ENG 11 UCF Franz Kafka The Metamorphosis Annotated Bibliography Humanities Assignment Help

ENG 11 UCF Franz Kafka The Metamorphosis Annotated Bibliography Humanities Assignment Help. ENG 11 UCF Franz Kafka The Metamorphosis Annotated Bibliography Humanities Assignment Help.


(/0x4*br />

The Annotated Bibliography is the first step in your literary research paper. In order to complete the research paper, you must be sure that you can find an adequate number of scholarly sources to support your claims.

In this assignment, you will present your research sources along with annotations to explain their relevance to your project.

The topic and thesis of your project should be listed at the top of the assignment. You can choose from any of the selections in the Topics for Long Papers category presented in your text on pages 1195-1200.

Then, find at least six scholarly sources that you plan to use as evidence to support your research. Primary sources (the literary texts themselves) should also be listed in your final works cited page and may be listed here, but they do not count toward your total of six critical sources.

Here are two resources for formatting your annotated bibliography that should be helpful:

https://owl.english.purdue.edu/owl/resource/614/02…

http://writingcenter.unc.edu/handouts/annotated-bi…

Here is a resource on writing a literary paper that may be helpful:

https://owl.english.purdue.edu/owl/resource/618/02…

Here is a resource for evaluating sources that should be useful:

http://www.csuchico.edu/lins/handouts/eval_website…

Utilize these resources along with the Troy Library to complete your annotated bibliography. This is a critical step in preparing your final research paper.

ENG 11 UCF Franz Kafka The Metamorphosis Annotated Bibliography Humanities Assignment Help[supanova_question]

PAD 4822 University of Central Florida New York Municipality Discussion Humanities Assignment Help

Choose one local government (municipal, county, school, or special district) to profile for this week’s discussion assignment. Provide the following information in your discussion post:

  1. What local government you choose to profile
  2. A link to their website
  3. A little background on the services or programs they provide (2-3 sentences)
  4. Description of at least one intergovernmental issue they face. This can relate to relationships with the state or Federal Government, or other similar governments (e.g. county-county). (3-4 sentences)

Last, comment on at least ONE classmate’s post with any additional challenges you think that area may face. For example, you may profile the City of Orlando, but you comment on a classmate’s post on Orange County. Your comment should address an additional intergovernmental challenge Orange County may face that your classmate did not mention.

[supanova_question]

Florida State College The Transportation Industry During COVID 19 Essay Writing Assignment Help

Use the Internet to find a current news article that relates to freight transportation and the supply chain. The article should have some content that speaks to freight transportation and import/export activities. Start by looking in sources that are dedicated to the transportation industry, such as trade journals and industry-specific news sources. You will submit a 1-2 page summary (not including the title page and reference page). describing the content of the article, and the specific contribution the article has in regards to the topic.

This article must be from a source inside the United States, it can not be an overseas article. The essay must be written in APA style format. The assignment must be completed by 7/18/2020 11:59 PM EST. The subject must be in the Transportation and Supply Chain Industry.

[supanova_question]

Harvard University Black College Athlete Personal Experience Reflection Business Finance Assignment Help

YOU ARE WRITING FOR a BLACK College Athlete. REFLECT ON HOW THE THEORY WOULD APPLY TO MY LIFE OF A BLACK COLLEGE ATHLETE

YOU CAN USE THE “TRY BEING A BETTER LISTENER” THEORY (POWER POINT WILL BE BELOW) OR THE “BREAKING A RULE” THEORY (READING WILL BE BELOW)

This is a class about communication; this is a communication assignment. By far the most open-ended of all the Friday assignments, this is also possibly the most difficult. Go do communication and tell me about why it’s communication. In other words, go live your life in such a way that you are actively applying course concepts to your everyday life in a consequential fashion. Then, reflect on that experience. This reflection should not only be an application of the course concept (though it should be that). Through applying a concept to your own life, your life will then “talk back” to that concept or theory. In other words: you are “testing” the theory with your personal experience. Likely the theory will provide a starting point, but your experience will be messier somehow. Reflect on why that is and what it teaches you about the theory you chose.

HOW TO DO IT:

  • Make sure you’re doing something. Apply communication theory to your life
  • You can use any theory/concept from class so far (not limited to Week 4:
    • Try being a better listener
    • Try breaking a “rule” (see rule-breaking reading for tomorrow)
    • Try acting differently in a CMM-type conversation
  • Recommend: read through the theory/concept you want to apply before you do it
  • The write up:
    • Summarize what you did
    • Explain what that teaches you about the theory
    • “Extend” the theory

Some examples:

  • You learn about social construction (theory/concept) and the ways your language creates/maintains/can destroy the social world around you. Use that theory in a way that creates, maintains, or destroys a social world you are participating in.
  • You learn about the importance of communication in close relationships (week 3: ch. 10 has many concepts and theories to choose from) and you apply some of the concepts to a relationship that matters to you.
  • You learn about organizational rules and rule-breaking and apply expectancy violations theory (concept/theory) to a rule that you find annoying.

After doing communication/applying the theory to real actions in your life, write a two-page (double-spaced) reflection on what you did and why you think that was a useful application of the theoretical concept you chose from class. Dig in and expand in order to explain why this action was important or consequential in some way. The best reflections (the ones that will earn A’s, see ‘oh dang’ factor) will include a brief discussion of how your experience informs the theory you chose, how the messiness of life teaches you about what the theory lacks or ignores.

Rubric

Personalized the activity and engaged with course material according to the instructions and reflected thoroughly on that activity

/6

Activity chosen and reflection on that activity demonstrates understanding of course concept

/4

Provides unique insight into the theory or concept you chose

Aka the “oh daaaaang” factor

/3

Submits a clean paper that covers all requirements (grammar, word count, etc.)

/2

[supanova_question]

HC 450 Herzing University Week 2 New Decision Support System Discussion Health Medical Assignment Help

Unit 2 Discussion

1717 unread replies.1717 replies.

Discussion: Unit 2, Due Wednesday by 11:59 pm CT

Instructions

  • This week’s review involves the use and development of decision support systems. If you were the HIM manager of an acute care facility, how would you approach a project in developing a new decision support system to support a quality improvement initiative? What types of activities and tools would you use a guide to explore and select the new system?

Please be sure to validate your opinions and ideas with citations and references in APA format.

The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.

Peer Response: Unit 2, Due Sunday by 11:59 pm CT

Instructions

  • Always construct your response in a word processing program like Word. Check for grammar, spelling, and mechanical errors. Make the corrections and save the file to your computer.
  • Find the post that you are going to reply to.
  • Submit your peer response.

Please be sure to validate your opinions and ideas with citations and references in APA format.

[supanova_question]

[supanova_question]

NSG 426 UOPX Integrity in Practice Ethic & Legal Considerations Essay Writing Assignment Help

Assignment Title: Legal Issues Facing Nurses

Research common legal issues in health care or choose one of the legal case studies from the Nurses Service Organization.

