“Introduction to Advanced Pathophysiology” Program Transcript NARRATOR: In this program, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pathophysiology for the advanced practice nurse. Let's listen as she provides her insights to this course. DR. TERRY BUTTARO: So advanced pathophysiology is definitely a difficult course. There's a lot of memorization as you go through this course, really trying to understand things at the cellular level-- how do organs function? What happens, for example, when that organ stops functioning, whether it's because of an infection or a malignancy? But if you don't understand this, if you don't kind of learn, not only the normal, but definitely that pathophysiology part, as an advanced practice nurse, then you're not going to be able to really put the picture together when someone comes in. So for example, understanding what the liver does is really important when somebody comes in with abdominal pain or anorexia, because you have to figure out, well, what could this be? So you have to get that history about, well, when did this start? Does it happen all the time? Are there other things going along with this? And then, when you do your physical exam, you have to understand, well, not only where the liver is and what it does, but what else do you have to look for in the physical exam to determine if there is a problem with the liver. And that's not only the liver, because the knee bone is connected to the thigh bone. So every organ affects another organ. So it's essential that we understand that. And it does require a lot of work. It does require a lot of work. But what you want to do is have this really good understanding about each system so that when somebody comes in, you might not remember exactly, but something clicks. And you say, maybe it's this. And then you can go look it up to see, well, what diagnostics do I have to do? And truthfully, advanced pathophysiology takes from health assessment so that when you learn how to do a really good health assessment and good history, and then a good physical exam, you take the important data from the history and from the physical exam, and you put that together. And you say, you know, this doesn't look so much like the liver. This acts more like the stomach. And that's how you work out your differential. And it's not that there's every one thing. We all want to keep our minds open to the different pathophysiologic processes in the body to be sure that we're not attributing one disease to a patient when it could be something else. So we have © 2012 Laureate Education, Inc. 1 to keep our minds open. So that's why it's important. You can't only learn one system. You have to learn all the systems. Online learning's a little bit different than when you actually go to school. It really requires that a student is able to ...

1. “Introduction to Advanced Pathophysiology”
Program Transcript
NARRATOR: In this program, Dr. Terry Buttaro, associate
professor of practice
at Simmons School of Nursing and Health Sciences, discusses
the importance of
pathophysiology for the advanced practice nurse. Let's listen as
she provides her
insights to this course.

2. DR. TERRY BUTTARO: So advanced pathophysiology is
definitely a difficult
course. There's a lot of memorization as you go through this
course, really trying
to understand things at the cellular level-- how do organs
function? What
happens, for example, when that organ stops functioning,
whether it's because of
an infection or a malignancy? But if you don't understand this,
if you don't kind of
learn, not only the normal, but definitely that pathophysiology
part, as an
advanced practice nurse, then you're not going to be able to
really put the picture
together when someone comes in.
So for example, understanding what the liver does is really
important when
somebody comes in with abdominal pain or anorexia, because
you have to figure
out, well, what could this be? So you have to get that history
about, well, when
did this start? Does it happen all the time? Are there other
things going along
with this?
And then, when you do your physical exam, you have to
understand, well, not
only where the liver is and what it does, but what else do you
have to look for in
the physical exam to determine if there is a problem with the
liver. And that's not
only the liver, because the knee bone is connected to the thigh
bone. So every
organ affects another organ. So it's essential that we understand
that.

3. And it does require a lot of work. It does require a lot of work.
But what you want
to do is have this really good understanding about each system
so that when
somebody comes in, you might not remember exactly, but
something clicks. And
you say, maybe it's this. And then you can go look it up to see,
well, what
diagnostics do I have to do?
And truthfully, advanced pathophysiology takes from health
assessment so that
when you learn how to do a really good health assessment and
good history, and
then a good physical exam, you take the important data from the
history and from
the physical exam, and you put that together. And you say, you
know, this
doesn't look so much like the liver. This acts more like the
stomach. And that's
how you work out your differential.
And it's not that there's every one thing. We all want to keep
our minds open to
the different pathophysiologic processes in the body to be sure
that we're not
attributing one disease to a patient when it could be something
else. So we have
© 2012 Laureate Education, Inc. 1

4. to keep our minds open. So that's why it's important. You can't
only learn one
system. You have to learn all the systems.
Online learning's a little bit different than when you actually go
to school. It really
requires that a student is able to pace themselves and study
frequently, because
it's on their own time. And so in some respects, online is really
great, because
you can do in your own time. You don't have to travel. You can
do it at midnight if
you want. I've had students before who do some aspects of
online when they're
at lunch at work, because they have a little bit of quiet time.
And that works out
well.

