None Assignment Example | Topics and Well Written Essays - 750 words - 1

None - Assignment Example Further to this, the prompt gives other fallacious statements of the reasons why individual and other Americans should own guns. For instance, it cites the border threats posed by immigrants from Latin America and other forms of gangs. It argues that the borders have become porous hence allowing job seekers, al-Qaida agents, as well as other terrorist organizations. Moreover, it asserts that the border has increased insecurity by allowing individual committing criminal activities such as robbery, kidnapping, murder, rape among others (Rick 17). Therefore, the prompt believes that owning a gun is the only solution towards the increased insecurity in the US specifically in the southern border. There are many fallacies that are emanating from the above prompt. For instance, many US citizens believe that owning a gun can be the only solution to their insecurity. This is not the case because guns do not ensure security, but are for shooting and killing (Lunger 67). Owning a gun does not ensure the security, but threatens and intimidate those living around and who dont own. In many cases, people have been killed even when they have guns. For instance, law enforcement agents have been killed when in patrol through being ambushed (Goss and Cook 133). This is an indication that owning or possessing a gun does not guarantee the security. There are many ways citizens can protect themselves other than owning a gun. Secondly, the prompt asserts that the porous US borders more so in the south have led to insecurity by allowing immigrants. This is a fallacy; not all illegal immigrants are security threats. There are many who have been of help to the US government by offering labor in areas where citizens cannot reach (Goss and Cook 133). Some immigrants are in US legally hence should not be viewed as illegal immigrants. Instead, they should be viewed as people who can contribute positively to the US economy. Lastly, there are a number of cases when the gun owners

Jocasta: Queen Of Thebes

Jocasta: Queen Of Thebes Jocasta: Unacknowledged Misunderstood Surrounded by powerful and royal men, left in the background as if she; Jocasta Queen of Thebes was not important. In Sophocles play Oedipus the King, Queen Jocasta endures a tragic fate of her own. Queen Jocasta is not only imperative to the aiding of the story, but gives an more in depth look into Sophocles tragedy. To many people Oedipus is deemed as tragic individual within the play, but not only he should be focused on, Jocasta has encountered just as many tragedies if not more. She receives news about the murder of her husband king Laius, marries her son Oedipus and commits suicide when she finds out the prophecy from oracle has come true. Many people know the story of Oedipus the king, Oedipus who is prophesized to murder his father and marry his mother. At birth Oedipus is taken up to the mountains with his feet bonded to die, to protect the king and queen from the prophecy of the oracle. Perhaps if the story where told in Jocastas point of view, then readers would understand the amount of devastations she has really suffered. Readers will see that more then anything else; Jocasta is an innocent a victim of circumstances. Pregnant with her first child, Jocasta receives the prophecy from the oracle of Delphi that if she bores a son, he will kill the king and marry her. What would any young and impressionable mother do in that situation; but listen to the wise words of her husband and king. King Laius tells her that they must get rid of the baby. â€Å"I am fifteen and afraid to resist and tell myself it is my husbands right; the gods decree a wife obey her spouse (Jocasta)†. Jocasta, not much of a woman yet, can not do anything more then listen to her husband. She must give up her only child, although it is not what she wants to do, she must because it is her only option. â€Å"The only choice a woman has is that she wed accepting what the gods and men decree (Jocasta)†.Women in Jocastas time had no say no say in thing at all. All decisions were made by the men in their lives, their fathers, husbands and the gods. Women could not complain about the decision made, they could only accept th e decision and live with them. In Ruth F. Eisenbergs â€Å"Jocasta†, Sophocles play is told in Jocastas point of view. Eisenberg retells the story by giving a deeper insight on the struggles Jocasta faced as the young wife of Laius and also as the Queen of Thebes. â€Å"The baby cries, and Laius turns away. He summons a servant and orders me to hand my baby over, threatening me when I cry. The king