Monday, December 30, 2019

Essay on Solutions for Terrorism - 976 Words

Terrorism is a controversial issue which spans the globe, Terrorism is defined as using force to influence or change a political decision. This is a relevant definition which can easily be related to in this day and age. There are many ideas about how to deal with this menacing threat one being a diplomatic solution some believe that the United Nations (UN) should step in and resolve it peacefully. Others oppose this idea and believe that the only solution is violence. Many up hold the idea of violence and that joint North Atlantic Treaty Organisation (NATO) and special forces operations should tackle the threat head on The history of terrorism can be traced back as far as the French revolution and Guy Fawkes. These acts of terrorism†¦show more content†¦One possible solution to preventing further blood shed is simple diplomacy. This theory is to meet the terrorists’ masterminds on common ground. Whether the terrorists may simply be paid to disappear or sign a ceasefire, treaty or some sort of amnesty has not yet been out lined to the public but the United Nations must be searching for a peaceful resolve without a major loss of civilian or military life. I believe that a diplomatic solution will never permanently abolish terrorism or postpone it in any way. In my opinion modern day terrorists are simply too radical to sign any kind of diplomatic contract with the western world that will not allow them to practice or express their believes. A more realistic campaign to end terrorism would be one of military, NATO and special forces campaigns across the middle-east and Asia. The assassination of leaders and masterminds and a crack down of people and political leaders that publicly express their support for bombings and public demise. Also organisations and entrepreneurs which secretly fund terrorist campaigns and weapon funds should be detained and prosecuted. This solution to terrorism is greatly opposed by many government officals and the public alike. Although many would like to think that there is a diplomatic solution the harsh truth is that there isn’t. To most the idea of terrorism is a car bomb in Jerusalem or an Arab firing aShow MoreRelatedSolution for Terrorism1480 Words   |  6 PagesII Problem Solution Essay The Solution for Terrorism Terrorism, which has been around for as long as people can remember has been on the rise for the past ten years. Terrorists use bombings, kidnappings, hijackings, murders as a way to achieve a political goal such as the release of so called â€Å"political prisoners†. These radicals do not just target the United States, but they focus on all parts of the world, in every way, shape and form. There are many different types of terrorism, for many differentRead MoreTerrorism : An Imperative For Economic, Political And Military Solutions1321 Words   |  6 PagesTERRORISM IN AFRICA; an Imperative for Economic, Political and Military Solutions. The bombings of the United States embassies in Tanzania and Kenya were marked indicators that Africa based terrorist groups were increasing threats to the interests of democratic societies in Africa those of all freedom loving societies the world over. Our policy makers have for long treated the Middle East and Asia as the main battlegrounds in the war on terror. Those regions have been joined by Africa inRead MoreThe Solution to Terrorism is Searching for Osama Bin Laden in Afghanistan610 Words   |  3 PagesThe Solution to Terrorism is Searching for Osama Bin Laden in Afghanistan Unfortunately in the past few months the United States has had to take safety precautions never seen before in America. Every public place has new rules and regulations of exactly what one can have. In entering somewhere such as Yankee Stadium, one can no longer have a backpack. One must also be patted down to check for weapons or bombs or whatever else one could possibly bring in that could cause the death count to riseRead MoreWhy Canada Should Pursue And Combat All Potential Terrorists On A Global Scale1541 Words   |  7 Pagesattacks, the world must discuss how to effectively combat terrorism in a way that minimizes harm. Throughout the following paper, I will summarize four contrasting responses to terrorism, included in a document adapted from Terrorism: How Should We Respond, of the Choices Program at the Watson Institute for International and Public Affairs at Brown University. I will then discuss why I believe Canada’s most effective response to terrorism would be a unique combination of Options Two and Four. I believeRead MoreAustin Iannitti Isis : Our Biggest Threat1432 Words   |  6 Pagesthis country, terrorism. In this paper, my focus is on ISIS and how dangerous their current recruitment of US citizens truly is. Terrorism is such a broad and controversial topic that it would be nearly impossible to properly write about it in 5-6 pages. That is why the specific topic of ISIS and their recruitment of US citizens is much more fitting. Many people have different opinions on how to handle terrorists and the war on terrorism, but not many people will defend terrorism. Most of thoseRead More Terrorism Essay1090 Words   |  5 Pages Terrorism is a form of violence that is difficult to define. The State Department defines terrorism as quot;premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents, usually intended to influence an audience.quot; Terrorism is not a random, undirected, purposeless act of violence, it has definite goals and violence is the medium of attaining those goals. The most well-known, recent instance of terrorism were the attacksRead MoreTerrorism Is A Huge Problem901 Words   |  4 PagesTerrorism is a huge problem affecting the American public in many ways. There have been 76 cases involving radical islamic terror attacks targeting the United States since the attacks of 9/11. (Mueller) The first issue with Terrorism is laws are not strict enough to deter terrorist from attacking. If terrorist believe they can get out of harsh punishments, then our current laws need to change. Killing innocent people is one of the most unethical acts someone can commit. The punishments for doingRead MoreMajor Problems That Contribute to the Dilemma of War Facing the World1410 Words   |  6 Pagesthreat of danger and violence. Solutions to this seemingly unjust