5. But you also get distracted easily, because you can be home.
And there's tons of
distractions at home. So you have to really focus. And you have
to study every
week. And this is true for all education.
Learning this information is complex. So people certainly have
to read, but
reading isn't enough. You have to figure out how you learn best.
Are you a visual
learner? Are you an auditory learner? Hopefully, you get a little
bit of both. And
that will help you.
I think using the online system and discussing questions with
your fellow
students is really helpful. You can say, you know, I read this,
but this doesn't
really make sense to me. Why does somebody have heart
failure? What's the
difference between systolic and diastolic? I don't get that. And
so another student
who might actually be working in a cardiac unit might be able
to explain it better
in clearer terms to you than the book does.
The other thing is probably making note cards is really
important so that you can
study in free moments. That can be helpful. Sometimes,
podcasts or just actually
recording what the highlights are so that you could listen in the
car, that can be
helpful, too. But it's really understanding that you cannot let it
go to the exam,
that learning has to occur every single day.

6. And for the most part, I would say to students, when the week
starts on a
Monday, first, look over the outline or the PowerPoint that is
available to you
online. Then go back and do the readings. And if there's any
kind of exercise, do
those exercises, because those exercises are going to help you
figure out, well,
did I really learn that, or do I have to go back?
And then have a few notes. You don't have to take copious
notes. You don't want
to do that. You only want to take notes on what you don't
understand. But what
you don't understand in either advanced pathophysiology or
pharmacology, you
want to write something a little quickly.
© 2012 Laureate Education, Inc. 2

7. So what I usually tell students they absolutely have to know is,
so what would the
patient complain about with this? What do you have to look for
in the physical
exam? What are the diagnostics that might be done for this
disorder?
And then, what are the medications? What's the
pharmacological treatment that
a patient's going to need for this disorder? And what are you
going to have to
teach the patients?
So if you can kind of figure out a kind of a formula for
[INAUDIBLE] learning
about what's the clinical presentation, what's the physical exam,
what diagnostics
go along with the heart failure, for example, what are the
medications treated,
that will help you. But you also have to know what's the basic
pathophysiologic
process for that disorder, because if you don't understand that
pathophysiologic
process, you're not going to understand how the drugs we're
going to give fix it.
So if somebody comes in with heart failure, you know that their
heart has failed in
some way. That's all it is. The pump is not working the way it
should be. But

8. when the pump doesn't work well enough, the lungs fill up with
fluid, and the
patient's short of breath, and their oxygen level goes down. So
how do you get
rid of that fluid?
Well, the first medicine, or one of the first, is usually a diuretic.
So what are you,
as a nurse, going to look for first? You're going to give that
diuretic, that
furosemide.
Then you're going to be listening to the lungs to see, is it
getting better? Is their
breathing getting better, is their oxygen level getting higher, is
their respiratory
rate going down? It's because you're going to be watching them.
And then there's many other things. It's not only one simple
thing we do. But it's
putting that whole picture together.
And when you're studying, whether it's pathophysiology or it's
advanced
pharmacology, you should be trying to have this picture of your
patient in your
mind. What does this patient look like? What's going on? How
am I going to treat
them? And then, how am I going to evaluate the treatment?
So it's really picking out the clinical presentation for that
patient-- what do they
complain of-- and then thinking about what the
pathophysiologic process is. And
it really is trying to figure that out at the cellular level.

9. What happens when a patient has cancer? What happens? So
lung cancers, for
example, they start 30 years often before a patient comes in
with symptoms.
So I had a patient come in a couple weeks ago who complained
about back pain.
And when I asked her about the back pain, she said, well, you
know, I've had this
© 2012 Laureate Education, Inc. 3
for about six months. It wasn't too bad in the beginning. But it's
really right across
my back here. And I said, well, did you ever smoke? And she
said, yeah, I
smoked for about 30 years.
So I'm thinking to myself, what could cause this? What causes
that kind of pain?
It wasn't pain when she moved. So then thinking about, well,
what could happen

