Acute Exacerbation Of A Diabetic Foot Ulcer Nursing Essay

Acute Exacerbation Of A Diabetic Foot Ulcer Nursing Essay This paper will critically analyse the care of a patient with an acute exacerbation of a long term condition. It will address the importance of carrying out a holistic assessment and will seek to justify the care plan put in place to manage the patients condition. Confidentiality has been maintained in accordance with the Nursing and Midwifery guidelines (NMC 2008). Tom is a 72 year old gentleman who was diagnosed with type 2 diabetes 15 years ago. He was started on medication to manage his diabetes 7 years ago but due to his worsening blood glucose control he has since been converted to insulin one year ago. Tom had been independent with the management of his diabetes with support from his local GP surgery. Recently he developed an ulcer on his right foot with resultant wound infection which made him unable to attend his surgery. Due to the wound infection he had been finding it difficult to keep his blood sugar levels within acceptable limits so he was referred to my caseload for diabetes and wound management. Managing long term conditions has become a priority in healthcare particularly due to the increasing prevalence of diseases such as diabetes which requires a heavy use of resources (DoH 2007a, Singh Armstrong 2005). There is a need to encourage patients to be as active as possible in their care which will help reduce the need for hospital admission through empowering patients and promoting self care. There is evidence that patients who understand their condition through support from healthcare professionals and are allowed to contribute fully in their care will result in less incidence of acute exacerbation (DoH 2006). However there has been difficulty in providing the on-going support and care co-ordination in the community that could prevent crisis events from occurring in the first place. This has lead to a key focus on the ways that this can be achieved in practice through such services as community matrons, rapid response and 24 hour district nursing services (DoH 2007b). Relating this specifically to diabetes; the implementation of expert patient programmes and DESMOND (Diabetes education and self management for ongoing and newly diagnosed) have sought to reduce the incidence of acute exacerbations and diabetes related complications through patient education and empowerment (NHS Choices 2011a, DoH 2001a). The government have placed the care required for those with long term conditions into three main groups; case management, disease management and self care (DoH 2007b). In this case, Tom required disease management of his diabetes and self care interventions. Acute exacerbation can be defined as a medical crisis of a chronic illness (Strauss et al 1984). More recently it has been described as an acute presentation of an existing major illness (The Kings Fund 2010). In this situation Toms existing illness was diabetes and the acute presentation was the development of a diabetic foot ulcer that had become infected and affected his blood sugar control. Recent statistics show that the number of people with diabetes has risen from 1.4 million to 2.9 million since 1996 and it is expected to rise significantly over the next 15 years (Diabetes UK 2011). The research also shows that diabetic foot problems account for more hospital stays than all other diabetic related problems put together and affect between 4-10% of diabetics (NHS Diabetes 2012, DoH 2001). Preventing foot problems in diabetics has been a priority in the UK over the past 10 years which has been highlighted in government publications such as NICE guidance and the National Service Framework for Diabetes (NICE 2008, NICE 2004, DoH 2001a). Despite these publications a survey carried out in 2007 found that 23% of diabetics did not receive a foot check which has contributed to the introduction of the Putting Feet First Framework emphasising the need for appropriate assessment and management of diabetic feet (Diabetes UK 2011b). Mason et al (1999) indicate that patients who are at high risk of foot complications must be identified. The National Service Framework for Diabetes supports this view and indicates that patients must have annual foot checks and access to specialist foot care clinics with timely referrals (DoH 2001b). In my area of practice we have an integrated care pathway in place for diabetic foot wounds that aims to provide the patient with optimal care. An integrated care pathway involves a multidisciplinary approach for a specific condition that aims to ensure a seamless approach to care and helps healthcare professionals make clinical decisions (Middleton, Barnett Reeves 2001). As soon as Tom was under my caseload, I referred him straight away to the local diabetic foot clinic as the NICE guidance for foot care states that patients with an ulcer should be referred within 24 hours (NICE 2004). It was important that Tom received specialist input quickly as he currently had a localised infection which placed him at risk of systemic infection and amputation if the infection was not resolved (Edmonds Foster 2006). The foot clinic consisted of a team of podiatrists, Clinical Nurse Specialists in Diabetes, a Dietician and a Diabetologist. When Tom came back from his first appointment, he had already started on the integrated care pathway which we used as our primary documentation between services. This benefited Toms care as it improved the continuity and quality of the documentation (Roberts Middleton 2000, Renholm, Leion-Kilpi Suominen 2002). Also, due to having diabetes nurse specialists at the clinic this meant that his medication regime could be reviewed a s well as receiving specialist foot care. The aim was to reduce his blood sugar levels as the hyperglycaemia was preventing his ulcer from healing and there is a general consensus that improving glycaemic control improves wound healing and prevents the risk of acute complications (Mcintoish 2007, Meyer 1996). Through Tom seeing the multidisciplinary team in one environment and by utilising the ICP, this prevented his care from becoming fragmented. Also due to having access to specialist clinicians in the field of diabetic foot management this enabled him to receive expert advice and care. This was evident in the management of his wound infection where judicious prescribing of antibiotics took place by specialist clinicians (Timmons et al 2009). This was vital in preventing any further deterioration in Toms health and managing the acute exacerbation. Tom visited the foot clinic once a week and a wound care plan was constructed until a review needed to be carried out. This is where the importance of a holistic assessment took place taking into