Category: Cardiovascular Diseases

Introduction

Nowadays it is necessary to introduce relevant training to stay healthy. In this case, it is necessary to take physical condition such a heart rate and weight before starting active participation in the fitness programs. The primary goal of this assignment is to design a cardiovascular program, which will suit my personality. Moreover, I would like to emphasize the choosing the exercises in agreement with the personal traits define the motivation strategy, which is necessary to stay on track until the end.

Furthermore, the goals will be set using the SMART approach. Consequently, I would like to underline that setting the right goals is the key motivator for the successful completion of the training. Finally, the program will be proposed based on my individuality, personal traits, goals, and motivation. The design will include six seek schedule, durations, intensities, and locations of the training. In the end, the conclusions are drawn.

Cardiovascular Activity and My Personality

It is evident that cardiovascular activity has to be determined based on personal traits. I can define myself as being a rather calm person, but I prefer to stay in shape. Moreover, I have to mention that I am determined and prefer to achieve the desired goals. Nonetheless, sometimes I lose interest in the subject and terminate the activity entirely. Lastly, I have to mention that I like to spend time with my friends and devote my free time to hobbies.

In this case, non-monotonous physical activity, which involves a challenge, and does not occupy a significant amount of time, is the most suitable one. As swimming and cycling are considered cardiovascular activities, it will be beneficial to have them once or twice a week, as they are rather relaxing compared to regular cardiovascular exercises. Moreover, the recently conducted research revealed that people stay happier if they train with friends (Rettner, 2013).

In this case, my friends will motivate me and help me achieve higher results. Lastly, I have to mention that due to my determination, regular cardiovascular exercises in the form of interval training have to be included as a part of my six-week training. Nonetheless, they are rather simple and do not occupy a lot of time. In this case, a combination of squats and push-up might be the most suitable exercise since it is rather simple and entertaining (Alleva, 2011). Additionally, this particular exercise will help me stay healthy and improve my physical condition. In the end, it could be said that paying attention to my personal traits and lifestyle will help develop a coherent training program, which will help me to stay motivated for six weeks.

Motivation Strategies

The next step is to develop a coherent motivation strategy, which will help me stay motivated until the end of the training period. One of the motivation techniques, which is actively used by the coaches to motivate sportsmen to reach higher scores, is public posting (Martin & Sharpe, 2009). In this case, this technique is applicable to me, as I will be able to see my individual progress. Another motivational strategy is sufficient planning, as it allows make the exercise a habit (Murphy, 2008). It is evident that this approach will also encourage me to do the sports, as I will see the daily progress and how many more steps I have to take to reach the final goal.

Nonetheless, a decision balance sheet will help evaluate the pros and cons of the development of the new program. The benefits are an increase in physical activity, better health condition, and higher energy supply. Moreover, not only my health will be improved but I will also improve the relationship and communication with my friends since they will take part in some of the activities and exercises. Nonetheless, one of the drawbacks is the fact that I might overestimate my abilities and engage in too many activities and exercises. Moreover, the weather conditions might affect my plans since cycling and jogging have to be done outdoors.

Lastly, I will devote less time to my hobbies and have to change my lifestyle. Nonetheless, I have to mention that staying healthy and evolving my daily routine will be beneficial for my physical and social development, as we live in a flexible world, and it is essential to be able to adapt to challenges.

SMART Goal Setting

In this case, setting goals has a dramatic influence on the motivation and the total output (Smithers, 2015). SMART goal setting is the most appropriate technique, which can be used to establish the goals and reach success (Lee, 2010). It is evident that I have to set multiple goals, as my training will involve cardiovascular exercise and activities such as jogging, cycling, and swimming. Having a separate goal for each sport will allow me to monitor my progress efficiently.

The first goal can be formulated as ‘I will be able to change my lifestyle habits and make one of the activities such as jogging, cycling, and swimming a compulsory part of my weekly schedule by the end of the six-week training period’. It is evident that my goal is measurable since I will use posting to mark whether I was engaged in this activity once a week. Another goal is to improve my cardio techniques by increasing the number of push-ups (from 10 to 30), squats (from 10 to 45), and a combination of squats and push-ups (from 10 to 30) by the end of the six-week training period. The last goal is to improve my jogging or swimming abilities from one kilometer to four by the end of the six-week training period.

It could be said that all the goals correspond with the primary principles of SMART goal setting since they are specific, measurable, achievable, relevant, and time-limited. In the end, it could be said that these goals will help me stay motivated since I know that I am able to achieve them.

Overview of Cardiovascular Training Program

The cardiovascular training program will be created based on the motivational strategies, personal traits, and SMART goals since these elements determine my abilities to train efficiently and enjoy every moment of my training. Firstly, the training modes such as cycling, jogging, swimming, and some regular cardiovascular exercises will be involved to keep the muscles in shape. Some of the exercises are push-ups, squats, a combination of squats and push-ups will be practiced. It could be said that interval training will be the most suitable approach since it does not consume a lot of time and allow improving the health condition rapidly (Geddes, 2014).

The technique of a combination of push-ups and squats is rather easy. Firstly, it is necessary to do the regular squat, and then reach the ground with your hands. After that use your hands and get into the plank position (Alleva, 2011). Now the push-up can be performed. Nonetheless, it is necessary to jump on your feet after you are done with the push-ups. It could be said that the exercise is rather easy, but it involves work out of all muscles.

As for interval training, it is evident that it will consist of rapid exercising by doing squats, push-up, and a combination of squats. For the first week, the number of squats, push-ups, and combinations will be ten per interval. It is apparent that the training will consist out of three intervals for seven minutes with a one-minute break between them. The interval training will take place four times a week. Additionally, one time a week swimming, cycling, or jogging is compulsory for one hour. During the second and third weeks, the number of each element will be increased by 12. The frequency will remain the same.

Nonetheless, jogging, cycling, or swimming have to be implemented twice per week. In turn, during the fourth and fifth the number will be 15. The frequency will rise to one additional day of training. Moreover, jogging, cycling, or swimming will be obligatory twice a week. During the last week, the intensity will be increased, and now it will be seventeen times per exercise per interval. The frequency of jogging, swimming, or cycling will remain the same.

Figure 1. Abstract training schedule for six weeks.

