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Patient With A Long Term Condition Nursing Essay

Share this: Facebook Twitter Reddit LinkedIn WhatsApp This study will focus on the causes and effects of the long term condition type 2 diabetes. How the condition is diagnosed will be explored along with different treatments and the impact treatments may have on the patient. As well as this psychosocial impacts of type 2 diabetes will be explored, in relation to the patient’s family and friends. In agreement with the Nursing and Midwifery Council, (NMC) Code of Professional Conduct (NMC, 2005) concerning safeguarding patients, no actual names or places will be revealed. This is why the named patient will be known as Megan. The patient being described is a seventy year old lady who lives in a flat in the city centre with her husband Ron. Megan has had type 2 diabetes for 15 years, which has been poorly controlled by medication and diet. Megan’s diabetes has now progressively worsened and she has been commenced on a self-managed insulin therapy plan. As well as care from her husband Ron, Megan is also registered with the community nursing team and her local general practitioner and she attends a regular diabetic clinic. Megan has recently suffered a hypoglycaemic attack during a shopping trip, and received treatment in hospital. Megan responded to treatment but was admitted due to a high temperature. Pathophysiology Diabetes Mellitus has two principle classes, type 1 and type 2; approximately 90% of people with diabetes suffer from type 2, (Burden 2003a). Type 1 diabetes is characterised by the destruction of the Beta cells. The islets of Langerhans within the pancreas contain two types of cells, alpha cells and beta cells. Alpha cell secrete glucagon and beta cells secrete insulin. Patients with type 1 diabetes do not have this insulin production often due to the destruction of the beta cells. Type 1 diabetes is therefore treated with insulin. Type 1 diabetes is a catabolic disorder characterised by a lack of insulin, raised blood glucose levels and a breakdown of body fats and proteins. The lack of insulin in the body of type 1 patients means they are prone to the development of Ketoacidosis, (Porth, 2002). Type 2 diabetes usually develops when the body no longer produces adequate insulin or when the body resists insulin action. The resistance to the insulin stimulates further insulin secretion from the beta cells to overcome the demand to maintain a normoglycemic state. Over time the response from the beta cells decline due to exhaustion. Type 2 usually occurs in the over 40’s and is initially diet and exercise controlled, however, due to the decline in insulin production the patient may eventually need insulin therapy. The insulin resistance has been attributed to increased intra-abdominal fat; approximately 80% of type 2 sufferers are overweight. Obese people have an increased resistance to insulin action and an impaited suppression of glucose production, (Porth, 2002). The initial approach to the treatment of type 2 diabetes should take into account the underlying pathophysiology of the disorder and target a reduction in insulin resistance through modification of causative lifestyle habits, along with pharmacologie intervention, (Roman, R et al 2008). The signs and symptoms of diabetes appear more rapidly in type 1; type 2 may go undiagnosed for some time due to the slow onset, (Diabetes UK, 2000). The most common signs and symptoms of the disease are; glucosuria, polydipsia (exsessive thirst), polyuria (passing excessive urine), infections, weight loss, muscle cramps, lethargy, visual disturbances and ketoacidosis may be present, (Burden, 2003a). Hypoglycaemic attacks such as Megans can occur in both type 1 and type 2 diabetes. Hypoglycaemia occurs when the blood glucose levels fall below 3.5mmol/L however symptoms rarely appear until levels drop below 3mmol/L. The three main causes of hypoglycaemia are; excessive insulin, insufficient food and unusual exercise. Symptoms rapidly develop usually taking between 5-15 minutes, (Alexander, Fawcett and Runciman, 2002). Signs and symptoms which accompany hypoglycaemia are sweating, confusion, headache, nausea, rapid pulse and trembling. These are described as being neuroglycopenic, characterised by an impaired cognitive function, unusual or aggressive behaviour, or they can be adrenergic involving the sympathetic and parasympathetic systems, (Burden, 2003b). Nursing process The nursing process is based upon individual nursing. In previous years nurses were allocated tasks, rather than patients to care for. The importance of patient centred care is now recognised and nurses are allocated patients rather than jobs (Roper, Logan and Tierney, 1996). The nursing process has a series of 4 interactive phases . The first phase is accessing which is carried out at the start of treatment but important to remember continued assessment as the treatment or illness may progress. The second phase is planning, the aims are to prevent previously identified problems progressing to actual problems. This improves the problems that cannot be solved and prevents a treated problem from reoccurring. To achieve these objectives goals need to be set in collaboration with the patient and their family. In the case of the patient being incapacitated the family or next of kin would usually make these decisions. These goals should be built into a nursing care plan. The third phase is implementing the care aims. Nursing interventions are carried out as part of this; it is helpful and necessary for nurses to make clear the reasons and decisions that lay behind these interventions. The fourth phase is evaluation, which is similar to assessment. The idea is to ascertain whether or not the goals have been achieved or are being achieved. This provides footing for