Heart Failure Case Study Essay

Your client, Mr. Black, is a 72-year-old man who called his TeleNurse Line from home and, based on the symptoms he described, was advised to go directly to the Emergency Department at his local hospital. His admitting diagnosis is exacerbation of heart failure (HF). His Ht is: 5’9†, Wt. 235 lbs. He states that his usual weight is about 220. Upon admission, his symptoms are: extreme shortness of breath; unable to tolerate lying flat; heavy, aching feeling in his chest; respirations labored @ 32/min.; radial pulse 108 and regular; BP 150/78; color dusky and O2 Sat is 82% on room air; slight diaphoresis; peripheral edema is 3+ pitting, ankle to knee bilaterally and sacral edema is also present. Bilateral BS present with coarse crackles in both lower lobes. He appears frightened and anxious; he states, â€Å"This is the worst it has ever been – please don’t leave me alone.† Past Medical/Social History: Coronary Artery Disease (CAD), hypertension, cor pulmonale, emphysema-moderate stage. He smoked 2 packs per day for 35 years, and quit 5 years ago. Hospitalized 3 times previously for HF; the most recent hospitalization was 6 months ago. He is a retired insurance salesperson; married and lives with his wife in a condominium. Sedentary life-style; plays golf occasionally. He skipped his diuretics over the weekend because he was golfing. 1. Which stage of the NYHA classification system and the ACC/AHA staging system would Mr. B’s symptoms best fit within? Why? I think his NYHA classification would be Class II. He has Coronary Artery disease and ordinary activity causes fatigue for him Mr. B’s ACC/AHA stage is Stage D. He has been hospitalized 3 times previously for HF. 2.Discuss the differences between right and left heart failure, consider the   pathophysiology, physiological progression, and signs and symptoms. Left Sided: -The most common -Results from left ventricular dysfunction. This prevents normal forward blood flow causing blood to back up into the left atrium and pulmonary veins. Increased pulmonary pressure causes fluid leakage from pulmonary capillary bed into the interstitial and then the alveoli -Manifests as pulmonary congestion and edema Right Sided: -occurs when right ventricle fails to contract effectively. -Causes a backup of blood into the right atrium and venous circulation. -Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema -May also result from an acute condition such as right ventricular infarction or pulmonary embolism -Core Pulmonale can also cause right sided HF -Its primary cause is Left sided HF. Left sided HF results in pulmonary congestion and increased pressure in the blood vessels of the lungs. Eventually chronic pulmonary hypertension results in right sided hypertrophy and HF 3. Mr. Black’s orders include: a bedside chest x-ray, ECG, echocardiogram, and the following labs: Troponin I, CK-MB, CBC with differential, BNP, Digoxin level, Electrolytes, Mg++, ABG’s, BUN and creatinine. What is the rationale for performing each of these diagnostics tests? How will the findings/information obtained from the tests be useful in managing Mr. Black’s care? Bedside chest x-ray: ECG Troponin I: present in MIs CK-MB: CBC: BNP: High in patients with HF Digoxin: Electrolytes Mg ABG BUN Creatinine: Mr. Black is stabilized and transferred to the Cardiac Telemetry unit with the following orders: Oxygen at 2-4 liters per nasal cannula to keep O2 Sat > 90% Complete bed rest with HOB elevated 60-90 degrees, legs dependent Saline Lock IVFurosemide (Lasix) 80 mg I.V. push Stat I&OFurosemide (Lasix) 80 mg I.V. push every 8 hr. Daily weight Albuterol Inhaler 2 puffs twice per day Pulse oximetry – continuousK-Dur 10 mg. p.o. daily Foley catheterASA 81 mg p.o. daily TelemetryMetoprolol 100 mg p.o. twice daily Diet: 2 Gm Na Lisinopril 10 mg p.o. daily Fluid restriction of 1000 mL/dayHCTZ 50 mg p.o. daily Code status: Full codeDigoxin 0.25 mg p.o. daily; Hold for HR < 60 bpm Lovenox 60mg SQ every 12 hrsDucosate sodium 100 mg p.o. daily 4. Discuss the rationale for each of the orders above Patients with HF typically have oxygenation problems Furosemide is a loop diuretic Daily Weight- water retention Pulse ox- monitor O2 Foley Catheter: monitor output and on bed rest K Dur: ASA Metoprolol: beta blocker that treats high BP Lisinopril: ACE inhibitor for HTN Lovenox: Prevents and treats clots Fluid Restriction: Excess fluid strains the heart Digoxin: Treats rhythmic problems Ducosate: Stool Softener 5. Identify 3 priority nursing diagnoses to include in the nursing care plan for Mr. Black. Excess fluid volume Decreased cardiac output Impaired gas exchange 6. What changes/assessment findings would alert the nurse that Mr. Black’s condition is worsening? Fatigue and dyspnea continue to worsen, weight continues to increase, edema and chest pain worsens, pleural effusion and dysrhythmias begin to develop, hepatomegaly, and renal failure begins to occur Mr. Black responds well to the treatment plan and his acute symptoms resolve within 3 days. His weight returns to 220 lbs. and he is able to perform his ADL’s with minimal SOB and able to sleep comfortably with 2 pillows. Discharge plans are finalized. 7. Which state of the NYHA Classification system and the ACC/AHA staging system Would Mr. Black’s symptoms now fit? NYHA- Class II ACCF/AHA- Stage C 8. Select 2 discharge topics (your choice) to focus on. Discuss what should be included in the discharge teaching plan for Mr. B. (and his wife) for each topic. Activity and rest: exercise training can improve symptoms of HF, however Mr. B needs to understand that he will need lots of rest during and after exercise and that he shouldn’t overexert himself. Teach Mr. B’s wife to monitor his exercise and encourage him to take breaks when needed Drug therapy: Teach Mr. B and his wife the expected action of all his medication and how to recognize drug toxicity. Also teach him and his wife how to take a pulse rate and what range the pulse rate should be in. Teach them the symptoms of hypokalemia and hyperkalemia if diuretics are order. Self BP monitoring may also be appropriate in Mr. B’s situation. Heart Failure New York Heart Association Classification American College of Cardiology/American Heart Association Guidelines Treatment Recommendations Stage A. People at high risk of developing heart failure (HF) but without structural heart disease or symptoms of HF -Treat hypertension, lipid disorders, diabetes. -Encourage patient to stop smoking and to exercise regularly. -Discourage use of alcohol, illicit drugs. -ACE inhibitor if indicated Class I. Patients with cardiac disease without limitations of physical activity. Ordinary physical activity doesn’t cause undue fatigue, palpitations, dyspnea, or anginal pain. Stage B. People who have structural heart disease but no symptoms of HF. -All stage A therapies -ACE inhibitor unless contraindicated -Beta-blocker unless contraindicated Class II. Patients with cardiac disease who have slight limitations of physical activity. They’re comfortable at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain. Class III. Patients with cardiac disease who have marked limitation of physical activity. They’re comfortable at rest. Less than ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain. Stage C. People who have structural heart disease with current or prior  symptoms of heart failure. -All stage A & B therapies -Sodium-restricted diet -Diuretics -Digoxin -Avoid or withdraw antiarrhythmic agents, most calcium channel blockers, and nonsteroidal anti- inflammatory drugs. -Consider aldosterone antagonists, angiotensin receptor blockers, hydralazine, and nitrates. Class IV. Patients with cardiac disease who can’t carry out any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. Any physical activity increases discomfort. Stage D. People with refractory heart failure that requires specialized interventions. -All therapies for A, B, and C -Mechanical assist device, such as biventricular pacemaker or left ventricular assist device -Continuous inotropic therapy -Hospice care Caboral, M. & Mitchell J. (2003). New guidelines for heart failure focus on prevention. The Nurse   Practitioner, 28, 22. Evaluation of Edema Four-point scale 1+ to 4+: 1+ – pitting barely detectable 4+ – pitting persistent and deep (1† or 2.54 cm.)

