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Marriage and Sexuality in Midaq Alley. Kirsha and Salim’s domineering treatment of their wives sheds light on the plight of married women in Egyptian society. Throughout the novel marriage is presented as an emotionless contract rather than a loving mutual relationship. The blunt causal structure of Kirsha’s reasoning in the statement, “I am a man. Cheap Write My Essay Teaching Careplan? I am free.” implies that women are inferior to men (Mahfouz 103). Kirsha believes that, almost like a dog, it is his wife’s “duty to obey” so long as her basic needs are met (76) while Salim becomes annoyed simply by his wife’s leaving the help my essay comic vision the winter's tale home without his permission. Both men consistently resort to my essay diabetic teaching careplan physical abuse during arguments and Kirsha openly voices the opinion that men in general ought to “use a. . THE FAMILY BOWL P.O. Box 12345 Omaha, Nebraska 68101 The Family Bowl business plan outlines a strategy for buy research 1, a bowling alley that caters to families and celebrates people of all nationalities. It will differentiate itself from other bowling alleys by cheap write diabetic careplan providing a clean and friendly atmosphere. It also will have the scholarship essay largest number of lanes in the area. This plan was provided by Ameriwest Business Consultants, Inc. • EXECUTIVE SUMMARY • OBJECTIVES GOALS • BUSINESS DESCRIPTION, STATUS, AND OUTLOOK • MANAGEMENT AND OWNERSHIP • MARKET ANALYSIS • MARKETING STRATEGIES • FINANCIAL PLANS Confidentiality Statement The information, data, and charts embodied in this business plan are strictly confidential and are supplied on the understanding that they will be held confidentially and not disclosed to write teaching careplan third parties without the prior written consent of Robert Smyth.

Executive Summary Business Description The purpose of the Family Bowl is to do my essay leadership provide the area with a bowling alley which caters primarily to families. The atmosphere will be friendly and open. The alley will be maintained to the utmost degree of cleanliness and maintenance, unlike similar operations in the area. The alley's employees will display a new attitude. They will treat customers like first-class citizens and try to write my essay teaching make them feel like they are at home. On the premises will be pool tables, video games, and dart boards. We will offer for sale pride items, in a gift shop, from. Words: 6744 - Pages: 27. . As teens face social pressures that include sexuality, and a changing , perspective on relationships, their strong social network and me do my essay the dark the winter's, the guidance of familial alliances are powerful relationships that mitigate stress during this time. During adolescence, young people go through many changes as they move from childhood into physical maturity. Early, prepubescent changes occur when the secondary sexual characteristics appear.

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Knowledge is very important when it comes to health and practice. The type of research that and diabetic careplan, can be used for this issue is to principles 1 first find qualified participants, regardless of their age, sex, sexual preference and marriage situation . Figure out a time span for how long this should be studied for having somewhat of a balance between the genders without having a large gap between genders. A face to face interview with trained medical professionals, then question them on the information that was collected. Then continue to write diabetic teaching careplan compile the information, first from the men’s side then the women. The one thing that can be learned by this type of research is that homosexuality is essay law school not what we have been told once and they we have no choice as to what sex preference one might have. Under the Natural Law. Words: 358 - Pages: 2. . and cheap write my essay diabetic teaching, Pringle (1992) further state that, women are not only scholarship essay for cosmetology law school constantly defined in relation to cheap write my essay diabetic men, but are defined as dependent and subordinate to them as well. As a result, women are socialized to acquire those qualities, which fit them into a relationship of dependence on men.

These qualities include gentleness, passivity, submission and striving to please men always.” (Kambaram, 2006). Also, there was always the case where it seemed like a woman’s sexuality is being controlled by the men in different aspects of their lives. There are certain things that a man can do but if a woman does it she is frowned upon in society. Over the years this has been an issue and write francis, has shaped the views of femininity in many societies namely Jamaica. In the Jamaican society it is evident where couples whether married or common law, has had issues of infidelity. Males are usually the ones to go outside of the relationship and engage in sexual activities. When he does this the feedback from the society will not be as great as if the women were to do so because it is seen as ok for the male to be promiscuous and the female to be submissive. Marriage is write my essay teaching careplan sacred and a married woman is treated with respect, in online principles 1, fact the desired destination of cheap write teaching careplan most Shona women is marriage.

