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DISCUSSION # 1
Hypertension remains one of the most chronic conditions that primary care providers manage. In the United States, approximately 45.6% of adults have hypertension (Arcangelo et al., 2017). Many adults are unaware that they have hypertension because hypertensive patients usually are asymptomatic. Hypertension increases the risks of developing other chronic conditions such as cardiovascular disease and chronic kidney disease. The goals for hypertension are to manage blood pressure, and reduce cardiovascular events such as stroke, myocardial infarction, and prevent renal disease. The average adult’s blood pressure range is systolic <120 and diastolic <80 ( Arcangelo et al., 2017). Parameters fluctuate when underlying conditions are present. Treatment guidelines are dependent on the presence of underlying comorbidities, race and age. There are many different antihypertensive drug treatments which can be used alone or in combination to achieve therapeutic management of hypertension. Different drug classes are used in the management of hypertension such as diuretics, beta blockers, ACE inhibitors, angiotensin 2 receptor blockers, renin inhibitors, calcium channel blockers, peripheral alpha 1 receptors, central alpha 2 receptor blockers agonists, and direct vasodilators. When initiating the most appropriate antihypertensive drug treatment prescribers must consider a patients age, race, underline comorbidities and current medications (Arcangelo et al., 2017).
Describe types of arrhythmias and their treatment
Arrhythmias arise from either below or above the ventricles (Arcangelo et al., 2017). They can be regular or irregular and tachycardia or bradycardia may be present. Supraventricular arrhythmias develop in the atria, SA node, or AV node, which occur above the ventricles. AV node arrhythmias result from delayed or absent SA node conduction to the AV node. These types of arrhythmias are typically non life threatening but have the potential to cause reduced cardiac output, which could lead to problems. Arrhythmias that occur below the ventricles originate within the ventricle or the bundle of hiss. These types of arrhythmias require immediate intervention and are life threatening. Before initiating any treatment, a thorough assessment and investigation of identifying treatable conditions that could be causing arrhythmias is and remains the priority. Treatable conditions that could be causing arrhythmias include electrolyte imbalances, drug overdoses, drug interactions with other medications,, herbal supplements thyroid disorders, metabolic acidosis renal failure, myocardial infarction, pulmonary embolism, hypoxemia, and congenital defects in the heart. Arcangelo et al. (2017) report that over the past several decades, the treatment approach for arrhythmias has shied away from the use of antiarrhythmic drugs and has moved toward the use of nonpharmacological therapies. This shift away from the use of antiarrhythmic drugs is due to the Cardiac Arrhythmic Suppression Trial or CAST , increase clinical evidence supporting nonpharmaceutical strategies, and evidence showing in trials and studies that rhythm control regimen has no benefit over rate control regimen. Nonpharmacological treatments include radio frequency catheter ablation, which terminates the focal area of occurrence and implantable cardioverter defibrillators. However, once a diagnosis of an arrhythmia has been established that requires drug therapy the appropriate agents must be chosen. Antiarrhythmic drugs include classes I though IV, digoxin, adenosine, and atropine. The goals when treating arrhythmias with antiarrhythmic medication include relieving acute episodes of irregular rhythms, establish a sinus rhythm, and the last goal is to prevent further episodes of arrhythmias. When selecting the most appropriate agent to treat an arrhythmia disorder the practitioner must determine how urgent the treatment is needed. Some patients, such as symptomatic patients, require more urgent treatment, whereas asymptomatic patients may not (Arcangelo et al., 2017).
Discuss Atrial Fibrillation
Atrial fibrillation is a type of arrhythmia that is characterized by loss of coordination of electrical and mechanical activity in the Atria (Arcangelo et al., 2017). Symptoms that are associated with atrial fibrillation include chest pain or discomfort, shortness of breath, palpitations, fatigue, dizziness, hypotension, and syncope. During a physical examination, the practitioner may find irregular pulses and irregular jugular vein pulsations. A hallmark sign of atrial fibrillation is an irregularly irregular rhythm, in which an electrocardiogram can confirm the diagnosis. Atrial fibrillation can be either stable or unstable. Patients presenting with symptoms are considered hemodynamically unstable and would require urgent treatment. In comparison to an asymptomatic patient which is regarded as hemodynamically stable. Some conditions that cause atrial fibrillation include acute myocardial infarction, hypoxia, pulmonary embolism, electrolyte imbalances, drug toxicity and alcohol intoxication. Treatment for atrial fibrillation begins with identifying any treatable causes to resolve acute atrial fibrillation promptly (Arcangelo et al., 2017). The first step for treatment of atrial fibrillation is determining if the atrial fibrillation is stable or unstable. If the atrial fibrillation is stable medications to slow ventricular rate such as beta blockers is the first line of treatment that should be initiated first. Once rate is successfully controlled, rhythm control can be assessed. Patient can be considered for restoration of sinus rhythm. This can be done in a hemodynamically stable patient with either electrical, such as direct current cardioversion, or pharmacological with antiarrhythmic drugs. Current cardioversion requires sedation or anesthesia and has low risk for associated complications in contrast to pharmacological cardioversion, which places patient at risk for thromboembolic event. If atrial fibrillation is unstable an immediate direct current cardioversion is the first line of therapy. If patients continue to be symptomatic with adequate ventricular rate control or if adequate ventricular rate control cannot be achieved, antiarrhythmic drug therapy is considered to maintain sinus rhythm after conversion to sinus rhythm. The selected agent of antiarrhythmic drug is dependent on the presence of structural heart disease (Arcangelo et al., 2017).
