Gestational Diabetes Mellitus

Gestational Diabetes Mellitus In order to ensure that the outcome of the pregnancy is the best for mother and baby, a routine is undertaken which is embraced by the term Ante Natal care. Ante natal care is simply caring for the mothers before labour and delivery and also preparing the mothers fully for delivery because of safe motherhood. This can only be achieved by if mother is seen early preferably before the 10th week and at regular intervals thereafter. In this essay, I will be discussing one of the factors which are (GDM) gestational diabetes mellitus which affects the normal physiological pregnancy state. Gestational diabetes mellitus (GDM) is defined as carbohydrate in tolerance resulting in hyperglycaemia of variable severity with its onset and first recognition during pregnancy. Insulin is an essential hormone required for glucose transfer into the muscle and adipose tissue cells. For women with diabetes mellitus, pregnancy can present some particular changes for both mother and the child. If the woman who is pregnant has diabetes, it can cause early and very large babies (Macrosomia). Management of pregnant mothers with diabetes needs very firm and accurate control even in advance of having pregnancy. There are question whether the condition is natural during pregnancy or not. Gestational diabetes is caused when the insulin receptors do not function properly, due to pregnancy related factors such as the presence of human placental lactogen that interfere with susceptive insulin receptors. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied, so may be a natural occurrence (Littleton, 2005,). During a normal pregnancy, many physiological changes occur such as increased hormonal secretions that influence blood glucose levels, such as glucose – drain to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin. Moving further, I as the ante-natal clinic nurse will first try to collect as much information as I can from the patient. During her 12th week of gestation, Mrs. B came for her ante natal case booking. She was already 3 months and this was her initial visit to the ante natal clinic. I booked Mrs. B by obtaining subjective data from her. I as the nurse, firstly I offered her seat so that she can sit in level with me. After that I took her personal history after greeting the client. She was feeling ease and welcomed. I communicated with her in English because she was able to understand and I also kept in mind that level of education might be low so I used simple interpretations of facts. Her first impression was very good because she was a Primip-gravida and she looked happy and relaxed. Her physical characteristics were good, because (posture) she was sitting comfortably and even she was working normally without any problem (gait). She looked health during her first visit to the clini c. After this observation during interview, I had taken her full personal history. Her full name is Mrs. B. She was born on 15th of April, 1989 at Labasa Hospital. Her age now is 24 years. Just because she is Fijian, I did not ask for her father’s name, nevertheless, she is married to a Fijian, 25 year old businessman. She is a primary school teacher. Her husband’s name is Mr. C and they reside in Namara, Labasa and both of them are Methodist. Both have attended tertiary institutions and are well educated. She gave her husband’s name and phone number for emergency purpose. Secondly, I obtained Mrs. B family history. Not much information was given by Mrs. B because her parent and grandparents were of Fijian origin and they lived in village. Her mother had diabetes only. Thirdly, I took the medical history of Mrs. B, according to her she is not having any medical problems and she was never admitted before for any illness. Mrs. B is only allergic to penicillin anti biotic. In her social history, it is interesting to know that this would be their first child in the family, so no case of negligence or overcrowding in the home. They both, husband and wife earn enough for their upcoming family. She is not a teenager and has a good age for first child bearing. She is physically, psychologically and financially strong to mother a child. They live in a concrete and iron roofing house and they reside in an industrial area. They both neither smoke nor consume alcohol or drugs. She did not have a surgical history. She did not have any abdominal, pelvic, cardiac surgeries or either injuries. I did not ask anything about her previous obstetric history because this was her first pregnancy. As a nurse, I asked her about any abortionsmiscarriage but Mrs. B said no because they used family planning devices before so she did not had any abortions and miscarriage. There was no gynaecological history for Mrs. B. Her menstrual history, she has menses which last f or 3 days- 4 days. She was fourteen years when she had had her first menses (menarche). Just