The Discussion Section question is:  

Add a comment pertaining to the effect of workload on coronary blood flow. Please detail our potential to image the ratio of decrease blood flow for  diagnostic value. Add to to the DICUSSION PANNEL for this unit. 

Here some example for you :

1- The effect of workload on coronary blood flow and our potential to image the ratio of decrease blood flow for diagnostic value:

According to The Journal of the American Association, coronary blood flow is determined by the rate at which blood flows out of the coronary arteries to other parts of the body. For example, during rest, the amount of blood flows through the coronary arteries is 225 ml per minute which is 4-5% of total cardiac output. During stress, the blood flow is faster and the heart muscle contracts during systole. As a result, during diastole, the cardiac muscle relaxes to allow the flow of blood through the body without any resistance. One significant effect on coronary blood flow is the workload the heart is subjected to during stress. With an increase in stress rate, the heart reacts to pump blood in a faster rate to ensure oxygen is supplied to the rest of the body. When imaging, the vasodilator stress agents are helpful in decreasing the blood flow and relaxing the heart muscle. These pharmacological agents help when measuring the supply to the heart and viewing the heart’s workload.

2- The following is regarding the effect of workload on coronary blood flow and our potential to image the ratio of decrease blood flow for diagnostic value:

The heart is a very smart organ with very smart systems. An auto-regulatory mechanism known as coronary autoregulation is constantly maintaining the interaction of pressure and resistance of coronary blood flow. Decreases in pressure are compensated for by decreases in resistance and conversely, increases in pressure by increases in resistance so that flow remains constant for a give cardiac workload. This regulatory mechanism operates within the range of physiologic arterial pressures but fails during hypotension when flows become strongly dependent on the driving pressure.

For imaging purposes, pharmacological vasodilator stress agents seek to maximally lower the vascular resistance through relaxation of the vascular smooth muscle cell at the level of the microcirculation, thereby uncoupling coronary flow (supply) and myocardial work (demand). With the help of such pharmacological agents, imaging can take place in order for diagnostic purposes.

References

Schelbert H. R. (2010). Anatomy and physiology of coronary blood flow. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 17(4), 545–554. doi:10.1007/s12350-010-9255-x

3- The effect of workload on coronary blood flow and our potential to image the ratio of decrease blood flow for diagnostic value: 

Blood flow to the heart mainly occurs during diastole, the great majority of blood flow to the left ventricle occurs during diastole. The diastolic pressure from the aorta propels blood through the coronary circulation. The more coronary blood flow to the left ventricle means the longer time that diastole will last. The right ventricle receives blood equally during both systole and diastole. Diastole lasts for about two thirds of the cardiac cycle. The coronary arties through the myocardium are compressed during ventricular contraction when fibers are thickening and are unable to fill.  The pressure within the left ventricle offers resistance to this flow. Blockage of coronary arteries can reduce coronary blood flow at rest, resulting in a buildup of a clot, and also anything that causes arteries to constrict and not allow the vasodilatation to even improve coronary blood flow.

For imaging potential of decreased blood flow, pharmacological vasodilator stress agents can be utilized to cause a lower vascular resistance through relaxation of the smooth muscles of the heart during a nuclear stress test. This can lead to measuring the supply and demand of the heart, it is which these pharmacological stress agents that when can possibly use to help increase the potential to image the ratio of decreased blood flow for diagnostic reasons and value.

The previous page is sending you to https://federalcriminallawcenter.com/2016/04/categories-drugs-controlled-substances-act/.

Do you think the ability to prescribe controlled substance benefits the Nurse Practitioners practice? Why or why not?  In Florida all controlled substance prescribed must be reported to E-FORCSE Dispense Guide. By accessing E-FORCSE database you will avoid multiple healthcare providers re filling narcotics not due, or multiple narcotics to the same patient.   References  Comprehensive Drug Abuse Prevention and Control Act of 1970. Retrieved on March 10, 2019 from https://en.wikipedia.org/wiki/Comprehensive_Drug_Abuse_Prevention_and_Control_Act_of_1970  Kellams, J. R., & Maye, J. P. (2017). The last state to grant nurse practitioners DEA licensure: An education improvement initiative on the Florida prescription drug monitoring program. Journal of addictions nursing, 28(3), 135-142. doi: 10.1097/JAN.0000000000000177  U.S Department of Justice and Drug Enforcement Administration. Diversion control division. Application for Registration Under Controlled Substances Act of 1970 (NewApplicants Only). Retrieved from https://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp

APRNs are licensed registered nurses who have earned a graduate degree at the master’s or doctorate level and achieved national advanced practice certification for their specific practice area. The APRN designation includes Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, Psychiatric Certified Nurse Practitioners and Clinical Nurse Specialists. Florida law requires APRNs to practice within a collaboration protocol with a physician or dentist.

        State laws regulating nurse practitioners in Florida are among the strictest in the nation. Florida law requires that nurse practitioners are supervised by physicians. While the supervising physician does not need to be available to the NP in person he/she must be available by phone for consultation. State law also requires that patients be notified when the physician will and will not be present in the clinic.  (Practitioners, 2015). These hours must be conspicuously posted in each office staffed by nurse practitioners and supervised by a physician so patients are aware when the MD will be on site.  There is no minimum amount of time the physician must be present in the clinic, they must simply alert patients if the supervising MD is off site. Rules for specialty clinics are even stricter in Florida.  Physicians in specialty practice may supervise nurse practitioners at only one location in addition to their primary practice and these clinics must be no more than 75 miles apart. Rules for specialty clinics are even stricter in Florida.  Physicians in specialty practice may supervise nurse practitioners at only one location in addition to their primary practice and these clinics must be no more than 75 miles apart.

        APRNs are proven to provide effective and high-quality patient care. A review of studies published over the past 18 years demonstrate comparable performance between nurse practitioners and primary care physicians on clinical outcomes, including reduction of symptoms and overall health improvement. Patients seen by nurse practitioners also report higher rates of satisfaction. In addition, APRNs are more readily recruited to states that authorize full practice. Full scope of practice regulation is associated with a higher supply of nurse practitioners in rural areas and counties facing health-professional shortages. (Practitioners, 2015)

References

Practitioners, A. A. (2015, October 09). Scope of Practice for Nurse Practitioners . Retrieved from AANP American Association of Nurse Practitioners: https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

 Men and women have always paired off in sexually exclusive relationships, but before the dawn of agriculture, humans may have been promiscuous. Share your opinion on the pros and cons of having more than one partner from an outsider’s point-of-view. No less than 300 words. Must give a response to at least 2 of your classmates’ posts. 

Rough Draft Quantitative Research Critique and Ethical Considerations

Write a critical appraisal that demonstrates comprehension of two quantitative researchough studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

AttachmentsNRS-433V-RS3-ResearchCritiqueGuidelinesPart II.docx
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