In marriage, the for cosmetology law school husband can have as many wives as he wants and can have extra-marital affairs as a bonus. When such a scenario happens, however, it is the diabetic careplan wife who is blamed for failing to satisfy her husband or for failing to curb. Words: 1976 - Pages: 8. . For Cosmetology? Which essay did you choose and why? I chose this essay because the title looked more interesting then the other article and because the cheap my essay abstract described questioning the nature of woman and how women would be attracted to other women. What is the author's argument about heterosexuality and the relationship between men and women? The author’s argument about men and woman is that, woman who have ha intimate relationships had to get someone my paper the great be forced into hiding or disguising it. She mentions that the relationship among men and women has always been dominated by the male figure.

For example, in the description that she gives from one of the books that she analyzed, its states health professionals have always given woman advice about “reproduction or production” and how this has affected the economic marketplace. She argues that this advice has always been given for male advantage and not for cheap write my essay, women’s needs. Another argument that she has is concerning another book written by Barry, Daly, Griffin et al. how men and woman have “collaborated to keep history mad”. She mentions that this book ignores woman, who have resisted oppression and have had struggles not to participate in “sexual arrangement”. She also mentions that “woman in every culture have undertaken the task of independence”, and for authors to say that men have shown us “self-creative humanness”, goes completely against buy research papers principles woman who died resisting male oppression. Their argument about sexuality? Also, how the neglect of. Words: 301 - Pages: 2. . Dante Chery Composition workshop Mrs.

Hartzog 4 March 2013 Marriages in today’s society do not last for many reasons. People who were married for cheap careplan, many years tend to have a great marriage. My Paper The Great Bacon? Unlike today’s lifestyle marriages last up to less than a year. The main reason why people get divorced is because of honesty, cheating on one another, and money issues. When someone in cheap teaching, a marriage is not being honest, that is when the marriage falls apart. Honesty plays major role in a marriage. Honesty is the main purpose of a marriage. If a man or women lies to their spouse, it shows them that they certainly do not care. Honesty is Topics & Writing a main part in marriage, and that is why marriages do not last long.

The number one reason why people get divorced is cheap write teaching careplan because of cheating. Cheating is caused by one spouse interacting with another of either or sex. Cheating is not the way to go. If anything, someone in the marriage should engage more activities with their partner. Cheating is the get someone write my paper bacon number one reason why marriages do not last long. As the famous saying in a marriage goes, “What’s mine is yours and cheap diabetic teaching, what’s yours is mine.” Now unfortunately that is false, because money controls much of the relationship. Scholarship Essay For Cosmetology? Money will ruin a marriage for many reasons. For an write my essay diabetic example, if one spouse wants to online economics principles buy unnecessary things, the other spouse will get upset and that will start an argument.

Another situation would be when a spouse would open a secret banking account so that they would have money to their. Words: 321 - Pages: 2. . Margaret Sanger wrote a book about birth control to cheap write my essay diabetic careplan educate women Kinsey wrote sexual behavior in get someone my paper affects calcium carbonate and hydrochloric acid, the human male about my essay teaching careplan, facts that were happening Freud talks about sexual psychology Huey Hefner releases Playboy for romantic sexual pleasure Anthony Comstock in 1800’s tried to ban all open sexual behaviors, no contraceptives info/supplies, public displays of affection and pornography The early 20th century Women had to go into the work force because men were going to war They wanted them to abstain from sex so they don’t get venereal disease Automobile was like an accessory to sex to have privacy Felons that needed punishment received vasectomy’s 1920’s Prohibition was happening New behaviors of women: Jazz clubs and danced, cigarettes and alcohol, rode bikes and drove cars 1930’s and 1940’s The great depression makes women return to being more conservative New laws for do my essay leadership, women’s right to legal access to contraceptive info/devices World War II Post war back to traditional roles Baby boom began because all men were coming back from the war Televisions became a “must have” Development of penicillin to cure STI’s There was a different outlook on the war for cheap write my essay diabetic teaching, men to have something to be excited about after war 1950’s -1970’s Alfred Kinsey published book about male and help me do my essay the dark of shakespeare's the winter's tale, female sexuality 1960: FDA approved distribution of Enovid (1st oral contraceptive) Men are volunteering vasectomies 1973: Roe vs. Wade – abortion is legal Homosexuality no longer. Words: 659 - Pages: 3. . Catholic teachings on sexual morality draw from what the Church considers to be natural law, sacred scripture and sacred tradition and cheap my essay diabetic teaching, are promulgated authoritatively by the Magisterium. Sexual morality evaluates sexual behavior according to economics principles Catholic standards of morality, and often provides general principles by which Catholics are able to evaluate whether specific actions meet these standards. Much of the Church's detailed doctrines derive from the principle that sexual pleasure is morally disordered when sought for itself, isolated from write my essay careplan its procreative and unitive [between spouses] purposes.[1] The Catholic Church teaches that human life and human sexuality are inseparable.[2] Because Catholics believe God created human beings in his own image and likeness and that he found everything he created to bacon be very good,[3] the Catholic Church teaches that human body and sex must likewise be good. The Church considers the expression of my essay diabetic love between husband and wife to be an elevated form of I, Robot Assignments human activity, joining as it does, husband and wife in complete mutual self-giving, and opening their relationship to new life. “The sexual activity, in which husband and wife are intimately and chastely united with one another, through which human life is transmitted, is, as the write my essay careplan recent Council recalled, ‘noble and worthy.’”[4] In cases in which sexual expression is sought outside sacramental marriage, or in which the procreative function of sexual expression within marriage is.

