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, The APN is seeing a 78-year old male with a long standing history of poorly
controlled hypertension. When evaluating for hypertensive target organ
damage, the APN should look for evidence of:
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In the manic phase of bipolar disorder the patient often exhibits symptoms of elevated levels
of euphoria and self-esteem and feelings of grandiosity. Energy levels are greatly enhanced
even after only a few hours of sleep each night. The increased energy, however, does not lead
to organized plans and thoughts. The individual may show poor judgment in spending money,
may become hypersexual, or may make poor business commitments. Other hallmarks of
mania are excessive, rapid, loud, and pressured speech.
Left ventricular hypertrophy - LVH is a common finding in patients with hypertension. It
is defended as an increase in the mass of the left ventricle which can be secondary to
an increase in wall thickness, and increase in cavity size or both. The increase in mass
predominantly results from a chronic increase in afterload of the LV caused by the
hypertension. The heart has to work harder to overcome the increase systemic
vascular resistance.
Chronic inflammatory disorder, causing mucosal edema and reversible airflow
obstruction. Asthma is a chronic inflammatory disorder of the bronchial mucosa, which
causes bronchial hyperresponsiveness, constriction of the airways and variable airflow
obstruction that is reversible.
lactic acid
Feedback: Occlusion of the coronary arteries deprives the myocardial cells of glucose needed
for aerobic metabolism. Anaerobic metabolism occurs, which causes the accumulations of
lactic acid. Lactic acid irritates the myocardial nerve fibers, sending pain messages to the
cardiac nerves and upper thoracic posterior roots located in the left shoulder and arm.