Atrial Fibrillation Essays Examples

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Warfarin vs Debagatrin

Words: 1986 Length: 4 Pages Document Type: Essay Paper #: 56680608

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 (U.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 by as much as 68%, patient compliance with treatment (time in therapeutic range [TTR]) is a significant problem because of the requisite periodic monitoring of dose effectiveness and the risk of major bleeding events (Ezekowitz, 2007). Because dabigatran doesn't require the labor and time intensive monitoring that warfarin does, the…… [Read More]

Bibliography:

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.
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Neuman Health Care Systems Model Preventative Care

Words: 1131 Length: 4 Pages Document Type: Essay Paper #: 6216492

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. Recent 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 activity before his wife's passing, like his small farm in Passaic County, New Jersey. However, as he has been bruised by his work in the harvest, it might be best he have assistance, especially after he has been diagnosed with a heart condition: Atrial fibrillation. There is potential that he…… [Read More]

Sources:
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
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Sallie Mae Fisher Ms Fisher Is an

Words: 335 Length: 1 Pages Document Type: Essay Paper #: 22623704

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, & Defaye, 2005). This type of weight gain means that the body is holding onto…… [Read More]

Works Cited:
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.
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Primary and Secondary Assessment

Words: 2293 Length: 7 Pages Document Type: Essay Paper #: 84681736

Secondary Assessment

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 the capillary bed refill time as part of the primary assessment. (Gilbert, Souza & Pletz, 2009)

The secondary assessment is carried out after the primary assessment. This is a systemic assessment and is complaint-focused. Relevant physical examination is conducted as well as a brief overall head to toe examination. The…… [Read More]

Bibliography:
Lake E. (2002) Development of the practice environment scale of the nursing work. Index.Res Nurs Health.134(6):264 -- 7.

Reason J. (2000) Human error: models and management. BMJ. 320:768 -- 70. [PMC free article] [PubMed]

Swash, M., & Glynn, M. (2007). Hutchison's clinical methods. (22 ed., pp. 1-119). Edinburgh: Saunders Ltd.
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Relationship Between Cardiac Disorders and Sleep Apnea

Words: 3079 Length: 11 Pages Document Type: Essay Paper #: 27014487

Cardiac Disorders and Sleep Apnea

The objective of this study is to ascertain the relationship between cardiac disorders and sleep apnea. Toward this end, this work will examine the research on this area of study.

An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Strike Council, and Council on Cardiovascular nursing report states that "Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease. Obstructive sleep apnea (OSA) affects an estimated 15 million adult Americans and is present in a large proportion of patients with hypertension and in those with other cardiovascular disorders, including coronary artery disease, stroke, and atrial fibrillation." (Somers, et al., 2008, p.1080) Central sleep apnea occurs primarily in patients with heart failure. (Somers, et al., 2008, paraphrased)

The work of Halberstadt (2010) states that many deaths that occur among individuals in their 40s and older which have been attributed to heart disease or automobile accidents "may actually be related to an unseen epidemic of snoring and sleep apnea. Apnea, a potentially deadly phantom, is the frequent stoppage of breathing caused by relaxed tissues in the…… [Read More]

References:
Halberstadt, Jerry (2010) Sleep Apnea, The Phantom Cause of Heart Disease and Accidents. Healthy Resources. 2010. Retrieved from:  http://www.healthyresources.com/sleep/apnea/articles/protect.html 

Kohnlein, T., Welte, T., Tan, LB and Elliott, MW (2002) Central Sleep Apnea Syndrome in Patients with Chronic Heart Disease: A Critical Review of the Current Literature. Thorax 2002, 57:547-554. Retrieved from: http://thorax.highwire.org/content/57/6/547.full
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Cardiology Telemetry Annotated Bibliography

Words: 1273 Length: 4 Pages Document Type: Essay Paper #: 26541553

Compendium to Research in Cardiology and Telemetry

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.

The 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). The 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. The participants to the investigation all received at least 6 dosing intervals D. while admitted in the Telemetry 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 tolerance which determined a high degree of safety in the study's relatively healthy adult cohort with persistent AF. LA and AF also contributed to the predictability of the duration of the D. dose. The hypothesis proved correct: that acute pharmacological conversion rate of D. is (< or +) than previously…… [Read More]

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Staffing Shortages in Nursing Are a Consequence

Words: 4317 Length: 14 Pages Document Type: Essay Paper #: 6266637

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 Resilience, this review will allow a look into performance improvement concerns and practice through a particular lens.