10. in that area?
Is it the spinal column that's causing this? But she didn't have
any numbness and
tingling in her arms. She didn't have a problem with moving her
arms. She didn't
have muscle pain.
So then you have to go really way back more to the cellular
level, what organs
are there. So really, it's kind of the lungs and the muscle and the
spinal column in
the back. There's not a ton of other things.
So you need to figure out, well, how am I going to figure out
what this is? And I
couldn't think of a lab test. But an X-ray would at least tell me,
well, are her lungs
OK? And the X-ray would also at least show what her spine
looked like. So that's
why it's so important to kind of think about pathophysiology
and understand
what's happening.
© 2012 Laureate Education, Inc. 4
Learning Resources
Required Readings
Huether, S. E., & McCance, K. L. (2017). Understanding
pathophysiology (6th ed.). St. Louis, MO: Mosby.
· Chapter 1, “Cellular Biology”
This chapter reviews cellular biology to establish a foundation
for exploring the pathophysiology of disease. It also covers the

11. structure and function of cellular components, cell-to-cell
adhesions, cellular communication, cellular metabolism,
membrane transport, the cell cycle, and tissues.
· Chapter 2, “Genes and Genetic Diseases”
This chapter explores genetic disorders and factors that impact
genetic disorders. It also examines how mutations and
chromosomal abnormalities lead to transmission of genetic
disorders.
· Chapter 4, “Altered Cellular and Tissue Biology”
This chapter examines disorders related to cell adaptation,
injury, and death. It also explores disorders associated with
altered cellular and tissue function as a result of aging.
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of
disease: An introduction to clinical medicine (8th ed.). New
York, NY: McGraw-Hill Education.
· Chapter 2, “Genetic Disease”
This chapter reviews the clinical manifestations,
pathophysiology, and genetic principles of genetic diseases. It
also explores different types of genetic diseases and the
mechanisms involved.
· Chapter 5, “Neoplasia”
This chapter explores various disorders associated with
neoplasia. It also covers causes and effects of common cancers
and tumors resulting from neoplasia.
RUBRIC TO FOLLOW

12. Outstanding Performance
Excellent Performance
Proficient Performance
Room for Improvement
Main Posting:
Response to the discussion question is reflective with critical
analysis and synthesis representative of knowledge gained from
the course readings for the module and current credible sources.
44 (44%) - 44 (44%)
Thoroughly responds to the discussion question(s)
is reflective with critical analysis and synthesis representative
of knowledge gained from the course readings for the module
and current credible sources.
supported by at least 3 current, credible sources
40 (40%) - 43 (43%)
Responds to the discussion question(s)
is reflective with critical analysis and synthesis representative
of knowledge gained from the course readings for the module.
75% of post has exceptional depth and breadth
supported by at least 3 credible references
35 (35%) - 39 (39%)
Responds to most of the discussion question(s)
is somewhat reflective with critical analysis and synthesis
representative of knowledge gained from the course readings for
the module.
50% of post has exceptional depth and breadth
supported by at least 3 credible references

13. 31 (31%) - 34 (34%)
Responds to some of the discussion question(s)
one to two criteria are not addressed or are superficially
addressed
is somewhat lacking reflection and critical analysis and
synthesis
somewhat represents knowledge gained from the course
readings for the module.
post is cited with fewer than 2 credible references
0 (0%) - 30 (30%)
Does not respond to the discussion question(s)
lacks depth or superficially addresses criteria
lacks reflection and critical analysis and synthesis
does not represent knowledge gained from the course readings
for the module.
contains only 1 or no credible references
Main Posting:
Writing
6 (6%) - 6 (6%)
Written clearly and concisely
Contains no grammatical or spelling errors
Fully adheres to current APA manual writing rules and style
5.5 (5.5%) - 5.5 (5.5%)
Written clearly and concisely
May contain one or no grammatical or spelling error

14. Adheres to current APA manual writing rules and style
5 (5%) - 5 (5%)
Written concisely
May contain one to two grammatical or spelling error
Adheres to current APA manual writing rules and style
4.5 (4.5%) - 4.5 (4.5%)
Written somewhat concisely
May contain more than two spelling or grammatical errors
Contains some APA formatting errors
0 (0%) - 4 (4%)
Not written clearly or concisely
Contains more than two spelling or grammatical errors
Does not adhere to current APA manual writing rules and style
Main Posting:
Timely and full participation
10 (10%) - 10 (10%)
Meets requirements for timely and full participation
posts main discussion by due date
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
Does not meet requirement for full participation
First Response:

