Pneumonia is an inflammatory condition of the lung
affecting primarily the microscopic air sacs known as
alveoli.
Pneumonia is the most common infectious cause of death
in the United States.
It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young, the
elderly, and the chronically ill.
Pneumonia is usually caused by infection with viruses or
bacteria and less commonly by other microorganisms,
certain medications and conditions such as autoimmune
Diseases
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
this is the comparative case study on Choledocholithiasis with the patient admitted in TUTH Mahargunj. this presentation provide comprehensive knowledge on choledocholithiasis including its causes, pathophyisiology, clinical presentations as well as treatment modalities and nursing management.
Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a case study on acute pancreatitis describing factors such as patient demographic data , pharmacist intervention , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigation etc
this case study was prepared for my academic purpose ......
please comment .........
thank u,,,,,
Myocardial Infarction - Case Presentation and an OverviewAbubakkar Raheel
Case Presented by Final Year MBBS sudents of Frontier Medical College at the 1st Clinico-Pathological Conference for the year 2015.The Presentation is divided into two parts. First part is about a case of an Acute ST Segment elevated Myocardial Infarction with. Its management at the Hospital and the findings. Second part is about the pathophysiology, Cinical signs and symptoms and an effective gold standard treatment of MI.
during my internship in gastroenterology department i presented the case, chairperson was my beloved sir Prof AHM Rowshan. this is a case about a 20 year old female presented with abdominal pain, fever which was low grade, and weight loss with marked anorexia for few months. the diagnosis was a dilemma. patient was undergone laparoscopic biopsy from intrabdominal enlarged lymph nodes and ultimately the diagnosis was a case of Non-Hodgkin's lymphoma and treated by chemotherapy.
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
Pneumonia is an inflammatory condition of the lung
affecting primarily the microscopic air sacs known as
alveoli.
Pneumonia is the most common infectious cause of death
in the United States.
It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young, the
elderly, and the chronically ill.
Pneumonia is usually caused by infection with viruses or
bacteria and less commonly by other microorganisms,
certain medications and conditions such as autoimmune
Diseases
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
this is the comparative case study on Choledocholithiasis with the patient admitted in TUTH Mahargunj. this presentation provide comprehensive knowledge on choledocholithiasis including its causes, pathophyisiology, clinical presentations as well as treatment modalities and nursing management.
Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a case study on acute pancreatitis describing factors such as patient demographic data , pharmacist intervention , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigation etc
this case study was prepared for my academic purpose ......
please comment .........
thank u,,,,,
Myocardial Infarction - Case Presentation and an OverviewAbubakkar Raheel
Case Presented by Final Year MBBS sudents of Frontier Medical College at the 1st Clinico-Pathological Conference for the year 2015.The Presentation is divided into two parts. First part is about a case of an Acute ST Segment elevated Myocardial Infarction with. Its management at the Hospital and the findings. Second part is about the pathophysiology, Cinical signs and symptoms and an effective gold standard treatment of MI.
during my internship in gastroenterology department i presented the case, chairperson was my beloved sir Prof AHM Rowshan. this is a case about a 20 year old female presented with abdominal pain, fever which was low grade, and weight loss with marked anorexia for few months. the diagnosis was a dilemma. patient was undergone laparoscopic biopsy from intrabdominal enlarged lymph nodes and ultimately the diagnosis was a case of Non-Hodgkin's lymphoma and treated by chemotherapy.
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docxhallettfaustina
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docxhallettfaustina
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Running head HEALTH HISTORY AND PHYSICAL ASSESSMENT 1Heal.docxjeanettehully
Running head: HEALTH HISTORY AND PHYSICAL ASSESSMENT 1
Health History and Physical Assessment
Hannah Gabon
Chamberlain College of Nursing
NR304 Health Assessment II
Professor Christa Stigler
August 2019
Hannah Gabon
Hannah Gabon
Hannah Gabon
Health History Assessment and Physical Assessment 2
Health History Assessment and Physical Assessment
I conducted a health assessment on a 70 year’s old male patient from California who was
suffering from hypertension. The patient is currently taking diuretics medication which cause
increase urination. The medication also causes his sodium and fluids levels to drop thus lowering
patient’s blood pressure so it’s imperative to balance and monitor vital sign. The patient stated
that he was moderately satisfied with the care received in the facility. The patient is a smoker and
stated his concern of experiencing vision issues and heart failure, which prompted immediate
care for this patient.
Before being admitted to the hospital, patient stated that he was experiencing chest pain
which was not ending nor was it increasing in exertion. He did not experience nausea, vomiting,
dizziness or unconsciousness. He took some pain killers with no relief but managed to sleep in
the morning. After beginning his daily activities, the pain increased and was then rushed to the
hospital. He underwent some test that clarified that he was suffering from hypertension. When I
reviewed patient past medical records, it showed that he has condition at early age and minor
surgery. I reviewed the patient's cardiovascular, eyes, nose, throat, respiratory system, and his
immune system. Patient immunization was also put into consideration when I reviewed his past
medical record as this will be helpful planning for his care.
Thirty years ago, the patient developed a diffuse rash after he was injected with penicillin
which he was allergic to, but it was not known. Some of his past health operations includes:
chest pains in 1990 and minor surgery on his left arm. He has a medical case of pneumonia at an
early age, which did not take long to heal. The patient was raised by his stepmother since his
mother passed away 72 years ago from heart failure. His father passed on 68 years ago after
committing suicide in his house. His wife died 10 years ago after struggling with tuberculosis for
Hannah Gabon
98440000000099648
what condition?
Health History Assessment and Physical Assessment 3
a long period of time. He has six children; two are deceased after both suffered from
hypertension. He has 20 grandchildren and 10 great-grandchildren. His family have history of
hypertension but no known history of tuberculosis.
The patient’s physical assessment findings were that he had an elevated blood pressure of
125/80 which shows that it was high, but it is controllable. I also found that he had a unique heart
sound which was as a result of an enlarged heart. The patient had a swoll ...
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
How to Give Better Lectures: Some Tips for Doctors
case study on Cardiomyopathy
1. 1
CARDIOMYOPATHY
OOBBJJEECCTTIIVVEESS OOFF CCAASSEE SSTTUUDDYY PPRREESSEENNTTAATTIIOONN
To share experience and knowledge to friends and supervisors.
To get feedback from the friends and supervisors for further improvement.
To develop confidence in facing the mass and presenting skills.
RATIONAL FOR THE SELECTION OF CASE
Cardiomyopathy causes more than 27,000 deaths each year in the United States (American
Heart Association, 2001).
• The mortality rate is highest for African Americans and the elderly I selected this case as
to learn in depth about the disease condition.
• Providing nursing care by applying nursing process.
• To provide holistic nursing care to the patient using the nursing process.
• To gain knowledge about the specific disease, it’s etiology, sign and symptoms and
management process.
METHODOLOGY
The methodology adopted to produce this report was based on:
History taking and interviewing to the patient and her visitors .
The observation and ,physical examination to the patient
Discussion with teachers, senior staffs and doctors
Using various text books and references of Medicine and related net search technology.
BIO-DATA OF MY PATIENT
2. 2
Patient’s Name : - Surya Maya Rai
Age/ sex : - 67yrs/female
Marital status : - Married
Education : - Illiterate
Occupation : - Housewife
Religion : - Hindu
Address : - Kathmandu, Basbari
Diagnosis : - Cardiomyopathy
Ward : - Medical intensive care unit
Bed No. : - 16
IP No. : - 45795
Date of admission : - 2068/11/15
Interview date : - 2068/11/18
Date of discharge :- 2068/12/21
Attending physician : - Dr. Rabi Mall
Informants : - Patient (self) & her Husband
CHIEF COMPLAIN
Shortness of Breath for 2 days
Pedal Edema for 1 month
HISTORY OF PRESENT ILLNESS
As stated by the patient party, patient was apparently well 2 days back when she started
having shortness of breath on exertion. she also had pedal edema for one month and made
her difficult to mobilize. so she was taken to the emergency department of Sahid Gangalal
National Heart Center
3. 3
she was diagnosed as known case of DCM 2 year back. She was having her medicine
regularly. She was admitted to the general ward of SGNHC on 2068/11/15. then she was
transfer to Medical Intensive Care Unit for Increased Shortness of breath and admitted there
No any skin change ,bowel and bladder are normal, she had no history of any abnormality of
the menstrual cycles.
