Kelly adored her three year old son johnny. she rushed home from work every day eager to be with him. one day she came home and noticed that he was not interested in walking or running but preferred to sit or even lie down. she thought he might just be tired, but the next morning, and even days later, his behavior didn't change. in addition she noticed that he seemed to be clumsier overall, tripping over his own feet, frequently falling and dropping things that he was carrying. he also complained about pain in his legs. kelly brought johnny to his pediatrician the pediatrician took his medical history. during the physical examination johnny displayed lordosis, difficulty rising from a lying or seated position, trouble jumping and running, and walking on his toes. the pediatrician ordered a series of tests: an enzyme tests which showed high levels of creatine kinase; an electromyography which indicated weakness due to destruction of muscle tissue not damage to nerves; lung monitoring tests which came back normal; and genetic testing which showed a mutation in a muscle specific protein. student questions:
1. what part of muscle physiology is likely affected?
2. identify three remarkable signs/symptoms and use at least one proper clinical term.
3. provide a primary diagnosis.
4. present one treatment option for this patient. include a brief explanation.

Mr smith a 52 year old patient, is admitted to the coronary care unit with the diagnosis of acute inferior myocardial infarction. the patient has a history of smoking two packs of cigarettes for 35 years, and he drinks a six pack of beer on weekend nights, but does not drink the rest of the week. he is the sole financial support for his family. he is a consultant for a company and is out of town during the week days. mr smith has gained 20 pounds. he is 5 foot, 6 inches, weighing 200 pounds. his diet consists mostly of fast foods. he rarely exercise. his wife care for their three teenage children. the eldest son, 17 years of age, totaled the family car when drinking and driving 2 days ago and he is in the local children’s hospital in the intensive care unit in critical condition. mr smith developed chest pains and slumped over in his chair during an argument with his wife about their teenage daughter, who is 15 years of age and wanted to get birth control pills. the wife is in the waiting room while the nurses settle mr smith into his room. the youngest son, 13 years of age, is at a friends house. the teenage daughter is staying at the bedside of the criticall i’ll eldest son. the wife blames her eldest son for her husband’s heart attack and told the emergency department nurse that she does not care to see her son i’ll. a. what maladaptive response to stress may have contributed to mr smith’s development of an illness b. based on the case study, what family assessment data may be used to determine coping strategies being currently used by the family. c. what nursing interventions should be used to promote effective coping for the patient and his family?