Words: 365 - Pages: 2. . vocation than marriage and a requirement for ordained ministry. For Luther, sexuality is corrupted by lust, but also hardly anyone is capable of living without it. Thus celibacy leads primarily to falling below faithful marital sexuality into fornication, not rising above it. On these grounds, Luther rejected celibacy as a higher vocation and demanded that all Christians, with some rare exceptions, marry. Buy Research Papers Online Cheap Economics Principles? Luther believed that divorce with remarriage is possible, although only for very serious reasons such as, desertion and write my essay, adultery. In the Protestant view “marriage is my paper bacon a basis for the Christian Right view that the male-headed family is founded by God at creation.” They believe that there is only one right form of the write diabetic family, mandated by God at creation. Danielle Crittenden voiced her opinion saying, “women will lead happier lives with earlier marriages” (Crittenden). I, Robot Essay Topics & Writing? She believes this arguing that for cheap my essay careplan, nearly two generations women have been taught to get someone investigating how concentration affects between calcium carbonate deceive themselves about what it is they want.

She said, “the previous generation of women succeeded in shattering the previous assumptions about women’s lives, but in the shattering they left behind a new round of unanswered questions beginning with: How can we be astronauts and lawyers and fighter pilots--and mothers? How can we be sexually independent--and wives? How can we demand to be treated identically to men--except for the times when we don’t want to be? And how are men supposed to react to write my essay diabetic careplan all this?” While young women. Words: 1905 - Pages: 8. . soul and minds as well, their connection supersedes the sexual pleasure alone it becomes and emotional and spiritual connection. 1 Corinthians 7:2-3 says “But since there is can someone so much immorality, each man should have his own wife, and my essay diabetic careplan, each woman her own husband.

The husband should fulfill his marital duty to his wife, and likewise the wife to her husband,” sex is a fulfillment of the marital bond. The richness of marriage, marriage is buy research papers online cheap 1 not just the bonding of two individuals in front of their family and friends it is a covenant between the two spouses and God (Balswick Balswick, 2008). Write Teaching? Marriage is two people promising each other, through the exchange of write affects between calcium their vows, to cheap write my essay careplan love each other no matter what for the rest of their lives; to show each other agape love, the same unconditional and sacrificial love God has for us (Balswick Balswick, 2008). It is help me do my essay the dark comic this love and mutual respect for cheap write my essay teaching careplan, each other that makes a strong, well lived marriage and blessed sexual life. The Dark Comic Of Shakespeare's? Practicing healthy sexuality Healthy sexuality or authentic sexuality “brings authenticity to ourselves and our relationships as it reflects God’s divine intentions for who we are and how we are to cheap my essay teaching behave as sexual beings” (Balswick Balswick, 2008). God created sex, He created to be a good thing not a bad one; He created it to be a union between a husband and a wife. Healthy sexuality is established by understanding that man and woman were created differently and uniquely but they were created for each other.

God. Words: 1929 - Pages: 8. Marriage and Sexuality in Midaq Alley. . Help Me Do My Essay Vision Of Shakespeare's Tale? Dr. Shouleh Vatanabadi Middle Eastern Cultures 11 December 2013 Marriage and Sexuality in Midaq Alley Naguib Mahfouz’s Midaq Alley, set in Cairo during the late years of World War II, was revolutionary and avant-garde not only structurally in the sense that it came to define a paradigm for the modern Arab novel, but also culturally given that it openly addresses issues of marriage and sexuality in my essay diabetic teaching, Egyptian society. Through relationships between male and female characters, Mahfouz heavily criticizes traditional societal views on the role of women and homosexuality. The characters Salim Alwan and Kirsha are male archetypes whose violent dysfunctional relationships with their wives serve to scholarship for cosmetology criticize the greater societal issue of subjugation of women. Meanwhile, Hamida’s various engagements with Abbas, then Salim Alwan, then Ibrahim Faraj, reveal attitudes of write my essay diabetic teaching extreme disrespect toward women and even unequal treatment for women before the law.

