Cardiovascular and Neurologic Conditions Essay

Week 10 discussion Discussion: Diagnosing and Managing Common Cardiovascular and Neurologic Conditions Cardiovascular and neurologic conditions are among the leading causes of death and hospitalization of women in the United States (Centers for Disease Control and Prevention, 2008a). As an advanced practice nurse, you must routinely monitor patients at risk of these conditions and recommend the appropriate health screenings and preventive services. When assessing patients for these conditions, it is important to keep in mind that while some female patients might present with typical signs and symptoms, others might present with atypical signs and symptoms that are unique to women. For this Discussion, consider signs and symptoms presented by the women in the following case studies and develop differential diagnoses: Case Study 1 A 48-year-old overweight African American female is in the clinic for a wellness visit. Cardiovascular and Neurologic Conditions Essay. A routine fasting lipid panel returned with the following results: Total cholesterol: 305 mmol/L Low-density lipoprotein (LDL): 180 mg/dl High-density lipoprotein (HDL): 30 mg/dl Triglycerides: 165 mg/dl Case Study 2 You are seeing a 63-year-old African American female for a two-week history of intermittent chest pain. The pain varies in intensity and resolves with rest. She does not believe it has increased over time. She is a nonsmoker with a history of hypertension treated with Lisinopril 10 mg once daily. She had an exercise stress test one year ago that was within normal limits. Her physical exam findings are as follows: HR–90, BP–150/92, R–22, O2Sat 98% RA; lungs: clear to auscultation bilaterally; cardiovascular: apical pulse of 90 RRR, no rubs, murmurs, or gallops. Chest wall mildly tender to palpation that reproduces her complaint of pain.

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Extremities include no clubbing, cyanosis, or edema. The remainder of the exam is within normal limits. Case Study 3 A 32-year-old Asian American female is in the clinic for a history of recurrent headaches for the past year, occurring monthly, lasting up to 12–18 hours. The headaches are sometimes associated with photophobia, nausea, and vomiting. She takes either acetaminophen or ibuprofen for relief that is not always successful. She uses Ortho Tricyclin for birth control. Her physical exam is within normal limits. To prepare: Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources. Review and select one of the three provided case studies. Analyze the patient information. Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient. Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments. Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis. Cardiovascular and Neurologic Conditions Essay

Learning objectives for this chapter

By the end of this chapter, we would like you:

-To explain how to rapidly and accurately assess a variety of medical conditions related to the respiratory, cardiovascular and neurologic systems in the emergency care setting.

-To describe the common presentation of medical conditions related to the respiratory, cardiovascular and neurologic systems in the emergency care setting.

-To explain how to effectively manage a variety of medical conditions related to the respiratory, cardiovascular and neurologic systems in the emergency care setting.

Respiratory emergencies

People may present to emergency care settings in the UK with a variety of respiratory conditions, with symptoms ranging from relatively mild and transient to severe and life-threatening. Respiratory compromise can result in brisk deterioration, and without rapid intervention, respiratory failure and death may result. It is essential that nurses working in emergency care settings are able to assess and manage patients with respiratory illness. Cardiovascular and Neurologic Conditions Essay

The assessment of the patient with respiratory illness must begin with an assessment of airway, breathing and circulation (ABC). A more focused assessment of the respiratory system can then be undertaken; this will involve:

• A detailed assessment of the patient’s respiratory system. The nurse should measure the patient’s respiratory rate with the aim of identifying dyspnoea (i.e. shortness of breath). Other signs of dyspnoea include increased work of breathing, nasal flaring, retractions, accessory muscle use, tracheal tugging, grunting, difficulty speaking in compete sentences, pallor or cyanosis, and tripod positioning. The nurse should also auscultate the patient’s lungs, listening for adventitious lung sounds.

• A rapid neurological assessment. Tools such as the GCS assess the functioning of a patient’s central nervous system, including their level of consciousness, via their response to verbal and / or painful stimuli. Changes to mental status in a patient with respiratory illness are early warning signs of deterioration.Cardiovascular and Neurologic Conditions Essay

• A rapid head-to-toe assessment. As one of the body’s fundamental life-sustaining systems, complications with the respiratory system can have a variety of (sometimes subtle) systemic effects. In particular, the nurse should observe for characteristics such as ‘barrel chest’ and clubbing of the fingernails – both key signs of chronic hypoxia and respiratory illness.

