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Cerebral Hydrolysis Case Study
3. Assess peripheral and central pulses, including cap refill.
1. Pulses are weak with reduced stroke volume and cardiac output. Cap refill is slow.
4. Assess for changes in the level of consciousness.
1. Early signs of cerebral hypoxia are restlessness and anxiety, with confusion and loss of
consciousness occurring in later stages. Older patients are especially susceptible to reduced
perfusion to vital organs
5. Assess respiratory rate and rhythm.
1. Rapid shallow reparations are characteristic of decreased cardiac output
6. Assess patient output
1. The renal system compensates for low blood pressure by retaining fluid and sodium. Oliguria is a
classic sign of inadequate renal perfusion from reduced cardiac output.
7. Use the pulse ox to
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Myocardial Perfusion Imaging (MPI)
Myocardial Perfusion Imaging is also known as (MPI). It is an imaging modality used in nuclear
medicine to demonstrate the heart muscle functions; a low dose of radioactive agent is used for this
study called a radiotracer. There are two different types of techniques used for myocardial perfusion
imaging. The first is, single photon emission computed tomography (SPECT) and the second,
positron emission tomography (PET). Myocardial perfusion imaging is commonly done for patients
whose experience some type of chest discomfort, a recent myocardial infarction, or it may be used
to access the blood flow to the myocardium that has been restored by bypass, stent or angioplasty. It
can also be used to diagnose coronary artery disease. According to ... Show more content on
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Coronary artery disease also known as CAD, is the narrowing of the arteries, that's caused by
expansion of plaque. When compared to other forms of modality for diagnosing coronary artery
disease it may be the method of choice. When myocardial perfusion imaging is directly compared to
exercise echocardiography, comparable sensitivities were revealed. When compared to myocardial
contrast echocardiography or cardiac magnetic resonance imaging similar comparison was seen.
Myocardial perfusion imaging may be used if a different test was vague just as if myocardial
perfusion imaging was inconclusive a different modality may be used. For women ECG
(electrocardiogram) is usually the diagnostic of choice. There have been several studies that have
concluded that ECG maintain a high number of false positive in women. With using MPI it's more
sensitive in diagnosing coronary artery disease in women. According to Loong (2004) "A recent
study was performed where out of 1140 women 86% of women were diagnosed with coronary
artery disease by MPI" (p.4). Some physicians suggest that women who have an intermediate
probability of coronary artery disease, myocardial perfusion imaging is the non–invasive
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Symptoms And Treatment Of Skin
When asked about their major illnesses, the client stated to have hypertension, severe dyspnea, and
edema. The client also stated that she suffered from a heart attack in the past, which was due to high
blood pressure. Many of the client's problems branched off from the heart attack and hypertension.
For example, a heart attack and high blood pressure can cause heart failure, heart failure can cause
pulmonary edema, and pulmonary edema can lead to swelling of the lower extremities and dyspnea
(Grossman & Porth, 2014). However, the most recent hospitalization for the client was due to severe
edema, and trouble breathing. Severe edema is one of the major causes for impaired skin integrity.
Skin integrity is defined as "the state in which an individual's skin is at risk of being adversely
altered" (kloop, Storey, & Bronstein, 2012). There are three major factors that can relate to client's
skin alteration: decreased tissue perfusion, prolonged bed rest, and pulmonary edema.
One factor that can cause impaired skin integrity is decreased tissue perfusion. Decreased tissue
perfusion refers to "decrease in oxygen resulting in failure to nourish tissues at the capillary level"
(Wilson, 2012). Reduced tissue perfusion causes the body to become distressed because it is not
receiving enough oxygen. This causes the blood to "shunt to the core of the body where the vital
organs are located," such as the heart and the brain (Grossman & Porth, 2014). Since the client
suffered from
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Nursing Case Study Essay
Impaired Gas Exchange r/t
Behaviors:
Oxygen Saturation that falls as low as 91% on room air at rest and after exertion
After two to three minutes on Nasal Cannula of 2 Liters, Oxygern Saturation rises to 97 or 98%
Pt is out of breath and physically tired after getting up to the bathroom and shower
Rhonchi auscultated in the right middle and lower lobes
Desired Outcomes:
The patient's oxygen saturation will be kept above 96% throughout the entire shift
The patient will be able to tolerate ambulation to the bathroom and to the shower with minimal
shortness of breath
Nursing Interventions:
1. Monitor the patient's oxygen saturation frequently (once per hour) at rest and after exertion on
room air
2. Place patient on nasal ... Show more content on Helpwriting.net ...
Assess patient's tissue perfusion through capillary refill and pulses
2. Monitor the patient's oxygen saturation frequently
3. Instruct the patient to reposition herself frequently and supply extra pillows for bony prominences
like heels and elbows
4. Assess all areas of the skin to look for pressure ulcers and pay close attention to foot care
5. Keep the patient warm
Rationale:
1. Capillary refill and pulses will give a good indication of the kind of perfusion the patient is
experiencing. By checking these on the tips of the fingers and toes, the nurse will ensure proper
assessment. Prolonged capillary refill or absence of pulses can indicate a serious problem and may
result in tissue ischemia
2. Oxygen saturation has a great deal to do with tissue perfusion. The less oxygen–rich blood that is
able to circulate throughout the body, the less perfusion is going on and the greater the risk for
ischemia.
3. Pressure ulcers are a problem for anyone who is not mobile on a regular basis. With decreased
tissue perfusion, the patient is at an even greater risk for tissue breakdown. Repositioning will
ensure that no spot on
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Essay about Nursing Instructor
Nursing Instructor
PHYSICAL HISTORY:
My clinical rotation was at St. Francis Hospital on the orthopedic/medical–surgical floor, 5–1. I was
assigned JB for a patient 10/7 and 10/8. He was one day post–op from an elective bilateral knee
arthroplasty.
JB is a 69 year old Caucasian male who stands 6 feet tall and weighs 251 pounds. He has a history
of hypertension, benign prostatic hyperplasia, degenerative joint disease, and renal calculi.
Medications taken at home: Nifedipine 60 mg. QD to manage his hypertension and nonsteriodal
anti–inflammatories for the DJD.
JB's major problem is the degenerative joint disease (DJD) also referred to as osteoarthritis.
According to Colodny, more than 50 million Americans suffer from ... Show more content on
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JB was admitted to St. Francis on 10/6, the day of surgery. On post–op day one 10/7 his vital signs
were: Pulse–84, Respirations–20, Blood Pressure–130/70, and Temperature 101.5 F. on 10/8 they
were 86, 20, 135/74, and 102.0 respectively. All vital signs except for the temperature were within
normal limits for this patient. He received Tylenol 650 mg. pm every 4 hours for elevated
temperature. Laboratory results showed a low hemoglobin of 8.6g/dl (normal 12–16g/dl) and a low
hematocrit of 25.2% (normal 36–41%). JB received 1 unit (500 cc) of RBCs on 10/7 and 10/8. All
other laboratory values were within normal limits. The primary nurse felt the transfusions
contributed to or caused the elevated temperature because JB showed no other signs of infection
through physical assessment or laboratory values.
JB had clear lung sounds bilaterally. He had palpable pedal pulses and was positive for color,
motion, and sensation in both affected extremities. Capillary refill was less than 2 seconds. His skin
was warm and clean. He was diaphoretic due to an increased temperature. He had a quarter size
reddened area on his coccyx that was being monitored and protective nursing interventions were
instituted to prevent skin breakdown.
JB was oriented to time, person, and place.
SOCIAL HISTORY:
JB was born and raised in Connecticut. He and his wife have been married
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Hypovolemic Shock Case Study
Hypovolemic shock is an emergency condition caused by loss of whole blood (hemorrhage), plasma
(burns), or interstitial fluid (diaphoresis, diabetes mellitus, diabetes insipidus, emesis, diuresis, and
diarrhea) in large amounts. This makes the heart unable to pump enough blood to the body (Heller,
2014). The severe compromise in blood flow and therefore systemic perfusion contributes to
cerebral, renal, or hepatic ischemia and possible organ failure. It is the most common type of shock
in children with dehydration and trauma being the most common factors (McCance, 2010. pp 1703).
Pathophysiology
Hypovolemic shock begins to develop after losing about a fifth or more of the normal amount of
blood in the body resulting in compensatory vasoconstriction, increased SVR (systemic vascular
resistance) and increased afterload in order to improve blood pressure and perfusion to core organs
of the body (Heller, 2014) (McCance, 2010. pp 1672). Compensatory mechanisms have limited use
and benefit.
Hypovolemic compensations:
Systemic vasoconstriction – increases left ventricular afterload and myocardial oxygen consumption
and may produce tissue ischemia.
Prolonged tachycardia – may impair subendocardial blood flow and increase myocardial oxygen
consumption; both may ultimately contribute ... Show more content on Helpwriting.net ...
After the onset of hypovolemic shock, the primary goals are to replace blood and fluid volume via
IV infusion; maximization of oxygen delivery, and minimization of oxygen demand. Patient is
positioned in a manner that supports maximal circulation and airway patency (oxygenation,
ventilation, and perfusion). Diligent treatment of fever, fear and pain are necessary to reduce oxygen
demand. Humidified supplementary oxygen is given as needed at up to 10 to 15 L/min by non–
rebreathing mask or bag–mask ventilation and is monitored continuously through pulse oximetry
(McCance, 2010. pp
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A Brief Note On Electro Encephalography ( Eeg )
Electro–encephalography : Electro–Encephalography (EEG) is primarily an electrophysiological
monitoring method, recording the electrical activity of the brain. It involves placing electrodes along
the scalp, which measure voltage fluctuations resulting from the ionic flux across the brain neurons.
These are recorded graphically and typically referred to as 'brain waves'. Prior to the advent of
Computed Tomography (CTScan) and Magnetic Resonance Imaging (MRI), EEG monitoring was
the primary diagnostic tool for stroke, epilepsy and other focal brain disorders. EEG monitoring in
the settings of cardiac surgery can be initiated before induction by anesthesia and continues in the
post operative phase , in the intensive care unit (ICU). EEG monitoring is useful to detect seizures .
The most common neurological symptoms manifest in the neonatal cardiac surgical intensive care
unit include – Non convulsive seizures and Status Epilepticus; the primary cause being Hypoxic
Ischemic Encephalopathy(HIC). Studies reveal that the incidents of HIC increase in the presence of
adverse events like cardiac arrest and also in the use of Mechanical Circulatory Support, ECMO,etc.
EEG can be influenced by the use of hypothermia and anesthetic agents. Use of deep hypothermia
leads to isoelectricity, a marker of reduction in cerebral metabolism. The threshold for isoelectricty
can be a useful indication for adequacy of
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AKI Case
Frederick was given a preliminary diagnosis of a prerenal AKI. AKI is a complex condition with
various different definitions available, most including a rapid decline in kidney function and the lack
of ability of the kidneys to filter blood, subsequently leading to increased levels of serum creatinine
and BUN levels in the blood (Cheung et al., 2008). AKI is the leading cause of nephrology
consultation in the UK and carries with it high mortality rates (Basile, 2012). The primary causes of
an AKI are hypoxia, ischemia and nephrotoxicity. The main underlying feature of an AKI is a rapid
decrease in the glomerular filtration rate (GFR), which is strongly linked with a decrease in blood
flow to the kidneys. The GFR depends on the interplay between ... Show more content on
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It is secondary to under–perfusion of otherwise normally functioning kidneys and if detected early
can be reversible. In Mr Jones's case, his kidney's experienced hypo–perfusion during surgery.
Hypo–perfusion consequently causes azotemia due to the excess nitrogenous wastes in the blood.
Medications, such as high doses of dopamine, can cause prerenal kidney injury due to the
production of intrarenal vasoconstriction, which can lead to hypo perfusion of the glomeruli
(Nissenson, 1998). The kidneys have an enormous blood supply and account for 20–25% of cardiac
output. This blood supply is needed for the removal of waste products and the management of fluid
and electrolyte balances. If the blood flow to the kidneys is reduced, this has a decreasing effect on
the GFR leading to a decreased urine output, filtration and reabsorption of filtered material through
the glomerulus. This can lead to further issues and effect other organs in the body. Fredrick
experienced a decreased urine output as a symptom of his reduced GFR. Fredrick's increased
respiration rate noted during assessment was an indicator of his deterioration and alerted the medical
team that there was an underlying issue. During the nurse's assessment, they observed that Frederic
had very poor urine output, which is also linked with the drop in the GFR in the kidneys. Thus,
encouraging the nursing staff to take immediate action with thereputic
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Dr. Steward's Priority Problems With Impaired Cardiac...
Focused Assessments and Priorities Mr. Steward's priority problems include impaired cardiac tissue
perfusion, impaired gas exchange, and pain. We are concerned about impaired cardiac tissue
perfusion because the pt. is exhibiting signs of myocardial ischemia including chest pain and
shortness of breath (Gillespie, 2012). Although we acknowledge that impaired cardiac tissue
perfusion can decrease the function of the heart and will have the potential to affect the perfusion
and delivery of oxygen to other end organs, our primary focus will be a focused cardiovascular
assessment (House–Kokan, 2012). At 1800, Mr. Steward was SOB, had shallow and rapid breathing
(RR = 44), and a SaO2 of 72% on RA. Due to the fluid buildup in his lungs, Mr. Steward has
impaired gas exchange, and requires supplemental oxygen to maintain his SaO2; this warrants a
focused respiratory assessment. Mr. Steward was pain free until this morning. He initially
complained of right–sided chest pain and then complained about pain in his hip and ankle. We
recognized this was a new onset of pain that persisted, despite giving him some pain medication.
