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14.1: Case Study: Your Support System - Biology

14.1: Case Study: Your Support System - Biology



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Case Study: A Pain in the Foot

Amari loves wearing high heels when they go out at night, like the stiletto heels shown in Figure (PageIndex{1}). Amari uses gender-neutral pronouns, such as they, them, and their. They know high heels are not the most practical shoes, but they like how they look. Lately, Amari has been experiencing pain in the balls of their feet—the area just behind the toes. Even when they trade heels for comfortable sneakers, it still hurts when they stand or walk.

What could be going on? Amari searches online to try to find some answers. They find a reputable source for foot pain information—a website from a professional organization of physicians that peer reviews the content by experts in the field. There, Amari reads about a condition called metatarsalgia, which produces pain in the ball of the foot that sounds very similar to what they are experiencing.

Amari learns that a common cause of metatarsalgia is the wearing of high heels because they push the foot into an abnormal position. This results in excessive pressure being placed onto the ball of the foot. Looking at the photograph above, you can imagine how much of the body weight is focused on the ball of the foot because of the shape of the high heels. If they were not wearing high heels, the weight would be more evenly distributed across the foot.

As they read more about the hazards of high heels, Amari learns that heels can also cause foot deformities such as hammertoes and bunions, small cracks in the bone called stress fractures, and may even contribute to the development of osteoarthritis of the knees at an early age.

These conditions caused by high heels are all problems of the skeletal system, which includes bones and connective tissues that hold bones together and cushion them at joints such as the knee. The skeletal system supports the body’s weight and protects internal organs, but as you will learn as you read this chapter, it also carries out a variety of other important physiological functions.

At the end of the chapter, you will find out why high heels can cause these skeletal system problems and the steps Amari takes to recover from their foot pain and prevent long-term injury.

Chapter Overview: Skeletal System

In this chapter, you will learn about the structure, functions, growth, repair, and disorders of the skeletal system. Specifically, you will learn about:

  • The components of the skeletal system, which include bones, ligaments, and cartilage.
  • The functions of the skeletal system, which include supporting and giving shape to the body, protecting internal organs, facilitating movement, producing blood cells, helping maintain homeostasis, and producing endocrine hormones.
  • The organization and functions of the two main divisions of the skeletal system: the axial skeletal system, which includes the skull, spine, and rib cage; and the appendicular skeletal system, which includes the limbs and girdles that attach the limbs to the axial skeleton.
  • The tissues and cells that make up bones and their specific functions, including making new bone, breaking down bone, producing blood cells, and regulating mineral homeostasis.
  • The different types of bones in the skeletal system, based on shape and location.
  • How bones grow, remodel, and repair themselves.
  • The different types of joints between bones, where they are located, and the ways in which they allow different types of movement depending on their structure.
  • The causes, risk factors, and treatments for the two most common disorders of the skeletal system: osteoporosis and osteoarthritis.

As you read this chapter, think about the following questions:

  1. Amari suspects they have a condition called metatarsalgia. This term is related to the term “metatarsals.” What are metatarsals, where are they located, and how do you think they are related to metatarsalgia?
  2. High heels can cause stress fractures, which are small cracks in the bone that usually appear after repeated mechanical stress, instead of after a significant acute injury. What other condition described in this chapter involves a similar process?
  3. What are bunions and osteoarthritis of the knee? Why do you think they can be caused by wearing high heels?

Case Study: Cancer in the Family

Figure 5.1.1 Family tree – three generations.

People tend to carry similar traits to their biological parents, as illustrated by the family tree. Beyond just appearance, you can also inherit traits from your parents that you can’t see.

Rebecca becomes very aware of this fact when she visits her new doctor for a physical exam. Her doctor asks several questions about her family medical history, including whether Rebecca has or had relatives with cancer. Rebecca tells her that her grandmother, aunt, and uncle — who have all passed away — had cancer. They all had breast cancer, including her uncle, and her aunt also had ovarian cancer. Her doctor asks how old they were when they were diagnosed with cancer. Rebecca is not sure exactly, but she knows that her grandmother was fairly young at the time, probably in her forties.

