BCH210H1 Lecture : lec23 Nat part1

49 views12 pages

copperraccoon231

13 Dec 2011

School

Department

Course

Professor

For unlimited access to Class Notes, a Class+ subscription is required.

hwpark22 and 40161 others unlocked

BCH210H1 Full Course Notes

Verified Note

49 documents

Document Summary

Case study: nat: blood supply to the brain and stenosis, embolus and ischemia, ldl cholesterol in blood and risk, lipoproteins and cholesterol, ldl production, internalization, athersclerotic plaque, dietary fat and health, arachidonate, cox, eicosanoids, and asa. Nat is a 59 year-old male stock trader at the tse. Nat gave up smoking 10 months ago: known as a very talkative individual by his family, stressful life because of tse, before this he smoked 4-5 cigarettes a day. Nat: 82 kg weight, 175 cm tall. Recently began medication to control hypertension: high blood pressure, before meds: bp 145/90, now with meds: bp 125/80 (optimal bb120/80) One day at work, nat finds he can"t talk! He can move and see and hear, but cannot produce speech: inability to talk is called aphasia. Suggesting that something is happening at the command centre: if you can talk, but you are talking gibberish called dysarthria. Nat goes quickly to the emergency at st mikes.

Related Questions

Medical History:
Mr. AB, a 60 yr old Caucasian male, comes to your fitness center for an exercise program. He is apparently healthy but has a 15 yr history of hypertension. His goal is to improve his health and fitness and reduce his risk for heart disease. In the past he did heavy resistance training and powerlifting. At present he has a body mass index of 31 kg Â· mâ2. His medications include aspirin (325 mg daily) and atenolol (50 mg daily). He has a familyhistory of premature CHD; his low-density lipoprotein (LDL) cholesterol is elevated (165 mg Â· dlâ1); his resting BP is 148/88 mmHg; and his resting heart rate is 60 beats Â· minâ1. He drinks three or four cans of beer with dinner each evening.

Diagnosis:
Mr. AB has a lengthy history of hypertension. Additional risk factors include obesity, age, family history, dyslipidemia, sedentary lifestyle, and elevated alcohol consumption.

Exercise Test Results:
During a recent maximal exercise test, Mr. AB exercised for 6 min using the Bruce treadmill protocol and achieved a maximum heart rate of 130 beats Â· minâ1 and BP of 240/90 mmHg. He did not develop any significant arrhythmias or ST-segment changes.

Exercise Prescription:
Mr. AB achieved 81% of his age-predicted maximal heart rate (HRmax). The test was negative for underlying cardiovascular ischemia. The initial prescription should be set at a modest intensity (40% V.O2R), and emphasis should be placed on building exercise duration to increase energy expenditure. Non-weight-bearing activities should be emphasized initially to minimize risk of musculoskeletal injury.

Questions:
1. Is it necessary for Mr. AB to exercise at high intensity to help manage his hypertension?

2. How will atenolol (a b-blocker) affect the prescription of a target heart rate range for Mr. AB?

3. What is an appropriate aerobic exercise prescription for Mr. AB?

4. What advice would you give Mr. AB about going back to heavy resistance training and powerlifting?

5. What additional lifestyle modifications should be discussed with Mr. AB to optimize his BP control?

Personal Information

Name: Mrs. Paula Johnson

Age: 65 years old

Gender: Female

Description

Mrs. Paula Johnson is a 65-year-old white woman with a previous history of a sedentary lifestyle, hypertension, hypercholesterolemia, and diabetes mellitus type II. She is a heavy smoker since she was 20 years old. She was brought to the emergency room because her family found her unresponsive on the floor. She was diaphoretic. Her family thought she had her diabetes decompensated. Mrs. Johnsonâs daughter indicated her mother was complaining of nausea and epigastric pain the day before. Also, her blood pressure was high.

On the physical examination we found:

Remarkable Signs on Physical Exam by Regions

Chest: Palpitation

Remarkable Signs on Physical Exam by Systems

Integumentary system: Profuse diaphoresis, coldness, and pallor

Respiratory system: Tachypnea

Cardiovascular system: Weak pulse, tachycardia, and hypotension

Nervous system: Unconsciousness. No other neurologic signs.

Lab Tests

Complete blood count (CBC)

Cardiac enzymes

Glucose level

Lipid panel

EKG

Cardiac catheterization

Diagnosis

Silent myocardial infarction

Other Diagnoses

Essential hypertension

Dyslipidemia

Diabetes mellitus

Supporting Material

Mrs. Johnson has been diagnosed with silent myocardial infarction. As we learned last module, the first step in pathophysiology is observation of noticeable changes, but what do we do when the patient does not outwardly experience symptoms? Chest pain is a scary symptom that usually alerts the physician and patient. However, if the patient or the physician is not alerted, the medical practitioner has to dig deeper to understand the cause or set of causes that contribute to the condition.

What are your initial reactions related to the case?

What is a heart attack?

Considering Mrs. Johnsonâs case, why does she have an increased risk of having a heart attack?

What is tissue perfusion? Which of the patientâs conditions can alter tissue perfusion? How?

What is hypertension? How does hypertension alter tissue perfusion?

Describe pneumonia. What risk factors does the patient have for pneumonia?

