Nursing in the Community Essay

In this assignment the topics discussed is a nursing problem related to a medical diagnosis taking from an example of a patient dealt with while the nursing student was out on clinical placement. For this assignment the patient has a diagnosis of Type 1 Diabetes Mellitus. Kevin Brophy (pseudonym) is a 9 year old boy that had come into the Paediatric Unit. He is of the Roman Catholic religion. He lives with only his mother and she is educated about his disease of Diabetes. His mother’s sister is a nurse also and knew how to manage his Diabetes and looked after him if his mother was busy. The multidisciplinary team have been treating him for the condition for 4 years. He gets hospitalized often to regulate his blood sugar levels and monitor his insulin intake. The nursing problem associated with his diagnosis is related to his diet and nutritional status and being able to monitor these with caution and ease. The nurse had a form for filling out what had he eaten that day and wha t time this had happened at in the ‘end of bed’ chart which was with his other documentation such as his vital signs and also the fluid balance intake and output chat. There was also a section in this form for documenting what level his blood sugars were and was directed to take record of them after every meal. The nurse then had an idea  of what sort of food he was eating and also a report of his blood sugars which were monitored closely throughout the day. The nurses primary responsibility was to ensure this boy was eating correctly and following the dietary guidelines of a Diabetic patient. The model of assessment/care used to treat Kevin was devised from Roper, Logan and Tierney (1980). The Roper, Logan and Tierney’s’ activity of living (AL) model of nursing consists of twelve activities of living. According to Aggleton & Chalmers (2000 P46), â€Å"Each AL specifies a relatively distinct type of human behaviour related to meeting a particular need.† Information was obtained from a booklet containing facts and advice on Diabetes and Healthy Eating from the Department of Health and Dietetics in Waterford Regional Hospital. This has described diabetes as a condition where the body is unable to control the amount of glucose i.e. sugar in the blood. Everyone’s blood has some glucose in it because your body needs glucose for energy. Normally your body breaks food down into glucose and sends it to the bloodstream. Insulin, a hormone made by the pancreas, helps to get the glucose from the bloodstream into the cells to be used for energy. In people with Type 2 Diabetes, the pancreas is not making enough insulin or is unable to use the insulin properly, or both. In people with Type 1 Diabetes, the pancreas is unable to make insulin full stop. Without insulin in the body, the blood glucose rises (Department of Nutrition and Dietetics, Waterford Regional Hospital 2006). To manage diabetes in paediatrics is primarily challenging and m uch more complicated than dealing with the diagnosis in adults with Diabetes (DH Diabetes Policy Team 2007, Christie et al 2009). Nurses have to educate and facilitate the self management of Diabetes and also introduce skills to gain the best possible control over the patient’s blood sugars i.e. glycaemic control. If these skills are not executed properly then diseases such as micro-vascular e.g. nephropathy or retinopathy or cardiovascular diseases (macro-vascular), which decreases the quality of life and a reduced life span (The Diabetes Control and Complications Study Group,1994). The nurses and patients responsibility is to monitor and control the intake of food and also be educated on what can have a negative or positive effect on the body. This is a major nursing problem associated with the Diabetic patient and  intervention by the nurse is necessary throughout. In doing so, the nurse must follow the Nursing Process in relation to their diet. Assessment Patients diagnosed with type 1 Diabetes are assessed for signs of Diabetic Ketoacidosis, including ketonuria, Kussmaul respirations, orthostatic hypotension, and lethargy. The patient is asked about symptoms of DKA, such as nausea, vomiting, and abdominal pain. Laboratory results are monitored for metabolic acidosis (i.e. decreased pH and decreased bicarbonate level) and for electrolyte imbalance. If the patient exhibits signs and symptoms of DKA, the nursing care first focuses on treatment of these acute complications, as outlined earlier. Once these complications are resolving, nursing care then focuses on long-term management of diabetes. The patient’s emotional status is assessed by observing his or her general demeanour (e.g., withdrawn, anxious) and body language (e.g., avoids eye contact). The patient is asked about major concerns and fears about diabetes; this allows the nurse to assess for any misconceptions or misinformation regarding diabetes. The nurse is also asse ssing the vital signs of the patient such as temperature, respiration, blood pressure etc. and develops a baseline of these results. In this case the patients normal vital signs were as follows : Temperature- 36.4ââ€" ¦, Blood Pressure- 114/70, Respiration rate- 18 breaths per minute. Nursing