will keep his own hands clean (Jocasta)†. Young and naive Jocasta must do what she is told by her husband or like Oedipus he might get rid of her. Jocasta could not question the great King Laius, she was not his equal. She was considered below him, like all the women other in Thebes during that time. Secondly, she fell in love with the man that solved the riddle of the sphinx, which happened to be her own son, Oedipus, who she has four children with. After many years of an unbearable and loveless marriage, Jocasta finally finds a man that she truly and deeply cares about. He is everything a woman would want smart, a good leader and loving. â€Å"He was at first my headstrong bull, but now he is what a man, a king, should be. Our love has brought to me the joy that I missed when I was young and thought Id never know (Jocasta)†. Her first marriage was so horrible she never though she would find real love. She is really happy with the man that her second husband is, he was everything King Laius was not. Her second husband gives her four beautiful children, children who she thought she would never have again. Two wonderful daughters and two strong sons, the four children she thought she would never have to give up. Everything was going perfect for Oedipus and Jocasta until the land started to come be dry and would not bare any crops. The people of Thebes began to suffer greatly and Oedipus decides to consult the oracle. Consequently, she finds out that everything oracle had predicted in fact did come true. A messenger from Corinth comes to tell Oedipus about the death of his alleged father Polybus, and asks him to come back to Corinth as the new king. Oedipus refuses because he fears he oracles prophecy will come true. The messenger reassures him that Merope his alleged mother did not have any children, and Oedipus was not their real son. Queen begged Oedipus not to continue to question the messenger but he does not listen. â€Å"In the name of the gods, no! If you havesome concern for your own life, then stop! Do not keep investigating this I will suffer-that will be enough (Sophocles)†. Queen no realizes that the prophecy may have actually come true, she tries to protect Oedipus form the truth but he does not listen to her.The messenger goes on to say that in fact Oedipus is the son of King Laius and Queen Jocasta. Queen Jocasta just as shocked as Oedipus if not more, is overwhelmed with as tonishment and pity. â€Å"I cant believe. I cant believe. Oh God. He is my son. Ive loved my son but not as mothers should, but in my bed, in me. All that I loved most, his youth that made our love the summer sun, wrong, all wrong. Vile(Jocasta).† Jocasta is so overwhelmed with guilt, shame and pity. After loveless years of marriage to find someone she really loved and to find out that he is her own son was extremely appalling to Jocasta. Jocasta realizes she was cursed form the day she married King Laius and that it is his entire fault, and because of him she is getting punished. Jocasta ashamed and disgusted cures the god and goddess that she prayed to her whole life. With the truth of the oracle being too much to bear, she could no longer live another day and commits suicide. Victimized by the gods and by her first husband, Jocasta was cursed from the day she was born. Her fate was already decided for her and there was no way around it. Everything she every loved was a cu rse, the five children she more were all curses destined to cause her deep pain. Jocasta Queen of Thebes was surrounded by powerful and royal men, and was left in the background as if she was not important. Queen Jocasta was not only imperative to the aiding of the story, but she gave a more in depth look into Sophocles tragedy. Jocasta should also be as a tragic hero, she had encountered many tragedies. After receiving news about the murder of her husband king Laius, she marries her own son; which was all too much for Jocasta to bear thus prompting her to commit suicide. Consequently, now that the story has been told from Jocastas point of view, readers will have a better understanding of the devastation that Jocasta has endure. Jocasta is in fact really the victim in the play; she is a victim of circumstance and truly has suffered as a result. Works Cited â€Å"Jocasta.† https://teacherweb.com/FL/SAS/Cabrera/Jocasta.pdf. N.p., n.d. Web. 12 Dec. 2009. . â€Å"Jocasta by Ruth Eisenberg.† Jocasta by Ruth Eisenberg. N.p., n.d. Web. 12 Dec. 2009. . Apollo!. â€Å"Sophocles: Oedipus Rex.† Poetry In Translation A.S. Klines Free Poetry Archive Main Site. N.p., n.d. Web. 12 Dec. 2009. . Sophocles Oedipus the King. Sophocles Oedipus the King. N.p., n.d. Web. 12 Dec. 2009. .

