Cardiac Physiology

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
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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
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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

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

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
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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.

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
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

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

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
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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
ProtekDuo® 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 (TandemLung®) and pump
(TandemHeart®). 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 ProtekDuo® 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.

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

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 York Heart 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
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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

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
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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

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, ...
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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

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,

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
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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 the hospital 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

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

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,

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
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

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

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

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
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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

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 of idiopathic intracranial hypertension [3]:
●Headache (92 percent)
●Transient visual obscurations (72 percent)
●Intracranial noises (pulsatile tinnitus) (60 percent)

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 adequate blood 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.

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

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

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,

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

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 ...
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

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

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
conduction Weber 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 Helpwriting.net ...
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

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

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

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 more content on Helpwriting.net ...
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

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 ≤ 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

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) ...
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

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,

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

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

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

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, or asthma
(Cunningham et al. 2015). Alongside those hardships, they may

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