Respond on two different days who selected different alterations and factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the cardiovascular alteration your colleague selected.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

                                                       Main Post

The purpose of this paper is to explore coronary artery disease (CAD), the roles of hypertension and dyslipidemia affect CAD, and exploring if genetics is a factor in CAD. The progression of CAD can lead to myocardial ischemia, infarction, and even death if left untreated. Heart disease remains the number one cause of death in the United States, and understanding these factors plays a continued role in developing strategies, both preventive and treatment efforts.

                                                Coronary Artery Disease 

CAD is normally the result of atherosclerosis, the build-up of plaque due to damaged endothelium that allows fat to accumulate and decrease the diameter of the vessel. The decrease in vessel size allows for blockage and decreased blood flow to the coronary vessel; this leads to ischemia, where the cells are deprived of blood and begin the process of dying if left untreated. Persistent ischemia or the complete occlusion of a coronary artery causes the acute coronary syndromes, including infarction, or irreversible myocardial damage (Huether & McCance, 2017). Also, known as a heart attack or myocardial infarction (MI). Fortunately, the incidence and mortality statistics for CAD have been decreasing over the past 15 years because of more aggressive recognition, prevention, and treatment (Huether & McCance, 2017). 

                         Hypertension’s Role in Coronary Artery Disease 

Hypertension is a consistent elevation of systemic arterial blood pressure (Huether & McCance, 2017).  Fortunately, hypertension a key factor in CAD is modifiable and can be monitored closely to prevent further disease progression. Hypertension is common; it ranks as the number one primary diagnosis in America. Pathophysiological mechanisms of blood pressure as a risk factor for CAD are complex and include the influence of blood pressure as a physical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion (Weber et al., 2016). The presence of hypertension further increases the risk of CAD and may explain why some individuals are more predisposed than others to developing coronary events (Rosendorff et al., 2015). Pathophysiological mechanisms of blood pressure as a risk factor for CAD are complex and include the influence of blood pressure as a physical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion (Weber et al., 2016). Hypertension, when diagnosed early, can be treated accordingly, decreasing the opportunity for the role of exacerbation of CAD.

                       Dyslipidemia’s Role in Coronary Artery Disease

 Huether & McCance (2017) define dyslipidemia as an abnormal concentration of serum lipoproteins, the result of genetic and dietary factors. The hardening aspect of this disease is the result of cholesterol deposits in the vessel, which decrease elasticity and make the vessel wall stiff  (Marsh & Rizzo, 2019). The elevation of lipoproteins creates a narrowing of the vessel diameter, which in turn decreases blood flow to arteries. When dyslipidemia occurs in the coronary arteries, the decreased blood flow can lead to ischemia or infarct, depending on the size of the blockage. Controlling the progression of the disease is important, modifying lifestyle habits; diet and physical activity can help to prevent further complications. Medications are also available to keep lipid levels balanced. 

Genetics Affects of Risk Factors in Coronary Artery Disease

Dyslipidemia is known as a heritable risk factor for CAD; patients with a family history should inform their practitioner to manage the disease process in the early state. Plasma lipids and lipoproteins are heritable risk factors for CAD, with heritability estimates ranging from 40% to 60% (Tada, Kawashiri, & Yamagishi, 2017). The best treatment is prevention, knowing a patient’s family history is paramount in controlling the lipid levels and keeping them at rates that will prevent CAD. Monitoring labs and dietary modifications assist those with family history and can avoid the progression of CAD. 

Conclusion

Cardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology (Lidin, Hellénius, Rydell-Karlsson, & Ekblom-Bak, 2018). Hypertension and dyslipidemia both can accelerate the development of CAD. Fortunately, both factors are modifiable and are manageable by lifestyle modifications. Genetics plays a role in both hypertension and dyslipidemia; obtaining an accurate family history allows for early monitoring and controlling the modifiable factors, diet, and physical activity can keep both hypertension and dyslipidemia well controlled. 

                                                                                                                                                  References

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Lidin, M., Hellénius, M.-L., Rydell-Karlsson, M., & Ekblom-Bak, E. (2018). Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice. BMC Cardiovascular Disorders, 18(1), 59. https://doi-org.ezp.waldenulibrary.org/10.1186/s12872-018-0792-6

Marsh, C. C. . P. D., & Rizzo, C., MD. (2019). Hypertension. Magill’s Medical Guide (Online Edition). Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=89093446&site=eds-live&scope=site

Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S., … White, W. B. (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Journal of the American Society of Hypertension, 9(6), 453–498. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jash.2015.03.002

Tada, H., Kawashiri, M., & Yamagishi, M. (2017). Clinical Perspectives of Genetic Analyses on Dyslipidemia and Coronary Artery Disease. Journal of Atherosclerosis and Thrombosis, 24(5), 452-461. https://doi-org.ezp.waldenulibrary.org/10.5551/jat.RV17002

Weber, T., Lang, I., Zweiker, R., Horn, S., Wenzel, R. R., Watschinger, B., . . . Metzler, B. (2016). Hypertension and coronary artery disease: Epidemiology, physiology, effects of treatment, and recommendations. Wiener Klinische Wochenschrift, 128(13-14), 467-479. doi:10.1007/s00508-016-0998-5

 

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Respond  on two different days by explaining how the leadership skills they described may impact your organization or your personal leadership, or by identifying challenges you see in applying the skills described.