Lying Essay

Consider thinking about the controversial issue on lying. People usually don’t particularly care about the little white lies, but lying is never a good solution in any situation, because whether it’s a small lie or a big lie, there is always some form of consequence to each and every fib. There are a few certain articles such as, â€Å"A Philosopher on Lying,† by Immanuel Kant who also believe lying should not be tolerated in any way. Just like in the article I mentioned earlier, â€Å"A Philosopher on Lying,† a German philosopher, Immanuel Kant, explains his point of view on lying. Every lie is dangerous; the size of the lie doesn’t matter. As Kant states in the article, â€Å"Don’t tell someone a lie, because then you are not treating the person with respect, as an individual.† If everyone would just imagine the person who they’re lying to, using that same lie towards themselves, they wouldn’t feel very good. If someone believes that the right thing to do is lie, no matter the situation, then everyone else should get the right to lie too. One lie leads to another in most cases, which turns into a huge mess of lies, and that could end up hurting everyone in the end. If someone lies to protect a friend or a family member, is it really being used in the proper situation? Well, it’s only going to hurt the person more in the end, rather than telling the truth in the beginning. If they attempt to keep in a big secret, especially from a close one, it may tear their relationship apart just knowing how long they kept that information from them. It would be much easier and highly worth it to just get the secret over with in the beginning. Keeping in a huge secret from someone has many bad side effects; however, people need to keep in mind that if that person kept something from them, they wouldn’t be happy either. According to an interview, â€Å"Brad Blanton: Honestly, Tell the Truth,† Blanton states that â€Å"Delivering the truth is easier, takes less time, and is less stressful.† Telling the truth sounds easier than it actually is; because action speaks louder than words. That is the main reason majority of people choose to lie. Many people disagree that every single small lie is a bad thing, because they don’t want to cause any pain or harm to the person they are fibbing to. According to the article, â€Å"It’s the Truth: Americans Conflicted about Lying,† Randy Cohen says that, â€Å"Not only is lying justified, it is sometimes a moral duty.† This basically states that people are only trying to protect loved ones from any serious harm. Lying is an issue that people have dealt with for as long as any living person could remember. It creates problems, and that’s pretty much it. I have never seen a lie that led someone to success and have it all work out in the end. Lying isn’t the right way to go, because someone will always suffer from some kind of consequence, big or small. It is much easier to tell the truth and get it over with, rather than keeping it away as a secret and end up spilling the truth out later. Fibbing is dangerous and always messes with peoples head, ending up in a line of regrets. If someone’s like me, lies almost never work out like how they’ll plan it in the end. Always tell the truth, because it gives respect, receives respect, and it’s definitely worth it in the end.

