Heart Failure Case Study

Heart Failure Case Study Sharon Heather Ferguson-Guy When it comes to Heart Failure the best form for a brighter future is to optimise the intervention with treatment goals that are vital for the patients’ health, well-being and gain a better chance of longevity. The benefits of obtaining a compatible medication treatment goal for the patient, is so to reduce the stress and anxiety for the patient, which in turn can minimise hospital admissions. Anyone that has other cardiovascular risks such as diabetes, smoking, excessive alcohol (with young adults; with excessive alcohol consumption, they may be susceptible to ‘holiday heart syndrome’ which it is also known as) (Sanders, et al. 2012, p.628) and elevated blood cholesterol levels. The following case study was given freely from a neighbour on his present health. I have changed his name to protect his confidentiality. Case study: Mr Lloyd is a 73 years old widower and has heart failure in the form of Atrial Fibrillation. He started to become breathless after riding his bike; that he did daily. He said that he also noticed excitable flutters in his chest, but did not take much notice as he thought it was because he had over exerted on an activity at his time of life and put it down to the aging process. He popped to his local General Practitioner with his experiences and was put on a low dose of Warfarin. After a couple of weeks he returned and told his General Practitioner that he was not feeling any better and did not feel right. His General Practitioner told him to continue his dosage for another week. Mr Lloyd enjoyed walking if he was not cycling, but, due to the weather he left the bike at home. While on his way he slipped on ice and banged his head on the pavement. He was taken to hospital for the rest of the day due to a possible concussion. At the point of leaving he complained he still had a headache. The doctor was not surprised as he had banged his head and prescribed pain relief and told him what to watch out for with head injuries (They were aware of his medication he was on at the time). After a week of pain relief he still did not feel right. His daughter took him to a different hospital. The doctor asked what medication he was on and told him that he was on still on the warfarin, they took him off it immediately, and replaced with a very low dose of aspirin. They immediately took him for a MRI (magnetic resonance imaging) scan that revealed that he had a haemorrhage on the brain; it had been there since the fall. History: There is not a family history of heart failure. Has not smoked for 50 years. Does not have any previous illnesses. Has never drank alcohol. Has worked away from home outdoors all of his working life until retirement. Admitted that his diet improved since his retirement, as with his previous job required him to be away from home quite a lot of the time and so his lifestyle then contained of hotels and bar meals. Has never been a big eater and portions were always small. Signs and symptoms: Feeling breathless on light activities, more so when cycling Feeling weak and more tired Dizzy after excursion Pale but not all the time. No sickness Heart beating too fast, rhythm was irregular No coughing Not confusion No weight gain as always active BP normal No depressive feelings or cognitive problems Tests done: Auscultated lungs for changes – non were found Blood test was taken Blood Pressure – high on his visit, but often fluctuated between normal and high Neck veins checked – no distension found ECG that read Atrial Fibrillation Electrocardiogram was performed for 24 hours No chest x-ray was performed Pitting oedema was slight at the end of the day Medication before fall: Warfarin – was later changed to Aspirin Salbutamol inhaler Furosemide (unable to remember dose) Cod liver oil 2 spoonful’s twice a day – home remedies (On further reading on drugs.com I was curious regarding his cod liver oil intake and the medication of warfarin he was taking that may interact due to it containing vitamin K, this reduces the effectiveness of the warfarin and flagged an air of caution) (drugs.com) Mr Lloyd still suffered tiredness and breathlessness. Medication after fall for 4 months: Aspirin Cod liver oil 2 capsules twice a day – home remedies Pravastatin 20mg – 1 daily (reduces the bad cholesterol) Salbutamol – when required Simvastatin 20mg – 1 daily (changed from pravastatin also reduces bad cholesterol) Spiro inhaler – when required (drugs.com) Mr Lloyd was told to weigh himself every morning as he got out of bed. This was so he could take part in his own progress on any weight gain or weight loss due to the change of medication and possible fluid retention. He noticed the frequency during the day and maybe once at night in going to urinate. With the changed medication Mr Lloyd still suffered tiredness and was breathlessness on light activities. After a review with a specialist his present medication treatment plan is: Apixaban 5mg – 1 x 2 daily (reduce the risk of stroke clots) Atorvastatin 10mg – 1 daily Cod liver oil 2 capsules daily home remedies (not spoonful’s anymore) Digoxin 125mcg – 1 daily (makes the heart beat stronger and a regular rhythm) Dutasteride 0.5mg – 1 