consideration the social, physical and psychological factors that impacted on the situation (Higgleton et al 1999). The research also indicates that the quality of holistic assessment is enhanced by ensuring the patient participates at all times (RCN 2004). By allowing Tom to contribute to the assessment process it enabled the care provided to become personalised and reflected his needs and not what we assumed them to be. Firstly it was vital that we carried out a physical wound assessment on each visit to Tom using the assessment tool in the integrated care pathway. It was important that we used the same assessment tool with an effective understanding of its use as studies have shown that nurses fail to assess wounds effectively (Dowsett 2009, Mcintosh Ousey 2008). Through using the integrated pathway it meant that all nursing staff were using the same assessment tools which ensured effective continuity of care. Nixon et al (2006) found that those who had a diabetic foot ulcer were 5.1 times more likely to have been wearing poorly fitting shoes and this was evident in Toms assessment with the Podiatrist. In the integrated pathway it was documented that he had a high degree of peripheral neuropathy after an assessment was carried out and his shoes were ill fitting. The presence of neuropathy had contributed to the formation of the ulcer as Tom was not able to feel the damaging pressure on his foot caused by inappropriate footwear. This situation needed intervention so he had full assessment of his feet and given choices on available footwear that took into account his preferences. Holistic assessment was a key factor in ensuring concordance as the footwear that the Podiatrist wanted him to wear may not have been agreeable to Tom and he may have refrained from wearing them continuously as directed. This would have lead to a further deterioration in the ulcer condition but through effective par tnership working they were able to come to a joint decision that was acceptable to Tom and the Podiatrist. This ensured that the assessment took into account his physical, social and psychological needs. Preventing deterioration in the foot ulcer had started with the assessment of his feet and footwear but it required more intervention in the form of patient education. Valk et al (2005) found that providing patients with information and education positively influences their behaviour to take responsibility for their foot health. This meant ensuring that Tom carried out things such as regular skin care and nail care and empowered him to take ownership of his care (DoH 2001).The only difficulty with checking his feet daily was that he was unable to bend down to apply any moisturising cream to his feet which was dealt with by assessing his social support network. He did not have any close relatives but he made the decision to obtain a private carer to help him with this twice a week. Toms current active foot ulcer and increased education from the multi-disciplinary team on the high risk of amputation had enabled him to make an informed decision to prevent further deterioration. Central to promoting the healing of diabetic foot ulcers is ensuring adequate nutrition (Thompson Furhrman 2005) but often the quality of nutritional assessments carried out in practice are poor (Johnstone 2006, Cartwright 2002). NICE guidance clearly states that diabetics with foot problems should receive specialist dietary advice (NICE 2008). In the foot clinic Tom was able to be seen by a dietician who was able to carry out a comprehensive assessment and plan of care that would help improve his dietary lifestyle with the aim to improve his blood sugar control. A significant factor in the nutritional assessment was that it was ongoing whereby he would see the dietician every other week to determine his progress. Tom had been managing his diabetes independently prior to his foot ulceration and it was vital that he carried on doing so where possible. Promoting self care was not simply providing Tom with relevant information and education about his condition; it was also about increasing his confidence (DoH 2009). Due to the uncontrolled blood sugars he had to be started on new insulin and he felt that he needed some support and supervision. A survey found that only 38% of diabetics received any psychological support during their care (DoH 2008) so it was at this point that we needed to provide him with the psychological and social support to sustain his self care. Together we were able to form a care plan that would be reviewed on a weekly basis. The district nursing team would visit him when his insulin was due to provide support and ensure he was injecting correctly. The support given to Tom needed to be tailored to his requirements by ensuring that information was given in the correct format (Mcintosh 2008). Those patients who have lived with diabetes for many years often have some form of reduced eyesight secondary to diabetic retinopathy or maculopathy (NHS choices 2011b). In Toms care he had reduced eyesight but he was still able to read with prescription glasses. This assessment showed that he would benefit from written leaflets but this needed to be followed up with verbal consultations. I gave him the necessary leaflets on diabetic foot care but ensured that we enabled him to ask questions if he felt this was necessary when we visited him at home. The primary aim was to meet his needs effectively and create optimal self care through education and empowerment. This assignment has critically examined the management of an acute exacerbation of diabetes with the assistance of a specialist foot clinic. Through timely referral processes, multidisciplinary input and the use of an integrated pathway it allowed the exacerbation to be controlled and managed in the community without the need for hospital care. This is particularly pertinent when the research describes the prevalence of diabetes and the intensive resources it frequently requires from secondary care to manage the acute complications of this condition. This episode of care has shown the positive effects of a specialist diabetic foot clinic which emphasises the need standardised care and access to this service across the UK. It has demonstrated how joined up care in the community helps to ensure a seamless approach to patient care in relation to a long term condition. This paper has also identified the importance of holistic assessment in the management of diabetic foot ulceration which ensures patients needs are fully addressed and assists them in achieving optimal self care. There needs to be an emphasis on educating and empowering patients but this must be provided in the correct format taking into account the patients requirements and literacy needs at all times.

