Lifestyle Modification and Pharmacological Therapy - Free Essay Example

Sample details Pages: 5 Words: 1377 Downloads: 8 Date added: 2019/05/07 Category Health Essay Level High school Tags: Diabetes Essay Did you like this example? Background/Introduction: GDM (gestational diabetes mellitus) is a disease that presents with carbohydrate intolerance and was initially discovered in pregnancy. In the majority of women, the postpartum glucose intolerance often gets back to normal levels, although there is a high risk of developing overt DM (diabetes mellitus) or impaired glucose tolerance later in life. Glycemic control has been achieved through various means including eating a balanced diet and taking medications such as insulin treatment. Methods: This paper sought to establish through a PICO question the extent to which in pregnant females with GDM (P), lifestyle modification (I) compares with pharmacological therapy (C) to aid in the improvement of diabetic control and pregnancy outcomes (O). Therefore, search for the relevant articles was conducted in various online databases guided by this PICO question for secondary data. Don’t waste time! Our writers will create an original "Lifestyle Modification and Pharmacological Therapy" essay for you Create order Results: In most of articles reviewed, an examination of the PICO question showed that lifestyle modification, through such efforts as engaging in exercise and eating a balanced diet, is an efficacious way of managing GDM similar to pharmacological therapy. Discussion: Lifestyle modification is an integral intervention to the prevention and control of patient outcomes when it comes to GDM. Conclusion and Recommendation: Lifestyle modification and pharmacological therapy works in achieving glycemic control in GDM. Compared to pharmacological therapy, it would be more advisable for pregnant women to embrace lifestyle modification as the most preferred means of achieving glycemic or diabetic control for improved pregnancy outcomes. Gestational diabetes mellitus (GDM) is a common complication of pregnancy with a reported prevalence of as high as sixteen percent, a rate that is on the rise across the globe (Wang et al., 2015). Maternal hyperglycemia has been established as causing a significantly high glucose transfer to the fetus, which occasions the overgrowth of the insulin-sensitive tissues and fetal hyperinsulinemia (Asemi, Samimi, Tabassi Esmaillzadeh, 2014). The resultant excessive fetal growth causes shoulder dystopia, heightened trauma at birth, or even perinatal deaths. Obesity and being overweight before pregnancy presents a risk factor for GDM, enhancing the probability of adverse pregnancy outcome for mothers and babies (Wang et al., 2017). Despite the fact that medical nutritional therapy (MNT) comes across an one of the cornerstone approaches to treating women with GDM, limited information exists as to the allowance of evidence-based recommendations concerning certain nutritional approaches that include control of fiber content or nutrient distribution in the management of GDM (Asemi, Samimi, Tabassi Esmaillzadeh, 2014). Besides limited information on dietary approaches to the regulation of outcomes in women with GDM, other factors such as gestational weight issues need to be addressed more for improved GDM-related pregnancy outcomes. Furthermore, even if regular exercise has been established as potentially reducing the risk of developing GDM, its efficacy still remains controversial (Wang et al., 2017). Medical nutrition therapy is also considered one of the mainstays of GDM treatment and management. Nevertheless, a limitation exists in data concerning the optimal diet that patients can use to attain glycemic control, as well as improved perinatal outcomes (Yamamoto et al., 2018). According to obstetricians and medical experts, physical exercise and eating a balanced diet are deemed as some of the best lifestyle modification methods that play a significant role in the prevention and management of GDM (Wang et al., 2015). Maternal overweight and obesity issues are pertinent to the framing of this topic on GDM as major contributing factors. These necessitate the conceptual model of BMI (body mass index) as one that determines the success of lifestyle modification (exercise and balanced diet) in improved GDM outcomes in pregnant women. It is prudent to note that a high BMI before or in the first trimester of pregnancy, as well as excessive GWG (gestational weight gain) in early and mid-pregnancy are deemed as early GDM markers that can be pharmacologically controlled or best managed through lifestyle modification. Purpose Statement In pregnant females with gestational diabetes mellitus (P), does lifestyle modification (I) in comparison with pharmacological therapy (C) help to improve diabetic control and pregnancy outcomes (O)? Methods Various academic databases were used in the