Predictive Value Of Cardiac Troponin

This study is relevant to the research question because they focused on testing n-terminal pro-b type natriuretic peptide and management of Heart Failure patients, however the patients were in a hospital in Canada. The study started with 534 patients from screening but 34 were excluded, and 17 patients did not participate after the first hospitalization, leaving 483 patients that were followed during the course of the study (Moe, Howlett, Januzzi, Zowall, 2007). The study used receiver-operating characteristic curve was used to analyze the data from the two groups (Moe, Howlett, Januzzi, Zowall, 2007). The tools used were clearly defined, reliable and valid. The researchers measured the proBNP level and physician initial diagnosis and then after they used the “logistic regression model” to predict whether knowledge of the proBNP levels aided in diagnosis and management of HF (Moe, Howlett, Januzzi, Zowall, 2007). The statistics used to analyze the date was relevant to the clinical research question. The study did not “perform age-stratified analysis” which may have an impact on the results, there was also a loss to follow up and the study was performed at multiple sites in Canada where as the patients for the clinical research question are located in Dallas service delivery area in United States of America (Moe, Howlett, Januzzi, Zowall, 2007). According to the researchers, the results of their study supported the “recently published HF consensus guidelines’” view that proBNP supports clinical diagnosis and cost effective care of patients (Moe, Howlett, Januzzi, Zowall, 2007). The implication of this study is that knowing the value of proBNP aids practitioners in the diagnosis and management of HF

TROPONINS – Markers of choice. Elevated between 4 and 6 hours after the onset of an acute MI and remains elevated for 8-12 days.

The study shows that disease-modifying medications were prescribed significantly more often in 2000 than in 1995, particularly in patients younger than 65 and in those aged 75 to 84 (Saczynski et al., 2009, p. 3). The study indicates that Beta-blockers and ACE inhibitors have been shown to improve survival and reduce hospitalizations in patients with Heart Failure. The second article mentioned about the elderly patients who have CHF not on or under dosage of Angiotensin Converting Enzyme (ACE) inhibitors. According to this article ACE inhibitors should be given for patients diagnosed asymptomatic left ventricular systolic dysfunction (LVSD) (EF<40%) and symptomatic heart failure with systolic dysfunction associated with other heart problems such as myocardial infarction, pulmonary hypertension. The suggested dosage for the CHF patients mentioned in the article and due to age-related changes in pharmacokinetic drugs, it also recommended the initial dosage must be half the standard dose and gradual increase after assessing renal function. After studying a group of elderly CHF patients revealed that higher or standard dose of ACE inhibitors reduce the risks of major clinical events. Results from the research display a decrease of hospitalizations due to cardiovascular reason, heart failure, and ischemic events in the standard-dose group. The study also found out that the adverse effects of high doses can be managed by reducing the dosage or by changing

Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of

Chronic Kidney Disease (CKD) is a disease that is described as a loss of kidney function gradually over time. As kidney function decreases, the waste collection in the body’s blood becomes high and makes the individual feel sick. This disease can lead to other complications in the body such as anemia, poor nutritional health, high blood pressure, and nerve damage. These complications will begin to progress and show as CKD progresses to advanced stages. Early detection of this disease is essential when it comes to treatment. If CKD is diagnosed early enough the disease progression can be slowed down and managed. This disease will eventually lead to failure of the kidneys

The most commonly evaluated clinical parameter measured in the ESRD population is the delivered dose of dialysis is by Kt/V. In this case, majority of the diabetic and non-diabetic population has an adequate dialysis based on their Kt/v (sp). But still many factors are needed to be considered. We should identify the possible causes for those patients who did not meet their required clearance. Check the patient’s vascular access. A Good vascular access provides adequate dialysis. Observe proper cannulation technique and rotate sites to prevent damage of the access. Proper priming should be observed to utilize the surface area of the dialyzer. Clotting of blood due to inadequate heparinization does not produce adequate clearance. The nurse should administer heparin per facility protocol or as ordered by the doctor. Monitor patient’s Kt/V through online clearance monitoring (OCM) to immediately evaluate the current urea clearance of the patient and to provide a prompt intervention and investigation as necessary.

Type 1 cardiorenal syndrome is defined as “Acute worsening of heart function leading to kidney injury and/or dysfunction” (7). Examples include acute heart failure, acute coronary syndrome or cardiac surgery resulting in worsening of renal function, or contrast induced nephropathy after coronary angiogram (8). 27 to 40% of patients admitted to the hospital with acute decompensated heart failure (ADHF) appear to develop acute kidney injury and fall into this clinical entity (9, 10). These patients experience higher morbidity and mortality, and longer hospital stay (2).

