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Essay Instructions: Title of Review article is
Study about the post cadiac surgery Atrail fibrillation Incidence :

first to describe every thing about post surgery AF ,mechanism etc than.
Compare the post cardiac surgery Atrial fibrillation incidence and compare it with different monitoring methods and duration from different papers and references which i mentioned some of them below, for e.g with monitoring Post surgery AF with ECG or 24 hrs ecg monitoring from oldest method to latest and advanced ,and other and latest and advance monitoring like with event recording and conclusion .and also compare the preoperative medication or no treatment for prevention of Atrial fibrillation after heart surgery for patients that will undergo heart surgery.
article should haveat least 20-30 References including 2006 articles as well.

I have given some articles references below which might help and to be added.

2) Atrial Fibrillation after Cardiac Surgery William H. Maisel, MD, MPH; James D. Rawn, MD; and William G. Stevenson, MD 18 December 2001 | Volume 135 Issue 12 | Pages 1061-1073
3)Atrial fibrillation after minimally invasive direct coronary artery bypass surgery
4) Review : Atrial Fibrillation after Cardiac Surgery William H. Maisel, MD, MPH; James D. Rawn, MD; and William G. Stevenson, MD
5) [Atrial fibrillation after coronary artery bypass surgery. The significance of preoperative vagus modulation and ectopic atrial activity]L Frost, H Molgaard, EH Christiansen, CJ Jakobsen, H Allermand, and PE ThomsenUgeskr Laeger, July 1, 1996; 158(27): 3919-23.

6) Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery :Anoar Zacharias, MD; Thomas A. Schwann,Incidence, Timing, Symptoms, and Risk Factors for Atrial Fibrillation After Cardiac Surgery :By Marjorie Funk, PhD, RN, Sally B. Richards, MSN, APRN, Jill Desjardins, MSN, APRN, Christy Bebon, MSN, APRN and Heather Wilcox, MSN, APRN. From Yale University School of Nursing, New Haven, Conn (MF, SBR), John Dempsey Hospital, University of Connecticut Health Center, Farmington, Conn (JS, HW), and Yale-New Haven Hospital, New Haven, Conn (CB). MD; Christopher J. Riordan, MD; Samuel J. Durham, MD; Aamir S. Shah, MD; Robert H. Habib, PhD

7) Incidence, Timing, Symptoms, and Risk Factors for Atrial Fibrillation After Cardiac Surgery
By Marjorie Funk, PhD, RN, Sally B. Richards, MSN, APRN, Jill Desjardins, MSN, APRN, Christy Bebon, MSN, APRN and Heather Wilcox, MSN, APRN. From Yale University School of Nursing, New Haven, Conn (MF, SBR), John Dempsey Hospital, University of Connecticut Health Center, Farmington, Conn (JS, HW), and Yale-New Haven HospitaAmerican College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery l, New Haven, Conn (CB).

8) American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery

9) Clinical Prediction Rule for Atrial Fibrillation David Amar, MD,* Weiji Shi, MS,† Charles W. Hogue, JR, MD,‡ Hao Zhang, MD,*

10) Predictors of Atrial Fibrillation After Coronary Artery Surgery Current Trends and Impact on Hospital Resources

11)Secular Trends in Incidence of Atrial Fibrillation in Olmsted County, Minnesota, 1980 to 2000, and Implications on the Projections for Future Prevalence,

Thanks for your cooperation .

Essay Instructions: Describe the pathophysiology of atrial fibrillation - What is occurring in the body? What signs and symptoms would you observe from a patient who has atrial fibrillation? What studies are available to confirm the diagnosis of atrial fibrillation? What medicines, treatments, and or surgeries are used for a patient who has atrial fibrillation? What types of things, including teaching, would a nurse do for a patient who comes into the hospital with atrial fibrillation?

Essay Instructions: Directions: Refer to the Milestone #2: Nursing Diagnosis and Care plan guidelines and grading rubric found in Doc Sharing to complete the information below. This assignment is worth 250 points, with 10 points awarded for clarity of writing, which means the use of proper grammar, spelling and medical language.
Type your answers on this form. Click ?Save as? and save the file with the assignment name and your last name, e.g., ?NR305_Milestone#2_Form_Smith? When you are finished, submit the form to the Milestone #2 Dropbox by the deadline indicated in your guidelines. Post questions in the Q&A Forum or contact your instructor if you have questions about this assignment.
1: Analyze Assessment Data:
Based on the health history information, identify the following:
A. Areas for focused assessment (30 points)
Provide a brief overview of those areas of strength and weakness noted from Milestone #1: Health History.


B. Client?s strengths (30 points)
Expand on areas identified as strengths related to the person's overall health. Support your conclusions with data from the textbook.