because Mrs. B was 12 weeks pregnant, I did not ask her about on set of movement but calculated her expected date of delivery (EDD). Her last menses occurred on 17th of February until 20th of February. It is a four days regular flow according to Mrs. B. So her expected date of delivery would be seventeen plus seven and add 9 months from indicated date, so that will be on 24th day of November. After this assessment, I did the physical examination of Mrs. B. Firstly, I took Mrs. B height and it was 168cm, her weight was 62.5kg and to notice difference in her weight, it had to be taken on every visit. Mrs. B urine test was done for protein and glucose, mid stream specimen was taken and this was done in all the visits to get the results from laboratory. Her blood pressure was taken. Blood test was also done for emergencies and surgical procedures. As a nurse, we also checked for edema. This may not be seen during initial visit but as pregnancy progress it can be noticed. All this assessments and examinations were done by two nurses since I had to have a female nurse since I was interviewing a female client and received a lot of information about Mrs. B and her health. This also built a foundation of a trusting relationship. In addition to this, a goal of antenatal care is equally important because this acts as guidance in caring for the antenatal case holistically. Firstly, the aim that is to monitor the progress of pregnancy in order to support the maternal health and normal fetal development and to ensure that the mother reaches the end of pregnancy in a healthy state and delivers a healthy baby. Nurses and midwives are the best people to detect the problem early, diagnose it and treat the problem before progression of labour and delivery. More of our aims include identification of women at risk. As a nurse you must educate clients at high risk pregnancy on their medications, follow-up, nutrition and exercise, so that they can get a positive result. To assess levels of health by taking a detailed history and to after appropriate screening test. Ask to identify risk factors by talking accurate details of past and present obstetric, medical, family and personal history. Another aim is to provide a good opportunity for the women and her family to express and discuss any concerns they might have about the current pregnancy and previous pregnancy loss, labour, birth or pueperium.. Lastly, the most vital is the delivery of the healthy term infant without signs of distress or any abnormality. Furthermore, the nurse’s role independently in managing for the gestational diabetes mellitus women are broad and as follows. A nurse must carry out a proper procedure when dealing with a GDM mother so that she and the infant’s risk of complications are reduced. Firstly, a nurse must obtain baseline data from the patient. Secondly, I carried my nursing assessment on Mrs. B, I took her vital signs. This was very much important because an increase in blood pressure and weight may be a sign of PIH, which is a frequent complication associated with diabetes. After that I asked Mrs. B about her gestational age because it assists in managing pregnancy and planning timing and method of delivery. Apart from this ultrasound examination was also carried out on Mrs. B for abnormalities, confirm age of gestation, and monitor the size and weight of fetus. Uterine size, fetal activity, fetal heart rate evaluate and reflect fetus status and well. Other intervention which I carried out independently was to monitor blood sugar level frequently, as this was checked more often than usual according to the doctor. Also I made sure that each time when checking the blood sugar level a proper record of the result and presented to the health care team for evaluation and modification of the treatment. Many may need extra insulin during pregnancy to reach their blood sugar targets since insulin is not harmful to the baby. During her one of the clinic, Mrs. B was examined routinely and was found that there was glucose in the urine and the blood system level was above targets. I gave insulin therapy to control the sugar further. Also I advised on the meals, to cut down sweets, eat three small meals and one to three snacks a day, maintain proper meal times and include balanced fibre intake in the form of fruits, vegetables and whole grains. Mrs. B attended her clinic when she was 24 weeks, after examining Mrs. B, her blood glucose level was not in control as a result. So we had to admit Mrs B to the ante natal ward for insulin therapy. The aim here was to stabilize the blood glucose level. Mrs. B was admitted. I explained her about the ward, orientated about the ward protocols, meal hours and the special diet which she will have. The first 2 to 3 days, 4 point was done to find out if patient should be adequately controlled on diet, if not then insulin was recommended. Mrs. B was supposed to