...Definition Heart failure occurs when abnormal cardiac function causes failure of the heart to pump blood at a rate sufficient for metabolic requirements under normal filling pressure. It is characterised clinically by breathlessness, effort intolerance, fluid retention, and poor survival. Fluid retention and the congestion related to this can often be relieved with diuretic therapy. However, diuretic therapy should generally not be used alone and, if required, should be combined with the pharmacological therapies outlined in this review. Heart failure can be caused by systolic or diastolic dysfunction, and is associated with neurohormonal changes. [1] Left ventricular systolic dysfunction (LVSD) is defined as a left ventricular ejection fraction (LVEF) below 0.40. It may be symptomatic or asymptomatic. Defining and diagnosing diastolic heart failure can be difficult. Recently proposed criteria include: (1) clinical evidence of heart failure; (2) normal or mildly abnormal left ventricular systolic function; (3) evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness; and (4) evidence of elevated N-terminal-probrain natriuretic peptide. [2] However, assessment of some of these criteria is not standardised Top of Form Search the BMJ[pic][pic] Bottom of Form • BMJ • BMJ Journals • BMJ Careers • BMJ Learning • Evidence Centre • BMJ Group [pic] [pic] [pic] [pic] [pic] [pic] Home | Log in | Athens...
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...The aim of this essay is to explore an acute deterioration in the health of an adult I have encountered during a clinical placement, in an acute care setting. The essay will begin with a definition of acute care, followed by the introduction of my patient and predisposing factors. This essay will include an explanation of the significant pathophysiological changes and related clinical manifestations and a critical analysis of the nursing interventions implemented during the acute episode of care, focusing on holistic care, rationale and evidence base. It will then describe the actual deterioration in the patient’s condition, and discuss the nurse’s role in the recognition and assessment of the actual deteriorating condition following the trusts policies. Assessment tools, monitoring, detecting and reporting will be considered. Finally this essay will include a discussion of the importance of multidisciplinary team collaboration in the diagnosis and provision of care during the acute episode, and a discussion on whether the deterioration could have been prevented by identifying any areas of practice which could change in relation to evidence based practice. For the purposes of privacy and confidentiality, in accordance with NMC (2008) code of conduct, the name of the patient will be changed to Peter and the placement area will remain as an acute care setting. According to McFerran (2008) the term “acute” is described as a disease of rapid onset, severe symptoms, and brief duration...
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...Pathophysiology cont. When discussing heart failure, the cellular level must be included. The overall changes in cardiac function associated with heart failure result in a decrease in cardiac output. This results from a decline in stroke volume that is due to systolic dysfunction, diastolic dysfunction, or a combination of the two. Systolic dysfunction results from a loss of intrinsic inotropy (contractility), most likely due to alterations in signal transduction mechanisms responsible for regulating inotropy. Diastolic dysfunction refers to the diastolic properties of the ventricle and occurs when the ventricle becomes less compliant, (stiffer), which impairs ventricular filling. Heart failure can be categorized by stages. The system includes four stages. • Stages A and B represent people who have not yet developed heart failure, but are at high risk because of coronary artery disease, high blood pressure, diabetes or other predisposing conditions. • Stage C includes patients with past or current symptoms of heart failure who have a condition called structural heart disease. • Stage D includes patients who have advanced heart failure that is difficult to manage with standard treatment (http://www.heart.org/HEARTORG/Encyclopedia/Heart-Encyclopedia_UCM_445084_Encyclopedia.jsp?levelSelected=8) A2 Clinical guidelines vs. standards of practice A critical element of the structure of care for heart failure patients is an ongoing quality assessment and improvement program. Chart...
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...Disability, Exposure (ABCDE) approach to assess and treat the patient. Do a complete initial assessment and re-assess regularly. Treat life-threatening problems before moving to the next part of assessment. Assess the effects of treatment. Recognise when you will need extra help. Call for appropriate help early. Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously. Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR) or Reason, Story, Vital signs, Plan (RSVP) approach. The aim of the initial treatment is to keep the patient alive, and achieve some clinical improvement. This will buy time for further treatment and making a diagnosis. Remember – it can take a few minutes for treatments to work, so wait a short while before reassessing the patient after an intervention. First steps Ensure personal safety. Wear apron and gloves as appropriate. First look at the patient in general to see if the patient appears unwell. If the patient is awake, ask “How are you?”. If the patient appears unconscious or has collapsed, shake him and ask “Are you alright?” If he responds normally he has a patent airway, is breathing and has brain perfusion. If he speaks only in short sentences, he may have breathing problems. Failure of the patient to respond is a clear marker of critical illness. This first rapid ‘Look, Listen...
