Mr. Zane is a 65 –year-old African Canadian male from Brampton, Ontario, Canada. He came to the Emergency Department with his wife of 30 years. Mr. Zane was sent to the Emergency Department by his primary healthcare provider because “he has not been feeling well” for the past few days. He describes a fullness in his head and chest without any associated symptoms. His medical history is pertinent only for primary hypertension, and he states that he ran out of his medication two weeks before he started experiencing symptoms.
Physical examination reveals an anxious man with a BP of 230/130 mm Hg and a heart rate of 108 beats per minute. Respirations are elevated at 22 breaths per minute. No papilledema is seen on funduscopic examination. Lungs have bilateral crackles, one quarter up from the bases. Cardiac examination reveals a regular tachycardic rhythm with normal S1 and S2. Jugular venous pressure is normal but demonstrates sustained fullness with abdominal pressure. The apical pulse is prominent. No pedal edema or abdominal bruits detectable. Peripheral pulses are equal.
Laboratory test results reveal normal CBCs, electrolytes, and renal functions. Several erythrocytes are present in his urine. Oxygen saturation is 89% on room air. A 12-lead ECG shows sinus tachycardia, left axis deviation, 4-6mm ST-segment depression across the pericardium. A chest X-ray is significant for moderate pulmonary venous congestion and cardiomegaly.
The findings indicate that patient is in a hypertensive crisis and needs immediate medical attention. Mr. Zane is 5 feet 9 inches tall and weighs 210 pounds. He reports no form of regular exercise or a special diet. Mr. Zane’s diet entails carbohydrate-dense foods, salted codfish, bacon, goat meat, and high glycemic index beverages. Mr. Zane has been smoking half a pack of cigarettes for the past five years and drinks a case of beer on weekends. Mr. Zane’s father died of a heart attack at 64-years-old, and his brother had a stroke at the age of 51.
PART 1: Questions
After being stabilized and monitored in the hospital, Mr. Zane is discharged home. Mr. Zane’s primary care physician prescribes him a long-acting calcium channel blocker as first-line monotherapy. Why are calcium channel blockers recommended as first-line therapy for African American people with hypertension? Explain.
Mr. Zane’s blood pressure remains elevated after being started on the calcium channel blocker. Mr. Zane is started on 50 mg of the thiazide diuretic, hydrochlorothiazide daily. Discuss the antihypertensive effects of hydrochlorothiazide.
What information must you share with Mr. Zane to increase adherence and decrease the adverse effects of hydrochlorothiazide? What should Mr. Zane be educated about concerning his disease process and the impact of adherence to the drug therapy regimen?
Mr. Zane’s physician is trying to establish a medication regime to best control Mr. Zane’s primary hypertension, and the β-blocker, carvedilol (Coreg), has been prescribed. Before initiating therapy, what past medical conditions should the nurse inquire about during the nursing assessment?
What should Mr. Zane know about the expected therapeutic and adverse effects of the β-blocker, carvedilol (Coreg)?
Chess is maybe the most mainstream and loved prepackaged game on the planet. A huge number of individuals play it every day, and a large number of dollars of sponsorship go into the big showdowns of chess. It appears be getting considerably increasingly well known as the years move on. In any case, what amount do we are aware of its history, and where the regal game originated from? This extraordinary game began in India in the sixth century—however that is only the beginning of learning the beginnings of chess. There are numerous legends encompassing the source of chess, and furthermore the guidelines of the game have changed such a great amount during its around 1500 years of history, that it is hard to follow precisely when "chess" appeared as we probably am aware it. In every locale, chess took on various guidelines, pieces, sheets, and such. Be that as it may, as indicated by Chess.com, "Today we realize that chess started from the Gupta Empire (600CE), of India. The pieces originate from the essential military components of that time: the infantry, the elephants, the mounted force and the chariots" ("History of Chess: The Basics"). A few specialists have guaranteed the game could have started in China, yet these appraisals are in the minority. In India, the game was alluded to as Chaturanga, and has been referenced in Persian original copies. From India, chess ventured out to Persia. As expressed from Medium.com, "In seventh Century AD it was received as Satranj in Sassanid Persia. A few varieties of chess advanced in Persia" (Naval, Saini). The sovereign and minister had restricted development as of now, not at all like the wide development it has now. As indicated by Ancientchess.com, "The type of chess which at long last landed in Europe was at that point being played in Persia somewhere in the range of 1,350 years back, when that region of the world was vanquished by Muslim armed forces in the mid seventh century. The game turned out to be extremely well known in the Muslim world, and it was conveyed back, all through Islam, across North Africa and in the long run into Europe" ("Chess History"). In this way, the Muslim world was liable for the more noteworthy movement of the game. Likewise, in Persia, the main unmistakable chess pieces started to develop that are like our advanced ones. Furthermore, before chess got broad in Europe, it was brought to Spain and Sicily through the Moors, who were Muslim occupants in those regions. This was around 800 AD. Another large occasion was that by 900 AD, Muslim chess players were composing books on the methods of chess. This can be said to be the main works on chess hypothesis (Murray, H. J. R). Despite the fact that our worldwide chess game has numerous variations in numerous nations, the most mainstream one played today around the globe began to turn into a distraction in Europe around 1000 AD. As per Ancientchess,com, "… the chess which came to Europe from Asia, going starting with one culture then onto the next, remained for all intents and purposes unaltered for right around a thousand years. Indeed, even as pieces changed shape and personality, the principles of the game remained amazingly steady. The primary known printed event of the new principles is dated 1497 — however that composition appears to show that the new game was at that point commonly known" ("Chess History"). Chess spread like an out of control fire all through Europe after the guidelines had been changed with the goal that the sovereign and minister had more prominent versatility, and was even called "frantic sovereign chess" and different minor departure from this title. With the recently discovered speed of chess, the game become additionally energizing and nuanced. This was the beginning of our cutting edge chess, and it appears the notoriety and development of chess has not halted since (Naval, Saini). Chess is a round of around 1,500 years that started in India, headed out to Persia, and through Muslim impact, spread all through Europe. In that movement, its guidelines have definitely changed, and its pieces have likewise changed. There are as yet a few varieties of chess in numerous nations, similar to China, Japan, Korea, and the sky is the limit from there. In any case, the worldwide chess we play today was created in Europe by giving the sovereign and minister more prominent force—making the game all the more exciting, and simultaneously, unpretentious. Works Cited "History of Chess: The Basics." Chess.com, Chess.com, 15 May 2018, www.chess.com/article/see/the-historical backdrop of-chess. Maritime, Saini. "A Brief History of Chess – HalfChess – Medium." Medium.com, Medium, 26 Apr. 2017, medium.com/halfchess/a-brief-history-of-chess-e5ceeffdf99e. "Chess History." Chess Variants – Ancient Chess – How to Play – Xiangqi – Shogi – Shatranj, ancientchess.com/WordPress/?page_id=269.>GET ANSWER