have 4 points procedure, so I kept her on nil by mouth post midnight. Blood specimen one was collected at 7am, then patient to have breakfast. Specimen 2 was taken at 9.30am. Specimen 3 was taken at 1.30pm and 4th one was taken at 6.30pm. Moreover, the health care team as a whole had collaborative role towards care of the pregnant mother who was reaching 26 week gestation. Effective ante natal care for women with diabetes mellitus should be provided by a multidisciplinary team in a joint diabetes and antenatal clinic (Fraser, 2009). The woman is seen often as required in order to maintain good glycaemia control. Treatment depends on the blood glucose levels. The midwife should involve both the diabetic nurse or (midwife) specialist and dietician in dietary interventions. Mrs. B was advised by the dietician about nutrition; ideally diabetic women who anticipate pregnancy will follow a prescribed well balanced dietary regimen before conception and will be in a state of good metabolic control. The dietician advised Mrs. B on the caloric requirement for the normal weight client is 35 calories per kilogram. Doctors advised Mrs. B on insulin treatment. Physiotherapist advised Mrs. B on importance of moderate exercise during pregnancy example walking, swimming because it helps lower blood glucose level this decrease need for insulin. Also Mrs. B was advised by the doctor on other medical management such as oral metformin medications. Nurses should also monitor blood glucose on a regular basis throughout pregnancy. So counselling before pregnancy (for example about preventive folic acid) and multi disciplinary management are important for good pregnancy outcome. Moreover, highlighting the reasons for the interventions carried out gives an idea that why this particular nursing intervention on Mrs. B who was diagnosed as gestational diabetes. Firstly as a nurse, I identified Mrs. B at GDM risk. It was better that her problem was identified earlier or else if she would not have been attending her clinics there would have been increased risk for hyperglycaemia, infection, pregnancy induced hypertension and also hydramnios. Since Mrs. B was diabetic, the infant would have been at high risk of macrosomia and also congenital abnormalities. All this would have lead to difficulties in vaginal deliveries. Secondly, baseline vital signs, height, weight should be monitored in every subsequent visits. Blood pressure was taken when I asked Mrs. B to lie in a left lateral position so that an accurate reading was achieved. Mrs. B was also monitored by (sonography) ultrasound examining subsequently during her visits for fetal abnormalities, confirmation of g estational age and also to monitor size and weight of fetus. Activity (kicking) fetal movement was also maintained by nurses to find that fetus remains active. Collaboratively, urinalysis, culture and sensitivity were done to detect asyptomatic bacteriuria, a precursor to event pyelonephritis, to which the diabetes is especially prone. Midwives also performed a fundal examination, initially and subsequently atleast once a trimester for Mrs. B to detect any vascular changes accompanying diabetes. Mrs. B was also advised by the dietician on nutrition and hydration to maintain blood glucose targets to normal. Client knowledge about self monitoring by the midwives allows the development of an appropriate teaching plan to ensure compliance and minimize risk of complications. Mrs. B was also educated on support system and services because of the high risk of the pregnancy so that necessary support system and assistance can be obtained. Psychosocial and economic factors with special consid eration to the parental stress evoked by the high risk pregnancy was explained to her so that she does not take too much stress which can lead to high risk pregnancy, research has shown that gestational diabetes experience more stressful responses than pre gestational diabetics for all aspects of the medical regimen (Perry, (2006). 4 points procedure was done on her following the glucose tolerance test for the proceeding of insulin therapy. After insulin therapy Mrs. B was discharged and called for her clinic subsequently to detect whether blood glucose was maintained or not. During her visits, the midwives performed abdominal examination, vaginal examination and fundal palpation to establish and affirm that fetal growth is consistent with gestational age during progression of pregnancy. This was done to detect fetal growth, fetal lie, fetal presentation etc. When Mrs. B was 35 weeks, during her clinic it was found that the blood glucose level was maintained, there was no glucose in urine and no other signs as before due to gestational diabetes two which was medically controlled. To sum up, later on during her 37 weeks of gestation Mrs. B was having labour pain and she was rushed to hospital with all her belongings needed together with the