Develop a three year professional action plan Essay

Build up a multi year proficient activity plan - Essay Example Medicinal services would in reality be the main business in the United States. Tasks research-type investigation and application for the mind boggling issues included would be helpful for any medicinal services framework. The biggest issue, there are insufficient individuals considering professions in the human services industry. As of now, the social insurance industry in the United States faces a significant number of similar issues going up against different ventures, yet there would be some huge political contrasts. All the while, medicinal services would be illustrative of a colossal section of the economy, and it needs our assistance. The individuals filling in as a feature of the medicinal services framework are commonly devoted to offering the most ideal support. The issue is, the workforce and, all the more critically, the executives, don't have the important preparing or information to utilize the accessible assets. Under these specific conditions, it would be far fetched that any private industry would make due with the degree of waste and wastefulness ordinarily found in social insurance. Human services is a systematic no other realized plan of action. There would be numerous chiefs with clashing objectives and targets. The primary thought ought to be the intense consideration emergency clinic. As of now, most emergency clinics in the United States, and on account of Canada basically all, are not-revenue driven, autonomous companies. Glouberman and Mintzberg would recognize four distinctive administration bunches for which they use the term four universes inside the emergency clinic condition. Clinical activities are overseen in a descending concentration because of specialists and attendants and their attention on tolerant consideration. Directors and trustees center in an upward thought toward the individuals who control or reserve the foundation. In addition, representatives, for this situation supervisors and medical caretakers, would rehearse some administration inside the foundation, while specialists and trustees would oversee outside the clinic as from the outside in, since they are in fact not workers and are subsequently free of its proper position. The universe of fix, which is described by short, concentrated and basically non-individual clinical intercessions, would be viewed as a quadrant of this specific perfect. Normally, North American specialists would not work legitimately for the emergency clinics. They are in truth private business people who have affirmation benefits at a medical clinic. There are a rare sorts of people who might comprise as salaried emergency clinic representatives, yet the dominant part would in certainty reliably take a shot at a charge for-administration premise with the medical clinic. To expand their salary, specialists would regularly show up at whatever point the patient requires a fix and intercession or treatment of some structure. Starting here they would push ahead. As a potential social insurance administrator it is ideal to comprehend the political and different interrelationships between specialists, medical attendants, emergency clinic staff and organization. Human services chiefs face another division, which speaks to the universe of care. This is the world spoken to by medical attendants. Medical attendants are suppliers who work legitimately for the clinic on compensation and regularly represent the biggest part of its working spending plan. They work in their own inner administration chain of command and have a one of a kind relationship with patients. They are

Kate Nash †“Made of Bricks” free essay sample

In spite of a portion of the severe surveys of Kate Nash’s  ­album â€Å"Made of Bricks,† the 20-year-old British vocalist and musician has completely prevailed upon me. I’m the sort of individual who cherishes any music that makes me need to chime in, and Kate has done quite recently this. Her single â€Å"Foundations†  ­begins with a vivacious, carefree sound that will undoubtedly paint a grin on anybody’s face and power one to pull out the  ­little bundle of verses to chime in. Nash’s British pronunciation joined with her delightful tone simply gobble me up. She takes the words directly from anyone’s mouth who has managed testing connections, and she builds up the verses in a bright, welcoming way. Despite the fact that her arbitrary, enthusiastic verses are for the most part beguiling, they are dulled by the normal utilization of swear words. Many accept the main accomplishment on her collection is the hit single â€Å"Foundations,† however the various beats of every melody attracted me. We will compose a custom paper test on Kate Nash †â€Å"Made of Bricks† or on the other hand any comparable subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page Anyone searching for a high-vitality new style ought to doubtlessly pay special mind to Kate Nash. She has an alternate interpretation of music and paints the narrative of harmed hearts very well.

