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By F. Dargoth. Hofstra University.

Further reading Hawker is a leading authority on hepatic failure; her chapter (1997a) is an accessible and useful source order venlor 75 mg mastercard anxiety love. Langley and Pain (1994) discuss some of the options for medical treatment generic venlor 75 mg with mastercard anxiety disorder treatment, while Stanley et al cheap 75 mg venlor free shipping anxiety symptoms electric shock sensation feelings. Artnal and Wilkinson (1998) give a case study of fulminant failure from paracetamol buy discount venlor 75 mg online anxiety symptoms everyday. Clinical scenario Fabio Galvani is a 26-year-old male who has recently completed a six-month backpacking trip to southeast Asia. Since his return he has been feeling increasingly unwell with nausea, vomiting, fever with influenza-like symptoms. He was admitted to hospital for investigations after behaving in a confused and agitated manner. Doctors made a diagnosis of fulminating hepatic failure and grade 3 hepatic encephalopathy. Review your understanding of hepatitis B virus: • Likely route (portal of entry) and mode of transmission • Incubation period • Survival outside host cells (how long virus can live outside body) • Infectious risk to friends, family and health care workers. Specify proactive nursing strategies, which can minimise potential complications (prioritising care, type of psychological support, nutrition, health promotion, use of specialists). Immunity Classifications of immunity derive from historical schools of immunology, which increasingly recognised that different modes of immunity existed concurrently. Nonspecific immunity is any defence mechanism not targeting specific microorganisms. Specific immunity is necessarily acquired through exposure to various organisms or antibody vaccination. Cell-mediated immunity causes T-lymphocytes to respond to (nonspecific) protein by producing various lymphokines; humoral immunity is mediated by antibodies (B-lymphocytes) in the blood, and is antigen-specific. Nonspecific immunity Many body systems include defence mechanisms against foreign material, all potentially compromised by critical illness and treatments (e. Specific immunity Specific immunity is achieved through two types of lymphocytes: T and B. T-lymphocytes T-lymphocyte precursors originate in bone marrow, migrating to and maturing in the thymus gland (Abbas et al. Antigen recognition by T-lymphocytes causes enlargement and differentiation into (Johnson 1994): ■ killer cells (cytolytic) attach to invading cells, then secrete • lymphotoxins (kill invading cells) • lymphokines (attract lymphocytes and macrophages) • interferon (inhibits viral replication, enhances action of killer cells) ■ helper cells assist B-lymphocytes increase antibody production (Johnson 1994). Intensive care nursing 386 B-lymphocytes B-lymphocytes, produced in the bone marrow, respond to foreign antigens by becoming antibody producing cells (Abbas et al. Three (IgA, IgG, IgM) primarily neutralise toxins and viral activity, promoting bacterial lysis and phagocytosis. IgA Relatively unimportant for systemic humoral immunity, this is found mainly in mucus membranes (Abbas et al. IgE This attaches to cell membranes of basophils and mast cells, triggering histamine (Young-McCaughan & Jennings 1998). Readily entering tissue spaces, IgG coats micro-organisms prior to phagocytosis (Hudak et al. IgM This is the first immunoglobulin secreted during primary immune response to antigens (Young-McCaughan & Jennings 1998). Immunodeficiency Failure of the immune system is usually secondary to either autoimmune pathologies (e. The immune system can also be over-whelmed by infection or complex surgery/invasive treatment, exposing patients to opportunistic infections (e. During healthy maturation T-lymphocytes are exposed to self-antigens, developing tolerance so that surviving T-lymphocytes tolerate the body’s own tissue (Abbas et al. Steroids Despite variable use over many decades to treat various conditions, steroid therapy remains controversial, tending to treat symptoms (inflammation) rather than causes. Symptoms include: ■ skin rashes (typically: face, palms, soles, ears) ■ jaundice ■ diarrhoea Treatments include corticosteroids and chemotherapy (e. History First reported in 1981 (Pratt 1995), this virus quickly created levels of fear and stigma unknown since syphilis epidemics. Hysteria was heightened by it being a sexually transmitted disease and its early association with homosexuals and, to a lesser extent, intravenous drug users—a stereotype ignoring global statistics: 71 per cent is transmitted heterosexually (Pratt 1995). Universal precautions minimise infection risks to healthcare workers from all infections, without stigmatising specific groups. Nurses can Intensive care nursing 388 valuably