babies’ clothes and other things. She was admitted direct to the labour ward in the preparation room. fetal heart rate monitoring and vaginal examination was done. She was 3-4cm dilated and was taken to first stage room for further assessment on partogram and vaginal examination. The following morning she gave birth to a healthy term infant without signs of distress and or hypoglycaemia. Therefore, our strength was that we collaboratively, the health care team identified the patient at risk on an early stage that is why there was no complication during or after delivery. And our weakness lies if all the health care team do not identify high risk of pregnancy at an early stage therefore, early booking is equally very important. (Approx words:2500) References Brown, D., Edward, H. (2005). Medical-Surgical Nursing: Assessment Management of Clinical Problem. Australia: Elsevier. Crisp, J., Taylor, C. (2013). Potter Perry’s Fundamentals of nursing (4th ed.). Australia: Elsevier. Fraser, D, M., Cooper, M, A. (2009). Myles Textbook for Midwives (15th ed.). Australia: Elsevier. Perry, L. (2006). Maternity Nursing (7th ed.). Australia: Elsevier. Mc Kinney, E., James, S., Murray, S., Ashwill, J. (2005). Maternity Child Nursing (2nd ed.). Australia: Elsevier. Littleton, L, Y., Engebretson, A. (2005). Maternity Nursing Care. USA: Elsevier. 1

Hinduism and Death Essay -- essays research papers

Each month our educational center section provides the Hinduism Today staff with a 'kind of group meditation. Individually we ponder our subject, and together we discuss it in detail. These past 30 days our meditation was on death. You might think we had a morbid March. Not so, since, as U.S. General George Patton rightly noted, "For Hindus death is the most exalted experience of life." This idea is sometimes hard for non-Hindus to grasp - especially for atheists facing Eternal Oblivion and for those of the semitic faiths which define death as a kind of punishment for man's sin and disobedience. According to this view, death is the ultimate sign of man's spiritual failure, a belief which understandably arouses instincts of denial and injustice. We may feel shamed, penitent, guilty and graced, not to mentioned frightened. And that's a long way from exultation. No such thoughts attend the dying and death of a Hindu. Of course, there is much sadness surrounding the passing of friends and family, but that is honest acknowledgement of our love and attachment to life and to each other. Inside we know that death is OK, it is natural. Inside we know that the soul, even if it was less than perfect in this life, is continuing its appointed journey toward Liberation and will, in time, reach the other shore. Such knowledge is reassuring, whether the death is another's or our own. Thus, Hindus called death by a lofty name - Maha Samadhi, "the Great Superconscious State." And to be near an awakened soul at the time he or she gives up the body is considered one of the most auspicious and blessed of opportunities. If we see death as the opposite of life, then life is good and death is bad. But if we see life and death not as hostile but as collaborative parts of a greater whole called samsara (the cosmic evolutionary cycle of birth-death-rebirth), then life is good and death is also good. Both are part of the Cosmic-What-Is. That being so, the pious Hindu approaches death as a mediation and a sadhana, as a spiritual opportunity. The physical body's impending demise compels him to practice detachment which yogis find easy but which is so difficult to achieve in the tumult of life. Yama's nearness brings an urgency to strive more than ever, to plunge deeper into consciousness in a renewed search for the Divine Self. No longer can he put it off. No mor... ...ht by fighting medical and legal battles in growing numbers. Death is personified in most cultures. The Greeks called him Thanatos, and to the Romans he was Mors. IN India he is Yama, riding on a black water buffalo, green in color, dressed in red. The pigeon and owl are his messengers, his weapon is a mace. He carries a noose, called kala-sutra or "black threat," with which he snares the life force, prana, and draws it from the body. He is also called Mrityu, "death," Kala, "time" and Dharma Raja, "King of Justice." There is much to be said of the Hindu insights on death, and only a fraction of it fit into the four pages you will find at the center of this issue. We intend to do more in the future and welcome readers' contributions. Our objective is to share the message of the awakened ones who conquered death and knew the body's dissolution as freedom from bondage, as liberation into the Light, as a flowing of the finite into the Infinite. They asked us to think fearlessly about death, to fathom its meaning. They urged us in exiting life to let go of the ego and be the immortal Self which time and again shrugs off the shackles of sorrow.