Diagnosis Based on the assessment data, the main diagnoses the nurse must adhere to are as following: Risk for fluid volume deficit in relation to polyuria and dehydration, imbalanced nutrition related to imbalance of insulin, food, and physical activity. The main ones that are focussed on in this essay are the imbalance of insulin and the patient’s diet. Planning The major goals for the patient may include maintenance of fluid and electrolyte balance, optimal control of blood glucose levels. The nurse would plan suitable charts and regimes for the patient to follow. Intake and  output are measured. IV fluids and electrolytes are administered as prescribed, and oral fluid intake is encouraged when it is permitted. Vital signs are monitored hourly for signs of dehydration (tachycardia, orthostatic hypotension) along with assessment of breath sounds, level of consciousness, presence of oedema, and cardiac status. If the patient agrees with the diet plan and increases his fruit and vegetable intake this can highly optimise nutritional health, promote a healthy image and reduce the chances of obesity (Lock et al., 2005). In Diabetes, diet is a chief obstacle in the control of the condition (Watson et. al 1997). The patient’s goals in agreeing with a healthy diet for their Diabetes are as follows: 1) To regulate and sustain lipid levels an d blood glucose back to their normal state. 2) To avoid fluctuations in their blood glucose levels during the day. 3) To manage and control a desirable body weight. 4) To prevent or hinder the growth or advancement of renal, neurological or cardiovascular difficulties (Watson et. al 1997). The nurse should introduce a dietary plan for the patient with the Diabetes. This controls the amount of calories that are needed for each day and the magnitude of these calories to be assigned to carbohydrate, protein and lipids. This is determined by a person’s age, weight, gender, activity and their dietary intake before they discovered the disease. In general, the amount of targeted calories allocated to each food type is in the region of 50-60% carbohydrate, 10-15% protein and under 30% of fat (Rees and Williams,1995). In the diet, the concentrated sugars should be strictly limited e.g. sweets, jam, cake, and should only represent a minute part of a meal to prevent rapid increase in the blood sugar levels. The unrefined carbohydrates such as whole-meal bread, fruit and vegetables, and also fibre-rich f oods, should be consumed as an alternative to the refined carbohydrates as mentioned before. Implementation Meal planning is put into practice, with the control of glucose as the primary goal. The nurse must consider factors before beginning to intervene such as the patient’s lifestyle, cultural background, activity level, and their food preferences. A suitable caloric intake allows the patient to achieve and maintain the desired body weight. The nurse would encourage the  patient to eat complete and wholesome meals including snacks that have been prescribed in the diet that the team has devised for Kevin. The nurse needs to take into consideration of the fluid intake and keeps records of IV and other fluid intake, also record urine output measurements. Hypoglycaemia is the most dreaded acute difficulty in the disease of Diabetes, and can be a major factor in the hindering of the metabolic control in the body. Night-time hypoglycaemia states, more common in the paediatric side of Diabetes, places an immense worry for the child themselves but also the parents, as it more likely to go unnoticed and care for (Nordfeldt S, Ludvigsson J 2005). Hypoglycaemia may occur if the patient skips or delays meals, does not follow the prescribed meal plan, or greatly increases the amount of exercise without modifying food intake and insulin. In addition, hospitalized patients or outpatients who fast in preparation for diagnostic testing are at risk for hypoglycaemia. Juice, milk, or glucose tablets are used for treatment of hypoglycaemia. The patient is encouraged to eat full meals and snacks as prescribed in the meal plan. If hypoglycaemia is a recurring problem, the whole dietary plan must be looked over and improved if needed. The risk of hypoglycaemia with rigorous insulin routines, it is of the utmost importance for the nurse to review with the patient the signs and symptoms, possible causes, and measures for prevention and treatment of hypoglycaemia. The nurse should emphasise to the patient and family the importance of having information on diabetes at home for refer ence. Evaluation After putting this plan into practice, the nurse found that it helped in the treatment and care of Kevin Brophy in managing and controlling his Diabetes. After following the Roper Logan and Tierney model of Nursing it helped understand his Activities of Daily Living and how the patient could work his new dietary plan into these ADL’s and control his blood glucose to prevent hypoglycaemia. Kevin will also be able to be knowledgeable of and carry out duties in a way to control his diabetes mellitus and also maintain adequate fluid volume in the body. He will be able to monitor his blood glucose periodically throughout the day, administer his own