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WHAT ARE THE EXOCRINE FUNCTIONS OF THE PANCREAS?
SECRETES ENZYMES AND AN ALKALINE SUBSTANCE
WHAT DO THE ALPHA AND BETA CELLS SECRETED BY THE ISLETS OF LANGERHANS ASSOCIATED WITH
BETA - INSULIN
ALPHA - GLUCAGON
WHAT DOES INSULIN DO BESIDES GLUCOSE REGULATION?
REGULATES POTASSIUM LEVELS.  IF THERE IS TOO MUCH INSULIN, POTASSIUM WILL DROP.  IF TOO MUCH INSULIN IS GIVEN THE HEART CAN STOP
DESCRIBE TYPE I DIABETES
BODY DOES NOT MAKE INSULIN.  WHEN THEY ARE HOME THEY HAVE TO TAKE INSULIN INJECTIONS.

TYPE II IS INSULIN RESISTANCE-PERSON MAKES INSULIN, BUT THEIR BODY DOES NOT ABSORB INSULIN AND USE IT AS THEY SHOULD. THEY USUALLY TAKE ORAL MEDICATIONS, NOT INSULIN.

GESTATIONAL DIABETES: INSULIN GIVEN USUALLY BY PUMP. ORAL MEDS ARE TERATOGENIC. 

ALL FORMS REQUIRE WEIGHT LOSS, EXCERCISE, AND FOOD TO SUPPORT.

ONLY ABOUT 10% OF DIABETICS ARE TYPE I
WHY ARE MOST DIABETICS IN HOSPITAL SETTINGS GIVEN INSULIN INJECTIONS, EVEN TYPE II AND GESTATIONAL?
BECAUSE PTS ARE OFTEN NPO AND CAN'T TAKE OTHER MEDS.  ALSO, SOMETIMES THEY HAVE SPIKED AND NEED TO BE REGULATED.
STRESS AND DECREASED ACTIVITY IN HOSPITAL SETTING ALSO USUALLY RESULT IN INSULIN ADMINISTRATION. INFECTIONS AND ILLNESS ALSO INCREASE BLOOD SUGAR
DESCRIBE TYPE I DIABETES
COMES FROM IMMUNODESTRUCTION OF THE BETA CELLS.
CLINICAL MANIFESTATIONS: THIRSTY, POLYURIA, HUNGRY, LOSE WEIGHT, TIRED, LETHARGIC, AND VISUAL CHANGES
CHECK BLOOD GLUCOSE LEVELS
WHAT DO WE WANT OUR GLUCOSE LEVELS TO BE AT?
FASTING: 127
AIC: 7
WHAT ARE SOME TREATMENTS FOR DIABETES I?
CARB COUNTING, EXERCISE, INSULIN REPLACEMENT THERAPY
HOW CAN INSULIN BE GIVEN?
REGULAR INSULIN-CLEAR-GIVEN IN SLIDING SCALE INSULIN (MAY BE GIVEN TO TYPE II IN HOSPITAL) - FAST ACTING-WORKS WITHIN MINUTES

MPH-NOVALOG-CLOUDY-LONGER ACTING INSULINS

LANTIS - TAKES ABOUT 24 HOURS BEFORE IT TAKES EFFECT

APRIDA - FAST ACTING INSULIN
HOW OFTEN DOES BLOOD SUGER MONTIORING NEED TO BE PERFORMED ON A PERSON WITH INSULIN DRIP?
EVERY HOUR
DESCRIBE TYPE 2 DIABETES MELLITUS
*INSULIN RESISTANCE AND A REDUCATION IN ADEQUATE ..?
*OBESE
CLINICAL MANIFESTATIONS: MAY BE NONE. VISUAL CHANGES, NEPHROPATHY, CORONARY ARTERY DISEASE, PERIPHERAL VASCULAR DISEASE, RECURRENT INFECTIONS, NEUROPATHY (IE FEET AND HANDS ARE NUMB AND TINGLE AT SAME TIME)
WHAT ARE THE TYPE II DIABETES DIAGNOSTIC CRITERIA?
BLOOD GLUCOSE LEVEL IS CHECKED: USUALLY COMES FROM GLUCOSE TOLERANCE AND POSTCRANIAL?

