...Cardiovascular Disease Surgery for coronary artery disease (CABG), valve repair and replacement, and the treatment of aortic disease, all have a remarkable history of success and evolution. Just as with computer technology, the trend in surgery has been to become smaller, faster and better. The treatment of cardiovascular disease (CVD) is moving towards less invasive and, in many cases, catheter based technologies. First interventional radiologists, then cardiologists, and now cardiac and vascular surgeons have embraced this trend. Clinicians are encouraged by outcomes that appear to be at least as good, albeit with trade-offs, and a high level of patient acceptance. Hybrid operating rooms - rooms combining operating room sterility and functionality with fixed angiography and echocardiographic imaging- are rapidly growing in prevalence and gaining increased interest from hospital administrators. These rooms are used by cardiac surgeons, vascular surgeons, interventional cardiologists, and neuro-interventionalists, and are suited for both open and closed procedures, as well as collaborative “hybrid” procedures. Given the dynamic nature of this room, these investments require thoughtful preparation operationally and logistically, especially when planning for physician and support staff that will work and cover call in this room. The Shift from CABG to PCI to hybrid procedures as a paradigm Twenty-five years ago, when the remarkable survival benefit of coronary revascularization...
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...Associate Level Material Medical Report This assignment is for you to create a screening tool for potential hires in your health care facility. As the health care administrator, you would want to ensure that your future employees have a strong understanding of medical reports and medical terminology. You are writing these reports for the applicants to read, interpret, and answer a set of questions you have developed. Refer to the samples of medical records reports on pages (142-144, 196, & 261-263) of the textbook. Each medical record should be completed and contain two questions you would ask of the potential hires. The following suggestions will help you get started: • Sometimes it is easier to start at the end. Think of the diagnosis the patient will receive. If you know what the end diagnosis will be, it makes it easy to know what symptoms, signs, and diagnostic methods would be used to achieve that diagnosis. • For the History of Present Illness, consider what questions the physician might ask the patient about his or her chief complaint and symptoms and then chart that in this section. This section serves as an account of what the patient would report, based on their symptoms. Remember, symptoms are subjective, in that they are conditions experienced by the patient, and are therefore included in the patient history. • For Past Medical History, document anything the patient may indicate in terms of past medical conditions that would be relevant...
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...Methanolic extracts of QI had been prepared by using distilled water i.e. 200 mg/kg p.o. Methanolic extracts of QI significantly reduce the harmful lipid layer in blood serum at varying concentration and dose dependent manner which shows that the plant carries the hypolipidemic properties. It reduces the LDL, VLDL, cholesterol, triglyceride and raise HDL level in blood serum upto certain extent which was may be due to the inhibition of lipid peroxidation as the plants contain some active ingredients acting as antioxidants. Our result shows that the plants extracts recover the disorders in lipid metabolism noted in hyperlipidemic state. KEY WORDS: Hypolipidemic, Hypocholesterolemic, Passive smoking (PS), Hyperlipidemia, Quisqualis indica, Coronary heart disease. 1. INTRODUCTION: Hyperlipidemia refers to elevated levels of lipids and cholesterol in the...
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...CASE STUDY 1 Acute coronary syndrome Patrick Gallagher Case outline Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include: Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC. On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T. 1 Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A On admission to Accident and Emergency...
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...Case Study 5—Coronary Artery Disease It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P., a 60- year-old retired businessman, is married and has 3 grown children. As you take his health history, he tells you that he began feeling changes in his heart rhythm about 10 days ago. He has hypertension and a 5-year history of angina pectoris. During the past week he has had more frequent episodes of midchest discomfort. The chest pain has awakened him from sleep but does respond to NTG, which he has taken sublingually about 8 to 10 times over the past week. During the week he has also experienced increased fatigue. He states, “I just feel crappy all the time anymore.” A cardiac catheterization done several years ago revealed 50% occlusion of the right coronary artery (RCA) and 50% occlusion of the left anterior descending (LAD) coronary artery. He tells you that both his mother and father had CAD. He is taking amlodipine, metoprolol, lipitor, and baby ASA qd. Setting: Hospital, outpatient cardiac rehabilitation Index Words: coronary artery disease (CAD), hypertension, angina, lifestyle modification, medications, laboratory values, assessment, risk factors, pacemaker 1. What other information are you going to ask about his episodes of chest pain? [k] Use the following memory aid to obtain information from the patient who has chest pain. FACTOR QUESTIONS TO ASK PATIENT P Precipitating events What events or activities precipitated...
