Narrowing of the pulmonary artery. Leads to decreased pulmonary blood flow and right ventricular hypertrophy


Congenital birth defect


1. Heart murmur

2. Exercise intolerance

3. Oliguria

4. Pale cool extremities

5. Tachycardia

6. Jugular vein distension

7. Periods of cyanosis

8. Peripheral edema


Dilation of constricted area via cardiac catheterization or surgical management

Nursing Intervention

1. Assess for CHF

2. Small frequent feedings to conserve energy

3. Administer oxygen

4. Fluid restrictions

5. Medications




Instruct Client:

1. About the pacemaker & programmable rate

2. The signs of battery failure & when to notify the healthcare provider

3. Report any signs of infection at the insertion site (fever, redness swelling, or drainage)

4. Report signs of dizziness, weakness or fatigue, edema of the ankles or legs, chest pain, and shortness of breath

5. Carry his or her pacemaker identification card at all times and to obtain and wear a Medic-Alert bracelet

6. How to take a radial pulse daily and to keep a pulse diary of each pulse rate

7. Avoid contact sports

8. Inform all healthcare providers of pacemaker insertion

9. Make airport security aware that he or she has a pacemaker, as it may set off security system

10. Most electronic devices may be used with no interference with pacemaker function

11. Avoid antitheft devices in department stores and transmitter towers

12. Use cell phone on the side opposite the pacemaker













Smoking and lung cancer

By far the biggest cause of lung cancer is smoking. It causes more than 8 out of 10 cases (86%) including a small proportion caused by exposure to second hand smoke in non smokers (passive smoking).

Here are some facts about smoking and lung cancer

  • The more you smoke, the more likely you are to get lung cancer but the length of time you have been a smoker is even more important than how many cigarettes you smoke a day
  • Starting smoking at a young age is even more harmful than starting as an adult
  • Stopping smoking reduces your risk of lung cancer compared to continuing to smoke. The sooner you quit, the better your health – but it’s never too late
  • Passive smoking (breathing in other people’s cigarette smoke) increases the risk of lung cancer, but it is still much less than if you smoke yourself

It is almost impossible to work out the risk of occasional passive smoking. We know that the risk of lung cancer for passive smokers goes up the more cigarette smoke they are exposed to. Overall, people exposed to environmental tobacco smoke at work or at home have their risk of lung cancer increased by about a quarter compared to people who are not exposed to it. Heavy exposure to environmental tobacco smoke at work has been shown to double the risk of lung cancer.

Cigarette smoking is the main cause of lung cancer. But pipe and cigar smokers are still much more likely to get lung cancer than non smokers. They are also much more likely to get cancer of the mouth or lip.

In the past, lung cancer has been more common in men than women. Now, because more women smoke, it is almost as common in women.

Other risk factors

Some other things increase lung cancer risk. But they increase the risk by only a small amount and far less than smoking.  They are

  • Exposure to radon gas
  • Exposure to certain chemicals
  • Air pollution
  • Previous lung disease
  • A family history of lung cancer
  • Past cancer treatment
  • Previous smoking related cancers
  • Lowered immunity

Exposure to radon gas

Radon gas is a naturally occurring radioactive gas which comes from tiny amounts of uranium present in all rocks and soils. The radon gas can build up in homes and other buildings. The highest levels have been found in south west England, but higher than average levels may be found in many other parts of the UK.

Radon is one of the biggest causes of lung cancer after smoking. The risk from radon increases the risk from smoking. Smokers with high indoor levels of radon have a particularly high risk of getting lung cancer. So if you live in a high radon area, it’s even more important to stop smoking.

Exposure to certain chemicals 

A number of substances that occur in the workplace may cause lung cancer. In particular, these include asbestos, silica, and diesel exhaust. Exposure to asbestos in the construction industry and shipbuilding is now much lower than in the 1960s. But asbestos is still a cause of lung cancer because cancers take so long to develop. And smokers are at even higher risk.

Silica which is used in glass making, may cause a condition known as silicosis. This condition increases the risk of lung cancer.

People at the highest risk of lung cancer caused by diesel fumes are miners and professional drivers.

Air pollution

We know that air pollution can cause lung cancer. The risk depends on the levels of air pollution you are regularly exposed to.

Previous lung disease

Having had a disease that caused scarring in the lungs may be a risk factor for a type of lung cancer called adenocarcinoma of the lung. Tuberculosis (TB) can make scar tissue form in the lungs. People who have had TB have double the risk of lung cancer. This risk continues for more than 20 years.

Chlamydia pneumoniae is a type of bacteria that can cause chest infections. Some studies have shown that people with antibodies to chlamydia pneumoniae have an increased risk of lung cancer. The risk is greater for people who smoke.

A family history of lung cancer

Researchers are looking into the impact of family history on lung cancer. The risk is even greater if a brother or sister has lung cancer, rather than a parent. This risk is regardless of whether or not you smoke. But families of smokers might be exposed to cigarette smoke and so have an increased risk of lung cancer whether they have inherited a faulty gene or not.

Because there is a pattern of increased risk of lung cancer in family members, researchers think it is likely that there is at least one faulty gene that can increase the risk of lung cancer and be passed down in families (inherited). Research trials are trying to find such a gene.

Past cancer treatment

There is some evidence that particular cancer treatments might increase your risk of lung cancer. A review of lung cancer after treatment for breast cancer shows that ways of giving radiotherapy for breast cancer in the past increased the risk of developing lung cancer. But the most up to date methods of giving radiotherapy to treat breast cancer do not seem to increase the risk of primary lung cancer.

Recent research shows that women who have estrogen receptor negative breast cancer may be at increased risk of developing lung cancer.

