Assignment Questions Essay
Assignment Questions Essay
Congestive heart failure is one of the conditions that affect a significant proportion of the world’s population. The condition is largely managed with the use of pharmacological agents. Some medications are contraindicated in this disease. One of them is calcium channel blockers. The mechanism of action of calcium channel blockers is attributed to its ability to block the calcium ion channels in the heart muscles. The blockage results in impeded entry of calcium ions into the cardiac muscles, hence, decreased rate of action potential generation. The blockage also reduces the electrical conduction of the heart, hence, lowered cardiac workload. Despite this mechanism, calcium channel blockers are contraindicated in patients with congestive heart disease because the blockage results in negative chronotropic and ionotropic effects that can precipitate further acute decompensated heart failure. The additional cardiac effects of the use of calcium channel blockers include reduced cardiac output and possible activation of compensatory mechanisms to increase cardiac contractility and output (Vider & Zada, 2019). Therefore, these effects make calcium channel blockers to be contraindicated in patients suffering from congestive heart failure.
Angiotensin converting enzyme inhibitors are used in the treatment of congestive heart failure. These drugs work by reducing the circulating levels of angiotensin II in the blood. They also reduce the plasma levels of vasopressin and norepinephrine. The effects arise due to the inhibition of the actions of angiotensin converting enzyme that activates angiotensin I to angiotensin II. Therefore, they are used in patients with congestive heart failure because they promote vasodilation, reduced cardiac contractility, workload, and output (Perrone, 2015). The effects lead to additional benefits that include improved hemodynamics, reduced symptoms of dyspnea and fatigue, and correct hyponatremia and diuretic requirements.
Body mass index (BMI) is largely accepted as a method that is used in determining one’s weight and risk for obesity, overweight, or underweight. It is calculated by dividing the weight of a person by his or her height in meters squared. This approach of measurement measures weight rather than the body’s total mass of fat. The tool of measurement comprises of weight in kilograms and height in centimeters. The height is converted into meters for calculation of the body mass index. The components of the BMI scale include very severely underweight, severely underweight, underweight, normal, overweight, and obese. There are several categories of BMI scales. One is considered very severely underweight if the BMI ranges between 0 and 15 kg/m (squared). A BMI of 15-60 is considered severely underweight, 16-18.5 underweight, 18.5-25 normal, 25-30 overweight, and above 30 kg/m (squared) considered obese (World Health Organization, Kallioinen & Granheim, 2017).
Body mass index scales can be used when providing health education to the patients. The patients are educated on the various categories of scales and their implications. For instance, they are informed about what being severely underweight or overweight means and the health risks associated with it. A nurse also performs a practical demonstration to the patients on how to determine their BMI. They then use the information to come up with plans of care for them. For instance, the nurse will educate a patient who is underweight on the importance of taking a balanced diet and the need for a review by a nutritionist. Similarly, the nurse will educate a patient who is obese on the importance of active physical activity, taking adequate and balanced diet, and the need for close monitoring of weight (Holloway, 2019). The nurse also educates the patient on the risks of being overweight such as diabetes and hypertension.
Migraine headache is one of the conditions that affect most of the people globally. Its accurate diagnosis is dependent on the acquisition of both subjective and objective data from the client. Several aspects related to subjective data are obtained from the client. One of them is the severity of the pain and its characteristics such as stabbing, throbbing, and dull ache. The nurse should also ask about the location of the pain. Such questions should include asking about the activities that are associated with the pain. The nurse will obtain relevant data such as increasing severity of the condition with exertion. The nurse should also anticipate findings such as features of migraine headache that include vomiting, photosensitivity to light and sound. The feelings of the patient during and after attacks should also be asked. This would aid in classifying the nature and severity of the attack. Often, patients might report feeling tired, muscle pain, and photosensitivity. The nurse should also ask about the existence of any sensory or visual disturbances with the disease (Gil-Gouveia, Oliveira, & Martins, 2016). It is anticipated that worsening of migraine headaches is likely to cause visual and sensory disturbances. Lastly, the nurse should obtain relevant family history of migraine headache. There is a high risk of the disease in families with a history of migraines.