promote health education for patients, their friends and families, and healthcare colleagues. This clumsy arrangement is complicated by inaccuracies of enzyme replication, causing frequent mutations (Abbas et al. Further studies may clarify when and where aggressive treatment is more appropriate than palliative care. Many patients are malnourished (with weight loss) from prolonged illness on admission. Increased motility from both disease and drugs causes diarrhoea, vomiting and nausea. Nutrition should therefore be a priority; gut malfunction may necessitate parenteral nutrition (Macallan 1994). Drugs to prevent nausea and diarrhoea help to restore comfort and dignity; mouthcare provides comfort and helps to prevent opportunist infection. Many patients suffer both cognitive and behavioural changes, such as memory loss, apathy and poor concentration. Isolation, whether in side rooms or by hanging signs over beds, merely reinforces stigmatisation (hence the value of universal precautions); however, using side rooms to provide privacy can be valuable for patients and their families and friends. This can cause additional distress following bereavement, but a nurse’s duty of confidentiality to patients is absolute (apart from specific legal requirements), and extends beyond the death of patients. Dilemmas raised through clinical practice can usefully be discussed among unit teams and thus contribute to the professional growth of all involved. Treatments and interventions increase infection risks, but proactive infection control can reduce risks from nosocomial infection. Extreme reactions to the stigma of a fictional killer virus are effectively illustrated in the film Outbreak (Warner Brothers 1995). Clinical scenario Paul Edwards is 24 years old and was admitted to intensive care for invasive ventilation following a respiratory arrest. The infection control nurse has been asked to approach Paul’s girlfriend and flatmates for screening. Although Leah Betts’ death in 1995 from one uncontaminated tablet of Ecstasy (Towers 1997) captured popular media attention, this death was not isolated; nurses working in acute care increasingly admit patients who have taken overdoses. Illegal drugs and popular subculture trends change rapidly, and trends may have already changed by the time studies appear. There is a paucity of material available on these drugs, and unfortunately this means that even relatively recent material is potentially out of date by the time it is published. Trends in drug use often have significant geographical, cultural and social variations, limiting generalisability of studies. Although drug abuse can occur at any age, drugs such as Ecstasy tend to be taken by adolescents and young adults; at the risk of stereotyping, this chapter refers to this group. With illegal drugs, users and friends are often understandably reluctant to seek medical help until dehydration and collapse occur (Cook 1995). When help is sought, friends may be reluctant to share information with hospital staff, fearing anything revealed may be passed on to the police (Jones and Owens 1996).

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Nursing theories either implicitly Domain or explicitly direct all avenues of nursing discount venlor 75 mg on-line anxiety 9 things, including A discipline of knowledge and professional practice nursing education and administration venlor 75 mg low cost anxiety 9 year old. Nursing must be clearly defined by statements of the do- theories provide concepts and designs that define main—the theoretical and practical boundaries the place of nursing in health and illness care generic 75mg venlor with mastercard anxiety symptoms ringing ears. The domain of nurs- Through theories generic venlor 75 mg otc anxiety network, nurses are offered perspectives ing includes the phenomena of interest, problems for relating with professionals from other disci- to be addressed, main content and methods used, plines who join with nurses to provide human serv- and roles required of the discipline’s members ices. The processes and prac- At the same time, theories must provide structure tices claimed by members of the discipline commu- and substance to ground the practice and scholar- nity grow out of these domain statements. Nursing ship of nursing and also be flexible and dynamic to theories containing descriptions of nursing’s do- keep pace with the growth and changes in the dis- main may incorporate a statement of the disci- cipline and practice of nursing. The focus may be set in statements about human, social, and ecological concerns addressed by nursing. Later, Donaldson and Crowley (1978) stated that a disci- The discipline of nursing is a community pline has a special way of viewing phenomena and of scholars, including nurses in all venues, a distinct perspective that defines the work of the where nursing