The State Of Ethics And Privacy Essay - 967 Words

To: Amanda Greeley Manager – IT Google From: Jancy James Kochmuriyil Intern Date: September 17, 2015 Re: STATE OF ETHICS AND PRIVACY You have asked that I look into the state of privacy and ethics at Google and present my thoughts and opinion on it. I would like to address a few issues that I have found in the following paragraphs. Google as a company with its modest beginning in 1998 and its mission statement to â€Å"organize the world’s information and make it universally accessible and useful†, has grown into so much more. Google is now the most searched website and is also the most dominant search engine in many countries. Heard that even some of the Microsoft Employees prefer Google than their own search engine. This shows how popular Google is. Violation of copyright and Privacy We are now living in a world where information about almost anything and everything is available at the click of a button and Google helps make it possible. While everyone loves Google it is important to not to stain that reputation and put any wrinkle on its merits. With the availability of information comes the risk of violation of privacy. Despite having good code of ethics and privacy, Google has been subject to criticism concerning the privacy of its users. Google as a search engine keeps track of its user’s search history and uses tracking cookies to collect enormous amounts of information - personal and general. Information collected through one simple search will not giveShow MoreRelatedComprehensive Legislation Of Social Media Privacy1559 Words   |  7 PagesMedia Privacy Reading and Writing Workshop II, Section 007 Qiu Jin (Rachel) August 11, 2014 Comprehensive Legislation to Protect Social Media Privacy Abstract The article makes a research on both the present situation of social media users’ privacy, and the work of the FTC and other federal departments to protect social media privacy. 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The purpose of surveillance, or one particular instantiation of surveillance, is probably the mostRead MoreResident Rights in Long Term Care Facilities1536 Words   |  7 Pagesa necessity in a long term care setting and incorporate values and ethics. Resident rights provide privacy and confidentiality for the resident they promote quality of life and set standard rules for a caregiver to follow. In a professional setting such as a long term care facility, professional values and ethics are an absolute necessity. Sometimes the definition of values and ethics is unclear. Professional values and ethics are a set of moral principles and standards of conduct, supporting theRead MoreThe Privacy Of The Internet1737 Words   |  7 Pagesinternet were to Google a search for the word â€Å"privacy† as of June 2015, there would be close to 2 billion hits. Discussions of privacy, piracy and internet breaches are everywhere. The numerous Google hits show there is nearly universal agreement that (1) we have less privacy and more information than we used to, and (2) this is bad.Information itself is, of course, not bad, but as we have witnessed recently, even personnel record maintained by the United States government are subject to unethical hackingRead MoreEthics And The Field Of Healthcare1542 Words   |  7 Pagesare supposed to advocate for their patients, as well as protect their privacy and confidentiality. When a patient put’s the nurse in a situation that could potentially affect other people, what should she do? The nurse must be familiar with genetic testing, the impact it can have on the patient and society, the ANA Code of Ethics, privacy and confidentiality, and the implications to breach confidentiality agreements. Privacy and Confidentiality Related to Genetics The nurse is often responsibleRead MoreShould Justin Ellsworths Parents Have Been Given Access to His Email?1102 Words   |  5 Pageskilled in Iraq. After his death, his parents wanted access to his emails. Yahoo, his email service provided declined their request stating that their privacy policy prohibited them from disclosing the contents of his email to anyone. Now I was asked to review this from a utilitarian and deontological view. Utilitarian Utilitarian ethics is the idea that the moral worth of an action is determined solely by its utility in providing happiness or pleasure as summed among all sentient beingsRead MoreThe Ethical and Legal Concerns of Employee Monitoring Essay1463 Words   |  6 Pagesreviewing their employee’s emails, voice mails, and phone conversations (Evans, 2007). However, in some instances when the employees found out about the monitoring they were left with the feeling that there has been a violation of their rights to privacy. Employee monitoring could fall under the organizational structure of human resources. The human resources department of an organization has the responsibility of hiring new employees, delivering, and developing proper training to make sure thatRead MoreCelebrities and Privacy1609 Words   |  7 Pageswhether they should expect their privacy to be respected by the media. Media comes in various forms, with the more common ones being newspapers, tabloids, radio, paparazzi, internet, social media and many more. A conflict of rights? Article 8 of the European Convention on Human Rights stated that every person has the â€Å"right to respect for his private and family life. His home and his correspondence†. However, it contradicts with Article 10 of the same Act that states that everyone has the right to