retrieval of literature to be used in the paper. A comprehensive literature search was conducted through online biomedical databases, as well as specific literature resources. These databases included ProQuest, EBSOhost, Ovid, JSTOR, and MEDLINE/PubMed, which are search platforms recommended for systematic literature reviews in the healthcare professions by the United States National Library of Medicine (NLM). These large databases when combined with a general Internet search using Google Scholar created the opportunity of maximizing the number of relevant papers found in the search. From the initial search performed using Google Scholar and the other medical-related databases, a comprehensive literature review was done to assess, critically examine, as well as synthesize the information that was obtained from these platforms. Instead of an Internet-wide search though, these databases came in handy when narrowing the search to specific articles on GDM. The systematic review carried out in this paper entailed a search strategy to assess and find articles for inclusion and eligibility through the application of various filters and keywords. The search was based on several key terms that included gestational diabetes mellitus, pharmacological therapy, exercise, balanced diet, and lifestyle modification. Several combinations of these key words were used to find the relevant sources in answering or addressing the research question. With the appearance of many articles after a preliminary search, only the scholarly and peer-reviewed papers on these topics were chosen. Another important filter when searching for articles entailed a strict definition of the time frame for narrowing in on the most relevant publications to be used. In most academic writing and for professionalism purposes, the literature sought after is usually that which falls within five years of the current date. Therefore, the publications used in this case had to be those between 2013 and 2018. Results The articles included in this paper were mostly original research studies conducted using randomized clinical control tests or trials for empirical data and quantitative analysis. The articles used can be described as formulating evidence-based recommendations when it comes to lifestyle modification as a way of controlling GDM. Therefore, the empirical nature of the studies shows that logical conclusions could be drawn from the results obtained when conducting the randomized control trials. The PICO question identified the pregnant women as the population being studied with the themes of obesity and being overweight featuring prominently in the literature. These themes are considered as significant risk factors for the development of GDM. The theme of pharmacological therapy also features a lot with insulin-related treatment being considered in how it compares to the proposed intervention, which is lifestyle modification. According to the literature, lifestyle modification mostly features exercise and dietary considerations. Improved health outcomes are captured in the preventive theme that is abundant in the literature, even as most studies performed randomized clinical trials. The underlying assertion or prevalent theme from responding to the PICO question is that of prevention being better than cure. GDM is a special type of DM that has been receiving increased attention among clinicians due to its dire consequences for mothers and babies. Different therapies, pharmacological (insulin) and non-pharmacological (nutrition/diet and exercise) are necessary in the treatment and management of patients with GDM (Wang et al., 2017). Pharmacological therapies are instituted once the patient has presented with symptoms of DM when pregnant. Non-pharmacological therapies can be adopted even before diagnosis with the disease. Therefore, the non-pharmacological therapies compare favorably to their pharmacologic counterparts since they offer more preventive care that has better or improved overall health outcomes. GDM is a medical condition that is frequently witnessed during pregnancy and often described as the intolerance to glucose upon conception (Benhalima et al., 2015). Since physical exercise is an excellent way of controlling weight and staying healthy, healthcare professionals are increasingly recommending this for GDM prevention and management (Kgosidialwa et al., 2015). Eating a balanced diet at the correct time is also helpful in the attainment of glycemic control while reducing treatment costs by eliminating the need for insulin (Kanani Leuva, 2017). At the moment, the initial treatment for GDM is medical nutrition therapy with more randomized controlled trials needed for the comparison of various dietary strategies (Moreno-Castilla et al., 2013). Regular exercise also potentially lowers the risk of developing GDM and can be employed during pregnancy (Moreno-Castilla et al., 2013).