Unzipped :: Free Essay Writer

Unzipped In the expository text Unzipped- everything teenagers want to know about love, sex and each other, Bronwyn Donaghy has written about the facts and consequences of teenage sex. By doing so she has presented us with her old fashioned ideologies and her strong ‘anti-teenage-sex’ values and attitudes. As the audience Donaghy has tried to scare us into believing and following these attitudes, which are very evident throughout the entire text. Virginity and abstinence is the way to go. This text is targeted at young youths who are curious and want to explore their sexuality and their parents who Donaghy thinks should be open and willing to educate their children on the subject. In order to do this she has employed the use of three different writing styles: These being narrative, expository and real life accounts. Between chapters and further the different sexual topics, Donaghy has split the information up by an ongoing fictional story, which runs through the entire book. It is a narrative story about two inquisitive and curious adolescent teenagers who fall in love and start to get ‘full on’ but then decide against the idea of sex as it is simply too complicated. Donaghy has done this by using very ‘down to earth’ language that she thinks teenagers can relate to and a simplistic story line. However by trying to relate to teenagers at what she perceives is their level in my opinion gives the story very little realism in regards to reality as she simply cant ‘pull it off’. The story is made to almost look superficial. Within the story it is made very clear that abstinence is the way to go, reflect Donaghy’s ideologies. As the writer she does not even try to hide this attitude of hers and at one stage, through Ben’s mum is able to vocalise th is: ‘ Love is a wonderful thing†¦. Sex on the other hand, can be very dangerous in the hands of the young and inexperienced.’ She then goes on to say: I sincerely hope you wont’. This is in relation to Ben and Lucy’s sex life. By creating this story Donaghy tries to manipulate us as the audience to accept these ideas and her values as being right. To further shape our response towards this very strong attitude Lucy and Ben adhered to Ben’s mum’s opinion and further Donaghy’s ideologies. She developed these characters in order to express her perception of what teenage relationships should be like in her eyes.

On Education-Emerson Essay

Imaging you are the only person at a concert; now imaging yourself surrounded by other who are just as enthusiastic about the concert as you are. One may give you a certain aspect of importance, while the other could make you feel like you belong to something bigger than yourself. The situation you prefer ultimately depends on your personality, that is to say, you as an individual. Present day America has become just that, a large gathering center for individuals from all corners of the globe; the great â€Å"melting pot of the world† to say the least. With all the diversity of unique talents, ideals, beliefs, and traditions that can be found outside one’s front-door step, a few questions arise: why is individualism not sought after and praised in today’s curriculum instead of being generalized into groups as one usually is? Likewise, is our current system of education preparing young minds to be conformists while slowly killing the individual? Ralph Waldo Emerson, one of the foremost intellectuals of the nineteenth century, theorized about an education system structured around the importance of the individual as its main foundation. Emerson believed that â€Å"our modes of Education aim to expedite, to save labor; to do for the masses what cannot be done for masses, what must be done reverently, one by one: say rather, the whole world is needed for the tuition of each pupil†. To put it differently, he believed the pupil may benefit more from personalized curriculums than from an education system aimed to teach by the masses to save money, time, and labor. In my opinion, from seeing the problems with our current Education system, I feel partially inclined to agree with Emerson and his idea to distance the education system from â€Å"teaching by the masses† and focus more on the individual For one, I firmly believe that today’s education system is more focused meeting the states standards and less focused on the student itself. The amount of standards an educator has to cover over the course of the year makes it nearly impossible to make individually customized teaching plans, thus the introduction of a curriculum in which everyone learns and works at the same pace. This can come at a steep price because although exposing every student to the same lesson demonstrates fairness and indiscrimination, it may also have negative repercussions on the young and inexperienced mind. In an education system like this, the individual is not valued because he is not seen as one student but generalized and group with other, whether it is by age or grade level. In the classroom for example, we are taught the basic knowledge context that everyone is expected to know, very rarely do we see any encouragement for those who want to dive in depth into a subject or personalized assistance for those who desperately need it. From my own experienced, I have always yearned to learn more about subjects I was interested in but if one cannot do that, then going to school becomes a chore. Statistics show that 8,300 high school students drop out each day (â€Å"High†). According to Buzzfeed, an online website, one of the top 5 reasons High School Students drop out is because they start finding classes uninteresting and the same can be said for college student. When the classes get dull they start centering their life’s around their jobs and eventually drop out to go in the pursuit of money. We have statistics and the reasons for the large amount of dropout backing up the fact that there is something wrong with today’s education system, yet appropriate measures to adjust the education system aren’t being made; the personal interest and curiosity of the student are not being met to inspire ones desire for knowledge. In addition to the lack of time, the reason for why individuality is not valued is due in part to the poor teacher-to-student ratio which does not do the creative mind just. Everyone needs space to think; however, we seem to be cramming in as many students as we can into one classroom, widening the teacher-to-student