance of the gospel of Christ in the world,
it is surprising that this question has occupied so
little space in our deliberations. But this may well be
the most important and urgent issueon
the global missions agenda today.
1. William E. Schubert, I Remember John
Sung (Singapore: Far Eastern Bible College
Press, 1976), pp. 65-66. See also
John Sung, The Diaries of John Sung —
An Autobiography, trans. Stephen L. Sheng
(Brighton, Mich.: Luke H. Sheng &
Stephen L. Sheng, 1995), pp. 34, 183, and 198-99.
2. Patrick Johnstone, Operation World (Carlisle:
OM Publishing, 1993), pp. 643ff.; and Patrick
Johnstone and Jason
Mandryk, Operation World (Carlisle: OM Publishing,
2001), pp. 747ff.
3. Samuel Huntington, The Clash of Civilizations
and the Remaking of World Order (London:
Simon & Schuster, 1997).
4. See, e.g., Bong Rin Ro, “The Korean
Church: Growing or Declining?” Evangelical

Review of Theology 19, no. 4
(October 1995): 336-53; and Yonggi Hong,
“Nominalism in Korean Protestantism,”
Transformation16, no. 4 (1999): 135-41.
5. Charles Kraft, Christianity with Power (Ann
Arbor, Mich.: Servant Books, 1989).
6. David Bosch, Transforming Mission (Maryknoll,
N.Y.: Orbis, 1991), p. 216.
7. Francis Schaeffer,Death in the City (London:
InterVarsity, 1969), p. 74.
8. R. H. S. Boyd, An Introduction to Indian
Christian Theology (Madras: CLS,1975), p. 109.
9. Tom Houston, “Mobilizing a Church on the
Move — Global Clashes: Global Gospel,”
unpublished manuscript, n.d., p.
19.
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