daily (used with Tamsulosin, reduce risk of urinary blockage) Omerprazole 20mg – 1 daily (acid reflux) Spiro inhaler – when required Tamsulosin hydrochloride 400mcg m/r capsules 1 daily– muscle relaxant, ease flow of urine (drugs.com) This drug therapy is working well and clear from any adverse reactions and only visits the General Practitioner twice yearly. Blood pressure is stable at 110/75 bpm. His weight has not changed. Mr Lloyd still charts his input and output of fluids. With this, he is able to monitor and report to his now General Practitioner any noticeable differences, to which, there is not any. Current status: Even though Mr Lloyd had to endure some frustrating discomfort with tiredness and breathlessness from past medications, these just didn’t suit him, (It may have been a perfect combination for somebody else) and the time it had to take to get the correct treatment goals and drug therapy to his own body’s balance, Mr Lloyd is continuing his everyday activities without any problems of breathlessness or tiredness that have hugely decreased. He has decided with himself and with agreement from his General Practitioner that after about 17.00 he will start to slow down, and relaxes after food, and will potter in his garden instead of cycling. I have only ever known Mr Lloyd to cycle everywhere and all day. He tells me that he now enjoys seeing a television programme to the end instead of falling asleep half way through. His medication has slowed down his ventricular rate and that he will go for another review later on this year. Mr Lloyd said that he would not mind if the dose was lowered or none at all as he does not like to be reliant on medication. The specialist Doctor after reviewing Mr Lloyd advised him to attend a rehabilitation gym (sponsored by the British Heart Foundation) to monitor his exercise regime and to teach him how to keep fit in a healthy way for his age. They also educated him on a tasteful diet without the worry of blandness. He still goes to the gym, mainly because he has made many friends with similar conditions, and able to swap ideas. Mr Lloyd values the presence of the professional medical staff that are there for any health or heart concerns. Treating congestive heart failure with medication: To optimise the correct and suitable medication would be to find the patients correct balance. This will take a selection of medication over a period of time in order to reach the optimum goal of drug therapy. The reason for this is to make less strain on the heart by using the correct combination of drug and its correct dosage. We must try and increase the cardiac output so the blood can pump more blood every minute. This will in turn improve the pumping action of the heart and reduce the hearts workload. So medication or a medical intervention may be suggested, the severity or damage would be taken into consideration. If there is a valve problem, it may be fixed with a repair or a replacement. If a more invasive form of fixing is needed, surgical implants may be required. This may be a pacemaker. This is a ventricular assisted device that contains a pulse generator with one, two or three electrode leads that give off electrical impulses to and from the heart (British Heart Foundati on 2014, p.13)(Cleland 2006, pp.72-44). A more severe case may include a heart transplant which includes a recently deceased donor that is a match for the recipient. There are risks involved like any other surgery, but a heart transplant may be rejected due to rejection, infection or the new heart does not work properly. (Cleland 2006, pp.79-80) We need to take the effort off the workload on the heart by decreasing the fluid overload and reduce the blood pressure, so medication to reduce the heart rate and increase vasodilation (widen the blood vessels, by relaxing the smooth muscle cells). Diuretics would be one solution that would help with the fluid overload. This will increase the urine output and so in turn decreases the fluid overload. Different diuretics such as thiazide and loop diuretics that will cause a general loss of sodium and water from the body but also other electrolytes (minerals in the blood). This must be monitored for hypokalaemia (low potassium) because of sodium and water loss, potassium can be lost from the body in large quantities. (Cleland 2006, pp.54-63)(Class notes 2014/15) Another diuretic is a potassium sparing diuretic, it is an aldosterone antagonist (blocks the sodium retention effects of aldosterone in the kidney). This may cause a reverse problem, the potassium sparing diuretic can cause the body to retain too much potassium, so the patient must be monitored for hyperkalaemia (high potassium). An imbalance of hypokalaemia or hyperkalaemia in the body will be a risk of the electrical problems in the heart. By using diuretics the patient will be monitored for hypotension (low blood pressure) this is due to the fluid retention and the reduction of blood pressure medication. You must also monitor serum creatinine (waste product in the blood that comes from muscle activity and kidney function indicator). If the levels of this get too high, it will be an indication that the kidneys are having problems. (Class notes 2014/15)(Cleland 