A Cultural Problem, an Economic Crisis - 1099 Words

In the past two years, Western society has experienced what many of its leaders have called the worst financial crisis since the Great Depression. At the very least, it has been the worst period of instability that our younger generations have ever seen in their lifetimes. But unlike other financial crises that have largely been triggered by external forces, such as the oil embargoes of the 1970’s, this latest one was a product of our own internal policies and practices; even more so, of our cultural outlooks on the very notion of finance, credit, and debt itself. Specifically, the financial crisis that has just come to pass was the result of the new culture of neo-liberalism and the hyper-individuality and debt-based consumption that it†¦show more content†¦This higher-level shift in the modes of production in Western society has been one of the major sources of the cultural shift that has led to our modern state of affairs. From Fordism to the post-war, entire fam ilies would form professional identities around the head of the household’s employer. With the shift in the modes and local of production that neo-liberal globalization however, the current generations cannot form such attachment or association. As Barry puts it, â€Å"the new flexible form of capitalism has transformed the work experience and as a result ‘people can’t identify themselves with a particular labour or with a single employer’†. So then, if someone of the current generation, by virtue of the neo-liberal system into which they have been born, cannot form a profession identity like their fathers or grandfathers had, what does that leave? Smart points out that, without the confidence or security that employment held before modern global neo-liberalism, people have increasingly formed their identities around their time off the clock. 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Free Radiology Research Study Critique Free Essays

Critique: Research Study Radiology 1. Citation Upton, D. Upton , P. We will write a custom essay sample on Free Radiology Research Study Critique or any similar topic only for you Order Now (2006). Knowledge and Use of Evidence-based practice by allied health and health science professionals in the United Kingdom. Journal of Allied Health, 35:3, 127-133 2. Study Purpose The following critically reviews a paper by Upton and Upton (2006), concerned with clinical effectiveness (CE) and evidence-based practice (EBP) and the differences between them amongst different professional groups. It compares 14 different groups in terms of how they understand and implement CE and EBP. Evidence-based practice is the application by health care professionals of the most appropriate research evidence to clinical situations, taking into account the whole context in which they operate, including the client’s needs (Hoffman et al 2009). Clinical effectiveness, according to the Department of Health (1996) is â€Å"the extent to which specific clinical interventions, when deployed in the field for a particular patient or population, do what they are intended to do† (DoH 1996; cited Hamer and Collinson 2005).Upton and Upton suggest that the differences between these concepts in different fields has, so far, been under researched. 3. Literature Upton and Upton’s literature review is fairly short, and forms part of the introduction. While it might be slightly clearer to separate this out from other areas covered in the introduction, this seems a fairly standard academic practice. The review does not explain what either CE or EBP are, nor of the history of the terms. While this might be superfluous to the paper, and while the author’s might assume the expected audience will be familiar with the terms already, the term, EBP, for example is, to some extent, ambiguous (Roberts and Yeager 2004), and a statement here, rather than later of the definition used would have been welcome. The bulk of the review looks at existing research which explores â€Å"the views and knowledge of health care professionals toward EBP† (Upton and Upton 2006), pointing out that they mainly concern medical practitioners, with fewer looking at others including McCaughan et al (2002) (nurses) and Iqbal and Glenny (2002) (dental practitioners). They discuss the studies which, like theirs, do compare different professions (Palfreyman et al 2004; Metcalfe et al 2001). These find common features and differences between the groups: nurses, for example, rate their EBP abilities lower than physiotherapists. Not only are existing studies, few, their scope is limited and omits key areas of interest. As such the literature review provides a good justification for Upton and Upton’s study, by showing the deficit of existing research. However, as an overview of the concepts of EBP and CE it is less successful. In addition it does not suggest a theoretical model to shape and give depth to the study, for example one which predicts differences between professional groups, like that of Gawlinski and Rutledge (2008), who suggest that different models of EBP meet different needs of differing clinical environments. 