p5

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Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

Ashley Pittman 

 

1 posts

 

Re:Topic 2 Mandatory Discussion Question

 

  1. The American Cancer Society can act as a resource to newly diagnosed cancer patients by providing unbiased information.  Information is presented in non-medical terms and is easily accessible.  Their website has information from prevention to treatment and all steps in between including side effects from treatment.  The ACS website offers information on financial assistance as well as resources for family members who may be affected by the new diagnosis.  The link for getting involved provides people with options to donate money or their time.  Volunteering with an organization such as the ACS can be quite beneficial for those affected by cancer as well as connecting people who are facing the same diagnosis.
  2. Factors that include incidence and mortality rate include poor diet, sedentary lifestyle, being overweight or obese, use of tobacco and/or alcohol, living a high-risk lifestyle, coexisting infections such as HIV and Hep C, and sun exposure.  Changes that we are seeing to reduce incidence and mortality include increased education and awareness, access to screenings (colorectal and/or cervical), vaccines (HPV), and treatment of those coexisting infections.
  3. The research topic that I found was related to the financial costs of smoking-related illnesses and their impact on society.  It’s estimated that society faces a loss of $422 billion in health-related expenses.  The importance of this particular study was the focus on low and middle-income countries, the first of its kind.  These countries account for 40% of the cost mentioned.  By bringing this to attention hopefully we can provide more education and resources to these areas. 

 

 

 

 

 

Response to a discussion board peer reviewed_SR

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-REPONSE TO A PEER DISCUSSION BOARD! 150 words 1 reference within 5 yrs. APA format must have in text citations to match references. NO cover page needed. 

 

A Practice Change that an Advanced Practice Nurse Could Initiate 

        According to Kurtzman & Barnow (2017), the advanced practice nurse (APN) role was created in response to an increased demand for primary care in health care centers (HCCs).  Because of the fast-growing population in the medical setting, there is a great need for health care providers to be readily available for treatment and prevention of diseases. The APN could initiate a practice change and make up the shortfall of the vastly growing demand. The APNs are most often in primary care and family medicine practices, but also work as specialists in hospitals. 

Use a Change Model that Reflects a Team Approach 

          The APN role is individualized care that focuses on a patient’s medical issues as well as the effects of illness. The National Ambulatory Medical Care Survey used a design-based and model-based inference and weighed all estimates with the impact of the care of an APN delivered versus primary care physician (PCP) delivered care (Morgan et al, 2017). An APN work along with PCP may serve as a patient’s mid-level healthcare provider, and they may treat patients of all ages depending on their specialty. 

Explain how the Identified Change Would be Implemented in the Workplace 

        The APNs are qualified to diagnose medical problems, order treatments, perform advanced procedures, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions within their scope of practice. Morgan et al., (2017) stated that patient-centered medical home models are a multifaceted approach to primary care designed to better meet the needs of patients with chronic disease. The APN stresses health promotion and education during hospitalization. An APN has the acquired the expert knowledge base, complex decision-making skills, and clinical competencies for comprehensive practice. 

Describe Barriers that may be Encountered with Change Implementation 

         According to Morgan et al., (2017), it has been requiring a physician involvement for an APN to prescribe medications. For example, the APN can’t prescribe controlled substances. Moreover, a supervising physician needs to be on site. As a standard of practice, a full prescriptive authority and chart co-signatory requirements determined at the practice level of the APN (Morgan et al, 2017). However, an adaptable collaboration of practice for PCP and APN to achieve the best outcomes for patients. 

Discuss how an Advance Practice Nurse Would Overcome those Barriers 

       Findings of Kurtzman & Barnow (2017), suggests that APN care is comparable with a PCP in HCCs and suggest that greater use of APNs unlikely to have a dramatic effect on patient care.

 

In conclusion, the APN can examine patients, diagnose illnesses, prescribe uncontrolled medications, and provide treatments. The APN role and responsibilities similar to those of PCP and able to perform collaborative treatment and care. 