2006, pp.59-63) Other medications that will be help congested heart failure is to now focus on the blood vessels, the aim is to stimulate the function of the vasodilation that will rest the heart by slowing it down. The most used medication is called an ACE inhibitors (Angiotensin-converting enzyme) (Cleland 2006, pp.53-56) this will block the enzyme that forms angiotensin II also known as ARBs (angiotensin receptor blockers) (Cleland 2006, pp.56-57) this causes the vasoconstriction to raise the blood pressure. The ACE inhibitor will interrupt the cycle of angiotensin II, this will then decrease the blood pressure. The increase of vasodilation with the ACE inhibitors and vasodilation will lower the blood pressure and so helps to reduce the workload on the heart. There will be a drop in aldosterone (is a corticosteroid hormone that stimulates absorption of sodium by the kidneys) levels causing a decrease in fluid overload. A medication called ARBS (Angiotensin Receptor Blockers) reduce the activity of the angiotensin II in the blood. You would prescribe this if the patient is not able to tolerate an ACE inhibitor. (Class notes)(Cleland 2006, pp.56) Beta blockers block the binding of norepinephrine (neurotransmitter) to the beta receptors on the heart, this will cause a decrease in the heart rate. Which in turn will decrease the blood pressure and the workload of the heart. With such an amount of medication, it is advisable to monitor the patient for hypotension. (Class notes 2014/15)(Cleland 2006, pp.57-59) References: Bibliography British Heart Foundation (2014) Pacemakers. Chronic heart failure | introduction | Guidance and guidelines (no date) Available at: http://www.nice.org.uk/guidance/cg108/chapter/introduction (Accessed: 13 May 2015) Cleland, J. (2006) Understanding heart failure. London: Family Doctor Publications in association with the British Medical Association Prescription Drug Information, Interactions Side Effects (no date) Available at: http://www.drugs.com (Accessed: 14 May 2015) Sanders, M. J., Lewis, L. M., Quick, G. and McKenna, K. D. (2012) Mosby’s Paramedic Textbook [With DVD]. 4th edn. United States: Elsevier/Mosby Jems Citation (Chronic heart failure | introduction | Guidance and guidelines, no date) (Prescription Drug Information, Interactions Side Effects, no date) (Sanders et al., 2012, p. 628) (British Heart Foundation, 2014, p. 13) (Cleland, 2006, p. 56) (Cleland, 2006, pp. 57 – 59) (Cleland, 2006, pp. 57 – 59) (Cleland, 2006, pp. 56 – 57) (Cleland, 2006, pp. 53 – 56) (Cleland, 2006, pp. 59 – 63) (Cleland, 2006, pp. 54 – 63) (Cleland, 2006, pp. 79 – 80) (Cleland, 2006, pp. 72 – 74) Case study given freely by my neighbour. Font used – Calibri light. Size 11. Size 9 for references My draft copy was kindly read and checked by: The Clinical Manager and three different Clinical Supervisors at Yorkshire Ambulance Service.

Multicultural Educational System Essay -- Multiculturalism Education C

Multicultural Educational System Historically, The United States has been a racially and ethnically a diverse nation. Since Americans represent a variety of cultures and have a variety of viewpoints, we share many cultural traditions, values, and political ideals that cement us together as a nation. Children can develop their ideas and their identity at early stages in schools. Education should stress the value of diversity and avoid portraying one culture or group as superior to others. A multicultural educational system would not only educate the students in a classroom, but also enrich the teacher and society. The definition of multiculturalism is education that focuses on providing equal opportunity for students who’s cultural or language patterns make it difficult for them to succeed in traditional programs. (Oxford) Some discuss multicultural education as a shift in curriculum, perhaps as simple as adding new and diverse materials and perspectives to be more inclusive of traditionally underrepresented groups. Others talk about classroom climate issues or teaching styles that serve certain groups while presenting barriers for others. Still others focus on institutional and systemic issues such as tracking, standardized testing, or funding discrepancies. Some go farther still, insisting on education change as part of a larger societal transformation in which we more closely explore and criticize the oppressive foundations of society and how education serves to maintain the foundations such as white supremacy, capitalism, global socioeconomic situations, and exploitation. The melting pot theory is the Americanization process brought about by teaching everybody English and American social ideals from European Ethnic Cu... ... 30, 2004 Levine, Daniel U. (1997) Foundations of Education, Education in Culturally Diverse Society. Pages 159-170, 535. Houghton Mifflin Company, Boston Meacham, Jack (2003) Student Diversity in classes and Educational Outcomes: Student Perceptions, Pages 627 retrieved from Eric Journal September 30, 2004 Ryan, Francis. (1993) The Perils of Multiculturalism, Educational Horizons, spring, pgs 134-138 Sternberg, Robert J. (2002) Educational Psychology, Group Differences, The Big Picture. Pages 191-225 Allyn and Bacon, Boston. Shorter Oxford English dictionary (5th ed.). (2002). New York: Oxford University Press. Viadero, D. Increased choice found to have modest impact on school improvement. Edweek. Retrieved Nov 7,2004 from Edweek.com Watkins, William. (1994) Multicultural Education... Educational Theory, v. 44, no. 1, winter, esp. pp. 99-110