4. Approach and Methodology The authors do not explicitly discuss the paradigm under which their research was carried out, and their ‘methodology’ section is only one paragraph. A paradigm is the approach to the research taken by researchers. Johnson and Christensen (2010) suggest that there are three major paradigms, qualitative, quantitative and mixed methods, each of which embraces a set of assumptions about epistemology and the nature of reality. Upton and Upton’s approach is quantitative, empiricist and positivist. Positivism was established by Comte in the early 19th Century, and assumes that the world is objective of human experience, and knowable through our senses.Empiricism is concerned with factual data, and empirical research’s ideal method is the scientific method, whereby clear hypotheses are formulated prior to research and are designed to be tested against empirical evidence. Data is primarily numerical, and outcomes are objective and measurable. This approach contras ts with a qualitative, interpretivist approach, which deals with text, subjectivity and the richness of experience (Tappen 2010). Given that Upton and Upton want to investigate an under-researched area, it is understandable why they used a quantitative approach, as it allows them to investigate a larger data set and draw more generalisable conclusions, and also give scope for assessing statistical significance. However, a qualitative approach would have allowed them to look in more detail at how different types of practitioner experienced EBP and CE, which would have added richness to the study. 5. Sample Again, there is relatively little detail given by the authors here. They tell us that 1000 members of Allied Healthcare Professions (AHP) and Health Science Services (HSS) were selected, and that the sample represents the proportions of each practicing in the UK. While they assure us that ‘specific statistical methods were used to establish sample size’, there is little discussion of what these were or why they were selected over other possible methods. The authors are informative about the response rate (66.6%), and add that most were female, but there are other details about the sample which are not discussed, and which might have been useful to know. For example, how were participants contacted, and what was the wording used to ask them to take part There is potential for bias here, if the method of contact attracted practitioners who had had either predominantly bad or good experiences of EBP or CE. Postal questionnaires were used, and here the authors do discuss alt ernative methods, and give a reasonable justification for their choice. In addition, although the authors discuss gender, it might have been interesting to know more about participants. Was there bias towards older or younger respondents, or towards one or other social class They suggest there is a bias towards women, but as this represents the breakdown between men and women in the occupations overall, this does not seem to present a particular problem. 6. Data Collection Data was collected by questionnaire, distributed by post. The authors used a questionnaire that had already been developed and tested, by Upton and Lewis (1998). Therefore the reliability and validity (whether the questionnaire gives the same results repeatedly, over time, and whether it tests what it sets out to test: Babbie 2008) had already been established. They also distinguish between content and face validity, and confirm that both are good for the questionnaire. Face validity is weaker than content validity, and confirms simply that an instrument seems to measure what it is intended to measure. Content validity covers the â€Å"full domain of the concept† and whether it measures all this domain (Rubin 2011). Upton and Upton give a fairly good breakdown of the content of the questionnaire, dividing their discussion into the sections contained in it, including demographics, respondent knowledge of CE and EBP, the extent to which respondents practice different aspects of CE and EBT, and barriers to implementation of EBP. For each, they explain the ways in which each aspect were assessed using an appropriate instrument.What is missing here is any discussion of why these instruments were selected over alternatives, and whether alternatives exist. Although Upton and Lewis’s (1998) instrument seems well regarded, there are also the ‘Evidence-Based Practice Beliefs Scale’ and ‘Evidence-Based Practice Implementation Scale’s (Melnyk et al 2008), and the ‘Evidence-Based Practice Attitude Scale (Aarons, 2004), for example (Rice et al 2010). The authors give more detail about how participants were contacted here, via a ‘publicity notice’. This might give rise to bias, however, as those who were motivated to take part might well have stronger opinions about EBP and CE and want to express these. Other selection methods might have been considered. There is also no information about the length of time taken to distribute and collect the questionnaires, nor how long the respondents were given to complete them. A longer time might have led to more detailed results, but also to the possibility of other influences effecting responses. Because the questionnaires were distributed by post, there also seems to be little provision for dealing with problems which might be encountered by respondents while completing their forms. 