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History and RN-Evidence based practice

History and RN-Evidence based practice

Week 1 Reply to discussion posts When replied to discussion posts, please state you agree to the posts or add something to the discussion posts. Please include references if needed. Discussion Post 1: Professor & Class, I have chosen to do my case study on an 80-year-old male, type 2 diabetic on insulin and OHA’s suffering from bouts of hypoglycemia. Upon review of the case, a pattern developed identifying that the incidents occurred while he was home alone. When the caregiver was not present the patient was not receiving his injections as scheduled which lead to irregular administration followed by episodes of hypoglycemic drops. This sharp decline in the patients’ blood sugar levels caused a mixture of symptoms leaving the patient fearful of coma and/or death. “A research hypothesis is a specific statement that predicts the direction and nature of the results of a study.” (Houser, p.100). With this in mind I developed the following; P = population of interest = An 80-year-old male. I = intervention of interest = insulin dependent with OHA’s, suffering from reoccurring bouts of hypoglycemia, trained in self-administration of Degludec. C = comparison of interest = decrease/eliminate the hypoglycemic episodes. O = outcome of interest = With dietary modifications along with the long-acting basal insulin taken once daily. Demonstrating a fasting blood glucose level & HbA1c levels a stabilizing and no further episodes of hypoglycemic episodes noted or reported. T= time= No reported timeline mentioned The prognosis in this scenario would be that with proper education/training and medication individuals are provided an outcome of eliminated episodes of hypoglycemia. Answer: Discussion post 2: When developing a research question it is best to keep it focused. According to Houser (2016) “do not include more than one major concept per question (pg. 105). If we make a research question complex it will hard to focus. It would be best then to make multiple questions instead all in one question. I have chosen to do a PICOT question on the case study of the 57-year-old female that failed the course of oral hypoglycemic agents (OHAs) and was then placed on an insulin pump. Does an insulin pump work for all active lifestyle patients? Diabetic patients with an active lifestyle that need insulin to control their blood sugar(P) how does an insulin pump (I) compare to self-injection of insulin (C ) influence the number of hypoglycemic episodes (O) over a 3 month period (T). This type of PICOT question is a treatment (therapy) question. I am seeking to answer the question if active patients are better with an insulin pump or self-medicating with insulin injections. I researched with keywords” insulin pump” and “physical activity”. Found an article called Impact of insulin pump on quality of life on diabetic patients by Ghazanfar, Rizvi, Khurram, Orooj, and Qaiser (2016). A study was conducted whether an insulin pump is better than using an insulin pen. 81.1% of the patients on an insulin pump decreased the frequency of having a hypoglycemic episode. The other 13.5% did not have any hypoglycemic episodes. This study does answer the question that patients with an active lifestyle will benefit with the use of an insulin pump and that it does reduce the risk of hypoglycemic episodes. Answer: Discussion post 3: Based on the second case study presented, I have formulated the following PICOT clinical question which focuses on treatment is: Do adult females with normal kidney function respond better to the use of degludec insulin and lifestyle modifications versus the use of biphasic insulin aspart 30/70 over a 2 month period? PICOT P: Population of interest: Adult females with normal kidney function I: Intervention of interest: patient was started on biphasic insulin aspart 30/70 and then transitioned to degludec insulin with lifestyle modifications C: Comparison of interest: Fasting blood glucose levels 170 mg/dl and a post prandial levels ranging from 230 to 280 mg/dl with some hypoglycemic episodes using biphasic insulin compared to 110 mg/dl fasting glucose levels and 180 mg/dl post prandial levels with minimal or no hypoglycemic episodes using degludec insulin and lifestyle modifications. O: Outcome of interest: blood glucose levels improved to desirable levels with minimal or no episodes of hypoglycemia using degludec insulin and incorporating lifestyle modifications. T: Time: Result given after the first 3 months treatment with biphasic insulin aspart 30/70, and over 2 months of time on degludec and lifestyle modifications, blood glucose improved and a minor episode of hypoglycemia. According to the American Diabetic Association, there has been studies that show better result with the use of Degludec insulin compared to the use of biphasic insulin aspart. It states that the improved levels of HgA1c and fasting blood glucose with fewer hypoglycemic episode are superior to those of biphasic insulin aspart in patients with uncontrolled type 2 diabetes. Answer: Discussion post 4: I was fascinated how each settled region of America developed in such different ways. After about