Stroke

A patient has experienced a bleed in the left frontal lobe of their brain. Describe the changes that are likely to affect motor function after this bleed.
Mobility, respiratory functions, swallowing and speech, gag reflex and self-care abilities.

Why would there be no deficit in sensory function?
A stoke causes a disruption in the specific brain pattern. An injury on one side of the brain due to a stroke affects the motor function of the opposite side of the body such as arm, leg, face may droop.

COPD

If a patient has emphysema, which body system does this condition affect?
Emphysema generally affects the lungs of older people; even non-smokers can sometimes be affected.

The doctor has written 'patient has a barrel chest'. Define this term and discuss how this develops. A barrel chest develops when the alveoli isstretched and large amounts of air becomes trapped. This then causes a flattening of the diaphragm, creating a round bulging like chest from the lungs being stretched.

Why would a barrel chest impair ventilation?
A barrel chest would weaken ventilation because the lungs would be overinflated and would make it difficult to breathe.

Describe in detail what occurs in each of the four stages of respiration. Which of these stages does COPD impact on and how does the disease impair normal function?
Pulmonary ventilation:Air moving in and out of the lungs also known as breathing.

External respiration:Transportation of gases between the alveoli and blood also known as (pulmonary gas exchange).

Respiratory gas transport:Carbon dioxide and oxygen travelling into the body through the bloodstream.

Internal respiration:Transportation of gases between the systemic capillaries and tissue cells. All the gas exchanges follow the law of diffusion: movement occurs towards the area of lower concentration of the diffusing substance.

Pulmonary ventilation is the stage of respiration that impacts on COPD by the airways being swollen or thicker than normal mucus is increased and unable to transport the air in and out of the lungs.

On discharge, the respiratory physician recommends referral for pulmonary rehabilitation. Explain why this would be important for the patient to attend.
A respiratory physician would recommend a referral for pulmonary rehabilitation for many reasons such as:

• Premature infants have difficulties keeping their lungs inflated because of the lack of alveoli.
• Many birth defects of respiratory systems are cleft palate and cystic fibrosis.
• The lungs carry on growing until young adult hood.
• In older aged patients the thorax stiffens and lungs become less flexible. A protective method of the respiratory system does not work as effective leaving the respiratory tract vulnerable to infections.

Ischaemic Heart Disease

If a patient has ischaemic heart disease, explain what part of the body is being affected.
Ischaemic heart disease affects the heart muscle in the chest between the lungs and behind the sternum.

Explain the changes that occur in the coronary arteries as a result of this condition.
Coronary arteries change during this process due to the build-up of excessive fat inside the walls of the blood vessels. When this occurs over time this blocks and reduces the free flow of blood to the heart which could lead to heart attacks.

List four risk factors and explain how these factors contribute to the development of the disease

• Physical activity: Having low or non-existent physical activity puts you at risk due to not enough energetic activities to get the blood pumping. Physical activity can help with blood cholesterol, diabetes, obesity and lower blood pressure in some cases.
• Smoking- active and passive smokers: Smokers have doubled the chances of having heart attacks than people who do not smoke or passively smoke. The smoke creates a tar build up in the arteries which can cause a blockage.
• Being overweight: Overweight or excessive body fat (especially in waist area) are also in the high risk area of developing heart disease and strokes. Excessive weight strains the heart making it work harder and faster causing high blood pressure. Other health issues may occur such as diabetes is likely to develop in overweight people.
• Stress: Stress has been known to cause major risk factors to heart disease. Some studies have found that a stressed individual's health behaviours and socioeconomic change during stressed times such as overeating, alcoholism, start smoking or smoke more than they would normally.

Describe the signs and symptoms that occur with an acute ischaemic episode.

• Palpitation: Feeling that your heart skipping beat or beating too quickly.
• Dyspnea: Difficulty with breathing.
• Chest pains: Discomfort in chest area from increased physical activity.
• Cold sweat, nausea or light-headedness could also occur.

A patient presents at ED with acute chest pain and tachycardia. Discuss the interventions provided by the health care team in the first 15 minutes of their care.
Start an examination of the patient with by doing a quick visual test. Does the patient look well? (Comfortable/ uncomfortable) or life threatening (near death). Check patient's airways, blood pressure, heart rate, ECG and respiratory rate. If normal vital signs and chest pain has ceased the problem has been resolved but if ECG is not normal the proceed to further history and examination.

Chronic Kidney Disease

Discuss the effects of blood pressure on glomerular filtration.
I the blood pressure is too low, no glomerular filtration will occur as it is enabled by high pressure system. When blood pressure is too low your kidneys will shut down and no urine is produced.

Why are patients with chronic kidney disease often anaemic? What is the under-lying cause of this?
Patients with chronic kidney disease often have anaemia due to the decreased production of hormone erythropoietin by the kidneys, which occur when the running of the renal tubular cells is decreased.

Hormonal Regulation

Aldosterone, atrial natriuretic peptide and anti-diuretic hormone all play a role in the regulation of water, electrolytes and blood pressure. Discuss each hormone covering the following:

1. Where is the hormone produced?

• Aldosterone:Is produced in the outer section of the adrenal cortex in the adrenal glands.
• Atrial natriuretic peptide: Is produced, stored and released by the cardiac myocytes of the atria of the heart.
• Anti-diuretic hormone: It is produced in a part of the brain called the hypothalamus.

2. What triggers the release of the hormone?

• Aldosterone: If a decrease of blood pressure is detected, the adrenal gland is encouraged by the stretch receptors to release aldosterone, which increases sodium reabsorption from urine, sweat and the gut.
• Atrial natriuretic peptide: It released by the atrial stretch of the heart.
• Anti-diuretic hormone: It is released when the body is dehydrated and causes the kidney to preserve water, therefore concentrating the urine and reducing urine volume.

3. What is the target organ/cell of the hormone?

• Aldosterone: Kidney and adrenal cortex
• Atrial natriuretic peptide: Kidney
• Anti-diuretic hormone: Kidney

4. What action does the hormone bring about?

• Aldosterone: Regulates the amount of electrolytes in the body.
• Atrial natriuretic peptide: Restrains sodium ions reabsorption and renin release in the kidney.
• Anti-diuretic hormone: conserve body water by reducing the loss of water in urine.

5. What is the end result of this action?

• Aldosterone: Aldosterone test can be performed to detect low blood potassium, heart failure or kidney diseases.
• Atrial natriuretic peptide: Restrains secretion of aldosterone by decreasing blood volume and blood pressure in the adrenal cortex.
• Anti-diuretic hormone: As a result urine volume decreases and blood volume increases.