Discuss types of anemia, causes, symptoms, and treatment options
Anemia is a condition in which there is an insufficient amount of red blood cells or hemoglobin in the blood, reducing the oxygen carrying ability for physiologic needs (Arcangelo et al., 2017). The ranges that consider a man to be anemic is a hemoglobin of less than 13 and for a woman a hemoglobin less than 12.0. The causes for anemia include blood loss, nutritional deficiency, or syndromes of malabsorption such as inflammation or malignancy, inherited as in sickle cell and thalassemia, lastly may occur from disease treatments for cancer HIV or hepatitis C. Anemia occurs due to decreased production or increased disruption of red blood cells. The classification of anemia or organize according to their pathophysiologic bases. Signs and symptoms a patient will experience with anemia include fatigue, headache, weakness, sensitivity to cold, pallor, and loss of skin tone. When diagnosing anemia, a thorough history and physical examination, including laboratory testing (Arcangelo et al., 2017). Acute post hemorrhagic anemia or chronic blood loss occur from a massive hemorrhage from a spontaneous tramatic event or a chronic bleeding ulcer. Identifying and correcting the blood loss is a priority which may include treatment of shock, restoration of blood volume, and blood transfusion (Sandhu & Singh, 2024). Sickle cell anemia is an inherited autosomal recessive disorder that is characterized by abnormal red blood cells. In many cases, it is half moon-shaped red blood cells or sickled shape. The abnormally shaped sickled red blood cells are incapable of transporting adequate nutrients to body is attributed sickle cell crisis and this occurs when the red blood cells that are abnormally shaped get stuck in the blood vessels cutting off blood supply to organs. Sickle cell crisis is extremely painful. Sickle cell crisis are brought on by stress, high altitudes, cold temperatures, fever, or infection. Management of sickle cell anemia focuses on prevention and treating any associated complications. Hydroxyurea can be used for prophylactic treatment to reduce the number of sickle cell crisis. Sickle cell management include analgesics, hydration, resolution of infection, if present. Anemia caused by diminished production of red blood cells includes iron deficiency anemia. Iron deficiency anemia is primarily prevalent in young children and women of childbearing age and is the most common nutritional deficiency worldwide. Iron deficiency anemia diagnosis is made by low hemoglobin and low iron stores. The causes of iron deficiency anemia are caused by insufficient iron intake, inadequate absorption from the GI tract, or an increased iron demand that is not being fulfilled. Laboratory testing confirmed diagnosis which include a low serum of iron and ferritin concentrations and a high total iron binding capacity. Anemia is treated with dietary supplements and iron preparations which are taken orally. Blood transfusions are sometimes indicated but are reserved for patients who are hemodynamically unstable and have signs of end organ ischemia from acute GI bleeds. Anemia of chronic renal failure is an anemia that is due to a reduction in erythropoietin production in the kidneys. Chronic kidney disease risk factors include hypertension, autoimmune diseases, African ancestry, diabetes, older age, and family history of renal disease. Treatment includes multivitamins, erythropoietin treatment, and iron supplements. Anemia of chronic disease includes thalassemia, vitamin B deficiency, folate deficiency aplastic anemia. Thalassemia is a congenital disorder of hemoglobin synthesis that comes in different forms, ranging from mild thalassemia, where patients do not require any treatment, and in contrast to more severe cases, forms are managed with blood transfusions and folate supplementation. Anemias resulting from vitamin B12 deficiency or pernicious anemia, and folate deficiencies are managed with replacement of deficiencies. Vitamin B12 is given intramuscular or deep subcutaneously due to the inability to absorb vitamin B12 from the GI tract due to lack of intrinsic factor. Folate deficiency is dependent on the dietary source furthermore replenishment of vitamin deficiencies is the mainstay for management. Aplastic anemia results from bone marrow failure, which can be inherited or developed from an injury. Diagnosis is made with lab tests such as CBC. Aplastic anemia is mainly treated with supportive care for mild cases. However, in more severe cases, a red blood cell and platelet infusion may be needed in addition to antibiotics for infections and antifungal prophylaxis for a low neutrophil count. In severe cases of aplastic anemia hematopoietic stem cell transplantation may be needed along with immunosuppression therapy (Arcangelo et al., 2017).
