Pathophysiology of Diabetes Nephropathy and Atherosclerosis free essay sample

Nathan amp; Delhanty (2005, p. 42) maintains that these complications may be present at the time of diabetes mellitus diagnosis and refer to diabetes as a ‘silent killer† as diabetes can go unnoticed until a major health event occurs. Diabetes is a major risk factor in the development of diabetes nephropathy and atherosclerosis. The person with diabetes (PWD) is at increased risk of mortality and morbidity than the general population but these are further increased in the presence of complications. There is a crossover in pathophysiology of both nephropathy and atherosclerosis and the choice of these diabetes complications for this paper is purposeful as they have persistent hyperglycaemia over time as a common denominator (Fowler 2008; Chadban et al. 2009, pp. 32). The severity of hyperglycaemia and presence of hypertension were in evidence in the U. K. Prospective Diabetes Study (UKPDS) (Adler et al. 2003, pp. 225-232). Hypertension from nephropathy also influences cardiovascular risk by exacerbating atherosclerosis. We will write a custom essay sample on Pathophysiology of Diabetes Nephropathy and Atherosclerosis or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Although both type 1 diabetes (T1D) and type 2 diabetes(T2D) are affected by complications, the focus of this paper will be on T2D. Firstly, analysis on the microvascular complication of diabetes nephropathy will be discussed and secondly, the macrovascualr complication of atherosclerosis. Major risk factors associated with these complications will be discussed along with the pathophysiological processes of diabetes nephropathy and atherosclerosis. Management strategies for treating diabetes nephropathy and atherosclerosis complications will be discussed with one treatment strategy for each condition which may be delivered by a diabetes educator. The role of risk management for diabetes complications is to take a proactive multifactorial approach with better glycaemic and blood pressure control, the most common two strategies utilised. For the PWD making strategies sustainable achieves better outcomes (Thomas et al. 2006, pp. 140-144) Diabetes patient education of diabetic complications has proven to have beneficial positive health outcomes (Colagiuri et al. 009, p. 7). Promoting self-monitoring of blood glucose(SMBG), lifestyle education(diet, exercise, smoking and alcohol cessation) and increase in knowledge are some of the benchmarks. The National Consensus Report was introduced to address desired key outcomes and avoid criticism (Colagiuri et al. 2009, p. 8). In Australia Diabetes Educators work within their scope of practi ce to deliver patient education; in this paper the delivery of management strategies is within the scope of the diabetes educator(DE) and nursing practice. DIABETES NEPHROPATHY Diabetes nephropathy is a common microvascular complication of diabetes and is the leading contributor to end-stage kidney disease (ESKD). In Australia, 20-22% of the patients with this condition will require dialysis and possibly a kidney transplant (Ali, 2011; O’Reilly; Bilious amp; Donnelly 2010). Nephropathy in persons with diabetes is more prevalent in Type 1 Diabetes (T1D) than Type 2 Diabetes (T2D) with a higher incidence in Indigenous Australians. statisics Progression is more clearly cut in T1D but has a significant impact on T2D(Chadban et al. 009, p. 31). Diabetes nephropathy is defined by proteinuria greater than 500 mg in 24 hours. Microalbuminuria is measured by the albumin excretion rate (AER) and levels between 30 to 300 mg/24 hr mark the beginning of renal involvement but without immediate intervention, the PWD will progress to proteinuria and nephropathy (Chadban et al. 2009,p. 33). Approximately 7% of T2D have microalbuminuria at the time of diagnosis, which can progress to ESKD (Fowler, 2008, p. 77-82; Bilious amp; Donnelly, 2010, p. 120). UKPDS incidence in T2D of microalbuminuria was 2% per year, with 10-year prevalence from diagnosis of 25%; which increases cardiovascular risk that has a cumulative incidence of 10 to 40% (Adler et al. 2003, p. 225-32; Bilious amp; Donnelly, 2010, p. 121; Chadban et al. 2009, p. 11). Diabetes nephropathy is the commonest cause of hypertension in patients with diabetes (Fowler, 2008, p. 77-82; Bilious amp; Donnell, 2010,p. 119). Kaartinen et al(2007, p. 778) indicate strong evidence that insulin resistance is present in even mild to moderate chronic renal insufficiency before any sign of kidney function impairment is manifested. It is not clearly understood why a PWD progresses to renal failure and others do not, as there does not appear to be a casual correlation between good or poor control. What is relevant is the amount of protein that contributes to progression of this condition. (Chadban et al. 2009; Gaede et al. 1999). Diabetes nephropathy is a chronic condition that takes years to manifest itself and it is approximately an average of 5 to 8 years before an initial diagnosis of diabetes is made, by which time microvascular and macrovascular damage has occurred (Nuovo 2007, p. 40; Pirart 1978, pp. 168-188). The early sign of renal impairment is the leakage of protein into the urine from abnormal GFR. However serious signs and symptoms are persistent hypertension, oedema, anaemia, hyperglycaemia, proteinuria, haematuria, oliguria and anuria(less than 100ml urine per day). The presence of overt proteinuria requires immediate intervention and early referral to nephrologist. Blood pressure and glycaemic co ntrol has been shown to decrease protein and stabilise renal function (RACGP Diabetes Management Guidelines 2011/2012, pp. 62-63). Risk Factors Hypertension and hyperglycaemia are seen as the major contributing factors to the development of nephropathy. The presence of central obesity with the addition of smoking, sedentary lifestyle all adds to the demand on the body that over stresses insulin to meet these demands. Genetic phenotypes, genetic susceptibility, has been indicated as risk factors, but past studies have been inconclusive. Other factors of elevated serum lipids and the amount and origin of dietary protein is crucial and ethnicity with increased incidence in indigenous Australians. The predictability of diabetes nephropathy can be gauged by the length of long