Comment Jamella

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 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 120-150 WORDS

 

The American Cancer Society is an organization that is dedicated to eliminating cancer. The American Cancer Society has all sorts of informative links and information that can help you understand and cope when someone you care about has been diagnosed with cancer. If it was my friend or family member I would tell them about the website www.cancer.org it has many ways to learn about the different forms of cancer along with the risk factors and treatment plans for the cancer you are dealing with. The website also includes information on how to speak to someone in person and get information that you are looking for along with local group setting you can attend to get education on cancer (American Cancer Society, 2016).

Statistics show that an estimated 1.5 million new cancer cases diagnosed each year over the next decade. Some of the factors that contribute to the yearly incidence and mortality rates of various cancers in Americans include: obesity, smoking, alcohol, physical inactivity, lack of education, and lack of health care coverage. “Cancer was responsible for nearly one in four deaths in the United States in 2011, making it the second leading cause of death overall. It is already the leading cause of death among adults aged 40 to 79, and is expected to overtake heart disease as the leading cause of death among all Americans within the next several years. “The change may be inevitable, but we can still lessen cancer’s deadly impact by making sure as many Americans as possible have access to the best tools to prevent, detect, and treat cancer” (Simon, 2014).

One area of research that is funded by the American Cancer Society is Childhood cancer. This is done by using society’s full time researchers and external grantees to monitor and engage in new treatments, improvement of existing treatments, and addressing the side effects they can result from having childhood cancer. The research is broken down into the different kinds of cancer that children, this is also done to help prevent the long term suffering of the treatment effects that include things like hearing loss, heart disease, secondary cancers, and some learning disabilities. Palliative care is something that is important for the researchers to continue to gather information and continue their working together with the National Palliative Care Research Center (American Cancer Society, 2016).

                                                                      References

American Cancer Society. (2016, August). Childhood cancer research highlights. Retrieved from http://www.cancer.org/research/acsresearchupdates/childhood-cancer-research

American Cancer Society. (2016, September). Take a loved one for a checkup. Retrieved from http://www.cancer.org/cancer/news/features/take-a-loved-one-for-a-checkup

Simon, S. (2014, December). Statistics report: 1.5 million cancer deaths avoided in 2 decades. Retrieved from http://www.cancer.org/cancer/news/news/facts-figures-report-cancer-deaths-avoided-in-2-decades

p4

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Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

Ashley Pittman 

 

1 posts

 

Re:Topic 3 Mandatory Discussion Question

 

Upon admission to the unit, she will need a head to toe assessment as well as a peripheral IV.  Labs will need to be drawn (CBC and BMP).  Her VS will need to be monitored along with daily weight.  Ms J. will need to be monitored with telemetry as well.  She will need O2 and to be placed on a fluid restriction as well as strict I&O. 

 

Lasix is a loop diuretic and is used to remove excess fluid from the body via the urinary system.  By doing so, the heart and blood vessels are less strained decreasing blood pressure and stain on the vessels.  This will also alleviate shortness of breath and difficulty breathing.  Vasotec is an ACE inhibitor.  ACE inhibitors relax vessels to make blood flow easier.  They are commonly used to treat HTN therefore reducing risk of stroke, heart attack and kidney damage.  Metoprolol is a beta-blocker and is typically used in conjunction with the Vasotec to treat HTN. Morphine can be used to treat breathlessness by reducing anxiety. 

 

 

 

Diabetes: Uncontrolled diabetes has long-term effects on the vascular system causing damage that can lead to atherosclerosis as well as nerve damage that may cause dysfunction in the heart as well.  Managing blood sugar is the best intervention for these clients.  Through diet, exercise and medication, maintaining a healthy blood sugar can eliminate risk. 

 

Hypertension: Over time, high blood pressure causes damage to the heart because the heart has to work harder and is less efficient.  Medication and lifestyle changes can help reduce damage. 

 

Myocardial infarction: After a patient has experienced an MI there is damage done to the heart muscle itself which causes the heart to be less efficient and oxygenated.  Patients who have experienced MI need close follow up and medication adherence. 