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...pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting. Mr. Smith reports no previous history of chest pain or pressure. He smoked one pack of cigarettes daily for 13 years but quit smoking last year. He denies a family history of heart disease. Upon initial examination he did not have jugular venous distension, no carotid bruits, normal S1 and S2 with an S3 present. No S4 or murmurs auscultated. Lung sounds clear to auscultation bilaterally, bowel sounds normal, all pulses palpable 2+/4, no edema present. Diagnostic data: BP: 165/98 mmHG HR: 96 bpm RR: 30 breaths/min Temp: 37 C SaO2: 96% with 2L/min O2 per nasal cannula Wt:100 kg A 12-lead ECG was performed in the emergency room showed: Normal Sinus Rhythm (NSR) with frequent premature ventricular contractions. ST segment elevation in Leads 1, aVL, and V2 through V6 (3mm). ST segment depression in Leads III and aVF. Q waves in V2 through V4. The chest X-ray revealed slight cardiomegaly with mild congestive heart failure. An echocardiogram reveals an ejection fraction of 30% and mild mitral valve regurgitation. Mr. Smith’s cardiac enzyme lab values were as follows: Admission 2000 Admission 2400 Day 1 0400 |CK (U/L) |255 |7400...
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...Assignment: SCIE207 Phase 4 Lab Report Title: Exploring Endocrine, Circulatory, and Respiratory Systems Instructions: Your lab report will consist of the completed tables. Label each component of the endocrine, cardiovascular (circulatory), and respiratory systems and their functions in the following tables. When your lab report is complete, post it in Submitted Assignment files. 1. Endocrine System: Observe the diagram showing the major organs of the endocrine system. Using the textbook and Virtual Library resources, fill in the following table: Endocrine System Note: Some organs support the system, but may not produce or secrete hormones. |Number |Name of the Organ or Part |Hormone(s) Produced or Secreted | |1 |Parathyroid glands |Produces the parathyroid hormone that regulates levels of calcium | | | |in the bloodstream (Falls, p. 111, 2012). | |2 |Thyroid gland | Produces thyroxine and calcitonin which control body metabolism; | | | |transforms to energy from nutrients (Falls, p. 111, 2012). | |3 |Trachea |This organ does not secrete a hormone but only supports | |4 |Pineal gland ...
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...HEART RHYTHMS * 0.4 sec is the PR wave (it is actually the P-Q wave but called the PR wave) and it should be ≤ 0.20 sec. If it’s ≥ than that it indicates 1° heart block. * NSR: normal sinus rhythm, contraction originates from SA node and beats at 60-100 bpm * Sinus (atrial) Bradycardia: SA node discharges at < 60 bpm. TREATMENT is atropine and pacemaker if they become symptomatic. Usually the contractions are irregular but the same distance apart so they are irregular-regular * Sinus Tachycardia (atrial dysrhythmias): SA node discharges at > 100 bpm. Regular but fast; they won’t have heart block because the SA node is firing too rapidly. TREATMENT is BB or CCB to ↓ HR and BP * PAC (Premature Atrial Contraction): impulse travels across atria via abnormal pathway, creating a disturbed P wave. Contraction originates from ectopic focus in atrium other than the SA node. Caffeine and diet pills predispose people to these but they don’t adversely affect health. TREATMENT is none. * Atrial Flutter: atrial tachycardia resulting in recurring, regular sawtooth flutter waves. The ratio of atrial to ventricle contractions is 3:1. TREATMENT is synchronized cardioversion (like defibrillation but the less Joules, 150-200 vs 300, and you must push the “sync” button to synchronize the energy so as to not direct it onto the T wave and send the patient in V-fib) and ablations. * Valve Replacement: patient must be put on blood thinner afterwards and must be anticoagulated...
