abortion 7 essays

Police States and Territories of India and Civil Services Examination free essay sample

IPS officials are enlisted from the state police frameworks and from the thorough Civil Services Examination led by Union Public Service Commission each year. [7] Due to a continuous deficiency of cops in India, the Ministry of Home Affairs proposed the formation of an Indian Police Service Limited Competitive Examination to be directed by UPSC. [8] The Civil Services Examination has a three phase serious choice procedure. At stage one, there is a target type assessment called the starter test. This is a passing assessment. It comprises of a General Studies paper and a bent test. Just the applicants who pass this can show up for the Main Examination which comprises of nine papers. Every applicant needs to choose a discretionary subject (one paper) and to take six General Studies papers, an Essay, an English language paper and a territorial language paper. This is trailed by a meeting. After determination for the IPS, applicants are assigned to a framework. We will compose a custom article test on Police: States and Territories of India and Civil Services Examination or on the other hand any comparable point explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page There is one framework in every Indian state, except for three joint units: Assam-Meghalaya, Manipur-Tripura, and Arunachal Pradesh-Goa-Mizoram-Union Territories (AGMUT). 66% of the quality of each framework is filled straightforwardly by IPS officials and the remaining are advanced from the separate states unit officials. State Police Services (India) Indian Police Service and Law implementation in India The State Police Services , essentially known as State Police or SPS are police benefits heavily influenced by separate state administrations of the States and regions of India. The competitors chose for the SPS are generally posted as Deputy Superintendent of Police or Assistant Commissioner of Police once their trial period closes. On endorsed acceptable assistance in the SPS, the officials are assigned to the Indian Police Service. [1] The enrollment to this administration is finished by the separate State Governments, for the most part through State Public Service Commissions. The enrollment to SPS is likewise on a similar example as that for IPS. The main distinction is that the enrollment of SPS officials is made by the State Public Service Commission worried through generally a joined serious assessment for State Civil Services which on account of IPS is through the All-India Civil Services Examination directed by Union Public Service Commission . Be that as it may, if there should be an occurrence of Union Territory, enlistment to SPS is likewise made by Union Public Service Commission through the Civil Services Examination as one of the Group-B Services. State police necessity in enormous States like Tamil Nadu, Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Maharashtra and Andhra Pradesh is more noteworthy when contrasted with the littler States like Himachal Pradesh, Punjab, Haryana, Kerala, Sikkim and north-eastern States. After choice, which again depends on the decision of administration and value of an applicant, chose competitors are required to experience enthusiastic trial preparing before getting posted as ACP or DSP.

How Self-Conscious Emotions Affect BPD

How Self-Conscious Emotions Affect BPD BPD Print How Self-Conscious Emotions Affect BPD By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Learn about our editorial policy Kristalyn Salters-Pedneault, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on May 29, 2019 Daniel Allan/Getty Images More in BPD Diagnosis Treatment Living With BPD Related Conditions If you have borderline personality disorder (BPD), self-conscious emotions can play a major role. Due to the disorder, feelings are intensified and can cause harmful reactions. Find out more about self-conscious emotions and how they impact your mental health.   What Are Self-Conscious Emotions? While some emotions are considered basic emotions, meaning that they require little or no sense of self to experience or recognize, self-conscious emotions are related to our self-concept and an understanding of our relationship to other people and the larger community.   