The heart is a hallow, cone-shaped

organ about the size of the fist. It is

located in the mediastinum,
between the lungs and underlying
the sternum. It is enclosed by a
double layer of fibroserous
membrane known as pericardium.
The parietal, or outermost,
pericardium serves to protect the
heart and anchor it to surrounding
structures. The visceral pericardium
adheres to the surface of the heart
forming the heart’s outermost layer,
the epicardium. The heart wall
contains two additional layers: the
myocardium which is the middle
and thickest muscular layer of the
heart and is responsible for the
contraction of the heart and the
endocardium which is the
innermost layer of the heart that
lines the chambers and valve.
 The heart also has four chambers, two atria (left atrium and the right atrium)
and two ventricles (left ventricle and the right ventricle). The two atria and two
ventricles are separated longitudinally by the interventricular septum, forming
two parallel pumps. The atria and ventricles are separated from one another by
the atrioventricular(AV) valves, the tricuspid valve on the right and the bicuspid
or mitral valve on the left. The ventricles in return, are separated by the great
vessels (the pulmonary arteries and aorta) by the semilunar valves: the pulmonic
valve on the right and aortic valve on the left. The valves serves to direct the
flow of blood, allowing it to move from the atria to the ventricles, and then
ventricles to the great vessels, but preventing backflow. The heart has four one-
way valves, the aortic, mitral valve, pulmonary valve and tricuspid valve. The
blood supply of the heart comes from the left and right coronary arteries.

 Deoxygenated blood from the veins enters the right side of the heart through
the superior and inferior vena cavae. From here, it flows into the right ventricle,
which pumps it through the pulmonary artery into the lungs for gas exchange at
the alveolar/capillary membrane. Freshly oxygenated blood returns to the left
atrium via the pulmonary veins. From here, the blood enters the left ventricle to
be pumped out to the systemic circulation through the aorta.
 With each heart beat, the myocardium goes through a
cycle of contraction (systole) and relaxation (diastole).
Systole is when the heart ejects ( propels) the blood into
the pulmonary and systolic circulations. Diastole is when
the ventricles fill with blood. The diastolic phase of the
cardiac cycle is twice as long as the systolic phase. This is
important because diastole is largely a passive process.
The longer the diastolic phase allows this filling to occur.
S1 is the first sound, beginning of ventricular systole and
caused by closure of the atrioventricular valves-the
tricuspid and the mitral. S2 is the second sound and the
beginning of the ventricular systole, the sound is caused
by closure of the semilunar vales, the aortic and the
pulmonic.
 The main functions of cardiovascular system are to
transport oxygen, hormones and nutrients to the tissues,
also, the transport of waste products to the lungs and
kidneys for excretion. The conducting system of the heart
consist if the SA node, the AV nod, Bundle of His and the
Purkinje fibers
The amount of blood the heart pumps out in each
beat is called the stroke volume. When this volume is
multiplied by the number of the heart beat in one
minute, it becomes the cardiac output. When the
cardiac output is multiplied by the total peripheral
resistance, it becomes the blood pressure. The preload
is the degree of stretching of the heart muscle when it
is filled up with blood. The after load is the resistance
to which the heart must pump to eject the blood.
The vascular system is consists of the arteries, veins
and capillaries. The arteries are the vessels that carry
blood away from the heart to the periphery. The veins
are the vessels that carry blood to the heart. The
capillaries are lined with squamous cells and connect
the veins and arteries.
 THE PACREAS
The pancreas is a
glandular organ that
secretes digestive
enzymes (internal
secretions) and hormones
(external secretions). In
humans, the pancreas is a
yellowish organ about 7
inches (17.8 cm) long and
1.5 inches (3.8 cm) wide.

The pancreas lies beneath

the stomach and is
connected to the small
intestine at the
duodenum (first section
of small intestine).
 The pancreas contains enzyme producing cells that secrete
two hormones. The two hormones are insulin and glucagon.
Insulin and glucagon are secreted directly into the
bloodstream, and together, they regulate the level of glucose
in the blood. Insulin lowers the blood sugar level and
increases the amount of glucagon that is stored carbohydrate
in the liver. Glucagon slowly increases the blood sugar level
if it falls too low. If the insulin secreting cells do not work
properly, diabetes occurs.
 The pancreas produces the body's most important enzymes.
The enzymes are designed to digest foods and break down
starches.
 The pancreas also helps neutralize chyme and helps break
down proteins, fats and starch. Chyme is a thick semifluid
mass of partly digested food that is passed from the stomach
to the duodenum. If the pancreas is not working properly to
neutralize chyme and break down proteins, fats and starch,
starvation may occur.
 Non-Modifiable Factors
Modifiable Factors
Age 72yo
Obesity – BMI: 34
Family History
Sedentary Lifestyle
Hx Hypertension
Hx DM

