Nursing Care of the Patient
With Endocrine Disease
Køren K. Gi,ttùngs
Unfolding Case Study #36 T,, Jenny
Jenrry is a56-year-old female who is scheduled for a routine primary care provider's
(PCP) visit to follow-up on her hypertension. She reports no signi-ficant complaints
other than her vision being blurry; she states, "I need to go to the eye doctor to
have my eyes checked." At the conclusion of her visit, the PCP orders a basic meta-
bolic panel (BMP) and complete blood count (CBC) to be drawn. Jenny receives a
phone call 2 days later from her PCP's office to schedule an appointment for later
that day. Jenny is told that her blood sugar is elevated. At her appointment, Jenny
and the nurse begin by reviewing Jenny's risk factors for diabetes.
Exercise 6-lz Select øl.l tltøt øþþly
Identify risk factors commonly associated with diabetes mellitus:
E Obesiry
fl ege less than 45 years
E Caucasianrace
I Family history
D History of gestational diabetes
E History of delivering babies over 9 pounds
eResource 6-l: To review risk factors associated with diabetes, consult
Epocrates Online: [Pathway: -+ hnpt//online.epocrates.com -> select the
"diseases" tab -+ enter "Diabetes" into the search field -+ review content
related to "risks"]
Jsnny reports that her mother and grandmother were diabetics. She is also over
45 years old and overweight at 5 feet 2 inches anld 2OO pounds. Jenny still finds it
hard to believe that she could be diabetic since she is feeling okay; she asks the
nurse to explain to her how diabetes occurs.
Anstpers to tbis cbapter begin on page 231
215
216 CHAPTTR 6: ENDOCRINE DISEASE
Exercise 6-22 Multiple-cltoí.ce question
The nurse educating Jenny on type 2 diabetes determines that she understands tþs
information when she states:
A. "I am not producing any insulin because of a problem with my immune
system."
B. "I will need to take insulin for the rest of my life.,'
c. "I'm not making enough insulin or my body isn't as sensitive to it.,,
D. "I won't need to make any dietary changes if I take my medicine."
Exercise 6-32 Møtcbing
Match the type of diabetes in Column A with its typical characteristics in Column B
Answers in Column A can be used more than once.
ColumnA Column B
A. Type L diabetes Onset is usually under 30 years old
B. Type 2 dial¡etes patient is often thin at time of diagnosis
Treated with diet, exercise, and oral agents
Patient is often obese at time of diagnosis
Antibodies are present in the body
Patients require insulin for life
G) ;ffi::i,"",'J ^ä¿'"äîîî#."å:*t'#i;:lË:iffi,îå:ä. _enter "Type 2 Diabetes" into the search field -+ in the "overview,'section,
select "pathophysiology" and review content]
By the time it is Jenny's turn to see her PCP, she has a beginning understanding
about diabetes. Her PCP sits with her and begins by reviewing hãr hboratory re-
sults. Her fasting plasma glucose from her last visit was 236 mg/dL.The pCp lists
some typical signs and symptoms of diabetes, and he asks J.
This case discusses a 62-year-old woman with type 1 diabetes and hypoglycemia unawareness who underwent professional continuous glucose monitoring on two occasions. The initial monitoring revealed no overnight hypoglycemia but significant hyperglycemia throughout the day. Therapy was adjusted based on these results. Follow-up monitoring showed fewer post-meal excursions but continued hyperglycemia after high-fat dinners. Examination of the patient's diary revealed she had been inaccurately recording her blood glucose levels. Professional CGM was useful in identifying patterns of hyperglycemia and informing changes to the patient's insulin regimen and dietary advice.
A 8-year old girl was admitted to the emergency department with symptoms of diabetic ketoacidosis. Testing revealed high blood sugar and laboratory results confirmed type 1 diabetes. She was treated with intravenous fluids and insulin to stabilize her condition. Her parents were provided diabetes education over multiple sessions to learn about type 1 diabetes, blood glucose monitoring, insulin administration, dietary management, hypoglycemia, and sick day rules. Through counseling, the parents' understanding of managing their daughter's condition improved.
The document discusses non-drug management of diabetes mellitus through lifestyle changes including diet and exercise. It covers definitions of diabetes, types of diabetes, principles of diabetes care like learning about diabetes and monitoring health indicators. It provides details on healthy diet, types of exercise, testing before exercise and sample exercise programs. The non-drug management aims to control blood sugar levels through patient education, monitoring and encouraging lifestyle modifications.
The document summarizes non-drug management of diabetes mellitus. It discusses lifestyle changes like following a healthy diet, regular exercise, and weight control as important non-drug approaches. Monitoring health indicators like blood glucose, blood pressure, cholesterol and attending regular medical checkups are also emphasized to manage diabetes and prevent complications long-term without relying solely on medication.
The document summarizes non-drug management of diabetes mellitus. It discusses lifestyle changes like following a healthy diet, regular exercise, and weight control as important non-drug approaches. Monitoring health indicators like blood glucose, blood pressure, cholesterol and attending regular medical checkups are also emphasized to manage diabetes and prevent complications long-term without relying solely on medication.
Diabetes refers to a group of diseases that affect how the body consumes blood sugar (glucose). Glucose is an important source of energy for the cells that make up muscles and tissues. It is also the main source of energy for the brain.
This patient is presenting with classic symptoms of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Her key symptoms include polyuria, polydipsia, and unintentional weight loss which developed acutely over 3 weeks. She now appears lethargic. HHNS is a life-threatening complication of diabetes that develops in patients with type 2 diabetes. Urgent treatment is needed to correct the hyperglycemia and dehydration through IV fluids and insulin therapy. She requires admission to the hospital for close monitoring and management.
This case discusses a 62-year-old woman with type 1 diabetes and hypoglycemia unawareness who underwent professional continuous glucose monitoring on two occasions. The initial monitoring revealed no overnight hypoglycemia but significant hyperglycemia throughout the day. Therapy was adjusted based on these results. Follow-up monitoring showed fewer post-meal excursions but continued hyperglycemia after high-fat dinners. Examination of the patient's diary revealed she had been inaccurately recording her blood glucose levels. Professional CGM was useful in identifying patterns of hyperglycemia and informing changes to the patient's insulin regimen and dietary advice.
A 8-year old girl was admitted to the emergency department with symptoms of diabetic ketoacidosis. Testing revealed high blood sugar and laboratory results confirmed type 1 diabetes. She was treated with intravenous fluids and insulin to stabilize her condition. Her parents were provided diabetes education over multiple sessions to learn about type 1 diabetes, blood glucose monitoring, insulin administration, dietary management, hypoglycemia, and sick day rules. Through counseling, the parents' understanding of managing their daughter's condition improved.
The document discusses non-drug management of diabetes mellitus through lifestyle changes including diet and exercise. It covers definitions of diabetes, types of diabetes, principles of diabetes care like learning about diabetes and monitoring health indicators. It provides details on healthy diet, types of exercise, testing before exercise and sample exercise programs. The non-drug management aims to control blood sugar levels through patient education, monitoring and encouraging lifestyle modifications.
The document summarizes non-drug management of diabetes mellitus. It discusses lifestyle changes like following a healthy diet, regular exercise, and weight control as important non-drug approaches. Monitoring health indicators like blood glucose, blood pressure, cholesterol and attending regular medical checkups are also emphasized to manage diabetes and prevent complications long-term without relying solely on medication.
The document summarizes non-drug management of diabetes mellitus. It discusses lifestyle changes like following a healthy diet, regular exercise, and weight control as important non-drug approaches. Monitoring health indicators like blood glucose, blood pressure, cholesterol and attending regular medical checkups are also emphasized to manage diabetes and prevent complications long-term without relying solely on medication.
Diabetes refers to a group of diseases that affect how the body consumes blood sugar (glucose). Glucose is an important source of energy for the cells that make up muscles and tissues. It is also the main source of energy for the brain.
This patient is presenting with classic symptoms of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Her key symptoms include polyuria, polydipsia, and unintentional weight loss which developed acutely over 3 weeks. She now appears lethargic. HHNS is a life-threatening complication of diabetes that develops in patients with type 2 diabetes. Urgent treatment is needed to correct the hyperglycemia and dehydration through IV fluids and insulin therapy. She requires admission to the hospital for close monitoring and management.
This biology project summarizes information about diabetes. It was submitted by Harsh Jain of Class XII to his teacher, Miss Prachi Agarwal. The project defines diabetes, describes the main types and their causes. It covers the signs and symptoms, diagnosis, treatment including lifestyle changes and medications, and prevention of diabetes complications. The project emphasizes managing diabetes through regular checkups, medication, exercise, diet, and blood sugar monitoring.
The document provides guidelines for diagnosing and treating diabetes. It discusses criteria for diagnosing diabetes based on A1C, fasting plasma glucose, and oral glucose tolerance tests. It recommends testing asymptomatic people at high risk and screening for gestational diabetes. Treatment involves medical nutrition therapy, weight management, physical activity, pharmacologic agents like metformin, insulin therapy, and glycemic goals. Guidelines are provided for various aspects of diabetes management and treatment.
7 lies that the diabetics often talk to their doctormisurali
The document discusses 7 common lies that diabetics tell their doctors and the importance of being honest. It outlines problems such as not regularly checking blood sugar levels, not taking medications as prescribed, lack of exercise, unhealthy dieting, sexual dysfunction, smoking, and undisclosed supplement use. The document stresses that being honest with doctors about lifestyle and medications is important for properly managing diabetes and receiving appropriate treatment recommendations.