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...Heart Failure Western Governors University Pathopharmacological Foundations for Advanced Nursing Practice Heart Failure It is estimated that about five million people in the United States are living with heart failure with an overwhelming number of 550,000 newly diagnosed cases each year, costing the nation roughly $32 billion dollars per year (Centers for Disease Control and Prevention, 2016). Heart failure is a complex, pathophysiological condition in which the ventricles of the heart is weakened and unable to pump effectively to meet the body’s needs for nutrients or has lost adequate filling capacity. Clinical presentations of heart failure depends on which ventricles have failed to pump blood adequately; left ventricular failure, also known as congestive heart failure (CHF) is more common than right ventricular failure (McCance & Huether, 2014). The most common symptoms of heart failure are shortness of breath, fatigue, and peripheral edema. HF is not a disease, but rather a manifestation of a diseased heart. Large number of disorders can lead to heart failure, and with the aging population and many surviving primary cardiac events, it is no surprise that the most common reason for hospitalization in patients older than 65 years old is heart failure (McClintock, Mose, & Smith, 2014). Heart failure has become a major public health problem because it is the only cardiac condition that continues to increase in prevalence (McClintock, Mose, & Smith, 2014)...
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...anxiety & cardiac workload. 오류! 책갈피가 정의되어 있지 않습니다. 4. 12-lead ECG & monitor in order to check hypotension & bradycardia, which may lead to hypoperfusion. 오류! 책갈피가 정의되어 있지 않습니다. Ineffective tissue perfusion 오류! 책갈피가 정의되어 있지 않습니다. 1. Monitor vital signs (Hourly) and saturation oxygen to determine baseline and ongoing change. 오류! 책갈피가 정의되어 있지 않습니다. 2. Administer oxygen by Hudson’s mask (6-10L/min) and monitor the effectiveness to increase oxygenation of myocardial tissue and prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 3. Monitor respiratory status for sysptoms of heart failure to maintain appropriate levels of oxygenation & Observe for signs of pulmonary oedema. 오류! 책갈피가 정의되어 있지 않습니다. CORONARY ANGIOGRAM 5 Nursing responsibilities and rationale pre angiogram 5 CORONARY ARTERY BYPASS GRAFT 6 Definition (3marks) 6 ANTICOAGULANT THERAPY 7 Nursing Responsibilities 7 APTT. (3marks) 7 WOUND MANAGEMENT 8 DISCUSS MOIST WOUND –HEALING ENVIRONMENT 8 DEFINE 5 DIFFERENT TYPES OF EXUDATES 9 NEUROVASCULAR...
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...Acute Coronary Syndromes: Do They Differ from Men? Symptom Presentation and Treatment for Women Experiencing Acute Coronary Syndromes: Do They Differ from Men? There is an overwhelming cultural perception in the United States that coronary artery disease and heart attacks are a disease affecting men and that they are most deadly to the male species. In fact, Acute Myocardial Infarctions, or heart attacks, kill more women then all cancers combined and a female experiencing a heart attack is more likely to die from it than a man (Shirato & Swan 2010). Is there a difference between the way women and men experience an Acute Coronary Syndrome (ACS) whether it is Unstable Angina or a true Acute Myocardial Infarction (AMI)? Numerous studies have identified the symptoms females experience when they are suffering from a cardiac event and compared them to males resulting in noteworthy trends identified in the female symptoms. It is also noted that the perception of female cardiac symptoms by the lay community, the health care community and the patients themselves, contribute to the increased death rate in women with AMI. With improved public health education focused on what we’ve learned about the prevalence and seriousness of women experiencing an ischemic cardiac event and their unique symptoms, along with improved training for health care providers that promotes early recognition and aggressive medical treatment for all patients with cardiovascular disease, we can...