When Mr. Steward was discovered in his room clutching his chest, we recognized this as a non–
verbal sign of pain and asked him whether he was having chest pain. Although Mr. Steward doesn 't
provide a definitive answer, he displayed non–verbal signs of pain, such as restlessness, frequent
shifting in bed, and act of clutching his chest. Recognizing Mr.
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Ischemic Stroke Case Study
Multiple Thresholds for Different Components of the Brain in Ischemic Stroke Perfusion Imaging
Introduction
Stroke
Stroke is a disease of national and global significance in prevalence, impact and cost [1–4].?Stroke
is the third leading cause of death and leading cause adult disability in Australia [3]. Furthermore,
the number of stroke sufferers is expected to increase in the future as the Australian population
ages[5]. Stroke can be categorized into ischemic and hemorrhagic subtypes as each has a different
mechanism and long term outcome. Ischemic stroke makes up 87% of all strokes and is caused by
an occluded cerebral blood vessel causing hypoperfusion to areas upstream of the occlusion that
result in tissue damage and dysfunction. Of all ... Show more content on Helpwriting.net ...
Mixed common threshold for grey matter and white matter overestimate the perfusion lesion in
white matter, but underestimate the tissue in white matter [71, 89, 90](summary of the threshold for
grey matter and white matter separately from previous studies in figure 7). The variation of absolute
perfusion values is highly individual. Furthermore, the variation of the absolute threshold is high
between these studies (CBV range from1.67 to 2.4 6 ml/100g in grey matter, with a range of 1.19 to
1.7 6 ml/100g in white matter; CBF range from 17.7–34.6 ml/100g/min in grey matter, and a range
of 12.3 to 20.9 ml/100g/min in white matter). Relative thresholds are able to delineate perfusion
lesion better than absolute thresholds, due to relative thresholds are more consistent comparing to
absolute thresholds, whereas, absolute thresholds varies individually, as previous research has been
demonstrated [55, 56, 92]. However, these results lack of standardization and validation to define
the optimal thresholds for grey matter and white matter separately. All of these previous studies had
a limited number of patients, ranging from 9 to 21. It is clear, no agreement on multiple optimal
thresholds setting to delineate acute tissue pathophysiology in grey matter and white matter
separately using perfusion
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Laser Therapy Case Study
The fetoscopic laser therapy [17] is currently recognized as the first–line treatment for stage I to IV
TTTS diagnosed before 26 weeks of gestation, resulting in better survival and neurological
outcomes of fetuses. However, because laser therapy has to coagulate the placental anastomotic
vessels between the two fetuses in TTTS, the decreased placental perfusion to the donor twin with
FGR may cause a higher fetal demise rate than in the TTTS donor without FGR [18]. Furthermore,
the procedure of laser therapy is not free of complications. In our series, 11.4% of treated cases
experienced premature rupture of membranes (PROMs) within 3 weeks, and 2.2% of treated cases
developed chorioamnionitis needing termination [11]. So in the TTTS twins ... Show more content
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MtDNA increases have been associated with hypoxia in the placentas of FGR [8]. Our results
further suggest that the rescue perfusion from the AGA– to sFGR–fetuses determines the placental
hypoxic status in the sFGR twins between these two groups. One potential etiology of sFGR in MC
twins is its low placental share [12]. Our results (Figure 2) of similar placental discordance in the
TTTS with sFGR (group 1) and the no TTTS twins with sFGR (group 3) provided evidence against
the hypothesis that the different degrees of low placental share in the sFGR twins led to different
placental mtDNA contents between these two groups. We have previously reported that the fetal /
placenta weight (F/P) ratio is increased in MC twins with sFGR [19] when rescue perfusion from the
larger placental territory to the sFGR one through vascular anastomoses works to promote growth of
the sFGR twin. By this compensatory mechanism, the sFGR twin in each pair of shunt–patent twins
(group 3) gets more perfusion than its small placental territory would usually supply, resulting in the
alleviation of hypoxic stressors and a decrease of mtDNA content in the sFGR placental territory.
On the other hand, laser therapy disrupts the vascular shunt between the TTTS twins and terminates
the aforementioned rescue perfusion, resulting in hypoxia and,
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Septic Shock: A Case Study
Nurses play a significant and a very critical role in decreasing incidence of septic shock by early
identification immediate treatment. The first role of the nurse starts with assessing and recognizing
patients who are at risk for sepsis. According to Janice Tazbir, RN., M.S., CCRN, early recognition
of sepsis could decreases the mortality rate by 25% (Tazbir, 2012) Tazbir identified, very ill patients
due to an infectious agent, patients in the intensive care unit, patients with invasive devices, patients
with wounds, burns, and surgeries are at higher risk for sepsis that could lead to septic shock.
However, nurses must keep in mind that some patients may not always develop the same classic
signs of sepsis due to the effects of different medications that they may be receiving. For this reason,
prevention is the key and it starts with implementing a thorough hand hygiene, and maintaining ...
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Kleinpell, Aitken, and Achorr 2013, recommend that crystalloids solutions, such as normal saline
and lactated ringers, or albumin, should be the fluids of choice when initiating fluid resuscitation.
Their recommendation is based on a study trial that was conducted to evaluate the effectiveness of
artificial colloids. The results indicated no survival benefits when using artificial colloids comparing
to crystalloids (Kleinpell, Aitken, and Achorr 2013).
In case of persistent hypotension after administering IV fluids, the nurse should advocate placing a
central line to closely monitor central venous pressure (CVP). The Surviving Sepsis Campaign
added a new guideline in 2012 to monitor CVP every 30 minutes for 6 hours straight. This allows
the nurse at the bedside to be able to quickly resuscitate the patient with adequate fluids until the
CVP normal level of 8–12 is achieved. (Surviving Sepsis Campaign,
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Nursing Care Plan
Nursing Diagnosis # 1 Ineffective breathing pattern related to decreased oxygen saturation, poor
tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain,
decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath,
BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly
purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain,
oxygen saturations of 85–95% 2L NP, immobility 95% of the day, and adventitious sounds
throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and
obesity
Goals
1) The patient will demonstrate effective breathing ... Show more content on Helpwriting.net ...
Health Promotion
Canada food guide
Exercise programs
Nursing Diagnosis # 2
Impaired skin integrity related to limited mobility, impaired tissue perfusion, decreased cardiac
output, altered nutritional and hydration status, increased moisture, decreased sensory perception
and excess weight as evidenced by patient being bed reddened 95% of the day, +2–+3 peripheral
edema, stage III– IV coccyx pressure ulcer, drainage from the coccyx ulcer, high blood pressure,
decreased oxygen saturation between 85–95 % 2L NP, weak peripheral pulses, obesity, excessively
dry skin, sores on both legs (blister–like), denial of pain regarding dressing changes, and excessive
diaphoresis with movement secondary to CHF, hypertension, hyperlipidemia, and non–insulin
dependent type II diabetes.
Goals
1) The patient will sit on the side of the bed by the end of the day and by the end of
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Compartment Syndrome Analysis
Compartment Syndrome is a condition where there is an increase of pressure within a confined area
that is detrimental to the circulation and function of the tissues in the area (Grossman et al., 2014).
Fascia, a dense connective tissue, surrounds and separates the muscles and nerves into
compartments in the extremities. These fasciae provide sites of attachment for muscles, maintain the
positioning of muscle groups during motion and during contraction improve the mechanical
advantage of the muscle (Von Keudell et al., 2015). These fasciae create a low compliance, defined
anatomical area with their dense fibrous nature. These defined anatomical areas have a finite
volume, meaning that it can only endure a finite pressure (Rekha, 2010). A compartmental
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The Effect Of Perfusion On The Body As Well As The...
Various disease states related to profusion and the multitude of systems effected by perfusion
insufficiency.
Jason M. Carter El Centro Collage
Author note
Jason M. Carter, Department of Nursing, El Centro College
Jason Carter is studying for his degree in Nursing Science at El Centro College
Jason Carter Department of Nursing El Centro College, Dallas Texas 75202
Contact Jasonmcarter@yahoo.com
Abstract
This paper will discuss the effects perfusion has on the body as well as the multiple body systems
that are effected from poor perfusion. We will be looking at the relationships between profusion as it
relates to ischemic stroke, myocardial infarction, and tuberculosis. This paper will use online journal
entries from EPSCO as well as off line entries from Lewis to help us find a better understanding into
the related topics at hand. Lastly I will discuss stroke in depth as it pertains to my clinical
experience and explain the strong link profusion has on ischemic stroke and the measures used to
retain brain tissue. We will look at research done by Agarwal, Smriti (2015) that looks at the
effectiveness and time saving procedures researched by his team when detecting stroke as well as
research done by Dong, Hongli (2015) that shows a strong correlation between vitamin b12 and
folic acid and the prevention of an ischemic event.
Keywords: Ischemic Stroke, Perfusion
Various disease states related to profusion and the multitude of systems effected by
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Npc Case Studies
This is a prospective study which approved by the Human Research Committee. From June 2010 to
May 2013, after informed and consent, 140 patients with NPC were enrolled into our study when the
following criteria were met; (1) completed chemo–radiation NPC patient who follow up with Doctor
at interval of 6 months, 1 years, and 1.5 years who the doctor was predict of the recurrenct NPC and
was sent for CT scan of the nasopharynx and (2) patient was older than 18–year–old. The exclusion
criteria included; (1) patient who refused participating the study (2) patient who had not completed
two years follow–up and (3) patient had the contraindication for contrast–enhanced CT scan such as,
pregnancy, allergic iodinated contrast medium or renal impairment (GFR < 30 mL/min). ... Show
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When CT perfusion?. The perfusion CT parameters were obtained and analyzed. After that, all
patients were routinely followed up by ENT examination and contrast–enhanced CT scan of the
nasopharynx and neck for two years. During two years follow–up, the patient who had the
suspicious foci of recurrence from ENT examination or conventional CT will undergo tissue
diagnosis. After complete follow–up, patients were divided into two groups based on the final
diagnosis of LR or non–LR groups. LR group defined as positive malignancy from the pathological
report. The criteria for the non–LR group including (a) negative malignancy from the pathological
report or (b) no suspicious foci of tumor recurrence from serial ENT examination or conventional
CT follow–up (table1). The perfusion CT parameters were analyzed and compared between these
two
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Myocardial Perfusion Imaging : Myocardial Obstruction And...
Myocardial Perfusion Imaging also known as MPI is an imaging modality used in nuclear medicine
to demonstrate the heart muscle functions; a low dose of radioactive agent is used for this study
usually technetium –99m based radiotracer. There are two different types of techniques used for
myocardial perfusion imaging, single photon emission computed tomography (SPECT) and positron
emission tomography (PET). Myocardial perfusion imaging is usually done for patients who
experience some type of chest discomfort, recent myocardial infarction, or to access the blood flow
to the myocardium that has been restored by bypass, stent or angioplasty. And it can be used to
diagnose coronary artery disease. According to Kostkiewicz (2015) "the best candidates for
Myocardial Perfusion Imaging also known as (MPI) are people with poor exercise, ECG
abnormalities, and pretest likelihood of disease according to the ECS guidelines" (p. 2). This
modality is able to assess the severity of coronary obstruction and the extent of it; it's also able to
localize hemodynamically the importance of stenosis. According to Johns Hopkins, Myocardial
Perfusion Imaging shows the blood flow through the heart through either during exercise or
pharmacologic. Doctors order these test for many reasons, some reasons include; check to see if
there is narrowing of the coronary arteries, check to see if there's any damage from a heart attack,
determine how well your heart will handle physical activity, decide if you
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Ultrasound Therapy Lab Report
Objective: The principle of focused ultrasound therapy (FUS) is to elevate the pathological tissue
temperature rapidly therefore to ablate the target tissue. While absorbing the thermal energy from
ultrasound beam, the target tissue also have thermal exchange with surround tissues by conduction
and convection. The blood vessels can generate more effective convection on the proximity. If the
target pathological tissue locate the proximity of blood vessel, the thermal convective effect from
blood flow must be considered.
Thiel fluid is an advanced technology to store tissues, and it does not cause significant difference on
thermodynamics properties. Therefore the Thiel kidney is the idea specimen for the perfusion and
FUS therapy experiment. ... Show more content on Helpwriting.net ...
The Thiel kidneys are placed into the sealed waterproof plastic bag, and the renal artery is used as
the inflow, while the renal vein as the outflow. A tube is connect to the plastic bag to extract the
saline water back to the heart lung machine to complete the circulation. Cable ties are required to
close the distal of the artery to guarantee the whole saline water is perfused into the kidney's blood
circulation network (Figure 1).
The simulator is placed under the image–guided FUS surgical environment. Multiple image
technologies is used for the FUS therapy experiment. X–Ray (OEC9900, GE, USA), MR scan (1.5T,
GE, USA) are used to image the perfusing model.
The ExAblate 2000 (Insighte, Haifa, Isreal) focused ultrasound is used to ablate the kidney
perfusion model. The result will state the effect of blood flow on FUS therapy. The parameters for
MRgFUS in this experiment are as follows: TE=100ms, TR=150ms, Flip Angle=60°, Slice
Thickness=5mm. Acoustic Power=20W, Duration Time=20s. The sonication target position were
selected nearby main vessels, approximately 5mm away from the vessesl. Each selected position
were sonicated twice, one under the conidtion with blood flow, while the other without. The overall
flow speed is controlled at 500 mL/min for porcine kidneys and 200 mL/min for human kidneys.
The temperature rises are
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Fluid Resuscitation Protocols And Interventions Have...
Fluid Resuscitation in Burn Patients
Fluid resuscitation protocols and interventions have established guidelines for nursing care of burn
patients in hospital settings. Although these protocols aid the nurse in making treatment decisions,
the nurse must first understand the fluid pathophysiology of burns, the different fluid alternatives,
the amount of fluid volume infusions allowed and their effects within the patient's body, as well as,
any complications related to fluid resuscitation for burn patients. In addition, fluid resuscitation
should be carefully and diligently monitored to ensure the main goal of therapy which is to attain
adequate tissue perfusion while minimizing patient's complications.