• Additional assessments to assist with diagnosis – including chest X-rays or CT scans, a full blood count (FBC), and arterial blood gas (ABG) analysis – will also be used.

A health history is particularly important during respiratory assessment. Nurses must ask a patient about their smoking history, as smoking is a leading cause of respiratory disease in the UK. Nurses must also ask patients about their exposure to respiratory pathogens and hazards.

During assessment, a nurse may identify one or more of a variety of medical conditions related to the respiratory system. The most common conditions, and their management in the emergency care setting, are described following:

• Acute bronchiolitis – this is a severe inflammation of the bronchioles, caused most often by a virus (e.g. influenza, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, etc.). Patients with bronchiolitis present with symptoms of a cold or virus, and a severe cough with dyspnoea, chest pain and fatigue.Cardiovascular and Neurologic Conditions Essay

• Pneumonia – pneumonia is an acute inflammatory reaction in the lungs in response to the presence of pathogens, often bacteria. Patients with pneumonia present with fever, fatigue, a cough with haemoptysis, dyspnoea and pleuritic chest pain. On auscultation of the patient’s chest, ‘crackles’ will be heard, and it may also be possible to identify areas of consolidation.

• Asthma -a chronic obstructive disease of the lungs, characterised by hyper-reactive inflammation and narrowing of the airways. Although this is a chronic disease, patients can present with acute exacerbations which present as severe dyspnoea, coughing, wheezing, chest tightness and distress.

• Chronic obstructive pulmonary disease (COPD) – COPD is a progressive and irreversible disease, often associated with smoking. Although this is a chronic disease, patients can develop acute complications, presenting as severe dyspnoea, the production of purulent sputum, pleuritic chest pain and distress.

• Spontaneous pneumothorax – pneumothorax involves an accumulation of air in the pleural space around the lung/s, and the resultant ‘collapse’ of the lung/s. Pneumothoraxes may develop following a traumatic insult; however, they can also be spontaneous, or develop during severe respiratory illness.

• Pulmonary embolus (PE) – a PE is a condition where a substance occludes a large vessel in the lungs. Patients with PE present with a variety of non-specific symptoms, including worsening dyspnoea, tachycardia, cough, diaphoresis and anxiety. Diagnosis is difficult, and may require CT scans, ABG analysis, electrocardiography (ECG) and also perhaps ultrasonography.

• Inhalational injury – these are injuries caused when a person inhales substances – including hot gasses produced by fire, water, and / or a foreign body. Patients with an inhalational injury will present with a variety of non-specific symptoms, including dyspnoea, coughing, gagging and choking, tachypnoea and pleuritic chest pain.Cardiovascular and Neurologic Conditions Essay

There are a variety of less-serious medical conditions related to the respiratory system. These conditions include influenza, acute viral rhinitis, epistaxis, sinusitis, acute pharyngitis / laryngitis, peritonsillar abscess, among others. In most cases these are mild and self-limiting conditions.

Any of the conditions described above can lead to acute respiratory distress syndrome (ARDS), or the failure of the respiratory system. There are two types of ARDS:

• Hypoxaemic respiratory failure – also referred to as oxygenation failure, which is caused by an imbalance between ventilation and perfusion in the lungs. In severe cases, this may result in shunt, where blood leaves the heart without having participated in gas exchange (e.g. no oxygen in, no carbon dioxide out).

• Hypercapnoeic respiratory failure – also referred to as ventilation failure, which is caused by an imbalance between the supply of, and demand for, oxygen in the lungs. Although this often presents as an acute condition, it may also be chronic.

The administration of high-flow oxygen via a non-rebreather mask is fundamental to the management of all the respiratory conditions described in this section. A patient with a respiratory condition must also have their blood oxygen saturation (SaO₂) continuously monitored, using a pulse oximeter. The psychosocial care of a patient with a respiratory condition is also important for nurses in the emergency care setting.Cardiovascular and Neurologic Conditions Essay

Cardiovascular emergencies

As with the respiratory conditions described in the previous section of this chapter, cardiac conditions are commonly seen in emergency care settings in the UK. Patients with cardiac conditions often present with symptoms that are mild, transient and non-specific. If these conditions are not rapidly assessed, identified and properly managed, significant disability or death can result.

