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성인 간호학-영문

Question One : Select five key pieces of assessment data that support a diagnosis of acute heart failure. Explain why/how this data presents in heart failure.According to Dicstein et al. (2008, 2395), pulmonary congestion on chest X-ray is considered as a great important assessment data for diagnosing acute heart failure. In the case of Slaughter, scattered white area on both lung fields on CXR indicates cardiogenic pulmonary edema as contradiction for a diagnosis of pneumonia (Wilson, 1983, 310). Particularly in, Kerly B lines in CXR demonstrate increased lymphatic pressure (Dicstein et al., 2008, 2396). As pulmonary venous pressure increases continuously, fluid moves from pulmonary capillary to interstitial space (Lewis et al. 2008, 887). Lymphatic pressure rise is caused by lymphatic flow increase to drain fluid into intravascular or lymphatic space.Nohria, Mielniczuk & Stevenson (2005, 33) mention that the third heart sound is significant to diagnose HF as a sign of ventricular dyso manage the problems identified from the assessment data. For each intervention you have selected, outline two specific evaluation criteria that would indicate to you, the nurse that this patient’s problem is improved or resolved.1) Decrease in oxygen demand of bodyAccording to Collins et al. (2008, 46), immediate stabilization should be applied as an initial treatment for AHF to decrease oxygen consumption of body. Primarily, nurses could provide effective strategies to minimize oxygen demand caused by anxiety or musculoskeletal and respiratory movements (Williams and Maryland, 2006, 371). They insist that emotional support through confident reassurance could lower patients’ anxiety level as well as giving information could make patients control their anxiety which provokes dyspnea effectively. In addition, Syrett and Taylor (2003, 154) suggest that to let patients express their specific anxiety is helpful to remove fear related with breathlessness. However, In the case of Slaughter,l/m O2 via Hudson mask should be an indication of NIV (Masip, 2007, 121). Currently, Non Invasive Ventilation (NIV) has widely accepted as a beneficial treatment for acute pulmonary edema, which includes continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) (Masip, 2007, 119). Basically, NSV lets collapsed alveolar units by pulmonary edema expand through positive pressure, which could lead in decreasing pulmonary congestion and increasing cardiac output (Chatti et al. 2007, 115). In general, PSV is considered more superior than CPAP, however, according to Valipour, Cozzarini and Burghuber (2004, 150), there is no difference between the two in terms of effect to cardiogenic pulmonary congestion. But, NIV application must be dependent on patients’ systolic blood pressure (SBP), which is greater than 110mmHg (Valipour, Cozzarini and Burghuber, 2004, 123). Similarly, Masip (2007, 145) claim that to imply NIV is possible when patients’ SBP is more than 100mmHg. H2428). In terms of diuretic agents, there remains as argue about its benefit. Basically diuretics are expected to decrease preload by removal of intravascular volume (Luca et al. 2007, 95). According to Shin et al. (2007, 6), current initial agents for AHF contains diuretics when patients have congestion with normal to high BP for immediate symptom relief. In the study by Chatti et al. (2007, 115), use of diuretics is possible to patients with SBP between 100 and 140mmHg, which indicates limited left ventricular systolic function but not impaired. They also explain that although AHF patients present edema in the lungs, they could have often normal or even hypovolemic status, therefore, there need to be careful using of diuretic. Lewis et al. (2008, 890) support the idea of Chatti et al. that loop diuretics could be administrated after enough assess for hemodynamic and renal function. On the other hands, Hodt, Steine and Atar (2006, 3) argues that non-beneficial effect of diuretics suchcardiac perfusion (Lewis et al. 2008, 872). When this intervention was effective, nurses could assess stable blood pressure maintenance, resolved dyspnea and arrhythmia.Reference listChatti, R., N. B. Fradj, W. Trabelsi, H. Kechrche, M. Tavares and A. Mebazaa. 2007. Algorithm for therapeutic management of acute heart failure syndrome. Heart Failure Review 12(2): 113-117.Collins, S., A. B. Storrow, J. D. Kirk, P. S. Pang, D. B. Diercks and M. Gheorghiade. 2008. Beyond pulmonary edema: diagnostic, risk stratification, and treatment challenges of acute heart failure management in the emergency department. Annals of Emergency Medicine 51(1): 45-57.Dickstein, K., A. Cohen-solal, G. Filippatos, J. V. Macmurray, P. Ponikowski, P, Alexander, P. Wilson, A. Stromberg, D. J. V. Veldhuisen, D. Atar, A. W. Hoes, A. Keren, A. Mebazaa and K. Swedberg. 2008. ESC guidelines for heart failure 2008. European Heart Journal 29: 2388-2442.Erickson, B. 1991. Heart sounds and murmurs: a practical guide. St. L 6

의/약학| 2011.12.11| 8페이지| 7,000원| 조회(113)

성인간호, 간호, 성인 간호학, 성인 간호학- 영문 re, Decrease in..

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영문 cover letter

Dear SirPlease consider this letter of introduction as an expression of my interest in the position at XX Environmental Services. I have enclosed my resume for your review.At this point in my career, I am seeking to continue my experience in automotive industry with a dynamic workshop that offers an opportunity to utilize my training and to develop my knowledge/skills as a motor mechanic.Although I have been studying light vehicles at XXX TAFE since the beginning of 2009, I always long for working on bigger motors in trucks because I was once doing that job during military service in Korea. Driving trucks and maintenance were my duty and I really liked it and enjoyed it. However the service term is fixed so I had to be transferred to the reserve list. After the period, deep inside of my heart I have missed the time I spent with diesel engines.I am confident that I am suitable for the position as an apprentice mechanic. If I have a chance to start my career at XX working on diesel engines, I will do my best using what I have learnt at institute and in military because I am keen to learn about diesel engines and heavy vehicles.I am ready to work and learn something related to my job which makes the stage I am on now firm and endurable so that I can step up to the fertile future by beginning as a diesel mechanic with an industry leader.Highlight of my qualification include: Servicing vehicles in YAP Motors, Blackburn, VICOil change, Filters, Brakes, Boots, Tyres, Repairing cooling system, Ignition system, Steering system, Exhaust system, Driveline, etc.Diploma of Automotive Technology, Box Hill InstituteDriving and maintaining trucks & lorries during Military service Bachelor of Economics in International trade from XX University, Seoul, KoreaSelf-motivated; able to set effective priorities to achieve short-term/long-term goals and meet operational deadline. Ability to see change as an opportunity rather than as a threat Enthusiasm for opportunities to learn new technical and interpersonal skills Excellent Excel, WordMy resume can show you just a small sample of the kind of results I can get for your workshop. It also outlines a self-development program, something you probably demand from your staffs.Now I would like to use my knowledge and energies serving your workshop while furthering my understanding of the profession. I would be happy to discuss my background more fully with you in a personal interview.Yours sincerely

외국어 이력서| 2011.12.11| 2페이지| 5,000원| 조회(905)

호주, Cover Letter, 외국어이력서, 영문-cover letter, 영..

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