Figure 1 displays the potential schedule of all the activities, which are necessary for the six-week period. It is evident that having the activity such as cycling or swimming in between the activities will help me to relax and enjoy the time. Moreover, the interval training will be done in the evenings since it is the most suitable time for me due to studies and other activities. Moreover, some of the days off are also necessary since the muscles need to rest for some period to return to the appropriate condition.

As for the locations, it is evident that some of the exercises such as jogging and cycling are dependent on the weather conditions. Consequently, if the climatic conditions are not appropriate, they can be replaced with swimming as it takes place indoors. In terms of health benefits, it is evident that swimming has to be done indoors since the cold water might be a cause of the significant health damage (Geddes, 2014). Furthermore, it is evident that jogging can be replaced with a treadmill. In turn, cycling can be replaced with a stationary bicycle when it is essentiality. Speaking of the simple exercises, the location can also be modified since they can be done both indoors and outdoors.

As for the progression, the monitoring will be conducted at the end of every week. The testing will include my ability to do a particular number of exercises such as push-ups, squats, and a combination of squats and push-ups. At the end of the first week, I have to be able to do fifteen times per element without having any breaks. At the end of week three, the goal is twenty times. In turn, at the end of week four, it is 25 per push-ups and a combination of squats and push-ups and 30 for squats. At the end of week five, I have to maintain the number 25 of push-ups and a combination of squats and push-ups and increase the number of squats to 35. At the end of the training program, I will be able to reach my goal.

In terms of jogging, cycling, and swimming, I have to try each activity to get an understanding, which one is the most suitable for me. It is evident that in this instance, it plays the role of the motivator. Consequently, it has to be chosen carefully, as I consider it as entertainment. In this case, it will change my perception of sports, fitness, and training, and it will make me believe that it is an essential attribute of my everyday routine and a potential source of entertainment and joy. It is evident that the duration will remain the same. Nonetheless, the number of required kilometers will be increased by every week since; otherwise, I will not be able to reach my goals.

In conclusion, it could be said that this training will contribute to the development of my physical condition and encourage the development of healthy habits in my lifestyle. Moreover, it could be said that it is rather intensive, but still, it is challenging and entertaining since it involves various exciting activities.

Conclusion

In conclusion, it could be said that training is an essential part of our life since it makes us stay healthy. This paper revealed that doing fitness with friends is one of the key motivators for success. Moreover, the exercises have to be entertaining, simple and challenging at the same time. Otherwise, they would not keep me motivated and determined until the end of the program. Furthermore, personal traits, characteristics, and individuality have to be taken into account while designing the fitness program for any individual. Moreover, the lifestyle also has a substantial impact on the person’s motivation and goal setting. Consequently, it was revealed that goal setting contributes to the development of motivation.

Changing locations and activities is also advantageous, as in this case, the continuous change of exercises will allow me to enjoy doing sport and living my life. Moreover, it was revealed that doing one or two days of cycling or swimming will keep me on track and let me feel relaxed for some time. Nonetheless, my primary concern is the weather and availability of my friends since these two factors might influence my success and performance. Lastly, the plan might be readjusted if I would see that I am not able to keep up with it. However, it has to be mentioned that the goals are relevant and highly achievable since they were constructed using the SMART strategy. Nonetheless, I have to pay careful attention to my health since I have to remember that highly intensive training might do more harm than good.

References

Alleva, M. (2011). Today’s workout: squat thrust with a push-up. The Ledger. Web.

Geddes, L. (2014). Exercise: Which regimes are worth the pain? The Guardian. Web.

Lee, K. (2010). Planning for success: Setting SMART goals for study. British Journal of Midwifery, 18(11), 744-746.

Martin, M., & Sharpe, T. (2009). Using public postings a motivation strategy in physical education, sport, and adult exercise settings. Strategies, 22(3), 8-12.

Murphy, S. (2008). Get up and get going. The Guardian. Web.

Rettner, R. (2013). Exercise more fun when friends join you, new research shows. The Huffington Post. Web.

Smithers, S. (2015). Goals, motivation, and gender. Economic Letters, 131, 75-77.

The heart is one of the muscular organs that pump blood through the blood vessels by repeated, rhythmic contractions. The heart is composed of cardiac muscle, an involuntary muscle tissue which is found exclusively within this organ where the term cardiac from the Greek καρδία or kardia meaning “heart”. It is said that the average human heartbeat is at 72 BPM and that it will beat approximately 2.5 billion times during a lifetime of 66 years (OBGyn.net, 2008).

The Structure of the Heart

The heart is situated in the middle of the thorax with the largest part of the heart slightly offset to the left but for dextrocardia, it is on the right. It is located underneath the breastbone. It is usually felt on the left side because the left heart or left ventricle pumps stronger as it directs to all body parts. The sac pericardium encloses the heart and is surrounded by the lungs. The pericardium is made of two parts: the fibrous pericardium, a dense fibrous connective tissue; and the serous pericardium which is a double membrane structure containing a serous fluid to reduce friction during heart contractions. The mediastinum is the name of the heart cavity and is a subdivision of the thoracic cavity (DuBose, 2008).

The heart has a natural pacemaker that regulates the pace or rate of the heart. It sits in the upper portion of the right atrium (RA) and is a collection of specializes electrical cells known as the SINUS or SINO-ATRIAL (SA) node (Heart Site, 2008).

The heart is like the spark plug of an automobile generating a number of ‘sparks’ per minute. It was described that each ‘spark’ travels across a specialized electrical pathway and stimulates the muscle wall of the four chambers of the heart to contract and empty in a certain sequence or pattern. First stimulated are the upper chambers or atria followed by a slight delay to allow the two atria to empty. Then, the two ventricles are finally electrically stimulated (Heart Site, 2008).

In the heart, like the automobile, adrenaline acts as a gas pedal and causes the sinus node to increase the number of sparks per minute that increases the heart rate. The nervous system controls the release of adrenaline. Normal beats are at around 72 times per minute and the sinus node speeds up during exertion, emotional stress, fever, or when the body needs an extra boost of blood supply. It and slows down during rest or under the influence of certain medications. It was found that well-trained athletes also tend to have a slower heartbeat (Heart Site, 2008).

The sequence of electrical activity within the heart

Heart Site (2008) further described that as the SA node fires, each electrical impulse travels through the right and left atrium causing the two upper chambers of the heart to contract. The electrical activity is recorded from the surface of the body as a “P wave” on the patient’s EKG or ECG (electrocardiogram). The electrical impulse moves to an area known as the AV (atrioventricular) node and is held up for a brief period to allows the right and left atrium to continue emptying its blood contents into the two ventricles. The delay is known as a “PR interval” where the AV node acts as a “relay station” (Heart Site, 2008).

