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Nursing Diagnosis: Decreased Cardiac Output Related to: Impaired cardiac muscle contraction Conditions that compromise blood flow Structural impairment of the heart Difficulty of the heart muscle to pump Increased exertion in workload Alteration in stroke volume Plaque formation High blood viscosity Atherosclerosis Sedentary lifestyle As evidenced by: Increased central venous pressure (CVP) Increased pulmonary artery pressure (PAP) Tachycardia Dysrhythmias Ejection fraction less than 40% Decreased oxygen saturation Presence of abnormal S3, S4 heart sounds upon auscultation Chest pain (angina) Presence of abnormal lung sounds upon auscultation Difficulty breathing (dyspnea) Rapid breathing (tachypnea) Restlessness Fatigue Intolerance in activities Prolonged capillary refill time Significant weight gain Edema Expected outcomes: Patient will manifest blood pressure and pulses within acceptable limits

middle notes are Patchouli and Jasmine

Life is too precious to smoke tobacco and therefore, we must save ourselves from it

However, the entire lining of the gut and urinary system is exposed to the carcinogens in spit tobacco

(56) Thyme Thymus vulgaris F.) (Lamiaceae), native to Mediterranean regions and commonly used as a culinary herb, was reported to be used as an herbal cigarette, (57) and this could be due to the presence of thymol, one of the major constituents of thyme essential oil (representing 1064%)