A Year End Review How Everything Can Change in a Year

A Year End Review How Everything Can Change in a Year Oh, what a difference a year can make! One year ago, on December 14, 2010, we started The Minimalists. Since then, almost everything in our lives has changed. A year ago we both worked for large corporations. Now we work for ourselves and pursue our passions every day. A year ago we were unhappy with our lives. Now were living meaningfully by contributing beyond ourselves in meaningful ways. A year ago we could hardly spell HTML, let alone build a website. Now we have a successful blog. A year ago we had zero people reading our words (other than some vapid corporate emails). Now we have over 100,000 monthly readers, and our essays have been read by over a million people in 151 countries this year. A year ago zero people subscribed to our site. Now tens of thousands of people subscribe via email to get our free essays. A year ago no one was interested in following us on Twitter or Facebook. Now we have thousands of people who interact with us through social media. A year ago we hadnt published anything. Now weve published a bestselling book. A year ago we had spreadsheets full of goals, and we would beat ourselves up when we didnt achieve those goals. Now Ryan lives with one goal at a time, and Joshua has no goals at all. A year ago we strived to make everything perfect. Now we embrace the imperfection of our daily lives. A year ago we were a couple of guys stuck in Dayton, Ohio. Now were traveling the country on a our first book tour and meeting the most amazing people weve ever met, dishing out hundreds of free hugs in the process. A year ago there was a considerable amount of discontent in our lives. Now were happy, and when we look in the rearview mirror, everything is different. Now, we arent trying to impress you with our accomplishments; rather, we want to impress upon you the power of a year. As human beings, we often overestimate what we can accomplish in a short period of time (e.g., six-pack abs in two weeks), but we drastically underestimate what we can accomplish in a year or two. Most of the above mentioned accomplishments  werent goals we developed at the beginning of the year. They just happened, organically, as we worked hard to add value to other peoples lives. Thus, we discovered that when we add value to other peoples lives, everything else tends to fall into place. The big life changes dont happen overnight: Give yourself some time. Put in the necessary effort. Keep at it. Youll be surprised with what can happen in a year. Subscribe to The Minimalists via email.

Character Analysis of Juliet From William Shakespeares...

Character Analysis of Juliet From William Shakespeares Romeo and Juliet Juliet is a young girl living in Elizabethan times. She is from a rich background. Although the play is set in Italy, it is really about English characters. Shakespeare is giving a glimpse of a thirteen year old girl (Juliet) living in the Sixteenth century. The nurse is like a mother to Juliet. She is very important in her life. When Lady Capulet is talking about Juliet, she says ...Thou knowest my daughters of a pretty age (p.25) and the nurse replies ... I can tell her age unto an hour. (p.25) showing she is close to Juliet as most parents would be conscious of the precise age of their children. This shows that Lady†¦show more content†¦Such as And stint thou too, I pray thee, Nurse say I (p.27) and It is an honour I dream not of (p.27). Juliet is very courteous to people. She calls her mother Madame (p.25) and is polite to people when she speaks. Juliet speaks to her nurse as a mother, even though Lady Capulet is her mother. She says such things to the nurse as Go ask his name... (p.45) at the Capulets feast. She is talking to the nurse and asking her to go up to Romeo and ask his name and whether or not he is marry. She is asking the nurse because the nurse is closer to Juliet than her mother. This is probably because the nurse has been with Juliet for a large part of her life. Juliet speaks to her mother as if she were just a friend, or distant relation. She calls her mother Madame... (p.25) which shows that she is not close at all with her mother. When Lady Capulet is talking about Juliet, she says ...Thou knowest my daughters of a pretty age (p.25) and the nurse replies ... I can tell her age unto an hour. (p.25) showing she is close to Juliet as most parents would be conscious of the precise age of their children. This shows that the nurse is closer to Juliet than Lady Capulet, and Lady Capulet has not spent a great deal of time with Juliet. SECTION 3: ========== Juliet falls in love with Romeo, the Capulet familys enemy. She marries Romeo inShow MoreRelatedTragic Hero in Othelo by William Shakespeare996 Words   |  4 Pagesmuch alike. He has written many plays including Othello and Romeo and Juliet. Shakespeare was a man who wrote plays that followed the same literary conventions. These conventions included tragic hero, fallacy, irony, and also suspense. A tragic hero is a male figure who is high in society and one who always has a tragic flaw. Most of them are rich and intelligent men. In the story of Othello, Othello is the tragic hero. He was a character of nobility. He was a high in class and had high standardsRead More Analysis of Act Three Scene Five of William Shakespeares Romeo and Juliet1540 Words   |  7 PagesAnalysis of Act Three Scene Five of William Shakespeares Romeo and Juliet William Shakespeares Romeo and Juliet is a dramatic tragedy, and was first performed in 1595. The novel is about two young lovers, Romeo Juliet and the struggle with their relationship. Romeo and Juliet are from opposing families, the Montagues and the Capulets. The conflict between their two families causes problems for their love of one another. Shakespeares