As always, the assessment of a patient with cardiac illness must begin with an assessment of airway, breathing and circulation (ABC). A more focused assessment of the cardiovascular system can then be undertaken; this will involve:

• A detailed assessment of the patient’s cardiovascular system. The nurse should measure the patient’s heart rate as well as the quality of the patient’s peripheral pulses and their blood pressure. The nurse should also observe the patient for other signs of cardiac dysfunction – including pallor and / or cyanosis, diaphoresis and dyspnoea. The nurse should also auscultate the patient’s heart, listening for adventitious heart sounds.

• A rapid head-to-toe assessment. In particular, nurses should assess the patient for sensory and motor deficits, and altered mental status with neurological symptoms. Although they are an ‘acute’ condition, most acute coronary syndromes occur progressively over several hours, and may present with general and non-specific symptoms.Cardiovascular and Neurologic Conditions Essay

• An assessment of the patient’s chest pain, using the ‘OPQRST’ mnemonic. Pain due to cardiac dysfunction is often described as ‘crushing’ or ‘squeezing’ and it may not necessarily be felt in the chest.

• Additional assessments to assist with diagnosis – including chest X-rays or CT scans, blood tests to assess for cardiac biomarkers, and perhaps an ultrasound. An electrocardiogram (ECG) is a standard part of the assessment for all patients with suspected cardiovascular conditions.

During assessment, a nurse may identify one or more of a variety of medical conditions related to the cardiovascular system. The most common conditions, and their management in the emergency care setting, are described following:

• Myocardial infarct (MI) – a MI occurs when one of the arteries in the heart becomes occluded. An MI may be diagnosed by ECG and may be classified as one of two types: (1) an ST-Segment MI (STEMI), or (2) a Non ST-Segment MI (Non-STEMI). Patients experiencing an MI present with chest or radiating pain, nausea, dyspnoea, diaphoresis, fatigue and dizziness, and they may be very anxious.

• Angina pectoris – angina occurs when the arteries in a patient’s heart become partially occluded, often due to narrowing. Angina may be classified into one of two types: (1) stable, where chest pain occurs in a pattern following a predictable amount of exertion, or (2) unstable, where chest pain may occur unpredictably at any time, including without exertion.

Patients experiencing an acute exacerbation will present with many of the same symptoms as for an MI. But whereas an MI will be evident on an ECG, angina pectoris will not.Cardiovascular and Neurologic Conditions Essay

• Dysrhythmias – ‘dysrhythmia’ is a term used to describe an abnormality in the normal rhythm of the heart. These are classified into two categories: (1) tachycardias (heart rate >100 beats per minute), and (2) bradycardias (heart rate <60 beats per minute). Dysrhythmias may be due to a variety of causes; however, acute coronary syndromes, such as MI and angina, are common causes.

• Pericarditis – this occurs when the pericardium is inflamed, often due to infection. Pericarditis can lead to a range of significant complications, including MI and cardiac arrest. Patients with pericarditis experience a range of non-specific symptoms of infection, dyspnoea and severe chest pain, and dysrhythmias may also be evident.

• Aortic aneurysm – an aneurysm is a dilated area of a blood vessel. Often, aneurysms occur in the aorta which carries oxygenated blood from the lungs / heart to the rest of the body. Aneurysms may occur anywhere along the aorta, and if they rupture (or dissect) massive haemorrhage and rapid deterioration may result.

• Hypertensive crisis – a hypertensive crisis occurs when a patient’s blood pressure is so high that there is a risk of acute end-organ damage. It is often due to dysfunction in the endocrine and / or renal systems. The close monitoring of patients is important so that complications can be rapidly identified and managed.

Neurological emergencies

In addition to traumatic injury, neurologic emergencies may also originate from physiological and medical causes. These can result in rapid disability and death; therefore, it is essential for nurses working in emergency care settings to be able to assess and manage these conditions.Cardiovascular and Neurologic Conditions Essay

During assessment, a nurse may identify one or more of a variety of medical conditions related to the neurologic system. The most common conditions, and their management in the emergency care setting, are described following:

• Headache, including migraine – headaches are one of the most common neurological conditions seen in emergency care settings in the UK. People typically present to emergency care settings with migraines, severe headaches. Migraines may be classified as: (1) vascular, caused by acute cerebral vasodilation, or (2) muscular, due to skeletal muscle contractions in the head or neck. There are a variety of ‘triggers’ for migraines – however they may also occur spontaneously. Headaches are a common symptom of other acute neurological illnesses, and a patient should be investigated for other underlying causes.