After the delay, the electrical impulse travels through both ventricles through the right and left bundle branches with the electrically stimulated ventricles contract. Blood is pumped into the pulmonary artery and aorta and is recorded from the surface of the body as a “QRS complex”. The ventricles then generate an “ST segment” and T wave on the EKG (Heart Site, 2008).

Hemodynamic effects of breath-holding

Finoff et al (2003) found that voluntary breath-holding significantly affected the heart rate response during exercise (P=.03). In their study, “breath-holding during all 3 exercises resulted in a mean heart rate increase of 18.5±7.3bpm, compared with a mean increase of 20.0±6.7bpm when subjects breathed freely.” There is significant interaction between exercise type and breath-holding (P=.01), the effect of exercise on heart rate was analyzed separately for each level of the breath-holding. In addition, the heart rate increase during OPSU with breath-holding was greater than that for the SPSU with breath-holding (21.0±8.1bpm vs 16.3±7.3bpm; P=.04).

The report indicated that voluntary breath-holding significantly increased the SBP, DBP, and mean blood pressure for all 3 exercises compared with the free-breathing condition (table 2). Likewise, ANOVA revealed no interactions between exercise type and blood pressure responses as a function of breath-holding. Breath-holding significantly increased the RPP elevations during all 3 exercises (mean, 38.2±19.3bpm•mmHg with breath-hold vs 31.5±12.4bpm•mmHg without breath-hold; P=.02), without any interaction between exercise type and breath-holding response.

Breath-holding was confirmed by a nasal cannula that monitored airflow, or lack thereof, while the subject performed the exercise with the mouth closed. The report suggested that even if these differences are not likely clinically meaningful, the slightly blunted heart rate increase with breath-holding may be a result of a Valsalva-like effect induced by breath-holding. The initial phase of a Valsalva response is characterized by a brief duration, mild reflex tachycardia, followed by more prolonged bradycardia caused by an increase in vagal tone.

Enoff et all (2003) added that the quantitative SBP, DPB, and mean blood pressure increases during the 3 abdominal exercises performed with breath-holding were approximately twice those seen when the same exercises were performed without breath-holding. There are only minor, insignificant differences between exercises. It only meant that breath-holding would increase blood pressure parameters.

The effect of breath-holding on blood pressure parameters and the RPP, regardless of the etiology, is of potential clinical significance as breath-holding doubles the average blood pressure increase, with some of our normal subjects exhibiting SBP and DBP elevations of over 60mmHg.

The study concluded that when performing the OPSU, SPSU, or the AbSculptor exercises as used in this investigation, normal individuals may experience peak heart rate and mean blood pressure increases that may exceed 30bpm and 50mmHg, respectively. Likewise, Enoff et all suggested that voluntary breath-holding significantly increased the peak blood pressure elevations and RPP for all 3 exercises, but particularly for the OPSU.

Based on their findings, they suggest that:

1. the acute hemodynamic changes of abdominal exercise are potentially clinically relevant,
2. clinicians should consider avoiding the OPSU exercise as used in this study in patients with vascular risk factors, and
3. patients should be instructed to avoid breath holding during abdominal exercise training to avoid potentially detrimental increases in blood pressure and cardiac stress (Enoff et al, 2003).

The Cardiac Cycle

The cardiac cycle is the sequence of events that occur when the heart beats with the two phases:

• Diastole – Ventricles are relaxed.
• Systole – Ventricles contract (Wikipedia, 2008).

In the diastole phase, the atria and ventricles are relaxed and the atrioventricular valves are open. In this process, de-oxygenated blood from the superior and inferior vena cava flows into the right atrium and the open atrioventricular valves allow blood to pass through to the ventricles (Wikipedia, 2008).

As described in the Wikipedia (2008), the systole phase has the right ventricle receives impulses from the Purkinje fibers and contracts while the atrioventricular valves close and the semilunar valves open. De-oxygenated blood is then pumped into the pulmonary artery where the pulmonary valve prevents the blood from flowing back into the right ventricle.

“The pulmonary artery carries the blood to the lungs. There the blood picks up oxygen and is returned to the left atrium of the heart by the pulmonary veins. In the next diastole period, the semilunar valves close and the atrioventricular valves open. Blood from the pulmonary veins fills the left atrium. (Blood from the vena cava is also filling the right atrium.) The SA node contracts again triggering the atria to contract. The left atrium empties its contents into the left ventricle. The mitral valve prevents the oxygenated blood from flowing back into the left atrium,” (Wikipedia, 2008).

Frank-Starling law of the heart

The Frank-Starling law of the heart or the Frank-Starling mechanism states that the more the ventricle is filled with blood during diastole (end-diastolic volume), the greater the volume of ejected blood will be during the resulting systolic contraction (stroke volume) (Wikiedia, 2008).

The force of contractions will increase as the heart is filled with more blood and is a direct consequence of the effect of an increasing load on a single muscle fiber. The increased load consequently stretches the myocardium and enhances the affinity of troponin C for Calcium, hence increasing the contractile force (Wikipedia, 2008).

This is usually the case of premature ventricular contraction where it causes early emptying of the left ventricle (LV) into the aorta (Wikipedia, 2008).

Reference

OBGyn.net. (2007) “Embryonic Heart Rates.” Web.

Terry J. DuBose. Web.

Finnoff, Jonathan T., Jay Smith, Phillip A. Low, Diane L. Dahm, & Shawn P. Harrington MDa (2003). “Acute hemodynamic effects of abdominal exercise with and without breath holding.” Sports Medicine Center, Mayo Clinic, Rochester, MN, USA, Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Heart Site.com (2008). “Heart Electrical Activity.” Web.

Wikipedia (2008) “Frank-Starling law of the Heart.” Web.

It is an offense to use performance enhancement drugs while engaging in various competitive sports. This is mainly because performance enhancement drugs give athletes an unfair advantage over their competitors. Sportsmen face the risk of huge penalties should regulatory bodies discover that they use performance enhancement drugs.

However, this does not deter sportsmen from using performance enhancement drugs. From time to time, various sportsmen fail the test for performance enhancement drugs. Performance enhancement drugs affect the physiology of athletes by increasing their energy and endurance. Nandrolone is one of the most common performance enhancement drugs.