insulin, increase his own fluid balance and monitor his urine output. He should demonstrate a participation in activities that include having a proper diet, exercise and  lifestyle (Palandri, M.K. 1993). He also should be wary of and identify community, outpatient resources for obtaining further diabetes education. Conclusion To conclude, Kevin will need continuous assessment and advice on managing and controlling his Diabetes diagnosis. He will need support from his mother and also help from the multidisciplinary team that works with him and his mother in the hospital. In following the Roper Logan and Tierney model he will then be able to manage his ADL’s better and be more understanding with the condition of Diabetes. He will be able to control his dietary intake and follow a routine throughout life to deal with his diagnosis. References Aggleton, P., Chalmers, H. (2000)Nursing Models and Nursing Practice. (2nd edn). London: Macmillan. Lock, K., Pomerleau, J., Causer, L., Altmann, D.R. & McKee, M. (2005) The global burden of disease attributable to low consumption of fruit and vegetables. Bull. World. Health. Organ. 83, 100–8. Nordfeldt S, Ludvigsson J. Fear and other disturbances of severe Hypoglycaemia in Children and Adolescents with Type 1 Diabetes. J. Pediatr. Endocrinol. Metab. 2005; 18: 83–91. Palandri, M.K. and Sorrentino, C.R. (1993). Black and Matassarin – Jacobs, Pocket Companion for Luckmann and Sorensen’s Medical – Surgical Nursing: A Psychophysiologic Approach. 4th Edition. W.B. Saunders. The Diabetes Control and complications Study Group (1994) Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial Research Group. J. Pediatr. 125, 177–188. Waterford Regional Hospital (2006) Department of Nutrition and Dietetics Watson et. al (1997) Clinical Nursing and Related Sciences 5th edn. Bailliere Tindall, 24-28 Oval Road, London NW1 7DX. Patricia Power Sorcha Dineen Miriam Cass 20053881 Patricia Chesser Smyth Nursing in the Community Module Leaders

Drugs and Their Effect on Society Essay

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In the late 1800’s and early 1900’s Chinese’s immigrants brought over opium and created opium dens in much part of the west coast where the drug itself left the user in a euphoric and mind and mood altering state. In the late 1960’s and early 1970’s with the hippie cultural, much part of the society was introduced to drugs like psychedelics which would be considered LSD and other drugs with heavy usage like mushrooms, marijuana and hashish and in other forms of society like the inner cities heroin pelage the communities with how highly addictive and deadly the drug came to be with heavy use. In the late 1970’s and early 1980’s cocaine became the prominent drug in club the atmospheres of disco techs and later became in the form of crack cocaine that pelage major cities around the U. S. with addiction and violence over the drug trade. In the early 1990’s till recent years many perception drugs and meth have been highly addictive and have been a part of the illegal drug trade. The DEA was established in 1973 that was assisted by President Richard Nixon in its creation as a form of a task force with combating drug smuggling and use within the United States of all the drugs deemed illegally additive or dangerous. â€Å"Controlled substances are generally grouped according to both pharmacological and legal criteria into the following seven categories: stimulants, depressants, cannabis, narcotics, hallucinogens, anabolic steroids and inhalants. (Schmalleger, 2012, p. 341) By federal law these categories are deemed illegal from use or distribution; stimulants: cocaine and amphetamines; cannabis: cannabis plants, hashish, hashish oil and marijuana; narcotics: codeine, Dilaudid, heroin, methadone, morphine and opium; hallucinogens: belladonna, LSD, Ectstasy (MDMA), mescaline, MDA and PCP; anabolic steroids: nandrolene, oxandrolene, oxmetholone and stanozolol; inhalants: acetate, amyl nitrite, butyl nitrite, carbon tetrachloride, chloroform, Freon, nitrous oxide and toluene. Trafficking is a form of distribution of illegal drugs through the means of either smuggling which is the illegal shipment of controlled substances across state and national boundaries in many different methods like shipment overland, direct shipments to U. S. ports concealed in containers or packed with legitimate products, flights onto United States commercial airplanes or private aircrafts and airdrops to vessels waiting offshore to smuggle drugs into the U. S. boarders. The DEA follows different routes used by traffickers and one of the methods to track the occurrences is the Heroin Signature Program (HSP) is a Drug Enforcement Administration program that employs special chemical analyses to identify and measure chemical constituents of sample of seized heroin. Border patrols have protected the boarders to ensure that traffickers are disparaged from attempting to smuggle in their products. The supply and demand has kept smugglers in business because as long as there is a need for their product by the users and suppliers; distributors of the drugs will find new and advanced methods of smuggling in drugs. Government agencies have enacted