For example, to experience the basic emotion fear, you only need to perceive something as threatening. But to experience a self-conscious emotion, such as guilt, you must have both a sense of self and an understanding of your behavior, such as recognizing when you did something wrong.   The self-conscious emotions include both positive emotions like pride or confidence as well as negative emotions like shame or jealousy.   Purpose   Scientists believe that self-conscious emotions have an evolutionary basis. They help you survive by promoting social inclusion, such as helping you stay in the good graces of others. For example, when you express embarrassment after violating some social norm, the expression of that emotion helps you to repair relationships. For instance, if you have hurt a friend and apologize to her, your face may turn red and you may not be able to meet her eyes. Your friend will know how badly you feel and may be less angry with you.   These feelings also probably help prevent you from violating social norms in the future. If you know you will feel guilty if you steal from someone, you are more likely to avoid that behavior altogether.   Borderline Personality Disorder and Self-Conscious Emotions Research has shown that people with BPD are more likely to have unpleasant or negative self-conscious emotions. The cause of this is two-fold. Because BPD can cause you to experience more intense emotions and feelings of shame or guilt, this can cause inappropriate or destructive behaviors, such as sexual interactions or violence. These experiences also shape how people with BPD interpret behaviors. For instance, someone who has had an inappropriate sexual relationship will feel shame or guilt and may perceive a persons actions as predatory. This can cause them to react to that person aggressively, even if the other person is innocent. The link between BPD and self-conscious emotions can start a cycle of destruction, leading a person to self-harm or suicidal thoughts.   If you feel you struggle with self-conscious emotions and you have borderline personality disorder, its important to talk about this with your therapist or health care provider. They can help you handle self-conscious emotions in a healthy way that doesnt harm yourself or others. By learning coping strategies, such as taking a break from the situation, you can process the emotions fully and establish whether or not your reaction is equal to what has actually happened. Your therapist will help you improve these skills so you can manage your illness and better maintain your relationships.

The Management Of Grief By Bharati Mukherjee And Araby

There is a great importance of theme and literary characteristics when attempting to connect various literary works, as it allows the reader to make a deeper connection and understanding of the stories. Although The Management of Grief by Bharati Mukherjee and Araby by James Joyce had incredibly diverse settings, one may connect the two by the similar themes shared in both works. Both authors also frequently use recurring imagery and main character point of view in their stories, to further the readers understanding of the themes. On the other hand, the stories can also be described as different through their settings, plot structures, and characters. The short stories have both similarities and differences when it comes to themes and literary characteristics. These two short stories showcase the diversity of writing as although the stories are quite different, both can be related through the authors styles of writing. The connection between these literary works proves that there is always a deeper meaning, despite their slight differences. Both The Management of Grief and Araby share the reoccurring theme of love and loss. The main characters of each story both fight their own battles to cope with the losses of loved ones. Shaila Bhave of The Management of Grief, loses her entire family in a plane hijacking accident and is forced to go on without her loved ones. Similarly, the young boy of Araby seems to lose his chance with a woman he is in love with from afar as he

Should We Blame Video Games For Violence - 1295 Words