Nandrolone is a steroid whose primary function is building muscles. The drug helps in rebuilding damaged tissues and red blood cells. Nandrolone also increases bone density. Increase in bone density is partially responsible for the increase in red blood cells. This makes nandrolone very effective in treating anaemia. Nandrolone also increases appetite and stimulates muscle growth.

Increase in muscle growth and strength of bones make nandrolone an excellent performance enhancement drug. Increase in strength is due to nandrolone’s ability to increase the body mass and reduce the fat mass (Baechle & Earle, 2009, p. 185). Nandrolone is an efficient performance enhancement drug in sprinting. This is because sprinting requires high amounts of energy.

Nandrolone increases the risk of suffering from cardiovascular diseases. Continued use of nandrolone lowers HDL cholesterol and increases LDL cholesterol. Change in the levels of LDL and HDL cholesterol coupled with other risk factors lead to a significant increase in the risk of suffering from cardiovascular diseases.

However, nandrolone also increases the activity of post-heparin triglyceride liver. Reduction in post-heparin triglyceride reduces the risk of cardiovascular diseases regardless of the levels of LDL cholesterol (Mooney & Vergel, 2000, p. 26).

Nandrolone also affects the respiratory system. The drug increases the respiratory muscle strength. This is highly beneficial to patients suffering from chronic obstructive pulmonary disease (COPD). Increase in muscle strength is due to the increase in diaphragm muscle mass. This increases aerobic metabolism and endurance levels of athletes (Dekhuijzen et al, 1999, p. 1044).

The kidney is the main organ that purifies chemicals in the blood. Introduction of drugs into the blood places undue pressure on the kidney. Frequent use of high amounts of nandrolone may cause renal failure as one of the side effects. Despite the fact that one of the side effects of nandrolone is renal failure, patients with end stage renal failure use the drug as an adjuvant therapy to parenteral nutrition (Hasso, 2009, p. 19).

Sprinters require vast amounts of energy while competing. Therefore, sprinters go printers go to great lengths to ensure that they accumulate enough energy while competing. This increases their chances of winning their respective races. Nandrolone is one of the major performance enhancing drugs that athletes use. However, it is an offense for athletes’ test samples to test more than 2.0 µg/L of nandrolone. Nandrolone is detectable in urine and hair.

The International Olympic Committee penalises athletes who fail the test for nandrolone. Penalties for failing the drug test range from ban for a few years to lifetime ban. Sprinter Marion Jones is one of the high profile athletes who have failed the test for nandrolone. Marion Jones admitted to using nandrolone. Subsequently, the International Olympic Committee striped her Olympic medals she had won (Zimniuch, 2009, p. 128). Marion Jones’ doping admission led to her fall from grace.

References

Baechle, TR & Earle, RW. 2009. Ebk essentials strength training and condition, Human Kinetics, Champagne, IL.

Dekhuijzen, PNR, Machiels, HA, Heunks, L MA, van der Heijden, HFM, & van Balkom, RHH. 1999. ‘Athletes and doping: eVects of drugs on the respiratory system’, Thorax, vol. 54, no. 1, pp. 1041-1046.

Hasso, RA. 2009. ‘Histological toxic effect of nandrolone decanoate on the kidney of male rabbits: part one’, The Medical Journal of Basrah University, vol. 27, no. 1, pp. 19-22.

Mooney, M & Vergel, N. 2000. Built to survive: A comprehensive guide to the medical use of anabolic steroids, nutrition, supplementation and exercise for HIV (+) men and women. Milestones Publishing, Houston, TX.

Zimniuch, F. 2009. Crooked: a history of cheating in sports, Taylor Trade Publications. Lanham, MD.

PJ’s current symptoms include worsening of chest pain from his stable angina; he has recently noticed that less physical exercise is needed to induce pain, and it generally occurs more frequently. The symptoms are consistent with unstable angina; normally, the latter diagnosis for stable angina patients is associated with the aggravation of pain, prolongation of periods for which it lasts, and its occurrence at rest (Giustino et al., 2015). In PJ’s case, chest pain does not occur at rest; however, the described symptoms may be early signs of unstable angina. The patient should be educated on available surgical methods of treating his condition; these include angioplasty and the placement of stents; in some cases, a more invasive procedure, such as a heart bypass, may be considered.

The ST-segment elevation is a sign of an MI; in fact, it is the first medical concern if the elevation is detected (Hanna & Glancy, 2015). However, it can be indicative of several other conditions, some of which may coexist with STEMI. These conditions include early repolarization, pericarditis, left ventricular hypertrophy, left bundle branch block, preexcitation, and hyperkalemia. An important consideration is the pattern of elevation, as this indicator can be different for different diagnoses.

The MI diagnosis can be further confirmed by a blood test; if the patient suffered a heart attack, the blood sample will contain certain cardiac markers (enzymes); however, their level does not rise immediately after a heart attack, which is why treatment for an MI should be provided before the blood test results confirm the diagnosis. According to Lilly (2012), pathophysiological responses to an MI include pain, diaphoresis, and loss of consciousness; these symptoms are due to the decrease of blood flow in the heart and subsequent damage to the cardiac muscle.

References

Giustino, G., Baber, U., Stefanini, G. G., Aquino, M., Stone, G. W., Sartori, S., … Mehran, R. (2015). Impact of clinical presentation (stable angina pectoris vs unstable angina pectoris or non–st-elevation myocardial infarction vs st-elevation myocardial infarction) on long-term outcomes in women undergoing percutaneous coronary intervention with drug-eluting stents. The American Journal of Cardiology, 116(6), 845-852. Web.

Hanna, E. B., & Glancy, D. L. (2015). ST-segment elevation: Differential diagnosis, caveats. Cleveland Clinic Journal of Medicine, 82(6), 373-384. Web.

Lilly, L. S. (Ed.). (2012). Pathophysiology of heart disease: A collaborative project of medical students and faculty (5th ed.). Baltimore, MD: Wolters Kluwer. Web.

Introduction

Advanced practice nurses have to be ready for numerous responsibilities in the workplace and rely on the evaluations and examinations of different factors, including risk factors, individual patient issues, and behavioral aspects. The impact of the pharmacokinetics and pharmacodynamics cannot be ignored in the creation of a patient treatment plan for patients with stroke and hypertension history because these processes help to investigate drug absorption, distribution, metabolism, and elimination (Spinler, 2017). In this paper, a particular case of patient CB will be analyzed in terms of the factor of ethnicity that may influence the pharmacokinetic and pharmacodynamic processes of the currently prescribed drugs.