Select a legal case study of interest or area in which you have experience.

Analyze the legal case study. Ensure you include the following:

  • Summarize the legal issues present in the case.
  • Brainstorm risk-mitigation techniques that the hospital could have employed to prevent the situation.
  • Determine actions the nurse could have taken to improve the outcome.

Cite at least 3 evidence-based, peer-reviewed sources published within the last 5 years to support your positions.

Include an APA-formatted reference list.

Format your assignment as 875-word paper.

Grading Rubric:

-Summarizes the legal issues present in the case

-Lists risk-mitigation techniques

-Includes potential nurse actions for improving the outcome

-Cites at least 3 evidenced-based, peer-reviewed sources published within the last 5 years

-Assignment is free to grammatical errors, language maintains a scholarly and succinct tone

-Follows a structure that is clear, concise, and appropriate

NSG 426 UOPX Integrity in Practice Ethic & Legal Considerations Essay Writing Assignment Help[supanova_question]

Ashford New Rules on Wellness Programs Spark Privacy Worries Article Discussion Humanities Assignment Help

(Everything must be in own words).

Question 1: Must be 350 words or more

Watch the GEN103 Scholarly & Popular Resources (Links to an external site.) and How to Read a Scholarly Article (Links to an external site.) videos, and review the Source Types handout,

Read this scholarly, peer-reviewed article:

Ajunwa, I., Crawford, K., & Ford, J. S. (2016). Health and big data: An ethical framework for health information collection by corporate wellness programs. Journal of Law, Medicine & Ethics, 44(3), 474–480. https://doi.org/10.1177/1073110516667943

Depending on first letter of your last name, read one of the following:

Reflect: You read two articles that address the same topic but are different types of sources. Consider the following questions:

  • What characteristics make the sources different?
  • How do those differences add to or detract from the credibility of the sources?
  • How could you use each of the sources in school, at work, or in your personal life? Think of at least two specific examples.

Write: Based on your learning in the Prepare and Reflect sections above, write at least three paragraphs that fully address the prompt below. Cite any sources you use or refer to.

  • Identify the type of source you read in addition to the scholarly, peer-reviewed article. Who is the audience for each source? How does the intended audience affect the choice of language, images, and organization?
  • Analyze the credibility of the two sources that you read. What specific features of the articles led you to conclude the source was or was not credible? Provide at least one specific example for each source.
  • Explain how each source might be used to address a specific information need. What research situations would be appropriate for each source? What concerns would you have about using the sources in those situations?

Your initial post must be at least 350 words and address all of the prompt’s elements.

Question 2: Must be 100 words or more

Prepare: Take a few minutes to think about this course and the material covered in the course so far.

Reflect: Reflect on what you found interesting, surprising, or confusing in this past week. What did you learn that caused you to understand an issue differently? What habits, tips, or resources did you discover that helped you to complete your course work more effectively or efficiently? Cite clear examples and details to support your post.

Write: This discussion forum is an opportunity for you to explore topics that interest you, share critical insights and questions that you are working with, share your struggles and triumphs, and discuss difficulties that may have arisen this week, hopefully finding solutions. Your posts should describe your experiences in the course this past week, prompting further discussion. You should address at least one of the following questions:

  • What struck you in particular as you explored the course materials this week?
  • How might you apply this information to your life in the future?
  • What insights have you had?
  • What have you been struggling with?
  • What questions have come up for you at this point?
  • What helpful tips have you picked up in this course or in a past course?
  • What questions do you haveabout the assignment that your classmates might be able to help with? (If you have a question for the instructor, be sure to contact your instructor through email or Canvas messaging).

You are required to post at least 100 total words in this forum this week. You can post one time or ten times; the only requirements are you post at least 100 words total and you engage in conversation related to course. Ask questions, answer questions, provide extra resources you found that are interesting, or engage in a debate about something you learned this week.

Provide a full explanation of the issues you discuss in your posts. For example, if you write that you had difficulty finding sources for your annotated bibliography, explain where in the process you had difficulty. Was it thinking of search terms? Did your search locate too many sources that were not relevant to your topic? Did your search return too few results? Did you have difficulty finding credible sources?

[supanova_question]

Solution Focused Therapy Case Study Analysis Humanities Assignment Help

Read the “Case Study Analysis.”- attached

  • Solution-focused

Write a 1,000-1,500-word analysis of the case study using the theory you chose. Include the following in your analysis.

  • What will be the goals of counseling and what intervention strategies are used to accomplish those goals?
  • Describe
    the process of treatment using this theory. This should include a
    description of the length of treatment, the role of the counselor, and
    the experience of the client as they work from beginning to termination
    of therapy.
  • How does this theory address the social and cultural needs of the client? (Cite specific research findings)
  • Describe
    how your chosen theory supports the use of a constructivist philosophy
    throughout the counseling process. How does a collaborative approach
    change the ability for clients to create and accomplish their goals
    through counseling services?
  • How should a counselor who
    utilizes post-modern / collaborative approaches interact with their
    clients in order to prevent undue harm, risk, or confusion from impeding
    the progress of therapy?

Include at least six scholarly references in your paper.

Each
response to the assignment prompts should be addressed under a separate
heading in your paper. Refer to “APA Headings and Seriation,” located
on the Purdue OWL website for help in formatting the headings.

Prepare this assignment according to the guidelines found in the APA Style Guide,

[supanova_question]

PG Community College Diabetes Mellitus Article Summary Humanities Assignment Help

