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Non-Insulin Dependent Diabetic - Question 1

Heart Rupture

Heart rupture is the most common reason of death after acute MI followed cardiogenic shock. Ten per cent acute MI is complicated by Cardiac rupture and happens within about 5-9 days in the healing phase. However, 24 hours after the introduction of thrombolytic therapy, the greatest risk appears to have disappeared. In an attempt to lessen the risk attempts have been made by means of the first aid with the help of beta blockers. With regard to a widespread MI or hypertension, the risks of Heart rupture seem to be greater in adults. Blood pericardium causes rapid death resulting in cardiac tamponade pulseless electrical activity and cardiac arrest. In case of Mr. Maxwell, as he is suffering from acute Myocardial Infarction, Heart rupture is the most likely complications Mr Maxwell may be developing (Jones, et al., 2014).

Heart Failure

Heart failure is another complication Mr Maxwell may be developing after his acute Myocardial Infarction, and it is regarded as one of the more serious complications of MI, due to the inability of the heart for providing suitable cardiac output for the metabolic needs of the body. Loss of contraction of the damaged myocardium as a cause of left ventricular remodelling causes 25-50% of acute MI heart failure complications. It develops at first glance within the first few days of MI. Generally, symptoms of Heart failure do not occur because of a decrease in cardiac output, yet the body has compensatory measures for maintaining appropriate output. Fluid retention, such as, increases lung / peripheral edema and increases sympathetic activity which causes tachycardia. With regard to a number of cases, the situation could rapidly improve into cardiogenic shock. The goal of nursing management is to monitor myocardial function stress reduction and treatment effects such as fluid balance, daily weight, blood pressure, heart rate, exercise tolerance level, and related clinical features (Davies, et al., 2013).

The complication related to heart failure should be prioritised first as Heart failure is not only a progressive but also a chronic situation in terms of which sufficient blood cannot be pumped by heart muscle or fulfilling the requirements of the human body for oxygen as well as blood. Essentially, the heart cannot carry the burden of its work.

Non-Insulin Dependent Diabetic - Question 2

Changes in The Patient's Lifestyle

The patient needs to change his own lifestyle. Especially in any activity, behaviourally and emotionally it raises the workload of the heart. The nurse should take both temporary nursing interventions to change the patient’s life as a result and is advised to change his or her lifestyle to improve the patient’s health. Noise contaminants should be avoided to ensure patient’s peace of mind. Similarly, air pollution should be avoided to prevent shortness of breath, which can cause significant hypoxia for the concerned patient (Bajaj, et al., 2015).

The Patient's Diet

Diet plays an important role in maintaining the health of patients with heart failure. Patients need to change their diet to follow regular, lean, short prescriptions. Therefore, patients need to be provided salt-free and fat-free food at the time of hospitalization. When the heart is weak less blood is pumped to the kidneys, retaining fluid and water. A salt-free diet reduces the risk of fluid retention and reduces the stresses of the week heart.

A fat-free diet reduces the risk of ischemic heart disease. Even in patients with reduced body metabolism, foods should be cooked softly to reduce the effort of mechanical digestion of solid foods. A large diet puts pressure on the heart and consequently increases work pressure. To reduce heart pressure, patients should be advised to maintain a half-bird position after each meal. Calorie rich foods should be provided as an energy supplement. Since the body's short metabolism weakens its immunity, it is necessary to provide vitamin-rich foods to boost the patient's immunity. In order to improve the condition of Mr. Maxwell, nurses should look into the increases the patient's immunity.

Drug Administration and Oxygen Therapy

In the clinical setting, physicians prescribe medications for the symptomatic treatment of heart disease. The nurse's job is to administer the prescribed medication. Nurses, however, are expected to have knowledge of so-called pharmacological treatments and side effects of these drugs to ensure patient progress and prevent treatment-related complications. Without careful administration, heart failure can lead to serious side effects. Proper medication such as Angiotensin receptor blockers, Aldosterone antagonist, Beta blockers, and Combination medicines should be provided by the nurses. Oxygen therapy can facilitate breathing And it can reduce the workload of the heart (Hofmann, et al., 2017).

Coordination of Diagnostic Tests for Effectual Scientific Management of Heart Failure Patients

The jurisdiction of diagnostic tests in the clinical setting and prescriptions for patients with heart failure are within the jurisdiction of the physician. Along with that the main responsibility of the nurses is to conduct the procedure of diagnostic as well as to observe the outcomes obtained by the doctor in order to explain the treatment consequently. The most common diagnostic tests are chest X-rays, electrocardiograms (ECGs) and blood tests

Non-Insulin Dependent Diabetic - Question 3

Transfer and Communication Decisions

There are some physical and psychosocial requirements as well as logistic considerations for safe transfer of Mr. Maxwell. These are as follows:

Physical requirements:

Aviation

Patients with potential respiratory tract infections during transport should be internalized with a cuffed electrolyte endotracheal tube (ETT) that should be properly secured after proper positioning. Mr. Maxwell requires a properly placed nasogastric tube to prevent cravings for gastric contents during transplantation.

Respiration

The value of arterial blood gas should be properly optimized to control ventilation. In case of Mr. Maxwell chest drainage should be done, especially before transport, especially before air.