7. Results and Discussion The authors present their results in some detail, using both tables and written presentation, which makes the data easier to understand.Although they mention that the response rate was high, at 66.6%, some more detail about drop out rates would have been welcome here. For example, did the 66.6% represent the proportion of people who completed the full survey, or just a part of the survey? The authors divide the discussion by question type, looking in turn at ‘knowledge of concepts and principles of CE and EBP’, ‘Reported use of EBP’, ‘Acting on evidence from a variety of sources’, and ‘barriers to the application of EBP’. This allows clarity in the discussion. They also explain the details of the results well, with a logical pattern of explanation. For example, they say that overall, knowledge of CE and EBP was low, and then give more detail showing there are clear distinctions between different professions, with more psychologists and physiotherapists rating their knowledge in the ‘high’ category than other professions including podiatrists and speech therapists. The authors also back up the intuitive reading of the results with statistical analyses, and note the drawback that small cell numbers in some cases prevent such a confirmation. For reported use of EBP, there are again differences between the professional groups, with a particular link between frequency with which gaps in knowledge are identified and profession. Other key findings in this, and subsequent sections, are clearly reported. There is a separate table for each sub-section of the questionnaire, and each is clear and easy to read. Because the tables (perhaps because of space constraints) summarise information across both the range of professions and for each aspect rated, it is not immediately obvious which professions are ranked higher for each aspect. Also, the tables summarise the aspects rather than using the verbatim wording, for example â€Å"monitoring own practice† and â€Å"critical analysis†. It might have been interesting to see the actual wording used in the questionnaire. In addition, while statistical information is presented more fully in the text, key information is missing from the tables, for example standard deviation in table 4. Similarly also, the discussion of ‘knowle dge of the concepts and principles of CE and EBP’ includes a description of statistical tests including a one-way analysis of variance, but these results are not presented in the tables. Even though the author’s sample size is relatively high, some cells were so small that certain categories had to be removed from the analysis, for example, orthoptists for ‘reported use of EBP’. This is unfortunate, as it means the full range of professions cannot be assessed for this category. The authors also present a detailed and intelligent discussion of what the results mean.Their conclusions seem to be backed up by the results, for example, their initial claim that there are â€Å"some differences between professional groups in terms of knowledge base and self-reported use of CE and EBP†: this was discussed in the earlier results section. This summary is initially concerned to draw out key themes from the results section. They first suggest that while both HSS and AHP groups have low levels of knowledge, the lowest levels were from professionals from HSS groups. As well as reporting this, they suggest that this is due to the relatively recent introduction of the concept to these professionals, as well as differences in the extent to which each group are involved in day-to-day care of patients.This is interesting, but might the discussion might have had more depth had the differences between HSS and AHP been brought out in more detail during the literature revi ew. They also do not give references for their claims about the differences between HSS and AHP groups, so there is no context for their discussion. However, this is a valuable discussion, as it suggests that part of the problem is the lack of an evidence base for certain professions including radiographers and podiatrists. This insight could be used to generate new practice in these professions.There are similarly useful discussions of other areas of the findings, for example the differences between groups’ ratings of EBP skills. The authors suggest that psychologists, for example, rate their skills higher due to a different emphasis put upon a degree during training. This again throws a useful light upon possible revisions to the way professions are managed. However, Upton and Upton’s discussion here is again marred by lack of reference to any other academic sources. This fruitful area must, surely, have already attracted academic discussion One positive here is tha t Upton and Upton do not simply stick to one possible explanation, but consider others, for example that respondents rating of their skills does not match their actual skill level. Their discussions of other areas, for example application of EBP and barriers to its uptake, also display positive and negative features; bringing out key aspects of the results well, and providing interesting interpretations of these results, but with less referencing and relating the results to other academic research than might be useful. Overall, there could have been a little more discussion of overall themes that arose across sections, for example the need for better management of different professions with more uniform integration of EBP, and improved training in its use. One final, positive point about the results and subsequent discussion is that the authors talk about methodological drawbacks, including those related to postal surveys (respondents may be less honest than with other research methods).They do not, however, consider other possible limitations, for example the lack of any qualitative data, which might have given a richer perspective on what respondents felt emotionally about using EBP and CE. They also do not discuss relationship of the data to any overarching theoretical framework, which might also have added depth to the study. 