â€Å"Should We Blame Video Games for Violence† Video games; a pastime for many people across the world, a form of entertainment, and, of course, a way to destress yourself from the outside world. Video games have been around since October 18, 1958 and have been evolving rapidly through the years. â€Å" More than fifty years ago, before either arcades or home video games, visitors waited in line at Brookhaven National Laboratory to play â€Å"Tennis for Two,† an electronic tennis game that is unquestionably a forerunner of the modern video game† (â€Å"The First Video Game† 1). Since then, you can play video games at a local arcade or buy a copy of a game you like at a store like Gamestop! There are several companies and millions of titles of games to play from and, definitely, a wide variety of platforms to play on. Video games have a plethora of genres and types of games to play. For example, one could embark on a new journey in a role-playing game like Fallout 3 to playing an american football game in the Madden series. The options do not just end right there! Since video games are advancing so if there content! Specifically, in their action and shooter genre. In a modern action/ shooting games, one can see the blood and even characters get their head blown off. Some video game titles have mass murder scenes and even sexual themes. â€Å"As the level of violence in video games has increased, so has concern for the effects on those who play - especially those who play a lot† (â€Å"Video GameShow MoreRelatedThe Effect of Violence in the Media on Children Essay1150 Words   |  5 PagesTelevision, movies, and video games are a big part of childrens lives in todays technologically advanced society. However, there is a big controversy questioning the effects of these media outlets on children. Much of society claims to have proof for the belief that media violence affects children negatively. However, I am skeptical of the evidence that is stated to prove that claim. I feel that society has placed the blame on these mediums for the violent acts, however serious or trivial,Read More Violence in the Media is Not to Blame for the Effect on Children1158 Words   |  5 PagesThe Effect of Violence in the Media on Children Television, movies, and video games are a big part of children’s lives in today’s technologically advanced society. However, there is a big controversy questioning the effects of these media outlets on children. Much of society claims to have proof for the belief that media violence affects children negatively. However, I am skeptical of the evidence that is stated to prove that claim. I feel that society has placed the blame on these mediums forRead MoreThe Effects Of Media On Young Children, Teenagers, And Adults1297 Words   |  6 Pagesoutraged by violence in the media. Whether in video games, books, radio, music, or television, there is always someone or something to blame for the violence. Violence is everywhere in the media , there is no disagreeing with that. Whether it be movies, television, video games, or music, there will always be violence, but blaming it on movies, television, video games, or music is not the answer. If blame needs to be placed why are the parent of the children who choose to commit acts of violence not Read MoreViolence in Television, Movies, and Video Games Should Not Be Censored1653 Words   |  7 PagesVIOLENCE IN TELEVISION, MOVIES, AND VIDEO GAMES SHOULD NOT BE CENSORED Television, movies, and video games have a great influence on the minds of todays youth. But, what exactly are the effects of such an influence? Certain people have exaggerated the effects that these media have on todays youth. Many people, including government officials, have singled out these three media sources as the cause of some types of violence simply because it is an easy target for laying the blame. The truth isRead MoreYouth Violence: Is the Media to Blame?1514 Words   |  7 PagesYouth Violence: Is the Media to Blame? COM/156 07/27/13 Mallory Dunkley Youth Violence: Is the Media to Blame? Not all children who watch violent programming get in trouble with the law; some feel that there is a strong direct link between the two. There is a good deal of compelling data that suggests that there is a direct link between the media and youth violence. Throughout our history, the media has and can influence people in different ways but the more obvious questionRead MoreVideo Games and Their Role in Violence and Bullying Essay1374 Words   |  6 Pagesmature video games that the children play on their media device. However, many people say that there are other reasons that children show aggressive behavior and why they become bullies to other children. I believe that there are other reasons than video games that cause a child to