Understanding the fluid pathophysiology of burns
Local and systemic inflammatory response occurs within the body due to fluid shifts from
intravascular compartments into the interstitium caused by changes in capillary permeability. The
body's specific response to burns directly correlates with the total body surface (TBSA) percentage
affected. Patients with 25% TBSA burns experience an increase in generalized capillary
permeability, at 30% TBSA burns patients are affected by a disruption on the cellular ion gradient
lasting several days and requiring a longer hospitalization stay, and patients with 50% TBSA burns
end up losing half of their fluid resuscitation volume due to increased leaks into the non–thermally
injured tissue (Diver). Several studies coincide that the
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Acute Stroke
The initial signs of acute stroke on nonenhanced CT are subtle but signs that may be visible would
include: loss of distinction between white and grey mater, hypodensities in the brain parenchyma,
loss of appearance of sulcal markings on surface of the brain and obscured delineation of basel
ganglia. The presence of hyerdensity in a main artery may imply thrombus in a main cerebral artery.
In the absence of contrast this sign has a high specificity but a low sensitivity for middle cerebral
artery occlusion. Overall a nonenhanced CT brain in acute stroke has a sensitivity as low as 26%. If
more than 30% of the distribution of the middle cerebral artery shows evidence of acute strioke
thrombolysis is contraindicated. The Alberta Stroke Program Early CT Score ( ASPECTS) can be
used to categorise patients as suitable or not for thrombolysis. In this system the ... Show more
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This has the effect to produce contrast between vascular structures and surrounding soft tissues.
Depending on the timing of imaging after IV injection arteries veins or soft tissues are highlighted.
For the purposes of acute evaluation of stroke as is described above an initial non contrats CT scan
is performed , followed immediately afterwards by a CT angiogram to evaluate vascular structures
from aortic arch to the vertex. This technique is very accurate for diagnosing occlusion of any of the
cerebral arteries be they intracranial or extracranial. It will also diagnose the presence of stenosis or
dissection of the carotid arteries or middle cerebral arteries. From these images reconstructions of
intracranial and extracranial cerebral arteries can be made. A contrast enhanced cerebral angiogram
is essential for the planning of thrombectomy as it will provide precise anatomy of cerebral arteries,
any stenosis or thrombus in each
... Get more on HelpWriting.net ...
Essay On Cardiopulmonary Bypass
Cardiopulmonary bypass (CPB) has contributed to the evolution of modern day cardiac surgery. The
establishment of extracorporeal circulation has helped the surgical team to carry out complicated
surgical manouevers for treatment of complex cardiac lesions, especially complex congenital
cardiac lesions, some of which were hitherto considered as inoperable. The advances in equipment
and use of innovative techniques in perfusion have contributed to decreased mortality and/or
morbidity in patients undergoing cardiac surgery in the modern day settings. However the necessity
for monitoring the patient on cardiopulmonary bypass is of paramount importance. One of the key
areas monitored during CPB is the neurological status of the patient. The inherent features of CPB
like unphysiological flows, the fluctuations of temperature (use of hypothermia and rewarming),
practices like hemodilution, organ protection strategies and unavoidable consequences like Systemic
Inflammatory Response Syndrome (SIRS), all contribute to neurological sequelae. The possibility of
neurological sequelae is enhanced in neonatal cardiopulmonary bypass, wherein the concept of
extra–corporeal circulation is stretched to its limits. Hence neurological monitoring assumes a
central place in the practice of 'safe, optimal perfusion' . ... Show more content on Helpwriting.net ...
It receives almost 14% of the total cardiac output. The average cerebral blood flow is
55ml/min/100gm of brain tissue, which can increase upto 100ml/min/100gm brain tissue in
neonates. The brain also contributes to 25% of the Total Oxygen Consumption
(3.5mlO2/min/100gm brain tissue). Studies have revealed that the white matter of the brain
contributes to almost 94% of the cerebral oxygen consumption whereas the gray matter contributes
the remaining 6%. The sensorimotor area of frontal cerebral cortex is most susceptible to ischemic
brain injury
... Get more on HelpWriting.net ...
Brain Perfusion Visual Analysis
1.3.3 Image analysis The analysis of brain perfusion SPECT images is primarily visual. The visual
analysis is based on a flexible and comprehensive qualitative evaluation of the image, and even
more importantly, it includes the reader's medical judgment and the particular diagnostic question in
each patient [Refs]. The visual analysis also helps to prevent misinterpretation when there are
technical artifacts present in the image. However, the visual analysis is susceptible to inter– reader
variability, especially in cases where CBF alterations may be subtle. This is one of the reasons for
the need for quantitative methods of image analysis. Furthermore, quantitative methods are
particularly useful in research, and make it easier, for example, to study associations with clinical
variables of interest in a particular disease. One of the quantitative methods used for years in brain
perfusion SPECT has been the method based on regions of interest (ROI). The method has evolved
... Show more content on Helpwriting.net ...
Therefore, the relationship between brain regions (i.e. connectivity) is not considered in the analysis,
thus ignoring important features of the complex network that is the brain [Refs]. In recent years
methods have been developed to study brain connectivity using neuroimaging [Refs], one of which
is based on graph theory that can be applied to brain perfusion SPECT data (it is described below).
The quantitative methods explained so far quantify the CBF (in one way or another) but in relative
units, which implies that the regional CBF values are relative to the number of counts corresponding
to a reference value. The reference value may be the mean value of a specific brain region (e.g., the
cerebellum) or the whole brain. The reference value should not be affected by the pathology under
study, so that the regional relative CBF values are due to the effect of the disease in the patient and
not to the reference
... Get more on HelpWriting.net ...
Description Key Terms Of The Movement Of Blood Through The...
Perfusion
Concept Definition: the movement of blood through the body via veins and arteries to deliver
oxygen and nutrients and to remove carbon dioxide and waste.
Concept Key Terms: Acute coronary syndrome: obstructive thrombus formed in the coronary artery
by the rupturing of an artheromateus plague
Afterload: the amount of resistance to the flow of blood out of the ventricles
Apical impulse (pulse): the pulse measured with stethoscope at 5th intercostal space mid line with
the clavicle
Artherosclerosis: plaque build up in the lining of arteries
Atrioventricular (AV) node: the area of the heart conduction system responsible for receiving
impulses from the SA node via intermodal pathways and stimulate the ventricles to contract
Baroreceptors: nerve fibers that help control blood pressure and located in the aortic arch and
carotid arteries
Brachial (pulse): peripheral site at brachial artery in the anticubutal area
Cardiac conduction system: the heart generated electrical signals that create an electrical action
potential.
Cardiac output: volume of blood pumped by the left ventricle(ltr/min)
Cardiac stress test: test where exercise or medication is used to increase the oxygen demand of the
body to analyze the function of the heart
Carotid (pulse): artery located on the neck on each side of the trachea
Compliance: for each unit of pressure the amount of blood that is in any given area of circulation
Contractility: the heart muscles ability to
... Get more on HelpWriting.net ...
Cardiomyopathy, Raynaud's And Perfusion
Cardiomyopathy, Raynaud's and Perfusion
Adequate perfusion supplies the entire body with necessary oxygen and nutrients to sustain life. The
process of oxygenation and perfusion can be affected by a multitude of factors. A few examples are,
a decreased oxygen carrying capacity, hypovolemia, neuromuscular disease, central nervous system
alterations and chronic diseases (Potter, Perry, Stockert, & Hall, 2013, p. 826). Two specific
examples of conditions affecting perfusion are cardiomyopathy and Raynaud's phenomenon.
Perfusion
Perfusion is one of three steps in the process of oxygenation. Ventilation is the mechanical action of
inhaling oxygen and expelling carbon dioxide through the use of the diaphragm. This oxygen is
dispersed ... Show more content on Helpwriting.net ...
829). In restrictive CMP the ventricular wall is stiffened and therefore loses its ventricular
compliance. This causes the ventricles to become resistant to filling and thus demand high filling
pressures to maintain CO (Kupper & Mitchell, 2014, p. 829). Clinical manifestations include trouble
breathing, inability to tolerate exercise, and an overall feeling of exhaustion (Kupper & Mitchell, p.
829). These manifestations often occur because the ventricular filling is compromised since the
heart cannot increase CO by increasing the heart rate alone (Kupper & Mitchell, 2014, p.
... Get more on HelpWriting.net ...
The Complications Associated With Diabetes Mellitus ( Dm )
Abstract This paper explores the complications associated with Diabetes Mellitus (DM) including
altered tissue perfusion. Altered tissue perfusion occurs as a result of DM and can cause many
complications such as diabetic foot ulcers. Although altered tissue perfusion is not the only cause of
ulcers, it contributes to the acceleration and degeneration of tissue once an ulcer forms. This paper
also covers nursing diagnoses, individualized nursing interventions, patient and treatment goals as
well as evaluation of outcomes, associated with an actual patient. I was able to treat a patient with
hyperglycemia within my critical care clinical experience. It also covers the psychosocial concepts
that influence teaching readiness, growth and ... Show more content on Helpwriting.net ...
Small arteries in diabetic patients experience changes due to increased atherosclerosis. Tissue
perfusion depends upon fasting plasma glucose and fasting insulin levels which are also dependent
upon how sensitive the patient is to the insulin. Increased permeability to large molecules such as
albumin is increased in diabetes, which can be associated with hyperglycemia (Levy, et al., 2008).
Studies have shown patients with type 2 diabetes experience decreased coronary flow which is
related to hemoglobin A1C and fasting plasma glucose levels (Marketou, et al., 2008). Mild insulin
resistance can also be associated with a decrease in coronary flow. In addition, a decrease in
myocardial perfusion in diabetic patients is related to decreased blood flow. An impairment in
peripheral circulation leads to ischemia, which is associated with pain in the lower legs called
intermittent claudication, which may result in lacerations of the feet (Levy, et al., 2008). Peripheral
vascular disease (PVD) can cause thrombosis of the arteries causing tissue death. Gangrene from
Diabetes Mellitus (DM) can lead to amputations beginning in the toes and moving into the foot
(Lemone, Burke, & Bauldoff, 2011).
Diabetes Mellitus is a chronic disease that has become an epidemic as it effects more and more the
population each year. DM is a group of metabolic diseases, stemmed from the Endocrine systems,
characterized by hyperglycemia
... Get more on HelpWriting.net ...
Atherosclerosis Case Exercise
A diagnosis of PVD indicates that there's a lack of tissue perfusion to the extremities, in this case to
the patient's feet. This lack of tissue perfusion to the feet can be caused by a type of condition where
it inhibits blood flow, which prevents oxygenated blood from reaching the extremities. Without
oxygenated blood reaching the extremities, it will cause damage to the tissue as seen with ML's right
toe. Having the ulcer on the right toe, indicates how there is lack of perfusion reaching that area.
In chronic arterial insufficiency, the arteries are affected as they can become occluded or narrowed.
By having the arteries occluded or narrowed, it will cause a decrease of blood flow. The decrease of
blood flow is caused by atherosclerosis,
... Get more on HelpWriting.net ...
Lack Of Recellularization Essay
One of the major challenges that cardiac tissue engineering should cope with it effectively, is the
generation of a thick vascularizable, cardia tissue to diffuse oxygen beyond the limited distance
(200µ), to support cardiomyocte survival and maturation in the 3D replica of native organ. In
addition, optimize amount of decellularization agents related to tissue types, age, and sex is critical
to determine successful recellularization and remodeling of the engineered heart [47]. Obviously, the
perfusion decellularization method has ensured successful whole organ decellularization with a
well–preserved of the vascular tree [48], [23]. This method applies perfusion system to pass mild
detergent through the intrinsic vascular networks. In spite of decreasing in the diffusion distance of
decellularization ... Show more content on Helpwriting.net ...
Thrombosis has been regarded as a main hurdle in transplantable whole organ engineered grafts.
Therefore, an optimal recellularization methods would be at the forefront of diminishing thrombosis
in the long term. In practice, lack of re–endothelialization of the heterotopic transplanted heart
induced thrombosis [54]. H. Kitahara and colleagues have recently demonstrated the first
heterotopic transplantation of an acellular and recellularized of the whole porcine heart fabricating
by the perfusion system. They have administered two potential recellularization procedure to
determine which of them contributed to prevent thrombosis. The first one was a coronary perfusion
technique, in which the cell was delivered evenly throughout the whole heart. The second other
method was a direct injection of the cell source. In that report, a whole porcine heart initially
perfused with 1% SDS 1% triton X100 was added to remove cell debris, the process took less time
(13h) as compared to the time required in another
... Get more on HelpWriting.net ...
Acute Pancreatitis Case Study
Evidence Based Practice Critical Review CT as a Prognostic Tool Clinical question: Can CT be used
to predict the outcome and progression of acute pancreatitis in patients exhibiting early signs and
symptoms? Database and search–terms: Database: PubMed – Clinical Queries with 'prognosis
category' and 'narrow scope' selected. Search–terms: CT AND predict AND outcome AND (acute
pancreatitis) AND symptoms Search results: After evaluation of the abstracts, of the 16 results
uncovered from the search, only six actually discuss CT as a prognostic tool in predicting the
outcome of patients with acute pancreatitis. Of these six potential articles, the rationale behind
rejecting five was based on whether or not they also investigate patients ... Show more content on
Helpwriting.net ...
