Patient is admitted with decompensated heart failure, with signs and symptoms of pulmonary edema from the poor output of the heart, arrhythmias specifically atrial fibrillation with rapid ventricular response (RVR). The nurses interventions at the time of admission should be a full assessment, blood work to check for electrolyte imbalance, infection, and etc, EKG and continuous tele monitoring to assess if the atrial fibrillation converts to sinus (paroxismal) or if she remains in a-fib (chronic), patient must be started on oxygen via nasal cannula, and she must be started on the medications stat. After being started on Lasix, nursing interventions should include monitoring for intake and output, safety is another intervention since the patient’s BP is low and she is in a-fib, she may experience dizziness and fall, therefore BP must be monitored and safety measures placed for patient. Patient should be positioned in high fowler’s to help with the breathing.
What is the rationale for the administration of each of the following medications?
IV furosemide (Lasix)- This is a loop diuretic used to prevent or treat fluid retension in patients with heart failure, liver disease, and renal failure. In this case, the patient has crackles in the lungs, is complaining of shortness of breath, has edema and distended jugular veins, low blood pressure, and coughing, all signs of heart failure and pulmonary congestion secondary to left sided heart failure.
Enalapril (Vasotec)-This is a ACE inhibitor (Angiotensin Converting Enzyme) which is used to treat hypertension and heart failure. It allows the ventricles to pump blood out of the heart.
Metoprolol (Lopressor)-This is a beta blocker used for hypertension, heart failure, coronary artery disease, and arrhythmias. IN this case, the Metoprolol can help with the patient’s heart failure by allowing the heart to relax and lower the heart rate. Metoprolol is a vasodilator, it relaxes the blood vessels of the heart. Since the patient is in heart failure and afib, his heart is working harder to pump blood and its overworking the heart and weakening it, therefore Metoprolol is used to treat this.
IV morphine sulphate (Morphine)-This is an opiate given to patients with angina and heart failure due to its effects on the sympathetic nervous system. The reduction of the sympathetic stimulation reduces heart rate, cardiac work, and myocardial oxygen consumption. In this scenario, the Morphine will be helpful in reducing the pateint’s anxiety, pain, heart rate, and will allow the heart to relax.
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Coronary artery disease (CAD)- The buildup of plaque/cholesterol in the arteries of the heart can diminsh blood flow to the heart and cause angina or heart attack if it is completely occluded. CAD can also cause HTN and in turn heart failure. CAD can be managed by controlling blood pressure, weight control, diabetes, hyperlipidemia, exercising, and if smoker, tobacco cessation. These will lower the chances of developing CAD. If patient is diagnosed with CAD, then they must be managed with blood thinners, statins, beta blockers, and ACE inhibitors. They should be counceled on low sodium diet, low fat/calorie diet, and exercise therapy. Sometimes, cardiac rehab is helpful for those with chornic angina and CAD. Making sure the patient is compliant with meds and their diabetes, cholesterol, and blood pressure are controlled will help prevent heart failure.
Hypertrohic cardiomyopathy-Blood vessels in the heart that are damaged from drug use of ETOH use cause cause heart failure. The weakned heart muscle can result in HF. These patients must be monitored for arrhythmias because patients with dilated cardiomypathy commonly have ventricular arrhythmias and low EF and have SCD or syncope. Often, they will require an ICD implant to prevent SCD (Nguyen, V., 2017). To prevent heart failure, patients wiht CMP need medications to help strenthen the heart muscle or avoid worsening of CMP. These medications include ACE inhibitors, ARB’s, beta blockers, diuretics, nitrates, and more. Referring to cardiac rehab is important for these patients as well.
Hypertension-The high pressure in the heart vessels causes the heart to overwork and eventually weaken causing heart failure. Patient education about low sodium diet, exercise, and medication compliance to control BP. Patients must be educated that if their BP is uncontrolled on meds, they need to seek medical attention.
Myocardial Infarction-Heart attack results in diminished or no blood flow to the heart muscle, causing the muscle to “die” and makes it harder for the heart to pump blood (American Heart Association, 2017). Similar to CAD interventions, patients with MI require long term medical therapy. MI can result in ischemic cardiomyopathy and in turn heart failure. Patients with ICMP also require a ICD implant if the EF does not improve with meds. These patients need constant monitoring of blood pressure and more MI’s or coronary blockages. Paitents with previous MI’s or CAD need annual stress test to evaluate their EF and check for cardiac ischemia. If indicated, a left heart catheterization and PCI should be perfomed before another MI hits them leading to HF.
Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.
Polypharmacy, or taking too many medications at the same time can have complications specially in the elderly population because they have poor mediation regimen, may be forgetful which can result in underdosing or overdosing of medications, may be taking herbal supplements at home that can interact with medications and cause adverse reactions (Woodruff, 2010).
Nurses can help avoid this problem.
1.Patient education about each medication, what it is taken for, what side effects to expect, what to avoid with this medication
2.Organize their pills. Give them a written copy of all of their meds and organize them into the time they should be taken and how many should be taken. For example, the paper can be divided into three parts (morning, lunch, night). Under each part, the names of the medications can be written so they know exactly what to take and when to take them and will prevent them from taking everything at the same time.
3. Teach them how to take their meds. For example, with food, with water, oral route, or injected.
4.Discard old, expired, or discontinued medications. Keep all meds together in one place.
References
American Heart Association. Causes of Heart Failure. 2017. Retrieved from
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Evaluate the affect the death penalty has on the prosecutor, defense attorney, criminal, and victim’s family.
/in Uncategorized /by JosephQuestion
Write a 500 to 700-word paper that explains positive and negative aspects of the death penalty. Present a persuasive argument regarding whether you believe the death penalty is proper or not.
Evaluate the affect the death penalty has on the prosecutor, defense attorney, criminal, and victim’s family.
Use research to support your assertions and beliefs.
Format your paper consistent with APA guidelines.
3 sources and 3 intext citations
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Communicating Change
/in Uncategorized /by JosephHRM 560 WEEK 9 DISCUSSION
(TWO DIFFERENT ANSWERS POSTED CHOOSE ONE)
1) “Communicating Change” Please respond to the following:
Present an argument as to which strategy discussed in Chapter 10 of the Palmer textbook would be most effective in communicating change within the organization where you currently work or one where you have worked. Identify one communication practice you can foresee yourself using in the future along with the expected benefits.
From the e-Activity, indicate at least two communication channels within the workplace and assess how they have evolved over the past two decades.
2) “Failure to Communicate” Please respond to the following:
Reflect on a situation in your professional life or the professional life of someone you know well, where a lack of communication has created a negative outcome. Describe the situation and indicate the three most significant factors that caused the communication breakdown.
Based on the recommendations made in Chapter 6 of the Kotter textbook for communicating effectively, propose at least two strategies that you could have implemented to improve the communications process in the situation you described in the first part of this discussion
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Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
/in Uncategorized /by JosephPatient is admitted with decompensated heart failure, with signs and symptoms of pulmonary edema from the poor output of the heart, arrhythmias specifically atrial fibrillation with rapid ventricular response (RVR). The nurses interventions at the time of admission should be a full assessment, blood work to check for electrolyte imbalance, infection, and etc, EKG and continuous tele monitoring to assess if the atrial fibrillation converts to sinus (paroxismal) or if she remains in a-fib (chronic), patient must be started on oxygen via nasal cannula, and she must be started on the medications stat. After being started on Lasix, nursing interventions should include monitoring for intake and output, safety is another intervention since the patient’s BP is low and she is in a-fib, she may experience dizziness and fall, therefore BP must be monitored and safety measures placed for patient. Patient should be positioned in high fowler’s to help with the breathing.
What is the rationale for the administration of each of the following medications?
IV furosemide (Lasix)- This is a loop diuretic used to prevent or treat fluid retension in patients with heart failure, liver disease, and renal failure. In this case, the patient has crackles in the lungs, is complaining of shortness of breath, has edema and distended jugular veins, low blood pressure, and coughing, all signs of heart failure and pulmonary congestion secondary to left sided heart failure.
Enalapril (Vasotec)-This is a ACE inhibitor (Angiotensin Converting Enzyme) which is used to treat hypertension and heart failure. It allows the ventricles to pump blood out of the heart.
Metoprolol (Lopressor)-This is a beta blocker used for hypertension, heart failure, coronary artery disease, and arrhythmias. IN this case, the Metoprolol can help with the patient’s heart failure by allowing the heart to relax and lower the heart rate. Metoprolol is a vasodilator, it relaxes the blood vessels of the heart. Since the patient is in heart failure and afib, his heart is working harder to pump blood and its overworking the heart and weakening it, therefore Metoprolol is used to treat this.
