Palliative Care in End Stage Congestive Heart Failure

Palliative Care in End Stage Congestive Heart Failure Congestive heart failure (CHF) is an inability of the heart to supply/pump blood to the body as it needs in normal. CHF is an acute illness and a chronic disease in which the passage of time may cause other physical and psychological diseases that poses a threat to the health of the patient, and may be the cause of life limiting (American Heart Association, 2010). This indicates the poor quality of life of the patient, exacerbating health problem. Hence, those patients need to attend palliative care to improve the quality of life. Palliative care for CHF patient is very important to relive or prevent the pain which may be able to be cause physical problems such as (respiratory disorder and sleep disorder) or psychological problems such as (depression and anxiety). Palliative care is supportive care which provides physical support, psychological support, spiritual support and social support and that is to provide the best as much as possible to improve quality of life (Davidson, Macdonald Newton, 2010). How can you help and support Verner from the palliative care perspective? From the case Mr. Verner has complaining from several problems related to his state of physical, psychological, social and spiritual. In the beginning I have to consider appropriate place of care either in hospital or at home if there is sufficient support in all ways (Patient UK, 2010). Then Ill start with him a comprehensive assessment for his situation from perspective of palliative care includes the physical and psychological, social, cultural and spiritual (existential). Mr. Verner has advanced heart failure or end stage heart failure where can be identified the stage according to Dunderdale, Thompson, Miles, Beer Furze (2005) by the New York Heart Association (NYHA). In addition NYHA can assess a variety of the physical symptoms and restrictions. An important aspect of Mr. Verner management is communication and listening, exploring his understanding and feelings about his illness. Exploring concerns about the future can provide opportunities to discuss death and preferences fo r end of life care (Jaarsma et al., 2009). There are physical and psychological complications caused by CHF. For example Mr. Verner case: he does not sleep at night because he has trouble breathing, probably he has pulmonary congestion/pulmonary edema because according to (American Heart Association, 2010) pulmonary edema is one of the complications of CHF. So, medical intervention is needs in order to address the symptoms experienced by the patient, because medical care is very important to reduce patient stress and anxiety. Providing support through effective communication, skills may lift the moral of the patient. During communication I have to be honest and fidelity also in dealing with this patient must be show kindness, compassion and respect. In order to helping Mr. Verner from the palliative care perspective I have to provide a good palliative symptom management, psychological, spiritual and social support will provide hope and reassurance. Emotional and social support is very important aspect for CHF patient. Where the presence of family, relatives and friends around of the patient would be a very strong supporter to improve the psychological status of the patient and reduce depression, anxiety, social isolation and loneliness (Jaarsma et al., 2009). Ill ask the provider of Social Work to communicate with family members to provide the counseling and patient needs from social services. Also the family members should be encouraged in participating with palliative care team to more improve in the physical care for the patient. Moreover, he may benefit from a referral to social services and district nursing. Liaison between his primary care team and the local palliative care team is strongly recommended and Mr. Verner could be given contact numbers for the palliative care services. Hospice care for further social support and respite may be beneficial. Providing spiritual support is one of the important aspect of palliative care whether from family or from clergy, to encourage and support the patient to let him look to the future with optimism and live with his society and daily activities in comfortable manner until he dies (Becker, 2010). Which problems and needs can you identify? From the case it shows to me Mr. Verner suffering from physical and psychological problems which include: Heart disease is the main cause of worsening of his situation and increase physical problems that are: According to Scherer et al., (2005) lack emotional and social in patients with CHF makes the psychological problems in evolution as experienced by Mr. Verner: Physical problems Nausea,Vomiting Vertigo all the day time Decreased appetite Lack of energy Trouble breathing Cough in night Sleeping disorder Psychological problems Depression Anxiety Social isolation/loneliness Hopelessness Fear of death Nursing diagnosis: Decreased cardiac output related to decreased myocardial contractility. Impaired gas exchange related to lung congestion resulting in trouble breathing and cough in night. Nutrition imbalanced less than body requirements related to nausea and vomiting. Fatigue related to lack of energy. Disturbed sleep pattern related to trouble breathing. Ineffective coping related to chronic illness (Berman, Snyder, Kozier Erb, 2008). Patients needs: Information about the disease process, treatment and general advice on what to do and what not to do. Physical support and managing symptoms