situation are hard to find and when presented, often fall dramatically short of any practical value. It may be wise to find a new approaches to managing war and terrorism due to a seemingly non-progressive status on its current understanding. The purpose of this essay is to present a solutions based argument that is designed to address the solutions to violence and seek and ending to war and terrorism in a productive and effective mannerRead MoreEssay on History of Terrorism1536 Words   |  7 PagesWe define terrorism as using force to influence or change a political decision. Given that there may be an array of situations the U.S. government and the American people are faced with on a daily basis, most would probably agree in saying that terrorism is the most imperative issue we are not only becoming victims to, but are interminably asked to deal with as well as finding a solution for. The history of terrorism can be traced back as far as the French revolution. Some of these acts of terrorismRead MoreThe Department Of Homeland Security Essay1483 Words   |  6 Pageswith terrorism problem that has a long history in the U.S. Terrorism has been a threat to U.S. security since the 1800. Terrorists continue to use powerful secret communication strategies and unexpected tools to achieve their intention in the U.S. soil. For example, the 9/11 terrorism attack that killed the highest number of American citizens in history succeeded because terrorist used hijacked passenger planes to perform the attack (Lutz and Lutz, 2013). Although the most notorious terrorism activity

Sunday, December 22, 2019

Obamas Dnc Romneys Rnc Rhetorical Analysis - 1731 Words

RHETORICAL ANALYSIS: Obama VS. Romney It is not relatively easy to be a great speaker. To pull your audience to you, and have them consuming every sentence you prepare for them, every word you breathe. Your audience has to believe in you, trust you. They need hope and encouragement. Every word produced, and every expression given away, has to be a part of the plan. Essentially, prevailing as a great speaker is an art; an art that must be practiced and polished until a fresh gem is formed. President Barack Obama and Mitt Romney are not unaware of this powerful tool. Romney describes how every hard working American deserves a better future. He argues that America has been in an economic downfall and if a new president is not elected,†¦show more content†¦This is an easily accessible area for advancement for Mitt Romney. â€Å"I wish President Obama had succeeded because I want America to succeed. But his promises gave way to disappointment and division. This isnt something we have to accept.† Here, Mitt Romney places himself alongside the public, as a citizen only wanting their president to successfully lead their country, and not as a competitor running to become the next president. This addresses sentiment within Romney’s listeners giving them reasons to doubt their current president, appealing to pathos. Romney explains in his speech that Obama has not led America in the right direction because he does not have the â€Å"basic qualification that most Americans have,† which is running a business. Here, he uses logo s and ethos; both proving himself, and constructing his credence to the power business that is the United States. Romney has strategically placed two concealed platters before the nation. When the first is revealed, he describes how Obama cannot continue leading the country because of his lack of business know-how, leaving his listeners empty handed and starving. They are now waiting for what will fix their problems. The second covered tray is already brighter, and more appeasing, and it hasn’t even been revealed yet: It is Romney’s plan. It is his plan to better the country. To formulate jobs for people, â€Å"lots of jobs.† He describes a step-by-step process that is easy to

Saturday, December 14, 2019

Diabetes Mellitus Study Guide Free Essays

DIABETES MELLITUS * Chronic multisystem dz , abnormal insulin production / impaired utilization * Disorder of glucose metabolism related to absent/ insuff insulin supply or poor utilization of inslin that’s available * 7th leading cause of death * leading cause of blindness, ESRD, lower limb amputation * contributing factor for heart dz/ stroke risk 2-4 x higher than without DM * INSULIN – hormone produced by cells in islets of Langerhans of pancreas. Normal – continously into bloodstream ( basal rate), or increased w/ meals (bolus) * Normal glucose range 70-120 mg/dL, average insulin secreted daily 40-50 U 0. 6 U/kg * Glucagon, epinephrine, GH, cortisol oppose effects of insulin counterregulatory hormones they blood glucose lebels, stimulate glucose production by liver, movement of glucose into cells. We will write a custom essay sample on Diabetes Mellitus Study Guide or any similar topic only for you Order Now Insulin released from cells – as precursor / proinsulin thru liver enzymes form insulin C-peptide ( C-peptide in serum urine indicator of cell function) * in plasma insulin after meal storage of glucose as glycogen in liver/ muscle, inhibits gluconeogenesis, fat deposition, protein synthesis * Nl overnight fasting release of stored g;ucose from liver, protein from muscle, fat from adipose tissue * Skeletal muscle adipose tissue receptors for insulin insulin-dependent tissues Type I Diabetes Juvenile onset, insulin-dependent, s/s abrupt but dz process present for several yrs, 5-10%, absent or minimal insulin production, virus/toxins, under 40, 40% before 20 yr * s/s thirst( polydipsia), polyuria, polyphagia ( hunger), fatigue, wt loss, Kussmaul respirations * immune mediated dz; T-cells attack destroy cells * genetic predisposition exposure to virus * Idiopathic diabetes – not atoimmune, strongly inherited, in small # pt w/ type I DM , African/Asian * Predispositio n HLAs human leukocyte ntigens when exposed to viral infection cells destroyed * Long preclinical period, s/s develop when pancreas can no longer produce sufficient insulin to maintain nl glucose levels * Req. insulin from outside source exogenous insulin eg. injection * No insulin diabetic ketoacidosis (DKA) life threatening, results in metabolic acidosis * â€Å"honeymoon period† – newely diagnosed pts, tx initiated pt experience remissions req little insulin because cells produce suff amount of insulin lasts 3-12 mths then req permanent insulin Prediabetes * risk for developing diabetes glucose levels high but not high enough for diabetes diagnosis * impaired fasting glucose IGF 100-125 mg/dL * 2 hr oral glucose tolerance test OGTT 140-199 mg/dL * HgB A1C – 5. 