main themes throughout the play are of love, conflictRead MoreRomeo And Juliet Analysis1384 Words   |  6 PagesAnalysis Essay #1: Romeo and Juliet Below write your essay based on the outline that you created. In William Shakespeare’s famous play, â€Å"Romeo and Juliet,† the supporting characters play enormous roles in the plot of the performance by helping Romeo and Juliet be together. The Nurse and Friar Laurence both cause dramatic changes to the play through the course of their actions, both with their own goals and reasons for their behavior. The Nurse is caring and pure, wishing simply for Juliet toRead MoreWilliam Shakespeare s Romeo And Juliet1287 Words   |  6 PagesComposition 2 Mr. Spera March 10, 2015 Romeo and Juliet Research Paper The movie Romeo and Juliet is a modern classic film that took place in 1996. Overall this is a timeless story that everyone should go and watch. This movie has an intriguing plot line that tells the story of two feuding families, The Montagues and The Capulets, and how the children of these two different families fall in love. The two children overcome various obstacles such as hiding their chemistry from their parents because it is forbiddenRead MoreWilliam Shakespeare s All The World s A Stage 1540 Words   |  7 PagesMegan Mackey Professor Raja Atallah English 1102 17 April 2017 Research Paper William Shakespeare once said, All the World’s a Stage —and now his quote can be applied to his literature within his tragedies (William Shakespeare 1). The generation of people today have a much different definition of tragedies than people did during the Shakespearean times. Shakespeare’s tragedies involve a protagonist whose character is developed so that it is clear that he is a heroic figure in the setting of theRead MoreWilliam Shakespeare s Romeo And Juliet923 Words   |  4 Pages Romeo and Juliet Analysis William Shakespeare often has a reputation among modern audiences as being antiquated and archaic. The first things that many people think of when contemplating Shakespeare are ancient locales, Early Modern English which is difficult to understand, and elaborate codpieces. Even modern productions, which often attempt to place the action in a more contemporary context, often can alienate prospective audiences with strange conceptual design choices. But, despite these preconceivedRead MoreAnalysis of Romeo and Juliets Exchange in William Shakespeares Romeo and Juliet593 Words   |  3 PagesAnalysis of Romeo and Juliets Exchange in William Shakespeares Romeo and Juliet Shakespeare explains 3 types of love, Courtly, arranged and spontaneous and even more. Love is one of the powerful emotions known by the human being. The most renown play Romeo + Juliet and has found its place in history. Shakespeare packs a great deal of meaning into each line. You can read Romeo + Juliet to find out about Elizabethan life, but in them you will also see reflected back atRead MoreRomeo And Juliet Film Analysis1647 Words   |  7 PagesDavies, Anthony. The film versions of Romeo and Juliet, Shakespeare Survey 49(1996):153-162 Web. 22 May 2017. 1. In this Journal articles by Anthony Davies, he attempts to trace, compare, and analyze the play of Romeo Juliet’s life throughout cinema. To do this, Anthony does a close reading of four different films directed by Cukor, Zeffirelli, Alvin Rakoff, and the BBC. With these films, Anthony delves into them while dissecting specific scenes to compare how they are different or similarRead MoreWilliam Shakespeare s Romeo And Juliet1236 Words   |  5 PagesMany associate the word with kindly feelings towards others and generally positive thoughts. It is a word that we use to describe our emotions of affection, devotion, fondness, and friendship. William Shakespeare s Romeo and Juliet centers around the epic, yet tragic, love of two adolescents. With Shakespeare’s use of figurative language and literary devices, he creates a central theme that love, no matter how strong or sweet, is poison. The term poison, although not commonly associated with love,Read MoreMercutio - a Monodimensional and Static Character in Shakespeares Romeo and Juliet?1718 Words   |  7 PagesDiscuss Mercutio in Shakespeare’s Romeo and Juliet in terms of character dimension, character development and his relation to major themes of the play. When looking at the content of characters in Shakespeare’s play „Romeo and Julietâ€Å" one can find a total of 21 people that are mentioned by name. While it is self-evident that characters such as Romeo and Juliet are essential to the play due to the fact that they form its title, a reader could ask what role the others might play in a literary context

Corruption Of Control In Animal Farm, By George Orwell

John Dalberg Acton once said, â€Å"Power tends to corrupt, and absolute power corrupts absolutely.† This seems similar in the case of Animal Farm, a book by George Orwell. In the story the tired animals rebel against their owner and set up their own government, but the pigs assume control and abuse their power which corrupts the whole system by oppressing the other animals and exploiting them. Even though the pigs abuse their power, the naive animals are the reason why the pigs rose to control because the working animals were tricked by the pig’s corruption of language, persuaded by their propaganda, and were naive time and time again. One reason why the pigs are still in control is because the animals were tricked by the pigs was when they†¦show more content†¦Another reason is that they could have tried to use their education and been smarter to realize what was going on in the farm. It clearly states in the novel that, â€Å"ALL â€Å"ANIMALS ARE EQUALâ €  (Orwell 13). It then changes for that to the same commandment, but with a twist. As shown in the last chapter â€Å"ALL ANIMALS ARE EQUAL, BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS† (Orwell 