Diabetes mellitus is a group of physiological dysfunctions characterized by hyperglycemia resulting directly from insulin resistance, inadequate insulin secretion, or excessive glucagon secretion. Type 1 diabetes (T1D) is an autoimmune disorder leading to the destruction of pancreatic beta-cells. Type 2 diabetes (T2D), which is much more common, is primarily a problem of progressively impaired glucose regulation due to a combination of dysfunctional pancreatic beta cells and insulin resistance. The purpose of this article is to review the basic science of type 2 diabetes and its complications, and to discuss the most recent treatment guidelines.
Key Words: Diabetes mellitus, insulin, hyperglycemia, glucose regulation.
Diabetes mellitus is a group of physiological dysfunctions characterized by hyperglycemia resulting directly from insulin resistance, inadequate insulin secretion, or excessive glucagon secretion (Ignatavicius & Workman, 2016; Lewis, Dirksen, Heitkemper, & Butcher, 2014). There are two main types of diabetes. Type 1 diabetes (T1D) is an autoimmune disorder leading to the destruction of pancreatic beta-cells. Type 2 diabetes (T2D), which is much more common, is primarily a problem of progressively impaired glucose regulation due to a combination of dysfunctional pancreatic beta cells and insulin resistance (Ignatavicius & Workman, 2016; Lewis et al., 2014). T2D is specifically defined by the American Diabetes Association (ADA) (2014a) as “a condition characterized by hyperglycemia resulting from the body’s inability to use blood glucose for energy…either the pancreas does not make enough insulin or the body is unable to use insulin correctly.” Currently, there are approximately 26 million people in the United States (U.S.) diagnosed with diabetes and another 79 million people with prediabetes, resulting in nearly one-third of the population being affected by the disease (Ignatavicius & Workman, 2016; Lewis et al., 2014). The purpose of this article is to review the basic science of type 2 diabetes and its complications, and to discuss the most recent treatment guidelines.
Pathophysiology, Etiology, And Manifestations
T2D generally develops in people with known risk factors and genetic predisposition, and may be related to environmental causes, such as viruses (Ignatavicius & Workman, 2016; Lewis et al., 2014; McCance, Huether, Brashers, & Rote, 2014; Seggelke & Everhart, 2012). The major risk factor for T2D is obesity, with abdominal obesity conferring the highest risk. Obesity is often associated with the consumption of high fat/carbohydrate diets and lack of physical activity. Obesity can also lead to insulin resistance. Other predisposing risk factors include low levels of HDL (“good cholesterol”), sedentary lifestyle, and polycystic ovary disease. There is also some data in the literature suggesting that people with depression have higher rates of diabetes and should be screened. A worrisome development is the increase in T2D in children, most likely related to obesity. Age, ethnicity, and heredity are non-modifiable risk factors (Ignatavicius & Workman, 2016; Lewis et al., 2014; McCance et al., 2014; Seggelke & Everhart, 2012).
While the person with T2D may have the classic signs related to hyperglycemia more often seen in T1D (polyuria, polydipsia, and polyphagia), signs and symptoms of T2D are often more vague and may include fatigue, possible weight gain, frequent infections, sores that heal slowly, and frequent vaginal yeast infections in women. Visual changes and alterations in sensation represent later signs and symptoms that occasionally drive people to seek health care (Ignatavicius & Workman, 2016; Lewis et al., 2014; McCance et al., 2014; Seggelke & Everhart, 2012).
Diagnostic Studies
Diagnostic studies for T2D usually include measures of both short-term and long-term glucose levels. Short-term measurements include a fasting blood glucose or a two-hour blood glucose drawn during an oral glucose tolerance test (OGGT). A random blood glucose can be useful in a patient with the classic symptoms of hyperglycemia. Long-term glucose measurement is combined with the hemoglobin A1C. (see Table 1). A diagnostic value obtained via fasting blood glucose, OGGT, or random blood glucose must be confirmed by a second test, preferably with the same test (ADA, 2013 2014b; Ignatavicius & Workman, 2016; Lewis et al., 2014; Pagana & Pagana, 2014).
The hemoglobin A1C measures the amount of glycosylated hemoglobin as a percent of the patient’s total hemoglobin over a period of two to three months, so it is particularly valuable for determining long-term control of disease in individuals with diabetes (Ignatavicius & Workman, 2016; Lewis et al., 2014; Pagana & Pagana, 2014). The hemoglobin A1C is a tiny part of normal hemoglobin. As red blood cells circulate through the body, some of the glucose that is also present in the bloodstream attaches to the A1C portion. The more glucose that is present, the more often this happens. Because the average lifespan of a red blood cell is 90 to 120 days, the measured A1C reflects the amount of glucose in the blood over the last approximately 120 days (ADA, 2014b; Pagana & Pagana, 2014).
Readings are expressed as a percentage. The higher the percent, the higher the glucose level over time. A hemoglobin A1C of 5% means that 5% of the hemoglobin is saturated with glucose. For the person without diabetes, a normal reading is 4% to 5.9%. Good diabetic control is indicat- ed when readings are less than 7%. Fair control is considered to be 8% to 9%, and poor control is anything over 9%. There is a discrepancy between recommended readings by the ADA (good control: A1C less than 7%) and the American College of Endocrinologists (good control less than 6.5%). The reading is not affected by fasting and can be taken at any time (ADA, 2013; Pagana & Pagana, 2014).
For those with known diabetes, other screening and diagnostic testing should be performed. These include annual fundoscopic eye examination, annual urine screen for creatinine (indicative for microalbuminuria and possible kidney involvement), visual examination of the feet at every visit to a health care provider, annual comprehensive foot examination (including microfilament testing for sensation), and at least annual assessments for cardiovascular risks. Routine monitoring can prevent complications related to diabetes or at least catch them in time for early treatment (Ignatavicius & Workman, 2016; Lewis et al., 2014).
Complications
Diabetes complications can be separated into two categories: microvascular and macrovscular (World Health Organization, 2013). Microvascular complications are due to damage of small blood vessels. Macrovascular complications are due to damage to larger blood vessels. Microvascular complications involve damage to the kidneys (nephropathy), leading to renal failure; eyes (retinopathy), leading to blindness; and the nerves (neuropathy), causing impotence and diabetic foot disorders that can result in infections and amputations. Macrovascular complications include cardiovascular diseases, such as strokes, heart attacks, and blood flow insufficiency to the legs. According to the literature, lower limb amputations are approximately 10 times greater in people with diabetes than in individuals without diabetes in developed countries (Ignatavicius & Workman, 2016; Lewis et al., 2014).
There are more macrovascular complications among individuals with diabetes that present at an earlier age (ADA, 2014a, c, 2015a; Ignatavicius & Workman, 2016; Lewis et al., 2014). Controlling blood pressure (target less than 130/80 mmHg) is vital to prevent or slow the onset of these conditions. The ADA recently revised its diastolic blood pressure standard to less than or equal to 90 mmHg. Managing lipid abnormalities is also vital to preventing and/or managing complications. The ADA targets are total cholesterol less than 200 mg/dL, lowdensity lipoproteins (LDL) less than 100 mg/dL, triglycerides less than 150 mg/dL, and high-density lipoproteins (HDL) cholesterol greater than 40 mg/dL in men and 50 mg/dL in women (ADA, 2014a, c, 2015a; Ignatavicius & Workman, 2016; Lewis et al., 2014).