Nursing Shortages and its Repercussions on Patient Care

In an article analyzing the turnout rate of oncology nurses, the study believed nurses within the oncology department of a chosen hospital expressed job dissatisfaction due to stress and burnout. "…it appears that oncology RNs who worked…… [Read More]

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Mortality Morbidity Heart Conditions

Words: 736 Length: 2 Pages Document Type: Essay Paper #: 48574328

Care Plan

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 to this (CDC.gov, 2015). The fact that loss of consciousness may have occurred with this patient due to orthostatic hypotension could indicate a more serious underlying condition.

Hyperlipidemia, or high cholesterol, affects 73.5 million adults in the U.S., or 31.7%, and fewer than 1/3 have their condition under control. People…… [Read More]

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Heart Disease and the Elderly the Objective

Words: 2889 Length: 10 Pages Document Type: Essay Paper #: 64407527

Heart Disease and the Elderly

The objective of this work in writing is to examine how heart disease takes a toll elderly. Toward this end, this work will conduct a review of literature that examines the toll that heart disease takes on the elderly population.

Approximately 18 million people or 7% of all individuals in the United States have heart disease. Heart disease affects older people more significantly as the elderly are more likely, according to reports "to have coronary heart disease, commonly known as a heart attack or chest pain, which is more debilitating than other types of heart disease." (National Academy on an Aging Society, 2000) Many types of heart disease are largely, preventable through controlling high blood pressure and diabetes and engaging in a lifestyle that is healthy. While some individuals with heart disease do not have trouble on a daily basis the majority of those with heart disease are limited in normal activities and this includes in the area of work. The leading cause of premature permanent disability in the U.S. workforce is coronary heart disease. (National Academy on an Aging Society, 2000) The variations in the activity levels for those who do and those who…… [Read More]

References:
Centers for Disease Control and Prevention. "Public Health and Aging: Trends in Aging -- United States and Worldwide." Morbidity and Mortality Weekly Report Vol. 52, No. 6, 101 -- 106 (2003).

Centers for Disease Control and Prevention. "The State of Aging and Health in America 2007." Retrieved from  http://www.cdc.gov/aging/pdf/saha_2007.pdf  July 26, 2007.
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19-Year-Old Caucasian Female With Panic Attack

Words: 3055 Length: 11 Pages Document Type: Essay Paper #: 27276026

B.S.

DOB: 12/25/1992

GENDER: Female

Race: Caucasian

RELIGION: Catholic

MARITAL STATUS: Single

OCCUPATION: College Student

CHIEF COMPLAINT: "I am scared. I feel like I can't catch my breath and my chest hurts."

Differential Diagnosis: There are a number of differential diagnoses for these presenting symptoms. The major ones will be explored here.

Possible Diagnosis

Myocardial infarction (MI), angina, acute coronary syndrome

Prodromal symptoms include fatigue, chest discomfort, or malaise in the days before the MI. A typical STEMI may occur without warning. Onset is not directly associated with severe exertion but concomitant with exertion. Other symptoms include: anxiety, light-headedness with or without syncope, nausea or indigestion, cough, diaphoresis, and/or wheezing.

Physical Exam: Physical symptoms can be variable. The typical chest pain of an acute MI is intense and continuous for 30-60 minutes, retrosternal, and may radiate up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm and may be described as burning, squeezing, aching, or sharp. Sometimes the main symptom is epigastric with indigestion. Hypertension or hypotension may be present depending on the foci of the MI. Acute valvular dysfunction may be present. Other symptoms such as confusion, anxiety, a sense of impending…… [Read More]

Sources:
Afifi, T.O., Asmundson, G.J.G., Taylor, S., & Jang, K.L. (2010). The role of genes and environment on trauma exposure and posttraumatic stress disorder symptoms: a review of twin studies. Clinical Psychology Review, 30, 101-112.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: Author.
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Post Stroke Nursing Case Study

Words: 1748 Length: 5 Pages Document Type: Essay Paper #: 49596002

Nursing

Mary Young is a 71-year-old Aboriginal Australian female. She has present with a number of different health issues, including osteoporosis, hypercholesterolaemia, atherosclerosis, atrial fibrillation and Type 2 diabetes. She has been feeling fatigued for the past several months, and her current admission was on account of increasing dizziness, blurred vision and persistent headache. She was found to have suffered an ischaemic stroke, of moderate to severe status. This paper will outline the primary admission diagnosis, the nursing problems, nursing management strategies and discharge planning for Mary.

