Joseph Case Study

Contextual analysis Chapter #3 Case Study: Chapter 3, Joseph’s Story A-H A. ) List Joseph’s chance factors and make a short outline of the data you have up until now. Recognize how his hazard elements would influence cell work. * The hazard factors that Joseph had were smoking, absence of activity, over the top weight gain, focusing on, greasy nourishments, and a family ancestry of vascular malady. Joseph is middle age Caucasian male who has endured a coronary failure. This may have been brought about by him not dealing with his body appropriately. Joseph is as of now at high hazard for coronary illness because of a family ancestry if vascular disease.He has likewise been focusing on, an expansion in weight, not working out, and undesirable eating. These things could all assume a job in how his heart is influenced and working. His cell capacities are being influenced in light of the fact that there is no oxygen streaming all through the body getting to the heart, cells, organelles, or layers that keep the body working appropriately. B. ) Assuming Joseph’ heart has halted, what cell procedure and film capacities will be influenced by the loss of oxygen, blood glucose, and waste expulsion? On the off chance that Joseph’s heart halted, the cell procedure and layer works that would be influenced are the vigorous procedure and the mitochondria. Oxygen and glucose are utilized in glycolysis which is responded in the mitochondria where ATP is delivered. Carbon dioxide is the waste item in this procedure and should be discharged. With oxygen and glucose not being available ATP can't be created and carbon dioxide can't be discharged out the body. Therefor the cells are starting to quickly pass on and the siphons are asking to close down.Without the principle vitality hotspot for all cells the body can't work appropriately. C. ) Which intracellular organelles have layers as a major aspect of their structures? How might the breakdown of the lay ers of these structures influence the capacity of Joseph’s heart cells? * The intracellular organelles that have layers as a feature of their structures are the Mitochondria which has two films, and the ER, Golgi which just have one, and the ribosomes don't have its own layer however it connects to them.Breaking down the mitochondria would influence Joseph heart since lysosome compounds which are bound inside the vesicles will process the plasma layers and the layers of different organelles. D. ) Two significant snippets of data the guidelines Joseph’s body needs to fix itself and his inclination for vascular malady are both contained inside the cell on what structures? †Joseph body is going to require its DNA to repeat itself, and furthermore the development and multiplication of his cells will be found on the Cytosol. E. Joseph’s respiratory failure has made the capacity of his cells change. What kinds of proteins in the cell film were associated with the homeostatic awkward nature of his heart cells? * The sort of proteins in the cell layer that was engaged with homeostatic irregularity of his heart cells were ATP. There was no ATP, so it influenced the siphons in the layer. The calcium levels rose, and it made proteases spill into the inside of the cell, assaulting the cytoskeleton. This made the lysosome chemicals digest the plasma films and layers of the organelles. F. Why was restoring oxygen stream to Joseph’s body so significant? What procedures would be influenced by the absence of oxygen? * Reestablishing oxygen stream to Joseph’s body was significant on the grounds that the body was not working appropriately without oxygen and ATP which each living organelle and cells in the body needs. There are additionally significant organs that need oxygen streaming to them, for example, the mind, heart, and lungs which expect oxygen to look after working. G. ) Consider by and by Joseph’s wellbeing history and haz ard factors. What might you be able to recommend to Joseph to decrease his hazard for another cardiovascular failure? I would recommend that Joseph deal with himself more by practicing more, keeping up a solid eating routine, staying calm, and investigating his family ancestry of vascular illness and taking his wellbeing increasingly genuine. H. ) Explain why Joseph’s heart bombed dependent on what you have realized so far about the capacity of cells in the human body? * Joseph was carrying on with an unfortunate way of life which comprises of undesirable eating, absence of working out, smoking, with a family ancestry of vascular illness; I imagine that Joseph heart fizzled on the grounds that his body could no longer capacity properly.Joseph heart was done accepting oxygen which made the cells work quickly to attempt to give oxygen stream to the heart. The body was denied of oxygen, glucose, and couldn't evacuate squander. There was no oxygen so the carbon dioxide levels in the body started to ascend due to not being discharged, and caused a low pH. The cells and films needed ATP the fundamental wellspring of vitality in cells. The mitochondria couldn't deliver ATP on the grounds that there was no oxygen, so the cells started to kick the bucket and the film siphons started to close down. There was no oxygen streaming all through the body which murdered the cells and they couldn't be repeated.

The Opening Free Essays

It is named Al-Fatihah, the Opening †considering the way that it opens the Book and by it the recitation in request begins. It is moreover named Umm al-Qur’an, the Mother of the Qur’an, and Umm al-Kitab, the Mother of the Book considering the way that the significance of the entire Qur’an is sketched out in that. It is in like manner named Sab’ul-Mathani, (the Seven Often Repeated Verses), Al-Hamd, (the Praise), Al-Shifa (The Cure) and Ar-Ruqya, the Spiritual Cure. We will compose a custom article test on The Opening or on the other hand any comparative subject just for you Request Now Its recitation is a condition for the sensibility of the interest. It is the Mecci Surah of the Holy Quran, which understands that it was found on the Prophet of God while He was in Makkah, for example before development to Madina. It was from the start the fifth part to be uncovered at this point after Furqan e Hameed was amassed, it was put close to the beginning. Al-Fatiha itself construes â€Å"The Opening† as this region comes content with start of the Holy Book and fills in as a Gateway to take a gander at Quran Majeed further. Also, it in like route fills in as the start of Salah. It in like manner has the joy of being the standard Surah that is made known completely. Dismissing the way that it incorporates 7 Ayats only, yet in spite of it clarifies the Veneration of the Almighty in a unimaginably extensive manner and furthermore is a hair-raising framework for request of progressing toward Allah for keeping one on the right way. Subject: Allah has taught in this Surah to humankind to offer request to Him, who is the Lord of this universe before pursuing down course and Who alone can allow it. The peruser ought to have a firm conviction that the Creator of the universe is the wellspring everything being equal and the assessment of Quran can give him direction. Islam requires a man to begin everything with the name of Allah. By doing this he will keep himself far from sketchy and wrong deeds. By then there is offered to of Allah Who is Master, Owner, Sustainer, Provider, Guardian, Sovereign, Ruler, Administrator and Organizer. By then it is solidified that He is the Master of the Day of Judgment, along these lines, everybody is liable for his deeds. Mankind is just admirer of the Lord and in this manner, humanity is mentioning bearing in each stroll around life. The course which make humanity positive is required. The individual will’s character off course will proceed through the viciousness of Allah (SWT)VIRTUES: There are numerous excellencies identified with this Surah.Hazrat Abu Saeed al-Khudri describes: â€Å"While on an excursion we completed at a spot. A young lady came to us and communicated: â€Å"The pioneer of this gathering has been stung by a scorpion and our men are truant, is there anyone among you who can recount something upon him to treat him?† Then, one of our men obliged her despite the way that we didn’t find that he knew any such treatment. Regardless, our sidekick went to the director and analyzed something upon him and the administrator was restored. Right away, the administrator gave him thirty sheep and gave every last one of us drain to drink. At the point when he returned, we asked our amigo: â€Å"Did you realize anything to acquaint upon him with fix him?† He communicated: â€Å"No, I just discussed Umm al-Kitab (for example Surah al-Fatiha) upon him.† We said that don’t do anything until the point that the second that we achieve Madinah and approach the Prophet with respect to this (hone and prize whether the sheep were legitimate or not for us). In the wake of achieving Madinah, we portrayed this to the Prophet (PBUH), whereupon he commented: â€Å"How may he come to comprehend that Al-Fatiha can be utilized as a fix? (PBUH) Distribute your compensation among yourselves and a ton a proposal for me likewise†.