Left Sided Heart Failure Concept Map

May 30, | nursing, med, NURS, Paper

Left Sided Heart Failure Concept Map
Left Sided Heart Failure Concept Map
The Map should be about Left-Sided Heart Failure
Assessment 1 – Concept map and guided questions.
Information 1 – Getting started.
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Your first assessment is generating a concept map for left heart failure and answering three questions related to a case study about a patient who has an acute exacerbation of heart failure. When preparing your assignment refer to the criteria and standards in the Learning Guide.
You can begin this assessment now by finding readings about heart failure and summarising the information under the headings of the pathophysiology template. This information can then be used for your concept map.
Some readings that you may find helpful to start your assignment are:
Your textbook:
Craft,J.A., Gordon,C.J., Huether,S.E., McCance, K.L., Brashers, V.L. & Rote,N.E.
(2015). Understanding pathophysiology – ANZ adaptation (2nd ed.).
Chatswood, NSW: Elsevier Australia. Chapter 23.
 
Also:
Aitken, L., Marshall,A. & Chaboyer, W. (2015).  ACCCN’s critical care nursing
(3rd  ed.). Chatswood, NSW: Elsevier Australia. Chapter 10.
 
Wagner, K.D. (2014).  High acuity nursing (6th ed.). Upper Saddler River, New
Jersey: Pearson. Chapter13.
 
(These books are available online from the Western Sydney University library). Left Sided Heart Failure Concept Map.
 
This is just to begin. You will then find more readings to add to your information.
 
Remember that the information in your concept map and answers to the questions must correlate with the references that you cite so keep an accurate record when preparing your assignment. The marker of your assessment will check your citations.
 
An example of a pathophysiology template for a left-sided ischaemic stroke and a concept map using this information has been attached to start you thinking about how you will approach your assignment. The concept map has been generated using Word Left Sided Heart Failure Concept Map. However, if you wish, you may prefer to use a concept map template that you may find on the web.
 
Below are the Sub-heading that needs to be in the Concept Map.
Disease
Definition
AETIOLOGY
PATHOGENESIS
PATHOGENESIS
 DIAGNOSIS
TREATMENT
COURSE OF DISEASE
PROGNOSIS
PREVENTION

The separate Reference page for Concept Map. You may have more than 2 reference
Visually Stimulating, add pictures in the background and visually Below is an sample example but this concept map needs to look unique and visually very appealing, please.
Add pictures of heart, lungs what ever connects to the Map and its information.
I have attached a sample of the concept map of another topic to guide you what information requires in the map. Left Sided Heart Failure Concept Map.
500 words and it is worth 25 Marks.

Please see attach other files for questions and Marking Criteria.

 
stroke_concept_map_map
 
Pathophysiology template
 
Disease: Ischaemic stroke affecting the dominant left cerebral hemisphere
Definition: An ischaemic stroke is death of brain tissue resulting from an occluded artery caused either by an atherosclerotic obstruction or embolus that interrupts blood supply to the area of the brain supplied by the occluded artery. The sudden loss of blood circulation results in a corresponding loss of neurologic function (Jauch, 2014). Left Sided Heart Failure Concept Map.
 
AETIOLOGY:
A depletion of blood flow in a cerebral artery resulting from a:

Thrombus –atherosclerotic plaque that has ruptured in a cerebral artery
Embolus
from heart e.g. left atrial thrombus, left ventricular thrombus, atrial fibrillation
from carotid artery (Craft &Gordon,2011)

 
PATHOGENESIS:

Interruption of blood flow to cerebral tissue initiates a biochemical ischaemic cascade.
Mitochondrial production of ATP ceases èdepolarisation è influx of sodium and calcium and efflux of potassium. Passive inflow of water into cells causes cytotoxic oedema and destruction of cells in infarct core.
Membrane depolarization also stimulates the release of neurotransmitters. Glutamate release èexcessive calcium influx into nearby neurons (exocitotoxicity) èdestruction of cells by lipolysis, proteolysis and free radicals.
Mitochondria break down releasing toxins and apoptotic factors.
Injured brain tissue triggers inflammatory response èrelease of inflammatory mediators ècell death and oedema

èdestruction of cells in infarct core  ènecrosis
èischaemic penumbra around core has diminished blood flow but preserved cellular metabolism.
 
Areas of necrotic tissue are not able to conduct nerve impulses so functions such as initiating and conveying motor impulses, receiving and interpreting sensory information and speech control will be interrupted.
(Bautista, 2014; Craft & Gordon, 2011; Maas & Safdieh,2009).
 
