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PID CONTROL OF A HYDRAULIC LIFT

1 write the Procedure of the experiment in new words in one page
—————————————————–
2/# write in one page a result and discussion about the experiment that is attached ( the data and charts are provided )
Some keys to help writing the results and discussion from these analysis’s:
*Determine the P controller term, PI Controller term, and the PID Controller term.
*Using this spreadsheet, determine the steady-state error that is associated with each. Determine the characteristics of each system, ie: Time Constant, Settling time, Percent Overshoot (%OS),Dampening Ratio (?), Natural Frequency (?).
*Discuss the effect of P, PI, and PID on the related system characteristics.
*What are the strengths and weakness of each control regime?
*What are some possible causes for error in this system? If there is any steady-state error, why is there?

describe how the VI functions and what is happening as the data moves through the system.

September 21, 2015 / by admin

PID CONTROL OF A HYDRAULIC LIFT

describe how the VI functions and what is happening as the data moves through the system.

September 21, 2015 / by admin

Business

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ANSWER BOTH QUESTION MAX 1 PAGE. ANSWER QUESTION ONE BY ONE

2. Do some research online of Greece’s recently resigned prime minister Alexis Tsipras, and specifically how his perspective on the country’s problems differed from that of Germany’s chancellor Angela Merkel.
3. Application: Who’s perspective are you more sympathetic with, Tsipras’ or Merkel’s, and who do you think will ultimately prevail? Do you think Greece will survive this crisis, or will it be forced to leave the euro zone? Do you favor Greece leaving the euro zone? Do you think the euro itself will survive in the long run, or has this crisis exposed its inherently fatal flaws? And what about the U.S., which is indebted at historic levels. Is the U.S. is heading for the same fate as Greece? What options do we have that Greece (as part of the euro zone) does not? Should the U.S. consider the options of defaulting on or “inflating away” its debt?

September 21, 2015 / by admin

Business

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ANSWER BOTH QUESTION MAX 1 PAGE. ANSWER QUESTION ONE BY ONE

September 21, 2015 / by admin

MAE101 Economic Principles Assignment, T2 2015.