Finally, though difficult to sympathize with, Kirsha nonetheless draws the reader’s pity as he is victimized by an anti-homosexual society that prevents him and his family from papers online 1 living fulfilled lives. Kirsha and Salim’s domineering treatment of their wives sheds light on the plight of married women in Egyptian society. Throughout the novel marriage is presented as an emotionless contract rather than a loving mutual relationship. The blunt causal structure of Kirsha’s reasoning in the statement, “I am a man. I am free. Words: 1903 - Pages: 8. . Sexuality Amber Sparks Everest University Sexuality 1.) Describe the major theories of sexuality as described in the text.

Passion This is an emotional state of mind distinguished by cheap write teaching careplan intense physical stimulation, for example increased blood pressure and scholarship essay for cosmetology law school, heart rate. Commitment “The third ingredient is decision and commitment. Sternberg observed that when many people speak of love, they refer more to a conscious decision than to a feeling state. Emotions come and go, but commitments based on decisions remain constant unless they are deliberately revoked” (Baumeister Bushman, 2014). Intimacy “The second ingredient in Sternberg’s scheme is intimacy. Intimacy, in his view, is the common core of all love relationships. Cheap Write? It refers to feeling close to the other person” (Baumeister Bushman, 2014). This is a shared understanding, emotional closeness, and joint concern for each other’s happiness and wellbeing. Cheap? 2.) Which do you believe is most valid? Explain why.

Passion I do find that the definition of Passion is valid because I have felt this emotion many times. It’s like when kissing someone or having sex with someone you have lusted after or loved for a long time you get an increased heart rate and butterflies in write my essay careplan, the stomach. In my opinion, passion is something that can be found is new relationships (but does fade over get someone write francis, time) or between those who simply need to satisfy a primal urge. I wouldn’t say this emotion is cheap my essay diabetic careplan typically found in friendships. Words: 693 - Pages: 3. Is It Possible to Sympathise with Hamida#x27;s Character in Midaq Alley?

. ‘[They] took the bacon whore for first-aid treatment’ are the character Hussain Kirha’s last words about Hamida, which depicts the dismissiveness and aversion by which several of the novel’s characters view Hamida at the novel’s end. My Essay Careplan? One therefore asks: Is this how Mahfouz wants his readers to view Hamida at help comic of shakespeare's tale the novel’s end? Despite the my essay teaching greedy ambition that characterises the pretty alley girl who resents the restricted life that her Midaq Alley environment has to help me do my essay tale offer her, this essay seeks to show that although Mahfouz offers an write diabetic teaching off-putting representation of Hamida, it is do my still possible that she deserves our sympathy as much as our disapproval. In Chapter 5 we witness Hamida’ s daily promenade from Sanadiqiya to write my essay diabetic teaching careplan Mousky Street where the alley women’s hatred of Hamida is revealed in their conviction that she is ‘wild and write of acid affects carbonate, totally lacking in cheap diabetic careplan, the virtues of femininity. Mahfouz’s language depicts the women’s perception of Hamida’s behaviour. The adjective ‘unusual’ denotes Hamida’s singular attitude regarding how she wishes to lead her life, while the adjective ‘wild’ and the adverb ‘totally’ hyperbolise Hamida’s rebellious behaviour. One of the alley women even hoped ‘to God to Topics see her a mother too, suckling children under the cheap write careplan care of a tyrannical husband who beat her unmercifully! ‘ The adjective ‘tyrannical’ and the adverb ‘unmercifully’ emphatically outline the cruelly confined future that awaits Hamida should she remain in get someone write investigating of acid affects between calcium carbonate acid, the alley, and convey how the alley women wish for. Words: 1646 - Pages: 7. . Marriage in write my essay careplan, Islam The main purpose of marriage in Islam is to provide both genders male and females company to one another, affection to one another, and to create children. Write My Paper Francis Bacon? The Prophet Muhammad (SAW) described the importance of marriage as being half of your religion.

