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Will be able to identify special dietary needs of the patient and will formulate a meal plan that will you reduce risk of recurrence of heart disease.

Introduction to Emphysema

Emphysema is defined as an abnormal enlargement of the air spaces that are present distal to terminal bronchioles, often in combination with alveolar wall destruction. The small distal airways and alveoli are initially affected, followed by destruction of the larger airways. Erosion of the alveolar septum results in enlargement of the airspaces (Jankowich & Rounds, 2012).

The two vital signs that get affected in emphysema are blood pressure and respiratory rate. Air space enlargement will increase respiratory rate and the person will face difficulty in breathing. The blood pressure will also be abnormally high due to destruction of the capillaries present in the alveolar walls.

Angina refers to chest pain that occurs due to inadequate blood flow to heart muscles. An imbalance between the oxygen demand of the heart and its supply, results in angina. This imbalance can occur due to an increase in oxygen demand during exercise or obstruction of the coronary arteries, or atherosclerosis (Jneid et al., 2012).

Myocardial infarction occurs due to decrease in blood flow to a part of the heart, thereby damaging heart muscles. There is reduced blood flow to the coronary arteries due to rupture of atherosclerotic plaques. Oxygen deprivation in the cells leads to development of ischemia, and cell injury, following which, the cells die (Thygesen et al., 2012). The type of myocardial infarction that might have occurred is ST elevation MI, where one of the major arteries of the heart might have got blocked (Authors/Task Force Members et al., 2012).

Heart failure results due to limited blood supply in the heart, subjected to increase demand of oxygen. Impairment of blood flow to heart for a prolonged period of time triggers ischemic cascade that blocks the coronary arteries in the heart, thereby resulting in its failure. Blockage of arteries deprives the cells of the necessary oxygen and ATP, resulting in necrosis and apoptosis of affected cells.

Swelling in the ankles and the legs might have occurred due to fluid accumulation inside the body, which is the direct indication of worsening heart failure. The fluid buildup due to reduction in blood flow makes the blood return through the veins. This results in fluid accumulation in lower Limbs.

It refers to a non cancerous enlargement in size of prostate gland. Most symptoms are urination problems, loss of control of the bladder, bladder stones, chronic kidney problem and urinary tract infection (Barry et al., 2017).

Pulmonary oedema refers to fluid accumulation in air-spaces and lung tissues. It results in impairment of gaseous exchange, and also leads to respiratory failure (Huh et al., 2012).

Two Vital Signs Affected with Emphysema

The symptoms that will be observed are coughing up blood or pink frothy sputum and paroxysmal nocturnal dyspnoea.

Problem

Goal

Course of action

Hypertension

Maintain blood pressure in acceptable range

· Administer thiazide diuretics

· Observe temperature, skin colour and oedema

COPD

Maintain airway patency

· Auscultate breath sounds

· Increase fluid intake 3000ml per day

Myocardial infarction

Control of chest pain

· Administer beta-blockers such as, propanolol and atenolol

· Administer morphine analgesic

Allied health workers are responsible for providing treatment and helping patients to rehabilitate. They are responsible for supporting diagnosis and facilitate easy recovery and promote good quality of life for the patients (Duncan & Murray, 2012). They also deliver scientific help in clinical laboratories and manage data and diagnostic instruments, essential for patient care.

  • Physiotherapist- Will help the patient to regain mobility that might get impact due to congestive heart failure.
  • Occupational therapist- Will assess the occupational performance for the patient and carry out cardiac rehabilitation programs to facilitate easy recovery.
  • Nutritionist- Will be able to identify special dietary needs of the patient and will formulate a meal plan that will you reduce risk of recurrence of heart disease.
  • Nurses- Will administered the prescribed medications for heart failure and COPD, thereby improving health outcome.

Stroke refers to brain injury that occurs due to interruption of blood supply to a part of brain. It occurs due to blood clots that blocks and artery which leads to the brain (Party, 2012).

Transient ischemic attack begins due to a temporary blockage of an artery, following which the blood returns to the brain on its own. Interruption of blood flow for a short period of time makes TIA last less than an hour (Wang et al., 2013).

FAST is an acronym commonly used for detecting and enhancing responsiveness to stroke victims. It stands for Facial drooping, Arm weakness, Speech difficulty and Time to call emergency services (Dombrowski et al., 2015).

Occurrence of 3 TIAs in the past year is a major concern as it predisposes the patient to a high likelihood of getting affected with stroke, resulting in death.

104 heart rate indicates tachycardia, which should be immediately treated by carotid-sinus massage, dive reflex and sedation. The patient should also be administered medicines, such as, beta-blockers and dietetics in order to reduce hypertension.

Scientific symptoms that might have been presented due to pulmonary embolism include shortness of breath dyspnoea, rapid breathing, tachypnoea, chest pain, cough and haemoptysis. He might have presented symptoms of cyanosis.

  • Dyspnoea- It refers to a subjective experience that results in breathing discomfort and distinct sensations such as, chest tightness, effort and air hunger (Davenport et al., 2013).
  • Tachycardia- It refers to increased heart rate, beyond 100 beats per minute, which occurs due to less blood flow in the heart and other regions of the body (Fenoglio et al., 2015).
  • Haemoptysis- It refers to coughing up of blood stains from or mucus from the larynx bronchi trachea and lungs. It is commonly seen in bronchitis, pneumonia, tuberculosis and lung cancer (Larici et al., 2014).
  • Diaphoresis- It refers to abnormal sweating or perspiration with regards to the environment and activity level and affects the entire body (Hanafusa et al., 2017).