                                                                     Main Post

The leadership of any given workplace sets the tone for the entire operation. One key factor of this was presented by Anyati, Sudiro, Hadiwidjaja and Noermijati in their article addressing ethical leadership and its effect on the workplace. Their study found that an ethical leaderships system results in an ethical climate and prevents what they describe as “deviant behavior’ in the workplace” (2018). Leaders that use unethical means to enforce their policies will likely be met with undesirable actions from their employees. Leaders that create an ethical work environment and preform under their own ethical scrutiny are, likewise, met with ethical and pleasing behavoir in the workplace.  

     An example of this in my workplace from our Chief Operations Officer at Grand Peaks Medical. She conducts herself in an ethical way in all instances. When she has a child that needs to be seen for an illness, she calls and makes an appointment, sits in the waiting room and insists that regular operations and flow continue despite the fact that she is our boss, she could easily have her child seen first. This in turn has created an atmosphere of ethics in our office. We all have followed suit with scheduling ourselves and our family members. It has also deterred staff and doctors from giving important members of the community preferential treatment over another patient because of their social status. Our patients are all treated ethically regardless of financial, insurance or social status. We also all feel that we can go to her with concerns, because we know that she will handle them ethically, maintaining confidentiality, and will get back to us will answers in a timely manner.  

     A type of Transformational Leadership, known as inspirational, has been shown to be the one of the most effective in producing outcomes and a happy and healthy work environment. The Inspirational leader sets organizational goals and although he or she has high expectations of his or her employees, the leader is supportive and positive (Zindeldin, 2017). I found this type of leadership a key factor in good leadership because I feel it makes the organization feel like they are working as a team to achieve the same goal.  

     An example of this was my manager when I worked on Labor and Delivery. Our Nurse Manager was this type of manager and ran a very effective team. Each nurse meeting was organized to develop a team goal to improve patient safety. Sometimes this meant improving medication error rates or decreasing the call to cut time for a cesarean section. Not only did she give us helpful ideas on how to improve, she would spend time on the floor, working with us, taking care of patients. This gave her to opportunity to see what was hindering the goal, and to see what could be improved in way of policy that would help us meet that goal. We felt supported and felt that our manager truly cared for each of us.  

     Both of these leaders made a decision, as descried in chapter 7 of the course text, to be influential leaders. They both genuinely care about the staff and maintain a level of credibility among staff that provides them with a high level of respect from their employees. Being a leader is a selfless endeavor, and the best leaders aim to improve the lives of others not to improve their own status (Mashall & Broome, 2017).  

 References

Aryati, A. S., Sudiro, A., Hadiwidjaja, D., & Noermijati, N. (2018). The influence of ethical leadership to deviant workplace behavior mediated by ethical climate and organizational commitment. International Journal of Law & Management, 60(2), 233–249. https://doi-org.ezp.waldenulibrary.org/10.1108/IJLMA-03-2017-0053 

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer. 

Zineldin, M. (2017). Transformational leadership behavior, emotions, and outcomes: Health psychology perspective in the workplace. Journal of Workplace Behavioral Health, 32(1), 14–25. https://doi-org.ezp.waldenulibrary.org/10.1080/15555240.2016.1273782 

 

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1. Imagineyou are working at a doctor’s office. You are approached by the office manager, who asks you to develop an effective way of storing patient information.
   
   Writea 350- to 700-word summary to your office manager informing her of the advantages of using electronic health records (EHRs) to store patient information. Be clear and concise, use complete sentences, and use examples to support your responses. Your summary should:
   • Discuss the functions and advantages of using EHRs.
   • Discuss three to four forms used to keep patient information in EHRs. What is the purpose of each form?
   • Describe the basic workflow of a health care organization using EHRs.
     Cite any outside sources according to APA guidelines. For additional information on how to properly cite your sources, access the Reference and Citation Generator in the Center for Writing Excellenc

 

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Purpose

This week’s graded topics relate to the following Course Outcomes (COs).

• CO 1 – Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)
• CO 4 – Identify teaching/learning needs from the health history of an individual. (PO 2)

The Assignment

In Week 6 you demonstrated a head to toe assessment of an adult participant. This week you and your classmates will reflect on physical assessment in your own nursing practice, and on the assessment you performed for your video assignment.

Please consider the following in your initial post:

1. Please share how physical assessment is performed in your practice area. How do you determine what type of physical assessment is appropriate in caring for your patients? Do you perform complete head to toe assessments, or are they typically more focused exams? (If you do not currently work in a patient care setting, you may reflect on observations from a clinical experience or prior work setting.)
2. Based on your observations, do you feel that patient assessments performed in practice are as thorough as they should be? Explain your answer.
3. Reflect on the assessment you performed for the video assignment. Perhaps you might compare your performance now, to how it might have been different when you were a brand new nurse? Or share something you learned (or were reminded of) by participating in this activity?

 

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Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size? 

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected. 

To Prepare:

· Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

· Develop a PICO(T) question to address the clinical issue of interest for the Assignment.

· Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles at the systematic-reviews level related to your research question.

· Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

· Identify and briefly describe your chosen clinical issue of interest.

· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

· Provide APA citations of the four peer-reviewed articles you selected.

· Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

 

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