NEED TO DETERMINE TYPE I OR TYPE II: USUALLY COMES FROM 3 HOUR GLUCOSE TOLERANCE AND CRANIAL?
DESCRIBE GESTATIONAL DIABETES?
GLUCOSE INTOLERANCE WITH THE ONSET OF PREGNANCY. OCCURS 4-14% OF PREGNANCIES. REQUIRES DIET MODIFICATIONS, EXERCISE, AND POSSIBLY INSULIN USUALLY IN PUMP FORM
WHAT ARE SOME COMPLICATIONS OF DIABETES (ACUTE)?
HYPOGLYCEMIA: COLD, CLAMMY, CONFUSED. PB AND MILK BEST TO GIVE. IF UNCONSCIOUS, GIVE D50 BECAUSE IT HAS A LOT OF GLUCOSE

DIABETES KETOACIDOSIS - DKA - DEHYDRATED AT CELLULAR LEVEL-USUALLY ALSO HAVE LOW POTASSIUM, GENERALLY PUT ON INSULIN DRIP. MAY HAVE ACETONE BREATH, KETONES PRESENT IN URINE 

HYPERGLYCEMIA HYPEROSMOLAR NONKETOTIC SYNDROM -HHNK - MAY BE THIRSTY, MAY BE IN COMA, NON KETOTIC EFFECT

THE SOMOGYI EFFECT: MAY FLUCTUATE RAPIDLY BETWEEN HYPER AND HYPOGLYCEMIA.   AND DAWN PHENOMENON

WHAT ARE SOME LESS ACUTE COMPLICATIONS OF DIABETES?
MICROVASCULAR COMPLICATIONS: IE RETINOPATHY, MAY ACTUALLY HAVE A STROKE IN THEIR EYES DUE TO LACK OF CIRCULATION. REGULAR EXAMS NEEDED.

MACROVASCULAR - BLOOD PRESSURE

NEUROPATHIES: NUMBNESS IN HANDS, FINGERS, TOES, FEET. MAY ALSO HAVE NEUROGENIC BLADDER IE THEY NAY NOT KNOW WHEN THEY NEED TO URINATE

INFECTION: ALL INFECTIONS MUST BE TREATED AS MAJOR INFECTIONS ESPECIALLY IF ON LOWER LEGS.
YOU HAVE INFLAMMATION OF THE LARGE INTESTINE, A CONDITION CALLED ULCERATIVE COLITIS.  WHAT IS THE MOST PROBABLE REASON THAT YOU WOULD DEVELOP IRON DEFICIENCY ANEMIA?
YOU ARE EXPERIENCING CHRONIC BLOOD LOSS IN YOUR STOOLS
YOU ARE PART OF THE HEALTH CARE TEAM AT A CLINIC FOR ADOLESCENTS WITH ANOREXIA NERVOSA. WHICH OF THE ASSESSMENTS THAT YOU PERFORM IS FOCUSED ON RECOGNIZING THE MOST COMMON CAUSE FOR MORTALITY IN THOSE WITH ANOREXIA NERVOSA?
CARDIOVASCULAR ASSESSMENT
WHICH DIETARY CHANGE WOULD BE RECOMMENDED FOR THE INDIVIDUAL WITH CELIAC DISEASE?
AVOID WHEAT, BARLEY, RYE, AND OATS
WHAT AFFECTS THE SENSATIONS OF HUNGER AND SATIETY AND THEREFORE PLAYS A MAJOR ROLE IN THE DEVELOPMENT OF OBESITY?
THE HYPOTHALAMUS
WHAT NUTRIENT DOES NOT CONTRIBUTE AS AN ENERGY SOURCE IN THE DIET?
VITAMINS
YOU ARE CARING FOR AN INDIVIDUAL WITH LIVER DISEASE, WHAT ARE YOU MOST CONCERNED ABOUT IN REGARDS TO THEIR NUTRITION?
PT MAY BE UNABLE TO ADEQUATELY STORE NUTRIENTS.
PT MAY BE UNABLE TO SYNTHESIZE NUTRIENTS
PT MAY BE UNABLE TO METABOLIZE MACRONUTRIENTS
YOUR PT HAS GALL BLADDER DISSEASE AND IS UNABLE TO STORE AND RELEASE ADEQUATE BILE TO THE SMALL INTESTINE. WHAT DIETARY MODIFICATIONS DO YOU SUGGEST?
DECREASE FAT INTAKE
YOU ARE WORKING IN THE NEWBORN NURSERY AND ARE AN ADVOCATE FOR BREASTFEEDING.  IT IS THE WINTER IN NORTHERN MINNESOTA AND YOU ARE CONCERNED WITH LOW SUNLIGHT EXPOSURE IN INFANTS WHO ARE BREASTFEEDING AS THEY MAY DEVELOP VITAMIN D DEFICIENCY. WHAT IS THE MAJOR MANIFESTATION OF BITAMIN D DEFICIENCY?
IMPAIRED MINERALIZATION IN GROWING BONES
YOU ARE PLANNING A NUTRITIONAL IN SERVICE TO YOUR CLINICS SERVICE AREA IN CALIFORNIA.  WHAT CONCEPT OF ALTERED NUTRITION SHOULD YOU FOCUS YOUR TALK IN ORDER TO ADDRESS THE LARGEST NUTRITIONAL PROBLEM IN YOUR AREA?
OVERNUTRITION
WHAT IS KNOWN ABOUT GLUCOSE TRANSPORT IN THE SMALL INTESTINE?
REQUIRES COTRANSPORT WITH SODIUM