different policies to somehow impact drug abuse like the Pure Food and Drug Act of 1906 which required manufactures to list their ingredients and specifically targeted mood-altering chemicals. The Harrison Act was passed in 1914 which was the first federal anti-drug legislation that required anyone dealing in cocaine, heroin and morphine and other drugs to register with the federal government and pay a tax of $1 per year with the authorized the registration of only those in the medical profession and outlawing the street use and street distribution of these drugs. In 1956 the Narcotic Control Act increased penalties for drug traffickers and made the sale of heroin to anyone under the age of 18 a capital offense. In 1970 the Comprehensive Drug Abuse Prevention and Control Act established five schedules that classified psycho-activity and potential for abuse. In 1988 the Anti-Drug Abuse Act proclaimed the goal for a â€Å"drug-free America by 1995 by increased penalties for drug users and made weapon purchases by drug dealers much more difficult. The goal of drug control acts are to battle illegal drugs from use and distribution by anti-drug legislation and strict enforcement, interdiction, crop control, asset forfeiture and antidrug education and drug treatment. Conclusion Early legislation against drug abuse focused on eradicating the wide spread problem of drugs in numerous of ways like requiring companies to list their ingredients on their products if it may alter the users mood or brain chemistry, taxation on drug companies, making harsher drugs illegal for sale or distribution and harsher sentencing for those whom distribute illegal drugs. Since numerous types of legislation; the focus has been much in fact on punishment and less on rehabilitation which has caused a financial strain on society and has given a stigma upon those involved in the drug trade or an abuser of these substances.

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Indifference curve analysis Essay Example | Topics and Well Written Essays - 1500 words

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The Balanced Scorecard as Performance Managment Tool Essay

The Balanced Scorecard as Performance Managment Tool - Essay Example The research paper will be divided into five chapters. First of all the research will highlight the main issue around which the whole story will travel. This chapter will include the introduction of the whole paper as well as the brief background of the problem. Moreover, chapter will also have a brief discussion about the need and significance of the study and its scope and effects on individuals. The second chapter will discuss the basic concepts and theory of the topic. A detailed literature review will be provided to support the research. In the next chapter, the research strategy and general methodology will be discussed. It will also elaborate the reason of adopting a specific design for the strategy. The 4th chapter will be the most important part of the research, which will show the comparison and analysis of the data collected through various means. It will also provide the recommendations with respect to its findings. The validity of the research is the focal point of the whole effort. It actually explains whether or not you have achieved your task. In other words it deals with the suitability of the methodology to the research. According to Mason , you must ask yourself â€Å"how well matched is the logic of the method to the kinds of research questions you are asking and the kind of social explanation you are intending to develop". The validity of proposed research will be established through different ways e.g. member check, peer analysis, negative analysis, audit-ability, conformability and balance

North Korea Essay Essay Example for Free

North Korea Essay Essay Imagine how life would be like if you lived in North Korea. A country so isolated and cut off from the rest of the world. Even after many decades from the war, North Korea and America have never truly been friends. North Korea holds America responsible for dividing their country into North and South. However there are many similarities and differences between America and North Korea. America is very different from North Korea. While we have a Constitution with a Bill of Rights, amendments and basic freedoms, they must follow whatever their leader says with no exceptions. Even though North Korea has a constitution and amendments, the leader still controls all of the country. American citizens are able to vote for their countries leader unlike North Korea, in which where the son of the leader takes his father’s place with ruling the country. So, only one man rules North Korea and all decisions are made by him. Distinct from North Korea, where people don’t have the due process of law, Americans have the right to try to prove that they are not guilty. North Koreans are brought up to love their leader and aren’t allowed to believe in anything else. For them, their leader is the greatest and he is always right. On the other hand, Americans are allowed to believe in whatever religion they choose is right for them. American citizens are all granted equal protection unlike