 

Obesity:  The heart has to work harder for those who suffer from obesity.  Lifestyle changes can help reduce risk of heart failure over time. 

 

 

 

The patient needs a current med list including brand and generic names along with doses and timing.  The medical providers should all be up to date on meds taken by the patient either via the list or EMR.  Patients need an organized system of storage for medications as well as assistance if there is any question regarding capability in managing medications.  Nurses need to provide education regarding medications and written material to be taken home with them regarding instructions for taking meds.  Written material needs to be in the patient’s primary language as well as large enough print to be read. 

 

 

 


 

 

 

Design Thinking Script

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Design Thinking Script (This Script will be the beginning of my capstone project)please read attachment before making a bid

Reflect on the content covered throughout the entire course.

Utilizing what you learned about design thinking this week, create a script that can be used to create a voice-over presentation or video in Week Six.

Review the Capstone rubric and Capstone: It’s Not Scary slide presentation. Your script should include: This will be a two part assignment, person accepting firts part must be will to accept part two.  You will find complete details attached

  • During this course, I came across x.
  • I see opportunity for improvement at my organization in      x.
  • I might want to focus my capstone on these one to three      areas.
  • How will this relate to the end user? Consider      consumer-centrism.

Click the Assignment Files tab to submit your assignment. 

Materials

· Capstone Rubric ATTACHED

· Capstone: It’s Not Scary ATTACHED

THEN

Design Thinking” from the Harvard Business Review (HBR) Explainer

Watch the video “Design Thinking” from the HBR Explainer series 

( Video Link: https://hbr.org/video/4443548301001/the-explainer-design-thinking )

Post a response to the following question on separate sheet of paper

  • How will you use      design thinking to begin to brainstorm about your capstone?

You can add at the end of paper I will cut and paste on separate sheet   

  

Part Two Due Oct 2nd

Design Presentation (MY Capstone project 

Create a 5- to 6-slide voice-over presentation or video using your script from Week Five.

  • Incorporate feedback from      faculty and any additional new learnings from the course.
  • Presentation should be 3 to 4      minutes with a clear and professional voice-over presentation of      information.

Cite at least 5 peer-reviewed, scholarly, or similar references.

Format your citations according to APA guidelines.

Subjects covered throughout this class

system thinking locally and on a national level,  the three C’s (Creativity, chaos and complexity), feedback loops, leverage points, different types of traps and opportunities such as Trap of escalation, tragedy of the commons, success to the successful, Drift to low Performance ,and  he trap of Shifting the Burden to the Intervenor among others Flow, Fulfillment, Creativity, and Respect, Gemba walk

P3

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Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

Chinyere Ojiyi 

 

4 posts

 

Re:Topic 5 Mandatory Discussion Question

 

The association of obesity with chronic diseases, such as heart disease, hypertension, sleep apnea, degenerative joint disease, gastroesophageal reflux disease, asthma, and depression, is well documented and reinforces the benefit of achieving and maintaining a “normal” weight.  Bariatric surgery provides dramatic improvement in these chronic conditions. Mr. C is currently obsessed at 295.9 pounds. Has high blood pressure, sleep apnea, fasting blood sugar over and above acceptable parameters. Elevated Cholesterol and triglycerides. He is at risk for diabetes and heart disease.  He will benefit from bariatric surgery and be able to this condition.

 

Mr. C to take Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime at 6am., 11am., 5pm and 10pm.

 

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime. To be taken at 10am, 3pm., and 9pm.

 

Take Ranitidine (Zantac) 300 mg PO at bedtime.

 

Health-perception: Mr. C. has a good perception of his health, understands the health danger and risks he is running and seeking information to help him achieve optimal health.

 

Health-management: Mr. C. has HTN, and has sleep apnea. Manages his HTN with low Sodium diet.

 

Nutritional-metabolic: Has gained approximately 100 pounds in the last 2-3 years. Patient eats 3 meals per day and a bedtime snack. Patient has high cholesterol and high triglyceride and his fasting glucose is146mg/dl. These are indication of poor nutritional choices and possibly poor metabolism.