Primary Admission Diagnosis

Mary was admitted to the ED with left-sided hemiparesis, aphasia, and hypertension. She had an irregular pulse rate. An ECG revealed atrial fibrillation. A thrombotic ischaemic stroke was suspected and confirmed on CT. She has now been stabilized, and has been admitted to the medical ward for clinical management and rehabilitation.

Thrombotic ischaemic strokes are caused by a number of factors. Among them, Mary has Type 2 diabetes, hypertension and atrial fibrillation. Thus, Mary possesses several risk factors that not only could have caused this stroke but may cause future strokes as well, if these factors are not addressed. Hinkle (2007) notes that this type of stroke involves blood flow…… [Read More]

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Autoimmune President George H W Bush

Words: 532 Length: 2 Pages Document Type: Essay Paper #: 50143410

The thyroid is regulated by the pituitary gland. Autoimmune diseases, infections, hormonal imbalance or hereditary conditions can result in thyroid malfunction. These thyroid disorders usually come in one of two forms: functional, such as hypothyroidism and hyperthyroidism, and structural, such as nodules and goiters, as in the case of the former President. Earlier this year, Barbara Bush had a mild relapse of her Graves' disease. She began experiencing heartbeat irregularities that can lead to cardiac arrest in older patients.

Graves' disease is the most common cause of hyperthyroidism in the United States. Symptoms of the disease, such as anxiety, restlessness, irritability, emotional instability, fatigue, muscle weakness or cramps, increased appetite, palpitations and heate intolerance can be accompanied by a quickened heartbeat, atrial fibrillation, tremor, an eye stare or changes in the hair. Other symptoms include increased sweating and bowl movements, shortness of breath on exertion and weight changes.

(Dwyer)

First Lady Barbara Bush showed signs of Graves' eye disease with exophthalmos, or eye protrusion. That her husband had the same condition is considered coincidental, for Graves' disease is not contagious. Once the disease becomes uncomfortable or noticeable enough, aggressive treatment is recommended, such as with prednisone or low dose radiation.…… [Read More]

Resources:
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Strokes and Their Causes Stroke

Words: 2130 Length: 5 Pages Document Type: Essay Paper #: 86971451



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 affected person may experience feebleness, paralysis particularly on one side of his/her body and abrupt and stern headache.

Stroke Identification

The diagnosis of stroke normally starts with a cautious therapeutic history regarding the beginning and distribution of signs and the existence of threat factors. Once this is done, other probable…… [Read More]

Works Cited:
Warlow, C. (1996). Stroke: A Practical Guide to Management. Boston: Blackwell

Science.
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Management of Left Ventricular Heart

Words: 3436 Length: 12 Pages Document Type: Essay Paper #: 90872428

(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 left ventricular systolic dysfunction (LVSD)

B. Beta-Blockers

Beta-blockers are recommended for all individuals with left ventricular systolic dysfunction heart failure combined with treatment of diuretics and ACE inhibitors. There is stated to be strong evidence that beta-blockers "...when added to standard treatment, improve life expectancy and reduce the risk of…… [Read More]

Sources:
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#
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Hyperthyroidism -- Overview and Analysis

Words: 2862 Length: 10 Pages Document Type: Essay Paper #: 28419653



Once a patient is being treated for hyperthyroidism, his or her health professional will usually test TSH and thyroid hormones several times each year to evaluate how well the patient is responding to treatment and to check for a worsening of the condition. ("Hyperthyroidism: Topic Overview -- Exams and Tests," WebMD, Last updated 6 Aug 2003) Other tests include an anti-thyroid antibody test, which may help specifically diagnose Graves' disease and autoimmune thyroiditis, if the patient is known to have a genetic history of Graves in particular. ("Hyperthyroidism: Topic Overview -- Exams and Tests," WebMD, Last updated 6 Aug 2003) radioactive thyroid scan and radioactive iodine uptake tests are also often performed to evaluate why the thyroid gland is overactive. "Radionuclide uptake and scan" can also easily distinguish the high uptake of Graves' disease from the low uptake of thyroiditis" and provide other useful anatomic information about failures in the patient's endocrine system due to iodine exposure. "Nonspecific laboratory findings can occur in hyperthyroidism, including anemia, granulocytosis, lymphocytosis, hypercalcemia, transaminase elevations, and alkaline phosphatase elevation," which may also show up in lab results. This is one reason why a full-lab workup is usually necessary in a patient with a thyroid…… [Read More]

