Skin and Respiratory System Disorders44 unread replies.44 replies.
The initial post must include responses to all the questions in this discussion.
Mr. J, age 42, is a construction worker in Las Vegas who lives with his daughter and grandson, Sammy. He recently noticed that a mole on his face seemed to be getting larger and darker. At first, he did not worry because he was in the sun a lot and assumed the change may have been caused by sunburn. After a month, not only was the mole larger and darker, but it appeared to be “bumpy.” His doctor diagnosed a malignant melanoma skin cancer following biopsy of the nevus. Mr. J reports pain in his right shin that does not go away when he puts his feet up or sleeps.
Discussion Questions
- Relate Mr. J’s skin changes to the warning signs for malignant melanoma.
- Discuss the normal progression of this malignancy. What is the significance of the bone pain that Mr. J is experiencing?
- Discuss the treatment available for this patient and the prognosis for recovery.
Discussion Questions
Mr. J is babysitting his grandson Sammy, age 3 years, who ate his dinner and then said his tummy hurt. Mr. J suggested he lie down in the adjacent room while his parents finished dinner. A few minutes later, Mr. J heard Sammy vomiting. He rushed in to lift Sammy up. When vomiting ceased, he noticed Sammy continued to cough and seemed to be choking. He was struggling to breathe, and a wheezing sound was obvious. It appeared that he had aspirated some vomitus. Mr. J drove him to a nearby hospital for examination.
- Discuss the specific effects of aspirating vomitus on Sammy, including the probable effects on his bronchi and lungs. Why might one lung be affected more than the other?
- Discuss the pathophysiologic changes causing the signs and symptoms and any tests required to clarify the effects on Sammy.
- Suggest some reasons for Sammy’s difficulty breathing and wheezing.
- Discuss the potential complications of aspiration of vomitus.
Expert Solution Preview
Introduction:
In this discussion, we will analyze the case of Mr. J, a construction worker who was diagnosed with malignant melanoma skin cancer and is experiencing bone pain. Additionally, we will discuss the case of his grandson, Sammy, who aspirated vomitus and is now experiencing difficulty breathing and wheezing. We will answer questions related to the skin changes noticed by Mr. J, the normal progression of malignant melanoma, the effects of aspirating vomitus on Sammy, pathophysiologic changes causing signs and symptoms, and potential complications of aspiration of vomitus.
1. Relate Mr. J’s skin changes to the warning signs for malignant melanoma.
The warning signs for malignant melanoma include asymmetry, border irregularity, color variability, diameter greater than 6mm, and evolving features such as changes in size, shape, or color. Mr. J’s skin changes fit these criteria, as the mole on his face is bumpy, larger, and darker. The diagnosis of malignant melanoma after a biopsy of the nevus is consistent with these warning signs.
2. Discuss the normal progression of this malignancy. What is the significance of the bone pain that Mr. J is experiencing?
Malignant melanoma can progress in various ways, including radial growth, vertical growth, and metastasis to other organs. Bone pain can be a symptom of metastasis to the bone. If this is the case for Mr. J, it would indicate that the cancer has progressed beyond the skin and may have entered the lymphatic or vascular systems. This indicates the need for further testing and prompt treatment.
3. Discuss the treatment available for this patient and the prognosis for recovery.
Treatment options for malignant melanoma include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. The choice of treatment will depend on the stage of the cancer, the location, and the extent of metastasis. The prognosis for recovery depends on several factors such as the stage at which the cancer was diagnosed, age, overall health, and response to treatment. However, early diagnosis and prompt treatment usually lead to a better prognosis.
4. Discuss the specific effects of aspirating vomitus on Sammy, including the probable effects on his bronchi and lungs. Why might one lung be affected more than the other?
Aspirating vomitus can introduce stomach acid and food particles into the lungs, which can cause inflammation and irritation, leading to decreased lung function, increased difficulty breathing, wheezing, and coughing. Additionally, inhaling vomitus can lead to aspiration pneumonia, which is a type of lung infection caused by bacteria that colonize the aspirated material. One lung may be affected more than the other because the vomitus could enter one lung’s bronchus instead of the other, leading to aspiration in only one lung.
5. Discuss the pathophysiologic changes causing the signs and symptoms and any tests required to clarify the effects on Sammy.
The pathophysiologic changes causing the signs and symptoms in Sammy involve the inflammatory response to the aspirated vomitus, which can lead to airway obstruction, bronchoconstriction, and decreased lung compliance. Tests required to clarify the effects on Sammy may include chest X-rays, bronchoscopy, and cultures of respiratory secretions to determine if there is any bacterial infection.
6. Suggest some reasons for Sammy’s difficulty breathing and wheezing.
Difficulty breathing and wheezing in Sammy could be due to the obstruction of airflow caused by the aspirated material, bronchoconstriction, and inflammation of the airways. Additionally, aspiration pneumonia could also contribute to these symptoms as the infection makes it more difficult for the lungs to function correctly.
7. Discuss the potential complications of aspiration of vomitus.
Potential complications of aspiration of vomitus include aspiration pneumonia, lung abscesses, respiratory failure, and even death. These complications can arise due to the toxic contents of the aspirated material, leading to inflammation, infection, and decreased lung function. The risk of aspiration is higher in people with weakened immune systems, neurological impairments, and those suffering from gastric reflux or esophageal disorders. Prompt diagnosis and treatment are essential for preventing further complications.