Map the Supply Chain Paper Essay

Introduction Prior to developing a supply chain map, it is important to identify and understand the nature of the plan, the importance of mapping, and the role the map plays in the strategy. The supply chain represents all companies that are in contact with a particular product. The supply chain is a network, which outlines the steps it takes to get a good or service from production to the final customer. The map links strategic processes of a firm to facilitate the evaluation of supply chain structure. In short, the supply chain categorizes the responsibilities of the manufacturer, distributor, dealer so duties avoid overlapping or duplication. The goal of a supply chain is to become more effective and efficient, which gives a competitive advantage over other competing supply chains. The following will map the supply chain of Pepsi-Cola beverage. The map will illustrate the process of manufacturing the product and continue until the retailer passes the product to the consumer. In the preceding supply chain map, the manufacture and distributor are both part of PepsiCo. The retailer makes up all grocery stores, convenience stores, and mass merchandise stores. Manufacturer Pepsi-Cola beverage is a favorable soft drink beverage that drinkers have become accustomed to its unique flavor. In order to ensure product consistency, around the world, manufacturing must follow strict guidelines. These guidelines include the quality of raw materials, ensure packaging meets company standards, finished product quality meets specifications, and ingredients are similar. To provide consistency in product quality is crucial to outline the supply chain tasks for the manufacturer. The functions of the manufacturer are specific to product quality, packaging, and shipping a high quality finished product to the operations facilities. Following the supply chain map in manufacturing outlines the duties of  manufacturing that ensure the product formula is identical regardless of which manufacturer produces the product. sources raw materials, such as sugar and aluminum for cans designs the packaging and graphics determines the proper ingredients and quantities regularly calibrates and calculates the formula throughout production produces the product and ensures quality introduces new products based on customer demands ships product to sales operations Distributor The next step in the supply chain map is the distributor. Once the distributor receives the product from the manufacturer, they allocate the quantities based on retailer needs. The distributor uses their relationship to secure product displays, write product orders, extend short-term credit to the retailer, and delivers product to the retailer. Pepsi-Cola distributors also supply manpower to ensure the product makes it to the shelf is maintained daily. The product chain tasks break down the required steps a distributor is responsible for. These tasks provide efficiencies and are assigned to make sure there is zero overlapping between the manufacturer and distributor. receives shipment from the manufacturer establishes relationships with retailers extends credit to retailers breaks down orders for direct store delivery (DSD) sale, deliver, and service product at retail location. Retailer The retailer allocates a specified amount of space for Pepsi Cola. The distributor is responsible for ordering, filling, and maintaining this space. The retailer determines products placed in advertisements, based on the distributor’s product allowances given to the retailer. The retailer also employs customer service representatives to support customer needs and provide them with the needed services to make the exchange of products for cash value. This completed process finalizes the transfer of the product to the consumer. provides shelf and display space for Pepsi Products advertises to drive consumers to the store determines product selection based on distributor’s allowances employs customer service representatives to assist the consumer processes the transaction transfers possession to the consumer In the supply chain of Pepsi-Cola beverage each company has a particular role. These functions are essential to the success of providing the product to the final consumer. A successful supply chain map designates specific tasks that each company is responsible. These tasks are specific and are meant to ensure the product makes it to their business in the most efficient and effective manner. Depending on how detailed and well thought out a supply chain map is, determines whether the plan can improve the efficiency of getting the product through each company channel. Many companies strive for an optimized supply chain because it can lead to lower costs for the enterprise. Other purposes of an optimized supply chain are to eliminate issues when product flows between businesses and to create a standard throughout the global market.

