...(On-line section available) |University of Iowa College of Nursing 3 Sem. Hrs # 096 : 030 | PSY 231 | 28 PSYC 205 | 34 PSYC 205 |PSY 205 or PSY 208 (On-line section available) | | |Microbiology or Elementary Bacteriology 3 credit | 15 BIOL 271 | BIO 4009 (On-line course section with on-campus lab) |University of Iowa College of Medicine 3 Sem. Hrs 061 : 190 Marian University (Indianapolis) BIO 214 | MBI 161 | 28 BIOL 281 | 34 BIOL 281 | BIO 205 |BIO 215 (On-line section available with weekly on-campus lab) | | Pathophysiology 4 credits | 29 NURS 270 | BIO 4020 (On-line section available) |University of Iowa College of Nursing 3 Sem. Hrs. 096 : 118 | | 28 ALH-270 | 34 ALH 278 | ALH 220 | BIO 263 (On-line section available) | | Pharmacology for Nurses 4 credits | 29 NURS 205 | BIO 4018 (On-line section available) |Indiana University Nursing B219 Pharmacology 3 Sem. Hrs. Jackson (MI) Comm. College NUR 121, Pharmacology Preq. A&P & Math course 3 Sem. credits | | 28 BIOL 286 | 34 ALH 271 | ALH...
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...Myocardial Infarction Mortality 1.0 Introduction In the UK, about 838,000 men and 394,000 women have had a myocardial infarction (MI) at some point in their lives, (NICE clinical guideline 48, 2007). The latest statistics from the British Heart Foundation state that approximately 227,000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess...
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...Chronic Angina Case Study Advanced Pathophysiology 2/2/14 1) Basis for diagnosis: Six month history of intermittent chest discomfort, described as lower substernal tightness with numbness of the left upper arm, only during exertion. + exercise stress test with pain and 1.5mm of ST segment depression. Class of Angina: Class 1 Chronic angina is associated with a fixed or stable coronary obstruction that creates a disparity between coronary blood flow and the metabolic demands of the myocardium. It is usually precipitated by situations that increase the metabolic needs of the heart such as physical exertion, cold, and emotional stress and relieved within minutes by rest or nitroglycerin. These symptoms occur repeatedly over time, sometimes months to years. This fixed or stable plaque is commonly associated with chronic angina whereas the unstable plaque is associated with unstable angina and myocardial infarction. It is these unstable plaques that are most prone to abrupt plaque changes, followed by thrombosis, that lead to MI, stroke, and sudden cardiac death. These unstable plaques can be divided into three categories of Acute Coronary Syndrome: Unstable Angina, NSTEMI, and STEMI. The pathophysiology between UA and NSTEMI are similar and include these key features: development of an unstable plaque that ruptures or plaque erosion with superimposed non occlusive thrombosis, an obstruction by spasm, constriction, dysfunction, or adrenergic stimuli, severe narrowing...
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...a. Depolarization b. Repolarization 2. What is a dysrhythmia, how does they affect CO? 3. Define premature ventricular contraction. How is it reflected in the EKG? 4. What are the causes for premature ventricular contraction? 5. What is an electrophysiology study and what are the nursing care considerations? 6. What is V-Tach? 7. How is it diagnosed? 8. What are the nursing care considerations associated with vtach? 9. What medications would be given and how would CPR and defibrillation be done? 10. What is ventricular fibrillation, nursing care, meds, dx, CPR, defib? 11. How do implantable cardioverter defibrillators work and what are the nursing considerations? 12. Describe premature atrial contractions. 13. Define A-fib, nursing considerations, and complications. 14. What is countershock and how does it work, what should you avoid? 15. How do antidysrhythmics work, what are they? 16. What is sick sinus rhythm? 17. What is a heart block and describe the differences between the different kinds. 18. Define nursing care for bradycarida including meds. 19. What are artificial pacemakers, what are the nursing considerations? 20. What are the different pacemaker modes? 21. What are the nursing considerations for pacemakers including medications? Coronary Circulation Disturbances 1. Outline the basic coronary circulation. 2. What is atherosclerosis and what does it effect? 3. Outline the progression of atherosclerosis. 4. What are the incidence of...
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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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...diagnoses allows reaching a clinical diagnosis. Woo and Robinson (2016), emphasizes completion of full comprehensive assessment coincide to pain etiology, pathophysiology, related comorbid conditions, activity level, and quality of daily life impact with pain experienced (p. 1352). I have been taught early in nursing, “pain perception from a patient is always whatever the patient says”. Establishing what pain is to a patient, to then developing realistic pain control goals set from patient expectations to achieving patient compliance. Commonly, goals to remove chronic pain entirely is not realistic. Suggestive, patient support involves providing patient education to achieve improvement in quality life...