C. Areas of concern (30 points)
Expand on areas previously identified as abnormal and those that place the person at a health risk. Support your observations with data from the textbook.

D. Health teaching topics (30 points)
Identify health education needs. Support your statements with facts from the Health History and information from your textbook.


2: Nursing Care Plan
Next, plan your care based on your analysis of your assessment data:
A. Diagnosis (30 points)
Write one nursing diagnosis that reflects a priority need for this person. Remember a wellness diagnosis is a possibility.

B. Plan (30 points)
Write one goal and one measurable expected outcome related to your nursing diagnosis. Explain why this goal and outcome is a priority. Include cultural considerations for this client.

C. Intervention (30 points)
Write as many nursing orders or nursing interventions that you need in order to achieve the outcome. Provide the rationale for each intervention listed.

D. Evaluation (30 points)
You will not carry out your care plan so you cannot evaluate the effectiveness of your nursing interventions. Instead, comment on what you would look for in order to evaluate your effectiveness.


Directions: Refer to the Milestone #1: Health History guidelines and grading rubric found in Doc Sharing to complete the information below. This assignment is worth 175 points, with 5 points awarded for clarity of writing, which means the use of proper grammar, spelling and medical language.
Type your answers on this form. Click ?Save as? and save the file with the assignment name and your last name, e.g., ?NR305_Milestone#1_Form_Smith? When you are finished, submit the form to the Milestone #1 Dropbox by the deadline indicated in your guidelines. Post questions in the Q&A Forum or contact your instructor if you have questions about this assignment.
Disclaimer: The focus of this assignment is on communicating details within the written client record. When taking a health history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do NOT need to disclose information that they wish to keep confidential. If the interviewee decides not to share information, please write, ?Does not want to disclose.?
BIOGRAPHICAL DATA (10 pts)
Date: 1/28/2012
Initials: L.S.
Age: 65 years old
Date of birth: 03/25/1946
Birthplace: Mexico
Gender: Male
Marital status: Widowed
Race: Hispanic
Religion: Catholic
Occupation: Retired
Health insurance: Medicare Part A and B, Empire Blue Cross Shield of New York
Source of information: Patient
Reliability of source of information: Patient self report
PRESENT HEALTH HISTORY/ILLNESS (15 pts) Primary diagnose Hematuria, High level of INR,
Reason for seeking care: Patient has blood in the urine and general weakness
Health patterns: Patient is on coumadin continued due to present condition of Atria fibrillation and deep vein Thrombosis
Health goals: Urinary pattern return to a normal condition, yellow/ straw color, correction of INR level to therapeutic range
HEALTH BELIEFS AND PRACTICES (15 pts) Patient is catholic, but do not practice his religion.
Beliefs and practices: Patient is Catholic, but does not practice his religion
Factors influencing healthcare decisions: None
Related traits, habits or acts: None
MEDICATIONS (15 pts)
Prescription medications: Coumadin 3mg by mouth daily, Flomax ( Tamsulosin)0.4mg by moth daily,Senna 187mg PO daily, Metoprolol Tartrate 12.5mg by mouth daily,Lisinopril 2.5mg by mouth twice a day, Finasteride 5mg by mouth daily, Docusate sodiun 100mg by mouth three times a day, Oxycodone 5/325mg by mouth every four hours as needed it for moderate to severe pain. Remeron 30mg by mouth at bedtime. Cardizem 10mg intravenous push as needed Allopurinol 300mg by mouth daily, Colchicine 0.6mg PO Daily. Levaquine 500 mg By mouth Daily
Over-the-counter medications: Acetaminophen 325mg two tabs PO every 4 hours PRN
Herbals: None
PAST HISTORY (15 pts)
Childhood diseases: Chicken Pox , Bronchitis
Immunizations: Influenza Vaccine valid date 10/04/2011,Pneumococcal vaccine 23-valent valid date at 1/25/2008, DTP Vaccine 1/1/1994
Allergies: No Known Drug Allergies
Blood transfusions: Once 10/11/2011
Major illnesses: Hypertension, Stroke, Deep Vein Thrombosis, Benign Prostatic Hyperplasia, Atrial Fibrillation, Gout, Depression, Anxiety, Chronic Bronchitis,
Injuries: None
Hospitalizations: Six Times
Labor and deliveries: None
Surgeries: Appendectomy
Use of alcohol: Current, 1 Can of Beer Daily
Use of tobacco: Current Smoker. Half pack a day
Use of illicit drugs: Never
EMOTIONAL HISTORY (15 pts)
Mental, emotional or psychiatric problems: Depression, Anxiety
FAMILY HISTORY (15 pts)
Father: Hypertension, Arthritis, Heart Condition, Asthma Cirrhosis of Liver, Colon Cancer
Mother: Hypertension, Hysterectomy, Osteoporosis, Multiple Falls, Dementia. Diabetes
Siblings: Asthma, Hypertension, Diabetes, Gastric Ulcers
Grandparents:
PSYCHOSOCIAL/ OCCUPATIONAL HISTORY (15 pts)
Occupational history: Bus Driver
Educational level: High School
Financial background: Own House
ROLES AND RELATIONSHIPS (15 pts)
Significant others: Three children, and sibling
Support systems: Family
ETHNICITY AND CULTURE (10 pts)
Ethnicity and culture: Hispanic
Physical and social characteristics that influence healthcare decisions: No evidence of physical, mental, and social characteristics noted, that can influence in healthcare decisions
SPIRITUALITY (5 pts)
Religious and spiritual needs: Patient do not practice his religion, but needs priest for spiritual support
SELF-CONCEPT (5 pts)
View of self-worth: Patient code is DNR, Do not resuscitate, it is patient ?s wish
Future plans: Consult urologist possible cystoscopy, hold Coumadin ( Warfarin) to correct the level of the INR to therapeutic normal range
REVIEW OF SYSTEMS (20 pts)
Skin, hair, nails: Pressure ulcers bilateral heels. Skin is dry, and edematous. Hair is clean, not sign of lice, clean fingernail not sign of fungal infections.
Head, neck, related lymphatics: Gag reflex is present, non-productive persistent cough, not sign of swollen lymph nodes of the neck at this time with palpation non-distended jugular veins
Eyes: Pupils equal reactive to the light, not any sign of conjunctivitis. Corrective Lenses in the past
Ears, nose, mouth, and throat: Mouth pink and moist. Patient able to swallow food without difficulty. Ears are clean not hearing aids, and signs of hard hearing noted.
Respiratory: Respiratory rate is 18, lungs bilateral anterior and posterior are clear, lower lobes bilateral diminished
Breasts and axillae: Warm and well perfuse not signs of swollen lymph nods with palpation.
Cardiovascular: Chest expended symmetrically, regular heart rate, Non adventitious heard sounds at this time
Peripheral vascular: Edema bilateral lower extremities + 2
Abdomen: Soft, non-distended, bowel sounds present bilateral
Urinary: Hematuria Urgency to urinate, urethra discharge without penile skin tear.
Reproductive: Male genitalia circumcised with normal phallus. scrotum is red and swollen
Musculoskeletal: Weakness and swollen +2 edema of the lower extremities, join pain with walking
Neurologic: Alter and oriented to time person and place. Follow commands properly. Eyes opening spontaneously. Glasgow Coma scale Score is 15

