The Anatomy And Physiology Of The Heart

The Anatomy And Physiology Of The Heart
The aim of this report is to provide an overview of chronic heart failure, examining signs symptoms and treatment related to the case study, medical
history. The anatomy and physiology of the heart will be discussed, and the pathophysiology of chronic heart failure.
Heart failure is a general term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissue with vital blood–borne
nutrients. Most causes of heart failure result from dysfunction of the left ventricle.
The size of the heart is approximately the size of a persons closed fist. The weight is less than a pound, the heart is snugly enclosed within the Infer
mediastinum, and the medial section of the thoracic cavity, the heart is flanked on ... Show more content on Helpwriting.net ...
The right side continues to propel blood to the lungs, the left side is not able to eject the returning blood into the systemic system circulation (Farrell &
Dempsey, 2014) Blood vessels in the lungs become swollen with blood, creating pressure within the lungs. Pressure within the lungs increases as fluid
leaks from the circulation into the lung tissue. Causing pulmonary oedema (Marieb, 2014)
Heart failure is a condition where the heart fails to pump and circulate an adequate supply of blood to meet the requirements of the body. The muscles
of the heart become less efficient and damaged, leading to overload on the heart. (Craft, Gordon, Tiziani, & Huether, 2011)
Some of the main pathologies of heart failure include. The muscle contraction of the heart may weaken due to overloading of the ventricle with blood
during diastole. In a healthy individual, an overloading of blood in the ventricle triggers an increases in muscle contraction, to raise the cardiac output.
In heart failure, however, this mechanism fails due to weakened cardiac muscles (Neighbors & Tannehill–Jones, 2010)
To compensate for the lowered cardiac output, the heart rate rises. This makes the condition worse as the heart muscles require more nutrients to work
and the myocardial muscles pump at an increased rate (Koutoukidis, Stainton, & Hughson, 2013)
There are several conditions that can lead to heart failure. One example is heart muscle damage caused by a
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Chronic Obstructive Pulmonary Disease ( Copd ) Essay
Chronic obstructive pulmonary disease (COPD) is a group of gradual, incapacitating respiratory conditions, which include emphysema and chronic
bronchitis. It is generally characterized by reduced breathing capacity, airflow restriction in the lungs, a persistent cough, and other various
symptoms. COPD is notoriously associated with a history of cigarette smoking and has become the number one contributor to mortality in chronic
disease of the lower respiratory tract. It is also defined as a preventable and treatable disease with some additive pulmonary effects. The pulmonary
component of COPD is defined by airflow limitation that is not deemed to be completely reversible. The aspect of airflow limitation is generally a
gradual process and is associated with an abnormal inflammatory response in the lung to foreign gases or particles (McCance, 2014).
The disease is quite common, affecting millions of Americans, and has forced its way all the way up to being the third leading cause of death in the
U.S. Consequently, COPD is also associated with significant hardships in other aspects of life. Adults with COPD may have limitations during
activities of daily living such as walking or climbing stairs (CDC, 2016). They may be unable to work and might require special equipment such as
oxygen tanks (Wheaton et Al. 2013). They may present with other chronic diseases such as arthritis, CHF, diabetes, CHD, stroke, orasthma
(Cunningham et al. 2015). Alongside those hardships, they may

Case Study Essay
Case Study #5
Heart & Neck Vessels, Lungs & Thorax
Mrs. Lee, 80 year old Asian American female
Admitted to the medical–surgical unit with a chief complaint of "breathing problems". She speaks broken English & requests that her daughter be
allowed to stay with her. She is on nasal cannula oxygen & sitting up in bed. At this time, she seems slightly short of breath, but is not in acute
distress. You note that she is pale & has a petite frame. Her ankles are swollen. Her daughter tells you that she has been complaining of feeling more
tired in the evenings & "unable to catch her breath". While at home, she has been sitting up either in an easy chair or in bed with three pillows. Her
daughter states that Mrs. Lee has not had to ... Show more content on Helpwriting.net ...
2. What additional questions should you ask regarding this patient's chief reason for seeking care?
Chest pain, dyspnea (especially on exertion), orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, history of cardiac problems, family history
of cardiac problems, cardiac risk factors, & current medications.
3. After completing the health history, you prepare for the physical examination. What steps should you include in your assessment?
Inspection, palpation, percussion, & auscultation of lung sounds, heart sounds, & adventitious sounds.
4. What should you keep in mind, regarding this patient's age, when assessing her neck veins?
View the right internal jugular vein when measuring jugular venous pressure. With aging, the aorta stiffens, dilates, & elongates, resulting in decreased
pulsations on the left side. In addition, use caution when palpating & auscultating the carotid artery. Pressure in the carotid sinus may cause a reflex
slowing of the heart rate.
5. Describe how you would assess her heart sounds.
Explain to her (through her daughter as necessary) what you will be doing. You might want to explain that t takes extra time to listen to her heart &
that just because you listen for a long time does not indicate there is a problem. Move your stethoscope in inch–long increments, in a Z pattern across
the chest, from the base of the heart, across & down, then over to the apex. Although heart sounds are generally lower in pitch,

Essay On Catheterization
The objective of this paper is to explain the procedure for inserting non–tunneled central venous catheters and possible uses and complications. The
technique for central venous catheterization was first described by Sven Ivar Sledinger in 1952 (Watcher 2000) and is still the standard for inserting
catheters today. There are variations, but the general procedure includes the following: 1. clean the skin with an antiseptic solution and if patient is
conscious, give local anesthesia 2. insert the needle into the desired blood vessel and aspirate to make sure you are in the vein 3. insert a guidewire
through the needle 4. advance the catheter over the guidewire to the appropriate distance 5. remove the guidewire 6. suture or staple the catheter to the
skin and place a sterile dressing over the insertion site (Jackson 2010) Generally, a chest x–ray is done to verify placement and to rule out a... Show
more content on Helpwriting.net ...
Other uses are central venous pressure monitoring, hemodialysis, hyperalimentation, vasopressor administration, (Watcher 2000), total parenteral
nutrition (TPN) and chemotherapy administration. When an ultrasound is used to guide the catheter to the correct place, the instance of complications
goes down dramatically. (Jackson 2010) The femoral CVC is not used as much as it is prone to infections and has a higher instance of blood clots.
(Jackson 2010). The subclavian CVC is contraindicated in patients with coagulation problems because if there are any issues when inserting, it is
difficult to apply pressure at the insertion site because of the clavicle bone is in the way. (Jackson 2010) Other contraindications: inserting a needle
through an area of infection, patients with distorted anatomy or landmarks, chest wall deformities, bleeding disorders and anticoagulation therapy,
vasculitis or suspected previous injury to the vessel to be used. (Watcher

Cardiac Physiology
Module 5 CARDIAC PHYSIOLOGY Case No. 1 Melvin Rodriguez was admitted at the intensive care unit. On the first hospital day, he developed
hypotension, BP of 70/40, cardiac rate of 100 beats per minute, rales all over lung fields, respiratory rate of 24 breaths per minute. Pertinent physical
examination showed patient was dyspneic, distented neck vein. Patient was on left ventricular failure with pulmonary congestion. Questions 1. What is
the Frank starling law of the heart? The Frank–Starling law of the heart (also known as Starling's law or the Frank–Starling mechanism or Maestrini
heart's law) states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end... Show more
content on Helpwriting.net ...
Digoxin enhances myocardial inotropism and automaticity but slows impulse propagation through the conduction tissues. Digitalis reciprocally
facilitates calcium entry into the myocardial cell by blocking the Na K adenosine triphosphatase pump. This calcium influx may account for its positive
inotropic action because this inotropic response is not catecholamine– or beta receptor– dependent and is therefore effective in patients taking
beta–blocking drugs. Digitalis was expected to increase contractility and return the Frank–Starling relationship toward that seen in a normal ventricle. 5.
Why was he sent home on a low sodium diet? Sodium is usually limited to prevent fluid accumulation. A low sodium diet was recommended to
reduce extracellular fluid volume and blood volume, and to prevent subsequent episodes of pulmonary edema. Case No. 3 Theresa Camantiles was a
38 year old home maker and mother of 4 children. Keeping house and driving the children to activities kept her busy. To stay in the shape, she took
aerobics classes at the local community center. The first sign that Theresa was ill was vague; she fatigued easily. However, within 6 months, Theresa
was short of breath, both at rest and when she exercised, and she had swelling in her legs and feet. She then sought medical consult. On physical
examination, she had distended jugular vein, liver was enlarged and had ascites in her peritoneal cavity and edema in her legs. A fourth

