...Introduction Stents were first developed in the late 1970s out of a need to keep coronary arteries open after balloon angioplasty (Cohen, 2006). Balloon angioplasty can weaken the arteries, sometimes causing them to collapse within a few days (Cohen, 2006). At that time, the only treatment available was emergency bypass graft surgery (Cohen, 2006). Further, angioplasty was causing restenosis in almost one-third of all patients (Cohen, 2006). Bare metal stents were developed in the mid 1980s out of a need to prevent or lower the incidences of restenosis due to angioplasty. While bare metal stents solved the problem of artery closure during the hospital stay, restenosis continued to occur in patients who received bare metal stents. In one-fourth of all cases, the stent experienced reblocking at around six months and had to be reimplanted (Cohen, 2006). Drug eluting stents were next developed in the hope that the pharmaceutical would prevent restenosis. Drug eluting stents have the same structure as a bare metal stent but are coated with a pharmaceutical. The pharmaceutical can also be contained within a thin polymer on the scaffolding of the stent to slow the release (Cohen, 2006). Drug eluting stents, in comparison to bare metal stents, decrease the risk of restenosis. However, drug elucting stents may increase the risk of stent thrombosis. Still searching for a solution that would reduce the risk of restenosis and stent thrombosis, a few companies are developing...
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...laboratory. Ultrasound has been an exceptional tool in assisting physicians with selection of coronary balloons, and stents for percutaneous coronary interventions. As a critical piece of data collection, ultrasound measurements have emerged as a frontrunner in evaluating vessel diameter and intra-lumen irregularities. This measurement and visualization has become paramount in the cardiac arena, when choosing proper sizing for stent selection. The influence of ultrasound in cardiology has shown...
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...1. Describe nursing care of the post angioplasty patient. A coronary angioplasty is a procedure to open an area of the arterial blockage in the heart that has become narrowed. This allows better blood flow through the artery and to the heart muscle. It is often done with a catheter that has an inflatable small sausage-shaped balloon at its tip. Coronary angioplasty is being increasingly used as a treatment for coronary artery disease; the proper evaluation and management of patients after the procedure are important issues. Although coronary angioplasty is a complex technical procedure, the methods routinely used to evaluate its results have many limitations. The management of the patient during the first 24 hours after angioplasty should focus on the prevention, detection, and if necessary treatment of acute vessel closure. Assessment: When the patient returns from the cardiac catheterization laboratory, the stability of the patient should be established initially. This will include, but is not limited to, EKG, vital signs, oxygenation level, urine output, cardiac, respiratory, pulmonary, gastrointestinal, and gentle urinary assessment. Particular attention must be paid to the peripheral vascular assessment of the lower extremities. Often the patient may return from the cardiac catheterization laboratory with a sheath in place. If this is the case, the institutional procedures for caring for sheaths should be applied. Some institutions, may allow the nurse to remove that...
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...Annual Report 2013 In 1921, Terumo began meeting the challenges in medical care © Courtesy of the Kitasato Institute archives In 1921, Terumo Corporation was founded by several medical scientists and doctors, including Dr. Shibasaburo Kitasato to produce clinical thermometers in Japan. Until then, these vital medical devices were imported, and had been since the close of WWI. In the late 19th century, Kitasato studied in Germany under Dr. Robert Koch, a founding father of microbiology and proponent of the germ theory. In fact, Kitasato was the first person ever to succeed in culturing tetanus microbes, after which he propounded serotherapy. Later, serotherapy was used to treat diphtheria patients, saving many lives. After returning to Japan, Kitasato founded the Institute of Infectious Diseases, the School of Medicine at Keio University, and the Japan Medical Association. Today, Kitasato is known as the father of modern medicine in Japan. Terumo’ s mission remains unchanged: to persist in the quest of contributing to human health and life, to maintain an indomitable spirit and meet each new challenge with the same determination that our founder, Dr. Shibasaburo Kitasato maintained throughout his life. Corporate Mission Contributing to Society through Healthcare We contribute to society by providing valued products and services in the healthcare market and by responding to the needs of healthcare providers and the people they serve. Corporate Vision Terumo's unique technology...
