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Echocardiogram is another important non-invasive diagnostic tool for AF. This test uses sound waves to produces an image of the heart and helps the cardiologist observe the different regions of the heart and assess their performance. [NIH]
Treatment for AF involves different approaches and may also be decided by the cardiologist depending on the nature of the AF. Paroxysmal AF, which lasts for a short duration (maximum few days) is usually treated with drugs that aim to control the sinus arrhythmia while cases of persistent AF maybe treated either for rhythm control or ventricular rate control. Drugs such as digoxin, (increases contraction and reduces rate) beta-blockers such as atenolol, metoprolol and calcium channel blockers such as verapamil are some of the avilable medications that try to improve the atrial refractory period to control AF. [Josephson, 2003]
Restoration of cardiac rhythm by means of electrical cardioversion is the most common intervention…
1) Maurits a. Allessie, MD, PhD & Penelope a. Boyden et.al (2001), 'Pathophysiology and Prevention of Atrial Fibrillation', Circulation. 2001;103:769, Available Online at, http://www.circ.ahajournals.org/cgi/content/full/103/5/769
2) NIH, 'Atrial Fibrillation', retrieved Sept 10th 2009, from http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html
3) Vias Markides & Richard J. Schilling, (2003), 'Atrial Fibrillation, Classification, Pathophysiology, Mechanisms and Drug Treatment', Heart. 2003 August; 89(8): 939 -- 943
4) Josephson Linda & McMullen Maureen, (2003), 'Atrial Fibrillation: Beyond Irregularly irregular', Nursing 2003, Available online at, http://findarticles.com/p/articles/mi_qa3689/is_200301/ai_n9182958/
After ICI discharge daily ECG or predischarge (Jansen et al., 1986; Evrard et al., 2000) Holter monitoring was used to detect arrhythmias. In some cases the monitoring may be continued beyond the hospital stay for 30 (Guarnieri et al., 1999) up to 90 days (eber et al., 1990). The use of the Holter monitor makes extended monitoring more feasible than when ECG was the only option.
Several anomalies have been found to act as indicators that AF may occur. For instance, prolonged P-wave duration was found to be an indicator of reoccurring AF (Gialiafos, 1999; Steinberg et al., 1993). Patients with a clinical history of AF were found to have a significantly longer intra-atrial and inter-atrial conduction time of sinus impulses (Centurion et al., 2002). The presence of preoperative supraventricular arrhythmias and fluctuations in autonomic balance were identified in some, but not all studies as a risk factor for post…
Allessie MA, Wijffels MC, Dorland R. Mechanisms of pharmacologic cardioversion of atrial fibrillation by Class I drugs. J Cardiovasc Electrophysiol.
Akdemir R, Ozhan H, Gunduz H, et al.2005. Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocardial infarction: primary angioplasty vs. thrombolytic therapy. Ann Noninvasive Electrocardiol. 2005;10:35-40.
Benjamin E., et al. 1994. Risk Factors for Atrial Fibrillation. The Framingham Heart
Simply stated, atrial fibrillation describes a condition in which the human heart beats at an excessively rapid rate that can result in diminished blood flow to the body. While the condition is not typically life-threatening, atrial fibrillation still requires immediate medical care because left untreated, the condition can result in adverse, long-term complications. To determine the facts, this paper reviews the relevant literature concerning the etiology and pathogenesis of atrial fibrillation, why it occurs, what happens in electrophysiology terms when atrial fibrillation is present, and prominent risk factors for the condition. In addition, a discussion concerning the prevalence of the condition is followed by an analysis of corresponding clinical signs and symptoms. A description of the diagnostic pathways used to diagnose the condition is followed by a discussion concerning short- versus long-term therapeutic interventions for atrial fibrillation. Finally, a summary of the research and important findings concerning these…
Dowling, Renee. Clinical Economics: Atrial Fibrillation, 2015, May 1. Medical Economics 92(9): 23-25.
EB Medicine.[internet] AF etiology, 2015 [cited December 4, 2015]. Available from https://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=53&seg_id=972 .
Gutierrez, Cecilia and Blanchard, Daniel G. Atrial fibrillation: Diagnosis and treatment. 2011, American Family Physician, 83(1): 61-68.
Hearth Rhythm Society. Types of atrial fibrillation, 2015 [cited December 4, 2015]. Available from http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Fibrillation-AFib/Types-of-AFib .
Lessening the Incidence of Postoperative Atrial Fibrillation
The issue of reducing or preventing atrial fibrillation (AF) after cardiac surgery has been the subject of numerous studies. Existing studies sought to establish which agents are effective in this process since multiple agents are used to prevent AF. Reduction of incidence of postoperative atrial fibrillation is critical in order to promote the outcomes of patients undergoing cardiac surgery. In addition to flutter, atrial fibrillation is usually observed in the immediate aftermath of cardiac surgery. While clinical studies have shown that medications have positive impacts in preventing atrial fibrillation, they can be cause of these kinds of arrhythmias. Therefore, clinicians are faced with the need to identify suitable interventions for lessening the incidence of postoperative atrial fibrillation in the aftermath of cardiac surgery, which is the subject of this research.
Clinical Question and Importance to Nursing
The incidence rates of postoperative arrhythmias such…
Abbaszadeh, M., Khan, Z.H., Mehrani, F. & Jahanmehr, H. (2012, Jan/March). Perioperative Intravenous Corticosteroids Reduce Incidence of Atrial Fibrillation Following Cardiac Surgery: A Randomized Study. Brazilian Journal of Cardiovascular Surgery, 27(1), 18-23.
Halonen et al. (2010, December 7). Metoprolol Versus Amiodarone in the Prevention of Atrial Fibrillation After Cardiac Surgery: A Randomized Trial. Annals of Internal Medicine, 153(11), 703-709.
Halonen et al. (2006, July 4). Intravenous Administration of Metoprolol is More Effective than Oral Administration in the Prevention of Atrial Fibrillation After Cardiac Surgery. Circulation, 114(1), 1-4.