Case Studies for Week 1 1. John Tucker, a 49-year-old truck driver, has a history of hypercholesterolemia and hypertension. In addition, he was recently told that he has chronic bronchitis after a visit to his provider for follow-up on a hacking, longstanding cough that is worse in the morning. John takes cholestyramine (Questran) daily for his elevated cholesterol and atenolol (Tenormin) for hypertension. He smokes 2 packs per day and consumes a six-pack of beer every day or two. On occasion, he takes Mylanta for indigestion and "a sour stomach." John is seen today at your Quick Care Clinic because his cough has worsened. It is accompanied by productive yellow sputum and a temperature of 102.2Â° F (39Â° C). He states he is allergic to penicillin. It made him sick to his stomach. The physician begins him on azithromycin (Zithromax). When you approach John about smoking cessation, he abruptly tells you that he's not interested. John tells you that he had a friend who was hospitalized with pneumonia, requiring intravenous antibiotics. John is taking atenolol for his hypertension. After completing his antibiotic course of therapy, John returns to the clinic for follow up. While he reports his fever and productive cough are gone, he tells you that he can't sleep because of an intense hacking cough, particularly at night. He is given a 3-day prescription for chlorpheniramine and hydrocodone (Tussionex), a schedule III antitussive. â¨ 1. Zithromax is within the drug class called _______________ 2. Based on ethical decision-making, would you insist that John stop smoking because it is a self-harm practice? â¨ 3. How do cigarettes and alcohol interfere with drug metabolism? 4. Zithromax has a moderate degree of protein binding. When two drugs have a significant degree of protein binding, there is_____________________ 5. After drug absorption and distribution, the body eliminates drugs by biotransformation and excretion. The chief organ of metabolism is the__________________ 6. Based on the pharmacokinetics of the drug Questran, and given Johns social habits, is this an appropriate drug choice in the management of John's primary hyper-cholesterolemia? Explain your answer. 7. Because of drug-drug and drug-food/nutrient interaction, Questran should be taken: ______â¨â¨8. John takes atenolol for hypertension. In drug-receptor interaction terms, atenolol is a ________ 9. Atenolol may or may not aggravate Johns pulmonary disease. Choose your answer and explain it. 10. Explain the mechanism by which Tussionex will relieve Johns cough? What patient teaching do you want to do with John in relation to this drug? 2. Mrs. Brown is 65. She is widowed, lives alone, and has two supportive children who live 1 hour away. She has a history of arthritis and hypertension managed with hydrochlorothiazide (HCTZ) 25 mg daily. Two weeks ago she was treated for bleeding in the upper gastrointestinal tract attributed to use of nonsteroidal anti-inflammatory drugs (NSAIDs). On the morning of admission, she awoke with a strong feeling of indigestion. She took Pepto-Bismol and Tums, but the feeling persisted. She also felt more tired and "winded." She drove herself to the hospital 12 hours after the onset of pain, and the emergency room (ER) nurse recommended that an electro-cardiograph (ECG) be obtained. ST wave elevations were noted in leads II, III, and AVF, indicating injury to the inferior wall of her heart. â¨â¨Note the long duration of time between the onset of symptoms of myocardial infarction and her arrival in the ER as well as her recent gastrointestinal bleeding. These factors contraindicate the use of fibrinolytic therapy in the setting of her acute coronary syndrome. â¨ 1. In the ER, Mrs. Brown's hands and legs feel cool and her pupils are dilated. The adrenergic receptor stimulation that most likely is the cause of these symptoms is: â¨beta1, beta2, alpha1, alpha2 2. The ECG monitor alarm sounds. The nurse notes the sudden onset of ventricular fibrillation. A code is called, and Advanced Cardiac Life Support (ACLS) efforts ensue. Mrs. Brown is defibrillated three times, and cardiopulmonary resuscitation (CPR) initiated. The drug that is indicated at this time is: Epinephrine, Atropine, Morphine 3. Mrs. Brown is stabilized and transported to the critical care unit (CCU) with a diagnosis of an acute inferior wall MI. On admission to the CCU her vital signs are BP 80/50, HR 102, and RR 22. Her skin is cool and clammy. The physician decides to place a pulmonary artery catheter for hemodynamic pressure monitoring and an arterial line for continuous blood pressure monitoring. Her blood pressure continues to be between 80 and 90 mm Hg systolic, and her urine output has decreased to 30 ml/hr. A dopamine infusion is ordered to begin at 3 Âµg/kg/min. Mrs. Brown weighs 67 kg. The intravenous infusion is supplied 400 mg in 500 ml D5W. What would be an objective finding that would indicate Mrs. Brown is responding to dopamine therapy other then a lower pulmonary capillary wedge pressure? 4. When infusing dopamine, what special precaution is necessary? â¨â¨5. Mrs. Brown's intravenous infusions are tapered off. She is on aspirin 325 mg enteric-coated 1 tablet daily, metoprolol (Lopressor) 25 mg twice daily, and nitroglycerin (NTG) 0.4 mg sublingually prn. What drug class is metoprolol in? 6. What two parameters are essential for the nurse to assess prior to giving the metoprolol to Mrs. Brown? 7. Research supports a decreased mortality rate when beta-blocking drugs are initiated after myocardial infarction. Why? 8. Myocardial infarctions can lead to problems with chronic heart failure called CHF. Beta blockers used to be contraindicated to use in someone who has heart failure. Is there still a risk of increasing symptoms of heart failure with the use of these drugs?

pearjellyfish345

BCH210H1 Lecture : lec23 Nat part1

BCH210H1 Full Course Notes

Document Summary

Get access

Related textbook solutions

Chemistry: Structure and Properties

Basic Chemistry

Principles of Chemistry Molecular Approach

Principles of Chemistry Molecular Approach

Chemistry: Structure and Properties

Chemistry: A Molecular Approach

Chemistry: A Molecular Approach

Principles of Chemistry: A Molecular Approach

Chemistry: The Central Science

Related Documents

BCH210H1 Lecture Notes - Lecture 23: Transient Ischemic Attack, Low-Density Lipoprotein, Hypertension

BCH210H1 Lecture Notes - Internal Carotid Artery, Transient Ischemic Attack, Cholesteryl Ester

Related Questions