 

Elimination: Not stated

 

Activity-exercise: Patient works at catalog telephone center. Probably sits all day, no exercise or activity was noted.

 

Sleep-rest: Patient has sleep apnea. Sleep apnea can lead to heart disease if untreated.

 

Cognitive-perceptual:  No impairment stated

 

Self-perception/Self-concept: Mr. C.  is aware of his obesity and is ready to take measures to correct it.

 

Role-relationship: Not stated

 

Sexuality-reproductive: not stated

 

Coping-stress tolerance: Not stated.

 

What actual or potential problems can you identify? Describe at least Five problems and provide the rationale for each.

 

Actual problems are hypertension, sleep apnea, elevated cholesterol, elevated triglycerides. Potential problems include diabetes, heart disease, stroke, peripheral, vascular disease etc. Mr. C needs to lose weight or he will become diabetic. He may already be, but he is unaware, his MD needs to order Hgbaic. Both elevated cholesterol and triglycerides are precursors to heart disease.  Sleep apnea if untreated can lead to heart disease. He can die in his sleep due to insufficient oxygen to the brain. There is a high reduction in mortality rates with bariatric surgery. There is a significant improvement in those diseases that are caused or worsened by obesity, including: blood pressure, diabetes, and heart disease, and stroke.

 

 

 

 

 

p3

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Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

Sandeep Kaur 

 

1 posts

 

This patient
is showing the sign and symptoms of systemic infection chills, sweating
fatigue, malaise, muscle ache, sensation of heat.

 

The muscle groups that are most
likely to be affected by this are the flexor hallucis longus, flexor digitorum
longus, and tibialis anterior. All three muscles stretch from the medial
malleolus to the popliteal joint. If the cellulitis were to continue further up
the leg, more muscles would be affected. This infection can damage the
lymphatic drainage system of the affected limb, causing chronic lymph edema.

 

This patient
is showing the sign and symptoms of systemic infection chills, sweating
fatigue, malaise, muscle ache, sensation of heat.

 

The muscle groups that are most
likely to be affected by this are the flexor hallucis longus, flexor digitorum
longus, and tibialis anterior. All three muscles stretch from the medial
malleolus to the popliteal joint. If the cellulitis were to continue further up
the leg, more muscles would be affected. This infection can damage the
lymphatic drainage system of the affected limb, causing chronic lymph edema.

 

The significance of these findings
is that they help guide us in how to care for the patient. IV antibiotics will
need to be started ASAP to combat the infection which is indicated by several
factors: elevated temperature, elevated WBC’s, neuts and bands, wound culture,
cellulitis, and the thick yellow drainage from the wound and unable to bear
weight. Miss G also need CT of left leg and MRI can give the better result with
the other lab work like CMP, CK, ABG, HgbA1C to rule out DKA and also to know
how well her blood sugar is. Miss G need monitoring of the vital sign. Because
when a patient is septic the HR goes up or down. Surgical consult will be
helpful too.

 

The fact that she cannot bear weight
and reports being in bed for 3 days suggests that she is most likely dehydrated
and suffers from malnutrition as well. An IV should be started for fluids,
possibly a banana bag or LR in order to rehydrate as well as give her body the
proper nutrients to help with wound healing.

 

This patient needs wound consult
because of open leg wound with left leg redness. The wound should be cleansed
and properly bandaged twice daily, depending upon the amount of drainage that
continues. It’s possible that a wound-vac might be needed as the patient also
suffers from diabetes and has poor circulation. Need to mark the red area in
order to see if the redness is increasing. Leg should be elevated for the
swelling. Calf measurement needs to be done to check if the leg size is
increasing.

 

Since the patient is complaining of
pain, which is evident by her not leaving her bed for 3 days, She needs around
the clock medicine for pain.