OCCURS THROUGH ACTIVE TRANSPORT

MUST FIRST BE REDUCED AS IS RARELY CONSUMED IN THE TYPICAL DIET
HOW DO YOU THINK VITAMIN A AND C DEFICIENCIES AFFECT WOUND HEALING?
Wound healing would not occur without the support of vitamins A and C, which are essential for collagen formation
WHAT IS YOUR APPROXIMATE CALORIC REQUIREMENT PER DAY TO MAINTAIN YOUR BODY WEIGHT?
Caloric requirements are determined based on the kcal/kg needed to maintain body weight. Caloric intake requirements depend on age, gender, activity level, current weight, pregnancy, and lactation. During times of growth, caloric requirements are higher. For example, caloric requirements are 115 kcal/kg at birth. This requirement decreases to 80 kcal/kg between ages 1 and 10 years and is about half of that (30 to 40 kcal/kg) in adulthood. Pregnancy demands add an additional 300 kcal/day. Lactation (breastfeeding) increases the requirement by 500 kcal/day.
WHAT DIETARY RECOMMENDATIONS WOULD YOU MAKE FOR THE INDIVIDUAL WHO IS NOT ABLE TO EFFECTIVELY PRODUCE OR UTILIZE BILE?
These individuals should consume a diet that has reduced fat and focuses on dietary fat sources that break down into shorter and medium (8 to 12 carbon) length fatty acid chains.
WHAT WILL HAPPEN TO NUTRIENT ABSORPTION IN CROHN DISEASE WHEN LARGE PORTIONS OF THE SMALL INTESTINE ARE INFLAMED?
 Virtually all nutrients are absorbed in the small intestine, with the exception of water and alcohol; loss of the absorptive surface of the small intestine will result in broad-range nutrient deficiencies.
Inflammation, particularly that which occurs with infection, stimulates the release of chemical mediators that promote insulin secretion. Insulin presence promotes the use of glucose for energy. How do you think this affects the adaptation to starvation?
 In the presence of insulin, body tissues continue to depend on glucose. Muscle mass quickly erodes. When 50% of protein stores are exhausted, recovery prognosis is poor.
WHY WOULD PANCREATIC DYSFUNCTION LEAD TO PROBLEMS WITH ABSORPTION?
Pancreatic enzymes are needed for the digestion and processing of all macronutrients, particularly fats. Without proper processing, these nutrients move quickly through the GI tract and are unable to be adequately absorbed.
YOU ARE PROVIDING NUTRITIONAL COUNSELING FOR A PERSON WITH CELIAC DISEASE. WHAT SPECIFIC FOODS WOULD YOU RECOMMEND AVOIDING? WHAT FOODS WOULD YOU SUGGEST AS SUBSTITUTIONS?
All wheat, rye, barley, and oats are excluded. This includes breads, cakes, cereals, pastas, beer, or any other foods made with these ingredients. Acceptable alternatives are milk and milk products, corn, rice, soy or potato-based grain products, eggs, peas, beans, nuts, seeds, tofu, fruits and vegetables, tea, and coffee.