† (Sahih Bukhari) TAFSEER OF SURAH AL-FATIAH:In the Name of Allah The primary ayah of Surah Fatiha is: For the purpose of Allah, the Beneficent, the Most Merciful. (Al-Fatiha: 1) This articulation is known as the bismillah. It respects relate it before doing any action. The Meaning of the letter Baa The Baa in the Arabic lingo can have three unmistakable ramifications: With †With/for Allah Looking for help †Seeking help of the name of Allah Looking for preferring †Seeking preferring with the name of Allah The Meaning of al-Rahman and al-Raheem Both these names are gotten from a comparative root letters: raa, haa, meem; which plans to give grace. They are along these lines tantamount in significance and both are related with Allah’s (SWT) Mercy. The way that Allah (SWT) sees two of His Names which show to do with Mercy, rather than Might and Power or so on, exhibits precisely how fundamental this Attribute is. The differentiation between al-Rahman and al-Raheem is that al-Rahman suggests Allah’s (SWT) Mercy to the entirety of creation. It is His Mercy which is loosened up to the two disciples and cynics; animals, and everything that exists. He says in the Qur’an: My Mercy encompasses all things. (Al-A’raf: 156) Al-Rahman thusly shows the preposterous boundlessness of Allah’s (SWT) Mercy. It is said in a hadith that Allah (SWT) disengaged Mercy into 100 segments and sent down only a solitary part to this dunya. It is from this one a player in His Mercy that animals demonstrate consideration to their descendants (Sahih Muslim). Al-Raheem suggests Allah’s (SWT) Mercy which is specific for the aficionados. He says in the Qur’an: Also, He is Full of Mercy to the Believers. (al-Ahzab: 43) Al-Raheem along these lines shows the doing of a movement. All Praise is a result of Allah The subsequent ayah is: All recognition be to Allah, the Lord of the significant number of universes. (Al-Fatiha: 2) The Meaning of Hamd and the Difference among Hamd and Shukr Hamd infers extol and besides appreciation. The analysts appeared differently in relation to respects to the association between the words hamd and shukr. Some said that the two of them have a comparable significance. Along these lines, the centrality of hamd, in their view, is equivalent to shukr (gratefulness, appreciation). Hamd is something which must be done with love and love, anyway shukr doesn't require this. Shukr is helped considering out which is done to a man anyway hamd is done essentially in light of the fact that the one being praised and expressed profound gratitude to is meriting that. The Meaning of Rabb is regularly deciphered as Lord yet it is fundamentally more including than that. It in like manner joins the significance of Nurturer, Sustainer, Cherisher and so on. The Rabb is the creator, ruler, expert and the individual who controls everything. It begins from the root letters raa, baa, baa: which expects to have predominance and power over something. The Meaning of ‘Aalameen A part of the differentiating points of view about it are that it implies: 1-Everything which exists other than Allah ta’aalaa 2-Mankind and the jinn 3-Those things which have a shrewdness, and they are four: humanity, jinn, heavenly emissaries, and beasts 4-Those things which have spirits The best view is the main, the affirmation being ayah 23 and 24 of Surah Shu’ara. (23) Said Pharaoh, â€Å"And what is the Lord of the universes?† (24) [Moses] expressed, â€Å"The Lord of the sky and earth and that between them, in case you should be persuaded.† The Beneficent, The Most Merciful The third ayah is: The Beneficent, The Most Merciful. (Al-Fatiha: 3) The explanation of these two names has quite recently been given. Why by then is it reiterated? This is to before long complement the importance of the idea of tolerance. Similarly, when something is repeated in the Qur’an, by then you should look at the ayah before it and after it, to see how they are associated. For this circumstance, the past ayah determined that Allah (SWT) is the Rabb of the extensive number of universes. Along these lines, His repeating the words, al-Rahman al-Raheem starting now and into the foreseeable future, exhibits to us that His being the Rabb †His taking of and supporting and pleasing us †is all bit of His Mercy towards us. Expert of the Day of Reward The fourth ayah is: The Only Owner of the Day of Recompense. (Al-Fatiha: 3) The Meaning of Maalik: The foremost articulation of this ayah can be examined in two courses: either as â€Å"Maalik† (with a madd after the meem) or as â€Å"Malik† (without the madd). Maalik suggests pro, and it insinuates â€Å"drain† †the obligation regarding. Malik infers ruler, and it insinuates â€Å"mulk† †the area of a man. God is the Lord of the Day when all periods of mankind collect on solicitation to render a record of their lead, and when each individual will be finally compensated or repelled for his deeds. The depiction of God as Lord of the Day of Judgment following the state of his liberality and compassion shows that we ought to remember another piece of God also to be explicit, that He will pass judgment on us all, that He is so absolutely extraordinary, that on the Day of Judgment no one will have the force either to restrict the prerequisite of orders that He announces or to shield anyone from getting the prizes that He decides to give. Therefore, we ought not solely to cherish Him for supporting and overseeing us and for His compassion and thoughtfulness towards us, anyway should moreover hold Him in awe by virtue of His value, and should not ignore that our conclusive rapture or misery rests absolutely with Him. You (Alone) We Worship The fifth ayah is: (Only you) we love and (just you) we demand help. (Al-Fatiha: 5) Presently, there is a move in the Surah from instructing us about Allah (SWT) and complimenting Him, to tending to Him.†We revere† infers we agree. Love is obedience and self-lowering. It means to lo

Bipolar Medication and Alcohol Interactions

Bipolar Medication and Alcohol Interactions February 11, 2020 Bipolar Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Your Rights Peter Cade / Getty images Doctors will commonly advise you to avoid alcohol while taking certain medications, particularly those used to treat mental health disorders. While it would be fair to assume that drowsiness is the main concern, there may be other, more serious consequences of mixing alcohol with bipolar drugs. Whether you are a heavy or occasional drinker, alcohol can undermine your therapy and increase your risk of drug toxicity, side effects, and even suicide. The Link Between Bipolar Disorder and Alcohol Use Bipolar disorder and substance use disorders often go hand in hand. According to a 2014 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorders occur more frequently in people with mental health disorders than the general population.?? This is largely due to the fact that co-occurring conditions like substance abuse and bipolar disorder (BP) are often treated as a single problem rather than as separate entities. As such, symptoms suggestive of bipolar depression or mania may actually be related to a drinking problem and go untreated. The opposite also holds true. Research published in the Journal of Affective Disorders concluded that alcohol abuse was the single most prevalent substance use disorder in people with bipolar I and bipolar II disorders.?? According to an analysis of 22 multi-center studies and 56 individual studies, no less than 30 percent of bipolar people met the clinical definition of substance abuse disorder (SUD). Of these, 42 percent were classified as having an alcohol abuse disorder (AUD). Cannabis abuse was seen in 20 percent of people with BP, followed by cocaine and methamphetamine at 11 percent. Men with BP were two to three times more likely to have AUD than women with BP. Complications of BP and AUD Alcohol abuse can complicate the management of bipolar disorder. Not only does drinking impair your judgment and make you more impulsive, but it also increases your risk of suicide, injury, hospitalization, and sexually transmitted infections like HIV. According to research from the Medical University of South Carolina, the risk for attempted suicide is nearly twice as high in people with BP and AUD as it is in those with BP alone.?? Moreover, the effect alcohol has on a persons moods and judgment can make adherence to drug therapies all the more difficult, undermining the very goals of treatment. Due to these inherent risks, it is best to abstain from alcohol completely if you have bipolar disorder. Not only can drinking make your BP symptoms worse, achieving sobriety may be far more difficult when faced with the dual diagnosis. BPD Medication Groups That Can Have Serious Interactions With Alcohol These following groups of psychotropic drugs used may have serious interactions with alcohol, ranging in severity from mild to life-threatening: Group A: Anti-Anxiety and Sedating Drugs This group of drugs includes benzodiazepines and certain prescription sleep aids such as: Ativan (lorazepam)Klonopin (clonazepam)Valium (diazepam)Xanax (alprazolam)Ambien (zolpidem)Lunesta (eszopiclone)Prosom (estazolam)Restoril (temazepam)Sominex (diphenhydramine) Group B: Tricyclic Antidepressants Tricyclic antidepressants are an older class of drug used to treat severe mood disorders and include: Elavil (amitriptyline)Anafranil (clomipramine)Norpramin (desipramine) Group C: SSRI and SNRI Antidepressants Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants include: Celexa (citalopram)Prozac (fluoxetine)Lexapro (escitalopram)Zoloft (sertraline)Luvox (fluvoxamine)Paxil (paroxetine)Effexor (venlafaxine)Cymbalta (duloxetine) Group D: Atypical Antidepressants Atypical antidepressants are a newer class of antidepressant which include: Wellbutrin (bupropion)Desyrel, Oleptrol (trazodone)Serzone (nefazodone)Remeron (mirtazapine) St. Johns Wort, an herbal supplement believed to have antidepressive effects, is also included in this drug group and has many other potentially dangerous interactions. Group E: Anticonvulsants Anticonvulsants used as mood stabilizers in people with BP include: Tegretol (carbamazepine)Lamictal (lamotrigine) Group F: Mood Stabilizers Other commonly prescribed mood stabilizers include: Lithobid, Eskalith (lithium)Depakene, Depakote (valproic acid) Group G: Antipsychotics Examples of antipsychotics used in bipolar therapy include: Zyprexa (olanzapine)Risperdal (risperidone)Seroquel (quetiapine)Abilify (aripiprazole)Geodon (ziprasidone) Possible Interactions With Alcohol by Medication Group Interaction Groups Drowsiness or dizziness All groups Increased risk of overdose Groups A, B, C, G Slowed breathing or difficulty breathing Groups A D Impaired motor control Groups A, F, G Unusual behavior Groups A, D, F Problems with memory Groups A D Increased depression Groups B, C, F, G Loss of effectiveness of antidepressant Groups B C Increased risk of suicide or suicidal ideation (most especially in adolescents and young adults) Groups B C Convulsions and heart rhythm disturbances Group B Liver damage Groups C (duloxetine) F (valproic acid) Increased effect of alcohol Group D (bupropion) Tremors Group F Upset stomach Group F Muscle or joint pain Group F Restlessness Group F Appetite loss Group F A Word From Verywell Some over-the-counter products, especially cough syrup and laxatives, may contain enough alcohol to interact with your medications. Ask your doctor or pharmacist if they are safe to use.

Prejudice - 1230 Words

Prejudice Presented By: Nor Anisa Bt. Musa What is Prejudice? * Everyone comes face to face with prejudice at some time or another. * Prejudice is when we recognizethat we feel and act less positively towards others. * The roots of prejudice can be found in the cognitive and emotional processes. * Prejudice may be perceived as acceptable and justified * All inequality and differential treatment is not perceived and responded to in the same way. The nature and origins of streotyping, prejudice and discrimination * Prejudice, stereotyping and discrimination often overlap. * Prejudice is the feelings we have about particular groups. * Prejudice is a negative prejudgement of a group and its individual†¦show more content†¦* Stereotypic judgment will be stable as long as the nature of the inter-group relationship that exists between any two groups is stable * When values and categorization change, stakes in the present status is altered. * Prejudice is an attitude, usually negative towards members of a social group based on their membership * It is dependent on the perceived norms and acceptability of doing so * Information that is consistent with prejudiced views often received closer attention and is remembered more * Prejudice may reflect more specific underlying emotional responses to different out-groups including fear, guilt and disgust. * Discriminatory actions that follow maybe different * Prejudice persist beca use disparaging others can protect our self-esteem. * Threats to our group’s interest can motivate prejudice and competition can escalate conflicts * Holding prejudiced views of an out-group allows members to bolster their own group’s image. * Prejudice stems from direct competition between groups over scarce and valued resources such as land, jobs, housing etc. * As competition escalates, members of opposing groups view each other in increasingly negative terms. * Competition can escalate into full-scale, emotion-laden prejudice. * Prejudice is derived from our tendency to divide world into ‘us’ and ‘them’. Categorization may be based on race, religion, gender, age occupation. * We view ourShow MoreRelatedPrejudice, Prejudice And Prejudice1074 Words   |  5 Pagesmarked prejudice against prejudice, and understandably so. More often than not, â€Å"prejudice† refers to an â€Å"antipathy based upon a faulty and inflexible generalizat ion.†1 Insofar as prejudice refers to thought or action beclouded by hatred, it warrants condemnation, not defense. However, prejudice also has a broader meaning. According to the Oxford Shorter Dictionary, it is: â€Å"a preconceived opinion; bias unfavorable or favorable.†2 It refers to â€Å"life circumstances† and â€Å"perspective.† Prejudice is anyRead MoreGeneral Conception Of Prejudice And Prejudice919 Words   |  4 PagesThe presence of stereotypes and prejudices existed from a long time ago along with the human history – partially often deeply integrated with religion or social status. In 21st century, people are facing with many different stereotypes and prejudices either directly or indirectly. Stereotype is a generalized belief or assumption towards some specific groups or people by the defined attributes or characteristics. Stereotyping can foster prejudice and shape people’s point of views and behaviors ofRead MorePrejudices: Challenging Level Prejudice2250 Words   |  9 Pagesâ€Å"We are each burdened with prejudice; against the poor or the rich, the smart or the slow, the gaunt or the obese. It is natural to develop prejudices. It is noble to rise above them,† Author Unknown. Unfortunately, throughout history our society has become victim to the upbringing and menacing of prejudices within. The prejudices that our fellow neighbors endure range from scowling facial expressions to violent hate crimes. As far back as the decades go, prejudice has been an ongoing problemRead MorePrejudice Essay - Prejudice, Shame, And Worthless904 Words   |  4 PagesPrejudice Sadness, shame, loneliness, judged, and worthless, these are all feelings that victims feel when prejudice is involved. My brother, Johnny, had never felt any of these emotions before his accident. He is the one, whom everybody wanted to be around. He made everybody laugh, and he was just fun to be around. But things dramatically changed on the day he got into a car accident. He lost his arm. Now everybody looks at him as if he is completely different. Before someone is to be prejudicedRead More Prejudice Essay1566 Words   |  7 Pagespaper I was very excited to find someone with a quite interesting and culturally diverse family background that I think would contribute a lot to the topic of prejudice and stereotype. This paper will discuss the views of stereotype and prejudice of my interviewee and also how the two factors have affected her life. Brown (1995) defines prejudice as a negative attitude, emotion, or behavior towards members of a group as a result of their membership o f that group. This negative attitude, emotion, or behaviorRead MorePrejudice and Discrimination1551 Words   |  7 PagesAnalytical Factsheet on Prejudice amp; Discrimination on Class Inequality Section 1: Executive Summary This essay is about prejudice and discrimination occurring in Singapore context to address Class discrimination. This essay will also show reasons to why prejudice and discrimination occurs and the effects of such inequity can cause to the society. In this case studies possible measures and solutions will be highlighted and suggested. Section 2: The issues and who are involved This essay willRead MorePrejudice in of Mice and Men1582 Words   |  7 PagesIn John Steinbecks novel, Of Mice and Men, there are many example of prejudice. The main types of prejudice shown in this novel are racial, sexual and social prejudice.   This essay is firstly going to look at racial prejudice. There is much racial  prejudice  shown in Of Mice and Men towards  Crooks  the black crippled stable buck. Crooks is more permanent than the other ranch hands and has his own room off the stables with many more possessions than them. This room is made out to be a privilege andRead MorePrejudice, Discrimination, And Discrimination1050 Words   |  5 PagesWhat is Aversive Prejudice/Discrimination All types of prejudice vary in some ways , some people are very blunt and some people merely whisper under their breath or secretly avoid the people they dislike. This falls more in between those line with this being an example of averise racism specifically â€Å" Aversive racists, in contrast, sympathize with victims of past injustice,support principles of racial equality, and genuinely regard themselves as non-prejudiced, but at the same time possess conflictingRead MoreDiscrimination And Prejudice And Discrimination1638 Words   |  7 Pagessexual discrimination, and others. Prejudice is a negative attitude toward a socially defined group and toward any person perceived to be a member of that group (Burgess, 2003). The purpose of her research was to talk about discrimination and prejudices and the affect they have on our day to day lives. She also defines prejudice and discrimination and takes a look at their relationship to stereotyping and racism. According to Burgess, ste reotyping often leads to prejudice and discrimination, with its definitionRead MoreStereotyping: The Nature of Prejudice1539 Words   |  7 PagesA lot of people understand and have gone through stereotyping, prejudice, and discrimination. Social Psychologists make a distinction between these by concentrating on either they include emotions, understanding, or attitudes. Racism is the influence, or reaction, visible feature of this triad. Racism includes a contradicting approach into individuals situated on their association in a specific organization. The psychological visible feature is stereotyping. Stereotypes are feelings concerning the