Case Introduction

In this case, a patient has a history of strokes, hypertension, hyperlipidemia, and diabetes. The combination of these diseases may provoke the progress of severe cardiovascular diseases. Therefore, pharmacokinetics and pharmacodynamics of every drug have to be investigated and used in regard to such factors as ethnicity. It is supposed for the patient to be African American.

Pharmacokinetics and Pharmacodynamics of Drugs

1. Glipizide (10 mg daily) is an anti-diabetic drug of the sulfonylurea class. It works as a blocker of potassium channels in beta cells and results in insulin encouragement and lowering blood glucose. Gastrointestinal absorption is fast and complete. However, it can be delayed by food intake by 30 minutes. Being a protein-bound substance, glipizide is usually distributed in the extracellular fluid. It is characterized by hepatic metabolism and urine excretion in 10-24 hours. Its half-life is about 2-4 hours. Side effects may include nausea, diarrhea, dizziness, or itching.
2. HCTZ (25 mg per day) is a diuretic medication to treat hypertension. It causes loss of water and potassium and increases serum uric acid. The absorption is about 50-60% and observed in the upper jejunum or duodenum. Protein-bound at 68%. This drug is not metabolized but eliminated without changes in the kidney fast. Its half-life is between 5 and 14 hours. Weakness, nausea, vomiting, and muscle pain may be observed as possible side effects.
3. Atenolol (25 mg per day) is a beta-blocker to prevent cardiovascular diseases and manage hypertension. It is used to bind beta receptors and promote sympathetic stimulation that results in cardiac output. It is absorbed in the gastrointestinal tract and exerted in the feces without changes. Minimal hepatic metabolism is observed. Half-life is 6-7 hours. Protein-bound at 6-16%. Side effects are constipation, dry mouth, and confusion.
4. Hydralazine (25 mg) is used to treat heart problems and hypertension by the possibility to facilitate the work of blood vessels and increase oxygen supply. It is 90%-absorbed in the gastrointestinal tract. Hepatic metabolism is observed through polymorphic genetic acetylation. Urine excretion is in the form of metabolites. Half-life is 3-7 hours. Protein-bound at 87%. Side effects are nausea, vomiting, and anxiety.
5. Simvastatin (80 mg per day) is used to decrease the level of lipids. This antilipemic agent helps to reduce the level of cholesterol. Its absorption is up to 85%. 95% bound to plasma proteins. Metabolism is in the liver. 3 hours of half-life. Elimination of an oral dose is in the urine and the feces. Side effects are muscle pain, confusion, and fever.
6. Verapamil (180 mg per day) is a calcium channel blocker that treats hypertension. It is absorbed by 90%. Protein-bound at 90%. Its elimination is 70% in the urine and about 16% in the feces. Its half-life is 2-7 hours. Its side effects include dizziness and constipation.

Glipizide increases the effect of verapamil. It is also suggested to combine verapamil and simvastatin to avoid heart problems. HCTZ may oppose the effects of glipizide by increasing the level of glucose in the blood and making diabetes treatment less effective. The combination of HCTZ and atenolol positively influences therapy for patients with hypertension.

Ethnicity and Drugs

Ethnicity plays a critical role in affecting pharmacokinetic and pharmacodynamic processes. Low plasma renin levels, genetic polymorphisms, and high levels of angiotensin II in African Americans are directly associated with the metabolism and absorption of antihypertensive drugs (Barranger & Hadley, 2017). There are no significant differences in the drug metabolism of the chosen medications for African Americans (Harman et al., 2013).

Still, African Americans poorly respond to ACE inhibitors and beta-blockers, and they better absorb calcium blockers. It is necessary to remember that diuretics are not required for patients with diabetes and hyperlipidemia due to the risk of insulin resistance (Barranger & Hadley, 2017; Barron & Willey, 2017). Mr. CB is a male African American, the consumption of Hydralazine and Verapamil can potentially be associated will less significant effects on addressing hypertension and hyperlipidemia.

Changes and Improvements in Treatment

Statins help to predict lipid levels increase. Still, a cholesterol absorption inhibitor may be offered instead of Simvastatin as an alternative (Savarese et al., 2013). The consumption of Glipizide is recommended with no changes. The metabolic effects of using Glipizide in African American patients are positive. Atenolol can be ineffective in addressing the patient’s hypertension with the focus on the associated hyperlipidemia and T2D.

The use of ACE inhibitors and angiotensin receptor blockers is preferable for patients with hypertension and T2D (Eshtehardi et al., 2015). However, African Americans may not respond to ACE inhibitors. In this case, the prescription of Teveten is recommended. It should be consumed in combination with hydrochlorothiazide, and its dosage should be adjusted to prevent side effects.

Conclusion

Ethnicity plays an important role in affecting pharmacokinetic and pharmacodynamic processes. Drugs should be carefully chosen regarding patients’ ethnicity and side effects. Some drugs for treating cardiovascular diseases can be less effective when proposed for African Americans. Depending on the absorption, metabolism, excretion, and distribution of drugs, it is important to plan the pharmacological treatment for patients and think about possible alternatives.

References

Barranger, K., & Hadley, D.E. (2017). Hypertension.. In V.P. Arcangelo, A.M. Peterson, V. Wilbur, & J.A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4^th ed.) (pp. 257-272). Ambler, PA: Lippincott Williams & Wilkins.

Barron, J., & Willey, V.J. (2017). Hyperlipidemia.. In V.P. Arcangelo, A.M. Peterson, V. Wilbur, & J.A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4^th ed.) (pp. 275-286). Ambler, PA: Lippincott Williams & Wilkins.

Eshtehardi, P., Pamerla, M., Mojadidi, M. K., Goodman-Meza, D., Hovnanians, N., Gupta, A.,… Zolty, R. (2015). Addition of angiotensin-converting enzyme inhibitors to beta-blockers has a distinct effect on Hispanics compared with African Americans and whites with heart failure and reduced ejection fraction: A propensity score–matching study. Journal of Cardiac Failure, 21(6), 448-456.

