Case StudyCushings Essay example - 1243 Words

Case Study 78 Cushing’s Syndrome Scenario You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome. Clinical Presentation †¢ Centripedal (truncal) obesity or†¦show more content†¦Prednisone can cause upset stomach. It can have serious side effect with vision problems. If it’s not helping with joint pain then the dose may need altering. 8. Differentiate between the glucocorticoid and mineralocorticoid effects of prednisone. Mineralocorticoids= †¨The name mineralocorticoid derives from early observations that these hormones were involved in the retention of sodium, a mineral. The primary endogenous mineralocorticoid is aldosterone, although a number of other endogenous hormones (including progesterone and deoxycorticosterone) have mineralocorticoid function. †¨Ã¢â‚¬ ¨Aldosterone acts on the kidneys to provide active reabsorption of sodium and an associated passive reabsorption of water, as well as the active secretion of potassium in the principal cells of the cortical collecting tubule and active secretion of protons via proton ATPases in the lumenal membrane of the intercalated cells of the collecting tubule. This in turn results in an increase of blood pressure and blood volume. †¨Ã¢â‚¬ ¨Ã¢â‚¬ ¨ Glucocortiocoids= †¨Glucocorticoids (GC) are a class of steroid hormones that bind to the glucocorticoid receptor, which is present in almost every vertebrate animal cell. †¨Ã¢â‚¬ ¨GCs are part of the feedback mechanism in the immune system that turns immune activity (inflammation) down. They are therefore used in medicine to treat diseases that are caused by an overactive immune system, such as allergies, asthma, autoimmune diseases and sepsis. GCs have