CLINICAL MANIFESTATIONS:
 
Just superior to the medullary junction, 90% of axons in the left pyramid cross to      the right ® right motor dysfunction.
The middle cerebral artery supplies the frontal, temporal and parietal lobes as well as the basal ganglia and internal capsule.                                              (Tocco,2011). Left Sided Heart Failure Concept Map
 
Therefore specific clinical manifestations include:

Hemiplegia and weakness on right side of body
Sensory loss on right side
Inability to see the right visual field of each eye
Aphasia
Apraxia
Dysarthria
Impaired reasoning
Behavioural changes
Problems with memory

(Bautista, 2014; Craft & Gordon, 2011).
 
DIAGNOSIS

Complete history
Physical and neurological examination
Brain MRI or CT scan – Essential in differentiating cerebral haemorrhage from ischaemic stroke. MRI is superior as cerebral ischaemia can be identified within minutes and can identify small areas of stroke.
Other tests for vascular imaging can be used e.g. CT angiography, magnetic resonance angiography

(Silverman & Rymer, 2009).
 
TREATMENT
The emphasis of ischaemic stroke treatment is placed on salvaging potentially reversible ischemic penumbra brain tissue, preventing secondary stroke and minimising longterm disability.                             (Jaunch, 2014).
 

Reperfusion
thrombolytic agent (e.g.tPA)
intra-arterial technique

Neuroprotection

-antithrombotic therapy (e.g. aspirin)
 

Nursing management

Acute phase

frequent evaluation of neurological status
frequent evaluation of vital signs
Monitor oxygen saturation – administer oxygen if required
Screen for swallowing deficits and manage appropriate hydration and nutrition strategies
Manage activities of daily living
Screen for communication deficits and address appropriate communication strategies
Prevent complications e,g pressure areas, contractures, DVT
Assess urinary and faecal continence and address appropriately
Left Sided Heart Failure Concept Map

 
Rehabilitation

begin as early as possible by preventing complications, passive and active movement and mobilizing as early as possible.
Support and encourage activities provided by physiotherapists, occupational therapists and speech therapists
Education – e.g. lifestyle modification, adherence to medications

(National Stroke Foundation, 2010).
 
 
COURSE OF DISEASE
 

With reperfusion – blood is restored to the area and signs and symptoms gradually resolve

Without treatment – Course is determined by severity of stroke. Ischaemia will extend to penumbra as stroke evolves, signs and symptoms worsen. As  cerebral oedema resolves, and with  structural and functional reorganisation recovery may continue for 6 months to a year. (peak recovery in about 3 months). Requires rehabilitation to optimise function. Left Sided Heart Failure Concept Map.

 
(Teasell & Hussein, 2014).

Complications

Contractures
Fatigue
Incontinence
Mood disturbances
Falls
Dysarthria and aphasia
 
PROGNOSIS

Stroke prognosis is influenced by factors such as age and stroke severity.
One in five likely to die within one month of suffering ischaemic stroke.
Of those who recover about 90% will experience some impairment
Left Sided Heart Failure Concept Map

(Dashe,2014)
 
PREVENTION
Eliminating modifiable risk factors will prevent an ischaemic stroke.

Don’t smoke
Diet high in fruit and vegetables, low in fats and salt
30 minutes of moderate-intensity physical activity on most days of the week
Maintain healthy BMI
Limit alcohol to no more than two standard drinks per day

(National Stroke Foundation, 2010)
 
If a history of atrial fibrillation – ensure adherence to anticoagulation therapy.
 
References
Bautista, C. (2014). Disorders of Brain Function. In S. Grossman & C. Porth (Eds),
      Porth’s pathophysiology: Concepts of altered health states (9th ed.). (pp489-
524). Philadelphia: Lippincott Williams & Wilkins.
Craft, J. & Gordon, C. (2011), Alterations of Neurological Function across the
Lifespan. In J.Craft, C.Gordon & A. Tiziani (Eds). Understanding
      Pathophysiology (pp 188-226). Sydney, Australia:Elsevier Australia.
Dashe, J. F. (2014). Stroke prognosis in adults. UpToDate. Retrieved from:
http://www.uptodate.com/contents/stroke-prognosis-in-adults
Jaunch, E.C. (2014). Ischemic stroke treatment and management, Retrieved from:
http://emedicine.medscape.com/article/1916852-overview
Maas, E.B. & Rymer, M.M. (2009). Ischaemic stroke: Pathophysiology and Principles
of Localization. Neurology 13 .Retrieved from:
http://www.turner-white.com/pdf/brm_Neur_V13P1.pdf
National Stroke Foundation (2010).  Clinical guidelines for stroke management

Melbourne Australia.