Hjalmarson et al. (2000, March 8). Effects of Controlled-release Metoprolol on Total Mortality, Hospitalizations, and Well-being in Patients with Heart Failure: the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). MERIT-HF Study Group. JAMA, 283(10), 1295-1302.
Lucio, E.A., Flores, A., Blacher, C., Leaes, P.E., Lucchese, F.A. & Ribeiro, J.P. (2004, January). Effectiveness of Metoprolol in Preventing Atrial Fibrillation and Flutter in the Postoperative Period of Coronary Artery Bypass Graft Surgery. Arquivos Brasileiros de Cardiologia, 82(1), 42-46.
Onk, O.A. & Erkut, B. (2015, October). Is the Preoperative Administration of Amiodarone or Metoprolol More Effective in Reducing Atrial Fibrillation. Medicine, 94(41). doi: 10.1097/MD.0000000000001576
Skiba et al. (2013, August). Prophylaxis Against Atrial Fibrillation after Cardiac Surgery: Beneficial Effect of Perioperative Metoprolol. Heart, Lung and Circulation, 22(8), 627-633.
Valtola, A., Kokki, H., Gergov, M., Ojanpera, I, Ranta, V.P. & Hakala, T. (2007, May). Does Coronary Artery Bypass Surgery Affect Metoprolol Bioavailability. European Journal of Clinical Pharmacology, 63(5), 471-478.
Efficacy and Safety of Dabigatran vs. Warfarin for Stroke
After more than five decades as the preferred anticoagulant worldwide, warfarin is being challenged by a new rival that doesn't require careful dosage monitoring. Pradaxa (dabigatran) was unanimously approved by the FDA on October 19, 2010 for treating atrial fibrillation (AF) patients, who are at an increased risk for suffering stroke and systemic embolisms (.S. Food and Drug Administration). Dabigatran acts by binding directly to thrombin. Warfarin (Coumadin) is an anticoagulant that functions by inhibiting the synthesis of vitamin K-dependent clotting factors (Lemos et al., 770-771). Variations in the levels of vitamin K in the diet can influence how effective a given dose of warfarin is for a patient, so appropriate therapeutic dosages are determined on an individual basis periodically through a standardized clotting test (international normalized ratio [INR]). Even though warfarin can reduce the risk of stroke in AF patients…
U.S. Food and Drug Administration. "FDA News Release: FDA approves Pradaxa to prevent stroke in people with atrial fibrillation." U.S. Food and Drug Administration, 19 Oct. 2010. Web. 22 Jan. 2011.
Schulman, Sam, Kearon, Clive, Kakkar, Ajay K., Mismetti, Patrick, Schellong, Sebastian, Eriksson, Hentry, Baanstra, David, Schnee, Janet, and Goldhaber, Samuel Z. "Dabigatran vs. warfarin in the treatment of acute venous thromboembolism." New England Journal of Medicine 361 (2009): 2342-2352. Web.
Wallentin, Lars, Yusuf, Salim, Ezekowitz, Michael D., Alings, Marco, Flather, Marcus, Franzosi, Maria Grazia, Pais, Prem, Dans, Antonio, Eikelboom, John, Oldgren, Jonas, Pogue, Janice, Reilly, Paul A., Yang, Sean, Connolly, and Stuart J., on behalf of the RE-LY investigators. "Efficacy and safety of dabigatran compared with warfarin at different levels of international normalized ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial." Lancet 376 (2010): 975-983. Web.
Neuman Health Care Systems Model:
Preventative Care for Mr. H
The Neuman Health Care Systems Model was created by Betty M. Neuman in an effort to help nursing students focus on wellness for the client system (McHolm & Geib, 1998). In order to create wellness for a client system, the nursing students use an Assessment and Analysis Tool, which will help in identifying Mr. H's problems (McHolm & Geib, 1998).
First, a nurse must find out Mr. H's profile and define his stressors. This must be done by the nurse and by the concerns expressed by the client (NeumanSystemsModel.org, 2011). It is clear that stressors in this 72-year-old widower's life are affecting his overall health. ecent changes in his life, such as the loss of his wife of 45 years, are a factor in his health changes. It is good that Mr. H is still trying to maintain his normal…
A.D.A.M. (2011). Hypotension. Retrieved January 21, 2011 from https://health.google.com/health/ref/Hypotension .
McHolm, F.A. & Geib, K.M. (1998, January-March). Nursing diagnosis: Application of the Neuman systems model of teaching health assessment and nursing process. Retrieved January 21, 2011 from http://findarticles.com/p/articles/mi_qa3836/is_199801/ai_n8792656/?tag=content;col1
NCBI. (2010, July 1). Pubmed health - Atorvastatin. Retrieved January 20, 2010 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH
NCBI. (2008, September 1). Pubmed health -- Furosemide. Retrieved January 20, 2010 from
Home health visits can be a useful method of identifying potential and actual health issues. Visiting the patient's home may provide the opportunity to identify issues which may not be readily apparent at a medical office. The home health visit is meant to assist in the promotion of the patient's health maintenance; limit further disability, and increase baseline health.
The visiting nurse will gain the ability to build a caring, professional, trusting, patient focused relationship. The home health nurse will be able to assist the patient by identifying, procuring and providing education for interventional items. The nurse will also know how to facilitate the communication of identified patient needs, in the home, to interdisciplinary members of the health care team (Liebel, Powers, Friedman, & Watson, 2012, p. 80).
The patient has been prescribed oxygen for home use by her physician. The patient states the she has not…
Sallie Mae Fisher
Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. With her age, and such an acute medical condition, she may undergo substantial changes in function and living standards.
Ms. Fisher has been hospitalized four times for exacerbation of her CHF in the last 6 months. One of her primary problems is most likely to be decline in function in activities of daily living (ADLs). During Post hospitalization, older patients experience changes in functional status, Mary seems not to recover well after hospitalization revealed by her frequent hospitalizations.