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...Ectopic pregnancy, Tension Pneumothorax and Myocardial Infarction Presenting complaint, history of presenting complaint and physical findings Name: Tashaine Campbell Date: March 27, 2013 Class: Practice of Medicine An ectopic pregnancy is one in which the fertilized egg attaches itself in a place other than inside the uterus. Almost all (more than 95 percent) ectopic pregnancies occur in a fallopian tube; hence the term "tubal" pregnancy. Rarely, the egg may implant elsewhere, such as in the abdomen, ovary, or cervix. Presenting complaint: Miss Mao who is 25 years old, complains of a "sharp and stabbing abdominal pain" accompanied by dizziness and eventual loss of consciousness/syncope. She also has been experiencing bleeding. History of presenting complaint/Illness: * She suddenly experienced a sharp right pain localized to the right iliac area, intensity described as 10/10, with radiation to the tip of the right shoulder. * There was accompanying nausea, dizziness and eventual fainting/loss of consciousness. * Most commonly presents 6–8 weeks after last menstrual period. * Classic triad: Pregnant, bleeding or spotting, pelvic pain. * Rupture causes sudden increase in pain, dizziness, and anemia leading to shock and cardiovascular collapse. * Some degree of intermittent abdominal pain in the past 2 weeks, which had initially been dull, but intensity has become much sharper and episodic. * She described...
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...Cardiovascular Case Study Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest 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...
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...Assignment #1 Johnson & Johnson and Guidant FIN 648 February 13, 2006 Shreyasee Kothari Shalini Ramchandren Mattia Valdisolo William Smith Guidant, a company in the surgical & medical instruments & apparatus, is in the process of being acquired by Johnson & Johnson (J&J), a company that engages in the manufacturing and selling of various products in the health care field. By evaluating each company’s current strategy, it can help to decipher if J&J is undertaking a company that can add value to its business. Using several strategy models, such as Porter, Kauppi, the BCG Growth Matrix, and a Strength, Weakness, Opportunities, and Threats (SWOT) analysis for each company, we can identify how these companies operate in their own industries, as well as compare each to assess compatibility. Porter’s Model: 1. Barriers to Entry a. Regulatory restrictions: Guidant has extreme federal restrictions, as mandated by the industry it is in. By operating in the United States (US), Guidant must comply with the laws of the Federal Drug Agency (FDA). Operations in other countries (over 100) must comply with FDA equivalents in their respective countries. (Guidant 10-K 2004) Primary operations are in the US, Asia, and Europe. “The regulations also hold true for J&J due to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that took effect on January 1, 2006. It will have a major impact on how drug companies negotiate...
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...the point of an MI, means that I more than likely have arteries full of plaque which ultimately leads to a sudden and extended obstruction of blood supple to myocardial tissue. My brain is already spinning in curiosity of the severity of ischemia in my left ventricle. What is even more scary to me, as a woman, is the higher risk of silent ischemia in women. Silent ischemia doesn’t produce any symptoms when the heart experiences ischemic events. So I guess after the shock wears off, that is when the “oh shit” moment is about to happen. 2. Myocardial Infarction(MI) is also known as a heart attack. MI results when the flow of oxygen rich blood to a myocardium suddenly becomes blocked. If blood flow is not restored quickly, this results in cellular death by necrosis or apoptosis. Acute MI is an important form of Coronary Heart Disease (CHD). MI can occur at any age, but the risk of frequency raises with age progression. It is estimated that MI causes more than 150,000 deaths annually in the US. The American male has a greater than 1 in 5 chance of sustaining an MI or fatal ischemic event before the age of 65. Females that are younger than 45 have a 6 fold lesser risk of MI than men of the same age, however after menopause the rate becomes essentially equal by age 80. The initiating event is the development of a thrombus on top of an ulcerated or cracked atherosclerotic plaque which causes a sudden change in the structure of the plaque. As platelets pass by the surface of the ruptured...