each one, I have to say it was difficult to choose just one colony as they all the pitfalls and merits. I finally chose the New England colony. The New England colony, while radical in their religious believes held strong bonds with their other settlers. They formed towns with a common meeting house (Keene, et al., 2011). They emphasized family and community which I think would be very important in the new world. This contrasted with the Chesapeake colony who focused more on developing wealth and their settlements were spread out decreasing their ability to defend themselves from Native American attacks (Keene, et al., 2011). I like that the New England colony chose to develop multiple towns instead of expanding one town. This decrease risk of illness and sanitary concerns when there are smaller populated individual towns. The location is superior as compared to the Chesapeake colony as they settled near marshes which are a breeding ground for pathogen carrying mosquitos (Keene, et al., 2011). Health in the New England colony was better than their other colonies in a few ways. According to the text, infant mortality was lower than that of England. Those who lived to that age of 20 in New England were likely to live into their 60s surpassing England’s life expectancy. There were of course many downsides of living in the New England colony. It was developed and controlled by Puritans. A radical wing of Protestantism. The leaders of the colony laid down that rules or laws of the colony which would lead to severe punishment if broken. For instance, the leaders made it a punishment of death to disobey one’s parent (Keene, et al., 2011) While this punishment never occurred it shows the severity of these leaders. The leaders (men in general) had a strong say in the lives of the settlers. While it was an improvement to allow all men to vote, differing from England, women did not carry many rights (Keene, et al., 2011). The colony itself was very rigid and strict as well as superstitious. This would sadly lead to the Witchcraft hysteria in 1692 (Khan Academy, 2018) Overall, if the object is to survive and have a family as well as stability, New England colony would be my choice. Quality of life however, may not be as good as other colonies given the religious intolerance and strict mandates. Answer: Discussion post 5: I tried very hard to not think of where I would have wanted to settle based on my life now, but instead based on a perceived life at that time. I have chosen New England. My draw is that, unlike other areas, this area was inhabited mostly by families that came together. Being a female, this would have been an important thing to consider. The living structure of close communities with a central meeting house makes me think that there was more support and help, resulting in a healthier and wealthier community. Though there was minimal religious tolerance, I’m not sure, for the specific purpose of relocating to another country, this was a bad thing in the start. As time passed, Rhode Island did become the hub for religious tolerance (Keene, Cornell, & O’Donnell, 2013). Imposing sobriety would have kept the fights and arguments down, and the work output up. It was a thriving area with a maritime economy, including ship building. The inhabitants generally enjoyed good health. Another important aspect of this area is the development of the Mayflower Contract (compact), which preserved order, created laws and offices, and it’s ideas carried over to the US Constitution (Mount, 2010). I see this as a progressive community that embraces democracy and the well being of all it’s citizens. Answer: Discussion post 6: If given the choice of which colony to settle in, I would choose the Upper and Lower South, more specifically the Carolinas. Probably doesn’t help that I live in South Carolina but despite that, as I was researching this topic, they felt like the most stable colony for a family to settle. Each colony was threatened with its own dangers, religious differences, and economic or political strains. The southern colonies were not dominated by a specific religion, so the people had more religious freedom than in other colonies. Also, climate was a big concern for settlers. Hard winters in the northern colonies would wipe out half of their population. The southern colonies would experience milder winters, but the heat becomes a concern the further south you settled and gave rise to disease. The original group of investors who asked King James for the charter of land, which would become known as the Carolinas, originally wanted the land to produce sugar cane but soon realized the climate was not tropical like they believed (Kaplan, 2009, p. 12). They were forced to find alternate means of economic growth without depending on exporting as their means of financial support in the beginning. “Rather than produce goods for export to England, Carolina began as a colony of a colony, providing naval stores such as pine tar resins to waterproof ships and food such as cattle for the West Indian islands” (Keene & O’Donnell, 2013, p. 54). Later, they began to export items like deer hide, slaves, and rice which made their economy flourish (Keene & O’Donnell, 2013). Answer: Discussion post 7: First