Normoglycemic State

Increased level of plasma

triglycerides Abnormal fibrinolysis
Low levels of high-density Coronary Artery Disease
lipoproteins Hypertension
Pumping ability of
the heart becomes HASCVD
impaired

Congestion of body tissues from Ventricular Gallop – S3

systemic venous congestion

CHF

Right Side of the heart is affected

Peripheral Edema Pulmonary Congestion

Pneumonia

Cough DOB Crackles

Modifiable Factors Non-Modifiable Factors
Obesity – BMI: 34 Age 72yo
Family History
Sedentary Lifestyle
Impaired Insulin Production Hx Hypertension
Hx DM
Fasting Hyperglycemia

Normoglycemic State

Increased resistance to the action of insulin

Increased visceral (intra-abdominal) fat

Peripheral Tissues inhibit glucose uptake

Increased in Blood Glucose Levels

Amount of glucose filtered by the glomeruli of the kidney exceeds

the amount that can be reabsorbed by the renal tubules

GLYCOSURIA

+ Large doses of water in the urine + HYPERGLYCEMIA

CKD
Tea-colored urine
POLYURIA Favor the growth of microorganisms Necrotic tissues
Output: 250cc/void

Impaired wound healing LICHENIFICATION

Intracellular dehydration
on right leg
Skin Infections
Water is pulled out of the body cells
including in the thirst center
CELLULITIS
POLYDIPSIA
 DIAGNOSTIC/LABORATORY STUDIES
NAME OF TEST DATE INDICATION FOR NORMAL VALUES ACTUAL SIGNIFICANCE OF THE
OR DONE THE TEST RESULTS/ RESULTS/FINDINGS
PROCEDURE FINDINGS

HEMATOLOGY` 2/8/10 Complete Blood WBC 5-10x109/L 12.6 (increased) Increase in WBC indicates an
    Count (CBC) is to   infection.
    check the specimen of (Fundamentals of Nursing, p
    venous blood; 800)
    includes hemoglobin,  
    hematocrit Used of Antiinfective drugs
    measurements, RBC such as Metronidazole
    count and indices, interferes in WBC count.
    WBC count and a (Diagnostic Tests, p 497)
    differential white cell
  count.
 
SEG 0.6-0.7% 0.85 (increased) Increase in segmenter indicates
  Viral or Bacterial Infection
(Fundamentals of Nursing, p
800)
 
NAME OF TEST DATE INDICATION FOR NORMAL VALUES ACTUAL SIGNIFICANCE OF THE
OR DONE THE TEST RESULTS/ RESULTS/FINDINGS
PROCEDURE FINDINGS

HEMATOLOGY` 2/8/10 Complete Blood LYM 0.2-0.4% 0.12 (increased) An increase in lymphocyte
    Count (CBC) is to   indicates Viral or Bacterial
    check the specimen of Infection (Fundamentals of
    venous blood; Nursing, p 800)
    includes hemoglobin,  
    hematocrit
EOSI 0.01-0.05% 0.03 (increased) Low in eosinophils indicates
    measurements, RBC
  Tissue injury (Fundamentals of
    count and indices,
Nursing, p 800)
    WBC count and a
 
    differential white cell
  count. 93 (decreased) Low in hemoglobin implies
HGB F:120-160
  Anemia (Fundamentals of
G/
L  
Nursing, p 800)

HCT 0.42-0.52% 0.29 (decreased) Decrease in hematocrit

  signifies anemia
(Fundamentals of Nursing, p
800)
NAME OF TEST DATE INDICATION FOR NORMAL VALUES ACTUAL SIGNIFICANCE OF THE
OR DONE THE TEST RESULTS/ RESULTS/FINDINGS
PROCEDURE FINDINGS
URINALYSIS 1/30/10 Urinalysis is to Physical      
    determine urine Color Amber Amber
NORMAL
    composition and Transparen Slightly Slightly Turbid
    possible abnormal cy Turbid 1.015
    components (e.g. Specific 1.010-1.025
  protein or glucose) or Gravity
infection. Chemical        
  Albumin Negative Positive (3) Presence of Albumin indicates
      diabetes mellitus.
      (http://en.wikipedia.org/wiki/P
      rotenuria)
      Indicates renal failure.
     