ration even further. One cannot master the lesson at hand if there is still a â€Å"shaky† foundation from the previous lesson due to the lack of sufficient assistance. With the fast pace that is required to meet all the requirements set forth by the United States, educators have little or no time to teach and assist those individuals who are in desperate need of attention, while at the same time neglecting to encourage, stimulate, and challenge those who fully grasp the material. The curriculum just doesn’t allow enough room for a student to show his creativity or stand out as an individual. Is it just to teach the same material to someone who learns at a slower pace and expect him to keep up with someone who is naturally inclined to that topic? Most would say no, yet this is precisely what the education system is doing. Consequently and perhaps more importantly, by doing so we may also be pushing one student too much while holding another individual back. I am afraid that in an attempt to educate everyone, we may be putting the individual at risk. Our current education systems have failed to comprehend that every individual is different and there is no one way to teach everyone. In short, we may be better off, as Emerson believes, to leave our traditional ways of teachings and focus on the individual. Furthermore, in my opinion the current curriculum is promoting conformism by establishing certain guidelines that encourage us to stay within the â€Å"normal† knowledge one should know. This strictness towards what is taught and what is not, what is acceptable and what is not allowed may be killing the young minds creativity and curiosity for knowledge. In essence, creating a system in which â€Å"going with the flow† is acceptable, may be leading you into a lifestyle of mediocrity. One does not have to go far to find conformism being taught at a very young age. For instance, look at your local preschool center. At an early age one is taught to walk into the classroom in a line, almost military-like, sit down and face the board like everyone else, and are even encouraged to suppress ones true desires and pretend to pay attention to the instructor. At an age where creativity and imagination is in its prime, the curriculum is already teaching one to stay within the lines while they color and goes as far as to indicate what color a certain object or person should be. What happens when a student chooses to color an object a different color? More than likely he is not praised for his creativity and his decision to stand out as an individual but scolded for not following instructions. The current curriculum might be trying to teach them disciplined but It is also preaching the idea that he is more valued when he â€Å"goes with the flow† than when he stands on his own. Is it not those that defy the â€Å"norms† who create the foundation for new styles and those few who think â€Å"outside the box† who move our society forward yet that sort of thinking is not promoted in the curriculum. I take a look at myself, and my college experience and notice conformism is a real issue. I see fellow peers do the minimum required of the instructor to pass the class, with no intent to learn anything more than what is required; they have no aspiration to exceed their past grades and are perfectly comfortable being average. Very rarely does one see someone who is well-rounded in a specific subject go out of their way and learn more than what the instructor covered. Even to someone like me, who prefers to stand out as an individual, waiting till next week to learn something as a class sounds more tantalizing than researching on my own. When the thinking, as to when one will be exposed to information, is done for us there is little to motivate us to take learning into hour own hands: â€Å"people who blindly follow rules are going along with the crowd and conforming. They are doing what’s easiest and avoiding challenge and having to think† (Harrison). By not going out of our way of the normal â€Å"flow† of life and society we may be condemning ourselves to a mediocre lifestyle. James Cooper once said, â€Å"All greatness of character is dependent on individuality. The man who has no other existence than that which he partakes in common with all around him, will never have any other than existence of mediocrity†(cooper 1). Overall, I believe that by having a general curriculum dictating when and how we learn, we may be more inclined to be satisfied with mediocrity and in turn conform to the â€Å"norms† of society. In conclusion, I strongly agree with the belief that educating the masses means slighting the individual (Emerson). The current Education system was intended to teach the masses, with respectable and admirable intents, but the system may have come too far and established an environment where creativity and individualism is a rare sight to see. There are some deep concerns with â€Å"teaching the masses† that I believe should be dealt with immediately if one wishes to move along as a society and bring to the world a new era of radical and critical thinker; that is to say, people who challenge and change the way we view the world. First off, the education system should allow for a sufficient margin of time so the educator may make certain adjustment to the curriculum based on the necessity of the students at that moment. Enough time is needed so the pupil may learn his natural pace and build his knowledge on a strong foundation. As for the intellectuals in the classroom, they should be given special modifications to the curriculum that may continue to challenge and grab his interest. Secondly, in an education system where everyone is taught the same, the speed and expectations of the classroom will almost always be that of the slowest person. This may be problematic because when you live your life doing only average work, you will conform to the idea that mediocrity is acceptable and life a life of mediocrity; never realizing your true otential. With all things considered, the ideal education system is one where its main focus is not inclined towards completing the curriculum, but one where teaching for the masses can inspire creativity in the individual by collaboration and competition with fellow peers. Overall, I agree with Emerson and I find it absolutely necessary for the education system to slowly distance itself from our present day curriculum and start focusing more on the individual to promote creat ivity and individuality.