127). The slight change of all the commandments symbolizes how much the farm is being changed and twisted by the will of the pigs. This last change shows that the farm has reverted back to it’s former state. If the animals were smarter and not have been so naive, and could have stood up to the pigs, resulting in the decline of Napoleon’s dictatorship. This is important because if they were smarter and wiser as a whole, than it would have been easy for them to not get fooled, making it way harder on the pigs to keep control. This is true because without the working class of animals supporting Napoleon, the pigs would not be able to live so lavishly. Standing up to the pigs and questioning them was very key for the animals when they knew something was fishy was very imp ortant, but when Clover asks Muriel to read the commandments for him, and realizes the slight change at the end every time, he never seems to go straight to the pigs and confront them. The working animals were to passive in this situation and were the most responsible for the pig’s continuing tyranny. And Finally, the animalsShow MoreRelatedAnimal Farm Character Analysis713 Words   |  3 Pagesâ€Å"ALL ANIMALS ARE EQUAL BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS† (Orwell 134). In George Orwell’s allegorical fable, Animal Farm, a group of animals lived with their master, Jones. Jones was an unfair man who didn’t care too much about the animals. One day Jones forgot to feed the animals, so they revolted. The animals wanted a perfect place without the corruption of man. The currently animal controlled land of Animal Farm, the smartest of all animals, the pigs take control. To prevent a human-likeRead MoreAnimal Farm by George Orwell1100 Words   |  4 PagesIntroduction: Widely acknowledged as a powerful allegory, the 1945 novella Animal Farm, conceived from the satirical mind of acclaimed author George Orwell, is a harrowing fable of a fictional dystopia that critiques the socialist philosophy of Stalin in terms of his leadership of the Soviet Union. Tired of their servitude to man, a group of farm animals revolt and establish their own society, only to be betrayed into worse servitude by their leaders, the pigs, whose initial virtuous intentionsRead MoreAnimal Farm By George Orwell845 Words   |  4 Pages The Russian Revolution in 1917 was portrayed in Animal Farm, to show how the government is more unequal, totalitarian and brutal just like presently. Animal Farm is created by George Orwell, who displays this story as a ridicule, teaches a lesson by showing the dangers of propaganda, and uses animals to hide the original individuals. During the Revolution, Russians had lost hope in Czar Nicholas II due to his rampant behavior and how the government was slowing separating; thereforeRead MorePower Corruption. It Is A Never A Leader’S Ideal Is To1081 Words   |  5 PagesPower Corruption It is a never a leader’s ideal is to cause harm are any wrongdoing to his people. Sometimes in his or her attempts to protect their country, some go to the extreme in efforts to shield from external forces. In the end though as history has proven, power is perception. Corruption is due to happen when those who govern separate themselves from whom they govern. In the novel Animal Farm, by George Orwell, George uses an allegorical reference between the animals in the story to symbolizeRead MoreThe Key Themes In Animal Farm By George Orwell952 Words   |  4 PagesAnimal Farm, an allegorical novel by George Orwell, depicts a very clear picture of the events leading up to the 1917 Russian Revolution and the Stalinist era of the Soviet Union. The techniques Orwell has used when writing this piece allows his robust view points and prominent reoccurring themes to become clear. A couple of themes that stood out the most to me was the use of education and intelligence, as well as corr uption of power and leadership to fuel oppression. Orwell uses the imagery of aRead MoreLord of the Flies Compared to Animal Farm Essay994 Words   |  4 Pagesuse fear as a control tactic in their countries as they want to make sure they have total power over their people. Fear is defined as an unpleasant and often strong emotion caused by anticipation or awareness of danger, often causing a person to act according to what is necessary for survival. Although fear can be unpleasant, many people like it in different ways; some like the suspense that scary movies bring, while others like the thrill that is created when cliff jumping. George Orwell’s allegoryRead MoreAnimal Farm, By George Orwell1089 Words   |  5 PagesIn George Orwell’s â€Å"Animal Farm†, the pigs as the farm leaders, use unknown language, invoke scare tactics and create specific laws, thereby enabling them to control other animals, to suit their greedy desires, and to perform actions outside their realm of power. Because of the pigs’ use of broad language, and the implementation of these tactics they are able to get away with avoiding laws, and are able to convince other animals into believing untrue stories that are beneficial to the pigs. The firstRead More1984: Governments Attempt to Control the Mind and Bodies of Its Citiz1253 Words   |  6 Pages1984: Governments Attempt to Control The Mind and Bodies of Its Citizens The novel Nineteen Eighty-Four by George Orwell is an American classic which explores the human mind when it comes to power, corruption, control, and the ultimate utopian society. Orwell indirectly proposes that power given to the government will ultimately become corrupt and they will attempt to force all to conform to their one set standard. He also sets forth the idea that the corrupted government will attempt toRead MoreGeorge Orwell s Animal Farm1403 Words   |  6 PagesGeorge Orwell believes â€Å"What you get over and over again is a movement of the