Question

Your patient has cardiovascular disease (CVD) and has been admitted with these vitals: BP 190/90, HR 100, RR 35. When asked about symptoms, the patient states, “I have a very bad headache and feel light headed.” History reveals he has had one heart attack three years ago. He is a pack a day smoker and often drinks more than one drink per day. When doing your morning assessment, you find a dime sized wound on his lower leg. The wound is open in the center and red around it. When asked, the patient states his feet and legs are cold much of the time and he no longer walks long distances because of pain in his legs.

Question: What is the most immediate concern for this patient and why? Include in your answer specific facts, data, examples, and other information drawn from your textbook

Answer 1

1. Effects of vasoconsctrictor hormone on blood pressure

Hyperosmolarity, angiotensin and sympathetic stimulation lead hypothalamus to stimulate the posterior pitutary, releasing vasopressin as a result. This will result in constriction of the blood vessels resulting in increased systemic vascular resistance thus increasing pressure. These hormones may increase the activated stretch ion channels leading to depolarization. It will cause intracellular calcium to increase and sodium gated voltage channel to increase. They also diminish the potassium channel gated by ATP. Vasoconstrictor hormone will increase angiotensin receptor reception 1. They will promote endothelial receptor reception on endothelium which leads to the production of endotheline.

Exposure to cold causes cutaneous vasoconstriction. Stimulants, antihistamines etc. are endogenous factors that trigger vasoconstriction. The patient's symptom presented with headache or light headed may result from revealable syndrome of cerebral vasoconstriction.

Vasoconstriction is the mechanism of negative feedback from the body to restore hemostasis. Vasoconstriction, for example, is a preventive measure in which the blood vessel constricts and blood moves with a high pressure to prevent hypoxia. ATP is used here to heighten the pressure. If the hemostasis is restored by this then the blood pressure is regulated.

The immediate patient concern in this case may be Pneumatic pressure therapy speedup because the circulation has to be enhanced. A pneumatic leg pump therapy may sometimes suggested.

Arteriosclerosis, venous insufficiency or other clotting and circulatory disorders can often cause the poor circulation. Ulcer on the legs can result from medical conditions such as diabetes, too. In this case diabetic wound healing is crucial. Where patient is diabetic. The smoking history, whether current or past, should also be considered as one of the causes here.

Usually, ulcers are affected in those patients with a history of swelling, vericose veins, and blood clotting. Usually, the wounds can be most commonly on the bottom of the feet at increased pressure points. Neutrophilic type of ulcers may or may not be painful in patients with diabetes.