to relieve/reduce suffering and improve general health for live comfortably. Emotional support to reduce the psychological symptoms, where the presence of family around him will be a catalyst for this support. Social services to provide equipment such as stair lifts, ramps, commodes and information about packages of care. Enhance the care, improve quality of life and provide end life care with respect culture (customs and traditions), dignity, beneficence, sympathy and empathy. Make a nursing care plan for Verner. Explain and motivate your suggested nursing interventions in accordance with the four key areas listed in the introduction. Patient with end stage of heart failure may present with a variety of symptoms, which are similar to patients with advanced cancer (Matzo Sherman, 2010). A detailed history, physical examination, investigations and establishment of patient priorities will help in the management of their symptoms and improvement of quality of life. An accurate drug history is important due to the nature of complex drug regimens. The difficulties of coping with unwanted drug side effects may cause patients to be afraid to report their non-concordance, which may precipitate hospital admission. Common physical symptoms are fatigue, pain, breathlessness, dizziness, cachexia, anorexia, nausea, insomnia, difficulty in walking, constipation (Jaarsma et al., 2009). Communication skills are very important part in palliative care between palliative care team and patients and their families. There are small things, but significant that matter to the patient and family such as: a clean, well-pressed uniform; neat and tidy hair; an upright posture; a smile; appropriate eye contact respecting gender, age, culture or disability; a clear introduction of self and most important of all: an attitude that reflect my positive interest in them as a person (Becker, 2010). Also during communicating with the patient must repeat the information. It is possible because poor cerebral blood may lead to confusion and memory problems (Patient UK, 2010). PHYSICAL SYMPTOMS SYMPTOM CONTROL Trouble breathing, Cough in night and Sleeping disorder INTERVENTIONS (N) AND RATIONAL (R) Initial (N) Check vital signs, heart rate, blood pressure and respiratory rate depth. Observe if any wheezes and crackles in lung bases or edema. (R) This assessment will be noting and presence of fluid in the lung with change in heart and respiratory rate (Lewis et al., 2007). (N) Administer O2 and put patient on semi follower position. (R) Over volume is increased in the heart failure patient so, it results in jugular vein distention and increased hepatojugular vein also (Morton, Fontaine, Hudak, Gallo, 2005). (N) Control pain if any, discomfort feeling. (R) Patients may experience chronic pain such as oedematous limbs or osteoarthritis, or as a result of previous heart surgery (Morton et al, 2005). Ongoing Monitoring (N) Monitor vital signs, level of consciousness, oxygen saturation, cardiac rhythm, respiratory status and urinary output (Berman, 2008). Nausea, Vomiting, Decreased appetite and Lack of energy (N) Encourage the patient to eat the liquid food use a small amount of alcohol. (R) Could be good method to stimulate appetite and improving mood and general self esteem (Berman, 2008). (N) (Dehydration) Observe skin or mucous membrane dryness and edema. ( Ongoing Monitoring ) Monitor urinary output. (R) Occurs most often with CHF patients. Hypovolemia fluid shifts and nutritional deficits contribute to poor skin and edematous tissue (Morton et al, 2005). Ongoing Monitoring (N) Help patient to do daily activities such as using a wheel chair. (R) Patient needs to fully care of and need someone to help him in accomplishing daily activities at least to feel satisfied (Lewis et al., 2007). The main symptoms related to the case that require specific interventions of the palliative care team Causes and effects on CHF patients Managing symptom Fatigue CHF patients feel constantly tired and lacking energy. The main factors contributing to fatigue are: abnormalities in skeletal muscle due to reduced perfusion and neurohumoral changes; the side effects of medications; reduced activity; anaemia; lack of appetite and muscle wasting (Scherer et al, 2005). Fatigue causes reduced quality of life because it severely restricts patients activities and creates difficulties in walking and getting out of the house. In the end stages of heart failure even managing personal hygiene and dressing can be difficult. Fatigue can also compound other physical symptoms such as constipation, oedema and pain (Davidson et al., 2010). Access to exercise programmes may be of benefit to reduce fatigue and can give patients greater sense of well being. Explanation to the patient and his family about the physiological causes of fatigue can help them understand what they are experiencing and referral to occupational therapy of physiotherapy for advice on energy conservation and exercise can be useful. Education about healthy eating and correcting anaemia can also be beneficial (Jaarsma et al., 2009). Breathlessness Commonly caused by pulmonary oedema due to failing left ventricular function or sometimes due to anaemia. Other causes such as chest infection should not be overlooked. Anxiety, depression and inactivity can also contribute to breathlessness (Davidson et al., 2010). Increasing diuretics is the first line treatment for breathlessness due to increasing congestion and providing by Respiratory Consultant. Home oxygen may be useful for patients with daytime low blood oxygen saturations. The use of