Harman, J., Walker, E. R., Charbonneau, V., Akylbekova, E. L., Nelson, C., & Wyatt, S. B. (2013). Treatment of hypertension among African Americans: The Jackson heart study. The Journal of Clinical Hypertension, 15(6), 367-374

Savarese, G., Costanzo, P., Cleland, J. G., Vassallo, E., Ruggiero, D., Rosano, G., & Perrone-Filardi, P. (2013). A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. Journal of the American College of Cardiology, 61(2), 131-142.

Spinler, S.A. (2017). Pharmacotherapy for venous thromboembolism prevention and treatment, stroke prevention in atrial fibrillation, and thromboembolism prevention with mechanical heart valves.. In V.P. Arcangelo, A.M. Peterson, V. Wilbur, & J.A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4^th ed.) (pp. 863-886). Ambler, PA: Lippincott Williams & Wilkins.

Cardiovascular Alterations

Cardiovascular alterations are associated with considerable health risks among teenagers and, on some occasions, death. Importantly, they are often asymptomatic and are difficult to detect unless specifically sought for. The current paper contains a diagnosis of a patient based on a scenario, determines the necessary treatment, and points to the potentially important genetic factors.

Considering the information available from the scenario, the most likely diagnosis of the patient is pulmonic stenosis (PS). The condition is caused by the insufficiency of the pulmonary valve which results in the resistance during the flow of blood from the right ventricle to the pulmonary artery (Huether & McCance, 2017). PS commonly produces a characteristic systolic murmur of moderate volume.

Other symptoms may be present, such as fatigue, shortness of breath, and rapid heart rate (Children’s National, n.d.). Nevertheless, their occurrence is most common in the most severe cases, which are relatively uncommon, whereas the majority of the impacted population has PS in the mild or moderate form, which are asymptomatic.

The treatment of PS depends on the severity and the progression of the condition. In most cases, the progression of PS stops at an early age, resulting in the mild form of the condition. In this case, no treatment is required (Cincinnati Children’s, n.d.). To determine the severity of PS, the patient is to be referred to echocardiography. In the case of moderate or severe pulmonic stenosis, balloon angioplasty is prescribed. The narrow area is dilated using a catheter with a special balloon device. The operation does not require open-heart surgery, is proven to be safe, and is sufficient in the overwhelming majority of cases (Herzog et al., 2016).

In older children, the procedure can be performed on an outpatient basis. The described treatment has been demonstrated to be efficient by numerous studies. In rare cases, the severity of the condition requires a surgical operation, such as pulmonary valvotomy or partial vulvectomy, that may be required. Both are open-heart procedures. Nevertheless, the outcomes of the patients subject to surgery are also highly positive (Gruber et al., 2013). It is important to understand that both the balloon dilation and surgical procedures result in an incompetent pulmonary valve. However, with the exceptions in the form of clinically significant incompetence, such an outcome is sufficient for toleration of the condition.

Limited evidence exists that pulmonic stenosis depends on genetic factors. Specifically, a chromosome abnormality can result in a higher occurrence of the condition in certain families. Since, as was explained above, the condition can remain asymptomatic in older children and adults, the patient’s parents may be unaware of the presence of cardiovascular alterations, which accounts for the lack of family history of premature cardiac death.

Admittedly, the only way to confirm the presence of a genetic link to the disease is to perform echocardiography on the parents to trace the familial occurrence. However, once PS is diagnosed and its severity is assessed, it may reveal important information about the likely progression of the condition in the patient. For instance, it would be possible to establish the necessity of a balloon angioplasty once the moderate PS is found in one of the parents. Therefore, it would be reasonable to search for a genetic link to identify the risks pertinent to the patient.

Pulmonic stenosis is a cardiovascular alteration associated with considerable health risks on rare occasions. Nevertheless, the risks can be effectively and safely prevented with balloon angioplasty or a surgical procedure. In some instances, genetic factors must be considered to facilitate timely and effective treatment and prevent adverse health effects.

References

Children’s National. (n.d.). Pediatric pulmonary stenosis. Web.

Cincinnati Children’s. (n.d.). Congenital pulmonary stenosis. Web.

Gruber, P. J., Wessels, A., Kubalak, S. W., Jacobs, J. P., Muralidaran, A., Reddy, V. M.,… Arruda, J. (2013). Pediatric cardiac surgery (4th ed.). Hoboken, NJ: Wiley.

Herzog, S., Dave, H., Schweiger, M., Hübler, M., Quandt, D., Kretschmar, O., & Knirsch, W. (2016). Effectiveness of balloon angioplasty in children with recurrent aortic coarctation depends on the type of aortic arch pathology. Journal of Interventional Cardiology, 29(4), 414-423.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Discuss psychological implications for cardiovascular conditions

Cardiovascular disease development is often associated with psychological factors. The link between the condition and the implications for a person’s psyche might create a vicious circle. In recent years, there have been researches on the subject matter, and so far, scientists put forward a viable hypothesis. A body’s response to acute and chronic stress might moderate the intactness of the cardiovascular system (Lagraauw, Kuiper, & Bot, 2015).

If like in the case of Mr. L, a condition emerges and progresses, it puts a major strain on a person’s activities and might even impair his or her quality of life. Mr. L.’s disease was so severe that he had to undergo surgery and receive a coronary artery bypass. Now that he has to do everything possible to recover and maintain a normal lifestyle, he might feel stressed. The anxiety that he might be experiencing might aggravate his condition completing the circle.

It is not readily easy to speculate as to how Mr. L’s disease impacts his productivity and job satisfaction. In case the accident that led to the surgery happened in the workplace, Mr. L. might have developed PTSD (post-traumatic stress disorder).

Among obvious implications of PTSD is the feeling of anxiety when exposed to the same environment where the accident happens (Hughes, Lusk, & Strause, 2016). If it is the case, Mr. L. might be struggling with feeling happy and safe at work. However, if he is mentally stable and has fully recovered, the only thing which he might worry about is job-related stress. The case description states that his activity on the job is moderate. It is possible to assume that his work routines do not increase his adrenaline and cortisol level and, hence, the likelihood of a repeated accident.

Discuss vocational issues for individuals with coronary artery disease

Coronary heart disease is one of the leading causes of death worldwide. The symptoms of coronary heart disease include chest pain or the feeling of pressure in the chest area which may be accompanied by painful sensations in the neck, jaw, arms, or stomach (Tousoulis, 2017). Other common symptoms involve sweating, fatigue, dizziness, nausea and vomiting, irregular heartbeat, breathlessness, and numbness (Tousoulis, 2017).