Fun With Starters :: essays research papers

The function of the starting system is to crank the engine to start it. The system is composed of the starter motor, starter relay (also called a solenoid), battery, switch and connecting wires. Turning the ignition key to the start position sends a signal to the starter relay through the starter control circuit. The starter relay then connects the battery to the starter. The battery supplies the electrical energy to the starter motor, which does the actual work of cranking the engine. This is pretty standard in most all-domestic and foreign autos. The starter on the 1987 Ford Thunderbird is relatively easy to change out for the home mechanic; all you need is a little patience, a socket set, and a little elbow grease. If you don’t know anything about auto repair then stop reading immediately and take your car to a qualified mechanic. Now for the folks with a little experience in dealing with the legendary P.O.S. that is the Ford Thunderbird, the first step is deciding whether or not you have a problem. If the starter motor doesn’t turn at all when the ignition switch is operated, make sure the shift lever is in neutral or park. The automatic transmission T-Birds of this model year comes equipped with a neutral start switch in the starter control circuit. This prevents operation of the starter motor unless the vehicle is in neutral or park. If your ride is equipped with a manual transmission, make sure the clutch pedal is completely depressed when starting. Next make sure that the battery is charged and all the battery and starter relay wires are secure. Now if the starter motor spins but the engine doesn’t turn over, then the bendix or drive assembly is slipping and the starter motor needs to be replaced. Okay, so all of that checked out swell for you. Well now we’ll move on to the relay switch. If when the key is turned, the starter relay clicks but the starter motor doesn’t turn at all then the problem lies with either the battery, the starter relay or the starter motor connections, or the starter itself. If the starter relay doesn’t click when you try to crank the engine, either the starter relay circuit is open or the relay itself is history. To check the relay, remove the push-on connector from the relay wire. This little sucker

How to write a winning personal statement for graduate and professional school Essay