Essay On Copd
Diagnostic Tests The physical signs and symptoms of COPD and CHF may coexist, and it will be hard for the physician to determine which causing
the shortness of breath to patient X. The history of progressive shortness of breath can help with the diagnosis and since patient X has history of
previous hospitalization of COPD, it is given that its mainly the cause. Chest x–ray shows hyperinflation of the lungs which is indicative of COPD.
Blood tests like complete blood count and biochemistry results does not show much relevance to disease however arterial blood gases demonstrates
hypoxia. Patient X displays poor improvement after 5 days and electrocardiogram presents high negative predictive value for the diagnosis of systolic
ventricular... Show more content on Helpwriting.net ...
Assessment from head to toe is also important. Examining the eyes, color of lips if cyanotic and cognition of patient may reveal signs of hypoxia.
Physical examination of large, barrel shaped chest may indicate hyperinflation. Auscultating the chest for wheezes which usually comes in COPD
may support the diagnosis and cause of SOB. There could be absent of breath sound and presence of crackles. It can help determine the right
medication regimen for the patient. Giving regular nebulization frequently and as needed can help patient breathe easier. Examining the hands for tar
staining and cyanotic of nail are common in COPD according to Bourdin et al. (2009). There could also be presence of hand flap or tremor, which
usually suggest retention of carbon dioxide (Bourdin et al. 2009). The breathing pattern of COPD patient may be abnormal and prolonged expiration
indicates airflow obstruction. Due to hyperinflation the chest wall may expand resulting to barrel shaped chest. We should also assess oedema in lower
extremities for it determine the amount of fluid retention in the body. Aside from these, 4 hourly observation or as frequent as necessary is also
necessary until the patient is stable. Heart rate and temperature are usually high because of lack of oxygen in the body. The heart compensates to meet
the body needs of oxygen so the heart pumps faster than usual. Due to metabolic activity of the body, body temperature rises, and we can observe in
patients with COPD

Nursing Case Studies Pathophysiology
The patient had been in his usual health: hypertension, dyslipidemia, and coronary artery disease on a medical regime until approximately 8:30 on
the morning of admission when his girlfriend found him unresponsive and lying on the floor of his home. She called emergency medical services
(EMS) and shortly after that, he regained consciousness, rose to sit in a chair, and reported chest pain and dizziness. He took two sub sublingual
nitroglycerin tablets. On examination by EMS personnel and at 8:42 am, they found that he was alert and oriented and appeared uncomfortable and
that he had pale and diaphoretic skin and was grasping at his sternum and moaning. He reported that he had taken his regular daily aspirin (325 mg,
orally) earlier in the... Show more content on Helpwriting.net ...
Supplemental oxygen was administered through a face mask at a rate of 15 liters per minute, and 2 intravenous catheters (18 gauge) were inserted, one
into the antecubital vein in the right arm and the other in a vein in the left forearm. At 8:50 am, the attendant recorded that the blood pressure was 110
/90 mm Hg, the pulse 51 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 98% and that the patient was reporting
chest pain rated at 7 on a scale of 0 to 10, with 10 indicating the most severe pain. A 12–lead ECG was then done showing a sinus rhythm at 60 beats
per minute; ST–segment elevation of 2 to 3 mm in the inferior leads (II, III, and aVF) and in leads V3through V6 and marked ST–segment depression
(reciprocal) with T–wave inversion in leads aVL, V1, and V2. Transport to thehospital was finally begun at 8:52 am. Three minutes later, the patient
vomited, became increasingly pale and diaphoretic, and then was unresponsive to voice. A 500–ml bolus of normal saline was pushed down one of his
IV lines and didn't change his status. An attempt at tracheal entubation was unsuccessful and instead, a nasopharyngeal airway was inserted. Thereafter,
the patient was noted to be breathing on his

Cardiac Tamponade Lab Report
Cardiac Tamponade is a life–threatening medical complication in which blood or fluids fill the area between the sac that encases the heart and the
heart muscle, placing tremendous pressure on the heart. The extreme pressure restrains the heart's ventricles from extending fully and keeps the heart
from functioning normally. The heart is not able to pump enough blood to the rest of your body, which could lead to organ failure, hypotension,
shock, and in the worst case possible even death. According to (NCBI) 2 out of 10,000 people can end up getting the condition. (Barwell, 2012)
This pressure is enough to back up blood returning to the heart as well. There are many different things that can cause the onset of cardiac
tamponade. There are several types of test that can be performed to see if the individual presents the signs of cardiac tamponade. An Echocardiogram
is the main test that is used in diagnosing and determining if the patient has cardiac tamponade. While performing an Echocardiogram, a sonographer
will pay special attention to the pressure of the mitral and tricuspid valve. The sonographer will use PW Doppler on both of these valves and see the
differences between the E waves and ... Show more content on Helpwriting.net ...
Weight loss, fatigue, and chest pain are among symptoms that could show in Cardiac Tamponade. (Yarlagadda, 2014) Other symptoms may include:
Dizziness, drowsiness, weak or absent pulse, anxiety and restlessness, sharp chest pain, palpations, rapid breathing, and discomfort. (Kato, 2014) Pale,
grey or blue skin; fainting, and problems breathing are all serious symptoms of Tamponade. Tamponade can cause many different symptoms to show
since the heart disease is so severe. Jugular venous distension tends to be one of the most common signs in clinical diagnosis of cardiac tamponade.
Low blood pressure and chest pain that radiates to the neck, shoulder, or back are not as common symptoms that could occur with Cardiac

M. T's Coronary Artery Analysis
The coronary artery that was occluded in M.T.'s coronary circulation were the right coronary artery. When coronary blood flow is interrupted for an
extended period, myocyte necrosis occurs. This results in MI. In the majority of MI, the decrease in coronary flow is the result of atherosclerotic CAD
(McCance & Huether, 2014). M.T. is experiencing transmural MI. According to H. Michael Bolooki (2010), a transmural MI is characterized by
ischemic necrosis of the full thickness of the affected muscle segment(s), extending from the endocardium through the myocardium to the epicardium.
M.T. was exhibiting crushing substernal chest pain radiating down his left arm. He was complaining of dizziness and nausea. During M.T.'s physical
exam, he... Show more content on Helpwriting.net ...
"Vasodilatation reduces cardiac preload and afterload and decreases the myocardial oxygen requirements needed for circulation. Vasodilatation of
the coronary arteries improves blood flow through the partially obstructed vessels as well as through collateral vessels" (Bolooki and Askari,
2014). Nitrates, such as nitroglycerin reverse the vasoconstriction associated with thrombosis and coronary occlusion. Morphine is the analgesic
opioid of choice for ischemic cardiac pain. Morphine has been shown in studies to decrease cardiac workload and decrease the anxiety and fear
associated with chest pain. The heart is influenced by the needs of the body. Bed rest is important during the acute phase of a myocardial
infarction because when a person is at rest, the organs, muscles and tissues will require a reduced amount of blood and oxygen (Peate and Jones,
2014). This results in a decrease workload of the heart and myocardial oxygen consumption, decreased blood pressure, and decreased heart rate.
Vital signs should be closely monitored after a STEMI to monitor for any potential complications. Hypotension is a potential complication when
using vasodilators such as nitroglycerin and in the use of opioids such as morphine sulfate to control pain associated with MI's. Blood pressure also
needs to be closely monitored because heart failure is a serious complication after a STEMI. Cardiac monitoring should be included for the first 24
hours after a STEMI for early detection