breathing and relaxation exercises can help reduce the anxiety, which often accompanies breathlessness (Davidson et al., 2010). PSYCHOLOGICAL (EMOTIONAL) SYMPTOMS Causes and effects on CHF patients Managing symptom/ Management Diagnosis of heart failure may make emotional stress. Depression, anxiety, social isolation and loneliness are common symptoms experienced by patient with end stage heart failure. The lack emotional and social support is an important predictor of morbidity and when patient become isolated and lack the ability to cope with his disease this can also be a significant predictor of mortality (Jaarsma et al., 2009). A patients experience of depression is often compounded by their physical symptoms. Psychological symptoms are can reduce quality of life. Mr. Verner says: I am not my disease, which can hinder hope for the future. From my experience when I give an opportunity to the patient as Mr. Verner condition, certainly will talk about dying. Fears of how he may die? How of pain? Emotional support is important for the patient. Effective communication with patient and his carer is needed from diagnosis and throughout the course of the illness. To maintain hope, patients can be offered good palliation of their symptoms and exploration of their preferences for care. Information needs to be available about the disease process, common feelings experienced and local social support services. Referral to psychology services or counselors may be required and some patients may benefit from an antidepressant (Jaarsma et al., 2009). Tricyclic antidepressants are not usually advised due to their pro-arthymic side effects. Selective serotonin reuptake inhibitor antidepressants (e.g. fluoxetine 20 mg once daily) are more commonly prescribed (Morton et al., 2005). SOCIAL AND FAMILY SUPPORT Causes and effects on CHF patients Management Social and family support is very important element, which engaging social services are a high priority may affect adversely on some psychological problems such as social isolation, loneliness and sadness etc. Specifically the social aspect may be involved in the following problems: financial status, capacity to self care, adherence with lifestyle and carer burden (Davidson et al., 2010). Mr. Verner misses his children and grandchildren because he does not have energy to talk on telephone. And that make him in bad condition. Social services to provide equipment such as stair lifts, ramps, commodes and information about packages of care; District nurses for assessment of symptoms and support. District nurses are often not aware of patients living with CHF until they become hospitalized; Community physiotherapy and occupational therapy for assessment and advice on exercise, energy conservation and home adaptations to aid in activities of daily living; Benefits advice patients may be eligible for disability or attendance allowance (Dunderdale, Thompson, Miles, Beer, Furze, 2005). And assist in communicating with family and give advice to family in order to be near Mr. Verner, even if the move to live with his children. The presence of family, relatives and friends around of the patient would be a very strong supporter to improve the psychological state of the patient and reduce depression, anxiety, social isolation and loneliness. SPIRITUAL (EXISTENTIAL) SUPPORT Spiritual support is an important aspect in palliative care. CHF reflected a gradual loss of identity and increased dependence and his illness make him incapacitate. Where it feels the burden on society and loses a sense of worth and meaning. Some patients have religious beliefs and feel comfortable than other patients who blame the Lord and say, Where is all this time? Why the God made me like this case? (Christian medical fellowship, 2011). Spiritual support is provided by a clinically certified interfaith chaplain and a qualified by the palliative care team. And chaplain role in this is to restore hope and existential then make the patient to cope the reality (University of Iowa Hospitals and Clinics, 2011). And small things will make Mr. Thomas in happiness or make a huge difference, such as to bring his cat or a visit from a close friend or inspiration in art, poetry, music (Becker, 2010).CONCLUSION Patients with CHF often experience a multitude of symptoms that affect adversely on their general health therefore it may happen to them to get sudden death. Participation with palliative care team is necessary to reduce the symptoms, provide the best as much as possible to improve quality of life and provide end life care with dignity. Nursing care plays an important role in the teamwork for patients with CHF, which can addressed with a variety of interventions, to relieve physical and psychological suffering, including treatment of pain, breathing difficulties and sleeping disorders. Communication is very important between palliative care team and patients and their families to adoption key work of care approach could improve patients access to appropriate palliative care. In addition, good communication between all those caring people for the patient in both primary and secondary care is essential. However, palliative care needs to be accessible early in the disease beginning beca use in the advanced stages patients may had worsened their health and then the team cannot provide the desired care. Finally I choose this case because I think the palliative care process as a practice in health part just for cancer patients but after dealing with Mr. Verner case I add to my nursing knowledge more specialized skills about the palliative care.