proletariat which is promptly characterized and betrayed by astute people at the top and then the growth of a new governing class. The one thing that never arrives is equality† (Letemendia 1). Orwell simply loathes revolution and thinks it is unfair to the majority, for the people. He thinks that while individuals change, the people in power are always corrupt and they will corrupt any attempt at change. He communicatesRead MoreAnimal Farm1555 Words   |  7 Pages Animal Farm written by George Orwell is an animal fable happens in a farm where animals start building a communism society, but end up being totalitarianism, hinting obliquely at the communists in the real world. The gaps between pigs and other common animals, demonstrate the theme that the corruption of power appears when majority is ruled. The intelligence superior allows the pigs placing themselves at a position which is closer to the power and which is more easily to corrupt. The inability

Gandhi the educator Free Essays

Gandhi was a prolific writer. One of Gandhi’s earliest publications, Hind SwaraJ, published in Gujarati in 1909, is recognised[by whom? ] as the intellectual blueprint of India’s freedom movement. The book was translated into English the next year, with a copyright legend that read â€Å"No Rights Reserved†. We will write a custom essay sample on Gandhi the educator or any similar topic only for you Order Now [206] For decades he edited several newspapers including Harijan in Gujarati, in Hindi and in the English language; Indian Opinion while in South Africa and, Young India, in English, and NavaJivan, a Gujarati monthly, on his return to India. Later, Nava]ivan was also published in Hindi. In addition, he wrote letters almost every day to individuals and newspapers. [207] Gandhi also wrote several books including his autobiography, The Story of My Experiments with Truth (GuJar ¤ti â€Å"acuu our-us-ed†), of which he bought the entire first edition to make sure it was reprinted. [77] His other autobiographies included: Satyagraha in South Africa about his struggle there, Hind SwaraJ or Indian Home Rule, a political pamphlet, and a paraphrase in Gujarati of John Ruskin’s Unto This Last. 208] This last essay can be considered his programme on economics. He also wrote extensively on vegetarianism, diet and health, religion, ocial reforms, etc. Gandhi usually wrote in Gujarat’, though he also revised the Hindi and English translations of his books. [209] Gandhi’s complete works were published by the Indian government under the name The Collected Works of Mahatma Gandhi in the 1960s. The writings com prise about 50,000 pages published In about a hundred volumes. In 2000, a revised edition of the complete works sparked a controversy, as It constituted large number of errors and omissions. [210] The Indian government later withdrew the revised edition Concrete Definition to Alms, Goals and Objectives of Education : If education Is the foundation of all growth and progress, then alms, goals and objectives are the four Interconnected and most significant components that gives direction to educational outcomes through the curricular content, syllabus and evaluations. These four components are highly Influenced by four Interconnected foundation blocks namely, epistemology (the nature of knowledge), society/culture, the Individual, and learning theories (Zals, 1976). But since alms, goals, and objectives, collectively as a component of curriculum provide direction and focus for the ntire education programme, they are particularly sensitive to these four fundamental forces. It was GandhlJl, who In 1937 first recognized the Interconnectedness of the eight curricular forces and questioned the futlllty of the British education system. Based on his wisdom and successful experiments with education In soutn ATrlca, ne put Tortn a Baslc toucatlon Plan which had the merit of achieving one aim of peace and freedom, for which all mankind yearns today. Also, recognizing the futility of a centralized plan and control in implementing programmes, he also utlined a comprehensive but decentralized model to be implemented by the village Republics. The vital objective of his model was to develop productive and social skills among the masses. To the centre, remained the overall responsibilities of coordinating and guiding the work of the states so that national policies could evolve from the grassroots. The Basic Philosophy (a) True education is all-round development of the faculties, best attained through action. It bases itself on the fact that knowledge and understanding develop in relation to problems set right by action. Information thrust on the mind only urdens the memory and causes intellectual indigestion, casting learning into oblivion. b) Education must be concrete and inter connected, not abstract or given in isolated sections. Concrete education allows the learner to manipulate problems or sets of problems and study their relationships, character and artistic sense. It allows the mind, heart, hand and eyes to work simultaneously in a correlated manner, resulting in a harmonious and well-balanced personality. (c) Education must be imparted in the child’s mother tongue and organically connected with the child’s Social and Cultural environment. How to cite Gandhi the educator, Papers

Conference Mobile Communication Healthcare -Myassignmenthelp.Com