 

Routine lab draws will need to be
made as well until the infection is under control that way you can ensure that
the infection is not getting worse and monitor the effects it is having on her
body. Since diabetics function and process things differently than normal, a
CBC and CMP would be helpful to monitor organ functions. Also, I would order a
FSBS AC and QHS along with oral diabetic  medications depending upon the
HgA1C level and FSBS results. This will not only help wound healing now but it
will help control further issues in the future.

 

 

 

It is also obvious that Ms. G would
greatly benefit from education on diabetes. Although we do not get the
information to know how this started or what her blood sugar levels have been,
it most likely started from a consequence of poorly managed diabetes. Since
diabetics suffer from poor circulation, along with neuropathy, they do not feel
wounds the same way a non-diabetic would. This could have started from
something as simple as a nic from shaving her legs but, left untreated, it
turned into something much worse. A diabetic should always check their feet and
legs thoroughly each night before bed to ensure all skin is intact. Nutrition
should also be something to educate on. Not only is nutrition a huge factor in
managing diabetes, it also plays a vital role in wound healing. The body cannot
heal without the proper nutrients and it is especially difficult if you are a
diabetic. Pt needs podiatrist to have her feet checked and nails cut. Pt needs
education on blood sugar check and how to give insulin and also a nutritionist
to help understand DM.

 

 

 

Another thing to consider, upon
discharge, is whether or not the patient will require home health services.
Stating that she lived alone, no body to help with food and she is in the bed
for three days. This shows the self-neglect of the patient. Assistance may be
required until the leg is fully healed. Pt needs homecare and a program
like Meals on Wheels that deliver meals for her. Other option is skilled
nursing facility. This patient also need emotional support. Powerlessness is a
huge issue with this patient. Her lack of function is the contributing factor.
She is dependent on others. An equal portion is directly related to her
perceived lack of control over decisions. This patient needs a therapeutic
relationship. Nurses should spend one‐on‐one time with her, keep commitments,
provide encouragement, listen attentively, be empathetic. Allow patient to
share her feelings. Encourage participation in self‐care and self‐management activities
so that patient feels less powerless. Giving realistic praise assists the
patient in developing positive feelings and enhances self‐concept. All feelings
are personal and have meaning for the patient. Support groups can serve as a
helpful means to improve interpersonal coping strategies. Counseling with
therapeutic goal setting has been shown to be helpful.

 

1. Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus

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M.K. is a 45 year old female; measuring 5’5” and weighs 225 lbs. M.K. has a history of smoking about 22 years along with a poor diet. She has a history of Type II diabetes mellitus along with primary hypertension. M.K. has recently been diagnosed with chronic bronchitis. Her current symptoms include chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. Her current medications include Lotensin and Lasix for the hypertension along with Glucophage for the Type II diabetes mellitus. The following are lab findings that are pertinent to this case:

Vitals

BP

158/98 mm Hg

CBC

Hematocrit

57%

Glycosylated hemoglobin (HbA1c)

7.3 %

Arterial Blood Gas Assessment

PaCO₂

52 mm Hg

PaO₂

48 mm Hg

Lipid Panel

Cholesterol

242 mg/dL

HDL

32 mg/dL

LDL

173 mg/dL

Triglycerides

184 mg/dL

 

 

1.    What clinical findings correlate with M.K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M.K.’s chronic bronchitis?

 

 

COMMENT KATARZYNA

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 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 120-150 WORDS

 

  1. Imagine that a family friend or colleague has just been diagnosed with cancer. Explain how the American Cancer Society might provide education and support. What ACS services would you recommend and why?

Unfortunately, cancer is not something rare in our society. Everyone knows someone diagnosed with cancer. Therefore, organizations like The American Cancer Society (ACS) are very useful and needed. Working as an Adult Oncology nurse I encounter patients diagnosed with this horrible disease on a daily basis. ACS is engraved in our floor and representatives come every day to see our patients and families as needed. They provide very needed information. Patients are usually so overwhelmed when they first learn about their disease. Talking to ACS representatives gives them opportunity to learn more about their new diagnosis and what steps they need to take from now on. ACS can help with setting up chemotherapy schedule and support between treatments. In that emotional time conversation with  counselor can be very beneficial. ACS can connect patients with support groups; talking to survivors and their journey might give patients a lot of hope.