50 Greek and Latin Root Words

In English grammar, a  root  is a word or portion of a word from which other words grow, usually through the addition of  prefixes and suffixes. By learning root words, you can decipher unfamiliar words, expand your vocabulary, and become a better English speaker.   The Roots of Words Most words in the English language are based on words from ancient Greek and Latin. The root of the word vocabulary, for example, is ​voc, a Latin root meaning word or name. This root also appears in such  words  as advocacy, convocation, evocative, vocal, and vowel. By dissecting words such as these, etymologists can study how a word has evolved over time and tell us about the cultures they came from. In some cases, root words might be slightly transformed en route to becoming part of words that were familiar with. In the above example, vowel is a word thats clearly related to the voc root and its family of derivative words, and yet the c in voc is not present. There are several reasons for this sort of pattern, and the changes often depend on what language each individual word comes from, but it serves as a reminder that not every word with the same root will look exactly the same. Root words are also useful for creating new words, especially in technology and medicine, where new innovations occur frequently. Think of the Greek root word tele, which means far, and inventions that traverse long distances, such as the telegraph, telephone, and television. The word technology itself is a combination of two other Greek root words, techne, meaning skill or art, and logos, or study. Because several modern languages share some of the same ancestor languages, its not entirely uncommon for several related languages to share root words. For instance, the Latin root voc, described above, is shared by several Romance languages. Connections between languages can be found in the shared roots between them, although one always has to be wary of false cognates - that is, words that sound like they have the same roots (and thus related meanings) but actually dont. Greek Root Words The table below defines and illustrates 25  of the most common Greek roots. Root Meaning Examples anti against antibacterial, antidote, antithesis ast(er) star asteroid, astronomy, astronaut aqu water aquarium, aquatic, aqualung auto self automatic, automate, autobiograph biblio book bibliography, bibliophile bio life biography, biology, biodegradable chrome color monochromatic, phytochrome chrono time chronic, synchronize, chronicle doc teach document, docile, doctrinal dyna power dynasty, dynamic, dynamite geo earth geography, geology, geometry gno to know agnostic, acknowledge graph write autograph, graphic, demographic hydr water dehydrate, hydrant, hydropower kinesis movement kinetic, photokinesis logos word, study astrology, biology, theologian narc sleep narcotic, narcolepsy path feel empathy, pathetic, apathy phil love philosophy, bibliophile, philanthropy phon sound microphone, phonograph, telephone photo light photograph, photocopy, photon schem plan scheme, schematic syn together, with synthetic, photosynthesis tele far telescope, telepathy, television tropos turning heliotrope, tropical Latin Root Words The table below defines and illustrates 25  of the most common Latin  roots. Root Meaning Examples ab to move away abstract, abstain, aversion acer, acri bitter acrid, acrimony, exacerbate audi hear audible, audience, auditorium bene good benefit, benign, benefactor brev short abbreviate, brief circ round circus, circulate dict say dictate, edict, dictionary duc lead, make deduce, produce, educate fund bottom founder, foundation, funding gen to birth gene, generate, generous hab to have ability, exhibit, inhabit jur law jury, justice, justify lev to lift levitate, elevate, leverage log, logue thought logic, apologize, analogy luc, lum light lucid, illuminate, translucent manu hand manual, manicure, manipulate mis, mit send missile, transmit, permit omni all omnivorous, omnipotent, omniscent pac peace pacify, pacific, pacifist port carry export, import, important quit silent, restive tranquil, requiem, acquit scrib, script to write script, proscribe, describe sens to feel sensitive, sentient, resent terr earth terrain, territory, extraterrestrial tim to fear timid, timorous vac empty vacuum, vacate, evacuate vid, vis to see video, vivid, invisible ​Understanding the meanings of the common word roots can help us deduce the meanings of new words that we encounter. But be careful: root words can have more than one meaning as well as various shades of meaning. In addition, words that look similar may  derive  from different roots. In addition, a handful of root words can stand on their own as whole words in and of themselves. This list includes words such as photo, kinesis, chrome, port, and script. Words like this tend to have related meanings on their own, then can also act as roots for longer, more complex words. Sources Bryant, Alice, and Robbins, Jill. Grow Your Vocabulary by Learning Root Words. VOANews.com, 28 November 2017.Grammarly staff. Why You Should Learn Roots. Grammarly.com, 6 February 2016.McCammon, Ellen. 50 GRE Words You Should Know. PrepScholar.com, 8 February 2017.