IV morphine sulphate (Morphine)-This is an opiate given to patients with angina and heart failure due to its effects on the sympathetic nervous system. The reduction of the sympathetic stimulation reduces heart rate, cardiac work, and myocardial oxygen consumption. In this scenario, the Morphine will be helpful in reducing the pateint’s anxiety, pain, heart rate, and will allow the heart to relax.
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Coronary artery disease (CAD)- The buildup of plaque/cholesterol in the arteries of the heart can diminsh blood flow to the heart and cause angina or heart attack if it is completely occluded. CAD can also cause HTN and in turn heart failure. CAD can be managed by controlling blood pressure, weight control, diabetes, hyperlipidemia, exercising, and if smoker, tobacco cessation. These will lower the chances of developing CAD. If patient is diagnosed with CAD, then they must be managed with blood thinners, statins, beta blockers, and ACE inhibitors. They should be counceled on low sodium diet, low fat/calorie diet, and exercise therapy. Sometimes, cardiac rehab is helpful for those with chornic angina and CAD. Making sure the patient is compliant with meds and their diabetes, cholesterol, and blood pressure are controlled will help prevent heart failure.
Hypertrohic cardiomyopathy-Blood vessels in the heart that are damaged from drug use of ETOH use cause cause heart failure. The weakned heart muscle can result in HF. These patients must be monitored for arrhythmias because patients with dilated cardiomypathy commonly have ventricular arrhythmias and low EF and have SCD or syncope. Often, they will require an ICD implant to prevent SCD (Nguyen, V., 2017). To prevent heart failure, patients wiht CMP need medications to help strenthen the heart muscle or avoid worsening of CMP. These medications include ACE inhibitors, ARB’s, beta blockers, diuretics, nitrates, and more. Referring to cardiac rehab is important for these patients as well.
Hypertension-The high pressure in the heart vessels causes the heart to overwork and eventually weaken causing heart failure. Patient education about low sodium diet, exercise, and medication compliance to control BP. Patients must be educated that if their BP is uncontrolled on meds, they need to seek medical attention.
Myocardial Infarction-Heart attack results in diminished or no blood flow to the heart muscle, causing the muscle to “die” and makes it harder for the heart to pump blood (American Heart Association, 2017). Similar to CAD interventions, patients with MI require long term medical therapy. MI can result in ischemic cardiomyopathy and in turn heart failure. Patients with ICMP also require a ICD implant if the EF does not improve with meds. These patients need constant monitoring of blood pressure and more MI’s or coronary blockages. Paitents with previous MI’s or CAD need annual stress test to evaluate their EF and check for cardiac ischemia. If indicated, a left heart catheterization and PCI should be perfomed before another MI hits them leading to HF.
Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.
Polypharmacy, or taking too many medications at the same time can have complications specially in the elderly population because they have poor mediation regimen, may be forgetful which can result in underdosing or overdosing of medications, may be taking herbal supplements at home that can interact with medications and cause adverse reactions (Woodruff, 2010).
Nurses can help avoid this problem.
1.Patient education about each medication, what it is taken for, what side effects to expect, what to avoid with this medication
2.Organize their pills. Give them a written copy of all of their meds and organize them into the time they should be taken and how many should be taken. For example, the paper can be divided into three parts (morning, lunch, night). Under each part, the names of the medications can be written so they know exactly what to take and when to take them and will prevent them from taking everything at the same time.
3. Teach them how to take their meds. For example, with food, with water, oral route, or injected.
4.Discard old, expired, or discontinued medications. Keep all meds together in one place.
References
American Heart Association. Causes of Heart Failure. 2017. Retrieved from
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Compare and contrast the three (3) levels of inspection
/in Uncategorized /by JosephQuestion
“Contract Provisions for Protection” Please respond to the following:
Compare and contrast the three (3) levels of inspection, and explain the fundamental manner in which they differ. Next, discuss which level of inspection is of greatest importance.
From the e-Activity, evaluate the significance of “inspection of supplies-fixed price” and then argue that the Inspection Clause of the FAR should put equal value on firm fixed price contracts and cost-plus contracts. Defend your rationale.
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Does outsourcing give businesses a competitive edge?
/in Uncategorized /by JosephQuestion
I need a general discussion for the following question of 250 words
Outsourcing
John Doucette, CIO of United Technologies, states that ‘If you’re not the lowest-cost provider of that service, you need to contract it out’ (Overby 2003). However, central to the Zappos business model and its success was to make insourcing decisions based on the criticality of the function to customer service.