When patients are ready, they can learn about treatments and what to expect after. Look Good Feel Better program helps dealing with physical changes, offers wigs, fitted breast jackets etc.

Sometimes, patients and their families want to give back and they can contribute to research. They can also learn about experimental treatments.

 

  1. According to statistics published by the American Cancer Society, there will be an estimated 1.5 million new cancer cases diagnosed each year over the next decade. What factors contribute to the yearly incidence and mortality rates of various cancers in Americans? What changes in policy and practice are most likely to affect these figures over time

Statistics show that cancer is predicted to be rising. Much research has proven that there are factors that contribute or can accelerate speed in which cancer would grow. Some factors like genetics cannot be modified (at least not yet) but there are multiple factors that we can influence. ACS lists things we can do to lower our probability to get that disease:

  • Staying away from tobacco
  • Being safe in the sun
  • Eating healthy
  • Staying active
  • Avoiding environmental carcinogens
  • Following preventive screening guidelines (ACS, 2017).
  1. Select a research program from among those funded by the American Cancer Society. Describe the program and discuss what impact the research will have on the prevention or treatment of cancer.

According to ACS: “We’ve invested more than $4.6 billion in cancer research since 1946, all to find more – and better – treatments, uncover factors that may cause cancer, and improve cancer patients’ quality of life”.

One of research that ACS is conducting is “Epidemiology Research Program”. It focuses on reduction”…  the cancer burden by conducting large, nationwide prospective studies that advance our understanding of cancer etiology, survival and long-term survivorship and inform cancer prevention and control programs, policies and guidelines”(ACS, 2017).

I find this program extremely important as it focuses, among other factors, on finding why the cancer starts. Prevention and being able to avoid factors that start the disease on the first place seems to give us the best chance to fight the disease.

References:

American Cancer Society. (2017). Stay Healthy. Retrieved from: https://www.cancer.org/healthy.html

American Cancer Society (2017).Epidemiology Research Program. Retrieved from https://www.cancer.org/research/we-conduct-cancer-research/epidemiology.html

COMMENT VANE

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 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 120-150 WORDS

 

What nursing interventions are appropriate for Mrs. J. at the time of her admission?

 

Patient is admitted with decompensated heart failure, with signs and symptoms of pulmonary edema from the poor output of the heart, arrhythmias specifically atrial fibrillation with rapid ventricular response (RVR). The nurses interventions at the time of admission should be a full assessment, blood work to check for electrolyte imbalance, infection, and etc, EKG and continuous tele monitoring to assess if the atrial fibrillation converts to sinus (paroxismal) or if she remains in a-fib (chronic), patient must be started on oxygen via nasal cannula, and she must be started on the medications stat. After being started on Lasix, nursing interventions should include monitoring for intake and output, safety is another intervention since the patient’s BP is low and she is in a-fib, she may experience dizziness and fall, therefore BP must be monitored and safety measures placed for patient. Patient should be positioned in high fowler’s to help with the breathing. 

 

What is the rationale for the administration of each of the following medications?

 

IV furosemide (Lasix)- This is a loop diuretic used to prevent or treat fluid retension in patients with heart failure, liver disease, and renal failure. In this case, the patient has crackles in the lungs, is complaining of shortness of breath, has edema and distended jugular veins, low blood pressure, and coughing, all signs of heart failure and pulmonary congestion secondary to left sided heart failure. 

Enalapril (Vasotec)-This is a ACE inhibitor (Angiotensin Converting Enzyme) which is used to treat hypertension and heart failure. It allows the ventricles to pump blood out of the heart. 

Metoprolol (Lopressor)-This is a beta blocker used for hypertension, heart failure, coronary artery disease, and arrhythmias. IN this case, the Metoprolol can help with the patient’s heart failure by allowing the heart to relax and lower the heart rate. Metoprolol is a vasodilator, it relaxes the blood vessels of the heart. Since the patient is in heart failure and afib, his heart is working harder to pump blood and its overworking the heart and weakening it, therefore Metoprolol is used to treat this. 