In addition, Ms. Fisher seems to gain weight fast an indication that her body is retaining extra fluid. This is a common complication associated with CHF. It appears that Ms. Fisher is not strict with her diet or in not monitoring her diet well to eliminate salt (De Lorgeril, Salen,…
De Lorgeril, M., Salen, P., & Defaye, P. (2005). Importance of nutrition in chronic heart failure patients. European Heart Journal, 2215-2217.
Mahoney, J.E., Eisner, J., Havighurst, T., Gray, S., & Palta, M. (2000). Problems of Older Adults Living Alone After Hospitalization. Journal Gen Intern Med, 611 -- 619.
Tracy Folsom is a 28-year-old female who was brought to the Emergency Department by her neighbor. The neighbor stated that Miss Folsom was found lying semi-conscious in the shower. The patient was received in the ED by the on call nurse. The nurse's performance with Miss Folsom's management is reviewed in this article.
Emergency evaluation of a patient is supposed be in a systematic manner. A systemic approach prevents the examiner from missing out important clues that may point to a patient's diagnosis. This approach is divided into primary and secondary.
As part of the Primary Assessment, the patient's Airway, Breathing, Circulation and degree of Disability was evaluated, as per protocol. Miss. Folsom's airway was patent, breathing was shallow, and her skin color was pink, indicating good perfusion. She was obeying commands and pupils were equal in size and reactive to light. It is also helpful to state…
Canadian Medical Association. (2007, July). Putting patients first ®: patient-centred collaborative care a discussion paper. Retrieved from http://fhs.mcmaster.ca/surgery/documents/CollaborativeCareBackgrounderRevised.pdf
Dean, R & Mulligan, J, 2009, 'Initial management of patients in an emergency situation', Nursing Standard, vol. 24, no. 5, pp. 35-41, (Academic Search Complete).
Gilbert, G., Souza, P., & Pletz, B. (2009). Patient assessment routine medical care primary and secondary survey. San Mateo County EMS Agency, 1-5. Retrieved from http://smchealth.org/sites/default/files/docs/243322118Patient_Assessment.pdf
Institute of Medicine. (2001) Crossing the quality chasm. Washington, DC: National Academy Press.
Does taking Metoprolol before cardiac surgery reduce the incidence of post-op atrial fibrillation
Postoperative atrial fibrillation (POAF) remains a prevalent supraventricular arrhythmia. PoAF has associated effects such as deteriorating hemodynamic, increased risk of stroke and increased probability of death. Beta-blockers have been recommended as effective intervention mechanism of preventing PoAF. Metoprolol is one such beta-blocker that is commonly administered to prevent the incidence of PoAF. The systematic review below entails an analysis of six clinical trials that explore the effectiveness of metoprolol. The analysis identifies reduced hospitalization length, reduced mortality and reduced financial burden as the beneficial impact associated with the administration of prophylactic. The small number of studies reviewed limits the validity of the conclusion warranting future large sample size research.
Annually, approximately 750,000 cardiac surgery are performed globally with postoperative atrial fibrillation (PoAF) being the prevalent complications (George, et al., 2018). With the increasing proportion of elderly population…
Compendium to Research in Cardiology and elemetry
Cotiga, D., et al. (2007). Acute Conversion of Persistent Atrial Fibrillation During Dofetilide Initiation. Pacing & Clinical Electrophysiology, 30(12), 1527-1530. doi:10.1111/j.1540-8159.2007.00902.x.
he researchers look at the role of Dofetilide (D) as "a highly selective blocker of the rapid component of the delayed rectifier potassium current;" approved for the treatment of atrial fibrillation (AF). he study is a replication of clinical trials that concluded in a satisfactory safety/efficacy profile in patients with left ventricle (LV) dysfunction or heart failure. he participants to the investigation all received at least 6 dosing intervals D. while admitted in the elemetry unit. Seventy seven percent (77%) of the patients converted to sinus rhythm (SR) after the first 2.2 ± 1.2 doses. Findings to the investigation revealed that: 1) D. had an unusually high pharmacological conversion rate; 2) demonstrated response with incremental dosage; and 3) correlated with a high…
The stent-based antenna can be used in monitoring of blood pressure from a minimally invasive device inserted for tracking the pulmonary artery in diagnostic and early warning system for cardiac health. In cardiac diagnostics, the foremost challenge in using a like device is the wireless transfer of data and power from within the blood vessel to external devices; whilst maintaining unrestricted blood flow through the artery.
Paoletti, R., Suess, T., Lesko, M., Feroli, A., Kennel, J., Mahler, J., et al. (2007). Using bar-code technology and medication observation methodology for safer medication administration. American Journal of Health-System Pharmacy, 64(5), 536-543. doi:10.2146/ajhp060140.
A three (3) inpatient nursing unit study on the implementation of a multidisciplinary approach to systematically decrease medication errors through the use of observation methodology and the deployment of electronic medication administration records (EMARs) and bar-coded-medication administration (BCMA) is discussed. Testing of two (2) intervention groups: 1) 20-bed cardiac control group in the telemetry unit; 2) a 36-bed medical-surgical unit. Testing was conducted utilizing a direct observation technique for data collection, the measurement of medication errors used the observation process was conducted in two (2) phases: 1) reimplementation; and 2) postimplementation. In the first phase of the study evaluating the medication administration process associated with a manual five (5) day medication administration record (MAR), a total of 188 errors were reported. During the second phase of the study, evaluation of the MAR process using EMAR and BCMA technology implemented under direct-observation. Accuracy rate in reporting before BCMA concluded at (86.5%); after BCMA, the rate rose to (97%). A (54%) reduction of errors to the MAR was observed following implementation the group's approach to medication safety.
Staffing shortages in nursing are a consequence of poor nurse retention and nurse satisfaction. Being a nurse requires a lot of dedication, patience, and ability to keep updated in a constantly evolving world. When hospitals and other medical facilities have staffing shortages or shortages in qualified nurses, the healthcare delivery of that particular place dwindles. Nurses are the backbone of any healthcare facility.