7%-6. 4% risk for diabetes * Increased risk for developing DM type II – if no preventive measures develop DM in 10 yrs * Long term damage to body heart, blood vessels occur in prediabetes * Usual ly no symptoms * Maintain healthy weight, exercise regularly, healthy diet risk of developing diabetes Type II Diabetes * Adult onset, non-insulin dependent, 90% * 35, overweight, tendency to run n families * African Am, Asian, Hispanics, Amerian Indians Some insulin is produced but either insufficient for body needs / poorly utilized * Gradual onset, many yrs undetected hyperglycemia, 500-1000mg/dL * Early usu. asymptomatic; high risk pt screen annually * Fatigue, recurrent inf, vaginal yeast inf, candida inf, prolonged wound healing, visual changes * Risk factor obesity ( abdominal/ visceral ) * 4 major metabolic abnormalities * insulin resistance tissue no response to insulin / unresp receptors – receptors are located on skeletal muscles, fat liver * ability of pancreas to produce insulin – fatigued from compensatory prod of insulin, ell mass lost * inappropriate glucose by liver – too much glucose for body needs – type II * altered prod. of hormone s cytokines by adipose tissue ( adipokines) role in glucose fat metabolism – type II. Two adipokines ( adiponectin leptin ) affect insulin sensitivity altered mechanism in type I I * Metabolic syndrome risk for type II cardio dz, cluster of abnormalities, insulin resistance, insulin levels, triglycerides, HDLs, LDLs, HTN * Risk factors for metabolic syndrome central obesity, sedentary lifestyle, urbanization, westernization Gestational Diabetes During pregnancy, 7% of pregnancies * High risk – severe obesity, prior hx of gestational DM, glycosuria, polycystic ovary syndrome, family hx of DM II screened at 1st prenatal visit * Average risk OGTT at 24-28 wks of gestation * Higher risk of cesarean delivery, perinatal death, neonatal complications * Will have nl glucose levels within 6 wks postpartum but risk of DM II in 5-10 yrs * Nutritional therapy – 1st line , if doesn’t work insulin therapy Other specific types of diabetes * Due to other medical co ndition or treatment causes abn blood glucose levels * Damage , injury, destruction of cell function Cushing’s, hyperthyroidism, pancreatitis, cystic fibrosis, hemochromatosis, TPN * Meds corticosteroid (prednisone), thiazides, phenytoin(Dilantin), antipsychotics – clozapine * Tx underlying condition, stop meds Diagnostic studies * A1C 6. 5 % ; greater convenience, no fasting req, less day to day alterations during stress/ illness * FPG 126 – no caloric intake for 8 hrs prior testing ; confirmed by repeated testing another day; if has s/s and FPG126 further testing OGTT not req * 2 hr OGTT 200, glucose load 75g accuracy depends on pt preparation, and factors that influence results. False negative impaired GI absorption, falsely elevated severe restrictions of carbs, acute illness, meds corticosteroids, contraceptives, bed rest * IFG impaired fasting glucose IGT prediabetes, 100-125 mg/dL, IGT 2 hr 140-199 * Glycosylated HgB – HgB A1C amount of glucose attached to HgB molecules over lifespan ( RBC 90-120 days ) DM pts should check it regularly, done to monitor success of tx / make changes to tx 6. % – risk of retinopathy, nephropathy, neuropathy dz affecting RBCs – can affect A1C results Treatment * Goals s/s, promote well being, prevent acute complications, prevent/ delay onset/ progression; met when pt maintain glucose level as near to nl, daily decisions about food intake, blood glucose testing meds, exercise * Rapid acting insulin – lispro (Humalog), aspart (NovoLog) – onset 0-15 min, peak 60-90 min, dur. -4 hrs , clear, give 15 min before meals ; bolus * Short acting – Regular (Humulin R, Novolin R) onste ? -1 hr, peak 2-3hr, dur 3-6 hrs, injected 30-45 min before meals; bolus * Intermediate acting – NPH, basal insulin, onset 2-4hrs, peak 4-10hrs can result in hypoglycemia, dur. 10-16 hrs, can be mixed w/ short rapid, cloudy, must be agitated before adm. Long acting – glargine (Lantus), detemir ( Levemir) addition to mealtime insulin, type I, to control glucose between meals overnight, without it risk of developing DKA, no peak – risk of hypoglycemia , not diluted or mixed, clear; onset 1-2 hrs, dur. 24hrs +, basal * Combination pt don’t want 2 separate injections, 2 type of insulin mixed together, not same control of glucose levels as with basal-bolus; ahort/rapid mixed w/ ntermediate provide both mealtime basal coverage * Storage vials room temperature 4 wks, heat freezing alter insulin, between 32-86 F; avoid direct exp to sunlight, extra insulin in fridge/ traveling-thermos, Prefilled syringes – sight impaired, manual dexterity; syringes w/ c;udy solution in vertical position needle up to avoid clumping of suspension, rolled gently, warm before injection. * Injection abdomen fastest absorption arm, thigh, buttock, rotate within 1 particular site; never into site that’s about to be exercised (heat = absorption onset), vial 1ml=100U, SQ 90 degrees * Needles ? 5/16 inch (short – children, thin adults); gauges 28,29,30,31 – higher gauge = smaller diameter = more comfortable injection * Recapping done only by person using syringe, never recap syringe used by pt; alcohol swabs in health care facility before inj to HAI, at home soap water * Insulin pump – continuous subq insulin infusion 24 hr/d basal rate , loaded w/ rapid acting insulin via plastic tubing to catheter in subq tissue. At meal time – bolus . (+) tight glucose control, similar to nl physiologic pattern, nl lifestyle, more flexibility (-) infection at site, risk of DKA, cost Problems w/ insulin therapy * Hypoglycemia * Allergic rxn – itching, erythema, burning around inj. site, may improve w/ low dose antihistamine ; rxns to Zinc, protamine, latex , rubber stoppers on vials * Lipodystrophy – atrophy of subq tissue if same inj site used Somogyi effect – rebound effect, overdose of insulin induces undetected hypoglycemia in hrs of sleep, produces glucose decline in response to too much insulin s/s headaches, night sweats, nightmares ; if in morning glucose – adcised to check glucose levels at 