Large Kneeling Statue of Hatshepsut

The Large Kneeling Statue of Hatshepsut is a magnificent piece of art located in the Egyptian section next to many other statues of the great pharaoh Hatshepsut. Out of all the statues of Hatshepsut, the Large Kneeling Statue of Hatshepsut was kept in the best shape and caught a lot of attention from the people in the room. Its great size is something truly remarkable, considering it was built in the New Kingdom of Ancient Egypt. More importantly, this statue is the first structure in art that depicts a woman leader. Not only is it a truly unique piece of work, but also it is a piece that is revolutionary for its time. The massive size of this statue leaves one wondering if women have always been just as powerful as men, if not more. Hatshepsut is the first recorded female pharaoh in all of time. Even though she was a queen, the Egyptians still gave her a beard, which was traditional in artworks for the pharaoh. This masculine feature gives her a solid presence. Even though she might not look like a powerful pharaoh, the beard helps her followers believe that she is just as commanding as any man. She also has on the nemes headdress typical for a pharaoh to wear. Looking into the face it is visible how old this structure is. It is very rough, rigid and is kind of hard to make out the eyes. However, the lips and nose seem very realistic and gives the viewer a sense of how much time and precision went into this piece many years ago. It can be seen that the Large Kneeling Statue of Hatshepsut was carved from a block because there is no space in between the legs and the block on the bottom. All of these incredible features that are usually linked as a part of man exemplify the queen as she felt on the inside. When looking into Hatshepsut’s face, there is no visible emotion. This was probably to make her seem serious about her reign over Egypt. Also, she is a heavy and bulky structure. The size, the beauty, and the image of the sculpture were all used a to her advantage. Her people saw her no differently from the other male emperors before her. The beard and the headdress were utilized as props to make her seem like the powerful woman. Hatshepsut is holding two orbs in both of her hands. This was a way of getting the message across to her people that she was also a giver. They were probably used as offerings to the gods. The orbs seem to kind of weigh down her arms. The legs support the arms from falling on the ground. This shows how there is weight bearing down on her arms due to the orbs that she holds in her hands. In addition, Hatshepsut is perfectly balanced. This balance creates calmness, reflecting the tranquil time period she was ruler. The orbs gives off a sense of how great a pharaoh was made to look through the artwork that they were in. In the New Kingdom time period, no one was really portrayed realistically, and that can really be seen in this work of art. Hatshepsut was the first woman pharaoh ever recorded in history. Although there are a few obvious breaks, this granite sculpture was put back together nicely. Because this piece is so important, the Metropolitan Museum of Art has to be careful of what to light up on the sculpture. This does not look easy because the statue is so massive, but the Met did a good job capturing the face with light, and the top of the orbs. The shadows also reflect how angular this statue really is, and the unrealistic body of the woman pharaoh Hatshepsut. For this weighty, magnificent piece of art to be produced in such a time period makes it something to really marvel at. It gives me a feeling of awe deep inside. The size, the beauty, and the description really leave its viewers pondering how it was constructed. It is known that it was carved out of a block, but the time and effort must have been a tremendous amount. They had to use brute strength and primitive tools to build art that would be hard to build today. To construct such a sculpture at the time is baffling because technology was almost inexistent in Ancient Egypt. This makes one think if they had help from an outside source such as aliens, and if so does this mean that aliens believe women are equal to men. In the time of 1550-1070 BCE when this large statue was created, Egypt was considered to be in its New Kingdom period, one of seven different periods in Ancient Egypt. During its time, the Large Kneeling Statue of Hatshepsut was praised for being a powerful leader. Today, the statue is seen in a totally different light. People look at Hatshepsut as a woman who changed the gender roles, not a woman who is doing a great job leading. The Ancient Egyptians probably didn’t think twice that their leader had a beard because that was the traditional way. Hatshepsut is sculpted with the idealized image of the pharaoh seen with a beard and the nemes headdress. This resembles another peace of art from the New Kingdom, the Mortuary Temple of Hatshepsut. This temple echoes what the cliff looks like just how Pharaoh Hatshepsut would echo what her followers looked like. Both peaces of art are were built to fit comfortably into their surroundings, except Hatshepsut was a woman. Menkaure and Wife Statue from the Old Kingdom of Ancient Egypt is also similar and different to Large Kneeling Statue of Hatshepsut. This statue is more formal and very stiff. Also, the queen is in her classic pose, putting her left hand over her body. In this statue, the king is similar to Hatshepsut. Nefertiti made by Thurmost from the Amarna period of Ancient Egypt is very different from the Large Kneeling Statue of Hatshepsut. Nefertiti just like many other statues from its time is more relaxed. Although she was not a queen, Nefertiti was very famous. She dressed like a beautiful woman and was the standard of beauty, unlike dressing like a man to fit in like Hatshepsut did. The Large Kneeling Statue of Hatshepsut makes one have a sense of belief that women have always been as powerful as men like women are portrayed today. It is a very impressive sculpture that really makes the viewer wonder how it was created. The size, beauty, and description make it a really noticeable piece of art from its time period. The artwork is a great example of how leaders are put into the art of their country. Queen Hatshepsut utilized the fact that she can influence men into following her by dressing more like them. This made the men feel comfortable with their leader; therefore, they would give their trust into her. Pharaoh Hatshepsut was a truly unique woman.