9. Conclusion and Clinical Implications The author’s conclusion is perhaps rather short. They simply summarise their key finding, that there are ‘very apparent differences in the knowledge and use of CE and EBP by members of the AHP and HSS’, and that there were other, discipline-related, differences. This brevity is somewhat disappointing. They do not consider any practical implications for the research, nor whether it would be appropriate for AHP and HSS members to show equal levels of awareness and use of CE and EBP. Also, they do not make any suggestions for further research, although as they earlier remarked that there is a lack of study in this area, there is a clear need for such research, perhaps investigating differences between professions further, or looking at ways knowlegge and use of CE and EBP can be increased overall. To summarise this paper, a critical analysis of a study by Upton and Upton (2006) has been presented, looking at all aspects of their work from introduction to discussion and conclusion. This is a paper with many interesting and well presented areas, but there are some negative points and areas which could be improved. References Aarons, G A (2004) ‘Mental health provider attitudes toward adoption of evidence based practice: The evidence-based practice attitude scale (EBPAS)’, Mental Health Services Research, 6, 61-74 Babbie, E R (2008) The basics of social research (4th edn.) Cengage Learning, USA. Department of Health (1996) Promoting clinical effectiveness a framework for action in and through the NHS, Department of Health, UK Gawlinski, A and Rutledge, D (2008) ‘Selecting a model for evidence-based practice changes: a practical approach’, AACN Adv Crit Care, 19:3, 291-300. Hamer, S and Collinson, G (2005) Achieving evidence-based practice: a handbook for practitioners (2nd edn.) Elsevier Health Sciences, Philadelphia PA. Hoffman, T, Bennett, S and Del Mar, C (2009) Evidence-Based Practice Across the Health Professions, Elsevier Australia, Australia. Iqbal, A and Glenny A, M (2002) ‘General dental practitioners knowledge of and attitudes towards evidence based practice’, Br Dent J, 193, 587–591 McCaughan, D, Thompson, C, and Cullum, N (2002) ‘Acute care nurses’ perceptions of barriers to using research information in clinical decision- making’, J Adv Nurs 39:46–60. Melnyk, B M, Fineout-Overholt, E, Mays, M Z (2008) ‘The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments’, Worldviews on Evidence-Based Nursing, 4, 208-216. Metcalfe, CR, Lewin S, and Wisher S (2001) ‘Barriers to implementing the evidence base in four NHS therapies: dieticians, occupational therapists, physiotherapists, speech and language therapists’, Physiotherapy87:433–441. Palfreyman, S, Tod, A and Doyle, J (2004) ‘Comparing evidence-based practice of nurses and physiotherapists’, Br J Nurs, 1:246–253. Rice, K, Hwang, J, Abrefa-Gyan, T and Powel, K (2010) ‘Evidence-Based Practice Questionnaire: A Confirmatory Factor Analysis in a Social Work Sample’, Advances in Social Work, 11:2, 158-173 Roberts, A R and Yeager, K (2004) Evidence-based practice manual: research and outcome measures in health and human services, Oxford University Press, Oxon. Rubin, A (2011) Practitioner’s Guide to Using Research for Evidence-Based Practice, John Wiley and Sons, USA Tappen, R (2010) Advanced Nursing Research: From Theory to Practice, Jones Bartlett Learning, Sudbury MA Upton, D and Lewis BK (1998) ‘Evidence based practice: a questionnaire to assess knowledge, attitudes and practice’, Br J Ther Rehabil, 5, 647–650 How to cite Free Radiology Research Study Critique, Free Research Paper Samples

Nursing Case study Medical

Questions: I: Mrs Joan McNeil is a 64-year-old widower who currently lives with her daughter due to a recent fall and DVT in her left calf.S: She has presented to your hospital with a DKA after having nausea and vomiting for the past 3 days which she was unable to tolerate anything oral and is dehydrated.B: Joan has been a type 2 Diabetic on Metformin for 30 years. Recently her GP started her on insulin a.c and nocte. Joan weighs 115 kg and suffers from Osteoarthritis and finds it difficult to mobilise. She also has hypertension in which she is medicated for.A: After spending the night in ED receiving IV fluids and an insulin infusion, she has been admitted to your ward with uncontrolled Type 2 Diabetes needing re-assessment and management. Joan currently has an intravenous infusion in progress and has a sliding scale, requiring 2/24 BSLs and additional insulin pre meals.R: Refer to the mediation charts.Question 1:a) Explain the aetiology and pathophysiology of Type 1 Diabetes and Type 2 Diabet es.In your answer compare the differences between Type 1 and Type 2 diabetes. Include: characteristics and treatment.b) Explain what a DKA is and possible reasons from the history why this would have occurred?Question 2:Joan has been a Type 2 Diabetic for 30 years. She has now been commenced on Insulin.a) Is she now considered a Type 1 diabetic? Explain your answer.b) Why would Joans GP have commenced her on Insulin a.c and nocte? Give a detailed explanation.Question 3:a) What are the symptoms of Hypoglycaemia?b) What is the treatment for Hypoglycaemia?Question 4:Mrs McNeils Blood Glucose levels for the past 12 