Rebecca’s doctor explains that while the vast majority of cancers are not due to inherited factors, a cluster of cancers within a family may indicate that there are mutations in certain genes that increase the risk of getting certain types of cancer, particularly breast and ovarian cancer. Some signs that cancers may be due to these genetic factors are present in Rebecca’s family, such as cancer with an early age of onset (e.g., breast cancer before age 50), breast cancer in men, and breast cancer and ovarian cancer within the same person or family.

Based on her family medical history, Rebecca’s doctor recommends that she see a genetic counselor, because these professionals can help determine whether the high incidence of cancers in her family could be due to inherited mutations in their genes. If so, they can test Rebecca to find out whether she has the particular variations of these genes that would increase her risk of getting cancer.

When Rebecca sees the genetic counselor, he asks how her grandmother, aunt, and uncle with cancer are related to her. She says that these relatives are all on her mother’s side — they are her mother’s mother and siblings. The genetic counselor records this information in the form of a specific type of family tree, called a pedigree, indicating which relatives had which type of cancer, and how they are related to each other and to Rebecca.

He also asks her ethnicity. Rebecca says that her family on both sides are Ashkenazi Jews (Jews whose ancestors came from central and eastern Europe). “But what does that have to do with anything?” she asks. The counselor tells Rebecca that mutations in two tumor-suppressor genes called BRCA1 and BRCA2, located on chromosome 17 and 13, respectively, are particularly prevalent in people of Ashkenazi Jewish descent and greatly increase the risk of getting cancer. About one in 40 Ashkenazi Jewish people have one of these mutations, compared to about one in 800 in the general population. Her ethnicity, along with the types of cancer, age of onset, and the specific relationships between her family members who had cancer, indicate to the counselor that she is a good candidate for genetic testing for the presence of these mutations.

Figure 5.1.2 Rebecca is not sure if she wants to know if she is at an increased risk of breast and ovarian cancer.

Rebecca says that her 72-year-old mother never had cancer, nor had many other relatives on that side of the family. How could the cancers be genetic? The genetic counselor explains that the mutations in the BRCA1 and BRCA2 genes, while dominant, are not inherited by everyone in a family. Also, even people with mutations in these genes do not necessarily get cancer — the mutations simply increase their risk of getting cancer. For instance, 55 to 65 per cent of women with a harmful mutation in the BRCA1 gene will get breast cancer before age 70, compared to 12 per cent of women in the general population who will get breast cancer sometime over the course of their lives.

Rebecca is not sure she wants to know whether she has a higher risk of cancer. The genetic counselor understands her apprehension, but explains that if she knows that she has harmful mutations in either of these genes, her doctor will screen her for cancer more often and at earlier ages. Therefore, any cancers she may develop are likely to be caught earlier when they are often much more treatable. Rebecca decides to go through with the testing, which involves taking a blood sample, and nervously waits for her results.


Features

New to This Edition

The main theme of this edition is how to build and retain B2B and B2C marketing relationships in the value chain, both off-line but increasingly also on-line.

Consequently, an important aspect of this edition is the strengthening of the on-line theme (social media, e-commerce etc.) which is now incorporated in all the chapters and in many cases and exhibits.

The books chapters, cases and exhibits are totally updated with the latest journal articles and company information. Besides that, the following new concepts are introduced in the single chapters:


Recommendations

Finding and Writing Cases

Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Instructors can consider in particular the National Center for Case Study Teaching in Science, a database featuring hundreds of accessible STEM- and social science - based case studies.

  • Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing The Way of Flesch: The Art of Writing Readable Cases Twixt Fact and Fiction: A Case Writer’s Dilemma And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes.

Implementing Cases

Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.

Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.

Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.

Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.

Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).

Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.

Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.

Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.