Overview of Diabetes Medical Devices-8-2022.pptxakramabdalla1
The document provides an overview of diabetes medical devices including insulin pumps, blood glucose meters (BGMs), and continuous glucose monitors (CGMs). It discusses the types and classifications of diabetes, functional types of insulin, ways of insulin delivery, generations of BGM sensors, and the principles and components of insulin pumps and BGMs. Enzymatic methods for blood glucose measurement using glucose oxidase and glucose dehydrogenase are also summarized.
Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose. It has many subclassifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycemia. This activity outlines the pathophysiology, evaluation, and management of DM and highlights the role of the interprofessional team in managing patients with this condition.
Objectives:
Describe the pathophysiology of diabetes mellitus.
Outline the epidemiology and risk factors of diabetes mellitus.
Review the treatment considerations and common complications of diabetes mellitus.
Identify the importance of improving collaboration and care coordination amongst the interprofessional team to enhance the delivery of care for patients affected by diabetes mellitus.
Access free multiple choice questions on this topic.
Go to:
Introduction
Diabetes mellitus is taken from the Greek word diabetes, meaning siphon - to pass through and the Latin word mellitus meaning sweet. A review of the history shows that the term "diabetes" was first used by Apollonius of Memphis around 250 to 300 BC. Ancient Greek, Indian, and Egyptian civilizations discovered the sweet nature of urine in this condition, and hence the propagation of the word Diabetes Mellitus came into being. Mering and Minkowski, in 1889, discovered the role of the pancreas in the pathogenesis of diabetes. In 1922 Banting, Best, and Collip purified the hormone insulin from the pancreas of cows at the University of Toronto, leading to the availability of an effective treatment for diabetes in 1922. Over the years, exceptional work has taken place, and multiple discoveries, as well as management strategies, have been created to tackle this growing problem. Unfortunately, even today, diabetes is one of the most common chronic diseases in the country and worldwide. In the US, it remains as the seventh leading cause of death.
Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. DM has several categories, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and secondary causes due to endocrinopathies, steroid use, etc. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM). T1DM presents in children or adolescents, while T2DM is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to poor lifestyle and dietary choices. The pathogenesis for T1DM and T2DM is drastically different, and therefore each type has various etiologies, presentations, and treatments.
The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014.
Prevalence has been rising more rapidly in low and middle-income countries than in
high-income countries.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower
limb amputation.
Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes.
In 2019, an estimated 1.5 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
A healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications
You can live with diabetes if you learn how! diabetes treatmentasucoms
Diabetes is a metabolic disease where the body does not properly process glucose due to inadequate insulin production or cells not responding to insulin. There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where the body does not produce enough insulin or cells do not respond properly; and gestational diabetes which affects females during pregnancy. Treatment involves monitoring blood sugar levels, eating healthy, exercising, and potentially taking medications or insulin to control glucose levels. Keeping diabetes managed is important to prevent health complications.
This document provides an overview of diabetes and a case study example. It begins by outlining the objectives of understanding the role of the endocrine system in regulating blood glucose and distinguishing between Type 1 and Type 2 diabetes. It then discusses a case study of a 14-year-old male brought to the emergency room unconscious who is found to have low vital signs. Laboratory results for the patient show extremely high blood glucose, low pH, and urine ketones, indicating diabetic ketoacidosis from not taking his insulin. The patient recovers after treatment with insulin and fluids.
Risk factors for diabetes during childhoodPratyush1693
Diabetes is a chronic metabolic disorder characterized by high blood glucose levels due to defects in insulin production or insulin resistance. The number of people with diabetes has risen dramatically worldwide from 108 million in 1980 to 422 million in 2014. India has a high prevalence of diabetes, with urban areas having higher rates than rural areas. Diabetes can be classified into type 1, type 2, gestational diabetes and other types. Risk factors include family history, age, ethnicity and obesity. Preventing and managing diabetes through lifestyle changes, medication and routine screening can reduce complications like kidney disease, eye problems and heart disease. Recent research focuses on vaccines to prevent type 1 diabetes and restoring insulin production through treatments like the BCG vaccine.
Idf course module 2 overview of diabetes managementDiabetes for all
This document provides an overview of diabetes management and education. It discusses:
1. The importance of patient education and ongoing monitoring to control diabetes.
2. The types of diabetes, treatments like insulin, and complications.
3. Guidelines for managing diabetes through healthy eating, physical activity, oral medications, and potentially insulin.
4. The role of diabetes self-management education and ongoing assessment of blood glucose and HbA1c levels.
C15 niddk what i need to know about diabetes medicinesDiabetes for all
This document provides information about different types of diabetes medicines including insulin, pills, and other injected medicines. It explains that diabetes medicines help keep blood glucose levels in target ranges to prevent health problems. The document discusses various types of insulin including injections, pumps, and other delivery methods. It also covers oral diabetes pills for type 2 diabetes including brands, classes, and how they work. Side effects of medicines are addressed. Resources for more information are provided.
C15 niddk what i need to know about diabetes medicinesDiabetes for all
This document provides information about different types of diabetes medicines including insulin, pills, and other injected medicines. It explains that diabetes medicines help keep blood glucose levels in target ranges to prevent health problems. The document discusses various types of insulin including injections, pumps, and other delivery methods. It also covers oral diabetes pills for type 2 diabetes including brands, classes, and how they work. Side effects of medicines are addressed. Resources for more information are provided.
This document discusses diabetes, including the different types and causes. Some key points:
- Diabetes is a group of metabolic diseases where a person has high blood glucose due to inadequate insulin production or cells not responding properly to insulin.
- There are an estimated 347 million people worldwide with diabetes, and it is predicted to become the 7th leading cause of death by 2030.
- The main types of diabetes are type 1, where the body does not produce insulin, and type 2, where the body does not produce enough insulin or cells do not respond properly to insulin.
- Risk factors for type 2 diabetes include family history, age, weight, and physical inactivity. Prevention focuses on maintaining a healthy weight and
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
Hypoglycemia Hyperglycemia In The Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
Hypoglycemia and Hyperglycemia in the Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
The document discusses diabetes mellitus, which is a major health problem worldwide. It provides information on the physiological basis of diabetes, classifications of diabetes, diagnosis methods, treatment approaches, changes in glucose and fat storage/mobilization caused by diabetes, and potential issues pharmacists need to be aware of when treating diabetic patients. The assignment involves answering questions about diabetes in under 1000 words and includes plotting glucose levels from patient data and commenting on the results. References should be included using the Harvard referencing style.
One of the most important ways we can strengthen our relationships w.docxdunhamadell
One of the most important ways we can strengthen our relationships with others is to show our respect by actively listening. By the same token, when we feel heard, we also tend to feel respected. Thus, it is helpful to learn the essential skills of being a good listener, allowing us not only to listen actively, but also model that process to others and be able to ask them to do the same for us. Here are the steps to active listening:
Listen to understand (rather than to formulate an answer/comeback).
Clear your mind and remain silent (offering visual and verbal feedback that shows you are listening).
Ask the person to expand or clarify (Tell me more... Could you give me an example? How did you feel... What happened next?).
Reflect the other person's thoughts and feelings (It sounds like.... Have I got that right?)
Now complete this journal entry.
Click on the Submit Assignment button in the top right of this window and type your journal entry into the text box. When finished, click the Submit Assignment button at the bottom of the the page.
Describe a time when you felt disrespected. In the box below, present the experience as if it is a scene from a novel. Describe the setting of where the event took place. Explain who was there. Show what they did and said. Explain how you felt.
In the box below, describe the same experience a second time, but this time revise what people said and did in a way that would have left you feeling fully respected. In this revision of history, have everyone speak and behave in ways that would have changed the outcomes and experiences for the better, leaving you feeling fully respected.
Diving Deep: How did knowing more about active listening help you revise the situation?
.
One of the five elements of emotional intelligence is self-awareness.docxdunhamadell
One of the five elements of emotional intelligence is self-awareness. Explain why emotional intelligence is crucial for effective leadership. Discuss what behaviors someone with a high degree of self-awareness would demonstrate within the context of leading and managing groups. Provide an example.
Discuss the purpose of strategic planning in a health care environment. Explain what factors affect future planning in an organization and what tools can be used for future planning.
.
More Related Content
Similar to Nursing Care of the PatientWith Endocrine DiseaseKøren K.docx
This biology project summarizes information about diabetes. It was submitted by Harsh Jain of Class XII to his teacher, Miss Prachi Agarwal. The project defines diabetes, describes the main types and their causes. It covers the signs and symptoms, diagnosis, treatment including lifestyle changes and medications, and prevention of diabetes complications. The project emphasizes managing diabetes through regular checkups, medication, exercise, diet, and blood sugar monitoring.
The document provides guidelines for diagnosing and treating diabetes. It discusses criteria for diagnosing diabetes based on A1C, fasting plasma glucose, and oral glucose tolerance tests. It recommends testing asymptomatic people at high risk and screening for gestational diabetes. Treatment involves medical nutrition therapy, weight management, physical activity, pharmacologic agents like metformin, insulin therapy, and glycemic goals. Guidelines are provided for various aspects of diabetes management and treatment.
7 lies that the diabetics often talk to their doctormisurali
The document discusses 7 common lies that diabetics tell their doctors and the importance of being honest. It outlines problems such as not regularly checking blood sugar levels, not taking medications as prescribed, lack of exercise, unhealthy dieting, sexual dysfunction, smoking, and undisclosed supplement use. The document stresses that being honest with doctors about lifestyle and medications is important for properly managing diabetes and receiving appropriate treatment recommendations.