Pathophysiology Paper

Running Head: Integrated Pathophysiology Integrated Pathophysiology Paper Confidential RNSG 2463 Instructor Date Integrated Pathophysiology 2 Patient Data Mr. F. is a seventy-three year old Caucasian male who is twice divorced and lives alone in Sweetwater, Texas. He has two children living, and two deceased children. Both of his parents are deceased; his father died at the age of sixty-nine of prostate cancer, his mother at the age of seventy-two of a stroke. He is self-employed, owning a local dirt contracting company for about thirty years now. Mr. F. tands five-foot and nine inches tall and weighs two hundred sixty pounds, exhibiting moderate obesity and has been for the past twenty-five years. He has a longstanding history of hypertension; approximately twenty years as well as a history of diabetes mellitus type two for twelve years, never having been insulin dependant. He has a smoking history of about fifty years smoking two packs per day and has been diagnosed a few years ago with chronic obstructive pulmonary disease, making him oxygen-dependant for two years. He claims to only drink alcohol on a social basis.Prior to his current admission, he stated that he has not been compliant with his diabetic diet, that he does not check his blood glucose regularly nor has he been following his medication regimen as he should. His last doctors appointment was two years ago. On July 6, 2008, Emergency Medical Services was called to Mr. F. ’s residence by a friend who found him in bed, conscious, but speaking incoherently. He had a nasal canula in place at three liters per minute. His glucometer done by emergency personnel showed a blood sugar of thirty-six.He was then given a bolus of dextrose fifty percent; he then returned to consciousness, but complained of some right arm and leg weakness. He had 3+ pitting edema bilaterally to lower extremities as well as 1+ presacral edema. He was then transported to Rolling Plains Memorial Hospital emergency room. Upo n arrival to the hospital, his vital signs were as follows; blood pressure- 200/103, heart rate- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per minute. His right sided weakness seemed to resolve per patient.He denied headache, vertigo and tinnitus. Diagnostics done at the emergency room showed a white blood cell count of 7. 8, hemoglobin of 12. 4, hematocrit of 37. 2, MCV of 95, and the platelet count along with coagulation studies showed to be normal. His renal function was abnormal at a BUN of 68 and a creatinine of 6. 1. His potassium level was 5. 4 and CO2 was 22. 3. His sodium level was 133, phosphorus levels were elevated at 6. 1, globulins were elevated at 4. 3, troponin level was slightly elevated at 0. 14 and CPK was normal. His BNP NT-Type was extremely elevated at 9674. along with his hemoglobin A1C was at 5. 8. Thyroid studies were Integrated Pathophysiology 3 found to be normal. The total cholesterol was 127, with HDL only at 24, LDL at 79 and triglycerides at 136. A further diagnostic study revealed by way of chest x-ray has shown cardiomegaly with mild venous congestion. The EKG shows poor R wave progression and nonspecific ST wave changes from previous. The echocardiogram showed 2+ mitral valve regurgitation with mild aortic stenosis and also an ejection fraction of over 50%. A renal sonogram shows diffuse cystic changes.A CT scan of his head revealed mild white matter changes but no other abnormalities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190. 3. The patient denied problems with urination such as frequency, urgency, dysuria, recurrent urinary tract infections or renal stones. Home medications included; Potassium chloride 10 mEq t. i. d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b. i. d. for a total of 20 mg daily, Albuterol inhaler, Furosemide 80 mg in the am and 40 mg in the pm. Mr. F. was admitted into the intensive care unit from the emergency room.Diseases/Pathophysiology Mr. F. ’s current disease processes are long-standing hypertension, obesity, COPD, Diabetes mellitus, chronic renal failure, and congestive heart failure. Hypertension is defined as a blood pressure greater than 140/90 mm Hg (Ignatavicius & Workman, 2006). It is caused by increases in cardiac output, total peripheral resistance, or both. The cardiac output is the volume of blood that is ejected by the heart each minute. Peripheral resistance is a resistance to the flow of blood out side of the heart. It can be considered either primary or secondary.Primary hypertension has no known causative factors other than relation to genetic predisposition, obesity, stress, increased alcohol intake, diabetes, and or sodium and water retention in which all increase the total workload of