Silverman, I.E. & Rymer, M.M. (2009). An atlas of investigation and treatment.
      Ischaemic stroke. Clinical publishing:Oxford,U.K. Left Sided Heart Failure Concept Map
Teasell, R.& Hussein, N. (2014)Brain reorganization, recovery and organizecare.
In Stroke rehabilitation clinician handbook 2014. Retrieved from:
http://www.ebrsr.com/sites/default/files/Chapter%202_Brain%20Reorganization,%20Recovery%20and%20Organized%20Care_June%2018%202014.pdf
Tocco, S. (2011). Identify the vessel recognize the stroke. American Nurse Today
      9 (6).    Left Sided Heart Failure Concept Map

Connecticut Nursing Certification and Licensure Essay

May 30, | nursing, med, NURS, Paper

Connecticut Nursing Certification and Licensure Essay
Connecticut Nursing Certification and Licensure Essay
In Connecticut, in order to practice as a nurse practitioner without a Collaborative Agreement, a  Connecticut licensed APRN who has maintained his or her Connecticut license for at least three (3) years and who has performed advanced practice level nursing activities in collaboration with a Connecticut licensed physician for at least three (3) years and for at least two thousand (2,000) hours may practice alone or in partnership with a physician or another licensed health care professional in this state. Any APRN who chooses to practice without a collaborative agreement is required to keep documentation of advanced practice level nursing activities performed in conjunction with a Connecticut licensed physician. Such APRN must keep such documentation for at least three (3) years after fulfilling such requirements and must provide it to the Department of Public Health for examination no later than forty-five (45) days after the department makes a request for such documentation Connecticut Nursing Certification and Licensure Essay. After fulfilling the criteria outlined above and before to practicing without a collaborative agreement, APRNs must provide written notification to the Department of their intention to practice without one.
In order to practice as a nurse practitioner requiring a Collaborative Agreement an APRN must work in cooperation with a Connecticut-licensed physician for the first three (3) years after receiving their license. “Collaboration” refers to a mutually agreed-upon working relationship between an APRN and a physician who is educated, trained, or has relevant expertise in the advanced practice registered nurse’s field of practice. A fair and adequate degree of consultation and referral, covering for the patient in the absence of an APRN, a means to assess patient outcomes, and a method of disclosing the connection to the patient are all part of the cooperation. The collaboration between such advanced practice registered nurse and a physician, in relation to the exercise of prescriptive authority, shall be in writing and shall address the level of schedule II and III controlled substances that such APRN may prescribe, as well as a method to review patient outcomes, including, but not limited to, the review of medical therapeutics, corrective measures, and diagnostic studies Connecticut Nursing Certification and Licensure Essay. The Department of Public Health will not collect copies of collaborative practice agreements on a regular basis. APRNs must, however, furnish the Department with a copy of the collaboration agreement upon request (Aprn practice. CT.gov, 2021).
To be eligible for advanced practice registered nurse licensure in Connecticut, a person must have a current Connecticut registered nurse license and hold and maintain current certification as a nurse practitioner, clinical nurse specialist, or nurse anesthetist from one of the recognized national organizations, such as American Nurses Credentialing Center, National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties, Pediatric Nursing Certification Board, American Association of Nurse Anesthetists, American Academy of Nurse Practitioners, Oncology Nursing Certification Corporation, or American Association of Critical-Care Nurses (Aprn practice. CT.gov, 2021) Connecticut Nursing Certification and Licensure Essay.
The documents for the APRN application may be found at http://www.ct.gov/dph/cwp/view.asp?a=3121&q=389400&dphNav GID=1821 on the Department of Public Health’s website. A number of original source papers will be required by DPH. Official transcripts from the issuing institution must be used to demonstrate post-basic nursing education. The dean or director of the program must verify pharmacology courses; the Board has provided a form for this purpose. Applicants who respond “yes” to any question concerning a negative professional background (for example, suspensions, investigations, or criminal convictions) must provide supporting proof. A personal statement as well as formal documentation such as court records will be requested by the licensing agency. Notarization is required on the application form. A current photograph will be taped to the applicant’s resume. The Commissioner of Public Health must be notified by an advanced practice nurse who has fulfilled the cooperation criteria and desires to practice independently. The Department of Public Health oversees the Connecticut Board of Examiners in Nursing. The Connecticut Department of Health has information on advanced practice nursing at http://www.ct.gov/dph/cwp/view.asp?a=3121&q=389400&dphNav GID=1821. The licensing agency can be reached at (860) 509-7603 or through email at dph.nursingteam @ ct.gov (Connecticut APRN LICENSE Requirements: Become a nurse practitioner in CT. NursingLicensure.org – A more efficient way to find nursing license requirements in your state, 2021) Connecticut Nursing Certification and Licensure Essay.