Microvascular complications are unique and common to diabetics (micro = small; seen in the smaller population of diabetics as compared with the larger general [non-diabetic] population). They result from exposure to high glucose that causes thickening of blood vessels. The end-target organs are affected by these complications, which include diabetic retinopathy, neuropathy, and nephropathy. Dermopathies also exist, but typically cause only mild discomfort and cosmetic dysfunction, and are not discussed here (Ignatavicius & Workman, 2016; Lewis et al., 2014).
Visual Complications
Diabetes is the leading cause of blindness in adults (Ignatavicius, & Workman, 2016; Lewis et al., 2014; Shotliff & Balasanthiran, 2009). The types of retinopathy include nonproliferative (most common) and proliferative. Nonproliferative retinopathy occurs when small blood vessels become partly occluded, leading to microaneurysms and leaking of capillary fluid. Vision is affected if the macula is involved. Proliferative retinopathy occurs when retinal capillaries become occluded and the body forms new capillaries in response. These new vessels are abnormal and fragile, which leads to hemorrhage. The new vessels can pull the retina out of place, leading to tears. Blindness results if the macula is involved. Individuals with diabetes tend to develop glaucoma and cataracts more frequently and at an earlier age than the general population (Ignatavicius, & Workman, 2016; Lewis et al., 2014; Shotliff & Balasanthiran, 2009). Dilated eye examinations are recommended annually to detect these conditions. Prevention is best obtained through tight control of blood glucose and blood pressure. Current treatments include photocoagulation and vitrectomy (Ignatavicius & Workman, 2016; Lewis et al., 2014; Shotliff & Balasanthiran, 2009). In photocoagulation, lasers seal the leaking blood vessels in the eye with heat (“Laser Photocoagulation for Diabetic Retinopathy,” 2015). Vitrectomy removes the vitreous gel from the eye (“Diabetic Retinopathy – Surgery,” 2014).
Diabetic Neuropathy
Diabetic neuropathy affects nearly two-thirds of all individuals with diabetes, and is probably the result of chronic high blood glucose that damages the nerves and blood vessels. Other risk factors include increasing age, obesity, and having concurrent peripheral vascular disease (Benbow, 2012; Sharp & Clark, 2011; Turns, 2011; Woo, Santos, & Gamba, 2013; Ziegler & Fonesca, 2015). Peripheral neuropathy involves altered sensations and ischemia, which usually occurs in the bilateral extremities starting first in the lower extremities and gradually moving upward. Individuals with diabetes can have a total lack of sensation, paresthesias, numbness, and loss of temperature sensation. This leads to complications, such as ulcers, amputations, atrophy of muscles, and loss of fine movements. The most common presentation is the “dia- betic foot,” where an infected ulcer started with an injury the patient was unaware of due to loss of sensation (Benbow, 2012; Turns, 2011; Sharp & Clark, 2011; Woo et al., 2013; Ziegler & Fonesca, 2015).
Prevention is the best method of management; tight glycemic control and daily foot inspections are crucial. Unfortunately, this works best in patients with T1D. The paresthesias can be managed with medications, such as topical creams, tricyclic antidepressants, antiseizure medications, selective serotonin reuptake inhibitors, or selective norepinephrine reuptake inhibitors (Benbow, 2012; Turns, 2011; Sharp & Clark, 2011; Woo et al., 2013; Ziegler & Fonesca, 2015). The FDA has only approved two drugs for the treatment of diabetic neuropathy: pregabalin ([Lyrica®], an anticonvulsant; and duloxetine [Cymbalta®], a serotonin-norepinephrine reuptake inhibitor) (Ziegler & Fonesca, 2015).
Although peripheral neuropathy is best known, autonomic neuropathy also affects many individuals with diabetes. This group of disorders includes diabetic gastroparesis, urinary retention, sexual dysfunction in men and women, bowel incontinence and/or diarrhea, postural hypotension, tachycardia at rest, angina-free myocardial infarction, and hypoglycemic unawareness (Ignatavicius, & Workman, 2016; Lewis et al., 2014.
Diabetic Nephropathy
Diabetic nephropathy is due to damage to small vessels in the glomeruli of the kidneys and affects up to 40% of individuals with diabetes (Thomas & Kodack, 2011). Diabetic nephropathy is commonly defined by abnormally high albumin levels in urine in a patient without known renal disease. The earliest indicator is microalbuminuria, defined as albumin excretion of less than 30 mg/day or a urinary albumin/creatinine ratio of greater than 3.0 mg/mmol (Bennett & Aditya, 2015). It is the leading cause of end stage renal disease and is more common among individuals with diabetes who smoke, and who have uncontrolled hypertension and chronically high blood glucose (Bakris & Weir, 2002; Bennett & Aditya, 2015; Thomas, & Kodack, 2011; Williams, Manias, Walker, & Gorelik, 2012). Despite the use of therapy to protect the kidneys of individuals with diabetes, end stage renal disease is increasing in the diabetic population at the rate of about 9% a year (Joint Committee on Diabetic Nephropathy, 2015; Kazawa & Moriyama, 2013; Krolewski, 2015).
The treatment of choice for diabetic nephropathy is either an angiotensin-converting enzyme inhibitor (ACEI) such as lisinopril [Zestril®] or an angiotensin receptor blocker (ARB) such as losartan [Cozaar®]. These drugs have a dual effect of controlling hypertension and slowing the progression of kidney damage and dysfunction. For patients with normal blood pressure and normal kidney function, this form of treatment may not be necessary. Patients who spill albumin in their urine should be treated with one of the described drugs. Providers should monitor these patients’ creatinine, potassium, and urine albumin excretion routinely. These laboratory values help assess the patient’s therapeutic response and monitor disease progression. However, relying on creatinine alone may lead to renal impairment being missed. If the glomerular filtration rate (GFR) meets the criteria for chronic kidney disease (< 60 mL/min/1.73 m2 for three months or more), the patient should be referred to a specialist for further management. Albumin concentration is a strong independent predictor of renal prognosis, but the severity of the albumin concentration does not always correlate closely with renal function. Renal impairment also increases the risk of hypoglycemia in the patient with diabetes. This is often multifactorial in etiology but is often the result of impaired gluconeogenesis seen in kidney disease (Andresdottir et al., 2014; Bakris & Weir, 2002; Bennett & Aditya, 2015; Thomas & Kodack, 2011; Williams et al., 2012).
A recent Cochrane review of 26 studies showed that the use of an ACEI decreased the number of diabetics who went on to develop chronic kidney disease (CKD) compared to other types of antihypertensive medications (Jicheng et al., 2013). The ACEIs significantly reduced the risk of new onset for both micro- and macroalbuminuria. ARBs did not show the same benefit; however, a subgroup analysis showed benefits in using ARBs in high-risk patients. There were only two published studies regarding the combination of ACEI and ARB (Jicheng et al, 2013). Of these two studies, only one demonstrated a benefit of using combined drugs. The current recommendation remains that ACEIs are the drug of choice to prevent CKD in patients with diabetes (Fried et al., 2015; Jicheng et al., 2013).