occurs. The call for clarity of focus continues in the current environment of nursing practice (Parse, 1997). This enhances auton- developed over centuries to communicate the na- omy, and accountability and responsibility are de- ture and development of nursing. The domain of nursing is also other forums on every aspect of nursing and for called the “metaparadigm of nursing,” as described nurses of all interests occur frequently throughout in the previous section of this chapter. Nursing the- Syntactical and Conceptual Structures ories form the bases for many of the major contri- Syntactical and conceptual structures are essential butions to the literature, conferences, societies, and to the discipline and are inherent in each of the other communication networks of the nursing dis- nursing theories. This struc- The tradition and history of the nursing discipline ture is grounded in the metaparadigm and is evident in study of nursing theories that have philosophies of nursing. There is recognition that relates concepts within nursing theories, and it is theories most useful today often have threads of from this structure that we learn what is and what connection with theoretical developments of past is not nursing. For example, many theorists have acknowl- nurses and other professionals understand the tal- edged the influence of Florence Nightingale and ents, skills, and abilities that must be developed have acclaimed her leadership in influencing nurs- within the community. In addition, nursing has a rich scriptions of data needed from research as well as heritage of practice. Nursing’s practical experience evidence required to demonstrate the impact of and knowledge have been shared, transformed into nursing practice. It is only by being Values and Beliefs thoroughly grounded in the discipline’s concepts, substance, and modes of inquiry that the bound- Nursing has distinctive views of persons and strong aries of the discipline, however tentative, can be un- commitments to compassionate and knowledge- derstood and possibilities for creativity across able care of persons through nursing. Nurses often interdisciplinary borders can be created and ex- express their love and passion for nursing. The state- concepts, language, and forms of data that reflect ments of values and beliefs are expressed in the new ways of thinking and knowing in nursing. The philosophies of nursing that are essential under- complex concepts used in nursing scholarship and pinnings of theoretical developments in the disci- practice require language that can be used and un- pline. The language of nursing theory facilitates Systems of Education communication among members of the discipline. Expert knowledge of the discipline is often required Nursing holds the stature and place of a discipline for full understanding of the meaning of special of knowledge and professional practice within in- terms. A distinguishing mark of any disci- This attribute calls attention to the array of books, pline is the education of future and current mem- periodicals, artifacts, and aesthetic expressions, as bers of the community. These indicators in- Closely aligned with attributes of nursing as a dis- clude procedures, tools, and instruments to cipline previously described is consideration of determine the impact of nursing practice and are nursing as a professional practice. Professional essential to research and management of outcomes practice includes clinical scholarship and processes of practice (Jennings & Staggers, 1998). Resulting of nursing persons, groups, and populations who data form the basis for improving quality of nurs- need the special human service that is nursing. Theory-based research is needed in ery and interdisciplinary work demands practice order to explain and predict nursing outcomes es- from a theoretical perspective. Nursing’s discipli- sential to the delivery of nursing care that is both nary focus is essential within an interdisciplinary humane and cost-effective (Gioiella, 1996). Because environment (Allison & McLaughlin-Renpenning, nursing theory exists to improve practice, the test of 1999). Nursing actions reflect nursing concepts and nursing theory is a test of its usefulness in profes- thought. Careful, reflective, and critical thinking is sional practice (Fitzpatrick, 1997; Colley, 2003). Chapters in and use of nursing theory offer opportunity for the remaining sections of this book highlight use of successful collaboration with related disciplines nursing theories in nursing practice. From the viewpoint of practice, know what they are doing, why they are doing what Gray and Forsstrom (1991) suggest that through they are doing, what may be the range of outcomes use of theory, nurses find different ways of looking of nursing, and indicators for measuring nursing’s at and assessing phenomena, have rationale for impact. These