The table below displays the mean MTT in patients with mild acute pancreatitis and severe acute
pancreatitis for each anatomical division of the pancreas. Head (seconds) Body (seconds) Tail
(seconds) Mild acute pancreatitis 10.9 ± 2.3 10.8 ± 2.6 10.5 ± 2.6 Severe acute pancreatitis 8.7 ±
2.2s 7.9 ± 1.9s 8.3 ± 1.7s In contrast, within one day of exhibiting symptoms, the mean permeability
surface area product values for head, body and tail of pancreas were already considerably lower (p =
0.0001) in patients with mild acute pancreatitis when compared to those with severe acute
pancreatitis. The table below displays the mean permeability surface area product values in patients
with mild acute pancreatitis and severe acute pancreatitis for each anatomical division of the
pancreas. Head (mL/100g/min) Body (mL/100g/min)
... Get more on HelpWriting.net ...
Alzheimer's Disease: How Cognition Decline?
How Cognition Decline?
Main reason for cognition decline could be buildup of plaque and dysfunctional proteins in the brain
interfering with neuronal function. Alzheimer's disease (AD) is an age–related neurodegenerative
disease that accounts for more than 60 % of all dementia cases. The disease is characterized by
cognitive deficits and memory loss through a process that lead to the presence of amyloid–β (Aβ)
plaques and neurofibrillary tangles (NFTs). This plaque is composed of abnormally
hyperphosphorylated tau protein in the brain. Amyloid beta (Aβ or Abeta) is a peptide of 36–43
amino acids, forms amyloid plaques in the brain and are toxic to nerve cells. These peptides result
from the amyloid precursor protein (APP), which is cleaved
... Get more on HelpWriting.net ...
Human Body Continuously Need Blood Supply Essay
Human body continuously need blood supply to the cell in order to deliver oxygen and nutrient to
the cells and carrying out carbon dioxide out of the cell. In order to have good perfusion in tissue, a
person has to have good cardiac health and patent vessels. Edema also affect tissue perfusion. There
are many reasons that disturbed the normal flow of blood like ECG rhythm, congestive heart failure,
hypertension, gestational hypertension, mitral valve prolapse, coronary artery disease, and
peripheral vascular disease, which are also the exemplars of perfusion. There are many risk factors
that can be modified to prevent the perfusion problem.
Blood pressure greater than 140/90 is known as hypertension. Excessive sodium intake,
hyperlipidemia, obesity, diabetes, extreme tobacco and alcohol use, over activity of sympathetic
nervous system, and over production of sodium retaining hormones and vasoconstriction substances
are major contributing factors of hypertension. Heredity, age, and gender are also the risk factors for
hypertension (Bucher & Dirksen, 2014). Hypertension is one of the most underlying cause of
impaired perfusion. High blood pressure for long period of time can shore up smooth muscles of
artery as a result of building up the strength through hypertrophy and hyperplasia, which results in
decrease size of arterial lumen. In older adult, the wall of artery become thick and hard due to above
contributing factors that I mention. This alter vasomotor tone and blood
... Get more on HelpWriting.net ...
Spinal Cord Protection Strategies For Thoracic...
Spinal Cord Protection Strategies for Thoracic Endovascular Aneurysm Repair With an incidence
once as high as 40%, spinal cord paralysis in thoracoabominal procedures has declined, however,
still remains a devastating threat post–surgery (Roman, Grewal, Taylor, & Grigore, 2014). Modern
techniques for repair of thoracic aneurysms and dissections include an open incision with
extracorporeal bypass and aortic clamping. This surgical procedure puts patients at great risk for
spinal cord paralysis. Open procedures required meticulous reimplantation of intercostal blood
vessels, deep hypothermic cardiac arrest, epidural cooling, and various pharmacologic interventions.
As surgical technique has advanced to percutaneous endograft repair, most of these techniques are
no longer needed. However, the incidence of paralysis is still prevalent in patients having a TEVAR
procedure. Naloxone, an opioid antagonist, has been studied as an additional pharmacologic adjunct
in the prevention of spinal cord paralysis (Roman, Grewal, Taylor, & Grigore, 2014). Spinal cord
injury can be multifactorial and a review of the literature indicates for patients undergoing
endovascular repair of thoracic aneurysms, the use of multiple spinal cord protection strategies
collectively reduce spinal cord injury compared to the use of naloxone as a primary measure.
Literature Review
Pathophysiology
To understand the techniques utilized for spinal cord protection, providers must first understand the
anatomy of
... Get more on HelpWriting.net ...
Brain Perfusion Scan Research Paper
Neurological Tests
A brain perfusion scan is a type of brain test that shows the amount of blood in certain parts of the
brain. This test tells doctors how the brain is functioning. There are different types of brain perfusion
scans. The test would take place in radiology. A doctor may do the test is a patient has epilepsy,
brain tumor, dementia, or has had a stroke.
A medical assistant can tell the patient the steps and how this is performed. They can also tell them
how long the procedure will take. The can give them information on what the doctor is looking for.
Also if they need someone to drive them to and from the doctors. They should tell the patient if they
are allowed to eat or drink before the procedure is done. The patient
... Get more on HelpWriting.net ...
Slow Wave Lab Report
Fig. 1. The effect of replacing extracellular chloride, [Cl–]o with gluconate on slow wave activity
recorded from mouse jejunal smooth muscle layer. Replacement of [Cl–]o by gluconate significantly
altered slow wave properties in a concentration dependent manner (see Fig. 2). A1, A2–C,
Representative traces of intracellular recording made in [Cl–]o: 13.3 mM (A1, A2); 39.9 mM (B);
and 119.8 mM (C), respectively. In 5 out of 9 experiments, slow waves were abolished (A1). In the
remaining 4 experiments, small amplitude residual slow wave activity was observed (A2). The
horizontal bar over each traces indicates perfusion period of low [Cl–]o solution. Expanded time
scales are shown at the bottom of A1, A2, B, and C with different time points before and after the
low [Cl–]o perfusion.
Fig. 2. Measurement of electrical slow wave properties upon replacing ... Show more content on
Helpwriting.net ...
6. The effect on slow wave activity of reducing [Ca2+]o in Krebs to the level of [Ca2+]o obtained
by adding gluconate (A) and isethionate (B) (see Fig. 5). Lowering [Ca2+]o did not replicate the
effect of replacing [Cl–]o with gluconate or isethionate on electrical activity in mouse jejunal
smooth muscle layer. A–B, Representative traces of intracellular recordings upon perfusion with
0.13 mM and 0.54 mM [Ca2+]o. Expanded time scales are shown below the traces. C–I,
Summarized data illustrating the effects of reduced [Ca2+]o on slow wave properties: At 0.13 mM
[Ca2+]o, (equivalent to the level found in 13.3 mM Cl–, 120.3 mM gluconate Krebs) a decrease in
the instantaneous frequency (F), shortening of slow wave width (G) and a decrease in the decay
times from 90 to 10% of peak amplitude (I) were observed. These effects were reversible on
washout. No change was observed in membrane potential (C) and the rest of the slow wave
properties (E, H). No effects were observed at 0.54 mM [Ca2+]o (equivalent to 13.3 mM Cl–, 120.3
mM isethionate Krebs; panel D–I). Values are mean ± SEM (N=4–5, *P < 0.05, paired t
... Get more on HelpWriting.net ...
Disadvantages Of CHO Cells
CHO (Chinese Hamster Ovary) cells are cell lines extracted from the ovary of the Chinese Hamster
and are exclusively used for commercial purposes in the production of recombinant therapeutic
proteins. Some proteins are to be synthesized using mammalian cells rather than the commonly used
microbial cells as the latter lacks the exact machinery to produce the complete protein or for safety
concerns. Among the mammalian cells, CHO cells continue to be the choice for the production of
several therapeutic proteins.
However there are certain disadvantages associated with CHO cells which include low productivity,
substrate–product stability, slower growth rate, low cell density, etc. These cell lines consume
nutrients continuously beyond stoichiometric needs. Thus, the mode of operation should be chosen
in such a way that they overcome the disadvantages of the CHO cell line.
The large scale production of therapeutic proteins in industries is done in suspension culture as the
adherent cell line poses a challenge in scaling up. Currently there are two dominant modes of
operation for producing therapeutic proteins based on mammalian cell lines (Hu and Aunins, 1997)
in industrial scale:
Fed–batch bioreactors
Perfusion ... Show more content on Helpwriting.net ...
There is a gradual addition of a fresh volume of selected nutrients during the growth–culture cycle.
It is basically a semi batch operation wherein nutrients are fed intermittently or continuously using
one or more fed streams. This is done to ensure that productivity and growth is promoted. Once a
run is finished, the culture is harvested and the product is sent to downstream processing. The
nutritional environment can be maintained approximately constant during the course of the batch.
Fed–batch culture is superior to conventional batch culture because concentrations of nutrients can
be
... Get more on HelpWriting.net ...
Perfusionist Personal Statement
I am a highly motivated perfusionist, and have the necessary skills and temperament required for the
challenges of a senior post. During my four years post qualification, I have demonstrated that I have
the ability to work well with colleagues, have good leadership skills and excel at motivating others. I
love to teach but also love to learn; I recently completed a MSc in Perfusion and have been able to
develop my teaching skills within the perfusion department.
I am extremely organised and have excellent time management skills; this enables me to work
efficiently to ensure the smooth running of any task undertaken. I am a very reliable person and
have an excellent attendance record (100%). I act in a professional manner both in theatre and whilst
representing perfusion elsewhere. I can ... Show more content on Helpwriting.net ...
I am comfortable being the 1st on call perfusionist and enjoy the challenges this brings. I work
extremely well under pressure and remain calm in confrontational and emergency situations.
I have a patient focused approach and have shown adaptabitlity within the dynamic changes of a
cardiac theatre and further afield. This has allowed me to contribute to the departments SOP's and
discuss our practice with the cardiac surgical team. I am confident that I would have great job
satisfaction continuing my career in perfusion and providing a senior role in your department.
Looking to the future, I would enjoy the management aspects of this senior role. I am interested in
joining the society or colleges' executive committees to help develop the profession over the coming
years
I aspire to participate in perfusion matters nationally. I have written review articles following
conferences and courses, within the society's bi–monthly publication (Perfusionist) and presented at
conferences (Cardiff University: Technology Enhanced Learning, Welsh Intensivist Training
... Get more on HelpWriting.net ...
Normothermic Perfusion Preservation
As evidenced, normothermic perfusion preservation is making a positive impact on the medical
community. There are many benefits to the normothermic perfusion technique that is causing its
rapid ascent, including: a unique opportunity to recover from established or acquired injury during
transplant, an ease of measuring organ function prior to implantation, and a remarkably improved
rate of both patient and liver survival post–operative. The injuries found in the transplant liver are
due either to pre–existing conditions from the marginal and cardiac arrest donors, or from the
ischemic conditions that occur in transplant. Among various transplant recipient groups, the rate of
liver graft rejection (and consequently severe complications or death) is significantly higher when
the donor liver has severe ... Show more content on Helpwriting.net ...
One of the most significant mechanisms of severe preservation injury arises from ischemia of the
organ resulting in an increase of antigen production. 1 This sets the precedence for the importance of
critically analyzing injury recovery potential as propagated though normothermic preservation as
opposed to cold static storage. Cold static storage lends itself heavily to injury as a result of oxygen
deprivation prior to removal, cold storage ischemia, rewarming, and reperfusion in the recipient
environment.2 Normothermic perfusion techniques effectively weave around the dangers of static
cold storage through the constant perfusion of blood, oxygen, and nutrients, all while maintaining a
sanguine environment for the excised liver. A 2011 study shows the drastic decrease of
proinflammatory genes and cytokines, endothelial cell injury, and
... Get more on HelpWriting.net ...
Reflection Of Genetic Communication For Nurses For Patients
Recently I took care of a patient N.S, 77–year–old male diagnosed with pneumonia by an ER doctor.
He transferred to hospital acute care medical unit after a few hours of stay in the ER. SBAR from
ER gave information on N.S: No known allergies, full code, NIBP 158/83, Heart Rate (HR) 92 beats
per minute, Temperature 36.8, respiration rate 18 breaths per minute, regular with decreased breath
sounds to the bilateral bases lower lungs, SPO2 98% 0n 2LNP. N.S has an occasional productive
cough and shortness of breath on exertion (SOBOE). N.S has a history of MI x 1 (dates not
mentioned) and coronary artery bypass graft (2009), HTN, and hyperlipidemia, asthma (for
unknown years).
More information on N.S or Patient as a Person
Getting to know the patient as a person is very important for nurses due to clinical judgement,
decision making, patient advocacy as well as a clinical learning process (Day, Paul, Williams,
Smeltzer, & Bare, 2010). By using effective therapeutic communication during patient assessment
also help build rapport with patient. I introduced my self to patient as his nurse for the day and I
found patient pleasant and co–operative. He verbally consented for further assessments. Patient
stated he has had fever and chills 2 days prior to hospital admission. He has been coughing green/
yellow sputum as well. Patient denied any chest pain, he also denied any nausea/ vomiting. In
addition to this information, I found out from ER notes that the patient has had a blood
... Get more on HelpWriting.net ...
Difference Between Poo2 And Sao2
For each of the four conditions below, give the expected changes (increased, decreased, or normal)
for PaO2 and SpO2/SaO2
Condition
PaO2
SpO2 / SaO2
Severe Anaemia
PaO2 remains normal. Severe anaemia is caused by a reduced amount of RBCs in the body. Oxygen
pressure only measures the free, unbound oxygen dissolved in the plasma. Since severe anaemia is
deficient in RBCs (oxygen molecules bound in haemoglobin in an RBC), it does not affect the
oxygen pressure.
Likewise, SaO2 remains normal. The oxygen saturation measures the amount of oxygen molecules
bound in the haemoglobin. Even if the the RBCs in the body are inadequate, the oxygen saturation
can still be normal since the remaining RBCs can still maintain an adequate amount of haemoglobin
... Get more on HelpWriting.net ...

