1.
Figure out the main problem/diagnosis. The main medical diagnosis is usually what brought
them into the hospital or it could be the root cause of their visit. For
example, a patient who had a heart attack two weeks ago may present to the
hospital with dyspnea and new onset heart failure. While dyspnea is their main
complaint, the main problem is heart failure since it is the root cause of
their difficulty breathing.
2.
Clearly structure your paper. This stems from a good outline. Before I ever sit
down to write the Pathophysiology portion of my profile, I figure out what the
main diagnosis/problem my patient is facing. Once you know the top problem,
write down the various other issues that your patient is dealing with and then
arrange your patho in a way that organizes the information in a logical
fashion. For example, if your patient’s primary diagnosis is heart failure (HF)
secondary to a recent myocardial infarction (MI) complicated by renal failure
(RF), I would outline the paper like this: Hx of present illness, patho of HF
(from macro to micro level, i.e. down to the cellular level) and how the
diagnosis of HF was made (echocardiogram, BNP, etc.), patho of MI in relation
to the development of HF, patho of RF which was caused by insufficient perfusion
secondary to the decreased cardiac output associated with HF, discuss the
patient’s current status (edema from fluid overload secondary to HF and RF,
dyspnea secondary to fluid overload leading to pulmonary edema, etc.), and
conclude with a paragraph discussing patient education (e.g. call the doctor
about significant weight gain in short period of time) and follow-up care (nutritional
consults, congestive heart failure out-patient clinic).
3.
Spend sufficient time discussing the pathophysiology
of the primary diagnosis. Write as much as
you need to sufficiently cover the topic, including the normal anatomy and
function, the pathophysiology of the disease, and the manifestations of the
illness and what causes each of them. When discussing acute kidney injury
(AKI), for instance, discuss the normal anatomy and function of the kidneys
(nephrons, tubules, glomeruli and how they are involved in filtering urine and
regulating fluid status), the original insult to the kidneys (e.g. decreased
perfusion from low cardiac output associated with HF), the stages of renal failure, and the stage the patient is
currently in and how each manifestation (peripheral edema, hypertension, and
decreased urinary output) relates to the diagnosis of AKI.
4.
Be sure to include procedures and studies related to
your patient’s diagnoses. If your patient
has HF, discuss how it was diagnosis such as by Transesophageal echocardiogram
(TEE) and BNP values. Discuss how this procedure, TEE, is performed and the
physician’s interpretation of the results (ejection fraction, hypertrophy of
ventricles, etc.).
5.
Write at least one paragraph or more on the other
diagnoses related to your patient’s primary condition. For instance, if the patient has HF, RF, and past
MI. Discuss how the MI led to his HF, the patho of MI, and how it is currently
affecting the patient (this could easily be three paragraphs). Also, discuss the
patho of RF and why it resulted from HF and how it manifests in the patient.
6.
Relate the information to your patient in each
paragraph. At the very minimum,
include your patient (e.g. their presentation, diagnosis, etc.) in the topic
sentence (usually the first sentence in a paragraph), and in the last sentence
of the paragraph.
7.
Integrate your patient’s labs into your paper. This is one of the best ways to relate your topic to
your patient (#3). Whenever you give your patient’s labs don’t just list their
lab values, include the normal ranges (specific to age and gender) and the
correct interpretation of the labs (low/high/normal). Then apply this
information to the patient and their diagnosis and prognosis. For example, your
patient has low hemoglobin, hematocrit, and red blood cell count; you know this
because these values are lower than the normal levels for an adult male,
indicating that he is anemic. After explaining this, address the reason for his
anemia. For example, he could be anemic as a result of insufficient production
of erythropoietin secondary to his renal failure.
8.
Integrate your patient’s medications into your
patho. This shows your
understanding of your patient’s condition as well as the indication for the
medications which they are prescribed. For example, your patient is on a statin,
ACE-inhibitor, aspirin, and beta-blocker; these are all standard medications
prescribed to a patient post MI. Don’t just list the medications; instead, talk
about the specific medication your patient is prescribed, its drug category,
mechanism of action, and indication for your patient. For example, your patient
is prescribed metoprolol (Lopressor), a cardioselective beta-blocker, which
decreases heart rate and blood pressure by blocking the beta-1 adrenergic receptors
in the heart. This medication is given to treat hypertension by lowering this
patient’s blood pressure.
9.
Read before your write. It is so much easier to write a patho if you’ve read
about the diagnosis and the related issues in your Med Surg and patho textbooks
and journal articles before you start writing. By doing this, you can avoid the
risk of plagiarism that arises from writing as you read. You also are able to demonstrate
your understanding by writing the information in your own words.
10. Read your patho
before submitting it. The flurry of
patho writing it is easy to miss grammatical mistakes and spelling errors that you
will be able to catch on your final pass over your paper. I usually like to read a paper out loud before submitting; this keeps me from just skimming the content. Remember to use spell
check and Google the spelling of words you are not sure how to spell. Finally, the undergraduate writing center at Liberty University is another great resource. They usually take a few days to review your paper, so start working on your patho and send it to them early if you want to be able to update your paper based on their comments before the deadline.