Does Othello Meet The Standards Of A Tragic Hero

Aaron Anderson Instructor Jason Hancock World Literature I 5 May 2015 Does Othello Meet the Standards of a Tragic Hero? William Shakespeare is considered one of the greatest play writers who ever lived. Students throughout the United States continue to read his sonnets and plays today. His style of writing and his use of metaphors are what truly make him a great writer. Shakespeare wrote many comedies such as A Midsummer Night’s Dream, Much Ado about Nothing, and The Taming of the Shrew. Shakespeare also wrote many tragedies such as Macbeth, Hamlet, and Romeo and Juliet. Many of Shakespeare’s tragedies contain a protagonist who is also a tragic hero. In order to determine whether or not a character is a tragic hero, one must find out what the qualities of a tragic hero are. According to Pepperdine University, a tragic hero must have noble stature, a tragic flaw, and free choice. The tragic hero must also suffer punishment he did not deserve, and have increased awareness (â€Å"The Characteristics of an Archetypal Tragic Hero†). Oth ello meets all of the qualifications in order to be a tragic hero. He had noble stature, a tragic flaw, and he had free choice. His punishment exceeded the crime, and his awareness increased before he had his downfall. Othello as well as other tragic heroes had a prestigious position. It is highly important for the character to have a great position to fall from to be a tragic hero, and his downfall must affect everyone in society as well (â€Å"TheShow MoreRelatedOthello: The Tragedy of an Aristotelian Tragic Hero Essay1531 Words   |  7 PagesShakespeares play, â€Å"Othello, the Moor of Venice,† is a powerful example of a tragedy and it’s main character, Othello, is an excellent illustration of what Aristotle constitutes as a tragic hero. The play imitates life through basic human emotions such as jealousy and rage. In addition, Othello is far from being a perfect character - another quality that meets Aristotles requirements. Othello also matches Aristotles idea s of tragic hero because our Othello realizes the error of his ways, causingRead MoreOthello : An Aristotelian Tragedy And Tragic Hero1604 Words   |  7 PagesOthello, an Aristotelian Tragedy and Tragic Hero When reading a story, specifically a tragedy, what stands out? Tragedy often enables its audience to reflect on personal values that might be in conflict with civil ideas, on the claims of minorities that it neglected or excluded from public life, on its on irrational prejudices toward the foreign of the unknown (Kennedy Gioia, 2103, p. 857). Readers feel sympathy for the characters, especially the tragic hero. Othello, the Moor of Venice isRead More Comparing Heroes and Villains in Measure for Measure, Othello, and Hamlet2339 Words   |  10 PagesComparing Heroes and Villains in Measure for Measure, Othello, and Hamlet According to John Steinbeck, Heroes are innocent; villains are cunning. This statement likely regards the internal aspects of characters, such as intellect, reasoning/motivation, and morality/responsibility, as indicated by consistency in action and/or articulation, as in direct speech or soliloquy. An examination of the heroes and villains in Measure for Measure, Othello, and Hamlet can determine whether Steinbecks generalizationRead MoreMacbeth as a Tragic Hero in Willian Shakespeares Macbeth2662 Words   |  11 PagesMacbeth as a Tragic Hero in Willian Shakespeares Macbeth Two and a half thousand years ago, Aristotle defined a tragedy as an imitation of an action that is serious, complete and of a certain magnitude. 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I shall argueRead MoreFemale Characters in Hamlet4091 Words   |  17 Pagesprotagonists. But to say that Shakespeare’s female characters are shallow, undeveloped and used just as a decoration on the stage is very wrong. Women in Shakespeare’s tragedies have no leading role and they are, to paraphrase Northrop Frye,[1] not tragic heroines, but heroines in a tragedy. All female characters in Shakespeare’s tragedies have one thing in common – they end up dead. It is always an untimely, unnatural death. This rule (rather than coincidence) is a theme of many debates among philologistsRead More Shakespeare in Contemporary Movies Essay4875 Words   |  20 Pagestries to calm his friend down by pointing out that everyone, even a scholar, is entitled to an opinion about Shakespeare and that is the point of the film, to collect all opinions. In response, the director, intensely frustrated, explodes, but why does he get to speak directly to the camera!? If Shakespeare has become a secular bible for contemporary America, then the scholars, at Harvard, Columbia, or anywhere else, are the priests who interpret the holy writ for the uneducated masses.Read MoreLangston Hughes Research Paper25309 Words   |  102 Pageshim royalty money for The Weary Blues, which was now being published. Jobless and uncertain about his future, Langston lounged around the apartment. His mother nagged him and refused to feed him if he did not work. She depended upon his paycheck to meet their expenses. Crisis magazine sponsored a literary contest with a $300 prize, donated by Amy Spingarn, whose husband, Joel Spingarn, was an educator, literary critic, and a NAACP official. Hughes won $40 for second and third place, while Countee

Aging- Living Organisms - 1908 Words