The Stigma Of Mental Illness Essay - 1243 Words

Mental illness has dated back as far as anyone can remember it was first documented as an illness by 5th century B.C., Hippocrates when, â€Å"He was pioneering and treating mentally ill people with techniques not rooted in religion or superstition; instead, he focused on changing a mentally ill patient’s environment or occupation, or administering certain substances as medications (Unite for Sight, 2016). This was unheard of since then and now most cultures believe that mental illness is a demonic punishment for being lazy. This is where the worldwide term of mental illness stigma comes from. That leads us to the question, â€Å"What is a mental illness stigma?† According to Peter Byrne writer of an article titled, â€Å"Stigma of mental illness and ways of diminishing it† defines a mental illness stigma as,† A sign of disgrace or discredit, which sets a person apart from others. The stigma of mental illness, although more often related to context than to a person s appearance, remains a powerful negative attribute in all social relations. Mental illness is still perceived as an indulgence, a sign of weakness and a product of being lazy† (Stigma of mental illness and ways of diminishing it, 2000). People who suffer from mental illness are afraid to let it be known to friends, family and bosses that they are suffering. This is because they are afraid that they will be treated differently or treated as an incompetent if found out by a boss. According to the American PsychologicalShow MoreRelatedMental Illness And Its Stigma1363 Words   |  6 PagesMental Illness and Its Stigma â€Å"One in five adults in America experience mental illness,† (Mental Health, n.d., para 1). Many people define mental illness as a characteristic that makes one irrational or delusional and derives a belief that those who have mental disorders are not suffering from a real disease, resulting in a negative view of those who suffer. There are three ways to defy this stigma that everyone, from media producers to the sufferers themselves, must participate in to break downRead MoreThe Stigma Of Mental Illness Essay1657 Words   |  7 Pagesor older, live with mental illness. This number represents 18.1% of all U.S. adults (National Institute of Mental Health, 2014). Stigma toward those who are seen as different have existed for as long as civilization itself, with the stigma for mental illness being one of the most prominent and long lasting that society has had to face throughout its ages (Arboleda-Florez Stuart, 2012). Increased understanding and awareness for those individ uals suffering from mental illness is necessary for usRead MoreThe Stigma Of Mental Illness1599 Words   |  7 PagesPeople suffering from mental illness and other problems are often the most discriminated, socially excluded, stigmatized, and vulnerable members of the society. They have to constantly struggle and face a double problem. Firstly, they have to struggle with the symptoms of the mental illness itself. They may face with problems such as illusions, delusions, hallucinations and other symptoms, which depend on a particular mental disorder. These symptoms do not allow the person to live a satisfactoryRead MoreThe Stigma Of Mental Illness1745 Words   |  7 PagesThe majority of people that have a severe mental illness are object to challenges in double measure. From one point of view, they wrestle with the symptoms and disablement that result from the illness. From another point, they are tested by the stereotypes and preconceived ideas that stem from the misunderstanding s about mental illness. As a culmination of both, people with a mental illness are stripped of the chances that define a quality life such as a good job, safe housing, adequate health careRead MoreThe Stigma Of Mental Illness2582 Words   |  11 Pagesplans provided coverage for mental health services to the same extent as physical health services, if they were covered at all. The reasons for the discrimination in health insurance vary, but mental illnesses historically have not been well understood by the public, and people have had a hard time understanding that mental illnesses are biologically based diseases that affect the mind and body just like any other disease that has solely physical manifestations. A stigma is said to occur when peopleRead MoreThe Stigma of Mental Illness1656 Words   |  7 Pagesdiagnosis might exacerbate the stigma of mental illness. In Corrigan’s study clinical diagnosis adds groupness for the collection of people with mental illness which wo rsens the level of prejudice (Corrigan 34). Corrigan states that this ultimately leads to overgeneralization, as there is an assumption that all individuals diagnosed with the same mental disorders behave the same way (Corrigan 34). According to Corrigan the stereotypic description of mental illness perceives to the public that, peopleRead MoreThe Stigma Of Mental Illness984 Words   |  4 PagesSo how do we eliminate the stigma on mental illness that has been shaped and formed fo1r centuries? Now that we know the role mental health plays in our society and how it affects people who suffer from it. We must find a way to reduce the stigma and discrimination associated with this term. I propose the first step to solving this issue is through the media education and information. The media, from new to movies, plays a crucial role in shaping the minds of young people and even adults. Media hasRead MoreThe Stigma Of Mental Illness1042 Words   |  5 PagesBreak the Stigma In today’s society we are becoming more aware of the way our words or judgement can hurt others. However, there’s still a lot of stigma around mental illness. This judgement we have towards people with mental illness is what keeps some of them from seeking the help they need. The stigma isn’t just from those without mental illness though. People with mental illness often have their own stigmas as well. We need to come together and show men and women with mental illness that it isRead MoreThe Stigma Of Mental Illness1602 Words   |  7 Pagescenturies have seeked to improve care and reduce stigma around those with mental illness. This began in 1942, when Harry Truman signed the National Mental Health Act, which requested the formation of a National Institute of Mental Health. Shortly after this, in 1949, the National Institute of Mental Health was established (â€Å"National Institute of Mental Health†). During the company’s 60 year lifespan they h ave focused on research about mental illness, educating the public, and improving the lives ofRead MoreThe Stigma Of Mental Illness1212 Words   |  5 Pagesexperiencing symptoms of mental illness. Patients suffering a physiological illness rarely hear these words, but they have begun to sound like a broken record to the mentally ill. Everyone sympathizes with the stomach, the liver, the eye, and many other organs in the body when they begin to malfunction, but no one sympathizes with the brain. It is unimaginable and almost abominable for the brain to get sick. Mental illness is probably the most misconstrued and trivialized illness, and this misconception

A Reflective Observation on Global Warming Free Essays