Question: Discuss About The Conference Mobile Communication Healthcare? Answer: Introduction: Diabetes is the most common cause of death among elderly patients and other populations alike. Diabetes is also a multi-factorial disease that occurs in people associated with other health issues like obesity, chronic heart diseases, kidney diseases and the leading cause of hospitalizations among geriatric patients. The case study describes a female patient who is 65 years old, having a medical history of diabetes for twenty years. The patient was admitted in the hospital from the emergency department with a case of severe glycemic shock, difficulty in breathing and severe back pain. On diagnosis, the reports showed that the patient has cardiac blockage, is currently obese with hypertension symptoms. The patient was also asses by Beck depression Inventory and showed positive results suggesting she was suffering from clinical depression but did not take any medication prior to this admission. The back pain of the patient was treated with pain medication to minimize the pain score. The report summarizes the care plan set up for the patient with reference to the current condition to treat her glycemic shock, administration of management for the condition and address the heart blockage and depression as well. Patient education is also an important factor for the completion of the care plan and the family of the patient was taught so that the home care can be arranged properly so as to reduce risk of hospital readmission. The family of the patient was also taught to monitor the patient to avoid the risk of falling which might cause severe repercussions, which is commonly observed in geriatric patients. Objective Data Pulse ox: 89% showing low levels Cough: No such detection Sputum: not detected Oxygen: room temperature Respiratory rate: 140/90 mm Hg very high, as seen in hypertensive patients Tachypneic/Hypoventilation (too slow/shallow: Respiratory effort: effort required due to blockage in heart Respiratory rhythm: difficult, erratic and very high due to heart blockage Breath sounds: no wheezing is observed, but breath rate very high Skin: WNL, normal Skin Turgor: Tenting Weight: 90kg/lb, overweight Capillary refill: WNL Apical pulse rhythm: irregularity seen Apical pulse rate: Tachycardia beats noted Heart Sounds: (Arrhythmic sounds noted) caused by hypertension Apical/radial deficit: yes Peripheral pulses: 80mmHg R radical= Doppler, R femoral= yes, R pedal=yes, R post tib=yes; L radical = yes, L femoral= Doppler, L pedal= yes, L post tib= yes. Edema: none such detected in the chest or throat, so no possible pathogenesis is the cause of breathing trouble R Hand/arm= no, R knee to thigh= no, R ankle to knee= non-pitting, R foot/ankle=no; L Hand/arm= no, L knee to thigh= no, L ankle to knee= no, foot/ankle=non pitting, Sacrum=non-pitting. Heart blockage noticed and needs immediate assistance. Deprivation of sleep due to difficulty in breathing Neurological Oriented to : patient Communication : slow but expressive Pupils:round, with a sluggish reaction to light. Glasgow Coma Scale(score range 0-15, Coma=7): Eye opening to: spontaneous=3, verbal command =2, pain=0, no response=1. Verbal responses to: slow and effort, converses=4, disoriented, converses=3, uses inappropriate words=4, incomprehensible sounds=1, no response=1. Motor responses to: verbal command = 5, localized pain=6, flexes and withdraws=3, flexes abnormally (decorticate)=4, extends abnormally (decerebrate)=3, no response = 1. Muscle tone strength Head/ neck: flaccid, Right hand: spastic, L Hand: flaccid, RUE: LUE: flaccid, RLE: flaccid, LLE: flaccid. The muscle on the leg seem to be stressed due to her weight and mild oedema is noticed on the joints due to pressure of weight. Legs: unable to walk properly due to weight gain Depression measurement: scored out of Beck Depression Inventory Erratic mood Low self esteem Sense of failure Lack of self confidence Body image issues Pity on self Old age depression Lack of satisfaction Slow movement Constant sighs Inability to express Demotivated boredom Musculoskeletal Gait: Appearance and no movement Arms: Appearance and movement Legs: Appearance and cannot walk Spine: Appearance and difficulty in moving Location of pain: back pain and soreness in legs Loss of activity: walking is being affected by the pain Description of pain: sharp and located Pain rating on a scale of 0-10: 6 Acceptable level for this client: 5 What makes the pain worse: walking and movement What makes the pain decrease: medication, and sleep. Psychosocial (and other relevant data) patients name: Surinder Kaur gender: Female birth date/age: 65 Marital status: Married Race/ethnicity: Indian languages spoken: English No such mental illness but chronic depression History: diabetes for 20 years and takes daily insulin Obese: 90kg/lb Hypertension Weight gain is the cause of depression Currently no medication is provided for depression Unable to walk due to obesity Suffers from hypertension and back pain Inability to walk Case Study of Client: (Holistic) Among different domains of Nanda approved nursing diagnoses, this assignment will utilize actual diagnosis. The patent in the case study is a 65 year old woman named Surinder Kaur. The patient in the case study had a more or less sedentary lifestyle and stayed in home. The patient had diabetes and had been getting insulin every single day. Still her blood glucose level as per her assessment had been discovered to be extremely high. Hence it can be stated from the assessment that has been carried out for the patient, it has to be mentioned that the patient had been unable to manage her blood glucose levels properly and hence a few other health care concerns have accumulated as well. First and foremost, as an indirect result of her high blood glucose level and her sedentary lifestyle the patient had been gaining weight from the past 5 years and had been obese. Along with that, there is direct link between the cardiac complications and hypertension, and the patient had also been sufferi ng from heart blockages and the hypertension ( Kusnanto, 2017). Surinder also had excessive back pain with a pain score of and had difficulty walking due to peripheral neuropathy, a common complication that is associated with diabetes. According to