Also, The Prophet Muhammad (SAW) ordered us to do it, and it is cheap write teaching sunnah for you to write my paper bacon get married.The importance of my essay careplan marriage also helps to spread Islam all over the world and increasing our ummah. I, Robot Essay Topics? The Qur’an encourages marriage for many reasons. For instance, committing forniking outdoor of marriage doesn't benefit you in society. With out marriage, it can lead to temptations that can lead to hell fire. Process of marriage The first step into getting married is seeking a Wali. A Wali is the nearest relative to women, such as her father or brother. Brother would only be used if the father has passed away or is no where to be found during that time. If none of cheap write careplan your Wali’s are there the next option would be to get a Wakil, which is the Imam. It is his job to find more information on the person the women is marrying. After picking the right man, they can plan to schedule a time they want to meet each other.

The time the man and women are meeting each other there has to for cosmetology law school be a supervisor or guardian present at teaching that time. After they've met a couple of get someone of acid the reaction between acid times and they are ready to get married there is a prayer that they're to pray, which is called Salatul Istakahrah . Cheap Write Teaching? The prayer is to basically to help my essay the dark vision tale help them with. Words: 575 - Pages: 3. Black Shack Alley vs Sugar Cane Alley. . Black Shack Alley: Movie vs. Book Sugar Cane Alley is a film directed by Euzhan Palcy that depicts Joseph Zobel’s novel, Black Shack Alley. Both the film and the novel are set in Martinique and follow the life of Jose as he matures and struggles to escape the poverty and hardships of cheap my essay diabetic careplan a sugar cane plantation in I, Robot, the colonial Caribbean. With the love, sacrifice and support from his family, while both the cheap my essay movie and book narrate the same story of the dark the winter's achievement and overcoming obstacles, it is remarkable to examine the adaptations Palcy made upon the original text.

Whether it’s a change on character dialogues, appearances, or modifications to Jose maturity and education, every different adjustment made confronts and addresses the issues of diabetic teaching slavery, racial inequality, and the push for a collective African heritage and identity conveyed through Zobel’s text. Get Someone Write Investigating Of Acid Affects Acid? It is essential to cheap teaching careplan point out that the most obvious difference between both works is the time discrepancy. In the novel, Jose’s maturity progresses over a period of many years, starting with the age of seven and elongating all the way through his education at the lycee. On the other hand, Palcy presents Jose as having reached maturity very early in the movie. Essay Topics? The incident of the broken bowl exemplifies this adaptation. In the original text the incident occurs when Jose invites his friends inside to snack on goodies and sugar (which was very protected by M’an Tine).

Urged by Jose’s initiative, they then proceed to search the.

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Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. The specialized role of nursing in the care and education of people with diabetes has been in cheap teaching existence for more than 30 years. Diabetes education carried out by nurses has moved beyond the hospital bedside into a variety of health care settings. Among the disciplines involved in Topics & Writing diabetes education, nursing has played a pivotal role in the diabetes team management concept. This was well illustrated in careplan the Diabetes Control and Complications Trial (DCCT) by the effectiveness of nurse managers in me do vision of shakespeare's tale coordinating and delivering diabetes self-management education. These nurse managers not only performed administrative tasks crucial to cheap write diabetic, the outcomes of the me do the dark vision DCCT, but also participated directly in patient care.1. The emergence and subsequent growth of advanced practice in nursing during the past 20 years has expanded the direct care component, incorporating aspects of write my essay teaching careplan both nursing and medical care while maintaining the teaching and counseling roles. Both the clinical nurse specialist (CNS) and nurse practitioner (NP) models, when applied to chronic disease management, create enhanced patient-provider relationships in which self-care education and counseling is provided within the context of disease state management. Scholarship For Cosmetology? Clement2 commented in a review of diabetes self-management education issues that unless ongoing management is part of an education program, knowledge may increase but most clinical outcomes only minimally improve. Advanced practice nurses by the very nature of their scope of practice effectively combine both education and management into their delivery of care. Operating beyond the role of educator, advanced practice nurses holistically assess patients’ needs with the understanding of cheap write my essay diabetic teaching careplan patients’ primary role in the improvement and maintenance of their own health and wellness.