nursing theoretical frameworks serve their practice, and have criteria for evaluating out- in powerful ways as guides for articulating, report- comes. Recent studies reported in the literature af- ing, and recording nursing thought and action. Further, these tion and refinement through research, must be re- studies illustrate that nursing theory can stimulate turned to practice (Dickoff, James, & Wiedenbach, creative thinking, facilitate communication, and 1968). Within nursing as a practice discipline, nurs- clarify purposes and relationships of practice. The ing theory is stimulated by questions and curiosi- practicing nurse has an ethical responsibility to use ties arising from nursing practice. Development of the discipline’s theoretical knowledge base, just as it nursing knowledge is a result of theory-based nurs- is the nurse scholar’s ethical responsibility to de- ing inquiry. The circle continues as data, conclu- velop the knowledge base specific to nursing prac- sions, and recommendations of nursing research tice (Cody, 1997, 2003). Can nursing theories in- form us how to stand with and learn from peoples Nursing Theory and the Future of the world? Can we learn from nursing theory how to come to know those we nurse, how to be Nursing theory in the future will be more fully in- with them, to truly listen and hear? Can these ques- tegrated with all domains of the discipline and tions be recognized as appropriate for scholarly practice of nursing. New, more open and inclusive ways to theo- ways to inform nurses for humane leadership in na- rize about nursing will be developed. Abdellah notes that nurses in with other disciplines such as politics, economics, other countries have often developed their systems and aesthetics. These authors expect a continuing of education, practice, and research based on learn- emphasis on unifying theory and practice that will ing from our mistakes. She further proposes an in- contribute to the validation of the nursing disci- ternational electronic “think tank” for nurses pline. Reed (1995) notes the “ground shifting” with around the globe to dialogue about nursing reforming of philosophies of nursing science and (McAuliffe, 1998). Such opportunities could lead calls for a more open philosophy, grounded in nurses to truly listen, learn, and adapt theoretical nursing’s values, which connects science, philoso- perspectives to accommodate cultural variations. Theorists will work in groups to We must somehow come to appreciate the essence develop knowledge in an area of concern to nurs- and beauty of nursing, just as Nightingale knew it ing, and these phenomena of interest, rather than to be. Perhaps it will be realized that the essence of the name of the author, will define the theory nursing is universal and that only the ways of ex- (Meleis, 1992). One challenge of nursing theory is the per- Nursing’s philosophies and theories must in- spective that theory is always in the process of creasingly reflect nursing’s values for understand- developing and that, at the same time, it is ing, respect, and commitment to health beliefs and useful for the purposes and work of the disci- practices of cultures throughout the world. Continuing students of the discipline are required to study and know It is important to question to what extent the basis for their contributions to nursing theories developed and used in one major and to those we serve, while at the same time culture are appropriate for use in other be open to new ways of thinking, knowing, cultures. Exploring structures of nursing knowledge and understanding the portant to question to what extent theories devel- nature of nursing as a discipline of knowledge oped and used in one major culture are appropriate and professional practice provides a frame of for use in other cultures.

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Mucus is not water soluble and so will not easily mix with saline; encrustations on dentures can be difficult to remove after soaking overnight order venlor 75 mg amex anxiety symptoms heart rate, and a few seconds contact with saline seems unlikely to significantly loosen airway encrustations order venlor 75mg online anxiety symptoms definition. Ackerman (1993) found saline instillation reduced PaO2 purchase 75 mg venlor visa anxiety chat room, possibly from bronchospasm or creating a fluid barrier to gas perfusion purchase 75 mg venlor with amex anxiety symptoms last all day. However Ackerman’s methodology alternated use and non-use of saline in the same patients, ignoring possible late complications of consolidation through inadequate removal of mucus. Temperature differentials between cold fluids and airways may trigger bronchospasm so that warming fluids (from hand heat) may reduce complications (Gunderson & Stoeckle 1995). There may be individual cases where saline is indicated, but