Nursing And Diabetes Essay Example for Free

Nursing And Diabetes Essay Patients with diabetes need to understand what diabetes is. Patients who understand what diabetes is and the complicated process associated with the disease are more likely to comply with the prescribed regimen. Diabetes Mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate (Davis, 2001). Diabetes is a chronic progressive disease that requires lifestyle changes, especially in the areas of nutrition and physical activity. The overall goal of medical and nutritional therapy is to assist persons with diabetes in making self-directed behavioral changes that will improve their overall health (Franz, 2012). Blood glucose monitoring and goals of blood glucose monitoring Testing blood glucose levels pre-meal and post-meal can help the patient with diabetes make better food choices, based on how their bodies are responding to specific foods. Patients should be taught specific directions for obtaining an adequate blood sample and what to do with the numbers that they receive. Research has found that patients who have had education on the use of their meters and how to interpret the data are more likely to perform self-blood glucose monitoring on a regular basis (Franz, 2012). There are many different glucose monitors available for patients. The patient needs to have a device that is easy for them to use and convenient. A patient’s visual acuity and dexterity skills should be assessed prior to selecting a blood glucose monitoring device. A device is usually selected to meet the patient’s needs in collaboration with a diabetic educator at a health care facility. The patient needs to be reminded to record the blood glucose values on a log sheet with the date and time and any associated signs and symptoms that he/she is experiencing at the time the specimen was obtained. This log should be shared with his/her primary care practitioner. A discussion of glycosylated hemoglobin (HbA1c) should include the reasons for doing the test, how it is performed and how the health care practitioner will interpret the data. These laboratory tests are ordered on a routine basis along with other laboratory tests that are being monitored for the patient. A simple method to describe the HbA1c is to tell the patient that the test measures the amount of sugar that attaches to the protein in the red blood cell. The test shows the average blood sugar during the last three months. The higher the blood sugar the higher the HbA1c. The high blood sugar over a long period of time causes damage to the large and small blood vessels therefore increasing the risk of complications from diabetes. Medications and Insulin The patient with diabetes needs to be reminded that the addition of medications to help manage his/her diabetes is not because they are failing at diet management. Many patients with diabetes become depressed or despondent when they have to begin taking oral hyperglycemic medications and/or insulin. The teaching session should include a review of the different types of oral diabetic agents. A review of the different types of insulins and how to mix insulins should also be discussed. Teach the patient about self-administration of insulin or oral agents as prescribed, and the importance of taking medications exactly as prescribed, in the appropriate dose (Davis, 2001). Patients should be provided with a list of signs and symptoms of hypoglycemia and hyperglycemia and actions to take in each situation. Complications from Diabetes The teaching regarding the complications encountered from diabetes should stress the effect of blood glucose control on long-term health (McGovern, 2002). The patient should be taught how to manage their diabetes when he/she has a minor illness, such as a cold, flu or gastrointestinal virus. The patient should also be taught how to watch for diabetic effects on the cardiovascular system, such as cerebrovascular incidents/stroke, coronary artery disease, and peripheral vascular disease. Patients should be taught how to be alert for signs of urinary tract, respiratory tract infections and signs of renal disease. Assessment for signs of diabetic neuropathy should also be included in the teaching plan. Diabetes is the leading cause of death by disease in the United States, it also is a contributing factor in about 50% of myocardial infarctions and about 75% of strokes as well as renal failure and peripheral vascular disease. Diabetes is also the leading cause of new blindness (McGovern, 2002). Patients with diabetes should also receive education on the importance of smoking cessation, cholesterol and lipid management, blood pressure monitoring and management and management of other disease processes. Skin and Foot Care Teach the patient to care for his feet by washing them daily, drying them carefully particularly between the toes, and inspecting for corns, calluses, redness, swelling, bruises, blisters, and breaks in the skin. The patient should be encouraged to report any changes to his/her health care provider as soon as possible. Advise the patient to wear non-constricting shoes and to avoid walking barefoot. The patient may use over-the-counter athlete’s foot remedies to cure foot fungal infections and should be encouraged to call their health care provider if the athlete’s foot doesn’t improve (McGovern, 2002). The patient should be reminded that he/she needs to treat all injuries, cuts and blisters particularly on the legs or feet carefully. Patients should be aware that foot problems are a common problem for patients with diabetes. Informing them of what to look for is an important teaching concern. The signs and symptoms of foot problems to emphasize are: feet that are cold, blue or black in color, feet that are warm and red in color, foot swelling, foot pain when resting or with activity, weak pulses in the feet, not feeling pain although there is a cut or sore on the foot, shiny smooth skin on the feet and lower legs Exercise and Diabetes A moderate weight loss of ten to twenty pounds has been known to improve hyperglycemia, dyslipidemia, and hypertension. The target goal for body weight for patients with diabetes is based on a reasonable or healthy body weight. â€Å"Reasonable body weight is the weight an individual and health care professional acknowledge as achievable and maintainable, both short-term and long-term (Franz, 2012, p.8).