Evaluating The Congestive Heart Failure Nursing Plan Nursing Essay

Evaluating The Congestive Heart Failure Nursing Plan Nursing Essay As defined by Phipps (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) congestive heart failure occurs when, the myocardium of the heart is unable to uphold a sufficient cardiac output to meet the bodys metabolic needs. Heart failure can result from either systolic or diastolic dysfunction (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). Assessment tools that will be used in the assessment of Mr. Toscana include, head to toe, physical, and systems assessments. A risk assessment will also be done on Mr. Toscana to insure that he is safe in hospital (Berman, A, Kozier, B, Erb, G.L, 2008,). As Mr. Toscana suffers from congestive heart failure a wide range of education and psychosocial support is available to help with his condition (Heart Foundation, 2010). A nursing care plan has been made to show four nursing diagnoses and interventions to reduce the impact of the diagnosis. These nursing diagnosess can be solved through a variety of diagnostic tests to make sure that ev ery possible outcome is looked at (Berman, A, Kozier, B, Erb, G.L, 2008). Mr. Toscana is taking a few medications at the present time to manage his cardiac issues along with other medical conditions he suffers from, these medications are, Lasix, digoxin, aspirin, warfarin and perindopril. (Tiziani, A, 2010), (Better Health Channel, 2010) PATHOPHYSIOLOGY OF CONGESTIVE CARDIAC FAILURE Both systolic and diastolic heart failure are second to myocardial injury. Progression of heart failure is highly dependent on the level of ventricular remodelling, this occurs after myocardial injury (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). The changes in ventricle shape and dimension will cause a decrease in its effectiveness as a pump. An increase on diastolic pressure possibly will further change the shape of the left ventricle, thus resulting in papillary muscle rearrangement and mitral insufficiency. It is more common for congestive heart failure to begin in the left ventricular systolic dysfunction. Some of the common causes for decreased left ventricular stenosis include that of, CAD, systemic hypertension, and aortic stenosis. CAD by diminishing the oxygen supply to the myofibrils decreases contractility. Hypertension causes the left ventricle to contract more with more force to eject blood into the aorta. (Monaha n, F, Sands, J, Neighbours, M, Marek, J.F, 2007) Over a period of time hypertrophy of the muscle fibres happens and an increase in myocardial oxygen consumption occurs. Aortic stenosis, the left ventricle must increase its pumping force to deliver blood through the tight valve. Heart failure will be the result when the hearts need of oxygen cannot be met and blood remains at the end of systole. (Mccance, K, Huether, S.E, Brashers, V.L, Rote, N.S, 2010,) CLINICAL MANIFESTATIONS OF CONGESTIVE HEART FAILURE As stated in Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007, Page 814, the clinical manifestations of heart failure occur secondary to elevated filing pressure and tissue hyperfusion Clinical manifestations of congestive heart failure can be broken down into the systems in which they affect the respiratory, cardiovascular, gastrointestinal systems and show effects in both cerebral and psychosocial. Clinical manifestations in respiratory are, dyspnoea, orthopnea, a persistent cough, crackles in the lungs. The cardiovascular system is affected by, the onset of angina, tachycardia, increase of systolic blood pressure and an increase in systolic blood pressure. Gastrointestinal clinical manifestations include that of, enlargement of the right upper quadrant of the abdomen, nausea and vomiting, pain in the epigastric region, anorexia and bloating. Confusion and restlessness can be seen as manifestations of cerebral, and anxiety is associated with manifestations to psychosocial. Generalised manifestations include oedema; either pitting or peripheral, weight gain and fatigue. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), (Mccance, K, Huether, S.E, Brashers, V.L, Rote, N.S, 2010,), (Better Health Channel, 2010) NURSING ASSESSMENT OF MR. TOSCANA For Mr. Toscana a variety of nursing assessments will be done upon admission. As well as the usual monitoring of vital signs, assessments such as, head to toe, physical and systems assessments, need to be completed. A head to toe assessment will be performed to give a detail initial assessment studying the whole body to see if there is any other factors that may cause harm or pain, in a head to toe assessment circulatory problems, pressure areas, existing wounds, can all be seen as well as gaining an in depth assessment of the skin. A physical assessment will be done on Mr. Toscana will also be performed, a physical assessment includes, inspection; which is the visual inspection of a person, palpation; the examination done by touch, auscultation; a form of examination by listening to the sounds made by the body (heart, lung and bowel), percussion; the examination done by tapping, percussion is done to listen for abnormal sounds and detect issue (Berm an, A, Kozier, B, Erb, G.L, 2008,). A systems assessment of Mr. Toscana will be beneficial because, along with the other forms of assessment a systems will be able to give a base mark of where he is, a systems assessment covers, central nervous (CNS), cardiovascular (CVS) assesses, respiratory (RESP), gastrointestinal (GIT), renal (RENAL), skin integrity (SKIN), and psychosocial (PSYCH). Together these forms assessment will provide a detailed amount of information to create a nursing care plan for Mr. Toscana, including interventions that need to be made, and things to implement to further his recovery and aid in his discharge. (Berman, A, Kozier, B, Erb, G.L, 2008,). NURSING CARE PLAN Please refer to appendices one for full nursing care plan. (Berman, A, Kozier, B, Erb, G.L, 2008,). (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), (Heart Foundation, 2010), (Holmesglen, 2009), (Better Health Channel, 2010) DIAGNOSTIC TESTS For Mr. Toscana there are a number of diagnostic tests that will help with the assessment, management and detection of underlying issues. Tests that can be performed on Mr. Toscana are as follows, a chest X-ray to see if there are any problems with his lungs, or vascular congestion, or congestion of the liver (this can suggest right sided failure) (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), a full blood test including electrolytes, an ECG to check the rhythm of the heart, and determine the causes for Mr. Toscanas symptoms. The use of urine analysis to see if infection is present, function of kidneys, traces of blood in relation to fluid build up. The combination of these tests will provide a baseline for assessment, guide the nursing care, and rule out all other possible causes of the symptoms that Mr. Toscana has presented with. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) RISK ASSESMENT From the history of Mr. Toscana a risk assessment can be done. Assessments such as falls, and pressure care. A falls risk assessment will be done on Mr. Toscana to determine the risk he is of falling, and if further measures need to be implemented to insure that he is safe while in hospital, a suitable framework for a falls risk is the FRAT tool, (Falls Risk Assessment Tool), (Department Of Human Services Victoria, 2005) a FRAT tool will show the level of risk that Mr. Toscana is, and risk factors. A pressure area risk check can be done by using the Braden risk assessment tool (Berman, A, Kozier, B, Erb, G.L, 2008,), (South Australia Health, Date Unknown). this will help minimise the risk of Mr. Toscana developing pressure areas where possible. Things at home can also be deemed a risk, things such as; not being compliant with his medications can lead to poor health, and stress can all affect his general wellbeing and lead to further the progression of medical condition s. EDUCATION AND PSYCHOSOCIAL SUPPORT For Mr. Toscana education is a must, education about the maintenance of his congestive heart failure, about the importance of taking medication on a regular basis. How to manage the affects of his congestive