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...Devin Moore Ben Cope Lifetime Fitness 4, May 2014 Drug Abuse in America Chapter 13 The United States is number one in illegal drug use throughout the world (cbsnews). Men, women and teens across the country are becoming addicted every day to drugs such as cocaine, alcohol, heroin and meth. While Marijuana isn’t technically addictive, it is still the number one used illegal drug in the United States. Marijuana has become legal in some areas in the United States. “Single adults were more likely to report marijuana and cocaine abuse”. These drugs literally destroy lives. People lose their jobs, families and homes because of drug abuse. It is a problem that has been and will be relevant for decades and decades. The definition of a drug is a “substance that alters the user’s ability to function”(Powerpoint). When your ability to function is affected, it affects your everyday life. This is why people lose their jobs and homes. People will spend all their money just get their fix. Cocaine is one of the more expensive drugs. It is very common within the wealthier communities because it can be afforded. Studies show that Americans are four time more likely to abuse cocaine then the other countries in the world (cbsnews). It is also one the most addictive drugs after Alcohol. Its different names are coke, cocaine, dope and white. It can be snorted for a quicker, shorter high or it can be injected which will cause a longer lasting high. Many people begin using...
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...Read the attached article regarding new techniques for treating heart attack victims and identify the problem statement for a study among residents in the Minn. area where this new technique is being practiced. This study is to learn how the residents feel about the new technique being used. You might want to include survivors of this technique to learn of their assessment of the technique vs. the more commonly used techinque of clot busting. |PAGE ONE | | | | | | | | | | | |[pic] | |[pic] ...
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...and the “old” lipid guidelines known as ATP III (Adult treatment plan III). What are your thoughs on these changes? Lipid management over the last decade has been utilizing guidelines from the 3rd report of the National Cholesterol Education Program. In November 2013 new guidelines were established with controversy regarding some of the changes that were to be made. The 2013 AHA/ACC lipid guidelines provide a new method to the management of hyperlipidemia, which differs from the ATP-III guidelines. The new guidelines created differ in that it includes the change from treating target levels or lab tests to treatment based on risk level and intensity of statin therapy. They identified 4 groups that would likely benefit from statin therapy: * History of arteriosclerotic cardiovascular disease (ASCVD) * LDL- cholesterol >190 mg/dl * Between 40-75 years of age with history of diabetes * Between 40-75 year of age and a 10-year ASVD Risk > 7.5% A second key difference is lack of LDL goals in order to monitor the effectiveness of cholesterol lowering medications. There were no recommendations made on follow up LDL testing, which differs from previous guidelines. The best way to accomplish the AHA/ACC recommended goals is to focus on decreasing cardiovascular disease events or ASCVD. Another major change to the guidelines states that non-statin therapies do not provide acceptable ASCVD risk reduction benefits compared to their potential for adverse effects. This...
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...CC 68 years old Male Endocarditis Social: * Spanish Speaking * Former Cigarette Smoker, quit 17 years ago Cardiac: * Endocarditis * AVR * CABG x1 * Abscess of aortic root * Pacemaker * Hypertension * Complete Heart Block * Mitral Regurgitation * Coronary Artery Disease * Aortic Stenosis * Paroxysmal A-Fib * Metoprolol tartrate (lopressor) * Amlodipine (Norvasc) * Enalapril (Vasotec) * Furosemide (Lasix) * D: Decreased cardiac output related to inflammation of lining of the heart and valves. * I: Monitor for symptoms of heart failure and decreased cardiac output. Listen to heart sounds, lung sounds and note flowing symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, Cheyne-Stokes respirations, fatigue, weakness, third and fourth heart sounds, and crackles in lungs. * D: Risk for infection due to previous diagnosis of endocarditis and recent surgery. * I: Observe and report signs of infection such as redness, warmth, discharge, and increased body temperature and white blood cells. Pain: * Acetaminophen (Tylenol) 650 mg * Oxycodone-acetaminophen (Percocet) 5-325 mg * D: Acute pain related to inflammation and surgery. * I: Conduct pain assessment using scale of 0-10 and implement pain management interventions. Circulatory: * Heparin (Porcine) 5,000 units * D: At risk for blood clots due to artificial valve, cardiac disorders, and lack of mobility...
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