become disobedient and unruly. There are many studies that show that video games are not the reason behind the youth’s behavior but other factors in their lives. Although the studies show that it is not video games to blameRead MoreDo Violent Vi deo Games Make People More Violent?1277 Words   |  6 PagesViolent Video Games Make People More Violent in Real Life? The American Psychological Association reports that more than 90% of children in the United States play video games.Among kids between the ages of 12 and 17, the number rises to 97%. The psychological group also reported that 85% or more of video games on the market contain some form of violence (Do Video Games Lead to Violence). A video game may be considered violent if it contains â€Å"violent† language, gore/blood, and crime. Video games areRead More Violent Video Games did Not Cause the Columbine High School Shooting1634 Words   |  7 Pagesscientific credentials or otherwise, I have concluded that video games are no more to blame for the ebullition found in today’s society than any other possible cause. However, the incessant brouhaha as well as the negative notoriety surrounding media and video games refuses to cease or let up. These claims—for or against video games—are ultimately subjective and inconclusive and very little can be confidently derived from them. Granted, the violence found in our youth is growing rapidly, and there mustRead MoreThe Media is not to Blame for the Violence in Society Essay698 Words   |  3 PagesThe Media is not to Blame for the Violence in Society People are quick to blame violence in our society on television, movies or video games because they are simple believable targets. We have to look beyond this disinformation and attack the real causes for the violence in our society. Violence in television programs, movies, or video games will not make a person kill someone else. People watch violent images all the time, and only a very small percent of them actually commit violent crimesRead MoreThe Pros And Cons Of Violent Video Games1534 Words   |  7 Pagesâ€Å"We cannot and will not ban the creation of violent video games. But, we can prevent the distribution of these disturbing games to children, where their effects can be negative.† (Kohl, Herb). Violent video games have been blamed for children poor school performance, mental development, and aggressive behavior; there are many studies conducted by different psychologists and experts in the area, and they came up with different results. Most people and studies beli eve that children are the primary

Redbox Free Essays

Management Policy November 19, 2012 Red Box Red Box is the industry leader in DVD rental kiosks. It has established itself as an inexpensive and convenient method for customers to rent DVDs. Although Red Box is a cost leader in its segment, it is threatened by the slow but impending disappearance of the DVD format. We will write a custom essay sample on Redbox or any similar topic only for you Order Now Threat of New Entrants RedBox has a cost performance advantage over possible new entrants since it is owned by a publicly traded company and already has an established distribution channel relationship. RedBox has an advantage over new entrants in that it already has a well-known brand image amongst movie viewers. People often say â€Å"why don’t you go just rent it from RedBox† during conversations. However, consumers can readily switch over to Blockbuster or cable pay-per-services. Porter’s Five Forces I. Bargaining Power of Buyers The bargaining power of buyers is high since it is extremely easy and inexpensive for the consumers switch viewing mediums. II. Threat of Substitutes The thread of substitutes is high due to competitors such as Netflix, Blockbuster, cable and satellite T. V. companies. III. Bargaining Power of Suppliers The bargaining power of suppliers is high since there are only a handful of movie studios that are able to supply the DVDs. Movie studios can limit the quantity, as well as increase the price and royalty payments of DVDs. Other wholesalers can also increase the price and limit the supply of DVDs. IV. Intensity of Rivalry among Existing Competitors The intensity among existing competitors is fierce since Blockbuster has the ability to install more rental kiosks at existing stores and sign new contracts with existing retailers. Customers can buy new movies for $5 at retailers such as Walmart or get