(1) assignment.
This version is worth 41 points, reweighted to 22 marks.
Submit your assignment via Cloud Deakin in the appropriate assignment dropbox by
11:59 p.m. on Monday 21 September 2015. Hard copies will NOT be accepted. Please
note the new, later, due date.
Extensions can only be granted by the Unit Chair (Dr Randy Silvers,
[email protected]).
This is an individual assignment; the work that you submit must be your own.
Plagiarism will incur penalties.
2
Background
For most of the goods and services that we have considered, markets operate with few
restrictions – we have studied the consequences of price controls and taxes and tariffs,
but those restrictions affect the prices that consumers pay and the prices that firms
receive, not who can or cannot be a consumer or producer.
Consider the markets for drugs:
(i) Some drugs, such as aspirin, ibuprofen, and antacids, are over-thecounter
– anybody can purchase them and the only restriction on their
production is much the same as that on most other products, namely
that its contents be listed and the product not be defective.
(ii) Other drugs, such as codeine and penicillin, require a prescription.
Anybody can purchase them provided that they have a note, signed by
a professional, who has passed a series of tests to demonstrate
competency and ethical behavior as an authority. Moreover, the
quantities purchased are limited by the note. As with the first category,
any firm can produce these pharmaceuticals, subject to the similar
regulations – there may be tougher standards in first obtaining
approval, such as demonstrating that the drug be both safe and
effective, and documenting potential side effects, in order to warn.
(iii) The last category of drugs, such as heroin and cocaine, are illegal. No
consumer can legally purchase the drugs, no firm can legally produce
them, and no professional is authorized to issue a note that allows the
purchase or production of the drug.
In this version, you will study why these three categories of drugs exist and how
making a drug illegal does not eliminate the market; rather, it becomes part of the socalled
“black market.” You will also learn about some of the ramifications of different
policies, such as the restrictions that create the second and third categories.
Useful references:
• the article for discussion in seminar week 6 (It’s Time to End the War on
Drugs);
• the Aplia problem set that was due 16 August, News Analysis — Optimal
Decision Making: A Parking Dilemma;
• the following 50-minute podcast for which there is also a transcript
available at the link:
http://thedianerehmshow.org/shows/2015-07-28/efforts-to-curb-thenations-
deadly-heroin-epidemic
3
Task 1: Voluntary Exchange and the Risk of Addiction
(a) Consider the first two markets described in the Background. Suppose that the
production in both markets is perfectly competitive. For each, derive the
equilibrium price, quantity, and consumers’ surplus.
(i) In the over-the-counter market, assume for simplicity that the market
supply is Qs = 40 + P and the demand is given by Qd = 184 – 8P.
(ii) In the prescription drug market, assume for simplicity that the market
supply is Qs = 10 + P/2 and demand is given by Qd = 100 – 2P.
(6 Points)
Unlike with the over-the-counter drugs, both prescription drugs and illicit drugs can
become addictive. A consumer does not know the probability that he will become
addicted until after he has consumed the drug.
Now, consider the third market, that for illicit drugs. We can think then of the
individual having an initial willingness to pay for an illicit drug (WTPo) and
subsequently, either an experienced willingness to pay (WTPe) or an addicted
willingness to pay (WTPa). Let the probability of becoming addicted be denoted by
padd — and thus, the probability of not becoming addicted and being able to continue
using the drug with experience is 1 – padd.
(b) Assume for simplicity that the current market price is $25. For a particular
consumer, let WTPo = 40, WTPe = 60, and WTPa = -$140 < 0.
(i) Interpret each WTP.
(ii) Show that if the probability of becoming addicted is 0.1 (padd = 0.1),
then the individual will choose to consume the drug.
(iii) Show that if the probability of becoming addicted is 0.4 (padd = 0.4),
then the individual will choose to not consume the drug.
(7 Points)
(c) One of the core principles of economics is that voluntary transactions make
those economic agents that transact better off. Discuss this in light of what you
have just shown above.
(3 Points)
(d) Some goods in each category have similar characteristics to goods in other
categories. In the U.S., the government has cracked down on prescription
painkillers, tightening the supply. Refer to the podcast. Show the effects of a
government crackdown on the market for heroin in a demand-and-supply