Especially in recent times, nurses provide prescriptions, treatment protocols, and diagnosis when doctors are away or busy. This literature review is meant to explain such a phenomena and how it relates directly to nurse satisfaction and nursing retention. From here, the connection crosses over to nursing care and healthcare delivery as standards of practice. Things like arrhythmias will be viewed to understand how nursing shortages attribute to lower quality of care. Utilizing Polk's theory of esilience, this review will allow a look into performance improvement concerns and…
Bosch, R., Kirch, W., Theuer, J., Pittrow, D., Kohlhaussen, A., Willich, S., & Bonnemeier, H. (2013). Atrial fibrillation management, outcomes and predictors of stable disease in daily practice: Prospective non-interventional study. International Journal Of Cardiology, 167(3), 750-756. doi:10.1016/j.ijcard.2012.03.053
GIANFERMI, R., & BUCHHOLZ, S. (2011). Exploring the relationship between job satisfaction and nursing group outcome attainment capability in nurse administrators. Journal Of Nursing Management, 19(8), 1012-1019. doi:10.1111/j.1365-2834.2011.01328.x
Hudgins, T. (2015). Resilience, job satisfaction and anticipated turnover in nurse leaders. Journal Of Nursing Management, n/a-n/a. doi:10.1111/jonm.12289
Minhas, R., Vogelaar, G., Wang, D., Almansoori, W., Lang, E., & Blanchard, I. et al. (2015). A prehospital treat-and-release protocol for supraventricular tachycardia. CJEM, 1-8. doi:10.1017/cem.2014.53
Morbidity and Mortality Statistics:
Hypertension affects around 1 in 3 Americans and according to the CDC only 52% of people have this condition under control (CDC.gov, 2016). In older men, two-thirds have hypertension, and one-third of white men have hypertension. There are nearly 1000 deaths from hypertension daily in the United States, around 360,000 per year. Hypertension is related to first heart attacks, strokes and chronic heart failure.
The patient also suffers from orthostatic hypotension, which is when blood pressure drops when going from a lying or sitting position to standing. The largest risk for elderly people is the increased risk of falling that this brings. The patient may have fallen because of this condition. It is caused by, or linked to, high blood pressure and prolonged bed rest, as well as other conditions not faced by this patient. Anemia or vitamin B12 deficiency is another potential contributor…
CDC.gov (2015). Postural hypotension. CDC.gov. Retrieved May 14, 2016 from http://www.cdc.gov/steadi/pdf/postural_hypotension-a.pdf
CDC.gov (2016). Atrial fibrillation fact sheet. CDC.gov. Retrieved May 14, 2016 from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm
CDC.gov (2016) Heart disease facts. CDC.gov. Retrieved May 14, 2016 from http://www.cdc.gov/heartdisease/facts.htm
CDC.gov (2016). High blood pressure. CDC.gov. Retrieved May 14, 2016 from http://www.cdc.gov/bloodpressure/index.htm
Te tyroid is regulated by te pituitary gland. Autoimmune diseases, infections, ormonal imbalance or ereditary conditions can result in tyroid malfunction. Tese tyroid disorders usually come in one of two forms: functional, suc as ypotyroidism and ypertyroidism, and structural, suc as nodules and goiters, as in te case of te former President. Earlier tis year, Barbara Bus ad a mild relapse of er Graves' disease. Se began experiencing eartbeat irregularities tat can lead to cardiac arrest in older patients.
Graves' disease is te most common cause of ypertyroidism in te United States. Symptoms of te disease, suc as anxiety, restlessness, irritability, emotional instability, fatigue, muscle weakness or cramps, increased appetite, palpitations and eate intolerance can be accompanied by a quickened eartbeat, atrial fibrillation, tremor, an eye stare or canges in te air. Oter symptoms include increased sweating and bowl movements, sortness of breat on exertion and weigt canges.
3. Fitzgerald, Paul. Graves Disease. 16 December 2003.
Accessed at: http://www.nytimes.com/2000/06/25/health/your-thyroid-may-be-talking-but-is-the-doctor-listening.html?pagewanted=2
Signs and Symptoms of Stroke
Patients with stroke symptoms are advised to seek out for emergency cure without any dilly-dallying. Definite signs of a stroke rely on the kind of stroke. However all kinds of stroke share several attributes. Warlow (1996, p.2) stated that cerebral embolism stroke generally comes on rather abruptly and is extreme right from the beginning. On the other hand schemic strokes signs consist of reduced vision in one eye or both eyes and stern headache. Other symptoms include feebleness, numbness or facial paralysis or arm and leg paralysis which are normally restricted on one side of the body.
Furthermore, other symptoms of schemic strokes include faintness, stability or coordination failure particularly when pooled with other signs. Hemorrhagic strokes are a bit different and the signs include loss of realization, distorted mental condition and seizure. Other signs include vomiting or stern nausea and extreme hypertension. Lastly, the…
American Heart Association and American Stroke Association (n.d.). Stoke diagnosis
Retrieved May 14, 2010, from http://www.americanheart.org
Caplan, L. R, Dyken, M.L., & Easton, J.D. (1996). American Heart Association Family
Guide to Stroke Treatment, Recovery, and Prevention. New York: Times Books.