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3. Evaluate issues from a range of perspective and be able to integrate these into a considered and practical approach to leadership and organisation Assignment: You have recently been promoted to the position of Head of a new department in your organization. You are now in charge of a small team of employees, whom you must lead in your new role. Your CEO has asked that you provide him with a report, emphasizing on how you intend to lead your team, citing the fact that you have recently attended this particular module of study. The report should include an assessment of the current leadership practices of the organization as well as a critical analysis of appropriate leadership styles that you think should be adopted. A further evaluation on other leadership requirements based on your learning throughout the module, the relevant theories, models, should be included in your report. This assignment must be answered in relation to the organization you currently work in or an organization that you have knowledge of. The main objective of this assignment is to integrate topics discussed throughout the term and how these can be applied to “real life” cases. This assignment will provide you with an understanding of the links between leadership in organizations, organizational directions and the skills to apply this understanding in a selected organization.

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I NTRODUCTION

Chiropractic is a type of complementary medicine with various definitions in different articles and other scientific resources. According to the World Health Organization’s (WHO) definition, chiropractic is 𠇊 health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system, and the effects of these disorders on general health”. Chiropractic treatment procedures emphasize the manual techniques, including joint adjustment and/or manipulation, with a specific focus on subluxation. 1

The basis of chiropractic approach to restoration and protection of health is the relationship between structure, specifically the spine and musculoskeletal system, and function, particularly as coordinated by the nervous system. In other words, based on the chiropractic approach, the body is regarded as a neuromusculoskeletal system in which disorder in one part of the system disturbs the other parts. Therefore, disorders in the body structure are removed so that stresses on the body’s nervous system can be alleviated and the general health of the body can be restored. 1-5

Chiropractic was founded by Daniel David Palmer in the United States of America (USA), in 1895, and it gradually attracted its proponents among doctors and other healers. Nowadays, chiropractic is taught in at least 40 universities and colleges, in 16 different countries ( table 1 ). Moreover, most of these are located in the USA as it is the birth place of chiropractic ( figure 1 ). Chiropractic is practiced worldwide and is regulated by law in 40 countries such as the USA, Australia, Germany, France, Brazil, Japan, England, and Denmark. 1,6-8 Moreover, at least 17 journals with the exact name 𠆌hiropractic’ publish chiropractic related articles worldwide 9-13 ( table 2 ).


4 SQL*Loader Case Studies

The case studies in this chapter illustrate some of the features of SQL*Loader. These case studies start simply and progress in complexity.

This chapter contains the following sections:

The Case Studies

This chapter contains the following case studies:

Loads stream format records in which the fields are delimited by commas and may be enclosed by quotation marks. The data is found at the end of the control file.

Loads data from a separate datafile.

Loads data from stream format records with delimited fields and sequence numbers. The data is found at the end of the control file.

Combines multiple physical records into one logical record corresponding to one database row.

Loads data into multiple tables in one run.

Loads data using the direct path load method.

Extracts data from a formatted report.

Adds a CLOB column called RESUME to the table EMP, uses a FILLER field (RES_FILE), and loads multiple LOBFILEs into the EMP table.

Loads a customer table that has a primary key as its OID and stores order items in a VARRAY. Loads an order table that has a REF to the customer table and the order times in a VARRAY.

Case Study Files

The distribution media for SQL*Loader contains files for each case:

    Control files (for example, ULCASE1.CTL)

If the sample data for the case study is contained in the control file, then there will be no .DAT file for that case.

If there are no special setup steps for a case study, there may be no .SQL file for that case. Starting (setup) and ending (cleanup) scripts are denoted by an S or E after the case number.

Table ń-1 lists the files associated with each case.

Table 4-1 Case Studies and Their Related Files

Additional Information: The actual names of the case study files are operating system-dependent. See your Oracle operating system-specific documentation for the exact names.

Tables Used in the Case Studies

The case studies are based upon the standard Oracle demonstration database tables, EMP and DEPT, owned by SCOTT/TIGER. (In some case studies, additional columns have been added.)

