Write a differential in this case and explain how each item in your differential fits and how it might not fit.
1) Coronary Artery Disease (CAD)/Coronary Heart Disease (CHD): In the United States, CAD accounts for one death every minute making it a leading cause of death (Kones, 2011). Individuals at risk for CAD include those with modifiable and non-modifiable risk factors. Non-modifiable risk factors for CAD include: age, race, family history. Modifiable risk factors include: hypertension, obesity, smoking, hyperlipidemia, diabetes, and minimal to no physical exercise. If untreated, CAD can lead to heart failure (Kones, 2011). Individuals with CAD may present to their primary care providers with symptoms such as: angina, shortness of breath, indigestion/heartburn, and dyspnea on exertion. Individuals develop CAD when plaque obstructs the coronary arteries
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Pulmonary hypertension occurs with elevated pulmonary artery and pulmonary capillary wedge pressures (Chopra, Badyal, Baby, & Cherian, 2012). Patients with pulmonary hypertension will typically present with dyspnea on exertion (Chopra et al., 2012). As the disease progresses, symptoms such as orthopnea, edema, angina, and heart murmurs may occur (Chopra et al., 2012). Pulmonary hypertension can be idiopathic or can develop due to street drug use, portal hypertension, and collagen vascular disease (Chopra et al., 2012). Pulmonary hypertension can lead to right-sided heart failure (Chopra et al., 2012). Pulmonary hypertension is diagnosed through chest x-ray, EKG, echocardiogram, and cardiac catheterization (Chopra et al., 2012). The dyspnea on exertion and orthopnea that the patient is experiencing may be linked to pulmonary hypertension. However, the other symptoms do not match this diagnosis. If the patient has heart failure it is probable that pulmonary hypertension can
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Additionally, some of the general diagnostic and pulmonary function tests are distinct in emphysema in comparison to chronic bronchitis. In the case of R.S. the arterial blood gas (ABG) values are the following: pH=7.32, PaCO2= 60mm Hg, PaO2= 50 mm Hg, HCO3- = 80mEq/L. R.S.’s laboratory findings are indicative of chronic bronchitis, where the pH and PaO2 are decreased, whereas PaCO2 and HCO3- are increased, when compare to normal indices. Based on the arterial blood gas evaluation, the physician can deduce that the increased carbon dioxide is due to the airway obstruction displayed by the hypoventilation. Furthermore the excessive mucus production in chronic bronchitis hinders proper oxygenation leading to the hypoxia. On the other hand, in emphysema the arterial blood gas values would include a low to normal PaCO2 and only a slight decrease in PaO2 which tend to occur in the later disease stages.
Coronary artery disease is a heart disease characterized by narrow arteries and restricted blood flow in arteries and is the major cause of morbidity and mortality globally.[1] According to WHO estimation, 6.8% in men and 5.3% in women are affected globally.[2-4] Cardiovascular disease account for 29% of all deaths in Canada; of all the cardiovascular death, 54% and 23% was due to ischemic heart disease and heart attack, respectively. The total costs for heart disease and stroke were more than $20.9 billion every year. [5,6] With more than 1 artery impacted, multivessel coronary artery disease is more complex and more likely accompanied by other comorbidities including diabetes or high blood pressure; multivessel coronary artery disease usually is more difficult to deal with, has worse prognosis and cost more compared with single coronary artery disease. [7]
It was to this respect that, the search could detect ‘’hypertension’’ as the leading risk factor for heart disease. And this preceded three quarters of heart failures cases as compared to coronary artery disease, which led to most heart failures in less than 40% of the cases. Also, an increase in left ventricular end-diastolic diameter became a mirror to the Framingham study as incident heart diseases in the individuals who are free from myocardial infarction. Although studies have shown that, the manifestation of heart failures can be present without the left ventricular systolic dysfunction, other risk factors could lead to that. Also, they (Framingham study) were able to detect ‘’too much of cholesterol’’ as a link to cardiovascular diseases. Moreover, research believed that has elevated among certain heart diseases such as coronary heart often leads to stroke, too high blood pressure among numerous patients. Having said that, the search discovered ‘’obesity’’ also as a concomitantly with hypertension which elevates lipids and diabetes versus questions on smoking behavior. Having said that, these risk factors are believed to have attributed to heart diseases. Therefore, it became a national concern to the general US population and that of the fourth director of Framingham heart study, William Castelli
CM:CPSW did a home visit and met with foster parent (Dorothy Bensalih), Emeri and Cantarah were present during the visit. Cantarah was playing with her iPad and Emeri was sitting next to her. CPSW talked with Cantarah briefly and asked about school and any other concerns. Cantarah reported that she is doing well and excited about her new iPad and plays with it after school, she said. Emeri was playing with his sister and seemed shy during the visit. CPSW asked Ms. Dorothy about any concerns with Cantarah's school. She reported that she went to school recently and talked with Cantarah's teachers and they reported no concerns to her. CPSW asked Ms. Dorothy if Cantarah can be referred to a school therapist. Ms. Dorothy stated that she does not trust any therapist and believes that they will harm Cantarah's way of thinking. She stated that if there is an issue or concerns with Cantrarah then we solve the problem as a family instead of professional. She mentioned that she believes that therapists do make situations more difficult and does not want Cantarah to go through the trauma.
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
The main symptom of the disease is shortness of breath, which gets worse as the disease progresses. In severe cases, the patient may develop cor pulmonale, which is an enlargement and strain on the right side of the heart caused by chronic lung disease. Eventually, this may cause right-sided heart failure. Some patients develop emphysema as a complication of black lung disease. Others develop a severe type of black lung disease in which damage continues to the upper part of the lungs even after exposure to the dust has ended called progressive massive fibrosis.
