Question

64 year old patient admitted yesterday with CHF, treated in the ER, transferred to ICU and improved. Patient is possible transfer out of the ICU in the morning, when patient develops increasing SOB over last 30 minutes. Feeling quite unwell, you notice the saturations have worsened and the BP is increased.

Patient complaining of SOB, vitals show sats have dropped off and you have started O2. BP is elevated at 190/100.

Past Medical History:

1. CAD
   1. NSTEMI 2003 with RCA stent,
   2. NSTEMI 2010 with LAD stent x 2
2. CHF – secondary to ischemic cardiomyopathy, EF 45%
3. Dyslipidemia
4. HTN
5. COPD

Social History:

Divorced with 3 adult children, lives with spouse, worked as a factory worker, alcohol on social occasions, & no history of smoking or drug use.

Medications:

• Metoprolol 25mg po BID
• Ramipril 10 mg po Daily
• ASA 81 mg po Daily
• Plavix 75mg po Daily
• Lipitor 40 mg po Daily
• Spiriva 18mcg 1 puff inh Daily

Initial Parameters:

Patient: Awake, alert, appropriate, but extremely SOB.

Vitals: BP 190/100, HR 110, RR 36, O2 sat 92% on 4L, Temp 36.8

Eyes: Open, pupils reactive

Lungs: ++ Crackles

Heart Sounds: Addition of S4

Heart Rhythm: Sinus Tachycardia

Abdomen: large, soft, non-tender

Bloodwork: (K- 3.2, PCO2 58, Glucose 5.3)

CXR: shows interstitial edema & Cardiomegaly

ECG: Sinus Tachycardia – Rate 110

I want to know that is homeostasis is present in patient .if no then why,if yes then why

Answer 1

No homeostatis is not maintained in the client. The reasons are:

The human body is an amazingly complex machine, but many of its parts and processes exist simply to maintain homeostasis.

• Many diseases are a result of homeostatic imbalance, an inability of the body to restore a functional, stable internal environment.
• Aging is a source of homeostatic imbalance as the control mechanisms of the feedback loops lose their efficiency, which can cause heart failure. The above mentioned client is 64 years old
• Diseases that result from a homeostatic imbalance include heart failure and diabetes, but many more examples exist. Hence, the client has c/o CHF, hyperlipidemia, cardiomegaly.
• Client is also a k/c/o COPD and  it disrupts the histidine-histamine homeostasis that could contribute to inflammatory processes.
• Disease is any failure of normal physiological function that leads to negative symptoms. While disease is often a result of infection or injury, most diseases involve the disruption of normal homeostasis..
• There are many underlying causes of homeostatic imbalances that lead to disease. Infectious diseases are caused by pathogens such as bacteria and viruses. Noninfectious diseases are caused by genes or environmental factors other than pathogens, such as toxic exposures or unhealthy habits. Like the client is an alcoholic and is a k/c/o COPD.