† More emphasis is now placed on waist circumference, rather than on actual weight. A waist circumference greater than 40 inches in men and greater than 35 inches in women indicates a risk for metabolic disease. This is now part of what is referred to as metabolic syndrome. Reducing abdominal fat improves insulin sensitivity as well as lipid profiles. The benefits from exercise result from regular, long term, and aerobic exercise. Exercise used to increase muscle strength is an important means of preserving and increasing muscular strength and endurance and is useful in helping to prevent falls and increase mobility among the elderly (Franz, 2012). Regular exercise can improve the functioning of the cardiovascular system, improve strength and flexibility, improve lipid levels, improve glycemic control, help decrease weight, and improve quality of life and self-esteem. Exercise increases the cellular glucose uptake by increasing the number of cell receptors. The following points should be considered in educating patients regarding beginning an exercise program. Exercise program must be individualized and built up slowly. Insulin is more rapidly absorbed when injected into a limb that is exercised, therefore can result in hypoglycemia (Ferri, 1999). Patients need to be informed that exercise of a high intensity can also cause blood glucose levels to be higher after exercise than before, even though blood glucose levels are in the normal range before beginning exercise. This hyperglycemia can also extend into the post-exercise state and is mediated by the counter-regulatory hormones (Franz, 2012, p. 62). The exercise program should include a five to ten minute warm-up and cool-down session. The warm-up increases core body temperature and prevents muscle injury and the cool-down session prevents blood pooling in the extremities and facilitates removal of metabolic by-products. Research studies show there are similar cardiorespiratory benefits that occur when activity is done in shorter sessions, (approximately 10 minutes) accumulated throughout the day than in activity sessions of prolonged sessions (greater than 30 minutes) (Franz, 2012). This is an important factor to emphasize with patients who don’t think they have the time and energy for exercise. Diet and Diabetes The American Diabetes Association (ADA) has established nutritional guidelines for patients with diabetes. Their focus is on achieving optimal metabolic outcomes related to glycemia, lipid profiles, and blood pressure levels. Patients with diabetes need to maintain a healthy diet consisting of multiple servings of fruits, vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry (Franz, 2012). The exchange diet of the ADA includes protein, bread, fruit, milk, and low and intermediate carbohydrate vegetables (Ferri, 1999). The food/meal plan is based on the individual’s appetite, preferred foods, and usual schedule of food intake and activities, and cultural preferences. Determination of caloric needs varies considerably among individuals, and is based on present weight and current level of energy. Required calories are about 40 kcal/kg or 20 kcal/lb per day for adults with normal activity patterns (Davis, 2001). Emphasis should also be placed on maintaining a consistent day-to-day carbohydrate intake at meals and snacks. It is the carbohydrates that have the greatest impact on glycemia. â€Å"A number of factors influence glycemic responses to foods, including the amount of carbohydrate, nature of the monosaccharide components, nature of the starch, cooking and food processing, and other food components (Franz, 2012, p.13).† Maintaining a food diary can help identify areas of weaknesses and how to prepare better menu plans. Recommendations for fiber intake are the same for patients with diabetes as for the general population. It is recommended that they increase the amount of fiber to approximately 50 grams per day in their diet. Insoluble and soluble globular fiber delay glucose absorption and attenuate the postprandial serum glucose peak, they also help to lower the elevated triglyceride levels often present in uncontrolled diabetes (Ferri, 1999). The discussion of diet management should also include a discussion of alcohol intake. Precautions regarding the use of alcohol that apply to the general public also apply to people with diabetes. Abstaining from alcohol should be advised for people with a history of alcohol abuse, during pregnancy, and for people with other medical conditions such as pancreatitis, advanced neuropathy, and elevated triglycerides. The effects of alcohol on blood glucose levels is dependent on the amount of alcohol ingested as well as the relationship to food intake. Because alcohol cannot be used as a source of glucose, hypoglycemia can result when alcohol is ingested without food. The hypoglycemia can persist from eight to twelve hours after the last drink of alcohol. When alcohol is ingested in moderation and with food, blood glucose levels are not affected by the ingestion of moderate amounts of alcohol. If the patient plans to consume alcoholic beverages they are to be included in the meal plan. The patient should be reminded that no food should be omitted because of the possibility of alcohol induced hypoglycemia (Franz, 2012). Coping with Diabetes The patient needs to understand that the diagnosis of diabetes mellitus as with any chronic illness can be unexpected and potentially devastating. Grief is the most common reaction of