Based on the readings in the ‘Outsourcing’ section and your own experience or research of outsourcing, how viable do you think outsourcing is as a human capital strategy?
You may wish to consider one or more of the questions below in your response. These are
suggestions only. You can consider other issues:
· With pressures on costs, is outsourcing inevitable?
· Does outsourcing give businesses a competitive edge?
· What needs to be done to make outsourcing successful?
· Should outsourcing always be under consideration as part of an organisation’s
· strategic HR management?
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develop and deliver a verbal communication for the scenario you have identified.
/in Uncategorized /by JosephFrom quick conversations to phone calls, meetings, formal presentations, and sales pitches, you must employ effective verbal communication skills at all times. While verbal interactions are extremely common, they can also be stressful. Every interaction contains the potential for success…and the danger of failure. To be “on your game” at all times requires purposeful practice, reflection, and adjustment based on input and feedback. No matter what your verbal communication skills are, you can improve them. In this assignment, you will develop and deliver a verbal communication for the scenario you have identified. Your communication should match your challenge or opportunity. For example, if your challenge is an interview for a new position, you may choose to record yourself answering a few key questions that might be posed by the interviewer. For the purposes of this course, your video presentation should not exceed five minutes. (Your scenario might require a much longer presentation, but limit your response to the key five minutes in this case.)
PART 1 – VERBAL COMMUNICATION (VIDEO) 1. Develop and Deliver Your Verbal Communication a) Use an impactful opening statement to engage, set context, and/or create relevant meaning for the audience b) Use compelling stories/statistics/facts to support your key message c) Where appropriate, make your request of the audience clear and actionable d) Use visual aids (where necessary) that support and complement your verbal communication, but which do not drive the conversation e) Limit recordings to no more than 5 minutes 2. Demonstrate Professional Presence a) Be authentic and genuine in your delivery b) Use the appropriate tone and vocabulary for your audience c) Use body language and eye contact effectively d) Speak concisely with clarity and confidence e) Build rapport and connect with your audience to grow the relationship f) Dress appropriately and employ an appropriate camera frame (with a neutral background that is free of distractions) g) Employ only professionally presented and appropriately prepared visual aids, if used VERBAL COMMUNICATION Due Week 10, worth 220 points From quick conversations to phone calls, meetings, formal presentations, and sales pitches, you must employ effective verbal communication skills at all times. While verbal interactions are extremely common, they can also be stressful. Every interaction contains the potential for success…and the danger of failure. To be “on your game” at all times requires purposeful practice, reflection, and adjustment based on input and feedback. No matter what your verbal communication skills are, you can improve them. In this assignment, you will develop and deliver a verbal communication for the scenario you have identified. Your communication should match your challenge or opportunity. For example, if your challenge is an interview for a new position, you may choose to record yourself answering a few key questions that might be posed by the interviewer. For the purposes of this course, your video presentation should not exceed five minutes. (Your scenario might require a much longer presentation, but limit your response to the key five minutes in this case.) PART 2 – REFLECTION AND FEEDBACK (WRITTEN) 3. Reflect on Your Presentation Preparation a) Describe the approach you took to plan for your presentation b) Explain how you rehearsed for the presentation c) Offer suggestions for how you might better prepare in the future 4. Use Feedback to Refine Your Communication a) Describe or list the feedback you received on your verbal communication from the week 8 Discussion Board 4. Use Feedback to Refine Your Communication a) Describe or list the feedback you received on your verbal communication from the week 8 Discussion Board b) Explain how you used the feedback to revise and improve your message and/or delivery
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Describe the effects of these diplomatic efforts for the U.S. and other countries.
/in Uncategorized /by JosephsSelect a president from the table, “Presidents and Their ‘Doctrines,’” in Roskin, Chapter 4. Then write a 3-5 page paper on the doctrine that president used according to Roskin. Your research must include at least four (4) credible sources, apart from your textbook. Your paper must address the following: Summarize a situation that required U.S. diplomatic efforts during the president’s time in office. Explicate the diplomatic doctrine the president followed, with reference to specific actions or events that occurred. Describe the effects of these diplomatic efforts for the U.S. and other countries. Assess, in conclusion, the advantages and disadvantages of the particular doctrine that was followed. Cite at least four (4) reputable sources in addition to the textbook, not including Wikipedia, encyclopedias, or dictionaries. Your assignment must: Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length. The specific course learning outcomes associated with this assignment are: Identify the cultural, economic, and political context of information resources, and interpret information in light of that context. Use technology and information resources to research issues in international problems. Write clearly and concisely about international problems using proper writing mechanics.