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...D’s heart and lungs sounds to reconfirm the diagnosis of heart failure. Further more, The ICU nurse should assess Mrs. D to identify the cause of her heart failure. Mrs.D ‘s 12-lead electrocardiogram reveals sinus tachycardia with an old inferior MI. The primary site of occlusion for inferior MI is Right Coronary Artery which comprises of Right ventricle (Moseley, Klein & Sole, 2013, p. 294). The nurse should anticipate Right sided Heart failure which occurs as a result of backed up blood in the body (excess volume). The ICU should also expect elevated central venous or right atrial pressure due to decreased cardiac output associated to increase preload .Mrs. D presented sign and symptom of Right sided heart failure such as lower extremities having +1 pitting edema bilaterally up to her mid calves (Moseley, Klein & Sole, 2013, p. 327). Mrs. D also presented positive S3 sound which is an indication of heart failure or fluid overload (Moore,...
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...For the purpose of discussion of pathopharmacological features of a specific disease process, this paper will provide information related to heart disease in the form of coronary artery disease (CAD). A1. Pathophysiology Analysis Cardiovascular disease (CVD) is the number one cause of mortality worldwide and becoming a steadily more investigated problem due to its prevalence. Much research is going into genetic, inflammatory mechanisms and neuro-hormonal factors related to CVD as scientific knowledge evolves regarding complexity of this broad pathophysiology. Atherosclerosis is the leading cause of the subsection of CVD called CAD. This is a form of arteriosclerosis where there is progressive thickening and hardening of the vessel walls of the two major coronary arteries and their branches. The thickening is an accumulation of lipid-laden macrophages inside the wall of the artery leading to the formation of lesions and plaque buildup (McCance, K. & Huether, S., 2014). When the plaque develops on the coronary artery walls the pumping ability of the heart becomes impaired as oxygen and nutrients needed for heart function may be partially or completely impeded. Complete occlusion of a coronary artery or one of its branches leads to a myocardial infarction (MI) evidenced by impaired myocardial metabolism and ischemic tissue death. Depending upon the location or branch of the artery where occlusion takes place, different regions of the heart muscle are affected...
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...Case Study #1 F.C. is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 0.18. F.C.’s family reports that his mental functioning has deteriorated significantly over the past few months. 1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to hepatocellular failure? Which are secondary to portal hypertension? Some of the more common manifestations or signs and symptoms of alcoholic cirrhosis are vomiting, fever, nausea, jaundice and portal hypertension all of which can damage the body over time. Jaundice is secondary to hepatocellular failure, with the decrease and destruction of these cells the bilirubin is unable to be processed correctly. Portal hypertension is mainly caused by cirrhosis in which the vomiting and nausea are secondary due to this. These symptoms are manifested due to the tightening of the portal vein leading to the liver thus causing an increase in overall pressure and vascular resistance being key factors in the manifestations. 2. Why is F.C. at particular risk for GI bleeding? F.C is at particular risk...
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...and b vitamins in their diet, restrict methionine, and exercise. Homocysteine is an unconventional risk factor for cardiovascular disease, and can also be used as a risk marker (Milani & Lavi, 2008). Homocysteine and The Cardiovascular System Cardiovascular disease involves all the diseases that affect the heart and vessels. There are many different diseases that affect the cardiovascular system. Atherosclerosis is one of these diseases. Atherosclerosis is characterized by the accumulation of soft, fatty and fibrinous deposits in the arterial vessel walls. These deposits later harden with time. This process can later affect the vascular system resulting in ischemic changes (Huether, McCance, Brashers, & Rote, 2008). The pathophysiology behind atherosclerosis begins with injury to the arterial walls. With this injury come inflammation, fibrin formation, lipid deposits, and plaque formation. The...
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...NURSING PROCESS PAPER Student Name: Date of Care: 10/14/09 Date of Admission: 10/10/09 I. HEALTH STATUS | Admitting Dx: COPD Exac/Chest Pain | Pt. Init.D.R | Rm No.353 | Age60 | SexM | RaceCaucasion | ReligionCatholic | OccupationDisabled | Surgery: Medical Treatment: Back Surgery/ Coronary Artery Bypass Grafting COPD Exac/Chest Pain | Chief Complaint/Reason for Hospitalization & Hx. of Present Illness (with 1-8 critical characteristics, Jarvis pg. 85) Chest Pain | | 1.Location: Midsternal chest pain radiating to left arm. 2. Quality/characteristics: Squeezing, tightening, felt like chest was going to explode. 3. Quantity: 8 on a scale from 1-10 4. Setting: at rest 5. Associative factors: SOB and nausea 6. Aggravating/relieving factors: Aggravated by activity, unable to relieve in any position 7. Timing (Onset, duration, frequency): Sudden and constant pain 8. Patient perception: Thought he was having a heart attack. | Other illness or conditions & year of onset. | | AllergiesNKA | COPD- 2004 Deep Vein Thrombosis -2002Anxiety-2000Depression-1998Lumbar/Cervical Spondylosis-1982HTN- 19XX-Patient cannot recall exact year | | Immediate Teaching Needs | | Hospital safety- Reminded patient to call for assistance, call light within reach, non skid footwear for reduction of falls. Talked with patient regarding fall safety. Teach non-pharmachological...