hours are as follows:0600: 13.5mmol/l; 0800: 14.5mmol/l; 1000: 9.9mmol/l; 1200: 15.0mmol/L; 1400: 7.7mmol/l; 1600: 6.8mmol/l; 1800: 3.2mmol/l; 1900: 10.6 mmol/l; 2100: 16mmol/l;a) Document these on the attached BGE (Blood Glucose Form).b) At 1200hrs you documented the BSL as 15.0. What would you do?Question 5:Identify 5 other conditions related to diabetes that Joan is at ris k of? Choose 1 and explain this in detail including pathophysiology, aetiology, signs and symptoms, medications and treatment options.Question 6:On arrival to the ward Joan gives you a bag containing her medications. This bag includes: Metformin, Actrapid, Protaphane, Digoxin, Ventolin Puffer, Coloxyl with Senna, Atenolol.For each of these medications please explain: The pharmacodynamics (how they work) on Mrs McNeils body. Why Joan would be taking these medications Trade names Dosage parameters Adverse reactions Nursing Considerations Patient educationQuestion 7:Mrs McNeil was commenced on IV fluids due to dehydrationa) What clinical manifestations would Mrs McNeil exhibited on admission for the Doctor to diagnose this.b) Outline in detail the Enrolled Nurses role in relation to managing Joans IVT.c) Identify and explain in detail at least 4 possible complications of having an IV Infusion.You have just completed a set of observations. These are as follows:BP: 160/96HR: 98R: 26O2 sa ts: 86%Joan is having difficulty responding to your questions in full sentences.d) What is Joan most likely suffering from?e) What could have caused this and why?Question 8:As part of the admission process you complete a patient medical history check. You identify that the patient has had a recent DVT in her left calf.a) After identifying this, what medication is used in hospital to prevent this from reoccurring?b) How does this medication work?c) Outline how you would administer this medication (please include equipment, process and safety precautions)d) Please sign the medication chart to indicate you have given the morning medications.Question 9:You assist Joan to the toilet, on returning to the chair Joan appears to be short of breath and complains of a squeezing sensation (heaviness) in her chest. Please explain your immediate actions in order of priority and provide a rationale for each.Question 10:Continuing on from above, you have just completed a set of observations. These are as follows:BP: 86/38HR: 46R: 24O2 sats: 80%Joan is sweating profuselyBased on the observations you decide to leave the patient to make a MET call.a) What is the criteria for making a MET call?Question 11:The Doctor diagnosed acute Myocardial Infarction as the troponin level was 0.9.a) What is the normal range for a troponin level?The following day, you are doing a ward round. You notice Mrs McNeil walking to the toilet on her own. You ask if she is ok and she responds yes. You continue your round. 20 minutes later you walk past Mrs McNeils room and notice she has not returned from the toilet. As you walk closer you see Mrs McNeil collapsed on the floor in the doorway of the toilet.b) What is your next response?c) Joan has No Pulse and is not breathing. You know you need to commence CPR, what does this involve. Give a detailed explanation of the resuscitation process. Ratio, depth of compression, frequency, checking of pulse, timing of interventions, other assistance etc.d) What medications are used in the management of a cardiac arrest. Explain the pharmacodynamics, dosage parameters and timing for these medicationsQuestion 12:After a long stay in hospital recovering from her MI, Joan is finally ready for discharge to a rehabilitation facility.a) Develop a discharge plan and a written handover to the facility. Using the ISBAR handover format ensure you include all information, events and medication pertaining to Joans stay hospital. Answers: 1. a) Type I Diabetes: in this condition the immune system of the body that fights against viruses and bacteria incorrectly demolishes the islet cells within the pancreas. Pathophysiology of this condition includes beta cells destruction within the pancreas in spite of which causative agent or risk factors are present (Schatz, Haller and Atkinson, 2010). Risk factors include autoimmune response towards the beta cells within the pancreas, consisting expansion of autoantibody-generating beta cells, CD8+ T cells, CD4+ T helper cells and innate immune system activation. Type II Diabetes: in this condition human system becomes insulin resistant or the pancreas may stop producing adequate amount of insulin. Insulin resistance that is the cell inability to respond properly to normal insulin levels takes place initially within fat tissue, muscles and liver (Taylor, 2012). Type I Diabetes Type II Diabetes Characteristics beta cells destruction within the pancreas in spite of any causative agent or risk factors In case of insulin resistance, liver inadequately releases proper amount of glucose in the blood stream Treatment Immunosupressive drugs: Cyclosporine A. Proper nutrition, regular exercise, lifestyle modification (Karlsen and Bru, 2000). b) DKA is considered as a life threatening illness among the sufferers of diabetes mellitus. This takes place mainly with those who are suffering from type I diabetes. It results from insulin shortage, and because of insulin insufficiency body switches to burn fatty acids and generates acidic ketone bodies which cause mainly the complications and symptoms (Egred, 2005). In this case study Mrs. Joan is a diabetic patient and suffering from this condition since last 30years. DKA most often takes place in those patients who previously have diabetes. Apart from that she is obese. From various researches it is seen that DKA may takes place among those who have features of diabetes type II and features include obesity and family history. 