• Seizures – a seizure is caused by abnormal, excessive electrical activity in the brain. Seizures may have a variety of causes, including physiological disorders and conditions of the central nervous system. Most seizures are self-limiting, and do not usually require emergency intervention. If the cause of the seizure is undetermined, further investigations must take place when the patient is stable.

• Stroke – the term ‘stroke’ is used to describe the loss of neurological functioning resulting from an acute disruption of blood flow to, and hypoxia in, a section of the brain. Strokes may be classified as: (1) ischaemic, when a vessel in the brain becomes occluded (often by a blood clot or atherosclerotic plaque), or (2) haemorrhagic, when a vessel in the brain ruptures and bleeds. In both types of strokes, patients will present with unilateral weakness or paralysis, difficulty with speech / gait / coordination, a severe headache, altered vision, sensory impairments and / or a changed mental status.Cardiovascular and Neurologic Conditions Essay

Despite the importance of waiting for a differential diagnosis, it is important to highlight that strokes must be treated rapidly. If a stroke patient presents late, supportive therapy only may be used.

• Meningitis – this is the inflammation of the meninges caused by a pathogen. Patients with meningitis usually present with the signs of acute infection – including fever, headache, photophobia, lethargy and nausea / vomiting – and they may also have seizures. Patients will sometimes, but not always, have a characteristic petechial rash. Meningitis is diagnosed conclusively using a lumbar puncture. Regular neurological assessment is essential in identifying patient deterioration.

Conclusion

This chapter has introduced the knowledge and skills required to accurately and rapidly assess, and effectively manage, a variety of respiratory, cardiovascular and neurologic conditions in the emergency care setting. It has also described the most common emergency presentations of conditions related to the respiratory, cardiovascular and neurologic systems.

Cardiovascular disease is a debilitating disease that is wide spread throughout the United States. This disease has been identified by Healthy People as one of their 2020 topics and objectives to focus on for decreasing and preventing further cardiovascular events in the United States. Through appropriate and recommended diet and exercise regimens we have the ability to decrease the occurrence in our future generations to come.Cardiovascular and Neurologic Conditions Essay

Controlling Cardiovascular Disease through Diet and Exercise

Cardiovascular disease is a national epidemic seen throughout the United States. Health care costs are soaring at an all-time high. According to Healthy People 2020 cardiovascular disease, such as stroke and heart disease, is among the most widespread and costly health problems currently seen in the US today (U.S. Department of Health and Human Services, 2012). Health care costs are reported to account for more than $500 billion per year alone (U.S. Department of Health and Human Services, 2012). These cardiovascular disease related issues account for the leading causes of death in the US; at the same time they are also the most preventable.

Cardiovascular health has become a major issue in the United States, even though there are possible ways to prevent and decrease chance of occurring. By improving your cardiovascular health through such things as diet and exercise, you will be able to improve your overall health and quality of life. One must utilize certain interventions to decrease possible risk factors that may increase your chance of having a stroke or heart attack. There are three main categories of interventions, those being: prevention, early detection and treatment.

Prevention is the key to living a healthier and longer life. Prevention starts with educating the public regarding what cardiovascular disease is, possible risk factors, and ways to prevent the occurrence from happening. By starting to educate at a young age regarding eating a healthy diet and maintaining an appropriate exercise regimen, we will be able to decrease the chance of developing cardiovascular disease and increasing one’s health and lifespan (U.S. Department of Health and Human Services, 2012).

Early detection should be initiated at an early age. One should assess his or hers primary and secondary risks factors for developing cardiovascular disease. Based on possible risk factors one may be able to determine if he or she is at an increased risk for development. Early detection includes checking one’s blood pressure as recommended, regular doctor check-ups, and lifestyle assessment. If detected early and controlled it is possible to decrease the risk of further development and complications.Cardiovascular and Neurologic Conditions Essay

Treatments can vary depending on severity and degree of risk factor. For example if one is diagnosed with diabetes, this can sometimes be controlled through diet and exercise versus a prescribed medication regimen. Anticoagulation therapy may also be a treatment for stroke and heart attacks, with appropriate aspirin dosing one may prevent such events. Smoking is a leading cause of both strokes and heart attacks; one should practice smoking cessation or seek additional assistance for quitting, there are many programs available to fit every lifestyle. In advanced cases one may need surgical intervention and procedures to correct, restore and prevent further damage.