(Diagnostic Test, p 353) 
     
Sugar Negative   Negative NORMAL
     
Chemical     Presence of Albumin indicates
Albumin Negative Positive (3) diabetes mellitus.
      (http://en.wikipedia.org/wiki/P
      rotenuria)
      Indicates renal failure.
     
  (Diagnostic Test, p 353)
   
       
Sugar Negative Negative NORMAL
   
 
NAME OF TEST DATE INDICATION FOR NORMAL VALUES ACTUAL SIGNIFICANCE OF THE
OR DONE THE TEST RESULTS/ RESULTS/FINDINGS
PROCEDURE FINDINGS
URINALYSIS 1/30/10 Urinalysis is to Cells      
    determine urine RBC  0-3/HPF 2-5/HPF  Decrease in RBC indicates
    composition and   anemia (Diagnostic Tests. p
    possible abnormal   378)
    components (e.g.    
  protein or glucose) or Presence of pus cells indicates
infection. Pus cells absent 1-4/HPF
infection (http://www.biology-
     
  online.org/dictionary/Pus_cell)
   
 
     
 
Bacteria  
absent An indication that there may
  Moderate
be a presence of (infection
     
http://www.biology-
   
online.org/dictionary/Bacteria)
     
 
   
 
Amorphous  
Result of the refrigeration
urates absent Some
process of urine
  (http://www.irvingcrowley.co
m/cls/urin.htm)
 
NAME OF TEST DATE INDICATION FOR NORMAL VALUES ACTUAL SIGNIFICANCE OF THE
OR DONE THE TEST RESULTS/ RESULTS/FINDINGS
PROCEDURE FINDINGS
BIOCHEMISTRY 2/15/10 Biochemistry is 1.9- 9.7 (increased) Increase in BUN
BUN
used to keep the 9.2mmol/   indicates congestive
 
body’s fluid L heart failure and renal
   
levels in balance,   failure. (Diagnostic Test,
and are necessary   p 56)
 
to help the     
 
muscles, heart    
171
work properly. Creatinin 53-133 Increase in Creatinine
e (increased) signifies heart failure
  mmol/L
  and renal failure.
 
  (Diagnostic Test, p 124)
   
   
     
 
      
     
K 3.6-5.5 Decrease in Potassium
3.3 (decrease) can be the side effect of
  mEq/L
his diuretics. (Diagnostic
Test, p 340)
NAME OF TEST DATE INDICATION FOR NORMAL VALUES ACTUAL SIGNIFICANCE OF THE
OR DONE THE TEST RESULTS/ RESULTS/FINDINGS
PROCEDURE FINDINGS
ARTERIAL 1/30/10 Arterial blood gas is pH 7.35-7.45 7.467 An increase in pH indicates
BLOOD   used to measure the alkalosis
GAS   partial pressure of (http://en.wikipedia.org/wiki/Ar
  arterial oxygen, terial_blood_gas)
  PaCO2,pH, oxygen
  Saturation and
pCO2 35- 40.5 NORMAL
  bicarbonate.
45mmHg
 
  pO2 80-100 76.8 (decreased) A decrease in O2 indicates that
 
  mmHg the patient is not respiring
 
  properly, and is hypoxemic.
  (http://en.wikipedia.org/wiki/Ar
  terial_blood_gas)
   
  HCO3a 22-25 29.5 (increased) An increase in HCO3− indicates
  mEq/L kidneys are working to
 

  compensate for a respiratory

issue so as to normalize the
blood pH
(http://en.wikipedia.org/wiki/Ar
terial_blood_gas)
 
        
Microbiology 1/30/10 Deals with the study of  
microorganisms Presence of Enterobacter
including bacteria, aerogenes
viruses, fungi and (heavy growth)
parasites which are of
medical importance
and are capable of
causing diseases in
human beings.
       
    Used to visualize  
Ultrasound 1/30/10 muscles, tendons, and Bilateral mild diffuse
many internal organs, to renal parenchymal
capture their size, disease moderately
structure and any distended urinary
pathological lesions bladder.
with real time
tomographic images.
Ultrasound has been
used by sonographers to
image the human body
for at least 50 years and
has become one of the
most widely used
diagnostic tools in
modern medicine.