2. a) No, she is not considered as Type I diabetic. This is because both features of these conditions are entirely different. Type II diabetes is characterized by increased glucose levels within the blood stream but in type I diabetes immune system destroy s the production of insulin by the pancreatic cells (Hassanein, Ewins and Worth, 2000). In this case body generates insulin but is not capable to identify and utilize it appropriately and that is why insulin therapy is given to the patient to control her blood sugar level. Her immune system does not destroy the insulin producing beta cells within the pancreas. b) Joans GP have commenced her on insulin dosages because Type II diabetes is completely curable and preventable. The recommendation is justified as Joan is diabetic for last 30years and consuming Protaphane and Metformin (Drugbank.ca, 2015). Yet her blood sugar level is not under control. Therefore commencement of insulin therapy prior meal and during the night time will help Joan to control her elevated blood sugar level. 3. a) The symptoms of hypoglycemia includes fatigue, pale skin, heart palpitations, anxiety, shakiness, hunger, irritability, sweating, blurry vision, nervousness, mood swing, sleeping difficulty, skin ting ling, loss of alertness, trouble in concentrating (Park et al., 2010). b) The treatment of hypoglycemia includes drinking juice or consuming glucose tablets or chewing sugary food (Bellenir, 2008). GP can also give a glucagon shot as for immediate purpose, because this raises the level of blood sugar.4. a) Blood Glucose Form: TIME BSL 0600 13.5mmol/l 0800 14.5mmol/l 1000 9.9mmol/l 1200 15.0mmol/l 1400 7.7mmol/l 1600 6.8mmol/l 1800 3.2mmol/l 1900 10.6mmol/l 2100 16mmol/l b) When it is documented that the BSL is 15.0 at 1200hrs, the responsible care provider should focus on her hyperglycemia treatment. It is also mentioned in this case study that she has diabetic keto acidosis, so taking care of this factor is of utmost important. Joan weighs 115kg so she should be administered with 6units of insulin. 5. 5 other conditions related to diabetes are: amputation, vision loss, nerve damage; kidney disease and stroke and heart complication. Amputation: the main two reasons associated with amputations of legs or feet include narrowing down of blood vessels, obstruction in adequate amount of blood circulation to the lower body portion. Sores or cuts in the legs or feet take time to heal properly and can get bad instead of getting healed. If a problem of damaged nerve is also present then the patient might not feel the ache because of foot problem (Healey and Healey, 2007). Sores if left untreated or ignored then the sores can become rapidly infected that leads to an emergency for amputation (Akram, Kerr and Mclennan, 2008). Treatment includes proper foot care, inspection of sores; avoid wearing badly fitting shocks and proper follow up with doctors. 6. DRUGS PHARMACODYNAMICS REASON TRADE NAMES DOSAGE PARAMETERS ADVERSE REACTIONS NURSING CONSIDERATION PATIENT EDUCATION Metformin Improves glucose tolerance, lowers basal and postprandial plasma glucose She is hyperglycemic Glucophage 1gm, twice Daily Stomach discomfort, lower back pain, cough, decreased appetite History of allergy and physical assessment like: skin color, lesions, liver evaluation Avoid alcohol consumption while administering with this drug Actrapid Helps glucose to enter the body cells from blood To manage the condition of diabetes Actrapid 4units/8hrs Excessive reduction all of blood glucose level sudenly Correct dosage should be prepared Education need to be given on lifestyle modification, proper diet Protaphane Helps glucose to enter the body cells from blood To control elevated level of blood sugar Protaphane 14units Excessive reduction all of a blood glucose level sddenly Correct dosage should be prepared Education need to be given on lifestyle modification, proper diet Digoxin A cardiac glycoside, treat congestive cardiac complication and arrhythmias because of reentry mechanism Control the rate of ventriculation in atrial fibrillation, manage congestive cardiac failure Digacin 62.5mcg/day Fainting, dizziness Need to be administered undiluted Patient should complain if any adverse effect initiates Ventolin Puffer A bronchodilator to control the condition of asthma To treat asthma or COPD Asthavent 2mg 3-4times/day Headache, flushing, hypokalaemia Assess lung sound, observe fore paradoxical spasm Patient should complain if any adverse effect initiates (Nhs.uk, 2015) Coloxyl with Senna Sennosides which are obtained from senna leaves, irritates bowel lining causing laxative effect Recommended for constipation Coloxyl II daily Weight loss, stomach pain As digoxin, blood thinner and diuretic tablets can affect Coloxyl, nurses should monitor if any adverse reaction arise Patient should complain if any adverse effect initiates (Aspenpharma.com.au, 2015) Atenolol It has lowest solubility in lipid and does not have membrane stabilizing activity She is hypertensive, so it is used to control her hypertension Normiten Daily Cold hand, feet, confusion History of sinus bradycardia and physical assessment: urine glucose, blood