Aging is a fundamental truth and an inevitable aspect of every living organism in the world. There are more than four hundred theories on ‘how’ and ‘why’ we age. None of them stands out as a single winner in explaining everything about ‘aging’ but in fact, they are all interconnected and together they explain the possible process of aging. This assignment attempts to explore the research based avenues which could possibly help Mickey live significantly longer than Minnie, based on the assumption that Mickey and Minnie inherit the same genetic programme but follow different life styles. Different authors and researchers define aging differently. Aging has been defined by Balducci(2007) as a loss of â€Å"entropy and fractality.† Loss of entropy implies a progressive reduction in an individual’s functional reserve, whereas loss of fractality implies a progressive reduction in the ability to coordinate different activity and negotiate the environment†. 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Aging is process that begins the day that we are born and only ends on the day that die (Woodrow, 2002). It involves gradual physical and psychological changes to the human body and mind, in addition to societal changes. Throughout one’s lifespan, adaptation plays a pivotal role in aging, as many are challenged with limitations throughout. In society today, it is common to hear people say that they want to age Read MoreImmunological Theory of Aging Essay748 Words   |  3 Pageshinder their short lives, especially those to evade the aging process. With society becoming increasingly interested in everlasting beauty and living longer, the race to discover the main contributor toward aging begun in the early nineteen hundreds. In the midst of this quest, several biological theories had been developed. Among these theories is the immunity or immunological theory. This paper will discuss the immunological theory of aging by explaining the theory, giving a history of its originRead More Gaining Control of the Gene Responsible for Apoptosis Essay examples1141 Words   |  5 PagesGaining Control of the Gene Responsible for Apoptosis When we gain control of the gene responsible for the phenomenon of apoptosis, we will be in control of aging. We are finding more evidence every day, indicating genetic links to all sorts of factors in the human being. We are just now beginning to scratch the surface of our own genetics. A landmark discover has just been unveiled: In February [2001], the two groups charting the human genome published their results—the entire 3 billionRead MoreLouis Pasteur Essay1279 Words   |  6 Pagesthe plane of polarized light; with the information from his studies, he became convinced him that asymmetry was one of the fundamental characteristics of living matter, a vastly important contribution to the field of science in general. 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GMO’s (Genetically Modified Organisms) are being created in order to help make these companies do that exact, along with a few other things. GMO’s are plants or animals that have undergone a process wherein scientists alter their genes with DNA from different species of livin g organisms, bacteria, or viruses to get desired traits such as resistance to disease or tolerance of pesticides. Although genetically modified organisms produce greater yields of what is needed/wanted, itRead MoreThe Problems of Aging on Elderly1197 Words   |  5 Pagesbeings ageing refers to physical and mental changes with respect to time. As the time passes a person grows old and his physical body becomes weak but his mentality has increased due to experiences.In scientific language senescenceis the term used for aging process. It is measured by the person’s date of birth which comes once in a year. The process of ageing is so interesting because it starts by your birth when you open your eyes for the first time in this world and then stops by your death. AgeingRead MoreGenetic Engineering : Medical Perfection Or Playing God1280 Words   |  6 PagesThesis Statement â€Å"Genetic engineering differs from cloning in key ways. Whereas cloning produces genetically exact copies of organisms, genetic engineering refers to processes in which scientists manipulate genes to create purposefully different versions of organisms—and, in some cases, entirely new living things†, duplication of genetic cells is known as human cloning. Development of genetic engineering biotechnologies undermines the natural autonomy of life. Does genetic engineering interfere

Wk6AssgnNixL - 1398 Words

Latin American Subtraction Algorithm Lisa Nix Walden University Dr. Mary Robinson, Instructor MATH-6562G-1, Base Ten Number System Operation: Addition/Subtraction October 21, 2013 Latin American Subtraction Algorithm The Latin American subtraction algorithm is based on the fact that the difference between the two numbers does not change while adding the same amount to the minuend and subtrahend (Indiana University Southeast, n.d.). This algorithm appears to be one that requires precision to detail as it is different from the traditional subtraction algorithm the majority of students have been taught. Regardless of teacher preference, providing students with various strategies allows them to experience the diversity in problem†¦show more content†¦A: Exemplary Work A = 4.00; A- = 3.75 All of the previous, in addition to the following: B: Graduate Level Work B+ = 3.50; B = 3.00; B- = 2.75 All of the previous, in addition to the following: C: Minimal Work C+ = 2.50; C = 2.00; C- = 1.75 F: Work Submitted but Unacceptable F = 1.00 Adherence to Assignment Expectations The extent to which work meets the assigned criteria. Assignment exceeds expectations, integrating additional material and/or information. Assignment

Lies the Media Tells Us Chapter 3 Big Pharma Free Essays

