Question

Scenario 2: A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF) In your Case Study Analysis related to the scenario provided, explain the following •   The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms. •   Any racial/ethnic variables that may impact physiological functioning. •   How these processes interact to affect the patient.

Answer 1

ANSWERS ;-

(A) The cardiovascular and cardiopulmonary pathophysiologic processes:-

* This scenario reveals that the patient is having pulmonary embolism.

* Pulmonary embolism refers to the obstruction of the pulmonary artery or one of its branches by a thrombi or blood clot that originates somewhere in the venous system or in the right side of the heart.

ETIOLOGY;

*Major operations

*Deep vein thrombosis

*Prolonged immobilization ,varicose veins etc are risk factors

* PATHOPHYSIOLOGICAL PROCESS:-

# The thrombus completely or partially obstruct a pulmonary artery or its branches----> increased alveolar dead space due to no or little bloo flow to that affected area----> the gas exchange is impaired or absent in this area--->release of substances like histamine,serotonin,catecholamines and prostaglandins from clot and surrounding area---> resulting constriction of regional blood vessels and bronchioles---> increased vascular resistance---> ventillation -perfusin imbalance.

# increased pulmonary vascular resistence --> increase in pulmonary arterial pressure --->increase in right ventricular work load to maintain pulmonary blood flow--->the work right ventricle reach exceeds its capacity-->. right ventricular failure---> decreased cardiac output--.low systemic blood pressure--->shock.

# resulting manifestations like dysponea,chest pain usually sudden and pleuritic,tachycardia ,palpitation and diaphoresis,

*EKG changes associated with acute pulmonary embolism may be seen in any conditions that causes acute pulmonary hypertension,including hypoxia causing pulmonary hypoxic vasoconstriction;

*Right ventricular strain pattern is seen upto 34% of patients and is associated with high pulmonary artery pressure.

(B) Any ratial or ethnic variables that may impact physiological functioning?

# The incidence of pulmonary embolism appears to be significantly higher in blacks than in whites,and higher in whites than other races Asian/Pacific/Islanders/American Indian patients have a markedly lower risk of pulmonaryembolism.

(C)How these processes interact to affect the patient ?

# After total knee replacement patients are adviced to ambulate by using  crutches or walker ;patient's age (65yrs) ,race/ethnicity and post operative pain contributed to his immobility causing thromboembolism and pulmonary embolism.``````````