Symptom Onset charecter Duration Aggrevating
factor
allevating
factor
Shortness of
breath
2 days Sharp pain Continues Not known Not known
Padal edema 2 month Mild Continuous Not known Not known
INVESTIGATION OF SYMPTOM
Past illness
Disease condition Childhood illness Disease condition Adulthood
illness
Measeals
Mumps
Whooping cough
Polio
Rheumatic fever
Tuberculosis
Malnutrition
Operation
Others
Yes No Yes No
Hypertension
Heart disease
Tuberculosis
Diabetes II
Filariasis
Malaria
Cancer
Asthma
Accidents
Others(hypothyrodism,
renal impairment)
2) Injuries and Accidents: My patient had no any history of external injuries and accidents.
4. 4
3) Hospitalization, Operations or Special Treatment: She had history of previous
hospitalization before 2 years back
5) Medication Taken at Home :- She uses to takes some home remedy like ginger, salt
besar for some common health problem.
6) Traditional Healer’s Prescription: she did not used to take the Traditional Healer’s
prescriptions.
7) Medical Practioner’s prescription:- According to patient’s husband, she takes medical
practioner’s prescription.
8)Self prescription: My patient use to take some common medicines like paracetamol,
brufen aciloc etc
9.FAMILY TREE
37 year,son
8 year.
grand daughter
Patient
Male
Female
39 year,
son
37 year,
daughter in -law
75 year, husband 67 year, patient
6year.
grandson
35 year.
daughter in-law
5. 5
10 Psychological:Client’s Reaction to illness:
My patient’s has normal reaction to her illness .
b) Client’s Coping Pattern:
She has good coping pattern by gossiping with relatives.
C) Client’s Value of Health:
She thinks that health is very essential for life. she thinks that health is wealth.
d) Client’s Perception of the Care Giver:
She thinks that all health care provider are good but everybody do not detailed explain
about the disease prognosis
11.Sociological:
A) Family Relationship:
Client’s Position in the Family: she is the house wife of the family.
Person Living With Client (Support System) : Her Family Members (husband and her son).
Recent Family Crisis or Changes: According to my patient, she has no any recent family
crisis
B) Occupational History: she is housewife., she is illiterate
12.Health belief and practice
Client’s Beliefs about Health and Illness: Her beliefs that the illness is caused by careless
of the diet
Client’s Health Practice: she has good health practice
Sources of Care(Modern /traditional):
sometimes they goes to traditional healer, but usually they goes to modern practice
12.Personal history
e) Leisure Time Activities: she spends her time with her friends, watching TV, chat with
friends, son and grand son
f) Chemical Use (type, frequency, problems related to use)
She is non smoker and non substance abuser but alcohol user . she had left 3 years back
6. 6
13. Gyne/obs history
• Menarche- 12 year
• Menstruation regular
• Menstrual bleeding normal
• Duration 4-5 days.
• No history of dysmenorrhoea.
• No history of the gynecological problem
Environmental history
• Type of family :- Joint Family
• No. of family :- 9 members
• Type of house :- Cemented house
• NO. of rooms :- 8
• Kitchen :- Separated
• Fuel used :- Gas
• Drinking Water :- Tap water
• Toilet :- Water seal
• Drainage System :- Closed drainage
PHYSICAL EXAMINATION
General Inspection:
Gait : Normal
Body Build : Thin
Consciousness : conscious and alert
Facial expression : ill looking
Vital signs
Temperature : 99.40 f
Pulse : 78b/minute and regular, normal volume and character
Respiration : 24 b /minute, regular
Blood Pressure : 100/80 mm Hg in both arms (supine)
Height : 5'
Weight : 52 kg
GENERAL EXAMINATION
7. 7
Pallor absent
Icterus absent
Lymph node not palpable
Clubbing, cyanosis absent
Edema present
Dehydration absent
Skin dry and rough.
Examination of head ,face and neck
1. Inspection of head
Hair colour and texture normal. Normal hair distribution graying of hair related to aging.
Rounded face wrinkle of skin related to age.Scar of injury present
2. Inspection of eyes
No discharge and redness of the eye lid, but swelling of the eyelid , slightly vision
problem
3. Inspection of ears
No discharge and pain, no hearing problem
4. Nose
No discharge , bleeding and smelling problem.
5. Mouth
Good oral hygiene, missing teeth present and dental carries, no cyanosis present.
6. Neck
No enlarged lymph node and thyroid gland, normal neck mobility is present
Respiratory examination
Inspection
8. 8
Shape of the chest- normal, equal movement of the chest both side, no venous
prominences or scar marks, trachea center. Spine normal. Shortness of breathe
Palpation
Non tender. Vocal fremitus present. Trachea in center. Chest expansion 3 cm, apex beat
5th intercostals space in mid, clavicular line
Percussion
Resonant in left side and dullness in organ area
Auscultation
Normal vesicular breath sound.
Cardiovascular system
Inspection:
Cardiac impulse in 5th intercostal space in MCl. No abnormal impluse seen.
Palpation
Non tender. Apex beat in 5th intercostals space in MCl, no thrill
Auscultation
S1 and S2 normal murmur heart sound
Abdominal problem
Inspection-
Normal shape and size.Distended ,no dilated superficial veins, no scar marks
Palpation-
Soft organomegaly present. No organomegaly
Percussion- Normal tympanic sound present
Auscultation-
Bowel sounds present (normal)
CNS examination
Higher mental function normal. Motor examination eg position of limbs normal ,no
atrophy, no ulcer. No abnormal movement. Normal muscle tone. Normal power in all
limbs. Deep tendon jerk (bicep,tricep,supinator ,knee and ankle) normal. Sensory normal.
Comfort sleep , rest
9. 9
Patient feeling of discomfort first day of admission. No properly sleep at night during
first day of admission.
Impression: No any systemic disorders present except slight dyspnea and peripheral
edema(pedal).
DEVELOPMENTAL TASK OF OLDER ADULT
My patient belongs to older adult, development task of my patient are
ACCORDING TO BOOK ACCORDING TO MY PATIENT
1. Seven developmental tasks for older
adult are listed.
2. Adjusting to decreasing health and
physical strength.
3. Adjusting to retirement and reduced
or fixed income
4. Adjusting to death of a spouse.
5. Accepting self as ageing person.
6. Maintaining satisfactory living
arrangement.
7. Redefining relationship with adult
children.
8. Finding way to maintaining quality
of life.
1. Adjusting to decrease health and physical strength.
2. the most common losses one of the health
,significant other a sense of being useful
,socialization ,income and independent living.
3. Adjusting to retirement by engaging in housewife
4. My patient was not faced death of spouse.
5. My patient accepted self as ageing person.
Structural and functional change associated with
ageing eg loss of hearing ,vision problem, dental
missing etc
6. My patient maintained satisfactory living
arrangement eg comfortable living arrange all
physical facilities.
7. Redefining relationship with adult children by give
permission to their children whatever they like.
8. My patient maintained quality of life through use
leisure time in social work, spiritual activities
CHAPTER II
10. 10
CARDIOMYOPATHY
Definition
Is a heart muscle disease associated with cardiac dysfunction. The cardiomyopathies are a
group of diseases that primarily affect the heart muscle and are not the result of congenital,
acquired valvular, hypertensive, coronary arterial, or pericardial abnormalities.It is classified
according to the structural and functional abnormalities of the heart musclesas:
Dillated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive or Constrictive cardiomyopathy
Arrythmogenic right ventricular cardiomyopathy
Unclassified cardiomyopathy
Etiology of cardiomyopathy
Pregnancy
Heavy alcohol intake
Viral infection
Chemotherapeutic medication
Iidiopathic
Genetics
DILATED CARDIOMYOPATHY (DCM)
This condition is characterized by dilatation and impaired contraction of the left (and
sometimes the right) ventricle.
11. 11
Distinguished by significant dilatation of the ventricles without simultaneous
hypertrophy.