ACE inhibitors and ARBs inhibit the renin-angiotensin system, which leads to lowered blood pressure. This, in turn, reduces both cardiovascular and renal risk, both of which are significant contributors to morbidity in the diabetic population, particularly in the older adult subset. However, research has shown that ACEIs and ARBs are vastly under-utilized in this population due mainly to concerns of providers about potential side effects. The ADA (2014a) recommends them as first-line treatment for patients with hypertension with or without albuminuria or other signs of renal insufficiency, no matter what age. Diuretics can also be considered in conjunction with this therapy. Appropriate labs (serum creatinine, potassium) should be monitored when using these drugs (Bennett & Aditya, 2015; Fried et al., 2015; Pagana & Pagana, 2015; Pappoe, & Winkelmayer, 2010).
Krolewski (2015) has proposed a “new paradigm” for diabetic nephropathy that does not use albuminuria as the marker of impaired renal function. After 25 years of research, Krolewski proposes monitoring the decline of GFR as a more accurate indicator of renal involvement in diabetics. Specifically in this model, the loss of greater than 3.5 mL/min/year of GFR indicates progressive renal decline. The decline in GFR precedes the onset of albuminuria, and unchecked, this process can lead to end stage kidney disease. Although the exact mechanism of this process is unclear, Krolewski claims that by using this model, one can separate patients into groups with rapid, moderate, or minimal rates of progression which can lead to better targeted therapies (Krolewski, 2015).
Lower urinary tract complications can also occur in patients with diabetes. Dysfunction can occur at the level of the bladder and the sphincter leading to problems of both storage and emptying. Bladder contractility is especially affected in patients with diabetes, often leading to hypocontractility, which worsens the longer the disease lasts. Urinary incontinence is a frequent finding that may not be related to age. Urinary retention, nocturia, weak urine stream, urinary tract infections (UTIs), and frequency are other complications. Erectile dysfunction (ED) can also occur. These seem to be related to increased responsiveness to parasympathetic input and decreased responsiveness to adrenergic input (autonomic neuropathy) (Kempler et al., 2011; Lee et al., 2015; Lemack, 2007; Pop-Busui et al., 2015; Vinik, Maser, Mitchell, & Freeman, 2003; Yilmaz et al,, 2014).
Bladder dysfunction occurs in 25% of patients with T2D. There is a high correlation between bladder disturbances and peripheral neuropathy. Patients often complain of symptoms, such as frequency and urgency, often leading to incontinence, nocturia, and the sensation of incomplete bladder emptying. Men may complain of symptoms confused with benign prostatic hyperplasia (BPH): weak urinary stream, dribbling, and interrupted urinary stream. The pathophysiology of this dysfunction appears to be a combination of alteration in detrusor smooth muscle, dysfunction of neurons, and urothelial dysfunction, all related to chronically high blood glucose (Kempler et al., 2011; Pop-Busui et al., 2015; Yilmaz et al., 2014).
Providers should screen patients complaining of these symptoms with a validated tool assessing incontinence and lower urinary tract symptoms (LUTS). A urinalysis with culture should be obtained to rule out UTI because patients with diabetes are so prone to infection and because UTI can lead to these symptoms. Urodynamic testing may be valuable for bladder dysfunction assessment. Post-void residual should be assessed. For patients who have severe bladder dysfunction, intermittent catheterization is the treatment of choice. Bladder training, including timed voiding and doublevoiding, is used for incontinence. (Kempler et al., 2011; Nazarko, 2015; Pop-Busui et al., 2015). Many medications used to treat bladder dysfunction (cholinergic and anti-cholinergic drugs) are inappropriate for older adults. Sacral neuromodulation, a surgical procedure, has good success with patients with diabetes (66.7%); however, infected devices had to be removed in 37.5% of diabetic recipients, limiting their practical usefulness (Nazarko, 2015).
ED is estimated to affect up to 90% of men with diabetes. Although many providers and patients are embarrassed to broach this topic, it is important to recognize and assess for it. ED is a well-established risk factor and independent predictor of serious cardiovascular events and coronary artery disease in men with diabetes. The pathophysiology relates mainly to decreased ability of the smooth muscle of the corpus cavernosum to relax and to impaired nitric oxide function. Neuropathy may also be implicated leading to decreased sensation in the glans penis, further compounding the ED. Providers should use validated tools to assess for the presence and impact of ED (Kempler et al., 2011; Moussa, Hill, Claydon, & Klufio, 2015; Pop-Busui et al., 2015). Women can also suffer from diabetes-induced impairment of sexual function, such as decreased desire, diminished lubrication, and decreased ability to achieve an orgasm (Yilmaz et al., 2014).
Management of ED includes sexual counseling (including the patient’s partner), good glycemic control, and medications, such as sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®). Other treatments can include intracavernous injections, intraurethral alprostadil (Caverject®), constriction devices, or prosthetic implants (Kempler et al., 2011). A challenge in treating these patients is the relationship to coronary artery disease. Many of these men are on nitrate preparations, which preclude the use of phosphodiesterase inhibitors, such as sildenafil. Patients should be encouraged to discuss this matter with their cardiologists; a “nitrate holiday” may make limited use of these types of drugs possible (Ignatavicius & Workman, 2016; Lewis et al., 2014).
Perioperative Complications
Individuals with diabetes present special challenges during the perioperative period. The hospital stay of the post-operative patient with diabetes is longer, with the patient experiencing more complications, including a 50% higher risk of mortality than patients without diabetes. Specific complications include wound infection (2 to 3 times higher), poor wound healing, hyperglycemia (including diabetic ketoacidosis), hypoglycemia, joint infection, and thrombotic events. Complications from other co-morbid conditions are also a possible problem (Dhinsa, Khan, & Puri, 2010; Levasque, 2013; Munoz, Lowry, & Smith, 2012; Sharp, & Clark, 2011; Wallace, 2012).
Good glycemic control is vital in the perioperative patient with diabetes, although there is disagreement on specific protocols. Tight control may decrease the incidence of wound infection. In fact, for elective surgery, reducing the A1C to 7% or less is ideal because patients in this range have an overall lower rate of wound infection. Control is complicated by the body’s response to surgery; stress increases the release of catabolic hormones and pro-inflammatory mediators, while at the same time decreases the release of insulin. This tends to lead to hyperglycemia. Overly aggressive glucose control, combined with hypoglycemic unawareness (common in older patients) can lead to hypoglycemia. Patients are best managed with a specific and detailed protocol using insulin during the operative and immediate post-operative period while the patient is still not eating. Typically, oral medications can be started once the patient is eating well. See the discussion on medications below for more detail (Dhinsa et al., 2010; Levasque, 2013; Munoz et al., 2012; Wallace, 2012).
Medications
