Summary: The Left Ventricular End-Diastolic Pressure

midchest discomfort. The chest pain has awakened him from sleep but does respond to NTG, which

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

John’s long standing Hypertension causes his heart to work harder, putting more strain on his heart and arteries. In order to achieve a gradient in pressure by which blood flows from an area of higher pressure to one of lower pressure, the left ventricle must exceed the increased pressure in the arterial system (Ref).

R E V I E W S H E E T 30 Anatomy of the Heart

His Pulse ox of 94% reading is on the lower side, but still in normal range which indicated that there is less oxygen perfusion.

The most serious health problem that the client has is impaired gas exchange. According to Sue Galanes (2007), impaired gas exchange is result from the balance between ventilation and perfusion is offset by a certain condition which affects the efficiency of the gas exchange. On account of client has congestive heart failure that can contribute to dyspnea, which means the efficiency of gas exchange is decreased. One of the significant defining characteristics of impaired gas exchange is dyspnea (Sabtu, 03 Agustus 2013). In addition, it was hard for the patient to talk in long sentence due to difficulty in breathing. Hence, impaired gas exchange is one of the health problems that the client suffered from. In regards of O2 is the basic element that all of cells and organs need, it can be considered as a fuel of human body. Therefore, impaired gas exchange is the most severe health problem the patient has currently.

Left Ventricular Systolic Dysfunction (LVSD, but commonly referred to as heart failure) is a chronic, progressive cardiac syndrome in which a damaged heart fails to beat efficiently and deliver enough blood to meet the body's needs. Although coronary heart disease (CHD) is the most common cause, for example, myocardial infarction, and many of the conditions are intertwined, there are several other causes of heart failure including cardiomyopathies, hypertension and valve disease.

One of the chief complaints Mr Johns presents is shortness of breath, also known as dyspnoea whilst he is resting. “Breathlessness is a multidimensional and subjective experience of difficulty or uncomfortable breathing originating from an intricate interaction between physiological and psychological factors” (Yorke 2014). Mr Johns presents a respiration rate of 28 breaths per minute, which is peculiarly elevated, and is specified as tachypnoea. Tachypnoea signifies that a greater volume of oxygen is needed to supply components of the body, or to recompense for limited supply in bodily systems where there has been a restriction of

Tanya has returned two months since the last appointment. During that time, she underwent a cardiopulmonary exercise test that revealed reduced ventilatory reserve, but an appropriate heart-rate response and no exertion oxygen desaturation. This is consistent with her exercise limitation being due to the mild airflow obstruction. She also underwent a CPAP implementation study that revealed good control of the obstructive events a 8cmH2O, but increasing central events (ie; complex sleep apnoea) with increase in pressures. Tanya has been using CPAP for the last three weeks in auto-set mode and this has led to some improvement in sleep quality and daytime symptoms.

amount of pressure exerted on arterial walls in the patient’s heart. Blood pressure is measured in

Endocrine: History of Type two diabetes, he stated that his blood before breakfast was 95.