HOW DO YOU MEASURE YOUR BMI?
 Do this by measuring your weight in pounds and converting this to kilograms (1 pound = 0.45 kg). Then, measure your height in inches and convert this to meters squared (multiply inches ×2.54 cm; divide this number by 100 cm/m; multiply this final number × itself to get meters squared). Then, the final step is to take your weight in kilograms and divide it by your height in meters squared.
GIVEN THAT VENTILATION-PERFUSION IS GRAVITY DEPENDENT, HOW DOES YOUR BODY POSITION AFFECT WHERE THE GREATEST VOLUME OF VENTILATION=PERFUSION OCCURS?
STANDING PROMOTES HIGHER RATIOS OF VENTILATION-PERFUSION IN THE LOWER BASES OF THE LUNGS; THE AREAS OF THE LUNG THAT ARE MOST DEPENDENT BECOME THE BEST VENTILATED AND PERFUSED.
HOW WOULD AN INEFFECTIVE RIGHT VENTRICLE AFFECT THE PULMONARY AND SYSTEMIC CIRCULATION?
AN INEFFECTIVE RIGHT VENTRICLE WOULD RESULT IN POOR MOVEMENT OF BLOOD INTO THE PULMONARY ARTERY AND PAST THE LUNGS.  THERE WOULD BE A BACK UP OF BLOOD SYSTEMICALLY RESULTING IN INCREASED HYDROSTATIC PRESSURE IN THE PERIPHERAL ORGANS AND TISSUES.
HOW WOULD MODERATE TO HEAVY AEROBIC EXERCISE AFFECT THE DEVELOPMENT OF COLLATERAL CIRCULATION OF THE HEART?
INCREASING DEMANDS WILL PROMOTE DEVELOPMENT OF COLLATERAL CIRCULATION.  THIS WILL INCREASE THE FUNCTIONAL RESERVES AVAILABLE TO THE HEART AND WILL PROMOTE MAXIMIZATION OF HEART PERFUSION.  THIS CAN BE BENEFICIAL IN TIMES WHERE PERFUSION IS SOMEHOW IMPAIRED.  BLOOD WILL STILL BE ABLE TO REACH A GREATER AMOUNT OF THE HEART THROUGH THESE COLLATERAL NETWORKS.
WHAT IS PERICARDITIS? WHAT WOULD BE THE PROBLEM WITH THIS CONDITION? WHAT CLINICAL MANIFESTATIONS DO YOU THINK WOULD BE PRESENT?
PERICARDITIS IS INFLAMMATION OF THE PERICARDIUM THAT CAN BE CAUSED BY INFECTION, MYOCARDIAL INFARCTION, MI, OR OTHER TRAUMA.  OFTEN THE CAUSE IS UNKNOWN.  THE MAJOR PROBLEM WITH THIS CONDITION IS RESTRICTION OF SMOOTH CARDIAC PUMPING DUE TO THE INFLAMED AND ROUGH PERICARDIAL MEMBRANES.  AS WITH OTHER INFLAMMATORY CONDITIONS, EXUDATE MAY DEVELOP.  CHEST PAIN IS A MAJOR CLINICAL MANIFESTATION.  PAIN WITH PERICARDITIS OFTEN WORSENS WITH INSPIRATION AND WITH LYING DOWN.  IF THE INFLAMMATION CREATES SUFFICIENT PRESSURE, CARDIAC COMPRESSION CAN RESULT (TAMPONADE) AND IMPAIR CARDIAC CONDUCTION AND CARDIAC OUTPUT.  CHRONIC INFLAMMAITON CAN RESULT IN CONSTRICTIVE PERICARDITIS, A CONDITION WHERE THE HEART IS ENCASED IN A RIGID SHELL.
WHAT WOULD HAPPEN IF THE AV NODE CONDUCTION WAS BLOCKED? WHAT WOULD HAPPEN IF THE BUNDLE BRANCH CONDUCTION WAS BLOCKED?