Medications to treat T2D include insulins and several different classes of oral medications. Insulin replaces the patient’s own endogenous insulin and is required in patients with T1D. Patients with T2D may need exogenous insulin to manage blood glucose levels during periods of acute stress (i.e., surgery or serious illness) or may use insulin to supplement their oral medications for tighter control (Ignatavicius & Workman, 2016; Lewis et al., 2014).
Insulins
Insulins come in rapid-acting, short-acting, intermediateacting, long-acting, and combination formulas (see Table 2). Regimes can include taking injections once, twice, or three times a day, or can involve a basal-bolus routine in which the patient takes a long-acting insulin once a day and supplements with rapid acting insulin at mealtimes. This allows greater flexibility in working with food intake (Cleary, 2013; Vallerand, & Sanoski, 2013).
Oral and Non-Insulin Injectable Medications
Several classifications of oral medications are available, with new drugs being developed at a rapid pace. Patients may be on mono- or dual therapy. When desired results are not achieved on single drug therapy, it is more beneficial to add a medication from a different class instead of switching drugs altogether (ADA, 2015c). Hospitalized patients, unless very stable, should have oral medications discontinued and their blood glucose values managed with insulin. See Table 3 for a discussion of oral and noninsulin injectable medications (ADA, 2015b; D’Arrigo, 2015; Ignatavicious & Workman, 2016; Vallerand & Sanoski, 2013).
Medication Use in the Hospitalized Patient With Diabetes Mellitus
The hospitalized patient (unless quite stable) should be taken off oral medications and switched to insulin. Most hospital policy calls for fasting and preprandial testing with sliding scale insulin based on the patient’s blood glucose readings. However, this does not take into account the upcoming meal with its carbohydrate load. The 2009 consensus statement from the ADA and the American Association of Clinical Endocrinologists discourages the use of this standard protocol. There is no scientific evidence to support this approach, and its use can be dangerous to patients. Rather, the consensus statement recommends scheduled subcutaneous insulin (for non-critical patients) using “basal, nutritional, and correctional components” (Kubacker, 2014, p. 33). The correctional component factors in the patient’s sensitivity to insulin and is calculated using available formulas (DeYoung, Bauer, Brady, & Eley, 2011). Poor glycemic control in the hospitalized patient can lead to several adverse outcomes, including increased morbidity and mortality, length of stay, number of admissions, and cost (Crawford, 2013; DeYoung et al., 2011; Kubacka, 2014; Seggelke & Everhart, 2012).
Other Care Measures
It is important that diabetics have an in-depth knowledge of certain self-care measures. They need to have a good understanding about appropriate nutrition, physical activity, sick day management, and self-monitoring of blood glucose (SMBG). It is the role of the health care provider to provide this education. To efficiently accomplish this, health care providers must remain current in these topics.
Nutrition
Nutrition is a cornerstone of care for all patients with diabetes. Nutritional modifications can be challenging for many patients, and the ADA recommends a registered dietician with knowledge and expertise in diabetes as part of the care team. A healthy diet for a diabetic can incorporate the same foods typically eaten by non-diabetics. The dietary goal is to eat in a way that promotes tight glycemic control and helps limit complications (i.e., cardiovascular). For the majority of individuals with diabetes, this includes eating 45 grams of carbohydrates at each of three meals and 15 grams of carbohydrates each of two to three daily snacks. As part of the total carbohydrate intake, 25 to 30 grams should be fiber. Protein should be 20% to 30% of total intake, with the rest being composed of healthy fats. Alcohol is allowed but should be used in moderation and with food to avoid hypoglycemia accompanied by unawareness because the effects of alcohol blunt the body’s response to hypoglycemia (Ignatavicious & Workman, 2016; Lewis et al., 2014).
Physical Activity
The ADA (2014a) recommends that individuals with diabetes get at least 150 minutes of exercise a week, which is an average of 30 minutes five days a week. Exercise has many benefits, both for glycemic control and reducing risk factors and co-morbidities, such as cardiovascular disease. The decrease in insulin resistance seen with exercise can last up to 48 hours. The ADA also recommends that diabetics not be sedentary for more than 90 minutes at a time (ADA, 2014a; Ignatavicious & Workman, 2016; Lewis et al., 2014).
Blood Glucose Monitoring
Blood glucose is considered a fifth vital sign for patients with diabetes. However, timing of testing is somewhat controversial. There are multiple potential times during the day to test: fasting, before each of three meals, after each of three meals, before and/or after exercising, and at bedtime (Ignatavicious, & Workman, 2016; Lewis et al., 2014; Schrott, 2004). Patients with type 2 diabetes tend towards fasting and 2-hour postprandial testing, which evaluates the effect of a carbohydrate load on blood glucose (Ignatavicious, & Workman, 2016; Lewis et al., 2014; Schrott, 2004). This allows the patient with diabetes to make decisions regarding meal composition and the timing of exercise toward fasting and 2-hour postprandial testing, which evaluates the effect of a carbohydrate load based on their individual responses. Even with normal fasting levels and “controlled” A1C readings, a large percentage of patients with diabetes will have higher than desired postprandial levels less than or equal to 140 mg/dL (Ignatavicious & Workman, 2016; Lewis et al., 2014; Schrott, 2004). Over the years, some studies have demonstrated better glycemic control in specific patient popula- tions who test after meals versus before (de Vegiana et al., 1995; Muhamad, Kadir, & Mohamed, 2012). However, a testing plan should ideally be developed in conjunction with the patient’s goals and willingness to participate in active care. Postprandial testing appears to be more highly correlated to reducing cardiovascular risk, which is an added benefit (Schrott, 2004) and is better correlated to tighter long-term control. Patients with T1D often test fasting and before meals; however, this is also controversial, especially in hospitalized patients (Ignatavicious & Workman, 2016; Lewis et al., 2014).
Sick Day Management
Sick day management should be planned in advance. The patient and provider should discuss and agree on a plan for when the patient is ill and not eating. The patient should be advised to check blood sugars more frequently, have food and beverage on hand that can be tolerated and that provide some carbohydrates, and continue at least a partial dose of his or her medication. Diabetic ketoacidosis is often caused by individuals with diabetes who discontinue their medications not realizing that their blood glucose continues to rise even though they may not be eating. Patients with diabetes should also know when to seek health care (Ignatavicious & Workman, 2016; Lewis et al., 2014).
Conclusion
Diabetes mellitus is a growing health care problem with ramifications affecting individuals’ health, the health care system, and the economy of the United States and the world (Ignatavicious & Workman, 2016; Lewis et al., 2014). Nurses in every setting will encounter patients/clients with diabetes. It is the role of all nurses to be properly educated about diabetes and the most current recommended treatments. It is also important to involve patients in the active management of their condition. These important roles could have a great impact on the prevention and management of this disease that has such high morbidity and mortality rates.
Sidebar