(NHS Institute for Innovation and Improvement, 2008)
The Angiotensin-converting enzyme inhibitors are stated to be "recommended as first-line treatment in all people with left ventricular systolic dysfunction (LVSD) "with or without symptoms of heart failure." (NHS Institute for Innovation and Improvement, 2008) Additionally it is stated that strong evidence exists that ACE inhibitors "...increase life expectancy in people with LVSD and reduce the risk of hospitalization -- the effect is greatest in those with more severe LVSD or more severe symptoms, but benefit occurs for all degrees of severity." (NHS Institute for Innovation and Improvement, 2008)
Prescribed for individuals who are intolerant of ACE inhibitors due to cough are
Angiotensin-II receptor antagonists which provide an alternative to angiotensin converting enzyme (ACE) inhibitors." (NHS Institute for Innovation and Improvement, 2008) There is stated to be evidence that AIIRAs supports life expectancy improvement and symptoms for those with heart failure due to…
Clinical Practice Guideline for Heart Failure Due to Left-Ventricular Systolic Dysfunction (2000) Kaiser Diagnostic and Treatment Documents. February 2000. Online available at: http://*****/cajud/heart/leftven.html
Heart Failure: Age from 16 Years Onwards (2008) Clinical Knowledge Summaries. NHS Institute for Innovation and Improvement. Online available at: http://www.cks.nhs.uk/heart_failure_chronic/evidence/references#
NHS Confederation and BMA (2005) New GMS contract. Department of Health. www.dh.gov.uk.
NICE (2002) Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. Technology appraisal no.39. National Institute for Health and Clinical Excellence. www.nice.org.uk [Accessed: 19/06/2007]. [Free Full-text]
The patient should drink less, participate in more physical activity and should eat a better diet. The blood pressure and cholesterol both need to come down immediately.
The patient needs to take the recommendations in question 5 or he likely has a very dim future if his BP and cholesterol is not lowered a lot. Blood pressure should be measured after the patient has rested for at least five minutes. He should be instructed in advance of the appointment what not to eat or drink so that the test result is not improperly influenced (e.g. drinking caffeine).
There is no advancement or progression in symptoms but blood pressure is still entirely too high. It needs to drop by at least 30 points to be within a non-hypertension range. Needs to be made clear to patient that while he is feeling fine for now, that will change…
Implantable Cardiac Devices
Heart disease remains one of the leading causes of death in the United States but there are a number of different implantable cardiac devices (ICDs) available today, including pacemakers, defibrillators and cardiac resynchronization devices, that can help people with heart disease or failure go on to lead normal lives by regulating their heart beats through a series of electric shocks. To determine the facts about these devices, this paper provides a review of the literature to explain the respective indications for these devices as well as their differences. Finally, a summary of the research and important findings concerning these implantable cardiac devices are provided in the conclusion.
eview and Discussion
Indications for each of the following: Pacemaker, ICD (defibrillator) & Cardiac esynchronization Devices
Pacemaker. According to Gregoratos et al. (1), this type of ICD is indicated for patients suffering from abnormalities of atrioventricular (AV) conduction which may…
1. Gregoratos, G et al. American Heart Association [Internet] ACC/AHA Practice Guidelines 2016 [cited 2016 April 26] Available from http://circ.ahajournals.org/content/97/13/1325.full .
2. American Heart Association. [Internet] What is a pacemaker. 2016 [cited 2016 April 26] Available from https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents / downloadable/ucm_300451.pdf.
3. Perry, P ICD -- The Beat Goes On: Experts Call for Expanded Coverage of ICDs, the Most Effective Method to Date for Preventing Sudden Cardiac Death in High-Risk Coronary Patients. The Saturday Evening Post 2004, March-April 276(2): 28-29.
4. Medtronic [Internet] 2012 ACCF/AHA/HRS Guidelines for Implantable Defibrillator and Cardiac Resynchronization Therapy for Cardiac Rhythm Abnormalities. 2012. [cited 2016 April 26] Available from http://www.medtronic.com/content/dam/medtronic-com-m/mdt/crdm / documents/2012-accf-aha-hrs-guidelines.pdf.
Patients with aphasia struggle with language disorders including both oral and written communication problems. Also, clinical depression is found to be common among many stroke victims. [NINDS]
Given the high stakes involving both mortality and morbidity, stroke prevention is considered a very vital health care policy. Prevention strategies are usually targeted on controlling the important 'first tier risk factors' which were mentioned earlier. First and foremost among these is to control hypertension. ased on evidence-based practices, the American Heart association recommends that antihypertensive treatment including the use of diuretics and class 1 ACEI drugs be standardized for all patients to prevent recurrent strokes as well as to serve as a proactive intervention against other cardiovascular complications. Since diabetes is considered a high risk factor for stroke, clinical practice also recommends that glucose levels for all diabetic patients with ischemic stroke be maintained near-normoglycemic levels. The AHA guidelines also…
1) Washington University, (2010) 'Stroke Information for Patients and Families: U.S. Statistics: ', retrieved Aug 2nd 2010, from, http://www.strokecenter.org/patients/stats.htm
2) Larry B. Goldstein, (2009), 'A Primer on Stroke Prevention and Treatment', Pub by American Heart Association.
3) NINDS, 'Post Stroke Rehabilitation Factsheet', retrieved Aug 2nd 2010, from, http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm
4) Ralph L. Sacco, MD, MS, @ Robert Adams MD et.al (2006), 'Guidelines for Prevention of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack', Stroke. 37:577, available online at, http://stroke.ahajournals.org/cgi/content/full/37/2/577
After studying the cardiovascular effects of various catecholamines, Moran and his research partner, Perkins, are published in the same journal as Ahlquist arguing "that DCI's activity belonged to Ahlquist's 'beta-adrenergic' type, and coined the term 'beta-adrenergic blocking drug', later shortened to 'beta-blocker'"
Sir James Black joins the cardiovascular team at Imperial Chemical Industries, Ltd., reads Moran's research and realizes the possibilities of synthesizing an analog to DCI that would be clinically useful.
Black's ICI report contradicts Waring's arguing that the "altered fat metabolism with associated changes in blood coagulability interact, permissively, with sympathetic neurohumoural stress responses to produce fatal damage."
Black synthesizes propranolol (Inderal)
ICI launches Black's first beta blocker treatment -- pronethalol (Alderlin).
The first clinical studies are conducted for the use of proopranolol.
ICI launches propranolol, the replacement for propranolol as it was found to cause thymic tumors in mice.