Contents of Table EMP

Contents of Table DEPT

References and Notes

The summary at the beginning of each case study directs you to the sections of this guide that discuss the SQL*Loader feature being demonstrated in more detail.

In the control file fragment and log file listing shown for each case study, the numbers that appear to the left are not actually in the file they are keyed to the numbered notes following the listing. Do not use these numbers when you write your control files.

Running the Case Study SQL Scripts

You should run the SQL scripts ULCASE1.SQL and ULCASE3.SQL through ULCASE10.SQL to prepare and populate the tables. There is no ULCASE2.SQL, because Case 2 is handled by ULCASE1.SQL.

Case 1: Loading Variable-Length Data

    A simple control file identifying one table and three columns to be loaded.

Control File

The control file is ULCASE1.CTL:

    The LOAD DATA statement is required at the beginning of the control file.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE1.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

SQL*Loader loads the DEPT table and creates the log file.

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, refer to your Oracle operating system-specific documentation.

Log File

The following shows a portion of the log file:

    Position and length for each field are determined for each record, based on delimiters in the input file.

Case 2: Loading Fixed-Format Fields

In this case, the field positions and datatypes are specified explicitly.

Control File

The control file is ULCASE2.CTL.

    The LOAD DATA statement is required at the beginning of the control file.

Datafile

The following are a few sample data lines from the file ULCASE2.DAT. Blank fields are set to null automatically.

Invoking SQL*Loader

Before invoking SQL*Loader, make sure you have run the script ULCASE1.SQL as SCOTT/TIGER. (The ULCASE1.SQL script handles both Case 1 and Case 2.)

Then invoke SQL*Loader at the command line:

EMP records loaded in this example contain department numbers. Unless the DEPT table is loaded first, referential integrity checking rejects these records (if referential integrity constraints are enabled for the EMP table).

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, refer to your Oracle operating system-specific documentation.

Log File

The following shows a portion of the log file:

Case 3: Loading a Delimited, Free-Format File

    Loading data (enclosed and terminated) in stream format. See Delimited Fields .

Control File

This control file loads the same table as in Case 2, but it loads three additional columns (HIREDATE, PROJNO, LOADSEQ). The demonstration table EMP does not have columns PROJNO and LOADSEQ. To test this control file, add these columns to the EMP table with the command:

The data is in a different format than in Case 2. Some data is enclosed in quotation marks, some is set off by commas, and the values for DEPTNO and PROJNO are separated by a colon.

    Comments may appear anywhere in the command lines of the file, but they should not appear in data. They are preceded with two hyphens that may appear anywhere on a line.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE3.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, see your Oracle operating system-specific documentation.

Log File

The following shows a portion of the log file:

Case 4: Loading Combined Physical Records

    Combining multiple physical records to form one logical record with CONTINUEIF see Assembling Logical Records from Physical Records .

Control File

The control file is ULCASE4.CTL:

    DISCARDFILE specifies a discard file named ULCASE4.DSC.

Data File

The datafile for this case, ULCASE4.DAT, looks as follows. Note the asterisks in the first position and, though not visible, a new line indicator is in position 20. Note that CLARK's commission is -10, and SQL*Loader loads the value converting it to a negative number.

Rejected Records

The last two records are rejected, given two assumptions. If there is a unique index created on column EMPNO, then the record for CHIN will be rejected because his EMPNO is identical to CHAN's. If EMPNO is defined as NOT NULL, then CHEN's record will be rejected because it has no value for EMPNO.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE4.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, see your operating Oracle system-specific documentation.

Log File

The following is a portion of the log file:

Bad File

The bad file, shown in the following display, lists records 8 and 9 for the reasons stated earlier. (The discard file is not created.)

Case 5: Loading Data into Multiple Tables

Control File

The control file is ULCASE5.CTL.

    REPLACE specifies that if there is data in the tables to be loaded (EMP and PROJ), SQL*loader should delete the data before loading new rows.

Data File

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE5.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, see your Oracle operating system-specific documentation.