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Cerebral Hydrolysis Case Study

  • 1. Cerebral Hydrolysis Case Study 3. Assess peripheral and central pulses, including cap refill. 1. Pulses are weak with reduced stroke volume and cardiac output. Cap refill is slow. 4. Assess for changes in the level of consciousness. 1. Early signs of cerebral hypoxia are restlessness and anxiety, with confusion and loss of consciousness occurring in later stages. Older patients are especially susceptible to reduced perfusion to vital organs 5. Assess respiratory rate and rhythm. 1. Rapid shallow reparations are characteristic of decreased cardiac output 6. Assess patient output 1. The renal system compensates for low blood pressure by retaining fluid and sodium. Oliguria is a classic sign of inadequate renal perfusion from reduced cardiac output. 7. Use the pulse ox to ... Get more on HelpWriting.net ...
  • 2.
  • 3. Myocardial Perfusion Imaging (MPI) Myocardial Perfusion Imaging is also known as (MPI). It is an imaging modality used in nuclear medicine to demonstrate the heart muscle functions; a low dose of radioactive agent is used for this study called a radiotracer. There are two different types of techniques used for myocardial perfusion imaging. The first is, single photon emission computed tomography (SPECT) and the second, positron emission tomography (PET). Myocardial perfusion imaging is commonly done for patients whose experience some type of chest discomfort, a recent myocardial infarction, or it may be used to access the blood flow to the myocardium that has been restored by bypass, stent or angioplasty. It can also be used to diagnose coronary artery disease. According to ... Show more content on Helpwriting.net ... Coronary artery disease also known as CAD, is the narrowing of the arteries, that's caused by expansion of plaque. When compared to other forms of modality for diagnosing coronary artery disease it may be the method of choice. When myocardial perfusion imaging is directly compared to exercise echocardiography, comparable sensitivities were revealed. When compared to myocardial contrast echocardiography or cardiac magnetic resonance imaging similar comparison was seen. Myocardial perfusion imaging may be used if a different test was vague just as if myocardial perfusion imaging was inconclusive a different modality may be used. For women ECG (electrocardiogram) is usually the diagnostic of choice. There have been several studies that have concluded that ECG maintain a high number of false positive in women. With using MPI it's more sensitive in diagnosing coronary artery disease in women. According to Loong (2004) "A recent study was performed where out of 1140 women 86% of women were diagnosed with coronary artery disease by MPI" (p.4). Some physicians suggest that women who have an intermediate probability of coronary artery disease, myocardial perfusion imaging is the non–invasive ... Get more on HelpWriting.net ...
  • 4.
  • 5. Symptoms And Treatment Of Skin When asked about their major illnesses, the client stated to have hypertension, severe dyspnea, and edema. The client also stated that she suffered from a heart attack in the past, which was due to high blood pressure. Many of the client's problems branched off from the heart attack and hypertension. For example, a heart attack and high blood pressure can cause heart failure, heart failure can cause pulmonary edema, and pulmonary edema can lead to swelling of the lower extremities and dyspnea (Grossman & Porth, 2014). However, the most recent hospitalization for the client was due to severe edema, and trouble breathing. Severe edema is one of the major causes for impaired skin integrity. Skin integrity is defined as "the state in which an individual's skin is at risk of being adversely altered" (kloop, Storey, & Bronstein, 2012). There are three major factors that can relate to client's skin alteration: decreased tissue perfusion, prolonged bed rest, and pulmonary edema. One factor that can cause impaired skin integrity is decreased tissue perfusion. Decreased tissue perfusion refers to "decrease in oxygen resulting in failure to nourish tissues at the capillary level" (Wilson, 2012). Reduced tissue perfusion causes the body to become distressed because it is not receiving enough oxygen. This causes the blood to "shunt to the core of the body where the vital organs are located," such as the heart and the brain (Grossman & Porth, 2014). Since the client suffered from ... Get more on HelpWriting.net ...
  • 6.
  • 7. Nursing Case Study Essay Impaired Gas Exchange r/t Behaviors: Oxygen Saturation that falls as low as 91% on room air at rest and after exertion After two to three minutes on Nasal Cannula of 2 Liters, Oxygern Saturation rises to 97 or 98% Pt is out of breath and physically tired after getting up to the bathroom and shower Rhonchi auscultated in the right middle and lower lobes Desired Outcomes: The patient's oxygen saturation will be kept above 96% throughout the entire shift The patient will be able to tolerate ambulation to the bathroom and to the shower with minimal shortness of breath Nursing Interventions: 1. Monitor the patient's oxygen saturation frequently (once per hour) at rest and after exertion on room air 2. Place patient on nasal ... Show more content on Helpwriting.net ... Assess patient's tissue perfusion through capillary refill and pulses 2. Monitor the patient's oxygen saturation frequently 3. Instruct the patient to reposition herself frequently and supply extra pillows for bony prominences like heels and elbows 4. Assess all areas of the skin to look for pressure ulcers and pay close attention to foot care 5. Keep the patient warm Rationale: 1. Capillary refill and pulses will give a good indication of the kind of perfusion the patient is experiencing. By checking these on the tips of the fingers and toes, the nurse will ensure proper assessment. Prolonged capillary refill or absence of pulses can indicate a serious problem and may result in tissue ischemia 2. Oxygen saturation has a great deal to do with tissue perfusion. The less oxygen–rich blood that is able to circulate throughout the body, the less perfusion is going on and the greater the risk for ischemia. 3. Pressure ulcers are a problem for anyone who is not mobile on a regular basis. With decreased tissue perfusion, the patient is at an even greater risk for tissue breakdown. Repositioning will ensure that no spot on
  • 8. ... Get more on HelpWriting.net ...
  • 9.
  • 10. Essay about Nursing Instructor Nursing Instructor PHYSICAL HISTORY: My clinical rotation was at St. Francis Hospital on the orthopedic/medical–surgical floor, 5–1. I was assigned JB for a patient 10/7 and 10/8. He was one day post–op from an elective bilateral knee arthroplasty. JB is a 69 year old Caucasian male who stands 6 feet tall and weighs 251 pounds. He has a history of hypertension, benign prostatic hyperplasia, degenerative joint disease, and renal calculi. Medications taken at home: Nifedipine 60 mg. QD to manage his hypertension and nonsteriodal anti–inflammatories for the DJD. JB's major problem is the degenerative joint disease (DJD) also referred to as osteoarthritis. According to Colodny, more than 50 million Americans suffer from ... Show more content on Helpwriting.net ... JB was admitted to St. Francis on 10/6, the day of surgery. On post–op day one 10/7 his vital signs were: Pulse–84, Respirations–20, Blood Pressure–130/70, and Temperature 101.5 F. on 10/8 they were 86, 20, 135/74, and 102.0 respectively. All vital signs except for the temperature were within normal limits for this patient. He received Tylenol 650 mg. pm every 4 hours for elevated temperature. Laboratory results showed a low hemoglobin of 8.6g/dl (normal 12–16g/dl) and a low hematocrit of 25.2% (normal 36–41%). JB received 1 unit (500 cc) of RBCs on 10/7 and 10/8. All other laboratory values were within normal limits. The primary nurse felt the transfusions contributed to or caused the elevated temperature because JB showed no other signs of infection through physical assessment or laboratory values. JB had clear lung sounds bilaterally. He had palpable pedal pulses and was positive for color, motion, and sensation in both affected extremities. Capillary refill was less than 2 seconds. His skin was warm and clean. He was diaphoretic due to an increased temperature. He had a quarter size reddened area on his coccyx that was being monitored and protective nursing interventions were instituted to prevent skin breakdown. JB was oriented to time, person, and place. SOCIAL HISTORY:
  • 11. JB was born and raised in Connecticut. He and his wife have been married ... Get more on HelpWriting.net ...
  • 12.
  • 13. Hypovolemic Shock Case Study Hypovolemic shock is an emergency condition caused by loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid (diaphoresis, diabetes mellitus, diabetes insipidus, emesis, diuresis, and diarrhea) in large amounts. This makes the heart unable to pump enough blood to the body (Heller, 2014). The severe compromise in blood flow and therefore systemic perfusion contributes to cerebral, renal, or hepatic ischemia and possible organ failure. It is the most common type of shock in children with dehydration and trauma being the most common factors (McCance, 2010. pp 1703). Pathophysiology Hypovolemic shock begins to develop after losing about a fifth or more of the normal amount of blood in the body resulting in compensatory vasoconstriction, increased SVR (systemic vascular resistance) and increased afterload in order to improve blood pressure and perfusion to core organs of the body (Heller, 2014) (McCance, 2010. pp 1672). Compensatory mechanisms have limited use and benefit. Hypovolemic compensations: Systemic vasoconstriction – increases left ventricular afterload and myocardial oxygen consumption and may produce tissue ischemia. Prolonged tachycardia – may impair subendocardial blood flow and increase myocardial oxygen consumption; both may ultimately contribute ... Show more content on Helpwriting.net ... After the onset of hypovolemic shock, the primary goals are to replace blood and fluid volume via IV infusion; maximization of oxygen delivery, and minimization of oxygen demand. Patient is positioned in a manner that supports maximal circulation and airway patency (oxygenation, ventilation, and perfusion). Diligent treatment of fever, fear and pain are necessary to reduce oxygen demand. Humidified supplementary oxygen is given as needed at up to 10 to 15 L/min by non– rebreathing mask or bag–mask ventilation and is monitored continuously through pulse oximetry (McCance, 2010. pp ... Get more on HelpWriting.net ...
  • 14.
  • 15. A Brief Note On Electro Encephalography ( Eeg ) Electro–encephalography : Electro–Encephalography (EEG) is primarily an electrophysiological monitoring method, recording the electrical activity of the brain. It involves placing electrodes along the scalp, which measure voltage fluctuations resulting from the ionic flux across the brain neurons. These are recorded graphically and typically referred to as 'brain waves'. Prior to the advent of Computed Tomography (CTScan) and Magnetic Resonance Imaging (MRI), EEG monitoring was the primary diagnostic tool for stroke, epilepsy and other focal brain disorders. EEG monitoring in the settings of cardiac surgery can be initiated before induction by anesthesia and continues in the post operative phase , in the intensive care unit (ICU). EEG monitoring is useful to detect seizures . The most common neurological symptoms manifest in the neonatal cardiac surgical intensive care unit include – Non convulsive seizures and Status Epilepticus; the primary cause being Hypoxic Ischemic Encephalopathy(HIC). Studies reveal that the incidents of HIC increase in the presence of adverse events like cardiac arrest and also in the use of Mechanical Circulatory Support, ECMO,etc. EEG can be influenced by the use of hypothermia and anesthetic agents. Use of deep hypothermia leads to isoelectricity, a marker of reduction in cerebral metabolism. The threshold for isoelectricty can be a useful indication for adequacy of ... Get more on HelpWriting.net ...
  • 16.
  • 17. AKI Case Frederick was given a preliminary diagnosis of a prerenal AKI. AKI is a complex condition with various different definitions available, most including a rapid decline in kidney function and the lack of ability of the kidneys to filter blood, subsequently leading to increased levels of serum creatinine and BUN levels in the blood (Cheung et al., 2008). AKI is the leading cause of nephrology consultation in the UK and carries with it high mortality rates (Basile, 2012). The primary causes of an AKI are hypoxia, ischemia and nephrotoxicity. The main underlying feature of an AKI is a rapid decrease in the glomerular filtration rate (GFR), which is strongly linked with a decrease in blood flow to the kidneys. The GFR depends on the interplay between ... Show more content on Helpwriting.net ... It is secondary to under–perfusion of otherwise normally functioning kidneys and if detected early can be reversible. In Mr Jones's case, his kidney's experienced hypo–perfusion during surgery. Hypo–perfusion consequently causes azotemia due to the excess nitrogenous wastes in the blood. Medications, such as high doses of dopamine, can cause prerenal kidney injury due to the production of intrarenal vasoconstriction, which can lead to hypo perfusion of the glomeruli (Nissenson, 1998). The kidneys have an enormous blood supply and account for 20–25% of cardiac output. This blood supply is needed for the removal of waste products and the management of fluid and electrolyte balances. If the blood flow to the kidneys is reduced, this has a decreasing effect on the GFR leading to a decreased urine output, filtration and reabsorption of filtered material through the glomerulus. This can lead to further issues and effect other organs in the body. Fredrick experienced a decreased urine output as a symptom of his reduced GFR. Fredrick's increased respiration rate noted during assessment was an indicator of his deterioration and alerted the medical team that there was an underlying issue. During the nurse's assessment, they observed that Frederic had very poor urine output, which is also linked with the drop in the GFR in the kidneys. Thus, encouraging the nursing staff to take immediate action with thereputic ... Get more on HelpWriting.net ...
  • 18.
  • 19. Dr. Steward's Priority Problems With Impaired Cardiac... Focused Assessments and Priorities Mr. Steward's priority problems include impaired cardiac tissue perfusion, impaired gas exchange, and pain. We are concerned about impaired cardiac tissue perfusion because the pt. is exhibiting signs of myocardial ischemia including chest pain and shortness of breath (Gillespie, 2012). Although we acknowledge that impaired cardiac tissue perfusion can decrease the function of the heart and will have the potential to affect the perfusion and delivery of oxygen to other end organs, our primary focus will be a focused cardiovascular assessment (House–Kokan, 2012). At 1800, Mr. Steward was SOB, had shallow and rapid breathing (RR = 44), and a SaO2 of 72% on RA. Due to the fluid buildup in his lungs, Mr. Steward has impaired gas exchange, and requires supplemental oxygen to maintain his SaO2; this warrants a focused respiratory assessment. Mr. Steward was pain free until this morning. He initially complained of right–sided chest pain and then complained about pain in his hip and ankle. We recognized this was a new onset of pain that persisted, despite giving him some pain medication. When Mr. Steward was discovered in his room clutching his chest, we recognized this as a non– verbal sign of pain and asked him whether he was having chest pain. Although Mr. Steward doesn 't provide a definitive answer, he displayed non–verbal signs of pain, such as restlessness, frequent shifting in bed, and act of clutching his chest. Recognizing Mr. ... Get more on HelpWriting.net ...