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...variables in the community with how they relate to patients and health. Cultural, religious, ethnic, and personal upbringings are variables that are considered to gain a basic understanding of the community framework. The purpose of this paper is to discuss three nursing diagnoses related to AL and his family living in a suburban community in Staten Island, New York. Interventions and outcomes will be expected for each diagnosis and will be integrated into the care plan and educational program specially designed for the chosen family. Family Assessment AL is a 65 year old man with an Italian ethnic background. He is a smoker who has been recently diagnosed with Type II Diabetes Mellitus, mild obesity, and a history of coronary artery disease with one stent last year. His physician stated he is borderline diabetic that could be managed through diet and lifestyle modifications, and could not advance if he is compliant with suggested regimens. He lives in a two-family residence with his wife, and his father who lives in the side apartment downstairs. He has two adult children who live within close range and visit several times a week. Jean Watson’s Theory of Human Caring When caring for a special population group within a community, the nurse must integrate clinical thought to assimilate specifically designed interventions for patients. Nurses must be conscious of their responses and actions that may inadvertently affect the patient’s response. Jean Watson’s Theory of...
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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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...Liceo de Cagayn university – graduate studies | Visual Perception Deficits | Cataract & Glaucoma | Submitted by: | Nadine Angelica C. Gadia – Casiño, RN | March 18, 2012Submitted to:Ms. Delia V. Realista, RN, MANProfessor | | I. Intoduction Cataract Cataracts are common and significant cause of visual defects all over the world. A cataract is an opacification or clouding of the lens of the eye. Cataracts develop because of the alteration of transport of nutrients and metabolism in the lens. This interferes with light transmission to the retina therefore affecting the ability to perceive images clearly. All cells of the lens formed in the lifetime is retained therefore prevalence of cataracts increase rapidly with aging. WHO estimates that cataracts account for 48% of reversible blindness worldwide, which translates to about 18 million people. Cataracts affect slightly more women than men. The Beaver Dam Eye Study in the US found that 23.5% of women and 14.3% of men had a visually significant cataract by the age of 65 years. Although cataracts can be surgically removed, in many countries surgical services are inadequate, and cataract remains the leading cause of blindness. Age is the greatest risk factor in the occurrence of cataracts. Cataract, though with unclear links, may be acquired through heredity and genetics (e.g., Wilson's disease, galactosaemia, myotonic dystrophy). Early formation of cataracts is associated with the following risk factors: ...
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...Devices for the Netherlands…..……………………………………………………………………4 2.2 The US Vision: From see and treat to predict and prevent……………………………………………………6 2.3 Conclusions…………………………………………………………………………………………………………………………..7 3. Medical device sector in the US………………………………………………………………………………………………………8 3.1 Economic Impact…..………………………………………………………………………………………………………………8 3.2 The Sector by State…..…………………………………………………………………………………………………………10 3.3 Key Institutes: Patent Applications in the Cluster Areas…..………………………………………………….13 3.4 Conclusions…..…………………………………………………………………………………………………………………….20 4. Turning research into novel medical devices………………………………………………………………………………….22 4.1 The Medical Device Development Process…..……………………………………………………………………..22 4.2 CIMIT: A Structure for Medical Device Innovation…..………………………………………………………….23 4.3 Stanford Biodesign: Innovation as a Discipline…..………………………………………………………………..26 4.4 Conclusions and Recommendations…..……………………………………………………………………………….28 5. Summary and Conclusions…………………………………………………………………………………………………………….30 6. Acknowledgements……………………………………………………………………………………………………………………….32 7. References…………………………………………………………………………………………………………………………………….33 Appendices A1 Selection of Key Institutes A2 Results Patent Analysis A3 Research Profiles 1. Introduction This report analyzes the R&D infrastructure in the United States in the field of new medical devices. It is part of the Innovative Medical Devices Initiative the Netherlands (IMDI.NL) thematic program that...