Treatment for other types of cancer has also been linked to a slightly increased risk of lung cancer some years later. People may have an increased risk of lung cancer if they have had treatment for

  • Hodgkin lymphoma
  • Some types of non Hodgkin lymphoma
  • Testicular cancer
  • A type of cancer of the womb

But it is important to remember that having no treatment for these cancers is a much greater risk to your health than the slight increase in risk from treatment. It is most important to get the treatment you need at the time. In some of this research, lung cancer risk seems to be increased even more in smokers, so if you have had radiotherapy to your chest it is very important not to smoke.

Previous smoking related cancers

People who have had a head and neck cancer, esophageal cancer or cervical cancer have an increased risk of lung cancer. This may be explained by the fact that the risk of these cancers is higher in smokers. But it could also be a result of radiotherapy treatment.

Lowered immunity

HIV and AIDS lower immunity and so do drugs that people take after organ transplants. An overview of research studies shows that people with HIV or AIDS have a risk of lung cancer that is 3 times higher than people who do not have HIV or AIDS. People who take drugs to suppress their immunity after an organ transplant have double the usual risk of lung cancer.

There is also in increased risk of lung cancer in people who have some autoimmune conditions. For example research shows that people with lupus (systemic lupus erythematosus or SLE) may have 2 to 3 times the average risk of lung cancer. People with rheumatoid arthritis may also have an increased lung cancer risk.






Risks of Breast Implants

Some of the complications and adverse outcomes of breast implants include:

  • Additional surgeries, with or without removal of the device
  • Capsular contracture, scar tissue that forms around the implant and squeezes the implant
  • Breast pain
  • Changes in nipple and breast sensation
  • Rupture with deflation of saline-filled implants
  • Rupture with or without symptoms (silent rupture) of silicone gel-filled implants

Implant Complications

The following is a list of local complications and adverse outcomes that occur in at least 1 percent of breast implant patients at any time. You may need non-surgical treatments or additional surgeries to treat any of these, and you should discuss any complication and necessary treatment with your doctor. These complications are listed alphabetically, not in order of how often they occur.

Complication Description
Asymmetry The breasts are uneven in appearance in terms of size, shape or breast level.
Breast Pain
Pain in the nipple or breast area
Breast Tissue Atrophy
Thinning and shrinking of the skin
Calcification/Calcium Deposits Hard lumps under the skin around the implant.  These can be mistaken for cancer during mammography, resulting in additional surgery.
Capsular Contracture Tightening of the tissue capsule around an implant, resulting in firmness or hardening of the breast and squeezing of the implant if severe.
Chest Wall Deformity Chest wall or underlying rib cage appears deformed.
Deflation Leakage of the saltwater (saline) solution from a saline-filled breast implant, often due to a valve leak or a tear or cut in the implant shell (rupture), with partial or complete collapse of the implant.
Delayed Wound Healing Incision site fails to heal normally or takes longer to heal.
Extrusion The skin breaks down and the implant appears through the skin.
Hematoma Collection of blood near the surgical site.   May cause swelling, bruising and pain.  Hematomas usually occur soon after surgery, but can occur any time there is injury to the breast.  The body may absorb small hematomas, but large ones may require medical intervention, such as surgical draining.
Iatrogenic Injury/Damage Injury or damage to tissue or implant as a result of implant surgery
Infection, including Toxic Shock Syndrome Occurs when wounds are contaminated with microorganisms, such as bacteria or fungi.  Most infections resulting from surgery appear within a few days to a week, but infection is possible any time after surgery.  If an infection does not respond to antibiotics, the implant may need to be removed
Inflammation/Irritation Response by the body to an infection or injury.  Demonstrated by redness, swelling, warmth, pain and or/loss of function.
Lymphedema or Lymphadenopathy Swollen or enlarged lymph nodes
Malposition/Displacement The implant is not in the correct position in the breast.  This can happen during surgery or afterwards if the implant moves or shifts from its original location.  Shifting can be caused by factors such as gravity, trauma or capsular contracture.
Necrosis Dead skin or tissue around the breast.  Necrosis can be caused by infection, use of steroids in the surgical breast pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy.
Nipple/Breast Sensation Changes An increase or decrease in the feeling in the nipple and/or breast.  Can vary in degree and may be temporary or permanent.  May affect sexual response or breast feeding.
Palpability The implant can be felt through the skin.
Breast sagging that is usually the result of normal aging, pregnancy or weight loss.
Redness/Bruising Bleeding at the time of surgery can cause the skin to change color. This is an expected symptom due to surgery, and is likely temporary.
Rupture A tear or hole in the implant’s outer shell.
Seroma Collection of fluid around the implant.  May cause swelling, pain and bruising.  The body may absorb small seromas.  Large ones will require a surgical drain.
Skin Rash A rash on or around the breast.
Unsatisfactory Style/Size Patient or doctor is not satisfied with the overall look based on the style or size of the implant used.
Visibility The implant can be seen through the skin.
Wrinkling/Rippling Wrinkling of the implant that can be felt or seen through the skin.






Accumulation of fluid in the abdominal/peritoneal cavity. Ascitic fluid can have many sources, such as liver disease, cancers, congestive heart failure, or kidney failure. The most common cause is advanced liver disease



Cross section of blood vessel with normal amounts of red blood cells, platelets, and white blood cells in plasma. Below it is another cross section of blood vessel with thrombocytopenia showing normal amounts of red blood cells, white blood cells, and too

Any disorder in which there is an abnormally low number of platelets. Often divided into 3 major causes of low platelets. Low production of platelets in the bone marrow, increased breakdown of platelets in the bloodstream, & increased breakdown of platelets in the spleen or liver





Indicates inflammation of the gallbladder. The client is asked to inhale while the examiner’s fingers are positioned under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain. Deep inspiration is limited.