  • 20.
  • 21. Ischemic Stroke Case Study Multiple Thresholds for Different Components of the Brain in Ischemic Stroke Perfusion Imaging Introduction Stroke Stroke is a disease of national and global significance in prevalence, impact and cost [1–4].?Stroke is the third leading cause of death and leading cause adult disability in Australia [3]. Furthermore, the number of stroke sufferers is expected to increase in the future as the Australian population ages[5]. Stroke can be categorized into ischemic and hemorrhagic subtypes as each has a different mechanism and long term outcome. Ischemic stroke makes up 87% of all strokes and is caused by an occluded cerebral blood vessel causing hypoperfusion to areas upstream of the occlusion that result in tissue damage and dysfunction. Of all ... Show more content on Helpwriting.net ... Mixed common threshold for grey matter and white matter overestimate the perfusion lesion in white matter, but underestimate the tissue in white matter [71, 89, 90](summary of the threshold for grey matter and white matter separately from previous studies in figure 7). The variation of absolute perfusion values is highly individual. Furthermore, the variation of the absolute threshold is high between these studies (CBV range from1.67 to 2.4 6 ml/100g in grey matter, with a range of 1.19 to 1.7 6 ml/100g in white matter; CBF range from 17.7–34.6 ml/100g/min in grey matter, and a range of 12.3 to 20.9 ml/100g/min in white matter). Relative thresholds are able to delineate perfusion lesion better than absolute thresholds, due to relative thresholds are more consistent comparing to absolute thresholds, whereas, absolute thresholds varies individually, as previous research has been demonstrated [55, 56, 92]. However, these results lack of standardization and validation to define the optimal thresholds for grey matter and white matter separately. All of these previous studies had a limited number of patients, ranging from 9 to 21. It is clear, no agreement on multiple optimal thresholds setting to delineate acute tissue pathophysiology in grey matter and white matter separately using perfusion ... Get more on HelpWriting.net ...
  • 22.
  • 23. Laser Therapy Case Study The fetoscopic laser therapy [17] is currently recognized as the first–line treatment for stage I to IV TTTS diagnosed before 26 weeks of gestation, resulting in better survival and neurological outcomes of fetuses. However, because laser therapy has to coagulate the placental anastomotic vessels between the two fetuses in TTTS, the decreased placental perfusion to the donor twin with FGR may cause a higher fetal demise rate than in the TTTS donor without FGR [18]. Furthermore, the procedure of laser therapy is not free of complications. In our series, 11.4% of treated cases experienced premature rupture of membranes (PROMs) within 3 weeks, and 2.2% of treated cases developed chorioamnionitis needing termination [11]. So in the TTTS twins ... Show more content on Helpwriting.net ... MtDNA increases have been associated with hypoxia in the placentas of FGR [8]. Our results further suggest that the rescue perfusion from the AGA– to sFGR–fetuses determines the placental hypoxic status in the sFGR twins between these two groups. One potential etiology of sFGR in MC twins is its low placental share [12]. Our results (Figure 2) of similar placental discordance in the TTTS with sFGR (group 1) and the no TTTS twins with sFGR (group 3) provided evidence against the hypothesis that the different degrees of low placental share in the sFGR twins led to different placental mtDNA contents between these two groups. We have previously reported that the fetal / placenta weight (F/P) ratio is increased in MC twins with sFGR [19] when rescue perfusion from the larger placental territory to the sFGR one through vascular anastomoses works to promote growth of the sFGR twin. By this compensatory mechanism, the sFGR twin in each pair of shunt–patent twins (group 3) gets more perfusion than its small placental territory would usually supply, resulting in the alleviation of hypoxic stressors and a decrease of mtDNA content in the sFGR placental territory. On the other hand, laser therapy disrupts the vascular shunt between the TTTS twins and terminates the aforementioned rescue perfusion, resulting in hypoxia and, ... Get more on HelpWriting.net ...
  • 24.
  • 25. Septic Shock: A Case Study Nurses play a significant and a very critical role in decreasing incidence of septic shock by early identification immediate treatment. The first role of the nurse starts with assessing and recognizing patients who are at risk for sepsis. According to Janice Tazbir, RN., M.S., CCRN, early recognition of sepsis could decreases the mortality rate by 25% (Tazbir, 2012) Tazbir identified, very ill patients due to an infectious agent, patients in the intensive care unit, patients with invasive devices, patients with wounds, burns, and surgeries are at higher risk for sepsis that could lead to septic shock. However, nurses must keep in mind that some patients may not always develop the same classic signs of sepsis due to the effects of different medications that they may be receiving. For this reason, prevention is the key and it starts with implementing a thorough hand hygiene, and maintaining ... Show more content on Helpwriting.net ... Kleinpell, Aitken, and Achorr 2013, recommend that crystalloids solutions, such as normal saline and lactated ringers, or albumin, should be the fluids of choice when initiating fluid resuscitation. Their recommendation is based on a study trial that was conducted to evaluate the effectiveness of artificial colloids. The results indicated no survival benefits when using artificial colloids comparing to crystalloids (Kleinpell, Aitken, and Achorr 2013). In case of persistent hypotension after administering IV fluids, the nurse should advocate placing a central line to closely monitor central venous pressure (CVP). The Surviving Sepsis Campaign added a new guideline in 2012 to monitor CVP every 30 minutes for 6 hours straight. This allows the nurse at the bedside to be able to quickly resuscitate the patient with adequate fluids until the CVP normal level of 8–12 is achieved. (Surviving Sepsis Campaign, ... Get more on HelpWriting.net ...
  • 26.
  • 27. Nursing Care Plan Nursing Diagnosis # 1 Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85–95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity Goals 1) The patient will demonstrate effective breathing ... Show more content on Helpwriting.net ... Health Promotion Canada food guide Exercise programs Nursing Diagnosis # 2 Impaired skin integrity related to limited mobility, impaired tissue perfusion, decreased cardiac output, altered nutritional and hydration status, increased moisture, decreased sensory perception and excess weight as evidenced by patient being bed reddened 95% of the day, +2–+3 peripheral edema, stage III– IV coccyx pressure ulcer, drainage from the coccyx ulcer, high blood pressure, decreased oxygen saturation between 85–95 % 2L NP, weak peripheral pulses, obesity, excessively dry skin, sores on both legs (blister–like), denial of pain regarding dressing changes, and excessive diaphoresis with movement secondary to CHF, hypertension, hyperlipidemia, and non–insulin dependent type II diabetes. Goals 1) The patient will sit on the side of the bed by the end of the day and by the end of ... Get more on HelpWriting.net ...
  • 28.
  • 29. Compartment Syndrome Analysis Compartment Syndrome is a condition where there is an increase of pressure within a confined area that is detrimental to the circulation and function of the tissues in the area (Grossman et al., 2014). Fascia, a dense connective tissue, surrounds and separates the muscles and nerves into compartments in the extremities. These fasciae provide sites of attachment for muscles, maintain the positioning of muscle groups during motion and during contraction improve the mechanical advantage of the muscle (Von Keudell et al., 2015). These fasciae create a low compliance, defined anatomical area with their dense fibrous nature. These defined anatomical areas have a finite volume, meaning that it can only endure a finite pressure (Rekha, 2010). A compartmental ... Get more on HelpWriting.net ...
  • 30.
  • 31. The Effect Of Perfusion On The Body As Well As The... Various disease states related to profusion and the multitude of systems effected by perfusion insufficiency. Jason M. Carter El Centro Collage Author note Jason M. Carter, Department of Nursing, El Centro College Jason Carter is studying for his degree in Nursing Science at El Centro College Jason Carter Department of Nursing El Centro College, Dallas Texas 75202 Contact Jasonmcarter@yahoo.com Abstract This paper will discuss the effects perfusion has on the body as well as the multiple body systems that are effected from poor perfusion. We will be looking at the relationships between profusion as it relates to ischemic stroke, myocardial infarction, and tuberculosis. This paper will use online journal entries from EPSCO as well as off line entries from Lewis to help us find a better understanding into the related topics at hand. Lastly I will discuss stroke in depth as it pertains to my clinical experience and explain the strong link profusion has on ischemic stroke and the measures used to retain brain tissue. We will look at research done by Agarwal, Smriti (2015) that looks at the effectiveness and time saving procedures researched by his team when detecting stroke as well as research done by Dong, Hongli (2015) that shows a strong correlation between vitamin b12 and folic acid and the prevention of an ischemic event. Keywords: Ischemic Stroke, Perfusion Various disease states related to profusion and the multitude of systems effected by ... Get more on HelpWriting.net ...
  • 32.
  • 33. Npc Case Studies This is a prospective study which approved by the Human Research Committee. From June 2010 to May 2013, after informed and consent, 140 patients with NPC were enrolled into our study when the following criteria were met; (1) completed chemo–radiation NPC patient who follow up with Doctor at interval of 6 months, 1 years, and 1.5 years who the doctor was predict of the recurrenct NPC and was sent for CT scan of the nasopharynx and (2) patient was older than 18–year–old. The exclusion criteria included; (1) patient who refused participating the study (2) patient who had not completed two years follow–up and (3) patient had the contraindication for contrast–enhanced CT scan such as, pregnancy, allergic iodinated contrast medium or renal impairment (GFR < 30 mL/min). ... Show more content on Helpwriting.net ... When CT perfusion?. The perfusion CT parameters were obtained and analyzed. After that, all patients were routinely followed up by ENT examination and contrast–enhanced CT scan of the nasopharynx and neck for two years. During two years follow–up, the patient who had the suspicious foci of recurrence from ENT examination or conventional CT will undergo tissue diagnosis. After complete follow–up, patients were divided into two groups based on the final diagnosis of LR or non–LR groups. LR group defined as positive malignancy from the pathological report. The criteria for the non–LR group including (a) negative malignancy from the pathological report or (b) no suspicious foci of tumor recurrence from serial ENT examination or conventional CT follow–up (table1). The perfusion CT parameters were analyzed and compared between these two ... Get more on HelpWriting.net ...
  • 34.
  • 35. Myocardial Perfusion Imaging : Myocardial Obstruction And... Myocardial Perfusion Imaging also known as MPI is an imaging modality used in nuclear medicine to demonstrate the heart muscle functions; a low dose of radioactive agent is used for this study usually technetium –99m based radiotracer. There are two different types of techniques used for myocardial perfusion imaging, single photon emission computed tomography (SPECT) and positron emission tomography (PET). Myocardial perfusion imaging is usually done for patients who experience some type of chest discomfort, recent myocardial infarction, or to access the blood flow to the myocardium that has been restored by bypass, stent or angioplasty. And it can be used to diagnose coronary artery disease. According to Kostkiewicz (2015) "the best candidates for Myocardial Perfusion Imaging also known as (MPI) are people with poor exercise, ECG abnormalities, and pretest likelihood of disease according to the ECS guidelines" (p. 2). This modality is able to assess the severity of coronary obstruction and the extent of it; it's also able to localize hemodynamically the importance of stenosis. According to Johns Hopkins, Myocardial Perfusion Imaging shows the blood flow through the heart through either during exercise or pharmacologic. Doctors order these test for many reasons, some reasons include; check to see if there is narrowing of the coronary arteries, check to see if there's any damage from a heart attack, determine how well your heart will handle physical activity, decide if you ... Get more on HelpWriting.net ...
  • 36.
  • 37. Ultrasound Therapy Lab Report Objective: The principle of focused ultrasound therapy (FUS) is to elevate the pathological tissue temperature rapidly therefore to ablate the target tissue. While absorbing the thermal energy from ultrasound beam, the target tissue also have thermal exchange with surround tissues by conduction and convection. The blood vessels can generate more effective convection on the proximity. If the target pathological tissue locate the proximity of blood vessel, the thermal convective effect from blood flow must be considered. Thiel fluid is an advanced technology to store tissues, and it does not cause significant difference on thermodynamics properties. Therefore the Thiel kidney is the idea specimen for the perfusion and FUS therapy experiment. ... Show more content on Helpwriting.net ... The Thiel kidneys are placed into the sealed waterproof plastic bag, and the renal artery is used as the inflow, while the renal vein as the outflow. A tube is connect to the plastic bag to extract the saline water back to the heart lung machine to complete the circulation. Cable ties are required to close the distal of the artery to guarantee the whole saline water is perfused into the kidney's blood circulation network (Figure 1). The simulator is placed under the image–guided FUS surgical environment. Multiple image technologies is used for the FUS therapy experiment. X–Ray (OEC9900, GE, USA), MR scan (1.5T, GE, USA) are used to image the perfusing model. The ExAblate 2000 (Insighte, Haifa, Isreal) focused ultrasound is used to ablate the kidney perfusion model. The result will state the effect of blood flow on FUS therapy. The parameters for MRgFUS in this experiment are as follows: TE=100ms, TR=150ms, Flip Angle=60°, Slice Thickness=5mm. Acoustic Power=20W, Duration Time=20s. The sonication target position were selected nearby main vessels, approximately 5mm away from the vessesl. Each selected position were sonicated twice, one under the conidtion with blood flow, while the other without. The overall flow speed is controlled at 500 mL/min for porcine kidneys and 200 mL/min for human kidneys. The temperature rises are ... Get more on HelpWriting.net ...
  • 38.