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...readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk factors are increased for an individual with hypertension, diabetes, coronary heart disease, congenital heart disease, and cardiomyopathy. Unhealthy behaviors can also be contributing factor as well for heart failure such as smoking, use of illegal drugs, and consumption of food high in sodium and cholesterol. II. Pathophysiology Heart failure (HF) is when the heart cannot pump out enough...
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...Discuss the current knowledge of the contribution of cellular and molecular components of the immune system to the pathology of type 1 diabetes Abstract An autoimmune disease resulting in insulin deficiency, Type 1 diabetes mellitus. There have been countless studies into its causes; there is still no solid answer. Previous studies strongly implicated Th1 cells to play a key role in the progression of type 1 diabetes, however, recent studies have been showing that this is inadequate to explain the pathology of the autoimmune disease Type 1 diabetes. In fact other constituents of the immune system are accountable; Th17 cells play a huge role in the cellular pathology of Type 1 diabetes. Introduction Type 1 Diabetes mellitus is an autoimmune disease which results from faults in immune response thus activating self-destroying T cells working against beta cells that produce insulin in the pancreas, causing a deficiency in insulin. Patients of Type 1 diabetes are required to inject insulin daily. Diagnosis of type 1 diabetes can occur at any age; however it is a chronic disease that is most common in childhood (Atkins et al. 2014.) Discoveries from epidemiological studies in humans with type 1 diabetes have shown that islet cell destruction goes through a number of stages (Campbell et al. 1990) the consequent low levels of insulin lead to higher levels of blood glucose. Common symptoms of this disease are frequent urination, increased thirst and weight gain. Before symptoms become...
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...Case 1 (Chapter 23: Alterations in Cardiovascular Function) A.O. was an 89-year-old woman with a long history of heart failure secondary to a large left ventricular infarct. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She took digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1.Which type of heart failure (left or right sided) is usually associated with dyspnea? What other clinical findings are likely to be present with this type of heart failure? A.O. has left sided heart failure. Other clinical findings that present with left sided heart failure are pulmonary congestion and inadequate perfusion of the systemic circulation and symptoms include orthopnea, cough, fatigue and edema and decreased urine output. Pulmonary edema and S3 gallop (3rd heart sound) is present with the physical examination, as well as high or low blood pressure. An echo can show decreased cardiac output and a chest x-ray may show an enlarged heart (Huether & McCance, 2012). 2.What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output? The cardiac output is dependent on the heart rate and stroke volume. The factors that affect heart rate are the central nervous system, autonomic nervous system, neural reflexes, atrial...
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...variation. In this case the cause of the exacerbation is CAP which has made it even more difficult for the patient to mobilize air for effective gas exchange. Differential diagnoses Heart failure. Heart failure (HF) was considered a differential diagnosis since common signs and symptoms of HF such as dyspnea, orthopnea, fatigue, and weakness were mentioned in the patient’s HPI. According to Colucci (2014) the patient’s history and physical, ECG, BNP, and chest x-ray are used to diagnose a patient with HF. Additionally, Colucci (2014) recommends that for a male patient with suspected HF who is symptomatic and has a history of myocardial infarction (MI), or basal crepitation (crackles), or ankle edema, an echocardiography should be performed to evaluate the patient’s hemodynamics and search for potential cases of HF. Mr. XX’s has no history of MI. During physical exam no edema was present, but crackles were auscultated and an echocardiography was ordered. Jugular venous pressure was not elevated, S3 or S4 were not present, and PMI was not displaced. ECG results were normal. BNP was below 100, which represents a normal value. Chest x-ray showed no cardiomegaly and the cardiac silhouette was normal. Finally, the echocardiography revealed no signs of HF, thus ruling out the diagnosis. Acute coronary syndrome. Acute coronary syndrome (ACS) is an umbrella term that includes: Unstable angina (UA), non ST-Elevation myocardial infarction (NSTEMI), and ST-Elevation myocardial infarction (STEMI)...
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