References:
AMA Featured Report. (2000) "Sex and Gender-Based Differences." Presented Dec 2000.Last updated 18 Aug 2005. Retrieved 1 Nov 2005 at http://www.ama-assn.org/ama/pub/category/13607.html

Bowen, R. (2003)"The Thyroid and Parathyroid Glands: Introduction and Index." Colorado State. H-books. Last updated 11 Oct 2003. Retrieved 1 Nov 2005 at  http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/thyroid/index.html 
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Exercises 10 Points Each How

Words: 1259 Length: 4 Pages Document Type: Essay Paper #: 8076657

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.

Question 6

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).

Question 7

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 if the proper lifestyle changes are not made.

Question 8

A full batter of blood work should be done to get the full picture of what is really going in with the patient. A urinalysis should also be done because that could be instructive as well.

Question 9

The cholesterol…… [Read More]

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An Overview of Pacemakers and Other Cardiac Devices

Words: 1288 Length: 5 Pages Document Type: Essay Paper #: 14223708

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.

Review and Discussion

Indications for each of the following: Pacemaker, ICD (defibrillator) & Cardiac Resynchronization 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 be asymptomatic; however, in some cases, patients will experience serious symptoms due to ventricular arrhythmias, bradycardia, or both). Consequently, Gregoratos and his associates (1) report that indications for pacemaker implants are related to the presence or absence of bradycardia-attributable symptoms. In addition, Gregoratos et al. (1) note that physician discretion…… [Read More]

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Stroke Is One of the

Words: 939 Length: 3 Pages Document Type: Essay Paper #: 36611783

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]

Stroke Prevention

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. Based 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 recommend that BP levels of diabetic patients be more rigorously monitored and controlled with appropriate class 2 hypertensive drugs. Cholesterol level management is also considered crucial in stroke prevention interventions. For patients with high lipid levels, the regimen includes treatment with appropriate satin agents. Since smoking is clearly accepted as…… [Read More]

Works Cited:
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.
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Medical and Medicine Perioperative Serum

Words: 2831 Length: 9 Pages Document Type: Essay Paper #: 38508525

Another group demonstrated that when insulin infusion was initiated in patients in the operating room before sternotomy and continued until the third postoperative day that there was improved glucose control. There was a 57% decrease in mortality rate, compared with control groups who were treated with subcutaneous insulin. Patients with diabetes have been shown to have worse outcomes compared to patients without diabetes. There have been no relationship was found between the presence of diabetes and the influence of hyperglycemia on outcomes. Patients who have diabetes, even though they are at increased risk for adverse outcomes because of having diabetes, have been found to have the same risk as patients without diabetes. Based upon these findings it would seem reasonable to say that that Perioperative serum glucose control for patients undergoing Coronary Artery Bypass surgery would be an encouraged best practice.

It has been found that strict glucose control is often difficult to achieve during cardiac procedures requiring cardiopulmonary bypass because of the stress of surgery. Administration of large amounts of insulin during surgery has been associated with an increased risk for postoperative hypoglycemia. Research has shown though, that glucose concentrations if maintained during surgery as close to normal as…… [Read More]

Bibliography:
1. Gandhi, Gunjan Y., Nuttall, Gregory A., Abel, Martin D., Mullany, Charles J., Schaff, Hartzell

V., O'Brien, Peter C., Johnson, Matthew G., Williams, Arthur R., Cutshall, Susanne M.,
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Beta Blockers Invented by Sir

Words: 1964 Length: 7 Pages Document Type: Essay Paper #: 19181337



1958

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'"

1959

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.

1959

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."