The ventricles of elevated systolic and diastolic volume but a decreased ejection
fraction
Left ventricular mass is increased but wall thickness is normal or reduced.
The histological changes are variable but include myofibrillary loss, interstitial
fibrosis and T-cell infiltrates.
When the causative factor cannot be identified, the term used is idiopathic DCM.
Idiopathic
Most patient present with heart failure or are found to have the condition during
routine investigation.
Arrhythmias ,thromboembolism and sudden death are common and may occur at any
stage.
Chest pain is a surprisingly the diagnosis.
Although some patient remain well for many year, the prognosis is variable and
cardiac transplantation may be indicated
Risk is subsiquently reduced by regerious medical therapy with beta blocker and
angiotensin receptor antagonist
Some patient may be considered for implantation of a cardiac defrillator
HYPERTROPHIC CARDIOMYOPATHY( HCM)
In HCM, the heart muscle increases in size and mass, especially along the septum
The increased thickness of the heart muscle reduces the size of the ventricular cavities
The ventricles to take a longer time to relax.
Making it more difficult for the ventricles to fill with blood during the first part of
diastole and making them more dependent on atrial contraction for filling
Structural changes may also result in a smaller than normal ventricular cavity and a
higher velocity flow of blood out of the left ventricle into the aorta,which may be
detected by echocardiography .
12. 12
HCM may cause significant diastolic dysfunction, but systolic function can be normal
or high, resulting in a higher than normal ejection fraction
It may also be idiopathic
RESTRICTIVE CARDIOMYOPATHY
Restrictive cardiomyopathy (RCM) is characterized by diastolic.
Dysfunction caused by rigid ventricular walls that impair ventricular stretch and
diastolic filling .
Systolic function is usually normal.Because RCM is the least common
cardiomyopathy.
Its pathogenesis is the least understood
Restrictive cardiomyopathy can be associated with amyloidosis (in which amyloid, a
protein substance, is deposited within the cell) and other such infiltrative diseases.
However, the cause is unknown in most cases (ie, idiopathic).
ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
ARVC occurs when the myocardium of the right ventricle is progressively infiltrated
and replaced by fibrous scar and adipose tissue.
Initially, only localized areas of the right ventricle are affected, but as the disease
progresses, the entire heart is affected.
Eventually, the right ventricle dilates and develops poor contractility right ventricular
wall abnormalities, and dysrhythmias
The prevalence of ARVC is unknown because many cases are not recognized.
ARVC should be suspected in patients with ventricular tachycardia originating in the
right ventricle (ie, a left bundle branch block configuration on ECG) or sudden
death, especially among previously symptom-free athlete.
The disease may be genetic (ie, autosomal dominant) . Family members should be
screened for the disease with a 12-lead ECG, Holter monitor, and echocardiography.
UNCLASSIFIED CARDIOMYOPATHIES
13. 13
Unclassified cardiomyopathies are different from or have characteristics of more than one
of the previously described cardiomyopathies.
Unclassified cardiomyopathies include fibroelastosis, noncompacted myocardium,
systolic dysfunction with minimal dilation, and mitochondrial involvement
Primary Myocardial Involvement
Idiopathic
Familial
Eosinophilic endomyocardial disease
Endomyocardial fibrosis
Secondary Myocardial Involvement
Infective
Viral myocarditis, Bacterial myocarditis ,Fungal myocarditis , Protozoal myocarditis
Metazoal myocarditis
Spirochetal
Rickettsial
Metabolic
Familial storage disease
Glycogen storage disease
Mucopolysaccharidoses( thickness secreation)
Hemochromatosis (Iron deposit in body)
Connective tissue disorders
Systemic lupus erythematosus
Polyarteritis nodosa
Rheumatoid arthritis
Progressive systemic sclerosis
Dermatomyositis
Infiltrations and granulomas
Amyloidosis
14. 14
Sarcoidosis
Malignance
Neuromuscular
Muscular dystrophy
Myotonic dystrophy
Friedreich's ataxia
Sensitivity and toxic reactions
Alcohol
Radiation
Drugs (doxorubicine)
Peripartum heart disease
Pathophysiology
It is a series of progressive events that culminate in impaired cardiac output.
Decreased stroke volume stimulates the sympathetic nervous system and the renin-
angiotensin-aldosterone response
Resulting in increased systemic vascular resistance and increased sodium and fluid
retention
Increased workload on the heart.
These alterations can lead to heart failure
CLINICAL FEATURE
According to book In patient
1. Signs and symptoms of heart failure (eg, dysponea on exertion,
fatigue).
2. Patient report paroxysmal nocturnal dyspnea, cough (especially
with exertion)
3. Orthopnea
4. Fluid retention,
5. Peripheral edema
Present
Present
Present
Present
present
15. 15
6. Nausea The patient may experience chest pain
7. Palpitations
8. Dizziness
9. Syncope with exertion
Present
Absent
Present
Absent
DIAGNOSIS OF THE CARDIOMYOPATHY
According to book In patient
1. Chest X-ray
2. Electrocardiogram
3. Echocardiogram
4. Radionuclide study
5. Cardio catheterization
1. Moderate to marked cardiac silhouette
enlargement, Pulmonary venous hypertension
2. ST-segment and T-wave abnormalities
3. Left ventricular dilatation and dysfunction
4. Left ventricular dilatation and dysfunction
5. Elevated left- and often right-sided filling
pressures. Diminishedcardiacoutput
INVESTIGATION
Component Inpatient Reference
Hemoglobin
WBC count
Neutrophil
Lymphocyte
Monocyte
Esinophil
Basinophil
Platlet
12.1%
9000/cumm3
68%
26%
00
06
00
31600
14-16gm%
4000-11000/cumm
40-75%
20-50%
2-10%
1-6%
<1%
150000-450000
Component In patient Reference range
ALT 38.0IU/L 5.0-35.0IU/L
16. 16
AST/GOT
Sugar
Urea
Creatinine
Sodium
Potassium
34.0
96 mg/dl
33mg/dl
184umol/l
137mEq/l
3.8mEq/l
5.0-40.0IU/L
65 – 140 mg/dl
10-45mg/dl
40-110umol/l
135-145mEq/l
3.6-5.5mEq/l
MEDICATIONS USED IN THE PATIENT
1. Tab Isoniazid 225mg+Tab Rifampicine 450mg+Tab Pyrezenamide 1200mg+Tab
Ethambutaol 825mg 3 tabs PO OD
2. Tab Pyridoxine 30mg PO OD
3. Enalpril 5mg OD continue
4. Asprin 75mg OD continue
5. Cloplet 75 OD continue
6. Tab Carvedilol 3.125 mg BD for 7 days
MEDICAL MANAGEMENT
Correcting heart failure with medication
Low sodium diet
Exercise and rest regimen
Controlling Dysrhythmia
Systemic anticoagulant
Restriction in fluid intake
Implantation of electronic devices(implantable cardioverter defibrillator)
17. 17
If patients exhibit signs and symptoms of congestion, their fluid intake may be limited
to 2 liters each day.
The person with HCM may also have to limit physical activity to avoid a life-
threatening dysrhythmia.
A pacemaker may be implanted to alter the electrical stimulation of the muscle and
prevent the forceful hyper dynamic contractions that occur with HCM.
SURGICAL MANAGEMENT
Left Ventricular Outflow Tract Surgery.
The most common procedure is a myectomy (sometimes referred to as a
myotomymyectomy),in which some of the heart tissue is excised.
Septal tissue approximately 1 cm wide and deep is cut from the enlarged septum
below the aortic valve.
The length of septum removed depends on the degree of obstruction caused by the
hypertrophied muscle.
Instead of a septal myectomy, the surgeon may open the left ventricular outflow tract
to the aortic valve by removing the mitral valve, chordae, and papillary muscles.
The mitral valve then is replaced with a low-profile disk valve.
The space taken up by the mitral valve is substantially reduced by the prosthetic valve
compared with the patient’s own valve, chordae, and papillary muscles, allowing
blood to move around the enlarged septum to the aortic valve in the area that the
mitral valve once occupied.
The primary complication of both procedures is dysrhythmia; additional
complications are postoperative surgical complications such as pain, ineffective
airway clearance, deep vein thrombosis, risk for infection, and delayed surgical
recovery.