Nacirema

The Nacirema change their behavior leading up to December 25th on their approved calendar. They believe that a spirit called â€Å"Christmas† will magically fill themselves and the people around then with joy and caring tendencies. They tell their offspring and little ones that a large man in a red suit with a white beard will break into their homes on the 25th and leave gifts if their behavior is good. If they are bad this man will leave black natural resources, coal.The children are also told to leave cookies for the man, although he is already extremely stout. The adults although supply the children with gifts and not coal, whether the child is good or bad by cultural norms. The women of the homes spend days prepping the home for others to come. They wipe down floors and use a large machine to attempt to remove debris from the soft areas of the floor, although the floor will just collect more dirt and debris over time.Some Nacirema even go knocking on the doors of other Nac irema and when they answer, they sing. The Nacirema dedicate literature, moving pictures, and several items to this spirit. Also, the Nacirema place large amounts of small balls of light and other items on or around their places of rest to honor the spirit. not really fake greed Nacirema is American spelled backwards and refers to, with a degree/pretense of anthropological self-distancing, aspects of the behavior and society of citizens of North America.Studying the Nacirema remains useful and productive for Americans even half a century after Miner first did so because it helps us realize how our behavior may be viewed by other cultures and what that impression will do for our relationship. Also, it helps us realize what parts of our behavior that we may have overlooked that are superficial, unnecessary, or flat out wrong.

Wide Sargasso Sea - Bertha Mason as a victim of Racial Oppression Essay

Wide Sargasso Sea - Bertha Mason as a victim of Racial Oppression - Essay Example It is the most successful novel of Rhys that consists of three parts and each of these parts is written using the narrative voice of different characters of the stories. The novel basically deals with the theme of racial discrimination and the roughness of displacement and integration. It deeply and sensitively describes the cultural barriers that exist between the whites and the blacks and explains the insecurities and adjustment problems that commonly arise when the people from different cultures are set to live together and use to hold certain prejudice for each other. Rhys touchingly describes the intricate relations of oppressor and oppressed through the depiction of the marital relations of the main character Antoinette that has been drawn from the character of Bertha Mason in Jane Eyre. The novel has been plotted in Jamaica and depicts the time after the liberation of the slaves in Caribbean. That was the depressed era when the tension over the issue of the racial inequity and hatred was on the peak level in Caribbean. The main character of the story is a lady Antoinette who spent her childhood in the West Indies and frequently faced the problems related to the ethnic prejudice and shrewdness. She neither succeeded to adjust among the white Europeans nor among the black Jamaicans whom she belongs but due to her white Creole heiress she remained different to them as well.

Venus Essay Example | Topics and Well Written Essays - 250 words

Venus - Essay Example Her genital area has a clear definition. This figurine has a large, round stomach. Her stomach hangs, but does not cover her genitalia She also has large flat buttocks. Her head has a pattern of concentric rings which can represent her hair or a kind of head dress. Her thighs and knees are large. She has no feet. This means she cannot stand on her own. She has no facial features. This makes her anonymous (Lammerhuber 2008). Venus of Willendorf is an exceptionally erotic figure. Her female aura was expressed in her ample bosom and detailed genitals. Her large sexual features depict her as a fertility icon. Her form portrays her nurturing abilities. She lacks a face. This imparts her with universality. She is a universal symbol of womanhood. Her lack of feet could be to provide immobility. Studies show that she may have been a prehistoric fertility goddess. Her power would lie in the ability to procreate. Other translations depict her as a doll for children in the prehistoric age. Venus of Willendorf has also been translated as a self-sculpture of a large woman. This figurine represents an impressive degree of artistic ability in its basic structure and intricate details (Lammerhuber