1962

Black synthesizes propranolol (Inderal)

1963

ICI launches Black's first beta blocker treatment -- pronethalol (Alderlin).

1964

The first clinical studies are conducted for the use of proopranolol.

1965

ICI launches propranolol, the replacement for propranolol as it was found to cause thymic tumors in mice.

1966

Propranolol is first marketed in the U.S.

1967

Lands identifies a variety of models of sensitivity to a variety of sympathomimetic amines and postulates that there are two types of beta-receptors -- beta 1 (primarily cardiac) and beta 2 (primarily found at the bronchial and vascular level). This results in…… [Read More]

Resources:
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].
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Coumadin Warfarin Sodium Better Known

Words: 776 Length: 3 Pages Document Type: Essay Paper #: 26343619

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 its reliability and therefore has a larger stake in providing objective information -- is a wise decisions. The information here is largely the same, but it is somewhat more imply presented and far more trustworthy (Drugs.com 2009). They do not provide a frequently asked questions resource for this drug, but…… [Read More]

References:
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 
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Stroke Prevention Prevalence in U S

Words: 1822 Length: 5 Pages Document Type: Essay Paper #: 4744688

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 be made aware of the fact that TIAs rarely show up in routine medical exams, and that they need to inform the doctor of these symptoms immediately.

References

Better Control of Hypertension Has Reduced Stroke Deaths. (1987, July/August). FDA Consumer, 21, 2.

Centers for Disease Control and Prevention Division of…… [Read More]

Sources:
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
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Gerontological & Griatric Nursing Nursing Paper-Gerontological &

Words: 1693 Length: 6 Pages Document Type: Essay Paper #: 9956260

GERONTOLOGICAL & GRIATRIC NURSING

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. (Royal College of Nursing, 2004).

Meanwhile, a nurse plays vital roles in providing family centred care to an elderly palliative client living at home with his or her spouse or family member.

Nurses' roles to an elderly palliative client are as follows:

Relief client from physical symptoms

Providing quality of life-care for an elderly patient

Family support

Assisting the…… [Read More]

Works Cited:
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.
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Care Needs Concerns and Treatment

Words: 4512 Length: 12 Pages Document Type: Essay Paper #: 58816657



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 patients with CAD or heart failure. However, the optimal combination of intervention components, including strategy, mode of delivery, frequency, and duration, remains unknown. Establishing consensus regarding outcome measures, inclusion of adequate, representative samples, along with cost-effectiveness analyses will promote translation and adoption of cost-effective nursing interventions" (Allen, 2010, p. 207).…… [Read More]

Resources:
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.
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Stroke Is Widely Regarded One of the

Words: 2569 Length: 8 Pages Document Type: Essay Paper #: 54959389

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). As a medical emergency, stroke as I have pointed out occurs when blood flow to the brain is interrupted. It is important to note that to function normally, cells in the brain need a constant supply of oxygen. A stroke occurs when the supply of oxygen-rich blood to some portions…… [Read More]

Bibliography:
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.
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Heart Failure Guidelines the 2009 Revision of

Words: 868 Length: 3 Pages Document Type: Essay Paper #: 26025758

Heart Failure Guidelines

The 2009 revision of the ACC/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults contains a number of evidence-based updates, revised text, and a new section called "hospitalized patient" (Hunt et al. e395). These revisions are the result of a task force that convened in 2008 and represent new findings published between 2005 and 2008.

Four stages along a continuum of heart failure are described, with the first two stages representing patients having medical conditions that increase the risk of heart failure (Hunt et al. e396). Stage A patients may have atherosclerosis, diabetes, hypertension, obesity, metabolic syndrome, or have a family history of heart failure, but without structural heart disease (Hunt et al. e405-e408). Treatment strategies for Stage A patients include aggressive management of medical conditions and encouraging lifestyle changes. Stage A patients with vascular disease or diabetes may also benefit from ACE inhibitors or ARBs.

