Family History An Individual Essay - 1225 Words

Family history is very important to an individual. By knowing where you come from, you can have a better perspective of your life and of others. Every person has a different origin, a different story to tell, and it’s up to the next generation to share the story of their ancestry to future generations. The paternal side of my family originated in Ireland, they later came over through Elis Island and resided in Waukon, Iowa. Throughout time my family moved and expanded, as generations past the McKenna name would broadened. My great-grandmother Ann was born in 1923 on a small rural farm just off the blacktop of Bluffton, Iowa. Churning butter, collecting eggs, and tending to the livestock cultivated the strong work ethic, she soon would pass on to her children and grandchildren. She attended a small town school with a grand total of 25 kids; Ann graduated with an eighth grade education. As time went on and she passed her schooling; she acquired jobs doing house work for others, but the pay was only 25 cents a week. Instead of continuing her low paying job she decided it would be best to work on the farm. While doing this she became close to her neighbor, William McKenna. The pair had attended the same church and saw each other often, they eventually started dating. On May 29, 1939 the two were married and they would soon start their ever-expanding family. After their wedding Ann and William purchased a small farm where they would soon begin their living. My great-grandmotherShow MoreRelatedEveryday Use By Alice Walker1698 Words   |  7 PagesFamily makes up most of your culture. To fully understand self-identity you need to investigate all the cultures you are included in your family and heritage. In the short story, â€Å"Everyday Use† Alice Walker takes a deep look into heritage. This story has a complicated relationships between the mamma and her two daughters. In this short story, it shows that your heritage will form your life. This will make you the person you are today. Culture is one of the most important part of self-identity. ItRead MoreMixed Race History : The Color of Water1405 Words   |  6 Pagesdifferent was her families quick acceptance of her future husband Julio Peralta. Based on history and individuals discussed throughout the course and Julio’s different background, I expected more opposition from her family. As we have seen throughout the course, acceptance of a spouse with a different look or complexion has not always been so easily accepted by families. For instance, we can again refer back to the case of Rachel in The Color of Water who was shunned by her family and even forgottenRead MoreIdentifying The Connection Between Families And Identify Of The Family Communicate With One Another1164 Words   |  5 PagesToday genograms are used in psychology and medical settings to identify the connection between families and identify how members of the family communicate with one another. There are several types of genograms that created for many reasons such as ethical, career, and sexual. This genogram helps an individual map out the connection of their contextual history with their framework. My experience of creating a genogram was an amazing feeling and it helped me discover several factors that occur inRead MoreIdentifying The Connection Between Families And Identify How Members Of The Family Communicate With One Another1252 Words   |  6 PagesToday genograms are us ed in education, psychology, and medical settings to identify the connection between families and identify how members of the family communicate with one another. There are several types of genograms that are created for many reasons such as ethical, career, and sexual. These genograms help an individual map out the connection of their contextual history and developmental framework. My experience of creating a genogram was an amazing feeling and it helped me discover severalRead MoreEssay on Uop Qnt 561 Business Research Methods1248 Words   |  5 Pagesstatus, tobacco use, family history of CHD, metabolic syndrome status, history of CHD, and patient prescribed medications. The dependent variable is atherosclerosis (plaque build-up in the arteries). Subjects for the study completed a questionnaire (see Appendix A) to determine inclusion validity and categorical variables that may affect results. All subjects are required to be currently treated with a statin drug and subjects with a known intolerance to niacin or a history of liver disease wereRead MoreThe Irish Culture And The Person I Interviewed1316 Words   |  6 PagesIreland is a country that is rich in culture, traditions, and faith. This country has struggled with over time with famine, religious tension, and even freedom. Many individuals immigrated to America in search of a better life. The person I chose to interview family came over to the United States when Ireland was struggling with famine. They came over on a boat through New York and changed there name to make it more American. For this paper I will further discuss the Irish culture and the personRead MoreTeenage Pregnancy Among Urban Adolescent Women1115 Words   |  5 Pagesteenage pregnancy was comple ted (Lang et al., 2013). The purpose of the study is to examine multi-level risk factors amongst minority adolescents with psychological disturbances as it relates to history of pregnancy (Lang et al., 2013). The study examines many risk factors such as risky individual behavior, family dynamics, and environment to determine if there is a direct correlation between past teenage pregnancies amongst adolescent with psychological disturbances. Method: The methodology of theRead MoreThe Importance Of Cultural History On Culture1294 Words   |  6 Pages Assessing Cultural History People are born physically, socially, and culturally unaware. Instinct is an unlearned behavior that all species encounter. Humans are different than other creatures. Humans need social experiences from their culture to survive (Macionis, 2002-04). Humans are the only creatures that depend on culture instead of instinct to survive (Harris, 1987). Culture is something that has be learned. We are not born with culture, but however born into culture. We are not handed ourRead MoreNursing Rua Nr 302 Essay1658 Words   |  7 PagesChamberlain College of Nursing NR 302 Health Assessment: Part I REQUIRED UNIFORM ASSIGNMENT GUIDELINES PART 1: THE HEALTH HISTORY PURPOSE Before any nursing plan of care or intervention can be implemented or evaluated, the nurse assesses the individual through the collection of both subjective and objective data. The data collected are used to determine areas of need or problems to be addressed by the nursing care plan. This assignment will focus on collecting subjective assessment dataRead MoreHow Does Alcohol Intervention Work?989 Words   |  4 Pagespsychologist, therapist, mental health counselor, social worker, or addiction specialist - who is trained in intervention.  [7] All the participants (i.e. spouses, parents, siblings, aunt and uncles, family friends, best friends, etc.)  will get together with this professional to discuss the severity of the individuals alcoholism and provide background on the case.   One of the most important tasks that each participant will have to complete is penning a love letter to the person with the alcohol problem. The