further assessment and planning, for example, if the goal has not been achieved the reason why is explored (Roper et al, 1996). Nursing Framework The Roper, Logan and Tierney model of nursing is called the Activities of Living in which there are 12 activities, (Appendix 1). The Activities of living model is very diverse and it is debated it is the most common used by british nurses, (Gray, 2002). Models have been criticised for not accommodating all patient situations and being too rigid. Walsh (1998) states that “Models are not set in tablets of stone, but rather are loose frameworks of ideas whose aim is to facilitate care, not to get in the way”, (Walsh, 1998). Walsh (1998) emphasises that readers should question any lack of psychological and social dimensions of the Roper, Logan and Tierney model and suggests that is a simplistic approach to assessment (Walsh, 1998). However Roper, Logan and Tierney break down the factors influencing the activities of living into five categories: biological, psychological, sociocultural, environmental and politicoeconomic, (Roper et al, 1996). Maintaining a Safe Environment Megan is an independent lady and should be aware of all the factors influencing her external environment, however due to her aging Megan has found she is becoming more dependent on others to assist her in keeping a safe environment. One factor which could affect Megan’s safety could be diplopia, this is a symptom caused by her diabetes which may make her vision blurred. When Megan suffers from a hypoglycaemic attack and becomes confused she is at her most vulnerable stage, which means the need for others to be aware of her situation is essential. In this instance Megan remains conscious throughout the attack, however unconsciousness is a major risk factor, as this would make Megan completely dependent. Once admitted to hospital Megan would need to be assessed on her absolity to maintain a safe environment, and safety problems that arise should be addressed (Roper et al, 1996). Communication Megan has no day to day difficulties with effective communication, however there are several factors which have affected her communication during her hypoglycaemic attack and during her hospital stay. Hypoglycaemic attacks can cause ineffective communication due to the neuroglycopenic symptoms of slurred speech and tingling around the lips (Alexander, et al 2002). Megan also confined that she was embarrassed due to her confusion after the attack and explained it left her feeling self-conscious. Megan therefore felt vulnerable, worried and confused. Roper (1996) believes this could lead to unwillingness to communicate to staff and other patients, (Roper et al, 1996). Breathing Megan is usually independent with her breathing, however when she suffered from her hypoglycaemic attack her breathing was disturbed. This lead to the district nurse monitoring Megan’s respirations, pulse, temperature and blood pressure. If Megan had not received immediate treatment from the district nurse she may have become unconscious and her breathing would have become shallow. Once Megan was admitted to hospital her respirations were monitored and her position was suited to her comfort and she was sat upright with ensured her breathing was not an issue. Eating and Drinking Until recently Megan’s diabetes had been controlled by diet and medication, however as this was no longer giving sufficient control Megan was commenced on insulin. Megan explained that her dietary intake has been poor due to skipped meals, this was concluded as the cause of her hypoglycaemic attack. Staff nurses carried out a blood sugar analysis and recognised a low blood sugar level and then administered a quick acting carbohydrate. In situations where medical staff are not available things such as sugary sweets or drinks can be used as a hypostop. On admission to hospital Megan’s eating and drinking habits were assessed by a dietician. Help and support is needed from all nurses and doctors to achieve a balance between diet, exercise, blood sugar monitoring and insulin administration. Patients need to be educated so it is possible for them to lead a normal life, (Roper et al, 1996). Eliminating Megan usually has no problems eliminating however her diabetes has caused polyuria due to the concentration of glucose in the glomerular filtrate, (Walsh, 2002). There is a possibility of incontinence during a hypoglycaemic attack which is why a urinalysis should be carried out on admission to hospital. It is essential patients know the location of the toilets. It was necessary to offer Megan a commode as she felt unable to walk to the toilet during some points, (Roper et al, 1996). Personal Cleansing and Dressing Megan currently has no problems with her cleansing and dressing but her increasing age and frailty may make some aspects of this difficult. In hospital Megan felt it was important that she continued with her normal routine and that she looks and feels as good as she usually does. The nurses on the ward therefore encouraged this and made the available privacy she needed. Controlling Body Temperature Megan was found suffering from pyrexia after her attack, possible due to the cold she was suffering from. Megan was therefore encouraged to cool down by shedding outer layers and using a fan. It was important to Megan that she felt comfortable and not too hot or cold. During her hospital stay Megan’s temperature was monitored. Mobilising During Megan’s hypoglycaemic attack she was unable to mobilise due to the neuroglycopenic symptoms she experienced (dizziness and unsteadiness). Occasionally muscle twitching and seizures may occur (Alexander et al, 2002). Megan’s safety should be a priority during these attacks. Megan was able to gain her mobility independently during her hospital stay. Working and Social Life Megan is retired however she