Overview of Diabetes Medical Devices-8-2022.pptxakramabdalla1
The document provides an overview of diabetes medical devices including insulin pumps, blood glucose meters (BGMs), and continuous glucose monitors (CGMs). It discusses the types and classifications of diabetes, functional types of insulin, ways of insulin delivery, generations of BGM sensors, and the principles and components of insulin pumps and BGMs. Enzymatic methods for blood glucose measurement using glucose oxidase and glucose dehydrogenase are also summarized.
Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose. It has many subclassifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycemia. This activity outlines the pathophysiology, evaluation, and management of DM and highlights the role of the interprofessional team in managing patients with this condition.
Objectives:
Describe the pathophysiology of diabetes mellitus.
Outline the epidemiology and risk factors of diabetes mellitus.
Review the treatment considerations and common complications of diabetes mellitus.
Identify the importance of improving collaboration and care coordination amongst the interprofessional team to enhance the delivery of care for patients affected by diabetes mellitus.
Access free multiple choice questions on this topic.
Go to:
Introduction
Diabetes mellitus is taken from the Greek word diabetes, meaning siphon - to pass through and the Latin word mellitus meaning sweet. A review of the history shows that the term "diabetes" was first used by Apollonius of Memphis around 250 to 300 BC. Ancient Greek, Indian, and Egyptian civilizations discovered the sweet nature of urine in this condition, and hence the propagation of the word Diabetes Mellitus came into being. Mering and Minkowski, in 1889, discovered the role of the pancreas in the pathogenesis of diabetes. In 1922 Banting, Best, and Collip purified the hormone insulin from the pancreas of cows at the University of Toronto, leading to the availability of an effective treatment for diabetes in 1922. Over the years, exceptional work has taken place, and multiple discoveries, as well as management strategies, have been created to tackle this growing problem. Unfortunately, even today, diabetes is one of the most common chronic diseases in the country and worldwide. In the US, it remains as the seventh leading cause of death.
Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. DM has several categories, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and secondary causes due to endocrinopathies, steroid use, etc. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM). T1DM presents in children or adolescents, while T2DM is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to poor lifestyle and dietary choices. The pathogenesis for T1DM and T2DM is drastically different, and therefore each type has various etiologies, presentations, and treatments.
The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014.
Prevalence has been rising more rapidly in low and middle-income countries than in
high-income countries.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower
limb amputation.
Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes.
In 2019, an estimated 1.5 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
A healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications
You can live with diabetes if you learn how! diabetes treatmentasucoms
Diabetes is a metabolic disease where the body does not properly process glucose due to inadequate insulin production or cells not responding to insulin. There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where the body does not produce enough insulin or cells do not respond properly; and gestational diabetes which affects females during pregnancy. Treatment involves monitoring blood sugar levels, eating healthy, exercising, and potentially taking medications or insulin to control glucose levels. Keeping diabetes managed is important to prevent health complications.
This document provides an overview of diabetes and a case study example. It begins by outlining the objectives of understanding the role of the endocrine system in regulating blood glucose and distinguishing between Type 1 and Type 2 diabetes. It then discusses a case study of a 14-year-old male brought to the emergency room unconscious who is found to have low vital signs. Laboratory results for the patient show extremely high blood glucose, low pH, and urine ketones, indicating diabetic ketoacidosis from not taking his insulin. The patient recovers after treatment with insulin and fluids.
Risk factors for diabetes during childhoodPratyush1693
Diabetes is a chronic metabolic disorder characterized by high blood glucose levels due to defects in insulin production or insulin resistance. The number of people with diabetes has risen dramatically worldwide from 108 million in 1980 to 422 million in 2014. India has a high prevalence of diabetes, with urban areas having higher rates than rural areas. Diabetes can be classified into type 1, type 2, gestational diabetes and other types. Risk factors include family history, age, ethnicity and obesity. Preventing and managing diabetes through lifestyle changes, medication and routine screening can reduce complications like kidney disease, eye problems and heart disease. Recent research focuses on vaccines to prevent type 1 diabetes and restoring insulin production through treatments like the BCG vaccine.
Idf course module 2 overview of diabetes managementDiabetes for all
This document provides an overview of diabetes management and education. It discusses:
1. The importance of patient education and ongoing monitoring to control diabetes.
2. The types of diabetes, treatments like insulin, and complications.
3. Guidelines for managing diabetes through healthy eating, physical activity, oral medications, and potentially insulin.
4. The role of diabetes self-management education and ongoing assessment of blood glucose and HbA1c levels.
C15 niddk what i need to know about diabetes medicinesDiabetes for all
This document provides information about different types of diabetes medicines including insulin, pills, and other injected medicines. It explains that diabetes medicines help keep blood glucose levels in target ranges to prevent health problems. The document discusses various types of insulin including injections, pumps, and other delivery methods. It also covers oral diabetes pills for type 2 diabetes including brands, classes, and how they work. Side effects of medicines are addressed. Resources for more information are provided.
C15 niddk what i need to know about diabetes medicinesDiabetes for all
This document provides information about different types of diabetes medicines including insulin, pills, and other injected medicines. It explains that diabetes medicines help keep blood glucose levels in target ranges to prevent health problems. The document discusses various types of insulin including injections, pumps, and other delivery methods. It also covers oral diabetes pills for type 2 diabetes including brands, classes, and how they work. Side effects of medicines are addressed. Resources for more information are provided.
This document discusses diabetes, including the different types and causes. Some key points:
- Diabetes is a group of metabolic diseases where a person has high blood glucose due to inadequate insulin production or cells not responding properly to insulin.
- There are an estimated 347 million people worldwide with diabetes, and it is predicted to become the 7th leading cause of death by 2030.
- The main types of diabetes are type 1, where the body does not produce insulin, and type 2, where the body does not produce enough insulin or cells do not respond properly to insulin.
- Risk factors for type 2 diabetes include family history, age, weight, and physical inactivity. Prevention focuses on maintaining a healthy weight and
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
Hypoglycemia Hyperglycemia In The Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
Hypoglycemia and Hyperglycemia in the Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
The document discusses diabetes mellitus, which is a major health problem worldwide. It provides information on the physiological basis of diabetes, classifications of diabetes, diagnosis methods, treatment approaches, changes in glucose and fat storage/mobilization caused by diabetes, and potential issues pharmacists need to be aware of when treating diabetic patients. The assignment involves answering questions about diabetes in under 1000 words and includes plotting glucose levels from patient data and commenting on the results. References should be included using the Harvard referencing style.
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One of the most important ways we can strengthen our relationships w.docxdunhamadell
One of the most important ways we can strengthen our relationships with others is to show our respect by actively listening. By the same token, when we feel heard, we also tend to feel respected. Thus, it is helpful to learn the essential skills of being a good listener, allowing us not only to listen actively, but also model that process to others and be able to ask them to do the same for us. Here are the steps to active listening:
Listen to understand (rather than to formulate an answer/comeback).
Clear your mind and remain silent (offering visual and verbal feedback that shows you are listening).
Ask the person to expand or clarify (Tell me more... Could you give me an example? How did you feel... What happened next?).
Reflect the other person's thoughts and feelings (It sounds like.... Have I got that right?)
Now complete this journal entry.
Click on the Submit Assignment button in the top right of this window and type your journal entry into the text box. When finished, click the Submit Assignment button at the bottom of the the page.
Describe a time when you felt disrespected. In the box below, present the experience as if it is a scene from a novel. Describe the setting of where the event took place. Explain who was there. Show what they did and said. Explain how you felt.
In the box below, describe the same experience a second time, but this time revise what people said and did in a way that would have left you feeling fully respected. In this revision of history, have everyone speak and behave in ways that would have changed the outcomes and experiences for the better, leaving you feeling fully respected.
Diving Deep: How did knowing more about active listening help you revise the situation?
.
One of the five elements of emotional intelligence is self-awareness.docxdunhamadell
One of the five elements of emotional intelligence is self-awareness. Explain why emotional intelligence is crucial for effective leadership. Discuss what behaviors someone with a high degree of self-awareness would demonstrate within the context of leading and managing groups. Provide an example.
Discuss the purpose of strategic planning in a health care environment. Explain what factors affect future planning in an organization and what tools can be used for future planning.
.
One of the challenges facing the Public Information Officer (PIO.docxdunhamadell
One of the challenges facing the Public Information Officer (PIO) is social media. Social media is both a friend and foe of emergency agencies. What is the role and responsibilities of the PIO? And what do Twitter, Facebook, and other social media sites mean these days to the PIO?
Using the internet or professional journals, find two articles and post the links to the two articles. One of these should show how an emergency agency uses social media in a positive manner, such as to inform and involve the local community being served. The other link should show how social media was used in an unprofessional manner, and made the agency involved look bad in the eyes of the public. Give a one paragraph summary of each link.
Please write a minimum of 250 words for your initial post due by 11:55pm ET on Thursday.
.
One popular measure of human capital today is employee engagement, w.docxdunhamadell
One popular measure of human capital today is employee engagement, which is defined as the degree to which employees focus, produce, innovate, contribute, and actively engage organizational goals. How do you see engagement? What are some of the examples of engagement metrics that an organization may collect and assess? In what ways do organizational actions across the “capital management star” impact employee engagement?
Please use at least two appropriate scholarly references formatted in the most current APA format.
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one paragraph with intext citation and reference follow up discussio.docxdunhamadell
one paragraph with intext citation and reference follow up discussion for the above discussion.Further the dialogue by providing more information and clarification. Provide feedback on whether you agree or disagree with their criticism. Explain why. Build on their posts by providing additional insight of your own
I'm going to attempt to evalutate the Mona Lisa by Leonardo da Vinci. This is totally foreign to me and I feel vulnerable trying to answer these questions! Any help or better insight to this stuff would be much appreciated.