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...Holistic Account of Care for a Patient or Client with Complex Needs What are complex needs? Who has them? It could be argued that everyone's needs are complex and as such, complex needs have been difficult to define (Rosengard et al., 2007). This essay intends to use literature to outline a systematic and holistic approach to care of a patient's complex needs. The nursing process and its framework of assessment, planning, implementation and evaluation will be utilised to provide a patient centred approach (Castledine, 2011). Rankin and Regan (2004) described complex needs as being a framework rather than a label that determines service eligibility. The needs of people include breadth (range of need) and depth (severity); these factors have to be taken into account when providing holistic care. Holistic care is defined as an approach which takes into consideration the physical, mental and social factors in an illness, rather than just the disease itself (Martin, 2010). The person this essay will centre around gave informed consent to have their notes consulted with the intention to write this essay, in line with the Nursing and Midwifery Council's (NMC) The Code (2008). There are seven elements to informed consent; competence to decide, voluntariness to decide, disclosure of information, recommendation of a plan, understanding of the disclosure and recommendation, decision of the plan and authorising of the plan (Beauchamp & Childress, 1994 pp. 145-146). In line with the...
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...Nurse Driven Education for A Patient Diagnosed With Chronic Systolic Heart Failure Refusing Diagnostic and Interventional Procedures Heather Horsley Wilkes University School of Nursing Abstract Heart failure (HF) is a chronic progressive disease, arising from structural or functional disorders of the heart, in which incidence increases with age. This review attempts to describe the types and causes of HF while focusing on variable aspects of patient education that have a positive effect on patient outcome and quality of life. Specifically, the potential benefits of this education for a 55 year old male patient diagnosed by transthoracic echocardiogram with chronic systolic heart failure, who has refused physician deemed necessary diagnostic testing and treatment. Keywords: heart failure, nurse driven education, heart failure, self-care Nurse Driven Education for Patient Diagnosed With Chronic Systolic Heart Failure Refusing Diagnostic and Interventional Procedures Heart failure (HF) is a major health care concern affecting over 5.7 million people in the United States. It is responsible for 1 in 9 deaths and costs the nation over 32 billion in health care expenses each year (Center for Disease Control, 2013). HF is the most common reason for hospitalization of people older than age 65 (Hinkle and Cheever, 2014). According to Hinkle and Cheever, HF is a “clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles...
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...the fatty deposit within the lining of your arteries. The factors which can reduce the risk of forming atheroma would be not to smoke, and choosing the right kind of foods, foods that are consider healthy for you to eat, and have a low salt intake, and having lots of physical activities in your life style. You also can keep your weight and waist size down, and drink alcohol in moderation rather than over doing it by drinking too much. You also need to keep your blood pressure, and your cholesterol level where it is important to keep it down. All of the people within the age of 40 should have a cardiovascular assessment if you are at risk of developing cardiovascular disease there are treatments to help you reduce the high blood pressure, and high cholesterol and it should be advised if you are at risk of developing it. The meaning of congestive heart failure means your heart does not pump enough blood to meet with the condition of your body’s needs. Within over time the condition of the narrowed artery disease, and high blood pressure would gradually cause it to be too weak or too stiff to fill up, and pump efficiently. You can’t always reverse many of the condition that leads up to heart failure the heart can often be treated with some good results. The term of heart disease or coronary (heart) arteries by atheroma which can cause, and can lead to having angina, heart attack, and failure of the...