2-4am if hypoglycemia present at that time. If it is insulin dosage in affecting morning blood glucose is reduced TX : less insulin * Dawn phenomenon – hyperglycemia on awakening in the morning due to release counterregulatory hormones in predawn hrs ( possibly GH/cortisol) adolescence/ young; TX: adjustment in timing of insulin adm. or in insulin. Predawn fasting glucose levels insulin production from pancreas , s. ff wt gain, hypoglycemia * Meglitinides repaglinide(Prandin) insulin prod, less likely cause hypoglycemia because more rapidly absorbed/eliminated, cause wt gain, take 30 min before meal, not if skipped * Biguanides – Metformin glucose lowering, first choice DM II/prediabetes, obese â€Å"starch blockers† slow down carbs absorption, taken with â€Å"first bite†, effectiveness check 2 hr postprandial glucose levels * Thiazolidinediones – Avandia â€Å"insulin sensitizers†, for pts w/ insulin resistance, don’t insulin Production, not cause hypoglycemia; risk of MI, stroke , not for pt w/ HF * DPP4 inhibitor – Januvia new class, slow inactivation of incretin hormones; DDP4 inh are glucose dependent = risk of hypoglycemia, no wt gain * Incretin mimetics – exenatide (Byetta) stimulate incretin horm which are in DM II, stim. of insulin, Suppress glucagon, satiety = caloric intake, slows gastric emptying; prefilled pen * Amylin analog Amylin hormone secreted by cells, co secreted w/ insulin Pramlintide (Symlin) is Synthetic , type I II when glucose level not achieved w/ insulin at mealtimes , subq thigh or abdomen NOT arm , not mixed w/ insulin – cause severe hypoglycemia ! * blockers — masks s/s of hypoglycemia, prolong hypoglycemic effects of insulin * Thiazide / loop diuretic — hyperglycemia, K Nutrition Type I meal planning, exercise, developed w/ pt’s eating habits activity pattern in mind, day to day consistency in timing amount of food eaten * Type II wt loss = improved insulin resistance, t otal fats simple sugars = calorie carbs intake; Spacing meals , wt loss 5-7% = glycemic control, regular exercise * Carbohydrates sugar, starches, fiber whole grains, fruits, veggies, low fat milk included min 130g/d * Glycemic index GI describe blood glucose levels 2 hrs after carb meal , GI of 100 = 50g glucose * Fiber intake 14g/1000 kcal * Fats 7% of total calories , 200mg/d cholesterol trans fats * Protein same for diabetes / normal renal function / gen. population, high proein diet not recommended * Alcohol inhibits gluconeogenesis ( breakdown of glycogenglucose) by liver; severe hypoglycemia in pt on insulin / oral hypoglycemic dx. Moderate alcohol consumption 2 drinks men, track carbs w/ each meal daily, set limit for max amount ( depends on age, wt, activity level) usu. 45-60g /meal ; also My Pyramid plate method ( ? nonstarchy veggies, ? starch, ? protein, nonfat milk fruit * Exercise 150 min/wk moderate intensity aerobic; DM II resistance training 3 x wk, most adults should 30 min moderate intensity activity 5 x most days * Exercise insulin resistance, blood glucose, wt loss which insulin resistance ( may need less meds), triglycerides, LDL, HDL, BP, circulation * Start slowly w/ progression. Insulin, sulfonylureas, meglitinides risk of hypoglycemia with increase physical activity esp if exercise at peak of dx or no food intake. Effect may last 48 hrs post exercise Exercise 1 hr after meal, have 10-15g carb snack every 30 min. during exercise (prevent hypoglycemia). Before exercise glucose immediate info about glucose levels – can make adjustments diet, activity, meds * Recomm. for all insulin-treated pts * Multiple insulin injections – 3 or more x day, done before meals, before after exercise esp in type I, whenever hypoglycemia suspected, when ill (stress), 2 hrs after start of meal – if effective Pancreas transplantation * For pt w/ ESRD, plan to have kidney transplant * Pancreas transplanted following kidney transplant, pancreas alone –rare * Pancreas alone only if hx of severe metabolic complications, emotional roblems w/ exogenous insulin, failure of insulin-based management * Improve quality of life, no exogenous insulin need, no dietary restrictions * Only partially able to reverse renal neurologic complications * Need lifelong immunosuppression to prevent rejection * Pa ncreatic islet cell transplantation in experimental stage, islets from deceased pancreas via catheter into abdomen portal vein Nursing management * Pt active participant in management of diabetes regimen * Few/no episodes of acute hyper/hypoglycemic episodes, maintain glucose level near nl * Prevent/ delay chronic complications * Adjust lifestyle to accommodate DM regimen w/ min. stress Nursing assessment Past hx mumps, rubella, viral inf, recent trauma, stress, pregnancy, infant9lbs, Cushing, acromegaly, family hx of DM * Meds compliance w/ insulin, OA; corticosteroids, phenytoin, diuretics * Eyes sunken eyeballs, vitreal hemorrhages, cataract * Skin dry, warm, inelastic, pigmented lesions on legs, ulcers(feet), loss of hair on toes * Respiratory Kussmaul – rapid, deep * Cardio hypotension, weak rapid pulse * GI dry mouth, vomiting, fruity breath * Neuro altered reflexes, restlessness, confusion, coma * MS muscle wasting * Also electrolyte abnormalities, fasting gluc ose level 126, tolerance test 200, leukocytosis, BUN, creatinine, triglycerides, cholesterol, LDL, HDL, A1C 45yrs without risk factors for diabetes Acute intervention * Hypoglycemia, DKA, HHS – hypersmolar hyperglycemic syndrome * Stress f acute illness/ surgery counterregulatory hormones hyperglycemia ( even minor upper resp infection or flu can cause this) * Continue regular diet, noncaloric fluids (broth, water, diet gelatin, decaffeinated), take OA/insulin as prescribed, monitor glucose Q4H * Acutely ill DM I , glucose240 test urine for ketones Q3-4H , medium/large report to MD * Ill eat than normal continue OA meds/ insulin as prescribed + carbohydrate containing fluids (soup, juices, decaffeinated) * Unable to keep fluids/ food down MD * Don’t stop insulin when ill counterregulatory mechanisms will glucose level * Food intake important body needs extra energy to deal w/ stress Extra insulin may be needed to meet this demand, prevent DKA in DM I * Intraoperati ve IV fluids insulin before, during, after sx when there’s no oral intake In DM II w/ OA – explain it’s temporary measure, doesn’t mean worsening of DM * If contrast medium (w/iodine) Metformin discontinued 1-2 days before sx, resumed 48 hrs after sx risk of acute renal failure. Resume after kidney function nl ( creatinine checked is nl) * Insulin adm teach proper administration, adjustments, side effects, assess response to insulin tx, if new to insulin assess ability to manage tx safely, cognitive status, ability to recognize/ tx hypoglycemia, if cognitive skill another responsible person must be assigned; diff to self inject/ afraid of needles * Follow ups inspect injection sites ( lipodystrophy ) * Short term memory deficit OA or short acting OA cuz doesn’t cause hypoglycemia * OA w/ diet activity, not take extra pill when overeating * Diligent skin care dental aily brushing/ flossing, inform dentist about DM * Foot care !!! scrapes, burns treated promptly monitored nonirritating antiseptic ointment dry sterile pad not start to heal in 24 hrs or infection MD * Regular eye exams * Travel – sedentary walk Q2H to prevent DVT prevent glucose , carry snacks, extra insulin COMPLICATIONS Diabetic Ketoacidosis DKA * Diabetic coma Profo und deficiency of insulin hyperglycemia, ketosis, acidosis, dehydration * Most likely in DM I pts, but sometimes in DM II ( severe illness/ stress) * Causes illness, infection, undiagnosed DM I, inadeq insulin dosage, poor self management, neglect * Insulin – glucose cant be properly used for energy fat broken for fuel ketones (by product) serious when excessive in blood alter pH, cause metabolic acidosis ketonuria (in urine) electrolyes depleted; impaired protein synthesis, nitrogen lost from tissues * Untreated depletion of Na, K, Cl, Mg, phosphate hypovolemiarenal failure/ retention of ketones glucose shockcoma (result of dehydration, lytes acidosis)death * s/s dehydration, poor turgor, dry mm, HR, orthostatic hypotension, Kussmaul , abdominal pain, sunken eyeballs, acetone fruity odor, early s/s lethargy,weakness * blood glucose 250, arterial blood pH IV access begin fluid/ electrolyte replacement NaCL 0. 45% or 0. 9% to restore urine output 30-60 ml/hr BP * gluco se level approach 250 5% dextrose added * Incorrect fluid repl sudden Na cerebral edema * Obtain K level before insulin started – insulin further K * Insulin withheld until fluid resuscitation K3. 5 * Too rapid IV fluids rapid lowering of glucose cerebral edema Hypersmolar hyperglycemic syndrome HHS * Life threatening, able to produce insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, ECF depletion * Less common than DKA * Often 60, in DM II Causes UTI, pneumonia, sepsis, acute illness, new DM II * Asymptomatic in early stages so glucose can rise very high 600mg/dL * The higher glucose in serum osm neurologic manifestations somnolence, coma, seizures, hemiparesis, aphasia * Resemble CVA (stroke) determine glucose level for correct dx * Ketones absent in urine * Tx similar to DKA * First IV 0. 45% or 0. 9% NS, regular insulin given after fluid replacement * Glucose fall to 250 – add glucose 5% dextrose * Hypokalemia not as significant as in DKA * HHs require greater fluid replacement * Assess VS, IO, turgor, labs, cardiac / renal monitoring related to hydration electrolyte levels, mental status, serum osm Hypoglycemia Low blood glucose glucagon epinephrine defense against hypoglycemia * s/s of epinephrine shaking, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor * brain req constant supply of glucose when affect mental functioning LOC, diff speaking, visual disturbances, confusion, coma, death * Hypoglycemis unawareness no warning signs until glucose reach critical point incoherent, combative, LOC often elderly w/ beta blocker meds * When very high glucose level falls too rapidly, too vigorous management of hyperglycemia * Mismatch in timing of food intake peak of isulin/ OA * Can be quickly reversed Check glucose levels, if contain fat that glucose absorption; check glucose in 15 min * Still 70 eat regular meal/snack low peanut butter, bread, cheese, crackers, check glucose in 45 min * No significant imptovement after 2-3 doses of 15g carb MD * Pt not alert to swallow 1mg glucagon IM in deltoid muscle ( nausea, vomiting rebound hypoglycemia) * Hospital setting 20-50ml of 50% dextrose IV push * CHRONIC COMPLICATIONS OF DM Angiopathy * end organ dz from damage to blood vessels (angiopathy) 2nd to chronic hyperglycemia * leading cause of diabetes-related deaths, 68% deaths due to cardio, 16% strokes * causes: accumul. Of glucose metabolism by products (sorbitol) damage to nerve cells, abnormal glucose molecules in basement membrane of small blood vessels (eye,kidney), derangement in RBCs – oxygenation to tissues * DM I keep blood glucose levels near to normal – retinopathy nephropathy (complications of microvascular complications) Macrovascular complications * Dz of large, medium size blood vessels , earlier onset in pt w/ diabetes * W 4-6x risk of cardiovascular dz, M 2-3 x * risk factors obesity, smoking, HTN, fat intake sedentary lifestyle * Smoking injurious to pt w/DM, risk for blood vessel dz, CV dz, stroke, lower extremity amputations * Maintain BP control – prevention of CV / renal dz Microvascular complication * Thickening of vessel membranes in capillaries/ arterioles in response to chronic hyperglycemia * Are specific to diabetes Eyes ( retinopathy ), kidneys ( nephropathy ), skin (dermopathy ) * Some changes present w/DM II at time of dx, but s/s not appear u ntil 10-20 yrs after onset of DM * Diabetic retinopathy – microvascular damage to retina, most common cause of blindness 20-74 yrs old. Nonproliferative most common, partial occlusion of small blood vesselin retina microaneurysms, Proloferative most severe, involves retina vitreous neovasculization ( form new blood vessels to compensate) if macula involved vision is lost * DM II dilated eye exam at time of diagnosis annually, DM I within 5 yrs after DM onset * Laser photocoagulation * Virectomy * Glaucoma Nephropathy – microvascular complication, damage to small blood vessels that supply glomeruli / kidney. Leading cause of ESRD in US; same risk for DM I II HTN, smoking, genetic predisposition, chronic hyperglycemia * Screen for nephropathy annually w/ measurement albumin / creatinine ratio * If micro/macroalbuminuria ACE inh ( lisinopril ) or angiotensin II rec antagonist ( Cozaar ) tx HTN delay progression of nephropathy * Aggressive BP management tight glucose control Neuropathy