Bipa Case Study Essay
A 70–year–old female with a 50–year history of uncontrolled hypertension despite a combination of antihypertensive agents that lastly includes:
amlodipine 10 mg, spironolactone 25 mg, losartan 100 mg, and furosemide 40 mg; all were used once daily. She was referred to our center as a case
of ADHF for further workup. On admission, the patient was in severe respiratory distress consistent with the New YorkHeart Association (NYHA)
class III–IV and was orthopneic but fully conscious with normal cognition. Physical examination showed: a blood pressure of 153/93 mmHg, heart
rate of 117 beats per minute, respiratory rate of 28 breaths per minute and oxygen saturation of 94% on BiPAP. She had bilateral basal crepitation,
bilateral scattered rhonchi, ... Show more content on Helpwriting.net ...
The diameter of the narrowest part was about 3 mm with significant prevertebral and intercostal collaterals. There was bicuspid aortic valve (BAV)
type 1 with severe asymmetric diffuse leaflet calcifications and marked calcifications of the ascending aorta and aortic arch. Aortography confirmed
the diagnosis of severe calcified juxtaductal CoA. There was a 70 mmHg peak to peak gradient across the coarctation, 90 mmHg gradient across the
aortic valve and the mean left ventricular pressure was 290/26 mmHg. Coronary evaluation demonstrated a significant proximal LAD lesion with a
fractional flow reserve (FFR) value of 0.78. A significant dilatation of the left internal mammary artery was also noted. The presence of high gradient
across the coarctation together with the presence of hypertension necessitates a curative treatment. A multidisciplinary heart team of interventional
cardiologists, cardiac anesthesiologists, vascular and cardiac surgeons decide to perform endovascular repair of both cardiac and vascular pathologies
by two–stage approach due to the significant comorbidities mainly uncontrolled hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary
disease and also the presence of severe calcifications of the ascending

The Central And Picc Line Insertion
I am going to discuss the central and PICC line insertion. I will to base about the safety of the insertion process. The benefits that come along with
choosing to insert a PICC line verse a peripheral IV. Like most topics, there will be risks involved, but with proper technique, you can prevent these
risks
This paper is going to cover peripherally inserted central catheter (PICC) and central lines. I am going to talk about what a PICC line is, how a
PICC line is inserted, what the benefits of using a PICC line are, the risks that come alone with the insertion process, and treatments offered when
using this method. There are many other ways to give treatments besides PICC line. A peripherally inserted central catheter or PICC line "is a thin
soft flexible tube" (Peripherally Inserted Central Catheter (PICC). (2015). It is usually inserted in the upper arm just above the elbow in a main
vein that will lead to the heart where the blood flows more rapidly. Midlines are inserted usually into the vein in the arm. Sometimes you will need to
use a leg vein when caring for infants. They last longer than a regular IV, but not as long as a PICC line. "It can usually be used for 2–4 weeks"
(Peripherally Inserted Central Catheter (PICC). (2015). The central venous catheter is "placed into a large vein leading into the heart and comes out
through a small opening in the chest area" (Peripherally Inserted Central Catheter (PICC). (2015). which they call the exit site. The big

Hepatic Portosystemic Shunt Case Study
Four years ago, one of our long time family friend was diagnosed with Cirrhosis. This is a disease of the liver that causes scarring and inflammation
of the liver. The liver cells affected by cirrhosis start to degenerate and affect functions of the liver. For sometime before, he had symptoms of
abdominal and legs swelling, blood in the stool and was suddenly gaining weight. The doctor described his condition as end of liver stage disease that is
preventing proper blood flow through the liver and recommended transjugular intrahepatic portosystemic shunt (TIPS) procedure to be performed.
Transjugular intrahepatic portosystemic shunt (TIPS) is a less invasive procedure done by putting a stent in a patient liver connecting portal vein and
the hepatic vein in order to relive vascular blood pleasure from the portal vein that can cause portal hypertension.
Liver is an important organ in human body. It has several important functions. This includes, purifying blood by removing harmful substances,
production of bile, and storage of nutrients. It also acts as a passage of blood from the spleen and the gastrointestinal tract to the inferior vena cava.
Hepatic portal vein is the ... Show more content on Helpwriting.net ...
The hepatic portal hypertension is caused by the increase of blood flow from the abdominal cavity and an increase of resistance to blood flow in the
liver. When this condition happens, it can lead to various complications this includes, swelling of the spleen, gastrointestinal bleeding, leg swelling
because of fluid, jaundice or the yellowing of skin, and accumulation of fluid in the abdomen. Increase in hepatic portal vein pressure leads to
collateral vessels formation that tries to bypass the liver and drain the blood into the general circulation. This can result in developments of enlarged
varicose veins in the esophagus that may result to bursting and leaking

Symptoms And Treatment Of Chest Pain Essay
CHEST PAIN INTRODUCTION Chest pains have different etiologies; it can be of life– threatening origin such as cardiac disease to pulmonary
origin or benign gastro intestinal and musculoskeletal, in some cases as a result of cocaine usage. Early diagnosis and treatment of life–threatening
chest pain will reduce associated mortality (Meeisel & Cottrell, 2015) This essay will discuss a case of Mr P, 63 year old with chest pain his
general appearance, general history, his physical examination, three diagnostics considerations and differential diagnoses for chest pain. It will
further discuss diagnostic tests carried out, the results, final diagnoses and rationales for the decision. GENERAL APPEARANCE: Mr P is
overly built 63 year old male, Caucasian origin, neatly dressed, appeared to be in moderate to severe chest pain, sweaty and dyspnoeic.
PRESENTING COMPLAINT: Mr P presents with of sudden onset of chest pain, the pain is constant, feels some tightness, pressure and squeezing in
the chest and radiates to lower jaw, neck and right shoulder, has vomited twice, dyspnoeic and some diaphoresis. HISTORY OF PRESENT
COMPLAINT: Patient reported sudden onset of chest pain while singing in the church, no previous history of chest pain. PAST HISTORY:
Hypertension, Hyperlipidemia, Diabetes Tonsillectomy at 9 years of age No other previous surgery No history rheumatic fever Up to date
immunisation as a child Prostate screen 2 years ago was normal. Medication: Metoprolol 100mg

Congestive Heart Failure Research Paper
I.Congestive Heart Failure
Heart failure (HF) is defined as a multifaceted clinical syndrome that can result from any structural or functional cardiac disorder that impairs the
ability of the ventricle to fill with or eject blood. In HF, the heart may not provide tissues with adequateblood for metabolic needs, and cardiac–related
elevation of pulmonary or systemic venous pressures may result in organ congestion1. In the United States, HF is increasing in incidence with about
5.1 million people suffering from HF and half of people who develop HF die within 5years 2. Over 75% of existing and new cases occurred in
individuals over 65 years of age, < 1% in individuals below 60 years, nearly 10% in those over 80 years of age. HF costs the ... Show more content on
Helpwriting.net ...
They have the ability to self–renew or multiply while maintaining the potential to develop into cells. Such as cells blood, heart, bones, skin, muscles,
brain etc. Stem cells have an interesting history that has been somewhat tainted with debate and controversy. In the mid–1800s it was discovered that
cells were basically the building blocks of life and that some cells had the ability to produce other cells.
Attempts were made to fertilize mammalian eggs outside of the human body and in the early 1900s, it was discovered that some cells had the ability
to generate blood cells. In 1968, the first bone marrow transplant was performed to successfully to treat patient's severe combined immunodeficiency.
There have been many stem cell discoveries since the early 1900's but the two majors were in 1998 when, Thompson, from the University of
Wisconsin, isolated cells from the inner cell mass of early embryos and developed the first embryonic stem cell lines. Then, in 1999 and 2000, scientists
discovered that manipulating adult mouse tissues could produce different cell types.