Elizabeth Kolbert’s chapter 2 entitled â€Å"A Warmer Sky† in her book â€Å"Field Notes From A Catastrophe† is basically about the discovery of global warming and the developments in its awareness. It also shows relevant data about certain factors that affect global warming. John Tyndall’s discovery of the ratio spectrophotometer in 1859 was the advent of the awareness in global warming. We will write a custom essay sample on A Reflective Observation on Global Warming or any similar topic only for you Order Now The function of the said device is to differentiate absorbance and transmittance of their radiation exhibited by the gases. Results of the tests showed that the gases commonly found in the air such as nitrogen and oxygen did not absorb nor transmit any radiation. However, other gases such as carbon dioxide and water absorbed visible and infrared radiation (p.36). With these results, Tyndall stumbled upon a baffling and shocking truth that will cause a worldwide sensation and concern in the following generations. Tyndall concluded that these gases contribute largely to the way the earth radiates and absorbs radiation from the sun. He thought of the atmosphere as a barrier that regulates the amount of radiation that enters the earth which affects its overall temperature. This notion was later known as the â€Å"natural greenhouse effect† (p.36). The sun, earth and many hot bodies emit radiation and the amount of radiation is directly proportional to its temperature. This is further explained by the Stefan-Boltzmann Law which sates that the temperature raised to the fourth power is directly proportional to the radiation emitted by the body. The role of the greenhouse gases is to absorb selectively the radiation from the sun and allow visible radiation to penetrate the atmosphere. The earth’s infrared radiation, on the other hand, is absorbed by the greenhouse gases and is emitted partially into space and partially back to earth. This phenomenon regulates the temperature on the surface of the earth. After Tyndall passed away from an overdose of a sleeping drug, Arrhenius continued what Tyndall left unfinished. Arrhenius studied the effects of altering carbon dioxide levels in the atmosphere and he found out that rising carbon dioxide levels will increase the earth’s temperature, hence, he coined the phrase â€Å"to live under a warmer sky† to the next generations (p.42) Interest in the climate change mellowed down after the death of Arrhenius. However, in the mid 1950’s, there was a rebirth in the awareness of global warming and this was due to Charles David Keeling, a chemist. The results of his research in the atmospheric carbon dioxide levels in the atmosphere or the â€Å"Keeling Curve† showed that the carbon dioxide level increases as time increases. The results were devastating as years pass by. The Keeling curve also showed that the carbon dioxide level in 2005 was 375 parts per million and with this terrifying rate, it will increase to 500 parts per million by the middle of the century which will greatly affect the temperature of the earth and will make us feel the full effects of global warming (p.44) Global warming threatens us to extinction. This is caused mainly by industrialization and we must stop, or if not, control the rise of carbon dioxide levels in the atmosphere to save the future generations. Global warming will cause the polar and ice glaciers to melt that constitute to a rise in sea level. This rise will flood coastal regions and other land masses. There is also an expected change of rainfall patterns across the globe that will greatly affect food crops and will be a major setback in food production in many nations. With the increase in temperature, plants and animals will be forced to live in cooler areas and those who are unable to adapt will be doomed of extinction.   (Global Warming, Encarta) How to cite A Reflective Observation on Global Warming, Essays

Teaching Plan Diabetes Mellitus free essay sample

According to the Centers for Disease Control and Prevention (CDC, 2011), 25. 8 million Americans, 8. 3 percent of the population, have diabetes and nearly 27 percent of those 26 million Americans, are undiagnosed. In 2010, the CDC reported nearly 2 million Americans aged 20 years and older were diagnosed with diabetes. Diabetic education is an important part of helping those with diabetes effectively manage the disease and prevent complications. Statistics from the CDC show that poorly managed diabetes is the leading of non-traumatic lower limb amputations in the United States . Patients with diabetes are at greater risk for serious complications with their feet than those who do not have diabetes. Implementing a diabetic foot care program for those patients receiving home health services can reach an often-overlooked at-risk diabetic population . The home health nurse has the perfect opportunity to implement a foot care regimen and reinforce the importance of proper foot care with her diabetic patients and their families/caregiver. We will write a custom essay sample on Teaching Plan Diabetes Mellitus or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page This teaching plan is a prevention plan designed to reinforce good foot care practices for a diabetic patient who needs a refresher on proper foot care or the newly diagnosed diabetic patient. The content is suitable for anyone who is age 18 or older with at least an eighth-grade education, and who can read/write English or Spanish. Any family members or caregivers should be present to learn proper foot care in case the patient becomes unable to practice proper foot care at some point in the future. Family members and caregivers are also excellent sources of support and positive reinforcement. Goal The goal of this teaching plan is to motivate the diabetic patient to engage in proper foot care, which can avoid serious complications. Patients with diabetes often do not recognize the how important it is to take care of their feet. Objectives Following a one-hour teaching session, the diabetic patient will be able to: 1. Recognize two ways diabetes can affect the feet (cognitive). 2. Describe two ways to keep the blood vessels healthy (cognitive). 3. Recognize the signs/symptoms that indicate an infection (cognitive). 4. Describe proper footwear (cognitive). 5. Recognize when to visit the doctor for foot care (cognitive). 6. Demonstrate proper foot care (psychomotor). a. Perform visual inspection of the feet b. Demonstrate proper foot cleansing c. Demonstrate proper toenail trimming d. Demonstrate proper application of lotion 7. Verbalize feelings of confidence in performing daily foot care to prevent foot complications (affective). 8. Verbalize any issues or concerns related to maintaining proper foot care, for examples, costs associated with proper footwear (affective). 9. Display continued interest in maintaining proper foot care (affective). The objectives of this program are learner-centered behavioral objectives, they place the emphasis on what the learner is expected to accomplish, have specific learning outcomes, and are observable . The teaching plan incorporates objectives from all three learning domains: cognitive, affective, and psychomotor. They follow the guidelines established by the ADA for Diabetes Self-Management Education for creating â€Å"action-oriented, behavioral goals and objectives† . Because of the difficult lifestyle changes associated with diabetic, it is important to include affective behavioral objectives to help the diabetic patient develop their own intrinsic motivations to change. Objective 9 is a long-term objective that the home care nurse evaluates at each subsequent home visit. Content The content of the teaching plan utilizes the diabetic foot care interactive tutorial from the Patient Education Institute, available at MedlinePlus, a service of the U. S. National Library of Medicine, National Institutes of Health, http://www. nlm. nih. gov/medlineplus/tutorials/. The content is available in three different formats: (a) an interactive tutorial with questions, (b) a self-playing tutorial without question, and (c) a text summary of the tutorial in a downloadable PDF file. The tutorials give the user the option to have the displayed text narrated, which is appropriate for use with visually impaired and auditory learners. The content reviewed for health literacy, supports the National Standards for Diabetes Self-Education . This teaching plan focuses on the interactive tutorial with questions. The plan can be delivered using the printed text summary. Health literacy is important to consider when choosing because patient education materials because studies have shown that an individual’s functional health literacy is usually lower than their general literacy. The U. S. Department of Health and Human Services defines health literacy as the ability of the individual to understand health information to make knowledgeable decisions about their care. This program considers health literacy by using plain language, a minimum amount of words supplemented with pictures, and presenting the information in a logical sequence, so that each section of the program builds upon the previous section. This allows the diabetic patient to internalize the knowledge acquired and apply it to future concepts, promoting independence and self-efficacy. The content of the program centers on positive behaviors and is not condescending in tone when narration is used. Time Allotment The teaching plan will take approximately one-hour to complete and consists of: (a) 35-minute interactive computer tutorial, (b) 15-minute patient demonstration of foot inspection and washing, and (c) 10-minute wrap-up session. Patient Assessment At the beginning of the home visit, the nurse asks the patient if she can assess the condition of the diabetic patient’s feet and review proper foot care with them. Asking permission gives the patient a sense of control over the situation and answers to the questions can help the nurse assess readiness to learn. To assess readiness to learn, the nurse will assess such things, as the patient’s present health condition, emotional state, and environment, all