The World War II By Kenneth D. Rose - 1642 Words

In the decades since World War II, there have been many attempts to glorify this generation through the media. Myth and the Greatest Generation: A Social History of Americans in World War II by Kenneth D. Rose, attempts to pare back the delusions of grandeur that often characterize histories of the World War II generation to show society as it was rather than how we have come to perceive it. Rose claims that often times when commentators focus on wars, they choose stories that are meant to make the population feel good as opposed to showing the realities. As a result, in retrospect wars seem to generate heightened patriotism and national unity (1). In this book, Rose hopes to give true honor to the Americans of this generation, not by glorifying their contributions, but by presenting a picture more in line with the historical record, hoping that in doing so his work will deliver a more accurate portrayal of â€Å"Americans at war† (3). Rose chooses not to rely heavily on secon dary source material, but rather to highlight the first-hand accounts of individuals who experienced the war. He does so in order to give them proper credit but also to show that the so-called Greatest Generation was not without flaws, and was indeed an ordinary generation that lived through traumatic events that tested their character (7). Rose divides the book into four parts, focusing first on â€Å"Americans Abroad.† He looks at the accounts of not only the soldiers themselves, but also the war correspondentsShow MoreRelatedMyth And The Greatest Generation1596 Words   |  7 PagesGeneration In the decades after the â€Å"Good War,† many attempts have been made to extol this generation in the media. Myth and the Greatest Generation: A Social History of Americans in World War II by Kenneth D. Rose, attempts to shine light on how life actually was for the generation that survived World War II, and came to be known as the greatest generation, rather than how that generation appears to us today. Rose claims that when people discussed the war they choose to focus on stories that helpedRead MoreJohn F. Kennedy983 Words   |  4 Pagesproblems passing science and foreign language classes, although he had a much easier time with English and history courses. With the help of his very supportive family, he managed to get through his problems. His family consisted of his parents, Rose and Joseph â€Å"Joe† Patrick Kennedy Sr., and his eight other siblings, Eunice, John F., Rosemary, Jean, Joseph Jr., Edward, Patricia, Robert F., and Kathleen. He was especially close to his older brother, Joe, and was always striving to be better thanRead MoreArthur Miller s Psychological And Social Magnitude Of His Characters1657 Words   |  7 Pageshonest examination of the course their country had taken post WWII. C. Arthur Miller created characters that wrestled with power conflicts, social and personal liability, influenced by the Great Depression and World War II, he tapped into the turmoil and dissatisfaction within the American mind. II. Arthur Miller was born in October 17, 1915 to Augusta and Isidore Miller in lower Manhattan near Harlem in the state of New York. Miller’s young adulthood was shaped by the poverty that surrounded him dueRead MoreNapoleons Collapse Essay2767 Words   |  12 Pages Research Outline I. Introduction - (Brief comment leading into subject matter - Thesis statement on the reasons why Napoleon’s empire collapsed) II. Body – Napoleon’s success and the process of the downfall, the reasons why the empire collapsed A. Napoleon’s story 1. Napoleon’s success a. Napoleon rose through the army b. Napoleon defeated Coalitions and became the emperor 2. The process of the downfall of the empire a. Many CoalitionsRead MoreBibliographic Essay on African American History6221 Words   |  25 PagesHine, and Stanley Harrold, The African American Odyssey (Upper Saddle River: Printice-Hall, Inc., 2000). Other general texts not to be overlooked are Colin A. Palmer’s Passageways: An Interpretive History of Black America Vol. I: 1619-1863 and Vol. II (Fort Worth: Harcourt Brace College Publishers, 1998), which emphasizes culture; and, Darlene Clark Hine and Kathleen Thompson’s Shining Thread of Hope: The History of Black Women in America (New York: Broadway Books, 1998), a work highlighting theRead MoreThe End Of The Cold War Essay4338 Words   |  18 PagesAbstract: This article discusses the end of the Cold War, covering the period from Reagan?s inauguration to the reunification of Germany, which marked the end of the last remnant in Europe of the Cold War. It looks at several factors that brought the conflict to a close: arms control, human rights issues, and ongoing conflicts in Latin America between the Soviet Union and the United States. The most important meetings and summits between the United States and the Soviet Union are discussed, includingRead MoreThe Soviet War : The Cold War Essay4147 Words   |  17 PagesCOLD WAR TERMINATION Most historians and foreign policy analysts in 1981 did not anticipate that within a decade the Cold War would be over and that it would end with relatively little violence and the end of the Soviet Union. Structural forces have received considerably less attention than the players in assessments on the end of the Cold War. There is widespread recognition that a stagnating Soviet economy definitely shaped Gorbachev s policy of perestroika to revive a command economy dominatedRead More The Politics of Space Exploration2865 Words   |  12 Pagespurposes, space travel was an unattainable aspiration of dreamers. During World War II, while Wernher Von Braun was designing V-2 rockets for the Germans, he privately yearned to transform Jules Verne’s fiction of space travel into fact. Outer space, however, did not fit into the Fà ¼hrer’s master plans; Hitler’s singular desire was to produce an â€Å"annihilating effect† through the V-2s capability for mass des truction. Even after the war, when Von Braun was working for the Americans, his plans to put a humanRead More Rome: The Eternal City Essay2264 Words   |  10 Pagescolor our perception of this legendary city.? Myth and reality are so closely intertwined that we would be remiss to examine the one without the other.? From a cluster of humble villages, arose a mighty people who would capture the admiration of the world for centuries thereafter.? To look at the history of Rome is to look at the history of civilization itself, for with Rome, modern civilization began. The Beginnings: Myth and Reality ?The circumstances surrounding the founding of this ancientRead MoreContinuity Theory of Adult Aging Essay3363 Words   |  14 PagesLooking at B. D. you would never know her strength. If you were generous you could say she was five feet tall, her face wrapped in leathery skin, and pepper gray hair sitting rather untamed on her head. Do not be mistaken, though, for B. D. has endured many hardships and has overcome them all. She is part Mexican, part Apache, and the mother of seventeen children, and one stepdaughter. She was the wife to a World War II Veteran, and the sole caregiver for a daughter paralyzed by spina bifida