Heart Failure Research Paper
METHODOLOGIES In order to obtain relevant information to support this topic, databases including PubMed, Medline, UpToDate, and Google
Scholar were used. Terms used in each search included and combined the following: mesenchymal stem cell, cardiac stem cells, HF, heart repair,
ejection fraction, cardiac output, cardiac index, mortality. Combining the terms yielded 42 results. Limiting these to human and English language
reduced it to 26 articles: the articles were then limited to double–blinded, randomized controlled studies as there are most appropriate for studying
questions regarding treatment, produced 22 articles. The abstracts of the excluded non–English paper were reviewed to ensure we did not miss relevant
studies. The articles that... Show more content on Helpwriting.net ...
Over 75% of existing and new cases occurred in individuals over 65 years of age, < 1% in individuals below 60 years, nearly 10% in those over 80
years of age2. HF costs the nation an estimated $32 billion each year, which includes the cost of health care services, medications to treat HF, and
missed days of work.3 TYPE OF CONGESTIVE HEART FAILURE Heart failure may be right sided or left sided (or both). In LV failure, the most
common symptoms are dyspnea, reflecting pulmonary congestion, and fatigue, reflecting low CO, tachycardia and tachypnea may also occur.
Dyspnea usually occurs during exertion and is relieved by rest. Patients with severe LV failure may appear visibly dyspneic or cyanotic, hypotensive,
and confused or agitated because of hypoxia and poor cerebral perfusion. Some of these less specific symptoms (eg, confusion) are more common in the
elderly 1. In contrast to LV failure, in RV heart failure, the most common symptoms are ankle swelling and fatigue, visible elevation of the jugular
venous pressure. Sometimes patients feel a sensation of fullness in the abdomen. Hepatic congestion can cause right upper quadrant abdominal
discomfort, stomach and intestinal congestion. In severe cases, peripheral edema can extend to the thighs or even the sacrum, scrotum and
occasionally even higher

Tachycardia Induced Cardiomyopathy Case Study
Mr S is tachycardic (Awtry, Jeon, & Ware, 2006), which means that there is disruption of the normal electrical impulse. The presence of atrial
fibrillation would suggest that the disruption in electrical activity is occurring in the left atrium rather than the sinus node. If the heart rate has been
elevated for a prolonged period it could lead to tachycardia induced cardiomyopathy (TIC) which can lead to HF (Patel & Whittaker, 2007). The
increase in resting bpm is a compensatory mechanism used to maintain cardiac output when there is a loss in pumping capacity (Watson, Gibbs, & Lip,
2000). The potential diagnosis of heart disease or failure is further evidenced by no palpable apex beat. This displacement of the apex beat usually
indicates cardiomegaly; cardiomegaly is a sign that the heart cannot keep up with its workload and so enlarges to compensate (Madhok et al., 2008).
This enlarged heart starts to retain fluid, causing the lungs to become congested and can potentially result in the irregular pulse found on
investigation (Kruijt & Turin, 2012). This excessive fluid in the airways can also be the cause of inspiratory crackles. If on examination there
appeared to be transudate, this can help to add to the clinical suspicion of chronic heart failure. The character of the crackle can also help in diagnosis;
a moist late inspiratory crackle suggests restrictive (alveolar) ... Show more content on Helpwriting.net ...
This sound can be an important sign of systolic heart failure because the myocardium is overly compliant, resulting in a dilated left ventricle which can
be due to dilated cardiomyopathy (Silverman, 1990). The jugular venous pressure (JVP) provides an indirect measure of central venous pressure. An
elevated JVP is most commonly caused by congestive heart failure; in particular it reflects right ventricular

Paper
Health Assessment
Physical Assessment Documentation Form
Date: __3/3/16
Patient Information Patient Initials| LD| Age| 30| Sex| Female|
General Survey
Does patient appear to be their stated age?| Yes| Level of consciousness| Alert and Oriented x3| Skin color| Caucasain| Nutritional status| No
malnurishment noted, pt she eats three meals a day| Posture and position| Patient maintains good posture and position| Obvious physical deformities|
No physical deformities noted| Mobility: gait, use of assistive devices, ROM of joints, no involuntary movement| no problems with mobility noted,
patient ambulates w/o assistance, ROM of joints intact, patient pt able to rotate feet, ... Show more content on Helpwriting.net ...
| Describe the purpose of the otoscope| checking ears for buildup and injuries, drainage, etc | Explain the Weber and Rinne tests| Rinne test involves
tuning fork to be placed on the mastoid bone, and ask when patient no longer hears the vibration,and checks for air conduction and bone
conductionWeber test involves stricking the tunning fork in placing in middle of head and ask what ear the sound is coming from, hearing sound in
both ears could be a sign of hearing loss (Stubblefield, 2014)| Nose External nose| External nose skin intact, no lesion noted, smooth skin noted, small
pores pt denies c/o, no problems noted| Patency of nostrils| Patency noted in nostrils, no drainage noted| Describe the purpose of the nasal speculum
exam | Nasal speculum is used to widen the nasal passage for inspection| Mouth and Throat Lips and buccal mucosa| mucosa moist no problems noted|
Teeth and gums| teeth and gums intact| Tongue, hard palate, and soft palate| all moist, intact, no problems noted| Tonsils| Tonsils in place, no redness,
or patches noted| Uvula (cranial nerves IX, X)| Uvula intact, no redness or patches noted, no lesion noted| Tongue (cranial nerve XII)| Tongue pink and
intact, no white patches or yeast noted| Neck Symmetry, lumps, and pulsations| Symmetry noted in neck, no lumps noted, pulsations present in veins|

Cava Clamping Case Study
What anaesthesiologist must be aware of superior vena cava clamping.
A 45 year male patient presented with low grade fever and shortness of breath on mild exertion since 1 month. His chest x ray showed large mass
shadow in right lung field. Computed tomography was performed which revealed large soft tissue density mass lesion with areas of necrosis and
internal calcification measuring 12.5 cm * 12 cm in right side of mediastinum. The mass was compressing right main bronchus and encasing superior
vena cava. Positron emission tomography scan revealed hypermetabolic heterogeneous enhancing mass lesion.Biopsy of the mass was performed and
Histopathological examination was suggestive of malignant leiomyosarcoma. Patient was scheduled for surgical ... Show more content on
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Measures to reduce central venous pressure (CVP) and cerebral metabolic rate for oxygen (CMRO2) can effectively allow to increase SVC clamping
time [4,6,7]. To maintain mean arterial pressure, fluid administration and vasopressor use plays important role. However fluid infusion through
cannula placed in upper limbs would cause further rise in cerebral venous pressure. Femoral venous or right atrial cannula would be effective in fluid
resuscitation. Neuroprotective methods like use of thiopentone and mild hypothermia can be used. BIS monitoring is essential during such surgery.
As brain metabolism is decreased, bispectral index also decreases. SVC decompression can be done by creating temporary veno atrial shunt or cavo
pulmonary anastomosis for drainage of the SVC. (5,8) J.Y. Perentes et al described a new temporary SVC bypass technique–preoperative
jugulo–femoral bypass or intraoperative innominate–femoral bypass using standard perfusion tubing. SVC clamping induced jugulo–femoral pressure
gradient drives blood from jugular to femoral vein without any need of a pumping device or additional heparinization beyond that required for SVC
reconstruction.(9) Hemodynamic imbalance and neurological effects of SVC clamping can be life threatening. Anaesthesiologist must be aware of
different options to manage such challenging