cardiac failure, and avoid the effects, support for Mr. Toscana is also imperative to aid in his recovery things such as providing strategies to minimise the health problems, referral to a social worker to help with issues that are affecting him at home. Support groups set up by the heart foundation of Victoria will help with the emotional issues related to having this condition. (Heart Foundation, 2010) The importance of education and psychosocial support will be seen through less medical admissions or problems, increased quality of life and will give Mr. Toscana the ability to be able to deal with small problems before they grow into something much bigger. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) , (Berman, A, Kozier, B, Erb, G. L, 2008,) (Better Health Channel, 2010) MEDICATIONS Mr. Toscana is taking a number of medications including, warfarin and digoxin. The action of Digoxin is, it increase the myocardial contraction force in the failing heart, decreases conductivity of the heart in particular the A-V node, increase on vagal activity this results in the slowing of the sinoatrial nodal rate, increases myocardial excitability this can result in ectopic beats this happens mostly through high doses of digoxin, oral digoxin effective in an approximate time frame of 1 hour, maximal effect is reached between four and six hours. The use of digoxin for Mr. Toscana is, to treat his congestive heart failure. Digoxin may produce a false ST-T wave change on an ECG if tested during exercise. Digoxin can cause the following adverse effects, gastrointestinal issues including, anorexia, nausea, vomiting, diarrhoea, and pain in the abdomen. Cardiovascular effects, ectopic beats, bradycardia, heart block. Tachycardia (ventricular). The adverse effect of toxicity is a decrease on appetite, nausea, vomiting, diarrhoea, severe stomach pains, weakness and tiredness, a slow and irregular heartbeat, blurred vision, drowsiness, mental depression or confusion, fainting and headaches. Nursing points/precautions which should be followed are that the tablet should never be halved; neither IM nor SC routes are recommended due to unpredictable absorption, because prolonged or intense pain and necrosis of the muscle to the client (Intramuscular), severe irritation may occur when given via a subcutaneous injection. A rapid IV administration should be avoided as it may cause hypertension and vasoconstriction. The action of warfarin is a suppressant of vitamin-K dependant synthesis of prothrombin in the liver, this prevents the extension of a clot that is already established of the formation of a new one, warfarin has an anticoagulant effect that is produced after 36-72 hours and can persist for between 4 and 5 days after the discontinuation of therapy. Th e use of warfarin is, as a prevention and management of the following, deep vein thrombosis (DVT) or pulmonary embolism, thromboembolism in atrial fibrillation, and can be used as an adjunct to therapy for coronary occlusion. For Mr. Toscana there is no relevant interaction with this drug. The adverse effects of warfarin are fatal or non fatal bleeding, nausea, vomiting, diarrhoea, alopecia, fever, hypersensitivity reaction, an overdose is seen by bleeding from the gums and haematuria, in rare cases skin necrosis is also seen. Some of the nursing points and precautions with warfarin are, that all intramuscular injections be avoided, and subcutaneous injection sites should be closely monitored for haematoma, make sure that the does is given the same time daily to Mr. Toscana, observation for the early signs of overdose things such bleeding especially important from the gums.( Tiziani, A, 2010) CONCLUSION Through a range of assessments, diagnostic testing, education and the development of a nursing care plan Mr. Toscanas condition should improve as well as his general wellbeing. Goals set out in the care plan will be achieved by interventions put in place insuring a quicker recovery for Mr. Toscana. Education is particularly important for Mr. Toscanas medication regime, support strategies will help with the improvement of overall health and wellbeing.