the assessment data discovered about the patient in the case study, it can be mentioned that all of the different health acre complexities that the patient is suffering from had been a direct or indirect consequence of her poor management of type 2 diabetes and resultant high blood glucose at more than 200 mg/Dl. Hence based in the thorough assessment, the nursing diagnosis for the patient is high blood glucose level with severe risk for uns Extremely high blood glucose levels and severe risk for instability. Assessing the patient for vulnerability to glyceamic shock to the patient so that there is no immediate danger to the patient. Medication administration and facilitating better management of the type 2 diabetes along with educating the patient regarding the diabetes management techniques as well. Encouraging the patient to adopt a healthier life style by starting to eat healthy and maintaining a strict dietary plan with a strict yet attainable physical exercise regimen. Assessment of signs of hyperglycemia so that there is no immediate insulin- glucose level imbalances that the patient is under. Diligently assessing the blood glucose levels of the patient preferably before meal times and at bed time as well ( Franks McCarthy, 2016). Assssing and monitoring the HbA1c-glycosylated hemoglobin levels of the patient as well. Administration of basal and prandial insulin so that tissue perfusion is promoted and helps in reverting the glucose concentration to the normal levels which in turn will slow down the progression of the microvascular disease ( Diab, 2012). Administration of Sulfonylureas like Glucotrol and Diabeta, meglitinides like Prandin, Biguanides like metformin, Phenylalanine derivatives lie starlix, alpha glucose inhibitors like the acarbose and miglitol, thiazolinidiones like actos and avandia and lastly Incretin modifiers like sitagliptin. The medication will decrease insulin resistance, increase insulin production and will delay the absorption of glucose into the blood ( Paschou Leslie, 2013). Monitoring the hypertension of the patient and administer hypertensive drugs as prescribed to the patient which will help in reducing the high blood pressure of the patent and will also work to reducing the risk for strokes. Educating the patient on how to monitor blood glucose on her own using the nursing glucose meters (Modic et al., 2012). Encouraging the patient to develop a healthier lifestyle that includes both dietary changes and active and determined fitness initiative. Engaging in a therapeutic casual conversation with the patient with a cultural liaison assistance to extract information regarding her sedentary lifestyle and diet pattern ( Wexler et al., 2012). Consultation with a dietician for her to help her develop a diet plan that will sit her nutritional requirements along with facilitating eight loss and cholesterol concentration drop. Encouraging the patient to eat less junk food and maintain a protein rich and antioxidant rich diet plan with lesser carbohydrate and fat content ( Juul et al., 2012). Educating the patient with interactive and cognitive therapeutic intervention towards changing her health behaviors towards a promotional health behavior for diabetes control. Enhancing the health literacy of the patient regarding diabetes and the associated co- occurring disorders so that she can work towards managing or preventing it. Lastly, encouraging and helping the patient to begin with mild and least tiresome exercise regimen to help her build her tolerance towards physical exercise. As the patient is accustomed to physical exercise help the patient build towards more tiresome and effective exercise patterns that are targeted at quick weight loss ( Spanakis Chiarugi, 2011). The current case study here focuses upon the Surinder Kaur who is a 65 years old woman and suffering from a number of co-morbid health conditions. She is suffering from hypertension along with back pain; hear blockage and diabetes; depression and weight gain. She had been talking insulin for the past 20 years. In this respect, a care plan could be made for the patient based upon the North American nursing diagnosis association (NANDA). The NANDA diagnosis could be divided into following four types such as actual diagnosis, risks diagnosis, health promotion diagnosis and syndrome diagnosis. In this respect, the actual diagnosis has been taken into consideration where the present health responses shown by the patient are taken into consideration. For the current study, a range of complications depicted by the patient have been taken into consideration. Out of this, blood glucose monitoring have been taken onto consideration for the current study. The patient her had been suffering from type 2 diabetes and had been taking insulin for the past five years. As mentioned by Rosenberg et al. (2014), excessive dose of insulin can often lead to the deposition of body fat. Some of these have been seen to contribute to the worsening of already existent clinical condition in the patient. As the patient has heart blockage the presence of obesity could further worsen the condition. As mentioned by Jindal et al. (2017), obesity has been linked with high blood cholesterol levels. Some of these conditions restricted the life processes of the patient. This further developed depressive thoughts or feelings within the patient. However, one of the most important clinical conditions which were expressed within the patient and needed immediate clinical intervention are monitoring of high levels of blood glucose level. Therefore, the high levels of blood glucose level could lead to fatal consequences where the patient could develop glycaemia shocks. The hyperglycaemia could be associat ed with a range of symptomatic expressions, which could dishevel the normal life of the patients. Some of these are