From the perspective of a descriptive critic I would comment on the lack of lines and use of shadowing to create separation. The colors are very muted throughout the piece with the exception of her skin. Her skin appears to glow in contrast to her clothes and the background giving the painting a lot of value (if I'm using that term correct)? Leonardo made her in the shape of an isosceles triangle with her shoulders turned slightly to give her a posed position and not a relaxed position (Jacobus & Martin, 2019).
From the perspective of an interpretive critic I would comment that it is the most famous piece of artwork in the world because of her unknown identity and smile. "It is thought to be of Lisa Gherardini, wife of a Florentine cloth merchant named Francesco del Giocondo," (Scailliérez, 2020). When Leonardo finished the painting, he gave the painting to France. The emotion responsible for her smile will always be a mystery and speculating on it never gets old. Leonardo also broke away from outlining images and used the technique sfumato which uses blending, layering, and transitions that are impossible to see (Mona Lisa, n.d.).
From the perspective of an evaluative critic I would comment that the form is fluid throughout the piece. Nothing sticks out in a bad way, Lisa just glows and her eyes are obviously the focus at first. Her gaze seems to captivate people and make people curious about her and what she's thinking. I would consider that point effective insight. This piece is obviously inexhaustable, has staying power in my own words, as it is studied in education and visited daily at The Louvre.
Jessica
Mona Lisa ...Leonardo's Masterful technique. (n.d.). Retrieved January 14, 2021, from https://www.pbs.org/treasuresoftheworld/mona_lisa/mlevel_1/m3technique.html
Jacobus, L.A., Martin, F.D. (2019). The Humanities through the Arts. New York: McGraw-Hill. Retrieved January, 13, 2021, from VitalSource Bookshelf: Humanities through the Arts
Scaillierez, C. (n.d.). Site officiel du musee du Louvre. Retrieved January 14, 2021, from https://www.louvre.fr/en/oeuvre-notices/mona-lisa-portrait-lisa-gherardini-wife-francesco-del-giocondo
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One page please!!1. Using conflict perspective, discuss the ca.docxdunhamadell
One page please!!
1. Using conflict perspective, discuss the causes of poverty and recommend two policy responses.
2 What does women’s employment during World War II reveal about social constraints on behavior with regard to gender?
3. What is the relationship between sex and gender? Provide an example of the difference between gender identity and gender expression
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One page per question What is a political party How do the tw.docxdunhamadell
The document asks several questions about political parties in the US, including how the Republican Party has aligned with Trump and the conflicts that have emerged during Trump's presidency, especially regarding the response to the coronavirus pandemic. It also asks how the pandemic and government response has impacted one's own political opinions and whether the media shapes public opinion.
One of the biggest challenges in serial killer investigation has.docxdunhamadell
One of the biggest challenges in serial killer investigation has always been the challenge of recognizing that different victims may be connected to the same killer. In the wake of the Bundy cast, the FBI created the ViCAP.
Describe the ViCAP program and why it was inspired by the Bundy case in particular. Is this an effective resource? What type of serial killer in particular would a program like ViCAP be used for?
Describe the Combined DNA Index System CODIS and answer the same questions as above.
Discuss why it is difficult for law enforcement agencies to work together when they are faced with a case such as that of an active serial killer. Should local law enforcement turn the case over to the FBI in these situations? Why might a Sheriff, in particular, be less willing to turn over control?
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One of the main jobs of historians is to interpret the past by revie.docxdunhamadell
One of the main jobs of historians is to interpret the past by reviewing primary documents, scholarly secondary sources, and then creating an analysis of this research. After reading your text and reviewing the assigned materials, consider each of the following assessments of the Emancipation Proclamation. Do agree or disagree with each of the four statements regarding the Emancipation Proclamation? Why? Be sure to consider the context of the author in your analysis.
"The act makes clear that the lives of our heroes have not been sacrificed in vain. It makes a victory of our defeats." Ralph Waldo Emerson (1862)
"We show our sympathy with slavery by emancipating slaves where we cannot reach them and holding them in bondage where we can set them free." William Seward (1863)
"[The Emancipation Proclamation was] the central act of my administration [and] the great event of the nineteenth century." Abraham Lincoln (1865)
"I cannot swallow whole the view of Lincoln as the 'Great Emancipator.' Anyone who actually reads the Emancipation Proclamation knows it was more a military necessity than a clarion call for justice." Barack Obama (2005)
This assignment should be at least 300 words and contain your reactions or questions about some specific issue within the historical narrative which you find compelling. For full credit, your paper must not simply sum up the reading or repeat points made there. Rather, I’m looking for you to create your own interpretation, or discuss some original insight. Include citations as needed.
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One of the responsibilities of the medical administrator is hand.docxdunhamadell
One of the responsibilities of the medical administrator is handling, sorting, and distributing the incoming mail.
In 1 to 2 pages address the following:
Identify four kinds of mails that may be received at a typical medical office.
Identify how to manage the privacy of incoming mail (electronic and paper).
Identify steps for handling all type of mail marked urgent.
Identify system(s) that should be created to ensure all mail is properly distributed.
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One of the examples I chose for my readings was, For Coloured .docxdunhamadell
One of the examples I chose for my readings was, “ For Coloured girls who have considered suicide/ when the rainbow is Enuf” by poet Ntozake Shanges. Shanges writes the excerpt in the first person. I enjoy writing stories in the first person. When writing in the first person everything is told intimately. The expert is about cruelty in a racist and sexist society. It is obvious from the name of the title the poet uses race to form an important part of the character’s identity. In the excerpt, she describes the lady that enters the stage as the “lady in Brown” and their racial identity and gender and only identified by their color have an effect, the perspective through which the readers experience all of the different narratives. Shanges uses common abbreviations and occasional derivations from traditional English as well as jargon and metaphors. This helps to reveal who the social group is. The use of language helps the protagonist express their feelings or explain their way of thinking. Shanges uses language that is very distinctive which makes the character’s voice very powerful. This excerpt has many similarities to the novel that I will be working on. The novel I will work on is in the first person and the theme is about discrimination and the injustices of human beings. I am happy I got a chance to read this excerpt, it was very powerful and gave me some ideas that I will most likely use for my novel.
Choose one example from the Module Four resources that you find most interesting. Discuss the influence of the narrative voice on your reading experience. Make sure to provide an excerpt that you think embodies the narrative voice used in your text.
In response to your peers, discuss how you could use this narrative voice in your own writing. For example, how might you apply techniques for using third-person limited point of view? How might you convey an unreliable, first-person narrator? Or do you think you could even use this type of narrative voice? If not, why not?
odule Three, you discussed methods of structuring narrative. Module Four focuses on how that narrative is told (as in, through whose means of perception) as well as the characters that populate it. Character has been called the “most important” element of creative writing (Stern 96), while point of view has been called the most “complex” (Burroway 276). Both address the who—who tells the piece, and who it is about. Sometimes, the two are one and the same, as with the first-person central narrator who tells a story about himself or herself. Often, however, they are different entities entirely—a narrative written in third-person limited or third-person omniscient point of view tells a story about other characters, for example, and a first-person peripheral narrator tells a story from a secondary character’s point of view. But even when the character and point of view are distinctly separate, the two elements, like everything else in a creative work, are inextricably .
One of the many reasons social workers conduct needs assessment.docxdunhamadell
One of the many reasons social workers conduct needs assessment is to provide support for new programs. Social workers have many methods available to collect necessary data for a needs assessment.
Social workers can use existing data from a wide range of sources, including local and national reports by government and nonprofit agencies, as well as computerized mapping resources. Social workers can gather new data through interviews and surveys with individuals and focus groups. This data can provide the evidence that supports the need for the program.
To prepare for this Assignment, review the needs assessment plans that you and your classmates generated for this week’s Discussion. Also, review the logic models that you created in Week 7 and any literature on needs of caregivers that you used to generate them. Consider the following to stimulate your thinking:
Getting information about the needs of the target population:
Who would informants be?
What is your purpose for interacting with them?
What questions would you ask?
What method would you use (interview, focus group, questionnaire)?
Finding potential clients:
Who would informants be?
What is your purpose for interacting with them?
What questions would you ask?
What method would you use?
Interacting with the target population:
Who would informants be?
What is your purpose for interacting with them?
What questions would you ask?
What method would you use?
By Day 7
Submit
a 2- to 3-page paper outlining a hypothetical needs assessment related to the support group program for caregivers. Include the following:
The resources needed to operate this service
The program activities
The desired outcomes
A plan for gathering information about the population served
Justifications for your plans and decisions
A one-paragraph conclusion describing how you might conduct a follow-up to the needs assessment at the implementation stage of the program evaluation
s
Dudley, J. R. (2014).
Social work evaluation: Enhancing what we do
. (2nd ed.) Chicago, IL: Lyceum Books.
(For review) Chapter 6, “Needs Assessment” (pp. 107–142)
Chapter 7, “Crafting Goals and Objectives” (pp. 144–164)
Document:
Tutty, L. M., & Rothery, M. A. (2010). Needs assessments. In B. Thyer (Ed.),
The handbook of social work research methods
(2nd ed.,pp. 149–162). Thousand Oaks, CA: Sage. (PDF)
Copyright 2010 by Sage Publications, Inc.
Reprinted by permission of Sage Publications, Inc. via the Copyright Clearance Center.
Optional Resources
Stewart, K. E., Phillips, M. M., Walker, J. F., Harvey, S. A., & Porter, A. (2011). Social services utilization and need among a community sample of persons living with HIV in the rural south.