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...a general concept meaning “susceptibility” and has a specific connotation in health care “at risk for health problems” (Chesnay & Anderson, 2012). The first theorist is Lydia Hall’s care, cure, and core theory. It refers to patients as having three needs of care: the physical, the medical, and the social needs. Nurses can easily provide the care, cure, and core theory to meet the needs of patients with congestive heart failure. Nurses using Lydia Hall’s theory assist with education, medical management, and provide physical, emotional or social support for congestive heart failure patients. The medical management and education offered by nurses increase patients knowledge, and the ability to manage their disease. They can prevent exacerbations, and reduce hospital readmissions (Davood, 2009). The care model dominates when nurses provide hands on care to the heart failure patients produces an environment of comfort and trust. It promotes open communication between nurses and patients. Open communication encourages the patient to express thoughts of fear and decrease their anxiety. Patients develop feelings of security and verbalize concerns of their disease management, emotional, and social issues in relation to the lifestyle changes they experiencing secondary to congestive heart failure (Davood, 2009). The cure model is noticed when nurses perform physical assessments and care management plans...
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...Heart Failure Western Governors University Pathopharmacological Foundations for Advanced Nursing Practice Heart Failure It is estimated that about five million people in the United States are living with heart failure with an overwhelming number of 550,000 newly diagnosed cases each year, costing the nation roughly $32 billion dollars per year (Centers for Disease Control and Prevention, 2016). Heart failure is a complex, pathophysiological condition in which the ventricles of the heart is weakened and unable to pump effectively to meet the body’s needs for nutrients or has lost adequate filling capacity. Clinical presentations of heart failure depends on which ventricles have failed to pump blood adequately; left ventricular failure, also known as congestive heart failure (CHF) is more common than right ventricular failure (McCance & Huether, 2014). The most common symptoms of heart failure are shortness of breath, fatigue, and peripheral edema. HF is not a disease, but rather a manifestation of a diseased heart. Large number of disorders can lead to heart failure, and with the aging population and many surviving primary cardiac events, it is no surprise that the most common reason for hospitalization in patients older than 65 years old is heart failure (McClintock, Mose, & Smith, 2014). Heart failure has become a major public health problem because it is the only cardiac condition that continues to increase in prevalence (McClintock, Mose, & Smith, 2014)...
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... INDEX S.N | CONTENT | PG.NO | 1 | Introduction | 5 | 2 | Definition Cardiomyopathy | 5 | 3 | Classification | 6 | 4 | Risk Factors | 7 | 5 | Clinical Manifestations | 7 | 6 | Diagnostic Evaluation | 7-9 | 7 | Dilated CardiomyopathyDefinition,Charecteristics,Types , Causes,Diagnostic Evaluation,Pathophysiology,Clinical Manifestations,Medical Management | 10-17 | 8 | Hypertrophic CardiomyopathyIncidence,Causes,Charecteristics,Clinical Manifestations,Medical And Nursing Management | 18-21 | 9 | Restrictive Cardiomyopathy-Other Names,Causes,Pathophysiology,Clinical Manifestations,Diagnostic Evaluation,Medical Management | 23-26 | 10 | Surgical management | 27-32 | 11 | Prevention | | 12 | Nursing Management,Home Care Management | 32-40 | 13 | Complications | 40-42 | 14 | Conclusion | 42 | 15 | Research Abstract | 42-43 | 16 | References | 44 | GENERAL OBJECTIVE: On completion of the course the students aquires indepth knowledge regarding cardiomyopathy and able to apply this knowledge with a positive attitude. SPECIFIC OBJECTIVE: On completion of the course the students are able to * Define cardiomyopathy * Classify cardiomyopathy * Enumerate the risk factors of cardiomyopathy * Describe the charestic pathophysiological changes in different types of casrdiomyopathy * Enlist the clinical manifestations of cardiomyopathy * Enumerate the diagnostic...
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...Women and Heart Disease Coppin State University Abstract Heart disease is a leading cause of death for women and men worldwide. Women are more vulnerable to myocardial infarction because of the size of their coronary arteries. They have unique risk factors such as a high level of cholesterol, hypertension, and smoking that cause heart disease, which leads to the high mortality rate. To reduce the high mortality rate among women, nurses must play their roles as educators because they interact frequently with patient, moreso than any other health care workers. Nurses must educate their patients on how to prevent the risk factors of heart disease. In order to reduce the high mortality rate due to MI in women, the Obama administration implemented the Patient Protection and Affordable Care Act (PPACA), popularly called t "Obama Care". This policy has mandated that insurance companies cover important preventive care at no cost, which will help eliminate the expensive bills that would have been incurred. As a future nurse, I would address the issue of heart disease by providing qualitative education and creating awareness of the causes and preventive measures of heart diseases. Keywords: Affordable Care Act, Heart Disease, Myocardial Infarction, "Obama Care", and Women's Health. Introduction Although both men and women have increased mortality rates due to heart disease in the United States, women have the higher rate and carry a heavier cardiovascular burden...