Sensory neuropathy (PNS)– loss of protective sensation in lower extremities amputations * Hyperglycemia sorbitol fructose accumulate in nerves damage * Distal symmetric polyneuropathy hand/ feet bilaterally * Loss of sensation – to touch/ temperature * Pain burning, cramping, crushing, tearing , at night * Paresthesias tingling , burning, itching * At times skin too sensitive (hyperesthesia) * Foot injury ulcerations without having pain TX : blood glucose control, topical creams capsaicin ( Zostrix ) 3-4 X/d pain in 2-3 wks, selective serotonin, norepinephrine reuptake inh ( Cymbalta ), pregabali ( Lyrica ), gabapentin Autonomic neuropathy – can affect all body systems lead to hypoglycemic unawareness, bowel incontinence, diarrhea, urinary retention Complications : * Delayed gastric emptying ( gastroparesis ) anorexia, n/v, reflux, fullness, can trigger hypoglycemia by delaying food absorption * Cardiovascular abnormalities , postural hypotension assess change from lying, sitting, standing, painless MI, resting tachycardia HR * Risk for falls * Sexual dysfunction ED in diabetic men 1st s/s of autonomic failure * Neurogenic bladder urinary retention, diff. voiding, weak stream empty bladder Q3H in sitting position, Crede maneuver ( massage lower abdomen) * Cholinergic agonists benthanechol Feet lower extremities Risk for foot ulcerations lower extremity amputations * Sensory neuropathy major rosk for amputations due to loss of protective sensations LOPS * Unaware of foot injury, improper footwear, stepping on objects w/ bare feet * Screening using microfilament insensitivity to 10g Semmes-Weinstein risk for ulcers * Proper footwear, avoid injuries, diligent skin care, inspect feet daily * PAD risk for amputations due to blood flow to lower extremities * PAD s/s intermittent claudication, pain at rest, cold feet, loss of hair, cap refill, dependent rubor ( redness when extr in dependent position ) * DX : ankle brachial index ABI angiography * Casting to redistribute weight on plantar surface * Wound control debridement, dressings, vacuum, skin grafting etc. Charcot’s foot ankle foot changes joint deformity need fitted footwear * Acanthosis nigricans – dark, coarse, thickened skin in flexures neck * Necrobiosis lipoidica diabeticorum – DM I, red-yellow lesions w/ atrophic skin , shiny transparent revealing blood vessels under the surface – young women * Granuloma annulare – DM I, autoimmune, partial rings of papules, dorsal surface of hands/ feet Infection Candida albicans, boils, fur uncles, bladder infections (glycosuria) antibiotics Gerentologic * reduction in cells, insulin sensitivity, altered carbohydrate metabolism * 20 % 65 YO * # of conditions treated w/ meds that impair insulin action ( How to cite Diabetes Mellitus Study Guide, Essay examples

Friday, December 6, 2019

Management Information Essay Example For Students

Management Information Essay Planning for Management Information SystemPlanning for Management Information System The biggest challenge and most critical success factor in reengineering projects are persuading the people within the organization to cooperate. When you begin to computerize a legacy system considers the advantages; reduced clerical cost, quicker processing time and improved customer service. Everyone knows that the computer capabilities alone make life a lot easier for all managers. The advantage of time and accuracy spread over the lifespan of the information system means improved long-term vision and focus for top, middle and lower managers.A management information system (MIS) focus is on information that management needs to prepare its job. This task becomes much more difficult when the major players have a tradition of high independence, are often confrontational to management, and are irreplaceable independent contractors. CIOs in major business organizations face exactly this situation; furt her complicated by the fact that the reengineering effort is crucial to the continued existence of the organization. Such discussion has driven the software industry to focus attention on software specifically designed to support the team approach essential to most service and customer oriented organizations. The importance of teamwork can not be over emphasize in achieving overall organizational goals, and the need to capture and manage an organizations knowledge base remain crucial. This teamwork enables the organization to achieve and sustain competitive advantage in their business. In considering the framework for an information system (IS) each level operational, tactical and strategic planning requires different IS. At the operational planning system, the IS collect, validate and record transactional data relating to acquisition or disbursement of resources. The data for account receivable and payables, payrolls, inventory level, shipping data, printed invoice and cash receipt s recorded as they occur. The operational-level IS characteristic are repetitive, predictable, emphasizes the past and detailed in nature just to name a few. The focus of the operational system is the daily tasks performed at the user level. The operational level manager uses this data to check every day tasks, i.e. ordering, shipping, inventory control, the essence of the business processes. We will write a custom essay on Management Information specifically for you for only $16.38 $13.9/page Order now The second level in the framework is the tactical system. This system provide middle-level managers with information to monitor and control operation while allocating their resources efficiently.The data is summarized, aggregated, or analyzed with a wide range of reports, i.e., summary, exception and ah hoc reports. The tactical information system differs from operational information system in the basic purpose: operational support the execution of tasks and a tactical information system supports a manager control over those tasks under their area of supervision as well as the allocation of resources to meet the company objectives set by top management. The data input and the information produced as outputs differ from the type of data involved, tactical characteristics are periodic in nature, with unexpected findings, comparative in nature with both internal and external sources. The tactical information system purpose and the regularity of report produced within the