Please Help!!

Generate a case study using the instructions below. Then give some background information. To put it another way, the "Before" situation. Don't go into too much detail regarding the client's background with the reader. However, give some insight into the "trigger" that prompted them to seek your help.

Question 1.

Is the use of amlodipine or furosemide recommended to normalize blood pressure in a case of hypertensive heart failure? If so, which is most effective?

Question 2.

How can diabetes cause endothelial dysfunction? What are the roles of ACE inhibitors in the kinin-kallikrein system? What are the mechanisms by which a decrease in the level of nitric oxide causes endothelial dysfunction?

Question 3.

Can sublingual nifedipine be given to a patient with malignant hypertension/accelerated hypertension? It seems to be a controversial issue with some favouring it and some against it.

Question 4.

Is the diagnosis of malignant hypertension based only on the basis of the retinopathy (even in the presence of a normotensive state)? Labetalol, parenterally, is suggested as a treatment for malignant hypertension. What other more readily available preparations (besides sodium nitroprusside) are recommended in addition to this drug? Parental labetalol is not available in Pakistan!

Question 5.

Patients at medium risk of DVT and pulmonary embolism are usually given specific prophylaxis with low-dose heparin at a dose of 5000 units subcutaneously every 8-12 hours until the patient is ambulatory. Is thefirst dose given immediately after, say, extensive varicose vein surgery of small and great saphenous veins?

Question 6.

'Anticoagulants are not necessary, as embolism does not occur from superficial thrombophlebitis' (K&C 7e, p. 809). Why?

Question 7.

Can we use enoxaparin for deep vein thrombosis (DVT) prophylaxis in the immediate postoperative period and in a case of cerebral haemorrhage? Wouldn't it increase the risk of haemorrhage in either case?

Question 8.

Can external jugular vein thrombosis cause tingling numbness over the earlobe and adjoining part of the lower face?

Question 9.

For how long does a patient have to stay in bed to be labelled as bedridden and to merit low-molecular-weight heparin (LMWH) as prophylaxis for deep vein thrombosis?

Question 10.

Is an inferior vena cava filter an alternative treatment for a patient with a history of recurrent deep vein thrombosis on lifelong anticoagulation with warfarin?