an individual diagnosed with diabetes. Resolution of the grief is dependent on variables such as education, economics, geography, and religious and cultural factors. The support of family and friends affects the long-term acceptance of the disease progression. Patients need to be aware that depression is common with chronic diseases such as diabetes. The depression should be recognized and treated as soon as possible since depression can affect glycemic control and complicate the management of the diabetes (Buttaro, 2008). The patient needs to understand that diabetes is a lifelong disease process that requires a lifetime commitment and lifestyle changes. The patient should be educated about empowerment – having the resources and knowing how and when to use them. The skills of empowerment that help the patient reflect on life satisfaction in the following areas: physical, mental, spiritual, family related, social, work related, financial, personal. The patient should be encouraged to establish goals which emphasize at least two of these areas in which he/she has control. In the session of coping with diabetes the patient should be assisted to develop better problem solving skills, which are necessary to manage a life-long disease such as diabetes. Coping with diabetes should also include stress management concepts. Stress management concepts should include: a definition of stress, the body’s reaction to stress, the effects of stress on diabetes management, identifying stressors, identifying methods of coping, relaxation exercises and identifying support systems to tap into. Management of the disease process should include eliminating or minimizing other cardiovascular risk factors for example blood pressure control, lipid control, and smoking cessation. Patients with diabetes should also be instructed on what to do when they become sick with a cold, flu, gastrointestinal virus, or other minor illness. They need to be aware that these minor illnesses can affect their diabetes and blood glucose levels (McGovern, 2002). Instruction on what to do when they become ill and the importance of continuing to take their diabetes medications and/or insulin and other general care should be discussed. Some basic guidelines for management during an illness or sick-day include maintain adequate hydration because of the risk of dehydration from decreased fluid intake, polyuria, vomiting, diarrhea, and evaporative losses from fever. Patient should be instructed to drink at least eight ounces of calorie free liquids every hour while they are awake. The beverages should be caffeine-free, since caffeine acts as a diuretic and can actually increase the chances of hypovolemia. If the patient is unable to tolerate fluids by mouth, antiemetic suppositories or intravenous fluids may be required. Vomiting that is persistent and intractable may require emergency room care. The patient should be encouraged to perform blood glucose monitoring more frequently while he/she is ill and to initiate urine ketone monitoring with urine dipsticks, during the illness (Franz, 2012). The patient should be instructed to continue taking his/her insulin and/or oral antidiabetic agents while ill and even when unable to eat. The omission of insulin is a common cause of ketosis and can result in a serious condition called diabetic ketoacidosis. The patient should be given a list of foods that contain fast acting carbohydrates that they can consume when they experience signs and symptoms of hypoglycemia. Patients should be encouraged to seek regular ophthalmologic examinations to detect for diabetic retinopathy. Regular dental examinations should also be encouraged to evaluate to potential areas that can become infected and possible oral lesions. Summary The teaching program for the patients with diabetes is designed to be held for six sessions. However, the sessions can be lengthened or shortened to meet the needs of the intended audience. These two to three hour sessions allow the patient to absorb the material that is being taught and to be able to ask questions. The learning needs are focused on managing their glucose levels and preventing complications of diabetes. The patient needs to be educated on the multiple disease processes associated with diabetes and the factors affecting each of these areas. The patient also needs to have the knowledge of how to manage their diabetes when they are ill and warning signs that they are hypo/hyperglycemic. Diabetic patients should be advised to contact their health care provider any time they are unsure what to do or have questions on how to manage their disease. There are many teaching handouts and pamphlets that are available free of charge from the various agencies. These handouts are available on a wide variety of subjects that can be used with the teaching plan. The evaluation criteria for the teaching plan would include an evaluation tool in which the patients could complete anonymously at the end of the program. References Buttaro, T.M., Trybulski, J., Bailey, P.P., Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice, 3rd. Edition. Philadelphia, PA: Mosby, Inc. NO Davis, A. (2001). Adult Nurse Practitioner: Certification Review. Philadelphia, PA; Mosby, Inc. Ferri, F. (2012). Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby, Inc. NO Franz, M. (Ed.) (2001). Diabetes Management Therapies: A Core Curriculum for Diabetes Education. 4th Edition. Chicago, IL: American Association of Diabetes Educators. Franz, M. (2012). American Diabetes Association Guide to Nutrition Therapy for Diabetes, 2nd Edition. Alexandria, VA: American Diabetes Association. Herfindal, E. and Gourley D. (2000). Textbook of Therapeutics: Drug and Disease Management. Seventh Edition. Philadelphia, PA: Lippincott Williams and Wilkins. NO McGovern, K., Devlin, M., Lange, E., and Mann, N. (Eds.) (2002). Disease Management for Nurse Practitioners. Springhouse, PA: Springhouse Corporation.