Corporate Responsibility and Society Essay

While commuting home from work, you take a detour through a residential area to avoid a congested main artery. Because only a few drivers take the detour, it removes several minutes from your commuting time due to the light traffic. Is your action generalizable? I do believe that my actions would be generalizable; therefore it would not pass the generalization test. According to Hooker, the meaning of generalization test is that the reason for your action should be consistent with the assumption that if everyone who has the same reason as you would act in the same manner (Business Ethics, 2011). The detour is not an area that is not allowed to be taken; it is there for anyone to take despite of the reason for taking it. Anyone that wanted to cut down their commute time in order to pick up a child from daycare, to get to school on time, to prepare dinner, or just because they no longer wanted to sit in traffic is irrelevant to the fact that they are able to take this route. In order to further put this generalization to the test we should see if it meets and passes all four Corollaries’. Corollary one states that an action is unethical if its general adoption would undermine a practice it presupposes. So everyone is free to take this detour through a residential neighborhood. Suppose everyone decided to take this detour, it would congest this neighborhood, children that normally ride their bikes on the side of the rode or play outdoors are more apt to being either hit by a car or injured by a vehicle in some way. This may pass the corollary test but it fails the generalization test. Corollary two states one shouldn’t be a free rider on the efforts of others. This corollary really doesn’t affect this example because every driver is free to make up his or her mind whether or not to take the detour. So this would pass corollary two. Corollary three states an action is unethical if generalizing the action is inconsistent with achieving its purpose. This actions is telling me that I take the detour when is best suites me, i.e. traffic is at its heaviest and I can achieve a shorter time commute by taking the detour. This action is then generalized when everyone who takes the regular congested route takes the detour when it best suites them. Thus my action of taking the detour is generalized, it would be impossible for those who take the detour when it best suites them to achieve the purpose of the action because the new detour would become congested and we are back to where we started. This action fails corollary three and the generalization test. Last but not least Corollary four states that an action is unethical if generalizing the action is inconsistent with the possibility that everyone who performs the action achieves its purpose. If this action is true then me taking the detour is ungeneralizable because it is impossible for everyone to enjoy the same avoidance of traffic congestion by taking the same detour. After completing all four Corollary test I have come to the conclusion that my action to avoid traffic by detouring through a residential area is ungeneralizable. Although my action may have passed a corollary test or two my action ultimately did not justify the action.

How Strong Is the Louisiana Superdome Roof

In August 2005, the Louisiana Superdome became a shelter of last resort as Hurricane Katrina set sights on New Orleans. Although 30 years old and built in a floodplain, the structure stood firm and saved the lives of thousands of people. How strong is  the Louisiana Superdome? Fast Facts: New Orleans' Superdome Construction: August 1971 to August 1975Land space: 52 acres (210,000 square meters)Area of roof: 9.7 acres (440,000 square feet)Height: 273 feet (82.3 meters)Dome diameter: 680 feet (210 meters)Main arena floor: 162,434 square feetMaximum seating: 73,208UBU  synthetic turf: 60,000 square feetCost (1971–1975): $134 million; Post-Katrina renovations and enhancements: $336 millionFun Fact: Host of more Super Bowls than any other stadium Building the Superdome The Superdome, also known as Mercedes-Benz Superdome, is a public/private New Orleans, Louisiana (NOLA), project designed by New Orleans native Nathaniel Buster Curtis (1917–1997) of Curtis Davis Architects. The contractors were Huber, Hunt Nichols. A domed structure is not a new idea—the concrete dome of the Pantheon in Rome has provided shelter for the gods since the second century. The 1975 Louisiana Superdome was not even the first large-domed sports arena to be built in the U.S.; the 1965 Houston Astrodome in Texas provided nearly a decades worth of experience for the NOLA architects. The design mistakes of the Astrodome would not be repeated. The new NOLA dome would not include skylight glare to impede the vision of the players below it. The Superdome would not even try to grow grass inside. Many sports stadia have playing fields below ground level, which allows the buildings height to be modest on the outside. A good example is the 2010 Meadowlands Stadium in New Jersey, whose exterior facade disguises the lower location of the field below ground level. This type of stadium design would not work in the flood-prone Mississippi River Delta. Because of a high water table, the 1975 Louisiana Superdome in New Orleans was built on a platform atop a three-story underground parking garage. Thousands of concrete pilings hold the steel frame exterior, with an additional tension ring to hold the weight of the enormous domed roof.  