HEART TRANSPLANTATION.
18. 18
a. The first human-to-human heart transplant
It was performed in 1967. Since then, transplant procedures, equipment, and medications
have continued to improve. Since 1983, when cyclosporine became available, heart
transplantation has become a therapeutic option for patients with end-stage heart disease
Cyclosporine is an immunosuppressant that greatly decreases the body’s rejection of
foreign proteins, such as transplanted organs.
Unfortunately, cyclosporine also decreases the body’s ability to resist infections, and a
satisfactory balance must be achieved between suppressing rejection and avoiding
infection
Common indication
o Cardiomyopathy
o Ischemic heart disease
o Valvular disease
o Rejection of previously transplanted hearts
o Congenital heart disease has severe symptoms uncontrolled by medical therapy,
no other surgical options
• A multidisciplinary team screens the candidate before recommending the transplantation
procedure.
The person’s age
Pulmonary status
other chronic health conditions
psychosocial status
family support
Infections
history of other transplantations,
compliance,
current health status
19. 19
• When a donor heart becomes available, a computer generates a list of potential recipients
on the basis of
o ABO blood group compatibility
o The sizes of the donor and the potential recipient,
o The geographic locations of the donor and potential recipient;
o Distance is a variable because postoperative function depends on the heart being
implanted within 6 hours of harvest from the donor.
Orthotropic transplantation
• Most common surgical procedure for cardiac transplantation.
• The recipient’s heart is removed, and the donor heart
• is implanted at the vena cava and pulmonary veins
• Some surgeons still prefer to remove the recipient’s heart leaving a portion of the
recipient’s atria (with the vena cava and pulmonary veins) in place.
• The donor heart, which usually has been preserved in ice.
• The donor heart is implanted by suturing the donor atria to the residual atrial tissue of
the recipient’s heart.
HETEROTOPIC TRANSPLANTATION
• The donor heart is placed to the right and slightly anterior to the recipient’s heart
the recipient’s heart is not removed.
• Initially, it was thought that the original heart might provide some protection for the
patient in the event that the transplanted heart was rejected.
• Although the protective effect has not been proved, other reasons for retaining the
original heart have been identified a small donor heart or pulmonary hypertension
• The transplanted heart has no nerve connections with the recipient’s body (ie,
denervated heart), and the sympathetic and vagus nerves do not affect the transplanted
heart.
• The resting rate of the transplanted heart is approximately 70 to 90 beats per minute,
but it increases gradually if catecholamines are in the circulation.
20. 20
• Patients must gradually increase and decrease their exercise (ie, extended warm-up
and cool-down periods), because 20 to 30 minutes may be required to achieve the
desired heart rate.
• Atropine does not increase the heart rate of these patients
Postoperative Care
• Heart transplant patients are constantly balancing the risk of rejection with the risk of
infection.
• They must comply with a complex regimen of diet, medications, activity, follow-up
laboratory studies, biopsies (to diagnose rejection), and clinic visits.
• Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf),
azathioprine (Imuran) or mycophenolate mofetil (CellCept), and corticosteroids (ie,
prednisone) to minimize rejection.
• Rejection and infection, complications may include accelerated atherosclerosis of the
coronary arteries
• Hypertension may be experienced by patients taking cyclosporine or tacrolimus; the
cause has not been identified.
• Osteoporosis frequently occurs as a side effect of the anti-rejection medications and
pre transplantation dietary insufficiency and medications.
• Post transplantation lymphoproliferative disease and cancer
• Weight gain, obesity, diabetes, dyslipidemias (eg hypercholesterolemia) hypotension,
renal failure, and central nervous system
• Respiratory, and gastrointestinal disturbances may be caused by the corticosteroids or
other immunosuppressants.
• Other complications are immunosuppressant medication toxicities and responses to
the psychosocial stresses imposed by organ transplantation.
• Patients may experience guilt that someone died for them to live, have anxiety about
the new heart, experience depression or fear when rejection is identified, or have
difficulty with family role changes before and after transplantation
21. 21
Survival rate
• The 1-year survival rate for patients with transplanted hearts is approximately 80% to
90%
• The 5-year survival rate is approximately 60% to 70%
Mechanical Assist Devices and Total Artificial Hearts
• Cardiopulmonary bypass for cardiovascular surgery and the possibility of performing
heart transplantation for end-stage cardiac disease have increased the need for
mechanical assist devices.
• Patients who cannot be weaned from cardiopulmonary bypass or patients in
cardiogenic shock may benefit from a period of mechanical heart assistance.
• The most commonly used device is the intra-aortic balloon pump.
• This pump decreases the work of the heart during contraction but does not perform
the actual work of the heart
Ventricular Assist Devices.
• More complex devices that actually perform some or all of the pumping function for
the heart also are being used.
• These more sophisticated ventricular assist devices can circulate as much blood per
minute as the patient’s heart, if not more.
• Each ventricular assist device is used to support one ventricle.
• Some ventricular assist devices can be combined with an oxygenator; the
combination is called extracorporeal membrane oxygenation (ECMO).
• The oxygenator– ventricular assist device combination is used for the patient whose
heart cannot pump adequate blood through the lungs or the body
• There are three basic types of devices: centrifugal, pneumatic, and electric or
electromagnetic.
22. 22
• Centrifugal VADs are external, nonpulsatile, cone-shaped devices with internal
mechanisms that spin rapidly creating a vortex (tornado-like action) that pulls blood
from a large vein into the pump and then pushes it back into a large artery.
• Pneumatic VADs are external or implanted pulsatile devices with a flexible reservoir
housed in a rigid exterior
• The reservoir usually fills with blood drained from the patient’s atrium or ventricle.
• The VAD then forces pressurized air into the rigid housing, compressing the reservoir
and returning the blood to the patient’s circulation, usually into the aorta.
• Electric or electromagnetic VADs are similar to the pneumatic VADs, but instead of
pressurized air.
• One or more flat metal plates are pushed against the reservoir to return the blood to
the patient’s circulation.
Total Artificial Hearts.
• Total artificial hearts are designed to replace both ventricles. Some require the
removal of the patient’s heart to implant the total artificial heart; others do not.
• All of these devices are experimental.
• Although there has been some short-term success, the long-term results have been
disappointing.
• Researchers hope to develop a device that can be permanently implanted and that will
eliminate the need for donated human heart transplantation for the treatment of end-
stage cardiac disease
• Most VADs and total artificial hearts are temporary treatments.
• While the patient’s own heart recovers or until a donor heart becomes available for
transplantation. Some devices are being investigated for permanent use.
• Bleeding disorders, hemorrhage, thrombus, emboli, hemolysis, infection, renal
failure, right heart failure, multisystem failure, and mechanical failure are some of the
complications of VADs and total artificial hearts
23. 23
DRUG PROFILE
1. Pyridoxine
Category: Vitamin
Brands available:a) ABDEC FORTE b)B-LONG C)BEPLEXELIXIR d)B-VITAL
Dosage regimen:
Dietary Deficiency
ADULTS: PO/IM/IV 10 to 20 mg/day for 3 wk.
Drug-Induced Deficiency Anemia or Neuritis
ADULTS: PO/IM/IV 100 to 200 mg/day for 3 wk; follow with 25 to 100 mg/day.
24. 24
Neuropathy
ADULTS: PO/IM/IV 50 to 200 mg/day.
Vitamin B6 Dependency Syndrome
ADULTS: PO/IM/IV 600 mg, followed by 30 mg/day for life. Dependency has been noted in adults
administered 200 mg/day. PYRIDOXINE-DEPENDENT INFANTS:IM/IV 10 to 100 mg, followed by 2
to 100 mg/day.
Metabolic Disorders
ADULTS: PO/IM/IV 100 to 500 mg/day
Indication: Pyridoxine deficiency, including inadequate diet, drug-induced causes (eg,isoniazid,
hydralazine, oral contraceptives) or inborn errors of metabolism
Adverse effect: CNS:Neuropathy; unstable gait; drowsiness; somnolence. EENT: Perioral numbness.