  • 39. Fluid Resuscitation Protocols And Interventions Have... Fluid Resuscitation in Burn Patients Fluid resuscitation protocols and interventions have established guidelines for nursing care of burn patients in hospital settings. Although these protocols aid the nurse in making treatment decisions, the nurse must first understand the fluid pathophysiology of burns, the different fluid alternatives, the amount of fluid volume infusions allowed and their effects within the patient's body, as well as, any complications related to fluid resuscitation for burn patients. In addition, fluid resuscitation should be carefully and diligently monitored to ensure the main goal of therapy which is to attain adequate tissue perfusion while minimizing patient's complications. Understanding the fluid pathophysiology of burns Local and systemic inflammatory response occurs within the body due to fluid shifts from intravascular compartments into the interstitium caused by changes in capillary permeability. The body's specific response to burns directly correlates with the total body surface (TBSA) percentage affected. Patients with 25% TBSA burns experience an increase in generalized capillary permeability, at 30% TBSA burns patients are affected by a disruption on the cellular ion gradient lasting several days and requiring a longer hospitalization stay, and patients with 50% TBSA burns end up losing half of their fluid resuscitation volume due to increased leaks into the non–thermally injured tissue (Diver). Several studies coincide that the ... Get more on HelpWriting.net ...
  • 40.
  • 41. Acute Stroke The initial signs of acute stroke on nonenhanced CT are subtle but signs that may be visible would include: loss of distinction between white and grey mater, hypodensities in the brain parenchyma, loss of appearance of sulcal markings on surface of the brain and obscured delineation of basel ganglia. The presence of hyerdensity in a main artery may imply thrombus in a main cerebral artery. In the absence of contrast this sign has a high specificity but a low sensitivity for middle cerebral artery occlusion. Overall a nonenhanced CT brain in acute stroke has a sensitivity as low as 26%. If more than 30% of the distribution of the middle cerebral artery shows evidence of acute strioke thrombolysis is contraindicated. The Alberta Stroke Program Early CT Score ( ASPECTS) can be used to categorise patients as suitable or not for thrombolysis. In this system the ... Show more content on Helpwriting.net ... This has the effect to produce contrast between vascular structures and surrounding soft tissues. Depending on the timing of imaging after IV injection arteries veins or soft tissues are highlighted. For the purposes of acute evaluation of stroke as is described above an initial non contrats CT scan is performed , followed immediately afterwards by a CT angiogram to evaluate vascular structures from aortic arch to the vertex. This technique is very accurate for diagnosing occlusion of any of the cerebral arteries be they intracranial or extracranial. It will also diagnose the presence of stenosis or dissection of the carotid arteries or middle cerebral arteries. From these images reconstructions of intracranial and extracranial cerebral arteries can be made. A contrast enhanced cerebral angiogram is essential for the planning of thrombectomy as it will provide precise anatomy of cerebral arteries, any stenosis or thrombus in each ... Get more on HelpWriting.net ...
  • 42.
  • 43. Essay On Cardiopulmonary Bypass Cardiopulmonary bypass (CPB) has contributed to the evolution of modern day cardiac surgery. The establishment of extracorporeal circulation has helped the surgical team to carry out complicated surgical manouevers for treatment of complex cardiac lesions, especially complex congenital cardiac lesions, some of which were hitherto considered as inoperable. The advances in equipment and use of innovative techniques in perfusion have contributed to decreased mortality and/or morbidity in patients undergoing cardiac surgery in the modern day settings. However the necessity for monitoring the patient on cardiopulmonary bypass is of paramount importance. One of the key areas monitored during CPB is the neurological status of the patient. The inherent features of CPB like unphysiological flows, the fluctuations of temperature (use of hypothermia and rewarming), practices like hemodilution, organ protection strategies and unavoidable consequences like Systemic Inflammatory Response Syndrome (SIRS), all contribute to neurological sequelae. The possibility of neurological sequelae is enhanced in neonatal cardiopulmonary bypass, wherein the concept of extra–corporeal circulation is stretched to its limits. Hence neurological monitoring assumes a central place in the practice of 'safe, optimal perfusion' . ... Show more content on Helpwriting.net ... It receives almost 14% of the total cardiac output. The average cerebral blood flow is 55ml/min/100gm of brain tissue, which can increase upto 100ml/min/100gm brain tissue in neonates. The brain also contributes to 25% of the Total Oxygen Consumption (3.5mlO2/min/100gm brain tissue). Studies have revealed that the white matter of the brain contributes to almost 94% of the cerebral oxygen consumption whereas the gray matter contributes the remaining 6%. The sensorimotor area of frontal cerebral cortex is most susceptible to ischemic brain injury ... Get more on HelpWriting.net ...
  • 44.
  • 45. Brain Perfusion Visual Analysis 1.3.3 Image analysis The analysis of brain perfusion SPECT images is primarily visual. The visual analysis is based on a flexible and comprehensive qualitative evaluation of the image, and even more importantly, it includes the reader's medical judgment and the particular diagnostic question in each patient [Refs]. The visual analysis also helps to prevent misinterpretation when there are technical artifacts present in the image. However, the visual analysis is susceptible to inter– reader variability, especially in cases where CBF alterations may be subtle. This is one of the reasons for the need for quantitative methods of image analysis. Furthermore, quantitative methods are particularly useful in research, and make it easier, for example, to study associations with clinical variables of interest in a particular disease. One of the quantitative methods used for years in brain perfusion SPECT has been the method based on regions of interest (ROI). The method has evolved ... Show more content on Helpwriting.net ... Therefore, the relationship between brain regions (i.e. connectivity) is not considered in the analysis, thus ignoring important features of the complex network that is the brain [Refs]. In recent years methods have been developed to study brain connectivity using neuroimaging [Refs], one of which is based on graph theory that can be applied to brain perfusion SPECT data (it is described below). The quantitative methods explained so far quantify the CBF (in one way or another) but in relative units, which implies that the regional CBF values are relative to the number of counts corresponding to a reference value. The reference value may be the mean value of a specific brain region (e.g., the cerebellum) or the whole brain. The reference value should not be affected by the pathology under study, so that the regional relative CBF values are due to the effect of the disease in the patient and not to the reference ... Get more on HelpWriting.net ...
  • 46.
  • 47. Description Key Terms Of The Movement Of Blood Through The... Perfusion Concept Definition: the movement of blood through the body via veins and arteries to deliver oxygen and nutrients and to remove carbon dioxide and waste. Concept Key Terms: Acute coronary syndrome: obstructive thrombus formed in the coronary artery by the rupturing of an artheromateus plague Afterload: the amount of resistance to the flow of blood out of the ventricles Apical impulse (pulse): the pulse measured with stethoscope at 5th intercostal space mid line with the clavicle Artherosclerosis: plaque build up in the lining of arteries Atrioventricular (AV) node: the area of the heart conduction system responsible for receiving impulses from the SA node via intermodal pathways and stimulate the ventricles to contract Baroreceptors: nerve fibers that help control blood pressure and located in the aortic arch and carotid arteries Brachial (pulse): peripheral site at brachial artery in the anticubutal area Cardiac conduction system: the heart generated electrical signals that create an electrical action potential. Cardiac output: volume of blood pumped by the left ventricle(ltr/min) Cardiac stress test: test where exercise or medication is used to increase the oxygen demand of the body to analyze the function of the heart Carotid (pulse): artery located on the neck on each side of the trachea Compliance: for each unit of pressure the amount of blood that is in any given area of circulation Contractility: the heart muscles ability to ... Get more on HelpWriting.net ...
  • 48.
  • 49. Cardiomyopathy, Raynaud's And Perfusion Cardiomyopathy, Raynaud's and Perfusion Adequate perfusion supplies the entire body with necessary oxygen and nutrients to sustain life. The process of oxygenation and perfusion can be affected by a multitude of factors. A few examples are, a decreased oxygen carrying capacity, hypovolemia, neuromuscular disease, central nervous system alterations and chronic diseases (Potter, Perry, Stockert, & Hall, 2013, p. 826). Two specific examples of conditions affecting perfusion are cardiomyopathy and Raynaud's phenomenon. Perfusion Perfusion is one of three steps in the process of oxygenation. Ventilation is the mechanical action of inhaling oxygen and expelling carbon dioxide through the use of the diaphragm. This oxygen is dispersed ... Show more content on Helpwriting.net ... 829). In restrictive CMP the ventricular wall is stiffened and therefore loses its ventricular compliance. This causes the ventricles to become resistant to filling and thus demand high filling pressures to maintain CO (Kupper & Mitchell, 2014, p. 829). Clinical manifestations include trouble breathing, inability to tolerate exercise, and an overall feeling of exhaustion (Kupper & Mitchell, p. 829). These manifestations often occur because the ventricular filling is compromised since the heart cannot increase CO by increasing the heart rate alone (Kupper & Mitchell, 2014, p. ... Get more on HelpWriting.net ...
  • 50.
  • 51. The Complications Associated With Diabetes Mellitus ( Dm ) Abstract This paper explores the complications associated with Diabetes Mellitus (DM) including altered tissue perfusion. Altered tissue perfusion occurs as a result of DM and can cause many complications such as diabetic foot ulcers. Although altered tissue perfusion is not the only cause of ulcers, it contributes to the acceleration and degeneration of tissue once an ulcer forms. This paper also covers nursing diagnoses, individualized nursing interventions, patient and treatment goals as well as evaluation of outcomes, associated with an actual patient. I was able to treat a patient with hyperglycemia within my critical care clinical experience. It also covers the psychosocial concepts that influence teaching readiness, growth and ... Show more content on Helpwriting.net ... Small arteries in diabetic patients experience changes due to increased atherosclerosis. Tissue perfusion depends upon fasting plasma glucose and fasting insulin levels which are also dependent upon how sensitive the patient is to the insulin. Increased permeability to large molecules such as albumin is increased in diabetes, which can be associated with hyperglycemia (Levy, et al., 2008). Studies have shown patients with type 2 diabetes experience decreased coronary flow which is related to hemoglobin A1C and fasting plasma glucose levels (Marketou, et al., 2008). Mild insulin resistance can also be associated with a decrease in coronary flow. In addition, a decrease in myocardial perfusion in diabetic patients is related to decreased blood flow. An impairment in peripheral circulation leads to ischemia, which is associated with pain in the lower legs called intermittent claudication, which may result in lacerations of the feet (Levy, et al., 2008). Peripheral vascular disease (PVD) can cause thrombosis of the arteries causing tissue death. Gangrene from Diabetes Mellitus (DM) can lead to amputations beginning in the toes and moving into the foot (Lemone, Burke, & Bauldoff, 2011). Diabetes Mellitus is a chronic disease that has become an epidemic as it effects more and more the population each year. DM is a group of metabolic diseases, stemmed from the Endocrine systems, characterized by hyperglycemia ... Get more on HelpWriting.net ...
  • 52.
  • 53. Atherosclerosis Case Exercise A diagnosis of PVD indicates that there's a lack of tissue perfusion to the extremities, in this case to the patient's feet. This lack of tissue perfusion to the feet can be caused by a type of condition where it inhibits blood flow, which prevents oxygenated blood from reaching the extremities. Without oxygenated blood reaching the extremities, it will cause damage to the tissue as seen with ML's right toe. Having the ulcer on the right toe, indicates how there is lack of perfusion reaching that area. In chronic arterial insufficiency, the arteries are affected as they can become occluded or narrowed. By having the arteries occluded or narrowed, it will cause a decrease of blood flow. The decrease of blood flow is caused by atherosclerosis, ... Get more on HelpWriting.net ...
  • 54.
  • 55. Lack Of Recellularization Essay One of the major challenges that cardiac tissue engineering should cope with it effectively, is the generation of a thick vascularizable, cardia tissue to diffuse oxygen beyond the limited distance (200µ), to support cardiomyocte survival and maturation in the 3D replica of native organ. In addition, optimize amount of decellularization agents related to tissue types, age, and sex is critical to determine successful recellularization and remodeling of the engineered heart [47]. Obviously, the perfusion decellularization method has ensured successful whole organ decellularization with a well–preserved of the vascular tree [48], [23]. This method applies perfusion system to pass mild detergent through the intrinsic vascular networks. In spite of decreasing in the diffusion distance of decellularization ... Show more content on Helpwriting.net ... Thrombosis has been regarded as a main hurdle in transplantable whole organ engineered grafts. Therefore, an optimal recellularization methods would be at the forefront of diminishing thrombosis in the long term. In practice, lack of re–endothelialization of the heterotopic transplanted heart induced thrombosis [54]. H. Kitahara and colleagues have recently demonstrated the first heterotopic transplantation of an acellular and recellularized of the whole porcine heart fabricating by the perfusion system. They have administered two potential recellularization procedure to determine which of them contributed to prevent thrombosis. The first one was a coronary perfusion technique, in which the cell was delivered evenly throughout the whole heart. The second other method was a direct injection of the cell source. In that report, a whole porcine heart initially perfused with 1% SDS 1% triton X100 was added to remove cell debris, the process took less time (13h) as compared to the time required in another ... Get more on HelpWriting.net ...
  • 56.
  • 57. Acute Pancreatitis Case Study Evidence Based Practice Critical Review CT as a Prognostic Tool Clinical question: Can CT be used to predict the outcome and progression of acute pancreatitis in patients exhibiting early signs and symptoms? Database and search–terms: Database: PubMed – Clinical Queries with 'prognosis category' and 'narrow scope' selected. Search–terms: CT AND predict AND outcome AND (acute pancreatitis) AND symptoms Search results: After evaluation of the abstracts, of the 16 results uncovered from the search, only six actually discuss CT as a prognostic tool in predicting the outcome of patients with acute pancreatitis. Of these six potential articles, the rationale behind rejecting five was based on whether or not they also investigate patients ... Show more content on Helpwriting.net ... The table below displays the mean MTT in patients with mild acute pancreatitis and severe acute pancreatitis for each anatomical division of the pancreas. Head (seconds) Body (seconds) Tail (seconds) Mild acute pancreatitis 10.9 ± 2.3 10.8 ± 2.6 10.5 ± 2.6 Severe acute pancreatitis 8.7 ± 2.2s 7.9 ± 1.9s 8.3 ± 1.7s In contrast, within one day of exhibiting symptoms, the mean permeability surface area product values for head, body and tail of pancreas were already considerably lower (p = 0.0001) in patients with mild acute pancreatitis when compared to those with severe acute pancreatitis. The table below displays the mean permeability surface area product values in patients with mild acute pancreatitis and severe acute pancreatitis for each anatomical division of the pancreas. Head (mL/100g/min) Body (mL/100g/min) ... Get more on HelpWriting.net ...