The pathophysiology is complex and often involves intermittent airflow obstruction, airway inflammation and bronchial hyper-responsiveness. Airway inflammation and mucus secretion results in obstruction of air flow and bronchial reactivity. T lymphocytes regulate airway inflammation by cytokine release. Several exogenous and endogenous stimuli result in bronchial hyper-reactivity or airway hyper-responsiveness, which results in bronchospasm and shortness of breath, coughing or wheezing (Maslan & Mims, 2014).

The patient would be made to sit in a semi upright position (45-60degree) with the knee either straight or bent. It would promote maximum chest expansion and help in oxygenation.

There would be an increase in respiratory rate beyond 25, due to hyperventilation that would make the patient exhale more than he inhales. An increase in the heart rate more than 100 beats per minute would also be observed due to chest tightness (Keenan, Formenti & Marini, 2014).

Introduction to Angina

Physiotherapist- Will help the patient to move by following moderate exercise that would help him recover from hemiplegia.

Speech therapist- Will facilitate regaining of speech and improve facial muscle movement for helping the patient to swallow food.

Pleurisy

c. inflammation of pleura

Pneumonia

c. inflammation of lungs due to infection

Atherosclerosis

e. narrowing of blood vessels due to development of plaques

Pneumothorax

a. abnormal collection of air or gas in the pleural space

Symptoms of atrial fibrillation include

b. rapid, irregular heartbeat

References

Authors/Task Force Members, Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., ... & Fernandez-Aviles, F. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European heart journal, 33(20), 2569-2619.

Barry, M. J., Fowler, F. J., O'leary, M. P., Bruskewitz, R. C., Holtgrewe, H. L., Mebust, W. K., & Cockett, A. T. (2017). The American Urological Association symptom index for benign prostatic hyperplasia. The Journal of urology, 197(2), S189-S197.

Davenport, M. S., Viglianti, B. L., Al-Hawary, M. M., Caoili, E. M., Kaza, R. K., Liu, P. S., ... & Hussain, H. K. (2013). Comparison of acute transient dyspnea after intravenous administration of gadoxetate disodium and gadobenate dimeglumine: effect on arterial phase image quality. Radiology, 266(2), 452-461.

Dombrowski, S. U., White, M., Mackintosh, J. E., Gellert, P., Araujo?Soares, V., Thomson, R. G., ... & Sniehotta, F. F. (2015). The stroke ‘Act FAST’campaign: Remembered but not understood?. International Journal of Stroke, 10(3), 324-330.

Duncan, E. A., & Murray, J. (2012). The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC health services research, 12(1), 96.

Fenoglio Jr, J. J., Pham, T. D., Harken, A. H., Horowitz, L. N., Josephson, M. E., & Wit, A. L. (2015). Recurrent sustained ventricular tachycardia: structure and ultrastructure of subendocardial regions in which tachycardia originates. The Josephson School: A Legacy of Important Contributions to Electrophysiology, 68(3), 187.

Hanafusa, N., Lodebo, B. T., Shah, A., & Kopple, J. D. (2017). Is There a Role for Diaphoresis Therapy for Advanced Chronic Kidney Disease Patients?. Journal of Renal Nutrition, 27(5), 295-302.

Huh, D., Leslie, D. C., Matthews, B. D., Fraser, J. P., Jurek, S., Hamilton, G. A., ... & Ingber, D. E. (2012). A human disease model of drug toxicity–induced pulmonary edema in a lung-on-a-chip microdevice. Science translational medicine, 4(159), 159ra147-159ra147.

Jankowich, M. D., & Rounds, S. I. (2012). Combined pulmonary fibrosis and emphysema syndrome: a review. Chest, 141(1), 222-231.

Jneid, H., Anderson, J. L., Wright, R. S., Adams, C. D., Bridges, C. R., Casey, D. E., ... & Peterson, E. D. (2012). 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable Angina/Non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update). Circulation, 126(7), 875-910.

Keenan, J. C., Formenti, P., & Marini, J. J. (2014). Lung recruitment in acute respiratory distress syndrome: what is the best strategy?. Current opinion in critical care, 20(1), 63-68.

Larici, A. R., Franchi, P., Occhipinti, M., Contegiacomo, A., del Ciello, A., Calandriello, L., ... & Bonomo, L. (2014). Diagnosis and management of hemoptysis. Diagnostic and interventional radiology, 20(4), 299.

Maslan, J., & Mims, J. W. (2014). What is asthma? Pathophysiology, demographics, and health care costs. Otolaryngologic Clinics of North America, 47(1), 13-22.

Party, I. S. W. (2012). National clinical guideline for stroke. Retrieved from- https://bsnr.org.uk/wp-content/uploads/2014/05/national-clinical-guidelines-for-stroke-fourth-edition.pdf

Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., ... & White, H. D. (2012). Third universal definition of myocardial infarction. European heart journal, 33(20), 2551-2567.

Wang, Y., Wang, Y., Zhao, X., Liu, L., Wang, D., Wang, C., ... & Jia, J. (2013). Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. New England Journal of Medicine, 369(1), 11-19.

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