what those indications currently are remains unclear. Substantial research evidence is needed before saline instillation can be recommended. Nebulisation produces smaller droplets which should reach distal bronchioles, but Asmundsson et al. Hyperinflation Hyperinflation (‘bagging’, to loosen secretions) can be achieved with manual (‘rebreathe’) bags or through most modern ventilators (e. Muscle recoil following hyperinflation mimics the cough reflex and so loosens secretions. It also potentially ■ removal raises intrathoracic pressure ■ removal reduces cardiac return ■ causes (mechanical) vagal stimulation (resulting in bradycardia) ■ causes barotrauma. Manual rebreathe bags are available in various sizes; adult systems should include ■ pressure escape valves ■ oxygen reservoirs if patients normally receive high concentration oxygen ■ 2-litre bags (ideal hyperinflation volume is 1. Relative merits of manual and mechanical hyperinflation remain debated (Robson 1998), but ventilator-controlled hyperinflation leaves nurses’ hands free while ensuring hyperinflation volume is both controlled and measured (limiting barotrauma). Children’s tracheas are smaller and so where 1 mm of oedema might cause slight hoarseness in adults, it would obstruct three-quarters of a child’s airway (Marley 1998). Despite the frequency and long history of mechanical ventilation, many dilemmas of nursing management remain unresolved, influenced more by tradition or small-scale (often inhouse) studies than substantial research and meta- analysis. No aspect of airway management should be considered routine; as with all other aspects of care, frequent assessment enables the individualisation of care in order to meet the patient’s needs. Overviews are usually best obtained from books, but many articles usefully pursue aspects in detail. Wood (1998) provides an extensive literature review on dilemmas of endotracheal suction. Reviewing literature for developing departmental guidelines, McKelvie (1998) gives a reliable overview. Identify those effects that you have observed in your own clinical practice and those from the literature. Lighter sedation ■ enables patients to remain semiconscious, thus reducing psychoses while promoting autonomy ■ reduces hypotensive and cardioinhibitory effects caused by most sedatives Light sedation is a narrow margin between over- and under-sedation. The focus is therefore a nursing one rather than pharmacological, although some widely used sedatives are described. Neuromuscular blockade, once a common adjunct of sedation therapy, is also mentioned. Shelly (1998) stresses that comfort (in its widest sense) can be achieved through sedation. Sedation is now usually only necessary for ventilation if patients have: ■ tachypnoea, which will cause exhaustion ■ discomfort from artificial ventilation (usually from oral endotracheal tubes; also for brief procedures such as cardioversion and bronchoscopy). There are some specific pathologies, such as intracranial hypertension, where sedation is therapeutic. Some authors suggest that potential line displacement justifies sedation (Shelly 1994). Amnesia prevents recall of often horrific procedures, but inability to recall experiences, however horrific, may cause greater psychological trauma (Perrins et al. Prolonged benzodiazepine use causes receptor growth and down-regulation (tolerance), necessitating higher doses (Eddleston et al. Endorphins (endogenous opiates) contribute to sedative effects of critical illness. Midazolam is largely hepatically metabolised and renally excreted, so failure of these organs may cause accumulation of active metabolites (especially with older people, who usually have reduced renal clearance); causing unpredictable increases in half-life with critical illness (Bion & Oh 1997). Being relatively cheap, midazolam is still used by many units for prolonged sedation. Flumazenil’s effect is far shorter than benzodiazepines (half-life under one hour (Armstrong et al. Opiates Most opiates have sedative effects; as analgesia is usually necessary, this ‘side effect’ can be beneficial, provided it is remembered when assessing sedation. Opiates may become Sedation 51 the most important part of sedative regimes (Bion & Oh 1997). Morphine remains one of the most powerful opiates, but newer drugs, such as fentanyl, achieve rapid sedation with strong respiratory depression (which facilitates ventilation). Propofol Propofol’s lipid emulsion facilitates transfer across the blood-brain barrier, achieving rapid sedation. Inactivity of metabolites (Sherry 1997) and rapid redistribution into fatty tissue (Eddleston et al. Widely used for short- term sedation, Propofol is relatively expensive and so some units restrict use to circumstances where sedation is planned to last less than one day. Propofol depresses cerebral metabolism, thus reducing both cerebral