DISCUSSION # 2
Question 1. Describe the goals of drug therapy for hypertension and the different antihypertensive treatment.
Hypertension is increased blood pressure with a systolic value of 140 or higher and a diastolic value of 90 or higher. The goal for drug therapy is to manage hypertension, reduce cardiovascular and renal disease, and maintain therapeutic blood pressure levels (Arcangelo et al., 2017). There are pharmacological and nonpharmacological treatment plans for hypertension. Nonpharmacological methods can include maintaining appropriate body weight, dieting, restricting dietary sodium, increasing physical activity, and reducing alcohol consumption. The first line of drug therapy for hypertension are thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and calcium channel blockers. Other drugs can include beta-adrenergic blockers, alpha blockers, central agonists, direct vasodilators, and adrenergic antagonists (Arcangelo et al., 2017). It is important to know the special population considerations such as hypertension in pediatrics, the elderly, and Black people.
Question 2. Describe types of arrhythmias and their treatment.
Cardiac arrhythmias occur when the rhythm of the heart is abnormal. There are different types of arrhythmias such a tachyarrhythmia, bradyarrhythmia, supraventricular arrhythmias, AV nodal arrhythmia, and ventricular arrhythmia (O’Leary et al., 2024). Patients may be asymptomatic or symptomatic. Arrhythmias may cause palpitations, weakness, loss of consciousness, heart failure, and sudden death. Supraventricular arrhythmias evolve above the ventricles in the atria, SA node, or AV node. It may present with either tachycardia or bradycardia or with regularity or irregularity. AV nodal arrhythmia originate at or within the AV node and are caused by delayed or absent SA node conduction to the AV node. Ventricular arrhythmia originates in the ventricles or the bundle of His and may cause loss of consciousness or death. Drug therapy can include sodium channel blockers, beta blockers, potassium channel blockers, and lastly calcium channel blockers in that order (Arcangelo et al., 2017). The goals for antiarrhythmic drug therapy are to relieve the acute episode of irregular rhythm, establish sinus rhythm, and prevent further episodes of the arrhythmia. Nonpharmacologic therapies for arrhythmia can include radiofrequency catheter ablation and implantable cardioverter–defibrillators (ICDs).
Question 3. Discuss atrial fibrillation.
Atrial fibrillation is a type of cardiac arrhythmia characterized by loss of coordination of electrical and mechanical activity in the atria. Thrombi can form in the left atrial appendage due to impaired ventricular filling and incomplete emptying of the atria (Arcangelo et al., 2017). Major complications of atrial fibrillation can include stroke, heart failure, dementia, and death. Management in this condition include preventing transient ischemic attack and stroke, restoring and maintaining sinus rhythm in selected patients, and controlling the ventricular heart rate. Drug therapy includes anticoagulant medications such as apixaban (Eliquis) and warfarin. While nonpharmacologic methods can include reduction of stressors, diet, and exercise.
Question 4. Discuss types of anemia, causes, symptoms, and treatment options.
Anemia is a condition in which there is a decrease in the number of red blood cells or hemoglobin in the blood. There are different types of anemia such as sickle cell aplastic, iron-deficiency, acute posthemorrhagic, chronic renal failure, vitamin b12 (cyanocobalamin) deficiency, folate deficiency, and thalassemia. All types of anemia give patients a reduced ability to carry oxygen to meet their physiologic needs. This varies by age, sex, altitude, and pregnancy status. Causes of anemia can include blood loss, nutritional deficiency, and malabsorption syndromes (Arcangelo et al., 2017). It can occur concurrently with inflammation or malignancy and can be inherited. Patients can present with fatigue, weakness, headache, vertigo, faintness, sensitivity to cold, pallor, and loss of skin tone. Drug therapy can include corticosteroids or other medicines that suppress the immune system (Arcangelo et al., 2017). Erythropoietin, a medicine that helps your bone marrow make more blood cells, can help treat anemia. Also, supplements of iron, vitamin B12, folic acid, or other vitamins and minerals. Nonpharmacological treatment can include blood transfusions.