factors that can affect a diabetic patient’s ability to learn . The nurse should also assess the patient’s ability to complete foot care tasks independently. If the patient is unable to complete any task independently, a family member or caregiver should be present. The nurse will have to assess their readiness to learn, as well. If the patient is not receptive, now might not be the right for a learning session or this patient may prefer to learn on their own . If the nurse determines the patient is not ready or prefers self-instruction, she asks permission to leave information on proper foot care. The nurse can follow-up with a similar interaction at the next visit to see if the diabetic patient has any questions or concerns regarding the material and see if the patient is ready to participate in a learning session. Interactive Computer Tutorial – 35 Minutes The interactive tutorial gives the diabetic patient the necessary knowledge to meet Objective 1 through Objective 5, and enhances their ability to complete Objective 6 during the 15-minute demonstration return demonstration of proper foot care. The entire teaching plan supports Objective 7 and Objective 8. As necessary, a family member or caregiver should take part in the learning. All participants are given a copy of the text summary prior to starting the tutorial. If they are tactile learners, they can take notes, underline, highlight, etc. , as they view the tutorial. The tutorial consists of 72 slides and takes approximately 30 minutes to complete. There are questions peppered throughout the tutorial, which provide immediate feedback to the diabetic patient and nurse. The nurse will explain to the other participants that the patient should answer the questions on their own. The first 27 slides set the stage for the learner, providing them with an overview of how and why feet are important, especially to a diabetic patient, before presenting information on prevention and proper foot care. The diabetic patient has to know why foot care is important to them and what the consequences are if they do not protect their feet in order to participate in preventative health behaviors . Slides 28 through 66 discuss prevention measures, foot care, footwear, how to prevent injuries, and the importance of regular checkups. The last five slides provide a summary of the important concepts learned. All of the slides contain a combination of words and pictures relevant to the discussion. Introduction. The Introduction provides the diabetic patient with a short overview of what the tutorial will cover. The first slide states an honest, straightforward fact, â€Å"Patients with diabetes are more likely than others to have problems with their feet. These problems can lead to dangerous infections of the foot† . Denial is common among patients with chronic illnesses so it is important to provide them with facts, no fluff, no medical jargon – just the important points (Lowenstein, et al. , 2009). The goal of the tutorial, how to recognize and treat foot problems to avoid serious complications is stated on the second slide. A Healthy Foot. This section provides the diabetic patient with a simple description of how healthy feet support the body, absorb pressure from the body, prevent infections from entering the foot, and most importantly, feel pain. Giving the diabetic patient a description of what a healthy foot does will help them grasp the next concept, how diabetes adversely affects the feet. Diabetes the Feet. These slides describe two ways diabetes can affect the feet: (a) nerve damage, and (b) narrowing of the blood vessels. The slides on nerve damage discuss how diabetic neuropathy decreases sensation to the feet and can cause feelings of numbness and tingling. Decreased sensation can prevent the diabetic patient from realizing they have a cut or blister on their feet. Numbness in the feet can affect balance and standing possibly leading to painless fractures or flattened arches. Flattened arches may cause blisters from unusual pressure points. The slides on damaged blood vessels explain how narrowed blood vessels lead to poor circulation in the feet and causes impaired healing of foot injuries, which could lead to gangrene and amputation. The section ends with three True/False questions (see Appendix A). If the patient gets a question wrong, the question appears again for them answer. They cannot move forward in the tutorial until they select the correct answer. Prevention. The most important prevention method is controlling blood sugar. This is on the first slide in the prevention section. A simple concept, yet many diabetic patients do not understand the importance of monitoring and controlling their blood sugar levels (Lowenstein, et al. , 2009). This slide is about reinforcing that message. The next slide discusses four other things diabetic patients can do to protect their feet (a) proper foot care, (b) proper footwear, (c) preventing injury, and (d) getting regular check-ups. While many people receive diabetic education, many fail to maintain proper foot care; diabetic patients report wearing inappropriate shoes and walking barefoot, and improper nail care despite education . This section ends with two True/False questions (See Appendix A). Foot Care. Proper foot care is important for preventing complications. Daily foot inspections are important way for a diabetic patient to prevent complications before they start. Foot inspections help the diabetic patient identify small problems and address them before they become serious. The first slide in this section stresses the importance of daily foot inspection. The next slide explains how to inspect the foot and to use a mirror if you cannot see the soles of the feet. The next three slides explain how to wash and dry the feet and apply lotion. A True/False question (see Appendix A) applying lotion is presented. The next three slides provide information on trimming toenails and signs of ingrown toenails, which need to be reported to the nurse or doctor. A True/False question about trimming the nails is next. The section continues with a slide discussing corns and calluses and the importance of talking to the doctor about them. Patients should not attempt to remove corns or calluses on their own. A True/False question (see Appendix A) on corns and calluses concludes this section. Before moving to the next session, the nurse will explain to the patient they should inspect their feet every day around the same time so that it becomes part of their daily routine. She should also stress that foot cleansing is performed daily, but does not need to be a separate activity, it can be done in the shower or while bathing. The water should be warm, not hot and the patient should test it with their hand or elbow. Toenails are trimmed before applying lotion so the patient is able to hold their toes without their fingers slipping. Footwear. Many of us probably do not think much about the shoes (or socks) we put on our feet, but for the diabetic patient, improper footwear (and socks) can lead to serious complications. The first slide tells the diabetic patient that the right shoes and socks can keep their feet healthy. The next three slides discuss proper and improper shoes and socks. Proper shoes are ones that allow the toes room to move. Improper shoes are tight, pointed or high-heeled shoes. Open toe or open-back shoes leave the foot exposed and increase the risk for injury. Socks should be clean and comfortable with no bumps (pressure sore) or tight elastic (circulation). This section ends with a multiple-choice question (see Appendix A) about circulation. The question builds upon information presented at the beginning of the tutorial. Integrating this question in the context of footwear helps the patient establish a connection between the two concepts. Requiring them to recall previous learning refreshes the information and increases probability of retention (Lowenstein, et al. , 2009). Before beginning the next session, the nurse should let the patient know that if they have Medicare Part B insurance, it may cover the some of the costs for special shoes or inserts. Preventing Injury. These slides provide the diabetic patient with important tips for preventing injuries to the foot: (a) never walk barefoot, (b) check the inside of shoes each time for small objects or torn linings that can create pressure points, (c) avoid contact with hot water or surfaces, and (d) avoid exposure to the sun and wear sunscreen. This section ends with a True/False question (see Appendix A) on nerves. Like the previous section, the question builds upon previously learned information and helps the patient establish a relationship between the two. The nurse will tell the patient they should keep a pair of slippers next to their bed to prevent them from walking barefoot when they get out of bed in the morning. Regular Checkups. The first two slides indicate the diabetic patient should see their doctor or podiatrist regularly (podiatrist is defined for the diabetic patient) and to have the doctor check their feet. The next slide is a reminder for the diabetic patient that a doctor should care for and remove corns or