graph.
(3 Points)
4
Task 2: Risk of Incarceration, Taxes, Production Costs, and Entry
(a) For those drugs in the third category, any consumer and any producer risks
being caught and incarcerated.
(i) Consider a consumer who is experienced but not addicted to such a
drug. Let his WTPe = 60. If the consumer is caught and incarcerated,
then he gets 0. Let his willingness to pay for alcohol, which is licit, be
54. Show that if the probability of being caught and incarcerated is 0.1,
then the consumer is indifferent between consuming the illicit drug
which entails the risk of being caught and incarcerated, or consuming
alcohol.
(ii) Consider producers. Previously, when the drugs were illicit, each
producer had certain explicit and implicit costs of production; suppose
that these are constant and equal to 20. A producer would sell six units
at a price of 28 each. Suppose that the probability that a producer is
caught and incarcerated is 0.25. Determine the amount of loss that a
producer would regard incarceration to be equivalent to, that would
make this producer indifferent between becoming a producer and not.
(iii) Each producer attempted to maintain a monopoly over its territory,
often by threatening potential entrants with physical harm — after all,
since the drug is illicit, the producer cannot avail itself of the judicial
system to enforce their monopoly or contracts/agreements. Suppose
that a local monopolist faces a demand given by Qd = 20 – P and has a
constant marginal cost equal to 4. Graph this local monopolist’s
demand, marginal revenue, and marginal cost. On your graph, identify
the monopolist’s profit-maximizing quantity and price, then shade the
areas that represent consumers’ surplus, deadweight loss, and profit.
(6 Points)
Return to Task 1 (b) and suppose that the government decides to legalize the illicit
drugs and impose a tax of $10. Let Qd = 100 – 2P and Qs = 10 + P/2.
(b) Derive the new equilibrium — the price that consumers pay, the price that
firms receive, and the quantity. What is the share of tax burden that consumers
bear and how is that share related to the elasticity of demand versus the
elasticity of supply?
.
(4 Points)
(c) Because the drug is now licit, explain why demand would change and write a
demand that is consistent with your explanation — for example, if you think
that demand would increase and become more elastic, then modify Qd = 100 –
2P to an equation that shows greater demand and is more elastic (at least at the
equilibrium).
Repeat for supply — explain why supply would change and write a supply that
is consistent with your explanation.
(4 Points)
5
Task 3: Government’s Choices
(a) Listen to the podcast, particularly the question and response by Marc Fisher
from 1:44 – 3:40 (starting at 10:07:50 in the transcript). Consider his statement
that the Mexican cartels switched from marijuana to poppy/heroin production
after marijuana became legalized in some states in the U.S.
(i) Use a supply-and-demand graph to show the effects of this crackdown
for Mexican drug cartels.
(ii) Do you agree with the statement that the legalization of marijuana in
some states impelled the Mexican drug cartels to switch to
poppy/heroin production, or do you think that they would have started
producing anyway because the demand for heroin increased? Explain.
(4 Points)
In articles for discussion in the seminars, you have discussed policies to reduce
children’s tobacco consumption and the various benefits and costs of ending the war
on drugs. Many politicians and social scientists compare illicit drugs to alcohol and
tobacco, two products that are licit and taxed despite each being addictive and
physically harmful. Certainly, there is uncertainty about the benefits and costs that
would result if currently illicit drugs such as heroin were made licit and taxed.
(b) Suppose that as a government leader, you believe that making heroin licit
would result in either per annum net benefits of $1 million or a net loss of $3
million, with probabilities 0.9 and 0.1, respectively.
If after one year, you learn that:
• the result is good (net benefits of $1 million), then you maintain the
licit status into the future, yielding net benefits each year into the future
— suppose that this stream has a current value of $5 million; or
• the result is adverse (net loss of $3 million), then you would like to
reverse the policy and make heroin illicit again. However, reversing
this policy has become difficult and would entail a cost that has a
current value of $10 million; thereafter, heroin would be illicit,
yielding no net benefits or costs compared to the current situation.
(i) Would it be prudent to legalize heroin or maintain its illicit status?
(ii) Relate this to alcohol and tobacco.
(4 Points)