them shipped to their homes from retailers such as Amazon. V. The Threat of Substitutes The threat of substitutes is high. A motion picture DVD is difficult to duplicate unless it is burned illegally. However, digital formats of movies are becoming more prevalent and as the smart phone population grows. Cellular signal carriers are also rapidly increasing their bandwidth and it is predictable, soon mobile signals will be as strong as or stronger than current broad band signals offered by cable providers. Automakers will eventually install TV monitors in each family vehicle that will allow children to watch movies downloaded or streaming live, instead of viewing DVDs. S. W. O. T. I. Strengths Redbox is owned by a publicly traded company and has the funding of its shareholders. Redbox has pre-existing retail contacts that were established by its parent company, Coinstar that enables them to expand faster than competitors who need to establish new contacts. II. Weaknesses Redbox is under the mercy of the movie studios. Should any movie studio decide to terminate their contract with Redbox, it will lose a significant percentage of its suppliers considering there are only a handful of movie studios. The movie studios also have influence on wholesale distributors, which can affect Redbox’s supply chain. III. Opportunities Redbox can enter the home digital rental market to directly compete with Netflix. It can also start selling other products, such as popcorn and soda, with its DVDs, in its vending machines. IV. Threats Redbox is threatened by the ever growing population of mobile users who will be able to download movies to their portable devices at speeds greater than DSL in the near future. Redbox is also under threat from pirated copies of movies that are prevalent worldwide. How to cite Redbox, Essay examples

Nursing 103 Final Essay Example

Nursing 103 Final Essay Notes for Final Chapter 6/11- Anaphylaxis Allergic reaction Acute Sx: hives, rash, itching and nasal secretions, fever, malaise Severe: hypotension, tachycardia, bronchoconstriction Tx: Benadryl, put vaccine in dominant arm, warm compresses, Tylenol Chapter 8- Pain NSAIDS -ASA, Ibuprofen (motrin), Ketorolac (Toradol), Naproxen (Naprosyn) Mild to moderate pain Take with full glass of water Do not mix ASA with other NSAIDS Monitor for GI bleeding Opioids –Codeine, Hydrocodone, -Morphine, Darvocet Moderate to severe pain Monitor for respiratory depression, urinary retention, constipation Naloxone to treat respiratory depression Chapter 10- Surgery –Laparoscopy- Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs . Laparoscopy is used to find problems such as cysts, adhesions, fibroids , and infection. Tissue samples can be taken for biopsy through the tube (laparoscope) –Pre op meds- –Urogential- is the organ system of the reproductive organs and the urinary system. These are grouped together because of their proximity to each other, their common embryological origin and the use of common pathways, like the male urethra. Radial mastectomy- removal of the entire effect breast, underlying chest muscles, and lymph nodes under the arms. (modified is when the chest muscles are intact. ) Chapter 12- Cancer –Tumor Markers proteins produced/secreted by malignant cells found in the blood CA 125- cancer protein PSA- prostate specific antigen ACTH- andrenocorticoptropic hormone hCG- pre gnancy –Diagnostic Tests Xray- cannot distinguish between xray and cysts and tumors CT scan- Renal, gastro and lymph node cancers. Check for allergy to shellfish Ultrasound- Uses sound waves. Best in breast and prostate. MRI- Uses radiofrequency. Best in head and neck tumors. We will write a custom essay sample on Nursing 103 Final specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Nursing 103 Final specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Nursing 103 Final specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Angiography- Tumor location is unknown. Page 1 Chapter 13- Death Dying –Kubler-Ross Denial, Anger, Bargaining, Depression, Acceptance –Advance Directives- legal document that specifies healthcare and financial affairs in case of incapcity –Living will -determines wishes in case of terminal illness or unconsciousness –Postmortem Care- Raise head of bed 30 degrees to prevent pooling –Hindu- Take loved ones home to die. Family and friends will keep a vigil until the moment of passing by singing, praying and reading