Chinese Parenting Style

Amy Chua, a ‘tiger mom’, shared her Chinese parenting style with the public through publishing book and writing article. Her harsh and rigid parenting style raised lots of discussion and concern around the public. They all raise a question- this parenting style can help children to succeed in the future? I think it may not be that easy to raise a child with harsh parenting style. To a large extent, I disagree the harsh parenting style equal a better future of the child. First we have to define what ‘tiger mom’ is.It is a Chinese parenting style that harshly and toughly pushes their children to meet their target or expectation, usually in the aspect of academic. In my opinion, better future includes better physical and mental health, wealth. According to a research which is done by Desiree Baolian Qin, a professor in the department of human development and family studies at Michigan State University, Chinese-American kids were more disadvantageous concerning levels of anxiety and depression and the amount of conflict in their families when comparing European-American kids.The parents do not care what their children’s feeling and perception is. The parents use their authority to push their children. There is a high possibility of conflict between different expectation from parents and children. As sometimes parents have high expectation to children, this put large amount of pressure on children. So, it triggers a certain level of anxiety of children. These combination make children become low self- esteem. Although they will become a profession in the future, they have a bad relationship and a negative impression on parents.Also, tough parenting style will affect children’s communication skill that largely relate to better future. Like popular tiger parent Amy Chua, she does not allow her daughter to stay at school to play with friends after school. A key concept of schooling is developing students’ social and commun ication skills. Parents do not let their children to go out but follow their tied schedule. The children will become not sociable. In workplace, there are not just apply professional skills but also communication and social skills that help people to promote to upper managerial level and work ffectively. Therefore, tiger mom is not equal to a better future. However, a coin has two sides, although Chinese parenting style is very mean, it has certain advantages on children’s future. Focusing on effort but not inherent ability is a feature or advantage of Chinese parenting style. Also, it is the key of distinguishing American and Chinese parenting style. Amy Chua doesn’t let her kids believe they can’t succeed. The style nurtures the children with inculcating the concept of working hard. It pushes children to limit to attain the goal which is set by their parents.This let the children realize that they can make it when working hard. It gradually develops their self confidence and determination to attain a goal. It is well prepared for future to work with colleagues. He or she will become a hard working and determined person in workplace. These are crucial feature of high position in management level. So, a tiger mom equals a better future in this way. Moreover, although parents giving lots of pressure on children will make the relationship tight, it trains children AQ when living and working under pressure.Adversity Quotient (AQ) is the ability of a person to deal with problems. Chinese parenting style harshly push children to achieve certain goals which is not easy to attain. In this time, children have to think of some ways to cope with the problems to satisfy their parents’ desire. As a result, the skills of problem solving are significant in workplace and also live independently. However, this style will largely effect children emotion when there is high possibility that conflict between children and parents.Even some kids have bee n diagnosed of mood disorder. This largely affects the relationship between parents and children and causes apparently mentally unhealthy. So, this is a better future for a child. In conclusion, I admit Chinese parenting style improves children ability of problems solving and develops their determination mind that give them a better future and achievement. However, the parenting style is tremendously rigid to a kid that easily harms their esteem and destroys family relationship.It will give a negative memory in their mind, even get an unrecoverable wound in their heart. Even though their future is bright and recognized, they have negative feeling and history in their mind that I am not notice as ‘better future’. Thus, I disagree a tiger mom equals a better future in a small extent. Reference list: http://www. livescience. com/18023-tiger-parenting-tough-kids. html http://www. raisesmartkid. com/all-ages/1-articles/47-authoritarian-strict-parenting-vs-permissive-which-is -better

Physical Education An Essential Part Of Any Course

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