4-16-13 National Healthcare Decisions Day

 

Working in healthcare the frequency of poor decision making when it comes to end of life decisions and choices has made many a good healthcare provider change careers. It becomes an ethical dilemma when patients are coerced into major procedures when the outcome will be poor regardless of the intervention. Many times it is because of poor communication between the patient, their family and the caring physicians.  This can largely be prevented through advanced care planning. Effective communication between the patient or legally designated decision-maker and health care professionals ensures decisions are sound and based on the patient’s understanding their medical condition, their prognosis, the benefits and burdens of the life-sustaining treatment and their personal goals for care.

The discussion should include what interventions would you agree to, what do you want to avoid? What do you want your family to know. Decisions include CPR, life support, respirators, tube feedings, surgical procedures, pain management, medications, skilled nursing facilities, hospice. How do you choose to spend your final days? At the bottom of this post you will find many wonderful resources to help you in decision making, and communication with family and physicians.

• Aging With Dignity (Five Wishes) – Order Online
• Physician Orders for Life Sustaining Treatment
• Caring Connections – Download Free State Specific Advance Directives
• Center for Practical Bioethics – Download for free
• Compassion and Choices – State-Specific Advance Directive Material
• Lifecare Advance Directives – Advance Directive Support Documents
• MedicAlert Foundation – Advance Directives for all 50 States
• MyDirectives (Platform to complete free advance directives online)
• National Resource Center on Psychiatric Advance Directives
• Project GRACE – Download
• The Will to Live Project
• The Patients’ Rights Council

advance care planning to keep healthcare centered around patient goals.

Cardiovascular Events

Smoking and Heart Disease

Cardiovascular risk falls as inflammatory response falls,  inflammatory markers are good indicators of this risk reduction.

Smoking is a prime factor in heart disease, stroke, and chronic lung disease. The relationship between smoking and cardiovascular disease is well documented, as is the association of smoking with increased levels of inflammatory markers and accelerated atherosclerosis. It is also well known that when smokers quit, their risk of mortality and future cardiac events declines.

Smoking triggers an immunologic response to vascular injury, which is associated with increased levels of inflammatory markers, such as C-reactive protein and white blood cell count. Several studies have shown that such markers predict future cardiovascular events. Markers such as C-reactive protein are also increasingly implicated in the pathogenesis of atherosclerosis. In more plain terms smoking causes acute inflammatory stress on atherosclerotic plaque, thus increasing the chance of a rupture. And when your atherosclerotic plaque ruptures, or breaks off, the resulting thrombus can lodge itself in the artery and block the blood flow. Thus causing a heart attack or stroke.

Smoking cessation timeline – the health benefits over time

• In 20 minutes, your blood pressure and pulse rate decrease, and the body temperature of your hands and feet increase.
• Carbon monoxide in cigarette smoke reduces the blood’s ability to carry oxygen. At 8 hours, the carbon monoxide level in your blood decreases to normal. With the decrease in carbon monoxide, your blood oxygen level increases to normal.
• At 24 hours, your risk of having a heart attack decreases.
• At 48 hours, nerve endings start to regrow and the ability to smell and taste is enhanced.
• Between 2 weeks and 3 months, your circulation improves, walking becomes easier and you don’t cough or wheeze as often. Phlegm production decreases. Within several months, you have significant improvement in lung function.
• In 1 to 9 months, coughs, sinus congestion, fatigue and shortness of breath decrease as you continue to see significant improvement in lung function. Cilia, tiny hair-like structures that move mucus out of the lungs, regain normal function.
• In 1 year, risk of coronary heart disease and heart attack is reduced to half that of a smoker.
• Between 5 and 15 years after quitting, your risk of having a stroke returns to that of a non-smoker.
• In 10 years, your risk of lung cancer drops. Additionally, your risk of cancer of the mouth, throat, esophagus, bladder, kidney and pancreas decrease. Even after a decade of not smoking however, your risk of lung cancer remains higher than in people who have never smoked. Your risk of ulcer also decreases.
• In 15 years, your risk of coronary heart disease and heart attack in similar to that of people who have never smoked. The risk of death returns to nearly the level of a non-smoker.

http://www.lung.org/stop-smoking/how-to-quit/

http://www.ffsonline.org/

http://www.quitnet.com/qnhomepage.aspx

 

Stroke Know Your Brain

Stroke Signs and Symptoms