Trial Data Transparency and Disclosure †Free Samples to Students

Question: Discuss about Trial Data Transparency and Disclosurethe . Answer: Introduction: There should be availability of opioid antagonist like naloxone while administering opioid in paediatric. Opioids have potential to produce sedation, nausea, vomiting, itching, urinary retention and constipation. Hence, nurse should monitor all these signs in the patients and report it promptly to the clinician. Dose related allergy can also be evident during administration of opioids. Management of side effects and allergy also include arranging adjuvant analgesia to reduce opioids dose. Nurse should monitor pain score and sedation score for altering dose and frequency of opioid administration. Respiratory depression is one of prominent factor which needs to be closely monitored during administration of opioids. If patient is kept on opioid administration for more than one week, weaning process should be implemented prior to cessation of opioid administration (Krashin et al., 2015). Researchers should inform participants that participants can withdraw from the study at any time point without any penalty or loss of benefit. Withdrawal of the participant form the study can be either from all the components of the study or some components of the study. Participants should infrom researchers about their withdrawal plan form the study. Participants should be given instructions about their withdrawal. Participants should be instructed to safely stop the medications. It would be helpful in preventing withdrawal symptoms in the participants. Participants might face problems after leaving the study. Participants should be well informed about the contact person to whom participants should be contacted after withdrawing themselves from the study. Return schedule should be prepared for the participants to assess adverse events due to treatments, procedures, or interventions. Research team should collect health information about the participant at the time of withdrawal from the study. Assessment data of the participants in the form of physical examination, biochemical analysis in the blood sample, photos and scans should be properly documented. This data should be used at the time of data analysis. Collected data of withdrawn participant should be incorporated along with the data of other participants data up to that particular time point. Collected data from the participants should be used for this particular study and it should not be used for any other purpose (NRC, 2011). High withdrawal rates secondary to the adverse reactions should make researcher to think about the anticipated risk-benefit ratio. Researchers should allow participants to withdraw from the study to reduce adverse effects in the participants (Lawton et al., 2017). Withdrawn participants from the study should not be replaced by new participants. However, additional participant from the same study should be incorporated to replace withdrawn participant. Arrangement of these additional participants should be made at the time of initiation of the study. Addition of new participants would not be helpful in comparison with the existing participants. If number of withdrawn participants raised above certain level, it would be difficult to get statistically significant results due to less power for comparison. Hence, researchers should make sure that optimum number of participants should be maintained in the study to get statistically significant results (Chen et al., 2015). Records from the study comprising of consent forms, data files and medical records should be stored in the archive of the organisation. Along with the data, biological samples used in the study should be stored in the archives. Both data and biological samples should be stored for minimum of five years. Achieve should be entirely secure under control of head of the institute. Data should also be stored in the electronic form. Consideration should be given to security safeguard, back-up plans and disaster recovery plans in the storage of data. Collected data should not be stored in the shared drive. Access to the stored files should be restricted to the principle investigator of the study upon approval by the head of the institute (Li et al.,2012). Confidentiality of the patient data should be maintained by authorizing external distribution of personal data to the key personal. Personal data about the patients should not be publicly available. Institute should develop certain laws and rules to maintain confidentiality of the data. Certain transformational methods should be implemented for maintaining confidentiality of the data. It involves modifications of certain details which can not retrieve data. Electronic storage of data is more susceptible for data leakage. Hence, more precautions should be taken in electronic storage of data. Data should be stored by providing codes for each participant. It would be helpful in hiding identity of the participant. Ancillary data like blood samples and photographs should be stored for a minimum of five years in the archive of the institute. For each sample certain code should be given, hence, confidentiality of the participant sample can be maintained (Berlin et al., 2014; Alemayehu et al., 2014). References: Alemayehu, D., Anziano, R.J., and Levenstein, M. (2014). Perspectives on clinical trial data transparency and disclosure. Contemporary Clinical Trials, 39(1), 28-33. Berlin, J.A., Morris, S., Rockhold, F., Askie, L., Ghersi, D., and Waldstreicher, J. (2014). Bumps and bridges on the road to responsible sharing of clinical trial data. Clinical Trials, 11(1), 7-12. Chen, Z., Aiyi, L., Yongming, Q., Larry, T., Naitee, T., Yi, T. (2015). Applied Statistics in Biomedicine and Clinical Trials Design. Springer. Krashin, D., Murinova, N., Jumelle, P., and Ballantyne, J. (2015). Opioid risk assessment in palliative medicine. Expert Opinion on Drug Safety, 14(7), 1023-33. Lawton, J., David, W., David, R., Jackie, E., et al. (2017). Staff experiences of closing out a clinical trial involving withdrawal of treatment: qualitative study. Trials, 18, 61. https://doi.org/10.1186/s13063-017-1813-y. Li, Z., Wen, J., Zhang, X., Wu, C., Li, Z., Liu, L. (2012). ClinData Express--a metadata driven clinical research data management system for secondary use of clinical data. AMIA Annual Symposium Proceedings, 2012, 552-7. National Research Council (NRC). (2011). The Prevention and Treatment of Missing Data in Clinical Trials. National Academies Press.