September 21, 2015 / by admin

MAE101 Economic Principles Assignment, T2 2015.

September 21, 2015 / by admin

Case Study Analysis and Care Plan Creation

Order Description

Assignment Assignment 2: Case Study Analysis and Care Plan Creation

Click here to download and analyze the case study for this week. Create a wholistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

Visit the online library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan.

Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information.
•Search term page to identify the codes applicable to the care plan. https://www.cms.gov/Medicare/Coding/ICD10/index.html
•This link will lead to an excel version of the latest codes: https://www.cms.gov/Medicare/Coding/ICD10ProviderDiagnosticCodes/codes.html

Click here to download the care plan template to help you design a holistic patient care plan. The care plan example provided here is meant only as a frame of reference for you to build your care plan. You are expected to develop a comprehensive care plan based on your assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.

Format

Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be 2 to 4 pages double-spaced and in 12pt font.

Name your document: SU_NSG6001_W2A2_LastName_FirstInitial.doc.

Submit your document to the W2 Assignment 2 Dropbox by Saturday, September 26, 2015.

Grading Criteria
Maximum Points

Care plan demonstrated involvement of the client in the process of recognition, planning, and resolution of the problem.
15

Care plan included effective nursing interventions that are customized for the client and appropriate to the goal.
15

Care plan included diagnostic work-up, medications, conservative measures, and follow-up plan.
15

Care plan provided rationale for choosing a particular treatment modality.
15

Care plan demonstrated logical diagnosis that was substantiated with relevant evidence.
10

Care plan focused on patient education and maintained a fine balance between major and minor health issues of the patient.
10

Care plan included nursing interventions that are specific, appropriate, and free of essential omissions.
10

Used APA standards consistently and accurately.
10

Total
100

THIS IS THE CASE OF STUDY FOR THIS WEEK
Pulmonology Case Study

HPI

A 65-year-old Caucasian female presents with a chief complaint of cough for two weeks. She has been complaining of dry cough since the past two weeks and low grade fever that started two days ago, and was as high as 101 orally. She has had a decreased appetite but no nausea and vomiting. The cough occurs during the night and she needs to sit up in a chair to be able to breathe easier. The cough is mainly dry, rarely productive.

She had been prescribed inhalers in the past; they have been helpful but she does not use them on a routine basis. She has been prescribed antibiotics in the past as well and that seems to help when she is acutely ill. She has been suffering from shortness of breath for the past two weeks following any kind of activity mainly because of the dry cough. She thinks it’s possible that there’s some problem with her “heart.” She is also complaining of slight sore throat, especially in the morning and feels she may have lung cancer.

The patient’s symptoms have been worsening over the past two days.

She has had similar episodes in the past. The last was three months ago when she had to go to the emergency room and they told her that she needed to be hospitalized. She declined hospitalization at that time and was treated and released. She says they gave her antibiotics and an inhaler before discharging her. She mentioned that though it took some time to feel better, there was gradual improvement in her condition following that treatment. According to her, this is the worst episode that she can remember. She’s very concerned today that she could have pneumonia and might require hospitalization.

She is seeking medical attention today because of the fever and prolonged nature of her illness.

PMH

Though she has been treated for this problem in the past with antibiotics and inhalers, she has not been hospitalized. The patient had a chest investigation the last time she had this problem. She states that she did not have pneumonia but did have “emphysema.” The healthcare professionals wanted to do pulmonary function tests, but she declined.

X-ray report:

X-ray results: Hyperinflation of both lungs with an increased AP diameter. There is evidence of emphysema. .

She states that she had asthma as a child and is a cigarette smoker. She also had a hysterectomy way back in 1970s. Besides these, she has no known chronic medical problems.

ROS

Shortness of breath with activity. No diaphoresis. She has had a fever. No nausea and vomiting. Denies chest pressure sensation with physical activity. No palpitations.

MEDICATIONS

The patient does not take any prescription medicines. She takes occasional over-the- counter Tylenol for pain.

Tylenol 650 mg, 2 PO as needed.

ALLERGIES/REACTIONS

She is allergic to sulfa drugs that cause a rash.

SOCIAL HISTORY

The patient has been widowed for 20 years. She is receiving an annual pension of

$40,000.00 and has some money that she has saved in the bank. She has a high school diploma and owns her house. Though she has little disposable income, her finances are essentially stable. She has little knowledge of community resources that are at her disposal.

She has a primary care provider, whom she sees three to four times every year for a physical examination. The physician is very busy and does not spend much time with her. She has insurance but it does not cover all her prescription medications. She relies on a lot on samples.

She has two grown-up daughters who live in the nearby community. They are both in their forties and are alive and well. The patient would like her daughters to be more involved in her life, but she is not sure how to approach them about this. The patient’s perception of self-efficacy has been declining over the past ten years. She feels that she could be feeling depressed because she does not get out of the house very often and this depression is only getting worse with each passing year.

The patient has very low level of day-to-day stress. However, she realizes that her depressive symptoms may be causing some of her physical symptoms.

She goes to church and has some contacts there. She sees her daughters once a month. These people are her support system, but she has no one to talk to on a routine basis.

HABITS

• Diet habits

She has a healthy diet and her dietary intake is adequate. The patient has positive health beliefs and knows that she should be doing more to maintain a healthy lifestyle. She does not get adequate exercise because of her shortness of breath. She enjoys visiting her physician.