In patients with heart failure, hypovolemia, cirrhosis, nephrotic syndrome, or hypoalbuminemia, renal function may be further compromised. BUN, creatinine clearance, and urine output should be monitored closely (Lexi-Comp, 2016).

Between 1943 and 1945, Dr. Willem Kolff finished his invention and tested the machine on 16 patients, but had unsuccessful trials. Around 1945, he treated a 67 year old who successfully woke up from a coma, after being on hemodialysis for 11 hours. With all the new advancements today, successful outcomes should be the first thing doctors think of, rather than, focusing on the number of patients nephrology can schedule in. Lupus is another concern that nephrology faces which affect all races and has made it more of a challenge for doctors throughout the years. In most cases, patients with end-stage renal disease and lupus get separated from the other patients because they are classified as higher risk. Antonio Inda-Filho, et al., believe that “The development of lupus-related end-stage renal disease (ESRD) confers the highest mortality rates among individuals with lupus” (590). Unfortunately, this is true only when doctors are unable to stabilize systemic lupus. This should not be a debatable topic, nephrologist need to communicate with rheumatology and come up with an aggressive dialysis plan, which will not only assist in the removal of the harmful toxins, but will also help with stabilization. Antonio Inda-Filho, et al., addressed that “The complication alterations contributes to the speeding process of atherosclerosis and a higher chance of infection” (591). End-stage renal disease does accelerate the formation

Empagliflozin was compared with placebo and analyzed for effects on morbidity and mortality in patients with T2D at high risk for CV events who were receiving standard of care.

Blood pressure: Blood pressure can be an important factor for predicting the mortality of patients. In most of the cases, the blood pressure of the patients is generally recorded when the patients are admitted to the hospitals. While conducting a study in UAE regarding factors affecting mortality it was observed that patients who died had significantly lower GCS and systolic blood pressure on arrival to hospital [6]. As per the study it was established that blood pressure was a significant factor for predicting the mortality. A study conducting in Stockholm it was observed that low blood pressure is directly related to mortality. Univariate chi-square tests showed that advanced age, male sex, lower education, institutionalization, cancer,

Chronic Kidney Disease (CKD) is among the leading causes of mortality throughout the world, and its prevalence and the health care costs resulting from it are considerable and increasing. CKD commonly is silent and asymptomatic until its late stages. Accordingly, CKD is diagnosed prior to symptomatic stage of kidney failure, resulting in delays in proper interventions and the emergence of adverse consequences in the CKD patients

An 86 year-old-Hispanic lady with history of hypertension, hyperlipidemia, type 2 diabetes, obstructive sleep apnea, and gastro esophageal reflux disease transferred from an outside hospital due to concerns for acute coronary syndrome. She was recently discharged from the hospital to an extended care facility (ECF) following the treatment of urinary tract infection and ACE’I induced angioedema. She received a dose of Epinephrine 2mg injection at the ECF for respiratory distress and stridor. Following this injection, she developed crushing sub-sternal chest pain that lasted for ten minutes. The patient was transferred to the local emergency department and was noted to have elevated troponin levels 3.59ng/ml (normal 0.00-0.034ng/ml) with no

There are good indicators for mortality ratio that help prediction of mortality in health care patients. Hyponatremia has strong association with all mortality causes in primary health care as well as pulmonary , head and neck cancers . [2] Red blood cell distribution width (RDW) is a good indicator for cardiovascular mortality as well as cardiovascular morbidity . [3] RDW is also associated with increased mortality in diseases rather than cardiovascular ones . [4] Preoperative routine blood tests are good predictor of the outcomes of the surgery , mortality ratio and length of stay in intensive care and hospital also laboratory results of albumin level have the upper hand in cardiovascular surgery . [5] plasma creatinine level is a good predictor

Mr. Armstrong has a history of renal insufficiency and uncontrolled hypertension, along with symptoms of fatigue, pedal edema, and occasional shortness of breath. He does not have a history of trauma or obstruction to his kidneys, but his creatinine and BUN levels are currently at 3.5 mg/dl and 40 mg/dl. Normal creatinine concentration values are 0.7 to 1.2 mg/dl and normal BUN values are 10 to 20 mg/dl; this reveals that Mr. Armstrong’s kidneys are not removing wastes properly (McCance, Huether, Brashers, & Rote, 2014).  Mr. Armstrong’s history of renal insufficiency and uncontrolled hypertension is commonly found in patients diagnosed with intrarenal (intrinsic) acute renal failure. Intrarenal acute renal failure can be categorized as