scriptures. The mantra is chanted and holy ash is placed on the forehead, and holy water or milk is dripped into the mouth. ever embalmed, and the organs are never removed for donation. Chapter 14- Shock –Lots of questions on shock. Please review carefully. Page 316. –Know types, symptoms, treatment for each) Chapter 16/17- Cardiovascular –Central Venous Pressure- CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. IN the thoracic vena cava. –Normal range is 3-8 mmHg –Inderal (propanolol)- treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches, tremors, and lowers the risk of repeated heart attacks. Its a beta blocker. – Chapter 18- Peripheral Vascular Disorders -Hypertension- BP 140/90. -Hypertensive Crisis- 180/120 -DASH diet- 2,000 calories. 7-8 grains, fewer than 2 servings of protein †¢Review pages 430- 438 Chapter 29- Urinary System –Urinary Tract Infection- #1 Noscomial infection Most common location is the bladder (cystitis) Most common upper UTI is kidney and renal pelvis (pyelonephritis) Most common bacteria to cause UTI is e-coli –Difference between Cystitis and Pyelonephritis Cystis- Dysuria, urgency, nocturia, Pyuria, Hematuria Pyelonephritis- Same as above plus flank pain, N-V-D, fever, malaise –Urinary Calculi. Stones made from Ca. Dull, aching to severe flank pain. Nausea, vomitting. Gross hematuria. –Lithotripsy- crushing stones through sound waves –Acute Renal Failure. -Rapid onset. Reversible. Most common cause is ishemia (poor perfusion to the kidney) Most common symptom is oliguria (urine output less than 400 mL/day) High BUN and creatinine levels Page 2 Occurs in 3 stages: initiation (up to days), maintenance phase (up to 2 weeks) and this is where all the problems occur, and the recovery phase (up to 1 year) Glomerulonephritis Leading cause of kidney disease and failure Caused by strep (a beta-hemolytic strep) Surrounded by bowmans capsule Sx: hematuria, proteinuria, hypoalbuminemia, azotemia (increase Nitrogen) Lasts 10-14 days –Nephrosis- nephrosis is any degenerative disease of the renal tubules. Nephrosis can be caused by kidney disease, or it may be secondary to another disorder. It should not be confused with nephritis, where inflammation is implied. –Nephrotic Syndrome Same as above but there is a significant loss of protein lost in urine Found in lupus and those with kidney disorders Sx: proteinuria, low albumin, high lipids, and severe edema in face and periorbital area. Blood clots are common. –Urine Dipstick H 6-6. 5 Specific gravity 1. 010-1. 025 Everything else is negative in a healthy patient –Potassium Normal 3. 5-5. 2 –Sodium Normal 135-145 Drugs that lower sodium levels are diuretics, (epi-/ norepi), decongestants and antidiabetic medications IV solutions that increase sodium are NaCL Chapter 31- Male Reproductive Transurethral resection of the prostate (TURP) is a surgical procedure that removes portions of the prostate gland through the penis. A TURP requires no external incision. Inserted through the penis and the wire loop is guided by the surgeon so it can remove the obstructing tissue one piece at a time. The pieces of tissue are carried by fluid into the bladder and flushed out at the end of the procedure. TURP is generally done to relieve symptoms due to prostate enlargement, often due to BPH. BPH is a condition in which the prostate gland may become quite enlarged and cause problems with urination. Symptoms may include Problems with getting a urine stream started . Nocturia, urgency, dribbling. Monitor for hemorrhage for the first 24-48 hours. Chapter 32- Female Reproductive –Metrorrhagia Bleeding between periods Sign of cervical or uterine cancer –Dilation and Curettage (D C) Page 3 –Cervical canal is scraped Monitor for circulation. Avoid pillow under legs. Avoid tampons for 2 weeks. –Vaginitis Fungal (candidiasis) Protozoan (trich. ) bacteria (granderella) Chapter 34/35- Endocrine System –Biofeedback Mechanisms (3 below) 1) glucose maintenance- interplay between insulin and glucagon, pancreatic hormones that release glucose and store glucose, respectively 2) body temperature maintenance -hypothalamus, nerves, skin, sweat glands, heart(beats faster if warm), kidneys -if your temp. increases due to exercise/warm weather/illness: sweating occurs to produce evaporation which leads to cooling -if your temp. ecreases due to cold weather/being scared/illness: goose bumps (piloerection) occurs, which are thought to be derived