23 Jul HOW DOES EACH LABORATORY TEST ORDERED IN THE EMERGENCY DEPARTMENT RELATE TO CELL METABOLISM?
Edward is a 37-year old sedentary executive who was seen for an annual physical examination 6 months Show more Edward is a 37-year old sedentary executive who was seen for an annual physical examination 6 months ago. He had no complaints other than feeling the everyday pressures of his job as a corporate attorney and head of the legal division. He admitted smoking two packs of cigarettes a day as a means of relieving stress. Edward is 175cm (5 feet 9 inches) tall and at the time of his examination weighed 83kg (185lb). His blood pressure was 148/90 mmHg and his serum cholesterol level was 285 mg/dL. He was advised to quit smoking exercise daily at a moderate pace and lose 9kg (20lb). He arrived in the hospital emergency department 3 months later complaining of severe chest pains and difficulty breathing. His wife reported he had appeared pale that evening had broke out into a cold sweat and had vomited shortly after arriving home from work. Once regular breathing was restored by the emergency medical team and his pain subsided a number of laboratory These tests included serum glutamic-oxaloacetic transaminase (SGOT) lactate dehydrogenase (LDH) prothrombin time lipid panel plus high-density lipoprotein (HDL) cholesterol sedimentation rate coagulation times fasting plasma glucose (FPG) blood urean nitrogen (BUN) and complete blood count (CBC). An electrocardiogram (ECG) was also ordered. The patient was then transferred to the coronary care unit for closer monitoring. The following test results were elevated: SGOT LDH LDL and total cholesterol triglycerides glucose prothrombin time white blood cell count and sedimentation rate. HDL level was low. The ECG revealed an infarction of the posterior wall of the myocardium. The diagnosis was myocardial infarction (MI) with underlying familial hypercholesterolemia. In consultation with the clinical dietitian (RD) the cardiologist ordered a liquid diet increasing it to a soft diet with low saturated fats 2 days later. The RD noted continued improvement in the patients appetite accompanying recovery and recommended changing the diet order to the therapeutic lifestyle changes (TLC) diet. A week later Edward was discharged. During convalescence the RD and nurse met with him and his wife several times to discuss his continuing care at home. At each follow-up clinic visit with the physician and nutritionist Edward showed good general recovery and enjoyment of his new modified fat and cholesterol food habits. 1) What predisposing factors in Edwards lifestyle place him in the high-risk category for coronary heart disease (CHD)? 2) Why was moderate consistent exercise originally recommended? 3) Explain the causes for Edwards initial symptoms? 4) How does each laboratory test ordered in the emergency department relate to cell metabolism? Why were results elevated? 5) Explain the association between the final diet order and his lipid disorder. 6) What nondietary needs might Edward have while convalescing at home? What community agencies might be of assistance? Show less
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