Altman, L. (2 Feb 1982), New class of drugs revolutionizes therapy for heart disease, [Online], Available: http://www.nytimes.com/1982/02/02/science/new-class-of-drugs-revolutionizes-therap-y-for-heart-disease.html?&pagewanted=print [22/10/09].
Archard, G. (2005), Beta-Blocker Use in CHF Patients: History of CHF Treatments, [Online], Available: http://www.medscape.com/viewarticle/510212_2 [22/10/09].
Betaxolol, (2008), [Online], Available: http://www.medicinenet.com/betaxolol/article.htm [22/10/09].
Bisoprolol, (2008), [Online], Available: http://www.medicinenet.com/bisoprolol/article.htm [22/10/09].
It is easily absorbed through the digestive tract and is therefore almost always administered orally; the substance can also be absorbed through the skin, so gloves would be worn when handling large quantities of warfarin sodium (WHO 1995). Warfarin works in the body to disrupt Vitamin K's role in synthesizing certain blood clotting factors, and for ths reason levels of Vitamin K ingestion must be monitored to ensure safe blood clotting times without reduced effectiveness (Newcomer 2003).
Patient Info and FAQ Site
Bristol-Myers Squibb Company, the manufacturer of the Coumadin brand name, operates a website at coumdin.com that provides a basic overview of the drugs use, dosages, possible side effects and dangers, and frequently asked questions (BMSC 2008). As the information here necessarily comes form a biased source, verifying its claims and conclusions on a site such as drugs.com -- which answers to its advertisers, admittedly, but which trades on…
Bristol-Myers Squibb Company. (2008). "Coumadin." Accessed 2 October 2009. http://www.coumadin.com/for_hcp.aspx
Drugs.com. (2009). "Coumadin." Accessed 2 October 2009. http://www.drugs.com/coumadin.html
Newcomer, J. (2003). "A Short History and Useful Factoids about Warfarin (Coumadin)." Flounder. Accessed 2 October 2009. http://www.flounder.com/warfarin.htm
WHO. (1995). "International Programme n Chemical Safety: Warfarin." Accessed 2 October 2009. http://www.inchem.org/documents/hsg/hsg/hsg096.htm#PartNumber:6
The most common cause is blockage of an artery, usually by a piece of atherosclerotic plaque in one of the brain's main arteries that ahs broken off and gotten stuck "downstream." TIA are also caused by blood clots that originate in the heart, travel to the brain, and become lodged in a small artery there. By definition, the symptoms of a TIA last less than 24 hours, in contrast to the symptoms of a stroke, which last longer -- and are often permanent. (Komaroff, 2006, p. 88)
An individual may have one or more experiences with a TIA, though they may have none, prior to the actual stroke vent, often leading up to it, within a year or more of the stroke event. If these symptoms are noted, and even if they go away an individual should still seek care to begin treatment for medical stroke prevention. Individuals should also…
Better Control of Hypertension Has Reduced Stroke Deaths. (1987, July/August). FDA Consumer, 21, 2.
Centers for Disease Control and Prevention Division of Heart Disease and Stroke (2008). Stroke Fact Sheet. Retrieved, December 5, 2008. http://www.cdc.gov/DHDSP/library/fs_stroke.htm
Ha, M., Lee, D., & and Jr.,. R. (2007). Association between Serum Concentrations of Persistent Organic Pollutants and Self-Reported Cardiovascular Disease Prevalence: Results from the National Health and Nutrition Examination Survey, 1999-2002. Environmental Health Perspectives, 115(8), 1204.
Health; Blood Pressure Drugs Can Prevent Strokes, Heart Attacks - Studies. (2008, April 2). Manila Bulletin, p. NA.
GEONTOLOGICAL & GIATIC NUSING
Nursing Paper-Gerontological & Griatric Nursing
End of Life Issues and the Elderly
(2) "Identify and discuss the role of the nurse in providing family centred care to an elderly client who is palliative and living at home with his/her spouse or another family member."
Palliative care is an approach to provide a coordinated medical, nursing, and allied health service to address the patient's physical, social emotional and spiritual needs for people with progressive incurable illness. Palliative care seeks to deliver allied health service within the environment of person's choice to improve quality of life for both an ill person and the family or friends. In the United States, Europe and other part of the world, number of people reaching the advanced age and having the need of specialities for the management of pain control continues to increase. (oyal College of Nursing, 2004).
Meanwhile, a nurse plays…
Bliwise, D.L. Bliwise, N.G. Partinen, M. et al.(1988). Sleep Apnea and Mortality in an Aged Cohort. Am J. Public Health.78:544-547.
Bruce, S.D. & Hendrix, C.C. (2006). Palliative Sedation in End-of-Life Care: The Role of The Nurse in Palliative Sedation. Journal of Hospice and Palliative Nursing.8(6):320-327.
Canadian Nurses Association (2008). Providing Nursing Care at the End of Life. Ottawa Canada.
Davies, E. & Higginson, I.J. (2004). Better Palliative Care for Older People. World Health Organization.
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the care management planning. For instance, there needs to be a clear decision and communication of all tests ordered and when the test results will be available. One of the most important aspects of this collaborative care will be the nursing interventions which can have significant impact on the patient's health and stabilization (Allen, 2010). In fact, strategic nursing care can even minimize readmission rates of Margaret and other patients with comparable conditions (Chen et al., 2012).
Prioritize the Nursing Care Needs of Margaret
The prioritization of nursing interventions is essential, and the way in which a nurse determines this priority is going to be something unique and distinct. "Trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in…
Adler, H.M. (n.d.). Toward a biopsychosocial understanding of the patient -- physician relationship: An emerging dialogue. (2007). J Gen Intern Med,22(2), 280 -- 285.
Afilala, J. (n.d.). Frailty in patients with cardiovascular disease: Why, when, and how to measure. (2011). Curr Cardiovasc Risk Rep, 5(5), 467 -- 472.
Allen, J.K. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: Systematic review.
Journal of Cardiovascular Nursing,25(3), 207-220.