Instead of a licensed physician, NPs practice under the jurisdiction of the State Board of Nursing. The NP must work with a physician for the first three years following first licensure. A fair and acceptable degree of consultation and referral, covering for the patient in the absence of such an advanced practice registered nurse, a means to assess patient outcomes, and a method of disclosing the connection to the patient must all be addressed in the written agreement. The NP can practice independently after three years. Prescriptive authority is given three years following first license, a written cooperation addressing the degree of Schedule II and III restricted drugs that an NP can prescribe is needed. A strategy for reviewing patient outcomes must be included in the partnership. After three years, the NP is free to prescribe on her own. State policy recognizes NPs as primary care professionals. A patient’s main care provider might be a participating, in-network physician or a participating, in-network advanced practice registered nurse (Connecticut scope of Practice policy – State Profile. Scope of Practice Policy, 2021) Connecticut Nursing Certification and Licensure Essay.
Controlled Substance Practitioner Registration allows practitioners to distribute, dispense, conduct research, administer, or purchase restricted drugs in the course of their professional practice if the Department of Public Health or another regulating entity has granted them permission. A valid active registration with the Department of Public Health is required of anybody seeking for this registration. If you have been convicted of a felony or if your license has been surrendered, revoked, suspended, limited, or refused, or if any such action is underway, no further proof is necessary. In Connecticut, licensed medical staff who prescribe restricted drugs must meet this criterion. In order to proceed with the Controlled Substances Registration application, all applicants will be required to have an application on file with the Department of Public Health. The application fee is $40 at first. ALL PRACTITIONERS WHO POSSESS A CONNECTICUT CONTROLLED SUBSTANCE REGISTRATION MUST REGISTER IN THE CONNECTICUT PRESCRIPTION MONITORING AND REPORTING SYSTEM*** at https://connecticut.pmpaware.net (Controlled substance practitioner registration. CT.gov, 2021) Connecticut Nursing Certification and Licensure Essay.
The DEA application is divided into six components. Personal/business information, activity, state license(s), history, payment, and confirmation. The DEA Form-224 is now available online (recommended), or you can fill out and submit a paper version. Other forms for new registration (Forms DEA-225, DEA-363, and DEA-510) are also now accessible online or can be mailed. For assistance with registration, contact the DEA Registration Service Center at 1-800-882-9539 (8:30 a.m. to 5:50 p.m. ET) or send an email to [email protected]. In your email, be sure to mention your DEA registration number. Alternatively, you may speak with a Local Registration Specialist (Registration, 2021). In CT controlled-substance prescriptive authority and drug schedules nurse practitioners are authorized to prescribe, Dispense, Administer, and procure Schedule II/IIN substances (2/2N), Schedule II/IIN substances (2/2N), Schedule IV substances (4), and Schedule V substances (5) (CSA registration tools, 2021).
Our Regional 1 Director has been honored with the AANP State Advocacy Award for Excellence, which honors committed advocates in each state who have made substantial contributions to raising NP knowledge and recognition. Improving Access for Patients Who Need Cardiac and Pulmonary Rehabilitation Services, Improving Medicare Patient Access to Needed Therapeutic Shoes, and Introducing/Reintroducing ourselves to our Members of Congress to educate them on the high-quality health care that NPs provide are just a few of the activities that our states are involved with (AANP regional directors and state representatives. American Association of Nurse Practitioners, 2020) Connecticut Nursing Certification and Licensure Essay.
Reference:
AANP regional directors and state representatives. American Association of Nurse Practitioners. (2020).https://www.aanp.org/about/about-the-american-association-of-nurse-practitioners-aanp/your-aanp-region/regional-directors-and-state-representatives.
Aprn practice. CT.gov. (2021). https://portal.ct.gov/DPH/Practitioner-Licensing–Investigations/APRN/APRN-Practice.
Connecticut APRN LICENSE Requirements: Become a nurse practitioner in CT. NursingLicensure.org – A more efficient way to find nursing license requirements in your state (2021).  https://www.nursinglicensure.org/np-state/connecticut-nurse-practitioner/. 
Connecticut scope of Practice policy – State Profile. Scope of Practice Policy. (2021). https://scopeofpracticepolicy.org/states/ct/.
Controlled substance practitioner registration. CT.gov. (2021). https://portal.ct.gov/DCP/License-Services-Division/All-License-Applications/Controlled-Substance-Practitioner-Registration.
CSA registration tools: Login. (2021). https://apps.deadiversion.usdoj.gov/webforms2/spring/main?execution=e1s1.
Registration. (2021). https://www.deadiversion.usdoj.gov/drugreg/index.html#2 Connecticut Nursing Certification and Licensure Essay.