Circulation

Mr. Maxwell should have at least two wide veins worked before the transplant. If external bleeding occurs, it should be properly controlled; the veins and skin should be excised, and treated with a vasopressor. Cross-mill blood availability may be required during shipping.

Disability or nerve condition

Patients with head trauma should have adequate monitoring and documentation of the Glasgow Coma Scale (GCS) during transportation and prior to the administration of decent paralysis. In addition to the pre-transfer checklist above, Mr. Maxwell should be protected from colds by keeping appropriate blankets. All baseline studies should be performed on the day of transfer to reflect the patient's current condition (Mihalko, et al., 2018).

Physiological options during transport

The transfer of patients by land or air causes various physiological changes in both the patient and the transport team, safely and seriously affecting the transfer of the patient. These include:

Noise

Different sources of noise during patient transfer are ambient air, helicopter rotors, pilots, engines and surveillance equipment. The generated sound can prevent Mr. Maxwell from leaving the hospital and interfere with the conversation between the physician and the transplant recipient.

Vibration

Different sources of vibration depend on the transfer mode. Non-uniform road and vehicle suspension causes vibrations in ground transport and turbulence in engines, rotors, drivers and air causes vibrations during air transport. Vibration may cause nausea, discomfort, headache, visual impairment, pain in fragile areas, increased spinal cord injury, intermittent hemorrhage, and may interfere with endotracheal and endotracheal intubation.

Acceleration and gravity

During transplantation, patients experience both radial and linear acceleration and loss of strength, and physiological effects may be more severe in critically ill patients due to their hypovolic and vasodilating properties. Sudden acceleration or damage can lead to transient hypertension and arrhythmia in patients. These effects can be minimized by placing the patient's trolley in the right corner of the long axis of the aircraft and placing the patient's legend towards the cookpit to avoid the venous pool (Belmont Jr,et al., 2014).

Temperature and humidity

The internal environment of the ambulance is kept cool with the help of air conditioning system which can cause hypothermia in sensitive patients especially newborns. These patients should be covered with a warm blanket when transferring. Humidity decreases with the height of the air transport and the secretions of the airways and mucous membranes can dry out. These patients require moist oxygen and eye lubrication using artificial tears or drops.

Non-Insulin Dependent Diabetic - Question 4

Acute kidney injury (AKI, a term known for acute renal failure in 2004) is associated with clinical syndrome of sudden renal dysfunction and poor prognosis. Hypertension is one of the common risk factors of acute kidney injury. Hypervolemia, along with sepsis is also regarded as risk factors associated with acute kidney injury. Other adverse effects associated with AKI include increased risk of interstitial renal disease, chronic kidney disease (CKD) and cardiovascular events.

Risk factors for AKI include serious infections, diabetes, aging, and CKD. Elderly people with diabetes are one of the special risk groups due to multiple risks, especially age, the presence of other Cumberbeds including CKD and the tendency to serious infections. A common infection in this population is community-acquired pneumonia (CAP) and a recent review found that the CAP ratio between diabetic patients was between 1.5 and 3.1. Both CAP and severe and non-severe CAP are affected by the infection, with a higher risk of death and long-term hospitalization for the disease. The same is true of older people with pneumonia and diabetes who have incomplete renal recovery. The cause of this adverse event is unknown after the onset of pneumonia in the elderly. Diabetes mellitus along with jaundice are also common risk factors of acute kidney injury. Mrs Maxwell should be informed about all of these risk factors related to acute kidney injury of Mr. Maxwell (Slaughter, et al., 2010).

References for Non-Insulin Dependent Diabetic Analysis

Bajaj, A., Sethi, A., Rathor, P., Suppogu, N., &Sethi, A. (2015). Acute complications of myocardial infarction in the current era: diagnosis and management. Journal of investigative medicine63(7), 844-855.

Belmont Jr, P. J., Goodman, G. P., Kusnezov, N. A., Magee, C., Bader, J. O., Waterman, B. R., &Schoenfeld, A. J. (2014). Postoperative myocardial infarction and cardiac arrest following primary total knee and hip arthroplasty: rates, risk factors, and time of occurrence. JBJS96(24), 2025-2031.

Davies, N. M., Smith, G. D., Windmeijer, F., & Martin, R. M. (2013). COX-2 selective nonsteroidal anti-inflammatory drugs and risk of gastrointestinal tract complications and myocardial infarction: an instrumental variable analysis. Epidemiology, 352-362.

Hofmann, R., James, S. K., Jernberg, T., Lindahl, B., Erlinge, D., Witt, N., ... & Ravn-Fischer, A. (2017). Oxygen therapy in suspected acute myocardial infarction. New England Journal of Medicine377(13), 1240-1249.

Jones, B. M., Kapadia, S. R., Smedira, N. G., Robich, M., Tuzcu, E. M., Menon, V., & Krishnaswamy, A. (2014). Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. European heart journal35(31), 2060-2068.

Mihalko, E., Huang, K., Sproul, E., Cheng, K., & Brown, A. C. (2018).Targeted treatment of ischemic and fibrotic complications of myocardial infarction using a dual-delivery microgel therapeutic. ACS nano12(8), 7826-7837.

Slaughter, M. S., Pagani, F. D., Rogers, J. G., Miller, L. W., Sun, B., Russell, S. D., ... & Adamson, R. M. (2010). Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. The Journal of heart and lung transplantation29(4), S1-S39.

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