still lives independently with her husband in their home. Megan also has two adult children and four grandchildren. Megan feels her diabetes adversely affects her ability to have an active social life. A diabetes specialist has therefore been assigned to Megan which will enable her to explore different ways to enjoy social activities such as eating out. The British Diabetic Association therefore emphasises patient education is essential (British Diabetic Association). Sleeping During her stay in hospital, Megan has found she is a sufferer from polyuria which could lead to a problem with nocturia; this could affect the amount and quality of sleep she gets. Megan was informed about sleep promotion during her stay in hospital as it influences an individual’s physical and psychological well-being. Megan reported that the hospital environment affected her sleep due to the change in lighting, ventilation, noises and bedding. Patients should be encouraged to go to bed and wake up at their normal times, however this may not be possible due to ward routine, (Humm, 2001). Dying Reoccurring hypoglycaemic attacks may result in death although this is rare it is still important that Megan’s diabetes is managed appropriately. (Scottish Executive, 2002). The most common cause of death in diabetes is coronary heart disease, the mortality being doubled for individuals with diabetes, (Burden 2003). Megan wished to discuss her fears about death which meant nurses were prepared to discuss this with her and her family. Epidemiology, Policies and Health Promotion The World Health Organisation (WHO) found that in 2009 over a million people in the UK suffered from diabetes (World health organisation 2011). As previously discussed 80% of type 2 diabetes sufferers are overweight. The initial control of diabetes through diet and exercise is paramount. Health professionals can give advice on this and there are many health initiatives run throughout the country to help. Two local initiatives are the Food co-op Network North-east and the Walk to Health. The food co-op network provides fresh fruit, vegetables and other healthy foods. The aim is to supply these foods to people at reasonable prices to promote and encourage healthy eating. The Walk to Health initiative is run from many hospitals and health centres. Patients are given packs containing maps of pre-planned routes between 1-8 miles long, the walks are safe and many can accommodate prams and pushchairs. They also give advice on safety and levels of fitness and have a diary for people to record their progress, (Health Promotions, 2003). All health professionals should be aware of such initiatives run in their area so they can help and encourage their patients to participate and improve their health. Share this: Facebook Twitter Reddit LinkedIn WhatsApp
The main objectives of writing the report are to do a case study on how the Universal Studio is able to attract the locals and tourists into investing in the place. The report would cover why universal studio is able to do so with its unique features. How it is better than its competitor (Escape Theme Park) or how it is in a way inferior to this competitor will be analysed using the SWOT analysis. Is there a raise in tourism in Singapore due to the universal studio. Understanding how universal studio was established and its importance in bringing revenue to Singapore and helping to raise the number of tourism attractions in Singapore. The report would be based on my first hand observation of how the universal studio works and became success. I made a visit to universal studio trip myself and saw it from the perspective of a tourist and a local. I had to decide why the place was worth going to and I did it by going there. I approached my friends who had been there for their reviews regarding universal studio and how they felt about the place to get a better understanding besides my own view or doing a survey on how people feel about universal studio. I also interviewed my friend who is working there to have a clearer picture of universal studio and what it does, and their daily routine of maintaining the flow of the people. What is Universal Studio Singapore? Universal Studio is a theme park built to raise tourism in Singapore. The theme park is located at Sentosa within Resort World Sentosa. Genting Group won the bid to build a second integrated resort in Singapore. On 19 April 2007 the building the Resort World Sentosa (RWS ) commenced. The park was opened to the public on 18 March 2010. The universal studio brings about lots of wonderful attractions including 24 movies – themed rides and attractions, new rides and shows based on blockbuster hits. It is both a locally and tourist enticing place for Singapore to build upon. The park was also opened for sneak preview during the Chinese New Year period to promote and let people know about the place to spend for special occasion and sightseeing purposes. History of Universal studio The successful bid on Genting group in building RWS making Singapore the second Universal Studio Theme Park opened in Asia and first in Southeast Asia. After the official opening, some of the attractions would be opening later at a different timing due to unfinished construction and safety of the people. The largest roller coaster has been hailed due to the safety and problems the theme park had encountered when the ride was opened. Achievements of universal studio Universal Studio has brought some attractions and rides which are available in other countries and brought it to Singapore for the locals and out tourists.. Each ticket would cost about 62 dollars for weekdays and 72 dollars for weekends for adult passes. With such a costly ticket it will certainly bring more income to Singapore. The place consists of 30 restaurants inclusive of food push carts and 20 unique retail stores