Stage B. patients have structural heart disease, but do not have heart failure (Hunt et al. e408-e410). Asymptomatic valvular disease, left ventricular remodeling, or a history of myocardial infarctions qualify patients for Stage B. classification. Treatment goals are the same as for State A patients, but may also…… [Read More]

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Maggot Debridement Therapy Is Maggot

Words: 2057 Length: 6 Pages Document Type: Essay Paper #: 94862551

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 Wound, Ostomy and Continence Nursing; a 59-year-old woman (a Jehovah's Witness) 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 Wound, Ostomy and Continence Nursing relates to an 87-year-old woman who had a serious wound on her lower leg (with "significant" dead tissue) (Steenvoorde, et al., 2008). The woman had a history of "cardiac decompensation…hypertension and atrial fibrillation" so the treatments used on her had to take those problems into consideration.…… [Read More]

References:
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.
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Pulmonary Sarcoidosis Is a Sometimes-Lethal Disease Affecting

Words: 1618 Length: 5 Pages Document Type: Essay Paper #: 24372280

Pulmonary Sarcoidosis

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 Risk 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 ethnic, gender, and familial bias in the patient population. African-Americans, Caucasians of northern European descent, Asians, and Puerto Ricans have a higher risk for developing sarcoidosis than the general population (American Lung Association, 2010, p. 81, 83). There is a slightly higher prevalence in women, and although incidence peaks for…… [Read More]

Works Cited:
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.
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Cardiovascular Case Study Management

Words: 3112 Length: 10 Pages Document Type: Essay Paper #: 51501524

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 that he just out of shape. It was worse upon admission to the hospital. Prior to this, the symptoms disappeared with the rest.

There is proof that cardiovascular patients suffer from social discrimination that is associated with a higher death rate. Although studies outlined that the social assistance is not…… [Read More]

References:
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.
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Discharge Education After HF

Words: 2817 Length: 10 Pages Document Type: Essay Paper #: 24277540

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 of educating patients and their families in preventing re-hospitalization for heart failure. Evidence-based practice from the Heart Failure Society of America (HFSA), the European Society of Cardiology (ESC), the American College of Cardiology (ACC), and the American Heart Association (AHA) all recommend that heart failure patients receive individualized discharge education…… [Read More]

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Palliative Case Study Example

Words: 555 Length: 2 Pages Document Type: Essay Paper #: 18524835

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 one of the most important aspects to nursing. End-of-life care encompasses a broad and sensitive aspect of the nursing practice in which the nurse must deal with death and the dying process. Generally the family will be emotional throughout this transition and great care must be taken to comfort them…… [Read More]

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The Diagnosis and Treatment of Arrhythmia

Words: 1461 Length: 5 Pages Document Type: Essay Paper #: 76244417

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 & Rottman 2015).

Common causes of the arrhythmia, risk factors, definition of rhythm via EKG findings. Paroxysmal Atrial Tachycardia (PAT) is caused by irregular firing of the electrical signals in the heart's upper chambers which then affects the electrical signals transmitted from the heart's natural pacemaker, the sinoatrial node (Overview of Paroxysmal Atrial Tachycardia 2016). As a result, the heart rate is accelerated which adversely affects the normal blood-pumping processes of the heart and the normal…… [Read More]

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Heart Transplant Asthma & Pulmonary

Words: 1811 Length: 6 Pages Document Type: Essay Paper #: 74860934

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.).#

BIBLIOGRAPHY

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

Flattery, Maureen P. And Kathy M. Baker. 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

Angiography in Patients with Pulmonary Hypertension: 10-Year Single-Center

Experience. 183 (3). American Journal of Roentgenology: American Roentgen Ray

Society, September 21, 2004. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/488868

Richardson, William S., et al. Gallstone Disease in Heart Transplant Recipients. 237 (2)

Annals of Surgery: Lippincott Williams & Wilkins, February…… [Read More]

Works Cited:
Tobacco Smoke: Insights from a Meta-Regression. Environmental Health

Perspectives: Medscape, October 25, 2007. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/564240

Yawn, Barbara and Mary Knudtson. Treating Asthma and Comorbid Allergic Rhinitis in Pregnancy: a Review of the Current Guidelines. Journal of American Board of Family Medicine: American Bord of Family Medicine, June 26, 2007
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Lee She Faces a Number

Words: 999 Length: 3 Pages Document Type: Essay Paper #: 61242717

¶ … 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 care professional can provide the most effective assistance to Ms. Lee.

What are the complications / co-morbidities / geriatric syndromes for which she is at risk?

Ms. Lee is at risk of facing a number of different complications associated with, the various conditions that she is suffering from. A few…… [Read More]