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A 64-year-old woman presents to the primary care office with shortness of breath, leg swelling, and fatigue. She has a history of type 2 diabetes and hypertension. She reports that recently she had been able to go for daily walks with her friends, but in the past month, the walks have become more difficult due to shortness of breath and fatigue. She also sometimes awakens in the middle of the night due to shortness of breath and has to prop herself up on three pillows. On physical examination, she is tachycardic (110 beats per minute) and has a blood pressure of 106/74 mm Hg. Fine crackles are noted on inspiration on bilateral bases. The cardiac exam reveals the presence of a third and fourth heart sound and jugular venous distension. 2+ pitting edema is noted in the knees bilaterally. An ECG shows sinus rhythm at 110 bpm with Q waves in the anterior leads. An echocardiogram shows decreased wall motion of the anterior wall of the heart and an estimated ejection fraction of 25%. She is diagnosed with systolic heart failure, secondary to a silent MI. 1. Discuss the pathophysiological mechanisms that can lead to heart failure. 2. Differentiate between systolic and diastolic heart dysfunction 3. Discuss the causes of the patient’s shortness of breath, awakening in the middle of the night, and the need to prop herself up on three pillows. Include pathophysiological mechanisms that cause each of these signs and symptoms. 4. Include two points of teaching for this patient 5.Support your response with at least one current evidence-based resource

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Explain your favorite work of fiction in the context of the social contract.

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Develop a business plan to increase nursing engagement and retention including measurable terminal objectives process map or algorithm to address the engagement of staff financial and staff implications cost-benefit ratio timeline for implement ting practicum

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Personal Statement

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parallel ports available on PIC887

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Dopamine Made Me Do it

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Philosophy 215 Contemporary Moral Problems

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Military Science

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