15. Post to colleague's main post that is reflective and justified with
credible sources.
9 (9%) - 9 (9%)
Response exhibits critical thinking and application to practice
settings
responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates
synthesis and understanding of learning objectives
8.5 (8.5%) - 8.5 (8.5%)
Response exhibits critical thinking and application to practice
settings
7.5 (7.5%) - 8 (8%)
Response has some depth and may exhibit critical thinking or
application to practice setting
6.5 (6.5%) - 7 (7%)
Response is on topic, may have some depth
0 (0%) - 6 (6%)
Response may not be on topic, lacks depth
First Response:
Writing
6 (6%) - 6 (6%)
Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by
two or more credible sources
Response is effectively written in Standard Edited English
5.5 (5.5%) - 5.5 (5.5%)
Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed

16. Provides clear, concise opinions and ideas that are supported by
two or more credible sources
Response is effectively written in Standard Edited English
5 (5%) - 5 (5%)
Communication is mostly professional and respectful to
colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible
sources
Response is written in Standard Edited English
4.5 (4.5%) - 4.5 (4.5%)
Responses posted in the discussion may lack effective
professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited
0 (0%) - 4 (4%)
Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited
First Response:
Timely and full participation
5 (5%) - 5 (5%)
Meets requirements for timely and full participation
posts by due date
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)

17. NA
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
Does not meet requirement for full participation
Second Response:
Post to colleague's main post that is reflective and justified with
credible sources.
9 (9%) - 9 (9%)
Response exhibits critical thinking and application to practice
settings * responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates
synthesis and understanding of learning objectives
8.5 (8.5%) - 8.5 (8.5%)
Response exhibits critical thinking and application to practice
settings
7.5 (7.5%) - 8 (8%)
Response has some depth and may exhibit critical thinking or
application to practice setting
6.5 (6.5%) - 7 (7%)
Response is on topic, may have some depth
0 (0%) - 6 (6%)
Response may not be on topic, lacks depth
Second Response:
Writing
6 (6%) - 6 (6%)
Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by
two or more credible sources
Response is effectively written in Standard Edited English
5.5 (5.5%) - 5.5 (5.5%)

18. Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by
two or more credible sources
Response is effectively written in Standard Edited English
5 (5%) - 5 (5%)
Communication is mostly professional and respectful to
colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible
sources
Response is written in Standard Edited English
4.5 (4.5%) - 4.5 (4.5%)
Responses posted in the discussion may lack effective
professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited
0 (0%) - 4 (4%)
Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited
Second Response:
Timely and full participation
5 (5%) - 5 (5%)
Meets requirements for timely and full participation

19. Posts by due date
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
NA
0 (0%) - 0 (0%)
Does not meet requirement for full participation
Total Points: 100
Discussion: Factors That Influence Disease
In clinical settings, some of the most common questions that
patients ask are Why do I have this? What caused this disorder?
Will it ever go away? These emotional questions can be
difficult to ask and to answer. However, for patients to come to
terms with their diagnoses and adhere to treatment plans, they
must have an understanding of factors that might have caused,
or continue to impact, their disorders. As an advanced practice
nurse, it is important that you are able to explain disorders,
associated alterations and symptoms, and changes that might
occur within your patients’ bodies.
To Prepare
· Review this week’s media presentation with Dr. Terry Buttaro.
Reflect on the importance of developing an in-depth
understanding of pathophysiology.
· Select a disorder from the following list:
· Adrenal insufficiency (Addison’s disease)
· Atherosclerosis
· Cholelithiasis (gallstones)
· Colon cancer
· Cystic fibrosis
· Hemophilia
· Nephrolithiasis (kidney stones)
· Osteoporosis

20. · Parkinson’s disease
· Tuberculosis
· Select one of the following patient factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how that factor might
impact your selected disorder, as well as potential associated
alterations and symptoms.
· Identify the pathophysiology of the associated alterations,
including the normal and altered cellular function. Consider
both intra- and extra-cellular changes that occur.
By Day 3
Post a brief description of a patient scenario involving the
disorder and the factor you selected. Explain how the factor
might impact your selected disorder, as well as potential
associated alterations and symptoms. Finally, explain the
pathophysiology of the associated alterations, including changes
in cellular function.