Moreover, the nurse should also obtain objective data related to the condition. Some of the expected objective findings in migraine
include raised pulse, pyrexia, and normal to slightly elevated blood pressure. There is also the likelihood of photosensitivity, visual, and sensory disturbances on physical assessment of the patient. Laboratory investigations such as complete blood count will reveal normal range of various parameters such as hemoglobin level and white blood cell count. Diagnostic investigations that include MRI are done to determine the type and involvement of the nervous system. Some of the subjective symptoms that would warrant emergency treatment include loss of sensory and visual disturbances and projective vomiting (Mannix et al., 2016). Abnormal findings from diagnostic investigations will also warrant emergency management of the patient.
Several aspects related to objective data will be noted in a patient with lower back pain. One of them is observed reduction in restlessness and anxiety with changing positions. Patients with spinal stenosis will report pain relief with changing their siting positions. The other objective data is observed incontinence due to decrease in the tone of anal sphincter. The decrease in tone is largely observed in patients with primary herniation of the spinal disc. There is also an expected positive straight leg raising sign with pathologies causing lower back pain such as cauda equine syndrome. Great toe extensor weakness as well as impaired ankle reflexes are anticipated in cases where there is disk herniation (Mao, 2019). Patients might also present to the hospital with symptoms that include calf wasting and weak ankle dorsiflexion, which could indicate disk herniation.
Abnormal posture might also be seen in patients with low back pain. The patient might walk in bent position that can indicate scoliosis or kyphosis. Negative results in squat test might also be obtained to show the existence of pathologies of the lower limb. Testing for movement might also reveal the pathologies contributing to the lower back pain. These include the use of tests such as overpressure, combined movements, repeated movements, and muscle strength tests to determine muscle strength. The overpressure test should not be associated with any pain. Active range of movements should be performed to determine whether there is muscle rigidity and painful movements. The patient flexes, extends, and does side flexion to determine abnormal findings such as pain, deviation, and painful arc (Brown et al., 2019). Therefore, these ranges of motion will aid in the diagnosis of the cause of low back pain affecting the patient.
Acute illness has a negative effect on the blood glucose level in diabetic patients. Often, acute illness will trigger elevated blood glucose level or hyperglycemia in diabetic patients. The mechanism of hyperglycemia is that the illness acts as a source of stress to the body. The body responds to the stressor by initiating counter-regulatory mechanism where there is hyper-secretion of cortisol, glucagon, and epinephrine. The hormones act by opposing the actions of the insulin, thereby, reducing actions of insulin in regulating blood glucose levels. However, the high level of blood glucose will resolve over time as the patient responds to the treatment (Cryer & American Diabetes Association, 2016). Therefore, it is important that blood glucose level is monitored in patients suffering from acute illnesses.
Acute illness also has an effect on diabetic medications used by patients with diabetes. The illness can alter the renal functioning thereby lowering the rate of drug elimination from the kidneys. This will affect the efficiency of drug action, hence, control of glucose in the body. The illness might also result in a loss of the total body fat content. This might be evidenced by wasting of the patient. Such changes will translate into the adoption of different regime of diabetic medications. There is also the aspect of drug interaction in case of an acute illness (Lea-Henry et al., 2017). Some medications lower the efficacy of medications used in the treatment of diabetes. For instance, the use of diuretics has been shown to lower the clinical efficacy of oral hypoglycemic. Therefore, acute illness has an adverse effect on the medications used in the treatment of diabetes.
PS: Please use APA format (title page, assignment and reference page, correct margin, double -spaced, etc.) to complete each assignment. The length of the assignment should be a minimum of one full typed page and must include at least one journal article to support your answer.
Why are calcium channel blockerWhy are calcium channel blockers contraindicated for use in patients with CHF and why are ace inhibitors used in patients with CHF?s contraindicated for use in patients with CHF and why are ace inhibitors used in patients with CHF?
Explain the components of a BMI scale, identify the various categories on a BMI scale and briefly explained how the BMI scale could be used when providing patient education.
Assignment # 3
What subjective and objective data would be noted in a patient who is experiencing a migraine headache and what objective subjective and objective data would be noted in a patient that you would refer to the emergency department for immediate evaluation?
What objective data would be noted in a patient with acute low back pain? Be sure to use appropriate terminology with range of motion testing.
Assignment # 5
Why is it important to assess blood sugars in a diabetic patient with an acute illness and how does acute illness affect medication?