from a response that enable the hair to stand on end causing more insulation and heat 3) fluid maintenance- -kidneys regulate how much fluid is excreted. If you are dehydrated they will produce less urine. If you drink a lot of fluid quickly, then more urine will be excreted –Thyroid sits on either side of trachea Isthmus connects two lobes Needs iodine to secrete t4 (thryoxine) and t3 (triiodonthronine) that increases metabolism Also secretes calcitonin that decreases excess calcium levels in the blood –Hyperthyroidism Too much thyroid hormone SS: Increased appetite, yet loses weight. If left untreated, will cause cardiac dysrhythmias and heart failure Develops into 2 disorders: Graves disease and thyroid crisis Graves disease (goiter exophthalmus- protruding eyes) –Exophthalmus- protruding eyes –Thyroid storm- High fever (gt;102), tachycardia, hypertension, restlessness, seizures, delirium –Thyroidectomy- Will be on lifelong replacement hormones Euthryroid state (balanced hormonal state before surgery) Nursing precautions: hemorrhage, respiratory distress, laryngeal nerve damage, tetany, thyroid storm Myxedema- form of hypothyroidism Brought on by exposure to cold, infx, temp, trauma, narcotics tranquilizers More frequent in women SS: seizures, lethary to coma, hypothermia. Respiratory and cardiovascular systems shut down. Tx: airway, Cardiac function, increasing Temperature and TH levels by getting levothyroxine by IV. Page 4 –Cushings Syndrome Adrenal cortex produce s too much cortisol (hormone) or ACTH SS: fat deposits in abdomen, clavicle, buffalo hump, round moon face, hirsutism (excessive facial hair) Dx: Increase cortisol level and elevate 24 hour urine test with 17- ketosteriods and 17- hyroxycortcosteriods. Low potassium, Sodium and glucose levels are also higher. Meds: lysodren and cytadren are commonly used. –Addisons Disease Adrenal insufficiency SS: decrease glucocoritcoids, mineralcorticoids, and androgens Tx: IV fliuids, glucose, Na, glucocorticoids, warm and quiet enviroment Dx: Decreased levels of cortisol, decreased 24 hour urine test with 17- ketosteriods, Potassium is increased, glucose and sodium are decreased. –Pheochromocytoma benign tumor of adrenal medulla Produces excessives amounts of epinephrine and norepinephrine Stimulates the sympathetic nervous system SS: BP 200-300/150 +, pounding HA, profuse sweating, tachycardia, flushing, Dx: increased catecholamine levels in the blood or urine, CT scan. Adrenaelectomy Nursing care: stabilize BP –Adrenalectomy Removal of adrenal gland High risk of Addisonian crisis or adrenal crisis. Addisonian Crisis hypotension, rapid weak pulse, extreme weakness, confusion, circulating collapse and shock. Dangerously low K+ levels. Diabetes Insipidus Results from lack of ADH hormone Two types: neurogenic (damage to pituitary) and nephrogenic (Kidneys) Risk for hypernatremia Sx: Polydipsia, polyuria (5-15 ml. day) urine specific gravity of less than 1. 005, very pale urine, weakeness, dehydration, tachycardia, poor skin turgor, dry mucous membranes Nursing Care: managing fluid and electrolytes, replacing ADH. Monitor daily weight. Meds: Vasopressin (monitor for h/a and abdominal cramps). Thiazide diuretics and low sodium diet Chapter 36- Diabetes Normal blood glucose is 70-100. –Diagnosing D iabetes plasma glucose level (gt;200) oral glucose tolerance test (2 hour test, gt;200) fasting blood glucose (8 hour test, gt; 126) –Peripheral Vascular Disease Greater in Type 2 Atherosclerosis of lower legs Page 5 Leads to gangrene. (Most common cause of amputations) SS: hair loss, atrophic skin, cool feet, red- white legs, thick toenails, pain with walking aand at rest (usually at night), diminished or absent peripheral pulses. Type 1 Diabetes Destruction of beta cells leads to state of absolute insulin deficiency Usually occurs in childhood Prone to developing ketoacidosis Insulin dependent Sx: Polyuria, polydipsia, polyphagia, weight loss, fatigue, malaise, blurred vision –Type 2 Diabetes Sufficient insulin to prevent ketoacidosis, but to lower blood glucose Usually occurs after 30 Most clients are obese Insulin requiring but not dependent Sx: Polyuria, polydipsia, obesity, recurrent infx, fatigue, blurred vision, parenthesias (numbness and tingling around mouth and hands and feet. ) ADA 1800 calorie Diet –Diabetic Acidosis Occurs in Type 1 diabetes Sx: hyperglycemia, dehydration, coma, BS gt; 250, ketonuria. Metabolic Ketoacidosis= fruity, alcohol breath Common in those who are undiagnosed. Tx: fluids, insulin, correction of electrolytes. Unconsciousness patients need 0. 