Romeo and Juliet Essay -- Literary Analysis, Shakespeare

Physical separation is a powerful obstacle that is sometimes faced by those bound to each other in love. It brings about intense emotional pain and can hinder any relationship with which true love is at its core. Shakespeare’s Sonnet 56 involved two lovers that experienced physical separation as a stumbling block in their kinship. The â€Å"sad interim† with which the lovers found themselves suffering caused the intensity of their love to vanish. With their love fading quickly, the two desired for â€Å"sweet love† to â€Å"renew thy force.† They wanted their love for each other to be â€Å"blunter be than appetite, / Which but today by feeding is allayed, / Tomorrow sharpened in his former might.† They wished for a love like hunger, constantly returning and needing to be quenched. However, due to their separation, the people’s â€Å"spirit of love† had become â€Å"a perpetual dullness.† The â€Å"hungry eyes† of their love would â€Å"wink with fullness† and had lost its potency and strength. In order to repair the love that had waned, the lovers longed to â€Å"Come daily to the banks† of the ocean so that the â€Å"Return of love† could come to their relationship, and they desired â€Å"this sad interim† to be â€Å"winter, which being full of care / Makes summer’s welcome thrice more wish’d.† Sonnet 56 was a sad story in which separation caused two people’s love to become dull and boring. The obstacle of separation was also evident in the relationship between Hero and Claudio found in the play, Much Ado About Nothing. At the beginning of the play, Don Pedro and some of his men returned to Messina after battling in war. One of the men that Don Pedro brought with him was young Claudio. Claudio was highly respected in the eyes of Don Pedro and had exceptional war performan... ...(RJ 3. 5. 197). Juliet was so disgusted with the thought of marrying Paris that she would rather â€Å"make the bridal bed / In that dim monument where Tybalt lies† (RJ 3. 5. 212-213). Out of desperation to prevent the wedding, Juliet went â€Å"to the Friar to know his remedy† (RJ 3. 5. 254). She told that Friar that she â€Å"long[s] to die / If what thou speak’st speak not of remedy† (RJ 3. 5. 67-68). The Friar provided Juliet with a poison that would cause â€Å"The roses in [her] lips and cheeks fade / To paly ashes, [her] eyes’ windows fall / Like when he shuts up the day of life† (RJ 4. 1. 101-103). Though Paris was taken by Juliet, Juliet had no desire to marry Paris. Their love was completely one sided. Paris desired the love of Juliet but Juliet did not grant the love in return. The obstacle of non-mutual love will prevent any relationship from being successful.