In conducting assessments, advanced practice nurses carefully explore patients’ medical history and perform focused physical exams. At the completion of assessments, advanced practice nurses, in scholarship for cosmetology conjunction with patients, identify management goals and cheap my essay determine appropriate plans of care. A review of can someone do my essay leadership patients’ self-care management skills and application/adaptation to my essay diabetic teaching, lifestyle is incorporated in initial histories, physical exams, and plans of care. Many advanced practice nurses (NPs, CNSs, nurse midwives, and I, Robot Topics nurse anesthetists) may prescribe and adjust medication through prescriptive authority granted to them by their state nursing regulatory body. Currently, all 50 states have some form of cheap write prescriptive authority for advanced practice nurses.3 The ability to prescribe and adjust medication is a valuable asset in caring for scholarship essay individuals with diabetes. Write My Essay Diabetic? It is a crucial component in the care of people with type 1 diabetes, and write my paper the great francis bacon it becomes increasingly important in cheap the care of patients with type 2 diabetes who have a constellation of comorbidities, all of which must be managed for successful disease outcomes. Many studies have documented the effectiveness of advanced practice nurses in managing common primary care issues.4 NP care has been associated with a high level of satisfaction among health services consumers.

In diabetes, the role of advanced practice nurses has significantly contributed to improved outcomes in the management of type 2 diabetes,5 in specialized diabetes foot care programs,6 in the management of diabetes in pregnancy,7 and in the care of pediatric type 1 diabetic patients and I, Robot Essay Topics & Writing Assignments their parents.8,9 Furthermore, NPs have also been effective providers of write my essay careplan diabetes care among disadvantaged urban African-American patients.10 Primary management of these patients by get someone my paper bacon, NPs led to improved metabolic control regardless of whether weight loss was achieved. The following case study illustrates the clinical role of advanced practice nurses in the management of a patient with type 2 diabetes. A.B. is a retired 69-year-old man with a 5-year history of write teaching type 2 diabetes. Do My Negative? Although he was diagnosed in teaching careplan 1997, he had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 118–127 mg/dl, which were described to him as indicative of “borderline diabetes.” He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries.

At the time of I, Robot Essay & Writing Assignments initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken. Referred by his family physician to the diabetes specialty clinic, A.B. presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of my essay teaching mild agitation, in the late afternoon. A.B. Papers Online Cheap Economics 1? also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to cheap my essay diabetic, the daily schedule. During the scholarship essay law school past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and cheap my essay careplan a “pancreas elixir” in an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results. He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for investigating how concentration of acid affects the reaction between calcium carbonate and hydrochloric acid me?,” he asks. “The doctor already knows the cheap write teaching sugars are high.”

A.B. states that he has “never been sick a day in my life.” He recently sold his business and has become very active in a variety of volunteer organizations. He lives with his wife of online 48 years and has two married children. Cheap Write My Essay Teaching Careplan? Although both his mother and can someone do my father had type 2 diabetes, A.B. has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the cheap my essay diabetic teaching Internet for the latest diabetes remedies. During the past year, A.B. has gained 22 lb.

Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG). A.B.’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. Essay For Cosmetology? His normal dinners consist of 2 cups of cooked pasta with homemade sauce and write my essay three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. Buy Research Online? He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening.

He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.” The medical documents that A.B. Cheap Write? brings to this appointment indicate that his hemoglobin A 1c (A1C) has never been 8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ?130/80 mmHg for both cardiovascular and renal health.11. A.B. has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. Essay Law School? However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to teaching careplan, date, and, in general, he has been remarkably healthy for can someone essay negative many years. A physical examination reveals the following: Weight: 178 lb; height: 5?2?; body mass index (BMI): 32.6 kg/m 2. Fasting capillary glucose: 166 mg/dl.

Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg. Pulse: 88 bpm; respirations 20 per minute. Eyes: corrective lenses, pupils equal and write my essay diabetic careplan reactive to light and accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy. Lungs: clear to auscultation. Heart: Rate and rhythm regular, no murmurs or gallops. Vascular assessment: no carotid bruits; femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally.

Neurological assessment: diminished vibratory sense to essay, the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the write teaching careplan ankle. Results of for cosmetology laboratory tests (drawn 5 days before the office visit) are as follows: Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl) Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl) Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl) Sodium: 141 mg/dl (normal range: 135–146 mg/dl) Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl) • Total cholesterol: 162 mg/dl (normal: 200 mg/dl) • HDL cholesterol: 43 mg/dl (normal: ?40 mg/dl) • LDL cholesterol (calculated): 84 mg/dl (normal: 100 mg/dl) • Triglycerides: 177 mg/dl (normal: 150 mg/dl)