located all over the park. 7 zones of movie themed worlds and 22 attractions have been designed. Visitors are not only able to access the Universal Studio, they can venture into Sentosa Island which is also a tourist attraction. It has brought the best movie – themed attractions within the seven zones to life, attracting locals and tourists into a dazzling place packed with fantasy for both children and adults, something they have been wishing for. Aims of Universal Studio It has successfully brought Singapore a unique theme park attracting lots of tourist and locals to visit it. Their aims for market are to bring tourism and economical of Singapore to a greater heights. It is to maintain quality service and entertainment to those who visited it for lasting memories. Hoping they would be back to visit the place again on their next trip back to Singapore. What is so unique about Universal studio? The unique points about Universal Studio is the 7 zones of movie themed world which has brought movies characters alive giving visitors memorable visit and trip making to money paid worthwhile. The 7 zones of themed world consist of The Lost World, Far Far Away, Madagascar, Ancient Egypt, Sci – Fi City, Hollywood and New York. All these places are built upon the movies themed and blockbuster hits. The place constructed is based on the movies featuring characters appearances, shopping and dining areas bringing the movie to life. Firstly, The Lost World is divided into two areas Jurassic Park and Waterworld. Featuring both two movie blockbuster hits which are popular among the people. The Lost World helps people to get to know more about dinosaurs and seeing the movies coming alive before their eyes. There are rides featuring the perspective of dinosaurs and how it is like to be surrounded with dinosaurs. Rides which consist of the bird eye view of the place, and some thrilling river raft ride ensuring us to be soaking wet at the of the ride. Waterworld is a water based attractions where we can get to see stunts, amazing explosion live in the water show. Far Far Away Land is a movie themed place inspired by dreamwork animations mainly featuring Shrek and the rich fairy tales life. Knowing the characters that living within the fairy tale walls coming to life. Shrek house was being build and there is Shrek 4D featuring a short and realistic movie where we can actually feel the action right from the seat in their short fairy tale adventure. Junior roller coaster is available to for riding too. Madagascar is also one of the dreamwork animation inspired theme zones where it features the dense tropical filled with wonderful characters of Madagascar in the movies. There is a merry go round where we can ride it to be feel like surrounding the Madagascar character and once again be like a child. Unfortunately not all the rides is opened there which will bring people to goes back next time when it is opened so as not to miss any wonderful attractions there. Ancient Egypt is a place featuring ancient pyramids and archaeologist site appearing in movies like the mummy similar to it. Roller coaster is the most exciting rides in the universal studio aside from the huge roller coaster which is not functioning till further notice. It allows us to feel the fire and actually knowing more of ancient pyramids. Sci – Fi City is a place featuring the modern place of people where future place would look like base on our high technology nowadays. It is also where the two major roller coasters situated at. It is just basically for sightseeing purposes since most of the attractions are closed due to safety issues. Hollywood is a themed place which features the Hollywood boulevard where dynamic architecture, palm trees and walk of the fame. It features shows like where universal monsters in a rock and roll musical performances bring joy to visitors. It is also the place where most of the shopping can be done. Many iconic Hollywood boulevard. New York is a place where the sidewalks and classic landmarks are being featured. There are facade set of movie scenes for real time movie productions. Where there are attractions that showed us how the movie is being produced and how tedious the actual filming would be bringing a spectacular effect for the movie screen. There would also be themed hotels available to cater the needs of people and their choice of preference. Thus, with the themed hotels and 7 zones of attractions made up of Universal Studio make it uniquely special and the only theme park found in Singapore. Difficulties faced Due to the technical problems, some might feel that the park is not up to expectations. The major rides are not operational till further notice might be turning some visitors down into visiting the place for the time being. Not all attractions are opened which states coming soon. Thus, some might want to wait for awhile when everything is working to make the trip and money worthwhile instead, paying 5 dollars for after hours to go in for some sightseeing. Furthermore, the ticket might not be available on the spot as there is limited admission visitors need to book in advance through internet. Some might not want to go about the fuss booking the ticket and stuffs. Strategies ( SWOT ) SWOT Analysis Strengths USS is located in the City State of Singapore – easily accessible and at the crossroad of major air traffic flow that can direct a huge potential market to the Studio. It has a very strong appeal to visitors and tourists, as Universal Studio is already a well-known Branding internationally. The individual attractions, shows and rides within USS are really world-class and offer unparalleled fun and enjoyment to the visitor USS is an important component within a newly-developed Integrated Resort in the Leisure Island of Sentosa that includes casino, conventions and meetings, hotel and F

