Case Scenario Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure. Subjective Data 1)Is very anxious and asks whether she is going to die. 2)Denies pain but says she feels like she cannot get enough air. 3)Says her heart feels like it is “running away.” 4)Reports that she is so exhausted she cannot eat or drink by herself. Objective Data 1)Height 175 cm; Weight 95.5 kg 2)Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58 3)Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation 4)Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82% 5)Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin Critical Thinking Questions What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications? 1)IV furosemide (Lasix) 2)Enalapril (Vasotec) 3)Metoprolol (Lopressor) 4)IV morphine sulphate (Morphine) Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.
Hypothetically, the wavelength scope of the close infrared electromagnetic range (800 nm and 1700 nm ) utilized as a part of optical correspondence suggests it offers to a great degree high transfer speed, thus giving higher information rates contrasted with other correspondence media, for example, the radio (1 mm-100 Mm ) and microwave (1 mm-1 m) frameworks . Further, this innovation requires no range authorizing prerequisites i.e. activity free groups, no shared impedance between the FSO frameworks (high spatial selectivity of the pillar), no Fresnel Zone prerequisite and hard to listen in on transmitted information , , . The mix of the optical remote and fiber is an examination territory been taken a shot at by my numerous specialists . This coordination is conceivable in light of the fact that the two optical advances offer high—speed optical transfer speed to address showcase issues. They both utilize the same optical transmission wavelength (800 nm – 1700 nm) . Also the two optical advances both offer a similar framework segments and can transmit computerized data utilizing a scope of conventions. The business focal points of FSO interchanges for arrange expansions incorporate the decrease of cost brought about on fiber-optic link and other related expenses, and in addition time for organizations . In spite of its possibilities, FSO correspondence connect is influenced by climatic lessening inferable from airborne particles, for example, mist, dimness, rain and snow which causes changes in both the force and the period of the got light flag thus constraining the accessibility of FSO for a given transmission extend and expanding the frameworks bit blunder rate . These incorporates the fine mode with measurement, under 2.5 µm, the aggregation mode with molecule distances across 0.1 µm < 2.5 µm and the coarse mode with width > 2.5 µm . These particles can develop in measure in areas of high moistness, and therapist by vanishing as dampness diminishes. The impact of environmental pressurized canned products in the channel on laser pillar spread can be resolved utilizing the Mie hypothesis which depends fundamentally on wavelength and molecule measure . The dimensionless size parameter shows the idea of the Mie estimation as it gives the connection between the molecule size and radiation wavelength. This is given numerically in condition 2.1 as where is wave number, is molecule sweep and is molecule wavelength. Table 2.1 adjusted from Ricklin et al  demonstrate a few wellsprings of vaporized in the environment. Airborne particles can be grouped into three modes in view of the distance across of the particles. Table 2.2 adjusted from O'Brien et al  demonstrates the constrictions caused by rain, snow and haze. Table 2.1 Estimates of particles littler than 20 micron range produced into or shaped in the air (106 metric tons/year) (adjusted from ) Common sources Soil and shake debris* 100-500 Timberland flames and cut consuming debris* 3-150 Ocean salt 300 Volcanic trash 25-150 Particles framed from vaporous discharges Sulfate from H2S 130-200 Ammonium salts from NH3 80-270 Nitrate from NO8 60-430 Hydrocarbons from plant exudations 75-200 Subtotal 773-2200 Man-made sources Particles (coordinate emanations) 10-90 Particles shaped from vaporous emanations Sulfate from SO2 130-200 Nitrate from NO8 30-35 Hydrocarbons 15-90 Subtotal 185-415 Add up to 958-2615 *Includes obscure measures of backhanded man-made commitments. Table 2.2 Attenuations caused by rain, snow and haze (adjusted from ) Weakening Visual range Clear climate 0.2 ÷1 dB/km 10 ÷25 km Rain 3 ÷9 dB/km 2 ÷4 km Snow 7 ÷12 dB/km 1 ÷2 km Mist cloudiness 30 ÷80 dB/km 200÷500 m Overwhelming mist 300 dB/km 50 m Elimination is a term which portrays the lessening of a laser bar as it goes through a medium containing iotas, atoms, and particles. As revealed in Ricklin et al , Goody and Yung characterized the crucial law of termination as that of Lambert, which expresses that "the elimination is straight in both power of radiation and in the measure of issue, gave that the physical state (i.e., temperature, weight, arrangement) is held consistent". Concentrated inquires about , , ,  have been led on the impacts of barometrical misfortunes, most particularly environmental sparkle, on FSO correspondence and a few arrangements have been proffered to decrease these impacts. 