OTHER: Numbness of feet; decreased sensation to touch, temperature or vibration; paresthesia; low
serum folic acid levels; burning/stinging at IM injection site; photoallergic reaction; ataxia.
Contraindications:Standard considerations.
Caution: Pregnancy: Category A. (Category C in doses that exceed the RDA.) Lactation: Excreted in
breast milk; may inhibit lactation. Children: Safety and efficacy not established in doses exceeding
nutritional requirements.
Nursing Implementation:
Instruct patient to swallow sustained-release preparation whole and not to break, crush or chew.
When giving via IM route, rotate sites.
IV preparation may be given undiluted or added to standard compatible IV solutions.
Store all forms of drug at room temperature in tightly-closed, light-resistant containers. Avoid freezing
injection
1. Isoniazide
Category: Antituberculosis drug ( first line drug) bacteriacidal
Brands available: a)Isokin b)Solonex c)Isonex d)Tubernex forte
Dosage regimen: 300mg /day Adult
5-10mg/kg/day children
Indication: Tuberculosis, Prophylaxis of tuberculosis.
Adverse effect: convulsion, joint pain, agranulocytosis, skin rash, buring sensation of feet, drowsiness,
hallucinations, abdominal pain, nausea, vomiting, epigastric distress, fever;
Contraindications: Hypersensitivity
25. 25
Caution: Severe renal impairment,hepatic failure pregnancy and lactation
Nursing implementation
Careful monitoring is necessary for black and Hispanic women, notice and inform side effect full course
of treatment should be given
.
2. Rifampicine
Therapeutic category: Antituberculosis drug ( first line drug), Antileprotis drug
Indications: Tuberculosis, Leprosy, Prophylaxis of meningococcal infections, prophylaxis of
meningitis due to H.influeza type B, treatment of asymptomatic carriers of Neisseria meningitis..
Dose regimen: TB: 450-600mg/day for first 2 month, 10-15mg/kg 3 times a week.
Adverse effect: Anorexia, nausea, vomotting, abdominal pain, hepatitis, acute renal failure,
drowsiness. Headache, atoxia, visual disturbance, skin rash, shock, eosinophila, transcient
leucopenia.GI disturbance, peptic ulceration, abnormalities of kidney function.
Contraindications: Hypersensitivity, jaundice, biliary destruction, severe hepatic disease impaired
hepatic renal functions.
Nursing implementation: Take in empty stomach informs patient that orange red urine is harmless,
take full course of the drug.
Storage condition: Store in cool and dry place.
3. Ethambutol
Therapeutic category: Antituberculosis drug ( first line drug)
Indications:Pulmonary and extra pulmonary tuberculosis
Dosage regimen:Adult:15-25mg/kg/day continuous upto 50mg/kg
Children 10-15mg/kg/day continuous
Adverse effects:headache,stomach upset. Anorexia, nausea, vomiting, skin rash. Hepatitis, neuritis,
dizziness, neuropathy, reduced renal clearanceof ureters.
Contraindication: drug allergy, optic neuritis, renal/ hepatic failure, history of epilepsy, neonates,
impaires pretreatment visual acquity.
Nursing consideration:visual function test is recommended before and during therapy liver function
test should be done.
Storage: store in a cool and dry place
26. 26
4. Pyrazinamide
Therapeutic category: Antituberculosis drug ( first line drug)
Indications: Tuberculosis
Dosage regimen: 20-35mg/kg/day (adult), 15-30mg/kg/day (children)
Adverse effects: joint pain hepatitis hepatomegaly, spleenomegaly. Arthrolgai, malaise, fever,
hyperuricaemia, rashes,photosensitivity, anemia
Contraindication: hypersensitivity, diabetes, hepatic, impairment condition ,gout renal failure.
Nursing consideration: liver function test should be done, full course of drugs should be done,
vitamin B6 should be supplement.
Storage: store in a cool and dry place
5. Carvedilol
Drug classes
Alpha- and beta-adrenergic blocker, Antihypertensive
Therapeutic actions
Competitively blocks alpha-, beta-, and beta2-adrenergic receptors and has some
sympathomimetic activity at beta2-receptors. Both alpha and beta blocking actions contribute to
the BP-lowering effect; beta blockade prevents the reflex tachycardia seen with most alpha-
blocking drugs and decreases plasma renin activity. Significantly reduces plasma renin activity.
Indications
Hypertension, alone or with other oral drugs, especially diuretics
Treatment of mild to severe CHF of ischemic or cardiomyopathic origin with digitalis,
diuretics, ACE inhibitors
Left ventricular dysfunction (LVD) after MI
Unlabeled uses: Angina (25–50 mg bid)
Contraindications and cautions
27. 27
Contraindicated with decompensated CHF, bronchial asthma, heart block, cardiogenic
shock, hypersensitivity to carvedilol, pregnancy, lactation.
Use cautiously with hepatic impairment, peripheral vascular disease, thyrotoxicosis,
diabetes, anesthesia, major surgery.
Available forms
Tablets—3.125, 6.25, 12.5, 25 mg
Hypertension: 6.25 mg PO bid; maintain for 7–14 days, then increase to 12.5 mg PO bid
if needed to control BP. Do not exceed 50 mg/day.
CHF: Monitor patient very closely, individualize dose based on patient response. Initial
dose, 3.125 mg PO bid for 2 wk, may then be increased to 6.25 mg PO bid. Maximum
dose, 25 mg PO bid in patients < 85 kg or 50 mg PO bid in patients > 85 kg.
LVD following MI: 6.25 mg PO bid, increase after 3–10 days to target dose of 25 mg bid.
Metabolism: Hepatic; T1/2: 7–10 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Bile, feces
Adverse effects
CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep
disturbances
CV: Bradycardia, orthostatic hypertension, CHF, cardiac arrhythmias, pulmonary edema,
hypotension
GI: Gastric pain, flatulence, constipation, diarrhea, hepatic failure
Respiratory: Rhinitis, pharyngitis, dyspnea
Other: Fatigue, back pain, infections
28. 28
Interactions
Increased effectiveness of antidiabetics; monitor blood glucose and adjust dosages
appropriately
Increased effectiveness of clonidine; monitor patient for potential severe bradycardia and
hypotension
Increased serum levels of digoxin; monitor serum levels and adjust dose accordingly
Increased plasma levels of carvedilol with rifampin
Potential for dangerous conduction system disturbances with verapamil or diltiazem; if
this combination is used, closely monitor ECG and BP
Slowed rate of absorption but not decreased effectiveness with food
Nursing management
Assessment
History: CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to
carvedilol, pregnancy, lactation, hepatic impairment, peripheral vascular disease,
thyrotoxicosis, diabetes, anesthesia or major surgery
Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, respiratory
status, LFTs, renal and thyroid function tests, blood and urine glucose
Warning :
Do not discontinue drug abruptly after chronic therapy (hypersensitivity to
catecholamines may have developed, causing exacerbation of angina, MI, and ventricular
arrhythmias); taper drug gradually over 2 wk with monitoring.
Consult with physician about withdrawing drug if patient is to undergo surgery
(withdrawal is controversial).
Give with food to decrease orthostatic hypotension and adverse effects.
Monitor for orthostatic hypotension and provide safety precautions.
Monitor patients with diabetes closely; drug may mask hypoglycemia or worsen
hyperglycemia.
29. 29
Monitor patient for any sign of liver dysfunction (pruritus, dark urine or stools, anorexia,
jaundice, pain); arrange for LFTs and discontinue drug if tests indicate liver injury. Do
not restart carvedilol.
Teaching points
Take drug with meals.
Do not stop taking drug unless instructed to do so by a health care provider.
Avoid use of over-the-counter medications.
You may experience these side effects: Depression, dizziness, light-headedness (avoid
driving or performing dangerous activities; getting up and changing positions slowly may
help ease dizziness).
Report difficulty breathing, swelling of extremities, changes in color of stool or urine,
very slow heart rate, continued dizziness.
