Case - In poor health; problem with feet swelling
Hints page 2

I. The Case (& preliminary "hints")

Case - In poor health; problem with feet swelling

II. The Patient's Chart (and baseline data)

Upon calling up Mrs. Delivery we are presented with vital signs data all of which appears to be within normal range (below).

 

Requesting <Your Patient's Chart > under the View option <Patient Charts or Lab Tests> yields (see below)

 

On this Chart we confirm the normal range vital signs values but note
- the report of "poor health" and in particular
- that she complains of her feet swelling.

III. Basic output data on the patient

We consider two possiblities for the "feet" swelling. These are

1) heart failure and 2) an imbalance beween capillary bed forces causing fluid to leave the vascular space and forces causing it to reenter. This page considers the failure hypothesis.

The heart failure hypothesis

We change our View output: tables to read out variables more relevant to a cursory initial cardiovascular investigation and then run the patient for 5 days to obtain a sense of stability.

These are, left to right,

• four cardiovascular indicators, mean arterial pressure (AP), cardiac output, left atrial filling pressure, right atrial filling pressure (RAP) and

• two indicators of edema and fluid balance [ lymph flow/minute (LYMPH) and total body water (BODH2O).
*Note: 0.6552E+05 = 65,520 Liters - see below

The resulting output of a 5 day run is shown below.

 

1] Examine the four cardiovascular variables, compare them with their normative values (use the Help section's
Help info on <Choose> option) and confirm that these are certainly not values indicative of serious heart failure.

2} Notice the behavior of the two fluid balance variables and conform that despite normal central cardiac values, that lymph flow is indeed elevated (and elevating progressively more!) and that this is reflected in the accumultation of progressively more edematous fluid in the body.

iV. More

This ends the first hints section on this case.

You should attempt again at this point to arrive at a diagnosis and, where possible, a treatment. To do so

• Return to the HUMAN model's Physiology Lab section for this patient and verify

- the diagnosis by finding the appropriate variables to support your argument and

- the treatment by changing parameters so as to stabilize the patient.

VI. Analysis

If you wish further analysis and a diagnosis on this case and information on how it was created, click on this link ( analysis ) and log in as requested.

* Note: Case hints and analyses are based heavily on Drs. Randall and Coleman's HUMAN-80 Instructor's Manual supplemented by notes of Dr. Coleman's in the model code itself and findings by myself and other colleagues over our years of use of these cases.