IV morphine sulphate (Morphine)-This is an opiate given to patients with angina and heart failure due to its effects on the sympathetic nervous system. The reduction of the sympathetic stimulation reduces heart rate, cardiac work, and myocardial oxygen consumption. In this scenario, the Morphine will be helpful in reducing the pateint’s anxiety, pain, heart rate, and will allow the heart to relax. 

 

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

 

 

Coronary artery disease (CAD)- The buildup of plaque/cholesterol in the arteries of the heart can diminsh blood flow to the heart and cause angina or heart attack if it is completely occluded. CAD can also cause HTN and in turn heart failure. CAD can be managed by controlling blood pressure, weight control, diabetes, hyperlipidemia, exercising, and if smoker, tobacco cessation. These will lower the chances of developing CAD. If patient is diagnosed with CAD, then they must be managed with blood thinners, statins, beta blockers, and ACE inhibitors. They should be counceled on low sodium diet, low fat/calorie diet, and exercise therapy. Sometimes, cardiac rehab is helpful for those with chornic angina and CAD. Making sure the patient is compliant with meds and their diabetes, cholesterol, and blood pressure are controlled will help prevent heart failure. 

 

Hypertrohic cardiomyopathy-Blood vessels in the heart that are damaged from drug use of ETOH use cause cause heart failure. The weakned heart muscle can result in HF. These patients must be monitored for arrhythmias because patients with dilated cardiomypathy commonly have ventricular arrhythmias and low EF and have SCD or syncope. Often, they will require an ICD implant to prevent SCD (Nguyen, V., 2017). To prevent heart failure, patients wiht CMP need medications to help strenthen the heart muscle or avoid worsening of CMP. These medications include ACE inhibitors, ARB’s, beta blockers, diuretics, nitrates, and more. Referring to cardiac rehab is important for these patients as well. 

 

Hypertension-The high pressure in the heart vessels causes the heart to overwork and eventually weaken causing heart failure. Patient education about low sodium diet, exercise, and medication compliance to control BP. Patients must be educated that if their BP is uncontrolled on meds, they need to seek medical attention. 

 

Myocardial Infarction-Heart attack results in diminished or no blood flow to the heart muscle, causing the muscle to “die” and makes it harder for the heart to pump blood (American Heart Association, 2017). Similar to CAD interventions, patients with MI require long term medical therapy. MI can result in ischemic cardiomyopathy and in turn heart failure. Patients with ICMP also require a ICD implant if the EF does not improve with meds. These patients need constant monitoring of blood pressure and more MI’s or coronary blockages. Paitents with previous MI’s or CAD need annual stress test to evaluate their EF and check for cardiac ischemia. If indicated, a left heart catheterization and PCI should be perfomed before another MI hits them leading to HF. 

 

 

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

 

Polypharmacy, or taking too many medications at the same time can have complications specially in the elderly population because they have poor mediation regimen, may be forgetful which can result in underdosing or overdosing of medications, may be taking herbal supplements at home that can interact with medications and cause adverse reactions (Woodruff, 2010). 

Nurses can help avoid this problem. 

1.Patient education about each medication, what it is taken for, what side effects to expect, what to avoid with this medication

2.Organize their pills. Give them a written copy of all of their meds and organize them into the time they should be taken and how many should be taken. For example, the paper can be divided into three parts (morning, lunch, night). Under each part, the names of the medications can be written so they know exactly what to take and when to take them and will prevent them from taking everything at the same time.

3. Teach them how to take their meds. For example, with food, with water, oral route, or injected. 

4.Discard old, expired, or discontinued medications. Keep all meds together in one place. 

 

References

 

American Heart Association. Causes of Heart Failure. 2017. Retrieved from 

http://www.heart.org/HEARTORG/Conditions/HeartFailure/CausesAndRisksForHeartFailure/Causes-of-Heart-Failure_UCM_477643_Article.jsp#.WZTzVcdlnL8

 

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