calluses. The next two slides stress the importance of catching foot problems early so they can be treated early. Untreated infections can lead to severe infections that can spread to the bone and may require surgery. These slides reinforce previous learning, integrating the information with the importance of seeing a doctor. This section ends with a True/False question (see Appendix A) about infections, again integrating information learned previously within the context of regular checkups. The nurse should remind the patient it is important for them to schedule regular visits to the doctor and to keep those appointments. Summary. The four slides in this section summarize the key points the diabetic patient should take away from the tutorial. The most important aspect of prevention is maintaining proper blood sugar levels and good foot hygiene. The last slide emphasizes that management of diabetes and good foot hygiene is dependent on the diabetic patient. Evaluation. Evaluation is accomplished with a process evaluation. The tutorial questions provide immediate feedback to the diabetic patient and the nurse. This allows both the diabetic patient and the nurse to assess learning throughout the program. Either the nurse or diabetic patient can make adjustments, such as repeating a section, or stopping the tutorial to provide further explanation . This method ensures the patient is meeting the objectives as they progress through the tutorial. Demonstration of Proper Foot Care – 15 minutes The nurse should give the patient a minute or two to let the information gel as she sets up the supplies for the foot care demonstration. If the patient’s range of motion or visual acuity does not allow them to inspect or clean their feet, a family member or caregiver will perform the inspection and cleaning. If the nurse determined from the assessment the toenails can be safely trimmed by the patient (or participant), she will also include nail trimming in the foot cleansing demonstration. When the nurse is ready for the demonstration, she will ask the patient to remove their shoes and socks while she removes the shoe and sock from one of her feet. To begin the demonstration, the nurse will explain what she is looking for: cuts, sores, red spots, swelling, lack of sensation, and anything that does not look right. Then she will examine the top and bottom (with mirror) of her foot and inspect the area between her toes while she explains what she is doing. The patient should return demonstrate on both feet and explain what they are doing. The nurse will observe: (a) how carefully the patient examines the tops and bottoms of their feet, (b) if they use a mirror when they cannot the bottoms of their feet, and (c) if they inspect between all their toes. The next part of the demonstration is proper foot cleansing. The nurse will do a mock demonstration on proper foot care and then observe the patient perform actual foot cleansing, drying, nail trimming on one nail (as necessary), and moisturizing. She will observe the following: (a) how the patient tests the water in the basin prior to putting their feet in, (b) how the patient dries the feet, (c) how the patient trims the toenail, and (d) if the patient puts lotion between the toes. While the patient is performing both skills, the nurse should refrain from asking any questions that require cognitive or affective responses because they interfere with psychomotor learning. Questions related to these domains should be presented before or after the demonstration. Evaluation. Evaluation of foot inspection and cleansing is based on instructor observation (see Appendix B). The nurse will assess the diabetic patient’s affective domain (Objectives 7 and 8) at the end of the demonstration by asking the patient to verbalize how confident they feel about performing foot care and if they have any concerns about proper foot care, for example, the costs associated with proper footwear. Wrap-Up – 10 minutes The nurse will review patient the To Do List (see Appendix C) and the list of Foot Care Tips (see Appendix D) that encourages them to continue practicing proper foot care. These lists are included in the booklet from the U. S. Department of Health and Human Service, National Diabetes Education Program , â€Å"Take Care of Your Feet for a Lifetime,† that the nurse will leave with the patient. This booklet, reviewed for health literacy, is an excellent reference tool for the diabetic patient after the education session. Method of Instruction There are three methods of instruction included in this teaching plan, self-instruction, one-on-one, and demonstration return demonstration. All three of these instruction methods are appropriate for one-on-one use and provide for immediate feedback. The interactive tutorial combines self-instruction with one-on-one instruction to enhance the learning process. The nurse and diabetic patient view the tutorial together, but the diabetic patient controls the movement among the slides, allowing them to progress at their own pace. The nurse is there to provide guidance and answer any questions. Both self-instruction and one-on-one instruction can be paced to meet the diabetic patient’s needs and both methods provide the opportunity for immediate feedback. One-on-one teaches in all the behavioral domains and is suitable for those with low literacy, a disadvantage with self-instruction. Self-instruction teaches in the cognitive and psychomotor domains. The tutorial complements the psychomotor learning process by introducing the patient to the steps for proper foot care before the demonstration return demonstration portion of the teaching session. Demonstration of proper foot care uses demonstration return demonstration, which is appropriate for learning in the psychomotor domain. By this time in the teaching session, the diabetic patient should feel comfortable with the nurse and not feel like the nurse is testing them on the return demonstration . The return demonstration by the diabetic patient happens right after the demonstration by the nurse also reduces the diabetic patient’s anxiety. Resources The interactive tutorial requires a computer and internet connection. Many homes today have computers and internet access. Some home health and public health agency nurses carry company laptops with internet access. The content can also be delivered using the printed text summary, which is the same information found in the tutorial. The hand-out is six pages long. The leave-behind booklet from NDEP can downloaded and printed by the general public or up to 10 copies can be ordered free from the NDEP website http://ndep. nih. gov/publications/PublicationDetail. aspx? PubId=67. Additional packages of 10 (up to 100 copies) can be order for two-dollars each. The patient should provide the basin, soap, lotion, mirror, nail clippers, emery board, and towel. The nurse should have these tools as wells, in case the patient does not have the appropriate tools. If the patient does not have the appropriate tools, they should be encouraged to obtain them. Summary The following concepts were considered when selecting this tutorial: Cost-effective and up-to-date evidence-based quality information from a reliable source. Narration for use with visually impaired and auditory learners. Content is appropriate for low-literacy patients. Adult learners are independent and self-directed learners, but they appreciate (even need) structure and direction . The tutorial allows for nurse- patient interaction providing that structure and direction. Gives the diabetic patient control over the learning process empowers them to learn (Lowenstein et al. , 2009). There are three other tutorials presented in a similar format available on the Medline website: an introduction to diabetes, eye complications, and meal planning. This gives the nurse a set of tools to help her patient manage diabetes. Why recreate the wheel when appropriate instructional materials are already available . This teaching plan will provide the diabetic patient with the necessary knowledge and tools to motivate self-directed behavioral changes towards proper foot care. Motivation, learning and behavior are inextricably linked. People tend to be intrinsically motivated; if the motivation to learn is not there, then the behavioral changes will not occur . References Bastable, S. (2008). Nurse as educator: Principles of teaching and learning for nursing practice. Sudbury, MA: Jones and Bartlett. Center for Disease Control and Prevention. (2011). National diabetes fact sheet, 2011. Retrieved from Center for Disease Control and Prevention: http://www. cdc. gov/diabetes/pubs/factsheet11. htm Corbett, C. F. (2003). A randomized pilot study of improving foot care in home health patients with diabetes. The Diabetes Educator, 29(2), 273-282. doi:DOI: 10. 1177/014572170302900218 Funnell, M. M. , Brown, T. L. , Childs, B. P. , Haas, L. B. , Hosey, G. M. , Jensen, B. , . . . Weiss, M. A. (2010, January). National Standards for Diabetes Self-Education. Diabetes Care, 33(Supplement_1), S89-S96. doi:10. 