At the back of the stage

The most prestigious event in the town where I considered being one of my most unforgettable moments in life because it's like a dream came true. Before, I'm Just an audience who dreamed to be part of the show who ramp at the stage watched by my own fellow Jimenez. But it's my fortune to be given a chance to be one of them. At the start I hesitate because it's my first time to ramp at the stage crowded by a lot of people, but I hanged my mind because I told to myself why not try it?There is nothing to lose of trying right? As long as we enjoy and we love what we do. Someone will say, how came that the Search for b. Jimenez 2014 is one of my unforgettable moment if I didn't made it to the top 5? Well, getting the Crown is not all that matter but what matters most is the learning, the experienced, the friendship we build with all the staff and the memories that I will treasured for the rest of my life. Not all of us had even a chance to be part of that prestigious event.So, win or lost that moment will still marked an important part of the piece of my heart and soul. In every competition it is not Just the Crown, the medals, or any awards that matters but it Is for us how we accept things without any regrets, because we all know within ourselves that we did our best and accept the fact that In every competition from small to the biggest one there will always be a winner and there Is always be a loser, Loser In the eyes of everyone but a winner for themselves.

AP history Yanamamo tribe

The Yeoman's diet consists of meat, fish, bananas, and fruits that are gathered. Each family is given a plot of land to garden. Bananas, plantains, sugarcane, mangoes, sweet potatoes, papayas, manioc, and corn are Just some of the crops that are grown. The Yeoman's are one of the last groups of people to practice Polygamy, or when a marriage consists of more than two people. In the Yeoman culture, a woman is in charge of all the domestic duties, chores, and taking care of the children. Basket weaving is a skill that the women of the tribe have perfected.These baskets are used for carrying and storing food. Yeoman children are to help their mothers with the day to day activities. At the age of eight, young boys begin to watch over the male members and learn the duties of a man in the Yeoman community. The language that Is spoken is comprised of four main languages, Yang, Sauna, Homonym and Yeoman. The Yeoman culture Is described as being filled with violence. The Womanly people have a history of acting violently towards other tribes, and each other. They are known to raid nearby villages, and Diana women and children.Violence Is one of the leading causes of Womanly death. Most of Yeoman males die violent deaths In constant conflict between neighboring tribes (Unknown, normally Indians of Brazil†). In the past, the Yeoman have generally attacked Europeans settlers that are Invading their land. This culture had remained almost completely Isolated from outside Influence until the twentieth century. In the asses, several missionaries came to the Womanly territory. With them they brought an abundance of Western goods, medical retirement, and offering to open up schools to the Womanly.Although with many promises to better their culture, the Womanly refused the westernizes and the missionaries failed to convert any of the Womanly people. This was Just one of the many challenges the Indigenous culture has faced from the Invasion of Western society. Although their population Is slowly decreasing, the Womanly people have been able to mammalian their Orlando way of life. AP history Yeoman tribe By Chelsea-Gerard community. The language that is spoken is comprised of four main languages, Yang, Sauna, Homonym and Yeoman.The Yeoman culture is described as being filled with violence. The Yeoman people have a history of acting violently kidnap women and children. Violence is one of the leading causes of Yeoman death. Most of Yeoman males die violent deaths in constant conflict between neighboring tribes (Unknown, ammonia Indians of Brazil†). In the past, the Yeoman have generally attacked Europeans settlers that are invading their land. This culture had remained almost completely isolated from outside influence until he twentieth century.In the asses, several missionaries came to the Yeoman treatment, and offering to open up schools to the Yeoman. Although with many promises to better their culture, the Yeoman refused the westernizes and the m issionaries failed to convert any of the Yeoman people. This was Just one of the many challenges the indigenous culture has faced from the invasion of Western society. Although their population is slowly decreasing, the Yeoman people have been able to maintain their original way of life.

A Social Study Finding People Through A Lens - 2248 Words

The idea of American Romanticism originated in the early 19th century. It encompassed the revolutionary spirit America was beginning to embody, and sought to break rigid societal norms of conformity by emphasizing the individuals importance, fueled by emotion as movement, in connecting to the world in which one lived. The movement utilized various facets of art to form an identity, which produced an overwhelming appeal to an American society with contradicting mindsets prevalent in trying to form what the said identity looked like. Though perhaps a topic that could be spoke upon to no extent, the American Romantic ideal becomes certainly prevalent while considering the works of Henry David Thoreau and Edward Curtis. Both men use elements†¦show more content†¦Thoreau proposes the notion that, Some of our northern Indians eat raw the marrow of the Arctic reindeer, as well as various other parts [ . . . ] And herein, perchance, they have stolen a march on the cooks of Paris. They get what usually goes to the fire. This is probably better than stall-fed beef and slaughterhouse pork to make a man of. Give me a wilderness whose glance to civilization can endure -- as if we lived on the marrow of koodoos and devoured raw (Thoreau, Walking). The fact of the matter is that Thoreau probably never saw real Indians eating reindeer antlers, and on the same stream of ideas, never actually met or lived with real Indians. But, he surly romanticizes who they are as a people. He uses the socially constructed notion that Indians are indeed savages to make his case that in savagery one is actually living. Thoreau is critiquing the â€Å"born with a silver spoon† society all around him, saying that to eat a raw animal makes more of a man than to eat an animal killed at a slaughterhouse, as a refined and civilized person would do. But, then again Thoreau despised the idea of etiquette. 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