1. Mr. J is a 52 year old male presenting to the clinic with a 2 week history of increasing dyspnea, exercise intolerance, swelling of the feet and a 6 pound weight gain. On exam he has an irregular heart rate and cardiomegaly. Based on these signs and symptoms what is the best explanation of what is happening to Mr. J: (filling in the blanks below will answer this)
Diagnosis:___________ (I am looking for the overall diagnosis not the irregular heart rate. Realize that the irregular heart rate is contributing to a more extensive disease process). Explain the underlying pathophysiology (what is going wrong at the tissue, organ or cellular level) that is causing the cardiomegaly ________, the dyspnea________, and the weight gain_______ (specifically where is the weight gain coming from- hint it has nothing to do with over eating).
How does the fluid leave the capillaries and why is it not all returning for Mr. J ? ______________
His irregular heart rate is diagnosed as atrial fibrillation. Blood clots are a risk with atrial fibrillation. During his hospital stay he begins having difficulty understanding what his family and health care providers are trying to tell him. Given his new diagnosis of atrial fibrillation, what complication might he be starting to develop? ____________ and why? ____________ Tell me where EXACTLY (based on the description of his symptoms) it is occurring. If you have the new diagnosis correct you would know this could occur in different regions, I want a specific location within the organ (as specific as possible) and not the organ in general?__________________.
2. Ms. X is a 68 year old who has smoked 2 packs a day for 40 years (an 80 pack year smoker). She presents to the ER with extensive mucous production, tachypnea, wheezing, and an oxygen saturation of 88%. This is a sign of low oxygen in the blood which is called _________. She is diagnosed with COPD with symptoms of bronchial mucous obstruction (in other words excessive, thick mucus production partially blocking the bronchi and bronchioles) and scaring of the alveoli.
What part(s) of the process of respiration does this interfere with?______________ Explain how it interferes with each part that you identify (leading to her signs and symptoms) _______________. CO2 build up in the blood often occurs as a result of the pathogenic processes described above which leads to one of the signs/symptoms she presents with, which one? ________________. Explain IN DETAIL how increased CO2 causes this symptom.______.
While in the ER, her blood pressure remained about 175/95, what stage of hypertension is she currently? __________