standing diabetes from diagnosis (RACGP Diabetes Management Guidelines 2011/2012, pp. 62-63; Fowler, 2008). Pathophysiology of Diabetes Nephropathy Understanding the anatomy and function of the glomerulus is pivotal in understanding diabetes nephropathy. The glomerulus is a globular shaped capsule with numerous capillaries that actively work at filtering fluid from the blood to form urine. The glomerulus is one of the key structures that make up the filtration section of the nephron, the functional unit of the kidney which supports the mesangial cells and matrix. Diabetes cycle of care can also contribute to the reduction of diabetes complications if followed diligently (RACGP Diabetes Management Guidelines 2011/2012, p. 34). Thirdly, the DE can deliver relevant information on the correlation between risk factors and possible complications to promote self-management of regular medications and SMBG; making target levels available and recognising the relevance of their own levels. There is no point in self-monitoring without understanding. The target HbA1c is lower or equal to 7 %( Chadban et al. 2009, p. 30-35). Nuovo (2007,p. 45) states a 1% drop in HbA1c will lower mortality in total mortality by 14%, and significantly a 43% decrease in amputations with a 24% decrease in renal failure. ACE/ARBS ACE/ARBs slow the development of CKD and CVD. As a management strategy in T2D introducing angiotensin-converting enzyme (ACE) inhibitors decrease blood pressure. Several studies have demonstrated reno protective effects of treatment with ACE inhibitor s and angiotensin receptor blockers (ARBs) and decreases risk of progression to microalbuminuria in patients by 60-70% (Adler 2003, pp. 25-232; RACGP Diabetes Management Guidelines 2011/21012, p. 58; Fowler 2008,pp. 77-82). Intensive intervention in T2D patients can reduce the progression of nephropathy and possibly slows progression of renal impairment(Schrier et al. 2007, p. 431). CARI recommends interventions including, â€Å"antihypertensive therapies, ACE inhibitors, and A II receptor antagonists, calcium channel blockers, dietary protein restriction and glucose control, and interventions to control hypercholesterolemia and hyperlipidaemia†(Chadban et al. 2009, p. 30-35). Diuretics may be considered to maintain urine output (Chadban et al. 2009, p. 30-35). Blood pressure control Hypertension is associated with an increased risk of many complications of DM, including cardiovascular disease, and the findings from the UKPDS indicate that any reduction in a person’s average blood pressure significantly reduces the risk of complications in nephropathy(Thomas 2006, pp2213-2234 ). Hypertension and diabetes should be diagnosed early and treated aggressively to prevent associated complications. The UKPDS showed hat blood pressure control helps to avoid cardiovascular complications in T2D and â€Å"†¦each 10 mmHg decrease in mean systolic blood pressure was associated with 12% reduction in the risk for any complication related to diabetes, 15% reduction in deaths related to diabetes, 11% reduction in myocardial infarction, and 13% reduction in microvascular complications† (Lago et al. 2007, p. 667). ATHEROSCLEROSIS The Australian Institute of Health and Welfare (AIHW) found PWD have an increased risk of developing coronary heart disease (CHD), stroke and peripheral vascular disease (PVD) with 60% reported they also had cardiovascular disease. Diabetes, kidney disease and CVD account for 25% of the burden of disease in Australia, and just under two-thirds of all deaths (AIHW 2004; AIHW 2009). Atherosclerosis leads to myocardial infarction, congestive cardiac failure (CCF) and cerebral vascular accident (CVA) stroke, PVD and lower extremity amputation (LEA). Atherosclerosis is 2 to 4 times more prevalent in T2D. Principally, the beta cells become insulin resistant, adding strain to the body and making it difficult for insulin to perform effectively(Bilious amp; Donnelly, 2010, p. ). Risk factors Risk factors that contribute to the development of and increase the risk for atherosclerosis are abdominal obesity, physical inactivity, hyperinsulinaemia, lipid abnormalities, altered platelet function, hypertension, smoking, microalbuminuria, increased fibrinogen levels and hyperglycaemia. Increased triglycerides and increased high density lipoproteins greatly impacting atherosclerosis(Maiti amp; Agrawal 2007, pp. 292-306). PWD with impaired kidney function and persons with metabolic syndrome are more prone to atherosclerosis (Kaartinen et al. 2007, p. 782). . Pathophysiology of Atherosclerosis Diabetes is a pro-inflammatory condition fuelling metabolic factors that contribute to atherosclerosis. Conventional risk factors are dyslipidaemia, hypertension, and coagulopathy as a result of the prolonged hyperglycaemic state of diabetes. Central to diabetes related risk factors for atherosclerosis is hyperglycaemia from insulin deficiency and insulin resistance. Diabetes specific risk factors play a role in the acceleration of atherosclerosis by increased levels of advanced glycation end-products (AGEs), increased oxidative stress, altered matrix production and altered endothelium, smooth muscle cells and macrophages. Macrophages are converted to foam cells that secrete pro-inflammatory cytokines (Goldberg 2004 , pp. 613-615; Maiti amp; Agrawal 2007,pp. 292-306). Hyperglycaemia promotes oxidative stress and glycation directing release of free radicals. Subsequently, lipid perioxidation allows foam streaky cells to form on the arterial walls causing endothelial dysfunction. Creager et al. 2003, p. 1527). A precursor to atherosclerosis is impaired nitric oxide which breaks down in response to hypertension, diabetes and dyslipidaemia (Maiti amp; Agrawal 2007, pp. 292-306). Release of increased free radicals promotes increased platelet aggregation with elevated levels of plasminogen activator inhibitor type 1 and impaired fibrinolysis, allowing an increased inflammatory response to occur (Morgensen 2003, pp. 45-46; Maiti amp; Agrawal 2007, pp. 292-306). Growth factors cause a proliferation and migration of smooth muscle cells associated with thrombosis and Angiotensin II promotes endothelial damage. Diabetes is a thrombolytic state leading to an imbalance of atherosclerotic lesions and plaque instability, in turn increases the PWD risk of cardiovascular events.