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...Health History and Examination Health Assessment of the Head, Neck, Eyes, Ears, Nose, Mouth, Throat, Neurological System, and the 12 Cranial Nerves Skin, Hair, Nails, Breasts, Peripheral Vascular System, Lymphatics, Thorax, Heart, Lungs, Musculoskeletal, Gastrointestinal, and Genitourinary Systems Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include relevant data for your client. |Student Name: xx |Date: 03/22/2015 | |Client/Patient Initials: I.F |Sex: Female |Age: 76 | |Occupation of Client/Patient: Stay at home | | |Health History/Review of Systems | | |(Complete and systematic review of systems) | | |Neurological System (headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, | | |difficulty swallowing, etc., medications): | | |dizziness once in a while. ...
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...1. Describe the relationship between assessment and diagnosis. Clinicians, in hope to find the correct treatment to help their clients experiencing dysfunctional symptoms and signs, use both the processes of assessment and diagnosis. The clinician will first take a psychological assessment in order to summarize the individual’s symptoms. This is done through a variety of ways, including objective and subjective tests, structured and unstructured interviews and observation. After completing an assessment, the clinician has an understanding of the individual’s symptoms, circumstances surrounding those symptoms as well as decides if and how to treat the individual. During an assessment, the clinician makes sure to highlight the abilities of the individual so that they can be compared to his abilities during and after treatment. This helps the clinician later on see the effects of the treatment and be able to change it if necessary. Only after an assessment, can the clinician make a clinical diagnosis. Clinical diagnosis is the way the person’s symptoms and signs learned in the assessment are organized and classified based on the Diagnostic Statistical Manual of Mental Disorders (DSM). The DSM is a standard guide to diagnose abnormal behaviors by providing criteria for each abnormal behavior listed. A clinician will gather all the information gained during an assessment and will organize it and see if it fits the criteria of any of the abnormal behaviors listed in the DSM. After...
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...Annotated Bibliographies Lisa Stevens Kaplan University Annotated Bibliographies Au, A., McAlister, F., Bakal, J., Ezekowitz, J., Kaul, P., & vanWalraven, C. (2012). Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.com/viewarticle/771215_print This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many that looked at prediction ability. The LACE+ index is a model that looks at length of stay, acuity, the Charlson comorbidity score and age, to predict readmissions. They found that no one model was appropriate in predicting the 30-day readmission rates, although using a combination of the models was an improvement to that predictor. The authors are all physicians, PhDs, or have a Master’s degree- helping to establish credibility. The authors also make a statement as to the funding of the project and that they (the authors) were solely responsible for all data collection, design and submission approval writing for the project, also lending credibility to the study. The references used for this study were appropriate in age, of the 28; 13 were...
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...Journal of Echocardiography (2011) 12, 421–430 doi:10.1093/ejechocard/jeq175 REVIEW Left atrial function: physiology, assessment, and clinical implications Gustavo G. Blume 1, Christopher J. Mcleod 1, Marion E. Barnes 2, James B. Seward 1, Patricia A. Pellikka 1, Paul M. Bastiansen 1, and Teresa S.M. Tsang 2* 1 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; and 2Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada Online publish-ahead-of-print 12 May 2011 The interest in the left atrium (LA) has resurged over the recent years. In the early 1980s, multiple studies were conducted to determine the normal values of LA size. Over the past decade, LA size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes, including major public health problems such as atrial fibrillation, heart failure, stroke, and death. More recently, functional assessment of the LA has been shown to be, at least as, if not more robust, a marker of cardiovascular outcomes. Current available data suggest that the combined evaluation of LA size and LA function will augment prognostication. The aim of this review is to provide a critical appraisal of current echocardiographic techniques for the assessment of LA function and the implications of such assessment for prediction and disease prevention. ------------------------------------------------------------------------------...
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