Pnma Case Studies

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Student Name: Scott Wood Clinical Dates: 1/20-1/21/2015
Initials of assigned patient: CH Unit ICU Room # 8
Patient’s admitting diagnosis: PNA/CHF

Discuss event(s) that led up to admission to critical care unit: Mr. H was admitted to the ER in Jamestown, TN on January 16th with shortness of breath, unproductive cough, and an overall feeling of weakness. Patient stated “I was having a hard time catching my breath and just felt real weak all over.” Patient was found to have a pleural effusion of the left lung with diminished breath sounds and rhonchi. He was diagnosed with acute respiratory failure and chronic cardiomegaly. Patient was transferred from Jamestown medical facility, due to high patient occupancy, to Methodist Medical Center in Oak
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The patient reports to only drink alcohol occasionally and denies smoking. The patient has metastasized melanoma skin cancer most probably related to his profession of back hoe operator for 33 years which exposed him daily to the damaging UV light of the sun. The patient also has a history of MI that has led to a decrease in the efficiency of his heart and decreased perfusion leading to his chronic kidney disease due to damage to his glomeruli and the musculature of the heart. This also related to his diabetes mellitus which causes his neuropathy and damages his glomeruli of the kidneys decreasing filtration leading to increased workload for the heart and kidneys, hypertension which increases the workload and leads to damage of the heart, and hyperlipidemia which decreased blood flow to the heart and body and increased the BP leading to the hyper tension all of which are damaging to both the heart and kidneys decreasing the efficiencies of both organs leading to systemic failure of the body as a whole. The patient has a history of gout that causes him pain and ambulatory issues decreasing activity, which limits his exercise potential and decreases the efficiency of his heart and promotes hyperlipidemia in conduction with dietary choices. The patient suffers from benign prostate hypertrophy causes discomfort and frequent difficulty and impairment of urination. The patient also experiences bouts of …show more content…
These contributing factors decrease cardiac output, systemic blood pressure, and perfusion to the kidneys leading to activation of the renin-angiotensin-aldosterone cycle and the baroreceptors in the aortic arch, carotid sinus. This stimulates of vasomotor regulatory centers in the medulla, which in turn activates the sympathetic nervous system release of epinephrine and norepinephrine from the adrenal glands causing constriction of arteries to increase blood pressure. The activation of the renin-angiotensin-aldosterone cycle leads to the retention of sodium and water, release of arginine vasopressin and endothelin (increases BP by vasoconstriction, afterload, and heart rate), and the release of cytokines that leads to ventricular remodeling by hypertrophy of the heart and dilation of the ventricles and decreased

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