Week 5 Final Assignment – HCM1201

Week 5 Final Assignment – HCM1201.

Introduction:In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.Tasks:Create a billing manual constructed of summaries of each type of insurance.Include the major requirements for billing for each type.Note inpatient or outpatient differences where appropriate.Explain how to determine from the patient which type they subscribe to.Submission Details:Submit this topic as an 8- to 10-page Microsoft Word document. Use APA standards for citations and references.Cite a minimum of three outside peer-reviewed sources to support your assertions and save it as SU_HCM1201_W5_Project_LastName_FirstInitial.doc. Submit the report to the Submissions Area by the due date assigned.Cite any sources using correct APA format on a separate page.
Week 5 Final Assignment – HCM1201

Watch black panther, Read: Williams “Three Theses about Black Panther” and write a 3page paper.

custom writing service Watch black panther, Read: Williams “Three Theses about Black Panther” and write a 3page paper.. I need an explanation for this Film question to help me study.

Formal Response papers (2-3pp) — Response papers should be composed in formal prose and be used to practice thesis development and argumentation. They should function primarily to develop and focus theses that may be refined into a final paper. You may approach a concept related to the assigned material, delve into details, explore broader themes, symbols, or ideas, or engage any other literary, critical, theoretical, analytical, or humanistic argumentation.
All formal writing assignments must follow these guidelines. Not following correct formatting with be penalized:
–Be formatted according to MLA
–Contain a works cited page
–Use one inch margins on all sides.
–12 pt, Times New Roman font
–Double spaced
–Last Name & Page # in top right corner
–Contains parenthetical citations
Film Writing: Best Practices
As this course is mainly engaged with film, you will be required to use time markers for each in-text citation: (Title of the Film Hour:Min:Sec) eg. (Batman 01:23:15). Because you will need to reference a fair amount of evidence in your analysis and writing (direct quotes, scenes from the films, articles, etc.), I highly suggest that you watch the film with subtitles on so you are able to write down the exact quote. You are expected to read and watch the entirety of whatever is assigned. If you take notes as you read, you will be much more prepared for the written assignments. Also, remember to save all of your work often and in multiple locations.
Watch black panther, Read: Williams “Three Theses about Black Panther” and write a 3page paper.

Moorpark College Othello The Moore of Venice Play by Shakespeare Discussion

Moorpark College Othello The Moore of Venice Play by Shakespeare Discussion.

http://shakespeare.mit.edu/othello/full.htmlInvolving such elements of human nature as good and evil, love and hate, jealousy, and even racism, “Othello” is a difficult play to characterize thematically. What makes Othello a tragic hero, and how is he central in the play? Considering so much of the plot depends on Iago’s diabolical character, what does he contribute to the theme? How about jealousy? Just how prevalent among the characters and causes of tragedy in the play is it? While Othello has much to say about human nature, how much is still relevant to our modern lives? Explain your interpretation of the play.
Moorpark College Othello The Moore of Venice Play by Shakespeare Discussion

Types of Environmental Pollution and Consequences on Human Health Discussion

Types of Environmental Pollution and Consequences on Human Health Discussion.

After reading the instructions provided in the course content, upload your Case Study in this Assignment folder. Make sure your references are in APA or MLA style. For your information, here is an example of a well-written paper with MLA citations and one with APA citations.The case study should written up as a Word document and be no more than 4 pages double-spaced not including references (MLA or APA). On the word document you should have: a title, your name, the case study, and work cited (APA or MLA).
 Once completed, submit it to this Assignment folder.
Types of Environmental Pollution and Consequences on Human Health Discussion