Going to the doctor’s office is never a fun experience. Probing, poking, and trying to decipher what the doc writes on your prescription can be confusing, however, the most upsetting part is what goes on behind closed doors. Big Pharma, chapter 3 of Lies the Media Tells Us, explains the PR tactics of drug companies. We will write a custom essay sample on Lies the Media Tells Us Chapter 3 Big Pharma or any similar topic only for you Order Now James Winter explains these tactics used to persuade doctors to use their brand. In some cases these doctors can get free vacations, cars, front row seating for a basketball game, and a stack of cash. The doctors that respond to these tactics are completely unethical. Doctors have the responsibility to prescribe the best drugs for their patients. Although many Doctors pick what gives the best gift package. Doctors have also been known to push drugs onto patients that may not really need it. This is due to the continual widening of guidelines. This widening is increasing proportions of the population so there are more candidates that fit into the category. This is when a condition gets called a disease. The best case scenario of this is Viagra. Viagra is for male sexual deficiency that has been shoved down America’s throat. There were many discrete commercials about it during day time air and more explicit commercials at night. There were also several celebrity endorsements, Hugh Hefner was glorified for being a user. What drug companies aim for are life-long medication users. These candidates are a gold mine for companies because they have created a dependency for the drug. Another highly publicized â€Å"disease† is high cholesterol. The Pfizer drug company has pushed their cholesterol pills for a decade now and all the marketing has worked. However, what they don’t tell you is that these pills run the risk of having more side effects than lowering cholesterol. By law these commercials need to state the side effects but when your being prescribed most doctors don’t dwell on these facts. This is wrong when there are better natural forms available. Although Doctors rarely discuss this with patients because these natural forms are very cheap or in some cases completely free. A healthy diet, naps, and some exercise are all examples of ways to lower cholesterol without taking prescribed pills. The push to take pills to help medical problems has completely consumed our country. In my opinion I feel that this correlates with the rise of plastic surgery. The easy way out is very popular among all ages because the time and effort that exercise or healthy diets needs is not necessary when pills and plastic surgery are in reach. These pharmaceutical companies adore patients that take their medicine and don’t ask questions. But what happens to the people that do? Not all doctors are shady and unethical. Nancy Olivieri and Dr. David Healy are true whistleblowers. Both have tried to get the medias attention to worn the public about unsafe drugs. Unfortunately, their good deed put them through heavy backlash and court cases. Olivieri and Healy saw their colleagues turn their backs on them and were fired. This is a tough price to pay when they were trying to do the right thing. Pharmaceutical companies can get away with all of this because they have the money. They pay off whistleblowers, they perform under the table deals with doctors, have multi-million dollar campaign ads for their drugs, and have celebrity endorsers. Although these tactics are very unethical there is one more that upset me the most. This is ghostwriting. Ghostwriting is a doctor that works for the drug company and writes an article for a drug that gets published in a medical journal. Lots of doctors write for medical journals but what separates them is their lack of honesty. These ghostwriters don’t say their affiliated with the pharmaceutical and praise the drug that the company wants to endorse. When these companies get articles published about their drug its free advertising. So when other doctors read the article their actually looking at an advertisement but they don’t know it. These medical journals are supposed to be unbiased and legitimate. This is undermining why these medical journals are published and taken so seriously. In my opinion this is the worst thing a pharmaceutical company can do. PR is a huge branch within the pharmaceutical company and they all have about the same strategies when a drug scandal breaks. I feel that this is crucial to why these companies have gotten away with so much. Their first tactic is denial. Like a child they deny everything and have accused the media of sensationalism and attack their accuracy of reporting. If the scandal doesn’t dissipate after they have three different options. First they could shutdown, this consists of claiming their is a conspiracy. Second option is an extrication which is hiring high priced lawyers to find an escape route or third which is purging. Purging is very interesting because they basically pick an employee in their own company, pay them to take the rap, and then tell everyone it was the employees fault. Most of the time they try to get someone that is going to retire; I guess everyone has a price. The last option of the pharm co. is the most used. This is the compensation tactic. The drug company offers the plaintiff a large settlement as long as the plaintiff agrees there was no malpractice. This corrupt business isn’t that big of a shock. Where ever their is a lot of money there is usually some unethical practices. However, I feel that their money has way too much control. Their funds are practically endless and they will come up with any lie to make more money. After reading this chapter I thought about Obama’s healthcare reform. I think the reason why their is so much backlash is because the pharmaceutical companies are scared about the future and if they will be able to keep these shenanigans going. I like the idea of Obama’s healthcare but I know that these companies will weasel their unethical views into it. Honestly, I don’t think there is anyway to stop this unless everyone working for these companies is fired and it is started back up from scratch. How to cite Lies the Media Tells Us Chapter 3 Big Pharma, Papers

Supporting social and emotional development and providing positive guidance free essay sample