6. Enalapril maleate
Drug classes
Antihypertensive, ACE inhibitor
Therapeutic actions
Renin, synthesized by the kidneys, is released into the circulation where it acts on a plasma
precursor to produce angiotensin I, which is converted by ACE to angiotensin II, a potent
vasoconstrictor that also causes release of aldosterone from the adrenals; both of these actions
increase BP. Enalapril blocks the conversion of angiotensin I to angiotensin II, decreasing BP,
decreasing aldosterone secretion, slightly increasing serum K+ levels, and causing Na+ and fluid
30. 30
loss; increased prostaglandin synthesis also may be involved in the antihypertensive action. In
patients with heart failure, peripheral resistance, afterload, preload, and heart size are decreased.
Indications
Treatment of hypertension alone or in combination with other antihypertensives,
especially thiazide-type diuretics
Treatment of acute and chronic CHF
Treatment of asymptomatic left ventricular dysfunction (LVD)
Unlabeled use: Diabetic nephropathy
Contraindications and cautions
Contraindicated with allergy to enalapril.
Use cautiously with impaired renal function; salt or volume depletion (hypotension may
occur); lactation, pregnancy.
Available forms
Tablets—2.5, 5, 10, 20 mg; injection—1.25 mg/mL
Hypertension:
Patients not taking diuretics: Initial dose is 5 mg/day PO. Adjust dosage based on patient
response. Usual range is 10–40 mg/day as a single dose or in two divided doses
.
Patients taking diuretics: Discontinue diuretic for 2–3 days if possible. If it is not possible
to discontinue diuretic, give initial dose of 2.5 mg, and monitor for excessive
hypotension.
Converting to oral therapy from IV therapy: 5 mg daily with subsequent doses based on
patient response.
Heart failure: 2.5 mg PO daily or bid in conjunction with diuretics and digitalis.
Maintenance dose is 5–20 mg/day given in two divided doses. Maximum daily dose is
40 mg.
31. 31
Asymptomatic LVD: 2.5 mg PO bid; target maintenance dose 20 mg/day in two divided
doses.
Give IV only. 1.25 mg q 6 hr given IV over 5 min. A response is usually seen within 15
min, but peak effects may not occur for 4 hr.
Hypertension:
Converting to IV therapy from oral therapy: 1.25 mg q 6 hr; monitor patient response.
Patients taking diuretics: 0.625 mg IV over 5 min. If adequate response is not seen after 1
hr, repeat the 0.625-mg dose. Give additional doses of 1.25 mg q 6 hr.
Excretion is reduced in renal failure; use smaller initial dose, and adjust upward to a
maximum of 40 mg/day PO. For patients on dialysis, use 2.5 mg on dialysis days.
If creatinine clearance 30 mL/min, the initial dose is 0.625 mg, which may be repeated.
Additional doses of 1.25 mg q 6 hr may be given with careful patient monitoring.
Pharmacokinetics
Metabolism: T1/2: 11 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
Preparation: Enalaprilat can be given as supplied or mixed with up to 50 mL of 5% dextrose
injection, 0.9% sodium chloride injection, 0.9% sodium chloride injection in 5% dextrose, 5%
dextrose in lactated Ringer's, Isolyte E. Stable at room temperature for 24 hr.
Infusion: Give by slow IV infusion over at least 5 min.
Adverse effects
CNS: Headache, dizziness, fatigue, insomnia, paresthesias
CV: Syncope, chest pain, palpitations, hypotension in salt- or volume-
depleted patients
GI: Gastric irritation, nausea, vomiting, diarrhea, abdominal pain, dyspepsia,
elevated liver enzymes
GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary
frequency, impotence
32. 32
Hematologic: Decreased Hct and Hgb
Other: Cough, muscle cramps, hyperhidrosis
Interactions
Decreased hypotensive effect if taken concurrently with indomethacin, rifampin
Nursing considerations
Assessment
History: Allergy to enalapril, impaired renal function, salt or volume depletion, lactation,
pregnancy
Physical: Skin color, lesions, turgor; T; orientation, reflexes, affect, peripheral sensation;
P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation;
urinalysis, LFTs, renal function tests, CBC, and differential
Interventions
Warning : Alert surgeon, and mark patient's chart with notice that enalapril is being
taken; the angiotensin II formation subsequent to compensatory renin release during
surgery will be blocked; hypotension may be reversed with volume expansion.
Monitor patients on diuretic therapy for excessive hypotension after the first few doses of
enalapril.
Monitor patient closely in any situation that may lead to a drop in BP secondary to
reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea)
because excessive hypotension may occur.
Arrange for reduced dosage in patients with impaired renal function.
Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer
second dose until BP has been checked.
Teaching points
Do not stop taking the medication without consulting your health care provider.
Be careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating,
vomiting, dehydration).
33. 33
Avoid over-the-counter medications, especially cough, cold, and allergy medications that
may interact with this drug.
You may experience these side effects: GI upset, loss of appetite, change in taste
perception (will pass with time); mouth sores (frequent mouth care may help); rash; fast
heart rate; dizziness, light-headedness (usually passes in a few days; change position
slowly, limit activities to those not requiring alertness and precision).
Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular
heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.
7. Aspirin
Apo-ASA (CAN), Aspergum, Bayer, Easprin, Ecotrin, Empirin, Entrophen (CAN), Genprin,
Halfprin 81, 1/2 Halfprin, Heartline, Norwich, Novasen (CAN), Ascriptin, Asprimox, Bufferin,
Buffex, Magnaprin
Drug classes
Antipyretic, Analgesic (nonopioid), Anti-inflammatory, Antirheumatic, Antiplatelet, Salicylate,
NSAID
Therapeutic actions
Analgesic and antirheumatic effects are attributable to aspirin's ability to inhibit the synthesis of
prostaglandins, important mediators of inflammation. Antipyretic effects are not fully
understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to
block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary.
Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of
thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs
at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of
prostacyclin, a potent vasodilator and inhibitor of platelet aggregation.
Indications
Mild to moderate pain
Fever
Inflammatory conditions—rheumatic fever, rheumatoid arthritis, osteoarthritis
34. 34
Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin
platelet emboli
Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable
angina pectoris
MI prophylaxis
Unlabeled use: Prophylaxis against cataract formation with long-term use
Contraindications and cautions
Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps,
asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common);
hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects,
hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding)
Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye's
syndrome in children and teenagers); children with fever accompanied by dehydration;
surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal
hemorrhage, prolonged gestation, and prolonged labor have been reported; readily
crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late
pregnancy has been associated with the following adverse fetal effects: low birth weight,
increased intracranial hemorrhage, stillbirths, neonatal death); lactation.
Available forms
Tablets—81, 165, 325, 500, 650, 975 mg; SR tablets—650, 800 mg; suppositories—120, 200,
300, 600 mg
Dosages
Available in oral and suppository forms. Also available as chewable tablets, gum; enteric
coated, SR, and buffered preparations (SR aspirin is not recommended for antipyresis, short-
term analgesia, or children < 12 yr.)
Minor aches and pains: 325–650 mg q 4 hr.
Arthritis and rheumatic conditions: 3.2–6 g/day in divided doses.
35. 35
Acute rheumatic fever: 5–8 g/day; modify to maintain serum salicylate level of 15–
30 mg/dL.
TIAs in men:1,300 mg/day in divided doses (650 mg bid or 325 mg qid).
MI prophylaxis: 75–325 mg/day.
Analgesic and antipyretic: 65 mg/kg per 24 hr in four to six divided doses, not to exceed
3.6 g/day. Dosage recommendations by age
Juvenile rheumatoid arthritis: 60–110 mg/kg per 24 hr in divided doses at 6- to 8-hr
intervals. Maintain a serum level of 150–300 mcg/mL.
Acute rheumatic fever: Initially, 100 mg/kg/day, then decrease to 75 mg/kg/day for 4–6
wk. Therapeutic serum salicylate level is 150 300 mg/dL.
Kawasaki disease: 80–180 mg/kg/day; very high doses may be needed during acute
febrile period; after fever resolves, dosage may be adjusted to 10 mg/kg/day.