  • 58.
  • 59. Alzheimer's Disease: How Cognition Decline? How Cognition Decline? Main reason for cognition decline could be buildup of plaque and dysfunctional proteins in the brain interfering with neuronal function. Alzheimer's disease (AD) is an age–related neurodegenerative disease that accounts for more than 60 % of all dementia cases. The disease is characterized by cognitive deficits and memory loss through a process that lead to the presence of amyloid–β (Aβ) plaques and neurofibrillary tangles (NFTs). This plaque is composed of abnormally hyperphosphorylated tau protein in the brain. Amyloid beta (Aβ or Abeta) is a peptide of 36–43 amino acids, forms amyloid plaques in the brain and are toxic to nerve cells. These peptides result from the amyloid precursor protein (APP), which is cleaved ... Get more on HelpWriting.net ...
  • 60.
  • 61. Human Body Continuously Need Blood Supply Essay Human body continuously need blood supply to the cell in order to deliver oxygen and nutrient to the cells and carrying out carbon dioxide out of the cell. In order to have good perfusion in tissue, a person has to have good cardiac health and patent vessels. Edema also affect tissue perfusion. There are many reasons that disturbed the normal flow of blood like ECG rhythm, congestive heart failure, hypertension, gestational hypertension, mitral valve prolapse, coronary artery disease, and peripheral vascular disease, which are also the exemplars of perfusion. There are many risk factors that can be modified to prevent the perfusion problem. Blood pressure greater than 140/90 is known as hypertension. Excessive sodium intake, hyperlipidemia, obesity, diabetes, extreme tobacco and alcohol use, over activity of sympathetic nervous system, and over production of sodium retaining hormones and vasoconstriction substances are major contributing factors of hypertension. Heredity, age, and gender are also the risk factors for hypertension (Bucher & Dirksen, 2014). Hypertension is one of the most underlying cause of impaired perfusion. High blood pressure for long period of time can shore up smooth muscles of artery as a result of building up the strength through hypertrophy and hyperplasia, which results in decrease size of arterial lumen. In older adult, the wall of artery become thick and hard due to above contributing factors that I mention. This alter vasomotor tone and blood ... Get more on HelpWriting.net ...
  • 62.
  • 63. Spinal Cord Protection Strategies For Thoracic... Spinal Cord Protection Strategies for Thoracic Endovascular Aneurysm Repair With an incidence once as high as 40%, spinal cord paralysis in thoracoabominal procedures has declined, however, still remains a devastating threat post–surgery (Roman, Grewal, Taylor, & Grigore, 2014). Modern techniques for repair of thoracic aneurysms and dissections include an open incision with extracorporeal bypass and aortic clamping. This surgical procedure puts patients at great risk for spinal cord paralysis. Open procedures required meticulous reimplantation of intercostal blood vessels, deep hypothermic cardiac arrest, epidural cooling, and various pharmacologic interventions. As surgical technique has advanced to percutaneous endograft repair, most of these techniques are no longer needed. However, the incidence of paralysis is still prevalent in patients having a TEVAR procedure. Naloxone, an opioid antagonist, has been studied as an additional pharmacologic adjunct in the prevention of spinal cord paralysis (Roman, Grewal, Taylor, & Grigore, 2014). Spinal cord injury can be multifactorial and a review of the literature indicates for patients undergoing endovascular repair of thoracic aneurysms, the use of multiple spinal cord protection strategies collectively reduce spinal cord injury compared to the use of naloxone as a primary measure. Literature Review Pathophysiology To understand the techniques utilized for spinal cord protection, providers must first understand the anatomy of ... Get more on HelpWriting.net ...
  • 64.
  • 65. Brain Perfusion Scan Research Paper Neurological Tests A brain perfusion scan is a type of brain test that shows the amount of blood in certain parts of the brain. This test tells doctors how the brain is functioning. There are different types of brain perfusion scans. The test would take place in radiology. A doctor may do the test is a patient has epilepsy, brain tumor, dementia, or has had a stroke. A medical assistant can tell the patient the steps and how this is performed. They can also tell them how long the procedure will take. The can give them information on what the doctor is looking for. Also if they need someone to drive them to and from the doctors. They should tell the patient if they are allowed to eat or drink before the procedure is done. The patient ... Get more on HelpWriting.net ...
  • 66.
  • 67. Slow Wave Lab Report Fig. 1. The effect of replacing extracellular chloride, [Cl–]o with gluconate on slow wave activity recorded from mouse jejunal smooth muscle layer. Replacement of [Cl–]o by gluconate significantly altered slow wave properties in a concentration dependent manner (see Fig. 2). A1, A2–C, Representative traces of intracellular recording made in [Cl–]o: 13.3 mM (A1, A2); 39.9 mM (B); and 119.8 mM (C), respectively. In 5 out of 9 experiments, slow waves were abolished (A1). In the remaining 4 experiments, small amplitude residual slow wave activity was observed (A2). The horizontal bar over each traces indicates perfusion period of low [Cl–]o solution. Expanded time scales are shown at the bottom of A1, A2, B, and C with different time points before and after the low [Cl–]o perfusion. Fig. 2. Measurement of electrical slow wave properties upon replacing ... Show more content on Helpwriting.net ... 6. The effect on slow wave activity of reducing [Ca2+]o in Krebs to the level of [Ca2+]o obtained by adding gluconate (A) and isethionate (B) (see Fig. 5). Lowering [Ca2+]o did not replicate the effect of replacing [Cl–]o with gluconate or isethionate on electrical activity in mouse jejunal smooth muscle layer. A–B, Representative traces of intracellular recordings upon perfusion with 0.13 mM and 0.54 mM [Ca2+]o. Expanded time scales are shown below the traces. C–I, Summarized data illustrating the effects of reduced [Ca2+]o on slow wave properties: At 0.13 mM [Ca2+]o, (equivalent to the level found in 13.3 mM Cl–, 120.3 mM gluconate Krebs) a decrease in the instantaneous frequency (F), shortening of slow wave width (G) and a decrease in the decay times from 90 to 10% of peak amplitude (I) were observed. These effects were reversible on washout. No change was observed in membrane potential (C) and the rest of the slow wave properties (E, H). No effects were observed at 0.54 mM [Ca2+]o (equivalent to 13.3 mM Cl–, 120.3 mM isethionate Krebs; panel D–I). Values are mean ± SEM (N=4–5, *P < 0.05, paired t ... Get more on HelpWriting.net ...
  • 68.
  • 69. Disadvantages Of CHO Cells CHO (Chinese Hamster Ovary) cells are cell lines extracted from the ovary of the Chinese Hamster and are exclusively used for commercial purposes in the production of recombinant therapeutic proteins. Some proteins are to be synthesized using mammalian cells rather than the commonly used microbial cells as the latter lacks the exact machinery to produce the complete protein or for safety concerns. Among the mammalian cells, CHO cells continue to be the choice for the production of several therapeutic proteins. However there are certain disadvantages associated with CHO cells which include low productivity, substrate–product stability, slower growth rate, low cell density, etc. These cell lines consume nutrients continuously beyond stoichiometric needs. Thus, the mode of operation should be chosen in such a way that they overcome the disadvantages of the CHO cell line. The large scale production of therapeutic proteins in industries is done in suspension culture as the adherent cell line poses a challenge in scaling up. Currently there are two dominant modes of operation for producing therapeutic proteins based on mammalian cell lines (Hu and Aunins, 1997) in industrial scale: Fed–batch bioreactors Perfusion ... Show more content on Helpwriting.net ... There is a gradual addition of a fresh volume of selected nutrients during the growth–culture cycle. It is basically a semi batch operation wherein nutrients are fed intermittently or continuously using one or more fed streams. This is done to ensure that productivity and growth is promoted. Once a run is finished, the culture is harvested and the product is sent to downstream processing. The nutritional environment can be maintained approximately constant during the course of the batch. Fed–batch culture is superior to conventional batch culture because concentrations of nutrients can be ... Get more on HelpWriting.net ...
  • 70.
  • 71. Perfusionist Personal Statement I am a highly motivated perfusionist, and have the necessary skills and temperament required for the challenges of a senior post. During my four years post qualification, I have demonstrated that I have the ability to work well with colleagues, have good leadership skills and excel at motivating others. I love to teach but also love to learn; I recently completed a MSc in Perfusion and have been able to develop my teaching skills within the perfusion department. I am extremely organised and have excellent time management skills; this enables me to work efficiently to ensure the smooth running of any task undertaken. I am a very reliable person and have an excellent attendance record (100%). I act in a professional manner both in theatre and whilst representing perfusion elsewhere. I can ... Show more content on Helpwriting.net ... I am comfortable being the 1st on call perfusionist and enjoy the challenges this brings. I work extremely well under pressure and remain calm in confrontational and emergency situations. I have a patient focused approach and have shown adaptabitlity within the dynamic changes of a cardiac theatre and further afield. This has allowed me to contribute to the departments SOP's and discuss our practice with the cardiac surgical team. I am confident that I would have great job satisfaction continuing my career in perfusion and providing a senior role in your department. Looking to the future, I would enjoy the management aspects of this senior role. I am interested in joining the society or colleges' executive committees to help develop the profession over the coming years I aspire to participate in perfusion matters nationally. I have written review articles following conferences and courses, within the society's bi–monthly publication (Perfusionist) and presented at conferences (Cardiff University: Technology Enhanced Learning, Welsh Intensivist Training ... Get more on HelpWriting.net ...
  • 72.
  • 73. Normothermic Perfusion Preservation As evidenced, normothermic perfusion preservation is making a positive impact on the medical community. There are many benefits to the normothermic perfusion technique that is causing its rapid ascent, including: a unique opportunity to recover from established or acquired injury during transplant, an ease of measuring organ function prior to implantation, and a remarkably improved rate of both patient and liver survival post–operative. The injuries found in the transplant liver are due either to pre–existing conditions from the marginal and cardiac arrest donors, or from the ischemic conditions that occur in transplant. Among various transplant recipient groups, the rate of liver graft rejection (and consequently severe complications or death) is significantly higher when the donor liver has severe ... Show more content on Helpwriting.net ... One of the most significant mechanisms of severe preservation injury arises from ischemia of the organ resulting in an increase of antigen production. 1 This sets the precedence for the importance of critically analyzing injury recovery potential as propagated though normothermic preservation as opposed to cold static storage. Cold static storage lends itself heavily to injury as a result of oxygen deprivation prior to removal, cold storage ischemia, rewarming, and reperfusion in the recipient environment.2 Normothermic perfusion techniques effectively weave around the dangers of static cold storage through the constant perfusion of blood, oxygen, and nutrients, all while maintaining a sanguine environment for the excised liver. A 2011 study shows the drastic decrease of proinflammatory genes and cytokines, endothelial cell injury, and ... Get more on HelpWriting.net ...
  • 74.
  • 75. Reflection Of Genetic Communication For Nurses For Patients Recently I took care of a patient N.S, 77–year–old male diagnosed with pneumonia by an ER doctor. He transferred to hospital acute care medical unit after a few hours of stay in the ER. SBAR from ER gave information on N.S: No known allergies, full code, NIBP 158/83, Heart Rate (HR) 92 beats per minute, Temperature 36.8, respiration rate 18 breaths per minute, regular with decreased breath sounds to the bilateral bases lower lungs, SPO2 98% 0n 2LNP. N.S has an occasional productive cough and shortness of breath on exertion (SOBOE). N.S has a history of MI x 1 (dates not mentioned) and coronary artery bypass graft (2009), HTN, and hyperlipidemia, asthma (for unknown years). More information on N.S or Patient as a Person Getting to know the patient as a person is very important for nurses due to clinical judgement, decision making, patient advocacy as well as a clinical learning process (Day, Paul, Williams, Smeltzer, & Bare, 2010). By using effective therapeutic communication during patient assessment also help build rapport with patient. I introduced my self to patient as his nurse for the day and I found patient pleasant and co–operative. He verbally consented for further assessments. Patient stated he has had fever and chills 2 days prior to hospital admission. He has been coughing green/ yellow sputum as well. Patient denied any chest pain, he also denied any nausea/ vomiting. In addition to this information, I found out from ER notes that the patient has had a blood ... Get more on HelpWriting.net ...
  • 76.
  • 77. Difference Between Poo2 And Sao2 For each of the four conditions below, give the expected changes (increased, decreased, or normal) for PaO2 and SpO2/SaO2 Condition PaO2 SpO2 / SaO2 Severe Anaemia PaO2 remains normal. Severe anaemia is caused by a reduced amount of RBCs in the body. Oxygen pressure only measures the free, unbound oxygen dissolved in the plasma. Since severe anaemia is deficient in RBCs (oxygen molecules bound in haemoglobin in an RBC), it does not affect the oxygen pressure. Likewise, SaO2 remains normal. The oxygen saturation measures the amount of oxygen molecules bound in the haemoglobin. Even if the the RBCs in the body are inadequate, the oxygen saturation can still be normal since the remaining RBCs can still maintain an adequate amount of haemoglobin ... Get more on HelpWriting.net ...