Self: My goal is to create a warm, positive, supportive relationship with children. I observed that positive, supportive environment would build confidence in children when my son was in pre k, I did volunteer work in his class, and I perceive that building warm, supportive, and positive relationship with children is important to build a positive self-concept, self-respect, and confidence in the children. I enjoy creating a family tree with children. I will create an environment that children sense their self-respect is valued and I will create space for each child in class like label their name on cubbies and photos, their works displayed at their eye level. According to children’s need, I will provide developmentally appropriate materials, and ensure that modified as needed, also special needs. I will show sensitivity towards children’s concerns and feelings. Also, I will express kindness and support for children when theyre having trouble. We will write a custom essay sample on Supporting social and emotional development and providing positive guidance or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I will encourage children’s to improve self-help, self-regulation skills and I will use books, resources, strategies, and curriculum that explain children to believe in themselves is important to succeed in the future.Social: My goal is to create a social environment that motivates children to come together and communicate with buddies. I will encourage the social development of children, and I believe that group activities support children’s social skills. I love to create art activity for children to cooperate with friends. I will commit to school and families to create an environment that will improve children’s social skills. To achieve this goal, I will plan a curriculum that supports children to interact and communicate with friends, like group play, center activity, cultural group, art, games, small group and a large group that they can enjoy mutual hobbies. I will use resources, stories, and books that support children’s social development, and I will ensure that children understand each others feeling and they respect their friends emotions. I will encourage them to develop pro-social skills such as helping, sharing. According to Lev Vygotsky theory, social interaction play develops cognition in the children, and I agree with his theory.Guidance: My goal is to create an environment that will encourage positive behavior toward the children and family. I believe that a well-organized environment that will support children’s undisciplined behavior to manage. I like to create positive guidance rules with children for the classroom that will be more effective and powerful interactions for t hem. I will encourage children’s to keep self-regulation and kind behavior with their friends, and I will create group play that will develop pro-social skills in the children. I will commit to school and families to that I will create an environment that will support to resolve the problem with the challenging behavior of the children. I will use techniques like self-control, speaking softly and privately that will help to handle negative behaviors in the children. I will provide materials that will help children to release negative feelings

Advancement Medical Healthcare Organization-Myassignmenthelp.Com

Question: Discuss About The Advancement Medical Healthcare Organization? Answer: Introduction: With the recent advancement of medical field and healthcare organization, they are able to successfully handle patients with a large number of chronic diseases altogether. The mean age of expectancy for individuals has increased. Healthcare professionals have become competent enough to handle many such cases with high expertise and their contribution has helped in increase in number of population of old age cohort. Maintaining such complex patients with huge number of chronic morbidities have brought happiness in families and helped them to live longer (Brownie, Scott Rossiter, 2016). The following report will mainly look over the interrelationship of complexity, chronicity and co-morbidity in healthcare. It will also help to untie a case study sequentially giving insights about how nursing professionals can use their critical thinking power to handle such cases effectively. Interrelationship of complexity, chronicity and co-morbidity in healthcare: A recent trend has been captured by researchers over time which has a magnanimous effect on the resources of not only healthcare centers but also on the lives of patients as well as their family members. Mostly in the high income countries, it is found that the population mortality curve has become somewhat rectangular suffering that the mean age death of the individuals has progressively extended towards much older age in comparison to previous years (Grembowski et al., 2014). However, the increase in longevity is has not been associated with reduction in morbidity of the patients. As more number of individuals is living for a much larger period of time than their predecessors, therefore they are being affected by more disorders. This trend is seen being associated with a growth in individuals living in with multiple concurrent chronic conditions called multi-morbidities or co-morbidities (Katjol et al., 2016). Most primary as well as secondary healthcare centers are facing increasi ng number of old aged patients with a number of chronic morbidities. This gives an overall concept of the complexity of the patients condition due to the presence of large number of chronic ailments in the form of co morbid symptoms. The most important factor that is supporting the patients to live longer lives are the growth of clinical practice guidelines under the influence of evidence based medicines and concerns for knowledge translation. They have helped many old patients to survive for long even in complex conditions with their chronic co morbid diseases but this had created a huge pressure on the resources of the healthcare centers as well as the family members increasing heir burden and poor quality lives. It is advised by researchers that healthcare industry should develop requisite management tools and care approaches which would help in providing appropriate care for all complex