information sys tem are drastically different from an operational system. The third level in the framework is strategic planning, designed to provide top managers with information that assist them in making long-range planning decisions for the business.The different in strategic and tactical are not always clear, because both types of information systems may use some of the same data, you might say that the systems sometimes overlap with the difference being in the data that the system uses. Typically, top management uses strategic planning system to forecast long-range company objectives. The characteristics are ah hoc basis, unstructured format, external source, and subjectivity, summary and predictive in nature. A MIS provides information for effective planning and tactical decision making, which is the foundation of operational level data system. A tactical planning system provides middle-level management with the ability to monitor and control resources.The tactical information system does not support the execution of operational tasks, but allow man agers visibility over the operation. Information systems are costly, to deploy and maintain, yet the maximization of economic value of IS in the long-run balance out over the initial set-up cost. The right software products enable teams of people to integrate their knowledge, work processes and applications to achieve improved business effectiveness.It has been suggested that the implementation of such technologies is more difficult and yields more unintended consequences than is typically acknowledged. First, how such technologies are used reflect the effects. Second, how these technologies are likely used when alternative tools co-exist, meaning predictability is difficult from technological characteristics. Third, because people use groupware with other people, one persons choices about how to use groupware may have consequences for other group members, user satisfaction. .ua2758568576d032b1ea9cc07ee9f83fb , .ua2758568576d032b1ea9cc07ee9f83fb .postImageUrl , .ua2758568576d032b1ea9cc07ee9f83fb .centered-text-area { min-height: 80px; position: relative; } .ua2758568576d032b1ea9cc07ee9f83fb , .ua2758568576d032b1ea9cc07ee9f83fb:hover , .ua2758568576d032b1ea9cc07ee9f83fb:visited , .ua2758568576d032b1ea9cc07ee9f83fb:active { border:0!important; } .ua2758568576d032b1ea9cc07ee9f83fb .clearfix:after { content: ""; display: table; clear: both; } .ua2758568576d032b1ea9cc07ee9f83fb { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ua2758568576d032b1ea9cc07ee9f83fb:active , .ua2758568576d032b1ea9cc07ee9f83fb:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ua2758568576d032b1ea9cc07ee9f83fb .centered-text-area { width: 100%; position: relative ; } .ua2758568576d032b1ea9cc07ee9f83fb .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ua2758568576d032b1ea9cc07ee9f83fb .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ua2758568576d032b1ea9cc07ee9f83fb .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ua2758568576d032b1ea9cc07ee9f83fb:hover .ctaButton { background-color: #34495E!important; } .ua2758568576d032b1ea9cc07ee9f83fb .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ua2758568576d032b1ea9cc07ee9f83fb .ua2758568576d032b1ea9cc07ee9f83fb-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ua2758568576d032b1ea9cc07ee9f83fb:after { content: ""; display: block; clear: both; } READ: A Lesson Before Dying EssayThe measurement for an effective MIS must be the users; usage and satisfaction have a strong correlation. Obvious, the effectiveness of MIS depends upon the use of the system and if the employees accept it. The information system department, managers and users together make the MIS process successful. The managers implement the MIS, their behavior and motivation play an important part in the variables for the system to be effective.Each designed MIS produce information for decision making throughout the organization.Lets examine several case studies with the implementation of MIS as seen in three distinct companies, an insurance company, a food m arketing company and a social service agency. The insurance company normal routine consisted of tons of policy paperwork generated daily to accomplish the company objectives.The company started on line systems supporting policy screening, creation and issuance in the 70s. An employee could key in new application information at his or her computer terminal, after the compilation of information an underwriter can evaluate the insurability of potential customers.After the approval process, the information system produces a policy data sheet. This business process makes it possible to handle inquiries from individual policyholders and sales agents seeking personal data information about policyholders. The home office linked to all locations of their sales agencies allowing sales agents to inquire on-line about policies with the capability to edit application information at their site. The home office can still update policies as well. Yes, this service provides the agencies with a competitive advantage in product marketing and custo mer service. The home office outsourced and purchased software that enable the sales agents to analyze alternative companies product and service options, resulting in winning the customers loyalty and a quicker sales. The company continues to grasp the future for innovations and anticipating their customers needs in the future.This approach along ensures valuable information for the senior-level management to plan as well as reduce overhead cost with improved productivity and better decision-making ability. Next, let look at the food industry and view how information system improved their process. The MIS geared toward physical distribution at the operational level, where update orders and invoices sent to the distribution centers and the system updates the account receivable and associate system files. The system prints invoices at the origin and destination location, resulting in reduced cost and faster payments equal more cash flow. The food company produced numerous reports that enabled the managers to conduct on-line credit checks from their account receivable status report, and identify delinquent accounts, before shipping the merchandise to the distribution centers.The customer services personnel have immediate access to open account allowing