excessive urination, excessive thirst, weight gain, diabetic neuropathy and diabetic retinopathy. As mentioned by Ng, Finnigan, Connellan, Kiernan Coward (2014), high levels of blood glucose can lead to a condition of nerve damage known as diabetic neuropathy. The diabetic neuropathy can have much serious consequences such as development of leg amputations in the patient. The leg amputations can disrupt the normal day to day movement making the patient dependent upon medication and aid. In this stage, additional level of support and care is required for the patient. Hence, the patient looses autonomy over their activities of daily living (ADL) which could further aggaravate the presence and expression of depression in the patient. The high blood glucose level has been associated with the development of retinopathy conditions which can affect the vision in the patient considerably. Therefore, the daily care activities of the patient need to be effectively monitored for the reduction in the clinical manifestations of the patient. Further complications The patient also had hypertension and was suggested regular medications for the control and management of depression. However, the patient hardly followed the medications pattern and doses. This increased the severity of clinical symptoms such as sleep deprivation in the patient. Moreover, the patient could not sleep owing to pain which was also aggravated due to psychological reasons ion the patient. Therefore, in order to control the pain and sleeo deprivation in the patient, the patient was suggested metformin and oxazepam, which could effectively control the rate of depression within the patient. In the lack of effective medication intake by the patient, she could be struck with lethal consequences such as myocardial infarction (MI). Therefore, in order to relieve the overall condition of the patient a holistic care regimen could be developed for the patient (Rossom et al., 2014). Discussion of interventions One of the most important nursing interventions and strategies which could be developed for the patient is implementation of physical exercises. Some of the physical exercises could include light walking, jogging along with light stretching. This could restore the movement and agility patterns in the patient. Additionally, provision of effective medication to the patient could also help in controlling and monitoring the blood glucose level. As mentioned by Zhou et al. (2017), provision of fresh food and supplements to the patient can also be effective in controlling the blood glucose level. The areas which had been highlighted as requiring care management in the above discussion are blood glucose monitoring and reduction in the symptomatic expression of several health co-morbidities. This area of care management was highlighted as the patient had expressed a number of physical abnormalities which impaired the daily life of the patient along with dependence upon insulin. Research and evidences have proved that too much of dependence upon insulin can impair the functioning of the heart and the patient was already suffering from heart blockage (Feigenbaum, 2012). Therefore, the patient had to be provided with a balanced care treatment plan which will help in reducing the daily life grievances of the patient. The focus has to be more upon a holistic care regimen. Additionally, diabetes could also stem unto a number of major health complications such as movement disability, retinopathy and cardiac shock. Therefore, in order to prevent such conditions from the disrupting the life of the patient an effective and balanced car plan is required. Additionally, the patient was also suffering from depressions which affected the rate of recovery of the patient. Hence, providing the patient with a holistic care regimen can help in infusing positive spirit in the life of the patient which could speed the recovery rate (Plat, 2017). Additionally, provision of effective counselling measures along with community based development program can also help in reducing the stress in the life of the patient. The community development program can also motivate Surinder Kaur to lose weight as she was suffering from obesity. Conclusion The above discussion makes it clear that the geriatric patients like Surinder Kaur, need to be closely monitored to avoid rick of glycemic shock. The care plan organized for the patient needs to holistic providing the medication with the respective rationale. Obesity is an indirect effect of diabetes, which needs to be controlled from early signs as weight gain had severe repercussions like cardiac blockage, which is very risky. The patient had also developed depression due to her prolonged illness, which needed to be addressed to help her recover. The glycemic shock was assessed and nutritive as well as pharmaceutical help was provided to her to minimize further risk leading to fatality. The main criteria of the care plan was to control the blood glucose level and control weigh gain to reduce her weight to help her improve her blocked heart condition and improve her ability to walk which she was then facing due to obesity. Obesity and diabetes are correlated with each other and crea te co-morbid conditions in geriatric patients. Cases like this require patient education planning after care plan management, which would help minimize the risk of hospital readmission and falling in these cases. The hypertensive condition clubbed with depression in the patient makes the situation serious and she needs to be well monitored in even home care facilities to minimize the risk of falling. References American Diabetes Association. (2015). Standards of medical care in diabetes2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 33(2), 97. Bray, G. A., Popkin, B. M. (2014). 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