If a person experiences these symptoms in the workplace, he or she might not only lose their ability to fulfill their duties but also be at risk of an adverse or even lethal outcome. The work that Mr. L. does requires a certain level of precision and other people, namely, truck drivers, depend on his expertise and safety provision. If he feels dizzy or nauseous at work, he might lose concentration and make mistakes.

Since Mr. L underwent surgery, he will have to make changes to his lifestyle which might interfere with his work activities. For instance, in the first weeks after the surgery, he will need to visit his doctor regularly to monitor his chest for infection and clean the chest incision. Since working hours and appointments might overlap, Mr. L’s employer might want to consider flexible working hours for the recovery period.

Another adjustment that the employer might make is delegating Mr. L. easier tasks for which he would not be pressed for time so that his stress level remains low. Generally, Mr. L. should avoid lifting heavy objects; however, only his doctor can specify whether he should or should not fulfill such duties. Usually, beyond ten weeks, patients are allowed to return to their routines fully, including challenging physical activities.

References

Hughes, C., Lusk, S. L., & Strause, S. (2016). Recognizing and accommodating employees with PTSD: The intersection of human resource development, rehabilitation, and psychology. New Horizons in Adult Education and Human Resource Development, 28(2), 27-39.

Lagraauw, H. M., Kuiper, J., & Bot, I. (2015). Acute and chronic psychological stress as risk factors for cardiovascular disease: Insights gained from epidemiological, clinical and experimental studies. Brain, Behavior, and Immunity, 50, 18-30.

Tousoulis, D. (2017). Coronary artery disease: From biology to clinical practice. Cambridge, MA: Academic Press.

Introduction

Cardiovascular conditions may differ in symptoms depending on the patient’s age, gender, and previous medical history. In women, some conditions can present additional problems or be asymptomatic (McSweeney, Pettey, Souder, & Rhoads, 2011). In Case Study 2, a 63-year-old African-American woman comes to the office with a complaint of intermittent chest pain that started two weeks ago. The patient’s signs and physical examination point to several diagnoses that require immediate intervention to prevent other severe issues from developing. The differential diagnosis includes stable angina, myocardial infarction, and costochondritis, and a treatment plan for the primary diagnosis is offered.

Differential Diagnoses

The first differential diagnosis is stable angina (angina pectoris) – chest pain that occurs due to reduced blood flow. The main symptoms of this condition include chest pain defined as pressure or burning, pain in the extremities or one’s jaw, neck, and back, fatigue, dyspnea, nausea, and sweating (Manolis et al., 2016). Furthermore, angina-related signs appear after physical exhaustion and can be mitigated by rest and medication (Manolis et al., 2016).

The patient’s description of the pain, as well as relieving and exacerbating factors, meets the description of stable angina. The palpation reveals the tenderness of the chest wall, and the blood pressure (BP) is raised, which is a common risk factor for angina.

The second possible diagnosis is a myocardial infarction, the blockage of blood to one’s heart. The signs of a heart attack are tightness or pressure in the chest, nausea, heartburn, abdominal pain, fatigue, sweating, and dizziness (Ford, Corcoran, & Berry, 2018). The patient’s high BP and age put her at increased risk of myocardial infarction. However, the patient states that pain resolves with rest, and she does not have any other symptoms. Thus, this diagnosis is less likely, although the risk of myocardial infarction exists if the patient’s pain remains unresolved.

Costochondritis is the final differential diagnosis because it is established by exclusion. This condition’s signs resemble those of angina and myocardial infarction, but they are caused by an inflammation of one’s cartilage (Boran & Boran, 2017). If diagnostic tests exclude angina, myocardial infarction, and show some characteristics of an infection, then this diagnosis can be considered. However, it is first necessary to review other systemic problems that are more urgent.

Treatment and Patient Education

The description of the signs and patient’s history shows that angina is the primary diagnosis. A repeat tress test, electrocardiogram, chest X-ray, and such blood tests a CBC, blood cultures, cardiac enzymes are crucial to rule out other conditions and support the final diagnosis (Tharpe, Farley, & Jordan, 2017). Angina can be a precursor to infarction or acute coronary syndrome, which may develop later. Thus, lifestyle change has to start immediately and be focused on healthy eating, safe exercising, and BP management.

Pharmacological treatment for the patient with angina and high BP is a combination of beta-blockers or non-dihydropyridine calcium channel blockers with BP control medication (Manolis et al., 2016). The management plan adds Metoprolol 50 mg orally twice a day to the patient’s Lisinopril to see how BP will change (“Metoprolol dosage,” 2019). Patient education should focus on nutrition, safe physical activity, stress management, and BP reduction.

Conclusion

Overall, the second case study presents a patient with multiple cardiovascular conditions that may affect each other and lead to severe problems if left untreated. The patient’s primary diagnosis is angina, but diagnostic tests are crucial to eliminating differential diagnoses. The treatment plan focuses on lifestyle changes, BP control, and blood flow improvement. Patient education has to include such information as healthy food choices and an exercise regimen that is not challenging.

References

Boran, M., & Boran, E. (2017). Tietze syndrome and idiopathic costochondritis – Treatment modalities, recurrence rates, seasonality. World Journal of Pharmaceutical Research, 6(8), 76-85.

Ford, T. J., Corcoran, D., & Berry, C. (2018). Stable coronary syndromes: Pathophysiology, diagnostic advances and therapeutic need. Heart, 104(4), 284-292.

Manolis, A. J., Poulimenos, L. E., Ambrosio, G., Kallistratos, M. S., Lopez-Sendon, J., Dechend, R.,… Camm, A. J. (2016). Medical treatment of stable angina: A tailored therapeutic approach. International Journal of Cardiology, 220, 445-453.

McSweeney, J. C., Pettey, C. M., Souder, E., & Rhoads, S. (2011). Disparities in women’s cardiovascular health. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 362–371.

Metoprolol dosage. (2019). Web.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

Introduction

Neurologic conditions may cause severe health outcomes and should be diagnosed and treated timely. In women, the problem is especially significant as some of these illnesses may be unique to females. This paper addresses a case of a patient presented with recurrent headaches. The report suggests the differential diagnoses and outlines the treatment strategy for this case. The paper also discusses the means of educating patients on migraines.