The diamond-shaped steel framework of the dome was placed onto the ring support all in one piece. Architect Nathaniel Curtis explained in 2002: This ring, capable of withstanding the massive thrusts of the dome structure, is made of 1-1/2-inch-thick steel and prefabricated in 24 sections that were welded together 469 feet in the air. Because the strength of the welds is critical to the strength of the tension ring, they were performed by a specially trained and qualified welder in the semicontrolled atmosphere of a tent house which was moved around the rim of the building from one weld to another. Each individual weld was x-rayed to ensure the perfection of the vital joints. On 12 June 1973, the entire roof, weighing 5,000 tons, was jacked down onto the tension ring in one of the most delicate and critical operations of the whole construction process. The Superdome Roof The Superdome roof is nearly 10 acres in area. It has been described as the worlds largest domed structure (measuring the interior floor area). Fixed dome construction fell from popularity in the 1990s, and several other domed stadiums have closed. The 1975 Superdome has survived its engineering.  The Superdomes roof system consists of 18-gauge sheet-steel panels laid down over the structural steel, writes architect Curtis. On top of this is polyurethane foam one inch thick, and finally, a sprayed-on layer of Hypalon plastic. Hypalon  was a state-of-the-art weatherproofing rubber material by Dupont. Cranes and helicopters helped place the steel panels in place, and it took another 162 days to spray on the Hypalon coating. The Louisiana Superdome was designed to resist wind gusts up to 200 miles per hour. However, in August 2005, Hurricane Katrinas 145 mph winds blew away two metal sections of the Superdome roof while more than 10,000 people sought shelter inside. Although many hurricane victims were frightened, the architecture remained structurally sound in part because of a 75-ton media center hanging from the roofs interior. This gondola of televisions is designed to act as a counterweight, and it kept the entire roof in place during the storm. The roof did not collapse or blow away. Post-Katrina Louisiana Superdome, August 30, 2005. Dave Einsel/Getty Images (cropped) Although people got wet and the roof needed repair, the Superdome remained structurally sound. Many victims of the hurricane were transported to Reliant Park in Houston, Texas, for temporary shelter in the Astrodome. The Superdome Reborn Prepping for Repair, Louisiana Superdome Roof, October 19, 2005. Chris Graythen/Getty Images (cropped) Soon after the hurricane survivors left the shelter of the Louisiana Superdome, the roof damage was assessed and repaired. Thousands of tons of debris were removed and several upgrades were made. Ten thousand pieces of metal decking were examined or installed, coated with inches of polyurethane foam  and then several layers of urethane coating. In 13 short months, the Louisiana Superdome reopened to remain one of the most advanced sports facilities in the nation. The Superdome roof has become an icon of the city of New Orleans, and, like any structure, is the source of continual care and maintenance. Repairing the Louisiana Superdome, May 9, 2006. Mario Tama/Getty Images (cropped) Sources Karen Kingsley, Curtis and Davis Architects, knowlouisiana.org Encyclopedia of Louisiana, edited by David Johnson, Louisiana Endowment for the Humanities, March 11, 2011, http://www.knowlouisiana.org/entry/curtis-and-davis-architects. [accessed March 15, 2018]Nathaniel Curtis,  FAIA,  My Life In Modern Architecture, The University of New Orleans, New Orleans, Louisiana, 2002, pp. 40, 43, http://www.curtis.uno.edu/curtis/html/frameset.html [accessed May 1, 2016]National Register of Historic Places Registration Form (OMB No. 1024-0018) prepared by Phil Boggan, State Historic Preservation Officer, December 7, 2015, https://www.nps.gov/nr/feature/places/pdfs/15001004.pdfSuper Bowl Press Kit February  3, 2013, www.superdome.com/uploads/SUPERDOMEMEDIAKIT_12113_SB.pdf [accessed January 27, 2013]Mercedes-Benz Superdome Renovations, http://www.aecom.com/projects/mercedes-benz-superdome-renovations/ [accessed March 15, 2018]Kim Bistromowitz and Jon Henson, Superdome, Super Roof,Roofing C ontractor, February 9, 2015, https://www.roofingcontractor.com/articles/90791-superdome-super-roof-iconic-mercedes-benz-superdome-in-new-orleans-sports-its-brightest-look-yetAdditional photo credits: Meadowlands interior LI-Aerial/Getty Images; Meadowlands exterior Gabriel Argudo Jr, gargudojr on flickr.com, Creative Commons 2.0 Generic (CC BY 2.0)