Smoking: She has smoked one pack per day for 40 years. Alcohol: She denies alcohol use
Substance Use: She denies any street drug use

WORK HABITS

She has always been a hairdresser; is retired now. She goes to church and occasionally attends some of their functions. Her hobbies include sewing. She is from the United States and lives in a suburban setting. Crime rate in her locality is low with easy access
to public transportation. There are a variety of community groups, but she is not aware of these resources.

FAMILY HISTORY

Her two older sisters are alive and well, one with osteoporosis and one with breast cancer. Her 75-year-old sister was diagnosed with osteoporosis at the age of 55. Her 72- year-old sister was diagnosed with breast cancer at 60 years of age.

PHYSICAL EXAMINATION

Vital Signs: BP: 130/72 left arm sitting regular cuff; T: 101 po; P: 100 and regular; R: 20, non-labored; Wt: 130#; Ht: 55”.

HEENT: White material on the buccal mucosa; does not wipe off with tongue blade. Lymph Nodes: None
Lungs: Decreased breath sounds, dull to percussion right lower lobe. End expiratory wheeze in right lower lobe. No rales or rhonchi. Increased anterior-posterior diameter to chest wall.

Heart: RRR without murmur Carotids: No bruits Abdomen: Benign

Rectum: Not examined

Genital/Pelvic: Not examined

Extremities, Including Pulses: 2+ pulses throughout, no edema

Neurologic: Not examined

LAB RESULTS/RADIOLOGICAL STUDIES/EKG INTERPRETATION

CBC- WBCs 15, 000 with + left shift

Pulse oximeter reading: SAO2: 98%

Radiological Studies

CXR – Same as X-ray

EKG

Normal sinus rhythm

THIS IS THE EXAMPLE of my first week THAT YOU HAVE TO FOLLOW TO DO THIS Cardiology Case Study

Name
Date

Professor:

South University

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 2

Care Plan

Patient Initials: A.H. Age: 52 Sex: M

Subjective Data

A.H. is being seen here today for a follow up visit following stent placement.

Patient had stent placed on previous admission and is concern that he will have continued

episodes of angina, even with having stents placed. Patient is seeking information on his

risk factors associated with angina (Week 1: Cardiology Clinical Case, 2015).

Client Complaints

Patient is asymptomatic and has no new complaints at this time. Patient is being

seen for follow up treatment status post stent placement. Patient is seeking education on

his risk factors for angina following stent placement (Week 1: Cardiology Clinical Case,

History of Present Illness

Patient presented to the emergency department with four hour of chest pain. The

patient when presented complained of shortness of breath with exertion and he was

diaphoretic. The patient states that the pain in his chest was crushing, substernal, and

radiated to his neck and jaw. Patient had these episodes for four days and was fearful to

go to the hospital to seek help. Patient stated that the pain was worse today and he could

not resolve with rest. Patient states that he has been having similar episodes for over six

months but he just thought the episodes were due to him being out of shape. Patient

stated that he normally could resolve his angina episodes by rest prior to his visit to the

emergency room. The patient was admitted to the hospital, transferred to the cardiac

floor, and a catheterization was scheduled. Prior to transfer the patient symptoms were

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 3

relieved by the emergency room with medication. The patient was hospitalized for four

days and had stents placed during this admission. The patient is seeking advice regarding

his concern of future angina attacks (Week 1: Cardiology Clinical Case, 2015).

Past Medical History

The patient has been diagnosed with hypertension and high cholesterol; however,

he is not compliant with his medications, and he stopped taking them. The only surgery

that the patient has had in the past before the stent placement was a cholecystectomy and

that was over ten years ago. The patient denies any allergies and the only other

hospitalization was for his cholecystectomy. The patient had an EKG on file at his PCP

office from when he was prescribed his hypertensive medications. The patient did have

his cholesterol level periodically checked. The patient was prescribed daily medications

on discharge from the hospital, and has been complaint with his discharge regimen, and

the medication list is as follows:

? Tenormin XL 50 mg daily

? Lipitor 10 mg daily

? Glucophage 500 mg BID

? Baby Aspirin 81 mg daily

(Week 1: Cardiology Clinical Case, 2015)

Significant Family History

The patient has two older brothers that are currently being treated for

hypertension and type two diabetes. The brothers were diagnosed in their forties with

these disorders. Both the patient parents are deceased. The patient father dies from heart

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 4

disease and his mother dies from breast cancer (Week 1: Cardiology Clinical Case,

Social and Personal History

The patient is a carpenter and makes about 50,000.00 dollars a year. He is a high

graduate. The patient lives with his wife in a one bedroom apartment in the inner city that

has a high crime rating. They live pay check to pay check and his spouse is disabled.

They have three grown children that do not live in the area. He does not participate in any

physical activity. They have limited community involvement and do not have any family

in the area. He lacks social and emotional support. The patient has limited health

insurance coverage and uses the local clinic as his PCP. The patient prescriptions are not

covered by his current health care plan (Week 1: Cardiology Clinical Case, 2015).

The patient eats one large meal a day after work and does not eat breakfast. The

patient when he does eat lunch consist of fast food. The patient eats limited fruits and

vegetables and mostly eats pasta and meat when he meals at home. The patient smokes a

pack a day for over thirty years. The patient does not drink and does not use any illegal

drugs. The patient does not have any hobbies outside the home and will read when he at

home. The patient states that the exercise that he receives as a carpenter is enough

physical exercise for him to be healthy and feels like he got enough exercise when he was

younger (Week 1: Cardiology Clinical Case, 2015).

Client’s Support System

The patient is married to a disabled spouse from uncontrolled diabetes type two.

He lacks any family support and is isolated from the community. The patient uses the

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 5

local clinic as a primary care source, so he never sees the same practitioner (Week 1:

Cardiology Clinical Case, 2015).

Behavioral or Nonverbal Messages

The patient has anxiety regarding returning to work. The patient is scared that he

will be unable to care for his spouse, due to his recent illnesses. The patient has high

stressed levels and is worried over his finances. The patient has a strong family sense and

believes that as a real man he should be able to care for his family and should be strong

enough not to suffer from any diseases. The patient suffers from depression. He is dealing

with his depression by over eating and sleeping excessively (Week 1: Cardiology Clinical

Client Awareness of Abilities, Disease Process, and Health Care Needs

Patient is fearful of being able to continue to financially take care of his spouse

and himself. The patient is seeking advice on the risk factors for angina. The patient

needs education on the causes of angina and his risk of heart disease. The patient also

needs assistance with his medications due to lack of insurance coverage for medication.

The patient has limited knowledge on his disease process and the reason for stent

placement (Week 1: Cardiology Clinical Case, 2015).

Objective Data

The patient’s objective data is as follows:

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 6

? WT- 220 POUNDS

? HT- 70 INCHES

? BMI- 31.6 (Calculate Your Body Mass Index, n.d.)

Physical Assessment Findings:

? LYMPH NODES- None

? LUNGS- Decreased breath sounds throughout no adventitious sounds

? HEART- RRR without murmurs noted

? CAROTIDS- Right Bruit

? ABDOMEN- Obesity

? RECTUM- Not Examined

? GENTITAL/PELVIC – NA

? EXTREMITIES WITH PULSES- Decreased pedal pulses BL with lower

leg edema from ankle to mid-calf

? NEUROLOGIC- Not Examined

? EKG- No changes from baseline

? TOTAL CHOLESTEROL- 210

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 7

? TRIGLYCERIDES- 250

? FASTING BLOOD SUGAR- 140

? CXR- Hyperinflation of the lungs without infiltrates noted

? EKG- No change noted from previous

Client’s Support System: Disabled Spouse

Client’s Locus of Control and Readiness to Learn: Patient is showing his wiliness to learn

by coming to follow up appointment and seeking advice on risk factors for angina. He

has been following his discharge planning and taking his medications as prescribed

(Week 1: Cardiology Clinical Case, 2015).