North Korea where only high-ranking officials are provided with those same basic protections. Also, there is no Internet, and cell phones are banned from the country, which block the people from communicating with the rest of the world. Most Americans are provided with basic needs, but in North Korea, a lot of people (child or adult) go blind because they don’t have those basic needs. Lastly, because hospitals and medical care in North Korea is so bad, many people don’t get the treatment that they desperately need. Thankfully, in the U.S., we have good Medicare and trained doctors who are able to cure people every day. American rights also have many similarities to those of North Korean citizen. Both countries have very strong militaries. We similarly strive to become independent countries. The people in America and North Korea have responsibilities, duties, and limited rights. For example like paying taxes and respecting the leader/president. Even though the strictness of these  three elements may change in each country, people in both countries still have to do these things. Although America is a democratic country and North Korea is a theocracy, they both have a strong government system. North Korea is ruled by Kim Jon Sun, our government has three branches and a president. Citizens of America are required to have a passport to travel to other countries, which is a lot like how North Korean’s are needed to have documentation in order to go to different places in their country. There are certainly more differences than similarities between America and North Korea. Living in North Korea would most definitely not be easy. So many things are available to us in the U.S. that wouldn’t be available to us in North Korea. American citizens have fair rights and can believe in whatever they want. We are able to travel to other countries and live according to our rules. Over looking all of the pros and cons of both countries, America would undeniably be an easier and more unrestricted country to live in.

Associates degree Essay Example for Free

Associates degree Essay Picture this: You’re at the end of your summer before your senior year in high school. All summer, you’ve been working your minimum wage job, completing a project for school, and spending time with your friends and family. Every day is unique. Every day is new. You meet new people, go new places, and make new memories. Suddenly, and all too quickly, summer comes to an abrupt end. Senior year begins and the days go by faster than ever. You were courageous this year; you took â€Å"hard† classes. Well, hard classes means more schoolwork than ever before. More than you were expecting. And don’t forget about your job, three or four days a week after school for five or six hours, and one or both days of the weekend for eight hours. This is harder than you thought. You’re always tired. You’re always behind. You catch up one day, and are behind by the next. If you didn’t have to work, you could probably catch up. However, if you don’t work, you have no money to drive, and definitely no money for college. College is the one word you wish to avoid, but know it is inevitable. Applications are due soon, and you don’t have a clue what you want to do, much less where you want to go. Even if you were sure, there’s still a chance you can’t afford it. Coming from a family of five who lived in a one bedroom apartment when I was born, I am very lucky to be where I am now, and I know this. I have seen firsthand that with hard work and determination, everyone can succeed. I know I have the opportunity to do anything I want, be anyone I want. I could be an architect, a photographer, an engineer, a chemist. Anything. But what do I want to do? Where do I want to go? What type of school would be best for me? Deciding on if college is right for you, and if so, which college you want to attend is a very important decision to make. It will cost you a lot of money, and is not a decision to take lightly. Colleges can be broken down into two basic types, which can then be broken down further. The first of these is two-year colleges. Two-year institutions, sometimes called community or junior colleges, have programs that offer up to an associate degree, Associate of Arts (A. A. ) or Associate of Science (A. S. ), following successful completion of a two-year, full-time program. A few two-year colleges also offer the final two years of an undergraduate program only, awarding the bachelors degree rather than the associate degree. There are two basic types of programs at community and junior colleges, so when you start your search, having your career goals in mind will help in selecting a school. Some programs are strictly academic and are to prepare students to transfer to a bachelors degree program at a four-year school. Others are more applied and provide career training in specific areas (technical college). Though some of the credits offered at this second type of school may be accepted by a four-year institute, this type of school is not designed for students planning to transfer to such an institute. The next basic type of school is a four-year institution (college or university). The college or university, sometimes