Administrative and Politics Dichotomy Free Essays

For many years, the political-administrative dichotomy has been one of the most disputed theories of public administration. Despite serious debates and critiques, the differences between politics and public administration have been present over the past decades. The question still remains today whether or not politics and public administration can work together for one common good-to serve the people for which hey govern. We will write a custom essay sample on Administrative and Politics Dichotomy or any similar topic only for you Order Now Today, politics and administration are linked in many ways. A few examples are: administrators initiate policy, administrative acts have political consequences, and administrators shape policy after the fact and civil servants are not politically neutral. Skelley, B. D. (2008) Another aspect of the administrative-political divide is the philosophical ideals in the western culture of the Greek civic-culture (political) and political-administrative relationship has been an important question for over a century now. Skelley, B. D. 008) Woodrow Wilson, in his article â€Å"The Study of Administration† (1887), wrote of how to position public administration in relation to politics. His idea is the forefront to which the idea that public administration is somehow distinct from politics. Public administration is supposed to be the instrument used or the delivery vehicle for translating policies into action, while politics is about making the policies. Demir, T. Nyhan, R. (2008) The d ichotomy is still influencing public administration due to numerous public administrators are laiming neutrality from political influences. Neutrality refers to the ability to do government work, do it to the standard that has been set, rather than to one’s own standard or for other loyalties or personal gain. How to cite Administrative and Politics Dichotomy, Papers