First off, what is a stroke? A stroke is when a blood clot travels to the brain blocking an artery or vessel, this cutting of supply of blood flow to an area, essential causing brain cells to die, and brain damage to occur. When this process occurs in an area of the brain, that area will be unable to function properly (National Stroke Association, 2013). Depending on where in the brain and how big of an area is affected, determines what abilities are affected. Some abilities that may be affected include speech, personality, gait, muscle tone, memory, vision and much more. Statistics show that up to 80 percent of strokes are preventable and 2/3 of survivors will have some form of disability noted (National Stroke Association, 2013). Cardiovascular and Neurologic Conditions Essay

Next what is heart disease and how does it affect one’s life. The most prevalent type of heart disease observed in the United States is coronary artery disease (Center for Disease Control and Prevention, 2012). Coronary artery disease occurs when plaque builds up in one’s arteries that supply the heart blood. Build up can eventually decrease or block the blood supply to the heart, and in some cases break off and clot a coronary artery causing a heart attack or even travel to the brain causing a stroke (Center for Disease Control and Prevention, 2012). High levels of plaque buildup increases one’s risk of a heart attack, heart failure and angina (Center for Disease Control and Prevention, 2012). Heart disease is a very debilitating and prevalent disease seen within the western lifestyle.

In many instances the population is aware of their possible risk factors, but fails to intervene and control as necessary. There are several risk factors that one may modify and control to decrease such events from occurring. At the same time one should know that there are risk factors one may possess that are not modifiable and play significant roles in health status. Leading causes that are easily modified include controlling ones blood pressure, cholesterol, diabetes, weight, activity level and refraining for smoking (U.S. Department of Health and Human Services, 2012). By educating the population on these easily modifiable changes they will be able to prevent long-term damages that can occur when not properly maintained.Cardiovascular and Neurologic Conditions Essay

Cardiovascular disease can be affected by many aspects of one make up. Things such as one’s age, gender and race are non-modifiable and can carry an increased risk for occurrence. Possible factors that may influence one’s health status and also may be unable to be modified are things such as access to healthy foods, access to quality health care, community resources and educational opportunities (U.S. Department of Health and Human Services, 2012). .

Blood pressure and cholesterol are the top two major contributors to cardiovascular disease. It is reported that every one in three adults have high blood pressure; however it is untreated blood pressure that is a major risk factor. Approximately half of the population with blood pressure issues does not have it under control (U.S. Department of Health and Human Services, 2012). Healthy People 2020 suggest that one should have blood pressure screened starting at the age of 18, and then every two years there forth (U.S. Department of Health and Human Services, 2012).

The best way to decrease the number of cardiovascular disease and solve this epidemic is through a healthy diet and exercise regimen. Depending on association and one’s risk factors, there may be several different types of recommendation and intervention necessary. Diet and exercise are the most suggested and effective interventions for prevention throughout one’s lifespan.Cardiovascular and Neurologic Conditions Essay

Exercise is great for many things, from decreasing weight, to improving self-esteem. In this case it helps decrease the amount of excess weight to decrease the amount of strain that is put onto the circulatory system. It is said that one should maintain a good exercise regimen throughout one’s life. The recommended amount of exercise one should get is five days a week, approximately 30 minutes per day (National Stroke Association, 2013). Ideally one should participate in aerobic and strength-training exercises. Exercise doesn’t have to be boring, it can be considered taking a bike ride, play a sport, briskly walking your dog, taking a walk through the park, the main idea is to maintain an active pace for at least thirty minutes. By decreasing your weight you can also decrease your chances of developing hypertension, high cholesterol, and diabetes, which all plays a major role in strokes and heart attacks (U.S. Department of Health and Human Services, 2012). Physical activity may be influenced by one’s surroundings. The amount of greenness in one’s surroundings can potentially have an effect on coronary heart disease and stroke. It’s shown that a greater area of surrounding greenness promotes one’s physical activity due to the promotion of outside activities such as community walking, biking areas and sports (Pereira, et. al., 2012).Cardiovascular and Neurologic Conditions Essay