Log File

The following is a portion of the log file:

    Errors are not encountered in the same order as the physical records due to buffering (array batch). The bad file and discard file contain records in the same order as they appear in the log file.

Loaded Tables

These are results of this execution of SQL*Loader:

Case ņ: Loading Using the Direct Path Load Method

This case study loads the EMP table using the direct path load method and concurrently builds all indexes. It illustrates the following functions:

    Use of the direct path load method to load and index data. See Chapter ň.

In this example, field positions and datatypes are specified explicitly.

Control File

The control file is ULCASE6.CTL.

    The SORTED INDEXES statement identifies indexes:presorting data:case study the indexes on which the data is sorted. This statement indicates that the datafile is sorted on the columns in the EMPIX index. It allows SQL*Loader to optimize index creation by eliminating the sort phase for this data when using the direct path load method.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE6.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, see your Oracle operating system-specific documentation.

Log File

The following is a portion of the log file:

Case 7: Extracting Data from a Formatted Report

In this case study, SQL*Loader string processing functions extract data from a formatted report. This case illustrates the following:

    Using SQL*Loader with an INSERT trigger (see the chapter on database triggers in Oracle8i Application Developer's Guide - Fundamentals ).

Note: This example creates a trigger that uses the last value of unspecified fields.

Data File

The following listing of the report shows the data to be loaded:

Insert Trigger

In this case, a BEFORE INSERT trigger is required to fill in department number, job name, and manager's number when these fields are not present on a data line. When values are present, they should be saved in a global variable. When values are not present, the global variables are used.

The INSERT trigger and the package defining the global variables is:

Note: The phrase FOR EACH ROW is important. If it was not specified, the INSERT trigger would only fire once for each array of inserts because SQL*Loader uses the array interface.

Control File

The control file is ULCASE7.CTL.

    The decimal point in column 57 (the salary field) identifies a line with data on it. All other lines in the report are discarded.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE7.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, refer to your Oracle operating system-specific documentation.

Log File

The following is a portion of the log file:

    A warning is generated by the difference between the specified length and the length derived from the position specification.

Dropping the Insert Trigger and the Global-Variable Package

After running the example, run the script ULCASE7E.SQL to drop the insert trigger and global-variable package.

Case 8: Loading Partitioned Tables

    Partitioning of data. See Oracle8i Concepts for more information on partitioned data concepts.

Control File

The control file is ULCASE8.CTL. It loads the LINEITEM table with fixed length records, partitioning the data according to shipment date.

    Specifies that each record in the datafile is of fixed length (129 characters in this example).

Table Creation

In order to partition the data, the LINEITEM table is created using four partitions according to the shipment date:

Input Data File

The datafile for this case, ULCASE8.DAT, looks as follows. Each record is 129 characters in length. Five blanks precede each record in the file.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE8.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, refer to your Oracle operating system-specific documentation.

Log File

The following shows a portion of the log file:

Case 9: Loading LOBFILEs (CLOBs)

    Adding a CLOB column called RESUME to the table EMP

Control File

The control file is ULCASE9.CTL. It loads new records into EMP, including a resume for each employee. Each resume is contained in a separate file.

    This is a filler field. The filler field is assigned values from the datafield to which it is mapped. See SQL*Loader DDL Support for LOBFILES and Secondary Data Files (SDFs) for more information.

Input Data Files

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE9.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, refer to your Oracle operating system-specific documentation.

Log File

The following shows a portion of the log file:

Case 10: Loading REF Fields and VARRAYs

    Loading a customer table that has a primary key as its OID and stores order items in a VARRAY.

Control File

    This is a filler field. The filler field is assigned values from the datafield to which it is mapped. See SQL*Loader DDL Support for LOBFILES and Secondary Data Files (SDFs) for more information.

Invoking SQL*Loader

Before invoking SQL*Loader, run the script ULCASE10.SQL as SCOTT/TIGER.

