Cardiovascular status, testing

Tests of Cardiovascular Status. Pulse strength, regularity, heart rate, and blood pressure measurements should be evaluated. Some topically administered ocular drugs, such as atropine and p-blockers, can affect systemic blood pressure and cardiac activity. This is especially important before and during long-term treatment with P-blockers in those patients with glaucoma. 

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

The initial visit of a perimenopausal or postmenopausal woman is the most appropriate time to obtain a complete medical history, perform a physical examination, and educate the patient. Medical history should include determination of a personal or family history of thrombotic problems. The physical examination should include a complete cardiovascular examination, clinical assessment of thyroid status, and breast and pelvic examinations. Papanicolaou cervical cytologic examination and screening mammography negative for malignancy are required before initiating hormone therapy. Thyroid function tests and lipoprotein lipid profile also should be performed at the discretion of the clinician. 

Preoperative assessment of coronary status and cardiovascular function is based on clinical evaluation, noninvasive and invasive diagnostic testing. Physical performance is evaluated according to simple exercise tasks (e.g. walking up stairs), and is quantified by grading their metabolic equivalent (MET, table 1). At a performance of 4 MET or more, the patient is usually fit for vascular access surgery in locoregional anesthesia (ERA) without further cardiac evaluation [6]. 

Beriberi is caused by a deficiency of thiamin (also called thiamine, aneurin(e), and vitamin Bj). Classic overt thiamin deficiency causes cardiovascular, cerebral, and peripheral neurological impairment and lactic acidosis. The disease emerged in epidemic proportions at the end of the nineteenth century in Asian and Southeast Asian countries. Its appearance coincided with the introduction of the roller mills that enabled white rice to be produced at a price that poor people could afford. Unfortunately, milled rice is particularly poor in thiamin thus, for people for whom food was almost entirely rice, there was a high risk of deficiency and mortality from beriberi. Outbreaks of acute cardiac beriberi still occur, but usually among people who live under restricted conditions. The major concern today is subclinical deficiencies in patients with trauma or among the elderly. There is also a particular form of clinical beriberi that occurs in patients who abuse alcohol, known as the Wer-nicke-Korsakoff syndrome. Subclinical deficiency may be revealed by reduced blood and urinary thiamin levels, elevated blood pyruvate/lactate concentrations and a-ketoglutarate activity, and decreased erythrocyte transketolase (ETKL) activity. Currently, the in vitro stimulation of ETKL activity by thiamin diphosphate (TDP) is the most useful functional test of thiamin status where an acute deficiency state may have occurred. The stimulation is measured as the TDP effect. 

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