High Dependency Unit Analysis 2022

Running head: HIGH DEPENDENCY UNIT 1
High Dependency Unit
Name of Author
Institution
Date of Submission

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High Dependency Unit
This analysis would be done based on case study one for Mr. Curtis. H eis a 74 year old man
admitted for cholecystectomy. Mr. Curtis has a medical history of hypertension and myocardial
infarctions for the last two years.
Cardiac Arrhythmia
According to the electrocardiogram of Mr. Curtis, the heart rhythm indicates that he is
suffering from atrial fibrillation. The number of R waves observed within 6 seconds are 11
multiplied by 10 makes it 110 making the ventricular rate of Mr. Curtis to be about 110bpm.The
interpretation is due to the irregular heart rate coupled by lack of the P-waves. Lack of distinct P-
waves indicates that the electrical impulses do not originate from the SA node like for a normal
healthy heart. The electrical waves must be originating from multiple ectopic sites within the
heart. Further, there is a lack of an isoelectric baseline from the ECG. As noted in the diagram,
there are fibrillatory waves that could easily be confused with P-waves indicating the presence of
atrial fibrillation. Moreover, the PR interval in the ECG demonstrates no interval. Also, the QRS
width is normal, indicating a major characteristic of atrial fibrillation (Schnabel et al., 2015;
Nielsen et al., 2015).
Abnormalities and structural changes that affect the normal functioning of the heart are
the most common causes of atrial fibrillation. However, lifestyles changes and other health
conditions can also predispose one to atrial fibrillation. Dzeshka et al., (2017), notes of the
cormobidity of hypertension and atrial arrhythmia in most patients. An underlying history of
hypertension can predisposed one to the cardiac condition (Ogunsua et al., 2015). Further, atrial

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fibrillation can also be caused by a medical history of myocardial infarction. Atherosclerosis that
is often accompanied by the progressive development of coronary syndromes like myocardial
infarction predisposes one greatly to atrial fibrillation as they affect the structure and functions of
the heart tissues (Violi et al., 2016; Kamel et al. 2016; Orr et al., 2016). Age is another factor that
predisposes one to atrial fibrillation. At an advanced age of 70 years and above, there is limited
physical activity that individuals can engage in. As such, older people may tend to live a
sedentary lifestyle that increases chances of developing atrial fibrillation. Avgil-Tsadok et al.,
(2016), notes that the prevalence of atrial fibrillation among the elderly is quite high.
The treatment options for atrial fibrillation may depend on the severity of the symptoms
and the underlying medical conditions that may associate the symptoms. Anticoagulants can be
used as the first line of treatment for atrial fibrillation. This is because; atrial fibrillation could
cause clots that may cause stroke and other vascular complications (Kirchhof et al., 2016).
Secondly, cardioversion can be used to try resetting the heartbeats to be normal through the
application of an electric shock. Thirdly, there should be the administration of medications for
management like flecainide and sotalol that are known antiarrhythmics to reduce the incidences
from reoccurring (Macle et al., 2016).
Pathology and Treatment
According to the ABG results of Mr. Curtis, his pH level 7.33 is within the normal range
indicating a balance in the number of hydrogen ions in his blood. However, the partial pressure
of oxygen (PaO2) in his blood is 68mmHg, which is abnormal. It is below the normal threshold
for normal ventilation. It is an indication of hypoventilation, heart decompensation, reduced
volumes of oxygen inhaled by Mr. Curtis, and other pulmonary issues like an obstructive

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pulmonary disease. Similarly, the ABG results indicate abnormality with a value of 58mmHg
that is above the normal threshold. This is an indication that the lungs of Mr. Curtis do not have
the capacity to exchange carbon dioxide freely. According to Powell et al. (2016), Mr. Curtis
could be suffering from acute pulmonary edema that could be affecting the ability of the lungs to
exchange air effectively. Alternatively, his lungs could be obstructed and hence causing the
deviation of partial CO2 from the normal values. Subsequently, the carbon dioxide content
indicated by HCO3- is within the normal range. The HCO3- indicates that Mr. Curtis has a
functional kidney and renal functions. Lastly, the oxygen saturation levels in the arterial blood
SaO2 is within the normal range.
Acute pulmonary oedema (APO) is caused by elevated hydrostatic pressure of the
pulmonary capillary which leads to transudation of fluid into the alveoli as well as pulmonary
interstitium. The increase in pressure subsequently increases pressure in the pulmonary vein as
well as that of the microvascular system in the lungs leading to APO. It should be noted that
alveolar gas and the pulmonary capillary blood are separated by a thin membrane referred to as
capillary-alveolar membrane. Normal physiologic functions of the system entail fluids
exchanging between the interstitium and the vascular bed. The main site of exchange is located
at the lungs across the endothelial membrane in form of fluids. The filtrates from the lungs
normally get confined within the interstitial spaces where they are transported through the
lymphatic vessels to the heart. The movement of these filtrates takes place through the
pulmonary lymphatic vessels by built-in pressure from their formation sites to where they are
being removed or exchanged. The quantity of the filtrate and its associated protein content
depends on three major factors. These are the transvascular hydrostatic pressure and the protein
colloid pressure difference as well as the permeability of the endothelial barrier to both water and