9% normal saline to replace sodium. Start with 0. 9, then 0. 45%. Dextrose is added to prevent hypoglycemia. –Exercise Reduces blood glucose by increase glucose use by the muscles. Eat snack before exercising. Avoid exercising if fasting is gt; 250. –Only regular insulin may be given b y the IV route. –HHS (Hypersmolar Hyperglycemic State) Occurs in Type 2 Characterized by severely high glucose (600 or gt;), extreme dehydration, and altered LOC, grand mal seizures. –Differences between DKA and HHS DKAHHS Type 1Type 2 Lethary Coma Kussmauls breathsRapid, shallow breathing Glucose gt;250Glucose gt; 600 *Kussmauls breathing – rapid, deep respiration to prevent decrease in pH. –Somogyi Effect Morning rise in glucose after a nighttime hypoglycemia. Sx: temors, night sweats, and restlessness. Tx: Eat bedtime snack –Dawn phenomenon Rise in glucose between 4 am and 8 am. Tx: increase insulin dose or changing injection time from dinnertime to bedtime Page 6 –Hyperglycemia Sx: Increased thirst and frequency Diet: low carbohydrates and sugar, sufficient hydration, and frequent small meals. –Hypoglycemia Sx: carry an emergency snack high in carbohydrates to help raise low blood sugar. People who have experienced hypoglycemia in the past should eat meals at regular intervals, avoid excessive alcohol and never drink alcohol on an empty stomach. Chapter 37- Nervous system Cerebrovascular Accident- Brain attack or stroke Thrombotic CVA- Caused by atherosclerosis of arteries. Happens during or after sleep. Embolic CVA- caused by problems with the heart Hemorrhagic CVA- caused by hypertension Right Side vs Left side Effects left sideEffects right side VisualSpeech (Left-Language) UnawareAware ImpulsiveSlow, cautious –Heat stroke heat cramps, heat syncope (fainting), and heat exhaustion . nausea, seizures, confusion, disorientation, and sometimes loss of consciousness. Remove any extra clothes. Frost bite Dont put direct heat on it. Wrap in blankets or move to a warmer environment. Chapter 38- Intracranial Disorders –Closed head injuries Coup-contrecoup- jerking forward-jerking back –Concussion brain injury resulting from violent shaking or impact –Contusion bleeding into soft tissue resulting from blunt force –Epidural Hematoma severe blow to brain causing arterial bleeding between skull and dura mater. –Subdural Hematoma injury between dura mater and subarachnoid layer –Intracerebral Hematoma Bleeding into brain caused by gunshot wound or depressed skull fracture –Simple partial seizure- jerking of finger, hand, foot, leg and face. Called Jacksonian March. – Sx: flashing lights, tingling sensations, or hallucinations. –Complex Partial Seizures Sx: lip smacking, aimless walking, picking up clothing –Absence seizures- In children. blank stare. Lasts 5-10 seconds. May be unaware. –Tonic-clonic seizures- Adults and children. From trauma. Stages: aura, tonic phase, clonic phase, postictal phase Up to 30 mins Page 7 Chapter 39- Neurologic and Spinal –Multiple Sclerosis degenerative disease that damages myelin sheath surrounding axons. Marked by periods of exacerbation and remission Effects Women between 20-50 Myelin sheath is the white matter in the CNS Pt is prone to UTIS, pressure ulcers, joint contractures, pneumonia, depression Dx: CSF (cerebrospinal fluid analysis). Look for IgG. , MRI and CT scan. –Parkinson’s Disease Results from a lack of dopamine 3 cardial signs: tremor, rigidity, bradykinesia. Pill-rolling. Levodopa- Used to treat shaking, stiffness, and slow movement Anticholinergic- Med for Parkinsons –Sx: dry mouth, orthostatic hypotension, constipation, urinary hestation, pupil dilation, blurred vison, dry eyes, photosenstivity, increased heart rate. –Myasthenia Gravis Marked by periods of exacerbation and remission Sx: eyelid ptosis (drooping eye), diplopia (double vision), slurred speech, nasal voice, difficulty chewing or swallowing Face appears to have a snarl or grimace Risk for aspiration and respiratory insufficiency –Cholinergic Crisis caused by taking meds too early. Sx: Severe muscle weakness, NVD, increased salviation, sweating, bradycardia. –Myasthenic crisis Caused by taking meds late Sx: muscle weakness, inability to speak/swallow, respiratory distress, anxiety –Trigeminal Neuralgia Causes pain along both sides of face.