oxygen consumption and intracranial pressure (Viney 1996). A number of disadvantages have been reported with propofol: ■ bradycardia from resetting of carotid receptors (Sherry 1997) ■ hypotension from resetting of baroreceptors, sympathetic inhibition and increased venous capacitance (Robinson et al. Use of any drug or equipment beyond a manufacturer’s licence places the onus of legal liability on the users (see Chapter 45). Since propofol does not have any analgesic effect, concurrent analgesia should be given. Intensive care nursing 52 Bolus sedation The introduction of shorter-acting sedatives together with the improvement of infusion pump technology has largely replaced the use of bolus sedation with continuous infusions. Like analgesia, bolus sedation can cause fluctuations between under- and over- sedation (Shelly 1998). Where sedative effects are prolonged, constant infusion can result in over-sedation (Shelly 1998). The lighter levels of sedation now preferred create relatively narrow margins between over-sedation and under-sedation. Over-sedation is arguably inhumane, depriving patients of life awareness, but it also causes respiratory and cardiovascular depression (compromising tissue perfusion) and so it potentially prolongs recovery. Drugs also increase the costs of patient care, placing further burdens on (usually) stretched unit budgets. Thus unnecessary drugs are psychologically, physiologically and financially undesirable. Increased protein (muscle) breakdown from stress-induced hypermetabolism (see Chapter 3) prolongs ventilatory weaning and (eventual) ambulation, thus increasing the risk of later complications such as pneumonia and thromboses. However, sedation is difficult to measure, both because the needs of patients vary (Shelly 1998) and because of the discrepancies between different assessors (Westcott 1995). Gently brushing the tips of eyelashes can usefully identify if someone is sedated deeply enough to tolerate traumatic interventions (e. However, a more precise measurement is desirable for evidence-based nursing assessment and the search for precision has created various sedation scales, most developed in this country, many initially for drugs research. Some scales, such as Bion and Ledingham, are too complex and time-consuming for routine use, and few have been tested for reliability (Olleveant et al.

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Here is where they differ: The flu causes a sudden onset of severe aching buy cheap venlor 75 mg anxiety symptoms rocking, pain discount 75mg venlor with visa anxiety symptoms one side of body, headache trusted 75 mg venlor anxiety lump in throat, and high fever (39º–40ºC) purchase venlor 75mg online anxiety erectile dysfunction. Colds develop more slowly, don’t usually cause fever, and cause only mild aching and fatigue. The flu is a serious respiratory illness and can lead to bronchitis, pneumonia, and respiratory failure. Over-the-counter remedies, such as antihistamines, decongestants, and cough suppressants, may provide some symptom relief, but these products do not prevent or speed healing. Antihistamines cause dry eyes/nose/mouth and drowsiness, and decongestants can raise blood pres- sure and cause dizziness and insomnia. Tylenol (acetaminophen) can help reduce fever, aches, and pains, but it should be avoided by those with liver or kidney disease. Aspirin can also help these symptoms, but it should not be taken by children or teenagers because of the risk of Reye’s syn- drome. Those with kidney disease, ulcers, or risk of bleeding (taking blood thinners) should also avoid aspirin. It is not necessary to see your doctor for a cold unless you or your child have a fever greater than 38ºC along with aching, fatigue, sweating, and chills, or if there is vomiting, ear pain, coloured phlegm, or if symptoms persist longer than 10 days. C • For a sore throat, gargle with warm salt water and try lozenges that contain one or more of the following ingredients: slippery elm, marshmallow, vitamin C, zinc, eucalyptus, or menthol. Echinacea: Shown in several studies to reduce the severity and frequency of cold symptoms. Dosage: 300–600 mg capsules twice daily or 2–4 mL tincture four to six times daily at the first sign of a cold for seven to 10 days. Vitamin C: Several studies have shown that vitamin C can reduce the duration and severity of colds. Zinc lozenges: Help relieve symptoms (coughing, sore throat, and runny nose) and shorten the duration of a cold. Dosage: One lozenge every few hours while awake, up to a maximum 4 to 6 lozenges daily. Complementary Supplements Aged garlic extract: Taken regularly, it may help prevent colds by supporting immune func- tion. Look for a product that provides at least one billion live cells and includes Lactobacillus acidophilus and bifido- bacterium, such as Kyo-Dophilus. Some research suggests