Blair, M. (2016). Diabetes mellitus review. Urologic Nursing, 36(1), 27-36. doi:10.7257/1053-816X.2016.36.1.27
References
References
American Diabetes Association (ADA). (2013). Diagnosis and classification of diabetes mellitus. Diabetes Care, 36(supplement), S67-S74.
American Diabetes Association (ADA). (2014a). Common terms. Retrieved from http://www.diabetes.org/dia betes-basics/common-terms/
American Diabetes Association (ADA). (2014b). Diagnosing diabetes and learning about prediabetes. Retrieved from http://www.diabetes. org/are-you-at-risk/prediabetes/?loc =superfooter
American Diabetes Association (ADA). (2014c). New standards of care provide guidelines for statin use for people with diabetes to prevent heart disease. Retrieved from http://www. diabetes.org/newsroom/press-re leases/2014/new-standards-of-careprovide-guidelines-for-statin-usefor-people-with-diabetes-to-preventheart-disease.html
American Diabetes Association (ADA). (2015a). Diabetes management guidelines. Retrieved from http://www. ndei.org/ADA-diabetes-managementguidelines-microvascular-complica tions-foot-care.aspx
American Diabetes Association (ADA). (2015b). Standards of medical care in diabetes – 2015: Abridged for primary care providers. Clinical Diabetes, 33(2), 97-111.
American Diabetes Association (ADA). (2015c). What are my options? Retrieved from http://www.diabetes. org/living-with-diabetes/treatmentand-care/medication/oral-medica tions/what-are-my-options.html
Andresdottie, G., Jensen, M.L., Carstensen, B., Parving, H., Rossing, K., Hansen T.W., & Rossing, P. (2014). Improved survival and renal prognoses of patient with type 2 diabetes and nephropathy with improved control of risk factors. Diabetes Care, 37, 1660-1667.
Bakris, G.L., & Wier, M. (2002). ACE inhibitors and protection against kidney disease progression inpatients with type 2 diabetes: What’s the evidence? MedScape. Retrieved from http://www.medscape.com/ viewarticle/445180
Benbow, M. (2012). Diabetic foot ulcers. Journal of Community Nursing, 26(5), 16-19.
Bennett, K., & Aditya, B.S. (2015). An overview of diabetic nephropathy: Epidemiology, pathophysiology, and treatment. Journal of Diabetes Nursing, 19(2), 61-67.
Cleary, D. (2013). Insulin therapy in type 2 diabetes. Mosby’s nursing consult. Retrieved from http://www.nursing consult.com/nursing/clinical-updates/full-text?clinical_update_id= 198175
Crawford, K. (2013). Guidelines for care of the hospitalized patient with hyperglycemia and diabetes. Critical Care Nursing Clinics of North America, 25, 1-6.
D’Arrigo, T. (2015). New type 2 diabetes medications. WebMD. Retrieved from http://webmd.com/diabetes/ features/new-diabetes-medications? pate=2&print=true
de Veciana, M., Major, C.A., Morgan, M.A., Asrat, T., Toohey, J.S., & Lien, J.M., (1995). Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. New England Journal of Medicine, 333(19), 1237-1241.
DeYoung, J., Bauer, R., Brady, C., & Eley, S. (2011). Controlling blood glucose levels in hospital patients: Current recommendations. American Nurse Today, 6(5), 12-14.
Dhinsa, B.S., Khan, W.S., & Puri, A. (2010). Management of the patient with diabetes in the perioperative period. Journal of Perioperative Nursing, 20(10), 364-367.
“Diabetic Retinopathy – Surgery.” (2014). Retrieved from http://www.webmd. com/diabetes/tc/diabetic-retino pathy-surgery
Fried, L.F., Emanuele, N., Zhang, J.H., Brophy, M., Connor, T.A., Duckworth, W., … VA NEPHRON-D Investigators. (2015). Combined angiotensin inhibition of the treatment of diabetic nephropathy. The New England Journal of Medicine, 369, 1892-1903.
Hazard, A., & Sanoski, C.A. (2013). Davis’s drug guide for nurses (13th ed.). Philadelphia, PA: F.A. Davis Company.
Ignatavicius, D.D., & Workman, L. (2016). Medical-surgical nursing: Patientcentered collaborative care (8th ed.). St. Louis, MO: Elsevier.
Jicheng, L.V., Percovik, V., Foote, C.V., Craig, M.E., Craig, J.C., & Strippoli, G.F.M. (2013). Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database of Systematic Reviews, 8. doi:10.1002/ 14651858.CD004136.pub3
Joint Committee on Diabetic Nephropathy. (2015). A new classification of diabetic nephropathy 2014: A report from Joint Committee on Diabetic Nephropathy. Journal of Diabetes Investigation, 6(2), 242246.
Kazawa, K., & Moriyama, M. (2013). Effects of a self-management skillsacquisition program on pre-dialysis patients with diabetic nephropathy. Nephropathy Nursing Journal, 40(2), 141-148.
Kempler, P., Amerenco, G., Freeman, R., Frontoni, S., Horowitz, M., Stevens, M., … Toronto Concensus Panel on Diabetic Neuropathy. (2011). Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes/Metabolism Research Reviews, 27, 665-677.
Krolewski, A. S. (2015). Progressive renal decline: The new paradigm of diabetic nephropathy in type 1 diabetes. Diabetes Care, 38, 954-962.
Kubacka, B. (2014). Achieving glycemic control in hospitalized patients: A balancing act. Nursing 2014, 44(1), 30-37.
“Laser Photocoagulation for Diabetic Retinopathy.” (2015). Retrieved from http://www.webmd.com/diabetes/ laser-photocoagulation-for-diabeticretinopathy
Ledet, G., Graves, R.A., Bostanian, L.A., & Mandal, T.K. (2015). A second-generation inhaled insulin for diabetes mellitus. American Journal of Health-System Pharmacy, 72, 11811187.
Lee, S.H., Lee, S.K., Choo, M.S., Ko, K.T., Shin, T.Y., Lee, W.K., … Kim, D.H. (2015). Relationship between metabolic syndrome and lower urinary tract symptoms: Hallym Aging Study. BioMed Research International, 2015, 1-8.
Lemack, G.E. (2007). Lower urinary tract dysfunction in the diabetic elderly. Aging Health, 3(5), 647-651.
Levasque, C.M. (2013). Perioperative care of patients with diabetes. Critical Care Nursing Clinics of North America, 25, 21-29.
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., & Butcher, L. (2014). Medicalsurgical nursing: Assessment and management of clinical problems (9th ed.). St. Louis, MO: Elsevier.
McCance, K., Huether, S., Brashers, V., & Rote, N. (2014). Pathophysiology: The basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Meetoo, D., & Allen, G. (2010). Understanding diabetes mellitus and its management: An overview. Nursing Prescribing, 8(7), 320-326.
Moussa, N., Hill, M.C., Claydon, A., & Klufio A. (2015). Managing erectile dysfunction in diabetes. Practice Nursing, 26(2), 88-91.
Muhamad, R., Kadir, A.A., & Mohamed, M. (2012). Assessing glycaemic control in primary care setting: A randomized control trial between fasting and 2 hours postprandial blood glucose monitoring in type 2 diabetic patients attending Klink Rawatan Keluarga, Hospital Universiti Sains Malaysia, Kelantan. International Medical Journal, 19(1), 20-26.
Munoz, C., Lowry, C., & Smith, C. (2012). Continuous quality improvement: Hypoglycemia prevention in the postoperative surgical population. MEDSURG Nursing, 21(5), 275-280.
Nazarko, L. (2015). Solve the case: Urinary frequency and recurrent urinary tract symptoms. Nurse Prescribing, 13(9), 458-463.
Pagana, K.D., & Pagana, T.J. (2014). Mosby’s manual of diagnostic and laboratory tests (5th ed.). St. Louis, MO: Elsevier.
Pappoe, L.S., & Winkelmayer, W.C. (2010). ACE inhibitor and angiotensin II type 1 receptor antagonist therapies in elderly patients with diabetes mellitus: Are they underutilized? Drugs & Aging, 27(2), 8794.
Pop-Busui, R., Hotaling, J., Braffett, B.H., Cleary, P.A., Dunn, R.L., Martin, C, L., … Sama, A.V. (2015). Journal of Urology, 193(60), 2045-2051.
Schrott, R.J. (2004). Targeting plasma glucose: Preprandial versus postprandial. Clinical Diabetes, 22(4), 169-172.
Seggelke, S.A., & Everhart, B. (2012). Managing glucose levels in hospital patients. American Nurse Today, 7(9), 27-31.
Sharp, A., & Clark, J. (2011). Diabetes and its effects on wound healing. Nursing Standard, 25(45), 41-47.
Shotliff, K., & Balasantiran, A. (2009). Diabetic retinopathy and eye screening. Practice Nurse, 38(9), 23-28.
Thomas, S., & Kodack, M. (2011). Managing the patient with T2DM with RI. The Clinical Advisor, 89-93. Retrieved from http://www.clinicaladvisor.com/features/managingtype-2-diabetes-with-renal-impair ment/article/199963/
Turns, M. (2011). The diabetic foot: An overview of assessment and complications. British Journal of Nursing, 20(15), S19-S25.
Vallerand, A.P., & Sanoski, C.A. (2013). Davis’s drug guide for nurses (13th ed.). St. Louis, MO: FA Davis.
Vinik, A.I., Maser, R.E., Mitchell, B.D., & Freeman, R. (2003). Diabetic autonomic neuropathy. Diabetes Care, 26(5), 1553-1664.
Wallace, C.R. (2012). Postoperative management of hypoglycemia. Orthopaedic Nursing, 31(6), 328-333.
Williams, A., Manias, E., Walker, R., & Gorelik, A. (2012). A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: A feasibility randomized controlled trial. Journal of Advanced Nursing, 68(11), 25152525.
Woo, K.Y., Santos, V., & Gamba, M. (2013). Understanding diabetic foot ulcers. Nursing2013, 43(10), 36-42.
World Health Organization. (2013). Diabetes, complications. Retrieved from http://www.who.int/diabetes/ en/
Yilmaz, S.D., Bal, M.D., Celki, S., Beji, N.K., Dinccag, N, & Yalcin, O. (2014). Lower urinary tract symptoms in diabetic women with and without urinary incontinence. International Journal of Urological Nursing, 8(2), 71-77.
Ziegler, D., & Fonseca, V. (2015). From guideline to patient: A review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. Journal of Diabetes and its Complications, 29, 146-156.
Additional Readings
Icks, A., Haastert, B., Trautner, C., Giani, G., & Hoffman, F. (2009). Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. Findings from nationwide insurance data, Germany, 20052007. Experimental and Clinical Endocrinology & Diabetes, 117, 500504.
Khardori, R. (2015). Type 2 diabetes mellitus. Medscape. Retrieved from http://emedicine.medscape.com/ article/117853-overview
National Diabetes Clearinghouse (2012). Insert C: Types of insulin. Retrieved from http://diabetes.niddk.nih.gov/ dm/pubs/medicines_ez/insert_C. aspx
National Institutes of Health (NIH). (2014). Blood sugar test. Medline Plus. Retrieved from http://www. nlm.nih.gov/medlineplus/ency/article/003482.htm
WebMD. (2015). Diabetes drugs you inject that aren’t insulin. Retrieved from http://www.webmd.com/diabetes/ guide/diabetes-non-insulin?page=2)
AuthorAffiliation
Meg Blair, PhD, MSN, RN, CEN, is a Professor, NE Methodist College, Omaha, NE.
Publication title: Urologic Nursing; Portland
Volume: 36
Issue: 1
Pages: 27-36
Number of pages: 10
Publication year: 2016
Publication date: Jan/Feb 2016
Section: General Clinical Practice
Publisher: Anthony J. Jannetti, Inc.
Place of publication: Portland
Country of publication: United States, Portland
Publication subject: Medical Sciences–Urology And Nephrology
ISSN: 1053816X
e-ISSN: 21684626
CODEN: URNUES
Source type: Scholarly Journals
Language of publication: English
Document ty