Perhaps the architecture is the most challenging and interesting course anyone interested in becoming an architect must undergo. I love architecture as it is influential in creativity, thus shaping our physical environment and promoting design solutions in terms of sustainable regeneration programmes linked to public building, housing and urban design. I am an ambitious, challenge oriented and hardworking person with desires to become a qualified architect. Indeed, my life in the city of Shiraz, Iran has led to my motivation of the architectural environment. My father was an engineer and since my childhood, I admired his engineering works and in most cases offered my help to him. As a result, this great experience led to my desires to learn design and structural things. During my time living in the city of Tehran, I witnessed the high degree of expansion of the city, and this made me appreciate the wonderful architectural knowledge and structure of buildings in the city. Numerous individuals have obtained their post-secondary architectural education in UK and became great professionals with new and innovative ideas widely accepted and appreciated in Iran. Likewise, the UK has promoted energy saving techniques globally, and this led to my decision to study in the country as energy saving and sustainability is important (Irving & Malik, 2005). Having studied sciences and mathematics in secondary school, I felt that I had a solid engineering foundation. Essentially, geometry that was my favorite topic followed a design course that shaped my drawing and design talent. In my free time, I have always taken close interest in architectural matters by practicing drawing and design. Therefore, my passion is based on turning architecture into a career, and I hope enrolling for an architecture undergraduate degree in UK is significant for achieving my dream. As I am about to conclude on my current course in architecture, I consider enrolling for MBA for my postgraduate degree education. Lastly, I believe that my existing skill and experience coupled with my hardworking nature and commitment would provide me the platform to excel in my MBA that I am about to enroll. Business Administration Personal Statement My commitment in enrolling in masters in MBA reflects an investment in my future that will help fill my knowledge gap, as well as offer a platform for the next step in my career. MBA is probably the widely recognized and the best course sought after management qualification. With the obligation of interacting with different cultures worldwide, this course would provide me with a practical hands-on experience that will prepare my career after the university. Management is a key tool in any field of study and challenges are also bound to occur. However, enrolling in this course will make me a better professional and develop my potential and finally realize my career dreams. Developing a career as Berman (2013) writes, requires cross-cultural interaction. I have the ability to express personal opinions and ideas. This is significant for succeeding in an environment where interpretation of opinions and ideas of other people is instrumental.In particular, good communication has assisted m e during my foundation year as a student in UK. I worked as part of a multicultural group and most recently conducted an anthropological research project that has also upgraded my cultural knowledge and interaction. The research project included designing a survey using a questionnaire to be completed by the local people we approached in the city center of Cambridge. The study findings were presented using PowerPoint presentation and indeed working with such a group was highly rewarding. Besides, I captained The Qods Tennis Club in Tehran and also practiced music and playing guitar.Currently, I consider enrolling for an MBA course with a realistic time frame to fully enjoy and appreciate my studies. Indeed, one of the most activities I enjoy in my professional life is empowering other through leadership. Leading groups provides me the opportunity to to develop my colleagues and enhance their skills. Having successfully captained a tennis team and spearheaded my research project, I c onsider the potential traits of leadership that has provided me with the ability to significantly lead in various capacities. As such I have developed a sincere interest in leadership, and in particular, running groups. Likewise, enrolling for MBA course is essential for fulfilling my business and financial career dreams. Besides, my personal quality incorporates high standards of respect, commitment, and attitude to work, good communication and proven ability to make good judgments, be innovative and work well under pressure. Therefore, having evaluated my career interest, I believe it would be an interesting idea to shift from architectural to MBA. I consider MBA a comprehensive career as even the traits of leadership, financial management, and the entire business world is intertwined with any career, architecture included. I have a good time in UK Cambridge University because of the teaching quality and the highest professionals standards f the courses offered. Besides, I believe the UK your MBA teaching in strengthened by world-class research that provides postgraduates authoritative and innovative approaches to theory and practice (Stelzer, 1997). References Berman, S. J. (2013). Pass the bar: A practical guide to achieving academic and professional goals. Irving, B. A., & Malik, B. (2005). Critical reflections on career education and guidance: Promoting social justice within a global economy. London: Routledge Falmer. Stelzer, R. J. (1997). How to write a winning personal statement for graduate and professional school. Princeton, N.J: Peterson’s. Source document

The Ongoing Debate Over the Use of Stem Cells Essay

In the past two decades, many technological and scientific advances have been made in order to make life easier for many people who suffer from cancer, disease and sickness. Among these advances there is something revolutionary called stem cells. Stem cells can help restore and regenerate almost all parts of the human body such as the heart, kidney, liver, and many other organs. Although stem cells offer a lot, there are many views against and for stem cells, and among these views lies the debate of whether stem cells should be legalized or not (NIH 2). Stem cells offer exciting new opportunities in the field of science such as regenerating human body parts, but many people are still debating whether or not the use of stem cells is†¦show more content†¦In order to get stem cells from embryos, the embryo must be destroyed, and many people view this as killing a human, making it immoral. These embryonic cells can be given different tasks such as making a specific organ, a nd this is how different body parts can be made. Stem cells have been published in newspapers since 1998, but no institute or company invested money or time into stem cells until 2001, when the Canadian Institute of Health Sciences decided to fund the research of stem cells. Stem cells have three general properties, which are being capable of dividing and renewing for long periods, they have to be unspecialized, and they have to be able to give rise to specialized cells (NIH 3). Stem cells are unspecialized cells in embryos and umbilical cords that can be modified using signals in order to make specialized cells which then have the ability form into various different body parts such as livers, kidneys, hearts, and other major organs. The process of when an unspecialized stem cell turns into a specialized stem cell is called differentiation (NIH 1). 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