How do alterations in the clotting cascade contribute to the development of hemorrhagic disorders, and how can nurse practitioners use their understanding of the underlying pathophysiology to develop targeted interventions that address the various aspects of care for patients with these conditions?
Sample solution
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
Sample Answer
Sample Answer
Alterations in the Clotting Cascade and Hemorrhagic Disorders
Introduction
Hemorrhagic disorders are characterized by an increased tendency to bleed, which can result from various alterations in the clotting cascade. Understanding the underlying pathophysiology of these disorders is crucial for nurse practitioners (NPs) as they develop targeted interventions to manage and care for affected patients. This essay explores how changes in the clotting cascade contribute to hemorrhagic disorders and discusses how NPs can apply this knowledge in clinical practice.
The Clotting Cascade
The clotting cascade is a complex series of events that lead to the formation of a stable blood clot to prevent excessive bleeding. It consists of two main pathways: the intrinsic pathway, which is activated by damage to the blood vessel, and the extrinsic pathway, which is triggered by external trauma. Both pathways converge into a common pathway that culminates in the conversion of fibrinogen to fibrin, forming a stable clot.
Alterations Leading to Hemorrhagic Disorders
1. Deficiencies in Clotting Factors: Genetic conditions such as hemophilia A (factor VIII deficiency) or hemophilia B (factor IX deficiency) result in decreased levels of specific clotting factors, impairing the intrinsic pathway and leading to prolonged bleeding times. Patients may experience spontaneous bleeding episodes, particularly in joints and muscles.
2. Von Willebrand Disease: This condition results from a deficiency or dysfunction of von Willebrand factor (vWF), which is essential for platelet adhesion. A lack of vWF leads to impaired platelet function, contributing to mucosal bleeding and easy bruising.
3. Liver Disease: The liver synthesizes most clotting factors; therefore, liver dysfunction can lead to decreased production of these factors. For instance, cirrhosis may result in coagulopathy, increasing the risk of bleeding due to decreased levels of factors such as prothrombin and fibrinogen.
4. Medications: Anticoagulants (e.g., warfarin, heparin) disrupt the clotting cascade by inhibiting specific factors or altering the synthesis of vitamin K-dependent factors. Over-anticoagulation can lead to significant bleeding complications.
5. Disseminated Intravascular Coagulation (DIC): This complex disorder involves systemic activation of the clotting cascade, leading to widespread clot formation and subsequent consumption of clotting factors and platelets. The paradoxical result is a bleeding tendency due to depletion of these components.
Role of Nurse Practitioners in Managing Hemorrhagic Disorders
Nurse practitioners play a crucial role in the management and care of patients with hemorrhagic disorders. By understanding the underlying pathophysiology, NPs can implement targeted interventions that address both the physiological aspects and the psychosocial needs of their patients.
Targeted Interventions
1. Assessment and Monitoring: NPs should conduct thorough assessments that include a detailed patient history, physical examination, and laboratory tests (e.g., complete blood count, coagulation panel). Regular monitoring for signs of bleeding (e.g., hematuria, ecchymosis) can help identify complications early.
2. Patient Education: Educating patients about their specific disorder, including triggers for bleeding episodes and self-management strategies, is vital. For example, patients with hemophilia should be educated on avoiding activities with high injury risk and recognizing signs of bleeding.
3. Medication Management: NPs should ensure appropriate management of anticoagulant therapy. This includes regular monitoring of INR levels for patients on warfarin and providing education on medication adherence and potential interactions.
4. Collaboration with Specialists: NPs should collaborate with hematologists for patients requiring advanced management options, such as factor replacement therapy or genetic counseling for inherited bleeding disorders.
5. Emergency Preparedness: NPs should develop an emergency plan for patients at risk for severe bleeding episodes, including access to emergency medications (e.g., desmopressin for von Willebrand disease) and clear instructions on when to seek urgent care.
6. Psychosocial Support: Acknowledging the psychological impact of living with a bleeding disorder is essential. NPs can provide resources for support groups or counseling services to address anxiety related to bleeding risks.
Conclusion
Alterations in the clotting cascade are fundamental contributors to the development of hemorrhagic disorders. Understanding these mechanisms enables nurse practitioners to implement targeted interventions that enhance patient care and improve outcomes. By focusing on assessment, education, medication management, collaboration, emergency preparedness, and psychosocial support, NPs can effectively address the complex needs of patients with these conditions. Through a comprehensive approach grounded in pathophysiological knowledge, nurse practitioners can significantly impact the quality of life for individuals affected by hemorrhagic disorders.
