Complete 20 pages APA formatted article: Care of Patient in Acute and High Dependency Care.

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Complete 20 pages APA formatted article: Care of Patient in Acute and High Dependency Care. TThis article sets out the appropriate and suggested care for patients under acute, high dependency or critical care placement. Specifically, the patient that will be studied has had a Myocardial Infarction. Initially, the profile of the patient has been made available for the purpose of developing a care plan.

Patient’s Altered Physiology

Theories attempting to explain the physiologic changes that occur during the aging process include genetic theories, cellular theories, and organ system theories. Other physiologic concepts of aging that are proposed are nutrient deprivation, lipofuscin, wear and tear theory, and cross-linking theory. Psychologic theories abound and include disengagement theory, activity theory, life course theory, and continuity theory. None of the said theories or constructs can claim sufficient evidence to account for aging effects that are experienced by older people. The majority of theorists and practitioners agree that with advanced age come factors such as increased vulnerability, increased susceptibility to disease, decrease in vitality, and slowed response to and recovery from stress.

The structural changes described translate into specific cardiovascular problems, such as hypertension, decreased cardiac output, CHF, valvular dysfunction, and cardiac arrhythmias or conduction disturbances. Other changes in cardiovascular physiology compound these problems. Already mentioned is the decreased arterial oxygen tension, which can aggravate any vascular problem and make elderly patients with circulatory compromise (coronary artery or peripheral artery insufficiency) have more severe symptoms than they would, based on their anatomic vascular disease alone. The elderly also have an increased resting heart rate, perhaps related in part to an increased level of catecholamines. Nonetheless, when increased heart rate or contractility is needed, in the case of physiologic stress, there is a decrease in responsiveness to beta-adrenergic stimulation. Thus maximum heart rate and ability to increase the ejection fraction are less.

The elderly are also much more sensitive to small changes in plasma volume. The natural changes of aging in the kidneys, coupled with changes in the function of the renin-angiotensin axis, actually make the elderly person more susceptible to dehydration. There is a decreased thirst drive. Vasopressin secretion is decreased in response to decreased plasma volume. There is also decreased renin production, therefore decreased angiotensin, and, ultimately, decreased aldosterone production. In addition, when plasma volume is decreased, the elderly person may be more symptomatic because compensatory mechanisms such as the baroreceptor reflex are also less responsive. Thus the elderly person with small decreases in plasma volume might be light-headed, dizzy, or even syncopal.

One study found a substantial drop in arterial blood pressure in elderly patients after a meal. There have been significant increases in this group in postprandial symptoms, including syncope, angina, and myocardial infarction (MI). The mechanism of postprandial hypotension is thought to be the diversion of blood flow to the gut, resulting in a relatively reduced intravascular volume elsewhere in the vascular tree. Other relatively mild hemodynamic changes occur with defecation, urination, and postural change.

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