AIDS Care,
23(3), 340–347.
Note:
Retrieved from the Walden Library databases.
Walter, H. J., Gouze, K., Cicchetti, C., Arend, R., Mehta, T., Schmidt, J., & Skvarla, M. (2011). A pilot demonstration of comprehe.
one 2-3 page essay (typed and double-spaced). Your essay should have.docxdunhamadell
one 2-3 page essay (typed and double-spaced). Your essay should have a brief introduction followed by several paragraphs – one major point for each paragraph – and a short conclusion.
Topic:
Explicate this passage by Rose Schneiderman (it comes from Todd’s “Remembering the Unknowns”). You answer should include a brief discussion of Schneiderman, who she was and the context in which she was speaking. (You should find this information in the article and not on Wikipedia.) Who was she talking to when she made this speech? What does she mean when she says that public officials “have the workhouse just back of all their warnings”? Why does she say that she “can’t talk fellowship” with those who organized the meeting (and were sitting in the orchestra seats)? Your answer should include a discussion of social class.
I would be a traitor to those poor burned bodies if I were to come
here and talk good fellowship. . . . We have tried you citizens; we
are trying you now and you have a couple of dollars for the sorrowing
mothers and brothers and sisters by way of a charity gift. But every
time the workers come out in the only way they to protest against
conditions which are unbearable, the strong hand of law is allowed to
press down heavily upon us. Public officials have only words of warning
or us – warning that we must be intensely peaceable, and they have the
workhouse just back of all their warnings. The strong hand of the law
beats us back when we rise. . .. I can’t talk fellowship to you who are
gathered here. Too much blood has been spilled. I know from my
experience it is up to the working people to save themselves. And the
only way is through a strong working-class movement (Todd, 67).
.
One complex issue that a public organization has to monitor on a.docxdunhamadell
One complex issue that a public organization has to monitor on a regular basis is how to manage the mission and goals of the organization. There are many theories that have impacted the field of public administration, and this assignment will give you a chance to critique a few of these theories.
Part 1: In this section, you will critique the theories of Fredrick Taylor (hierarchical) and Mary Follett (integrative). First, include a brief description of each theory in your own words. Next, include at least three pros and cons for each theory. Finally, include at least three ways each theory directly impacts public administration.
Part 2: In this section, you will critique a theory of your choice that can be used to effectively manage public organizations. You will need to include a brief description of the theory in your own words, three pros and cons for this theory, and at least three ways in which the theory directly impacts public administration.
Your presentation must be at least 12 slides in length. Be sure to cite any sources that you use in APA format.
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One implication of diverse cultures is that elements of one cult.docxdunhamadell
One implication of diverse cultures is that elements of one culture (e.g., values, attitudes, behaviors, perceptions) can create conflict with elements of another culture.
Prepare a report on cultural diversity and conflict. In your report, address the following:
**3-4 pages***
Evaluate the interaction of cultural diversity with conflict in international negotiations.
Assess the important indicators of diversity management in organizations. What is seen, heard, experienced when diversity management is or is not present?
Analyze some of the social and organizational consequences of not concentrating on diversity management, including negotiations and the organization in general.
Evaluate how organizations might capitalize on diversity in its negotiation party for producing better negotiated outcomes and organizational results.
Defend at least three ways that leaders might enhance diversity management in international activities to support larger goals. Defend your recommendations with research.
Research peer-reviewed articles on global leadership, diversity, diversity training, and industrial age.
Recommendation for the level one headings for the body of your paper:
Cultural Diversity and Conflict
Indicators of Diversity Management
Social and Organizational Consequences
Capitalizing on Diversity
Best Practices for Diversity Management
Book references but feel free to use other scholarly sources
Brett, J. M. (2014).
Negotiating Globally
, (3rd ed.). San Francisco, CA: Jossey-Bass. ISBN: 9781118602614
Lewicki, R. J., Saunders, D. M. and Barry, B. (2014).
Negotiation: Readings, Exercises, and Cases
. New York, NY: McGraw-Hill. ISBN: 9780077862428
.
On the project topic of Phishing. Please complete the below tasks.docxdunhamadell
On the project topic of Phishing. Please complete the below tasks:
1. An abstract for the topic"Phishing".
2. An APA format paper in not less than 600 words. Please make sure to cite all the resources accurately in the Paper with reference. Please make sure to include the abstract as well. Please make sure to use at least 6 references.
3. A list of annotated bibliography for all the references used.
4. A PowerPoint slide deck with 12 slides explaining the topic "Phishing"
.
On the tomcat drive in folder cosc210 you will find file named Paint.docxdunhamadell
On the tomcat drive in folder cosc210 you will find file named PainterStartup.zip. This file contains the source code for the start of a Painter program. In its current state, Painter can create boxes and text objects at given locations. Both boxes and text objects can be repositioned and resized using a mouse. The task is to add to the program the implementation for an oval, line, image, and group objects.
Instructions:
Add an oval object. An oval is very similar in implementation as the box, except it renders an oval instead of a rectangle. The oval can be repositioned by dragging the object to a new location. The oval can be resized by first clicking over the oval to display grab handles and then dragging a grab handle to a new position. The grab handles are to be rendered at the same positions as the box. Likewise, clicking anywhere in the smallest rectangle that encloses the oval performs selection.
Add a Line object. A Line is to be created by selecting a Line tool and then click and drag over the canvas. The line is rendered from the point of the initial click to the mouse pointer. On releasing the mouse the construction of the line object is completed. A partial implementation of a PtrDrawLine object is provided. You will need to fix the rendering, click over, and test for inside a rectangle.
A Line is selected by clicking anywhere over the line. Right now if you click anywhere in the rectangular region hold the line, then the line is selected. The implementation is in the isOver method. This needs to be fixed to only select when the click is on the line.
Given below is a partial solution to determine if a mouse click position (the x and y parameters to the isOver method) is over a line:
double ratio = (double) getDeltaY( ) / (double) getDeltaX( );
if (Math.abs(((x - getX( )) * ratio) - (y - getY( ))) <= 1) {
return true;
}
You need to modify this code when the y to x ratio is less than -1 or greater than 1. (hint: Inverse the roles of x and y)
The isInside method provides the implementation for determining if the line is inside a rectangular area as specified by the parameters. This code does not work right if the ending point of the line is to the left or above the starting point. Fix this to work in all cases.
Add an Image object. An Image object is created by selecting an Image tool and then clicking anywhere on the canvas. On clicking the canvas, a File Selection Dialog should be displayed. The dialog prompts for selection of .gif and .jpg files. On selecting a .gif or .jpg file and clicking “Open”, an Image object that renders the image of the selected file is created at the click position. Image selection and drag behaviors are the same as a Box object. The image object additionally renders lines at the edges of the image (as done in Box).
The code for displaying a File Selection Dialog is:
JFileChooser fileChooser = new JFileChooser();
f.
On November 3, 2020, Californias Privacy Rights Act is on the b.docxdunhamadell
On November 3, 2020, California's Privacy Rights Act is on the ballot. As of the time this assignment is being written, we do not know whether it will pass or not. Please write a 250 word essay on what the Act contains, and if it passed the ballot or not. Please tell why it passed or did not pass.
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On Human Capital (250 Words)The neoliberal understanding of h.docxdunhamadell
On Human Capital (250 Words)
“The neoliberal understanding of human abilities as sources of potential income redefines child-rearing by treating a broader range of activities of care and cultivation, and not only educational and professional training, as potential ‘investments’ in the human capital of children.”
Susan Koshy argues that, under neoliberalism, parents understand that raising their children is about making investments in human capital. Have you experienced this in your own life? In what ways have your parents treated you like an investment? In what way have they treated you otherwise? How do you know the difference?
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ompile the information you have gathered on your companies in weeks .docxdunhamadell
ompile the information you have gathered on your companies in weeks 1-4 to answer the following questions.
What is the relationship between your companies and their respective employees and investors? How do these relationships affect financial performance?
Are there any issues outstanding for your companies? How do these issues affect the overall financial viability of your companies?
Compare and contrast your two companies using the financial statements for the two firms and the accumulated data.
Justify if you were going to make an investment in one of the two companies, which one would you select? Why?
Prepare a comprehensive final report that summarizes your research and analysis of the two companies you selected for your Final Project over all weeks of this course.
Submission Details:
Submit a 4-5 page Microsoft Word document, using APA style
Name your file: SU_FIN4060_W5_CP_LastName_FirstInitial.doc
Submit your assignment to the
Submissions Area
by
the
due date assigned.
.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
Nursing Care of the PatientWith Endocrine DiseaseKøren K.docx
1. Nursing Care of the Patient
With Endocrine Disease
Køren K. Gi,ttùngs
Unfolding Case Study #36 T,, Jenny
Jenrry is a56-year-old female who is scheduled for a routine
primary care provider's
(PCP) visit to follow-up on her hypertension. She reports no
signi-ficant complaints
other than her vision being blurry; she states, "I need to go to
the eye doctor to
have my eyes checked." At the conclusion of her visit, the PCP
orders a basic meta-
bolic panel (BMP) and complete blood count (CBC) to be
drawn. Jenny receives a
phone call 2 days later from her PCP's office to schedule an
appointment for later
that day. Jenny is told that her blood sugar is elevated. At her
appointment, Jenny
and the nurse begin by reviewing Jenny's risk factors for
diabetes.