THE AV NODE PROVIDES THE ONLY CONNECTION BETWEEN THE TWO CONDUCTION SYSTEMS (ATRIA AND VENTRICLES); THE ATRIA AND VENTRICLES WOULD BEAT INDEPENDENTLY OF EACH OTHER IF THE TRANSMISSION OF IMPULSES THROUGH THE AV NODE WERE BLOCKED.  THE HEART RHYTHM WOULD BE INEFFICIENT; THE ATRIA WOULD NOT COMPLETELY EMPTY PRIOR TO THE VENTRICLES CONTRACTING.  THE BUNDLE BRANCH BLOCK WOULD PREVENT VENTRICULAR CONTRACTION.  IF UNILATERAL, ONE VENTRICLE WOULD BE AFFECTED.
WHAT HAPPENS TO PRELOAD WHEN VENOUS RETURN IS SLUGGISH? WHAT HAPPENS TO PRELOAD WHEN VENOUS RETURN IS EXCESSIVE AND CARDIAC MUSCLE FIBERS GET STRETCHED TOO FAR?
WHEN VENOUS RETURN IS SLUGGISH, LESS BLOOD ENTERS THE VENTRICLES AND THE PRELOAD IS REDUCED.  THIS LEADS TO DECREASED CARDIAC OUTPUT AS THE STROKE VOLUME IS LESS. THE HEART RATE WOULD HAVE TO INCREASE IN ORDER TO COMPENSATE.  WITH EXCESSIVE STRETCHING OF THE CARDIAC MUSCLE FIBERS ( OR WITH IMPAIRED CONTRACTILITY), PRELOAD IS EXCESSIVE AND THE HEART IS UNABLE TO OVERCOME THE PRESSURE IN THE VENTRICLES.
WHAT WOULD YOUR BODY NEED TO DO TO MAINTAIN OPTIMAL BLOOD PRESSURE IF YOU HAD INCREASED PERIPHERAL VASCULAR RESISTANCE (PVR) AS MAY OCCUR WITH ARTERIOSCLEROSIS ( A CONDITION OF STIFFENING OF THE ARTERIES)?
SINCE THE PRODUCT OF CARDIAC OUTPUT AND PVR COMPRISES BLOOD PRESSURE, AN INCREASE IN PVR WOULD REQUIR A DECREASE IN CARDIAC OUTPUT IN ORDER TO COMPENSATE AND MAINTAIN A STABLE BLOOD PRESSURE.  SINCE CARDIAC OUTPUT IS NEEDED TO CONTINUOUSLY PERFUS ORGANS, OFTEN CARDIAC OUTPUT WILL REMAIN STABLE AND HYPERTENSION IS THE RESULT.
DO YOU THINK THAT IT IS MORE PROBLEMATIC TO HAVE PERSISTENT ELEVATIONS IN SYSTOLIC OR DIASTOLIC BLOOD PRESSURE?
ALTHOUGH BOTH ARE PROBLEMATIC, PERSISTENT ELVATIONS IN DIASTOLIC PRESSURE INDICATE THAT THE INDIVIDUALS ARTERIES ARE NOT ALLOWED ADEQUATE REST BETWEEN CARDIAC CONTRACTIONS; THIS PRESENTS A GREAT DEAL OF STRESS ON THE ARTERIES WITHOUT AN ADEQUATE RECOVERY PERIOD.
THINK BACK TO THE LAST TIME YOU FELT DIZZY WHEN YOU STOOD UP TO FAST, WHY DO YOU THINK THIS OCCURRED? HOW DID THE BARORECEPTORS RESPOND?
ORTHOSTATIC HYPOTENSION CAN OCCUR FOR NUMEROUS REASONS INCLUDING DEHYDRATION OR LOW BLOOD VOLUME.  BARORECEPTORS RESPOND BY RECOGNIZING A DECREASED STRETCH IN THE VESSEL WALL.  THIS DECREASED STRETCH ON THE BARORECEPTORS SIGNALS A FALL IN BLOOD PRESSURE.  THE BARORECEPTORS THEN ALERT THE CARDIAC CONTROL CENTER TO TRIGGER THE SYMPATHETIC NERVOUS BRANCH TO VASOCONSTRICT THE VESSELS AND PROMOTE INCREASED PVR. HEART RATE IS ALSO INCREASED.
WHAT IS THE MECHANISM FOR DEVELOPMENT OF VENOUS THROMBI FORMATION IN AN INDIVIDUAL ON BED REST?
SKELETAL MUSCLE CONTRACTION PLAYS A MAJOR ROLE IN AIDING BLOOD RETURN TO THE HEART.  BED REST DECREASES EXTREMITY SKELETAL MUSCLE CONTRACTION AND BLOOD POOLS IN THE LOWER EXTREMITIES.  BLOOD STASIS ALLOWS COAGULATION AND FORMATION OF THROMBUS.