Phases Of Septic Shock And Effects And Cad On The Heart
Phases of Septic Shock and Effects and CAD on the Heart
A nurse?s responsibility is to assess vital signs repeatedly looking for changes from the baseline levels, review laboratory data related to changes in
serum lactate levels, total white blood cell (WBC) count, and the differentials. Increasing serum lactate level, a normal or low total WBC count, and a
decreasing segmented neutrophil level with a rising band neutrophil level indicate sepsis. The change is also a left shift in relation to the
oxyhemoglobin dissociation curve. If unidentified progression of this syndrome can lead to death. If a nurse identifies the beginnings of sepsis the
probability of reversal and uncomplicated recovery is greater.
Situation 1 An acute nurse knows that the cause of sepsis results from a systemic response to an infection that has entered the bloodstream leading to
widespread inflammation. Sepsis leads to impaired oxygenation and tissue perfusion Gram–negative bacteria, gram–positive bacteria and fungi enter the
blood stream either directly from the site of infection or indirectly as a result of toxic substances released by the bacteria production of bacteremia.
Bacteria and fungi live anywhere a micro–organism can grow and remain alive even without a host. Patients can acquire an infection from endogenous
sources such as wounds on the skin, genitalia, mouth, or infection of the gestational tract or nose. Exogenous sources include door handles, bathrooms,
restaurant/ fast

Left Side Heart Failure
The left side of the heart brings oxygen–rich blood from the lungs through the left atrium to the left ventricle, then out into body. When the left side of
the heart is damaged or can't pump as well, it has to work harder to send blood through the body. This causes fluid to build up in the body, especially
the lungs. That's why shortness of breath is one of the most common symptoms of heart failure. Systolic failure happens when the heart doesn't pump
out blood the way it should. Diastolic means the heart doesn't fill back up with blood as it should. The symptoms of left sided heart failure are
tachypnea, increased work of breathing, crackles initially heard in lung bases, but when severe, heard throughout the lung fields, pulmonary edema, and
dullness in lung fields to finger percussion, pleural effusion detectable by reduced breath sounds at the bases of the lungs, and cyanosis. ... Show more
content on Helpwriting.net ...
The right side of the heart brings in the circulated blood from the body and sends it to the lungs for oxygen circulation. When the left side of the heart
weakens, the right side of the heart has to work harder to compensate. Again, as the heart muscle loses strength, blood and fluid become backed up in
the body. The person may experience swelling and trouble catching breath. The symptoms of right sided heart failure are peripheral edema, ascites,
hepatomegaly, increased jugular venous pressure, presence of a parasternal heave indicating the compensatory increase in contraction strength,
congestion of the gastrointestinal tract resulting in weight loss, impaired liver

Monitoring At Risk For Elevated Icp Monitoring
ICP Monitoring Indications. Of monitoring of ICP : ICP monitoring is generally indicated in patients who meet all three of the following criteria:
1. The patient is suspected to be at risk for elevated ICP.
2. The patient is comatose (Glasgow coma scale score в‰¤ 8).
3. The prognosis is such that aggressive ICU treatment is indicated. Suspicion of increased ICP is usually based on clinical signs (Tables 2 and 3)
and the results of a computed tomography (CT) scan showing significant intracranial mass effect with midline shift or effacement of the basal
cisterns. However, in comatose patients with TBI, intracranial hypertension occurs in approximately 10% of patients with normal CT scans; this risk
is even higher in patients more than 40 years old, with motor posturing, or with hypotension (systolic blood pressure < 90 mmHg) . If a patient is
awake and can follow commands, it is unlikely that ICP is dangerously elevated (11), and the benefits of ventricular drainage or ICP monitoring
probably do not outweigh the risks. Careful monitoring of mental status in an ICU will usually suffice in these cases.
1.INTRAVENTRICULAR CATHETERS. These devices directly connect the intracranial space to an external pressure transducer via saline
–filled
tubing. The bedside pressure transducer must be positioned at the level of the foramen of Monroe (external auditory meatus) to accurately reflect ICP.
The catheter is usually connected to both a

Acute Decompensated Heart Failure
Sensing process is the initial stage of our process. Heart problems like Chronic Heart Failure Disease affected people have 70% of possibility to cause
of critical heart failure i.e. Acute Decompensated Heart Failure (ADHF). The concept of outpatient monitoring for early detection and treatment of
ADHF is not new. However, the question of which parameters to monitor and what specific detection strategies should be used to prevent
hospitalization has not been adequately addressed. Symptoms such as orthopnea and physical examination signs such as pulmonary rales, peripheral
edema, and elevated jugular venous pressure reflect increased ventricular filling pressures and vascular congestion and are often used for the diagnosis
of ADHF. However,

Clinical Reasoning And Nursing Practice
Clinical reasoning is embedded in nurses' thinking for patient care (Levett–Jones 2013). It is a spiral, continuous mental process, underpinned by
critical thinking theory and a sound body of nursing knowledge (Levett–Jones 2013). The clinical reasoning cycle includes considering patient's
situation, collecting cues, processing information, identifying problems, establishing goals, taking action, evaluating outcomes and reflecting on the
process undertaken (Levett–Jones 2013). Nursing practice for registered nurses is guided both by the National Competency Standard (Nursing and
Midwifery Board of Australia 2006) and the Nursing Practice Decision Flowchart (Nursing and Midwifery Board of Australia 2010) to ensure patients'
safety and to optimise care by challenging medical assumptions and facilitating evidence–based practice. The clinical reasoning framework, therefore,
allows nurses to prioritise the most time sensitive and specific information, to recognise deteriorating patients and to manage complex clinical
situations (Levett–Jones & Bourgeois 2011). This paper will focus on processing information and identifying the two major problems in the case study
of Mr. Brown, a 74–year–old man, who was admitted to hospital after a 'fainting' episode with chief complaint of dizziness.
Interpret
Mr. Brown presented in the hospital after a syncopal episode observed by his wife with complaint of dizziness and lightheadedness. Syncope, the result
of the sudden drop of blood pressure

Medical Diagnosis Of Heart Failure
The sarcoplasmic reticulum is the major intracellular site for calcium release and storage in the myocyte. In the heart failure, the movement of calcium
ions in and out of the cell is no longer effective. These changes in calcium handling lead to alterations in myocyte contraction and relaxation, which will
contribute to worsening diastolic dysfunction in heart failure (Karch, 2013).
Medical Diagnosis of Heart Failure
The diagnostic methods in heart failure are directed toward establishing the cause of the disorder and determining the extent of the dysfunction
(Grossman & Porth, 2014). The methods used in the diagnosis of heart failure include risk factor assessment, history and physical examination,
laboratory studies, ... Show more content on Helpwriting.net ...
Electrocardiography can be used to detect underlying disorders of cardiac rhythm, or conduction abnormalities. Chest x–rays provide information about
the size and shape of the heart and pulmonary vasculature and the presence of pulmonary edema (Grossman & Porth, 2014). Radionuclide
ventriculography and cardiac angiography are recommended to detect CAD as the underlying cause of heart failure. Cardiac magnetic resonance
imaging (CMRI) and cardiac computed tomography (CCT) are used to document ejection fraction, ventricular preload, and regional wall motion
(Grossman & Porth, 2014).
The monitoring methods include central venous pressure (CVP), pulmonary artery pressure monitoring, thermodilution measurements of cardiac
output, and intra–arterial measurements of blood pressure are used in the acute, life threatening episodes of heart failure (Grossman & Porth, 2014).
After a complete physical examination and history collection and by verifying the results of laboratory studies, chest x–ray, echocardiogram and CT
scan, the diagnosis of heart failure is formulated for the patient S.K.
Management of Heart Failure
The goals of treatment for heart failure are determined by the rapidity of onset and severity of the heart failure and directed towards relieving the
symptoms, improving the quality of life, and reducing or eliminating the risk factors (Grossman & Porth, 2014). There are