The Essay is Not Only About the Writing Process

The Essay is Not Only About the Writing ProcessA couple of years ago, a friend of mine was looking for an essay about the writing process to give his AP English Literature class. The teacher's exact words were, 'This is a high-stakes test and it needs every advantage we can get.'I am sure he was not the only teacher in our public schools to tell middle school students that they needed a way to demonstrate their mastery of writing. I know the frustration - they have worked so hard to prepare for this important test. And I know that students just want to be accepted into the competitive colleges and universities.An essay can be the best tool available for judging your capability in the art of writing. One slip up and it can wipe out all of your hard work. That is why it is so important to know how to write an essay.It is no longer enough to know that you are a writer - you also need to know what to write, and how to write it. If your essay is poorly written, you will have an even worse grade on the exam. And, even worse, you may be rejected from taking the next one.This brings me to the importance of an essay. We must write an essay and be aware of the techniques that we use to get what we want. You must be able to identify your strengths and weaknesses and be able to use the process of elimination to choose the points that will help you get what you want.It is not an easy process. What once may have seemed like the obvious way to do things has now become ineffective. All too often we fall back on the old tried and true methods to get what we want.For example, if you are desperate to get into that college you have always wanted, you can resort to begging for a spot. Your essays may be embarrassing. Or, you may be naive enough to believe that your talent will take you to that college, even though you have never attended or have taken a college level course.In order to avoid the embarrassment, the struggle, and the false hope that go along with writing an essay, we must think before we speak. It is true that you must put forth all of your effort to make your essay the best that it can be. But, you must remember that the final judgment rests with the reader.

