Cover some of these subjects: Somebody says that fats make you “fat?” Are they correct? What is the difference between fats and oils from the viewpoint of nutrition? Account for the fact that some oils are called saturated oils. What are some of the factors that determine where a lipid is a fat or an oil at room temperature? What is a fatty acid? Describe saturated fats or fatty acids. Explain how the body makes cholesterol from saturated fats. Describe trans fats. What are some of the reasons why you should limit the amount of saturated fat or trans fat in your diet?  Name some of the foods which contain natural saturated fat. Are their any natural vegetable products that inherently contain saturated fats? Are there any natural foods that are inherently high in trans fats?  Many food products have a very high saturated fat content or trans fat that is introduced during food processing. Describe the food processing that converts an oil, margarine or peanut butter into a product that has a high saturated fat content. Provide 3 full APA citations that are evidence-based. 

What search engines or databases are you using to identify the articles for your Weekly Article Summary assignment? What key words are you using for your search? Have they been effective in finding articles that are relevant to your clinical practice? Include rationale.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

 Based on this case study, consider to answer the questions that are at the end.
Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.

The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.

Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit. 

1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring 

Diuretics

              The therapeutic effect of diuretics is based on their ability to promote increased elimination of water and sodium from the body. They are considered the first-line for treating hypertension. There are three main types of diuretics, which are thiazides, potassium-sparing diuretics, and loop diuretics. Thiazides act by inhibiting the absorption of sodium chloride in the distal convoluted tubule, loop diuretics work by selectively inhibiting the reabsorption of sodium chloride by acting on the sodium-potassium-chloride symporter in the loop of Henle, and potassium-sparing diuretics act on the collecting tubules to decrease reabsorption of sodium (Aronow, 2018).

ACE Inhibitors

             The therapeutic action of ACE inhibitors is based on preventing the conversion of inactive angiotensin I to the active angiotensin II, which promotes the ACE inhibitors blood pressure lowing effect. They promote vasodilation, which prevents the narrowing of the blood vessels. Additionally, AC inhibitors also increase bradykinins and prostaglandins, which promotes reduction of blood pressure (Aronow, 2018).

ARBs

         ARBs work by blocking angiotensin II from binding to its respective receptor, which, in turn, prevents it from promoting vasoconstriction and fluid retention. The receptors are found on the muscles surrounding the blood vessels. The effect of ARBs in blocking angiotensin II promotes vasodilation, which in turn reduces the pressure of the blood. The effect of ARBs also reduces the effort the heart has to put in pumping the blood (Aronow, 2018).

CCBs

         Calcium channel blockers lower the blood pressure by preventing the entrance of calcium into the vascular smooth muscles. The effect of CCBs promotes vasodilation by reducing the contractibility of the blood vessels. Two types of CCBs exist, those that act on the peripheral blood vessels and those that act on both the peripheral blood vessels and cardiac muscles. While both of them are effective in managing hypertension, the nondihydropyridines, which act on both the cardiac muscles and peripheral blood vessels, are also effective in treating cardiac arrhythmias. Both types can be used as monotherapies in managing hypertension (Aronow, 2018).

Sympathetic Nervous System Drugs

          These drugs function by activating the sympathetic nervous system as hypertension has been linked to different modifications of the functions of the SNS. The main drugs that have been proven effective in activating the SNS and modifying its functions include ACE inhibitors, CCBs, diuretics, and alpha-blockers.

Patient Education for Antihypertensive Medication

         Patient education is important when prescribing or administering antihypertensive medication. Some of the considerations that patients should be educated on include the importance of adhering to their prescribed medication to promote its effectiveness in helping them control their blood pressure, and avoiding taking an extra dosage after forgetting to take their medication. Taking a higher dosage than the prescribed number of tablets can lower the blood pressure to very low point and increase the patient’s risk of complications or death. Other teaching points should incaalude the importance of talking to a physician before introducing another drug or supplement to the regimen to avoid drug-drug interactions and the need to report any adverse reactions that the patient might experience after using the drugs (Burnier & Egan, 2019). Taking these precautions seriously can reduce the risks of complications and promote effective management of hypertension.  

References 

Aronow, W. S. (2018). Antihypertensive drug therapy. Annals of Translational Medicine, 6(7), 123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015954/.Burnier, M., & Egan, B. M. (2019). Adherence in Hypertension: A Review of Prevalence, Risk Factors, Impact, and Management. Circulation Research, 124. 1124-1140. https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.313220.