Central Venous Pressure Research Paper
central venous pressure (CVP) line is a long, thin, flexible tube that is inserted into superior vena cava or into the right atrium and end up in the
thoracic. CVP catheter can be left far longer than an intravenous catheter (IV), so its useful For long–term treatment such as infection, cancer, or it used
to to provide nutrition. It allows monitoring blood pressures such as the central venous pressure, the pulmonary artery pressure, and the pulmonary
capillary wedge pressures. It can be used to estimate cardiac output and vascular resistance. It's also allows the patient to have medicine or fluids at
home instead of in the hospital.
Types :
1– Tunneled Central Venous Catheters : is a long flexible tube which one end be placed in or near

Air Embolism: Endovascular Procedure
Air embolism
Introduction
Air embolism is a rare but potentially serious complication of endovascular procedures, and can involve both the venous and arterial systems. The
risk is higher in procedures where there is low or negative intravascular pressure; in these situations, bleeding is less likely to occur, and so air may
instead enter the vessel. If air travels to a distant organ where there is insufficient collateral supply, ischemia or infarction may occur.
We review air embolism in the context of interventional radiology, although air embolism can also occur with barotrauma,lung biopsies and during
surgical procedures, most notably neurosurgery and cardiothoracic surgery. In the former, patients may be operated on in the upright position,... Show
In those patients under anesthesia, reduced end–tidal CO2 may be noted as the earliest indicator of air embolus. Additionally, the anesthesiologist may
also note reduced oxygen saturations. Importantly, reduced oxygen saturation on pulse oximetry is considered a late sign of vascular air embolism
[7].Many radiologists may never see a case of symptomatic air embolus in their careers, and so understanding the pathophysiology and treatment is
important.
The neurological signs and symptoms may be related to direct passage of venous air across a patent foramen ovale or related to reduced cardiac output
and associated cerebral hypoperfusion[7]
Two key factors which determine the outcome of vascular air embolism are the rate and volume of air accumulation[7]. Animal studies have been
performed to estimate the volume of air required to produce lethal circulatory arrest, with case reports suggesting the lethal dose of air in adults is
between 200 and 300 cc, or 3 – 5 ml/kg[7, 11, 12]. Although at first glance, one may consider this a very large amount of air that would not easily be
introduced to the vascular system, it has been shown that a 14 gauge needle can transmit 100 cc or air per second with a pressure gradient of 5 cm
H20. A 15 French (5 mm diameter) peel–away sheath used during placement of a tunneled hemodialysis catheter can allow 300 cc

Auscultation Of The Heart
Heart murmurs are swishing or whooshing sounds created by turbulent blood with each heartbeat. This sound is usually observed through auscultation
of the heart with a stethoscope. Many times, this sound is indicative to underlying cardiac abnormalities. However, the sound can be benign and many
live without incident and asymptomatic. Abnormalities to the structure of the heart may be the main cause. These malfunctions can be congenital in
nature or may come with stress on the heart and valves. Common structural conditions are stenosis of the heart (mitral, aortic, tricuspid, pulmonary),
regurgitations (mitral, aortic, tricuspid), septal defects and patent ductus arteriosus. Damage to the structure may also be caused by myocardial
infarction, ... Show more content on Helpwriting.net ...
Assess heart/lung sounds – Auscultating exhibits clarity for abnormal adventitious sounds such as S3 related to ventricular hypertrophy and S4
indicative to atrial hypertrophy and hypertension. Listen for pulmonary malfunction and fluid in lung bases.
Monitor hemodynamic status for elevation in systemic vascular resistance and decrease in cardiac output.
Maintain strict input and output to assist in monitoring cardiac status.
Encourage relaxation by providing comfortable environment reducing stimulation while reducing systemic stimulus.
Encourage patient to stop smoking. Provide her with education and offer smoking cessation.
Monitor medications for signs and symptoms of toxicity, side effects, and adverse effects.
Diltiazem is an antihypertensive medication called calcium channel blockers (CCB). In African–Americans hypertensive patients CCBs are more
effective than other anti–hypertensive medications. Possible side effects from the medication that this patient demonstrates are headache, dyspnea,
dizziness and excessive weight

Biventricular Decompression For Acute Cardiogenic Shock...
Ambulatory Central VA–ECMO with Biventricular Decompression for Acute Cardiogenic Shock
Central Message
We describe the off–pump insertion of a partial right ventricular assist device and a left ventricular assist device with extracorporeal membrane
oxygenation: a novel technique that allows for walking central VA–ECMO with direct biventricular decompression.
Introduction
Cardiogenic shock is a life threatening emergency that results in high mortality rates 1. Inadequate coronary and systemic perfusion are often present,
and commonly lead to multi–organ failure, which, results in further insult and injury. Initial management involves the use of vasopressors and inotropes
to improve cardiac output and systemic perfusion. Surgical ... Show more content on Helpwriting.net ...
We optimized his medical therapy, inotropic support and performed a successful cardioversion. Despite these interventions, the patient's clinical status
continued to decline with worsening fluid retention, progressive AKI (SCr 3.8mg/dl) and multiple episodes of ventricular tachycardia and ventricular
fibrillation terminated by his implantable cardiac defibrillator (SAVE score–2) 5. We made the decision to insert a partial right ventricular assist device
and a left ventricular assist device with extracorporeal membrane oxygenation for biventricular support and oxygenation. The patient underwent a left
mini–thoracotomy, with off–pump trans–apical placement of a 31 French ProtekDuoВ® cannula. We secured the device using 3.0 Prolene purse–string
sutures. The cannula provided a route for blood exchange with the inflow port located in the left ventricle and outflow port and cannula tips situated
2–3cm above the aortic valve. The blood circulated by the cannula passed through an extra–corporeal membrane oxygenator (TandemLungВ®) and
pump (TandemHeartВ®). We also placed a 21 French IVC–SVC venous cannula via the femoral vein and connected the tubing to the inflow of the
trans–apical ProtekDuoВ® cannula (figure 1). The LVAD was up
–titrated to a flow of 4.4 L/min at 7000rpm.
Within 24 hours after the procedure, we observed a vastly improved response to diuretics, the AKI started to resolve and he was successfully extubated.