Stroke is widely regarded one of the leading causes of deaths in the U.S. Indeed, recent statistical figures paint a grim picture with regard to the number of people who suffer a stroke in the U.S. each year. In basic terms, strokes are triggered by an interruption of blood flow into the brain. In this text, I concern myself with the physiological processes associated with stroke. In so doing, I will amongst other things define the disease and the body systems it affects, its causes, manifestation, and complications. Further, I will also discuss the hereditary or familial factors commonly associated with stroke.
Stroke: An Overview
In basic terms, stroke is said to be "an abrupt onset of neurological functions caused by a sudden reduction of cerebral blood flow, which is due in turn to either an ischemic occlusion or a hemorrhagic episode" (Gulini, Gianelli, Quaglia, and Marrucci, 2000, p. 239).…
Eisenberg, M.G., Glueckauf, R.L. & Zaretsky, H.H. (Eds.). (1999). Medical Aspects of Disability: A Handbook for the Rehabilitation Professional (2nd ed.). New York, NY: Springer Publishing Company.
Gulini, M., Gianelli, M., Quaglia, W. & Marrucci, G. (Eds.). (2000). Receptor Chemistry Towards the Third Millennium. Amsterdam: Elsevier Science.
Huether, S.E. & Mccance, K. (2012). Understanding Pathophysiology (5th ed.). Philadelphia, PA: Elsevier Science.
Mohr, J.P., Grotta, J.C., Wolf, P.A., Maskowitz, M.A., Mayberg, M.R. And Kummer, R.V. (2011). Stroke: Pathophysiology, Diagnosis, and Management (5th ed.). Philadelphia, PA: Elsevier Health Sciences.
Given the frequency of pressure ulcers, the strategies used in mitigating those wounds must be effective. Sherman reports that 61 ulcers in 50 patients got maggot therapy and 84 ulcers in 70 patients did not receive maggot therapy (instead, those wounds received traditional care). The results showed that "eighty percent of maggot-treated wounds were completely debrided" but only 48% of conventionally-treated wounds were "completely debrided" (Sherman, 208).
(Qualitative) Laura Jean van Veen presents a case in the Journal of ound, Ostomy and Continence Nursing; a 59-year-old woman (a Jehovah's itness) was seriously injured in an auto accident in Vancouver. In order to save her legs (her religion did not permit blood transfusions) the family asked for maggot therapy. After applying maggots weekly for 6 weeks, "…the patient [was] now free of infection" and had skin graft surgery (van Veen, 2008, 432).
(Qualitative) Another case study in the Journal of ound,…
Courtenay, M., Churdh, J.D.T., and Ryan, T.J. (2000). Larva therapy in wound management.
Journal of the Royal Society of Medicine, Vol. 93, 72-74.
Fenn-Smith, P. (2008). Case Study: Maggot Debridement Therapy. Wound Practice and Research, 16(4), 169-170.
Paul, Aaron G., Ahmad, Nazi W., Lee, H.L., Ariff, Ashraff M., Saranum, Masri, Naicker,
Sarcoidosis is a sometimes-lethal disease affecting primarily the lungs and thoracic lymphatic system, and its hallmark feature is noncaseating granulomas in multiple tissues and organs (Hoang and Nguyen, 2010, p. 36; American Thoracic Society, 1999, p. 736). Over 90% of all sufferers have pulmonary involvement, but granulomas are frequently found in other organs and tissues, including the skin, eyes, liver, spleen, parotid glands, central nervous system, muscles, bones, and genitourinary tract (Hoang and Nguyen, 2010, p. 36). When death does result, it is typically due to pulmonary fibrosis. What follows is a review of pulmonary sarcoidosis from a clinical perspective.
Causes and isk Factors
The cause of sarcoidosis is unknown, but research into the nature of the resulting granulomas suggests immune dysregulation in genetically susceptible individuals is the primary causative factor (American Thoracic Society, 1999, p. 738-740). The genetic contribution appears to be significant, as evidenced by an…
American Thoracic Society. (1999). Statement on Sarcoidosis. American Journal of Respiratory Critical Care Medicine, 160, 736-755.
American Lung Association. (2010). State of lung disease in diverse communities 2010. Lung.org. Retrieved 5 Mar. 2012 from http://www.lung.org/assets/documents/publications/lung-disease-data/solddc_2010.pdf .
Baughman, Robert P., Lower, Elyse E., and du Bois, Roland M. (2003). Sarcoidosis. Lancet, 361, 1111-1118.
Drent, Marjolein, De Vries, Jolanda, Lenters, Merinke, Lamers, Rob J. s., Rothkranz-Kos, Snjezana, Wouters, Emiel F.M. et al. (2003). Sarcoidosis: Assessment of disease severity using HRCT. European Radiology, 13, 2462-2471.
Although the severities of congestive signs may be similar, medical evaluation should be instructed to determine whether there is accompanying proof of cardiovascular disease. Physical proof of cardiovascular disease contains the narrow pulse pressure, cool arms, and legs, and sometimes changed mentation, with supporting proof sometimes provided by reducing serum sodium level and deteriorating renal function. Cardiovascular disease is frequently difficult to recognize through phone contact but may be suspected when previously effective diuretic increases fail, nurses report lower blood pressure, or patients explain improved lethargy.
Facilitators and barriers to optimal disorder management and outcomes
Environmental factors and cultural beliefs; motivators and hinders
In this case, the client thought he was suffering from a heart attack and feared to come to the hospital. The symptoms had presented for four days before the patient sought help. The patient had been suffering from similar symptoms for the past six months, but thought…
American Association of Cardiovascular (2013). Guidelines for cardiac rehabilitation and secondary prevention programs. John Wiley & Sons.
Bunting-Perry, L.K., & Vernon, G.M. (2007). Comprehensive nursing care for Parkinson's disease. New York: Springer Pub.
Holloway, N.M. (2014). Medical-surgical care planning. Philadelphia: Lippincott Williams & Wilkins.
Gulanick, M. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis: Mosby.