called an institute when offered programs focus on engineering or other technical courses, award a bachelors degree. The Bachelor of Arts or Bachelor of Science degrees are the most common, but many other bachelor’s programs are offered. Bachelors degrees are typically awarded after successfully completing a four-year, full-time program. Programs in some fields of study or at some institutions can be longer than four years. Some colleges have an affiliation with a specific religious group. If you’re looking at going to a four-year institution, a good place to start your search is a college guide. These guides show you the different types of four-year institutions available to you. Information provided by individual colleges can help influence your decision as well as. Both two-year colleges and four-year universities can be further broken down. One further division is public and private institutes. Generally, two-year community colleges, and state colleges or universities are publicly supported (funded). The state these institutions are located in generally provides the majority of their funding. The cost of private schools is generally higher because they do not receive the same state or federal funding. Colleges and universities with religious affiliations are private schools. Most are Christian (Roman Catholic and Protestant). Most often, you do not need to be a follower of any specific religion to attend a religiously affiliated college and these institutions generally strive to avoid effecting any students religious views. Cost of college can be a very important thing to take into consideration when choosing a college. Tuition costs have been going up at an increasing rate for many years. â€Å"In its most recent survey of college pricing, the College Board reports that a moderate college budget for an in-state public college for the 2011–2012 academic year averaged $21,447. A moderate budget at a private college averaged $42,224. † In the past 30 years, the cost has increased by over 500%, and that cost is expected to continue increasing by around 8% per year (the cost of living has only increased by approximately 250% in that same time period). That’s an additional $1,500 per year for in-state public colleges, and around $3,000 more per year for private colleges! Why, though, has this cost been increasing so drastically? In most other countries in the world, college is either payed for by taxes, or is very affordable. But what makes up this cost? The majority is tuition. Tuition is what colleges charge for the instruction they provide. Tuition is charged either by the semester or quarter depending on the college. Typically, one year of school is made up of classes ranging from early fall to spring (i. e late August through early May). Tuition for in-state residents at a public university is a bargain compared to what out-of-staters pay (often double the tuition of residents). Other costs (which will be covered in the following paragraphs) are generally about the same for residents or non-residents. Tuition at some colleges can also vary by major. Students in the sciences, engineering, computing, premed programs, and the fine arts often pay more. This â€Å"variable tuition† is something to keep in mind if you have a program/major in mind. Student fees are the next major part of the overall cost of college. These include anything from library access and parking, to registration and student government. Colleges usually give a total student fee, although this is generally only broken down into the most significant parts. However, other things that are generally included in these costs are health insurance, use of athletic facilities, ID cards, diplomas and graduation costs, lab supplies, computer access, student activities, and local bus service. Housing, meals, books, and other school supplies make up the majority of the rest of the total cost of college. Many colleges offer on-campus housing that varies greatly in price and comfort. Meal plans may also be purchased. Depending on the college, some plans are included with the cost of housing, while other schools keep the two separate. The plans can vary from as little as 7 meals a week or less to all you can eat, depending on how much you want to pay. Laptops are provided by most colleges, however the price to use these machines is usually quite hefty. While it may be expensive to rent a laptop, most often you will have access to nearly any program, as well as being able to purchase cheaper, student copies of programs to keep permanently. In high school, I was hardly told anything about college. Never was it even suggested that it might be a good idea to research different types of schools. After reading article after article about different types of colleges, and the factors to include in the total cost, I feel like I am finally beginning to understand the different types of colleges and the cost that comes along with them. There is still a lot of research to be done, but at least I am beginning to find my way. Hopefully, if you (the reader) are also thinking about college, and maybe even in a similar situation to me, this has helped you start working towards your final decision.