Introduction And Learning Objectives Of Heart Failure
Introduction and Learning Objectives
Heart failure is a debilitating condition, affecting around 1–2% of the UK population (Sutherland, 2010). Its prevalence is rising due to an increase in
its risk factors, most notably an increased population life expectancy (Patient.co.uk, 2014). In the scenario Mr Williams is an obese 65–year–old man,
exhibiting numerous symptoms indicative of congestive heart failure. In this PBL write–up, I aim to explore the issues raised, whilst relating them to
the pathophysiology of heart failure.
Learning Objectives
Whilst discussing the scenario, our group came up with the following objectives:
1.Define any unknown terms
2.What is heart failure?
3.Explain the signs and symptoms presented by Mr Williams
4.Diagnosis of heart failure
5.Treatment of heart failure
Unknown Terms
We identified "pulsus alternans" as an unknown term from the scenario.
Pulsus Alternans is characterised by alternate strong and weak beats during a regular sinus rhythm (Weber, 2003). The systolic pressure can vary up to
50mmHg between beats (Kumar and Clark, 2009).
What is heart failure?
Heart failure is a result of any structural or functional cardiac disorder, leading to an impaired ability of the heart to pump a sufficient circulation to
metabolising tissues (Sutherland, 2010). It can also be called "congestive heart failure", as fluid retention is a common symptom. The main causes of
heart failure are ischaemic heart disease, cardiomyopathy and hypertension

Hyspnoeic Case Studies
PHYSICAL EXAMINATION: Mr P is alert, orientated and responds appropriately to questions. He is clean shave with low hair cut. He is Height
183cm weight 88kg, Body Mass Index (BMI) 26.3, which shows that he is overweight. He appears to be anxious and in moderate to severe
distress, his hands are moist and cold. His colour is good; he lies flat with moderate chest discomfort. Vital signs: Blood pressure (BP) Right hand
167/95, left hand 170/98, and no significant difference in BP of both arms. Cardiac arrhythmias noted, heart rate (HR) 106 beat per minute; heart
rhythm was irregularly irregular, but no evidence of blood loss or internal bleeding, radial pulses was strong bilaterally. Mr P was dyspnoeic, mild
to moderate increased work of breath noted, respiratory rate (RR) was 28 but no hypoxia, oxygen saturation by finger probe was 96 % on room air.
Therefore there was no need for supplementary oxygenation. Oxygenation is recommended to maintain saturation of oxygen above 90% in
suspected ACS. No sign and symptoms of infection or sepsis, he was a febrile, temperature was 37.4 degree centigrade. No diabetes ketoacidosis
(DKA), blood sugar level (BSL) 8.6 mmols was within acceptable limit. DKA is a contributing factor to nausea and vomiting in diabetic patient with
acute myocardial infarction (MI). Skin: Warm, wet and sweaty (diaphoresis) but good colour. Diaphoresis is a common occurrence in patient with
acute MI. No lesion, no nail clubbing and no cyanosis. Head, Eyes,

Delta Waves Case Study
A 45–year–old male comes into the emergency department with symptoms of acute dizziness, dyspnea, chest pressure, and palpitations. He states that
he feels that his heart is "racing.". He has a history of hypertension (HTN) and coronary heart disease (CAD) status post one bare metal stent. He is
currently on clopidogrel, aspirin, metoprolol, and Llisinopril. His BP blood pressure is 87/60 mmHg, pulse heart rate 160––170 beats/min, respirations
rate 26 breaths/min, oxygen saturation 90% on room air, and afebrile. His physical exam has pertinent positive findings of diminished global breath
sounds and rapid sinus heart sounds. He has no jugular venous distention (JVD), abdominal tenderness, nuchal rigidity, lower extremity swelling, or
focal ... Show more content on Helpwriting.net ...
Atrial fibrillation would not be in sinus rhythm and it would not have discernable P waves present on ECG tracing.
Choice "C" is not the best answer. Sinus vs. supraventricular tachycardia (SVT) is based on how high the heart rate is. If the heart rate is greater than
120 bpm with narrow QRS waves, it is considered SVT.
Choice "D" is not the best answer. The vignette states that the QRS length is less than 120 milliseconds. Ventricular tachycardia consists of wide QRS
waves that are greater than 200

Intravenus Lines
Intravenous fluids are administered through either a central or peripheral line. A central line is an intravenous line made of a small flexible tubing used
to intravenous medications, blood, or to collect blood samples. A central line is inserted under the skin away from the vein, and it comes out from a
subcutaneous route. A cuff is placed around the tunneled part of the line securing placement and helping to prevent infection to the insertion site.
Central lines are inserted into large veins in the central circulation (Caring, 2015). The catheter is threaded into the internal or external jugular vein; it
can also be threaded into the lower third of the vena cava leading to the superior part of the right atrium. When inserted, a chest x–ray is done to
confirm placement and position of the catheter, and to check for pneumothorax (Central, 2015). A peripheral line is a vein in the arm, hand, or in an
infant in the scalp. A peripherally inserted central line, also known as a PICC line, is another type of catheter used to administer intravenous
medications. PICC lines are inserted in the inner arm toward the shoulder, moving to a ... Show more content on Helpwriting.net ...
When caring for a central line of a small child for infant, never let the child chew on it and make sure not to put it in the genital area (Caring, 2015).
Do not let anyone play around or with your central line because a broken central line can hinder your treatment and cause harm to others. Letting pets
and others near the central line can cause germs to enter the line, and germs can cause a blood stream infection (Caring, 2015). Make sure to store all
supplies and medications out of the reach of children (Caring, 2015). If you drop your supplies in the floor, discard them, and get new ones. Make
sure to check with your provider and pharmacy on your medications some may need to be kept refrigerated. Never use scissors near your central line
(Caring,

Anna Stork's Demographic Narrative
Demographic Narrative
Anna Stork is a 72–year–old white female who was diagnosed with congestive heart failure 2 years ago. She has periodic exacerbations of CHF
requiring numerous hospital admissions in the last six months. She has been followed by the Medical Center of Trinity Hospital cardiologist, Dr. D.
Patel since the diagnosis. Anna's past medical history is significant for anterior MI approx. 5 years ago, stent implanted, atrial fibrillation, arthritis, IAD
and pacemaker implanted, and CHF. Her surgical history includes; stent, IAD, and pacemaker implanted. She denies any allergy history.
Anna stroke lives with her husband Steve Stork in a three–bedroom apartment in Newport Richey, Florida. Her both parents are deceased. Her father
died at 68 due to myocardial infarction and mother died at 92 due to old age problems. She has a total of 4 siblings. One sister with hypertension which
is controlled by medications and diet, one brother with hypertension and cardiomyopathy, and the other 2 siblings (boy and girl) are in good health
with no current illnesses. Her husband has mild dementia, diabetes, and hypertension. She has 2 children (son & daughter); both are healthy with no
significant medical history. Anna Stork is happily married for 40 years. She denies alcohol, tobacco, and illicit drug use. She was a former smoker and
quit smoking few months ago. One of her sister own few day care centers and she work 8 hour shift 3 days a week in one of her

COPD-Chronic Obstruction Pulmonary Disease: A Case Study
Week Five: R.Rabitt
COPD– Chronic Obstruction Pulmonary Disease is characterized by airway obstruction, which worsening with expiration. COPD is a progressive
disease, and typically gets worse over time; it is an umbrella term to describe a group of diseases such as emphysema, chronic bronchitis and asthma.
According to the Centers for Disease Control and Prevention (CDC), COPD is the fourth leading cause of death in the United States. Approximately
12 million people in the United States have been diagnosed with COPD. Many more may be affected and don't know they have it. Its generality
increases with age. Men are more likely to have the disease, but the death rate for men and women is the same (2014).
One of the biggest causes of COPD is a cigarettes smoking. Habitual smoking can inflame the linings of the airways in the lungs and can make the ...
Show more content on Helpwriting.net ...
There are two types of pneumothorax: primary spontaneous pneumothorax which is rupture of an air–filled bleb on the surface of the lung because of
alveolar pressure and the secondary spontaneous pneumothorax, which is more serious because is associated with, lung disease that cause trapping of
gases and destruction of lung tissue. The most common cause of secondary spontaneous pneumothorax is emphysema and it is a life–threatening due
to poor compensatory reserves (Grossman & Porth, 2014).
Intervention for COPD is focused on managing underlying conditions. The goal is to improve airway function. Some strategies include using
antibiotics to treat infection, diuretics which reduce pressure on the heart and lungs, some bronchodilators to help expanding the airways, as well as
corticosteroids to reduce inflammation, and last in severe cases use of mechanical ventilation can be efficient and effective to keep oxygenation in an
optimal level