2337/dc-S089 Lowenstein, A. J. , Foord, L. , Romano, J. C. (2009). Teaching strategies for health education and health promotion. Working with patients, families, and communities. Sudbury, MA: Jones and Bartlett Publishers. Neder, S. , Nadash, P. (2003). Individulized education can improve foot care for patients with diabetes. Research briefs. Home Healthcare Nurse, 21(12), 837-840. Retrieved from http://journals. lww. com/homehealthcarenurseonline/Fulltext/2003/12000/Individualized_Education_Can_Improve_Foot_Care_for. 13. aspx The Patient Education Institute. (2013). Diabetes Foot Care. Retrieved from MedlinePlus: http://www. nlm. nih. gov/medlineplus/tutorials/diabetesfootcare/htm/index. htm U. S. Department of Health and Human Services. (2013, April 10). Health Literacy. Retrieved from Health. gov: http://www. health. gov/communication/literacy/ U. S. Department of Health and Human Services, National Diabetes Education Program. (2012). Take care of your feet for a lifetime. A booklet for people with diabetes. (NIH Publication No. 12-4285. NDEP-4). Retrieved from http://ndep. nih. gov/publications/PublicationDetail. aspx? PubId=67 Appendix A Questions in the Tutorial Diabetes the Feet 1. People with diabetes who have damaged nerves in their feet are less likely to feel injury to their feet than people without diabetes. True or False. True Answer Correct. Because nerves carry the feeling of pain, people with damaged nerves in their feet are less likely to feel injury to their feet. False Answer Incorrect. Nerves carry the feeling of pain. People with damaged nerves in their feet are less likely to feel injury to feel injury. 2. People with diabetes are more likely to have narrow blood vessels than people without diabetes. True or False. True Answer Correct. Diabetes affects the blood vessels throughout the body, however, the blood vessels of the feet, kidneys, and eyes are especially vulnerable. False Answer Incorrect. Patients with diabetic are more likely to have narrow blood vessels than people without diabetes. 3. All diabetic patients with diabetes will have foot problems. True or False. True Answer Incorrect. Not all patients with diabetes will experience foot problems. Good hygiene and successful control of diabetes can delay or prevent these problems. False Answer Correct. Not all patients with diabetes will experience foot problems. Good hygiene and successful control of diabetes can delay or prevent these problems. Prevention 1. To keep their feet healthy, patients with diabetes should avoid walking. True or False. True Answer Incorrect. Exercising, such as walking is important for controlling diabetes and keeping the blood vessels healthy. The healthier the blood vessels, the less likely foot problems will appear. Use sensible footwear! False Answer Correct. Exercising helps keep the blood vessels of the body healthy, which leads to healthier feet. Use sensible footwear! 2. Stopping smoking can help prevent or delay foot complications. True or False. True Answer Correct. Smoking can reduce the blood flow to the feet. This makes it difficult for the feet to receive the nutrients and oxygen they need for health and healing. False Answer Incorrect. Smoking can reduce the blood flow to the feet. Foot Care 1. It is preferable to avoid putting lotion between the toes. True or False. True Answer Correct. It is preferable to avoid putting lotion between the toes. The excessive moisture that may result can be a breeding ground for infections. False Answer Incorrect. It is better to keep the area between the toes dry. 2. Patients with diabetes can cut off corns and calluses on their own. True or False. True Answer Incorrect. Patients with diabetes should not cut the calluses and corns on their own. They should ask their healthcare provider to help. False Answer Correct. 3. It is better to trim nails before and not after taking a shower. True or False. True Answer Incorrect. It is preferable to trim nails after soaking them, such as after taking a bath or shower. False Answer Correct. It is preferable to trim nails after soaking them, such as after taking a bath or shower. Footwear 1. Pale and cold feet indicate which of the following? a. Poor Circulation b. Damaged Nerves a. Poor Circulation Correct. Pale and cold feet may mean the feet are not receiving adequate supply of blood. b. Damaged Nerves Incorrect. Pale and cold feet may mean the feet are not receiving adequate supply of blood. Exercise, such as walking, is important for controlling diabetes and keeping the blood vessels healthy. The healthier the blood vessels are, the less likely foot problems will appear. Preventing Injury 1. Frequent tingling or numbness may indicate that the nerves are damaged. True or False. True Answer Correct. Odd feelings of numbness and tingling should be reported to the doctor. They may mean the nerves are damaged. False Answer Incorrect. Frequent of numbness and tingling may mean the nerves of the feet are damaged. Regular Checkups 1. Redness and swelling in the feet with increased heat are signs of an infection. True or False. True Answer Correct. Redness, swelling, increased temperature, fever, and chills are all signs of infections. Call your doctor immediately if you notice any of these signs. False Answer Incorrect. Redness, swelling, increased temperature, fever, and chills are all signs of infections. Call your doctor immediately if you notice any of these signs. Appendix B Foot Care Observation Evaluation Critical Elements YES NO Comments Inspects the tops/bottoms of feet. Uses mirror when appropriate. Inspects between all toes. Tests water with hand or elbow. Gently dries feet and between the toes. Trims toenails before applying lotion Trims toenails straight across, not too far down. Uses an emery board to file the edges, does not cut them with the clippers. Does not apply lotion between the toes Verbalizes feelings of confidence in performing daily foot care Verbalizes any issues related to proper foot care Appendix C To Do List Make plans now to take care of your feet for a lifetime. Check each item when completed. ____ Use the foot care tips on the other side of this page. ____ Put this list where I will see it every day. ____ Get a pair of nail clippers, an emery board, and pumice stone if my doctor tells me to. ____ Buy soft, lightly padded, seamless socks. ____ Buy a pair of shoes that fit well and protect my feet. ____ Place slippers beside my bed to wear when I get out of bed. ____ Get a mirror to help me see the bottoms of my feet. ____ Ask for help from a family member or caregiver if I cannot see my feet. ____ Keep my next doctor’s visit. ____ Ask my doctor if my insurance will cover the cost of special shoes or inserts. ____ Ask my health care team about diabetes services and supplies that may be covered by Medicare or other insurance plans. ____ Ask my doctor or nurse to look at my feet at every visit. ____ Talk with my health care team about safe ways I can be more active each day. ____ Stop smoking. Call 1-800-784-8669 to get help with quitting. ____ Work to manage my diabetes to prevent foot problems. Source: To Do List from The National Diabetes Education Program booklet, â€Å"Take Care of Your Feet for a Lifetime†. Available at http://ndep. nih. gov/publications/PublicationDetail. aspx? PubId=67. Appendix D Foot Care Tips 1. Check your feet every day. Look at your bare feet every day for cuts, blisters, red spots, and swelling. Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing. 2. Wash your feet every day. Wash your feet in warm, not hot, water every day. Dry your feet. Be sure to dry between the toes. 3. Keep the skin soft and smooth. Rub a thin coat of lotion over the tops and bottoms of your feet, but not between your toes. 4. Smooth corns and calluses gently. If your doctor tells you to, use a pumice stone to gently smooth corns and calluses. Do not use over-the-counter products or sharp objects on corns and calluses. 5. If you can see, reach, and feel your feet, trim your toenails regularly. If you cannot, ask a foot doctor (podiatrist) to trim them for you. Trim your toenails straight across and smooth the corners with an emery board or nail file. 6. Wear shoes and socks at all times. Never walk barefoot. Wear shoes that fit well and protect your feet. Feel inside your shoes before putting them on to make sure the lining is smooth and that there are no objects inside. 7. Protect your feet from hot and cold. Wear shoes at the beach and on hot pavement. Wear socks at night if your feet get cold. Do not test bath water with your feet. Do not use hot water bottles or heating pads on your feet. 8. Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two or three times a day. Do not cross your legs for long periods of time. Do not smoke. Call 1-800-QUITNOW (1-800-784-8669). 9. Be active every day. Talk to your health care team about safe ways you can be more active. 10. Check with your health care team. Have your doctor or nurse check your bare feet and tell you if you have foot problems or may get foot problems in the future. Remember that you may not feel the pain of an injury. Call your health care team right away if you find a cut, sore, blister, or bruise on your foot that does not begin to heal after a few days. Follow your health care team’s advice about foot care.