Exercise 6-lz Select øl.l tltøt øþþly
Identify risk factors commonly associated with diabetes
mellitus:
E Obesiry
fl ege less than 45 years
E Caucasianrace
I Family history
2. D History of gestational diabetes
E History of delivering babies over 9 pounds
eResource 6-l: To review risk factors associated with diabetes,
consult
Epocrates Online: [Pathway: -+ hnpt//online.epocrates.com ->
select the
"diseases" tab -+ enter "Diabetes" into the search field -+
review content
related to "risks"]
Jsnny reports that her mother and grandmother were diabetics.
She is also over
45 years old and overweight at 5 feet 2 inches anld 2OO
pounds. Jenny still finds it
hard to believe that she could be diabetic since she is feeling
okay; she asks the
nurse to explain to her how diabetes occurs.
Anstpers to tbis cbapter begin on page 231
215
216 CHAPTTR 6: ENDOCRINE DISEASE
Exercise 6-22 Multiple-cltoí.ce question
The nurse educating Jenny on type 2 diabetes determines that
she understands tþs
information when she states:
A. "I am not producing any insulin because of a problem with
my immune
system."
B. "I will need to take insulin for the rest of my life.,'
3. c. "I'm not making enough insulin or my body isn't as sensitive
to it.,,
D. "I won't need to make any dietary changes if I take my
medicine."
Exercise 6-32 Møtcbing
Match the type of diabetes in Column A with its typical
characteristics in Column B
Answers in Column A can be used more than once.
ColumnA Column B
A. Type L diabetes Onset is usually under 30 years old
B. Type 2 dial¡etes patient is often thin at time of diagnosis
Treated with diet, exercise, and oral agents
Patient is often obese at time of diagnosis
Antibodies are present in the body
Patients require insulin for life
G) ;ffi::i,"",'J ^ä¿'"äîîî#."å:*t'#i;:lË:iffi,îå:ä. _enter "Type 2
Diabetes" into the search field -+ in the "overview,'section,
select "pathophysiology" and review content]
By the time it is Jenny's turn to see her PCP, she has a
beginning understanding
about diabetes. Her PCP sits with her and begins by reviewing
hãr hboratory re-
sults. Her fasting plasma glucose from her last visit was 236
mg/dL.The pCp lists
some typical signs and symptoms of diabetes, and he asks Jenny
if she is experi-
encing any of them.
4. Exercise 6-4: Select ølt tbat øþpty
Identify coÍunon clinical manifestations associated with
diabetes mellitus
E rolyuria
E Decreased appetite
Q Decreased fluid intake
E Vision changes
fl natigue
eResource 6-3: For more information regarrding clinical
manifestations
associated with diabetes mellitus, refer to the Merck Manual:
fpathwayt
www.merckmanuals.com + select "Merck Manual of Diagnosis
and
o
Answers to tbis cbapter begin on page 2J1
CFIAPTER 6: ENDOCRINE DISEASE Questions 217
o
Therapy" --> enter "Diabetes" into the search field + select
"Diabetes
Mellitus (DM)" -à select "Symptoms and Signs" and review
content]
Jenny reports that her vision has been blurry, but she thought
that she needed
new glasses. She also recognizes that she has been drinking and
urinating more
than usual. Based on her symptoms and elevated fasting plasma
glucose, the phy-
5. sician suspects Jenny has type 2 diabetes.
eResource 6-4: To learn more about the diagnostic work-up for
Jenny,
refer to Medscape on your mobile device: [Pathway: Medscape
*) enter
"Type 2 Diat¡etes" into the search fleld + select "Type 2
Diabetes
Mellitus" -+ select "'$7'orkup" and review content]
To further confirm the diagnosis, he orders a random fingerstick
blood sugar and
Hemoglobin A1C (HgbAlC).
Exercise 6-52 Sbort ønsu)er
Briefly explain how a HgbAlC is used to evaluate blood glucose
compared to a ran-
dom blood glucose level.
o eResource 6-5zTo learn more about HgbAlC, refer to
Medscape on yourmobile device: [Pathway: Medscape -+ enter
"A].C" into the search field -+
select "Hemoglobin A1C testing"and review content]
Jenny's blood results are ready within a short period of time.
Her fingerstick blood
sugar is 286 and her HgbAlC is 9%. Her physician orders
metformin 500 mg
orally twice a day, andJenny is scheduled to meet with a
diabetes educator in2 days.
Exercise 6-6: Fill-in
Identify three ways in which metformin acts to maintain normal
blood glucose levels:
1
6. 2
3
o eResource 6-6:To review patient teaching regarding
metformin withJenny, refer to Epocrates on your mobile device:
[Pathway: Epocrates ->
enter "metformin" into the search field + select "metformin" -)
scroll
down to review "common reactions" and other relevant content]
Jenny meets with the diabetes educator as scheduled. During her
appointment,
they discuss many topics including nutrition and exercise. The
educator begins by
talking about meal planning and caloric needs.
Anstaers to tbis cba.pter begin on page 231
218 CHAPTER 6: ENDOCRINE DISEASE guestions
rxefcrse o- / 2 .Íttt-Nt .
For obese patients who are diabetic, the key to treatment is:
Exercise 6-8: Fùll-in
Identify the food groups that are part of the Exchange List
system and give one ex-
ample of a specific food within each group:
Exercise 6-9: True orfølse
Identify whether the following statements about nutrition in the
diabetic patient are
true or false:
7. 1. Soluble fiber lowers blood glucose levels by slowing the rate
of
glucose absorption from these foods.
2. Alcohol used in combination with chlorpropamide
(Diabinese)
may cause facial flushing, warmth,.rrauseal and vomiting.
3. Nutritive sweeteners have no effect on blood glucose levels.
Exercise 6-l0t Multìple-cltoíce question
The nurse educating Jenny on exercise determines that she
needs further instruction
when she states:
A. "Exercise will lower my blood glucose level.,,
B. "I should try to exercise at the same time each day.,,
C. "Walking is generally a safe form of exercise.,'
D. "I should exercise more when my glucose levels are more
than
25O mgldL;'
o eResource 6-72 To learn more about nutritional management
of patientswith diabetes, refer to Medscape on your mobile
device: [pathway:
Medscape -+ enter "nutrition" into the search field -+ select
"Nutritional
Management of Patients with Diabetes" and review content]
Jenny is given a blood glucose monitor with instructions for
self-monitoring of her
glucose levels. Once Jenny's blood glucose level is stabilized,
she is instructed to
test at least fwo to three times per week.
8. 1.
2.
3.
4.
5.
6.
7.
8.
Ansuters to tbis cbapter begin on pøge 2J1
CHAPTER 6: ENDOCRINE DISEASE Questions 219
Exercise 6-ll: Select øll tltøt øpply
Identify other ci¡cumstances in which more frequent testing is
recommended:
D Missing a mealtime
Ü Symptoms of hypoglycemia
I Changes in medications
E During periods of increased stress
E Times of illness
The diabetes educator explains to Jenny how metformin works
to control her
blood glucose level. Jenny expresses concern that she may have
9. to use insulin if
the metformin is ineffective, but the nurse explains that there
are many other oral
agents availat:le that can be tried before moving to insulin.
Exercise 6-l2t Mø.tcbing
Match the medication in Column A with its drug classification
and action in Column B.
ColumnA
A. chlorpropamide
(Diabinese)
B. glipizide
(Glucotrol)
C. metformin
(Glucophage)
D. acarbose
(Precose)
E. nateglinide
(Starlix)
Column B
Alpha-glucosidase inhibitor; delays intestinal
absorption of complex carbs
First-generation sulfonylurea; stimulates beta
cells of the pancreas to secrete insulin
Nonsulfonylurea insulin secretagogue;
stimulates th.e pancreas to secrete insulin
Second-generation sulfonylurea; stimulates beta
cells of the pancreas to secrete insulin
10. Biguanide; inhibits production of glucose by
the liver
o eResource 6-8: To learn more about these medications,
consultMedscape on your mobile device: [Pathway: Medscape -)
enter "Type Z
Diabetes" -+ select "Medication" and review content]
As Jenny's appointment draws to an end, the diabetes educator
teaches her about
hypoglycemia and long-term complications.
Exercise 6-15: Multiple-cltoice question
The nurse educating Jenny on hypoglycemia determines that she
understands the in-
formation when she states:
A. "I won't get hypoglycemic when I am only taking
metformin.,'
B. "If I feel my blood sugar dropping, I will eat some chocolate
candy)'
C. "My family should be educated on how to help me if I
become hypogþemic."
D. "Hypoglycemia most often occurs t hour after meals."
Anstaers to this cbapter begin on þage 231
220 CÉ{APTER 6: ENDOCRINE DISEASE Qøes¿loøs
Exercise' 6-14: Fnll-nn
Identify the macrovascular and microvascular complications
that can occur witlì
diabetes:
11. Macrovascular Microvascular
L
eResoufce 6-9zTo learn more about microvascular and
macrovascular
complications, refer to Medscape on your mobile device:
[Pathway:
Medscape -+ enter "Type 2 Diabetes" -> select "Treatment and
Management" -) select'Approach and Considerations" and scroll
down
to review contentl
Exercise 6-15: Select øll tÍtøt øpply
Identifiz foot care techniques recommended for diabetic patients
B Assess feet daily
E Lotion the feet, especially between the toes
fl Use hot water for soaking the feet
D trim toenails straight across
E Never walk barefoot
o eResource 6-LO: To supplement patient teaching regarding
diabetes,refer to:
I MedlinePlus's interactive tutorial, Dia.betes-Introduction:
http://goo.gl/nJn7B
I National Institutes of Health's (NIH's) pamphlet, Your Guid.e
to
Diabetes: Type 1 and Type 2:http://goo.g/bgBNl
eResource 6-L1: To learn about the American College of
Physicians
recommended vaccinations forJenny to help keep her healthy,
download
the ACP Immunization Advisor (ACP-IA) "app" onto your
12. mobile device
(http://goo.gllNzQlB). [Pathway on your mobile device: ACP-
IA ->
select "frrud" -+ enter "age" aîd "Condition" (Note: There are
no special
considerations for Jenny) -+ select "Show Vaccines"]
Unfolding Case Study #37'% Lorrie
Lorrie is a 60-year-old female who was recently diagnosed with
hypothyroidism.