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Read the Forbes article 4 Ways to Help Your Team Adapt to Change by Jeff Boss. Which of these suggestions have you seen used in your organization?
/in Uncategorized /by Joseph1. The Work Breakdown Structure (WBS) is one of the most valuable and commonly used tools available to the project team. Select one task your department or group is responsible for in your current or a previous job . Alternatively you may select a company you are familiar with or desire to research. Using the process of decomposition list two subtasks. Further decompose ones ubtask into two work packages. As a final step provide two levels of effort for one of the work packages. (Has to be at least 200 words)2. A project manager has the responsibility to develop team members skills and expertise. Read the Forbes article 4 Ways to Help Your Team Adapt to Change by Jeff Boss. Which of these suggestions have you seen used in your organization? Which one do you think would be most beneficial to introduce to your current work group, and why? (Has to be at least 200 words)
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Define a teratogen and then choose either the embryonic period or the fetal period and describe the effect a teratogen may have during that period.
/in Uncategorized /by JosephDefine a teratogen and then choose either the embryonic period or the fetal period and describe the effect a teratogen may have during that period.
1.Teratogens affect prenatal development differently according to the specific prenatal stage during which the teratogen is ingested. Define a teratogen and then choose either the embryonic period or the fetal period and describe the effect a teratogen may have during that period. 2.What are some issues associated with premature infants? Justify your response with academic literature and/or research. 200 WORDS
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Briefly write about Timkens history and its traditional strategy. Then discuss its strategic initiatives for expanding into the European market (Western Europe and Central Europe). (20 points)
/in Uncategorized /by JosephBusiness Policy and Strategy Course MGMT 485
Fall 2016
Students Name: ________________________________
Section-I: Case: The Timken Company: Market Entry into Romania (A)
1. Please discuss some of the features of the global ball and roller bearings industry. Then conduct an analysis of this industry using Porters Five Forces Model. Finally as you reflect share a perspective about this industry. (You can draw the Five Forces Model and then discuss it or simply discuss it without drawing it.) (20 points)
2. Briefly write about Timkens history and its traditional strategy. Then discuss its strategic initiatives for expanding into the European market (Western Europe and Central Europe). (20 points)
3. What are the pros and cons for Timken in its proposed investment to acquire Rulmenti Grei (RG)? What are the merits and risks for Timken? Is this investment aligned with Timkens strategic intent for the European market? Should Mr. Jon Elsasser proceed with the proposal? Why or why not? (20 points)
4. Positioned in 1997 what can you say about Timken and about RG as you review their respective resources and capabilities as well as their performance? If the proposal is submitted and Timken wins the bid to acquire RG how do you see the integration working out? Looking at the financial data for the Timken Company (Exhibit 3) and for RG (Exhibit 8) provide some numeric support regarding financial assessment under resources. (25 points)
Section-II:
1. To build a new organization or a new team a firm must first hire talented employees and then hire a manager. (1 point)
True False
2. A leader of an organization must be the spirit of the organization. Include a specific example of someone who functioned as the spirit of the organization and with that example briefly comment on the meaning and significance of this statement. (2 points)
3. An organization must do the following to survive and prosper in its industry over the longer run. Circle the right answer. (1 point)
a) Hire talented employees
b) Invest in training and development of its people
c) Build a strong culture
d) Innovate continually
e) Provide excellent customer service
f) Keep costs low
g) All of the above
4. On starting as a new CEO of a small firm you notice that the morale of the employees is very low. We had discussed a layered model for representing the composition of a business enterprise. This model had results at the top and culture and ethics toward the lower deeper end. With that model in mind discuss two specific steps you would take to improve morale and mention how these steps would help. (2 points)
5. Briefly describe the difference between a strong culture and a weak culture. (2 points)
6. What might be two symptoms in an organization that would make you say that this organization has an unhealthy culture? (2 points)
Section-III: A thought-provoking question in the context of strategic management (5 points)
Walmart is about 50 years old company. IBM Boeing UPS PepsiCo CocaCola and many others are nearly 100 years old. What is it about Walmart that in half the time it has achieved the status of worlds largest company and with more than double the revenues of some of these other firms? Identify and discuss some factors (internal and external) that might explain this. Consider the components of the firms strategic management process and the external environment in which it operates.
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