Metabolism: Hepatic (salicylate); T1/2: 15 min–12 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
Adverse effects
Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage,
excitement, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis,
fever, coma, CV collapse, renal and respiratory failure (dose related, 20–25 g in adults, 4
g in children)
Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma,
rhinitis)
GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatotoxicity
Hematologic: Occult blood loss, hemostatic defects
Hypersensitivity: Anaphylactoid reactions to anaphylactic shock
Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental
confusion, lassitude (dose related)
36. 36
Interaction
Increased risk of bleeding with oral anticoagulants, heparin
Increased risk of GI ulceration with steroids, phenylbutazone, alcohol, NSAIDs
Increased serum salicylate levels due to decreased salicylate excretion with urine
acidifiers (ammonium chloride, ascorbic acid, methionine)
Increased risk of salicylate toxicity with carbonic anhydrase inhibitors, furosemide
Decreased serum salicylate levels with corticosteroids
Decreased serum salicylate levels due to increased renal excretion of salicylates with
acetazolamide, methazolamide, certain antacids, alkalinizers
Decreased absorption of aspirin with nonabsorbable antacids
Increased methotrexate levels and toxicity with aspirin
Increased effects of valproic acid secondary to displacement from plasma protein sites
Greater glucose lowering effect of sulfonylureas, insulin with large doses (> 2 g/day) of
aspirin
Decreased antihypertensive effect of captopril, beta-adrenergic blockers with salicylates;
consider discontinuation of aspirin
Decreased uricosuric effect of probenecid, sulfinpyrazone
Possible decreased diuretic effects of spironolactone, furosemide (in patients with
compromised renal function)
Unexpected hypotension may occur with nitroglycerin
Decreased serum protein bound iodine (PBI) due to competition for binding sites
False-negative readings for urine glucose by glucose oxidase method and copper
reduction method with moderate to large doses of aspirin
Interference with urine 5-HIAA determinations by fluorescent methods but not by
nitrosonaphthol colorimetric method
Interference with urinary ketone determination by the ferric chloride method
Falsely elevated urine VMA levels with most tests; a false decrease in VMA using the
Pisano method
Nursing considerations
Assessment
37. 37
History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding
ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K
deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza;
children with fever accompanied by dehydration; surgery scheduled within 1 wk;
pregnancy; lactation
Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes,
affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC,
clotting times, urinalysis, stool guaiac, LFTs, renal function tests
Interventions
Give drug with food or after meals if GI upset occurs.
Give drug with full glass of water to reduce risk of tablet or capsule lodging in the
esophagus.
Do not crush, and ensure that patient does not chew SR preparations.
Do not use aspirin that has a strong vinegar-like odor.
Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis,
activated charcoal, supportive therapy.
Teaching points
Take extra precautions to keep this drug out of the reach of children; this drug can be
very dangerous for children.
Use the drug only as suggested; avoid overdose. Avoid the use of other over-the-counter
drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose
can occur.
Take the drug with food or after meals if GI upset occurs.
Do not cut, crush, or chew sustained-release products.
Over-the-counter aspirins are equivalent. Price does not reflect effectiveness.
You may experience these side effects: Nausea, GI upset, heartburn (take drug with
food); easy bruising, gum bleeding (related to aspirin's effects on blood clotting).
38. 38
Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult
breathing; nausea, vomiting, bloody stools.
NURSING MANAGEMENT
Assessment
• Detailed history of the presenting signs and symptoms.
• Identifies possible etiologic factors, such as heavy alcohol intake, recent illness or
pregnancy, or history of the disease in immediate family members.
• If the patient complains of chest pain, a thorough review of the pain, including its
precipitating factors, should be performed.
• The review of systems includes the presence of orthopnea, paroxysmal nocturnal
dyspnea, and syncope or dyspnea with exertion.
• usual weight, any weight change, and limitation to activities
• patient’s support systems are identified, and members are involved in the patient’s
care and therapeutic regimen.
• Vital signs
• Calculation of pulse pressure and identification of pulsus paradoxus
• Current weight; determination of weight gain or loss
• Detection by palpation of the point of maximal impulse, often shifted to the left
• Cardiac auscultation for a systolic murmur and third and fourth heart sounds
• Pulmonary auscultation for crackles
• Measurement of jugular vein distention
• Identification of presence and severity of edema
Nursing diagnoses
1. Decreased cardiac output related to structural disorders
2. caused by cardiomyopathy or to dysrhythmia from the disease process and medical
treatments
39. 39
3. Ineffective cardiopulmonary, cerebral, peripheral, and renal tissue perfusion related to
decreased peripheral blood flo(resulting from decreased cardiac
4. Impaired gas exchange related to pulmonary congestion
5. Activity intolerance related to decreased cardiac output or excessive fluid volume, or
both
6. Anxiety related to the change in health status and in role functioning
7. Powerlessness related to disease process
8. Noncompliance with medication and diet therapies
Potential complications
• Congestive heart failure
• Ventricular dysrhythmias
• Atrial dysrhythmias
• Cardiac conduction defects
• Pulmonary or cerebral embolism
• Valvular dysfunction
Planning and Goals
• Improved or maintained cardiac output
• increased activity tolerance
• Reduction of anxiety
• Adherence to the self-care program, increased sense of power with decision making,
and absence of complications.
41. 41
Henderson concept of nursing is interesting from the prospective of time. Nursining help the
patient to meet the basic need through the formation of nurse pt relationship.
She was one of the earlier leader who believed nurse need a liberal education including
knowledge of science and humanities. Aside from the definition of nursing and the fourteen
component of basic nursing care, the nurse is expected to carryout the physician therapeutic.
Person view as individual requiring assistance to achieve health and independence or peaceful
death. person and family are view as a unit. Person consist of biological, psychological
,sociological and spiritual component. Person is either sick or well and strive towards a state of
independence. person needs strength, will or knowledge to perform activities necessary for
healthy living. The individual has 14 basic need for survival.
Nursing process
Her definition and explanation of nursing do not directly fit the step of nursing process.
Assessment
She does not refer directly to assessment ,she implies in description of the 14 component of
basic nursing care. To complete the assessment phase the nurse need to analyze data. according
to her the nurse must have knowledge about what is normal in health and disease. Using this
knowledge the nurse would data compare the assessment data
Nursing diagnosis:
She does not specifically discussed nursing diagnosis. She believes that physician makes the
diagnosis and nurse acts upon that diagnosis. Base on the assessment and analysis of the data, the
nurse can identify the actual problem .
Planning:
Regarding the planning of care, she states plans need continue modification based on individual
needs. She emphasize that nursing care is always arranged around or fitted into the physician
therapeutic plan.
42. 42
Implement:
Handerson nursing implementation is based on helping the patient meet the 14 component
Nursing assessment
The 14 components are:
1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes-dress and undress.
7. Maintain body temperature within normal range by adjusting clothing and modifying
environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinio
11. Worship according to one’s faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.
Nursing process
1. Analysis
Compare data to knowledge base of health and disease the patient eat and drink is
inadequate
Nursing diagnosis
43. 43
• Identify the patient ‘s ability to meet own need with or without assistance .
• The patient unable to meet eat and drinks need without assistance.
• ( Altered nutrition: less than body requirements related to decrease appetite secondary
to disease condition)
Nursing plan
• Patient encourage to take balanced diet and frequent small meal.
• Suitable environment will provide while taking food
• Treat the disease with medications or any other measures.
• Advise to increase the activity and ask to mobilize
Nursing implementation
• Patient encouraged to take balanced diet and frequent small meal..
• Suitable environment was provided while taking food.
• Treat the disease with medications or any other measures.
• Advised to increase the activity and asked to mobilize
Evaluation
My patient able to eat and drink adequately with out assistance.
2. Analysis
Patient was unable to Communicate with others in expressing emotions, needs, fears, or
opinion
Nursing diagnosis
• Identify the patient ‘s ability to meet own need with or with out assistance .
• Patient unable to communicate with other expressing emotion, needs, fears or
opinion with out assistance .
• ( Anxiety related to the change in health status and in role functioning)
Nursing plan
44. 44
• The patient will provide with appropriate information about cardiomyopathy and
self-management activities.
• Patient will provide atmosphere in which the patient feels free to verbalize
• Patient will provide discuss about treatment modalities .
• Providing the patient with realistic hope helps to reduce anxiety while the patient
awaits a donor heart.
Implementation
• The patient is provided with appropriate information about cardiomyopathy and self-
management activities.
• Patient was provided atmosphere in which the patient feels free to verbalize.