patients (Aquitrre et al., 2017). Therefore it can be seen that complexity, chronicity and co morbidity are interlinked and the concept should be clear to all healthcare professionals so that they can rightly handle the upcoming challenges in healthcares. Pathophysiology of COPD and its association with cigarette smoking both in active and passive mode: COPD is characterized by three important occurrences which affect the health of the patient. They are airway inflammation, mucocilliary dysfunction as well as consequent airway structural changes. The first occurrence which is the airway inflammation is mainly caused by the chronic inflammation of airways, pulmonary blood vessels as well as lung tissues mainly as the results of the exposure of the airway to different inhaled irritant such as tobacco smoke. The inhaled irritants cause inflammatory cells like that of the neutrophils, CD8+T-lymphocytes, B cells and macrophages to come together and accumulate. These cells eventually become activated that helps in the initiation of the inflammatory cascade. This in turn results in the release of various types of inflammatory mediators like as tumor necrosis factor alpha (TNF-), interferongamma (IFN-), matrix-metalloproteinases (MMP-6, MMP-9), C-reactive protein (CRP), interleukins (IL-1, IL-6, IL-8) and fibrinogen (Celi, 2014). They cause sustenance of the inflammatory process which ultimately leads to the damage of various tissues as well as range of different systematic effects. The chronic inflammation also causes outset of the diseases and leads to different types of structural changes in the lungs which causes perpetuation of the airflow limitation. The second factor is the structural changes. Due to airway remodeling, inflammatory response remains associated with COPD that leads to narrowing of the airways. Three factors which contribute to this is the peribronchial fibrosis, building up of the scar tissue that result from the damage to the airways and also occurrence of over multiplication of the epithelial cells which line the airways. Symptoms of emphysema may also take place when there is parenchymal dysfunction. This is associated with the loss of lung tissue elasticity which results due to destruction of the structures that support and fed the alveoli (Adnot, 2014). The small airways collapse during exha lation resulting in impeding airflow, trapping air in the lungs and reducing the lung capacity. The third factor is the mucociliary dysfunction. Smoking and inflammation result in the enlargement of the mucous glands that line the walls of the airway. This causes the goblet cells metaplasia which in turn causes the healthy cells of the lungs to be replaced by mucus secreting cells. The mucocilairy system which is responsible for clearing mucus form the airways also gets damaged dye to the inflammations. Therefore excess mucus is formed in the airways that eventually accumulate that blocks the airways and worsen the airflow (Milne King, 2014). The above mentioned pathophysiology can be linked with the patients condition. She was herself a smoker which had already affected the condition of the lungs. Though she had quitted the smoking habit, she is still projected to danger as her husband is a smoker and she is vulnerable to passive smoking. The tiny particles of the smoke enter into her lungs each time she inhales the smoke, the bronchial tubes get swollen and inflamed. Lining of the airways produces larger amount of mucus which traps the irritants. The combined effect of these makes the airways thickened in the patient as well as narrowed because of swelling and mucus. This cause reduction in the amount of airflow and increased mucus results in persistent cough. In these ways, she has become a COPD patient. Pathophysiology of the osteoarthritis and rationale behind the patients present condition: Osteoarthritis mainly takes place due to the malfunction of the chondrocyte. Due to this reason the structure of the cartilage changes. The production of the large protein which usually helps in the retainment of water within the cartilage gets reduced. As a result of these, the cartilage gradually becomes dehydrated overtime and therefore becomes more brittle (Arden et al., 2014). Therefore when a load is applied on them, the structure is more likely to fail and as a result of which cracks begin to occur. This cracking in the cartilage is termed as fissuring. In course of time as more cracks begin to develop, piece of cartilage begins to flake away and no new cartilage is produced in the gaps (Mobasheri Batt, 2016). In course of time, no cartilage remains left that would cover the bone. Hence, any movement of the joints requires the bone to move directly against the bones. Therefore it causes successive pain the individuals (Olivotto et al., 2015). The patient of the case study had a strenuous livelihood of a cleaner and mechanical tear and wear over the years had resulted in her to develop symptoms of arthritis. Symptoms that the nurse should take in consideration before designing her care plan: The patient who has come for consultation to the clinic has disorders like COPD and arthritis like symptoms. With the gradual advancement of age, she is noticing gradual loss of mobility and increased issues with her breathing even when she is conducting minor works and walking small distances. This is disrupting her caring for her grandchildren. The nurse found that her body weight has increased from 64 Kg to that of 72 Kg in the last 3 months. She is also having pain and discomfort arising from her spine. Hence the patient is having a set of complex symptoms which the nurse to critically analyze properly so that she can develop an intervention plan which will help he patient to handle all her symptoms effectively and help her enjoy a better quality life. Interaction between hypertension, COPD and arthritis: As the patient is suffering from COPD, the amount of oxygen that is going to the blood gets reduced. This