the heart and increase fluid volume with in the vascular space (Zerwekh, Claborn & Gaglione, 2006). Secondary hypertension is elevated blood pressure with a n identifiable cause that may include but not limited to; renal stenosis, congenital heart defects, Cushing’s syndrome, pheochromocytoma, untreated sleep apnea, MAOIs, chemical stimulants such as cocaine, methamphetamines etc. or pregnancy induced (Zerwekh, Claborn & Gaglione, 2006). Obesity is a disease within many diseases with many varying causes. According to Ignatavicius and Workman (2006), an obese person weighs at least 20% above the upper limit of the normal range for ideal body weight and refers to an excessive amount of body fat in which can be distributed differently and cause an array of problems according to the distribution, Integrated Pathophysiology 4 especially android obesity with excess fat at the waist and abdomen; this pattern carries the greatest health risk.Chronic Obstructive Pulmonary Disease is a progressive and irreversible condition characterized by diminished inspiratory and expiratory capacity of the lungs (Mosby’s, 2002). Emphysema along with chronic bronchitis is complications that lead to COPD. The etiology is more often than not, a long history of smoking cigarettes or other forms of smoking tobacco. The lungs lose elasticity and tend to cause hyperinflation due to the alveoli in the lung losing its elastin, in which then narrows and produces a surface area that decreases and is no longer functioning properly for adequate gas exchange.The accumulated air that is unable to be absorbed properly becomes trapped and causes the collapse of the smaller airways called bronchioles. With the lungs hyperinflated, this flattens the diaphragm, thus causing the individual to utilize accessory muscles to breath, increasing the respiratory rate to compensate. Patients with COPD have bouts with chronic bronchitis which is an inflammation of the bronchi and bronchioles triggered usually by tobacco smoke.The irritants from the smoke cause inflammation, with vasodilation, mucosal edema, and bronchospasms; the increased inflammation increases the size of the mucosal glands and produce large amounts of thick mucus, causing the bronchial walls to thicken and impair airflow (Ignatavicius & Workman, 2006). Diabetes Mellitus comes in many forms; the main characteristic is elevated blood glucose due to complications in the insulin secretion or action or both (Ignatavicius & Workman, 2006).When diagnosed with diabetes other than type one, the beta cells in the islets of Langerhans that produce insulin and the alpha cells that produce glucagon, which counteract one another, either decrease in production of these hormones or can possibly produce at a normal balance. If there is normal production of these hormones, mainly insulin (the hormone that transports glucose into the cells), it is usually cellular resistance to insulin that is causing the diabetes.When the cells are not receiving the necessary glucose needed for cellular function and metabolism, the body is unable to utilize the glucose, store carbohydrates, fat s and proteins; therefore the unused glucose remains in the blood causing hyperglycemia and regulatory mechanisms in the body tend to cause the release of more glucagon which cause the release of stored glucose in the liver into the bloodstream as well, therefore increasing the blood glucose level even more. Homeostasis is Integrated Pathophysiology 5 nterrupted, systemically causing damage. The etiology of type two diabetes can be a combination of many factors; however the well known contributor is obesity. Chronic renal failure is a progressive, irreversible kidney injury, and kidney function does not recover (Ignatavicius & Workman, 2006). The kidneys are in charge of filtering the metabolic wastes in the bloodstream that comes from cellular metabolism throughout the body as well as reabsorption of necessary electrolytes.When long-term damage is sustained in the cells of the kidneys (nephrons) by factors such as longstanding hypertension, function is progressively altered exhibit ed by the inability to excrete the nitrogenous wastes; therefore they accumulate in the kidneys and blood stream. Altered glomerular filtration rate, abnormal urine production, poor water excretion, electrolyte imbalances, and metabolic abnormalities occur as a result of renal failure. The body’s ability to dilute urine is decreased; therefore urine output decreases causing fluid overload.The failure occurs in stages with the last being end-stage renal disease in which all renal function eventually ceases. Congestive heart failure also known as left-sided heart failure may result from hypertensive coronary artery