Therapeutics Fibrillation and Atrial Flutter

Questions: 1. Discuss digoxin and its place in therapy. Include in your answer (but not limited to) aspects that relate to how it works, what it is used for, therapeutic drug monitoring and patient specific information. 2. Choose one of the newer (novel) anticoagulant drugs (NOACS) and discuss its place in therapy. Make particular note of recent studies for evidence of safety and efficacy. 3. Discuss long acting beta agonists (LABAs) and their use. Include (but not limited to) aspects that relate to pharmaceutical care of patients that may be using these drugs as well as more specific information relating to the class of drug. Answers: 1. Digoxin primarily acts by inhibiting sodium-potassium adenosine triphosphatase (Na+/K+ ATPase) in the myocardium. By virtue of this inhibition, there is increase in the intracellular sodium levels which results in the reverse exchange of sodium and calcium through sodium-calcium exchanger. In normal condition, three sodium ions get imported for every one calcium ion exported out of the cell. After the reversal of exchange of ions, there is increased concentration of calcium ions in the cell for the contractile proteins like actin and myosin. Digoxin decreases heart rate by increasing intracellular calcium level which increase length of the phase 4 and phase 0 of the cardiac action potential (1). Digoxin is mainly useful in condition of irregular heart beat like atrial fibrillation and atrial flutter and occasionally it is useful for the treatment of heart failure. Due to high ventricular rate, there is the inadequate diastolic filling time. Digoxin reduce this ventricular rate by reducing the rate of conduction in AV node which leads to the increase in its refractory period. As a result there is the improvement in the pumping activity of the heart due to the improvement in the filling. Even tough digoxin is not the first choice in heart failure it can be used for heart failure. Therapeutic drug monitoring of digoxin is essential both for efficacy and toxicity because of its narrow therapeutic index. This narrow therapeutic index reflects there is large overlap between the drug concentration in the plasma and its therapeutic effect and toxic effect. Side effects of digoxin are concentration dependent. If plasma concentration of digoxin is more than 0.8 nanograms/mL, it exhibits its adverse effects (2). Digoxin should not be administered in patients with low potassium level. Digoxin usually competes with and share binding site of K+ for Na+/K+ ATPase pump. Hence, digoxin exhibits adverse effects in patients with low potassium level. Patients with other electrolyte imbalance conditions like hypomagnesemia, hypercalcemia and hypernatremia may reduce therapeutic effect of digoxin, even though its plasma concentration is adequate. Patients with hypothyroidism and with renal impairment may affect concentration of digoxin in the plasma. Hence, these patients should be closely monitored for plasma concentration of digoxin. Hypoxia and alkalosis caused due to the chronic lung disease may result in the adverse effects of digoxin (1, 2). 2.Dabigatran (Pradaxa) : Anticoagulant drugs are particularly useful for the thromboembolism. Dabigatran, a direct thrombin inhibitor was approved in 2010 and this is only drug available in the market in this class of direct thrombin inhibitor. Warfarin was used since long time as anticoagulant, however it was associated with very narrow therapeutic window and patient to patient variability is more and requires frequent drug monitoring. With novel oral anticoagulants, there is no need of frequent drug monitoring. Coagulation pathway involves multiple components and inhibition or alteration one component can also alter entire pathway. Direct thrombin inhibitors act on the last step by inhibiting thrombin. This last step of coagulation pathway involves conversion of prothrombin to thrombin. This thrombin facilitate conversion of fibrinogen to fibrin which results in the clot formation (3). RE-LY trial (Randomized Evaluation of Long Term Anticoagulant Therapy) with dabigatran conducted on 18,113 subjects with non-vascular atrial fibrillation (AF) with the dose of 110 mg twice daily exhibited superior effect in reduction of stroke as compared to warfarin. Also both the doses of dabigatran like 110 and 150 mg twice daily exhibited major, intracranial and total bleeding with lesser incidence as compared to the warfarin (4). In another study with 2782 asian patients, it has been shown that both the doses of dabigatran exhibited advantage over warfarin in CHADS score. This CHADS score is the good predictor of stroke and bleeding in anticoagulant therapy (5). In another trial with 149 patients in left atrial ablation for atrial fibrillation, dabigatran at the dose of 110 mg twice daily proved to be safe and effective as compared to the acenocoumarol (6). 3. Long acting beta agonists (LABAs) specifically 2 adrenergic receptor agonists are useful in moderate to severe asthma and also in patients with chronic obstructive pulmonary disease (COPD). This class of drugs include formoterol, arformoterol, bambuterol, clenbuterol, formoterol and salmeterol. This class of drugs have duration of action approximately 12 hours. However, other than formoterol other drugs of this class are not in routine use for acute exacerbations of asthma because of onset of action of these class of drugs is slower than short acting 2 agonist such as salbutamol. This class of drugs exhibits longer duration action because of addition of the long lipophilic side chain which binds and unbinds to the adrenergic receptors continuously. This class of medication is used as controller medication in case of asthma and it can be used once or twice a day (7). This class of medication can be used in combination with the inhaled steroids. Various health guidelines mentioned t hat, this class of medication should be prescribed in severe asthma instead of mild asthma. In recent studies, it is evident that there are more asthma exacerbations and deaths in patients with salmeterol group as compared to the placebo group. In this study, 26,000 people with asthma were recruited and salmeterol was given twice daily. Hence studies with large subjects should be conducted for combination of long acting 2 agonist along with corticosteroids to reduce these severe exacerbations of asthma. Long acting 2 agonist should not be used for immediate effect or to get rid of quick symptoms (8). In majority of the cases long acting 2 agonist should be used in combination with inhaled corticosteroids because there are chances of severe exacerbations of asthma without use of concomitant steroid. These exacerbations of asthma are due to the continuous augmentation of inflammation in the absence of steroids. In few cases, asthma seems to exacerbate during the use of 2 agonist, and this condition should be brought to the notice of doctor. Long acting 2 agonist should be given to children below 4 years with more care. Pregnant women should not use long acting 2 agonist (9). References: Ziff OJ, Kotecha D. Digoxin: The good and the bad. Trends Cardiovasc Med. 2016 Oct;26(7):585-95. MacLeod-Glover N, Mink M, Yarema M, Chuang R4. Digoxin toxicity: Case for retiring its use in elderly patients? Can Fam Physician. 2016 Mar; 62(3):223-8. Ageno W, Eikelboom J, Lip GY. Dabigatran in clinical practice: Contemporary overview of the evidence. Int J Cardiol. 2016 Oct 1; 220: 417-28. Hori M, Fukaya T, Kleine E, Reilly PA, Ezekowitz MD, Connolly SJ. Efficacy and Safety of Dabigatran Etexilate vs. Warfarin in Asian RE-LY Patients According to Baseline Renal Function or CHADS2 Score. Circ J. 2015; 79(10):2138-47. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 11391151 Efremidis M, Vlachos K, Letsas KP, Giannopoulos G, Lioni L, Georgopoulos S, Vadiaka M, Deftereos S, Sideris A. Low dose dabigatran versus uninterrupted acenocoumarol for peri-procedural anticoagulation in atrial fibrillation catheter ablation. J Electrocardiol. 2015 Sep-Oct;48(5):840-4.. Karbasi-Afshar R, Aslani J, Ghanei M. Efficacy and safety of conventional long acting 2- agonists: systematic review and meta-analysis. Caspian J Intern Med. 2016 Spring;7(2):64-70. Bacharier LB. Step-down therapy in asthma: a focus on treatment options for patients receiving inhaled corticosteroids and long-acting beta-agonist combination therapy. Allergy Asthma Proc. 2012 Jan-Feb; 33(1):13-8. Hernandez G, Avila M, Pont A, Garin O, Alonso J, Laforest L, Cates CJ, Ferrer M. Long-acting beta-agonists plus inhaled corticosteroids safety: a systematic review and meta-analysis of non-randomized studies. Respiratory Research. 2014; 15:83 DOI:10.1186/1465-9921-15-83