results in the production of high blood pressure in the blood vessels form the heart to that to the lungs. This makes it even more difficult for the heart as it cannot pump much needed blood to the rest of the body. Moreover this disorder of the lungs also cause body to produce more red blood cells thereby making the blood thicker and it becomes difficult for the heart to pump (Kirby Coxson, 2015). Therefore a person having both COPD and hypertension has to breathe faster in order to take in more oxygen. When a person suffers from such a situation, the doctor usually prescribed a proper lifestyle and correct medications which help to keep any harmful effects in heck and the patient can thereby lead proper quality life (Petersen et al., 2014). Another link up that may be found is that between osteoarthritis as well as high blood pressure. This has been stated by many researchers that a person suffering form osteoarthritis often suffer form joint pain as well a stress which in turn results in the rise of the blood pressure. Anxiety that a person usually develops due to lack of independence and fears about debility may also result the pressure to rise. Often worries about finances of management, rehabilitation and becoming incapacitated result in contribution to blood pressure elevation. Use of non steroidal anti-inflammatory medications also result in the development of high blood pressure in osteoarthritis patients but this cannot be the case as she uses only paracetamol to cure from the pain. The nurse should also be sure not to provide any NSAIDS as they may increase the blood pressure of the patient (Crofford et al., 2013). The patient is also seen to develop have gained weight and this would have a very harmful impact on the health of the patients. A greater body weight will put in more pressure and load on the bones which will affect the patients and her mobility will decrease over time due to the excessive pain that occur due to heavy weight on such bones. Medications provided to the patient and rationale behind it: Symbicort which is prescribed to the patient due to his COPD is formed form the combination of the budesonide as well as formoterol. The former one is the steroids which helps in the reduction o the inflammation that occurs in any part do the body and formoterol is a bronchodilator which helps in the relaxation of the muscles in the airways that helps in improvement in breathing. Therefore this medication is a right type of drug prescribed to the patient (Bagherisadhegi, Lahrnib Chrystyn. 2015). Spiriva contains tiotropium which is very much helpful to prevent symptoms like wheezing, shortness of breath and others which patients with COPD often face. This medication mainly works by relaxing the muscles around the airways s that they can easily open up and the patient can breathe more easily. Salbutamol is the medication which is often used as inhalers by patients. They work by acting on the receptors present in the beta 2 receptors. This medication actually helps in the stimulation of the receptors which in turn causes the muscles in the airways to relax. This allows the airways to open and help the patient in easy breathing (Ballantine, 2017). Paracetamol is prescribed to the patients for mild to moderate pain in muscular spasms as well. For inflammatory arthritis often nurses prescribe the use of paracetamol with non steroidal anti inflammatory drug. However, the nurse should be very careful as this is a complex case and the patient already has hypertension. It is suggested by the researchers that NSAIDS often increase the blood pressure and therefore if do happens in the patients, she might face threats to her life. Hence she would be very careful in providing medication to the patient for arthritis. Perindropil is along acting angiotensin converting enzyme inhibitor which is prescribed by doctors to treat high blood pressure, heart failure as well as stable coronary artery diseases in form of perindopril arginine. In case of this patient, it would be helpful in controlling his high blood pressure by relaxing the blood vessel and helping in easy and smooth passage of blood (Sirenko et al., 2016). Nurses intervention: Besides this medication, the nurse should also introduce proper lifestyle management plans for her along with proper diet system is that she can effectively mange her weight. As she is osteo-arthritis, she would be given some freehand exercises and would also be asked to consult with physiotherapist for best effects. Proper medication should be followed in order to tackle the symptoms of COPD and arthritis and hypertension. The management of such complete situation of the patient will result in outflow of finances which would provide a hard time on her family. As her daughters would be working, the entire care giving responsibility would be on her husband who is also aged and might get stressed when providing care to such complex patients. Therefore, a strenuous situation may arise but proper planning with the members of the family and correct healthcare education will benefit the patient and also all the members successfully. Conclusion: The nurses of this age are educated with the most modern form of nursing that uses evidence based studies as their mode of development of skills. These had helped them to understand the interrelationship of the different chronic illness faced by the patients. They try to find the link by properly understanding their pathophysiology and then link them with the patients condition. They then try to provide medication and interventions which will help patients to overcome their symptoms. At the same time, they also need to be careful that the medication do not cause drug drug interaction which affects the patients negatively. Hence, student nurses should develop themselves according to this trend so that they can practice their profession with skill and knowledge. References: Adnot, S. 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