Her granddaughter, Alissa, who is in college studying to be a
registered nurse, is
very interested in learning more about hypothyroidism so that
she can help to
educate her grandmother about her disease process. Alissa
begins by reviewing
basic anatomy and physiology of the thyroid gland.
1
2
3
2
o
o
Ansuters to this cbapter begin on page 2Jl
CI-L{PTER 6: ENDOCRINE DISEASE Qøestlo'?s 221
13. Exercise 6-16z Select øll tltøt aþþly
ldentrfy the hormones released by the thyroid gland:
B ftryroxitte (T4)
Q Thyroid-stimulating hormone (TSH)
E Triiodothyronine (T3)
E calcitonin
E ,tntidiuretic hormone (ADH)
Exercise 6-17: Fíl'l-i.n
Essential for the synthesis of thyroid hormones,
through diet.
Exercise 6-7.82 Sbort a'nsu)er
Briefly explain how the release of thyroid hormone is regulated
in the body.
is obtained
o eResource 6-L2:To learn more, Alissa refers to Medscape on
hermobile device: [Pathway: Medscape -+ entef
"hypothyroidism" -+ select
"Ovefview" -) review content listed under "Background,"
"Epidemiology,"
and " PathophysiologY"J
Alissa is aware that many endocrine disorders have general
signs and symptoms,
which may be initially ignored or thought of as being a part of
14. the normal aging
process. Áirr" asks her grandmother what types of signs and
symptoms she was
experiencing.
Exercise 6-t9z P¡l'Lín
Identify three common signs and symptoms that may indicate an
endocrine disorder:
1.
)
3.
eResource 6-t3:To learn more about coÍunon signs and
symptoms
associated with an endocrine disordeq refer to the Merck
Manual:
I Hypothyroidism: [Pathway: www.mefckmanuals.com -) select
"Merck
Manual of Diagnosis andTherapy" -+ entef "hypothyroidism"
into the
search field + select "hypothyroidism" -+ select "symptoms and
Signs"
and review content]
I Endocrine Disorders: [Pathway: www.merckmanuals'com -t
select
"Merck Manual of Diagnosis and Therapy" -) enter "Endocrine
Disorders" into the search field -+ select "Endocrine Disorders"
and
review content]
15. Answers to tbis cÍra'Pter begin on page 231'
222 CIIAPTER 6: ENDOCRINE DISEASE
Lorrie tells her granddaughter that she had been feeling very
tired and hadenergy for cleaning the house or family activities.
Because she didn't initiallyanything was really wrong, Lorrie
did not seek medical attention, but waitedher regularþ scheduled
púmary carcprovider's (PCp) appointment 3 monthsto mention
her fatigue. Her pCp ordered some laboratory tests to be done
onday and scheduled her for a follow_up appointment in 1
week.
Exercise 6-2O: Select ølt tbøt øppty
Identify clinical manifestations associated with hypothyroidism:
fl weight loss
E Fatigue
E lrritability
D Hair loss
D Increased pulse
fl Feeling cold in awarmenvironment
oË,i::ä::'i"',ÍJ;,';î:å,ä?T3:ï:"i:,;å:1f, ,ffi,î1ïï:',1îî::"n
field -+ select "crinicar presentation" and r*i.* åontentl
Exercise 6-2Iz LIøtcttí.ng
Match the laboratory test in column A with its description and
normal value in
Column B.
ColumnA
A. TSH
16. B. T3
C. T4
D. Free T4
Column B
_7Û%o is protein-bound; normal is 5 to L.). mcg/dL
-
Direct measurement of unbound thyroxine;
normal is 0.8 ro 2.7 ng/dL
-
Best screening test for thyroid function; normal is
0.4 to 4.2 nIU/L
_ More accurate indicator of hyperthyroidism;
normal is 70 to 204 ng/dL
o;::,:ö::,9"ïJ;,Y:ååË3:ï:i:ffi :,";,;ffi,T*,,in,o,he
search field -+ select "work-up" -> select
,,íiboritory studies,,and review
contentJ
At her follow-up appointment, Lorrie received her diagnosis of
hypothyroidismand was started on levothyroxine (synthroid)
0.075 *g"or"tiy daily.Later,Alissa
reviews the medication with her grandmother so that sãe clearly
understands theneed to continue taking it as direited.
Anszaers to tbß cbapter begin onpage 2J1
17. CHAPTER 6: ENDOCRINE DISEASE Questions 223
Exercise 6-22: True orla.lse
Identify whether the following statements about thyroid
hormone replacement ther-
apy are true or false:
1. TSH levels are used for monitoring the effectiveness of
thyroid
hormone replacement and in making dosage adjustments of the
medications.
2. Signs of overdose are manifested as hyperthyroidism
(tachycar-
dia, weight loss, nervousness, and/or chest pain).
3. Thyroid hormone replacement is only needed until symptoms
subside; the medication can then be discontinued.
eResource 6-16z To learn more about this medication, Alissa
consults
Epocrates on her mobile dêvice: [Pathway: Epocrates -+ enter
"synthroid"
into the search field + review contentl
@
Since Lorrie has only recently been diagnosed with
hypothyroidism and started on
levothyroxine (Synthroid), she continues to have some- clinical
manifestations that
she did not previously know were related to the hypothyroidism.
Lorrie continues
18. to tire easily, feel cold despite'warmer environmental
temperatures, and struggle
with constipation. Alissa has found some nursing interventions
through her study
of hypothyroidism tl:rat may be useful to her grandmother.
Exercise 6-23: Multiple-cltoi.ce questíon
V/hen educating her grandmother on controlling her fatigue,
Alissa determines that
she understands the information when she states:
A, "I should push to get all of my housework done in one block
of time."
B. "f don't want to ask for help; I need to keep pushing myself."
C. "I need to get used to feeling tired since I will feel like this
the rest of my life."
D. "I need to space my activities so I can rest in befween."
Exercise 6-242 Multþle-cboice qaesti.on
Øhen educating Lorrie on how to maintain a normal body
temperatt)re, her grand-
daughter determines that she needs further instruction when she
states:
A. "I can just layer my clothing to provide more warmth."
B. "I can use heating pads or an electric blanket when I go to
bed."
C. "I should stay aw^y from cold, ûafty areas."
D. "I won't feel cold all the time once my medicine starts
working."
Exercise 6-25: Select øll tbøt øþþly
Identify interventions designed to improve constipation:
D use laxatives regulady
D Increase fluid intake if no restrictions
19. E Increase activity as tolerated
E Use enemas on a biweekly schedule
fl Increase fiber content in diet
Anstuers to tbis cba.pter begin on þage 231
224 C}IAPTEP. 6: ENDOCRINE DISEASE
o Ilypothyroid.ism: lvba.t Euery parient Needs toeResource 6-
172 Fot more patient education informafion, referKnout:
Alissa has compreted her study of hypothyroidism and educated
heron her disease process, but she decides to review a rittle
information
roidism since she knows that this can occur as a result of
ingestion
thyroid hormone.
Exercise 6-26: Select øil tba.t øþþty
Identift clinical manifestations associated with hyperthyroidism:
on
of
fl Nervousness
fl Heat intolerance
E Progressive weight gain
Ü Poor appetite and decreased intake
D Tachycardia
Exercise 6-27. F¿lt-irt
Identify three atypical signs and symproms of hyperthyroidism
rhat the elderþ
may present:
20. Gl eResource 6-rg: Arissa uses Medscape on her mobile device
tov supplement her_understanding of hyperthyroidism:
[pathway: Medscape-) enter "hyperthyroidism" into the sãarch
field -+ rãview contentl
Exercise 6-28: True orføtse
Identifir whether the following statements about laboratory
results used to diagnose
hyperthyroidism are true or false:
1. TSH levels are decreased with untreated hyperthyroidism.
2. Free T4 levels are decreased with untreated hyperthyroidism.
1.
)
:).
Unfolding Case Study #jg % finda
Linda is a 59-year-old femare with a medical history of
hypertension, asthm a, andchronic bronchitis. sle ha_s a
pasthistory of smoking orré ,o one and aharfpacksof cigarettes
per day for 35 years. Linda quit smokin! when her asthma
worsened;she has been smoke-free for 3 years now. As part of
her treatment regimen, Lindahas been takingprednisone 2o mg
oru:|ry dairy forthe past ii ,rrorrtrrr. at her mostrecent primary
care provider's (PCP) appointment, ;"iida expresses concern at
the
Ansuters to tbis cbaþter begin on þage 231..
Management Services
21. Spring 2015
Sustaining change in
manufacturing companies
By Bob Lillis and Marek Szwejczewski
W
hy do changes stick in some organisations, while
in others they peter out and decay? A fter all, for
most companies, it is a strategic imperative to
sustain change and its associated performance improvement.
Sustainability means th a t the new working practices and the
improved performance persist fo r an appropriate period of
time. The change has become the norm. It is 'how we do things
around here' and is not a one-off or a temporary improvement
but is on-going. Unfortunately, the failure rate o f change
initiatives is high - 70-90% are believed to fail.