Due to the atrial ectopics contractions the lung diseases occurs. When the blood pressure is high in the arteries then this occur. These premature heart beats are more common in the aged people.
Since 1960 the age-adjusted mortality rates for cardiovascular disease (CVD) has declined steadily in the U.S. due to multiple factors, but still remains one of the primary causes of morbidity and premature mortality worldwide. Greater control of risk factors and improved treatments for cardiovascular disease has significantly contributed to this decline (Centers for Disease Control and Prevention, 2011). In the U.S. alone it claims approximately 830,000 each year and accounts for 1/6 of all deaths under the age of 65 (Weiss and Lonnquist, 2011). Based on the 2007 mortality rate data an average of 1 death every 37 seconds is due to cardiovascular disease (Lloyd-Jones et al., 2009). Controlling and reducing risk factors is crucial for saving lives. There are a number of contributing risk factors for cardiovascular disease, which may appear in the form of hereditary, behavioral, and psychological, all of which ultimately converge in social or cultural factors.
Today, cardiovascular disease is “the number one killer in the United States and the developed world” (Sapolsky, 2004, p. 41). Coronary heart disease (CHD) is the most common form of cardiovascular disease, and is responsible for claiming an unreasonable amount of lives every year. CHD can begin to accumulate in young adults, but is prominently found in both men and women in their later adult lives. As a result of CHD, men typically experience heart attacks, whereas women present with chest pains, known as angina (Matthews, 2005).
One of the leading causes of death in the United States is heart disease. “Approximately every 29 seconds one American will have a heart attack, and once a minute one American will die from a heart attack” (Ford-Martin and Odle, 915). According to the Gale Encyclopedia of Alternative Medicine men over the age of 45 and women over the age of 55 are considered at risk for heart disease. Heart disease is a major cause of death. It is beneficial to individuals who seek to prevent heart disease to recognize the risks leading to heart attacks as they are one of the primary indications of developing heart disease; especially those that fall into the at risk age groups. These risks consist of some that cannot be changed such as heredity risks, or those that can change such as smoking habits. It is very important to know these specific risks for prevention and to understand the symptoms of heart attacks, such as sweating or the feeling of weakness so if these or other symptoms occur people are aware. Finally heart disease treatment is of vital importance if you experience a heart attack so you can learn how to prevent another one from occurring.
Even when the disease has progressed, the signs and symptoms may very similar to other conditions that affect the heart and the lungs. To determine if you have pulmonary hypertension, your doctor may recommend one or several tests that help rule out other disorders that could be causing your symptoms. Your doctor will diagnose Primary Pulmonary Arterial Hypertension (PPAH) based on your medical and family history, a physical exam, results from tests and procedures the tests and procedures also will help your doctor determine the cause of your PPH, and its severity. (INFORMATION SUPPORT HOPE) Some of these tests may include Echocardiography, Chest X ray, EKG, Right heart catheterization (use of a special device that the doctor threads through a vein into the heart and arteries of the lungs to measure pressure in the arteries and test how well the heart is pumping), Pulmonary function tests, and Exercise testing. (Primary Pulmonary Hypertension. (2014, January 1)) “The doctors had to do a right catheterization and echocardiography on me to find out if I had Primary Pulmonary Hypertension. Because doing the EKG and Chest X rays are not accurate in my opioion. ” (personal communication, August 26, 2014)
Patients with advanced COPD are prone to develop secondary complications of the disease. The goal of treatment is to restore functional status as quickly and as much as possible and to alleviate distress and discomfort. The main diseases associated with pulmonary arterial hypertension are that anemia Osteoporosis and coronary heart disease. Cor Pulmonale refers to altered structure or function of the right ventricle, resulting from pulmonary hypertension (PH) associated with chronic lung disease In the course of COPD endothelial dysfunction occurs in the pulmonary artery, which has a decreased secretion of Vasoactive mediators such as nitric oxide and Prostacyclin come, this leads, also enhanced by the hypoxia to
In the case study it is the left lung that is in distress, and as the pressure increases within the left lung it can cause an impaired venus return to the right atrium (Daley, 2014). The increased pressure can eventually affect the right lung as the pressure builds in the left side and causes mediastinal shift which increases pressure on the right lung, which decreases the patients ability to breath, and diffuse the bodies tissues appropriately. The increase in pressure on the left side where the original traum... ... middle of paper ... ... 14, January 29).
Throughout my lifetime, I have never had to think very much about the working world and everything that went with it. All through high school I took classes I liked or thought would be interesting to me, but never thought that all of those classes were preparing me for what was to come. Before I knew it, it was time to go to college. The four years of high school had flown by and now it was time to choose a major for college. I had never given much thought as to what I wanted to do for the rest of my life. The only real occupations that I had really gotten to experience were teaching, the jobs that my parents had, and others such as doctors, dentist, most of the occupations that everyone sees while they are growing up. When I finally decided on my major, I chose engineering, but I didn’t know if I would like it or not. The only prior knowledge I had about it was the fact that my grandfather was an electrical and chemical engineer, and that my parents and teachers said that I would be good at engineering. Recently I have been interested in civil engineering, but what does one do with such a degree? What opportunities are available to a person with a degree in civil engineering on the job market? The broad curriculum that covers many different fields of engineering make civil engineering a major that allows a person to work in nearly any field they wish.