Discharge Education to Promote Self-Efficacy in Heart Failure
An Education Intervention For Patients With Heart Failure
Management of congestive heart failure (CHF) continues to be a financial burden on the economy of the United States of America (USA); responsible for multiple hospital admissions and readmissions of patients with HF within thirty days post discharge. The disease has been associated with personal, physical, and economic challenges. As the population increases, the number of individuals affected with this condition is also increasing. According to the American Heart Association (2009), an estimated 400,000 to 500.000 new cases occur annually, with additional annual cost of more than $33 billion dollars added to the U.S. economy.
Discharge education, which attempts to reduce readmission rate, has become a valuable metric in the provision of health care. For effective management of heart failure symptoms, patient education is a necessity (Gruszczynski, 2010). Sara Paul (2008) discussed the importance…
Anderson, C., Deepak, B.V., Amoateng-Adjepongn, Y.,Zarich, S., (2005). Benefits of Comprehensive inpatient education and discharge planning combined with outpatient
Support in elderly patients with congestive heart failure. Congestive Heart Fail, 11(6),
Annema, C, Luttik ML, Jaarsma, T, (2009), Reasons for readmission in heart failure:
A.J., an 82-year-old female, was admitted three weeks ago with acute on chronic congestive heart failure (CHF) after presenting to the emergency department (ED) with c/o progressive worsening SOB, leg edema, and fatigue. She has a history of severe CHF, atrial fibrillation, myocardial infarction (MI), renal insufficiency, and hypothyroidism. Since admission, A.J. has needed intubation and ventilation for acute decompensated heart failure due to a massive MI. She is alert when not sedated but has been too unstable for a cardiac catheterization and has needed vasoactive medications to support her blood pressure. Her renal function has declined and plans are being made for hemodialysis. Today when speaking with A.J.'s husband, he conveys to you her nurse that "she would not have wanted all of this." "
Discuss the pros and cons of continued therapy and what role nursing can play in helping the patient and family.
This case deals with…
Arrhythmias cause irregular hearts beats in ways that can be life-threatening but there are a number of different types of arrhythmias that require different interventions. To determine the facts, this paper reviews the relevant literature to provide the etiology and pathogenesis, prevalence, clinical signs and symptoms, diagnostic pathways and optimal therapeutic approaches for paroxysmal atrial tachycardia, ventricular fibrillation and Brady arrhythmias, followed by a summary of the research and important findings concerning these three disease states in the conclusion.
Paroxysmal Atrial Tachycardia
Etiology & Pathogenesis. This type of arrhythmia can occur in individuals who have normal hearts as well as in people who have structurally abnormal hearts including those with congenital heart disease, especially following surgical repair of valvular or congenital heart disease (Budzikowski & ottman 2015).
Common causes of the arrhythmia, risk factors, definition of rhythm via EKG findings. Paroxysmal Atrial Tachycardia (PAT) is caused by irregular firing of…
Brady arrhythmias. Boston Medical Center. [cited 2016]. Available: https://www.boston cardiovascular.org/handler.cfm?event=practice, template&cpid=50108.
Budzikowski, AS, Rottman, JN. Atrial Tachycardia. Medscape: News and Perspectives. [cited 2016]. Available: http://emedicine.medscape.com/article/151456-overview .
Burke, MM, Laramie, JA. Primary Care of the Older Adult: A Multidisciplinary Approach. St. Louis, MO: Mosby, 2009.
Gialama, F, Prezerakos, P. The Cost Effectiveness of Implantable Cardioverter Defibrillators: A Systematic Review of Economic Evaluations. Applied Health Economics and Health Policy, February 2104, 12(1), 41-45.
Its use on those with acute PAH should be performed with caution. The complication rate was observed at 2%
in patients with acute PAH. The use of the procedure was deemed relatively safe for chronic pulmonary arterial hypertension. Severely ill patients should be subjected to non-invasive imaging method exhaustively before resorting to pulmonary angiography (Hofman et al.).#
Albert, Nancy M. Caring for Patients with Pulmonary Hypertension. Nursing:
Springhouse Corporation, May 1999. Retrieved on April 25, 2009 from http://findarticles.com/p/articles/mi_qa3689/is_199905/ai_n8846566/?tag=content;col1
adesch, David, et al. Medical Therapy for Pulmonary Arterial Hypertension.
131 (6). Chest: American College of Chest Physicians, July 20, 2007. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/560041
Flattery, Maureen P. And Kathy M. aker. Evidence for Racial Disparity in Cardiac
Transplantation Survival Rates. Journal of Cultural Diversity: Tucker Publications,
March 22, 2004. Retrieved on April 26, 2009 from http://findarticles.com/p/articles/mi_m)MJU/is_1_11/ai_n6183827/?tag=content;col1
Hofman, Lawrence V., et al. Safety and Hemodynamic Effects of Pulmonary…
Albert, Nancy M. Caring for Patients with Pulmonary Hypertension. Nursing:
Springhouse Corporation, May 1999. Retrieved on April 25, 2009 from http://findarticles.com/p/articles/mi_qa3689/is_199905/ai_n8846566/?tag=content;col1
Badesch, David, et al. Medical Therapy for Pulmonary Arterial Hypertension.
131 (6). Chest: American College of Chest Physicians, July 20, 2007. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/560041
¶ … Lee she faces a number of problems related to: her hypertension, coronary artery disease, Parkinson's disease, the loss of memory and her lack of compliance. This is problematic for most health care professionals, because they need to create some kind of strategy that can address these issues. While at the same time, motivating her to embrace the fact that she needs some help to: prevent the situation from becoming even more serious. To deal with these challenges nurses must be able to use a number of different tools and tactics. To determine how to achieve these objectives requires: discussing the concerns about the various complications, interpreting the result of the Fall Risk Assessment, how one could subtly encourage her to seek outside care and prioritizing the best way an intervention will take place. Once this occurs, it will provide the greatest insights as to how the trained health…