Human Enlightenment: a Comparison of Kant and Newman Essay

The diligent is a 70 years oldish man, admitted in Clinton Cardiology Center for repeated chest pain, fainting, hypotension, thoracic discomfort and cough, which appeared perfectly the same day. The clinical exam showed cold, pale, sweated skin, dyspnea, tachycardia, a diastolic murmur in the 3rd intercostal space near the sternum edge, a third degree systolic murmur above the lower sternum, and a occupation pressure of 80/60 mmHg. The electrocardiogram showed signs of right ventricular overload.The diligent was known with arterial hypertension form 2009, had an episode of atrialfibrillation and wooden-headed vein thrombosis of the right calf in 2005 and had a hip replenishment in 2010. An echocardiographic exam in 2006 noted an ascending aorta aneurism. He had been toughened with Betaxolol 20 mg/day for hypertension, Amlodipine 5 mg/day, Indapamide 1. 5 mg/day and Trimetazidine 35 mg x 2/day. He was also treated for a severe depression (Olanzapine). The uncomplaining state s having worked as an ac take careant at some point in his life has the cursory beer but never smoked he doesnt exercise at all and cannot stand for long period of time.The patient is a steep fall luck. LEARNING STYLE English is the patients outset language and he can read and write he states having a degree in accounting. He is both an auditory and verbal pupil who loves to talk and crack jokes. He speaks clearly and has no trouble communicating at all. He is however feeling discouraged, depressed and is anxious of his topical situation but is not eager to learn how to manage his viands and weight as he is not able to exercise cod to dyspnea he is also partially weight bearing on his left leg and is seeing PT as a offspring from hiship surgery and is still non-compliant with his therapy. The doctor has put him on clean medication Reteplase (Retevase) after the doctor diagnosed him with acute myocardium infarction. RETEPLASE (RETEVASE) Reteplase is a thrombolytic medicate that is used to dissolve and break the blood clots that brace a bone marrow attack. It works by activating a substance that helps to break up blood clots. Blood clots can prevent oxygen and nutrients from getting to the heart, which causes create from raw material death and long-term damage to the heart. Its indicated for use in the prudence of acute myocardialinfarction (AMI) in adults for the improvement of ventricular social function following AMI, the diminution of the incidence of congestive heart failure and the reduction of mortality associated with AMI. Reteplase is abandoned by guessing into a vein (IV). Generally, it is given as 10 + 10 whole of measurement double bolus injection. EACH BOLUS disposed(p) OVER 2 MINUTES. WITH THE 2ND BOLUS GIVEN, AN INITIAL DOSE follows by a second dose 30 proceeding later. Two 10 unit bolus injections are required for a complete treatment. CONTRAINDICATIONS Active internal discharge Recent intracranial or intraspinal surgery or trauma.Severe lawless hypertension Known eject diathesis ADVERSE REACTIONS hypersensitivity reactions, haemorrhage GI upset, hypotension, pyrexia cardiogenic shock, ar pulseias, AV block, pulmonary edema Heart failure, cardiac arrest, ischemia, myocardial rupture, mitral regurgitation, pericardial effusion, venous thrombosis, cholesterol embolism SIDE EFFECTS The more or less frequent adverse reaction associated with Retavase is bleeding. Other side set up overwhelm Pain, redness, or swelling at the injection site Nausea and regurgitate Severe headache, eye pain or vision changes. fast apathy or weakness, especially on one side of the body Sudden headache, confusion, problems with speech, or balance INTERACTIONS Anticoagulants blood thinners (e. g. , warfarin or heparins) Antithrombocyte do drugss (e. g. , clopidogrel, dipyridamole, ticlopidine) NSAIDs (e. g. , ibuprofen, naproxen) Drugs that alter platelet function (such as aspirin ) may sum up the risk of bleeding if ad ministered prior to or after Retavase (reteplase) therapy DOSAGE Reteplase is for endovenous administration only. Reteplase is administered as a 10 + 10 unit double-bolus injection.Two 10 unit bolus injections are required for a complete treatment. Each bolus is administered as an intravenous injection over 2 minutes. The second bolus is given 30 minutes after initiation of the first bolus injection. Each bolus injection should be given via an intravenous line in which no other medication is organism simultaneously injected or infused. No other medication should be added to the injection solution containing reteplase. There is no experience with patients receiving repeat courses of therapy with reteplase. Nursing Implications reminder racy signs, especially blood pressure and pulse. (Decreasing blood pressure, increase in pulse may indicate internal bleeding). Protect patient from blot by maintaining limited mobility during drug therapy. Monitor all possible sites of bleeding duri ng infusion. Ensure that cardiac rhythm is monitored during therapy. (Dysrhythmias may occur with reperfusion of myocardium). Monitor blood profile during and after therapy for indications of blood loss due to internal bleeding. (Patient has increased risk of bleeding for 2-4 days post therapy. ) Lab test considerationsPlasminogen (Administration of Retavase(reteplase) may cause decreases in plasminogen and fibrinogen Degradation of fibrinogen in blood samples removed for analysis NURSING PROCESS Assessment Prior to administration die hard complete health history including allergies, drug history and possible drug interactions Obtain a baseline ECG and electrolytes, ABG, blood urea northward and cardiac enzyme levels Assess lab values obtain CBC, PT, Hgb, Hct, platelet count Asses vital signs and neurological status Assess for recent surgery or trauma, bleeding disorders, or history ofhemorrhagic stroke or GI bleeding Nursing Diagnoses Tissue perfusion, In effective related to a dverse effects of medication Injury, Risk for (bleeding) related to adverse effects of medication Knowledge, dearth related to drug therapy, action, and side effects Planning Patient article of faith and demonstrate understanding of risks and benefits of drug therapy. Inform patient that legal action testament be limited during infusion and pressure dressing may be needed to prevent whatever active bleeding. Patient will endure free of unusual and excessive bleeding. Maintain effective tissue perfusion. perpetually monitor cardiac rhythm and explain to patient that cardiac rhythm will be monitored during treatment. Instruct patient of increased risk of bleeding, activity restriction, and frequent monitor during this time. Teach patient regarding need for frequent vital signs. Take and record vital signs every 15minutes during infusion and for 2 hours following. intervention Continue to monitor for adherence and compliance. At start of therapy watch for any signs of hypersens itivity, shortness of breath and a feeling of tightness and pressure in the chest.Check patient vital signs frequently andmonitor his skin gloss and sensory of function of extremities every hour. Evaluation Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met. Protect patient from injury by maintaining limited mobility during drug therapy this helped to prevent any go since hes a high risk for falls. By monitoring his vital signs, especially blood pressure and pulse (Decreasing blood pressure, increase in pulse may indicate internal bleeding) this reduced risks for any internal bleeding. Patient understands the risks and benefits of the drug therapy.The teaching plan is reasonable and effective as well and if implemented today would serve to teach the patient and assist him to better manage the MI and prevent other related complications such as hypertension, embolisms, dyspnea and circulation. REFERENCES ?2009 Edition Delm ars Nurses Drug Handbook By George R. Spratto, Ph. D. , Adrienne L. Woods pages 1394-1395 ?http//www. rxlist. com/retavase-drug/patient-images-side-effects. htm ?http//www. drugs. com/cons/retavase. html ?http//reference. medscape. com/drug/retavase-reteplase-342289 ?http//www. mayoclinic. com/health/drug-information/DR602387.