Patient Evaluation and Medical History

The patient is a 32-year-old Asian American woman who presented to the clinic for recurrent headaches. She notes that the episodes of headaches occur every month and may last up to 12-18 hours. The woman also reports episodes of photophobia, vomiting, and nausea. She uses either acetaminophen or ibuprofen as treatment measures, but sometimes they cause no relief. The patient uses Ortho Tricyclin as a birth control method. The symptoms show that the case may be an example of a neurologic condition.

Differential Diagnoses

The primary diagnosis for this case is a migraine, which is a condition that can last for hours and days and be associated with sensitivity to light, vomiting, and nausea (“Migraine,” 2019). A migraine can be caused by hormonal changes in women, which, in their turn, are a result of using birth control pills. Differential diagnoses for the patient include 1) intracranial hypotension associated with nausea and vomiting, 2) trigeminal neuralgia that may be determined by the episodes of recurrent severe pain, and 3) narrow-angle glaucoma associated with headaches, nausea, and vomiting (“Trigeminal neuralgia,” 2019). To confirm the diagnosis, it is necessary to perform blood tests to reveal possible blood vessel problems, along with magnetic resonance imaging (MRI), computerized tomography (CT) scan, and lumbar puncture.

Treatment

The treatment strategy for a migraine includes the use of triptans for moderate to severe headaches (Mayans & Walling, 2018). In this case, 6.25 mg of Axert after the first sign of a migraine was recommended, the patient was informed that she should not take more than two doses a day. Alternative treatments for the condition included muscle relaxation exercises once a day, massage therapy once a week, and acupuncture two times a month.

Education

To educate patients on the management and treatment of migraines, medical professionals should discuss with them the possible causes of the condition. They may include stress, changes in the sleep pattern or environment, diet, and medications (“Migraine,” 2019). It is also vital to discuss the potential adverse effects of birth control medications with female patients. Tharpe, Farley, and Jordan (2017) note that clinicians should consider the history of headaches in prescribing this type of contraception to women. In addition, medical professionals should suggest management strategies based on screening and test results, as the symptoms of the condition can be similar to the signs of more severe diseases. It is crucial to inform individuals that migraines can be managed using the alternative methods discussed above.

Conclusion

Migraines can lead to severe pain and be associated with other adverse symptoms, such as nausea, photophobia, and vomiting. This case shows that for some individuals, this condition may be caused by hormonal changes related to the use of oral contraceptives. It is necessary to educate female patients about the risk factors associated with birth control pills, as well as educate individuals on the traditional and alternative ways of management of the condition.

References

Mayans, L., & Walling, A. (2018). Acute migraine headache: Treatment strategies. American family physician, 97(4), 243-251.

Migraine. (2019). Web.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

Trigeminal neuralgia. (2019). Web.

Introduction

In the provision of healthcare services, an organization should be keen on presenting mechanisms that will provide the best of services that can be relied on by its clients. Shapiro Cardiovascular is a major organization in the United States that has been top in the provision of expert surgery to several clients. Taking the situation of Shapiro Cardiovascular Organization, several considerations are necessary towards the realization of their goals (Drucker & Ferdinand, 1999). Below are some of the elements that are ideal in the realization of goals and objectives for the organization.

Mission Statement

The organization is aimed at providing the best medical and healthcare services to all clients. It also has the responsibility of offering reliable surgical solutions to all that are in need. This kind of mission will enhance the realization of goals towards the provision of the best health care solutions to various individuals who need the services from the organization.

Standards and Scope

The scope is towards better service delivery and surgical solutions; the organization assumes several standards and a scope that has to be followed accordingly. The first standard is to have expert heart operation and surgical procedures. Nurses and management staff have been provided with the high operational standards that they are obliged to maintain. Everything in the organization has to be done with the highest degree of integrity towards the delivery of the best services to the clients and customers (Cooper & Campbell, 2009).

Government Regulations and Accreditation Organization’s Influence

Being one of the major providers of surgical solutions in the country, the organization has maintained its reputation and has been receiving clients from not only the country but also from other different parts of the world. However, some of the health regulations put up by the government and accreditation have been necessary for this operation. The government requires that the organization offers expert surgical quality services that address the needs of particular patients (Houdmont & Leka, 2010). It is only when such requirements have been met that the organization can be accredited towards the provision of such services of health in the country. Government regulations have been important in ensuring the best health care service provider to the people. As well, there is a need to make sure that some Medicare and Medicare demands have been met by the organization before accreditation starts operating in the country.

Findings of a Quality Director’s Functions

From the interview done, several roles and challenges have been identified as key to such operations. Some of the roles and functions include organizational functionality and leadership. This has to be done in the best way possible to increase the realization of goals in the organization (Houdmont & Leka, 2010). Leadership is another important role that comes with management portfolio towards the realization of organizational healthcare goals. However, some challenges faced by the director in the organization include increased patients and human resource issues. Financial and decisions issues have also been a major challenge in the organization.

Performance Awareness and Improvement Process

Through leading and mentoring, performance awareness has been injected into all working employees and other stakeholders in making sure that the performance has been on top. This has been addressed through decisions and leading procedures on all the stakeholders (Madura, 2008). For improvement’s sake, there has been the need to have appropriate decisions and organizational change which promote service delivery in the organization.

Measurement Process

Towards a measurement of success, clients act as a benchmark depending on their comments and services offered to them. In such a case, there has been the need of ensuring that all operations have been done in the best way possible and hence leading to effective service delivery (Mattsson, 2005).

Framework and Communication of Results

A managerial approach has been adopted at Shapiro, appropriate decisions are implemented which favor operations in the organization. Results and performance of the company are usually communicated through portfolios and meetings (Bennet & Wirth, 2009). These meetings act as avenues for decision-making and ensure that there has been an improvement in service delivery.

References

Bennet, A. & Wirth, C. (2009). Fundamentals of Finance: financial institutions and markets. New York: New Press.

Cooper, C. & Campbell, Q. (2009). International handbook of work and health psychology. Chicago: Chicago University Press.

Drucker, P. & Ferdinand, D. (1999). Management Tasks, responsibilities, practices. New York: Oxford University Press.

Houdmont, J. & Leka, S. (2010). Occupational Health. New York: Oxford University Press.

Madura, J. (2008). International Financial Management. New York: Longman.

Mattsson, L. (2005). Environmental Economics. Wellington: Oxford University Press.