Tutor profile: Trey P.
Subject: Health and Medicine
What are the current AHA recommendations for determining hypertension in adults?
Great question! To ensure you get the most up-to-date, accurate information, I am linking the most recent guidelines from the AHA. These guidelines were released in 2021 and give lots of great recommendations as to staging hypertension, proposed treatments, and scheduling protocols for seeing the Primary Care Provider. https://www.acc.org/latest-in-cardiology/articles/2021/06/21/13/05/new-guidance-on-bp-management-in-low-risk-adults-with-stage-1-htn If you have any questions about the article, please let me know and I would be more than happy to explain it to you.
Can you help me understand the nursing process?
Great question! The nursing process is the foundation for all critical thinking and problem solving done in nursing. Think of the nursing process like a "game plan" or "rule book" by which you approach every patient issue in nursing. Let's go through each step below. 1. Assessment: You are taking in information from every possible source. This could be information from the patient (medical history, medications, labs, orders, signs/symptoms, etc.) or things you observe in the environment (bed position, call light in reach, smells or sights). Imagine this stage as a time to gather up all information you can that is pertinent to the issue. 2. Diagnosis: You take the information you learned in the assessment phase, and you determine what the underlying issue is. For instance, let's say a patient was complaining of pain following recent surgery. In the assessment phase, you would gather up all necessary data - pain scale from the patient, determine the type, quality, province, timing, and radiation of pain, observe surgical incision, etc. You would use that information in the diagnosis phase to determine the cause of his pain. Continuing from the patient scenario above, let's say you diagnose the patient's pain as acute pain related to surgical incisions as evidenced by the patient rating pain as sharp, shooting, 9/10 abdominal pain that worsens with flexion of the abdomen and is relieved with pain medicine. This diagnosis guides the rest of your treatment plan, so it is critical to be as descriptive and pertinent as possible. 3. Planning: You take the diagnosis and you come up with the most rational method to fix the problem. In this phase, you consider all treatment options. For the patient as described above, you may consider non-pharmaceutical methods of pain relief such as relaxation techniques, deep breathing, or distraction. Other options would be to administer prescribed analgesics such as morphine or hydrocodone. In this case, you determine the best option would be to administer morphine due to the intensity of pain, and given the patient is medically stable to receive morphine (BP and resp rate are within normal limits), you decide it is safe to administer. In this phase, you also consider the best way to administer the treatment. In this case with morphine, you decide the IV route will have the quickest onset. 4. Implementation: You take the decided plan that you determined in the previous step and you put it to action in the implementation phase. In this phase, you put into action your plan using the best, evidence-based practice you have at your disposal. You administer morphine using appropriate medication administration technique, ensuring the IV is patent, the patient's vital signs are stable, diluting the medication (especially since it is a narcotic), pushing over 4-5 minutes, etc. 5. Evaluation: You evaluate the efficacy of your treatment implementation. For this patient, this could involve returning in 15-30 minutes to determine whether the morphine improved the patient's pain. Sometimes the implementation can not be effective, which if that was the case in this scenario, you would return to step 3 (planning) and choose another treatment option. If you have any more questions, please let me know!
Can you help me understand congestive heart failure?
Great question! I'll start with general A/P. The heart is responsible for continuously receiving blood from the body, pumping it through the pulmonary circuit, and then sending the blood to the rest of the body. If you need a review of the blood flow through the heart, see below. The receives blood from the body (via superior and inferior vena cava) on the right side of the heart (right atrium and ventricle), pumping blood through the pulmonary circuit (via pulmonary arteries and veins) and returning the oxygenated blood to the left side of the heart (left atrium and ventricle), and pumping blood to the rest of the body (via the ascending aorta, aortic arch, and descending aorta). If the heart is damaged or malformed in some way, the heart muscle has a lower level of function and blood will start to back up through the system. If the heart is damaged on the left side, then blood will back up into the pulmonary circuit. If the heart is damaged on the right side, the blood will back up into the systemic circuit. Sometimes, both the right and left side of the heart is damaged and you will have backup into both the pulmonary and systemic circuit.
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