2 Attachments

ReplyForward

[supanova_question]

USF Mercy for Animals Pro Vegetarian & People Behind Beef Media Message Analysis Humanities Assignment Help

Critical Thinking Paper 2 Media message analysis

Write a 3-4 page paper that demonstrates media literacy skills by describing and analyzing two media messages.

Topic:

Link of media message 1:

Link of media message 2:

TASK-RELATED SKILLS 60%

Background of Issue & Types of Media Messages (20%)

The student provides an overview with background information on the topic of the media messages.

The two media messages are either an ad (text and images) and/or a PSA/video of not more than 1 – 2 minutes.

The two media messages are opposing viewpoints about a social issue.

The two media messages originate from a company or an organization and not produced by an independent news outlet.

The sources must be messages constructed to persuade the audience.

Analysis of media messages (40%)

The student adequately analyzes both (2) media messages:

identifies who created the message and describes the purpose with background information of who created it

describes creative techniques used to attract attention and recognizes any misleading information

discusses how different people might understand the media messages differently

discusses the lifestyles, values and points of views represented in or omitted from the messages

The core concepts/questions of media literacy and others (from the reading text)

Recognize what the media maker wants us to believe or do

Name the “tools of persuasion” used

Some of the “creator/author”s language techniques

Discover the part of the story that is not being told

LANGUAGE 40%

General Writing Skills (30%)

-The student demonstrates good English language writing skills at the sentence, paragraph, and whole-paper level.

-Ideas can be understood clearly with little reader effort

-Sentences are well constructed, there is good use of vocabulary and punctuation is used consistently well

– use figurative language .

Organization (10%)

The sentences and paragraphs show cohesion: connections between ideas and sentences are evident

There are general paragraphing skills: topic sentence, development, concluding sentence.

Outline:

– Background to the controversial issue you have chosen

-Analysis media message 1 (at least 2 paragraphs)

-Analysis media message 2 (at least 2 paragraphs)

– Which is more effective and why?

Be sure to:

Provide links to the two messages at the beginning of the paper

Use size 12 font

Double-space the lines

Have 1” margins on the left, right, top, and bottom of the page

Include your name, your class and section, and the date at the top of the paper.

[supanova_question]

ENG 11 UCF Franz Kafka The Metamorphosis Annotated Bibliography Humanities Assignment Help

ENG 11 UCF Franz Kafka The Metamorphosis Annotated Bibliography Humanities Assignment Help

× How can I help you?