• Cholesterol-to-HDL ratio: 3.8 (normal: 5.0) AST: 14 IU/l (normal: 0–40 IU/l) ALT: 19 IU/l (normal: 5–40 IU/l) Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l) A1C: 8.1% (normal: 4–6%) Urine microalbumin: 45 mg (normal: 30 mg) Based on my essay, A.B.’s medical history, records, physical exam, and lab results, he is online principles 1 assessed as follows: Uncontrolled type 2 diabetes (A1C 7%) Obesity (BMI 32.4 kg/m 2 ) Hyperlipidemia (controlled with atorvastatin)

Peripheral neuropathy (distal and symmetrical by cheap teaching, exam) Hypertension (by previous chart data and exam) Elevated urine microalbumin level. Self-care management/lifestyle deficits. • High carbohydrate intake. • No SMBG program.

Poor understanding of diabetes. A.B. presented with uncontrolled type 2 diabetes and a complex set of can someone do my negative leadership comorbidities, all of which needed treatment. The first task of the NP who provided his care was to select the most pressing health care issues and prioritize his medical care to address them. Although A.B. stated that his need to lose weight was his chief reason for seeking diabetes specialty care, his elevated glucose levels and his hypertension also needed to cheap my essay careplan, be addressed at the initial visit. The patient and his wife agreed that a referral to a dietitian was their first priority.

A.B. acknowledged that he had little dietary information to help him achieve weight loss and that his current weight was unhealthy and “embarrassing.” He recognized that his glucose control was affected by large portions of bread and pasta and agreed to start improving dietary control by reducing his portion size by one-third during the week before his dietary consultation. Weight loss would also be an important first step in buy research papers 1 reducing his blood pressure. The NP contacted the registered dietitian (RD) by telephone and referred the patient for write a medical nutrition therapy assessment with a focus on buy research papers cheap economics 1, weight loss and improved diabetes control. Cheap Diabetic Teaching? A.B.’s appointment was scheduled for the following week. The RD requested that during the intervening week, the patient keep a food journal recording his food intake at do my essay meals and snacks. She asked that the cheap write diabetic careplan patient also try to estimate portion sizes. Although his physical activity had increased since his retirement, it was fairly sporadic and weather-dependent. After further discussion, he realized that a week or more would often pass without any significant form of exercise and that most of his exercise was seasonal. Whatever weight he had lost during the can someone negative leadership summer was regained in the winter, when he was again quite sedentary. A.B.’s wife suggested that the two of cheap write diabetic careplan them could walk each morning after breakfast. She also felt that a treadmill at home would be the I, Robot Topics & Writing Assignments best solution for getting sufficient exercise in inclement weather.

After a short discussion about the positive effect exercise can have on glucose control, the patient and his wife agreed to write my essay careplan, walk 15–20 minutes each day between 9:00 and my paper bacon 10:00 a.m. A first-line medication for this patient had to be targeted to improving glucose control without contributing to weight gain. Thiazolidinediones (i.e., rosiglitizone [Avandia] or pioglitizone [Actos]) effectively address insulin resistance but have been associated with weight gain.12 A sulfonylurea or meglitinide (i.e., repaglinide [Prandin]) can reduce postprandial elevations caused by increased carbohydrate intake, but they are also associated with some weight gain.12 When glyburide was previously prescribed, the patient exhibited signs and teaching careplan symptoms of hypoglycemia (unconfirmed by SMBG). Me Do My Essay The Dark Of Shakespeare's The Winter's? ?-Glucosidase inhibitors (i.e., acarbose [Precose]) can help with postprandial hyperglycemia rise by blunting the effect of the entry of carbohydrate-related glucose into the system. Write My Essay Teaching Careplan? However, acarbose requires slow titration, has multiple gastrointestinal (GI) side effects, and reduces A1C by get someone write my paper investigating of acid the reaction between calcium, only 0.5–0.9%.13 Acarbose may be considered as a second-line therapy for write my essay diabetic teaching careplan A.B. but would not fully address his elevated A1C results. Metformin (Glucophage), which reduces hepatic glucose production and improves insulin resistance, is not associated with hypoglycemia and can lower A1C results by 1%. Although GI side effects can occur, they are usually self-limiting and can be further reduced by slow titration to dose efficacy.14. After reviewing these options and do my essay negative leadership discussing the need for improved glycemic control, the NP prescribed metformin, 500 mg twice a day. Possible GI side effects and the need to avoid alcohol were of concern to cheap my essay teaching, A.B., but he agreed that medication was necessary and that metformin was his best option. The NP advised him to take the medication with food to leadership, reduce GI side effects.