WHEN PREPARING AN INTRAVENOUS FLUID OR MEDICATION, ALL AIR MUST BE REMOVED FROMT HE TUBING OR SYRINGE.  DESCRIBE THE CONSEQUENCE OF BEING CARELESS IN AIR REMOVAL
SMALL AMOUNTS OF CIRCULATING AIR ARE OF LITTLE CONSEQUENCE.  INSERTION OF AIR GREATER THAN ABOUT 100 ML OR MORE CAN LEAD TO SUDDEN DEATH AS AIR BUBBLE COALESCE (AIR EMBOLI) AND PHYSICALLY OBSRUCT THE FLOW OF BLOOD IN THE MAIN PULMONARY ARTERY, RIGHT SIDE OF THE HEART, AND CAN CAUSE RIGHT VENTRICULAR FAILURE.  THEN LEFT VENTRICULAR FAILURE, NO PUMPING OF BLOOD FROM THE LEFT VENTRICLE, SEVERE HYPOTENSION, SHOCK AND DEATH
BASED ON THE PRESSURE DIFFERENTIAL BETWEEN THE RIGHT AND LEFT SIDES OF THE HEART, DO YOU THINK IT IS MORE COMMON TO HAVE A LEFT TO RIGHT OR RIGHT TO LEFT SHUNT? WHICH ONE WOULD MOST LIKELY RESULT IN CYANOSIS?
THE LEFT SIDE OF THE HEART HAS A GREATER PRESSURE SO A LEFT TO RIGHT IS MORE COMMON.  A RIGHT TO LEFT IS MOST LIKELY TO RESULT IN CYANOSIS AS DEOXYGENATED BLOOD IS DISTRIBUTED SYSTEMICALLY.
LOW DOSE DAILY ASPIRIN IS COMMONLY USED TO PREVENT MI.  ASPIRIN REDUCES PLATELET AGGREGATION.  HOW WOULD THIS MEDICATION HELP TO PREVENT MI?
ASPIRIN REDUCES THE ACCUMULATION OF PLATELETS AT THE SITE OF INJURY.  IF THE ATHEROSCLEROTIC PLAQUE BREAKS OFF, PLATELETS ARE LESS LIKELY TO ACCUMULATE AT THE SITE IN SUFFICIENT QUANTITIES TO OBSTRUCT THE LUMEN OF THE ARTERY.
HOW DO YOU THINK PHARMACOLOGIC INTERVENTIONS DIFFER BETWEEN SYSTOLIC AND DIASTOLIC LEFT VENTRICULAR FAILURE?
SYSTOLIC FAILURE IS TREATED WITH DRUGS THAT IMPROVE CARDIAC CONTRACTILITY OR REDUCE PERIPHERAL RESISTANCE.  DIASTOLIC FAILURE IS TREATED WITH DRUGS THAT INCREASE THE RELAXATION AND PROLONG THE DIASTOLIC PHASE OF THE CARDIAC CYCLE
HOW ARE COMPENSATORY MECHANISMS SIMILAR BETWEEN SHOCK AND HEART FAILURE? HOW ARE THESE DIFFERENT?
BOTH INVOLVE STIMULATION OF THE SYMPATHETIC NERVOUS SYSTEM, THE RENIN ANGIOTENSIN MECHANISM, AND VASOMOTOR TONE.  THE GOALS ARE DIFFERENT.  SHOCK COMPENSATION AIRMS TO INCREASE VASCULAR VOLUME, TONE, AND SHUNT BLOOD TO VITAL ORGANS; HEART FAILURE COMPENSATION AIMS TO REDUCE THE WORKLOAD ON THE HEART.  SINCE WORKLOAD ON THE HEART IS GREATLY INCREASED WITH HEART FAILURE, ANOTHER DIFFERENCE CAN BE THE HYPERTROPHY CHARACTERISTIC OF HEART FAILURE NOT NECESSARILY FOUND WITH SHOCK.
IN EVALUATING MODIFIABLE CARDIOVASCULAR RISK FACTORS FOR YOUOR PATIENT, WHICH IS NOT CONSIDERED MODIFIABLE?
FEMALE GENDER

POORLY CONTROLLED DIABETES, HYPERLIPIDEMIA, AND HYPERTENSION ARE ALL MODIFIABLE
YOUR PATIENT IS EXPERIENCING PERIPHERAL EDEMA, HEPATOMEGALY, ASCITES, AND SPLENOMEGALY. WHICH OF THE FOLLOWING CONDITIONS WOULD BE CONSISTENT WITH THE PTS FINDINGS?
RIGHT SIDED HEART FAILURE
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