and valvular diseases arising particularly from the mitral and aortic valves. When CHF occurs from any etiology such as systemic hypertension and structural changes, the ventricles of the heart are unable to contract and or relax properly causing blood to congest around the heart.As a result of this congestion in and around the heart, tissue perfusion diminishes and blood accumulates in the pulmonary vessels. Cardiac output eventually decreases and compensatory mechanisms such as sympathetic nervous system stimulation, the renin-angiotensin system activation in the kidneys (RAS), other neurohumoral responses and myocardial hypertrophy will occur (Ignatavicius & Workman, 2006).The hypoxic state of the tissues stimulate the nervous system which increases the heart rate and blood pressure due to vasoconstriction and this stimulation increases venous blood return to the heart, which in turn stretches the myocardial fibers causing dilation and eventually thickening of the walls of the heart and chambers within it, consequently causing enlargement (cardiomegaly). The heart then tries to contract harder and eventually exhausts and reduces the force of the contractions; therefore decreasing cardiac output.The vasoconstriction of the arteries increases the afterload which is the resistance that the heart must pump. This low output causes a decrease in b lood flow to the kidney’s which results in the activation of the RAS in turn causes sodium and water retention. Cardiac preload and afterload increase causing contractile dysfunction. Integrated Pathophysiology 6 Integration Mr. F. reported that he has been obese for approximately twenty-five years. A few years after the significant weight gain, he was diagnosed with hypertension.At his own admission, his lifestyle of high fat, cholesterol, salt and sugar intake as well as a long history of smoking cigarettes left little to be desired and have contributed significantly to his current condition. Several years after having been diagnosed with hypertension, he was told he had diabetes and COPD. Upon his recent hypoglycemic episode, he was diagnosed then as having chronic renal failure with congestive heart failure. All of these diagnoses tie well in together, starting with obesity. When a person is obese, the excess weight, especially around the waist and abdomen as seen in Mr.F . causes the workload on the heart to increase due to the excess adipose tissue surrounding the visceral organs and weight in general. Being obese puts one at high risk factors for developing hypertension and heart disease as Mr. F. has. Obesity also places one at high risk for developing diabetes type two due to the fact that adipose tissue and cells that accumulate have a high tendency to become insulin resistant as well as the surrounding cells and tissue; therefore the body can not utilize the glucose and hyperglycemia occurs.A prolonged period of insulin resistance eventually leads to the beta cell failure causing decreased insulin production. The same high fat, cholesterol, and sodium diet that contributed to the patient’s obesity in the first place, causing his heart to have to work harder, more than likely caused him to develop hypertension. The fact of his non-compliance with his medication regimen for hypertension and diabetes, 100 pack per year smoking habit as wel l as noncompliance with prescribed diabetic diet, lead to his further complications of renal failure and lastly CHF.With prolonged hypertension and particularly uncontrolled diabetes mellitus, diabetic nephropathy changes the kidneys in a way that reduces kidney function and eventually, renal failure. Chronic high blood glucose levels cause hypertension in kidney blood vessels and excess kidney perfusion (Ignavicius &Workman, 2006). This increase in pressure within the kidneys cause the blood vessels to leak out that allows large particles such as albumins and proteins to form deposits in the kidneys and their blood supply.This narrows the vessels and decreases oxygenation to surrounding kidney tissue; therefore causing hypoxia and eventually irreversible cell death. As this progresses, scarred tissue forms and the ability to filter urine from the blood ceases causing renal failure. Once in renal failure, the patient’s kidneys were not able to regulate the fluid volume by ade quate excretion, therefore the excess fluid was pooled back into the vascular Integrated Pathophysiology 7 space. This fluid volume overload caused an increased cardiac workload which eventually leads to congestive heart failure.Mr. F. ’s smoking history was the primary cause of his COPD; however it is exacerbated by the collection of fluid in his vascular space due to renal failure, the loss of elasticity of