Literature Review Assignment Example | Topics and Well Written Essays - 2250 words

Literature Review - Assignment Example Clinical symptoms of CHF include: breathing problems, fatigue, exercise intolerance and peripheral oedema, and frequent thirst. According to Donner et al. (2012, p. 442), some of the causes of heart failures include high sodium consumption, consumption of foods that are poor in vitamins, mineral and fiber, high intake of saturated fat, cholesterol, and simple carbohydrate. Among adults with over 65 years, CHF is the leading cause of hospitalization. Doris et al. (2007) argue that effective management of heart failure requires pharmacological management combined with non-pharmacological interventions. This position is significant in this literature review because of the need to evaluate the best option between pharmacological and non pharmacological management interventions. It will be vital to evaluate which option will provide the best management that will ensure no reoccurrence of hear failure in elderly patients. In this literature review, three themes stand out in the management of congestive heart failure namely; pharmacological treatment therapies, non pharmacological treatment therapies, and a combination of the two management therapies. PHARMACOLOGICAL MANAGEMENT THERAPIES Pharmacological management therapies involve administration of a drug to alleviate the symptoms of CHF. Diuretics such as furosemide, torsemide, bumetanide and thiazide are important drugs in the management of CHF. Administration of these drugs can either be through intravenous bolus every 12 hours or by continuous intravenous infusion. Debates still exist on the most effective way of administrating these drugs. Similarity Some studies have shown that administration by continuous intravenous infusion is more effective in the management of CHF. Differences However, these studies have received a fair share of criticism. Similarly it is not clear as to whether administration of high dose of diuretics is more effective in management of CHF than administration of low doses of diuretics. Th is means that current guidelines on administration of diuretics are based on expert opinion. This has resulted in variation in the mode of administration and the dosing. The integration/synthesis of the evidence There is still some controversy on the administration of pharmacological management therapies. This may have some negative impact on the treatment of CHF among elderly patients. For example, in a study done by Felker et al. (2011), it was observed that among patients with acute decompensated heart failure (HF), there no significant differences in â€Å"patients’ global assessment of symptoms† or in the change in renal function on administering diuretic therapy by bolus when compared with continuous infusion or at a high dose as compared with a low dose (p.797). These findings do not agree with findings of previous study, which recommended that continuous intravenous infusion is more effective than intravenous bolus. Critique of the evidence This leaves the medi cal doctor at a dilemma and thereby, no agreement on the best way to administer pharmacological treatment to patients. Unless this is done, varying expert opinion will still be used in the administration of diuretics by clinicians, and this poses a danger to the patients because such treatment will be based on try and error. NON PHARMACOLOGICAL CHF MANAGEMENT THERAPIES Non pharmacological CHF management therapies involve the use of non drug approaches to alleviate the symptoms (Kostis, et al., 1994).

English - Huckleberry Finn Research Paper Example | Topics and Well Written Essays - 1500 words

English - Huckleberry Finn - Research Paper Example Huck outcome of his adventures is he finally owns a lot of money which he puts in the bank for safety purposes. Huck used to live with a widow called Miss Watson who was a kind but oppressive woman. They were staying together with Miss Watson sister after he was adoption (Twain 109). The start of the book depicts Huck sadness with the new life after his adoption. The level of cleanliness, mannerisms, attendance of both school and the church, does not thrill him. However, he perseveres after his friend challenges him to stay respectable if he wants to join Tom new gang. Huck lives a comfortable life until the reemergence of his drunken father who surfaces in town and claims a share of Huck money. The neighboring judge ,but a new judge who comes to their town believes in Hucks biological fathers’ right and goes to an extent of accommodating him in his home with a view of reforming him. He does all these so as to give custodial rights to Huck father; the judge fails as Pap, Hucks father revert to his past unethical behavior. He stays in town for some months distressing his son as he has already learned reading and tolerance of the widow habit to transform him into a better person. Outraged by Pap’s behavior, the widow orders him to keep away from her residence. This results in Pap kidnapping Huck and puts him across the riverbanks in a small cabin. The father locks Huck in the cabin and goes to drink and thereafter beats him mercilessly when he comes back home drunk. Huck escapes after the confinement and aggressive daily beatings. He accomplishes to escape to freedom after slaughtering a pig and spreading blood in the cabin in the pretext of his death. He hid on a highland found at the heart of Mississippi river as he watches people from the town search for his corpse. He meets Jim, who is a slave of Miss Watson, a few days later on the island. He has chosen to escape listening to the widow conversation on her intention to sell her to another planta tion near the river. He is afraid of inhumane treatment in the other plantation and separation from his family. They join forces despite Huck conviction on the moral obligation of offering his help to a fugitive slave (Twain 145). During one of their camping expedition in the island, they come across a dead man with bullet shots. They find him inside a house on a raft as they try capturing it with an aim of looting the house. Jim prohibits Huck from having a glimpse of the face of the dead man. They are forced to move out of the island after Hucks gets information that another man suspects that Jim stays in the highland. The man justifies his statement by stressing the smoke that emanates from the island. They proceed to the states that condone slavery up the river. On their way to St. Loise, they come into contact with robbers on a ruined steamboat. They finally escape with the thieves’ loot. One night, both Huck and Jim, meet a group of young men in search of fugitive slave s. Huck lie to the group by informing them that his father is suffering in the raft infected with small pox. The men offer Huck money and disappear as they are afraid of the infectious disease. Their raft is hit by a steam boat, and the two of them are alienated. He finds himself in Grangerford’s family. The elopement of a Grangerford daughter elopes with Shepherdson son resulting to a gun cross fire that leads to the murder of numerous