The NP also discussed with the patient a titration schedule that increased the dosage to 1,000 mg twice a day over a 4-week period. She wrote out this plan, including a date and time for telephone contact and medication evaluation, and write diabetic careplan gave it to the patient. During the visit, A.B. and his wife learned to use a glucose meter that features a simple two-step procedure. Online Cheap Economics Principles 1? The patient agreed to use the meter twice a day, at my essay teaching careplan breakfast and dinner, while the metformin dose was being titrated. He understood the need for glucose readings to guide the choice of medication and to evaluate the effects of his dietary changes, but he felt that it would not be “a forever thing.” The NP reviewed glycemic goals with the patient and buy research economics principles his wife and assisted them in deciding on initial short-term goals for weight loss, exercise, and medication.

Glucose monitoring would serve as a guide and diabetic teaching assist the leadership patient in modifying his lifestyle. A.B. drew the line at cheap write careplan starting an antihypertensive medication—the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec), 5 mg daily. He stated that one new medication at a time was enough and that “too many medications would make a sick man out of get someone write my paper calcium carbonate acid me.” His perception of the state of his health as being represented by cheap my essay teaching, the number of medications prescribed for him gave the advanced practice nurse an important insight into the patient’s health belief system. The patient’s wife also believed that a “natural solution” was better than medication for I, Robot Topics & Writing treating blood pressure. Although the use of an cheap my essay diabetic, ACE inhibitor was indicated both by the level of hypertension and by the presence of microalbuminuria, the decision to write my paper investigating how concentration of acid the reaction calcium carbonate and hydrochloric, wait until the next office visit to further evaluate the write my essay careplan need for antihypertensive medication afforded the patient and his wife time to buy research papers cheap economics principles 1, consider the importance of cheap my essay teaching careplan adding this pharmacotherapy. Help Me Do My Essay Of Shakespeare's Tale? They were quite willing to read any materials that addressed the prevention of diabetes complications. However, both the patient and his wife voiced a strong desire to cheap write teaching careplan, focus their energies on cheap economics principles 1, changes in food and physical activity. Cheap My Essay Diabetic? The NP expressed support for their decision.

Because A.B. was obese, weight loss would be beneficial for many of his health issues. Because he has a sedentary lifestyle, is 35 years old, has hypertension and Essay peripheral neuropathy, and is being treated for hypercholestrolemia, the NP performed an electrocardiogram in write teaching careplan the office and referred the patient for law school an exercise tolerance test.11 In doing this, the NP acknowledged and respected the write my essay teaching mutually set goals, but also provided appropriate pre-exercise screening for buy research cheap economics the patient’s protection and safety. In her role as diabetes educator, the NP taught A.B. and his wife the importance of foot care, demonstrating to the patient his inability to feel the light touch of the cheap teaching monofilament. She explained that the loss of protective sensation from peripheral neuropathy means that he will need to be more vigilant in checking his feet for any skin lesions caused by poorly fitting footwear worn during exercise. At the conclusion of the visit, the NP assured A.B. that she would share the essay plan of cheap write teaching care they had developed with his primary care physician, collaborating with him and discussing the findings of me do vision any diagnostic tests and procedures.

She would also work in write teaching careplan partnership with the RD to reinforce medical nutrition therapies and improve his glucose control. In this way, the NP would facilitate the continuity of care and keep vital pathways of buy research papers online cheap principles communication open. Advanced practice nurses are ideally suited to play an cheap write my essay diabetic, integral role in the education and medical management of people with diabetes.15 The combination of clinical skills and can someone essay leadership expertise in teaching and counseling enhances the delivery of care in a manner that is both cost-reducing and effective. Inherent in the role of advanced practice nurses is the understanding of shared responsibility for health care outcomes. This partnering of nurse with patient not only improves care but strengthens the patient’s role as self-manager. Geralyn Spollett, MSN, C-ANP, CDE, is associate director and an adult nurse practitioner at the Yale Diabetes Center, Department of Endocrinology and Metabolism, at Yale University in New Haven, Conn. Write My Essay Teaching Careplan? She is an associate editor of Diabetes Spectrum.

Note of disclosure: Ms. Spollett has received honoraria for speaking engagements from Novo Nordisk Pharmaceuticals, Inc., and Aventis and has been a paid consultant for Aventis. Both companies produce products and devices for the treatment of diabetes. 2017 by online cheap economics 1, the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353 .