While studies have focused on the factors th at minimise
initiative failure and help ensure the successful implementation
o f the change, far less is understood about how to sustain
the initiative once the initial implementation period is over.
For example, research into change initiatives specifically in
manufacturing organisations, have tended to cohere around
either how to implement total quality management (TQM)
successfully or the success factors affecting the process o f lean
production implementation. However, the most comprehensive
study into how to sustain any organisation's change initiative
once it has been successfully implemented, was th a t carried
out by Buchanan et al (2005). Their thorough review of what
is known and w ritten about sustaining organisational change
identified a set o f 11 common factors. The outline definitions
of
these factors are shown in Table 1.
22. For example, the influence o f Leadership is commonly
accepted as im portant in successfully sustaining change. This
factor would include facets such as, has the senior leadership
team established a clear and consistent vision? Is the Leadership
also leading the change once the implementation phase is
over? Considering the factors in Table 1 and outline definitions
at face value, w hat is missing is any understanding o f the
Management Services
Spring 2015 41
FACTOR DEFINITION
Leadership Setting the vision, goals and leading the change
Individual Employees' individual commitment
Managerial Managerial style, approach, and behaviours
Financial Balance of costs and benefits
Substantial Perceived centrality, scale, fit with organisation
Organisational Policies, procedures, system, and structures
Cultural Shared belief, norms, and values
Political Stakeholder and coalition power and influence
Processual Implementation methods used
Contextual External conditions and threats
Temporal J Timing and pace of change activities
Table 1: Buchanan et al (2005) factors w ith definitions.
Respondents'
Job T itle
N um ber
o f Years
23. in Role
N um ber o f
Employees
A ffe c te d by
th e Change
Program m e
D u ra tio n o f
th e Change
Programm e
(in years
and all
o n -goin g)
M a n u fa c tu rin g
Sector___ _________
Operations site
director
human resources
director
3.5
5
800 3.5 Food processing
Deputy vice
president
5 100 1.5 Engineering
European
operations director
24. 3 18,000 1.5 Metals
Production manager 15 80 1.5 Petrochemical
Regional operations
manager
4 100 2.5
Chemicals
(detergents)
Production manager
Managing director
2
10
50 3
Chemicals
(Coatings)
General Manager 3.5 300 3.5 Semiconductors
Head of integration
compliance
4.5 200 3.5 Telecommunications
Service director 6 400 3.5 Machinery
Global environment
manager
4 55,000 4.5
Chemicals (paint/
coatings)
Operations director 4 170 4.5 Cement
Plant controller 4.5 200 4.5 Car accessories
25. Managing director 6 50 6.5 | Plastics
Table 2: Respondents' identification and interview sample.
relevance of all 11 factors in different contexts and the
respective influence th a t each individual factor may have
on encouraging sustainability. For instance, does employees'
individual commitment to sustaining the change outweigh the
managerial style, approach and its behaviours? Is Leadership
more im portant than the Financial factor to sustaining change?
In other words, do some factors have more impact than others
on successfully sustaining change? In this article, we report
preliminary findings from stage one o f a tw o stage research
project which sought to answer these questions.
Research study
We divided the study into tw o separate but interconnected
empirical stages. The first consisted o f in-depth interviews
w ith executives from 13 manufacturing companies which
had sustained a change initiative in their business. During
this stage, we investigated the relevance o f the 11 factors.
Several propositions were developed, some o f which are
reported here. Stage tw o seeks to test these propositions in
three manufacturing companies, one o f which is Maserati in
Italy. We w ill be reporting the results o f the second stage in a
subsequent issue.
The interviewees in stage one came from a sample of
individuals who had attended one o f our courses at Cranfield
School of Management. In seeking an interview w ith a
particular manufacturing manager or manufacturing director,
we knew in advance th at the potential respondent's business
had undergone a change initiative, although the length o f the
change period was unknown to us at the tim e o f the interview
request. Table 2 provides a list o f interviewee job titles, how
long the job holder had spent in th at role, the number of
26. employees in the company affected by the change initiative
and the manufacturing sector o f the business.
The duration o f the change initiative varied from a minimum
o f 1.5 years to 6.5 years and all were still ongoing. We fe lt
these periods o f time would be o f an appropriate duration to
justify a change initiative being called 'sustained'.
Stage one findings
E xtent o f
fa c to r's
influence
SUB
Strongly
influential
throughout
Strongly
influential at the
start becoming
less influential
as change was
sustained
Not influential
at the start
becoming
more strongly
influential as
the change was
sustained
Did not appear
to influence
or arise as
significant
27. 13 1 4 10 1
7 3
7 6 7
6 3 6
12 13
Findings suggest th at most o f the factors had a role to play in
sustaining change, but th eir influence varied depending on the
stage o f the change programme. Four types o f influences were
gleaned which are shown in Table 3. These were:
i) The factor was strongly present at the start o f the change and
throughout the change period.
ii) The factor was strongly present at the start o f the change
but its influence waned as the change continued.
iii) The factor was not strongly present at the start o f the
change but became more influential as the change
continued.
iv) The factor was not seemingly influential at any point in the
change or appears not to have arisen.
The research results o f stage one indicated th a t 10 o f the 11
factors identified by Buchanan et al (2005) had an impact on
the sustainability o f change initiatives. The analysis o f the
interview data indicated th a t the Temporal factor (the tim ing
Table 3: Frequency o f influence o f the 11 factors across the 13
companies.
28. M anagement Services
Spring 2015
and pace o f the change initiative) did not appear to contribute
to sustainability in our sample and is therefore not included in
Table 3.
The interviews suggested th a t factors differed in when they
had most influence. Based on the analyses, several propositions
were developed. The fo ur propositions we consider to be of
most interest were:
P1 Leadership [setting the vision, purpose, goals, and
challenges]
remains strongly influential throughout the duration o f a
sustained change programme
P2 Political [stakeholder, coalition power and influence] is at
its most influential in the early stages o f a sustained change
programme
P3 Managerial [managerial style, approach, behaviours] is at
its most influential in the later stages o f a sustained change
programme
P4 Individual [employee's individual commitment] is at its
most influential in the later stages o f a sustained change
programme
Our data analyses in stage one also provided some interesting
interactions between the various factors. So fo r example, at
company 2 in the engineering sector, whose change period
at the tim e o f interview had been 1.5 years and affecting
29. 100 employees (Table 2), the factors Substantial, Financial,
Leadership, Political, Processual and Contextual were strongly
present at the start o f the change programme and had
remained so throughout its duration. Four o f the factors
namely.
Individual, Managerial, Organisational and Cultural were not
strongly present at the commencement o f the change but
became more influential as the change continued.
In addition, we were also interested in whether the company
had replaced its Managing Director or Chief Executive Officer
at the commencement o f the change programme. We believed
th a t this could have been an im portant factor in sustaining
the change. It transpired th a t 7 o f the 13 companies were so
affected and on the basis o f these statistics, we consider the
impact o f replacing a company's MD or CEO on sustaining a
change programme is inconclusive and requires further research.
Conclusions
Sustaining change is not a simple procedure. Our research
findings suggest th at managers need to put emphasis on
different factors at different stages o f the change. It has long
been recognised th a t Leadership is im portant at the start o f
the
implementation process. Our research supports this view but in
addition points to just how critical it is later in the life o f the
initiative. The leadership cannot afford to reduce its efforts
once
the change initiative has been successfully launched. If it takes
a
back-seat and hands over to the management team, such action
w ill invariably lead to sustainability failure.
The influence in sustaining change o f the political aspect is
often forgotten. It is assumed th at having good Leadership is
more important. However, concern w ith the political aspects
30. o f the change initiative is vital if it is to be sustained. In the
interviews, most o f the senior managers pointed to the fact
that
they had obtained obvious and visible support fo r the initiative
from various stakeholders at the start o f the implementation.
The research also suggests th a t getting the commitment of
the Individuals in the organisation at the start o f the change
process may not be as im portant as some claim. However, to
succeed, the Leadership needs to get the commitment from
most
o f the Individuals once the implementation is complete in order
to sustain the change. A successful initiative launched can be
achieved w ith o u t the vast m ajority being committed.
However,
once the implementation phase is over, if the vast majority
o f Individuals are not committed then the initiative is likely
to peter out and fail. The Managerial factor is also im portant
in sustaining the change initiative but only at the later stage
o f the process. Managers have an im portant role in helping
the leadership team to ensure th a t the new ways o f working
introduced by the change initiative are adhered too.
The research is still ongoing in stage two, w ith one case study
completed and a further tw o currently being conducted.
Therefore,
it is too early in the study to categorically state the respective
influences of the various 11 factors on sustaining change in
manufacturing companies. We hope the research, by indicating
which factor to focus on during the various stages o f the
change
programme, will ultimately prove helpful to those
manufacturers
keen on making change initiatives in their organisation stick.
31. References
Buchanan, D, Fitzgerald, L, Ketley, D., Gollop, R, Jones, J L,
Sharon Saint, L, Neath, A and Whitby, E (2005). 'No going
back:
A review o f the literature on sustaining organizational change',
International Journal o f Management Reviews, Vol 7, No 3, pp
189-205.
A bout the Authors
Dr Bob Lillis is senior lecturer in service operations
management
at Cranfield School of Management, Cranfield University
Dr Marek Szwejczewski is professor o f operations strategy
at Cranfield School o f Management and Director o f the UK's
Best Factory Award Scheme. To find out more about sustaining
organisational change, email [email protected]
mailto:[email protected]
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