Diet can play a major role in one’s health. A healthy diet includes appropriate servings of fruits, vegetables, fish, soy, whole grains, lean meats, eggs, and dairy per daily recommendations. It has been shown in studies that consuming fruits and vegetables can reduce your risk of stroke. One should consume at least three to five servings of fruits and vegetables per day it is suggested (Sherzai, et. al., 2012). A vegetarian diet have been shown and linked to additionally reducing one’s risk of hypertension, type II diabetes, and heart disease. Simply one should consume recommended amounts of fruits and vegetables from an early age on. It is shown that increased amounts of sodium intake can additionally contribute to high blood pressure, still yet we as Americans exceed the recommended daily intake (U.S. Department of Health and Human Services, 2012). Increased levels of salt are generally seen in the restaurant and fast food industries, by decreasing the amount of food consumed outside the home one may have the ability to decrease one’s sodium intake. Decreasing one’s sugar consumption may additionally reduce CVD, especially fructose consumption (Thornley, et. al., 2012). The average recommended sugar intake is no more than six teaspoons per day for women, and nine per day for men (Thornley, et. al., 2012).

Hospitals and nurses can have a huge impact on prevention, identification and prevention of cardiovascular disease. As a nurse one may encourage lifestyle goals that may improve one’s prevention of heart disease. It is shown that adequate physical exercise, healthy weight, blood pressure control, diabetes screening, diabetes control, and anticoagulation therapy are favored to reduce risk (Suri, et. al., 2010). It was shown that within 12 months of lifestyle modifications the majority of patients had seven out of nine risk factors for CVD under control (Suri, et. al., 2010).Cardiovascular and Neurologic Conditions Essay

Controlling one’s risk factors for heart disease and stroke prevention remains a challenge. Modification of life style to reduce the chance of cardiovascular disease needs to be initiated at a young age. Addressing these risk factors early will help prevent possible complications. By educating the public about the effects of poor cardiovascular health and interventions to help prevent it from occurring, we will be able to reduce the number of deaths per year related to this life altering disease.

Reference Page

Center for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. (2012). Heart disease . Retrieved from website: http://www.cdc.gov/heartdisease/

Hayman, L. L., Helden, L., Chyun, D. A., & Braun, L. T. (2011). A life course approach to cardiovascular disease prevention. European Journal Of Cardiovascular Nursing, 10S20-31. doi:http://ezproxy.marshall.edu:2948/10.1016/S1474-5151(11)00113-7 http://ezproxy.marshall.edu:2472/login.aspx?direct=true&db=cin20&AN=2011214745&site=ehost-live. Cardiovascular and Neurologic Conditions Essay

Kajantle, E., Raikkonen, K., Henriksson, M., Leskinen, J., Forsen, T., Heinonen, K., Pesonen, A., & Osmond, C. (2012). Stroke is predicted by low visuospatial in relation to other intellectual abilities and coronary heart disease by low general intelligence. PLos One,7(11), 1-8. Retrieved from www.plosone.org

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National Stroke Association. (2013). What is stroke?. Retrieved from http://www.stroke.org/site/PageServer?pagename=stroke

Pereira, G., Foster, S., Martin, K., Christian, H., Boruff, B. J., Knuiman, M., & Giles-Corti, B. (2012). The association between neighborhood greenness and cardiovascular disease: an observational study. BMC Public Health, 12(1), 466-474. doi:10.1186/1471-2458-12-466 http://ezproxy.marshall.edu:2472/login.aspx?direct=true&db=aph&AN=79974344&site=ehost-live

Sherzai, A., Heim, L., Boothby, C., & Sherzai, A. (2012). Stroke, food groups, and dietary patterns: a systematic review. Nutrition Reviews,70(8), 423-435. doi:10.1111/j.1753-4887.2012.00490.x. http://ezproxy.marshall.edu:2472/login.aspx?direct=true&db=aph&AN=78111037&site=ehost-live

Suri, A., Tincey, S., & Gupta, S. (2010). Cardiovascular disease. Practice Nurse, 40(9), 44-49. http://ezproxy.marshall.edu:2472/login.aspx?direct=true&db=aph&AN=57086565&site=ehost-live

Thornley, S. S., Tayler, R. R., & Sikaris, K. K. (2012). Sugar restriction: the evidence for a drug-free intervention to reduce cardiovascular disease risk. Internal Medicine Journal, 46-58. doi:10.1111/j.1445-5994.2012.02902.x http://ezproxy.marshall.edu:2472/login.aspx?direct=true&db=aph&AN=82180015&site=ehost-live

U.S. Department of Health and Human Services. (2012). Healthy people 2020: Heart disease and stroke. Retrieved from website: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=21. Cardiovascular and Neurologic Conditions Essay