Nertila, nice work on this health history. The patient is very ill, with many different problems. Skin care and the bleeding seem to be major concerns. I wonder what his INR is? Your responses are clear and concise, and provide a picture of this person?s health. The only area lacking all criteria is medications ? you need to include the purpose and any effects. Thank you.

Essay Instructions: A writer who is familiar with Evidence Base Medicine in Level of Doctorate/ Professional School is needed to write this evidence-based article. The language of this paper needs to be in a doctorate/Professional level.
*This article should involve a summary of 3 individual clinical studies that are found via Pubmed. I listed all 3 articles that I want you to use below ( you can find the full article via Pubmed) all these trials are randomized control Trials.

In this article we are comparing the efficacy and safety of debigatran vs warfarin for prevention of stroke .

So in the first paragraph I want a little background information about Stroke and how its effecting people in States ect .
The second paragraph needs to talk about warfarin and dabigatran. ( introducing the topic question)
Then Each of the next 3 paragraphs summarizes the trials one of one .
Each of this trials needs to include a brief summery of Method, primary Endpoint and secondary if exists for the trial ,Results ( also P value listed ), conclusion of the studies and a sentence or two talking about writers conclusion and Limitation to the study ( base on authors opinion)
At the end I want 1 or 2 paragraphs discussion part in detail. In this section, writer concludes the final thoughts from 3 trials and how this will effect the pharmacist role .
Please when summerizing the trials try to say it in your own words not copy pasting from abstract of the study.

Journal #1: dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial.
Wallentin L, Yusuf S, Ezekowitz MD, Alings M, Flather M, Franzosi MG, Pais P, Dans A, Eikelboom J, Oldgren J, Pogue J, Reilly PA, Yang S, Connolly SJ; RE-LY investigators.
Lancet. 2010 Sep 18;376(9745):975-83.

Journal #2: Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO Study).
Ezekowitz MD, Reilly PA, Nehmiz G, Simmers TA, Nagarakanti R, Parcham-Azad K, Pedersen KE, Lionetti DA, Stangier J, Wallentin L.

Journal #3:Dabigatran versus warfarin in the treatment of acute venous thromboembolism. Results of the RE-COVER study].
Liakishev AA

Please email me If anything in this guideline is unclear for you .