2.2.1 PROPAGATION LOSS This air misfortune is related with the separation secured by the laser pillar. As indicated by Prokes , free space spread misfortune can be communicated as appeared in condition 2.2 [dB] (2.2) where L is the connection way separate, is the shaft disparity full edge and is the measurement of transmitting roundabout opening. For the Gaussian shaft and an adequately long connection separate ( >>) the extra pick up is = 3.7 dB. In Heatley et al , it was accounted for that for a point-to-point framework that work with a marginally veering shaft, the free space engendering misfortune would be 20 dB though in an indoor framework utilizing wide edge pillar, the free space misfortune would be 40 dB or more. At short connection separates, the aggregate transmitted power is identified at the collector on the grounds that the shaft spot breadth at the recipient position is lower than the distance across of the beneficiary focal point . 2.2.2 PHYSICAL OBSTACLES Physical impediments, for example, winged creatures, bugs, tree appendages, structures or different components can incidentally or for all time obstruct the laser viewable pathway , . Stage/building movement because of wind, differential warming and cooling, or ground movement after some time can bring about genuine misalignment of settled position laser correspondence frameworks . Legitimate arranging and site estimations are methods for keeping away from this impact . 2.2.3 ABSORPTION AND SCATTERING Sub-atomic retention process which is wavelength subordinate is a main consideration in shaft lessening. At wavelengths more noteworthy than 1µm, the impact of sub-atomic eradication can be irrelevant as iotas couple pitifully with electromagnetic field . Moreover, sub-atomic assimilations at these wavelengths are because of ingestion of episode radiation with just minor diffusing commitments . Airborne scrambling impact is caused by rain, mist, fog and snow. This impact represents the debasement in nature of administration experienced amid snow, rain, mist and fog as announced in a point by point estimation take by  over a time of one year in both rustic and urban regions. The outcomes likewise detailed in Heatley et al , demonstrated a comparable pattern however with rather less fluctuation amongst seasons and higher normal constrictions. For some atoms, the ingestion spectra have been estimated tentatively in the research facility and the separate eradication proportions of particular particles have been made accessible for assessment . Atomic assimilation can be limited by fitting determination of the optical wavelength . It has likewise been proposed in  that the weakening impacts because of diffusing can be limited by lessening the connection extend and additionally decreasing the optical power spending plan. The weakening caused by diffusing in decibel scale A10, scat is given by the result of the barometrical constriction coefficient α10, scat and the connection separate in kilometers. The scientific articulations are appeared in conditions (2.3), (2.4) and (2.5) . [dB/km] (2.3) Where is the molecule estimate conveyance coefficient characterized as: [dB] (2.5) 2.2.4 ATMOSPHERIC SCINTILLATION Sparkle is caused by sun oriented vitality warming up little air pockets inhomogenously, in this way making changing refractive list along the FSO interface . This outcomes in the dispersing of laser pillars at different points along the spread way and a resultant variance in both the force and period of the got light , .Atmospheric glimmer is less critical at separations under 500 m , , however debases execution of a FSO connect at scopes of the request of 1km or longer . The power I of an optical wave proliferating through turbulent climate is an arbitrary variable. The standardized difference of optical wave power, alluded to as the shine list, is characterized by condition (2.6)  where the precise sections mean a gathering normal. The glitter file demonstrates the quality of force changes. For frail vacillations, it is corresponding and, for solid changes, it is conversely relative to the Rytov difference for a plane which is appeared in condition (2.7)  where is the refractive-record structure parameter. This parameter is reliant on temperature, stickiness, climatic weight, elevation and wind quality . Bar meander is another event in an environmental channel which causes comparable impacts as barometrical shine. This is portrayed by the avoidance of the whole laser bar by optical tubules of bigger breadth than the bar, bringing about an irregular development of the light bar about the objective point. Air glimmer is a noteworthy disability of FSO correspondences frameworks, as it can create expansive transient plunges in the optical flag. It has been examined widely with different hypothetical models as of now proposed to portray the flag blurring , , . What's more, a few correspondence methods have been portrayed to relieve the flag blurring impact , , , . In , the mistake execution of earthbound FSO joins were displayed as PPM/Poisson diverts in turbulent climate. The shine impacts were demonstrated as lognormal for frail turbulence and as exponential for overwhelming turbulence. In Kiasaleh , the execution of an immediate recognition, APD-based PPM FSO correspondence framework in barometrical turbulence was portrayed. Here the frail turbulence connect was explored by displaying the gotten motion as a log-typical arbitrary process and furthermore as a negative exponentially disseminated got flag power. The double PPM was utilized as the tweak conspire for the framework. It>GET ANSWER