off, I would like to say I learned a lot about slavery that I didn’t know, and many of my misconceptions related to the cause of slavery were corrected. Arriving in the colonies, the settlers needed labor in order to perform the tasks to make their fortune. Due to illness and death, this was not always an easy task, especially when fortunes were being made in the Caribbean sugar fields specifically Barbados, or the Chesapeake tobacco farms. In a win-win situation, the indentured servant came to be. An indentured servant was usually a male from England that wanted to come to America, but could not afford the cost of the passage to America. They would contract with an employer who would in turn pay for the cost of their voyage, agreeing to work for an agreed amount of time, usually 7 years. When the contract was complete, the employers would usually then help the servant start their own life giving them tools and clothing (Keene, J., Cornell, S., & O’Donnell, E., 2013). Slaves were originally indentured servants, first arriving in America in 1619. A Dutch ship, the White Lion, was in a battle with a Spanish ship and captured 20 slaves (which were being used in large numbers in Spain). When the White Lion stopped in Jamestown for repairs, they traded these slaves, who were used as indentured servant, in return for the repairs their ship needed (History of slavery, N.D.). As the demand for agricultural labor increased, more and more slaves were traded in Africa. The Bacons Rebellion led the way for the slave laws to become harsher, preventing freedom, and in 1640 the Virginia court sentenced the first black servant to slavery, to be owned for life. Answer: Discussion post 8: Land demands for labor grew as the early settlers began to colonize. Initially landowners took in indentured servants. They were individuals who agreed to work without pay for a span of 4-8 years in exchange for their fare to America. As part of they deal they were also given room and board and if they survived the agreed term they were given a piece of land, money and their freedom. The servants came willingly with the hope of a future of their own making. The servants and slaves were similar as they were both seen as the property of the land-owner. However indentured servants had hope for light at the end of the tunnel after fulfilling their term of service whereas slaves were considered the property of the master for life. Slaves were kidnapped and sold into slavery and were not given the option to come voluntarily. Slavery gradually replaced indentured servitude as the primary means of labor in the south. Slaves were denied the right to own property and were not paid. Slaves depended on their owners for basic necessities, food, clothing and shelter. Living conditions for the slaves differed from one another. They were determined mostly by their geographical location, the type of work they did as in farm servants or house servants and sometimes the financial status of the slaveholder. “ Slavery was a brutal and exploitative labor system, but the experience of individual slaves varied greatly from region to region”, (Kenne, Cornell, O’Donell, 2011). Slavery was a vital source of labor to colonial life. Answer: Discussion post 9: Indentured servants were individuals that wanted to immigrate to the colonies without having the money. They were contracted typically 4-7 years of servant work for an employer in exchange for payment toward the expenses for travel to the colonies, room & board, food, clothing, and passage dues. Once the contract was done they could leave with the clothes and tools acquired. They were not slaves. They were seen as inexpensive labor that was needed in the demanding and expanding colonies. Slaves on the other hand soon came after. They were taken from Africa and brought to the Americas as a business for slave traders. Most slaves that were coming to the mainland colonies would go to the Carribean first where they would train to become slaves. As the demand for laborers increased slave traders skipped the layover and shipped directly to the mainland. There was no contract for release. It was permanent unless they were freed by their masters. The colonial government made sure that the slaves were obedient to their white masters forming slave codes that were without limits (Keene, Cornell, & O’Donnell 2012). With the increase in demand for labor, the cost for indentured servants increased as well. Once the servants were released they had a need for land which threatened the current owners of the lands. The colonial landowners recognized this and opted for slaves that were more economical for them and a workforce that was neverending (PBS. 2014). I believe economic realities played a bigger role in all of this when they realized servants were costing more and a threat at the end of their contract with the accumulation of land and slaves were cheaper for the landowners and profitable to slave traders. But race does have to do with it too. Slave codes prove that race has involvement when they have written rules to show that the white masters have dominance over the black slaves, even including children born of white fathers from slaves. Answer:

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