Fluent Essays

Answer the question on your words about 250-300  ( 50/question) words in a total for 6 questions.   I am giving you the answers in the attached file. Just number the questions and answer them accordingly in your own words. All answers must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) .  No older than 5 years.   Using APA format   Answers must be scholarly and be 5-6 sentences in length with rationale and explanation.   Turnitin over 15% will not be accepted. Case Studies 1 & 2 (Combined in one) Grade criteria is divided as follows: Case Study 1 Question 1 = 2 points Question 2 = 1 point Question 3 =2 points Total 5 points Case Study 2 Question 4 = 2 point; Question 5=1 points Question 6=2 points Total: 5 points Total 10 points Answer 1: Pericarditis Chest pain is the most common symptom of pericarditis, it is most often sharp and pleuritic in nature. Usually it is precordial or retrosternal, with exacerbation by inspiration or coughing, and it decreases in intensity when the patient sits up and leans forward. The presence of a pericardial friction rub on physical examination is pathognomonic for acute pericarditis. It is generated by friction between the two inflamed layers of the pericardium. It has a scratching, grating sound like leather rubbing against leather. Friction rubs tend to vary in intensity between different auscultations. Answer 2: (1) characteristic chest pain · sharp and pleuritic in nature. Usually it is precordial or retrosternal, with exacerbation by inspiration or coughing, and it decreases in intensity when the patient sits up and leans forward (2) pericardial friction rub · the pericardial rub can be heard even after cessation of breathing (3) Electrocardiographic (ECG) changes · PR segment depression. · T wave remains positive in most of the EKG leads (4) new or worsening pericardial effusion. Answer 4 ECG Changes- Electrocardiogram of Acute Pericarditis EKG may be diagnostic in acute pericarditis, changes might occur within a few hours of the onset of symptoms, but changes are not always present. Serial electrocardiograms are helpful in patients with acute pericarditis because it causes characteristic 12-lead EKG changes that have typically evolved sequentially through 4 stages that occur several days after the onset of pericarditis symptoms. The patient of the case study presents to consultation for chest pain that started 24 hours ago, so this is indicative of Stadium I of Acute Pericarditis shows on the Electrocardiogram of the patient pic # and #2. Stage 1 Acute pericarditis, stage 1 Concave ST-elevation, PR segment depression, positive T wave. Changes occur within a few hours of the onset of symptoms. On the electrocardiogram is mainly characterized by diffuse concave ST-segment elevation in almost all EKG leads (except V1 and aVR) and absence of reciprocal ST-segment changes. Diffuse PR segment depression can also occur (noted in picture 1of the patient) This electrocardiographic sign is more specific for acute pericarditis, although it is less sensitive. At this stage, T wave remains positive in most of the EKG leads. ANSWER 5: MEDICAL TREATMENT. The choice of drug should be based on the medical history of the patient, including contraindications, previous efficacy or side effects, the presence of concomitant diseases favoring aspirin over other NSAIDs when aspirin is already needed as an antiplatelet treatment. Acute pericarditis is a self-limiting disease without significant complications or recurrences in 70% to 90% of patients. If the laboratory data support the clinical diagnosis, symptomatic treatment with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) with gastroprotection should be initiated. Colchicine is recommended first-line therapy as an adjunct to aspirin/NSAIDs. Low-dose corticosteroids should be considered in cases of contraindications/failure of aspirin/NSAIDs and colchicine, and when an infectious cause has been excluded, or when there is a specific indication such as autoimmune disease. Serum CRP guides the treatment length and response to therapy. Other procedure: Pericardiocentesis, may be considered if a large effusion is present that affects  heart function  , or to assist to identify the cause by cultured the pericardial fluid. Pericardotomy (cutting a hole in the pericardial sac) or pericardectomy (removing the sac completely) may be needed for recurrent pericarditis that causes scarring within the pericardial sac and prevents the heart from beating properly. General recommendations, physical activity, and lifestyle changes The first non-pharmacological recommendation is to restrict physical activity to no more than is usual for patients not involved in competitive sports until symptoms have been resolved and the diagnostic tests normalized (i.e. CRP, ECG and echocardiogram). ANSWER 6: INITIAL TREATMENT The initial evaluation should be focused on screening for specific risk factors that would alter the appropriate treatment. The predictors that have been identified as being associated with an increased risk of complications during follow-up are tamponade, recurrences, and constriction. The major risk factors associated with poor prognosis in acute pericarditis include high fever, subacute course, evidence of large pericardial effusion, cardiac tamponade, and failure to respond within seven days to non-steroidal anti-inflammatory drugs (NSAIDs). The minor risk factors, including acute pericarditis associated with immunodeficiency, trauma, anticoagulant therapy, and myocarditis (myopericarditis). Any clinical presentation that may suggest an underlying etiology (e.g. a systemic inflammatory disease) or with at least one predictor of poor prognosis (major or minor risk factors) warrants hospital admission and an etiology . Triage of Acute Pericarditis . Answer 3: The diagnostic most often is made on the basis of patient medical history, (PMH), signs and symptoms reported (nonproductive cough or hiccup, dyspnea, and heart rate palpitation), diagnostic test, and labs. Doppler echocardiography. The diagnostic test of choice for large effusions, cardiac tamponade, and constrictive pericarditis is two-dimensional Doppler echocardiography. This imaging modality can demonstrate moderate or large effusions, as detect inflammation, pericardial effusion or tamponade, and heart failure. Ct imaging may be the best diagnostic tool to determining the size, shape, and location of pericardial effusion and may be used to guide p ericardiocentesis. CMR imaging may assist with detection of inflammation and adhesions. 12-lead ECG may show concave ST elevation in many, if not all , leads and may show depressed PR segments or atrial dysrhythmias. LABORATORY TESTS Laboratory studies are useful for excluding ot her possible causes of symptoms and clarifying the underlying cause of pericarditis. Testing is individualized but frequently includes a complete blood cell count (CBC), an erythrocyte sedimentation rate (ESR), cardiac enzyme levels, and serum chemistries. Non-specific elevations in the CBC and ESR are common in patients with pericarditis. Chest X-ray  A chest X-ray can show changes in the size and shape of your heart. The images may show an enlarged he art if excess fluid has collected in the pericardium. If more than 250 mL of fluid has