Cool Research Paper Topics

Cool Research Paper TopicsToday in United States universities and colleges are devoting a lot of their time to cool research paper topics. Cool research paper topics offer the students the time to explore different concepts, to think critically, and to write creatively. They allow them to demonstrate that they can develop ideas and solve problems through proper research and innovative thinking.In the first place the themes for undergraduate schools can be chosen from among the cool research topics in the internet. These themes and topics can include statistics, economics, biology, information technology, and psychology.While choosing a topic for the research paper one should always keep in mind that the topic must not only have the ability to engage the readers but also the need to be meaningful and unique. Choosing topics for a research paper that is too generic or very common will not help in making the paper interesting and engaging. So, it is necessary to give consideration to a topic that is out of the ordinary or unordinary.Cool research paper topics allow the writers to solve difficult problems. It is important to focus on the subject so that one can write about it in a scientific way. The topics and themes chosen should be more challenging than what is the norm and hence, more interesting. This will make the readers interested in reading about the paper.In the same way, it is necessary to provide enough information so that the readers can form an original idea. Also, it is good to give appropriate background information so that the readers understand what the author is talking about.An important thing to consider is to make the paper easy to read and understand. After all, we want the readers to get hold of the subject and the concepts easily and without trouble. So, it is important to use vocabulary appropriate to the topic and should also be short.While choosing a topic for a research paper, it is also necessary to make sure that the topic is not vagu e or complex. Most of the topics nowadays that are cool research paper topics have a number of subtopics that bring to light some of the most important information that may be relevant for the topic and may also help the readers in solving the problem.In addition, while choosing a topic for a research paper it is important to keep in mind that it should have an element of challenge. Thus, if you are able to create this element in the theme then you are well on your way to writing a good research paper topic.

Research Paper Topics For Schizophrenia and Schizoaffective Disorder

Research Paper Topics For Schizophrenia and Schizoaffective DisorderKnowing the research paper topics for schizophrenia and schizoaffective disorder can be quite helpful. Both disorders share many similarities. Both are often accompanied by delusions, hallucinations, and changes in behavior. This article will help you in your quest to understand more about the research paper topics for schizophrenia and schizoaffective disorder.It is quite common for a person with schizophrenia or schizoaffective disorder to lie about the things that make them feel better. This makes it even more difficult to treat these conditions. What they don't tell you is that when a person with schizophrenia lies, he or she can also 'shrug off' the treatments that are meant to correct the problem.Symptoms are similar to many other psychological disorders. It is important that you always discuss the research paper topics for schizophrenia and schizoaffective disorder with your physician. Many times a doctor has seen similar symptoms in many patients. If the symptoms do not fit any other diagnosis, it is a good idea to rule out other possibilities before your doctor diagnoses you.There are many different treatment options available for schizophrenia and schizoaffective disorder. The best way to find out about these options is to consult with your physician. Your physician will be able to help you decide on the best course of treatment.Research paper topics for schizophrenia and schizoaffective disorder usually involve cognitive therapy. Cognitive therapy involves finding ways to identify the source of the problem, dealing with the problem, and changing the problem. Many times when people with schizophrenia have unusual delusions, they will have difficulty following through with their goals.One excellent way to help patients deal with the problem is to give them exercises that help them focus on the task at hand. Some examples of such exercises include focusing on an object like a candle fla me, a pair of eyes, or a distant object, while thinking about the problem you face. These types of exercises will help to get you back on track with your goal.It is also helpful to find a counselor who can help patients with schizophrenia and schizoaffective disorder deal with their fear of leaving home. There are many things that people with schizophrenia experience that are stressful and upsetting. When this is combined with the feeling of isolation and the fear of being alone, the anxiety can cause problems in life.When people with bipolar and other control disorders are found to have schizophrenia, they often spend a great deal of time alone. This causes great anxiety. This is why counseling for both schizophrenia and schizoaffective disorder is so important. In addition to helping to manage the problem, it is also important to help control the amount of time spent alone.

How to Write an Essay Without Using a Dictionary

How to Write an Essay Without Using a DictionaryWriting an essay is not that hard. It is the ways of doing it and that you can get the results that are so challenging that one would think it impossible. However, all the words that you put down, it is still very good. The best way to do it is by writing an essay without using a dictionary.What will you do? You will use your mind to research the topic and then write the essay. The reason for this is that when you do not use a dictionary, you do not find out anything when you look up the words that you have used in your article. The main thing is that you are sure to find out all the hard words. However, the main fact is that you will not be able to get your mind around the words that you will be using.How will you do this? What you can do is to read the articles that have been written by writers. There is nothing better than to read what is written by these people because they would be able to teach you something that would surely help you when you write your essay. If you know how to read, then it will be the same for you to write.If you are not sure about how to use these words in the best possible way, then do it in a manner that would not let your writing suffer. Do not use the long words that may sound more awkward to you. Just remember that you want to create an impressive article. The reason for this is that you are not the only one doing the writing, so others would like to see what you will do with your work.These words are not something that should be just used in your essay. Some of the words that you should always avoid are common.The common ones include the words such as why, how, what, why should and, how could. These words may sound good, but if you are just going to use them in your essay, then you are just going to be turning yourself in to the offender. The other thing that you would need to remember is that the more important words that you choose for your essay, the more important they are to read.As you can see, this is the best way to get some of the more difficult words that you would need to have in your essay. It is very easy to get into the habit of using this kind of words in your essay.