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...TRANSPLANTATION * TYPES OF TRANSPLANT * DONOR WORK UP * RECIPIENT WORK UP | 8 - 14 | 4 | PRE OPERATIVE MANAGEMENT | 14 - 15 | 5 | INTRA OPERATIVE MANAGEMENT | 16 | 6 | POST OPERATIVE MANAGEMENT | 16 - 17 | 7 | COMPLICATIONS OF KIDNEY TRANSPLANT | 17 - 18 | 8 | NURSING PROCESS | 18 - 21 | 9 | HEALTH EDUCATION FOR PATIENT | 22 | 10 | CONCLUSION | 23 | 11 | REFERENCES | 24 | INTRODUCTION URINARY SYSTEM The urinary system consists of the kidneys, ureters, urinary blabber and urethra. The kidneys produce the urine and account for the other functions attributed to the urinary system. The ureters convey the urine away from the kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to outside of the body. WHAT DO NORMAL KIDNEYS DO? * Remove extra water. * Remove waste products. * Balance chemicals in the body. * Help control blood pressure. * Help make red blood cell. * Help build strong bones. When the kidneys no longer able to perform normal functions and starts to deteriorate, renal failure will occur, this condition may be acute or chronic. Then the following problems will occur: * Retention of waste and toxic products and excess water. * Nausea * Vomiting * Loss of appetite * Tiredness * Swelling...
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...Arrhythmias * Are common and often benign, but can indicate underlying heart disease. They often occur intermittently and so can be difficult to diagnose. * Can present with palpitations, chest pain, presyncope/syncope, hypotension, pulmonary oedema. Some are asymptomatic e.g. AF. * History taking make sure include: * Precipitating factors, onset, nature (fast/slow, regular/irregular), duration, associated symptoms (chest pain, dyspnoea, collapse). * Causes: * CARDIAC: * MI. * CAD. * LV aneurysm. * Mitral valve disease. * Cardiomyopathy. * Pericarditis. * Myocarditis. * Aberrant conduction pathways. * NON-CARDIAC: * Caffeine. * Smoking. * Alcohol. * Pneumonia. * Drugs (β2 agonist, digoxin, L-dopa, tricyclics). * Metabolic imbalance (K, Ca, Mg, hypoxia, hypercapnia, acidosis, thyroid disease, phaeochromocytoma). * Tests: * Bloods: FBC, U&E, glucose, Ca, Mg, TSH. * ECG: look for signs of IHD, AF, short P-R interval, long QT interval, U waves. * If ECG normal consider doing 24 hour tape. * Echo: look for structural heart disease. * Others: exercise ECG, cardiac catheterisation etc. * Types of Arrhythmias: * Bradycardias: * If asymptomatic and rate >40bpm then no treatment. * Look for cause and stop any drugs that may be the...
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...I. Introduction - Shock (Chapter 11) A. Review of anatomy and physiology B. Pathophysiology Initiation | * Decreased tissue oxygenation * Decreased intravascular volume * Decreased Myocardial contractility (cardiogenic ) * Obstruction of blood flow (obstructive) * Decreased vascular tone (distributive) * Septic (mediator release) * Neurogenic (suppression of SNS) | No observable clinical indications Decreased CO may be noted with hemodynamic monitoring | Compensatory | * Neural compensation by SNS * Increased HR and Contractiliy * Vasoconstriction * Redistribution of blood flow from nonessential to essential organs * Bronchodilation * Endocrine Compensation (RAAS, ADH, glucocorticoid release) * Renal reabsorption of sodium, chloride, and water * Vasoconstriction * Glycogenolysis | * Increased HR (EXCEPT NEUROGENIC) * Narrowed pulse pressure * Rapid, deep respirations causing respiratory alkalosis * Thirst * Cool,moist skin * Oliguria * Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy progressing...
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