that it can help prevent and shorten the duration of a cold. When the heart can no longer pump blood efficiently through your body, blood and fluids back up into the circulatory sys- tem, causing swelling in your lungs, legs, feet, and ankles and congestive symptoms such as shortness of breath. C Heart failure can develop suddenly due to damage caused by a heart attack, or it can develop gradually after years of having high blood pressure, coronary artery disease, or a defective heart valve. A number of lifestyle factors contribute to heart failure such as smoking, obesity, and diet. In many cases it is possible to prevent heart failure by controlling the risk factors that damage the heart. Maintaining a healthy diet, exercising regularly, not smoking, and reduc- ing stress can help significantly. There are also a variety of supplements that can strengthen the function of the heart. Signs and symptoms are similar to those of chronic heart failure, but are more severe and start suddenly. C • Diabetes increases the risk of high blood pressure and coronary artery disease. Your doctor will rec- ommend a combination of lifestyle measures and medications to help improve the strength of the heart and reduce symptoms of heart failure. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril), and ramipril (Altace). Examples include carvedilol (Coreg), metoprolol (Lopressor), and propranolol (Inderal). Digoxin (Lanoxin): Increases the strength of your heart muscle contractions and slows the heartbeat. Diuretics: Commonly called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. In some cases, surgery can be done to correct the underlying problem, such as replac- ing a faulty heart valve, or doing bypass surgery on severely narrowed arteries. For those with severe heart failure that can’t be helped by surgery or medications, a heart transplant may be necessary. In this section I outline dietary, lifestyle, and supplement strategies that help improve heart function. Dietary Recommendations Foods to include: • Cold-water fish contains beneficial fatty acids that can help reduce blood pressure and C cholesterol. Foods to avoid: • Alcohol can weaken heart function and interacts negatively with many heart medications. Foods high in sodium include snack foods (chips, pretzels), deli meats, soft drinks, and fast foods. Note: Those with heart failure may need to limit fluid intake to prevent water retention. Tobacco damages blood vessels, reduces the oxygen in your blood, and makes your heart beat faster. Top Recommended Supplements Coenzyme Q10: An antioxidant that naturally occurs in all cells and is involved in energy production. C Complementary Supplements Calcium and magnesium: Essential for proper muscle contractions and blood vessel health. Fish oils: Over 30 studies have shown that the omega-3 fatty acids in fish oil can help lower blood pressure, reduce atherosclerosis, and protect against heart attack. Garlic: Helps lower blood pressure and cholesterol, reduces clotting, and prevents plaque formation in the arteries. Most of the research showing benefits has been done on aged garlic extract (Kyolic). L-taurine: An amino acid that helps increase the force and effectiveness of heart-muscle contractions. Natural relaxants: Hops, lemon balm, passionflower, and valerian are herbs that can help promote calming, which can help those under stress. Lactium (milk protein extract) and Suntheanine (green tea extract) are also effective in promoting calming, reducing stress, and improving sleep. Most people experience an occasional change in bowel habits; when it is persistent, it is referred to as chronic constipation. During the digestive process, food passes from the stomach to the intestine where nutrients and water are absorbed into the body. The waste products of digestion create a stool, which travels through the intestines with muscle contractions. Anything that slows the passage of stools through the intestines or increases the amount of water absorbed by the body—such as a lack of fibre, fluids, or physical activity; medication; or ignoring the urge to def- ecate—can lead to constipation. Chronic constipation affects 31 percent of people between 19 and 65 years, and approximately 45 percent of people over 65 years. This can be a debilitating and uncom- fortable problem, but there are a number of lifestyle recommendations that can help. Note: See your doctor if you notice blood in your stool or have black stools, as this could signify a serious problem. Ex- amples include Dulcolax (bisacodyl), Senokot (senna), castor oil, and cascara. These drugs work quickly (overnight), but may cause abdominal cramping and are recom- mended for short-term (a few days) use only. Bulk-forming laxatives add bulk and water to the stools, which improves passage through the intestines.

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