Question

ompensation is in shock. food gas ed acidosis Ms. X's condition becomes less stable and she remains in the hospital. On the seventh day following admission, she is Found unconscious on the floor of her bathroom. Her pulse is weak and elevated, and her skin is moist with pallor evident. Her BP is 50 systolic Adlagnosis of cardiogenic shock is made and resuscitation efforts are started. 10. Explain why Ms. X. has experienced cardiogenic shock at ome this time. as "warm 11. Describe the effects of cardiogenic shock on the organs of the body. 12. What problems will occur if decompensated shock occurs? How is compensation limited in this situation? 13. Ms. X dies shortly later. What is the cause of death in this case? re fatigue ecides to appears er blood rregular d leads of serum cardial forma- essful years e has gym like had ore airs CASE STUDY B Essential Hypertension Ms. J., aged 48 years, has essential hypertension, diagnosed 4 years ago. She has not been taking her medication during the past 6 months because she has been feeling fine. Now she has a new job and has been too busy to enjoy her usual swimming and golf. She has decided to have a checkup because she is feeling tired and dyspneic and has had several bouts of dizziness, blurred vision, and epistaxis (nosebleeds) lately. On examination, her blood pressure is found to be 190/120, some rales are present in the lungs, and the retinas of her eyes show some sclerosis and several arteriolar ruptures. The physician orders rest and medication to lower the blood pressure, as well as an appointment with a nutritionist and urinary tests to check kidney function. 1. Describe the pathophysiology of essential hypertension. 2. Explain the possible problems associated with the high diastolic pressure. 3. Explain the significance of the retinal changes. 4. The doctor suspects mild congestive heart failure. Explain how this can develop from hypertension. 5. Give two other possible signs of CHF. 6. List two medications that are helpful in treating hypertension, and describe their actions. CHAPTER SUMMARY Laart function may be imraidh

Answer 1

Case Study B

Name of the client: Ms. J…

Age: 48 years old

Diagnosis: Essential HTN (for 4 years)

Personal history:

• Non-compliance with medication since 6 months.
• Has moved to a new job

Present complains: Feeling tired, dysneic, bouts of dizziness, blurred vision, epistaxis

On examination:

• BP 190/120
• Rales in lungs( on auscultation)
• Sclerosis in the retina and several arteriolar ruptures.

Physician order:

• Rest
• Medications to lower blood pressure.
• Appointment with nutritionist
• Urinary test to check kidneys

Pathophysiology of Essential Hypertension

Essential hypertension is also referred to as primary hypertension. It is defined as an increase in the systolic BP more than 140 mmHg and diastolic BP more than 90mmHg, without a known cause.

The pathogenesis for essential hypertension is multifactorial. The factors contributing to this disease can be Genetics, autonomic nervous system, rennin angiotensin- aldosterone system, endothelial dysfunction, obesity, etc. All of these factors lead to defects in renal sodium homeostasis, functional vasoconstriction, and defects in vascular smooth muscle growth and structure. As a result of defects in the renal sodium homeostasis, there is inadequate excretion of sodium which causes the retention of sodium and water in the body. Because of increased water retention the plasma and extracellular volume increases which leads to an increase in the cardiac output. The functional vasoconstriction increases vascular reactivity which increases the total peripheral resistance. On the other hand, the defects in the vascular smooth muscle growth and structure also increase the vascular wall thickness leading to increased peripheral resistance. As a result of the increased cardiac output and increased peripheral resistance hypertension develops.

Possible problems associated with the high diastolic pressure

Diastolic pressure is the pressure in the arteries when the heart is at rest. Normal diastolic pressure is 80mmhg, it is considered to by high when above 90mm Hg. People with high diastolic pressure are at increased risk of developing:

• Stroke: It is defined as reduced blood flow to the brain leading to cell death and paralysis. If the diastolic pressure increases the stroke volume also reduces, therefore the supply of blood to the brain also reduces leading to stroke.
• Stable angina: stable angina is chest pain at rest. When the diastolic pressure increase the pressure in the arteries is higher even at rest, this may cause the reduced blood supply to some heart muscles and may cause stable angina.
• Abdominal aortic aneurysms: The aortic tissue wall under high pressure because of the increased diastolic pressure. The tissue wall weakens and forms an aneurysm. It is a life-threatening condition.

Significance of the retinal changes

The retina is a light-sensitive tissue present at the back of our eyes. It converts the lights into nerve signals and transfers it to the brain for the formation of an image. When patient has been suffering from hypertension since a long time, like in this case Ms. J has been suffering from essential hypertension since 4 years and also had not been taking medicines since last 6 months; in such case the wall of the blood vessels reaching the retina thickens and narrows and may make the retina to swell up. This limits the retinal function and may cause blurred vision

Development of mild congestive heart failure from hypertension

Congestive heart failure is a chronic progressive disorder characterized by the buildup of fluid around the heart because of which the cardiac muscles cannot pump blood efficiently. When a patient has been suffering from hypertension for a long period of time their heart walls thicken and become larger to cope with the increased demands of the body. The doctors had suspected that Ms. J… is suffering from mild congestive heart failure; this may be because of her increased blood pressure. Due to increased blood pressure the left ventricles enlarge in size, a patient may develop atherosclerosis, this may lead to myocardial infarction. The myocardial muscles lose their capacity, arrhythmia may develop. The cardiac muscles may undergo remodeling which causes the n=ventricular dilation leading to congestive heart failure.

Two possible signs of CHF

Two possible signs of CHF are:

• Shortness of breath (Dyspnea): as the heart in ineffective in pumping the blood backs up in the pulmonary veins causing difficulty in breathing
• Tiredness or fatigue, dizziness: the heart is not able to meet the demands of the body. The blood supply to the muscles, tissues and brain may reduce leading to tiredness, fatigue. Ms. J… had reported that she is feels tired and dyspneic. These both can be taken as signs of CHF.

Two medications used in treating hypertension and their actions.

Two medications used to treat hypertension are

Diuretics : Diuretics increase the absorption of sodium and water from the renal tubules and thereby increases the urine output. This helps to lower the blood pressure .

Examples : Lasix ( furosemide)

Beta-blockers: These drugs binds with the beta-adrenergic receptors and blocks adrenaline from binding to these receptors. This inhibits the sympathetic activity and thereby it reduces the heart rate and force of the pump and also reduces the stroke volume.

Example: labetalol ( Trandate)