Diagnosis And Treatment Of The American Heart Association
"According to the American Heart Association (AHA) affects nearly 5.7 million Americans and is responsible for more hospitalizations than all forms
of cancer combined. It is the number 1 cause of hospitalization for Medicare patients. With improved survival of patients with acute myocardial
infarction and with a population that continues to age, heart failure will continue to increase in prominence as a major health problem in the United
States" (Dimitru, 2015,p. Epidemiology). I chose to report on this condition because my grandmother had lived with this condition undiagnosed for
many years. I feel that early diagnosis and treatment will lead to better outcomes. With the increasing number of cases each year it is important for the
family nurse practitioner to diagnose and treat this chronic condition.
Patient Demographics Kim is a 53 year old woman who developed 6/10 (on a 0–10 pain scale) chest pain and shortness of breath in the airport after
flying from Chicago, IL to Sioux Falls, SD. She was transported to the hospital by paramedics. She was alert and oriented with stable vital signs and
oxygen saturation of 87%. Her electrocardiogram (EKG) showed normal sinus rhythm with no acute abnormalities; heart rate of 90. History included
hypertension for 15 years, mild obesity, and hyperlipidemia. She has a 20–pack year history of smoking and no history of alcohol or illicit drug abuse.
Her risk factors for coronary disease include hypertension, hyperlipidemia, and

Clinical Assessment And Circumferential Treatment Of...
Lymphedema is the swelling of soft tissues as a result of the accumulation of protein–rich fluid in the extracellular spaces. Secondary lymphedema is
precipitated by an event causing blockage or interruption of the lymphatic vessels. It is a potential complication that may affect quality of life of
patients treated for breast cancer. Life–long risk factors of post–breast cancer lymphedema are related to the extent of axillary node involvement, type
of breast surgery, and radiation therapy, as these factors decrease lymphatic drainage and increase stasis of fluid in the areas of skin and subcutaneous
tissues that drain to those regional lymph nodes. Breast cancer– related lymphedema (BCRL) can involve the arm and hand, as well as the ... Show
In addition to invasive breast cancer, 60,290 new cases of in situ breast cancer weare expected to occur among women in 2015. Moreover, an
estimated 40,290730 breast cancer deaths weare expected in 2015 [2]. However, as a result of advances in early detection and treatment, compared to
today breast cancer patients can expect survival that is similar to age–matched women without the disease, [3]. Tthe 5–year relative survival for women
diagnosed with localized breast cancer has increased from 80% in the 1950s to 899% today [2].
Although breast cancer treatments, including surgery, radiotherapy, chemotherapy, and hormonal therapy, have improved patients outcomes, they
cause patients to potentially suffer from substantial adverse effects [34]. One complication of these treatments is lymphedema, a chronic health
problem, troublesome to both patients and health professionals [5]. Lymphedema describes a set of pathological conditions in which there is an
accumulation of protein–rich fluid in soft tissues as a result of the interruption of lymphatic flow [46, 7]. It is most commonly found in the extremities;
however, it also can be found in the head, neck, abdomen, lungs, and genital regions [58]. Although the incidence of breast cancer–related lymphedema
is unclear due to differences in diagnoses, the different characteristics of the patients studied, and

Anatomical And Structural Differences Between Arteries And...
Briefly identify and discuss the anatomical and structural differences between arteries and veins.
I found the differences between arteries and veins are their functions they provide to the heart as well as their structure. Arteries transfers blood away
from the heart into the periphery resulting in the pressure of the blood in the arteries being high. Where as, the veins transfer blood towards the heart.
Arteries carry oxygenated blood distributing it in the periphery as the pulmonary artery moves deoxygenated blood into the lungs for purification.
The wall of an artery consists of three layers machining it thicker than veins. The elasticity within the layers of the muscle allows arteries to handle
great pressures of blood within it. The thickest layer is known as tunica media as the other two are recognized as tunica externa, and tunica interna.
The vein obtains blood from the periphery and carries it towards the heart. Veins are known to carry deoxygenated blood and transfers it the heart for
purification. The pulmonary vein is known to carry oxygenated blood. However, there are semilunar valves found within the vein that does not allow
retrograde flow of blood in preventing blood to flow in the opposite direction. Veins are thinner when compared to arteries consisting of thin elastic
muscle layers with one thick layer being the tunica adventitia. Arteries consist of: carrying oxygenated blood expect for the pulmonary artery; deeply
found in the body; thick walled and

Idiopathic Intracranial Hypertension
Discussion
History
In 1890, a German physician named Quicke described a neurological condition in which patients had signs and symptoms of increased intracranial
pressure without a brain tumor being present [1]. Between 1927 and 1937, Dr. Dandy, a pioneer of neurosurgery was able to gather the most common
signs and symptoms of 22 patients with pseudotumor cerebri [2]. These symptoms included headache, nausea, vomiting, diplopia, dizziness, and loss of
vision. It is important to note that the patient seen in our clinic was not experiencing any of the mentioned symptoms except for vision loss. According
to Dr. Dandy, the most common ocular signs were bilateral papilledema and some patients had retinal hemorrhages, which indicated long–standing
severe intracranial hypertension. In each case intracranial pressure was measured by ventricular or lumbar puncture and measured to be anywhere from
250 to 550 mm of water and in every instance the ventricles were smaller than normal and symmetrical. The treatment for most of these patients was a
right sub–temporal decompression. This was done if the signs and symptoms indicated a need for intervention. In most patients there was a complete,
spontaneous cure [2]. A more recent prospective study of 50 patients showed the breakdown of the most common symptoms ofidiopathic intracranial
hypertension [3]:
в—ЏHeadache (92 percent)
в—ЏTransient visual obscurations (72 percent)
в—ЏIntracranial noises (pulsatile tinnitus) (60 percent)

Potassium Compliance Report
Precautions used during administration of potassium–contain solution to prevent injury or death Potassium regulation in the body is impetrative to our
body's homeostasis. Small fluctuations in the normal potassium blood levels can be dangerous. Should an individual require potassium therapy client
safety is the priority. As always the five rights of medication should be closely followed when administering medications. (Ignatavicius, 2013, pg.
185) Potassium is available in various concentrations and can be caustic, as a result it should never be given subcutaneous or IM injection. As
mandated by The Joint Commission "concentrated potassium should be diluted and added to IV solutions in the pharmacy by registered pharmacist
and concentrated vials of potassium cannot be in patient care areas" (Ignatavicius, 2013, pg. 185). The ratio of potassium dilution has very specific
perimeters also. IV administration of should not exceed 1mEq of potassium to10mL of solution. When giving larger dose a programed infusion
device is recommended to ensure the infusion rate of 5 to 10 mEq/hr while never increasing the above 20 mEq/hr. (Ignatavicius, 2013, pg. 185). Prior
to infusion the nurse checked and rechecked again potassium containing solutions, verifying the prescription for the correct dose of potassium. It is
necessary to take great care in... Show more content on Helpwriting.net ...
The respiratory system uses breathing to compensate for these changes. The changes in CO2 affect receptors in the respiratory area of the brain. As the
CO2 levels continue to raise the central receptors send signal to increase breathing. Increasing the rate and depth of breathing, increasing the amount
CO2 exhaled. In turn, lowering the build up of CO2 in the lungs and in the ECF. As this process continues arterial CO2 returns to appropriate level,
normal breathing resumes. (Ignatavicius, 2013, pg.

The Anatomy And Physiology Of The Heart

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The Anatomy And Physiology Of The Heart