Then invoke SQL*Loader at the command line:

Additional Information: The command sqlldr is a UNIX-specific invocation. To invoke SQL*Loader on your operating system, refer to your Oracle operating system-specific documentation.


CASE STUDY 2: ANGINA PECTORIS

Present Illness

Patient B is 42 years of age and works as a newspaper editor. He presents to the emergency department complaining of chest pain radiating into both arms, accompanied by diaphoresis and shortness of breath. He has been having episodes of transient substernal and shoulder pain over the past week. He is admitted to the CCU.

Medical History

Patient B is being treated for hypertension and is currently taking 100 mg metoprolol twice per day. He does not exercise and has smoked a pack of cigarettes daily for 20 years. He reports being under considerable job stress. He is overweight, with a body mass index of 35.

Assessment and Diagnosis

Upon admittance to the CCU, a full physical exam is conducted ( Table 5 ). An ECG shows ST segment depression and T wave inversion consistent with subendocardial ischemia in the inferior and anterior leads. An incomplete left bundle branch block is also noted. Laboratory studies (CBC, urinalysis, and cardiac isoenzyme levels) are all within normal limits, although cardiac isoenzymes are in the upper range.

PATIENT B'S PHYSICAL EXAM RESULTS

Based on the results of the assessment, Patient B is diagnosed with:

Management

Patient B stays in the CCU for three days. During that time, serum cardiac enzyme levels and repeat ECGs confirm a diagnosis of subendocardial ischemia rather than MI. Coronary artery angiography is done to clarify the coronary artery anatomy and finds a 35% to 45% occlusion of the left anterior descending artery. The possibility of coronary artery vasospasm is not excluded because no ergonovine trial is done. Repeat evaluation for coronary artery bypass surgery is planned for the future, with conservative medical treatment in the interim.

At discharge, Patient B is prescribed:

Digoxin (Lanoxin): 0.25 mg daily

Controlled-release nitroglycerin: 6.5 mg every 12 hours

Nifedipine (Procardia): 10 mg three times daily

Sublingual nitroglycerin (Nitrostat): 0.4 mg as needed for chest pain

Study Questions

Distinguish between the symptoms of angina and MI.

What are the signs and symptoms of stable angina?

Define unstable angina. How is it diagnosed and treated?

Describe Prinzmetal (variant) angina.

What clues suggest the common noncardiac causes of chest pain?

List specific nursing measures regarding medications, diet, activity, lifestyle changes, and emotional support that should be implemented for Patient B.

During his stay in the CCU, Patient B asks if he has to change his lifestyle, as he really did not have a "heart attack." How would you respond?

Discuss the nursing diagnosis of self-concept in regard to patients with angina. How does this major problem impact their perception of self? Their relationships with others?

PATIENT B'S PHYSICAL EXAM RESULTS


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I enjoyed this course as it covers the fundamentals for real beginners and Ben did good job of explaining most of the concepts. Also, a big plus for enthusiastic way of presenting the theory which really made the whole experience pleasurable.

This course covers important concepts in Business Analysis and provides a jumping off point for new BAs to begin their career. I like that the instructor offered personal insights from real world experiences which helps you relate the concepts to your own projects and work.

Really great course! Suits all learning styles. Really informative, covers a lot of material and great resources. Ben is a great teacher on the subject and makes it simple to understand. Highly recommend this course.

The course is very good, informative and knowledgeable. Most important aspect of this course and the factor which matches for me is that, it provided majority of information with practical approach which are used in day to day activities.

The course was recommended by a friend for it's simplicity. Indeed it met my expectations. Simple and easy to understand the scope of the course. The examples bring home the point. The personal experience and thoughts of the facilitator are noteworthy.

I wish I could leave a 10 star review. Ben thanks a lot for taking the time to explain the concepts in detail. This BY FAR THE BEST Salesforce Business Analysis training I have received! You are THE BEST!

Amazing experience in doing this course. it provides you with the knowledge of Salesforce and a fair bit of practical real life scenarios for that topic. I do want to give the perfect 5 stars