for immediate visibility and response to customer inquiries about deliveries and shipments, similarly cash payments received automatically applied to customers on-line account.Let us not forget to look at the marketing advantages with MIS as well. Sales analysis reports reflect the customers history product information file; this data generates report by product line in each territory each month for middle-level managers to forecast demands for any specific product item.Normally, this begs the question about production and if the company can continue to support the demands of the customers. At this junction, the IS gives managers additional insight about demand and the need to forecast for future buys. The company established a bill-of-material file, which computerized the ingredients for each product line and created batch size for all products. This process minimized the work process and improved the manufacturing ordering process for each customer batch orders.The product specification file served as the database of reference information enabling the manager the ability to print text on all purchase orders. The text file produced a finished goods inventory, which is transferred to the branch warehouse stockroom in v arious locations; this information is based on sales analysis report (demand). In the finance and administration department, the updated account receivables correlates with customers billing and cash receipts. A monthly exception report generated from the aged balances spits out a collection letter automatically to the respective recipients at specified intervals. The MIS enabled the food marketing company to process orders more timely, manage inventories more efficiently and organize their production section. Bottom line cost savings of MIS results in more revenue and a better customer relationship and senior-level managers focusing their attention on emerging trends in the market. .u480ae7b40e19571c43b3673c36d1d09f , .u480ae7b40e19571c43b3673c36d1d09f .postImageUrl , .u480ae7b40e19571c43b3673c36d1d09f .centered-text-area { min-height: 80px; position: relative; } .u480ae7b40e19571c43b3673c36d1d09f , .u480ae7b40e19571c43b3673c36d1d09f:hover , .u480ae7b40e19571c43b3673c36d1d09f:visited , .u480ae7b40e19571c43b3673c36d1d09f:active { border:0!important; } .u480ae7b40e19571c43b3673c36d1d09f .clearfix:after { content: ""; display: table; clear: both; } .u480ae7b40e19571c43b3673c36d1d09f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u480ae7b40e19571c43b3673c36d1d09f:active , .u480ae7b40e19571c43b3673c36d1d09f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u480ae7b40e19571c43b3673c36d1d09f .centered-text-area { width: 100%; position: relative ; } .u480ae7b40e19571c43b3673c36d1d09f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u480ae7b40e19571c43b3673c36d1d09f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u480ae7b40e19571c43b3673c36d1d09f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u480ae7b40e19571c43b3673c36d1d09f:hover .ctaButton { background-color: #34495E!important; } .u480ae7b40e19571c43b3673c36d1d09f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u480ae7b40e19571c43b3673c36d1d09f .u480ae7b40e19571c43b3673c36d1d09f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u480ae7b40e19571c43b3673c36d1d09f:after { content: ""; display: block; clear: both; } READ: History of Kickboxing Martial Arts EssayA social service department utilizes MIS in the public sector by providing financial assistance to the residences, i.e. medical assistance, food stamps, facilitate foster home and adoption, day care, school service, family planning, housing and legal services. The MIS processes new applications and payments. The applicant applies and become eligible then the system creates an on-line record for them. The system automatically prints an identification card for the payroll master file that entitles the recipient to service for which the bill goes to the social service department. An on-line inquiry and update of the applicant record are also possible.The payroll master file sorts, generates the welfare check, and lists them on the payroll register, which generates historical report for managers.In all three case studies, the information systems support transactional processing. The user involvement in each of the project selection ensures the effectiveness of the information system and its acceptability. How do you measure utilization and performance in MIS? The term utilization is the extent that the intended users use the information system (IS) for its intended purpose.The term performance measures the improvement of the business process that supports the IS implementation. These measurements observed through business records, visual or electronic inspections and take the personal opinions and attitudes out of the decision-making loop. The multiple variables sometimes are difficult to identify, but the IS department must be impartial if the true value is realized of a successful IS project. A successful IS project can be measure best with psychometric tests of attitude, interests, and opinions such as user information satisfaction in the broadest sense. The performance measures of the business determine the effectiveness of the MIS. You can see that information technology give companies a competitive edge, once an information based service enters other company either catch up or eliminate the original innovator competitive advantage thus raising the stake for those participating in the marketplace. Today, company can link its customer to its order entry system, thus improving efficiency and improve business performance. Sure, an effective information system, if efficient reduces needless paperwork and allows the customer access to available stock information before committing to the purchase of goods and services. Let not forget about effective too, the information system provide better service to its customers, for instance, i.e. the creation of electronic travel supermarket through on-line reservation system, i.e. www.priceline.com or www. 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Burr Ridge, Illinois. Irwin McGraw-Hill. Trevino. L.K., R.L. Daft, and R.H. Lengel. (1987). Media Symbolism, Media Richness, and Media Choice in Organizations: A Symbolic Interactionist Perspective, Communication Research. 14(5): 553Category: Technology