National Strategy for Combating Terrorism Essay

In the recent years, global terrorism has come into picture as a serious problem that threatens the world peace. The world community has expressed deep concern over the menace of terrorism in different parts of the world. Terrorism has struck countries like the United States, India and countries in Middle East and other parts of Asia. The terrorist attack on September 11, 2001 forced the United States to take a tough posture on this issue. The George Bush administration formulated a national strategy for combating terrorism, known as the Bush Doctrine. However, the war on Afghanistan and Iraq also revived the debate over the principles of the Just War Doctrine that exists for centuries. These two doctrines are contrasting in nature. A large number of people believe that the Bush Doctrine violates the basic principles of Just War. Just War Doctrine Just War always distinguishes between justifiable and unjustifiable use of force. The main objective of Just War is to restrain the use of arms and use them only when the peace and justice are in danger. A war always causes widespread destruction. It results in the killing of innocent civilians and creates economic and social turbulence. Although the war ends within a few days and or months, the survivors feel the impact for the years to come. People from different sections of the society always questioned the use of violence to preserve peace. Although killing is morally not justified, the inevitable war between states often leads to mass killing. Just War Doctrine aims at the protection of unarmed civilians and the need for necessary measures to minimize deaths. Just War is a theory practiced by the Catholic Church. The Catechism’s teachings on Just War forbid the intentional destruction of human life. It states that all the citizens and governments must work for peace. However, it allows a country to go to war for its self-defense if all peace efforts have failed. Just War theory believes in the principle of legitimate self-defense in the form of war. However, the threat must be real and grave and there should be no alternative to avoid war . It completely denounces initiating armed conflict without any provocation. The main principles of Just War are: ? Before going into war, it is necessary to explore all non-violent options to resolve the conflict. ? A legitimate authority must endorse the use of violent force by using discretionary power. ? A Just War fought against injustice with right intentions, is always justifiable. ? It prohibits States from using unnecessary use of force. Peace is the ultimate goal of a Just War. ? Just War allows use of force only against the armed combatants. It requires all States to take necessary steps to avoid civilian casualties . Just War makes a clear distinction between the use of arms against sovereign nations and the political compulsion of going to war. Nobody can justify the mass killings. However, the circumstances often warrant such an action. A Just War is defensive and cannot be aggressive under any circumstances. The main concern in every war is the loss of lives and property. Civilians always suffer heavily whenever there is a war. Just War Doctrine strongly emphasizes on protecting the lives of innocent civilians. National Strategy for Combating Terrorism (Bush Doctrine) In the wake of the terrorist attack on 9/11, President George Bush led the way to fight against global terrorism. The military doctrine of the United States had been a policy of deterrence for years. George Bush changed it into a policy of striking at the countries that threatens the interests of the United States. Under the Bush Doctrine, the United States adopted the idea of pre-emptive strikes on the suspected countries. The Bush Doctrine is a national strategy for combating terrorism. The new doctrine clearly states that the US would not allow any country to question its military supremacy. It also believes that the US has a bigger role to play in maintaining peace in the world by waging war against the rogue nations and terrorists. It denounced terrorism in strong words and calls for non-compromise on its national interests . The need of a comprehensive strategy to combat terrorism has become necessary keeping the strong capabilities of the terrorists. By using weapons of mass destruction, terrorists sent a clear signal that they could launch attacks on important installations at their will. The Bush Doctrine identified possible threats in three categories. These potential threats are global terrorist organizations, states that harbor such organizations and rogue states. It defined rogue states as states that oppress their own citizens and squander the national properties for the self-interest of the rulers. Countries that disregard international law and threaten their neighbors are also fall in the same category. In this context, the Bush Doctrine termed Iraq, North Korea and Iran as rogue states. However, the focus was on Iraq. The US policy stated in clear terms that it would not wait and watch until the rogue nations acquire or develop the weapons of mass destructions and use them to destroy the humankind . Preemptive strike is not a substitute for the non-military measures such as financial sanctions and diplomatic offensive to isolate a nation that practices dangerous propaganda. It is just an add-on policy to combat the new threat of invisible war launched by the terrorist groups. The main objective of the Bush Doctrine is not to tolerate the ghastly act of terrorism in any form. Conclusion In the past decades, people from some sections of the society developed new ways of terrorizing people to force the government and administration to meet their demands. Suicidal attacks in the United States, India, Israel and Iraq are the examples of the newly developed way of warfare. There is little option left with the states to tackle terrorism. A full-fledged war against terrorism and countries harboring terrorists has become inevitable. In this context, the Bush Doctrine seems to be an effective option. The leaderships in the world always explored ways for dialogue and discussion to tackle such problems. However, from the recent incidents, it has become clear that bringing the terrorists into negotiating table is almost impossible. They hardly showed any willingness to enter into dialogues. Their intransigent attitude forced the governments to take tough decision in curbing terrorism. Many people question the policy of the Bush Doctrine citing the principles of Just War Doctrine. However, in the recent years the world witnessed deadly acts of terrorism that killed thousands of people and caused loss of public and private property. In such a scenario, war against terrorism becomes completely justifiable. The only concern is about the loss of civilian lives. States going to war must address this concern properly and take necessary steps to avoid this. Bibliography Dolan, Chris J. In War We Trust: The Bush Doctrine and the Pursuit of Just War. Burlington, VT: Ashgate, 2005. Elshtain, Jean Bethke. Just War Against Terror: The Burden of American Power in a Violent World. New York: Basic Books, 2003. Daalder, Ivo H. , James M. Lindsey, & James B. Steinberg. The Bush National Security Strategy: An Evaluation. Washington: Brookings Institution, 2002.

Use Of Technology During High School - 876 Words

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