Religion Contract Essays - Christmas Traditions, Christmas

Religion Contract Nativity Alphabet A~ Angel B~ Bethlehem C~ Christ D~ Dawning Sun E~ Eucharist F~ Frankincense G~ Gold H~ Holy Spirit I~ Infant J~ Jesus K~ Kosher L~ Lord M~ Myrrh N~ Noel O~ Ooh Emmanuel P~ Peace On Earth Q~Queen of Bethlehem R~Rejoice S~ Sacraments T~ Three Kings U~ Universal Faith V~ Vigil W~ Wise men X~ Xavior Y~ Yondering Star Z~ Zackeriah #6 Silent Night Silent night holy night all is calm all is bright round yon virgin mother and child holy infant so tender and mild sleep in heavenly peace sleep in heavenly peace. Silent night holy night shepherds quake at the sight glorious stream from heaven afar, heavenly hosts sing alleluia Christ the savior is born! Christ the savior is born! Silent night holy night son of god loves pure light radiant beams from the holy face with the dawn of redeeming grace Jesus lord at thy birth Jesus lord at thy birth. #7 The three wise men that visited Jesus were Melchior Balthazar Gaspar #8 The gifts that were given to Jesus from the wise men were Gold Frankincense Myrrh # 12 The True Meaning of Christmas To me the true meaning of Christmas is simply not all about receiving gifts. It's a time of the year when it's Jesus' turn to be recognized. Christmas is Jesus' birthday, and this is the time where we should praise him and thank him for giving up his life for us. It is true that we should always thank him but we should really adore him at Christmas. Christmas is a time we should spend with our family and friends, for they are the people we care about most. Also everyone should attend mass to honor Jesus on this very special day. So when you think about Christmas don't think about what you are going to get but think about what you are going to give. #15 The Christmas traditions we have in my family are decorating our Christmas tree as a family. Every year we buy our tree a week before Christmas, and we decorate it when it falls. We do this as a family. I think there is no meaning behind decorating a Christmas tree with out the whole household family. Every year we also have a tradition of going to visit my grandparents at their house, and that's where we eat Christmas dinner. When we go down my grandparent's house its not just my household family down there it's the whole entire family to celebrate together. I think even when I have my own family I will always continue these traditions because they bring back memories of all the good times I have had with my family. #16 Dear journal, I'm writing today to speak on behalf of the situation of Joseph and my child that is soon to be born. I think this is the best gift a person could ever receive. Even though I ?m a virgin this still allows me to have a beautiful child. I think this is the most blessed miracle God has ever performed. T first I must admit I was shocked that I was chosen to be the mother of Jesus but, now I ?m so grateful. Sincerely, Mary #13 Christmas Christmas is a time for giving?not for receiving. Christmas is a time for sharing? not for selfishness Christmas is a time for prayer?not for play Christmas is a time for Jesus' birth? not for getting presents Christmas is a time for going to mass?not for making excuses Christmas is a time for love ?not for hatred Christmas is a time for everyone to share with the ones you love and respect. Everyone who seems just a little nicer during the Christmas season should learn from that change and keep it. Start the New Year a whole different way that you ended. Love one another, as you would like to be loved! #10 Summary of the life of saint Nicholas The legend of Santa clause began with a real person. Saint Nicholas, who lived many centuries ago. He is one of the most popular saints honored by Christians. He lived during the 4th century in lycia. There is not much known about him. Some stories say he was born in patara and traveled to Egypt and Palestine as a young man. After a while he became bishop of the church at mayra. By the 6th century his burial shrine was well known at myra. In 1087 his remains were moved to bari, Italy which became a crowed pilgrimage center in