Saturday, November 9, 2013

10 Suggestions for Writing a Solid Patho Paper

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 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 values (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. Remember to use spell check and Google the spelling of words you are not sure how to spell.

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