glucose, cholesterol CConsume drug with food id gastrointestinal upset takes place (Mayoclinic.org, 2015) 7. a) The clinical manifestations include extreme thrust, confusion, dry skin, mucous membranes, mouth, no urination and sunken eyes (Simmons, 2010). b) Nurses should have a good amount of knowledge about intra venous therapy. Many technical modifications are now in place those are time saving and innovative. This increases the therapy efficacy. The nurses need to be well equipped with these techniques.c) The complications may include hematoma infiltration, air embolism and phlebitis (Wittstock, Benecke and Zettl, 2003). d) Her blood pressure is at higher side, her heart rate is also increased and from her oxygen saturation measurement it is clearly understood that she is suffering from hypoxia. e) She could have suffering from loss of consciousness and increased palpitation because of dehydrated condition. 8. a) Heparin is used to prevent this from reoccurring.b) Heparin binds to antithrombin III and leads to instant inactivation of factors Xa and IIa. This heparin bound complex can inactivate plasmin (Drugbank.ca, 2015). Heparins antithrombotic effect is related well with the factor Xa inhibition. Heparin prevents formation of existing clots by diminishing further clotting and not a thombolytic agent.9. Immediate actions: support with oxygen mask as she is suffering from breathing shortness. The squeezing pain in the heart might represent a change of heart attack, so Digoxin can be administered or any other sublingual tablets can be immediately placed. 10. a) The criteria here that can be considered to give a MET call includes her sudden chest pain and raised heart rate and elevated blood pressure that indicate her chance to get a heart attack. 11. a) Normal range of troponin: 0-0.2ng/ml.b) The next response is a call to the medical emergency team.c) Turn patient onto her back, open airway using chin lift and head lift, keeping this passage open the personnel should look, feel, and listen to identify whether the patient is normally breathing and should take l ess than 10seconds. Listen at patients mouth for breathing sounds, look or movement of chest, feel for air on cheek. Chest decompression can be given and 2ventilations. d) ACE inhibitors can be used in this condition. Generic name: benazepril; Trade name: LotensinThis drug inhibits ACE in human (Nlm.nih.gov, 2015). This enzyme catalyzes conversion of angeotensin I to vasoconstrictor substance. Dosage: 20mg/day. 12. Joans discharge plan should be focused on her physiological conditions: DVT, DKA, diabetes and dehydrated condition. As the doctor has started insulin therapy, the patient should be educated properly regarding insulin administration. If help is required the hospital should arranged for nurse aide along with her. She should be provided with a template mentioning dos and donts, so that she can follow proper medication and its timing. References Akram, A., Kerr, R. and Mclennan, A. (2008). Amputation of lower left lip following dental local anaesthetic.Oral Surgery, 1(2), pp.111-113. Aspenpharma.com.au, (2015).Coloxyl - docusate | Aspen Pharmacare Australia. [online] Available at: https://www.aspenpharma.com.au/products/details/index/id/448/product/Coloxyl [Accessed 19 Feb. 2015]. Bellenir, K. (2008).Diabetes sourcebook. Detroit, MI: Omnigraphics. Drugbank.ca, (2015).DrugBank: Heparin (DB01109). [online] Available at: https://www.drugbank.ca/drugs/DB01109 [Accessed 19 Feb. 2015]. Drugbank.ca, (2015).DrugBank: Heparin (DB01109). [online] Available at: https://www.drugbank.ca/drugs/DB01109 [Accessed 19 Feb. 2015]. Drugbank.ca, (2015).DrugBank: Metformin (DB00331). [online] Available at: https://www.drugbank.ca/drugs/db00331 [Accessed 19 Feb. 2015]. Egred, M. (2005). Diabetic keto-acidosis and hyperkalaemia induced pseudo-myocardial infarction.Heart, 91(9), pp.1180-1180. Hassanein, M., Ewins, D. and Worth, R. (2000). Case presentation: An unusual cause of severe peripartum hypoglycaemia in type I diabetes.Diabetes Research and Clinical Practice, 50, p.215. Healey, J. and Healey, J. (2007).Diabetes. Thirroul, N.S.W.: Spinney Press. Karlsen, B. and Bru, E. (2000). Coping among adults with type I and type II diabetes.Diabetes Research and Clinical Practice, 50, p.231. Mayoclinic.org, (2015).Atenolol (Oral Route) Description and Brand Names - Drugs and Supplements - Mayo Clinic. [online] Available at: https://www.mayoclinic.org/drugs-supplements/atenolol-oral-route/description/drg-20071070 [Accessed 19 Feb. 2015]. Nhs.uk, (2015).Ventolin - Asthma medicines and drugs - NHS Choices. [online] Available at: https://www.nhs.uk/Conditions/Asthma/Pages/MedicineOverview.aspx?condition=Asthmamedicine=Ventolin [Accessed 19 Feb. 2015]. Nlm.nih.gov, (2015).Benazepril: MedlinePlus Drug Information. [online] Available at: https://www.nlm.nih.gov/medlineplus/druginfo/meds/a692011.html [Accessed 19 Feb. 2015]. Park, M., Freund, G., Donovan, S., Freund, G., Johnson, R. and Woods, J. (2010).Neuroendocrine mechanisms of behavioral changes induced by hypoglycemia. Urbana, IL.: University of Illinois. Schatz, D., Haller, M. and Atkinson, M. (2010).Type I Diabetes. Philadelphia: Saunders. Simmons, S. (2010). Acute dehydration.Nursing, 40(1), p.72. Taylor, R. (2012). Insulin Resistance and Type 2 Diabetes.Diabetes, 61(4), pp.778-779. Wittstock, M., Benecke, R. and Zettl, U. (2003). Therapy with Intravenous Immunoglobulins: Complications and Side-Effects.Eur Neurol, 50(3), pp.172-175.