DISCUSSION # 3
In healthcare, nurses can use many different learning theories and principles to provide high-quality care. For example, theories may include Invitational Learning Theory, Experimental Learning, Memory/Information Processing Model, and Invitational Learning. However, I believe that the most helpful theory in providing high-quality care to clients is the Invitational Learning Theory. Simply put, Invitational Learning Theory aims to encourage a learning environment that helps individuals reach their potential. (Purkey et al., 2021) When discussing Invitational learning theory, there are five assumptions that are vital to know in order to gain understanding. These assumptions include:
Understanding that people are valuable, responsible, and able and should be treated as such.
When providing education, it should be collaborative.
Understanding that this is a process that takes time.
People have untapped potential in many areas of human endeavor.
People have potential in areas such as policies, programs, and places and in areas designed to incorporate people willing to invite themselves and others personally and professionally.
(Purkey et al., 2021)
As nurses, our goal in treatment is education. First, we must foster an environment that encourages learning. I can use an individual who was just diagnosed with Diabetes. Many times, people are not sure about the disease they were just diagnosed with and are not sure how to live with it. As Nurse practitioners, it is important that we allow a safe place that promotes education and a learning environment. Once that is established, as the nurse practitioner, we must encourage collaboration and make the patient feel a part of their care plan. When this happens, the patient will feel more confident in sticking to the plan that was established because they were not just given a plan, but they played a role in creating a plan that they can abide by. When providing Invitational learning theory, it is vital that we build a positive relationship and utilize positive language. (Hourihan, 2023) In many cases, promoting a learning environment can also be challenging if a relationship is not established. Being able to reach the patient where they are is vital as this can allow the patient to see the effort you are making to reach them. When this happens, we can now begin the education process and build on the relationship that is being established. When providing teaching, we must treat one another with respect and use positive, encouraging language that helps the patient feel safe and more prone to be involved.
To conclude, as stated earlier, many Learning Theories and principles improve the quality of healthcare. However, the Invitational Learning Theory is best suited to providing high-quality care. Using this theory will allow patients to feel like important healthcare team members. When this occurs, you can rest assured that the patient will be more inclined to follow through with the healthcare plan provided. As we develop new traits in the field of nursing, we fall into patterns that work best for us in our every process. By relying on invitational theory, I can be confident that the quality of care will be high. DISCUSSION # 4 Advanced Nurse Practitioners use many theories and practices day in and day out. This ensures that they provide their patients with the highest quality of health care.
Dorothea Orem’s self-care deficit nursing theory is one of the major foundational nursing theories. This is when it focuses on the patient’s ability to perform self-care and the nurse when the patient is unable to meet their own self care needs. Within this theory there are three other concepts that all correlates. Self-care is the activities that a person performs on their own that keeps their health, well-being, disease prevention, and their health conditions up to speed. Self-care activities include things like keeping up with a healthy lifestyle. This means making sure to exercise each and every day as well as eating right to make sure your nutrition is well in check. Making sure that you are getting enough rest and sleep at night is also very important. Most people don’t realize how lack of sleep effects your daily lives. Maintaining personal hygiene and even being compliant with medications is all important. Managing those chronic conditions by taking medications is a huge self-care regimen. The main goal of Dorothea Orem’s theory is that people need to be self-reliant and responsible for their own selves. No one is going to take better care if oneself than they ca. Nursing comes into action with this theory because nurses make sure that each person is meeting those standards of self-care needs where they might be slacking. For example, if someone cannot brush their teeth or remember what medications to take every day. The nurse will ensure that that is happening and that is happening correctly (Gonzalo, 2014).
The theory of Interpersonal Relations by Peplau is also a very important nursing theory. This theory really focuses on the relationship between the patient and the nurse. This puts an emphasis on how the nurse and patient relations will show the improvement or disimprove of their health as time goes on. This theory is showing how the potential for the patient to be therapeutic depends on the nurse and how the nurse is providing care. This goes in phases. The first phase is the orientation phase. This is when the trust is first established between the patient and nurse. This usually happens within the first minute. Next is the identification phase. This phase is when the patient and nurse understand the roles of each person. The patient understands that the nurse is there to help them and that they can feel safe with them. Second to last is the exploitation phase. This phase is when the nurse and patient begin achieving goals that are to improve their health. Lastly, there is the resolution phase comes next. This phase happens once the previous goals are achieved and the health goals for the patient have been reached. There is no need for the nurse to continue caring for the patient because at this time they should be able to do it for themselves (Hagerty et al., 2019).
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