• Patient provided the time about discuss the treatment modalities.
• Providing the patient with realistic hope helps to reduce anxiety .
Evaluation
Patient was Communicate with others in expressing emotions, needs, fears, or opinion
3. Analysis
Patient was unable to move and maintain desirable postures.
Nursing diagnosis
• Identify the patient ‘s ability to meet own need with or with out assistance .
• The patient unable to move and maintain desirable postures with out assistance
• (Activity intolerance related to decreased cardiac output or excessive fluid volume, or
both)
Nursing plan
• Teach the patient about the need for planned cycles of rest and activity.
• Helps them to identify methods to balance rest with activity.
• Help the patient recognizes the symptoms that indicate the need for rest and the
actions to take when the symptoms occur.
• Patients with HCM need to avoid strenuous activity and sports.
Implementation
45. 45
• Teach the patient about the need for planned cycles of rest and activity. For example, after
taking a bath or shower, the patient should plan to sit and read the paper.
• Suggesting that patients sit while chopping vegetables, drying their hair, or shaving helps
them to identify methods to balance rest with activity.
• Help the patient recognizes the symptoms that indicate the need for rest .
• Help to the patient the actions to take when the symptoms occur.
Evaluation
Patient was move and maintain desirable posture.
4. Analysis
Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.
Nursing diagnosis
• Identify the patient ‘s ability to meet own need with or with out assistance .
• The patient unable learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health facilities with out assistance
(Noncompliance with medication and diet therapies)
Nursing Planning
• Patient will be teaching about the medication regimen, symptom monitoring, and
symptom management
• Helping patients cope with their disease status
• Assists them in adjusting their lifestyles and implementing a self-care program at
home.
Implementation
• Assists the patient and family to adjust to lifestyle changes.
46. 46
• Teaching patients to read nutritional labels, to maintain a record of daily weights and
symptoms
• and to organize daily activities to increase activity tolerance
• Assessed diet and fluid restrictions and to the medication regimen
• Explanation about symptoms that should be reported to the physician are emphasized.
Evaluation
The patient was able to learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health facilities with out assistance.
DIVERSIONAL THERAPY
Diversional Therapy is a client centered practice recognizes that leisure and recreational
experiences are the right of all individuals.
• These are often quite diverse and can range from: Games, outings, computers, gentle
exercise, music, arts and crafts.
• Individual emotional and social support
• Sensory enrichment, activities like massage and aromatherapy, pet therapy
• Discussion groups, education sessions like grooming, beauty care, cooking.
• The diversional therapy programme has definitely had a positive influence on
patient’s life and will continue to do so for as long as he is living at the hospital
• The divertional therapy suggested for my patient is Gardening and gentle exercise
• Social, cultural and spiritual activities
In my patient
In order to reduce anxiety and query about disease, I used following diversional therapy:
• I provided him suitable environment that help to express his feelings.
• I talked and interacted with him and his relatives about their family, occupation,
study.
47. 47
• Provide gentle exercise
• Provide opportunity talking with other patient.
• Listening music by mobile phone.
DAILY PROGRESS REPORT
Admission day (2068/11/18)
Vital signs
Respiration: 22/min Temperature: 37.2 °C
Pulse: 86/min BP: 100/70 mm of Hg
• Patient diagnosis of Cardiomyopathy with Rt sided pleural effusion was admitted in
medical from medical OPD.
• Patient came by walking. Vitals within normal range.
• Patient is conscious and well oriented to time place and person.
• Plan for diagnostic tapping today.
• Report CBC ,Hb, ESR is to be collected.
2068/11/19
1st day of admission
Vital signs
Respiration: 20/min Temperature: 36.8° C
Pulse: 64/min BP: 100/60 mm of Hg
• Patient’s general condition is fair. Vitals within normal range.
• Tolerating normal diet. Normal bowel and bladder habit.
• Patient is started ATT drugs. No any specific complain from patient side..
• Patient’s general condition is improving.
• Saturation maintained at room air tolerating normal diet.
48. 48
• Normal bowel and bladder habit. No soakage from tapping site.
• Patients complains of slight chest pain.
2068/11/20
Vital signs
Respiration: 20/min Temperature: 36.8° C
Pulse: 64/min BP: 100/60 mm of Hg
• Patient’s general condition is improve.
• Vitals within normal range.
• Tolerating normal diet.
• Normal bowel and bladder habit.
• Patient give instruction about ATT drug
• No any specific complain from patient side.
2068/11/20
2nd of admission
Vital signs
Respiration: 18/min Temperature: 98.8° f
Pulse: 68/min BP: 100/60 mm of Hg
• Patient improve the condition today.
• Assist patient for morning care.
• Attend morning round.
• Ambulate the patient.
2068/11/21
3rd day of admission
49. 49
Vital signs
Respiration: 18/min Temperature: 98.8° f
Pulse: 68/min BP: 100/60 mm of Hg
• Patient improve the condition and plan of discharge.
• Discharge patient today
• Provide health education
• At the time of hospitalization, the following teaching was given to client and his
visitor about health promotion including
Personal hygiene:
• The following informal teaching related to personal hygiene was provided:
• Trimming nail and keeping it clean.
• Washing hand before and after having food and after defecation.
• Also frequent hand washing is necessary for infection prevention.
• Oral hygiene and hair care is also necessary.
• wearing neat and clean dress.
2) Nutritious food:
• Encouraged for balanced diet and provided informal teaching on its importance and
sources.
3) Rest and sleep:
• Provided informal teaching regarding importance of enough rest and sleep for
patient’s recovery.
4) Infection prevention:
• Encouraged the client’s family to adopt infection control measures such as:
• Keeping environment clean
• Hand washing
• Washing raw vegetables and fruits properly before consuming it.
• Drinking safe water after purifying it, taught them about SODIS method of water
purification.
50. 50
• Care of the operative wound and its infection prevention
DISCHARGE TEACHING
Discharge medicine:
Tab Aspirin 75mg OD continue
Tab Enalpril 5mg OD continue
Carvedilol 3.125mg BD continue
At the time of discharge I was present there.
• Patient was informed about the follow up on 2068/12/15
• Patient was advised to have the prescribed medication on proper time and dose after
discharge. Patient was informed about the side effect of the drugs and importance of
continuation of ATT drug.
• Patient advice to be far from smoke, dust. Close the mouth while coughing, sneezing etc
SPECIAL GAGETS USED IN MY PATIENT
Sphygmomanometer
Stethoscope
ECG monitoring
X-ray machine
Pulse oxymeter.
U.S G mechine.
LEARNED FROM THE EXPERIENCE
This case study gives following opportunity and knowledge such as
• Identified the complete health need of older adult and give nursing care
• Provide comprehensive nursing care to the adult patient.
51. 51
• Assist in different type of diagnosis procedure of the patient
• Analyze the concept and approach to nursing practice according to trend and
technology
• Identified the factors influencing nursing practice.
• Develop competency in handling various gadgets.
• Identified the plan, implement and evaluate the educational need of the patient and
patient family.
REFERENCES
1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing Lippincott 12th edition
vol-1 p-776
52. 52
2. Black J.M &Hawks J.H. “Medical Surgical Nursing Clinical Management For Positive
Outcome”, division of Reed Elsevier India pvt ltd 8th edition ,vol -2 pg no 1392
3. Lippincott , “manual of nursing practice of the adult “ 8th Edition ,Jaypee brother pgno.
4. Devidson’s “principle and practice of mrdicine” 20th edition.pg.no .641
5. Smeltzer. C. Suzanne, Bare. G. Brenda, “Brunner and Suddarth’s Textbook of Medical
Surgical Nursing”, 12th edition (2010), Wolters Kluwer India Pvt. Ltd, Page no: 574-575
6. Kumar. Parveen, Clark. Michael, “Clinical Medicine”, 6th edition (2005), Elsevier
Limited,
7. Boon. A. Nicholas, Colledge. R. Nicki, “Davidson’s Principles and Practice of
Medicine”, 20th edition (20), Elsevier Limited
8. Mosby’s “Nursing Drug Reference” , 23rd Edition, 2010
9. Cardiomyopathy www.medlineplus.com