ICD-9 Diagnoses/Client Problems

? 413.9- OTHER AND UNSPECIFIED ANGINA PECTORIS

? 401.9- UNSPECIFIED ESSENTIAL HYPERTENSION

? 272.4- OTHER AND UNSPECIFIED HYPERLIPIDEMA

? 250.02- DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION,

TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

? 278.00- OBESITY UNSPECIFIED

? V79.0- SCREENING FOR DEPRESSION

? 309.28- ADJUSTMENT DOSORDER WITH MIXED ANXIETY AND

? V15.82- PERSONAL HISTORY OF TOBACCO USE

? 786.59- OTHER CHEST PAIN

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 8

Advanced Practice Nursing Intervention Plan

Coronary artery disease is the primary cause of death for both men and women in

the United States. CAD includes acute MI, angina pectoris, atherosclerotic cardiovascular

disease, and any chronic ischemic heart disease. There are modifiable and nonmodifiable

risk factors that lead to heart disease. The factors that the patient cannot control is his

family history, his age, and gender. The modifiable risk factors that the patient has

control over is his smoking, lack of physical exercise, diet, obesity, and stress level

(Buttaro, Terry, Trybulski, Bailey, & Cook, 2013 pg. 518-519).

Stable angina is precipitated by exertion and is typically relieved by rest. The

demand or reduction in myocardial oxygen supply are the factors that cause coronary

ischemia. There is three factors that determine the amount of oxygen needed; the heart

rate, systemic blood pressure, and left ventricular wall tension. The heart rate and blood

pressure influence the oxygen requirements because both determine the myocardial

workload. Activities and increased metabolic demands that increase the workload of the

heart increases that oxygen requirements and causes angina and ischemia (Buttaro, Terry,

Trybulski, Bailey, & Cook, 2013 pg. 520).

A.H. condition is complicated because he has comorbid diseases that will require

him to be followed by a cardiologist. The amount of follow up visits will be determined

by the cardiologist. The clinic that the patient uses as primary care will follow the

cardiologist recommendations. The patient will require management of his disease

processes and medications which the clinic is able to provide. A.H. will be provided with

nitroglycerin tablets and education will be provided on the use of these tablets. On the

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 9

visit the patient will be asked about the frequency of his episodes, the severity of pain,

and if he is using his nitro tablets. The patient will receive education on angina and the

warning signs of a heart attack (Buttaro, Terry, Trybulski, Bailey, & Cook, 2013).

The patient will continue with his prescribed medications because the use of

calcium channel blockers, beta blockers, and nitroglycerin help reduce the episodes of

chest pain (Alaeddini, 2014). This assigned treatment plan will also benefit the patient is

his management of hypertension. The patient will be provided with information and help

from the CDC website on smoking cessation. The patient primary care physician will

focus on diet, exercise, smoking, and management of his present illnesses. The patient

will receive lab work at his appointment to assess cholesterol levels, and diabetes control

(Alaeddini, 2014). The patient was provided with resources in his community that will

help him with his medication cost, diet planning, and exercise (Buttaro, Terry, Trybulski,

ADVANCED PRACTICE NURSING CASE STUDY WEEK ONE 10

References

Alaeddini, J. (2014, March 27). Angina Pectoris Follow-up. Retrieved from

https://emedicine.medscape.com/article/150215-followup

Buttaro, Terry, JoAnn Trybulski, Patricia Bailey, and Joanne Sandberg-Cook. Primary

Care, 4th Edition. Mosby, 2013. VitalBook file. Retrieved from

https://digitalbookshelf.southuniversity.edu/books/978-0-323-07501-

5/id/B9780323075015001208_s0340

Calculate Your Body Mass Index. (n.d.). Retrieved from

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

ICD-9 Code Lookup. (n.d.). Retrieved from https://www.cms.gov/medicare-coverage-

database/staticpages/icd-9-code-lookup.aspx

Week 1: Cardiology Clinical Case. (2015). Retrieved from

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