vascular system and congestive heart failure. The medication prescribed for Mr. F. ’s diabetes was Metformin 500 mg daily. This medication primary action was to decrease hepatic glucose production. The excess insulin in the blood triggers production of glucagon in which signals the liver to release stored glucose, in turn hyperglycemia results. This medication was changed due to Mr. F. s elevated BUN and creatinine which is where this medication is metabolized and excreted as well as his state of CHF. Continuing this medication could cause toxicity. The new medica tion he was placed on was a low dose of Actos which is metabolized in the liver and does not cause hypoglycemia as Metformin may. To treat his hypertension, Nifedipine was prescribed and it acts to lower blood pressure by inhibiting calcium transport into myocardial cells and smooth muscle cells within the vascular space resulting in vasodilation counteracting the vasoconstriction caused by hypertension.In addition to Nifedipine, the patient is prescribed an ACE inhibitor named Ramipril. This ACE inhibitor works on the renin-angiotensinogen system ultimately causing systemic vasodilation. This medication not only decreases the blood pressure, it decreases cardiac afterload in patients with CHF. Ramipril is metabolized in the liver, therefore indicated for patients at risk or in renal failure. Furosemide is a loop diuretic that is especially helpful in patients with edema due to hypertension, renal disease as well as CHF.Furosemide increases the renal excretion of water as well as so dium and other electrolytes, thus reduces the fluid volume in the vascular space. It also has a vasodilating effects that are beneficial in this patients regimen; however a potassium supplement must be given due to the potassium wasting caused by this loop diuretic. This patient’s dose of Furosemide was significantly increased due to the necessity of ridding his body of the accumulating fluid and stabilizing his blood pressure which in turn will prevent further damage to his kidney’s. Potassium is necessary for proper contractility of the heart.Mr. F. is on Potassium chloride 10 mEq t. i. d. to make up for the loss due to the loop diuretic effects. The Albuterol inhaler is used to dilate the bronchi thus increasing surface area of the air ways to enable oxygen and CO2 exchange. This inhaler can exacerbate hypertension, palpitations and have a negative cardiac effect as well as cause hyperglycemia; therefore must be used cautiously. Integrated Pathophysiology 8 Predicti on of Outcomes Although Mr. F. ’s acute condition was stabilized, his prognosis appears poor at this point due to his history of noncompliance.Even though he has decreased his cigarette habit to one pack per day, his condition will probably deteriorate unless he could totally abstain from smoking. While speaking with the patient, he assures that this has got his attention and he will remain compliant from here on out. The damage at this point is irreversible; therefore maintaining remaining function as it is now becomes a new priority, meaning that compliance is necessary at this point for this patient as continuing to be noncompliant will definitely lead to his demise.Aggressive diabetic counseling as well as reinforcement of adhering to his current medication regimen is crucial for this patient’s survival. Other disciplines that should be involved to ensure a better prognosis for Mr. F. are ones such as a dietician to help with meal and snack planning per diabetic pr otocol, continuing respiratory therapy to aid in oxygenation and supplies, physical therapy to build the patients strength and prevent venous stasis hence blood clots, and maybe even occupational therapy to assist him with maintaining independent activities of daily living.Routine follow up appointments with his physician as well as specialist for cardiac and pulmonary function are essential to his outcome. A diabetic support group would be ideal for this patient as he appears to be a person in need of a support team. Lifestyles are hard to modify, but when one gets backed into a corner, it can be done, even in the most noncompliant patients otherwise death is imminent. Integrated Pathophysiology 9References Deglin, J. H. & Vallerand, A. H. (2007). Davis’s Drug Guide, Tenth Edition. Philadelphia: F. A. Davis Company. Ignatavicius, D. D. & Workman, M. L. (2006). Medical Surgical Nursing, Critical Thinking for Collaborative Care. St. Louis: Elsevier Saunders. Mosby’s Med ical, Nursing, & Allied Health Dictionary (6th ed. ). St. Louis: Mosby, Inc. Zerwekh, J. , Claborn, J. C. & Gaglione, T. (2006). Mosby’s Pathophysiology Memory Notecards, Visual, Mnemonic, and Memory Aids for Nurses. St. Louis: Mosby, Inc.