Cardiovascular Lymphatic and Respiratory Systems Case Studies (graded)Class in this thread we will be looking at cardiovascular lymphatic and respiratory systems and their related patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in TerminalCourse Objective (TCO) 4. You must address all of the questions located after the example of case study and patient encounter of Sarah Eubanks. Case StudyHistory: Nancy Macron is a 53-year-old female who states that she was doing well until about 1 month ago when she developed dyspnea on exertion as well as nocturnal dyspnea and orthopnea (breathing discomfort occurring or made worse by lying flat). She also complained of peripheral edema over that period of time. The patient gives a history of atypical chest discomfort located over the left breast described as a dull ache. This has no relationship to exertion and is not relieved by rest. She denies a prior history of coronary artery disease or prior history of myocardial infarction in the past.Her risk factors are negative for hypertension or diabetes mellitus. She does admit to tobacco use about one pack per day over the past 5 years down from two packs a day over the preceding 20 years.Family History: Her family history is negative for coronary artery disease.Allergies: NoneMedications: Medications include Lanoxin 0.125 mg daily Slow-K 8 mEq t.i.d. and Lasix 40 mg a day.Operative History: She gives a history of cholecystectomy 5 years ago. Carcinoma of the colon was discovered and treated 10 years ago.Physical Examination: General: She is a well-nourished well-developed obese female in no acute distress. Blood pressure was 130/80 and pulse was 100 and regular. Her weight was 213 pounds and height 5’3.” HEENT: Head is atraumatic normocephalic. Eyes: Pupils equal round and reactive to light the sclera was clear and the conjunctiva was pink. Neck: Supple. There is a good carotid upstroke noted bilaterally. The thyroid was noted to be midline. No bruits were appreciated. Chest and Lungs: Clear to A & P (auscultation and percussion) without rales rhonchi or wheezes appreciated. Cardiac: S1 and S2 were heard no S3 (first through third heart sounds). No murmurs were appreciated. Abdomen: Bowel sounds were audible and felt to be normal. I was unable to palpate the liver or spleen. Extremities: Negative for cyanosis clubbing or edema.Impression: The history is compatible with congestive heart failure. However at this time the patient is not in congestive heart failure. This most likely is secondary to the fact that she is on Lanoxin Lasix and Slow-K. Except for smoking the patient does not have any risk factors. I have proceeded to evaluate her cardiac function by ordering a chest X-ray to evaluate cardiac size an echocardiogram with Doppler to evaluate left ventricular function and a stress test with Thallium to evaluate for the presence of coronary artery disease.Thank you very much for allowing me to see this patient. After the studies have been completed a follow-up letter will be forwarded.OUTPATIENT OFFICE ENCOUNTERSarah Eubanks is a 65-year-old female who recently had a mammogram that showed a focal abnormality in the superior aspect of the right breast. Nothing was palpable; however the surgeon felt that this area should be removed. Prior to presenting to the operating room the abnormality was localized with a Kopan’s wire placed under mammogram guidance. After the mass was excised the pathology report indicated that microscopic examination revealed a lesion that was 0.8 cm in diameter. The post-op diagnosis was infiltrating ductal carcinoma.DISCUSSION QUESTIONS:1. Reviewing the case study and provide the following in your post:A. Choose one body system describe its major structures and functions and then explain the terms used in this case study that relate to that system.B. Reviewing the patient’s case study list all diagnoses past and present and define word parts where appropriate.2. Reviewing the outpatient encounter of Sarah Eubanks accomplish the following and report in your findings and comments in your post:A. Go to Research a Disease or Condition in the A.D.A.M. multimedia encyclopedia. Read all the information under Cancer – breast and look at the six images. Read one of the Care Points. Go to CLINICAL ANIMATIONS (outside the encyclopedia on the ADAM home page) and look atLymphatics and the breast.B. After studying the material summarize or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste.C. Given Sarah’s diagnosis discuss what you consider the most likely prognosis and treatment?3. General questionsA. Describe the primary functions performed by the cardiovascular lymphatic and respiratory systems.B. Given your understanding of how the heart works as a result of the reading assignments for this week what causes the heart sounds that are heard on auscultation? What are murmurs?C. Name some other abnormal heart sounds and their significance.
